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Introduction: Adherence to a Mediterranean-style diet pattern has been associated with altered body fat distribution among African Americans. To further evaluate these relationships, we investigated associations of adherence to the Alternative Mediterranean Diet (aMED) pattern with fat deposition in an ongoing cohort study of African-Caribbean men.Methods: Diet was assessed from 2014-2017 using a 146-item semi-quantitative food frequency questionnaire in the Tobago Health Study (N = 800, mean age=64.1, mean BMI=27.7). Adherence to the aMED pattern (score range 0-9) was calculated as the following: +1 for intake above the population median for fruits, vegetables, whole grains, nuts, legumes, fish, and monounsaturated:saturated fat ratio; +1 for intake below the population median for red and processed meats; and +1 for alcohol intake between 10-25 grams per day. Walking, TV watching, and smoking were assessed by interviewer-administered questionnaires. Abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and pericardial adipose tissue (PAT) depot volumes were measured in a subset of this cohort (N = 679) using computed tomography. Multiple linear regressions were performed across adherence groups.Results: The average age was 64.1 ± 8.8 years old. After adjusting for age, walking, TV watching, total energy intake, and BMI (for VAT and PAT models only), PAT significantly decreased across increasing aMED adherence groups (P=0.0174), with median PAT being 8% lower in the high-adherence versus low-adherence group. No other fat measure significantly differed by adherence group (Table).Conclusion: Higher adherence to the aMED pattern was significantly associated with reduced PAT, but not with measures of general or central fat, in middle-aged and older African Caribbean men. Further studies are needed on dietary patterns and ectopic fat distribution to fully describe the potential impact of race/ethnicity.