Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study.

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 Mediterranean 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 Investigation into Cancer and Nutrition Study, a validated food-frequency questionnaire was interviewer-administered, and anthropometric, sociodemographic, physical activity, and other lifestyle characteristics were recorded. BMI and WHR were regressed on a score that reflects adherence to the traditional Mediterranean diet and potentially confounding variables. RESULTS In models in which total energy intake was included, adherence 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 approximately 650 and 150 g in the weight of an average-height man and woman, respectively, whereas the WHR was found to increase by approximately 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.