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Costs of Mediterranean and western dietary patterns in a Spanish cohort and their relationship with prospective weight change
  1. C N Lopez1,2,
  2. M A Martinez-Gonzalez1,
  3. A Sanchez-Villegas1,3,
  4. A Alonso1,4,
  5. A M Pimenta1,5,
  6. M Bes-Rastrollo1
  1. 1
    Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
  2. 2
    Harvard Medical School, Boston, MA, USA
  3. 3
    Department of Clinical Sciences, Universidad de Las Palmas de Gran Canaria, Gran Canaria, Spain
  4. 4
    Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
  5. 5
    Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
  1. Correspondence to Dr M Bes-Rastrollo, Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain; mbes{at}


Background: There is a scarcity of studies evaluating the relationship between food costs and adherence to different food patterns and obesity.

Methods: This was a dynamic cohort of Spanish university graduates (n = 17 197 for the cross-sectional baseline assessment and n = 11 195 for the prospective follow-up analyses). Mean age was 38.6 (SD 12.2) years, and 60% of participants were women. A 136-item food frequency questionnaire previously validated in Spain was used. Principal component analysis (PCA) was used to derive dietary patterns. Average cost of food was calculated from official Spanish government data. Self-reported weight was previously validated in the cohort. Body weight was assessed both at baseline and during follow-up.

Results: PCA identified two dietary patterns, designated as western and Mediterranean. Participants with the highest scores on the western dietary pattern (fifth quintile vs first quintile) spent less money (–€0.64 (−$0.80) per 1000 kcal (95% CI −€0.68 to −€0.61, p for trend <0.001)) on their daily food costs, whereas the opposite was true for the Mediterranean dietary pattern (+€0.71 (+$0.90) (95% CI +€0.67 to +€0.74, p for trend <0.001). After adjusting for dietary pattern scores and other potential confounders, higher daily food costs were significantly associated with greater weight gain.

Conclusions: These data suggest that a Mediterranean dietary pattern is more expensive to follow than a western dietary pattern. This economic barrier should be considered when counselling patients about following a healthy diet because cost may be a prohibitive factor.

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  • Funding The SUN Study has received funding from the Spanish Ministry of Health (grants PI070240, PI081943 and RD 06/0045), the Navarra Regional Government (projects 41/2005 and 36/2008) and the University of Navarra. CNL has been supported by the Paul Dudley White Traveling Fellowship, Harvard Medical School.

  • Competing interests None declared.

  • Ethics approval This study was approved by the institutional review boards of the University of Navarra. Informed consent was implied by the voluntary completion of the baseline questionnaire.

  • Provenance and peer review Not commissioned; externally peer reviewed.