Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort

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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Diet quality and attention capacity in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

British Journal Of Nutrition ◽

10.1017/s0007114517001441 ◽

2017 ◽

Vol 117 (11) ◽

pp. 1587-1595 ◽

Cited By ~ 10

Author(s):

Pontus Henriksson ◽

Magdalena Cuenca-García ◽

Idoia Labayen ◽

Irene Esteban-Cornejo ◽

Hanna Henriksson ◽

...

Keyword(s):

Executive Functions ◽

Mediterranean Diet ◽

Diet Quality ◽

Dietary Patterns ◽

Quality Index ◽

Maternal Education ◽

Healthy Lifestyle ◽

Mediterranean Diet Score ◽

Diet Quality Index ◽

Diet Score

AbstractAdolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5–17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β=0·16, P=0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P>0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted.

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Dietary changes and anxiety during the coronavirus pandemic: a multinational survey

European Journal of Clinical Nutrition ◽

10.1038/s41430-021-00897-3 ◽

2021 ◽

Author(s):

Vered Kaufman-Shriqui ◽

Daniela Abigail Navarro ◽

Olga Raz ◽

Mona Boaz

Keyword(s):

Mediterranean Diet ◽

Diet Quality ◽

Point Scale ◽

Cross Sectional ◽

Mediterranean Diet Score ◽

General Anxiety Disorder ◽

General Anxiety ◽

Stress Control ◽

Online Study ◽

Diet Score

Abstract Background/objectives The 2020 global coronavirus pandemic is characterized by increased anxiety. Anxiety has been associated with poor diet quality and weight gain, which may lead to obesity, a risk factor for adverse COVID-19 outcomes. The present study was designed to examine associations between diet quality and anxiety levels during the COVID-19 pandemic. Subjects/methods This cross-sectional, international online study was conducted between March 30 and April 25, 2020 and available in seven languages: Arabic (7.6%), English (43.7%), French (0.8%), Hebrew (42.1%), Italian (3%), Russian (1.1%), and Spanish (1.6%). Diet quality was assessed using the Mediterranean Diet Score (possible range: 0–17 points) and anxiety scored using the General Anxiety Disorder 7-point scale (GAD-7). The Google Survey platform was used to conduct the survey. Results A total of 3797 persons were included in the present analysis. More than 75% of respondents were female; most completed the survey in English or Hebrew. Median age was 31 (IQ = 18) years. Almost 60% indicated that their pre-pandemic diet was healthier than their current diet. The median Mediterranean diet score was 9 (IQ = 3). The majority (54%) of participants reported at least mild anxiety, while 25% reported moderate anxiety or more severe. In a logistic regression model of at least moderate anxiety, Mediterranean diet score (OR 0.92, 95% CI 0.89–0.95, p < 0.0001) reduced odds of elevated anxiety, even after controlling for age, sex and other variables. Conclusions Though causality cannot be inferred, associations between diet quality and anxiety might suggest public health interventions including diet and stress control during future mass lockdowns.

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Nut Consumptions as a Marker of Higher Diet Quality in a Mediterranean Population at High Cardiovascular Risk

Nutrients ◽

10.3390/nu11040754 ◽

2019 ◽

Vol 11 (4) ◽

pp. 754 ◽

Cited By ~ 4

Author(s):

Maria Bibiloni ◽

Alicia Julibert ◽

Cristina Bouzas ◽

Miguel Martínez-González ◽

Dolores Corella ◽

...

Keyword(s):

Folic Acid ◽

Cardiovascular Risk ◽

Mediterranean Diet ◽

Diet Quality ◽

Quality Index ◽

Mediterranean Population ◽

High Cardiovascular Risk ◽

Mediterranean Diet Score ◽

Nutrient Adequacy ◽

Diet Score

Background: Nut consumption has been associated with improved nutrient adequacy and diet quality in healthy adult populations but this association has never been explored in individuals at high cardiovascular risk. Objective: to assess the associations between consumption of nuts and nutrient adequacy and diet quality in a Mediterranean population at high cardiovascular risk. Design: baseline assessment of nutritional adequacy in participants (n = 6060, men and women, with ages 55–75 years old, with overweight/obesity and metabolic syndrome) in the PREDIMED-PLUS primary cardiovascular prevention randomized trial. Methods: nut intake was assessed using a validated food frequency questionnaire. Participants who reported consuming zero quantity of nuts were classified as ‘non-nut consumers’. ‘Nut consumers’ were participants who reported consuming any quantity of nuts. Nineteen micronutrients were examined (vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine). The proportion of micronutrient inadequacy was estimated using the estimated average requirements (EAR) or adequate intake (AI) cut-points. Diet quality was also assessed using a 17-item Mediterranean dietary questionnaire (Mediterranean diet score, MDS), a carbohydrate quality index (CQI) and a fat quality index (FQI). Results: eighty-two percent of participants were nut consumers (median of nut consumption 12.6 g/day; interquartile range: 6.0–25.2). Nut consumers were less likely to be below the EAR for vitamins A, B1, B2, B6, C, D, E, folic acid, and Ca, Mg, Se and Zn than non-nut consumers. Nut consumers were also more likely to be above the AI for K and Cr than non-nut consumers. Nut consumers had lower prevalence of inadequate micronutrient intakes, but also higher CQI, higher FQI, and better scores of adherence to the Mediterranean diet (Mediterranean diet score, MDS). Conclusions: nut consumers had better nutrient adequacy, diet quality, and adherence to the MedDiet than those non-nut consumers.

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Associations between energy density of meals and snacks and overall diet quality and adiposity measures in British children and adolescents: the National Diet and Nutrition Survey

British Journal Of Nutrition ◽

10.1017/s0007114516003731 ◽

2016 ◽

Vol 116 (9) ◽

pp. 1633-1645 ◽

Cited By ~ 7

Author(s):

Kentaro Murakami ◽

M. Barbara E. Livingstone

Keyword(s):

Energy Density ◽

Mediterranean Diet ◽

Diet Quality ◽

Nutrition Survey ◽

Cross Sectional ◽

Mediterranean Diet Score ◽

Dietary Record ◽

The Mediterranean ◽

Diet Score ◽

British Children

AbstractThis cross-sectional study examined how energy density (ED) of meals and snacks are associated with overall diet quality and adiposity measures in 1617 British children aged 4–18 years from the 1997 National Diet and Nutrition Survey. On the basis of data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of time (meals: 06.00–09.00, 12.00–14.00 and 17.00–20.00 hours; snacks: all others) or contribution to energy intake (EI) (meals: ≥15 %; snacks: <15 %). ED of meals and snacks was calculated on the basis of food only. Overall diet quality was assessed using the Mediterranean diet score (range 0–8). Irrespective of the definition of meals and snacks, ≥67 % of EI was derived from meals, whereas ED of meals was lower than ED of snacks (mean: 8·50–8·75 v. 9·69–10·52 kJ/g). Both ED of meals and ED of snacks were inversely associated with total intakes of vegetables, fruits, dietary fibre and overall diet quality and positively associated with total intakes of fat. However, the associations were stronger for ED of meals. The change in the Mediterranean diet score with a 1-unit increase of ED (kJ/g) was −0·35 to −0·30 for ED of meals and −0·09 to −0·06 for ED of snacks (all P<0·0001). After adjustment for potential confounders, all measures of ED of meals and snacks did not show positive associations with adiposity measures. In conclusion, although both ED of meals and ED of snacks were associated with adverse profiles of overall diet quality (but not adiposity measures), stronger associations were observed for ED of meals.

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The influence of energy standardisation on the alternate Mediterranean diet score and its association with mortality in the Multiethnic Cohort

British Journal Of Nutrition ◽

10.1017/s0007114516003482 ◽

2016 ◽

Vol 116 (9) ◽

pp. 1592-1601 ◽

Cited By ~ 8

Author(s):

Yurii B. Shvetsov ◽

Brook E. Harmon ◽

Reynolette Ettienne ◽

Lynne R. Wilkens ◽

Loic Le Marchand ◽

...

Keyword(s):

Los Angeles ◽

Mediterranean Diet ◽

Cancer Mortality ◽

Processed Meat ◽

Mediterranean Diet Score ◽

Multiethnic Cohort ◽

Cox's Regression ◽

Diet Score ◽

Component Scores ◽

Red And Processed Meat

AbstractThe alternate Mediterranean diet (aMED) score is an adaptation of the original Mediterranean diet score. Raw (aMED) and energy-standardised (aMED-e) versions have been used. How the diet scores and their association with health outcomes differ between the two versions is unclear. We examined differences in participants’ total and component scores and compared the association of aMED and aMED-e with all-cause, CVD and cancer mortality. As part of the Multiethnic Cohort, 193 527 men and women aged 45–75 years from Hawaii and Los Angeles completed a baseline FFQ and were followed up for 13–18 years. The association of aMED and aMED-e with mortality was examined using Cox’s regression, with adjustment for total energy intake. The correlation between aMED and aMED-e total scores was lower among people with higher BMI. Participants who were older, leaner, more educated and consumed less energy scored higher on aMED-e components compared with aMED, except for the red and processed meat and alcohol components. Men reporting more physical activity scored lower on most aMED-e components compared with aMED, whereas the opposite was observed for the meat component. Higher scores of both aMED and aMED-e were associated with lower risk of all-cause, CVD and cancer mortality. Although individuals may score differently with aMED and aMED-e, both scores show similar reductions in mortality risk for persons scoring high on the index scale. Either version can be used in studies of diet and mortality. Comparisons can be performed across studies using different versions of the score.

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Dietary Changes and Anxiety during the Coronavirus Pandemic: Differences between the Sexes

Nutrients ◽

10.3390/nu13124193 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4193

Author(s):

Mona Boaz ◽

Daniela Abigail Navarro ◽

Olga Raz ◽

Vered Kaufman-Shriqui

Keyword(s):

Mediterranean Diet ◽

Diet Quality ◽

Present Report ◽

Post Partum ◽

Inverse Association ◽

Mediterranean Diet Score ◽

Female Sex ◽

Baked Goods ◽

The Mediterranean ◽

Diet Score

The SARS-CoV-2 (COVID-19) pandemic has been associated with both increased anxiety, deterioration in diet and weight gain. These associations may differ by sex. The present report examines differences by sex in diet quality in order to determine whether associations between diet and psychological stress during the initial phase of the COVID-19 pandemic differed by sex. This online study is available internationally in seven languages. The Mediterranean Diet Score was used to measure diet quality, while the General Anxiety Disorder 7-point scale (GAD-7) was used to measure anxiety. Findings were compared by self-reported sex (male vs. female). A total of 3797 respondents provided informed consent and met eligibility criteria, of whom 526 women were omitted due to being pregnant or six months or less post-partum, or due to reproductive status not being reported. Thus, 3271 individuals are included in the present report, of whom 71.2% were women. The median age of women was 30 (interquartile range (IQR) = 16) years vs. 31 (IQR = 19) years, p = 0.079. The median diet quality score was 9 (IQ = 3) in both women and men (p = 0.75). Despite the overall similarity in diet score, several components of the score differed significantly by sex. Women reported consuming significantly more olive oil, daily servings of vegetables, and weekly servings of sweet baked goods. Men reported consuming significantly more sweetened/carbonated drinks, red meat, alcohol, legumes, and hummus/tahini. Women reported a GAD-7 score of 6 (IQR = 8), while men reported 3 (6), p < 0.001. An inverse association was detected between the Mediterranean diet score and the GAD-7 score in both women (rho = −0.166, p < 0.001) and men (rho = −0.154, p < 0.001), and the correlation coefficients did not differ by sex (p = 0.76). Mediterranean diet score and age both reduced the odds of elevated anxiety (GAD-7 ≥ 10), while female sex, deterioration of diet quality during the outbreak, unemployment, and completing the survey in English increased the odds of this outcome. During the COVID-19 lockdowns, overall diet quality did not differ by sex; however, some differences by sex in components of the total score were detected. Moderate to severe anxiety was positively associated with female sex and poorer diet quality even after controlling for age, employment status, and the language in which the survey was performed.

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High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort

Gastroenterology ◽

10.1053/j.gastro.2017.04.004 ◽

2017 ◽

Vol 153 (2) ◽

pp. 386-394.e2 ◽

Cited By ~ 49

Author(s):

Song-Yi Park ◽

Carol J. Boushey ◽

Lynne R. Wilkens ◽

Christopher A. Haiman ◽

Loïc Le Marchand

Keyword(s):

Colorectal Cancer ◽

Diet Quality ◽

High Quality ◽

Multiethnic Cohort ◽

Quality Indexes ◽

Reduced Risk

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Adequacy of Critical Nutrients Affecting the Quality of the Spanish Diet in the ANIBES Study

Nutrients ◽

10.3390/nu11102328 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2328 ◽

Cited By ~ 5

Author(s):

Josune Olza ◽

Emilio Martínez de Victoria ◽

Javier Aranceta-Bartrina ◽

Marcela González-Gross ◽

Rosa M. Ortega ◽

...

Keyword(s):

Older Adults ◽

Mediterranean Diet ◽

Diet Quality ◽

Balance Study ◽

Mediterranean Diet Score ◽

Scientific Authority ◽

The Mediterranean ◽

Critical Nutrients ◽

Diet Score

Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish “Anthropometry, Intake, and Energy Balance Study” (ANIBES) (n = 2285; 9–75 years), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0–7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults (>65–75 years) showed better DQIs than adults (18–64 years), without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population (69.5%) compared with the plausible energy reporters (49.0%), whereas for medium and high scores the percentages were higher in plausible reporters (41.2% vs. 26.2% and 9.8% vs. 4.3%, respectively). In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.

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