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General Endocrinology

SAT-840 - Influence of the use of the inverted food pyramid on the composition and function of the intestinal microbiome in individuals with metabolic syndrome: a systematic review

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT


Introduction: Metabolic syndrome (MetS) is associated with increased cardiovascular risk, and its pathophysiology has been linked to alterations in the gut microbiome (GM). Diet, as the main modulator of this ecosystem, plays a central role in this process. Dietary patterns consistent with the Inverted Food Pyramid (IFP), rich in fiber, unsaturated fats, and low-glycemic index foods, may promote greater microbial diversity, increase short-chain fatty acid (SCFA) production, and reduce systemic inflammation, mechanisms directly related to metabolic improvement. However, evidence remains heterogeneous in individuals with MetS.

Objective: To evaluate the influence of dietary patterns consistent with the IFP on the composition and function of the GM in individuals with MetS.

Methods: This systematic review followed PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, and Scopus for studies published between 2020 and 2025 using MeSH descriptors and free terms related to “Metabolic Syndrome,” “Diet,” and “Gastrointestinal Microbiome.” Randomized clinical trials and controlled studies involving adults with MetS undergoing IFP-compatible diets, such as Mediterranean, DASH, and diets rich in fiber and unsaturated fats, were included. Due to study heterogeneity, findings were synthesized narratively, and risk of bias was assessed using appropriate tools.

Results: Eight studies were included, involving crossover designs and lifestyle interventions. Diets included Mediterranean patterns supplemented with extra virgin olive oil, red wine, or nuts, as well as diets rich in fiber, resistant starch, polyphenols, and n-3 polyunsaturated fatty acids. These interventions showed favorable effects on GM composition and function, with increased microbial diversity and abundance of beneficial taxa such as Akkermansia muciniphila, Faecalibacterium prausnitzii, Bifidobacterium, and Lachnospiraceae NK4A136. Changes in beta diversity, higher SCFA production, and reductions in intestinal permeability and cardiometabolic risk markers were also observed. Additionally, reductions in inflammatory markers such as CRP, IL-6, and TNF-α, along with improvements in glucose, insulin, HOMA-IR, and triglycerides, were reported.

Conclusion: Dietary patterns consistent with the IFP appear to positively modulate GM composition and function in individuals with MetS, promoting greater microbial diversity, increased beneficial taxa, and improvement in inflammatory and metabolic markers. These findings suggest potential benefits of this dietary pattern as an adjuvant strategy for MetS management, although study heterogeneity still limits broader generalization.

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