To our knowledge, with the exception of a Spanish study in children, no previous study in adults has assessed the association between the overall quality of a diet and WHtR. A prior meta-analysis and a study specifically examining this issue in Mediterranean subjects also supported the predictive superiority of WHtR. The use of the WHtR is supported by a systematic review which assessed WHtR, WC, and BMI as predictors of diabetes or cardiovascular disease and found mean areas under receiving operator characteristic curves of 0.704, 0.693 and 0.671 for WHtR, WC and BMI, respectively. The use of the waist-to-height ratio (WHtR) instead of WC overcomes this problem by taking height into account. It is very likely that subjects with a given WC will have more abdominal fat than taller subjects with the same WC.
However, WC does not take differences in height into account. Waist circumference (WC) has been most commonly used to assess abdominal obesity. Nevertheless, it is well known that measures of abdominal obesity outperform body weight or BMI in predicting cardiovascular risk or diabetes –. The available studies in adults assessed body weight, weight changes or changes in body mass index (BMI) as measures of adiposity. In contrast with these methods, a brief tool assessing only a small number of foods measured in servings/d or servings/wk might enable a dietitian to provide immediate feedback to participants and to establish negociated changes with them to improve their dietary quality, setting the goals in easily understandable units (food servings). Īll these studies have mainly used full-length food frequency questionnaires (FFQ) usually with >100 items, 24-hour recalls or other time-consuming methods, to evaluate the adherence to the Mediterranean dietary pattern. Some clinical trials have also added support to this association –. The inverse association between the Mediterranean diet and adiposity indexes has been also reported in most –, but not all, cross-sectional assessments. This “Mediterranean” dietary pattern is typically based on whole or minimally processed foods and incorporates most of the protective factors (fruits and vegetables, legumes, whole grains, dietary fiber, fish, vegetable protein and vegetable fat from olive oil) but few of the adverse dietary factors (fast food, sugar-sweetened beverages, refined grain products, energy density, and partially hydrogenated or trans-fat) for obesity. Most of them found that an overall food pattern in line with the traditional Mediterranean diet was inversely associated with obesity risk or weight gain, ,, –. However, only some prospective studies have investigated the association of diet quality scores with obesity risk, –. The overall quality of a dietary pattern appears to affect adiposity and the risk of obesity to a greater extent than relative macronutrient quantity –. None of the other authors declare a conflict of interest. Salas-Salvadó (International Nut Council). Ros (California Walnut Commission) and J. Salas-Salvadó (International Nut Council) Grants Received: E. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors declare the following consultancies: E. RT is supported by a Rio-Hortega post-residency fellowship of the Instituto de Salud Carlos III, Spanish Government. CIBERobn and RTIC RD 06/0045 are initiatives of ISCIII, Spain.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: The Official funding agency for Biomedical Research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), provided the grants for his study: RTIC G03/140, CIBERobn, RD 06/0045, PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407 and PI11/01647. Received: MaAccepted: JPublished: August 14, 2012Ĭopyright: © Martínez-González et al. (2012) A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial. Citation: Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, et al.
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