Network meta-analysis ranks dietary strategies for metabolic syndrome in 1,244 patients

This network meta-analysis synthesized evidence from 20 randomized controlled trials involving 1,244 patients with metabolic syndrome. The analysis compared 23 different dietary strategies against control dietary regimens, examining effects on body mass index, fasting blood glucose, waist circumference, and lipid profiles. The study used surface under the cumulative ranking curve (SUCRA) values to rank interventions, with higher SUCRA percentages indicating better relative performance.

For body mass index, the energy restriction approach ranked highest (SUCRA 87.0%) with a mean difference of -5.69 (95% CI: -7.90, -3.20) compared to controls. Meal frequency modulation ranked second (SUCRA 85.8%). For fasting blood glucose, energy restriction again ranked first (SUCRA 85.1%), followed by the recommended dietary approach (SUCRA 71.0%). For waist circumference, meal frequency modulation was most effective (SUCRA 85.1%), while the recommended dietary approach showed a mean difference of -3.25 cm (95% CI: -7.51, -0.12).

Safety and tolerability data were not reported in the analysis. The study did not report on adverse events, serious adverse events, or discontinuation rates. Key limitations include the indirect nature of comparisons in network meta-analyses and the absence of long-term outcome data. The SUCRA rankings indicate relative efficacy but do not establish absolute clinical benefit or superiority.

For clinical practice, these findings suggest that among dietary strategies for metabolic syndrome, energy restriction and meal frequency modulation show promise for different metabolic parameters. However, clinicians should interpret these rankings cautiously given the indirect comparison methodology and lack of safety data. The analysis provides a relative hierarchy of dietary approaches but does not establish definitive superiority or guide specific dietary prescriptions.