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


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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Fig. 2



American Heart Association


American Healthy Eating Index


American Stroke Association

ARIC study:

Atherosclerosis Risk In Communities study


Body mass index


Cardiovascular disease

DASH study:

Dietary Approaches to Stop Hypertension study


Extra-virgin olive oil


High density lipoprotein


Health Professionals Follow-up Study


Low density lipoprotein

Look AHEAD study:

Look action for health in diabetes study


Mediterranean diet


Monounsaturated fatty acids


Nurses’ Health Study


“Prevención con dieta mediterránea” study


Polyunsaturated fatty acids

PURE study:

Prospective Urban Rural Epidemiology study


Randomized clinical trial


Saturated fatty acids


Sugar sweetened beverages


Trans fatty acids


World Health Organization


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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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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).

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  • Obesity
  • Overweight
  • Diets for weight loss
  • Mediterranean diet
  • Carbohydrate
  • Fat