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Adherence to a Mediterranean dietary pattern and weight gain in a follow-up study: the SUN cohort

International Journal of Obesity volume 30, pages 350–358 (2006)Cite this article

Abstract

Introduction:

The promotion of Mediterranean Diets has generated some doubts, because of the concern that its high fat content might lead to the development of obesity.

Methods:

Longitudinal analysis of 6319 participants in the SUN cohort study. We used a validated semiquantitative food frequency questionnaire (136 items). Baseline adherence to a Mediterranean dietary pattern (MDP) was assessed using a score (score_1) including vegetables, fruits, cereals, nuts, pulses, fish, olive oil and moderate consumption of red wine (positively weighted), whereas meat and dairy products were negatively weighted. We assessed the association between the overall baseline adherence to the MDP (score_1) and subsequent weight change after 28 months of follow-up. We also built another score (score_2) to assess changes in diet during follow-up and appraised the association between the joint exposure to both scores and weight change during follow-up.

Results:

Participants in the first quartile of score_1 (lowest baseline adherence to MDP) showed a higher weight gain (+0.73 kg) than those in the top quartile (+0.45 kg). The results indicated an inverse dose–response relationship (P for trend=0.016). A similar inverse association was apparent when we used change in adherence to the MDP (score_2). However, both inverse associations did not remain statistically significant after adjusting for relevant confounders. Consumption of dairy products was inversely associated with weight gain.

Conclusions:

Although participants increased their average weight during the follow-up period, weight increments were smaller among those with a higher adherence to an ‘a priori’ defined MDP. Results did not remain statistically significant after multivariate adjustment.

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References

  1. Kopelman PG . Obesity as a medical problem. Nature 2000; 404: 635–643.

    Article  CAS  Google Scholar 

  2. York DA, Rössner S, Caterson I, Chen CM, James WP, Kumanyika S et al. AHA Conference preceedings. Prevention Conference VII. Obesity, a worlwide epidemia related to heart disease and stroke. Group I: Worlwide demographics of obesity. Circulation 2004; 110: e463–e470.

    Article  Google Scholar 

  3. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.

    Article  Google Scholar 

  4. Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, Marti A, Martinez JA, Martín-Moreno JM . Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr 2002; 41: 153–160.

    Article  Google Scholar 

  5. Willett WC . Eat, Drink, and be Healthy. Simon & Schuster Source: New York, 2001.

    Google Scholar 

  6. Bosetti C, Gallus S, Trichopoulou A, Talamini R, Franceschi S, Negri E et al. Influence of the Mediterranean Diet on the risk of cancers of the upper aerodigestive tract. Cancer Epidemiol Biomarkers Prev 2003; 12: 1091–1094.

    PubMed  Google Scholar 

  7. Martínez-González MA, Sánchez-Villegas A, De Irala J, Marti A, Martínez JA . Mediterranean diet and stroke: objectives and design of the SUN project. Nutr Neurosci 2002; 5: 65–73.

    Article  Google Scholar 

  8. Martín-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernández-Rodríguez JC, Salvini S et al. Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 1993; 22: 512–519.

    Article  Google Scholar 

  9. Mataix J . Tabla de Composición de Alimentos, 4th edn. Universidad de Granada: Granada, 2003.

    Google Scholar 

  10. Moreiras O . Tablas De Composición De Alimentos, 7th edn. Madrid: Ediciones Pirámide: Madrid, 2003.

  11. Willett WC, Stampfer M . Implications of total energy intake for epidemiologic analyises. In: Willett WC (ed). Nutritional Epidemiology, 2nd edn. Oxford University Press: New York, 1998, pp 273–301.

    Chapter  Google Scholar 

  12. Lasheras C, Fernández S, Patterrson AM . Mediterranean diet and age with respect to overall survival in institutionalized, nonsmoking elderly people. Am J Clin Nutr 2000; 71: 987–992.

    Article  CAS  Google Scholar 

  13. Kouris-Blazos A, Gnardellis C, Wahlqvist ML, Trichopoulos D, Lukito W, Trichopoulou A . Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br J Nutr 1999; 82: 57–61.

    Article  CAS  Google Scholar 

  14. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E et al. Diet and overall survival in elderly people. Br Med J 1995; 311: 1457–1460.

    Article  CAS  Google Scholar 

  15. Schröder H, Marrugat J, Vila J, Covas MI, Elosua R . Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish Population. J Nutr 2004; 134: 3355–3361.

    Article  Google Scholar 

  16. Sánchez-Villegas A, Martínez JA, De Irala J, Martínez-González MA . Determinants of the adherence to an ‘a priori’ defined Mediterranean dietary pattern. Eur J Nutr 2002; 41: 249–257.

    Article  Google Scholar 

  17. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Excerc 2000; 32: S498–S504.

    Article  CAS  Google Scholar 

  18. Martínez-González MA, Lopez-Fontana C, Sánchez-Villegas A, Varo-Cenarruzabeitia JJ, Martínez JA . Validation of a Spanish Physical Questionnaire adapted from American Cohorts. Public Health Nutr (in press).

  19. McManus K, Antinoro L, Sacks F . A randomised controlled trial of a moderate-fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults. Int J Obes Relat Metab Disord 2001; 25: 1503–1511.

    Article  CAS  Google Scholar 

  20. Fernández de la Puebla RA, Fuentes F, Pérez-Martínez P, Sánchez E, Paniagua JA, López-Miranda J et al. A reduction in dietary saturated fat decreases body fat content in overweight, hypercholesterolemic males. Nutr Metab Cardiovasc Dis 2003; 13: 273–277.

    Article  Google Scholar 

  21. Flynn G, Colquhoun D . Successful long-term weight loss with a Mediterranean style diet in a primary care medical centre. Asia Pac J Clin Nutr 2004; 13: S139.

    Google Scholar 

  22. Ferro-Luzzi A, James WPT, Kafatos A . The high-fat Greek diet. A recipe for all? Eur J Clin Nutr 2002; 56: 796–809.

    Article  CAS  Google Scholar 

  23. Supreme Scientific Health Council. Dietary guidelines for adults in Greece. Arch Hellen Med 1999; 16: 516–524.

  24. Serra-Majem Ll, De la Cruz J Ngo, Ribas L, Tur JA . Olive oil and the Mediterranean diet: beyond the rhetoric. Eur J Clin Nutr 2003; 57: S2–S7.

    Article  CAS  Google Scholar 

  25. Trichopoulou A, Gnardellis C, Benetou V, Lagiou A, Bamia C, Trichopoulos D . Lipid, protein and carbohydrate intake in relation to body mass index. Eur J Clin Nutr 2003; 56: 37–43.

    Article  Google Scholar 

  26. Zemel M, Shi H, Greer B, Dirienzo D, Zemel PC . Regulation of adiposity by dietary calcium. FASEB J 2000; 14: 1132–1138.

    Article  CAS  Google Scholar 

  27. Pereira MA, Jacobs DR, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS . Dairy consumption, obesity, and the insulin resistance syndrome in young adults. JAMA 2002; 287: 2081–2089.

    Article  Google Scholar 

  28. Skinner JD, Bounds W, Carruth BR, Ziegler P . Longitudinal calcium intake is negatively related to children's body fat indexes. J Am Diet Assoc 2003; 103: 1626–1631.

    Article  Google Scholar 

  29. Li YC, Lyle RM, McCabe LD, McCabe GP, Weaver CM, Teegarden D . Dairy calcium is related to changes in body composition during a two-year exercise intervention in young women. J Am Coll Nutr 2000; 19: 754–760.

    Article  Google Scholar 

  30. Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA et al. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ 1998; 317: 1341–1345.

    Article  CAS  Google Scholar 

  31. Albert CM, Gaziano JM, Willett WC, Manson JE, Hennekens CH . Nut consumption and decreased risk of sudden cardiac death in the Physicians' Health Study. Arch Intern Med 2002; 162: 1382–1387.

    Article  Google Scholar 

  32. Kris-Etherton PM, Yu-Poth S, Sabate J, Ratcliffe HE, Zhao G, Etherton TD . Nuts and their bioactive constituents effects on serum lipids and other factors affect disease risk. Am J Clin Nutr 1999; 70: S504–S511.

    Article  Google Scholar 

  33. Sabate J . Nut consumption and body weight. Am J Clin Nutr 2003; 78: S647–S650.

    Article  Google Scholar 

  34. Tohill BC, Seymour J, Serdula M, Kettel-Khan L, Rolls BJ . What epidemiologic studies tell us about the relationship between fruit and vegetable consumption and body weight. Nutr Rev 2004; 62: 365–374.

    Article  Google Scholar 

  35. Martínez-González MA, Martínez JA, Hu FB, Gibney MJ, Kearney J . Physical inactivity, sedentary lifestyle and obesity in the European Union. Int J Obes Relat Metab Disord 1999; 23: 1192–1201.

    Article  Google Scholar 

  36. Martínez-González MA, Varo JJ, Santos JL, De Irala-Estévez J, Gibney M, Kearney J et al. Prevalence of physical activity during leisure time in the European Union. Med Sci Sports Exerc 2001; 33: 1142–1146.

    Article  Google Scholar 

  37. Varo JJ, Martínez-González MA, de Irala-Estévez J, Kearney J, Gibney MJ, Martínez JA . Distribution and determinants of sedentary lifestyles in the European Union. Int J Epidemiol 2003; 32: 138–146.

    Article  Google Scholar 

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Acknowledgements

We are indebted to the participants of the SUN Study for their continued cooperation and participation. The Department of Health of the Navarre Regional Government and Spanish Ministry of Health (Fondo de Investigaciones Sanitarias, projects 01/0619 and 04/042241 and G03/140, Red Temática de Dieta y Enfermedad Cardiovascular) are gratefully acknowledged for supporting the present study. We would like to thank other members of the SUN Study Group: M Seguí-Gómez, A Alonso, RM Pajares, JA Martinez, M Delgado-Rodríguez, M Serrano-Martínez, M Marques, A Marti, M Muñoz, F Guillén-Grima and I Aguinaga and our advisors from the Department of Nutrition of the Harvard School of Public Health: A Ascherio, W Willett and FB Hu, who helped us to design the SUN cohort study.

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Authors and Affiliations

  1. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

    A Sánchez-Villegas & L Serra-Majem

  2. Department of Preventive Medicine and Public Health, University of Navarra, Navarra, Spain

    A Sánchez-Villegas, M Bes-Rastrollo & M A Martínez-González

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  1. A Sánchez-Villegas
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Correspondence to A Sánchez-Villegas.

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Sánchez-Villegas, A., Bes-Rastrollo, M., Martínez-González, M. et al. Adherence to a Mediterranean dietary pattern and weight gain in a follow-up study: the SUN cohort. Int J Obes 30, 350–358 (2006). https://doi.org/10.1038/sj.ijo.0803118

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