Mediterr J Nutr Metab (2010) 3:47–54 DOI 10.1007/s12349-009-0056-1 ORIGINAL ARTICLE Psyllium improves dyslipidaemia, hyperglycaemia and hyperten- sion, while guar gum reduces body weight more rapidly in patients affected by metabolic syndrome following an AHA Step 2 diet Arrigo F.G. Cicero · Giuseppe Derosa · Marilisa Bove · Fabrizio Imola · Claudio Borghi · Antonio V. Gaddi Received: 9 April 2009 / Accepted: 9 June 2009 / Published online: 21 October 2009 © Springer-Verlag 2009 A.F.G. Cicero () Atherosclerosis and Metabolic Diseases Research Unit Internal Medicine, Aging and Kidney Diseases Department S. Orsola-Malpighi Hospital, University of Bologna Poliambulatorio Pad. 2 Via Albertoni 15, 40138 Bologna, Italy e-mail: afgcicero@cardionet.it G. Derosa Department of Internal Medicine and Therapeutics University of Pavia Pavia, Italy M. Bove · F. Imola · C. Borghi · A.V. Gaddi “GC Descovich” Atherosclerosis Research Centre “D. Campanacci” Clinical Medicine and Applied Biotechnology Department University of Bologna S. Orsola-Malpighi Hospital Via Massarenti 9, 40138 Bologna, Italy nificant improvement on plasma triglyceride concentra- tion (–13.3%) and systolic (–3.9%) and diastolic blood pressure (–2.6%). No significant difference was observed regarding the standard diet group in comparison to the baseline. On the basis of our data, psyllium could be more strongly indicated for patients that have to reduce a large number of cardiovascular risk factors, while guar gum could be more rapidly efficacious in strengthening the effect of diets aimed at reducing body weight. Keywords Metabolic syndrome · Soluble fibres · Hyper- tension · Hypercholesterolaemia· Hypertriglyceridaemia · Hyperglycaemia · Cardiovascular risk Introduction It is well known that a dietetic approach is always beneficial in the management of cardiovascular disease risk in people affected by relevant metabolic diseases such as hypercholes- terolaemia and diabetes, but also at a population level [1]. Increasing dietary fibre has been recommended as a safe and practical approach for cholesterol reduction [2]. However, “dietary fibre” is a collective term for a variety of plant substances that are resistant to digestion by human gastrointestinal enzymes [3]. Dietary fibres can be classified into two major groups depending on their solubility in water. The structural or matrix fibres (lignin, cellulose and some hemicelluloses) are insoluble, where- as the natural gel-forming fibres (pectin, gums, mucilages, and the remainder of the hemicelluloses) are soluble. Studies have focused on soluble fibres such as oats, psyllium, pectin and guar gum, and qualitative reviews have suggested that these fibres lower total and low-density lipoprotein (LDL) cholesterol [4, 5]. Water- Abstract The aim of this study was to comparatively evaluate the long-term effects of psyllium husk and guar gum supplementation on metabolic syndrome (MS) com- ponents. We randomised 141 MS patients to soluble psyl- lium husk powder or guar gum 3.5 g t.i.d. to be taken 20 min before the main 2 meals, or to a standard diet for a cumulative period of 6 months. Both fibres significantly improved body mass index (–7.2% vs. –6.5%), fasting plasma glucose (–27.9% vs. –11.1%) and insulin (–20.4% vs. –10.8%), HOMA Index (–39.2% vs. –16.7%), glycat- ed haemoglobin (–10.4% vs. –10.3%), low-density lipoprotein cholesterol (–7.9% vs. –8.5%) and apolipo- protein B (–10.5% vs. –5.6%), after 6 months of treat- ment. Only the psyllium supplementation exerted a sig-