A Mediterranean Diet-Based Culinary Intervention in Adults With Metabolic Syndrome (CUINAMET)

Impact of a Mediterranean Diet-based Culinary Medicine Intervention on the Reversal of Metabolic Syndrome and Biomarkers of Inflammation, Oxidative Stress, and Aging

Metabolic syndrome is a major public health concern associated with an increased risk of cardiovascular disease, type 2 diabetes, and premature mortality. The Mediterranean diet has consistently demonstrated beneficial effects on metabolic health and is recommended as a dietary strategy for the prevention and management of metabolic syndrome. However, most interventions have focused on conventional nutritional counseling and have paid limited attention to the culinary and gastronomic skills required to translate dietary recommendations into sustainable eating behaviors.

This randomized controlled trial will evaluate the effectiveness of a Mediterranean diet-based nutritional intervention complemented by culinary medicine training sessions compared with a nutritional intervention alone in Spanish adults with metabolic syndrome. The culinary medicine component is designed to enhance participants' food preparation skills, confidence in cooking, and ability to incorporate Mediterranean dietary principles into their daily lives.

Participants will be followed for 6 months to assess changes in metabolic syndrome components and other metabolic health indicators. The study aims to determine whether the integration of culinary medicine education enhances the effectiveness of conventional nutritional counseling in improving metabolic syndrome outcomes and promoting long-term adherence to a Mediterranean dietary pattern

Study Overview

• Status: Not yet recruiting
• Conditions: Metabolic Syndrome
• Intervention / Treatment: Behavioral: Mediterranean diet-based culinary intervention; Behavioral: Standard nutritional counseling

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Victoria S Pinto Manzo, Msc; Phone Number: 2907 +34 932275400; Email: victoriasabinap@ub.edu

Study Locations

• Spain
  • Barcelona
    • Barcelona, Barcelona, Spain, 08035
      • IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer (Hospital Clínic de Barcelona)
      • Contact: Victoria S Pinto Manzo, Msc; Phone Number: 2907 +34 932275400; Email: victoriasabinap@ub.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Men and women
• Age between 30 and 60 years
• Body mass index (BMI) between 20 and 35 kg/m²

• Presence of metabolic syndrome defined as having at least three of the following criteria:

  1. HDL cholesterol <40 mg/dL in men and <50 mg/dL in women
  2. Fasting glucose >100 mg/dL or use of hypoglycemic agents
  3. Triglycerides ≥150 mg/dL or use of lipid-lowering medication
  4. Blood pressure ≥130/85 mmHg
  5. Waist circumference ≥102 cm in men and ≥88 cm in women

Exclusion Criteria:

• Food allergies or intolerances to foods typical of the Mediterranean diet
• Gluten intolerance or celiac disease
• Adherence to a vegetarian or vegan diet
• Eating disorders (including anorexia nervosa, bulimia nervosa, and binge eating disorder)
• Moderate to severe psychiatric disorders that may compromise adherence to the intervention
• History of cardiovascular events
• BMI >35 kg/m²
• Extreme dietary patterns in the last 3 months (e.g., Atkins diet, very high-protein diets)
• Excessive alcohol consumption (>30 g/day for men and >20 g/day for women)
• Pregnancy or lactation
• Previous culinary training or formal culinary education

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control group	Behavioral: Standard nutritional counseling; Participants assigned to the control group will receive standard nutritional counseling in Mediterranean diet, consisting of three individual consultations at baseline, 3 months, and 6 months to monitor adherence to dietary recommendations. At each visit, health parameters will be assessed and questionnaires will be administered to evaluate dietary behavior and related outcomes. At baseline, 3 months, and 6 months, participants will undergo the same measurements as the intervention group. After completion of the study, participants in the control group will be provided with the Mediterranean recipe booklet and access to the educational videos on Mediterranean culinary preparations used in the intervention group.
Experimental: Culinary-Nutritional Intervention Group	Behavioral: Mediterranean diet-based culinary intervention; Participants assigned to the culinary-nutritional intervention group will receive three individualized nutritional counseling sessions in Mediterranean diet, at baseline, 3 months, and 6 months, including health assessments and questionnaire administration at each visit. At the baseline visit, participants will receive a Mediterranean recipe booklet. Throughout the intervention, they will also receive educational videos featuring Mediterranean culinary preparations and cooking techniques. In addition, participants will attend nine hands-on culinary medicine workshops over the 6-month intervention period. Workshops will be conducted every two weeks during the first 3 months (six workshops) and monthly during the last 3 months (three workshops). The workshops will focus on Mediterranean diet principles, healthy cooking skills, meal planning, food selection, and preparation of Mediterranean-style recipes to facilitate adherence to the dietary intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in metabolic syndrome components	Changes in metabolic syndrome components according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, including waist circumference, blood pressure, fasting glucose, triglycerides, and HDL cholesterol, measured as continuous variables, using a score ranging from 1 to 5.	Baseline, 3 months, and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body weight, fat mass and lean mass	Weight in kilograms (kg) using a calibrated electronic scale. Fat mass and lean mass in kilograms (kg) measured using dual-energy X-ray absorptiometry (DXA).	Baseline, 3 months, and 6 months
Body fat	Body fat expressed as a percentage (%) measured using dual-energy X-ray absorptiometry (DXA).	Baseline, 3 months, and 6 months
Height	Height, measured in centimeters (cm) using a wall-mounted stadiometer	Baseline, 3 months, and 6 months
Lipid profile	Lipid profile including total cholesterol (mg/dl), LDL cholesterol (mg/dl), HDL cholesterol (mg/dl), triglycerides (mg/dl), VLDL cholesterol (mg/dl), and non-HDL cholesterol (mg/dl) measured using standard enzymatic methods.	Baseline, 3 months, and 6 months
Liver enzymes	Liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP), measured in units per liter (U/L) using standard laboratory methods.	Baseline, 3 months, and 6 months
Total and direct bilirubin	Total and direct bilirubin, measured in micromoles per liter (µmol/L) using standard laboratory methods.	Baseline, 3 months, and 6 months
Serum albumin and total protein	Serum albumin and total protein, measured in grams per liter (g/L) using standard laboratory methods.	Baseline, 3 months, and 6 months
Glycated hemoglobin	Glycated hemoglobin (HbA1c), measured as a percentage (%) using standardized laboratory assays.	Baseline, 3 months, and 6 months
Dietary intake	Dietary intake, assessed using a validated Food Frequency Questionnaire (FFQ) to estimate habitual energy and nutrient intake. Nutrient and energy intake are expressed in grams per day (g/day), milligrams per day (mg/day), micrograms per day (µg/day), or kilocalories per day (kcal/day), depending on the dietary component evaluated.	Baseline, 3 months, and 6 months
Mediterranean diet adherence	Mediterranean diet adherence, assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). Scores range from 0 to 14, with higher scores indicating greater adherence to the Mediterranean diet.	Baseline, 3 months, and 6 months
Culinary habits	Culinary habits, assessed using the Home Cooking Frequency Questionnaire (HCFQ). The questionnaire evaluates the frequency of home cooking, food preparation behaviors, and culinary skills. Higher scores indicate greater frequency of home cooking and healthier culinary practices.	Baseline, 3 months, and 6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduced and oxidized glutathione	Reduced and oxidized glutathione (GSH and GSSG), measured in micromoles per liter (µmol/L) using enzymatic or chromatographic methods.	Baseline, 3 months, and 6 months
Gut microbiota composition	Gut microbiota composition, assessed by 16S ribosomal RNA (16S rRNA) gene sequencing of fecal DNA. Relative abundance of bacterial taxa is expressed as percentage (%).	Baseline, 3 months, and 6 months
Superoxide dismutase	Superoxide dismutase (SOD), measured in units per milliliter (U/mL) using standardized enzymatic assays.	Baseline, 3 months, and 6 months
F2-isoprostanes	F2-isoprostanes, measured in picograms per milliliter (pg/mL) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) or enzyme-linked immunosorbent assay (ELISA).	Baseline, 3 months, and 6 months
Malondialdehyde	Malondialdehyde (MDA), measured in micromoles per liter (µmol/L) using high-performance liquid chromatography (HPLC) or validated colorimetric assays.	Baseline, 3 months, and 6 months
Catalase	Catalase (CAT), measured in units per liter (U/L) using standardized enzymatic assays.	Baseline, 3 months, and 6 months
Inflammatory biomarkers	Inflammatory biomarkers, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and ghrelin, measured in picograms per milliliter (pg/mL) using multiplex immunoassays or enzyme-linked immunosorbent assay (ELISA).	Baseline, 3 months, and 6 months
Adipokines	Adipokines, including leptin and visfatin, measured in nanograms per milliliter (ng/mL) using multiplex immunoassays or enzyme-linked immunosorbent assay (ELISA).	Baseline, 3 months, and 6 months
Adiponectin	Adiponectin, measured in micrograms per milliliter (µg/mL) using enzyme-linked immunosorbent assay (ELISA).	Baseline, 3 months, and 6 months
High-sensitivity C-reactive protein	High-sensitivity C-reactive protein (hs-CRP), measured in milligrams per liter (mg/L) using immunoturbidimetric or immunoassay methods.	Baseline, 3 months, and 6 months
Circulating polyphenols and plasma carotenoids	Circulating polyphenols and plasma carotenoids, measured in micromoles per liter (µmol/L) using high-performance liquid chromatography (HPLC) coupled with mass spectrometry.	Baseline, 3 months, and 6 months
Urinary polyphenols	Urinary polyphenols, measured in milligrams of gallic acid equivalents per gram of creatinine (mg GAE/g creatinine) using the Folin-Ciocalteu method or chromatographic techniques.	Baseline, 3 months, and 6 months
Advanced glycation end products	Advanced glycation end products (AGEs), measured in nanograms per milliliter (ng/mL) using enzyme-linked immunosorbent assay (ELISA).	Baseline, 3 months, and 6 months
Fecal short-chain fatty acids	Fecal short-chain fatty acids (SCFAs), including acetate, propionate, and butyrate, measured in micromoles per gram of feces (µmol/g) using gas chromatography with flame ionization detection (GC-FID).	Baseline, 3 months, and 6 months
Health-related quality of life	Health-related quality of life, assessed using the 36-Item Short Form Health Survey (SF-36). Scores range from 0 to 100 for each of the eight domains and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, with higher scores indicating better health-related quality of life.	Baseline, 3 months, and 6 months
Physical activity,	Physical activity, assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Physical activity is expressed as metabolic equivalent of task (MET)-minutes per week (MET-min/week), with higher values indicating greater levels of physical activity.	Baseline, 3 months, and 6 months

Collaborators and Investigators

• Sponsor: Fundacion Clinic per a la Recerca Biomédica
• Investigators: Principal Investigator: Rosa M Casas Rodríguez, PhD, IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer (Hospital Clínic de Barcelona)

Publications and helpful links

General Publications

• Babio N, Toledo E, Estruch R, Ros E, Martinez-Gonzalez MA, Castaner O, Bullo M, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Basora J, Sorli JV, Salas-Salvado J; PREDIMED Study Investigators. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014 Nov 18;186(17):E649-57. doi: 10.1503/cmaj.140764. Epub 2014 Oct 14.
• Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, Medina FX, Battino M, Belahsen R, Miranda G, Serra-Majem L; Mediterranean Diet Foundation Expert Group. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011 Dec;14(12A):2274-84. doi: 10.1017/S1368980011002515.
• La Puma J. What Is Culinary Medicine and What Does It Do? Popul Health Manag. 2016 Feb;19(1):1-3. doi: 10.1089/pop.2015.0003. Epub 2015 Jun 2. No abstract available.
• Wolfson JA, Leung CW, Richardson CR. More frequent cooking at home is associated with higher Healthy Eating Index-2015 score. Public Health Nutr. 2020 Sep;23(13):2384-2394. doi: 10.1017/S1368980019003549. Epub 2020 Jan 10.
• Godos J, Scazzina F, Paterno Castello C, Giampieri F, Quiles JL, Briones Urbano M, Battino M, Galvano F, Iacoviello L, de Gaetano G, Bonaccio M, Grosso G. Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a "Planeterranean" diet. J Transl Med. 2024 Mar 21;22(1):294. doi: 10.1186/s12967-024-05095-w.
• Finkelstein A, Budd MA, Gray BE, Mirsky J, Tirosh A, Polak R. Personalized Culinary Medicine: Qualitative Analyses of Perceptions from Participants in Action and Contemplation Stages of Change Through a One-Year Bi-Center Randomized Controlled Trial. Nutrients. 2025 Feb 16;17(4):704. doi: 10.3390/nu17040704.
• Domper J, Gayoso L, Goni L, Perezabad L, Razquin C, de la O V, Etxeberria U, Ruiz-Canela M. An Intensive Culinary Intervention Programme to Promote Healthy Ageing: The SUKALMENA-InAge Feasibility Pilot Study. Nutrients. 2024 Jun 1;16(11):1735. doi: 10.3390/nu16111735.
• Sharma SV, McWhorter JW, Chow J, Danho MP, Weston SR, Chavez F, Moore LS, Almohamad M, Gonzalez J, Liew E, LaRue DM, Galvan E, Hoelscher DM, Tseng KC. Impact of a Virtual Culinary Medicine Curriculum on Biometric Outcomes, Dietary Habits, and Related Psychosocial Factors among Patients with Diabetes Participating in a Food Prescription Program. Nutrients. 2021 Dec 15;13(12):4492. doi: 10.3390/nu13124492.
• Heredia NI, Macias-Navarro L, Guevara DC, Sharma SV, Chow J, Bentley SS, Chukuigwe O, Pappa A, McWhorter JW. Testing of a Culinary Medicine Intervention for Racially/Ethnically Diverse Adults With Type 2 Diabetes. J Nutr Educ Behav. 2025 Apr;57(4):263-273. doi: 10.1016/j.jneb.2024.11.006. Epub 2025 Jan 15.
• Glanz K, Metcalfe JJ, Folta SC, Brown A, Fiese B. Diet and Health Benefits Associated with In-Home Eating and Sharing Meals at Home: A Systematic Review. Int J Environ Res Public Health. 2021 Feb 7;18(4):1577. doi: 10.3390/ijerph18041577.
• Partearroyo T, Samaniego-Vaesken ML, Ruiz E, Aranceta-Bartrina J, Gil A, Gonzalez-Gross M, Ortega RM, Serra-Majem L, Varela-Moreiras G. Current Food Consumption amongst the Spanish ANIBES Study Population. Nutrients. 2019 Nov 5;11(11):2663. doi: 10.3390/nu11112663.
• Casucci MG, Munoz-Martinez J, Caneda-Ferron B, Salinas-Roca B, Orta-Ramirez A, Vidal E, Rodriguez-Monforte M, Medeiro da Costa I, Costa V, Renzi S, Carrillo-Alvarez E. The Association Between Mediterranean Diet -Related Health Literacy, Cooking Skills and Mediterranean Diet Adherence in the Spanish Population. Nutrients. 2026 Jan 12;18(2):235. doi: 10.3390/nu18020235.
• Liu G, Zong G, Hu FB, Willett WC, Eisenberg DM, Sun Q. Cooking Methods for Red Meats and Risk of Type 2 Diabetes: A Prospective Study of U.S. Women. Diabetes Care. 2017 Aug;40(8):1041-1049. doi: 10.2337/dc17-0204. Epub 2017 Jun 13.
• Vignesh A, Amal TC, Vasanth K. Food contaminants: Impact of food processing, challenges and mitigation strategies for food security. Food Res Int. 2024 Sep;191:114739. doi: 10.1016/j.foodres.2024.114739. Epub 2024 Jul 6.
• Rinaldi de Alvarenga JF, Tran C, Hurtado-Barroso S, Martinez-Huelamo M, Illan M, Lamuela-Raventos RM. Home cooking and ingredient synergism improve lycopene isomer production in Sofrito. Food Res Int. 2017 Sep;99(Pt 2):851-861. doi: 10.1016/j.foodres.2017.01.009. Epub 2017 Jan 11.
• Martinez-Larrad MT, Corbaton-Anchuelo A, Fernandez-Perez C, Lazcano-Redondo Y, Escobar-Jimenez F, Serrano-Rios M. Metabolic syndrome, glucose tolerance categories and the cardiovascular risk in Spanish population. Diabetes Res Clin Pract. 2016 Apr;114:23-31. doi: 10.1016/j.diabres.2016.02.003. Epub 2016 Feb 21.

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: July 6, 2026
• First Submitted That Met QC Criteria: July 13, 2026
• First Posted (Actual): July 14, 2026

Study Record Updates

• Last Update Posted (Actual): July 14, 2026
• Last Update Submitted That Met QC Criteria: July 13, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: obesity; cardiovascular risk; inflammation; insulin resistance; oxidative stress; metabolic syndrome; lifestyle intervention; Mediterranean diet; culinary medicine; diet therapy
• Additional Relevant MeSH Terms: Pathologic Processes; Nutrition Disorders; Metabolic Diseases; Overnutrition; Body Weight; Glucose Metabolism Disorders; Hyperinsulinism; Overweight; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Obesity; Metabolic Syndrome; Inflammation; Insulin Resistance
• Other Study ID Numbers: HCB/2026/0570

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No