Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region.

María-Teresa García-Conesa,Paula Pinto,Georgia Eirini Deligiannidou,Teodora Ivanova,Vanda Andrade,Rui Jorge,Stefano Quarta,Elena Philippou,Dessislava Dimitrova,Marika Massaro,Viktorija Maksimova,Lence Miloseva,Tatjana Ruskovska,Christos A Kontogiorgis,Mihail Chervenkov,Christos Pafilas,Darinka Gjorgieva Ackova,Katarina Smilkov

doi:10.3390/nu12102960

Abstract

This study provides comprehensive validation of the 14-item Mediterranean Diet Adherence Screener (14-MEDAS) in an adult population from Greece (GR), Portugal (PT), Italy (IT), Spain (SP), Cyprus (CY), Republic of North Macedonia (NMK), and Bulgaria (BG). A moderate association between the 14-MEDAS and the reference food diary was estimated for the entire population (Pearson r = 0.573, p-value < 0.001; Intraclass Correlation Coefficient (ICC) = 0.692, p-value < 0.001) with the strongest correlation found in GR, followed by PT, IT, SP, and CY. These results were supported by kappa statistics in GR, PT, IT, and SP with ≥50% of food items exhibiting a fair or better agreement. Bland–Altman analyses showed an overestimation of the 14-MEDAS score in the whole population (0.79 ± 1.81, 95%Confidence Interval (CI) 0.61, 0.96), but this value was variable across countries, with GR, NMK, and BG exhibiting the lowest bias. Taking all analyses together, the validation achieved slightly better results in the Mediterranean countries but a definitive validation ranking order was not evident. Considering growing evidence of the shift from Mediterranean Diet (MD) adherence and of the importance of culture in making food choices it is crucial that we further improve validation protocols with specific applications to measure and compare MD adherence across countries and to relate it to the health status of a specific population.

Highlights

The dietary pattern associated with the Mediterranean Diet (MD) is characterized by the daily consumption of olive oil as the main source of fat, whole grains, fruits, and vegetables, weekly consumption of legumes, nuts, fish, and wine in moderation, as well as a moderate intake of lean fresh meat, and dairy products
Amongst the various scores that have been developed to measure MD adherence, the 14-item MEDAS screening tool was previously validated for the Spanish population in the PREDIMED study [6] and has been widely investigated for its applicability in several other countries around the world [7,8,9,10]
We provide for the first time, comprehensive validation data of the 14-MEDAS in several Southern European Mediterranean countries, i.e., GR, PT, IT, SP, and CY as well as in two Balkan bordering countries, NMK and BG

Summary

Introduction

The dietary pattern associated with the Mediterranean Diet (MD) is characterized by the daily consumption of olive oil (mainly extra-virgin or virgin olive oil) as the main source of fat, whole grains, fruits, and vegetables, weekly consumption of legumes, nuts, fish, and wine in moderation, as well as a moderate intake of lean fresh meat, and dairy products. This diet provides an important source of minerals, vitamins, mono- and polyunsaturated fatty acids, fiber as well as a broad range of bioactive antioxidant and anti-inflammatory compounds [1]. The PREDIMED study, a primary prevention nutrition-intervention trial, led to the development of the “Mediterranean Diet

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