Agreement among Mediterranean Diet Pattern Adherence Indexes: MCC-Spain Study

There are many different methods used to measure the degree of adherence to a Mediterranean diet (MD), limiting comparison and interpretation of their results. The concordance between different methodologies has been questioned and their evaluation recommended. The aim of this study was to evaluate the agreement among five indexes that measure adherence to a Mediterranean dietary pattern. The study population included healthy adults selected in the Multi-Case Control Spain (MCC-Spain) study recruited in 12 provinces. A total of 3640 controls were matched to cases by age and sex. To reach the aim, the following scores of adherence to a Mediterranean dietary pattern were calculated: Mediterranean diet score (MDS), alternative Mediterranean diet (aMED), relative Mediterranean diet (rMED), dietary score (DS) and literature-based adherence score (LBAS). The relative frequency of subjects with a high level of adherence to a MD varied from 22% (aMED index) to 37.2% (DS index). Similarly, a high variability was observed for the prevalence of a low level of MD: from 24% (rMED) to 38.4% (aMED). The correlation among MDS, aMED and rMED indexes was moderate, except for MDS and aMED with a high coefficient of correlation 0.75 (95% CI 0.74–0.77). The Cohen’s Kappa coefficient among indexes showed a moderate–fair concordance, except for MDS and aMED with a 0.56 (95% CI 0.55–0.59) and 0.67 (95% CI 0.66–0.68) using linear and quadratic weighting, respectively. The existing MD adherence indexes measured the same, although they were based on different constructing algorithms and varied in the food groups included, leading to a different classification of subjects. Therefore, concordance between these indexes was moderate or low.

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The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review

Public Health Nutrition ◽

10.1079/phn2005936 ◽

2006 ◽

Vol 9 (1a) ◽

pp. 132-146 ◽

Cited By ~ 221

Author(s):

Anna Bach ◽

Lluís Serra-Majem ◽

Josep L Carrasco ◽

Blanca Roman ◽

Joy Ngo ◽

...

Keyword(s):

Mediterranean Diet ◽

Dietary Pattern ◽

A Priori ◽

Epidemiological Studies ◽

Global Evaluation ◽

Food Groups ◽

Reference Pattern ◽

Diet Pattern ◽

The Mediterranean ◽

Quantitative Definition

AbstractThe purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components.Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations.A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

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Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood

Thorax ◽

10.1136/thx.2007.081745 ◽

2008 ◽

Vol 63 (6) ◽

pp. 507-513 ◽

Cited By ~ 152

Author(s):

L Chatzi ◽

M Torrent ◽

I Romieu ◽

R Garcia-Esteban ◽

C Ferrer ◽

...

Keyword(s):

Dietary Intake ◽

Mediterranean Diet ◽

Statistical Significance ◽

A Priori ◽

Food Groups ◽

Mediterranean Diet Score ◽

High Level ◽

The Impact ◽

Diet Score

Introduction:Dietary intake of specific nutrients or food groups during pregnancy could play a role in the risk of asthma and atopy in offspring, but specific dietary patterns have not been implicated. The authors evaluated the impact of maternal (during pregnancy) and child adherence to a Mediterranean diet on asthma and atopy in childhood.Methods:Women presenting for antenatal care at all general practices in Menorca, a Mediterranean island in Spain, over a 12 month period starting in mid-1997 were recruited. 460 children were included in the analysis after 6.5 years of follow-up. Maternal dietary intake during pregnancy and children’s dietary intake at age 6.5 years were assessed by food frequency questionnaires, and adherence to a Mediterranean diet was evaluated by a priori defined scores. During follow-up, parents completed questionnaires on the child’s respiratory and allergic symptoms. Children underwent skin prick tests with six common aeroallergens.Results:The prevalence rates of persistent wheeze, atopic wheeze and atopy at age 6.5 years were 13.2%, 5.8% and 17.0%, respectively. One-third (36.1%) of mothers had a low quality Mediterranean diet during pregnancy according to the Mediterranean Diet Score, while the rest had a high score. A high Mediterranean Diet Score during pregnancy (at two levels, using “low” score as the reference) was found to be protective for persistent wheeze (OR 0.22; 95% CI 0.08 to 0.58), atopic wheeze (OR 0.30; 95% CI 0.10 to 0.90) and atopy (OR 0.55; 95% CI 0.31 to 0.97) at age 6.5 years after adjusting for potential confounders. Childhood adherence to a Mediterranean diet was negatively associated with persistent wheeze and atopy although the associations did not reach statistical significance.Conclusion:These results support a protective effect of a high level of adherence to a Mediterranean diet during pregnancy against asthma-like symptoms and atopy in childhood.

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Adherence to a Mediterranean Dietary Pattern Is Associated with Higher Quality of Life in a Cohort of Italian Adults

Nutrients ◽

10.3390/nu11050981 ◽

2019 ◽

Vol 11 (5) ◽

pp. 981 ◽

Cited By ~ 13

Author(s):

Justyna Godos ◽

Sabrina Castellano ◽

Marina Marranzano

Keyword(s):

Quality Of Life ◽

Mediterranean Diet ◽

Dietary Pattern ◽

Linear Trend ◽

Significant Linear Trend ◽

Mediterranean Dietary Pattern ◽

Adherence Score ◽

Perceived Quality Of Life ◽

Health Related

Background: The observed rise in non-communicable diseases may be attributed to the ongoing changes of urban environment and society, as well as greater awareness of health-related issues and subsequent higher rates of diagnosis, which all contribute to the overall quality of life. The aim of the study was to test the association between adherence to the Mediterranean dietary pattern and self-reported quality of life in a cohort of Italian adults. Methods: The demographic and dietary characteristics of 2044 adults living in southern Italy were analyzed. Food frequency questionnaires (FFQs) and a Mediterranean diet adherence score were used to assess dietary intake. The Manchester Short Appraisal (MANSA) was used to assess self-rated quality of life. Multivariate logistic regression analyses were used to test the associations. Results: A significant linear trend of association was found for the overall quality of life and adherence to Mediterranean diet score. All of the components of the MANSA, with the exception of self-rated mental health, were individually associated with higher adherence to this dietary pattern. Conclusions: Adherence to a healthy dietary pattern is associated with the measures of better overall perceived quality of life.

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Adherence to the Mediterranean diet pattern, cognitive status and depressive symptoms in an elderly non-institutionalized population

Nutrición Hospitalaria ◽

10.20960/nh.360 ◽

2017 ◽

Vol 34 (2) ◽

pp. 338 ◽

Cited By ~ 14

Author(s):

Ana Hernández-Galiot ◽

Isabel Goñi

Keyword(s):

Depressive Symptoms ◽

Cognitive Function ◽

Mediterranean Diet ◽

Dietary Pattern ◽

Depression Scale ◽

Cognitive Status ◽

Cross Sectional ◽

Mediterranean Dietary Pattern ◽

Diet Pattern ◽

The Mediterranean

Abstract: Introduction: Scientific evidence indicates that adherence to the Mediterranean diet protects against the deterioration of cognitive status and depressive symptoms during aging. However, few studies have been conducted in elderly non-institutionalized subjects. Objetive: This study evaluated the relation between the adherence to the Mediterranean dietary pattern and cognitive status and depressive symptoms in an elderly population over 75 years. Methods: A cross-sectional study was conducted in a Mediterranean city (Garrucha, Spain) in 79 elderly people over 75 (36 men and 41 women). Adherence to the Mediterranean dietary pattern was determined using the Mediterranean Diet Adherence Screener (MEDAS). Cognitive function was determined by the Mini Mental State Examination (MMSE), and depressive symptoms were assessed by the Geriatric Depression Scale (GDS). Results: Most of population showed a very high adherence to the Mediterranean diet pattern and optimal cognitive and affective status. They consumed olive oil as their main source of fat, high levels of fish and fruit, low levels of foods with added sugars, and a low consumption of red meat. A significant inverse relation between the MEDAS and MMSE scores was found. However, no relationship was observed between the MEDAS and GDS.Conclusions: The Mediterranean diet pattern was positively related with the cognitive function, although the influence of a healthy dietary pattern on the symptomatology of depression was unclear. However, an effective strategy against cognitive function and depression would be to improve physical activity rates, establish lifelong healthy eating habits, and consume a nutritionally-rich diet in order to enhance quality of life of the elderly.

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Nutrition beyond the first 1000 days: diet quality and 7-year change in BMI and overweight in 3-year old children from the Dutch GECKO Drenthe birth cohort

Journal of Developmental Origins of Health and Disease ◽

10.1017/s204017442000118x ◽

2020 ◽

pp. 1-7

Author(s):

Petra C. Vinke ◽

Milou H. H. S. Luitjens ◽

Karlien A. Blijleven ◽

Gerjan Navis ◽

Daan Kromhout ◽

...

Keyword(s):

Birth Cohort ◽

Diet Quality ◽

Early Life ◽

Food Groups ◽

Early Prevention ◽

Total Study Population ◽

Healthy Development ◽

Study Population ◽

Diet Score ◽

Overweight Prevalence

Abstract The identification of early-life determinants of overweight is crucial to start early prevention. As weight gain accelerates between 2 and 6 years, we studied the association between diet quality in children aged 3 years and the change in BMI and overweight incidence in the following 7 years. From the Dutch GECKO Drenthe birth cohort, 1001 children born in 2006 or 2007 with complete data on diet (food frequency questionnaire at the age of 3 years) and growth at the age of 3 and 10 years were included. Diet quality was estimated with the evidence-based Lifelines Diet Score (LLDS). Measured height and weight at the age of 3 and 10 years were used to calculate BMI z-scores standardized for age and sex. The associations of the LLDS (in quintiles) with BMI-z change and overweight incidence were studied with linear and logistic regression analyses. Overweight prevalence in the total study population increased from 8.3% at the age of 3 years to 16.7% at the age of 10 years. The increase in overweight prevalence ranged from 14.7% in Q1 to 3.5% in Q5. Children with a better diet quality (higher quintiles of LLDS) increased significantly less in BMI-z (confounder adjusted βLLDS = −0.064 (−0.101; −0.026)). Children with a poor diet quality at the age of 3 years had a considerably higher risk for overweight at the age of 10 years (confounder adjusted OR for Q1 vs. Q5 was 2.86 (95% CI 1.34–6.13). These results show the importance of diet in healthy development in the early life following the first 1000 days when new habits for a mature diet composed of food groups with lifelong importance are developed, providing a relevant window for overweight prevention early in life.

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Abstract MP091: Healthy Eating Index and Food Based a Priori Diet Pattern Score and Mortality in Postmenopausal Women: The Iowa Women’s Health Study

Circulation ◽

10.1161/circ.125.suppl_10.amp091 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Jaakko Mursu ◽

Katie A Meyer ◽

Kim Robien ◽

Lisa Harnack ◽

David R Jacobs

Keyword(s):

Fatty Acids ◽

A Priori ◽

Total Mortality ◽

Healthy Eating Index ◽

Health Study ◽

Food Groups ◽

Diet Pattern ◽

Disease Specific Mortality ◽

Iowa Women's Health Study ◽

Diet Score

Introduction Summary measures of food quality such as the Alternative Healthy Eating Index (AHEI) predict the risk of total mortality and cardiovascular disease (CVD). Most of the scores are impractical for public use in that they are based on selected nutrients rather than foods. We have created an a priori diet pattern score which is exhaustive and food based. Hypothesis We assessed the hypothesis that food quality scores (both AHEI and a priori diet score) are associated with a reduced risk of total and disease specific mortality. Methods We analyzed data from 24,859 postmenopausal women free at baseline in 1986 of diabetes, CVD and cancer and mean age 61.4 years in the Iowa Women’s Health Study. Food intake was assessed at baseline using a validated 127-food-item Harvard food frequency questionnaire. The AHEI score was calculated based on the values of 9 components; vegetables, fruits, nuts and soy, the ratio of white (seafood and poultry) to red meat, cereal fiber, trans fatty acids, the ratio of polyunsaturated fatty acids to saturated fatty acids, the use of multivitamins, and alcohol intake. Each component could contribute 0-10 points to the total AHEI score, except multivitamin use (2.5 points for non-users or 7.5 points for users). The a priori food score was based on intake categories for 34 food groups rated by expert judgment as positive (n=17), neutral (n=7) or negative (n=10); these judgments resulted in a plant-centered diet. The total score was the sum of the category scores (0-3) for positively rated food groups plus reverse scores (3-0) for negatively rated food groups. Through December 31, 2008, 8528 total, 2982 CVD, and 2675 cancer deaths were identified through the State Health Registry of Iowa and the National Death Index. Results Mean ± SD AHEI was 35.8 ± 9.5 and a priori diet score 38.5 ± 8.2; correlation between scores was 0.6. In proportional hazard regression models adjusted for age, energy intake, marital status, education, place of residence, high blood pressure, body mass index, waist-hip-ratio, hormone replacement therapy, physical activity and smoking, relative risk (RR) was computed for highest vs. lowest quartile of the diet score. For AHEI, the multivariable adjusted RR was 0.82 (95% CI: 0.77-0.88) for total mortality. For CVD and cancer mortality the multivariable adjusted RRs for AHEI were 0.73 (95% CI: 0.65-0.82) and 0.86 (95% CI: 0.76-0.97), respectively. The a priori diet score had a multivariable adjusted RR for total mortality of 0.76 (95% CI: 0.71-0.81). For CVD and cancer mortality, the multivariable adjusted RRs for a priori diet score were 0.77 (95% CI: 0.69-0.87) and 0.83 (95% CI: 0.73-0.92), respectively. Conclusions In conclusion, both the food-based a priori diet score and the food- and nutrient-based AHEI were associated with a reduced risk of total and disease specific mortality in older women. A food-based score may be more practical for public health policy.

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Abstract 13: Adherence to Various Dietary Patterns and Risk of Recurrent Coronary Heart Disease and Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.135.suppl_1.13 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

James M Shikany ◽

Monika M Safford ◽

Joanna Bryan ◽

PK Newby ◽

Joshua S Richman ◽

...

Keyword(s):

Racial Differences ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Mediterranean Diet Score ◽

The Mediterranean ◽

Diet Score

Background: We have shown that the Southern dietary pattern, characterized by added fats, fried foods, organ and processed meats, and sugar-sweetened beverages, is associated with a greater risk of incident CHD in REGARDS, a national, population-based, longitudinal cohort. We sought to determine if the Southern pattern, other dietary patterns, and the Mediterranean diet score were associated with CHD events and mortality in REGARDS participants who previously reported CHD. Methods: REGARDS enrolled white and black adults aged ≥45 years between 2003-2007. Data were analyzed from 3,562 participants with CHD at baseline. Participants completed an FFQ at baseline, from which 5 dietary patterns were derived through factor analysis (Table). The Mediterranean diet score was calculated for each participant. Expert-adjudicated CHD events included myocardial infarction and CHD death. Cox proportional hazards regression was used to model the association of the dietary patterns and score with CHD events and death, adjusting for sociodemographics, lifestyle factors, energy intake, anthropometrics, and medical conditions. Results: Over 7 years of follow-up, there were 581 recurrent CHD events and 1,098 deaths. In fully-adjusted analyses, the highest quartile of adherence to the alcohol/salads pattern and highest group of the Mediterranean diet score were associated with lower risk of recurrent CHD compared to the lowest quartile/group (HR: 0.76; 95% CI: 0.59 – 0.98, HR: 0.78; 95% CI: 0.62 – 0.98, respectively). The highest quartile of adherence to the Southern pattern was associated with higher mortality (HR: 1.57; 95% CI: 1.28 – 1.91), while the highest group of the Mediterranean diet score was associated with lower mortality (HR: 0.80; 95% CI: 0.68 – 0.95). Conclusions: While the Southern dietary pattern was not related to risk of recurrent CHD, it was associated with higher mortality in REGARDS participants with existing CHD. Greater adherence to a Mediterranean diet was associated with lower risk of recurrent CHD and mortality.

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Abstract P515: Comparison of Dietary Measures Association With Incident Type 2 Diabetes: The Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽

10.1161/circ.141.suppl_1.p515 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Stephanie Tison ◽

April P Carson ◽

James M Shikany ◽

Keith Pearson ◽

George Howard ◽

...

Keyword(s):

Racial Differences ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

A Priori ◽

Incident Diabetes ◽

A Posteriori ◽

Regards Study ◽

Diet Score

Background: Previous studies have investigated the association of dietary patterns with risk of diabetes, but have not compared a priori and a posteriori dietary scores in the same diverse population. The objective of this study was to evaluate a priori and a posteriori dietary patterns associations with incident diabetes in the REGARDS study. Methods: This study included 8,875 Black and White adults with available dietary data, without diabetes (defined as fasting glucose>=126 mg/dL, random glucose>=200 mg/dL, or use of diabetes medications) at baseline (2003-2007), and with follow-up (2013-2016) status of diabetes. Dietary patterns were examined by quintile and included a posteriori Plant-based and Southern, as well as a priori scores of Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) Diet Score, Dietary Inflammatory Index (DII) and Dietary Inflammation Score (DIS). Modified Poisson regression was used to obtain risk ratios for incident diabetes with models adjusted for total energy intake, demographics, and lifestyle factors. Results: The mean (SD) age at baseline was 63.2 (8.5) years, 27.1% were Black, 56.2% were female, and 11.7% had incident diabetes at follow-up. Adherence to the Southern dietary pattern was positively associated with incident diabetes for all models (figure). After adjustment for demographic factors, the highest quintiles of DII and DIS were associated with incident diabetes and the highest quintiles of DASH scores were protective of development of incident diabetes. Conclusion: The Southern dietary pattern derived in REGARDS showed the strongest association with incident diabetes of all the dietary scores and of the a priori scores the DIS showed the strongest association with incident diabetes. The lack of association in adjusted models with the Mediterranean Diet and Plant-based pattern show these scores to be less pertinent. The DIS demonstrates food based dietary inflammation as one of the potential pathways for incident diabetes.

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Healthy dietary patterns from food diaries and FFQ are not associated with colorectal cancer risk: results from the UKWCS

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000348 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Petra Jones ◽

Janet Cade ◽

Charlotte Evans ◽

Neil Hancock ◽

Darren Greenwood

Keyword(s):

Colorectal Cancer ◽

Cancer Risk ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

Colorectal Cancer Risk ◽

Mediterranean Diet Score ◽

Bland Altman Method ◽

The Mediterranean ◽

Diet Score

AbstractDietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.

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Feasibility of the AusMed Diet Program: Translating the Mediterranean Diet for Older Australians

Nutrients ◽

10.3390/nu12041044 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1044 ◽

Cited By ~ 1

Author(s):

Karly Zacharia ◽

Amanda J. Patterson ◽

Coralie English ◽

Lesley MacDonald-Wicks

Keyword(s):

Mediterranean Diet ◽

Phase 1 ◽

Text Message ◽

Food Preferences ◽

Structured Interviews ◽

Mediterranean Countries ◽

Diet Pattern ◽

The Mediterranean ◽

Additional Support ◽

Diet Score

The Mediterranean diet pattern (MEDI) is associated with a lower risk of chronic conditions related to ageing. Adherence research mostly comes from Mediterranean countries with high cultural acceptability. This study examines the feasibility of a MEDI intervention designed specifically for older Australians (AusMed). Phase 1 involved a consumer research group (n = 17) presentation of program materials with surveys after each section. In-depth individual semi-structured interviews (n = 6) were then conducted. All participants reported increased knowledge and confidence in adherence to the MEDI, with the majority preferring a booklet format (70%) and group delivery (58%). Three themes emerged from interviews—1. barriers (complexity, perceived cost and food preferences), 2. additional support and 3. individualisation of materials. Program materials were modified accordingly. Phase 2 was a 2-week trial of the modified program (n = 15). Participants received a group counselling session, program manual and food hamper. Adherence to the MEDI was measured by the Mediterranean Diet Score (MDS). All participants increased their adherence after the 2-week trial, from a mean score of 5.4 ± 2.4 (low adherence) to a mean score of 9.6 ± 2.0 (moderate to high adherence). All found that text message support helped achieve their goals and were confident to continue the dietary change.

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