Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet

Abstract

Our objective was to develop a short questionnaire that can be easily used to estimate quantitatively the level of adherence to cardioprotective Mediterranean diets. The short questionnaire assessed the consumption of cardioprotective elements included in the Mediterranean diet (olive oil, wine, fruits, vegetables, fish, legumes and whole-grain intake). A low consumption of meat or meat-products was also included in the composite score. The relative risk of myocardial infarction for each category of the composite score obtained (range 0-9) was computed using data from a case-control study that included 171 cases of first myocardial infarction and 171 matched controls. We found an adjusted odds ratio ¼ 0.18 (95% confidence interval (CI): 0.03-0.97; P ¼ 0.04) for those scoring 7-9 points when comparing them with those scoring 1-2 points. An increment of one point in the score was associated with an 18% reduction in the relative risk of myocardial infarction (P ¼ 0.05).

Components of the mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease

“…Also, there is a reasonable possibility that the score we have used might not be discriminatory enough of the adherence to the Mediterranean dietary pattern. However, a similar instrument was able to predict total and cardiovascular mortality (Trichopoulou et al, 2003) and the risk of myocardial infarction in Mediterranean populations (Martínez-González et al, 2004). Another potential limitation is the design of the study as a randomized dietary intervention trial recruiting high-risk participants to test the hypothesis that enhancement of a Mediterranean-type diet for several years will reduce the incidence of cardiovascular events and could thus provide the highest level of clinical evidence on the benefits of the Mediterranean diet.…”

“…Conversely, subjects whose consumption of 'detrimental' foods (red meats, fat-rich dairy products, commercial pastries and snacks, artificially sweetened beverages) was above a pre-specified value were assigned a value of 0 and a value of 1 if the values were below the pre-specified cutoff point. The cutoff point of each specified item was established in accordance with the results of a case-control study that evaluated the risk of first non-fatal myocardial infarction (Fernández-Jarne et al, 2002;Martínez-González et al, 2004).…”

“…The baseline examination included the administration of a 14-item questionnaire indicating the degree of adherence to the traditional Mediterranean diet that is an extension of a previously validated questionnaire (Martínez-González et al, 2004). Values of 0 or 1 were assigned to each of 14 dietary components.…”

Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial

“…The frequencies were registered in nine categories that ranged from "never or almost never" to "≥6 times/day". The baseline adherence to the typical MeDiet was also measured by a simplified 14-item assessment questionnaire, an extension of a previously validated short questionnaire [17]. Energy and nutrient intake were derived using Spanish food composition tables [19,21].…”

Scientific Opinion on the substantiation of health claims related to fruits and/or vegetables (ID 1212, 1213, 1214, 1217, 1218, 1219, 1301, 1425, 1426, 1427, 1428, 1429, 1430) and to the “Mediterranean diet” (ID 1423) pursuant to Article 13(1) of Regulati

“…bread, cereals, legumes, potatoes, vegetables, fresh fruit, fish, wine, vegetable oils) by the sum of the total energy percentage from food groups (milk, cheese, eggs, animal fats and margarines, sweet beverages, cakes/pie/cookies, sugar) "less typical" of the "reference Mediterranean diet" (Fidanza et al, 2004); finally, some studies used different scales indicating the degree of adherence to the "traditional Mediterranean diet" with scores which were either calculated on the basis of the mean consumption of a series of "food groups" (e.g. vegetables, legumes, fruits and nuts, cereal, fish, meat, poultry, and diary products) within the same study population (Panagiotakos et al, 2005;2006a;2006b;Psaltopoulou et al, 2004;Trichopoulou et al, 2003; or on the basis of fixed thresholds of intake using similar "food groups" Martinez-Gonzalez et al, 2004 The Panel notes that different definitions of "Mediterranean diet" have been used in the references provided, and that therefore the diet which is the subject of the health claim is unclear.…”