Mediterranean Diet Adherence and Subjective Well-Being in a Sample of Portuguese Adults

The Mediterranean diet (MD) and other lifestyle characteristics have been associated with well-being, a broad multiparameter concept that includes individual’s subjective assessment of their own well-being (SWB). Some studies have suggested that diet influences SWB, thus, this work aimed to add novel information on the association of MD and SWB in a sample of Portuguese adults. Data on sociodemographic, economic, lifestyle, diet, and SWB were collected through a self-filled online questionnaire. MD adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS) score. Results showed a moderate adherence to the MD in 490 Portuguese adults (mean MEDAS of 7.4 ± 2.1). A higher MD adherence was found to be significantly positively associated with women, employed individuals, a higher number of meals per day, and those with frequent contact with nature (p-value < 0.0025, using Bonferroni adjustment). As a novelty, this study divided the participants into low SWB, medium SWB, and medium to high SWB profiles (3.9 ± 1.0; 6.2 ± 1.0; 8.2 ± 1.3, respectively; p-value < 0.05), which reported significantly increasing MEDAS scores (6.5 ± 2.1; 7.3 ± 2.1; 7.8 ± 1.9; respectively, p-value < 0.05).

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Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region

Nutrients ◽

10.3390/nu12102960 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2960 ◽

Cited By ~ 2

Author(s):

María-Teresa García-Conesa ◽

Elena Philippou ◽

Christos Pafilas ◽

Marika Massaro ◽

Stefano Quarta ◽

...

Keyword(s):

Mediterranean Diet ◽

Intraclass Correlation ◽

National Study ◽

P Value ◽

Kappa Statistics ◽

Food Diary ◽

Diet Adherence ◽

Mediterranean Countries ◽

Mediterranean Diet Adherence ◽

The Mediterranean

This study provides comprehensive validation of the 14-item Mediterranean Diet Adherence Screener (14-MEDAS) in an adult population from Greece (GR), Portugal (PT), Italy (IT), Spain (SP), Cyprus (CY), Republic of North Macedonia (NMK), and Bulgaria (BG). A moderate association between the 14-MEDAS and the reference food diary was estimated for the entire population (Pearson r = 0.573, p-value < 0.001; Intraclass Correlation Coefficient (ICC) = 0.692, p-value < 0.001) with the strongest correlation found in GR, followed by PT, IT, SP, and CY. These results were supported by kappa statistics in GR, PT, IT, and SP with ≥50% of food items exhibiting a fair or better agreement. Bland–Altman analyses showed an overestimation of the 14-MEDAS score in the whole population (0.79 ± 1.81, 95%Confidence Interval (CI) 0.61, 0.96), but this value was variable across countries, with GR, NMK, and BG exhibiting the lowest bias. Taking all analyses together, the validation achieved slightly better results in the Mediterranean countries but a definitive validation ranking order was not evident. Considering growing evidence of the shift from Mediterranean Diet (MD) adherence and of the importance of culture in making food choices it is crucial that we further improve validation protocols with specific applications to measure and compare MD adherence across countries and to relate it to the health status of a specific population.

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Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

Nutrients ◽

10.3390/nu13051432 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1432

Author(s):

Stefano Quarta ◽

Marika Massaro ◽

Mihail Chervenkov ◽

Teodora Ivanova ◽

Dessislava Dimitrova ◽

...

Keyword(s):

Mediterranean Diet ◽

Food Choices ◽

European Countries ◽

P Value ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

Sustainable Diet ◽

The Mediterranean ◽

The Republic ◽

Southern European Countries

The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.

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An Italian Survey on Dietary Habits and Changes during the COVID-19 Lockdown

Nutrients ◽

10.3390/nu13041197 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1197

Author(s):

Luana Izzo ◽

Antonio Santonastaso ◽

Gaetano Cotticelli ◽

Alessandro Federico ◽

Severina Pacifico ◽

...

Keyword(s):

Mediterranean Diet ◽

Dietary Habits ◽

Lifestyle Changes ◽

World Health ◽

Italian Population ◽

Online Questionnaire ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

The World ◽

The Impact

The World Health Organization has declared the coronavirus outbreak a Public Health Emergency of International Concern; the outbreak has led to lockdowns in several parts of the world, and sudden changes in people’s lifestyles. This study explores the impact of the first coronavirus disease 2019 (COVID-19) pandemic period on dietary habits, lifestyle changes, and adherence to the Mediterranean diet among the Italian population, through an online questionnaire, conducted from April to May 2020, involving 1519 participants. The 14-point Mediterranean Diet Adherence Screener (MEDAS) highlighted a medium Mediterranean diet adherence in 73.5% of responders, which principally included the younger population, aged 18–30 years (p < 0.05). In regards to changes in eating habits, 33.5% of responders declared an influence of the pandemic period on nutritional practice. A decrease in alcohol consumption was reported by 81% of responders, while an increase in frozen food consumption was reported by 81.3% of responders. In addition, 58.8% reported positive weight modification (40.8%, +1–3 kg); physical activity reduction was reported for 70.5% of responders. Our study contributes toward amplifying the investigation on the dietary habits and changes of the Italian population during the COVID-19 lockdown, although the pandemic is ongoing. Similar studies should be performed around the world to understand how the emergency has impacted people’s habits.

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ADHERENCE TO THE MEDITERRANEAN DIET IS NOT RELATED TO BETA-AMYLOID DEPOSITION: DATA FROM THE WOMEN’S HEALTHY AGEING PROJECT

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2018.12 ◽

2018 ◽

pp. 1-5

Author(s):

E. Hill ◽

C. Szoeke ◽

L. Dennerstein ◽

S. Campbell ◽

P. Clifton

Keyword(s):

Positron Emission Tomography ◽

Mediterranean Diet ◽

Beta Amyloid ◽

Amyloid Deposition ◽

Healthy Ageing ◽

Emission Tomography ◽

Diet Adherence ◽

Positron Emission ◽

Mediterranean Diet Adherence ◽

The Mediterranean

Background: Research has indicated the neuroprotective potential of the Mediterranean diet. Adherence to the Mediterranean diet has shown preventative potential for Alzheimer’s disease incidence and prevalence, yet few studies have investigated the impact of Mediterranean diet adherence on the hallmark protein; beta-amyloid. Objectives: To investigate the association between Mediterranean diet adherence and beta-amyloid deposition in a cohort of healthy older Australian women. Design: This study was a cross-sectional investigation of participants from the longitudinal, epidemiologically sourced Women’s Healthy Ageing Project which is a follow-up of the Melbourne Women’s Midlife Health Project. Setting: Assessments were conducted at the Centre for Medical Research, Royal Melbourne Hospital in Melbourne, Australia. F-18 Florbetaben positron emission tomography scanning was conducted at the Austin Centre for PET in Victoria, Australia. Participants: One hundred and eleven Women’s Healthy Ageing Project participants were included in the study. Measurements: Mediterranean diet adherence scores for all participants were calculated from the administration of a validated food frequency questionnaire constructed by the Cancer Council of Victoria. Beta-amyloid deposition was measured using positron emission tomography standardised uptake value ratios. Results: Gamma regression analysis displayed no association between Mediterranean diet adherence and beta-amyloid deposition. This result was consistent across APOE-ε4 +/- cohorts and with the inclusion of covariates such as age, education, body mass index and cognition. Conclusions: This study found no association between adherence to the Mediterranean diet and beta-amyloid deposition in a cohort of healthy Australian women.

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Validation of the Telephone-Administered Version of the Mediterranean Diet Adherence Screener (MEDAS) Questionnaire

Nutrients ◽

10.3390/nu12051511 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1511 ◽

Cited By ~ 4

Author(s):

Maria João Gregório ◽

Ana M. Rodrigues ◽

Clara Salvador ◽

Sara S. Dias ◽

Rute D. de Sousa ◽

...

Keyword(s):

Mediterranean Diet ◽

Large Population ◽

Population Based ◽

Validity And Reliability ◽

Face To Face ◽

Portuguese Version ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

The Face ◽

The Mediterranean

A 14-Item Mediterranean Diet Adherence Screener (MEDAS) questionnaire was developed and validated in face-to-face interviews, but not via telephone. The aims of this study were to evaluate the validity and reliability of a telephone-administered version of the MEDAS as well as to validate the Portuguese version of the MEDAS questionnaire. A convenience community-based sample of adults (n = 224) participated in a three-stage survey. First, trained researchers administered MEDAS via a telephone. Second, the Portuguese version of Food Frequency Questionnaire (FFQ), and MEDAS were administered in a semi-structured face-to-face interview. Finally, MEDAS was again administered via telephone. The telephone-administered MEDAS questionnaire was compared with the face-to-face-version using several metrics. The telephone-administered MEDAS was significantly correlated with the face-to-face-administered MEDAS [r = 0.805, p < 0.001; interclass correlation coefficient (ICC) = 0.803, p < 0.001] and showed strong agreement (k = 0.60). The MEDAS scores that were obtained in the first and second telephone interviews were significantly correlated (r = 0.661, p < 0.001; ICC = 0.639, p < 0.001). The overall agreement between the Portuguese version of MEDAS and the FFQ-derived Mediterranean diet adherence score had a Cohen’s k = 0.39. The telephone-administered version of MEDAS is a valid tool for assessing the adherence to the Mediterranean diet and acquiring data for large population-based studies.

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Dietary Intake, Mediterranean Diet Adherence and Caloric Intake in Huntington’s Disease: A Review

Nutrients ◽

10.3390/nu12102946 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2946

Author(s):

Christiana C. Christodoulou ◽

Christiana A. Demetriou ◽

Eleni Zamba-Papanicolaou

Keyword(s):

Huntington's Disease ◽

Huntington’S Disease ◽

Mediterranean Diet ◽

Rating Scale ◽

Age Of Onset ◽

Caloric Intake ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

Disease Rating ◽

The Mediterranean

Decades of research and experimental studies have investigated Huntington’s disease (HD), a rare neurodegenerative disease. Similarly, several studies have investigated whether high/moderate adherence to the Mediterranean Diet and specific macro and micronutrients can decrease cognitive loss and provide a neuroprotective function to neurons. This review systematically identifies and examines studies that have investigated Mediterranean Diet adherence, micro- and macronutrients, supplementation and caloric intake in people with HD, in order to identify if dietary exposures resulted in improvement of disease symptoms, a delay in age of onset or if they contributed to an earlier age of onset in people with HD. A systematic search of PubMed, Directory of open access journal and HubMed was performed independently by two reviewers using specific search terms criteria for studies. The identified abstracts were screened and the studies were included in the review if they satisfied predetermined inclusion criteria. Reference screening of included studies was also performed. A total of 18 studies were included in the review. A few studies found that patients who had high/moderate adherence to Mediterranean Diet showed a slight improvement in their Unified Huntington’s Disease Rating Scale and Total Functional Capacity. In addition, people with HD who had high Mediterranean Diet adherence showed an improvement in both cognitive and motor scores and had a better quality of life compared to patients who had low Mediterranean Diet adherence. Furthermore, a few studies showed that supplementation with specific nutrients, such as triheaptanoin, L-acetyl-carnitine and creatine, had no beneficial effect on the patients’ Unified Huntington’s Disease Rating Scale score. A few studies suggest that the Mediterranean Diet may confer a motor and cognitive benefit to people with HD. Unfortunately, there was little consistency among study findings. It is important for more research to be conducted to have a better understanding of which dietary exposures are beneficial and may result delaying age of onset or disease progression in people with HD.

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The Mediterranean diet, plasma metabolome, and cardiovascular disease risk

European Heart Journal ◽

10.1093/eurheartj/ehaa209 ◽

2020 ◽

Vol 41 (28) ◽

pp. 2645-2656 ◽

Cited By ~ 7

Author(s):

Jun Li ◽

Marta Guasch-Ferré ◽

Wonil Chung ◽

Miguel Ruiz-Canela ◽

Estefanía Toledo ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Mediterranean Diet ◽

Metabolic Response ◽

Cvd Risk ◽

Diet Adherence ◽

Metabolic Signature ◽

Mediterranean Diet Adherence ◽

Plasma Metabolome ◽

The Mediterranean

Abstract Aims To investigate whether metabolic signature composed of multiple plasma metabolites can be used to characterize adherence and metabolic response to the Mediterranean diet and whether such a metabolic signature is associated with cardiovascular disease (CVD) risk. Methods and results Our primary study cohort included 1859 participants from the Spanish PREDIMED trial, and validation cohorts included 6868 participants from the US Nurses’ Health Studies I and II, and Health Professionals Follow-up Study (NHS/HPFS). Adherence to the Mediterranean diet was assessed using a validated Mediterranean Diet Adherence Screener (MEDAS), and plasma metabolome was profiled by liquid chromatography-tandem mass spectrometry. We observed substantial metabolomic variation with respect to Mediterranean diet adherence, with nearly one-third of the assayed metabolites significantly associated with MEDAS (false discovery rate < 0.05). Using elastic net regularized regressions, we identified a metabolic signature, comprised of 67 metabolites, robustly correlated with Mediterranean diet adherence in both PREDIMED and NHS/HPFS (r = 0.28–0.37 between the signature and MEDAS; P = 3 × 10−35 to 4 × 10−118). In multivariable Cox regressions, the metabolic signature showed a significant inverse association with CVD incidence after adjusting for known risk factors (PREDIMED: hazard ratio [HR] per standard deviation increment in the signature = 0.71, P < 0.001; NHS/HPFS: HR = 0.85, P = 0.001), and the association persisted after further adjustment for MEDAS scores (PREDIMED: HR = 0.73, P = 0.004; NHS/HPFS: HR = 0.85, P = 0.004). Further genome-wide association analysis revealed that the metabolic signature was significantly associated with genetic loci involved in fatty acids and amino acids metabolism. Mendelian randomization analyses showed that the genetically inferred metabolic signature was significantly associated with risk of coronary heart disease (CHD) and stroke (odds ratios per SD increment in the genetically inferred metabolic signature = 0.92 for CHD and 0.91 for stroke; P < 0.001). Conclusions We identified a metabolic signature that robustly reflects adherence and metabolic response to a Mediterranean diet, and predicts future CVD risk independent of traditional risk factors, in Spanish and US cohorts.

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The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2017.1399120 ◽

2017 ◽

Vol 32 (7) ◽

pp. 1084-1091 ◽

Cited By ~ 7

Author(s):

Elisavet Parlapani ◽

Charalampos Agakidis ◽

Thomais Karagiozoglou-Lampoudi ◽

Kosmas Sarafidis ◽

Eleni Agakidou ◽

...

Keyword(s):

Pregnant Women ◽

Mediterranean Diet ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

The Mediterranean ◽

Size At Birth

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Study of Physical Fitness, Bone Quality, and Mediterranean Diet Adherence in Professional Female Beach Handball Players: Cross-Sectional Study

Nutrients ◽

10.3390/nu13061911 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1911

Author(s):

Alejandro Martínez-Rodríguez ◽

Javier Sánchez-Sánchez ◽

María Martínez-Olcina ◽

Manuel Vicente-Martínez ◽

Laura Miralles-Amorós ◽

...

Keyword(s):

Physical Fitness ◽

Mediterranean Diet ◽

Dietary Habits ◽

Broadband Ultrasound Attenuation ◽

Future Research ◽

Dominant Hand ◽

Cross Sectional ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

The Mediterranean

(1) Background: Beach handball is a relatively new type of sport, derived from team handball. The purpose of the study was to evaluate the physical fitness of elite players of this sport by studying some variables of sports performance, including strength, endurance and power, and dietary habits, and to assess bone ultrasonographic variables. (2) Methods: 33 beach handball players have participated in this research; 18 juniors (age: 16.7 ± 0.50) and 15 seniors (age: 24.8 ± 4.71). The athletes’ strength was evaluated using the Handgrip Test on the dominant hand, the height of jump was evaluated by a counter-jump on a contact platform, and velocity, agility, and resistance by the Yo-Yo test. The broadband ultrasound attenuation (BUA) and the sound of speed (SOS) through the calcaneus were also measured. The Mediterranean diet adherence (KIDMED) was the questionnaire used to evaluate eating habits. In the statistical analysis, descriptions and correlations were made between the study variables. (3) Results: Both in the case of the dynamometric hand strength test (p < 0.05) and in the lower extremity power test (p < 0.01), senior players presented significantly higher values compared to junior players (35.1 ± 3.84 vs. 31.8 ± 3.37 and 35.1 ± 6.89 vs. 28.5 ± 5.69 with the dynamometry and Abalakov tests, respectively). However, no differences were observed in the variables by playing position. Significant correlations between different variables have been established, highlighting negative correlations between BMI and weight with the Abalakov Jump Test and positive correlations between Yo-Yo and BUA, and, between BMI and BUA. (4) Conclusions: Older and trained players are in better physical fitness; high weight and BMI have a negative influence on power, agility, speed, and endurance. In general, adherence to the Mediterranean diet is moderate and it seems evident that there is a beneficial influence of beach handball on bone condition, as measured by ultrasound. However future research should be carried on, including dual-energy x-ray absorptiometry assessments and food intake registers for a whole week.

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Abstract P098: The Association Between Obesity Status and Long-Term Adherence to Mediterranean Diet in the PREDIMED Trial

Circulation ◽

10.1161/circ.127.suppl_12.ap098 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Jessica Cohen ◽

Eric B Rimm ◽

Miguel A Martínez-González ◽

Jordi Salas-Salvadó ◽

María I Covas ◽

...

Keyword(s):

High Risk ◽

Mediterranean Diet ◽

Average Score ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

Obesity Status ◽

Obese Subjects ◽

The Mediterranean

Background: The aim of this study was to determine if long-term adherence to a prescribed diet, in the context of the PREDIMED trial, a multi-year, randomized, controlled trial, was different among obese and non-obese participants after an average follow-up of three years. Previous studies only examined short term compliance or were not sufficiently powered to compare obese with nonobese participants. Methods: This randomized clinical trial included 6,463 subjects. All subjects were asymptomatic; females aged 55-80 years and males 55-80 years and were at high-risk for cardiovascular disease at baseline. Participants’ characteristics were measured at baseline and every 12 months. Obesity was defined as having a BMI of 30kg/m2 or more. The main outcome measure was achieving an average score of 10 points or more on a validated 14-point Mediterranean diet adherence scale over follow-up. Results: In all three dietary intervention groups, obesity status was significantly inversely associated with adherence to the Mediterranean diet; In the olive oil group, the odds ratio of obtaining a score of 10 or more was 23.4% (95% CI: 6.3, 37.5%) lower for obese subjects than for non-obese subjects after an average follow-up of three years. A similar pattern was also seen in the nuts group; the odds of obtaining a score of 10 or more was 24.3% (95% CI: 5.1,39.6%) lower for obese subjects than for non-obese subjects. In the low fat group, subjects who were obese at baseline had 25.7% (95% CI:5.7, 40.8%) lower odds of obtaining a score of 10 or more on the adherence score. All models were adjusted for relevant covariates. Conclusion: In this long-term trial of the Mediterranean Diet, adherence was high across all intervention groups. However, adherence was appreciably lower among obese participants after three years. Additional intervention efforts may be necessary to achieve the same adherence among high-risk obese individuals.

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