14-item Mediterranean Diet Adherence Screener Research Articles

Association of five diet scores with severe NAFLD incidence: A prospective study from UK Biobank.

This study aimed to contrast the associations of five common diet scores with severe non-alcoholic fatty liver disease (NAFLD) incidence. In total, 162 999 UK Biobank participants were included in this prospective population-based study. Five international diet scores were included: the 14-Item Mediterranean Diet Adherence Screener (MEDAS-14), the Recommended Food Score (RFS), the Healthy Diet Indicator (HDI), the Mediterranean Diet Score and the Mediterranean-DASH Intervention for Neurodegenerative Delay score. As each score has different measurements and scales, all scores were standardized and categorized into quartiles. Cox proportional hazard models adjusted for confounder factors investigated associations between the standardized quartiles and severe NAFLD incidence. Over a median follow-up of 10.2 years, 1370 participants were diagnosed with severe NAFLD. When the analyses were fully adjusted, participants in quartile 4 using the MEDAS-14 and RFS scores, as well as those in quartiles 2 and 3 using the HDI score, had a significantly lower risk of severe incident NAFLD compared with those in quartile 1. The lowest risk was observed in quartile 4 for the MEDAS-14 score [hazard ratio (HR): 0.76 (95% confidence interval (CI): 0.62-0.94)] and the RFS score [HR: 0.82 (95% CI: 0.69-0.96)] and as well as in quartile 2 in the HDI score [HR: 0.80 (95% CI: 0.70-0.91)]. MEDAS-14, RFS and HDI scores were the strongest diet score predictors of severe NAFLD. A healthy diet might protect against NAFLD development irrespective of the specific approach used to assess diet. However, following these score recommendations could represent optimal dietary approaches to mitigate NAFLD risk.

Cross-Cultural Adaptation of Mediterranean Diet Adherence Screener (MEDAS) Into Moroccan Arabic to Measure the Degree of Mediterranean Diet Adherence.

Background The Mediterranean diet (MD) has been recognized by several studies as beneficial for health improvement. The degree of adherence to this diet has also been evaluated using several scales, particularly time-consuming measures such as the Food Frequency Questionnaire (FFQ). This studyaims to (a) adapt into Moroccan Arabic the 14-item Mediterranean Diet Adherence Screener (MEDAS), which is a simple and brief tool that assesses the degree of diet adherence and was used in the Prevencion con Dieta Mediterranea (PREDIMED) study, and (b) determine its psychometric properties. Methods MEDAS consists of 12 questions on food frequency and two on dietary habits, with each question scoring 0 or 1. To translate and adapt the scale, Beaton et al.'s six-step cross-cultural adaptation process guidelines were followed. The screener's psychometric properties were tested on staff at the CHU Mohammed VI (Tangier), i.e., the hospital's administrative and maintenance staff, excluding medical and paramedical personnel. Internal consistency was evaluated using the Kuder-Richardson 21 (K-R 21) formula, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Moreover, criterion validity was performed using the Spearman correlation between the MEDAS and the MedQ-Sus scores. Discrimination performance was also tested using the receiving operating characteristic (ROC) curve. Results The validation study included 160 participants who completed both questionnaires. The K-R 21 formula estimated strong internal consistency in the range of 0.851. The ICC of test-retest reliability was significant at 0.876 95% CI [0.831-0.909]. The MEDAS score correlated significantly with the comparative MedQ-Sus score (Spearman's rho = 0.494 95% CI [0.363-0.606], p < 0.001). Also, MEDAS can strongly distinguish between MD adherence and non-adherence (optimal cut-off = 7.5, sensitivity 0.81, specificity = 0.57), with an area under the curve (AUC) value of 0.743 95% CI [0.667-0.819], p < 0.001. Conclusion The results showed that MEDAS is a valid and time-saving instrument for assessing adherence to the MD in the Moroccan population.

Adherence and Sociodemographic Determinants of Adherence to the Mediterranean Diet among Slovenian Adults and the Elderly.

The Mediterranean diet (MD) is considered a model for good health, and is promoted worldwide as one of the healthiest dietary patterns. Despite the MD's health benefits, the literature suggests that adherence to the MD tends to be in decline in most populations worldwide, including those in the Mediterranean region. The aim of this study was to investigate adherence to the MD, and its main sociodemographic and lifestyle factors, in the Slovenian population. Using a nationwide cross-sectional food consumption survey (SI.Menu), data were collected from a general questionnaire, from the 14-item MD adherence screener (14-MEDAS score), and from a questionnaire on the dietary habits of 850 adults and elderly people. The mean MEDAS score for the total study sample was 5.6 (SD 2.1), indicating a low adherence to the MD among the Slovenian population. The adherence to the MD was higher among women (OR = 1.534; 95% Cl 1.156-2.034), those with a university degree (OR = 1.527; 1.098-2.125; compared to those with no university degree), those who lived in a suburb or city (OR = 1.511; 1.016-2.249; OR = 1.568; 1.122-2.191; compared with those who lived in a village), non-smokers (OR = 1.561; 1.380-1.830; compared with smokers), and those who lived in the western part of Slovenia (OR = 1.558; 1.170-2.074; compared with those who lived in eastern Slovenia). Adherence to the MD in the Slovenian population is low, and is strongly related to educational level, gender, geographic region, place of residence, and smoking status. The frequency of the consumption of different food groups is also closely related.

Validation of the 14-item mediterranean diet adherence screener

The Mediterranean diet (MedDiet) is suggested as a healthy dietary pattern. 14-point Mediterranean Diet Adherence Screener (MEDAS) questionnaire is a valid and rapid tool to estimate the adherence to the Mediterranean diet. The aim of this study was to assess the validity of the 14-point Mediterranean Diet Adherence Screener in Turkish population. A total of 188 people (%58 females) participated in this study (31.7±10.97 years). Turkish version of the MEDAS questionnaire was applied with 3-day food record, and mean total Mediterranean Diet (MedDiet) score and each of the MedDiet component scores was calculated from both 3-day food records and MEDAS tool. Intra-class correlation coefficient (ICC) was used to evaluate the total score agreement between the two dietary assessment methods, and each of the MedDiet components was estimated using Cohen's kappa. This project was a cross-sectional study. There was good correlation between the food record total MEdDiet score and MEDAS-derived MedDiet score (r=0.750, p<0.001; ICC=0.749, 95% CI 0.679-0.806, p<0.001). Highest concordance was observed for olive oil for cooking (К=0.763), sugar sweetened beverages (К=0.666), sweets, pastries (К=0.753), and sofrito (К=0.796) while the lowest was for fish and seafood (К=0.196). Re-test analysis showed a similar mean total MedDiet score for both administrations of MEDAS. The MEDAS is a valid and reliable tool to assess adherence to the Mediterranean diet in Turkish population.

Short Mediterranean diet screener detects risk of prediabetes in Taiwan, a cross-sectional study

We aimed to determine whether the 14-item Mediterranean diet adherence screener (MEDAS) is suitable in Taiwan and associate the MEDAS score with the risk of prediabetes. In this cross-sectional study 346 patients were recruited between 2014 and 2019 at Taipei Tzu Chi Hospital. The MEDAS score was obtained with a 14-item MEDAS used in the PREDIMED trial. The blood glucose level is measured by fasting glucose and HbA1c. The results of the screener were analyzed for internal consistency and compared with the blood glucose level using multivariate regression models. The MEDAS score was significantly (p = 0.001) and inversely associated with both measures of blood glucose level. Adjusted data (95% CI) showed that each additional point in the MEDAS score decreases the risk of prediabetes with abnormal fasting glucose (> 100 mg/dL) level by 60% and the risk of prediabetes with abnormal HbA1c (> 5.7%) by 22.4%. Consuming at least 3 servings of legumes each week was significantly (p = 0.007) related to a lower risk of prediabetes under logistic regression. A higher score on the 14-item MEDAS screener was significantly associated with a lower risk of prediabetes.

Individual determinants of Mediterranean diet adherence among urban Lebanese adult residents

Purpose Many studies revealed positive health impacts of the Mediterranean diet (MedDiet), especially on metabolic disorders. Conversely, in Lebanon, recent information about determinants of adherence to the MedDiet are limited. This study aimed to examine the individual determinants of MedDiet adherence among adults in Lebanon. Design/methodology/approach A cross-sectional study was carried out during July 2021 among a convenient sample of 326 Lebanese adults. Data from participants were collected via an online survey developed by study researchers, composed of two well-structured questionnaires: a background questionnaire and a 14-item Mediterranean Diet Adherence Screener (14-MEDAS). Findings The mean MedDiet score in the total sample was 7.59 ± 2.22, reflecting moderate/fair MedDiet adherence. Consumption of fruits, vegetables, legumes and olive oil met the recommended MedDiet intake among most participants. Older age and having a regular routine of physical activity emerged as significant independent determinants of better MedDiet adherence. Originality/value Future public health interventions aiming at promoting MedDiet adherence shall target predominantly younger age groups of the Lebanese population and incorporate strategies to boost physical activity among target groups.

Mediterranean Diet Intervention in Patients with Myeloproliferative Neoplasm

Reasoning that a Mediterranean diet intervention is a low-risk, low-cost approach to reduce inflammation, we set out to test whether MPN patients can adopt a Mediterranean style eating pattern. We completed two randomized clinical trials to address the feasibility of a Mediterranean diet intervention in MPN patients. The primary objective of the 1st study was to test whether MPN patients can adopt a Mediterranean diet eating pattern with registered dietician (RD) counseling. We enrolled 28 patients with MPN (14 PV, 6 ET, 8 MF) into a 15 week interventional study. After a two-week observation period, patients were randomized to either a Mediterranean diet (MED) or the United States Dietary Guidelines for Americans (USDA) diet groups. Participants received active intervention for 10 weeks, comprising of weekly educational curriculum and personalized RD visits at weeks 3, 5, and 7 geared toward their assigned diet. Participants were observed for an additional 3 weeks post intervention. Adoption of a Mediterranean style eating pattern was quantified using the 14-Item Mediterranean Diet Adherence Screener (MEDAS), with a score of ≥8 regarded as highly adherent to a Mediterranean eating pattern. Over 75% of the participants in the MED group maintained a MEDAS score of ≥8 over the entire active intervention period demonstrating that MPN patients can successfully adopt a Mediterranean diet eating pattern with RD counseling and written curriculum. Symptom burden was assessed using the MPN-Total Symptom Score (MPN-TSS) measured at baseline, weeks 3, 6, 9, 12, and 15. Approximately half of the Mediterranean diet cohort enjoyed a ≥ 50% reduction in MPN-TSS at weeks 9-15 compared to baseline, whereas the maximum percentage of participants in the USDA arm achieving ≥ 50% reduction in their MPN-TSS was 31% at 15 weeks. Exploratory biological correlates included CBC, CMP, lipid, hsCRP, cytokine panel, and fecal microbiome analysis at weeks 1, 6, 9, and 15. Blood counts, electrolytes, kidney and liver function remained stable throughout the intervention period for both groups. We found no significant changes in cytokines (TNFα, IL-6, IL-8, IL-10, IL-22) or hsCRP in either diet group. Shotgun sequencing of fecal samples found no significant changes in microbial diversity, composition, or function associated with a MED diet intervention over time. Instead, we found the MPN subtype played a greater role in determining microbiome diversity, composition, and function. Individuals with Essential Thrombocythemia and Polycythemia Vera were more similar to each other, while those with Myelofibrosis (MF) were more disparate. This difference in the MF microbiome composition was associated with an increase in TNFα. Notably, members of the Bacteroidaceae family were positively associated with high TNFα levels. In a second randomized trial we tested the feasibility of an online diet intervention, with zoom based dietician counseling, electronic curriculum, and online based questionnaires. We recruited 28 symptomatic MPN patients not already adherent to a MED diet and randomized them to either a MED arm or DASH diet. Participants received written curriculum and attended zoom one-on-one RD sessions at weeks 3, 4, 8, and 12. Participants completed an online MPN-TSS survey. Participants attended most dietician visits, with only a 3.5% and 7.5% no show rate in the MED and DASH diet groups respectively. Participants were also compliant with online based daily surveys, with an average completion rate of 93.2% in the MED group and 69.3% in the DASH group. At week 16, 43% of participants in the MED group had a ≥50% reduction in MPN-TSS compared with 29% of participants in the DASH group. Taken together, these two studies demonstrate that MPN patients can adopt a Mediterranean diet eating pattern if given written curriculum and RD counseling. Moreover, a remotely administered intervention is feasible in this patient population. Although patients in all diet groups had a ≥50% reduction in MPN-TSS, the percentage achieving the ≥50% benchmark was higher in the MED arm for both diet studies. These data suggest that a Mediterranean diet, which is rich in anti-inflammatory foods, may be particularly beneficial to manage symptom burden in MPN. We are now moving on to larger randomized studies to rigorously test the impact of a MED diet intervention on symptom burden in MPN patients.

Mediterranean Diet and Atrial Fibrillation: Lessons Learned from the AFHRI Case-Control Study.

A relationship between lifestyle, diet, and atrial fibrillation (AF) remains unclear. Except for alcohol consumption, AF guidelines do not differentiate specific advice for this rhythm disorder. The aim of this study was to investigate the association between adherence to healthy dietary patterns and the presence of AF, among 104 low risk participants from the 1:1 matched case–control AFHRI (Atrial Fibrillation in High-Risk Individuals) study. Dietary data were obtained using a three-day food record. Adapted German versions of the validated 14-item Mediterranean Diet Adherence Screener (MEDAS) and the validated eight-item Healthy Eating Index (HEI) from the Epic Study served as the basis for data derivation. The median age of the study participants was 63.0 years, 73.1% were men. In multivariable adjusted binary logistic regression analyses, we found inverse associations between both dietary indices (MEDAS: Median = 3, HEI: Median = 54.9) and the presence of AF (odds ratio for MEDAS: 0.65, 95% confidence interval (CI): 0.47–0.91, odds ratio for HEI: 0.60, 95% CI 0.39–0.95). Further clinical studies are needed to confirm the extent to which high quality dietary patterns such as a Mediterranean diet influence the onset and natural history of AF, in order to provide dietary counselling.

‘Effectiveness of a remote nutritional intervention to increase the adherence to the Mediterranean diet among recovered depression patients’

ABSTRACT Background There is substantial evidence supporting that remote interventions are useful to change dietary habits. However, the effect of a remote intervention based on Mediterranean diet (MD) in depressive patients has been less explored. Objective This study aims to assess the effectiveness of a remotely provided Mediterranean diet-based nutritional intervention in the context of a secondary prevention trial of depression. Methods The PREDIDEP study was a 2-year multicenter, randomized, single-blinded trial designed to assess the effect of the MD enriched with extra virgin olive oil (EVOO) on the prevention of depression recurrence. The intervention group received usual care for depressed patients and remote nutritional intervention every three months which included phone contacts and web-based interventions; and the control group, usual care. At baseline and at 1-year and 2-year follow-up, the 14-item MD Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire (FFQ) were collected by a dietitian. Mixed effects linear models were used to assess changes in nutritional variables according to the group of intervention. The trial was registered at ClinicalTrials.gov NCT03081065. Results Compared with control group, the MD intervention group showed more adherence to MD (between-group difference: 2.76; 95% CI 2.13–3.39; p < 0.001); and a healthier diet pattern with a significant increase in the consumption of olive oil (p < 0.001), and a significant reduction in refined cereals (p = 0.031) after 2 years of intervention. Conclusions The remote nutritional intervention increases adherence to the MD among recovered depression patients. Trial registration: ClinicalTrials.gov identifier: NCT03081065.

Association of ideal cardiovascular health with cardiovascular events and risk advancement periods in a Mediterranean population-based cohort

BackgroundThe American Heart Association recommends Life’s Simple 7 as ideal cardiovascular health (ICVH) to reduce cardiovascular risk. Rate advancement period (RAP), a useful tool to quantify and communicate exposure impact on risks, may enhance communication about the benefits of achieving ICVH. We aimed to examine whether greater adherence to ICVH metrics was associated with reduced incidence of cardiovascular risk in a population-based cohort and estimate its impact on the timing of occurrence using RAP.MethodsProspective analyses of 3826 participants, initially free from cardiovascular disease at baseline, enrolled in the Vascular Risk in Navarra Study (RIVANA), a Mediterranean population-based cohort of Spanish adults. ICVH metrics were defined using participants’ baseline information as follows: never-smoker or quitting > 12 months ago, body mass index < 25 kg/m2, ≥ 150 min/week of moderate physical activity or equivalent, healthy dietary pattern (≥ 9 points on a validated 14-item Mediterranean diet adherence screener), untreated cholesterol < 200 mg/dL, untreated blood pressure < 120/80 mmHg, and untreated fasting blood glucose < 100 mg/dL. Participants were assigned 1 point for each achieved metric and were grouped according to their number of accumulated metrics in ≤ 2, 3, 4, and ≥ 5. The primary endpoint was major cardiovascular events (composite of myocardial infarction, stroke, or death from cardiovascular causes). Cox proportional hazard ratios (HRs) and RAPs with their corresponding 95% confidence intervals (95% CI) adjusted for potential confounders were calculated.ResultsDuring a median follow-up of 12.8 years (interquartile range 12.3–13.1), a total of 194 primary endpoints were identified. Compared to participants with ≤ 2 ideal metrics, HR (95% CI) for major cardiovascular events among participants meeting ≥ 5 metrics was 0.32 (0.17–0.60) with RAP (95% CI) of − 14.4 years (− 22.9, − 5.9).ConclusionsGreater adherence to ICVH metrics was associated with lower cardiovascular risk among Spanish adults of the RIVANA cohort. Adherence to ideal metrics may substantially delay cardiovascular risk.

Mediterranean Diet and Overactive Bladder.

PurposeThe relationship between nutrition and overactive bladder (OAB) has yet to be elucidated. Therefore, this study investigated the relationship between the Mediterranean diet and OAB.MethodsThe 14-item Mediterranean Diet Adherence Screener (MeDAS) and Overactive Bladder-Validated 8-question Screener (OAB-V8), validated in Turkish, were administered to 500 patients over the age of 18 who presented to outpatient clinics other than urology outpatient clinics. Of those patients, 174 with chronic diseases and urinary tract infections (based on urinalysis and a detailed medical history) were excluded. Therefore, 326 patients’ data were analyzed.ResultsThere was a negative correlation between the MeDAS and OAB-V8 scores. High OAB-V8 scores were associated with obesity (body mass index ≥30 kg/m2), being single, and a low education level.ConclusionsDietary patterns represent a broader perspective on food and nutrient consumption and may therefore be more predictive of disease risk. The Mediterranean type should be recommended in the first-line treatment of patients with OAB symptoms. It is easily possible to determine the compliance of patients with this diet by using the 14-item MeDAS.

1177-P: Mediterranean Diet Is Associated with a Better Estimated Renal Function in Overweight, but Not in Obese, Adults with Impaired Fasting Glucose

Background: Impaired fasting glucose (IFG) is a risk factor for renal function, whereas adherence to the Mediterranean diet may be protective. Methods: Cross-sectional study on 1016 overweight (OW) and 1297 obese (OB) adults (52 ± 12 yrs, 55% women) with IFG (s-glucose: 100-125 mg/dl) . Anthropometry, fat-free mass by BIA, s-creatinine, blood pressure, marital status, education, familiarity for diabetes and CVD, smoking and physical activity were evaluated. The 14-item MEDiterranean Diet Adherence Screener (MEDAS, score: 0-14 points) was used to assess Mediterranean diet. Glomerular filtration rate (eGFR) was estimated by CKD-EPI formula. Normal renal function was defined as eGFR ranged 90-140 ml/min/1.73m2, so that both cases of loss of renal function and cases of glomerular hyperfiltration were considered at risk of renal damage. Logistic regression stratified for BMI class and adjusted for above confounders was fitted to assess association of Mediterranean diet with normal renal function. Results: The prevalence of normal renal function was 55% (60% in OW, 52% in OB) . Compared to the first tertile, the highest tertile of MEDAS score was associated to higher odds being normal renal function in OW (OR 1.48, 95%CI 1.07, 2.04, Ptrend=0.014) but not in OB patients. Conclusion: Mediterranean diet is associated with a better renal function in OW patients with IFG. Disclosure A.Leone: None. R.De amicis: None. A.Foppiani: None. S.Bertoli: None. A.Battezzati: None.

Adherence to the Mediterranean Diet Has a Protective Role against Metabolic and DNA Damage Markers in Colorectal Cancer Patients.

Oxidative stress (OS) and inflammation have been related to colorectal cancer (CRC), but the influence of the Mediterranean diet (MD) on these parameters is unknown. Therefore, the aim of this study was to determine the association between adherence to the MD and markers of OS and DNA damage in CRC patients and to study the influence of adherence to the MD on metabolic and tumor-related factors. This prospective observational study included a total of 80 patients diagnosed with CRC. Adherence to the MD was estimated by the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire. The levels of OS markers (catalase, glutathione peroxidase, and glutathione system in serum; 8-oxo-7′8-dihydro-2′-deoxyguanosine and F2-isoprotanes in urine) and tumor and metabolic factors were determined. A total of 51.2% of our CRC patients showed a high adherence to the MD. These patients presented decreased levels of 8-oxodG, increased GPX and HDL–cholesterol levels, and a downward trend in the GSSG/GSH ratio with respect to patients with low adherence to the MD. In addition, a high adherence to the MD was associated with a lower histological grade of the tumor and a lower presence of synchronous adenomas. We conclude that a high adherence to the MD has a protective role against metabolic and oxidative DNA damage and improves antioxidant systems in CRC patients.

Physical activity and its association with Mediterranean diet patterns among Spanish university students.

Objective: the aim of the present study was to assess the level of physical activity and its association with Mediterranean dietary patterns in university students of health sciences at Universidad de Castilla-La Mancha (Spain). Method: a cross-sectional study was performed through an online survey. The final sample consisted of 555 university students (78.2 % females). Adherence to Mediterranean diet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). To measure physical activity, the Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used. Results: according to physical activity, 2.5 % of the participants were considered active and 35.1 % did both strength and flexibility activities. A greater association was seen between intake of fruits (OR = 1.95; 95 % CI, 1.25-3.04), pulses (OR = 1.51; 95 % CI, 1.00-3.20), and nuts (OR = 1.99; 95 % CI, 1.33-2.99) in those considered sufficiently active. Similarly, we found a significant relationship between the intake of fruits (OR = 2.28; 95 % CI, 1.49-3.47), pulses (OR = 1.41; 95 % CI, 1.00-2.08), nuts (OR = 1.96; 95 % CI, 1.34-2.86), and fish/seafood (OR = 1.67; 95 % CI, 1.15-2.43) in those who engaged in both strength and flexibility activities. Conclusion: this study suggests that consumption of certain Mediterranean foods was associated with higher levels of physical activity in a sample of Spanish university students.

Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.

A Remote Nutritional Intervention to Change the Dietary Habits of Patients Undergoing Ablation of Atrial Fibrillation: Randomized Controlled Trial.

BackgroundThe Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored.ObjectiveThis study aims to assess the effectiveness of a remotely provided Mediterranean diet–based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF).MethodsThe PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the Mediterranean diet enriched with extra virgin olive oil (EVOO) on the prevention of atrial tachyarrhythmia recurrence after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (Mediterranean diet enriched with EVOO) or a control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with provision of dietary recommendations, and participants had access to a web page, a mobile app, and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, Mediterranean diet classroom, and Your personal experience. At baseline and at 1-year and 2-year follow-up, the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire were collected by a dietitian by phone.ResultsA total of 720 subjects were randomized (365 to the intervention group, 355 to the control group). Up to September 2020, 560 subjects completed the first year (560/574, retention rate 95.6%) and 304 completed the second year (304/322, retention rate 94.4%) of the intervention. After 24 months of follow-up, increased adherence to the Mediterranean diet was observed in both groups, but the improvement was significantly higher in the intervention group than in the control group (net between-group difference: 1.8 points in the MEDAS questionnaire (95% CI 1.4-2.2; P<.001). Compared with the control group, the Mediterranean diet intervention group showed a significant increase in the consumption of fruits (P<.001), olive oil (P<.001), whole grain cereals (P=.002), pulses (P<.001), nuts (P<.001), white fish (P<.001), fatty fish (P<.001), and white meat (P=.007), and a significant reduction in refined cereals (P<.001), red and processed meat (P<.001), and sweets (P<.001) at 2 years of intervention. In terms of nutrients, the intervention group significantly increased their intake of omega-3 (P<.001) and fiber (P<.001), and they decreased their intake of carbohydrates (P=.02) and saturated fatty acids (P<.001) compared with the control group.ConclusionsThe remote nutritional intervention using a website and phone calls seems to be effective in increasing adherence to the Mediterranean diet pattern among AF patients treated with catheter ablation.Trial RegistrationClinicalTrials.gov NCT03053843; https://www.clinicaltrials.gov/ct2/show/NCT03053843

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students.

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

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

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.

Translation and cross-cultural adaptation of 14-item Mediterranean Diet Adherence Screener and low-fat diet adherence questionnaire.

The Mediterranean diet and the low-fat diet are recognized as cardioprotective dietary patterns, and the use of validated instruments that quickly identify adherence to these diets is very useful in the daily practice of the nutritionist. Our aim was to translate and cross-culturally adapt the 14-point Mediterranean Diet Adherence Screener (MEDAS) and a 9-item quantitative score of compliance with the low-fat diet (low-fat diet questionnaire) to the Brazilian Portuguese language. The process of translation and cultural adaptation was conducted in six stages: initial translation, synthesis of translations, back-translation, proof of cross-cultural equivalence, pre-final version testing, and final evaluation of the cultural adaptation process. Interviews and assessments were administered to 30 nutritionists, and to 51 healthy participants and 50 individuals at cardiovascular risk. MEDAS ranges from 0 (minimum) to 14 (maximum) points and a total score≥10 points was considered for high adherence to MedDiet. Low-fat diet questionnaire ranges from 0 (minimum) to 9 (maximum) points and a total score≥6 points was considered for high adherence to a diet restricted in fat. MEDAS and low-fat diet questionnaire were translated, synthetized and then back-translated, and few grammatical and/or semantic changes were required. About 24 participants suggested at least one modification in low-fat diet questionnaire's questions/terms, and 28 participants suggested at least one change in MEDAS items. The process produced a valid version of both the MEDAS and low-fat diet questionnaire in the Brazilian Portuguese language. Participants showed an average MEDAS questionnaire of 5.3±2.5 points, and an average low-fat diet questionnaire of 5.9±1.9 points. Nutritionists showed higher means of low-fat diet scores when compared to healthy and at high cardiovascular risk individuals (7.1±1.3, 5.6±2 and 5.4±1.9, respectively [P<0.0001]) but not for MEDAS questionnaire. With a cutoff of ≥10 points, 2.3% (95% CI 0.78-6.52) of the participants showed high adherence to MedDiet based on MEDAS score, and with a cutoff of ≥6 points, 58% (95% CI 49.5-66.1) of the participants showed high adherence to a diet restricted in fat based on the low-fat diet questionnaire. MEDAS and low-fat diet questionnaire were successfully translated to the Portuguese language. Regarding the results from questionnaires applied to our sample, in general, poor adherence was found for both Mediterranean and low-fat diet.

64-LB: Fourteen-Item Mediterranean Diet Score as Indicator for Prediabetes in Taiwan, a Cross-Sectional Study

Background and Aims: Prediabetes is considered a high-risk state of type 2 diabetes and a reversible condition with lifestyle changes. The Mediterranean diet is one of the recommended dietary patterns for reducing the risk of type 2 diabetes. This study aims to find association between the degree of adherence to the Mediterranean diet and blood glucose level in prediabetes patients and healthy controls. Methods: In this cross-sectional study 346 subjects were recruited between 2014 and 2019 at the Taipei Tzu Chi Hospital. The degree of adherence to the Mediterranean diet is measured by a 14-item Mediterranean diet adherence screener used in the PREDIMED trial. The blood glucose level is measured by fasting glucose (mg/dL) and glycated hemoglobin (%). Results: The Mediterranean diet adherence score is significantly and inversely associated with both measures of blood glucose level. Adjusted data (95% confidence intervals) shows that each additional point in the Mediterranean diet adherence score decreases the risk of prediabetes with abnormal fasting glucose level by 60% and the risk of prediabetes with abnormal glycated hemoglobin by 22.4%. Conclusions: The 14-item Mediterranean diet score is an effective indicator for prediabetes. Disclosure Y. Hou: None. Funding Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation (TCRD-TPE-109-RT-10)