The objective is to evaluate whether the medication in polymedicated metabolic syndrome patients could determine the effects of a pomegranate extract on i) metabolic markers, ii) inflammatory markers, and iii) the modulation of the gut microbiota.

Inclusion Criteria:

• Body mass index >30 kg/m2 or waist circumference >94/80 cm (males/females) in European-Caucasians subjects, plus two of the following:
• Triglycerides >150 mg/dL or under treatment against hypertrigliceridemia.
• Fasting glucose ≥100 mg/dL
• Diagnosed type 2 diabetes mellitus
• HDL-cholesterol (mg/dl) <40/50 (males/females) or under treatment against low HDLc values.
• Systolic blood pressure >130 mmHg o diastolic blood pressure >85 mmHg, or under anti-hypertensive drug treatment.

Exclusion Criteria:

• Age under 18 years
• Pregnancy or breastfeeding
• Antibiotic treatment within one month before inclusion in the trial
• Pomegranate allergy or intolerance (known or suspected)
• Chronic intestinal inflammatory diseases (ulcerative colitis, Crohn's disease, etc.)
• Malignancies
• Consumption of botanicals or dietary supplements within one month before the inclusion and during the trial.
• Consumption of ellagitannin-rich sources within one week before the inclusion and during the trial (pomegranate, walnuts, strawberries, raspberries, tea, blackberries and oak-aged wine).