Health promotion through the adoption of the mediterranean diet as a therapeutic proposal in the treatment and prevention of metabolic syndrome: a systematic review
Authors: Ferreira Maria Aparecida Orlando de Moraes , Rocha Priscila Mendes Maia , Oliveira Luciene Pereira de , Ricardi Gabriela , Ramos Katia Alves , Telles Cristiane Reis e Lopes , Silva Junior Antonio Carlos da , Silva Ariadne Fonseca Carvalho , Teixeira Thaysa Andressa Brandão Vilela , Moreira Eduardo Vinicius França , Moraes Moniquy Quintela Orlando de , Ferreira Júnior Amarildo Aparecido 
Published: September 2024

Introduction: Excessive weight gain generates comorbidities, many of which are characterized as metabolic syndrome (MetS). It is important to highlight the association of MetS with cardiovascular diseases, increasing global mortality by approximately 1.5 times and cardiovascular mortality by approximately 2.5 times. In this sense, the Mediterranean diet presents itself as the main therapeutic proposal in the treatment of MetS, as it corresponds to caloric limitations without altering the patient's adequate nutritional status. Objective: It was to investigate the effects of health promotion through the adoption of the Mediterranean diet as a therapeutic proposal in the treatment and prevention of metabolic syndrome, evaluating the nutritional benefit on quality of life. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 157 articles were found. A total of 26 articles were evaluated in full and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 28 studies that did not meet GRADE and AMSTAR-2. It was concluded that the studies showed the beneficial effects of the Mediterranean diet in reducing the prevalence of MetS. Furthermore, the dietary pattern described in the Mediterranean diet combined with physical activities can be used as a useful clinical tool in the treatment of metabolic syndrome. The suggested menu, with foods rich in fiber, is associated with reducing cardiovascular risk and, therefore, the Mediterranean diet is recognized as an agent for promoting health and preventing and treating obesity. In this sense, it appears that dietary factors can play a fundamental role both in the individual components and in the prevention and control of metabolic syndrome. Recent data associate the presence of MetS with lower consumption of whole grains, fruits, and vegetables. Therefore, there is a close relationship between these foods and dietary fiber, and, probably, soluble fiber is more directly related to these effects. A reduced prevalence of MetS was also observed in patients with systemic lupus erythematosus, a result of the good level of adherence to the Mediterranean diet. Furthermore, 25(OH)D status is associated with the composition, diversity, and functionality of the gut microbiota, and lifestyle intervention can modulate both the gut microbiota and 25(OH)D levels, potentially influencing metabolic pathways.