INS and metabolic syndrome: We hypothesize that major dietary patterns discussed in this review—namely the Mediterranean diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH) diet, and ketogenic dietary approaches—together with regular physical exercise, favorably modulate gut microbiota composition and function, thereby improving insulin sensitivity, lipid metabolism, BP regulation, inflammatory status, and overall cardiometabolic risk in individuals with MetS.