Modified Mediterranean Diet Score Research Articles

Association between different diet quality scores and depression risk: the REGICOR population-based cohort study.

Our aim was to determine the association between diet quality and depression incidence in the population-based REGICOR cohort study, Catalonia, Spain. Prospective observational study using participants' baseline (2003-2006), follow-up (2007-2013) and clinical records data. Five diet quality scores were derived from a food frequency questionnaire (FFQ) at baseline: the relative Mediterranean Diet Score (rMED), the Modified Mediterranean Diet Score (ModMDS), a Dietary Approaches to Stop Hypertension (DASH) score, a Healthful Plant-based Diet Index (HPDI) and the World Health Organization Healthy Diet Indicator (WHO-HDI). Participants using pharmacological antidepressant treatment were excluded as a proxy for presence of depression at baseline. At follow-up, the Patient Health Questionnaire (PHQ-9) was applied to assess depressive symptoms (≥ 10 defining depressive disorder). A secondary outcome was depression diagnosis assessed through clinical records. Logistic regression and Cox proportional hazards models were used. Main analysis included 3046 adults (50.3% women) with a mean age of 54.7 (SD = 11.6) years. After 6-years follow-up, 184 (6.04%) cases of depressive disorder were identified. There was 16% lower odds of depressive disorder per 1SD increase of rMED (OR = 0.84; 95%CI = 0.71-0.98). Secondary outcome analysis (n = 4789) identified 261 (5.45%) incident cases of clinical depression diagnosis over 12 years follow-up, and 19% lower risk of clinical depression was observed with the WHO-HDI (HR = 0.81; 95%CI = 0.70-0.93). Adjusting for BMI did not attenuate the findings. A significant inverse association between diet quality and depression incidence was found in this population-based cohort study, independent of sociodemographic, health and lifestyle. Adherence to a healthy diet could be a complementary intervention for the prevention of depression.

Adherence to the Mediterranean Diet and Colorectal Cancer Risk Among Moroccan Population: Hospital-Based Case Control Study.

Colorectal cancer (CRC) is a significant public health problem, including Morocco. The Mediterranean Diet (MD) has demonstrated potential anticancerogenic effects toward CRC in Northern Mediterranean countries. Using a Modified Mediterranean Diet (MMD) score adapted to southern countries, we investigated the relationship between adherence to the MD and the risk of CRC among the Moroccan population. During the study, we recruited 395 cases matched with 395 controls by sex and age (± 3 years). Using an adapted Food Frequency Questionnaire, we assessed the dietary intakes of participants to calculate the MMD score. We estimated the odds ratio and 95% confidence interval for both basic and adjusted models to evaluate the relationship between adherence to the MD and the risk of CRC. We observed a significant inverse association between adherence to the MD and CRC risk. In the adjusted model, moderate adherence to the MD was associated with 52% lower risk of CRC [odds ratio (OR*): 0.48 and 95% confidence interval (95% CI): 0.37-0.69], while high adherence to the MD was associated with 61% lower risk of CRC compared to the lowest category. When stratified by sex, both moderate [OR*: 0.36 (CI95%: 0.27-0.55)] and high [OR*: 0.43 (CI95%:0.27-0.74)] adherence were inversely correlated with CRC risk for women, while for men, only high adherence was inversely correlated with the risk of CRC [OR*: 0.3 (CI95%:0.19-0.5)]. Adherence to MD is associated with a decreased risk of CRC, an association that may be influenced by tumor location, sex, and age. Despite certain differences between northern and southern countries, the MD can be an effective preventative measure against CRC for populations in the Southern Mediterranean region.

Greater adherence to the Healthy Nordic Food Index is associated with lower all-cause mortality in a population-based sample from northern Germany

PurposeDietary pattern scores reflecting a high intake of beneficial food groups were associated with reduced mortality risk. Data on associations of such dietary pattern scores in population-based samples from northern Germany are lacking. Therefore, we examined the association of three dietary pattern scores with all-cause mortality in a moderate-sized prospective sample from northern Germany.MethodsThe study sample comprised 836 participants (43.8% females, median age 62.4 years). Based on a validated, self-administered Food Frequency Questionnaire, the dietary scores Dietary Approaches to Stop Hypertension (DASH), Modified Mediterranean Diet Score (MMDS), and Healthy Nordic Food Index (HNFI) were calculated. Cox proportional hazard regression models, adjusted for age, sex, body mass index, waist to hip ratio, education, smoking status, total energy intake, and physical activity, were used to separately relate DASH, MMDS, and HNFI to all-cause mortality.ResultsDuring a median follow-up period of 11 years, 93 individuals died. While DASH and MMDS scores were not associated with all-cause mortality, greater adherence to HNFI was associated with lower mortality hazards (HR: 0.47 [95% CI 0.25–0.89] when comparing the highest score quartile to the lowest; HR: 0.79 [95% CI 0.64–0.98] for HNFI modeled as a 1-Standard Deviation increment). Among different HNFI components, higher intake of oats and cereals displayed the most conclusive association with all-cause mortality (HR: 0.59 [95% CI 0.38–0.91] when comparing high and low intake).ConclusionIn an elderly general population sample from northern Germany, we observed greater adherence to HNFI to be associated with lower all-cause mortality.

Comparison of Different Dietary Indices as Predictors of Inflammation, Oxidative Stress and Intestinal Microbiota in Middle-Aged and Elderly Subjects.

During the last decades the gut microbiota has been identified as a key mediator in the diet-health interaction. However, our understanding on the impact of general diet upon microbiota is still limited. Dietary indices represent an essential approach for addressing the link between diet and health from a holistic point of view. Our aim was to test the predictive potential of seven dietary ratings on biomarkers of inflammation, oxidative stress and on the composition and metabolic activity of the intestinal microbiota. A cross-sectional descriptive study was conducted on a sample of 73 subjects aged >50 years with non-declared pathologies. Dietary inflammatory index (DII), Empirical Dietary Inflammatory Index (EDII), Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), Mediterranean adapted Diet Quality Index-International (DQI-I), Modified Mediterranean Diet Score (MMDS) and relative Mediterranean Diet Score (rMED) were calculated based on a Food Frequency Questionnaire. Major phylogenetic types of the intestinal microbiota were determined by real time polymerase chain reaction (qPCR) and fecal short chain fatty acids (SCFAs) by gas chromatography. While DII, HEI, DQI-I and MMDS were identified as predictors of Faecalibacterium prausnitzii levels, AHEI and MMDS were negatively associated with Lactobacillus group. HEI, AHEI and MMDS were positively associated with fecal SCFAs. In addition, DII and EDII explained lipoperoxidation level and Mediterranean scores the serum IL-8 concentrations. The lower detection of IL-8 in individuals with higher scores on Mediterranean indices may be partially explained by the increased levels of the anti-inflammatory bacterium F. prausnitzii in such individuals.

Modified Mediterranean diet score adapted to a southern Mediterranean population and its relation to overweight and obesity risk.

The current study aimed to develop a modified Mediterranean diet (MMD) score adjusted to the southern Mediterranean countries' cultural specificities and to evaluate associations between adherence to this modified score and overweight/obesity risk in Moroccan adults. Population-based cross-sectional study. Rural and urban areas of the five greatest provinces of Morocco. In total, 1516 participants were recruited between September 2009 and February 2017. Dietary assessment was obtained using a validated Moroccan FFQ. We constructed a MMD score focusing on twelve components. The MMD score ranged from 0 (no adherence to the traditional southern Mediterranean diet (MD)) to 12 (maximal adherence) and was categorised as low (scores 0-4), moderate (scores 5-7) and high (scores 8-12). Among the whole population, 754 (50·5 %) were women and 738 (49·5 %) were men, and the mean age was about 55·60 ± 13·70. In total, 58 % of participants were moderately active. Regarding educational level, 50·7 % were illiterate. The prevalence of overweight and obesity was 43·3 and 8·6 %, respectively. In multivariate analyses, close adherence to MMD (scores 8-12) was associated with reduced overweight/obesity risk (OR 0·61, 95 % CI 0·44, 0·84). The prevalence of overweight and obesity was very high among Moroccan adults. Adherence to the traditional southern MD may help prevent overweight and obesity.

Tree nut snack consumption is associated with better diet quality and CVD risk in the UK adult population: National Diet and Nutrition Survey (NDNS) 2008-2014.

To examine associations of tree nut snack (TNS) consumption with diet quality and cardiovascular disease (CVD) risk in UK adults from National Diet and Nutrition Survey (NDNS) 2008-2014. Cross-sectional analysis using data from 4-d food diaries, blood samples and physical measurements for CVD risk markers. To estimate diet quality, modified Mediterranean Diet Score (MDS) and modified Healthy Diet Score (HDS) were applied. Associations of TNS consumption with diet quality and markers of CVD risk were investigated using survey-adjusted multivariable linear regression adjusted for sex, age, ethnicity, socio-economic and smoking status, region of residency and total energy and alcohol intake. UK free-living population. 4738 adults (≥19 years). TNS consumers had higher modified MDS and HDS relative to non-consumers. TNS consumers also had lower BMI, WC, SBP and DBP and higher HDL compared to non-consumers, although a dose-related fully adjusted significant association between increasing nut intake (g per 4184 kJ/1000 kcal energy intake) and lower marker of CVD risk was only observed for SBP. TNS consumption was also associated with higher intake of total fat, mono-, n-3 and n-6 polyunsaturated fatty acids, fibre, vitamin A, thiamin, folate, vitamin C, vitamin E, potassium, magnesium, phosphorus, selenium and iron; and lower intake of saturated fatty acids, trans fatty acids, total carbohydrate, starch, free sugar, sodium and chloride. TNS consumers report better dietary quality and consumption was associated with lower CVD risk factors. Encouraging replacement of less healthy snacks with TNS should be encouraged as part of general dietary guidelines.

Composition of Human Gut Microbiota After a Mediterranean Diet Intervention Among Fire Fighters (OR23-05-19)

ObjectivesWhile it is known that specific components of diet namely fiber, fatty acids, or polyphenols can modulate the gut microbiota, literature describing the influence of a specific dietary pattern such as the Mediterranean Diet (MD) on enteric microbiota especially in relation to health are scarce. The aim of this study was to evaluate whether a MD intervention and the adherence to MD influences the gut fecal microbial composition in firefighters participating in Feeding America’s Bravest, a randomized control trial. MethodsParticipants were firefighters who received a MD Nutritional Intervention (n = 22) or standard dietary advice (n = 24) as part of a cluster-randomized, controlled trial for 12 months. A lifestyle and food frequency questionnaire was administered and adherence scores to the MD were calculated (PREDIMED and Modified MD Score). Bacterial 16S rRNA sequencing was performed from fecal samples, and the microbial composition was analyzed with a bioinformatics pipeline implemented using QIIME 2. R software was used for linear modeling. ResultsThe predominant bacteria phyla in both groups were Firmicutes (52.9%), Bacteroidetes (39.8%), Proteobacteria (3.5%), and Actinobacteria (2.0%). A significant increase in the genus Prevotella was found in those in the intervention group (1.45 log-fold, P = 0.018) compared to controls. Furthermore, linear modeling revealed that higher adherence to MD was associated with lower abundance of Lachnospiriceae UCG-010 (R2 = 0.205, P < 0.001) and Eubacterium ventriosum group (R2 = 0.101, P = 0.016). There were no significant differences in alpha or beta diversity between the control and intervention group. ConclusionsA MD intervention as well as higher adherence influence gut microbiota composition; specifically, Prevotella, a genus previously associated with plant-rich diets, was significantly higher in the intervention group. Additionally, higher adherence to MD was associated with multiple genera of bacteria previously involved in SCFA production, which may help elucidate the beneficial effects of the Mediterranean Diet. Funding SourcesGrant support: EMW-2014-FP-00612, US Department of Homeland Security and Ohio University Startup funds.Trial Registration Number: NCT02941757

Postdiagnostic Mediterranean and Healthy Nordic Dietary Patterns Are Inversely Associated with All-Cause Mortality in Long-Term Colorectal Cancer Survivors

BackgroundDietary factors are known to affect the risk of new-onset colorectal cancer (CRC), but information on the extent to which postdiagnostic diet affects mortality in long-term CRC survivors is scarce. ObjectiveWe investigated the association of 2 a priori–defined postdiagnostic dietary patterns [Modified Mediterranean Diet Score (MMDS) and healthy Nordic Food Index (HNFI)] with all-cause mortality in long-term CRC survivors. MethodsDiet was assessed at a median time of 6 y after cancer diagnosis in 1404 CRC survivors (median age: 69 y; 56% men) in a prospective cohort study in Northern Germany by using a semiquantitative food-frequency questionnaire. Cox proportional hazard models, adjusting for clinical and sociodemographic characteristics, were used to assess associations of the MMDS and the HNFI with all-cause mortality. ResultsA total of 204 patients died during a median follow-up time of 7 y after diet assessment. In multivariable-adjusted models, higher adherence to the modified Mediterranean diet was significantly associated with lower all-cause mortality (HR: 0.48; 95% CI: 0.32, 0.74 for highest compared with lowest score quartile and HR: 0.88; 95% CI: 0.81, 0.96 per 1-point increment in pattern score). Similarly, the HNFI was inversely associated with all-cause mortality when the highest was compared with the lowest index quartile (HR: 0.63; 95% CI: 0.39, 1.04) and when modeled as a continuous trait (HR: 0.90; 95% CI: 0.82, 0.99 per 1-point increment in the score). ConclusionOur results suggest that higher adherences to the Mediterranean diet and to the healthy Nordic diet after CRC diagnosis are associated with better overall survival in long-term CRC survivors.

Association Between Adherence to the Mediterranean Diet and Asthma in Peruvian Children.

PurposeAdherence to a Mediterranean diet pattern may be associated with lower asthma prevalence in children. We sought to corroborate these findings in Peruvian children.MethodsThis case–control study included children of ages 9–19 years living in Lima, Peru. A food frequency questionnaire (FFQ) was completed and diet pattern was analyzed using a modified Mediterranean diet score (MDS). Primary analysis investigated the relationship between MDS and asthma status. Maternal education, age, sex, and body mass index category were included in multivariate model. Secondary outcomes included asthma control, forced expiratory volume in 1 s (FEV1), allergic rhinitis, and atopic status.Results287 participants with asthma and 96 controls without asthma completed a FFQ. Mean age was 13.5 years. According to the asthma control test (ACT), 86 % of those with asthma were controlled (score >19). MDS scores ranged 6–18 (median 15). In adjusted analysis, being above the median MDS scores was associated with decreased odds of asthma [OR = 0.55, 95 % CI (0.33, 0.92), p = 0.02]. Among children whose mothers completed secondary education, being above the median MDS significantly decreased the odds of asthma [OR = 0.31, 95 % CI (0.14, 0.71), p < 0.01], whereas among those whose mothers did not complete secondary education there was no protective effect [OR = 0.86, 95 % CI (0.43, 1.7), p = 0.66]. There was no association between MDS scores and asthma control, FEV1, allergic rhinitis, or atopic status.ConclusionAdherence to the Mediterranean diet was inversely associated with having asthma among children in Lima, Peru. This effect was strongest among children with better educated mothers.

Mediterranean diet and colorectal cancer risk: results from a European cohort

The authors investigated the association of adherence to Mediterranean diet with colorectal cancer (CRC) risk in the European Prospective Investigation into Cancer and nutrition study. Adherence to Mediterranean diet was expressed through two 10-unit scales, the Modified Mediterranean diet score (MMDS) and the Centre-Specific MMDS (CSMMDS). Both scales share the same dietary components but differ in the cut-off values that were used for these components in the construction of the scales. Adjusted hazard ratios (HR) for the associations of these scales with CRC incidence were estimated. After 5,296,617 person-years of follow-up, 4,355 incident CRC cases were identified. A decreased risk of CRC, of 8 and 11 % was estimated when comparing the highest (scores 6-9) with the lowest (scores 0-3) adherence to CSMMDS and MMDS respectively. For MMDS the HR was 0.89 (95 % confidence interval (CI): 0.80, 0.99). A 2-unit increment in either Mediterranean scale was associated with a borderline statistically significant 3 to 4 % reduction in CRC risk (HR for MMDS: 0.96; 95 % CI: 0.92, 1.00). These associations were somewhat more evident, among women, were mainly manifested for colon cancer risk and their magnitude was not altered when alcohol was excluded from MMDS. These findings suggest that following a Mediterranean diet may have a modest beneficial effect on CRC risk.

Lifestyle, Mediterranean diet and survival in European post-myocardial infarction patients

The extent and benefits of adherence to lifestyle and dietary recommendations in secondary prevention are largely unknown. We examined the frequency of healthy dietary and lifestyle behaviours and their impact on survival in post-myocardial infarction (MI) patients in a prospective cohort study of elderly Europeans. Adherence to a Mediterranean-type diet was measured with a modified Mediterranean Diet Score (MDS) on an eight-point scale. Participants were 426 men and women, aged 70 years or more, from 10 European countries, with a history of MI. During 10 years of follow-up mortality was 53%. Frequency of non-smoking behaviour (85%), moderate to vigorous physical activity (54%), moderate alcohol consumption (45%) and a Mediterranean-type diet (63%) in patients differed only marginally as compared with 'healthy' elderly. The median MDS in patients from northern Europe was two points lower than in southern Europe. Non-smoking [hazards ratio (HR) 0.62; 95% confidence interval (95% CI) 0.44-0.88], physical activity (HR 0.69; 95% CI 0.53-0.90), moderate alcohol consumption (HR 0.77; 95% CI 0.58-1.02) and a Mediterranean-type diet (HR 0.75; 95% CI 0.57-0.97) were associated with lower all-causes mortality. Presence of at least three healthy behaviours was associated with 40% lower mortality. There is a strong relationship between lifestyle and dietary habits and mortality in post-MI patients. The findings implicate that substantial health gain can be obtained by better adherence to dietary and lifestyle recommendations.