Adherence to the Mediterranean diet in metabolically health and unhealthy obese women

Obesity is generally associated with many metabolic abnormalities. However, some people with obesity do not develop any metabolic dysfunction and are considered ‘‘metabolically healthy’’. Adherence to high-quality dietary patterns could be crucial in reducing obesity related morbidity. Therefore, we aimed to assess the adherence to the Mediterranean diet (MD) in metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) women. We performed a cross-sectional study on 2593 obese women (age 18–87) recruited at the International Center for the Assessment of Nutritional Status (ICANS), University of Milan. Anthropometric measurements were taken and BMI and A Body Shape Index (ABSI) were calculated. Blood parameters and systolic and diastolic blood pressure were measured. Medical history and treatments were investigated. MHO and MUO phenotypes were categorized following the harmonized criteria proposed by Lavie et al. Eating behavior was assessed using the Binge Eating Scale. Finally, the 14-item FFQ used in the PREDIMED study was used to assess the adherence to the MD (score >=9 points). A total of 538 (20.8%) women were categorized as MHO. Overall, the multivariate logistic regression model, adjusted for age, BMI, ABSI, marital status, education, physical activity, smoking, family history for diabetes and cardiovascular disease, and eating behavior, did not show any association between the adherence to the MD and the risk of having MUO phenotype (OR = 0.95; CI 95% 0.67–1.36, p = 0.801). However, when we stratified the analysis for age, we observed that women aged C 50 years (n = 1092) with a higher adherence to the MD had a lower likelihood of having MUO phenotype (multivariate OR = 0.57; CI 95% 0.34–0.97, p = 0.037) than women with a lower adherence. No association was found in younger women. In conclusion, the adherence to the Mediterranean diet might be beneficial for obese women aged >= 50 years to reduce the risk of obesity-related metabolic dysfunctions.