Abstract
The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial for assessment and immediate feedback. This instrument (MEDAS) was administered to 96 adults with a high cardiovascular risk (66% women, mean age 68.3 ± 6.0 years), recruited from general practices in Bristol, UK. Participants then completed a 3-day estimated food record, and the MEDAS was administered again one month later. A MedDiet score (range = 0–14) was calculated from the MEDAS’ administrations and food record to assess concurrent validity and test-retest reliability. Predictive validity was assessed by examining the association of the MEDAS-derived score with cardiometabolic risk factors and dietary intakes derived from the food records. The MEDAS-derived MedDiet score was higher by 1.47 points compared to food records (5.47 vs.4.00, p < 0.001), correlated moderately with the record-derived score (r = 0.50, p < 0.001; ICC = 0.53, p < 0.001) and there was borderline fair agreement between the two methods (κ = 0.19, 95% CI 0.07–0.31, p = 0.002; 95% limits of agreement −2.2, 5.1). Exact agreement within score categories and gross misclassificationwere 45.8% and 21.9%, respectively. The distribution of dietary intakes, reported on the food records by the MEDAS-derived total MedDiet score, was in the expected direction, but no association was observed with cardiometabolic risk factors. The two administrations of the MEDAS produced similar mean total MedDiet scores (5.5 vs. 5.4, p = 0.706), which were correlated (r and ICC = 0.69, p < 0.001) and agreed fairly (κ = 0.38, 95% CI 0.24–0.52, p < 0.001; 95% limits of agreement −3.1, 3.2). The English version of the MEDAS has acceptable accuracy and reliability for assessing MedDiet adherence among individuals with a high cardiovascular risk, in the UK, and can be used to rank individuals according to MedDiet adherence in research and practice.
Highlights
Cardiovascular disease (CVD) is an important global public health problem associated with death and disability [1]
Ninety-six participants completed the Mediterranean Diet Adherence Screener (MEDAS) at their first appointment and returned a food record
We showed that the English version of the MEDAS provided a borderline fair borderline fair estimate of Mediterranean diet (MedDiet) adherence, when compared to the reference instrument of 3-day estimate of MedDiet adherence, when compared to the reference instrument of 3-day estimated food estimated food records and similar rankings of participants on the basis of their MedDiet score
Summary
Cardiovascular disease (CVD) is an important global public health problem associated with death and disability [1]. Coronary heart disease and stroke result in approximately. Approximately 25% of hospital admissions for CVD are in patients with type 2 diabetes (T2D) [3] and CVD accounts for 52%. Of mortality among these patients [4]. £6.8 billion is spent by the National Health. The Mediterranean diet (MedDiet), rich in olive oil, nuts, fruits and vegetables, whole grains and pulses, low-fat dairy, fish, moderate alcohol amounts and limited quantities of red meat and sweets, has been the factor most frequently cited to explain the low CVD incidence and mortality [5]
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