Background: Given the recognized health effects of visceral fat, the understanding of how diet can modulate changes in the
phenotype ‘‘waist circumference for a given body mass index (WCBMI)’’, a proxy measure of visceral adiposity, is deemed
necessary. Hence, the objective of the present study was to assess the association between dietary factors and prospective
changes in visceral adiposity as measured by changes in the phenotype WCBMI.
Methods and Findings: We analyzed data from 48,631 men and women from 5 countries participating in the European
Prospective Investigation into Cancer and Nutrition (EPIC) study. Anthropometric measurements were obtained at baseline
and after a median follow-up time of 5.5 years. WCBMI was defined as the residuals of waist circumference regressed on
body mass index, and annual change in WCBMI (DWCBMI, cm/y) was defined as the difference between residuals at follow-up
and baseline, divided by follow-up time. The association between energy, energy density (ED), macronutrients, alcohol,
glycemic index (GI), glycemic load (GL), fibre and DWCBMI was modelled using centre-specific adjusted linear regression, and
random-effects meta-analyses to obtain pooled estimates. Men and women with higher ED and GI diets showed significant
increases in their WCBMI, compared to those with lower ED and GI [1 kcal/g greater ED predicted a DWCBMI of 0.09 cm (95%
CI 0.05 to 0.13) in men and 0.15 cm (95% CI 0.09 to 0.21) in women; 10 units greater GI predicted a DWCBMI of 0.07 cm (95%
CI 0.03 to 0.12) in men and 0.06 cm (95% CI 0.03 to 0.10) in women]. Among women, lower fibre intake, higher GL, and
higher alcohol consumption also predicted a higher DWCBMI.
Conclusions: Results of this study suggest that a diet with low GI and ED may prevent visceral adiposity, defined as the
prospective changes in WCBMI. Additional effects may be obtained among women of low alcohol, low GL, and high fibre
intake.