Adherence to dietary recommendations and risk of metabolic syndrome: Tehran Lipid and Glucose Study Firoozeh Hosseini-Esfahani a , Mahsa Jessri a , Parvin Mirmiran a,b, ⁎ , Sara Bastan a , Fereidoun Azizi c a Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box 19395-4763 Tehran, Iran b Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, PO Box 19395-4741 Tehran, Iran c Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box 19395-4763 Tehran, Iran Received 20 December 2009; accepted 15 June 2010 Abstract The “Dietary Guidelines for Americans Adherence Index (DGAI) 2005” was developed based on the latest dietary recommendations to assess the contribution of dietary patterns to chronic diseases. The objective of the study was to evaluate the association of dietary patterns as measured by the modified DGAI 2005 with both the prevalence of metabolic syndrome (MetS) and the MetS risk factors. In this population- based cross-sectional study, 2504 adults (1120 men and 1384 women), aged 19 to 70 years, were randomly selected from the third phase of the Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a food frequency questionnaire, and the DGAI score was calculated for all participants. Metabolic syndrome was defined according to Adult Treatment Panel III diagnostic criteria. Generally, mean values for waist circumference, triglyceride, and blood pressure were significantly higher among male compared with female participants (P b .05). Low high-density lipoprotein cholesterol was the most prevalent MetS risk factor among both men (65.4%) and women (72.5%). After mutual adjustment for confounding variables, those in the highest quartile category of DGAI had a 21% lower prevalence of MetS risk factors clustering than those in the lowest quartile (odds ratio [OR], 0.79; confidence interval [CI], 0.63-0.92; P for trend = .02). Being in the highest quartile category of DGAI score was shown to significantly reduce the prevalence of hyperglycemia (OR, 0.64; CI, 0.47-0.86; P for trend b .001), hypertension (OR, 0.76; CI, 0.70-0.93; P for trend = .05), and low high-density lipoprotein cholesterol (OR, 0.69; CI, 0.54- 0.94; P for trend b .001). Consuming a diet consistent with new dietary guidelines was associated with lower risk of MetS prevalence and some of its risk factors. Preventive interventions for MetS risk reduction should focus on the overall dietary pattern. © 2010 Elsevier Inc. All rights reserved. 1. Introduction Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities characterized by central obesity, hypertension, insulin resistance, prothrombotic state, and atherogenic dyslipidemia. According to the National Cho- lesterol Education Program Adult Treatment Panel Ш (NCEP ATP Ш), each abnormality of this syndrome can independently increase the atherosclerosis risk; and the clustering of these abnormalities is a risk factor for type 2 diabetes mellitus and cardiovascular disease (CVD) morbid- ity and mortality [1]. These metabolic abnormalities can also enhance the risk of developing colorectal [2], pancreatic [3], and female breast cancers [4]. Prevalence of MetS is increasing worldwide especially in non-Western Asian countries [5]; and in Iran, the prevalence rate of this disease has increased from 30.1% [6] in 2003 to 34.7% in 2009 [7]. Among several contributing factors that influence the prevalence of MetS, dietary habits play an essential role [8,9]; and accordingly, several studies have assessed the impact of dietary habits on the risk of MetS [10,11]. In 2004, the American Heart Association recommended adherence to the Dietary Guidelines for Americans (DGA) as a dietary approach to decrease the risk of Mets [12]. The DGA 2005 is a departure from earlier versions of DGA in Available online at www.sciencedirect.com Metabolism Clinical and Experimental xx (2010) xxx – xxx www.metabolismjournal.com ⁎ Corresponding author. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box 19395-4763, Tehran, IR Iran. Tel.: +98 21 22432503; fax: +98 21 22402463. E-mail addresses: mirmiran@endocrine.ac.ir, parvin.mirmiran@gmail.com (P. Mirmiran). 0026-0495/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.metabol.2010.06.013