Advantages of energy restriction approach in mitigating metabolic syndrome: A network meta-analysis

Based on previous studies, we hypothesized that the diverse dietary strategies might improve the health of patients with metabolic syndrome. This study aimed to compare the effects of different dietary strategies on indicators through a network meta-analysis. We searched CNKI, Wanfang Data, VIP, PubMed, Embase and Web of Science databases till November 5, 2024, to identify the randomized controlled trials on dietary strategies for improving of the indexes in patients with metabolic syndrome. Based on the inclusion and exclusion criteria, 20 articles involving 1244 subjects and 23 dietary patterns were included. The analysis revealed that among the five integrated dietary strategies, the Energy Restriction Approach ranked as the most effective intervention for improving key metabolic parameters. In reducing body mass index, the Energy Restriction Approach showed the highest efficacy (SUCRA 87.0%), followed closely by the Meal Frequency Modulation Strategy (SUCRA 85.8%). The Energy Restriction Approach significantly outperformed Control Dietary Regimen (MD = -5.69, 95%CI: -7.90, -3.20) and other strategies. The Energy Restriction Approach also ranked first (SUCRA 85.1%) in fasting blood glucose, with the Recommended Dietary Approach also showed notable benefits (SUCRA 71.0%). For waist circumference, the Meal Frequency Modulation Strategy was most effective (SUCRA 85.1%), with the Recommended Dietary Approach also demonstrating significant reductions compared to controls (MD = -3.25, 95%CI: -7.51, -0.12). Overall, the Energy Restriction Approach dominated in improving body mass index, fasting blood glucose, and metabolic outcomes, while the Meal Frequency Modulation Strategy and the Recommended Dietary Approach showed complementary strengths in waist circumference and lipid profiles, respectively.