Adherence to the Mediterranean dietary pattern and incidence of anorexia and bulimia nervosa in women: The SUN cohort
Objective: To our knowledge, no study has yet assessed the association between dietary patterns and incidence of eating disorders. This study aimed to assess the association between adherence to the Mediterranean dietary pattern (MDP) and incident risk of anorexia (AN) and bulimia nervosa (BN). Methods: We conducted a prospective cohort study of 11 800 women from the Seguimiento Universidad de Navarra follow-up project. Participants were classified as having incident AN or BN if they were free of AN or BN at baseline and reported a physician-made diagnosis of AN or BN during the follow-up period. Nutritional status, lifestyle, and behavioral variables were investigated and used as covariates. A validated 136-item food frequency questionnaire and the Trichopoulou score were used to assess adherence to the MDP. Results: After a median follow-up time of 9.4 y, 100 new cases of AN and BN were identified. The multivariate hazard ratio of AN and BN for the two upper categories of adherence to the MDP were 0.39 (95% Cl: 0.20-0.75) and 0.32 (95% Cl: 0.14-0.70; P-trend = 0.021). Inverse dose-response relationships were found for the consumption of cereals and olive oil and marginally for polyunsaturated fatty acid intake. To address reverse causation, multivariable linear regressions were run using a cross-sectional approach between adherence to the MDP and risk of AN and BN at baseline. No difference in adherence was found between participants with and without eating disorders. Conclusions: Our results suggest a potential inverse association between the MDP and the risk of AN and BN. Additional longitudinal studies and trials are needed. (C) 2018 Elsevier Inc. All rights reserved.