Dietary Adherence to a Structured Nutrition Intervention and Cardiometabolic Risk Reduction in Middle-Aged Adults with Metabolic Syndrome

Cardiometabolic disease, encompassing type 2 diabetes mellitus, dyslipidaemia, hypertension, and cardiovascular disease, represents the dominant cause of preventable premature mortality across India and globally. Structured dietary interventions combining low glycaemic index whole foods, increased legume and fibre intake, reduced refined carbohydrates, and moderate healthy fat consumption from sources including groundnut, mustard, and coconut oil have accumulated substantial observational and interventional evidence for cardiometabolic benefit in the Indian population context. This randomised controlled trial examined the effect of a structured twelve-month dietary adherence intervention, culturally adapted to Indian dietary traditions, on a comprehensive panel of cardiometabolic biomarkers in middle-aged adults with metabolic syndrome criteria at AIIMS New Delhi. A total of 386 participants aged 40-65 years meeting at least three International Diabetes Federation criteria for metabolic syndrome were randomised to a dietary intervention arm (n=193) receiving monthly dietitian-led counselling, culturally adapted meal planning support incorporating regional Indian cuisine, and dietary supplementation with cold-pressed groundnut oil, or a control arm (n=193) receiving general dietary advice pamphlets. Primary outcomes included change in BMI, waist circumference, fasting glucose, LDL-cholesterol, HDL-cholesterol, and inflammatory biomarkers CRP and IL-6. At twelve-month follow-up, the intervention arm demonstrated statistically significant improvements across all primary outcomes compared to controls, including a mean fasting glucose reduction of 14.1 mg/dL (p<0.001), LDL-C reduction of 26.4 mg/dL (p<0.001), and CRP reduction of 2.5 mg/L (p<0.001). Dietary Score adherence correlated strongly with biomarker improvement magnitude (r=0.67, p<0.001).