Mediterranean diet and mortality risk in metabolically healthy obese and metabolically unhealthy obese phenotypes

Park, Young Jun; Se, Steck; Tt, Fung; Zhang, J; Lj, Hazlett; Han, Kihye; Merchant, AT

doi:10.1038/ijo.2016.114

Cited by 36 publications

(43 citation statements)

References 55 publications

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“…[17][18][19] Studies have also looked into the association between mortality risk and adherence to diets, such as DASH, Healthy Eating Index (HEI) and Mediterranean diet in patients with and without unfavorable metabolic dysfunctions. 20,21 These studies support the idea that healthy dietary patterns can be helpful for patients with metabolic risk factors. Recently published data have identified sex-based influence on NAFLD and therefore, NAFLD is a sexually dimorphic disease.…”

Section: Introductionsupporting

confidence: 55%

“…This is reflected in part by the development of various diet‐related scores, such as the Dietary Approaches to Stop Hypertension (DASH), which is associated with reduced risk of cardiovascular disease and diabetes mellitus, and studies evaluating associations between healthy dietary patterns and risk of chronic diseases . Studies have also looked into the association between mortality risk and adherence to diets, such as DASH, Healthy Eating Index (HEI) and Mediterranean diet in patients with and without unfavorable metabolic dysfunctions . These studies support the idea that healthy dietary patterns can be helpful for patients with metabolic risk factors.…”

Section: Introductionmentioning

confidence: 79%

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Diet quality and its association with nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality

Yoo

Kim

Vazquez‐Montesino

et al. 2020

Liver International

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Background & Aims Healthy diet has been recommended for nonalcoholic fatty liver disease (NAFLD), although it is not clear whether improving diet quality can prevent mortality. We aim to assess the impact of quality of diet on NAFLD and mortality in subjects with and without NAFLD. Methods We performed cohort study using the Third National Health and Nutrition Examination Survey from 1988 to 1994 and linked mortality data through 2015. We used the Healthy Eating Index (HEI) scores to define diet quality, with higher HEI scores (Q4) indicating better adherence to dietary recommendations. NAFLD was defined as ultrasonographic hepatic steatosis. Results Multivariate analysis showed that subjects with higher diet quality were inversely associated with NAFLD in a dose‐dependent manner. During the median follow‐up of 23 years, having a higher diet quality was associated with reduction in risk of all‐cause mortality in the age, sex, Race/ethnicity‐adjusted hazard ratio (HR) (Q4, HR: 0.60, 95% CI: 0.52‐0.68) and the multivariate model (Q4, HR: 0.81, 95% CI: 0.71‐0.92). Higher diet quality was associated with a lower risk for all‐cause mortality in subjects without NAFLD; however, this protective association with diet quality was not noted in those with NAFLD. Furthermore, a high diet quality was associated with a lower risk for cancer‐related mortality in the total population and among those without NAFLD. This association was not noted in those with NAFLD. Conclusions High diet quality was inversely associated with NAFLD and was positively associated with a lower risk for cancer‐related and all‐cause mortality in those without NAFLD.

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Section: Introductionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 79%

Diet quality and its association with nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality

Yoo

Kim

Vazquez‐Montesino

et al. 2020

Liver International

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show abstract

“…Underlying mechanisms for these associations could include impaired insulin sensitivity, proinflammatory markers, and oxidative stress . In contrast, obese individuals who are within normal limits for metabolic characteristics (“metabolically healthy”) are at lower risk for cardiovascular morbidity and mortality compared with metabolically unhealthy obese individuals . This may be because metabolically healthy obese individuals have less visceral fat mass, lower ectopic fat deposition, and more favorable inflammatory and hormonal profiles than their metabolically unhealthy counterparts .…”

mentioning

confidence: 99%

The association between metabolic health, obesity phenotype and the risk of breast cancer

Park

White

Nichols

et al. 2017

Intl Journal of Cancer

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Beyond the current emphasis on body mass index (BMI), it is unknown whether breast cancer risk differs between metabolically healthy and unhealthy normal weight or overweight/obese women. The Sister Study is a nationwide prospective cohort study. Data came from 50,884 cohort participants aged 35 to 74 years enrolled from 2003 through 2009. Cox proportional hazards models were used to estimate multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for breast cancer risk. Metabolic abnormalities considered included: high waist circumference (≥88 cm); elevated blood pressure (≥130/85 mm Hg or antihypertensive medication); previously diagnosed diabetes or antidiabetic drug treatment; and cholesterol-lowering medication use. During follow-up (mean, 6.4 years), 1,388 invasive breast cancers were diagnosed at least 1 year after enrollment. Compared to women with BMI <25 kg/m2 with no metabolic abnormalities (metabolically healthy normal weight phenotype), women with a BMI <25 kg/m2 and ≥1 metabolic abnormality (metabolically unhealthy, normal weight phenotype) had increased risk of postmenopausal breast cancer (HR=1.26, 95% CI:1.01–1.56), as did women with a BMI ≥25 kg/m2 and no metabolic abnormalities (metabolically healthy overweight/obese phenotype) (HR=1.24, 95% CI:0.99–1.55). Furthermore, risk of postmenopausal breast cancer was consistently elevated in women with normal BMI and central obesity (normal weight central obesity phenotype) regardless of the criterion used to define central obesity, with HR for waist circumference ≥88 cm, waist circumference ≥80 cm, and waist-hip ratio ≥0.85 of 1.58, 95% CI:1.02–2.46; 1.38, 95% CI:1.09–1.75; and 1.38, 95% CI:1.02–1.85, respectively. There was an inverse association between premenopausal breast cancer and metabolically healthy overweight/obese phenotype (HR=0.71, 95% CI:0.52–0.97). Our findings suggest that postmenopausal women who are metabolically unhealthy or have central adiposity may be at increased risk for breast cancer despite normal BMI.

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“…; Appleby & Key ; Park et al . ), with findings from RCTs indicating that better blood glucose management, lower HbA1c levels and improvements in inflammatory and endothelial markers may contribute to these effects (Yokoyama et al . ).…”

Section: Discussionmentioning

confidence: 98%

“…Epidemiological data point to an association between the long-term adoption of plant-based dietary regimes and lower levels of obesity, lower BMI and WC (Roswall et al 2014;Appleby & Key 2015;Park et al 2016), with findings from RCTs indicating that better blood glucose management, lower HbA1c levels and improvements in inflammatory and endothelial markers may contribute to these effects (Yokoyama et al 2014).…”

Section: Discussionmentioning

confidence: 99%

An update of the evidence relating to plant‐based diets and cardiovascular disease, type 2 diabetes and overweight

Harland¹,

Garton

2016

Nutrition Bulletin

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Recent findings from meta-analyses, European cohorts and randomised controlled trials (RCTs) evaluating the relationship between plant-based dietary regimes (i.e. those with an emphasis on plant foods, such as vegetarian, vegan, Mediterranean or combination diets), and the incidence of, or risk factors for, cardiovascular disease (CVD), type 2 diabetes (T2D) and obesity are considered in this review. Evidence from meta-analyses of epidemiological studies indicates that those following plant-based dietary regimes have around 20-25% lower risk of developing CVD and a similar reduced risk of developing T2D. Evidence from RCTs indicates that those following plant-based dietary regimes have lower total cholesterol, low-density lipoprotein-cholesterol and blood pressure, and modest reductions in inflammatory and endothelial markers. Higher intake of plant foods has been associated with lower incidence of obesity, lower BMI and smaller waist circumference. For weight loss, it seems that following a plantbased dietary regime results in weight loss comparable to that achieved on conventional reduced calorie diets, but with better overall weight management. The totality of evidence indicates there are benefits for cardiovascular health, risk of developing T2D and weight management from following a plant-based dietary regime. From a nutritional perspective, plant-based diets tend to be lower in saturated fatty acids, higher in unsaturated fatty acids and fibre, and lower in energy density than typical 'Western' diets. These qualities may be at the core of the health benefits reported and/or it may be simply a greater proportion of plant foods in the diet that is beneficial in its own right.

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Mediterranean diet and mortality risk in metabolically healthy obese and metabolically unhealthy obese phenotypes

Abstract: Adherence to a Mediterranean dietary pattern appears to reduce mortality in the MHO phenotype, but not among the MUO phenotype in an obese population.

Cited by 36 publications

References 55 publications

Diet quality and its association with nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality

Diet quality and its association with nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality

The association between metabolic health, obesity phenotype and the risk of breast cancer

An update of the evidence relating to plant‐based diets and cardiovascular disease, type 2 diabetes and overweight

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