In metabolic syndrome, blood levels of apolipoprotein B (Apo B) reveal the presence of quantitative and qualitative alterations of atherogenic lipoproteins and therefore represent an indicator of the risk of developing cardiovascular disease (CVD). The objective of this study is to evaluate the effect of a combined dietary supplement containing glucomannan, white mulberry dry extract (d.e.), gymnema (d.e.), olive (d.e.), Cassia nomame (d.e.), Nopal, policosanols and chromium, compared to placebo, on Apo B in individuals with metabolic syndrome adhering to the Mediterranean diet. Furthermore, the effect of the dietary supplement on anthropometric parameters, waist circumference and body composition will be investigated.

Metabolic syndrome is a highly prevalent condition characterized by the simultaneous presence of multiple cardiometabolic risk factors, such as arterial hypertension, atherogenic dyslipidemia, hyperglycemia and abdominal obesity. According to the International Atherosclerosis Society (IAS), metabolic syndrome is a clustering of at least three of the following five medical conditions:

1. increased waist circumference (WC) (as per population- and country-specific definition)
2. increased levels of triglycerides (TG) (≥ 150 mg/dL)
3. reduced high-density lipoprotein cholesterol (HDL-C) levels (< 40 mg/dL in men and < 50 mg/dL in women)
4. increased blood pressure (BP) (systolic BP≥ 130 mmHg and/or diastolic BP≥ 85 mmHg)
5. impaired fasting glucose [fasting plasma glucose (FPG)≥ 100 mg/dL] In metabolic syndrome, blood levels of apolipoprotein B (Apo B) reveal the presence of quantitative and qualitative alterations of atherogenic lipoproteins and therefore represent an indicator of the risk of developing cardiovascular disease (CVD).

Troubling increases in high FPG, high body mass index (BMI), and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions, as shown by the Global Burden of Disease (GBD) Study Group. To date, several active ingredients of natural origin have been shown to favorably modify the individual components that have revealed the presence of metabolic syndrome. Among these, we find glucomannan and white mulberry dry extract.

The purpose of this study is to evaluate if a dietary supplement containing glucomannan, white mulberry dry extract (d.e.), gymnema (d.e.), olive (d.e.), Cassia nomame (d.e.), Nopal, policosanols and chromium, is able to significantly influence serum levels of apo B in individuals with metabolic syndrome adhering to the Mediterranean diet. Furthermore, the effect of the dietary supplement on anthropometric parameters, waist circumference and body composition will be investigated.

Inclusion Criteria:

• Male or female aged ≥ 18 years and ≤ 70 years old;
• Subjects with metabolic syndrome (according to the IAS criteria);
• Subjects with an estimated 10-year risk of CVD< 10% (as per the SCORE risk prediction algorithm of the ESC)
• Subjects who have the capability to communicate, to make themselves understood, and to comply with the study's requirements;
• Subjects agree to participate in the study and having dated and signed the informed consent form

Exclusion Criteria:

• Treatment with lipid-lowering drugs or taking food supplements that are effective on blood lipid levels;
• Chronic pharmacological treatments for any clinical condition not stabilized for at least 3 months;
• Known alterations in thyroid, renal or hepatic function (including transaminase values ≥ 3 times the times the upper limit of the normal range (ULN));
• Present or previous alcohol abuse;
• Pregnancy and breastfeeding;
• Subjects with known intolerance to one of the components of the tested dietary supplement;
• History or clinical evidence of any significant concomitant disease that could compromise the safety of the subject or the possibility of completing the study.