Objective: To analyse the association between macronutrient intake and body mass index (BMI). Design: A series of hospital-based case-control studies. Settings: Selected teaching and general hospitals in several Italian regions. Subjects: A total of 6619 subjects from the comparison groups of the case-control studies were included in the analysis. Methods: We obtained data from a validated 78-item food-frequency questionnaire submitted between 1991 and 2002. For various macronutrients, the partial regression coefficient (variation of BMI (kg m -2 ) per 100 kcal increment of energy intake) was derived from multiple linear regression models, after allowance for age, study centre, education, smoking habits, number of eating episodes and mutual adjustment for macronutrients. Results: BMI was directly associated with protein intake among women only (β = 0.68) and with unsaturated fats in both genders (for monounsaturated fats β = 0.27 for men and 0.26 for women; for polyunsaturated fats β = 0.27 for men and 0.54 for women), and inversely related to carbohydrates (β = - 0.05 for men and - 0.21 for women) and number of eating episodes in both genders (β = - 0.42 for men and - 0.61 for women) and to saturated fats among women only (β = - 0.57). Conclusions: These results confirm and provide convincing evidence that, after allowance for selected covariates including total energy intake, a protein-rich diet is not inversely related to BMI, and a carbohydrate-rich diet is not directly related to BMI.
