Abstract
Mediterranean diet (MD) is among the most commonly investigated diets and recognized as one of the healthiest dietary patterns. Due to its complexity, geographical and cultural variations, it also represents a challenge for quantification. The aim of this cross-sectional study was to assess reliability and validity of the Croatian version of the 14-item Mediterranean Diet Serving Score (MDSS), using the Mediterranean Diet Adherence Screener (MEDAS) as the referent test. We included the exploratory sample of 360 medical students, and a confirmatory sample of 299 health studies students from the University of Split, Croatia. Test-retest reliability and validity of the MDSS were tested using intra-class correlation coefficients (ICC), while Cohen's kappa statistic was used to test correct classification of subjects into MD adherent/non-adherent category. A very good reliability was shown for the overall MDSS score (ICC = 0.881 [95% CI 0.843-0.909]), and a moderate reliability for the binary adherence (κ = 0.584). Concurrent validity of the MDSS was also better when expressed as a total score (ICC = 0.544 [0.439-0.629]) as opposed to the adherence (κ = 0.223), with similar result in the confirmatory sample (ICC = 0.510 [0.384-0.610]; κ = 0.216). Disappointingly, only 13.6% of medical students were adherent to the MD according to MDSS, and 19.7% according to the MEDAS questionnaire. Nevertheless, MDSS score was positively correlated with age (ρ = 0.179: P = 0.003), self-assessed health perception (ρ = 0.123; P = 0.047), and mental well-being (ρ = 0.139: P = 0.022). MDSS questionnaire is a short, reliable and reasonably valid instrument, and thus useful for assessing the MD adherence, with better results when used as a numeric score, even in the population with low MD adherence.
Highlights
Nutrition has a profound impact on health, both in the short-term and life-long scale
There was no difference in Mediterranean diet (MD) compliance between men and women, assessed either with Mediterranean Diet Adherence Screener (MEDAS) (P = 0.224) or Mediterranean Diet Serving Score (MDSS) questionnaire (P = 0.202), even though women reported slightly higher MD adherence compared to men (21.4% vs 15.7%, respectively, for MEDAS questionnaire, and 14.9% vs 9.8% for MDSS questionnaire) (Table 2)
Women reported higher compliance with olive oil intake, chicken, red/processed meat and sofrito sauce intake according to MEDAS questionnaire, and with red meat intake according to MDSS questionnaire, while men reported slightly higher adherence to wine intake, which was overall very low among students (Table 2)
Summary
Nutrition has a profound impact on health, both in the short-term and life-long scale. According to the Global Burden of Disease Study for 2017, dietary risk factors are accountable for as many as 11 million deaths and 255 million DALYs worldwide, with the biggest contribution from high sodium intake, low intake of whole grains and fruit [1]. The MD is one of the most commonly investigated dietary patterns, with many beneficial effects for human health described so far [4], playing a role in prevention of cardiovascular diseases (CVD) [5,6,7], CVD risk factors [8], diabetes [9, 10], cancer [11, 12], protection of mental health [13, 14], and better health-related quality of life [15]
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