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Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study^1,2,3

¹ From the Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece (AT, AN, PO, and DT), and the Department of Epidemiology, Harvard School of Public Health, Boston, MA (DT)

Background: Adherence to a Mediterranean diet has been reported to increase longevity, but concerns have been expressed that such a diet may promote overweight and obesity.

Objective: The objective was to investigate whether adherence to the traditional Mediterranean diet, as operationalized in a Mediterranean diet score, is associated with body mass index (BMI) and waist-to-hip ratio (WHR).

Design: In a general population sample of 23 597 adult men and women participating in the Greek European Prospective Investigation into Cancer and Nutrition Study, a validated food-frequency questionnaire was interviewer-administered, and anthropometric, sociodemographic, physical activity, and other lifestyle characteristics were recorded. BMI and WHR were regressed on a score that reflects adherence to the traditional Mediterranean diet and potentially confounding variables.

Results: In models in which total energy intake was included, adherence to the Mediterranean diet was unrelated to BMI in both sexes and was weakly related to WHR only in women. When energy intake was not controlled for, a 2-point increase in the score was found to correspond to increases of 650 and 150 g in the weight of an average-height man and woman, respectively, whereas the WHR was found to increase by 0.001 units in men and 0.004 units in women.

Conclusions: Adherence to a Mediterranean diet was essentially unrelated to BMI, with small differences depending on model choice and having no practical consequences. Overweight is a genuine problem in Greece and perhaps other Mediterranean countries, but it is likely to be related to limited physical activity in conjunction with excessive positive energy balance.

Key Words: Obesity • overweight • Mediterranean diet • body mass index • waist-to-hip ratio • Greece

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