A narrative review of dietary patterns in cardiovascular-kidney-metabolic syndrome

Driven by the global rise in obesity and lifestyle transitions, cardiovascular-kidney-metabolic (CKM) syndrome has emerged as a pathophysiological continuum characterized by metabolic dysregulation and involving multi-organ interactions. Within the comprehensive management of CKM syndrome, dietary patterns represent a cornerstone of intervention due to their high modifiability and cost-effectiveness. Adopting the perspective of the CKM syndrome pathophysiological continuum, this narrative review provides a thematic overview of the current literature on the Mediterranean, DASH, plant-based, and ketogenic diets in relation to metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and cardiovascular disease. Evidence indicates that the Mediterranean and DASH diets, through established anti-inflammatory, antioxidant, and endothelial protective mechanisms, are the most consistently supported dietary patterns for CKM risk mitigation. The efficacy of plant-based diets is strictly quality-dependent: while healthful patterns rich in whole grains and vegetables are associated with improved cardiorenal outcomes, unhealthful patterns dominated by refined carbohydrates may exacerbate metabolic derangements. Although the ketogenic diet may improve glucose metabolism in the short term, concerns regarding elevated low-density lipoprotein cholesterol, potential hepatotoxicity, and limited long-term adherence suggest that its role may be more relevant in selected short-term settings than as a sustained long-term dietary pattern. Furthermore, structured dietary quality indices may provide useful tools for characterizing dietary exposure in relation to CKM and for generating mechanistic hypotheses. By integrating clinical and mechanistic evidence, this review outlines a stage-oriented conceptual framework to discuss how different dietary patterns may relate to distinct phases of the CKM syndrome.