Adherence to the mediterranean dietary pattern and incidence of anorexia and bulimia nervosa in women : the SUN cohort

Objective No study has assessed the association between dietary pattern and incidence of eating disorders. This study aimed to assess the association between the adherence to the Mediterranean dietary pattern (MDP) and the incident risk of anorexia (AN) and bulimia nervosa (BN). Research Methods & Procedures We conducted a prospective cohort study on 11800 women from the SUN 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 follow-up. Nutritional status, lifestyle and behavioural variables were investigated and used as covariates. A validated 136-item food frequency questionnaire and the Trichopoulou score were used to assess adherence to MDP. Results After a median follow-up of 9.4 years, 100 new cases of AN and BN were identified. The multivariate HR (95%CI) of AN and BN for the 2 upper categories of adherence to the MDP were 0.39 (0.20-0.75) and 0.32 (0.14-0.70) (Ptrend=0.021). Inverse dose-response relationships were found for the consumption of cereals and olive oil and marginally for the polyunsaturated fatty acids intake. To address reverse causation, multivariable linear regressions were run by means of a cross-sectional approach between the adherence to the MDP and the risk of AN and BN at baseline. No difference in adherence was found between participants with and without eating disorders. Conclusion Our results suggest a potential inverse association between MDP and the risk of AN and BN. Additional longitudinal studies and trials are needed.