Adherence to the Mediterranean Diet in Relation to Obesity Indices before and after a Weight Reduction Program in OSAS Patients

Obesity is considered as the most important risk factor for obstructive sleep apnea syndrome (OSAS). It has been estimated that 60-90% of all patients with OSAS are obese (1) and that weight reduction is a very effective modality in these patients. The role of the adherence to Mediterranean diet (MD) in the primary prevention of obesity has been reported (2). The greater adherence to the MD could play a role in the prevention of OSAS via an effect on obesity indices. Considering this, the present study aimed to examine the association of MD with obesity indices before and after a weight reduction program in OSAS patients. Forty obese patients composed the sample. The sampling method, intervention procedure and measurements are fully described elsewhere (3). In brief, two groups of patients with moderate to severe OSAS were formed. In both groups, the patients received continuous positive airway pressure (CPAP) therapy and weight reduction programs (MD vs prudent diet). The two groups were combined into one in order to increase the sample size and to get a wider range of the Mediterranean Diet Score (MedDietScore) values which would make more interesting the analysis. A paired sample t-test was performed to test the changes in the above measurements. Multiple linear regressions with backward selection was performed with MedDietScore as the dependent variable and age, gender, educational level, smoking, physical activity , obesity and OSAS severity indices as the initial independent variables set at baseline and end of the intervention. A P-value less than 0.05 was considered significant. Of the initial sample, 80% remained obese and the rest overweight after 6 months (Table 1). Multiple linear regression analysis after 6 months showed that MedDietScore was independently associated with BMI (P: 0.03, 95%CI:-1.40 to-0.32, beta =-0.45), while no associations were revealed between this score and obesity indices at baseline. Potential mechanisms linking increased MD adherence to protection against obesity development may include its lower energy density and its relatively low glycemic load. These beneficial factors, along with its higher fiber and water content, lead to increased satiation and lower calorie intakes. Moreover, the MD is highly palatable, which can increase both tolerance and compliance among individuals following it (4). The absence of any significant association between the MedDietScore and obesity indices at baseline and the reveal of the aforementioned association at the end of the