Adherence to the Mediterranean diet and cardiometabolic risk factors in morbid obese patients candidate for bariatric surgery

Abstract Morbid obesity significantly increases the risk of cardiometabolic disorders, complicating bariatric surgery outcomes. This study assessed the association between adherence to the Mediterranean diet (MD) and cardiometabolic risk factors among morbidly obese individuals undergoing bariatric surgery evaluation. A cross-sectional study was conducted with 369 morbidly obese patients (BMI ≥ 40 kg/m² or BMI ≥ 35 kg/m² with comorbidities) referred to Hazrat-Rasul-Akram Hospital obesity clinic between September 2023 and September 2024. Dietary adherence was evaluated using the Mediterranean Diet Score (MDS). Cardiometabolic risk factors were assessed according to ATP III criteria, including blood pressure, fasting blood sugar (FBS), triglycerides (TG), HDL cholesterol, and anthropometric measurements. Participants were categorized into quartiles based on MDS adherence.Participants in the highest quartile of MDS adherence exhibited significantly lower odds of elevated blood pressure (OR = 0.34, 95% CI: 0.16–0.70,p-trend = 0.01), low HDL cholesterol levels (OR = 0.34, 95% CI: 0.16–0.70,p-trend = 0.03), and elevated fasting blood sugar (OR = 0.42, 95% CI: 0.20–0.87,p-trend = 0.03). No significant associations were found for triglyceride levels.Higher adherence to the Mediterranean diet is inversely associated with key cardiometabolic risk factors among morbidly obese patients preparing for bariatric surgery. These results support integrating MD-based dietary interventions into preoperative nutritional counselling to improve cardiometabolic outcomes and surgical success.