Background and aims: Despite the efficacy of low-carbohydrate diets in the management of metabolic syndrome (MetS), it remains unknown if these favorable effects are mediated through changes in inflammation and endothelial dysfunction. We aimed to assess the effects of moderate substitution of dietary fats for carbohydrates on serum levels of adipocytokines, inflammatory indices, and biomarkers of endothelial function among women with the MetS.

Methods: In a randomized cross-over clinical trial, 30 overweight or obese (BMI >25) women with the MetS were randomly allocated to follow either a high-carbohydrate (HC) (60-65% carbohydrates, 20-25% fats) diet or a moderately restricted carbohydrate (MRC) (43-47% carbohydrate, 36-40% fats) diet, each for 6 weeks. After a 2-week washout period, individuals were switched to the alternate diet for an additional 6 weeks. In a fasted state, markers of inflammation [high-sensitivity C-reactive protein (hs-CRP), high-sensitivity interleukin-6 (hs-IL-6), high-sensitivity tumor necrosis factor-α (hs-TNF-α), and serum amyloid A (SAA)], endothelial function [E-selectin, serum intercellular adhesion molecule 1 (sICAM-1), and serum vascular cell adhesion molecule 1 (sVCAM-1)], and adipocytokines (leptin and adiponectin) were measured in both study arms at baseline and after 6 weeks.

Results: Consumption of an HC diet was associated with increased levels of SAA (3.27 ± 1.22 μg/ml) and decreased levels of adiponectin (-1.68 ± 2.30 ng/ml), while consumption of an MRC diet did not result in such unfavorable effects. Serum concentrations of leptin were reduced by the HC diet (p = 0.02), while they were not affected by the MRC diet. Changes in serum leptin levels were not significant between the two diets (p = 0.09). Serum concentrations of hs-CRP, hs-TNF-α, and IL-6 were not influenced by either diet. No significant differences between the two diets were found in terms of their effect on sICAM-1 and sVCAM-1 concentrations. Adherence to both diets resulted in a 9 ng/ml decrease in serum E-selectin levels (p < 0.05 for both).

Conclusions: Partial replacement of dietary carbohydrates by unsaturated fats prevents the increased levels of markers of systemic inflammation among women with the MetS.