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Cited by 207Nutritional Studies and DietDiet and metabolism studiesDietary Effects on Health

Mediterranean Diet and Obesity-related Disorders: What is the Evidence?

Open access
Muscogiuri, Giovanna, Verde, Ludovica, Sulu, Cem, Katsiki, Niki, Hassapidou, Maria, Frias-Toral, Evelyn, Cucalón, Gabriela, Pazderska, Agnieszka +3 more·2022·Current Obesity Reports
DOI 10.1007/s13679-022-00481-1PMC PMC9729142
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Abstract

Purpose of Review: Obesity is a chronic disease, a major public health problem due to its association with non-communicable diseases and all-cause mortality. Indeed, people with obesity are at increased risk for a variety of obesity-related disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease, and several cancers. Many popular diets with very different macronutrient composition, including the Mediterranean diet (MD), have been used, proposed, and studied for prevention and management of obesity. In particular, MD has been the subject of countless studies over the years and now boasts a large body of scientific literature. In this review, we aimed to update current knowledge by summarizing the most recent evidence on the effect of MD on obesity and obesity-related disorders. Recent Findings: The negative effects of obesity are partly reversed by substantial weight loss that can be achieved with MD, especially when low-calorie and in combination with adequate physical activity. In addition, the composition of MD has been correlated with an excellent effect on reducing dyslipidemia. It also positively modulates the gut microbiota and immune system, significantly decreasing inflammatory mediators, a common ground for many obesity-related disorders. Summary: People with obesity are at increased risk for a variety of medical disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. Therefore, there is an inevitable need for measures to manage obesity and its related disorders. At this point, MD has been proposed as a valuable nutritional intervention. It is characterized by a high consumption of vegetables, fruit, nuts, cereals, whole grains, and extra virgin olive oil, as well as a moderate consumption of fish and poultry, and a limited intake of sweets, red meat, and dairy products. MD proves to be the healthiest dietary pattern available to tackle obesity and prevent several non-communicable diseases, including cardiovascular disease and type 2 diabetes.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes evidence that the Mediterranean diet (MD) helps manage obesity and obesity-related disorders, especially when energy-restricted and combined with physical activity, and is associated with improved type 2 diabetes, dyslipidemia, cardiovascular outcomes, and some cancers. MD also favorably modulates gut microbiota and immune/inflammatory pathways, though the authors note further research is needed for several associations.

Key findings

  • MD is effective for weight loss, particularly with energy restriction and exercise: a meta-analysis of 16 RCTs (n = 3436) found greater weight loss versus control diets, with larger effects when energy restriction (mean difference −3.88 kg; 95% CI −6.54 to −1.21), increased physical activity (−4.01 kg; 95% CI −5.79 to −2.23), or follow-up >6 months (−2.69 kg; 95% CI −3.99 to −1.38) were included. In PREDIMED (n = 7447), ad libitum MD did not significantly change body weight versus low-fat diet, but MD with nuts reduced waist circumference (−0.923 cm; 95% CI −1.604 to −0.241; p = 0.008).
  • MD is associated with lower type 2 diabetes risk and improved glycemic control: prior meta-analyses reported 19–23% prevention, and in the Women’s Health Study (n = 25,317) higher MD intake was related to a 30% relative risk decrease over 20 years. In a network meta-analysis of 10 RCTs (n = 921 patients with type 2 diabetes), MD was superior to low-fat diet for HbA1c (−0.45%; 95% CI −0.55 to −0.34), fasting plasma glucose (−1.24 mmol/L; 95% CI −1.57 to −0.91), weight (−1.18 kg; 95% CI −1.99 to −0.37), waist circumference (−0.73 cm; 95% CI −1.26 to −0.19), triglycerides (−0.21 mmol/L; 95% CI −0.27 to −0.16), and HDL-C (+0.07 mmol/L; 95% CI 0.04 to 0.11).
  • MD is linked to lower cardiovascular and cancer risks: a meta-analysis of 38 cohort studies and 3 RCTs in diabetes found lower CHD (RR 0.73; 95% CI 0.62 to 0.86), MI (RR 0.73; 95% CI 0.61 to 0.88), stroke (RR 0.80; 95% CI 0.71 to 0.90), and total CVD death (RR 0.79; 95% CI 0.77 to 0.82). A cancer meta-analysis including 2,130,753 participants found lower cancer mortality (RR 0.86; 95% CI 0.81 to 0.91), colorectal cancer (RR 0.82; 95% CI 0.75 to 0.88), breast cancer (RR 0.92; 95% CI 0.87 to 0.96), gastric cancer (RR 0.72; 95% CI 0.60 to 0.86), liver cancer (RR 0.58; 95% CI 0.46 to 0.73), head and neck cancer (RR 0.49; 95% CI 0.37 to 0.66), and prostate cancer (RR 0.96; 95% CI 0.92 to 1.00).
  • MD favorably affects dyslipidemia and inflammation: the review reports that MD composition is correlated with excellent effects on reducing dyslipidemia and that it positively modulates gut microbiota and the immune system, significantly decreasing inflammatory mediators common to many obesity-related disorders.

Methods

  • Design: narrative review aimed at updating current knowledge on the effect of MD on obesity and obesity-related disorders; no systematic review protocol, search strategy, or formal quality assessment is reported in the text.
  • Data/sample: synthesizes evidence from RCTs, meta-analyses, prospective cohort studies, and cross-sectional studies, including major trials and cohorts such as PREDIMED, EPIC, the Women’s Health Study, and others; tables summarize meta-analyses of MD effects on obesity-associated disorders.
  • Analysis: narrative synthesis of reported effect estimates, confidence intervals, and mechanistic findings; no new primary data are presented.

Limitations

  • The paper states that further research is needed to establish the effects of MD on cardiovascular morbidity and mortality in patients with type 2 diabetes, to clarify the link between MD and diabetic neuropathy, and to determine which foods and nutrients are most effective for cancer outcomes; it also notes it remains unclear whether MD is more effective than other dietary interventions for reducing central adiposity.
  • Evident from the text: as a narrative review, it does not report a systematic search, inclusion criteria, or risk-of-bias assessment, so the evidence base is heterogeneous and conclusions rely on varied study designs and populations.
  • Evident from the text: some cited findings come from small or short-term studies (e.g., n = 11 crossover, n = 35 vs. n = 31 pilot), and effects may differ by Mediterranean versus non-Mediterranean populations, limiting generalizability.

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Integrity signals

Registry

Crossref · 10.1007/s13679-022-00481-1

Cites

153 of 153 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Premisecitation

    Emerging evidence suggests that the Mediterranean diet can reduce central adiposity and visceral fat.

    “Emerging evidence suggests that MD can reduce central adiposity and visceral fat, both of which have been associated with the risk of type 2 diabetes and CVD [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Prasad DS, Kabir Z, Dash AK, Das BC. Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: a clinico epidemiological evidence summary. J Cardiovasc Dis Res. 2011;2(4):199–205. source

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  • Premisecitation

    Obesity is consistently associated with increased mortality.

    “all of which render obesity to be consistently associated with increased mortality [7, 8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71–82. source

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    • cites [8] Di Angelantonio E, Bhupathiraju SN, Wormser D, Gao P, Kaptoge S, De Gonzalez AB, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776–86. source

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  • Interpretationcitation

    The beneficial effect of the Mediterranean diet on reducing central adiposity and visceral fat could be related to its high content of polyunsaturated fatty acids and monounsaturated fatty acids and low intake of saturated fatty acids.

    “The beneficial effect of MD on reducing central adiposity and visceral fat could be related to its high content of polyunsaturated fatty acids (PUFA) and MUFA and low intake of saturated fatty acids (SFA) [11].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Marventano S, Kolacz P, Castellano S, Galvano F, Buscemi S, Mistretta A, et al. A review of recent evidence in human studies of n-3 and n-6 PUFA intake on cardiovascular disease, cancer, and depressive disorders: does the ratio really matter? Int J Food Sci Nutr. 2015;66(6):611–22. source

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  • Premisecitation

    Previous meta-analyses showed that adherence to the Mediterranean diet could prevent type 2 diabetes development by 19-23%.

    “Previous meta-analyses showed that adherence to MD could prevent type 2 diabetes development by 19–23% [49, 50].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [49] Koloverou E, Esposito K, Giugliano D, Panagiotakos D. The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants. Metabolism. 2014;63(7):903–11. source

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    • cites [50] Schwingshackl L, Missbach B, Konig J, Hoffmann G. Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015;18(7):1292–9. source

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  • Study design and conductnone given

    Most studies on the Mediterranean diet and weight did not include assessments of physical activity or capture total energy intake, which could serve as significant confounders.

    “However, most of those studies did not include assessments of physical activity or capture total energy intake, which could serve as significant confounders.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 25
  • Classified as probably not a substantial claim. 4

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    Premisecitation

    A systematic analysis found that the Mediterranean diet was somewhat superior in producing weight loss compared to low-fat diets but similar to a low-carbohydrate diet and the American Diabetes Association diet.

    “MD was somewhat superior in producing weight loss compared to low-fat diets (range of mean weight loss −4.1 to −10.1 kg vs. −2.9 to −5.0 kg) but (similar to) same as low-carbohydrate diet and the American Diabetes Association (ADA) diet.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Mancini JG, Filion KB, Atallah R, Eisenberg MJ. Systematic review of the Mediterranean diet for long-term weight loss. Am J Med. 2016;129(4):407–15. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The Mediterranean diet may be more effective in Southern European populations due to better availability of specific food produce, cultural and other factors.

    “MD may be more effective in Southern European populations due to better availability of specific food produce, cultural and other factors.”
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    Premisecitation

    Adherence to the Mediterranean diet is protective against the occurrence of several diseases, in particular obesity and cardiovascular disease.

    “The adherence to MD dietary pattern has been showed to be protective against the occurrence of several diseases, in particular obesity and CVD [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96. source

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    Interpretationcitation

    The Mediterranean diet is an effective tool in reducing body weight, particularly when energy restricted and in combination with increased exercise.

    “In conclusion, MD is an effective tool in reducing body weight, particularly when energy restricted and in combination with increased exercise.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    People with obesity are at increased risk for hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease, and several cancers.

    “People with obesity are at increased risk for a variety of medical disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease (CVD), and several cancers [4–6]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of healthy lifestyle factors on life expectancies in the US population. Circulation. 2018;138(4):345–55. source

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    • cites [5] Smith AD, Crippa A, Woodcock J, Brage S. Physical activity and incident type 2 diabetes mellitus: a systematic review and dose–response meta-analysis of prospective cohort studies. Diabetologia. 2016;59(12):2527–45. source

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    • cites [6] Valencia WM, Stoutenberg M, Florez H. Weight loss and physical activity for disease prevention in obese older adults: an important role for lifestyle management. Curr Diab Rep. 2014;14(10):539. source

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    Interpretationcitation

    A high-fat, unrestricted-calorie Mediterranean diet was associated with little weight change and less central adiposity compared with a low-fat diet long term.

    “In conclusion, high fat, unrestricted calories MD was associated with little weight changes and less central adiposity compared with low-fat diet long term [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Fito M, Chiva-Blanch G, et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7(5):e6–17. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Mediterranean dietary pattern, compared to other diets, has been reported as the most effective in prevention of obesity and obesity-related diseases.

    “Mediterranean dietary pattern compared to other diets has been reported as having proved to be the most effective in prevention of obesity and obesity-related diseases [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Romaguera D, Norat T, Mouw T, May AM, Bamia C, Slimani N, et al. Adherence to the Mediterranean diet is associated with lower abdominal adiposity in European men and women. J Nutr. 2009;139(9):1728–37. source

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  • May combine two claims.

    Interpretationreasoning

    The Mediterranean diet is the healthiest dietary pattern available to prevent several non-communicable diseases, including cardiovascular disease and type 2 diabetes.

    “MD is the healthiest dietary pattern available to prevent several non-communicable diseases, including cardiovascular disease and type 2 diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The Mediterranean diet positively modulates the gut microbiota and immune system, significantly decreasing inflammation mediators, which is common ground for many obesity-related disorders.

    “Additionally, it positively modulates the gut microbiota and immune system, significantly decreasing inflammation mediators, common ground for many obesity-related disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the PREDIMED study, after a mean follow-up of 4.8 years, breast cancer rates were lower in the intervention groups with EVOO or nuts than in the control group with a low-fat diet; after multivariate adjustment, the EVOO group had a significantly lower risk of developing breast cancer, with a 28% lower risk for every 5% additional calories from EVOO.

    “Data from the PREDIMED study showed that after a mean follow-up of 4.8 years, the observed rates of breast cancer were lower in the intervention groups with EVOO or with nuts than in the control group with a low-fat diet. After multivariate adjustment, the group supplementing MD with EVOO had a significantly lower risk of developing breast cancer than the control group; for every 5% additional”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [148] Toledo E, Salas-Salvado J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, et al. Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial: a randomized clinical trial. JAMA Intern Med. 2015;175(11):1752–60. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Mediterranean diet is a dietary pattern recommended for cardiovascular prevention and has been promoted by the European Society of Cardiology/European Atherosclerosis Society 2019 guidelines for the management of dyslipidemia in addition to other lifestyle changes.

    “MD is a dietary pattern recommended for cardiovascular prevention and has been promoted by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2019 guidelines for the management of dyslipidemia in addition to other lifestyle changes (Table 1) [103].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–88. source

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  • May combine two claims.

    Premisecitation

    High adherence to the Mediterranean diet is associated with low BMI in 617 individuals, probably through antioxidant and anti-inflammatory effects synergistically exerted by high vitamin D levels or high adherence to MD on body weight.

    “Of interest, very recently in a cross-sectional, observational study, it was reported that high adherence to MD was associated with low BMI in 617 individuals, probably through the antioxidant and anti-inflammatory effects synergistically exerted by either high vitamin D levels or high adherence to MD on body weight [145••].”
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    • cites [145••]

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    Premisecitation

    Greater adherence to the Mediterranean diet is associated with a significantly lower risk of cancer mortality, colorectal cancer, breast cancer, gastric cancer, liver cancer, head and neck cancer, and prostate cancer.

    “A meta-analysis including 2,130,753 participants concluded that greater adherence to MD was associated with a significantly lower risk of cancer mortality (RR 0.86; 95% CI 0.81 to 0.91), colorectal cancer (RR 0.82; 95% CI 0.75 to 0.88), breast cancer (RR 0.92; 95% CI 0.87 to 0.96), gastric cancer (RR 0.72; 95% CI 0.60 to 0.86), liver cancer (RR 0.58; 95% CI 0.46 to 0.73), head and neck cancer (RR”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [146] Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients. 2017;9(10):1063. source

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    Premisecitation

    A recent meta-analysis found that adherence to the Mediterranean diet was associated with significantly lower incidences of coronary heart disease, myocardial infarction, stroke, and mortality from these causes.

    “A recent meta-analysis of 38 cohort studies and 3 RCTs (including patients with type 2 diabetes) found that adherence to MD was associated with significantly lower incidences of CHD (RR 0.73; 95% CI 0.62 to 0.86), MI (RR 0.73; 95% CI 0.61 to 0.88), and stroke (RR 0.80; 95% CI 0.71 to 0.90), as well as of CHD mortality (RR 0.83; 95% CI 0.75 to 0.92), stroke mortality (RR 0.87; 95% CI 0.80 to 0.96),”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] Becerra-Tomas N, Blanco Mejia S, Viguiliouk E, Khan T, Kendall CWC, Kahleova H, et al. Mediterranean diet, cardiovascular disease and mortality in diabetes: a systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit Rev Food Sci Nutr. 2020;60(7):1207–27. source

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  • May combine two claims.

    Interpretationreasoning

    Overall, adherence to the Mediterranean diet exerts several health benefits by improving cardiometabolic risk factors, including glucose and lipid metabolism, obesity indexes, and non-alcoholic fatty liver disease.

    “Overall, adherence to MD exerts several health benefits by improving cardiometabolic risk factors, including glucose and lipid metabolism, obesity indexes and NAFLD (Fig. 2).”
    Quote in the paperSubstantial claim

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    Premisecitation

    A higher intake of saturated fatty acids from meat products is related to the development of ASCVD, while a lower ASCVD risk is linked to a higher intake of saturated fatty acids from dairy sources.

    “de Oliveira et al. in the Multi-Ethnic Study of Atherosclerosis (n = 5209) reported that a higher intake of SFA from meat products is related to the development of ASCVD; on the other hand, a lower ASCVD risk has been correlated to a higher intake of SFA from dairy products [125].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [125] de Oliveira Otto MC, Mozaffarian D, Kromhout D, Bertoni AG, Sibley CT, Jacobs DR Jr, et al. Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2012;96(2):397–404. source

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    Premisecitation

    The Mediterranean diet has been negatively related to various chronic diseases, such as cardiovascular disease, cancer, obesity, type 2 diabetes, and other metabolic conditions.

    “In addition, it has been negatively related to various chronic diseases, such as CVD [106], cancer [107], obesity [108], type 2 diabetes [88], and other metabolic conditions [109].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [106] Migliaccio S, Brasacchio C, Pivari F, Salzano C, Barrea L, Muscogiuri G, et al. What is the best diet for cardiovascular wellness? A comparison of different nutritional models. Int J Obes Suppl. 2020;10(1):50–61. source

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    • cites [107] Laudisio D, Castellucci B, Barrea L, Pugliese G, Savastano S, Colao A, et al. Mediterranean diet and breast cancer risk: a narrative review. Minerva Endocrinol (Torino). 2021;46(4):441–52.

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    • cites [108] Barrea L, Pugliese G, Laudisio D, Colao A, Savastano S, Muscogiuri G. Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists. Crit Rev Food Sci Nutr. 2021;61(7):1201–11. source

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  • May combine two claims.

    Interpretationreasoning

    Adherence to the Mediterranean diet may contribute to the reduction of various cancers and overall cancer-related mortality.

    “In conclusion, all the above results suggest that adherence to MD may contribute to the reduction of various cancers and also of overall cancer-related mortality.”
    Quote in the paperSubstantial claim

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    Premisecitation

    In patients with type 2 diabetes, the Mediterranean diet can beneficially affect glycemic control and cardiovascular risk.

    “In patients with type 2 diabetes, MD can beneficially affect glycemic control and cardiovascular risk [54, 55].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [54] Martin-Pelaez S, Fito M, Castaner O. Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms. A review. Nutrients. 2020;12(8):2236. source

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    • cites [55] Pascual Fuster V, Perez Perez A, Carretero Gomez J, Caixas Pedragos A, Gomez-Huelgas R, Perez-Martinez P. Executive summary: updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. Endocrinol Diabetes Nutr (Engl Ed). 2021;68(4):277–87.

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    Premisecitation

    Adherence to the Mediterranean diet is associated with reduced risk of metabolic syndrome and improvements in its components (waist circumference, HDL-C, triglycerides, systolic and diastolic blood pressure, and glucose).

    “Adherence to MD was associated with reduced risk of metabolic syndrome (log HR −0.69; 95% CI −1.24 to −1.16). Results from clinical studies revealed the protective role of MD on components of metabolic syndrome, like WC (mean difference −0.42 cm; 95% CI −0.82 to −0.02), HDL-C (mean difference 1.17 mg/dl; 95% CI 0.38 to 1.96), TG (mean difference −6.14 mg/dl; 95% CI −10.35 to −1.93), systolic (mean”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299–313. source

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    Premisecitation

    The Mediterranean diet has been proposed as an effective nutrition therapy for patients with type 2 diabetes and/or non-alcoholic fatty liver disease, representing the first-line treatment for these metabolic diseases.

    “MD has been proposed as an effective nutrition therapy for patients with type 2 diabetes and/or NAFLD, representing the first-line treatment for these metabolic diseases [93, 95•, 96].”
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    • cites [93, 95•, 96]

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    Premisecitation

    In the Italian EPIC study, increased adherence to the Mediterranean diet was associated with an 8-11% lower risk of colorectal cancer in men and women, with the protective effect mainly for distal colon and rectal cancer and lower for proximal colon cancer.

    “Data from the Italian EPIC study involving 42,275 participants aged 25–70 years who did not have cancer at baseline found that increased adherence to MD was associated with an 8–11% lower risk of colorectal cancer in men and women [154]. The protective effect was observed mainly for distal colon and rectal cancer, whereas it was lower for proximal colon cancer [154].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [154] Bamia C, Lagiou P, Buckland G, Grioni S, Agnoli C, Taylor AJ, et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. Eur J Epidemiol. 2013;28(4):317–28. source

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    Premisecitation

    A previous umbrella review of meta-analyses found that high adherence to the Mediterranean diet was associated with a reduced risk of overall mortality, cardiovascular disease, coronary heart disease, myocardial infarction, overall cancer incidence, type 2 diabetes, and neurodegenerative diseases.

    “A previous umbrella review of meta-analyses found that high adherence to MD was associated with a reduced risk of overall mortality, CVD, coronary heart disease (CHD), myocardial infarction (MI), overall cancer incidence, type 2 diabetes, and neurodegenerative diseases [77].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72(1):30–43. source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Formisano et al. (2021) concluded that a high intake of dairy products was associated with hyperlipidemia (higher total cholesterol and HDL-C), while a diet with excessive meat products caused dyslipidemia (higher total cholesterol and TG levels and lower HDL-C levels).

    “They concluded that a high intake of dairy products was associated with hyperlipidemia (higher levels of total cholesterol and HDL-C), while a diet with an excessive amount of meat products caused a form of dyslipidemia (higher total cholesterol and TG levels and lower HDL-C levels) [126].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [126] Formisano E, Pasta A, Cremonini AL, Di Lorenzo I, Sukkar SG, Pisciotta L. Effects of a Mediterranean diet, dairy, and meat products on different phenotypes of dyslipidemia: a preliminary retrospective analysis. Nutrients. 2021;13(4):1161. source

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    Premisecitation

    Low vitamin D status is associated with increased blood pressure, dyslipidemia, impaired insulin metabolism, sleep disturbances, thus increasing the risk of cardiovascular atherosclerosis.

    “Therefore, low vitamin D status has been associated with increased BP [139, 140], dyslipidemia [139, 140], impaired insulin metabolism [138], sleep disturbances [141, 142], thus increasing the risk of cardiovascular atherosclerosis [139, 140].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [139] Muscogiuri G, Barrea L, Altieri B, Di Somma C, Bhattoa HP, Laudisio D, et al. Calcium and vitamin D supplementation. Myths and realities with regard to cardiovascular risk. Curr Vasc Pharmacol. 2019;17(6):610–7. source

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    • cites [140] Savanelli MC, Scarano E, Muscogiuri G, Barrea L, Vuolo L, Rubino M, et al. Cardiovascular risk in adult hypopituitaric patients with growth hormone deficiency: is there a role for vitamin D? Endocrine. 2016;52(1):111–9. source

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    • cites [138] Altieri B, Grant WB, Della Casa S, Orio F, Pontecorvi A, Colao A, et al. Vitamin D and pancreas: the role of sunshine vitamin in the pathogenesis of diabetes mellitus and pancreatic cancer. Crit Rev Food Sci Nutr. 2017;57(16):3472–88. source

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    • cites [141] Muscogiuri G, Barrea L, Annunziata G, Di Somma C, Laudisio D, Colao A, et al. Obesity and sleep disturbance: the chicken or the egg? Crit Rev Food Sci Nutr. 2019;59(13):2158–65. source

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    • cites [142] Muscogiuri G, Barrea L, Scannapieco M, Di Somma C, Scacchi M, Aimaretti G, et al. The lullaby of the sun: the role of vitamin D in sleep disturbance. Sleep Med. 2019;54:262–5. source

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  • May combine two claims.

    Interpretationcitation

    Overall, the Mediterranean diet has been shown to prevent chronic kidney disease, as well as decrease renal function decline and improve survival in patients with chronic kidney disease.

    “Overall, MD has been shown to prevent CKD, as well as decrease renal function decline and improve survival in patients with CKD [69].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] Chauveau P, Aparicio M, Bellizzi V, Campbell K, Hong X, Johansson L, et al. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol Dial Transplant. 2018;33(5):725–35. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In an intervention study on a population with high risk of ASCVD (n=49), subjects who followed the Mediterranean diet with virgin olive oil or nuts showed a reduction in interleukin-6 and soluble intercellular adhesion molecule-1, and a reduction in activation of biomarkers related to the atherosclerotic process.

    “In an intervention study conducted by Llorente-Cortés et al. in 2010 on a population with a high risk of ASCVD (n = 49), it was found that after 3 months, subjects who followed MD integrated with virgin olive oil or nuts showed not only a reduction in interleukin-6 and soluble intercellular adhesion molecule-1, significant inflammation mediators in the adhesion of leukocytes to the endothelial”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [120] Llorente-Cortes V, Estruch R, Mena MP, Ros E, Gonzalez MA, Fito M, et al. Effect of Mediterranean diet on the expression of pro-atherogenic genes in a population at high cardiovascular risk. Atherosclerosis. 2010;208(2):442–50. source

      Not checked in the free run.

27 of 27

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CKD meta-analysis has conflicting study and participant counts

    Minor

    The text attributes 13 studies and 27,618 individuals to reference [67], while Table 2 attributes four studies and 8,467 subjects to the same meta-analysis.

  • Diabetes-prevention study breakdown exceeds stated total

    Minor

    The listed categories contain 17 studies in total, rather than the stated 10.

    Reported 10 · recomputed 17

  • Table labels non-randomized studies as RCTs

    Minor

    The Table 2 entry calls all 50 studies RCTs but breaks them down into 35 clinical trials, two prospective studies, and 13 cross-sectional studies.

  • Alcohol guidance conflicts with inclusion of red wine

    Minor

    The same discussion says the Mediterranean diet recommends eliminating alcohol and describes red wine as one of its prominent food groups.

  • Metabolic-syndrome estimate falls outside its confidence interval

    Minor

    The reported log hazard ratio of −0.69 is outside its stated 95% confidence interval of −1.24 to −1.16.

5 of 5

Cites

3 retracted

Flagged first, then by citations

Research works printed but not linked: 2

  1. Network GBoDC. Global Burden of Disease Study 2015 (GBD 2015) Obesity and Overweight Prevalence 1980–2015. IHME Seattle; 2017.
  2. Federation ID. IDF diabetes atlas. 1st ed. Brussels, Belgium: International Diabetes Federation; 2019.

Cited by

Sorted by citations

Related

Authors
Muscogiuri, G., Verde, L., Sulu, C., Katsiki, N., Hassapidou, M., Frias-Toral, E., Cucalón, G., Pazderska, A., Yumuk, V. D., Colao, A., & Barrea, L.
Affiliations
  • Federico II University Hospital (IT)
  • University of Naples Federico II (IT)
  • Istanbul University-Cerrahpaşa (TR)
  • International Hellenic University (GR)
  • Escuela Superior Politecnica del Litoral (EC)
  • Pegaso University (IT)
Corresponding author
  • Muscogiuri, Giovanna
  • Barrea, Luigi
ORCID
Venue
Current Obesity Reports
Publisher
Springer Science and Business Media LLC
Published
2022-09-30
Volume
11
Issue
4
Pages
287-304
ISSN
2162-4968 (ISSN-L)
DOI
10.1007/s13679-022-00481-1
PMC
PMC9729142
OpenAlex
W4298087838
Semantic Scholar
d1b33c7fd6f0066a8680aafc8ebffbf5e9e2f76d
Cited by
207
References
153
Citations by year
2026: 36 · 2025: 62 · 2024: 67 · 2023: 40 · 2022: 2
FWCI
8.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Obesity Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Greater South Information System
Funders
Università degli Studi di Napoli Federico II
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
Keywords
Mediterranean diet, obesity, obesity-related disorders, weight loss, dyslipidemia, hypertension, type 2 diabetes, cardiovascular disease, gut microbiota, inflammation, extra virgin olive oil, non-communicable diseases, dietary intervention
MeSH terms
Noncommunicable Diseases, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Hypertension, Obesity, Diet, Mediterranean

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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