Treatment of the Metabolic Syndrome Given that overweight and obesity, physical inactivity, and an atherogenic diet contribute to the development of the metabolic syndrome, the institution of lifestyle modification is first-line therapy. Lifestyle modification involves the institution of changes in diet, exercise, and behavior to gradually achieve a modest degree of in- tentional weight loss.289,302 In the general population, a realistic weight loss goal is a 7% to 10% reduction in baseline weight over 6 to 12 months. Even if this degree of weight loss does not achieve a normal BMI, it imparts significant metabolic benefits. In general, the diet should be low in saturated fats, trans fats, cholesterol, and simple sugars and incorporate an increased intake of fruits, vegetables, and whole grains. Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES Exercise is an important factor in initiating and maintaining weight loss. A minimum of 30 minutes of moderate-inten- sity physical activity is recommended on most days of the week, with further increases in exercise imparting greater benefits. Implementation of the above lifestyle recommen- dations to achieve a gradual, modest weight loss has sig- nificant benefits in the general population. These include a significant reduction in BP, total cholesterol, triglycerides, and fasting glucose. In addition, there is a 58% reduction in the development of diabetes mellitus.303 A slightly different dietary approach to the metabolic syndrome may be the implementation of a Mediterranean- style diet. In general, the traditional Mediterranean diet consists of a high intake of monounsaturated fatty acids, primarily from olives and olive oil, and PUFAs, particu- larly -linoleic acid from nuts, as well as increased con- sumption of fruits, vegetables, whole grains, legumes, and fish, along with moderation in alcohol intake and lim- ited red meats (Table 12). 