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STATE-OF-THE-ART PAPER

The Effects of Diet on Inflammation

Emphasis on the Metabolic Syndrome

Dario Giugliano, MD, PhD^_*,_*, Antonio Ceriello, MD and Katherine Esposito, MD, PhD^_*

^_* Division of Metabolic Diseases, Center of Excellence for Cardiovascular Diseases, University of Naples SUN, Italy
Warwick Medical School, Coventry, United Kingdom

Manuscript received December 17, 2005; revised manuscript received February 27, 2006, accepted March 16, 2006.

^_* Reprint requests and correspondence: Prof. Dario Giugliano, Division of Metabolic Diseases, Policlinico Università di Napoli, Piazza L. Miraglia, 80031 Napoli, Italia (Email: dario.giugliano{at}unina2.it).

Reducing the incidence of coronary heart disease with diet is possible. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. This review examines the epidemiologic and clinical evidence concerning diet and inflammation. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while prudent dietary patterns cool it down.

Abbreviations and Acronyms   ALA = alpha-linolenic acid   CHD = coronary heart disease   CRP = C-reactive protein   CVD = cardiovascular disease   IL = interleukin   sICAM = soluble intercellular adhesion molecule   sVCAM = soluble vascular cell adhesion molecule   TNF = tumor necrosis factor

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