Abstract
ObjectiveIndependently of total caloric intake, a better quality of the diet (for example, conformity to the Mediterranean diet) is associated with lower obesity risk. It is unclear whether a brief dietary assessment tool, instead of full-length comprehensive methods, can also capture this association. In addition to reduced costs, a brief tool has the interesting advantage of allowing immediate feedback to participants in interventional studies. Another relevant question is which individual items of such a brief tool are responsible for this association. We examined these associations using a 14-item tool of adherence to the Mediterranean diet as exposure and body mass index, waist circumference and waist-to-height ratio (WHtR) as outcomes.DesignCross-sectional assessment of all participants in the “PREvención con DIeta MEDiterránea” (PREDIMED) trial.Subjects7,447 participants (55–80 years, 57% women) free of cardiovascular disease, but with either type 2 diabetes or ≥3 cardiovascular risk factors. Trained dietitians used both a validated 14-item questionnaire and a full-length validated 137-item food frequency questionnaire to assess dietary habits. Trained nurses measured weight, height and waist circumference.ResultsStrong inverse linear associations between the 14-item tool and all adiposity indexes were found. For a two-point increment in the 14-item score, the multivariable-adjusted differences in WHtR were −0.0066 (95% confidence interval, –0.0088 to −0.0049) for women and –0.0059 (–0.0079 to –0.0038) for men. The multivariable-adjusted odds ratio for a WHtR>0.6 in participants scoring ≥10 points versus ≤7 points was 0.68 (0.57 to 0.80) for women and 0.66 (0.54 to 0.80) for men. High consumption of nuts and low consumption of sweetened/carbonated beverages presented the strongest inverse associations with abdominal obesity.ConclusionsA brief 14-item tool was able to capture a strong monotonic inverse association between adherence to a good quality dietary pattern (Mediterranean diet) and obesity indexes in a population of adults at high cardiovascular risk.
Highlights
The overall quality of a dietary pattern appears to affect adiposity and the risk of obesity to a greater extent than relative macronutrient quantity [1,2,3]
Most of them found that an overall food pattern in line with the traditional Mediterranean diet was inversely associated with obesity risk or weight gain [1,4,6,10,11]
The PREDIMED trial has included 7,447 participants who were randomly allocated to one of three arms: 1) a traditional Mediterranean diet supplemented with extra virgin olive oil; 2) a traditional Mediterranean diet supplemented with tree nuts; or 3) a control diet
Summary
The overall quality of a dietary pattern appears to affect adiposity and the risk of obesity to a greater extent than relative macronutrient quantity [1,2,3]. Most of them found that an overall food pattern in line with the traditional Mediterranean diet was inversely associated with obesity risk or weight gain [1,4,6,10,11]. This ‘‘Mediterranean’’ dietary pattern is typically based on whole or minimally processed foods and incorporates most of the protective factors (fruits and vegetables, legumes, whole grains, dietary fiber, fish, vegetable protein and vegetable fat from olive oil) but few of the adverse dietary factors (fast food, sugarsweetened beverages, refined grain products, energy density, and partially hydrogenated or trans-fat) for obesity [2]. Some clinical trials have added support to this association [18,19,20]
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