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

Abstract

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.

Mediterranean diet assessment challenges: Validation of the Croatian Version of the 14-item Mediterranean Diet Serving Score (MDSS) Questionnaire

“…For example, a recent study identified as many as 28 different indexes being used in the literature, but only a very few scores fulfilled the applicability parameters and psychometric quality, while the overall level of evidence was scarce [ 34 ]. Other reviews have also found similar abundance of indexes used in the literature, and performed comparison of performance of several commonly used dietary indexes and questionnaires [ 8 , 20 , 47 – 52 ]. These studies have shown that there is no such thing as one ideal instrument, which would objectively measure the adherence to the MD [ 50 ].…”

Trends in Diet Quality and Related Sociodemographic, Health, and Occupational Characteristics among Workers in Spain: Results from Three Consecutive National Health Surveys (2006–2017)

“…Having an unhealthy diet is now generally considered a leading risk factor for disease and death [ 4 ]. Spain is a country with dietary recommendations based on the Mediterranean diet [ 5 ]. Nevertheless, the incidence of chronic conditions, such as cardiovascular, oncological, metabolic, and musculoskeletal diseases has risen in Spain over the last few decades, as has happened worldwide [ 6 ].…”

High variability of food and nutrient intake exists across the Mediterranean Dietary Pattern—A systematic review

“…Similarly, meat may have included meat products or processed meats or poultry as well as eggs, whereas dairy may be classified as total dairy, whole fat dairy, or without cheese (Panagiotakos, Pitsavos, & Stefanadis, 2006;Toledo et al, 2013). Recent studies have also found that MD indexes vary in their construction and consequently how these classify the adherence of individuals (Hernandez-Ruiz et al, 2018;Olmedo-Requena et al, 2019). However, to our knowledge this is the first study to review and capture the variability in reporting of the MD in (Table S2) terms of its construction and impact on foods and nutrient intakes across different countries.…”

“…The MDP is a pre-defined dietary pattern that includes a high intake of fruits and vegetables, legumes, nuts and seeds, olive oil and wholegrain cereals with moderately high intakes of fish, and regular moderate intakes of alcohol, low to moderate intakes of dairy products and low intakes of saturated fats and red meats (Trichopoulou et al, 2014). The original Mediterranean Diet Score (MDS) was based on patterns of eating in Greece (Trichopoulou et al, 1995) but has subsequently evolved, with a further 28 variations now in use, resulting in considerable variability in the method and the categorization of food groups and nutrients included within the scores (Craig et al, 2017;Davis, Bryan, Hodgson, & Murphy, 2015;Hernandez-Ruiz et al, 2015;Olmedo-Requena et al, 2019;Shaw, 2016;Zaragoza-Marti, Cabanero-Martinez, Hurtado-Sanchez, Laguna-Perez, & Ferrer-Cascales, 2018). It is also now used in non-Mediterranean and Mediterranean regions.…”