Martínez-González, M.A., A. García-Arellano, E. Toledo, J. Salas-Salvado´, P. Buil-Cosiales, D. Corella, M.I. Covas, H. Schrőder, F. Arós, E. Gómez-Gracia, M. Fiol, V. Ruiz-Gutiérrez, J. Lapetra, R.M. Lamuela-Raventos, L. Serra-Majem, X. Pintó, M.A. Muñoz, J. Wärnberg, E. Ros, R. Estruch, for the PREDIMED Study Investigators, 2012. A 14-Item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED Trial. PLoS ONE 7(8): e43134. doi:10.1371/journal.pone.0043134
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. Design: Cross-sectional assessment of all participants in the ‘‘PREvención con DIeta MEDiterránea’’ (PREDIMED) trial. Subjects: 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 -.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.