Proposal of a Mediterranean Diet Serving Score

Abstract

Background and AimsNumerous studies have demonstrated a relationship between Mediterranean Diet (MD) adherence and the prevention of cardiovascular diseases, cancer, and diabetes, etc. The study aim was to validate a novel instrument to measure MD adherence based on the consumption of food servings and food groups, and apply it in a female population from southern Spain and determining influential factors.Methods and ResultsThe study included 1,155 women aged 12-83 yrs, classified as adolescents, adults, and over-60-yr-olds. All completed a validated semi-quantitative food frequency questionnaire (FFQ). The Mediterranean Dietary Serving Score (MDSS) is based on the latest update of the Mediterranean Diet Pyramid, using the recommended consumption frequency of foods and food groups; the MDSS ranges from 0 to 24. The discriminative power or correct subject classification capacity of the MDSS was analyzed with the Receiver Operating Characteristic (ROC) curve, using the MDS as reference method. Predictive factors for higher MDSS adherence were determined with a logistic regression model, adjusting for age. According to ROC curve analysis, MDSS evidenced a significant discriminative capacity between adherents and non-adherents to the MD pattern (optimal cutoff point=13.50; sensitivity=74%; specificity=48%). The mean MDSS was 12.45 (2.69) and was significantly higher with older age (p<0.001). Logistic regression analysis showed highest MD adherence by over 60-year-olds with low BMI and no habit of eating between meals.ConclusionsThe MDSS is an updated, easy, valid, and accurate instrument to assess MD adherence based on the consumption of foods and food groups per meal, day, and week. It may be useful in future nutritional education programs to prevent the early onset of chronic non-transmittable diseases in younger populations.

Mediterranean diet in the southern Croatia – does it still exist?

“…Additionally, there were 4 questions about wine (red and white) and bevanda (mixture of red or white wine and water) consumption expressed in liters per week. According to the proposed MDSS approach (20), we created 14 categories of foods that comprised Mediterranean diet: fruit (including 2 questions; fresh and dried fruit), vegetables (5 questions; leafy, rooted, cruciferous, tomatoes, canned, and pickled vegetables), cereals (5 questions; white bread, wholegrain bread, rice, pasta, muesli), potatoes, olive oil, nuts, dairy products (5 questions; milk, yoghurt, sour cream, hard cheese, cottage cheese), legumes, eggs, fish (4 questions; blue fish, white fish, mollusks, octopus), white meat (2 questions; chicken, turkey), red meat (6 questions; beef, calf, pork, lamb, sausages, pancetta), sweets (7 questions; cakes, chocolate, cookies, bonbons, jam, sweetened fruit juice, fizzy drinks), fermented beverages (4 questions; red and white wine, red and white bevanda ). If the participants reported daily consumption of olive oil, fruit, vegetables, and cereals, they were awarded 3 points, for daily consumption of nuts and dairy products they were awarded 2 points, and for the consumption of the remaining 8 categories they were awarded 1 point.…”

“…If the participants reported daily consumption of olive oil, fruit, vegetables, and cereals, they were awarded 3 points, for daily consumption of nuts and dairy products they were awarded 2 points, and for the consumption of the remaining 8 categories they were awarded 1 point. These included potatoes (if consumed ≤3 servings/week), legumes (≥2 servings/week), eggs (2-4 servings/week), fish (≥2 servings/week), white meat (2 servings/week), red meat (<2 servings/week), sweets (≤2 servings/week), and fermented beverages (1 glass/d of wine or bevanda for women, 2 glasses/d for men; beer was not included) (20). In case these guidelines were exceeded for meat, eggs, potatoes, sweets, and wine or not reached for other categories, the participant would get 0 points.…”

“…Since our questionnaire allowed the highest frequency of consumption to be once a day, we combined 5 different types of vegetables (leafy, rooted, cruciferous, tomatoes, canned, and pickled vegetables) and thus awarded 3 points only to those participants who reported daily consumption of at least 2 types of vegetables or to those who consumed at least one type of vegetables every day plus the combination of other types, which added up to a consumption frequency of ≥7 days a week. The maximum possible MDSS score was 24 points, and the cut-off of ≥13.5 points was considered as good compliance (20). We excluded 125 participants from the analysis due to missing values needed for MDSS items calculation.…”

“…Correlation between MDSS score and age and education expressed as years of schooling was performed using Spearman rank test. Finally, multivariate logistic regression analysis was used to investigate the characteristics associated with greater compliance with the Mediterranean diet, using the upper quartile of 14 points as a cut-off, which also corresponds to a proposed MDSS cut-off for good compliance with the Mediterranean diet (20). The model included six covariates: age, sex, place of residence, years of schooling, smoking, and physical activity.…”

“…Animal products are more of a relish, and the priority is given to fish and white meat over red and processed meat (19). Recently, a new scoring system has been proposed to assess the individual compliance with the Mediterranean diet – Mediterranean Diet Serving Score (MDSS), claimed to be easy, valid, and accurate instrument to assess the Mediterranean diet adherence based on the consumption of foods and food groups per meal, day, and week (20). Its advantage is that it includes as many as 14 groups of foods, adding 1, 2, or 3 points to the total score based on the consumption frequency and the relative importance of the particular foods, without assigning negative points (20).…”