In June 2025, the Journal of the American College of Cardiology published an expert review of evidence-based lifestyle interventions for CKM syndrome.² Although few studies have examined dietary interventions specifically for CKM syndrome, existing research for metabolic, kidney, and cardiovascular disease highlights a consensus of diet quality and whole-diet patterns over single-nutrient approaches.

Stage Based Interventions

• Stage 0 encourages youth interventions to promote health through healthy diet, activity, and multi-component education within schools.
• In Stage 1, the goal is to prevent the development of metabolic risk factors in individuals with excess or dysfunctional adiposity. While intentional weight loss of at least 5% provides significant cardiometabolic prevention benefits, adopting a heart-healthy diet and increasing physical activity can improve health even without weight loss.¹ 
• Stage 2 is focused on metabolic and CKD risk reduction, with DASH and Mediterranean diets recommended alongside aerobic and resistance training to support glycemic management and reduced blood pressure, hypertriglyceridemia, and progression of CKD.¹ ² Concerns of subclinical CVD modify recommendations in
• Stage 3 to focus on interventions that can reduce non-calcified arterial plaques and CVD events; however, only one dietary study was included within the review. The DISCO-CT trial² found that a dietitian-led DASH dietary pattern significantly reduced non-calcified plaque in individuals with non-obstructive stenosis. Nutrition should also focus on kidney preservation through individualized protein goals, increased plant-based foods , and limited processed-food consumption. In addition, medication optimization and high-intensity exercise are recommended.
• Stage 4 includes dietary strategies for individuals with established CVD, with a focus on improving recovery and secondary prevention. The Mediterranean and low-fat dietary patterns are supported by evidence to reduce the recurrence of cardiovascular events post MI and reduce myocardial ischemia and coronary artery disease progression, respectively.
  In stage 4, like all stages, evidence-based pharmacotherapy and coordinated care with multi-disciplinary teams complement lifestyle interventions. While more research is needed to tailor strategies to individual needs at each stage, we can see that these stages have many overlapping recommendations. We can use a whole-person, comprehensive assessment approach instead of focusing on dietary interventions that treat diseases in isolation.