A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial

• Published in: PloS one Vol. 7; no. 8; p. e43134
• Main Authors: Martínez-González, Miguel Angel, García-Arellano, Ana, Toledo, Estefanía, Salas-Salvadó, Jordi, Buil-Cosiales, Pilar, Corella, Dolores, Covas, Maria Isabel, Schröder, Helmut, Arós, Fernando, Gómez-Gracia, Enrique, Fiol, Miquel, Ruiz-Gutiérrez, Valentina, Lapetra, José, Lamuela-Raventos, Rosa Maria, Serra-Majem, Lluís, Pintó, Xavier, Muñoz, Miguel Angel, Wärnberg, Julia, Ros, Emilio, Estruch, Ramón
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.08.2012; Public Library of Science (PLoS)
• Subjects: Adipose tissue; Adults; Aged; Aged, 80 and over; Assaigs clínics; Beverages; Body mass; Body Mass Index; Body size; Carbonated beverages; Carbonates; Carbonation; Cardiovascular diseases; Clinical trials; Confidence intervals; Cross-Sectional Studies; Cuina mediterrània; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diet; Diet, Mediterranean; Feeding Behavior; Female; Food; Food habits; Habits; Health care; Health risks; Humans; Hàbits alimentaris; Indexing; Internal medicine; Male; Medical personnel; Medicina preventiva; Medicine; Mediterranean cooking; Mediterranean diet; Mens health; Middle Aged; Nutrition research; Nuts; Obesitat; Obesity; Obesity - prevention & control; Odds Ratio; Older people; Persones grans; Preventive medicine; Primary care; Public health; Questionnaires; Risk; Risk analysis; Risk assessment; Risk factors; Studies; Surveys and Questionnaires; Type 2 diabetes; Vegetables; Waist Circumference; Weight control; United States > US; Minnesota; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0043134

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