Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Comparison of five international indices of adherence to the Mediterranean diet among healthy adults: similarities and differences

  • Aoun, Carla (Laboratoire de pharmacologie, pharmacie clinique et controle de qualito des medicaments, Faculty of pharmacy, Saint-Joseph University of Beirut) ;
  • Papazian, Tatiana (Laboratoire de pharmacologie, pharmacie clinique et controle de qualito des medicaments, Faculty of pharmacy, Saint-Joseph University of Beirut) ;
  • Helou, Khalil (Department of nutrition, Faculty of pharmacy, Saint-Joseph University of Beirut) ;
  • El Osta, Nada (Department of Public Health, Faculty of Medicine, Saint-Joseph University) ;
  • Khabbaz, Lydia Rabbaa (Laboratoire de pharmacologie, pharmacie clinique et controle de qualito des medicaments, Faculty of pharmacy, Saint-Joseph University of Beirut)
  • Received : 2019.03.08
  • Accepted : 2019.07.03
  • Published : 2019.08.01
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Abstract

BACKGROUND/OBJECTIVES: To compare five indices of adherence to the Mediterranean Diet (MD) among adults living in the Mediterranean region. SUBJECTS/METHODS: A total of 100 healthy Lebanese adults aged between 18 and 65 years. Face-to-face interviews to collect sociodemographic and medical information, to take anthropometric measurements, and to fill a validated, culturally adapted, food frequency questionnaire (FFQ). The score for each item was calculated following the recommendations for each corresponding index. The five MD indices were Mediterranean Diet Scale (MDScale), Mediterranean Food Pattern (MFP), MD Score (MDS), Short Mediterranean Diet Questionnaire (SMDQ), and the MedDiet score. RESULTS: Significant correlations were detected between items with P-values < 0.001. Minimal agreement was seen between MDScale and MedDiet score and maximal agreement between MDS and MedDiet score. Univariate and multivariate analyses showed that MDS and MedDiet scores had significant correlations with fiber and olive oil intake, main components of the MD. MDScale showed a significant correlation with waist-to-hip ratio and with total energy intake but none of the five indices was correlated to body mass index (BMI). CONCLUSIONS: The indices that showed the highest correlation with variables related to the MD are the MDScale and the MedDiet score; therefore, they can be used to assess our future study populations. Based on the current results, more than half of the study population was non-adherent to the MD and adherence to this diet did not appear to protect against being overweight ($BMI{\geq}30$).

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References

  1. Arvaniti F, Panagiotakos DB. Healthy indexes in public health practice and research: a review. Crit Rev Food Sci Nutr 2008;48:317-27. https://doi.org/10.1080/10408390701326268
  2. Martinez-Gonzalez MA, Garcia-Lopez M, Bes-Rastrollo M, Toledo E, Martinez-Lapiscina EH, Delgado-Rodriguez M, Vazquez Z, Benito S, Beunza JJ. Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort. Nutr Metab Cardiovasc Dis 2011;21:237-44. https://doi.org/10.1016/j.numecd.2009.10.005
  3. Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, Benito S, Tortosa A, Bes-Rastrollo M. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 2008;336:1348-51. https://doi.org/10.1136/bmj.39561.501007.BE
  4. Anastasiou CA, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou GM, Sakka P, Arampatzi X, Bougea A, Labropoulos I, Scarmeas N. Mediterranean diet and cognitive health: initial results from the Hellenic Longitudinal Investigation of Ageing and Diet. PLoS One 2017;12:e0182048. https://doi.org/10.1371/journal.pone.0182048
  5. Saulle R, Semyonov L, La Torre G. Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients 2013;5:4566-86. https://doi.org/10.3390/nu5114566
  6. Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies. Int J Cancer 2014;135:1884-97. https://doi.org/10.1002/ijc.28824
  7. Velazquez-Lopez L, Santiago-Diaz G, Nava-Hernandez J, Munoz-Torres AV, Medina-Bravo P, Torres-Tamayo M. Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity. BMC Pediatr 2014;14:175. https://doi.org/10.1186/1471-2431-14-175
  8. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995;61:1402S-1406S. https://doi.org/10.1093/ajcn/61.6.1402S
  9. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348:2599-608. https://doi.org/10.1056/NEJMoa025039
  10. Gardener S, Gu Y, Rainey-Smith SR, Keogh JB, Clifton PM, Mathieson SL, Taddei K, Mondal A, Ward VK, Scarmeas N, Barnes M, Ellis KA, Head R, Masters CL, Ames D, Macaulay SL, Rowe CC, Szoeke C, Martins RN; AIBL Research Group. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Transl Psychiatry 2012;2:e164. https://doi.org/10.1038/tp.2012.91
  11. Martinez-Gonzalez MA, Fernandez-Jarne E, Serrano-Martinez M, Marti A, Martinez JA, Martin-Moreno JM. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr 2002;41:153-60. https://doi.org/10.1007/s00394-002-0370-6
  12. Leighton F, Polic G, Strobel P, Perez D, Martinez C, Vasquez L, Castillo O, Villarroel L, Echeverria G, Urquiaga I, Mezzano D, Rozowski J. Health impact of Mediterranean diets in food at work. Public Health Nutr 2009;12:1635-43. https://doi.org/10.1017/S1368980009990486
  13. Zito FP, Polese B, Vozzella L, Gala A, Genovese D, Verlezza V, Medugno F, Santini A, Barrea L, Cargiolli M, Andreozzi P, Sarnelli G, Cuomo R. Good adherence to Mediterranean diet can prevent gastrointestinal symptoms: a survey from Southern Italy. World J Gastrointest Pharmacol Ther 2016;7:564-71. https://doi.org/10.4292/wjgpt.v7.i4.564
  14. Papadaki A, Wood L, Sebire SJ, Jago R. Adherence to the Mediterranean diet among employees in South West England: formative research to inform a web-based, work-place nutrition intervention. Prev Med Rep 2015;2:223-8. https://doi.org/10.1016/j.pmedr.2015.03.009
  15. Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, Corella D, Covas MI, Schroder H, Aros F, Gomez-Gracia E, Fiol M, Ruiz-Gutierrez V, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Munoz MA, Warnberg J, Ros E, Estruch R; PREDIMED Study Investigators. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 2012;7:e43134. https://doi.org/10.1371/journal.pone.0043134
  16. Panagiotakos DB, Pitsavos C, Stefanadis C. Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis 2006;16:559-68. https://doi.org/10.1016/j.numecd.2005.08.006
  17. Mila-Villarroel R, Bach-Faig A, Puig J, Puchal A, Farran A, Serra-Majem L, Carrasco JL. Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet. Public Health Nutr 2011;14:2338-45. https://doi.org/10.1017/S1368980011002606
  18. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 5th ed. Boston: Pearson/Allyn & Bacon; 2007.
  19. Papazian T, Hout H, Sibai D, Helou N, Younes H, El Osta N, Khabbaz LR. Development, reproducibility and validity of a food frequency questionnaire among pregnant women adherent to the Mediterranean dietary pattern. Clin Nutr 2016;35:1550-6. https://doi.org/10.1016/j.clnu.2016.04.015
  20. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D. Diet and overall survival in elderly people. BMJ 1995;311:1457. https://doi.org/10.1136/bmj.311.7018.1457
  21. Buckland G, Ros MM, Roswall N, Bueno-de-Mesquita HB, Travier N, Tjonneland A, Kiemeney LA, Sacerdote C, Tumino R, Ljungberg B, Gram IT, Weiderpass E, Skeie G, Malm J, Ehrnstrom R, Chang-Claude J, Mattiello A, Agnoli C, Peeters PH, Boutron-Ruault MC, Fagherazzi G, Clavel-Chapelon F, Nilsson LM, Amiano P, Trichopoulou A, Oikonomou E, Tsiotas K, Sanchez MJ, Overvad K, Quiros JR, Chirlaque MD, Barricarte A, Key TJ, Allen NE, Khaw KT, Wareham N, Riboli E, Kaaks R, Boeing H, Palli D, Romieu I, Romaguera D, Gonzalez CA. Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study. Int J Cancer 2014;134:2504-11. https://doi.org/10.1002/ijc.28573
  22. de la Fuente-Arrillaga C, Zazpe I, Santiago S, Bes-Rastrollo M, Ruiz-Canela M, Gea A, Martinez-Gonzalez MA. Beneficial changes in food consumption and nutrient intake after 10 years of follow-up in a Mediterranean cohort: the SUN project. BMC Public Health 2016;16:203. https://doi.org/10.1186/s12889-016-2739-0
  23. Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, Willett WC, Rimm EB, Hu FB. Changes in diet quality scores and risk of cardiovascular disease among US men and women. Circulation 2015;132:2212-9. https://doi.org/10.1161/CIRCULATIONAHA.115.017158
  24. Vidal-Peracho C, Tricas-Moreno JM, Lucha-Lopez AC, Lucha-Lopez MO, Camunas-Pescador AC, Caverni-Munoz A, Fanlo-Mazas P. Adherence to Mediterranean diet pattern among Spanish adults attending a medical centre: nondiabetic subjects and type 1 and 2 diabetic patients. J Diabetes Res 2017;2017:5957821.
  25. Savanelli MC, Barrea L, Macchia PE, Savastano S, Falco A, Renzullo A, Scarano E, Nettore IC, Colao A, Di Somma C. Preliminary results demonstrating the impact of Mediterranean diet on bone health. J Transl Med 2017;15:81. https://doi.org/10.1186/s12967-017-1184-x
  26. Echeverria G, McGee EE, Urquiaga I, Jimenez P, D'Acuna S, Villarroel L, Velasco N, Leighton F, Rigotti A. Inverse associations between a locally validated Mediterranean diet index, overweight/obesity, and metabolic syndrome in Chilean adults. Nutrients 2017;9:E862. https://doi.org/10.3390/nu9080862
  27. Kapelios CJ, Kyriazis I, Ioannidis I, Dimosthenopoulos C, Hatziagelaki E, Liatis S; PERSEAS Study Group. Diet, life-style and cardiovascular morbidity in the rural, free living population of Elafonisos island. BMC Public Health 2017;17:147. https://doi.org/10.1186/s12889-017-4053-x
  28. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Mahwah: Lawrence Erlbaum Associates, Publishers; 1988.
  29. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 2014;17:2769-82. https://doi.org/10.1017/S1368980013003169
  30. Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Mediterranean diet and metabolic syndrome: an updated systematic review. Rev Endocr Metab Disord 2013;14:255-63. https://doi.org/10.1007/s11154-013-9253-9
  31. Rienks J, Dobson AJ, Mishra GD. Mediterranean dietary pattern and prevalence and incidence of depressive symptoms in mid-aged women: results from a large community-based prospective study. Eur J Clin Nutr 2013;67:75-82. https://doi.org/10.1038/ejcn.2012.193
  32. Issa C, Darmon N, Salameh P, Maillot M, Batal M, Lairon D. A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon. Int J Obes (Lond) 2011;35:251-8. https://doi.org/10.1038/ijo.2010.130
  33. Fakhoury-Sayegh N, Younes H, Heraoui GN, Sayegh R. Nutritional profile and dietary patterns of lebanese non-alcoholic fatty liver disease patients: a case-control study. Nutrients 2017;9:E1245. https://doi.org/10.3390/nu9111245
  34. Parlapani E, Agakidis C, Karagiozoglou-Lampoudi T, Sarafidis K, Agakidou E, Athanasiadis A, Diamanti E. The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity. J Matern Fetal Neonatal Med 2017;13:1-8. https://doi.org/10.1080/jmf.13.1.1.1
  35. Martinez-Gonzalez MA, Hershey MS, Zazpe I, Trichopoulou A. Transferability of the Mediterranean diet to non-Mediterranean countries. What is and what is not the Mediterranean diet. Nutrients 2017;9:E1226. https://doi.org/10.3390/nu9111226
  36. Papazian T, Serhal A, Hout H, Younes H, Tayeh GA, Azouri J, Moussa Lteif FH, Kesrouani A, Khabbaz LR. Discrepancies among different tools evaluating Mediterranean diet adherence during pregnancy, correlated to maternal anthropometric, dietary and biochemical characteristics. Clin Nutr 2019;38:1398-1405. https://doi.org/10.1016/j.clnu.2018.06.960
  37. Guasch-Ferre M, Hu FB, Martinez-Gonzalez MA, Fito M, Bullo M, Estruch R, Ros E, Corella D, Recondo J, Gomez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Munoz MA, Pinto X, Lamuela-Raventos RM, Basora J, Buil-Cosiales P, Sorli JV, Ruiz-Gutierrez V, Martinez JA, Salas-Salvado J. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med 2014;12:78. https://doi.org/10.1186/1741-7015-12-78
  38. Buil-Cosiales P, Zazpe I, Toledo E, Corella D, Salas-Salvado J, Diez-Espino J, Ros E, Fernandez-Creuet Navajas J, Santos-Lozano JM, Aros F, Fiol M, Castaner O, Serra-Majem L, Pinto X, Lamuela-Raventos RM, Marti A, Basterra-Gortari FJ, Sorli JV, Verdu-Rotellar JM, Basora J, Ruiz-Gutierrez V, Estruch R, Martinez-Gonzalez MA. Fiber intake and all-cause mortality in the Prevencion con Dieta Mediterranea (PREDIMED) study. Am J Clin Nutr 2014;100:1498-507. https://doi.org/10.3945/ajcn.114.093757
  39. Urquiaga I, Echeverria G, Dussaillant C, Rigotti A. Origin, components and mechanisms of action of the Mediterranean diet. Rev Med Chil 2017;145:85-95. https://doi.org/10.4067/S0034-98872017000100012
  40. Willett WC. The Mediterranean diet: science and practice. Public Health Nutr 2006;9:105-10. https://doi.org/10.1079/PHN2005931
  41. Matsumoto Y, Sugioka Y, Tada M, Okano T, Mamoto K, Inui K, Habu D, Koike T. Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: the TOMORROW study. Clin Nutr 2018;37:675-80. https://doi.org/10.1016/j.clnu.2017.02.011
  42. Alkerwi A, Vernier C, Crichton GE, Sauvageot N, Shivappa N, Hebert JR. Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study. Br J Nutr 2015;113:259-69. https://doi.org/10.1017/S0007114514003456
  43. Trichopoulou A, Naska A, Orfanos P, Trichopoulos D. Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study. Am J Clin Nutr 2005;82:935-40. https://doi.org/10.1093/ajcn/82.5.935
  44. Rossi M, Negri E, Bosetti C, Dal Maso L, Talamini R, Giacosa A, Montella M, Franceschi S, La Vecchia C. Mediterranean diet in relation to body mass index and waist-to-hip ratio. Public Health Nutr 2008;11:214-7. https://doi.org/10.1017/S1368980007000833
  45. Naja F, Nasreddine L, Itani L, Adra N, Sibai AM, Hwalla N. Association between dietary patterns and the risk of metabolic syndrome among Lebanese adults. Eur J Nutr 2013;52:97-105. https://doi.org/10.1007/s00394-011-0291-3
  46. Nasreddine L, Hwalla N, Sibai A, Hamze M, Parent-Massin D. Food consumption patterns in an adult urban population in Beirut, Lebanon. Public Health Nutr 2006;9:194-203. https://doi.org/10.1079/PHN2005855
  47. Monteagudo C, Mariscal-Arcas M, Rivas A, Lorenzo-Tovar ML, Tur JA, Olea-Serrano F. Proposal of a Mediterranean diet serving score. PLoS One 2015;10:e0128594. https://doi.org/10.1371/journal.pone.0128594
  48. Zaragoza-Marti A, Cabanero-Martinez MJ, Hurtado-Sanchez JA, Laguna-Perez A, Ferrer-Cascales R. Evaluation of Mediterranean diet adherence scores: a systematic review. BMJ Open 2018;8:e019033. https://doi.org/10.1136/bmjopen-2017-019033
  49. Naja F, Hwalla N, Itani L, Baalbaki S, Sibai A, Nasreddine L. A novel Mediterranean diet index from Lebanon: comparison with Europe. Eur J Nutr 2015;54:1229-43. https://doi.org/10.1007/s00394-014-0801-1

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