A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial.
OBJECTIVE
Independently 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.


METHODS
Cross-sectional assessment of all participants in the "PREvención con DIeta MEDiterránea" (PREDIMED) trial.


METHODS
7,447 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.


RESULTS
Strong 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.


CONCLUSIONS
A 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.
Prevención con Dieta Mediterránea Network RD 06/0045, Instituto de Salud Carlos III, Spanish Government, Madrid, Spain. mamartinez@unav.es
Miguel Angel
MA
Martínez-González
Ana
A
García-Arellano
Estefanía
E
Toledo
Jordi
J
Salas-Salvadó
Pilar
P
Buil-Cosiales
Dolores
D
Corella
Maria Isabel
MI
Covas
Helmut
H
Schröder
Fernando
F
Arós
Enrique
E
Gómez-Gracia
Miquel
M
Fiol
Valentina
V
Ruiz-Gutiérrez
José
J
Lapetra
Rosa Maria
RM
Lamuela-Raventos
Lluís
L
Serra-Majem
Xavier
X
Pintó
Miguel Angel
MA
Muñoz
Julia
J
Wärnberg
Emilio
E
Ros
Ramón
R
Estruch
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D016017:Odds Ratio; D012306:Risk; D011795:Surveys and Questionnaires; D055105:Waist Circumference