| Summary: | 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 ‘‘PREvencio´n con DIeta MEDiterra´nea’’ (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 20.0066 (95% confidence interval, –
0.0088 to 20.0049) 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.
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