Does a healthy diet counter the ill-effects of obesity?

September 17, 2020

A healthy quality Mediterranean-like diet partially modifies the association between obesity and cardiovascular mortality, according to a new study published this week in PLOS Medicine by Karl Michaëlsson of Uppsala University, Sweden, and colleagues.

Higher body mass (BMI) accounted for 4.0 million deaths globally in 2015 and more than two-thirds of those deaths were due to cardiovascular disease (CVD). Studies have suggested that other factors, including healthy dietary patterns, might modify the higher risk of CVD associated with higher BMI. In the new study, researchers studied BMI, diet and mortality among 79,003 Swedish adults enrolled in the Swedish Mammography Cohort and Cohort of Swedish Men. Adherence to a Mediterranean-like diet (mMED) was assessed on a scale of 0 to 8, integrating information on intake of fruits and vegetables, legumes, nuts, unrefined or high-fiber grains, fish, red and processed meat, and olive oil. Information was also available on age, physical activity, smoking and socioeconomics of the cohort participants.

Over 21 years of follow-up, 30,389 (38% of participants) died. Among overweight individuals, the group with the lowest hazard ratio (HR) of all-cause mortality were those with high mMED (HR 0.94; 95% CI 0.90-0.98 compared with those with normal weight and high mMED). Obese individuals who also had high mMED did not have a significantly higher mortality compared with those with normal weight and high mMED (HR 1.03; 95%CI 0.96-1.11). Conversely, individuals with a normal BMI but low mMED had a higher mortality (HR 1.60; 95%CI 1.48-1.74) than those with normal weight and high mMED. For CVD mortality, which represented 12,064 of the deaths, the findings were broadly similar. However, while CVD morality associated with high BMI was reduced by adherence to a Mediterranean diet, it was not fully countered. Moreover, lower BMI did not counter the elevated CVD mortality associated with a low mMED.

"These results indicate that adherence to healthy diets such as a Mediterranean-like diet may be a more appropriate focus that avoidance of obesity for the prevention of overall mortality," the authors say. "Nonetheless, a healthy diet may not completely counter higher CVD mortality related with obesity."
Research Article

Peer reviewed; Observational; People

In your coverage please use this URL to provide access to the freely available paper:

Funding: The study was supported by grants from the Swedish Research Council (; grant nos. 2015-03257, 2017-00644, and 2017-06100 to KM). The national research infrastructure SIMPLER receives funding through the Swedish Research Council under the grant no. 2017-00644 (to Uppsala University and KM). The computations were performed on resources provided by the Swedish National Infrastructure for Computing's ( support for sensitive data SNIC-SENS through the Uppsala Multidisciplinary Center for Advanced Computational Science (UPPMAX) under Project SIMP2019004. SNIC is financially supported by the Swedish Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Michaëlsson K, Baron JA, Byberg L, Höijer J, Larsson SC, Svennblad B, et al. (2020) Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study. PLoS Med 17(9): e1003331.


Related Obesity Articles from Brightsurf:

11 years of data add to the evidence for using testosterone therapy to treat obesity, including as an alternative to obesity surgery
New research covering 11 years of data presented at this year's European and International Congress on Obesity (ECOICO 2020) show that, in obese men suffering from hypogonadism (low testosterone), treatment with testosterone injections lowers their weight and improves a wide range of other metabolic parameters.

Overlap between immunology of COVID-19 and obesity could explain the increased risk of death in people living with obesity, and also older patients
Data presented in a special COVID-19 session at the European and International Congress on Obesity (ECOICO 2020) suggests that there are overlaps between the immunological disturbances found in both COVID-19 disease and patients with obesity, which could explain the increased disease severity and mortality risk faced by obese patients, and also elderly patients, who are infected by the SARS-CoV-2 virus that causes COVID-19 disease.

New obesity guideline: Address root causes as foundation of obesity management
besity management should focus on outcomes that patients consider to be important, not weight loss alone, and include a holistic approach that addresses the root causes of obesity, according to a new clinical practice guideline published in CMAJ (Canadian Medical Association Journal)

Changing the debate around obesity
The UK's National Health Service (NHS) needs to do more to address the ingrained stigma and discrimination faced by people with obesity, says a leading health psychologist.

Study links longer exposure to obesity and earlier development of obesity to increased risk of type 2 diabetes
Cumulative exposure to obesity could be at least as important as actually being obese in terms of risk of developing type 2 diabetes (T2D), concludes new research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]).

How much do obesity and addictions overlap?
A large analysis of personality studies has found that people with obesity behave somewhat like people with addictions to alcohol or drugs.

Should obesity be recognized as a disease?
With obesity now affecting almost a third (29%) of the population in England, and expected to rise to 35% by 2030, should we now recognize it as a disease?

Is obesity associated with risk of pediatric MS?
A single-center study of 453 children in Germany with multiple sclerosis (MS) investigated the association of obesity with pediatric MS risk and with the response of first-line therapy in children with MS.

Women with obesity prior to conception are more likely to have children with obesity
A systematic review and meta-analysis identified significantly increased odds of child obesity when mothers have obesity before conception, according to a study published June 11, 2019 in the open-access journal PLOS Medicine by Nicola Heslehurst of Newcastle University in the UK, and colleagues.

Obesity medicine association announces major updates to its adult obesity algorithm
The Obesity Medicine Association (OMA) announced the immediate availability of the 2019 OMA Adult Obesity Algorithm, with new information for clinicians including the relationship between Obesity and Cardiovascular Disease, Diabetes Mellitus, Dyslipidemia, and Cancer; information on investigational Anti-Obesity Pharmacotherapy; treatments for Lipodystrophy; and Pharmacokinetics and Obesity.

Read More: Obesity News and Obesity Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to