1. Validity of the energy-restricted Mediterranean Diet Adherence Screener
- Author
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Camille Lassale, Josep Vidal, Miguel Ángel Martínez-González, Ana García-Arellano, Aurora Bueno-Cavanillas, Jordi Salas-Salvadó, José J. Gaforio, Francisco J. Tinahones, José López Miranda, Emilio Ros, José V. Sorlí, Maria Dolors Zomeño, Dolores Corella, Julia Wärnberg, Angel M Alonso Gómez, Helmut Schröder, Dora Romaguera, Clotilde Vázquez, PREDIMED-Plus Investigators, Nancy Babio, Olga Castañer, Josep A. Tur, José Lapetra, Montserrat Fitó, J. Alfredo Martínez, Ramon Estruch, Andrés Díaz-López, Pilar Matía-Martín, Lluis Serra-Majem, Lidia Daimiel, Vicente Martín, Jesús Vioque, Xavier Pintó, Miguel Ruiz-Canela, Instituto de Salud Carlos III, European Commission, European Research Council, Junta de Andalucía, Generalitat Valenciana, AstraZeneca, Govern de les Illes Balears, Centros de Investigación Biomédica en Red (España), Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (España), and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (España)
- Subjects
Blood Glucose ,Male ,Food intake ,Validation study ,Mediterranean diet ,Energy restriction ,Concurrent validity ,Blood Pressure ,Critical Care and Intensive Care Medicine ,Diet, Mediterranean ,Diet Surveys ,Body Mass Index ,Nutrition Policy ,Validity ,Environmental health ,Surveys and Questionnaires ,Validation ,Medicine ,Humans ,Mass Screening ,Dieta mediterranea ,Triglycerides ,Aged ,Caloric Restriction ,Randomized Controlled Trials as Topic ,Nutrition and Dietetics ,business.industry ,Limits of agreement ,Construct validity ,Reproducibility of Results ,Middle Aged ,Predimed ,Diet ,Female ,Short screener ,Guideline Adherence ,Diet, Healthy ,Waist Circumference ,business ,Biomarkers - Abstract
[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., The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund four coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal, including the following projects: PI13/00673, PI13/ 00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/ 00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/ 00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926; the Special Action Project entitled Implementación y evaluación de una intervención intensiva sobre la actividad física cohorte" PREDIMED-Plus grant to Jordi Salas-Salvadó; the Recercaixa grant to Jordi Salas-Salvadó (2013ACUP00194); the European Research Council Advanced Research Grant 2013–2018 (340918) granted to Miguel Ángel Martínez-Gonzalez, grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016, PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant and FEDER funds (CB06/03) to Josep A. Tur; the Astra Zeneca Young Investigators Award in Category of Obesity and Diabetes 2017 to Dora Romaguera; the ‘FOLIUM’ programme within the FUTURMed project from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014–2020 of the Balearic Islands). JR17/00022 contract to Olga Castaner from ISCIII. CIBERobn (Centros de Investigación Biomedica en Red: Obesidad y Nutrición), CIBEResp (Centros de Investigación Biomedica en Red: Epidemiología y Salud Publica) and CIBERdem (Centros de Investigación Biomedica en Red: Diabetes y Enfermedades). J. Salas-Salvadó gratefully acknowledges the financial support provided by the ICREA Academia programme. None of the funding sources took part in the design, collection, analysis, or interpretation of the data; in writing the manuscript; or in the decision to submit the manuscript for publication.
- Published
- 2021