Original Research The Association between Adherence to the Mediterranean Diet and Fasting Indices of Glucose Homoeostasis: The ATTICA Study Demosthenes B. Panagiotakos, PhD, Natalia Tzima, MD, Christos Pitsavos, MD, PhD, Christina Chrysohoou, MD, PhD, Antonis Zampelas, PhD, Dimitris Toussoulis, MD, PhD, Christodoulos Stefanadis, MD, PhD Department of Nutrition and Dietetics, Harokopio University (D.B.P., N.T., A.Z.), First Cardiology Clinic, School of Medicine, University of Athens (C.P., C.C., D.T., C.S.), Athens, GREECE Key words: Mediterranean diet, type 2 diabetes, IFG, insulin resistance, glycemic profile Objective: We investigated the association between adherence to Mediterranean diet and fasting indices of glucose homoeostasis, in a Greek adult population. Methods: During 2001–2002 we randomly enrolled 1514 men and 1528 women (18 – 89 years old) without history of CVD, from the Attica area. Diabetes mellitus (type 2) and impaired fasting glucose (IFG) were defined according to the established ADA criteria. Insulin resistance was evaluated by HOMA-IR. Dietary habits were assessed through a validated food frequency questionnaire and a diet score (range 0 –55) was developed (higher values means greater adherence to the Mediterranean diet). Results: The overall prevalence of diabetes type 2 was 7.9% in men and 6.0% in women (P = 0.05). Mean diet score was 26.3  6.8 in normoglycemic, 25.7  6.4 in IFG and 22.2  5.8 in diabetic subjects (p  0.001). In normoglycemic subjects who were in the upper tertile of the diet score we observed 7% lower glucose (p  0.05), 5% lower insulin (p  0.05) and 15% lower HOMA-IR (p  0.01) levels compared to subjects in the lower tertile of the diet score. Additionally, in diabetic/IFG participants who where in the upper tertile of the diet score we observed 15% lower glucose (p  0.05), 15% lower insulin (p  0.05) and 27% lower HOMA-IR (p  0.01) levels compared to those in the lower tertile. However, multiple regression analysis, adjusted for age, sex, BMI, waist-to-hip ratio, physical activity, smoking status, and presence of hypertension and hypercholesterol- emia, confirmed the previous associations in normoglycemic, but not in diabetic/IFG people. Conclusion: An inverse association was observed between adherence to Mediterranean diet and indices of glucose homeostasis, only in normoglycemic people. INTRODUCTION The prevalence of type 2 diabetes mellitus has increased rapidly the last decades and this phenomenon is related to a rise in the prevalence of excess weight and obesity, sedentary lifestyle, unhealthy dietary habits, growth of population and ageing [1–3]. Moreover, the number of people with a diagnosis of impaired fasting glucose (IFG), which is included in the term prediabetes, is expected to rise also [4]. All abovementioned people carry a series of risk factors for cardiovascular disease, including hyperglycaemia, dyslipidemia, and alteration in in- flammatory mediators and coagulation parameters [5,6]. The American Diabetic Association recommends attainment and maintenance of an optimum body mass index and a diet ac- cording to Diabetes Food Pyramid for prediabetic and diabetic people, but an enormous interest exists also regarding the ideal diet for the general population in order to prevent diabetes and enhance insulin sensitivity [7–9]. Even though there are reports for the advantageous effect of some isolated foods or food groups like fruits, vegetables, fiber Address reprint requests to: Demosthenes B. Panagiotakos, PhD, 46 Paleon Polemiston St., 166 74, Attica, GREECE. E-mail: d.b.panagiotakos@usa.net Abbreviations: IFG = impaired fasting glucose, HOMA-IR = homeostasis model assessment (IR = insulin resistance), LDL = low-density lipoprotein, HDL = high-density lipoprotein, SFA = saturated fatty acids, MUFA = monounsaturated fatty acids Journal of the American College of Nutrition, Vol. 26, No. 1, 32–38 (2007) Published by the American College of Nutrition 32