We read with interest the article by Azdbakht et al. (1), showing that a nutritional approach based on a Dietary Approaches to Stop Hypertension (DASH) diet reduced the prevalence of the syndrome by about one-third. This study adds to the mounting evidence that fighting metabolic and cardiovascular disease with diet is possible (2). As the DASH diet is very similar to the Mediterranean diet, these results confirm in the short term (6 months) previous findings obtained over a longer period of time (24 months) (3). The authors did a fine job obtaining such a significant weight loss (13 kg on the average in the weight-control arm and 15 kg on the average in the DASH arm), as the change in body weight expected with a program of intensive lifestyle changes may be less impressive (−6.7 ± 7.9 kg at 12 months) (3). Perhaps one would have expected a larger resolution of features of the metabolic syndrome in the weight-control arm (19% resolution). To give more strength to their work, the authors should also comment on some inconsistency in Table 2. Fasting blood glucose (FBG) was only 3 mg/dl at baseline in the control group (obviously a mistake); however, it seems difficult to imagine that the DASH diet increased FBG by 15 and 8 mg/dl on the average at 6 months (men and women), as in the results section the opposite is stated (obviously a mistake). As the table seems imprecise (the reason why values for men are reported as median and for women as mean is unclear), the authors should also check the huge SD of basal FBG. Lastly, there is an important thing missing: the starting and posttreatment quantity of energy consumed by participants is not reported, leaving the reader to assume that all subjects in both arms ate a diet with 500 kcal less than their caloric needs, without any check. The findings of Azdbakht et al. (1) confirm that diet is at least equivalent to drugs in reducing the prevalence of the metabolic syndrome (35).

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Diabetes Care
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Eur Heart J
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armineto M, D’Andrea F, Giugliano D: Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial.
Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ: Randomized trial of lifestyle modification and pharmacotherapy for obesity.
N Engl J Med
Orchand TJ, Tempros M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial.
Ann Intern Med