Original Research Communications Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study1–3

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 Mediter-ranean 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 Investiga-tion into Cancer and Nutrition Study, a validated food-frequency questionnaire was interviewer-administered, and anthropometric, sociodemographic, physical activity, and other lifestyle character-istics were recorded. BMI and WHR were regressed on a score that reflects adherence to the traditional Mediterranean diet and poten-tially confounding variables. Results: In models in which total energy intake was included, ad-herence 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. Am J Clin Nutr 2005;82