A Short Screener Is Valid for Assessing Mediterranean Diet Adherence among Older Spanish Men and Women1231,2,3

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Abstract

Ensuring the accuracy of dietary assessment instruments is paramount for interpreting diet-disease relationships. The present study assessed the relative and construct validity of the 14-point Mediterranean Diet Adherence Screener (MEDAS) used in the Prevención con Dieta Mediterránea (PREDIMED) study, a primary prevention nutrition-intervention trial. A validated FFQ and the MEDAS were administered to 7146 participants of the PREDIMED study. The MEDAS-derived PREDIMED score correlated significantly with the corresponding FFQ PREDIMED score (r = 0.52; intraclass correlation coefficient = 0.51) and in the anticipated directions with the dietary intakes reported on the FFQ. Using Bland Altman's analysis, the average MEDAS Mediterranean diet score estimate was 105% of the FFQ PREDIMED score estimate. Limits of agreement ranged between 57 and 153%. Multiple linear regression analyses revealed that a higher PREDIMED score related directly (P < 0.001) to HDL-cholesterol (HDL-C) and inversely (P < 0.038) to BMI, waist circumference, TG, the TG:HDL-C ratio, fasting glucose, and the cholesterol:HDL-C ratio. The 10-y estimated coronary artery disease risk decreased as the PREDIMED score increased (P < 0.001). The MEDAS is a valid instrument for rapid estimation of adherence to the Mediterranean diet and may be useful in clinical practice.

Abbreviations used:

CHD
coronary heart disease
HDL-C
HDL-cholesterol
ICC
intraclass correlation coefficient
LOA
limits of agreement
MEDAS
Mediterranean Diet Adherence Screener
PREDIMED
Prevención con Dieta Mediterránea
WC
waist circumference

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1

Supported by the Spanish Network RD06/0045/0000 [ISCIII, Sistema Nacional de Salud contract (CP06/00100, PI1001407] from Instituto de Salud Carlos III-FEDER, by grant CNIC06 from the Centro Nacional de Investigaciones Cardiovasculares, by grant ACOMP/2011/151 from the Valencia Goverment, by a joint contract of the Instituto de Salud Carlos III and the Health Department of the Catalan Government (Generalitat de Catalunya), CP 03/00115, and partially supported by the Generalitat of Catalunya (2005 SGR 00577). The CIBERobn is an initiative of the Instituto de Salud Carlos III, Spain.

2

Author disclosures: H. Schröder, M. Fitó, R. Estruch, M. A. Martínez-González, D. Corella, J. Salas-Salvadó, R. Lamuela-Raventós, E. Ros, I. Salaverría, M. Fiol, J. Lapetra, E. Vinyoles, E. Gómez-Gracia, C. Lahoz, L. Serra-Majem, X. Pintó, V. Ruiz-Gutierrez, and M-I. Covas, no conflicts of interest.

3

This trial was registered at Current Controlled Trials, London as ISRCTN35739639.