Rev Endocr Metab Disord (2013) 14:287–297
DOI 10.1007/s11154-013-9270-8
Tackling metabolic syndrome by functional foods
Muhammad Issa Khan & Faqir Muhammad Anjum &
Muhammad Sohaib & Aysha Sameen
Published online: 22 September 2013
# Springer Science+Business Media New York 2013
Abstract The metabolic syndrome is one of the most vibrant
and widely prevailing health concerns worldwide. It is char-
acterized by several metabolic abnormalities, which involve
obesity, insulin resistance, dyslipidemia, enhanced oxidative
stress; hypertension and increased pro-inflammatory state that
ultimate contribute towards poor health. The prevalence of
metabolic syndrome in Pakistan according to different defini-
tions is reported to be from 18 % to 46 %. Fifty percent of
Pakistani population is at high risk of metabolic syndrome as
being hypertensive. In studying dyslipidemia in Pakistan,
hypertriglyceridemia is found in 27–54 % of the population,
whereas 68–81 % has low levels of high-density lipoprotein
(HDL). Population likes to eat healthier diet without changing
their fundamental dietary pattern. Nutrition science has moved
on from the classical concepts of avoiding nutrient deficien-
cies and basic nutritional adequacy to the concept of positive
or optimal nutrition. Many traditional food products including
fruits, vegetables, flaxseed, oat, barley, whole grains, soy and
milk have been found to contain component with potential
health benefits. Nowadays, functional foods are used in the
prevention and amelioration of several chronic diseases, such
as the metabolic syndrome. The relation of the consumption of
certain functional foods and the improvement in health status
is regulated through health claims. This review focuses on the
different features of the metabolic syndrome and the influence
M. I. Khan (*) : F. M. Anjum : M. Sohaib : A. Sameen
National institute of Food Science and Technology, University of
Agriculture, Faisalabad, Pakistan
e-mail: drkhan@uaf.edu.pk
F. M. Anjum
e-mail: dgnifsat@ymail.com
M. Sohaib
e-mail: ftsohaib@homail.com
A. Sameen
e-mail: ayshasameen@uaf.edu.pk
of functional foods on these aspects, involving dyslipidemia,
improvement of insulin sensitivity, serum lipid profile, anti-
oxidant status, anti-inflammatory status and weight manage-
ment of humans.
Keywords Functional foods . Metabolic syndrome .
Hypertension . Dyslipidemia . Lipid profile
1 Metabolic syndrome
The metabolic syndrome is characterized by a group of met-
abolic risk factors in one person. The first unified consensus
about the definition of the Metabolic Syndrome was drawn up
during a meeting organized by the International Diabetes
Federation (IDF) in 2005. According to this the major con-
tributing factor is obesity measured by either waist circumfer-
ence or Body Mass Index (BMI). Besides central obesity, the
other factors to include for diagnoses of metabolic syndrome
include to estimation of triglycerides, reduced high-density
lipoprotein (HDL) cholesterol, blood pressure, or fasting plas-
ma glucose of human [1]. The pathophysiology is extremely
complex and has been only partially elucidated. Most patients
are older, obese, sedentary, and have a degree of insulin
resistance. The most important factors in order are weight,
genetics, aging and lifestyle, i.e., low physical activity and
excess caloric intake [2]. The central adiposity is a key feature
of the syndrome, reflecting the fact that the syndrome’s prev-
alence is driven by the strong relationship between waist
circumference and increasing adiposity. However, despite
the importance of obesity, patients who are normal weight
may also be insulin-resistant and have the syndrome [3].
Various strategies have been proposed to prevent the devel-
opment of syndrome. These include increased physical activ-
ity and a healthy, reduced calorie diet [4]. To maintain a diet
that keeps carbohydrates to no more than 50 % of total calories
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and consume complex carbohydrates (whole grain bread,
brown rice) instead of refined carbohydrates. Increase fiber
consumption by eating legumes and bean, whole grains, fruits
and vegetables. As much as 30 to 45 % of your daily calories
can come from fat. Consume healthy fats such as those in
canola oil, olive oil, flaxseed oil and nuts to as much as 30 %
of the total calories.
2 Functional foods
The definition of functional foods is not universal; neither
exists in a legislation of functional foods, which differs be-
tween different countries of the world. The most common used
definitions arise from the International Food Information
Council (IFIC) and from the International Life Sciences
Institute (ILSI). The IFIC described that functional foods are
‘foods or dietary components that may provide a health benefit
beyond providing basic nutrition’ [5]. The ILSI regards a food
as functional when ‘it has satisfactorily demonstrated to affect
beneficially one or more target functions in the body, beyond
adequate nutritional effects, in a way that is relevant to either
an improved state of health and well-being and/or a reduction
of risk of disease [6]. Food Products that provide specific
health benefits beyond the traditional nutrients they contained
are known to be functional. The concept of functional foods
was born in Japan in the 1980’s, where the term was first used
by the industry to describe foods that are fortified with specific
ingredients imparting certain health benefits. Functional attri-
butes of many traditional foods are being discovered and new
food products may be developed with beneficial components
from these traditional foods components.
The dietary fiber was the first of the functional ingredients
to be a commercial success and the sudden rise in demand for
drinks containing high levels of fiber in the late 1980’s is
considered the start of the functional foods market in Japan
and the rest of the world [7]. The product credited with being
the first Japanese functional food is a dietary fiber containing
soft-drink called Fiber-Mini (Otsuka Pharmaceutical)
launched in 1988, which uses water-soluble polydextrose as
its functional ingredient and is marketed for ‘gut regulation’.
In response, the Japan initiated a voluntary approval system in
which the term ‘functional foods’ was actually replaced by the
term ‘foods for specific health use (FOSHU)’. FOSHU foods
were defined by the Japanese Ministry of Health and Welfare
as ‘processed foods containing ingredients that aid specific
bodily functions as well as being nutritious’. Upon provision
of sufficient research data, 12 categories of health-enhancing
ingredients were recognized: dietary fiber, oligosaccharides,
sugar alcohols, peptides and proteins, glucosides, alcohols,
isoprenoids and vitamins, cholines, lactic acid bacteria, min-
erals, polyunsaturated fatty acids, and many others.
Rev Endocr Metab Disord (2013) 14:287–297
The development of functional food products will continue
to grow well into the 21st century as consumer demand for
these products is heightened. Factors contributing to this
reshaping of the food supply include: an aging population,
increased health care costs, self-efficacy and autonomy in
health care, advancing scientific evidence that diet can alter
disease prevalence and progression [8]. The scientific evi-
dence for functional foods and their physiologically active
components can be categorized into 4 distinct areas: (a) clin-
ical trials, (b) animal studies, (c) experimental in vitro labora-
tory studies, and (d) epidemiologic studies.
3 Classification of functional foods
Functional foods may be classified into four distinct groups;
1. Basic functional foods are the food or foods products that
are naturally rich in the biological active compounds such
as oat bran and psyllium rich in dietary fiber are associat-
ed with reduce coronary heart disease. Increased con-
sumption of fruits and vegetables have the association
with reduced risk for cancer and coronary heart disease.
2. Second are those foods having substantial scientific sup-
port, but currently lack approved health claim such as
garlic and n-3 fatty acids found in fish [9], which have
been shown in clinical trials to reduce serum cholesterol
levels in subjects with elevated levels.
3. Third category of functional foods are those that have been
fortified to enhance the level of a specific nutrient or food
component that has been associated with the prevention or
treatment of a disease or other clinical condition such as
calcium-fortified orange juice, pasta, or rice marketed to
reduce osteoporosis risk.
4. Fourth category of functional foods includes whole foods
that have been associated with reduced risk of disease
such as fermented dairy products (probiotics), which have
been shown to improve gastrointestinal health [10].
4 Functional foods of Asian Region
4.1 Garlic
Functional/nutraceutical foods are the core element of diet
based therapy owing to their health enhancing potential beyond
the basic function of supplying nutrients. The use of such
designer foods is an emerging trend among the health conscious
consumers thereby captured the major share of the global
nutrition market [11]. Garlic (Allium sativum) is one of the
most commonly consumed vegetables/herbs utilized both for
medicinal purpose and culinary practices as providing flavor
and taste to the final product. It is believed to be originated from
Rev Endocr Metab Disord (2013) 14:287–297
Central Asia and extended on the other part of the globe [12].
Historical background indicated Central Asia as the origin of
garlic that further extended to the other parts of the globe. Like
other herbaceous plants, the composition of garlic varies with
geographical location, harvesting time, agronomic practices
etc. It has been observed that garlic contains approximately
65 % water, 30 % carbohydrates and 5 % of other bioactive
components mainly sulfur containing compounds. Among
organosulfur group, cysteine sulfoxides and thiosulfinates
are relatively more important [13] (Table 1).
According to the estimation, about 95 % of the sulfur from
intact garlic cloves comes from two compounds namely S-
allyl-cysteine sulfoxide (SACS) and gamma-glutamyl-S-
allylcysteine (GGSA) [25]. These garlic bioactive constituents
S-allayl cysteine (SAC) and S-allyl mercepto cysteine
(SAMC) have capacity to reduce the cholesterol and provide
protection against physiological threats in human beings [26].
Garlic is one of the rich sources of sulfur containing com-
pounds like diallyl sulfide, allicin (diallylthiosulfate), GGSA
and SACS are collectively called allium. Healthful aspects of
garlic are well known and its functional ability includes free
radical scavenging, cardiovascular diseases prevention, and
immune stimulation, anti-infectious and anti-cancer proper-
ties. Major research interventions are focused on its potential
for preventing lifestyle related disorders like hypercholester-
olemia, hyperglycemia and weight management [27]. The
hypoglycemic activity of garlic, garlic oil and its organosulfur
constituents especially diallyl trisulfide resulted higher insulin
secretion and sensitivity in streptozotocin induced diabetic
rats [28]. However, there was no appropriate hypoglycemic
activity of garlic powder in streptozotocin (STZ) induced
diabetic animals. It is concluded that incoherent results are
partly due to different garlic preparations used in the various
experimental observations. The chemical profile of garlic
products is mainly depends upon the processing and working
conditions like temperature, preparation time and type of
solvents used for extraction.
Aqueous garlic extract has ability to decrease cholesterol
synthesis upto 75 % without cellular toxicity mediated by
Table 1 Functional food, their constituents and health benefits
Functional foods Functional components
Omega-3 enriched eggs Omega-3 fatty acids
Oat ß-glucan and phytochemicals
Fatty fish Omega-3 fatty acids (DHA and EPA)
Soy foods Isoflavones
Fortified margarines Plant Sterol and stanol esters
Probiotic foods Probiotics
Nuts Monounsaturated fatty acid and antioxidants Reduce the risk of coronary heart disease
Grape Juice Resveratrol
289
sterol 4-alpha-methyl oxidase. It is also effective in reducing
coronary calcium progression. It has been elucidated that
SACS decreases the activity of HMG CoA reductase enzyme
while significantly increases the activity of LCAT in isopro-
terenol (ISO)-induced myocardial ischaemia. Garlic and its
various preparations are used to prevent various cardiovascu-
lar disorders. Studies on both rats and rabbits have shown that
garlic extract alleviated diet induced hypercholesterolemia
[29].
4.2 Dietary fiber rich foods
Dietary fiber is present in many foods of our daily use. Fibers
include pectin, guar gum, psyllium and β-glucan which are
mostly present in oat, barley, fruits and vegetables. Structural
fibers like cellulose and lignin are generally present in cell
wall of plants. Dietary fiber intake decreases the risk of
cardiovascular disease as well as lowers blood cholesterol
levels. Studies show that by increasing the consumption of
dietary fiber by 10 g/d, risks of coronary events can be
reduced by 14 % [30]. Moreover, oat fiber, which contains
β-glucan, has shown to be very much effective in lowering
serum lipid profile [31]. It is also claimed that oat meal is
also helpful in reducing the risks of cardiac syndrome. The
psyllium seed husk also significantly reduces the blood
cholesterol levels. The mechanism involved behind the cho-
lesterol lowering effect of dietary fiber is the elevation of
bile acids excretion. The intake of dietary fiber reduces the
reabsorption of bile acids in the intestine and stimulates the
synthesis of cholesterol in the liver. Due to the formation of
bile acid, free cholesterol in the liver decreases which will
lead to the overall reduction of total body cholesterol level
[32].
4.3 Oats
Functional foods containing β-glucan are gaining popularity
in the world mainly because they can induce a decreased
energy intake including appetite control, glucose control,
Health Benefits Reference
Lower triglycerides, cholesterol, and reduce the risk for [14, 15]
coronary heart disease
Reduce total and LDL cholesterol, may help lower blood pressure [16, 17]
Reduce triglycerides, reduce coronary heart disease [18, 19]
Reduce total and LDL cholesterol [20]
Reduce total and LDL cholesterol [21]
Support gastrointestinal (GI) health, may boost immunity [22]
[23]
Exhibit heart-healthy effects [24]
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hypertension, and gut microbiota composition. The β-glucan
intake is directly linked with to decrease appetite that has been
proved by using gut hormone responses and subjective appe-
tite indicators. The dietary intake of β-glucan also improves
the glycemic index of meals and beneficially influences glu-
cose metabolism in patients with type 2 diabetes or Syndrome.
Oat products are a widely consumed as a dietary source of the
β-glucan which is a cholesterol-lowering soluble fiber. There
is now significant scientific agreement that consumption of
this particular plant food can reduce total and low density
lipoprotein (LDL) cholesterol, thereby reducing the risk of
coronary heart disease (CHD) [33]. The elevated total and
LDL cholesterol levels are one of the major risk factors for
cardiovascular disease. Oat products are a widely studied
dietary source of the cholesterol-lowering soluble fiber β-
glucan. Oat β-glucan, a soluble dietary fiber that is found in
the endosperm cell walls of oats, has generated considerable
interest due to its cholesterol-lowering properties. The FDA
has approved a health claim for β-glucan soluble fiber from
oats for reducing plasma cholesterol levels and risk of heart
disease in 1997. The recent studies results are consistently
supporting the theme that intake of oat β-glucan at daily doses
of at least 3 g may reduce plasma total and LDL cholesterol
levels by 5–10 % in normocholesterolemic or hypercholester-
olemic subjects. The studies described shown that, on average,
oat consumption is associated with 5 % and 7 % reductions in
total and LDL cholesterol levels, respectively [34].
4.4 Omega-3 fatty acids
Omega-3 fatty acids are derived from α-linolenic acid (ALA)
and are produced by plants. These substances are mostly
present in marine foods such as fatty fish and fish oil. When
consumed, ALA is converted to eicosapentaenoic acid (EPA)
which is further changed into docosahexaenoic acid (DHA).
Studies revealed that fish is a rich source of omega-3 fatty acids
such as EPA and DHA and their dietary intake is quite helpful
in controlling cardiovascular complications. Data obtained
from various trials indicates that dietary supplementation of
0.85 g/d EPA and DHA significantly reduces the risk of
syndromes like coronary heart diseases and sudden cardiac
failure [35]. Moreover, serum lipid concentration remains
unchanged after consumption of omega-3 fatty acids rich foods
[36]. It is also seen by various studies that level of triglycerides
is significantly lowered in the body by consuming 3–4 g/d
omega-3 fatty acids [37]. Food and Drug Administration
(FDA) approved that fish consumption is helpful in the treat-
ment of high concentration of triglycerides in the body [38].
On the other side, recent studies showed that lower doses of
EPA and DHA were only effective in controlling minor cardiac
problems and did not show beneficial effects against coronary
heart diseases [39, 40].
Rev Endocr Metab Disord (2013) 14:287–297
4.5 Cinnamon
Cinnamon contains polymeric compounds which have
insulin-enhancing ability. So it is considered as beneficial for
type-2 diabetics [41]. Consumption of cinnamon significantly
reduced blood glucose level, triglycerides and cholesterol in
diabetes patients [42]. The plasma glucose level was signifi-
cantly reduced in diabetics consuming cinnamon as compared
to the control group [43]. Despite contradictory results, it can
be stated that cinnamon significantly controls the diabetes
among the persons having high initial plasma glucose con-
centrations. Cinnamon extracts possess insulin-mimetic prop-
erties [44]. Cinnamon also boost up the phosphorylation of
insulin receptor which is related with enhanced insulin sensi-
tivity, which in turn is allied with better glucose and lipid
levels [45]. Cinnamaldehyde an active component of cinna-
mon has an anti-microbial property. Cinnamaldehyde also has
been researched for its anti-clotting and anti-inflammatory
properties, which help prevent unwanted clumping of blood
platelets [46].
4.6 Edible fruits
Guava (Psidium guajava L.) is rich in dietary fiber connected
with natural antioxidant compounds Moreover; it also con-
tains significant quantities of vitamin C, vitamin B1, B2, B6,
carotene and pectin [47]. The raw fruit peel possesses anti-
diabetic activity due to the presence of Mg. The guava leaves
are helpful in lowering plasma sugar level in alloxan-induced
diabetic rats. Punica granatum (Pomegranate) flower extract
also has blood glucose decreasing effect [48]. Similarly, seeds
of Punica granatum have anti-diabetic activity [49].
4.7 Coffee
The relationship between coffee consumption and controlling
metabolic syndrome is debatable. Some studies show that
coffee consumption is quiet helpful in reducing blood glucose
level while others reveal that acute consumption of coffee
creates glucose intolerance and decreases insulin sensitivity
[50]. The risk of developing type-2 diabetes was reduced by
50 % among the people consuming seven cups of coffee per
day as compared to these consuming none. The consumption
of coffee is beneficial in controlling diabetes but it also de-
creased insulin sensitivity. Insulin concentration was elevated
after the consumption of coffee. So there is a need to do more
work to elucidate the discrepancy regarding the consumption
of coffee [51, 52].
4.8 Soya proteins
Soybean is one of the most versatile foodstuffs and a very rich
source of essential nutrients consumed worldwide. It
Rev Endocr Metab Disord (2013) 14:287–297
possesses good quality protein which is comparable to other
protein foods and is suitable for all ages, infants to the elderly.
The soy protein is highly digestible (92–100 %) and contains
all the essential amino acids except methionine which is
relatively low but good source of lysine. Soybean-protein
products also contain a high concentration of isoflavones, up
to 1 g/kg [53]. The health benefits of soy proteins have been
documented, relate to the reduction of cholesterol levels and
menopause symptoms and the reduction of the risk for several
chronic syndromes. The addition of soy protein in diet or
replacing animal protein in the diet with Soy lowers blood
cholesterol. The cholesterol-lowering effect of soy is one of
the well-documented physiological effects. The regular con-
sumption of Soy proteins can result in significant reductions in
total cholesterol (9.3 %), LDL cholesterol (12.9 %), and
triglycerides (10.5 %), with a small but insignificant increase
(2.4 %) in high-density lipoprotein (HDL) cholesterol. Linear
regression analysis indicated that the threshold level of soy
intake at which the effects on blood lipids became significant
was 25 g. regarding the specific component responsible for the
cholesterol-lowering effect of soya; recent attention has fo-
cused on the isoflavones [54].
The meta-analysis of 8 randomized controlled trials dem-
onstrated that the isoflavones exhibited LDL cholesterol–low-
ering effect which is independent of soy protein. The presence
or absence of the soybean isoflavone fraction may be a con-
founding factor. This fraction, consisting primarily of genis-
tein, daidzein and glycetein, has been shown to have a
hypocholesterolemic effect in animals and humans [55]. The
potential mechanisms by which soy protein and/or isoflavones
induce lowering of blood cholesterol concentrations include
thyroid status, bile acid balance and the estrogenic effects of
genistein and daidzein. The studies have indicated that
isoflavones exhibit antioxidant properties and have favorable
effects on the arterial compliance. High short-term isoflavone-
containing soy intake slightly affects, of physiologic fluctua-
tions in bone turnover, but has no significant influence lipo-
protein parameters in young healthy women. Soy protein
isoflavones ameliorate the lipid profile in spite of high-
cholesterol intake, but has no obvious effect on blood sugar
level and can therefore be useful in hyperlipidemias especially
when cholesterol intake is simultaneously decreased.
Moreover, there is no direct dose–response relationship be-
tween soy isoflavone content and its lipid-lowering effect
[56].
4.9 Flaxseed
The dietary intake of omega-3 fatty acids (n-3 PUFA) de-
creases the risk of heart disease, inhibits the growth of prostate
and breast cancer, delays the loss of immunological functions,
and is required for normal fetal brain and visual development
[57]. Among the major oil seed, flaxseed oil contains the most
291
(57 %) of the omega-3 fatty acid, particularly α-linolenic acid.
The consumption of flaxseed has also been shown to reduce
total and LDL cholesterol [58]. Dietary flaxseed is one of the
most concentrated sources of protein, dietary fiber and essen-
tial fatty acids. The flaxseed has been targeted as a chief
source providing α-linolenic acid which can be easily incor-
porated into diet by feeding flax-based diets human. Flaxseed
is rich source of omega-3 polyunsaturated fatty acids and it is
helpful in prevention of cardiovascular diseases and cancer.
Flaxseed also contains all of the amino acids for a complete
protein. It is an excellent source of fiber, lecithin, vitamins and
minerals. Moreover, flaxseed is of fastidious significance for
its role in lowering the risk of breast and colon cancers [59].
Among the major seed oils, flaxseed oil contains the most
(57 %) of the omega-3 fatty acid, a-linolenic acid. It also
contains significant level of fiber-associated compounds known
as lignans. The two primary mammalian lignans, enterodiol and
its oxidation product, enterolactone, are formed in the intestinal
tract by bacterial action on plant lignan precursors. Flaxseed is
the richest source of mammalian lignan precursors [60]. The
regular consumption of flaxseed has also been shown to reduce
total and LDL cholesterol [61, 62], as well as platelet aggrega-
tion [63].
4.10 Milk and milk products
The hypocholesterolemic effect of fermented milk was dis-
covered more than 30 years ago during studies con-ducted in
Maasai tribesmen in Africa. The Maasai have low levels of
serum cholesterol and clinical coronary heart disease despite a
high meat diet. However, they consume daily 4 to 5 L of
fermented whole milk. Although a number of human clinical
studies have assessed the cholesterol-lowering effects of
fermented milk products [64]. More evidence supports the role
of probiotics in cancer risk reduction, particularly colon cancer.
This observation may be due to the fact that lactic acid cultures
can alter the activity of fecal enzymes (e.g., b-glucuronidase,
azoreductase, nitroreductase) that are thought to play a role in
the development of colon cancer.
5 Protective role of functional foods in metabolic
syndrome
5.1 Dyslipidemia and functional foods
Dyslipidemia is one of the primary causes for several meta-
bolic syndromes particularly coronary artery disease (CAD).
The elevated total cholesterol (TC), triglycerides (TG), low-
density lipoprotein-cholesterol (LDL-C) and lowered high-
density lipoprotein cholesterol (HDL-C) are conventional risk
factor in myocardial infarction patients [65]. Adak [66]
conducted a study with objective to frame out the lipid and
292
lipoprotein profile in non-diabetic patients which revealed that
levels of lipid, lipoprotein and their ratio among different age
group were found higher with increasing age and these were
statistically significant when compared with healthy control
group. The study also concluded the importance of assessing
the lipid profile and their ratio even in a normal individual as
these are atherogenic factors for development of myocardial
infarction and other coronary complications.
The serum lipid profile includes four basic components,
total cholesterol, HDL cholesterol, LDL cholesterol and tri-
glycerides. The level of lipids determines the cholesterol level
of the blood [67]. The serum cholesterol level can be favorably
decreased by consuming soybean products and vitamin B1.
They also revealed that by using diet containing soy proteins,
fruits and vegetables nutrient intake and serum lipid profile can
be improved in elderly women which are very helpful in
eliminating depression. [68]. A study was conducted in which
they fed two groups of older adults with soy-based food
supplements and beef [69]. The results demonstrated that beef
proteins increased the total cholesterol level particularly lipo-
protein cholesterol while the vegetable proteins did not show
any increase in the cholesterol level. They suggested that
lipoprotein-lipid profiles were differently changed with beef
and vegetable proteins because of changes in carbohydrate
intake and novel nutrient intake ratios in older adults.
Prebiotics in diet can increase colonic fermentation and
hypocholesterolemic effects of soy. Soy foods in conjunction
with prebiotics significantly improved serum lipid profile of
humans [70]. The detail of different functional food ingredient
and their role against different syndromes is described in
(Table 2).
5.2 Functional foods and insulin resistance
Diabetes is a chief health problem and is claimed to induce
micro and macro vascular complications. The patient needs
self-management and long-lasting therapeutic concerns to pre-
vent the severe damages of this deadly disease. Several func-
tional foods that possess hypoglycemic properties have been
used for curing diabetes and have shown significant results in
controlling hyperglycemia [71]. The effect of garlic (Allii
Sativi Bulbus) on diabetic rats and rabbits was studied and
concluded that garlic is helpful in lowering hyperglycemia
[72]. The garlic oil and diallyl trisulfide significantly can lower
diabetes in STZ-induced diabetic rats [73]. S-allyl cysteine
sulfoxide, a product from garlic can control the serum glycemic
levels in diabetic rats [74]. Garlic is also very effective in
raising pancreatic secretion of insulin and in liberating bound
insulin and bulbs of Allium cepa L. can also be used as herbal
treatment to cure diabetes. Moreover, the studies reported that
dietary intake of onion is a tool to ameliorate metabolic diabetes
and also possess hypoglycemic and hypo-cholesterolemic ef-
fects [75, 76]. Additionally, allyl propyl disulfide and S-methyl
Rev Endocr Metab Disord (2013) 14:287–297
cysteine sulfoxide (SACS) also have antidiabetic and anti-
hyperlipidemic properties [77]. Fenugreek (Trigonella foenum-
graecum L.) seed extracts, powder and leaves are shown to
lower down blood glucose and cholesterol levels in human
[78]. Fenugreek contains steroid saponin compounds which
decrease intestinal glucose uptake. Moreover, enzymes involved
in carbohydrate metabolism are also modified by ingestion of
fenugreek. The gel-forming ability of fenugreek fiber is also
helpful in decreasing glucose absorption by intestine. It is also
documented that hyperglycemia can be curtailed effectively by
consuming 25 g fenugreek seeds every day through diet [79].
Mangifera indica tree (Fruit, pulp, seeds, stem bark, leaves
and roots) possesses therapeutic properties that can be used to
cure diabetes [89]. Mangifera indica leaves can decrease hyper-
glycemia in diabetic mice. Bitter gourd (Momordica charantia
L.) is widely used in traditional medical practices to treat diabe-
tes. Several Studies revealed that extract and seed powder of
bitter gourd considerably decreases blood glucose level [90, 91].
Moreover, bitter gourd contains a polypeptide named as “plant
insulin” that is involved in controlling hypoglycemic effects in
humans [92]. Cloves (Syzygium aromaticum) can significantly
reduce hyperglycemia in type 2 diabetic mice [93]. Avena sativa
(Oats) is also considered as helpful functional food to decrease
cholesterol levels mainly due to the presence of β-glucan [94].
So, glucose level of diabetic mice can be checked by oat [95].
Nuts are considered a rich source of unsaturated fatty acids
which are helpful in maintaining glucose level and insulin
homeostasis [96]. Additionally, magnesium can decline the
insulin requirement [97]. In addition to this, nuts are enormously
blessed with vitamins, antioxidants, minerals and plant protein
that can be helpful in preventing diabetes. Glycemic reaction can
be controlled by consuming almonds because it contains anti-
oxidants and other bioactive compounds to control glycemic
mechanism and minimize he incidence of dibates. Foods rich in
antioxidants are claimed to be beneficial in minimizing the
incidence of syndromes. The naturally present antioxidants in
whole unprocessed foods as in fruits, vegetables, legumes,
beans, seeds, nuts, whole grains, spices and herbs are considered
superior in controlling the syndromes as compared to supple-
mented antioxidants [98].
5.3 Anti-hypertensive potential of functional foods
There is a pivotal link between nutrition and syndromes [99].
The relationship between food and health is emerged by
introducing the concept of functional foods. These foods
provide additional health benefits as well as basic nutrition
[100]. Functional foods contain many dietary proteins that
exert beneficial effects upon human health once released by
enzymes during gastrointestinal transit or by fermentation
during the processing of food [101]. Bioactive peptides having
size range in 2–50 amino acids have potential to increase
human health by exhibiting antihypertensive activities [102].
Rev Endocr Metab Disord (2013) 14:287–297 293

Table 2 Functional foods ingredients and their role in the amelioration of metabolic syndromes

Metabolic disorders Functional food ingredient Mechanism References

Serum blood profile Polypheonols Reduces cholesterol absorption and increases faecal cholesterol excretion [80]
Dietary fiber Increases excretion of bile acids [31]
Soy protein Variety of postulated mechanisms, such as increased bile acid excretion and a [56]
decrease in the insulin/glucagon hormone ratio
Omega-3 fatty acids Reduces hepatic synthesis and secretion of VLDL particles [57]
Insulin sensitivity Dietary fiber Soluble fiber reduces postprandial glucose concentrations and absorption of [81]
macronutrients, insoluble fiber increases satiety
Soy protein Contradictive evidence exists, more research is needed [82]
Coffee Inverse relation between coffee-intake and risk of diabetes in large cohort studies, [83]
but acute caffeine administration reduces insulin sensitivity
Anti-hypertensive Sodium-low foods Needs further investigation, association is present [84]
potential Mono-unsaturated fatty Needs further investigation, association is present [36]
acids
Anti-inflammatory Omega-3 fatty acids
Dietary modulation of genetic susceptibility, interferes with monocyte [85]
activity chemotaxis and alters eicosanoid synthesis
Dietary fiber Induces weight loss, improves glycemic control, lowers lipid oxidation, [86]
production of anti-inflammatory compound
Body weight management High protein foods Lowers energy intake through high postabsorptive satiating- and thermogenic [87]
effect
Thermogenic compounds Increases diet-induced thermogenesis [88]
Dietary fiber Decreases energy intake through satiety, lower postprandial glucose and insulin [81]
concentrations and secretion of satiety-inducing gut hormones

Bioactive peptides in functional foods can significantly reduce
the rate of hypertension in humans [103]. Moreover, hyper-
tension can be controlled by using different angiotensin
converting enzymes inhibitors like Enalapril and Captopril
[104]. In addition, animal and plant proteins possess strong
antihypertensive properties. Plant proteins from pea, soya
bean, garlic, wheat also contain strong inhibitors of hyperten-
sion [105]. A major problem with these bioactive compounds
is that these compounds have bitter taste. To overcome this
problem encapsulation is being practiced as an emerging
technique at industrial scale [106].
Dairy products like cheese and milk also contain significant
amounts of antihypertensive peptides. Moreover, sour milk has
Lactotripeptides isoleucine-proline-proline (Ile-Pro-Pro) and
valine-proline-proline (Val-Pro-Pro) and these compounds are
considered as strong antihypertensive agents [107]. The con-
centration of Ile-Pro-Pro and Val-Pro-Pro is increased during
ripening process of cheese up to 100 mg/kg after 4–7 months
storage period. Whey and casein fractions of yoghurt are also
shown to have strong antihypertensive activity that can be used
to curtail several syndromes [108]. The estimates revealed that
one third of the world population is suffering from hyperten-
sion. High blood pressure is also known to be a precursor of
other complications such as cardiovascular diseases including
coronary heart disease, peripheral artery disease and stroke
[109]. The consumption of functional foods to minimize the
incidence of hypertension is one of the dietary approaches.
Several studies documented that diet plays a vibrant role
controlling blood pressure so functional foods possessing
strong antihypertensive activity have been developed to com-
bat hypertension and syndromes [110].
The renin angiotensin system mainly controls hypertension
[111]. The consumption of sour milk significantly decreased
the blood pressure of hypertensive rats after 6–7 h of admin-
istration [112]. Β-casein possesses antihypertensive activity
that can be used to curtail hypertension. The oral administra-
tion of β- casein bioactive peptides with a dosage of 0.2–
2 mg/kg of body weight can significantly reduce rate of
blood pressure of hypertensive rats [113]. Products containing
lactotripeptides are also helpful in controlling elevated blood
pressure [114].
5.4 Anti-inflammatory potential of functional foods
There is a close association between intake of food and
syndromes. The bioactive components of food possess anti-
inflammatory capacity that is linked to improve the health
status of human being. Functional role of carotenoids has been
renowned for many years and they possess defensive role
against serious metabolic disorders such as cardiovascular
diseases [115]. Dietary fibers are customarily added to food
products as functional fibers to provide health benefits.
Cellulose, maltodextran, polydextrose and insulin are all func-
tional fibers isolated from different foods having positive
effect on laxation, attenuation of blood cholesterol levels and
blood glucose levels, increase of water-binding capacity of the
feces and softening of stools. Consumption of dietary and
functional fibers has ability to lessen irritable bowel syndrome,
294
incidence of coronary and cardiovascular heart diseases and
increase survival in obesity and diabetes [116].
Probiotics are emerging as an important dietary ingredient
and are being commercialized as functional foods that im-
prove the availability and digestibility of nutrients while
maintaining the balance of intestinal microflora in the gut.
Because of their positive effects on the immune system, pro-
biotics are helpful in averting and curing several gastrointestinal
(GI) disorders, such as gastroenteritis, hepatic encephalopathy,
lactose intolerance, diarrhea, and possibly inflammatory GI
diseases [117]. Prebiotics also enhance the mineral absorption
and appear to prevent the chances of hypertriglycemia and
irritable bowel syndromes (Roberfroid, 2001). Stanols and ste-
rols present in plant foods, nuts, cereals and vegetable oil tend to
reduce the cholesterol absorption in human intestine. Besides
their cholesterol lowering effect, these compounds have anti-
atherosclerosis, anti-inflammatory and anti-oxidative effects.
Spreads and margarine are recently fortified with plant sterols
and stanols as effective tools for cholesterol management [118].
Phytoestrogens (PEs) are plant compounds similar to estro-
gens with antibacterial, antiviral and fungistatic activity. PEs
are used to avoid contraception and as a therapy for women at
menopause, reduce the incidence of osteoporosis, attenuate the
menopausal symptoms in women [119]. The consumption of
spices and herbs for their health benefits has traditional historic
habits for centuries. Turmeric is commonly used as a spice than
as a medicine, though it has anti-inflammatory properties.
Some active components of turmeric are effective in the treat-
ments of inflammatory bowel disease, rheumatoid arthritis,
relief of liver damage and prevention of metastases. Saffron is
an anti-depressant drug and considered a tonic for the heart and
the nervous system. Gingerol an active ingredient in ginger is
thought to stimulate blood flow, relax blood vessels and relieve
pain. It is commonly used as a digestive aid and contains com-
pounds that alleviate motion sickness and inhibit vomiting and
nausea [120].
5.5 Thermogenic functional foods and weight loss
Thermogenesis is a process in which heat is produced in the
biological system and the fuel for heat production comes from
lipids and fat. The process of thermogenesis is helpful in
burning extra calories and in preventing the accumulation of
fat in body tissues. Thermogenic compounds which are natu-
rally present in many foods play an important role in control-
ling syndrome. Capsaicin is a thermogenic compound present
in red chilies which can reduce adiposity [121]. Capsaicin is
also beneficial for human health as it enhances diet-induced
thermogenesis in body and stimulates fat oxidation which is
quite helpful in reducing fat masses. The mechanism behind this
diet-induced thermogenesis is beta-adrenergic stimulation [122].
Yoshioka studied the effects of capsaicin on weight maintenance
and concluded that it was beneficial in maintaining body weight
Rev Endocr Metab Disord (2013) 14:287–297
after modest weight loss in human beings. Capsaicin is also
helpful in reducing appetite and inhibiting fat and food intake.
This results in enhancing thermogenic reaction and accelerat-
ing energy expenditure [123]. The combined effect of red
peppers and caffeine was studied on energy metabolism and
pointed out that it significantly increased thermogenesis and
prevented the deposition of fat in body by oxidation [124]. Red
peepers can also reduce appetite and energy intake by inducing
thermogenic reaction in the body. The capsaicin stimulated
sensory pathways of mouth and gastrointestinal tract and
showed satiety effects after oral administration [125]. Green
tea extract supplementation in diet showed reduction in
body fat, blood pressure and cholesterol levels in body [86].
Moreover, a combination of green tea extract, L-tyrosine,
caffeine, cayenne and calcium carbonate showed an increase
of thermogenesis. This also resulted in fat reduction and weight
maintenance [126].
6 Conclusions
The metabolic syndrome is multifactorial phenomenon and its
incidence is widely increasing along with its severe risk fac-
tors. Indeed, modifications of lifestyle and diet are mandatory
to decrease the incidence of these syndromes. Nutritional
therapies can potentially prevent or may decrease the chances
of incidence of these syndromes. Considerable experimental
evidence suggest that functional foods and nutritional supple-
ments can potentiate the insulin sensitivity, glucose tolerance,
obesity, hypertension and dyslipidemia have been reversed via
targeted application of these essential nutrients as functional
foods. In a nutshell, the use of functional and designer foods
endowed with solid scientific evidence of efficacy would help
to curtail the incidence of syndromes.
Conflict of interest The authors report no conflicts of interest for the
content of paper.
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