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The role of the Mediterranean diet on weight loss and obesity-related diseases

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Abstract

Pandemic obesity is a major public health problem because of its association with non-communicable diseases and all-cause mortality, which can be improved/delayed with weight loss. Thus, several scientific societies and governments have launched guidelines to reduce body weight and adiposity or, at least, to avoid weight gain. In spite of the abundant literature on the topic, there is still controversy on the relative roles of fat and carbohydrate in the diet on weight gain. Present recommendations to avoid weight gain and obesity are directed to reduce intake of total energy variably and of total fat to <30% of energy, in spite on the lack of evidence of protection against cardiovascular disease (CVD) and mortality. By contrast, both high and low carbohydrate diets are associated with CVD and all-cause mortality in prospective studies, with a safe intake level at ≈50% of energy. Many popular diets with widely different macronutrient composition, including the Mediterranean diet, have been used in obesity; when energy-restricted, all result in similar modest weight loss at 6 months, but the effects are largely lost at 12 months. The Mediterranean diet is a plant-based, high-fat, high-unsaturated fat dietary pattern that has been consistently associated with lower rates on non-communicable diseases and total mortality in prospective studies and with reduced CVD in the PREDIMED trial. For this merits above other diets, this dietary pattern might also be used advantageously for weight loss. The results of the PREDIMED and PREDIMED-Plus randomized controlled trials on adiposity variables in high-risk populations are discussed.

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Abbreviations

AHA:

American Heart Association

AHEI:

American Healthy Eating Index

ASA:

American Stroke Association

ARIC study:

Atherosclerosis Risk In Communities study

BMI:

Body mass index

CVD:

Cardiovascular disease

DASH study:

Dietary Approaches to Stop Hypertension study

EVOO:

Extra-virgin olive oil

HDL:

High density lipoprotein

HPFS:

Health Professionals Follow-up Study

LDL:

Low density lipoprotein

Look AHEAD study:

Look action for health in diabetes study

MedDiet:

Mediterranean diet

MUFA:

Monounsaturated fatty acids

NHS:

Nurses’ Health Study

PREDIMED study:

“Prevención con dieta mediterránea” study

PUFA:

Polyunsaturated fatty acids

PURE study:

Prospective Urban Rural Epidemiology study

RCT:

Randomized clinical trial

SFA:

Saturated fatty acids

SSBS:

Sugar sweetened beverages

TFA:

Trans fatty acids

WHO:

World Health Organization

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Acknowledgments

CIBER OBN is an initiative of the Instituto de Salud Carlos III, Spain. Supported by grants of the official funding agency for biomedical research of the Spanish government, Instituto de Salud Carlos III (ISCIII), through grants provided to CIBER OBN and FIS grants PIE14/00045, PI044504; PI13/02184, PI16/00381 i PI19/01226; Fundació la Marató de TV3, Spain, grant PI044003; and the Sociedad Española de Medicina Interna (SEMI), Spain, grant DN40585.

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  1. Department of Internal Medicine, Hospital Clinic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Ramon Estruch & Emilio Ros

  2. Centro de Invetigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain

    Ramon Estruch

  3. Department of Endocrinology and Nutrition, Hospital Clinic, IDIBAPS, Barcelona, Spain

    Emilio Ros

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  1. Ramon Estruch
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Correspondence to Ramon Estruch.

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R. E. reports grants from Cerveza y Salud, Spain, and Fundación Dieta Mediterranea, Spain. Also, personal fees for given lectures from Brewers of Europe (Belgium), Fundación Cerveza y Salud (Spain), Pernaud-Ricard (México), Instituto Cervantes of Alburquerque (USA); Instituto Cervantes of Milan (Italy), Instituto Cervantes of Tokyo (Japan), Lilly Laboratories (Spain), and Wine and Culinary International Forum (Spain), and non-financial support to organize a National Congress on Nutrition. Also he performed feeding trials with products from Grand Fountain and Uriach Laboratories (Spain).

E.R. reports personal fees, grants, and nonfinancial support from the California Walnut Commission and Alexion; personal fees and nonfinancial support from Danone; and nonfinancial support from the International Nut Council.

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Estruch, R., Ros, E. The role of the Mediterranean diet on weight loss and obesity-related diseases. Rev Endocr Metab Disord 21, 315–327 (2020). https://doi.org/10.1007/s11154-020-09579-0

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