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Nutritional Epidemiology

Adherence to the Mediterranean Diet Is Associated with Lower Abdominal Adiposity in European Men and Women^1,2,3

⁴ Department of Epidemiology and Public Health, Imperial College London, London W2 1PG, UK ⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508, The Netherlands ⁶ National Institute for Public Health and the Environment (RIVM), Bilthoven 3720, The Netherlands ⁷ Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Athens 11527, Greece ⁸ International Agency for Research on Cancer (IARC-WHO), Lyon 69372, France ⁹ Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, IDIBELL, Barcelona 08907, Spain ¹⁰ Medical Research Council, Epidemiology Unit, Institute of Metabolic Science, Cambridge CB1 8RN, UK ¹¹ Institut National de la Santé et de la Recherche Médicale, ERI 20, Villejuif EA 4045, France ¹² Institut Gustave Roussy, Villejuif F-94805, France ¹³ Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence 50139, Italy ¹⁴ Nutritional Epidemiology Unit, IRCCS Foundation, National Cancer Institute, Milan 20133, Italy ¹⁵ Dipartimento di Medicina Clinica e Sperimentale, Università di Napoli, Naples I-80131, Italy ¹⁶ Cancer Registry, Azienda Ospedaliera "Civile M.P.Arezzo", Ragusa 97100, Italy ¹⁷ University of Torino, Torino 10133, Italy ¹⁸ Health Information Unit, Public Health Directorate, Health and Health Care Services, Asturias 33001, Spain ¹⁹ Andalusian School of Public Health, Granada, and CIBER Epidemiology and Public Health CIBERESP Granada 18080, Spain ²⁰ Public Health Department of Gipuzkoa, Basque Government; CIBER Epidemiology and Public Health CIBERESP, San Sebastian, 20013, Spain ²¹ Public Health Institute of Navarra, and CIBER Epidemiología y Salud Pública, Pamplona 31003, Spain ²² Epidemiology Department, Murcia Health Council and CIBER Epidemiología y Salud Pública, Murcia 3008, Spain ²³ Cancer Research UK Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK ²⁴ Hellenic Health Foundation, Athens, 11527, Greece ²⁵ Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, 69120, Germany ²⁶ Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke 14558, Germany ²⁷ Department of Odontology, Cariology, Umeå University, Umeå, 90187, Sweden ²⁸ Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, 90187, Sweden ²⁹ Department of Surgery, Malmö University Hospital, Malmö, 20502, Sweden ³⁰ Department of Clinical Sciences in Malmö/Nutrition Epidemiology, Lund University, Malmö, 20502, Sweden ³¹ Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg 9100, Denmark ³² Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg 9100, Denmark ³³ Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen 2100, Denmark ³⁴ Institute of Community Medicine, University of Tromsø, Tromsø 9037, Norway ³⁵ EPOS-Iasis, Nicosia 2028, Cyprus

Given the lack of consistent evidence of the relationship between Mediterranean dietary patterns and body fat, we assessed the cross-sectional association between adherence to a modified Mediterranean diet, BMI, and waist circumference (WC). A total of 497,308 individuals (70.7% women) aged 25–70 y from 10 European countries participated in this study. Diet was assessed at baseline using detailed validated country-specific questionnaires, and anthropometrical measurements were collected using standardized procedures. The association between the degree of adherence to the modified-Mediterranean Diet Score (mMDS) (including high consumption of vegetables, legumes, fruits and nuts, cereals, fish and seafood, and unsaturated:saturated fatty acids ratio; moderate alcohol intake; and low consumption of meat and meat products and dairy products) and BMI (kg•m^–2) or WC (cm) was modeled through mixed-effects linear regression, controlling for potential confounders. Overall, the mMDS was not significantly associated with BMI. Higher adherence to the Mediterranean diet was significantly associated with lower WC, for a given BMI, in both men (–0.09; 95% CI –0.14 to –0.04) and women (–0.06; 95% CI –0.10 to –0.01). The association was stronger in men (–0.20; 95% CI –0.23 to –0.17) and women (–0.17; 95% CI –0.21 to –0.13) from Northern European countries. Despite the observed heterogeneity among regions, results of this study suggest that adherence to a modified Mediterranean diet, high in foods of vegetable origin and unsaturated fatty acids, is associated with lower abdominal adiposity measured by WC in European men and women.

^* To whom correspondence should be addressed. E-mail:d.romaguera-bosch{at}imperial.ac.uk.

Manuscript received 15 April 2009. Initial review completed 7 May 2009. Revision accepted 4 June 2009.

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