PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Acad Nutr Diet. Author manuscript; available in PMC May 1, 2013.
Published in final edited form as:
PMCID: PMC3433761
NIHMSID: NIHMS367143
Dietary Intervention Targeting Increased Fiber Consumption for Metabolic Syndrome
Philip A. Merriam, MSPH, Assistant Professor of Medicine, Gioia Persuitte, MPA, Research Assistant, Barbara C. Olendzki, MPH, R.D., Assistant Professor of Medicine, Kristin Schneider, Ph.D., Assistant Professor of Medicine, Sherry L. Pagoto, Ph.D., Associate Professor of Medicine, Judy Palken, RD, MS, Nutritionist, Ira S. Ockene, M.D., Professor of Medicine, and Yunsheng Ma, M.D., Ph.D., Associate Professor of Medicine
Philip A. Merriam, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-5848 (phone), 508-856-2022 (fax)
Philip A. Merriam: Philip.Merriam/at/umassmed.edu; Gioia Persuitte: Gioia.Persuitte/at/umassmed.edu; Barbara C. Olendzki: Barbara.Olendzki/at/umassmed.edu; Kristin Schneider: Kristin.Schneider/at/umassmed.edu; Sherry L. Pagoto: Sherry.Pagoto/at/umassmed.edu; Judy Palken: Judy.Palken/at/umassmed.edu; Ira S. Ockene: Ira.Ockene/at/umassmed.edu; Yunsheng Ma: Yunsheng.Ma/at/umassmed.edu
Corresponding author: Philip A. Merriam, MSPH, Assistant Professor of Medicine, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655
Keywords: Diet, nutrition, fiber, metabolic syndrome
Metabolic syndrome is highly prevalent in the U.S. and is a harbinger of diabetes and cardiovascular disease (CVD). With the staggering rise of diet-related chronic diseases such as diabetes and CVD, simple and effective dietary intervention strategies are needed. National dietary recommendations are ever-changing and complex, which can be overwhelming and confusing for individuals who are trying to prevent or manage a chronic condition. Some evidence suggests that healthy changes in one area of diet are associated with healthy changes in other untargeted areas of diet (1, 2). There is an opportunity to bridge a dietetics research gap by testing a simple dietary message focusing on fiber intake to improve risk factors of the metabolic syndrome.
Dietary Fiber and Metabolic Syndrome
Dietary fiber is the edible portion of a plant, classified as carbohydrates that undergo complete or partial fermentation in the large intestine (3, 4). A lower prevalence of metabolic syndrome is associated with dietary patterns rich in dietary fiber including fruits, vegetables, and whole grains; as well as foods not containing fiber such as dairy products, and unsaturated fats (5). Dietary fiber exerts protective cardiovascular benefits on several aspects of metabolic syndrome, including waist circumference, blood glucose, dyslipidemia, blood pressure, insulin control, and regulation of certain inflammatory markers (68).
Since dietary fiber has shown to be beneficial with regard to metabolic syndrome, this dietary component was selected to test a hypothesis that a simple dietary recommendation promoting fiber may result in improving overall dietary quality and weight loss for patients with metabolic syndrome. As part of an ongoing four-year randomized clinical trial entitled A Simple Dietary Message to Improve Dietary Quality for Metabolic Syndrome, (Clinical Trials Gov identifier: NCT00911885) (9) a fiber-focused dietary intervention was developed. This intervention focuses on educating individuals about fiber, and how to can increase consumption by eating a variety of fiber-rich foods. Individuals are instructed to gradually increase fiber intake to 30 or more grams a day, whereas Americans currently consume about 16 grams daily (10). The study protocol was approved by the University of Massachusetts Medical School Institutional Review Board and the intervention is ongoing.
The dietary fiber intervention contains four primary elements: didactic education, guided questions, experiential and exploratory tasting of foods high in fiber, and problem solving. Timing and topics of each session are included in Table 1. Group 1 is 90 minutes long whereas the remaining groups are 60 minutes. The first individual visit is 60 minutes and the second individual visit is 30 minutes. Meals are provided in Groups 9–11, and there is a pot-luck supper in group 12 where individuals are invited to bring dishes high in fiber. Snacks are provided at each of the remaining groups. The intervention length and numbers of groups were chosen to match the amount of time needed to deliver the dietary elements of the control arm.
Table 1
Table 1
Dietary Intervention for Increasing Fiber
An anticipated 120 individuals are expected to participate in the fiber arm of the study, each receiving a manual containing intervention materials organized by session, home activity worksheets, resources, recipes, and suggestions for choosing high fiber meals in restaurants. Participants are taught to make high fiber substitutions (i.e. using barley instead of white rice, whole grain breads and pasta instead of the white refined varieties, and consuming legumes in place of some of the meat in their diets) (See Table 1). Individuals are asked not to rely on fiber supplements, fiber bars, or any one food to increase their daily fiber, but rather to obtain fiber from a variety of foods. They are encouraged to gradually reach their fiber goal of >=30 grams/day, while self-monitoring their daily fiber intake using food diaries. Dietary assessment is conducted using multiple 24-hour dietary recalls.
Lifestyle interventions have proven difficult to implement for the management of metabolic syndrome, with no single dietary recommendation.(11) This intervention may assist dietitians and other health care professionals in delivering an effective yet simple dietary change message by encouraging a shift from the common Western diet of processed and white flour foods to one of fiber-rich foods, in contrast to the seven complex AHA dietary guidelines for healthy living. If proven successful, this method may offer a novel dietary intervention and establish future dietary guidelines for those with metabolic syndrome. Baseline results will be available in 2012 with outcome results available in 2013.
Conclusion
It is clear that high dietary fiber intake exerts clinical benefits on components of metabolic syndrome including, but not limited to weight loss (12). This study has the potential to deliver a different but straightforward message to current complex dietary guidelines, thereby benefiting the nutrition and dietetics community. Future research will continue to explore the benefits of less complex dietary messaging as it relates to the efficacy in the management of metabolic syndrome and other chronic diseases.
Footnotes
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Contributor Information
Philip A. Merriam, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-5848 (phone), 508-856-2022 (fax)
Gioia Persuitte, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-5195 (phone), 508-856-2022 (fax)
Barbara C. Olendzki, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-5195 (phone), 508-856-2022 (fax)
Kristin Schneider, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-7561 (phone), 508-856-3840 (fax)
Sherry L. Pagoto, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-2094 (phone), 508-856-3840 (fax)
Judy Palken, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-5195 (phone), 508-856-3840 (fax)
Ira S. Ockene, Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-3907 (phone), 508-856-4571 (fax)
Yunsheng Ma, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. 508-856-1008 (phone), 508-856-2022 (fax)
1. Olendzki BC, Ma Y, Schneider KL, et al. A simple dietary message to improve dietary quality: Results from a pilot investigation. Nutrition. 2009;25:736–44. [PubMed]
2. Spring B, Schneider K, Hedeker D, McFadden H, Moller A, Epstien L. Multiple behavior change in diet and activity: The make better choices (MBC) trial. Washington, DC: International Society of Behavioral Medicine; 2010.
3. Park Y, Subar AF, Hollenbeck A, Schatzkin A. Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study. 2011. Arch Intern Med. 2011;17112:1061–8. [PMC free article] [PubMed]
4. Van Horn L. Fiber, lipids, and coronary heart disease. A statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation. 1997;95:2701–4. [PubMed]
5. Giacosa A, Rondanelli M, Giacosa A, Rondanelli M. The right fiber for the right disease: an update on the psyllium seed husk and the metabolic syndrome. Journal of Clinical Gastroenterology. 2010;44 (Suppl 1):S58–60. [PubMed]
6. Aleixandre A, Miguel M, Aleixandre A, Miguel M. Dietary fiber in the prevention and treatment of metabolic syndrome: a review. Critical Reviews in Food Science & Nutrition. 2008;48:905–12. [PubMed]
7. Carlson JJ, Eisenmann JC, Norman GJ, Ortiz KA, Young PC. Dietary fiber and nutrient density are inversely associated with the metabolic syndrome in US adolescents. J Am Diet Assoc. 2011;111:1688–95. [PubMed]
8. Hermsdorff HH, Barbosa KB, Volp AC, et al. Vitamin C and fibre consumption from fruits and vegetables improves oxidative stress markers in healthy young adults. Br J Nutr. 2011:1–9. [PubMed]
9. Merriam PA, Ma Y, Olendzki BC, et al. Design and methods for testing a simple dietary message to improve weight loss and dietary quality. BMC Medical Research Methodology. 2009;9:87. [PMC free article] [PubMed]
10. Ma Y, Hebert JR, Li W, et al. Association between dietary fiber and markers of systemic inflammation in the Women’s Health Initiative Observational Study. Nutrition. 2008;24:941–9. [PMC free article] [PubMed]
11. Giugliano D, Ceriello A, Esposito K, Giugliano D, Ceriello A, Esposito K. Are there specific treatments for the metabolic syndrome? American Journal of Clinical Nutrition. 2008;87:8–11. [PubMed]
12. Galisteo M, Duarte J, Zarzuelo A, Galisteo M, Duarte J, Zarzuelo A. Effects of dietary fibers on disturbances clustered in the metabolic syndrome. Journal of Nutritional Biochemistry. 2008;19:71–84. [PubMed]