Proposal of a Mediterranean Diet Serving Score

Celia Monteagudo, Miguel Mariscal-Arcas, Ana Rivas, María Luisa Lorenzo-Tovar, Josep A Tur, Fátima Olea-Serrano, Celia Monteagudo, Miguel Mariscal-Arcas, Ana Rivas, María Luisa Lorenzo-Tovar, Josep A Tur, Fátima Olea-Serrano

Abstract

Background and aims: Numerous studies have demonstrated a relationship between Mediterranean Diet (MD) adherence and the prevention of cardiovascular diseases, cancer, and diabetes, etc. The study aim was to validate a novel instrument to measure MD adherence based on the consumption of food servings and food groups, and apply it in a female population from southern Spain and determining influential factors.

Methods and results: The study included 1,155 women aged 12-83 yrs, classified as adolescents, adults, and over-60-yr-olds. All completed a validated semi-quantitative food frequency questionnaire (FFQ). The Mediterranean Dietary Serving Score (MDSS) is based on the latest update of the Mediterranean Diet Pyramid, using the recommended consumption frequency of foods and food groups; the MDSS ranges from 0 to 24. The discriminative power or correct subject classification capacity of the MDSS was analyzed with the Receiver Operating Characteristic (ROC) curve, using the MDS as reference method. Predictive factors for higher MDSS adherence were determined with a logistic regression model, adjusting for age. According to ROC curve analysis, MDSS evidenced a significant discriminative capacity between adherents and non-adherents to the MD pattern (optimal cutoff point=13.50; sensitivity=74%; specificity=48%). The mean MDSS was 12.45 (2.69) and was significantly higher with older age (p<0.001). Logistic regression analysis showed highest MD adherence by over 60-year-olds with low BMI and no habit of eating between meals.

Conclusions: The MDSS is an updated, easy, valid, and accurate instrument to assess MD adherence based on the consumption of foods and food groups per meal, day, and week. It may be useful in future nutritional education programs to prevent the early onset of chronic non-transmittable diseases in younger populations.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Discriminative power of the MDSS…
Fig 1. Discriminative power of the MDSS (ROC curve) using the MDS as reference method.
The cutoff point for the reference method (MDS) was an MDS of 6, in agreement with other authors who considered that the upper tertile represents greater adherence to this dietary pattern [–26].
Fig 2
Fig 2
(a) Number of servings for each food group per meal, day, or week, according to MDSS tertiles. Differences by Student T-test: *p<0.05. s/m = serving/meal; s/d = serving/day; s/w = serving/week. (b) Number of servings for each food group per meal, day, or week for adolescent, adult, and elderly women. Differences by ANOVA: *p<0.001; §p<0.05. s/m = serving/meal; s/d = serving/day; s/w = serving/week.

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