Validity of the energy-restricted Mediterranean Diet Adherence Screener.

BACKGROUND

Short dietary assessment tools can be useful to estimate food intake and diet quality in large-scale epidemiological studies with time constraints.

OBJECTIVE

To determine the concurrent validity of the 17-item energy-restricted Mediterranean Adherence Screener (er-MEDAS) used in the PREDIMED (PREvención con DIeta MEDiterránea)-Plus trial and to analyse its capacity to detect 1-year changes in diet and cardiometabolic risk factors.

METHODS

Validation study nested in the PREDIMED-Plus (n = 6760, 55-75 years). Dietary data were collected by the 17-item er-MEDAS and a 143-item validated semiquantitative food frequency questionnaire (FFQ) at baseline and after 1-year intervention. Cardiometabolic risk markers were measured at both time points. A Mediterranean diet (MedDiet) score was derived from both instruments. Concurrent validity was evaluated by Pearson and intra-class correlation coefficients (ICC) and Bland and Altman limits of agreement. Construct validity was evaluated by assessing 1-year changes in FFQ-reported dietary intake and cardiometabolic profile changes in relation to changes in er-MEDAS.

RESULTS

A moderate to good correlation between the MedDiet score calculated by both measurement instruments was found: r = 0.61 and ICC = 0.60 (both p < 0.001). Agreement of each of the er-MEDAS items ranged from 55.4% to 85.0% with a moderate mean concordance (kappa = 0.41). Between baseline and 1-year follow-up, energy intake measured by the FFQ decreased by 242 kcal, while Mediterranean food consumption increased in participants with the highest increase in the er-MEDAS MedDiet score. An increase in the er-MEDAS MedDiet score ratings was associated with a decrease in BMI, waist circumference, triglycerides, fasting glucose, diastolic blood pressure, and triglycerides/HDL-cholesterol ratio (p < 0.001 for all), and with an increase in HDL-cholesterol (p = 0.006).

CONCLUSION

The er-MEDAS shows a modest to good concurrent validity compared with FFQ data. It shows acceptable construct validity, as a greater er-MEDAS score was associated with more favourable dietary and cardiometabolic profiles over time.

TRIAL REGISTRY

ISRCTN89898870; registration date, 24 July 2014. https://www.isrctn.com/ISRCTN89898870.

Informations de copyright

Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interest Dr Salas-Salvadó reports serving on the board of and receiving grant support (through his institution) from the International Nut and Dried Fruit Council and the Eroski Foundation, and serving on the Executive Committee of the Instituto Danone Spain and on the Scientific Committee of the Danone International Institute. He has received research support from Patrimonio Comunal Olivarero and Borges S.A., Spain. He reports receiving consulting fees or travel expenses from Danone; Eroski Foundation, Instituto Danone—Spain, and Abbot Laboratories. Dr Ros reports grants, non-financial support, and other fees from California Walnut Commission and Alexion, and non-financial support from the International Nut and Dried Fruit Council, all outside of the submitted work. Dr Pintó reports serving on the board of and receiving personal consulting fees from Sanofi Aventis, Amgen, and Abbott Laboratories, as well as personal lecture fees from Esteve, Lacer, and Rubio laboratories. Victor Micó reports grants from Fundación Cerveza y Salud. Dr Corella reported receiving grants from ISCIII during the conduct of the study. Dr Romaguera reported receiving grants from ISCIII during the conduct of the study and grants from Fundación AstraZeneca outside the submitted work. Dr Estruch reported receiving grants from ISCIII and olive oil for the trial from Fundacion Patrimonio Comunal Olivarero during the conduct of the study and personal fees from Brewers of Europe, Fundación Cerveza y Salud, Interprofesional del Aceite de Oliva, Instituto Cervantes, Pernaud Richar, Fundación Dieta Mediterránea, and Wine and Culinary International Forum; also nonfinancial support from Sociedad Española de Nutrición and Fundación Bosch y Gimpera and grants from Uriach Laboratories outside the submitted work. Dr López-Miranda reported receiving grants from Fondo de Investigaciones Sanitarias, ISCIII, during the conduct of the study. Dr Matía-Martín reported receiving grants from ISCIII during the conduct of the study and personal fees from Organización Interprofesional Láctea outside the submitted work. Dr Vidal reported receiving grants from ISCIII during the conduct of the study.