Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Interventions and public health nutrition

Weight loss with a modified Mediterranean-type diet using fat modification: a randomized controlled trial

Abstract

Background/Objectives:

There is evidence that Mediterranean diets with a high proportion of olive oil and nuts can be effective for weight management and prevention of cardiovascular disease. It might be difficult for populations with other eating habits to follow such diets. Therefore, a modified Mediterranean-type diet using fat modification through neutral and butter-flavored canola oil, walnuts and walnut oil with two portion-controlled sweet daily snacks was tested in Germany.

Subjects/Methods:

Randomized waiting-list control study with overweight/grade 1 obese subjects: 12-week self-help modified Mediterranean-type diet, 6 weeks of diet plans and 6 weeks of weight loss maintenance training. Trial duration was 12 months. Intervention group (IG) included 100 participants (average age of 52.4 years, weight 85.1 kg and body mass index (BMI) 30.1 kg/m2), waiting-list control group (CG) included 112 participants (52.6 years, 84.1 kg and 30.1 kg/m2).

Results:

Per-protocol weight loss after 12 weeks was 5.2 kg in IG vs 0.4 kg in CG (P0.0001), BMI −1.8 vs −0.1 kg/m2 (P0.0001), waist circumference −4.7 vs −0.9 cm (P0.0001). Triglycerides, total cholesterol and LDL cholesterol improved significantly in IG but not in CG. One-year dropouts: 44% in IG and 53% in CG. Weight loss after 12 months: 4.2 kg (pooled data).

Conclusion:

A five-meal modified Mediterranean-type diet with two daily portion-controlled sweet snacks was effective for weight management in a self-help setting for overweight and grade 1 obese subjects. Fat modification through canola oil, walnuts and walnut oil improved blood lipids even at 12 months.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2
Figure 3

References

  1. Max-Rubner-Institut, Editor. Nationale Verzehrsstudie II Ergebnisbericht, Teil 1. 2008. Available at http://www.mri.bund.de/fileadmin/Institute/EV/NVS_II_Abschlussbericht_Teil_1_mit_Ergaenzungsbericht.pdf.

  2. Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C . Übergewicht und Adipositas in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 2013; 56: 786–794.

    CAS  Article  Google Scholar 

  3. Ellrott T . Übergewicht und Adipositas. Psychiatr Psychother Up2date 2008; 2: 405–420.

    Article  Google Scholar 

  4. Deutsche Adipositas-Gesellschaft. Evidenzbasierte Leitlinie – Prävention und Therapie der Adipositas – Version 2014. Available at http://www.awmf.org/leitlinien/detail/ll/050-001.html.

  5. Australian Government – National Health and Medical research Council – Department of Health and Ageing. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents, and children in Australia. 2013. Available at http://www.nhmrc.gov.au/guidelines/publications/n57.

  6. Lau DCW, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E et al. Canadian clinical practice guidelines on the management and prevention of obesity in adults and children (summary). CMAJ 2007; 176 (Suppl 8), S1–S13.

    Article  Google Scholar 

  7. Scottish Intercollegiate Guidelines Network (Editor). Management of obesity: a national clinical guideline. 2010.

  8. Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D . Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord 2011; 9: 1–12.

    Article  Google Scholar 

  9. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359: 229–241.

    CAS  Article  Google Scholar 

  10. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.

    CAS  Article  Google Scholar 

  11. Anderson JW, Konz EC, Frederich RC, Wood CL . Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001; 74: 579–584.

    CAS  Article  Google Scholar 

  12. Wing RR, Phelan S . Long-term weight loss maintenance. Am J Clin Nutr 2005; 82: 222 S–225 S.

    Article  Google Scholar 

  13. Max-Rubner-Institut, Editor. Nationale Verzehrsstudie II Ergebnisbericht, Teil 2. 2008. Available at http://www.mri.bund.de/fileadmin/Institute/EV/NVSII_Abschlussbericht_Teil_2.pdf.

  14. Mithril C, Dragstedt LO, Meyer C, Blauert E, Holt MC, Astrup A . Guidelines for the New Nordic Diet. Public Helath Nutr 2012; 15: 1941–1947.

    Article  Google Scholar 

  15. Mithril C, Dragstedt LO, Meyer C, Tetens I, Biltoft-Jensen A, Astrup A . Dietary composition and nutrient content of the New Nordic Diet. Public Health Nutr 2013; 16: 775–785.

    Article  Google Scholar 

  16. Fletcher BC, Pine KJ, Woodbridge Z, Nash A . How visual images of chocolate affect the craving and guilt of female dieters. Appetite 2007; 48: 211–217.

    Article  Google Scholar 

  17. Massey A, Hill AJ . Dieting and food craving. A descriptive, quasi-prospective study. Appetite 2012; 58: 781–785.

    Article  Google Scholar 

  18. Stunkard AJ, Messick S . The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 1985; 29: 71–83.

    CAS  Article  Google Scholar 

  19. Westenhöfer J, Stunkard A, Pudel V . Validation of the flexible and rigid control dimensions of dietary restraint. Int J Eat Disord 1999; 26: 53–64.

    Article  Google Scholar 

  20. Askari G, Yazdekhasti N, Mohammadifard N, Sarrafzadegan N, Bahonar A, Badiei M et al. The relationship between nut consumption and lipid profile among the Iranian adult population; Isfahan Healthy Heart Program. Eur J Clin Nutr 2013; 67: 385–389.

    CAS  Article  Google Scholar 

  21. Banel DK, Hu FB . Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr 2009; 90: 56–63.

    CAS  Article  Google Scholar 

  22. Lin L, Allemekinders H, Dansby A, Campbell L, Durance-Tod S, Berger A et al. Evidence of health benefits of canola oil. Nutr Rev 2013; 71: 370–385.

    Article  Google Scholar 

  23. Saris WH, Astrup A, Prentice AM, Zunft HJ, Formiguera X, Verboeket-van de Venne WP et al. The carbohydrate ratio management in European National diets. Int J Obes Relat Metab Disord 2000; 24: 1310–1318.

    CAS  Article  Google Scholar 

  24. Drewnowski A, Bellisle F . Liquid calories, sugar, and body weight. Am J Clin Nutr 2007; 85: 651–661.

    CAS  Article  Google Scholar 

  25. Heymsfield SB1, van Mierlo CA, van der Knaap HC, Heo M, Frier HI . Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord 2003; 27: 537–549.

    CAS  Article  Google Scholar 

  26. Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J et al. The Look AHEAD Study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006; 14: 737–752.

    Article  Google Scholar 

  27. Bischoff SC, Damms-Machado A, Betz C, Herpertz S, Legenbauer T, Löw T et al. Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life - a prospective study. Int J Obes (Lond) 2012; 36: 614–624.

    CAS  Article  Google Scholar 

  28. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B, Dansinger ML et al. Ultra-processed products are becoming dominant in the global food system. Obes Rev 2013; 14: 21–28.

    Article  Google Scholar 

  29. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ . Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005; 293: 43–53.

    CAS  Article  Google Scholar 

  30. Goodpaster BH, Delany JP, Otto AD, Kuller L, Vockley J, South-Paul JE et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 2010; 304: 1795–1802.

    CAS  Article  Google Scholar 

  31. Claessens M, van Baak MA, Monsheimer S, Saris WH . The effect of a low-fat, high-protein or high-carbohydrate ad libitum diet on weight loss maintenance and metabolic risk factors. Int J Obes (Lond) 2009; 33: 296–304.

    CAS  Article  Google Scholar 

  32. Hönemann I, Ranke C, Austel A, Jarzemski S, Deeken I, Pleyer I et al. Changes of cardiovascular risk factors while following one of three currently discussed dietetic weight-reducing strategies. Aktuel Ernahrungsmed 2010; 35: 227–235.

    Article  Google Scholar 

  33. Rajaram S, Haddad EH, Mejia A, Sabaté J . Walnuts and fatty fish influence different serum lipid fractions in normal to mildly hyperlipidemic individuals: a randomized controlled study. Am J Clin Nutr 2009; 89: 1657–1663.

    Article  Google Scholar 

  34. Zambón D, Sabaté J, Muñoz S, Campero B, Casals E, Merlos M et al. Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. Ann Intern Med 2000; 132: 538–546.

    Article  Google Scholar 

  35. Iwamoto M, Imaizumi K, Sato M, Hirooka Y, Sakai K, Takeshita A et al. Serum lipid profiles in Japanese women and men during consumption of walnuts. Eur J Clin Nutr 2002; 56: 629–637.

    CAS  Article  Google Scholar 

  36. Byrne S, Cooper Z, Fairburn C . Weight maintenance and relapse in obesity: a qualitative study. Int J Obes Relat Metab Disord 2003; 27: 955–962.

    CAS  Article  Google Scholar 

  37. Westenhöfer J, Engel D, Holst C, Lorenz J, Peacock M, Stubbs J et al. Cognitive and weight-related correlates of flexible and rigid restrained eating behavior. Eat Behav 2013; 14: 69–72.

    Article  Google Scholar 

  38. Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN et al. Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity (Silver Spring) 2010; 18: 725–735.

    Article  Google Scholar 

  39. Blomquist KK, Grilo KM . Predictive significance of changes in dietary restraint in obese patients with binge eating disorder during treatment. Int J Eat Disord 2011; 44: 515–523.

    Article  Google Scholar 

Download references

Acknowledgements

This research was funded by Taste of Sweden Deutschland (Oerlinghausen, Germany), a manufacturer of flavored canola oil, and by the California walnut commission (Folsom, California, USA). Alba oil (flavored canola oil) was donated by Taste of Sweden, walnuts and walnut oil were donated by the California Walnut Commission.

Disclaimer

None of the sponsors had any role in the trial design, data analysis or reporting of the results.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A Austel.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Austel, A., Ranke, C., Wagner, N. et al. Weight loss with a modified Mediterranean-type diet using fat modification: a randomized controlled trial. Eur J Clin Nutr 69, 878–884 (2015). https://doi.org/10.1038/ejcn.2015.11

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.11

Further reading

Search

Quick links