In France, premature ripening (PR) is a widespread damage of a fungal disease of sunflower caused by Phoma macdonaldii. Previous results indicated that girdling canker at the stem base, caused by P. macdonaldii, was its primary cause. Previous studies have reported the influence of nitrogen and water supply on the incidence and severity of PR but an additional study was required to analyze the effect of plant density on the level of attack for a more comprehensive cultural control of PR. In a 2-year field study (2008 and 2009) in Toulouse (France), a susceptible cultivar (cv. Heliasol) artificially inoculated at star bud stage with P. macdonaldii was grown at three plant densities (4, 6.5 and 9 plants m−2) factorially combined with three N fertilization rates (0, 50/75 and 150 kg N ha−1) and two water regimes (irrigated and rainfed). P. macdonaldii symptoms were scored weekly to calculate the area under disease progress curve (AUDPC) and percentage of PR plants. Microclimatic conditions were monitored using thermo-hygrometers within the crop. The fraction of photosynthetically active radiation intercepted by the canopy (fPARi) and leaf area index (LAI) were measured at anthesis. Plant water status during the disease progression was characterized by crop simulation (SUNFLO) and N status at anthesis was assessed from shoot N content (Nm) analysis and N Nutrition Index (NNI) calculation. Increasing plant density resulted in a greater proportion of PR plants, and this proportion increased further when N was applied at 150 kg ha−1, the highest rate, and the crop was not irrigated. Despite differing canopy development, differences in microclimatic conditions between density levels were too small to explain the PR differences. However plant N concentration and diameter at stem base were closely related to PR incidence. Thin plants (grown at high density) with non-limiting N supply were the most susceptible to premature ripening. This study opens new avenues for the control of PR through crop management and emphasizes the key role of plant morphology in the development of the disease. Stem base diameter is a morphological trait that could be manipulated through crop management (plant density, N fertilization) and probably breeding in the future when developing integrated disease management systems in sunflower.