Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study) Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease. Determinants of the adherence to an “a priori” defined Mediterranean dietary pattern Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. Mediterranean diet and cognitive function: The sun project Mediterranean diet and CHD: the Greek European Prospective Investigation into Cancer and Nutrition cohort. Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial Mediterranean Diet and Type 2 Diabetes Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC) Study Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study Mediterranean diet adherence and cognitive function in older UK adults: the European Prospective Investigation into Cancer and Nutrition-Norfolk (EPIC-Norfolk) Study. Adherence to the Mediterranean Diet and all-cause mortality risk in an elderly Italian population: Data from the ILSA study Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study. Mediterranean diet and cognitive decline over time in an elderly Mediterranean population Effectiveness of cognitive-behavioral therapy based on the Mediterranean diet for the treatment of obesity. Educational intervention to improve adherence to the Mediterranean diet among parents and their children aged 1-2 years. EniM clinical trial. Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Adherence to a Mediterranean diet and risk of incident cognitive impairment
The Mediterranean diet ( MD ) is recognized as one of the healthiest dietary patterns and has benefits such as improving glycaemic control among patients with type 2 diabetes ( T2DM ) . Our aim is to assess the effectiveness of a multifactorial intervention to improve adherence to the MD , diet quality and biomedical parameters . The EMID study is a r and omized and controlled clinical trial with two parallel groups and a 12-month follow-up period . The study included 204 subjects between 25–70 years with T2DM . The participants were r and omized into intervention group ( IG ) and control group ( CG ) . Both groups received brief advice about healthy eating and physical activity . The IG participants additionally took part in a food workshop , five walks and received a smartphone application for three months . The population studied had a mean age of 60.6 years . At the 3-month follow-up visit , there were improvements in adherence to the MD and diet quality of 2.2 and 2.5 points , compared to the baseline visit , respectively , in favour of the IG . This tendency of the improvement was maintained , in favour of the IG , at the 12-month follow-up visit . In conclusion , the multifactorial intervention performed could improve adherence to the MD and diet quality among patients with T2DM OBJECTIVE We examined associations between two  Mediterranean diet ( MD ) adherence indexes ( the MD index , MDI , and the MD score , MDS ) and several blood biomarkers of diet and disease . SUBJECTS We studied 328 individuals from Catalonia ( Northeastern Spain ) , ages 18 - 75 , who provided fasting blood sample s , a subset of the 2346 individuals as part of a larger representative and r and om sample from the 1992 - 1993 Catalan Nutritional Survey . DESIGN AND METHOD Diet was measured using 24-h recalls . Biomarkers studied were plasma levels of beta-carotene , alpha-tocopherol , retinol , vitamins B12 , C and folates as well as serum total cholesterol , HDL cholesterol , LDL cholesterol and triglycerides . Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes , adjusting for potential confounders . RESULTS AND CONCLUSIONS Subjects with higher MD adherence , as measured by the two dietary indexes , had significantly higher plasma concentrations of beta-carotene , folates , vitamin C , alpha-tocopherol and HDL cholesterol . The most highly significant relationship was that between folates and the adherence to the MD Pattern , as determined by both indexes . These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern . This type of data not only informs the development of robust dietary adherence indexes , but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk Summary . Background : A prospect i ve cohort study with university level participants was initiated to study the effect of Mediterranean diet on health . Aims : The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern ( MDP ) . Method : This analysis includes 1587 males and 2260 females . MDP was defined “ a priori ” by summing the st and ardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable . Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females . Results : Women were more compliant than men with the MDP ( Coefficient regression ( b ) = 4.1 ; Confidence Interval ( CI ) 95 % = 3.2 to 4.9 ) . The compliance with the MDP was significantly poorer among younger participants both in men and women ( p < 0.001 in men and in women ) . Participants who were more physically active were more likely to fulfill the traditional MDP ( p = 0.01 in men and p < 0.001 in women ) . Conclusions : Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area . A more active life-style is associated with a better compliance with the MDP CONTEXT Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases , but its association with cognitive decline is unclear . OBJECTIVE To investigate the association of a Mediterranean diet with change in cognitive performance and risk for dementia in elderly French persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1410 adults ( > or = 65 years ) from Bordeaux , France , included in the Three-City cohort in 2001 - 2002 and reexamined at least once over 5 years .  Adherence to a Mediterranean diet ( scored as 0 to 9 ) was computed from a food frequency question naire and 24-hour recall . MAIN OUTCOME MEASURES Cognitive performance was assessed on 4 neuropsychological tests : the Mini-Mental State Examination ( MMSE ) , Isaacs Set Test ( IST ) , Benton Visual Retention Test ( BVRT ) , and Free and Cued Selective Reminding Test ( FCSRT ) . Incident cases of dementia ( n = 99 ) were vali date d by an independent expert committee of neurologists . RESULTS Adjusting for age , sex , education , marital status , energy intake , physical activity , depressive symptomatology , taking 5 medications/d or more , apolipoprotein E genotype , cardiovascular risk factors , and stroke , higher Mediterranean diet score was associated with fewer MMSE errors ( beta = -0.006 ; 95 % confidence interval [ CI ] , -0.01 to -0.0003 ; P = .04 for 1 point of the Mediterranean diet score ) . Performance on the IST , BVRT , or FCSRT over time was not significantly associated with Mediterranean diet adherence . Greater adherence as a categorical variable ( score 6 - 9 ) was not significantly associated with fewer MMSE errors and better FCSRT scores in the entire cohort , but among individuals who remained free from dementia over 5 years , the association for the highest compared with the lowest group was significant ( adjusted for all factors , for MMSE : beta = -0.03 ; 95 % CI , -0.05 to -0.001 ; P = .04 ; for FCSRT : beta = 0.21 ; 95 % CI , 0.008 to 0.41 ; P = .04 ) . Mediterranean diet adherence was not associated with the risk for incident dementia ( fully adjusted model : hazard ratio , 1.12 ; 95 % CI , 0.60 to 2.10 ; P = .72 ) , although power to detect a difference was limited . CONCLUSIONS Higher adherence to a Mediterranean diet was associated with slower MMSE cognitive decline but not consistently with other cognitive tests . Higher adherence was not associated with risk for incident dementia Objective Our aim was to evaluate the association between adherence to the Mediterranean Diet ( MedDiet ) and cognitive function in 823 participants ( 62 ± 6 years at baseline ) from a Spanish prospect i ve cohort ( SUN project ) . Method A vali date d 136-item food frequency question naire was used to assess the adherence to the MedDiet at baseline . The 10-point ( 0 to 9 ) MedDiet Score was used to categorize adherence to MedDiet . Cognitive function was assessed twice at follow-up with a mean follow-up time between exposure and outcome assessment of 6 and 8y using the  Telephone Interview of Cognitive Status-modified ( TICS-m , range 0 to 54 points ) . ANCOVA models were used to assess the association between adherence to the MedDiet and cognitive decline . Results In the multivariable-adjusted analysis of 2-year changes , a higher cognitive decline was observed among participants with low or moderate baseline adherence to the MedDiet than among those with better adherence ( adjusted difference = −0.56 points in TICS-m , 95 % CI = −0.99 to −0.13 ) . Conclusion A higher adherence to the MedDiet  might be associated with better cognitive function . However , observed differences were of small magnitude and further studies are needed to confirm this finding Adherence to the Mediterranean diet ( MD ) has been reported to improve CHD prognosis and to be inversely associated with CHD mortality . The aim of the present study was to investigate the association of adherence to the MD with CHD incidence and mortality in the Greek European Prospect i ve Investigation into Cancer and Nutrition cohort , a population with traditional Mediterranean roots . In a general population sample of 23,929 adult men and women with no CVD or cancer at enrolment , a vali date d FFQ was interviewer-administered , sociodemographic , physical activity and other characteristics were recorded , and arterial blood pressure and anthropometric characteristics were measured . In a median period of 10 years , 636 incident CHD cases and 240 CHD deaths were recorded . Associations of adherence to the MD , operationalised through a nine-component score ( 0 , poor ; 9 , excellent ) , with CHD incidence and mortality were evaluated through Cox regression controlling for potentially confounding variables . A two-point increase in the MD score was associated with lower CHD mortality by 25 % ( 95 % CI 0.57 , 0.98 ) among women and 19 % ( 95 % CI 0.67 , 0.99 ) among men . The association of adherence to the MD with CHD incidence was again inverse , but weaker ( hazard ratios 0.85 ( 95 % CI 0.71 , 1.02 ) among women and 0.98 ( 95 % CI 0.87 , 1.10 ) among men ) . With respect to score components , only meat among men ( positively ) and fruits and nuts among women ( inversely ) were associated with both the incidence of and mortality from CHD . The MD , as an integral entity , is inversely associated with CHD incidence and , particularly , mortality Background Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated . Aim To identify predictors of higher success of an intervention aim ed to increase adherence to a Mediterranean diet ( MeDiet ) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease : the PREDIMED ( PREvención con DIeta MEDiterránea ) trial . C and i date predictors included demographic and socioeconomic characteristics , cardiovascular risk factors , and baseline dietary habits . Methods A total of 1,048 asymptomatic subjects aged 55–80 years allocated to the active intervention groups ( subjects in the control group were excluded ) . Participants ’ characteristics were assessed at baseline among subjects . Dietary changes were evaluated after 12 months . Main outcome measures were : attained changes in five dietary goals : increases in ( 1 ) fruit consumption , ( 2 ) vegetable consumption , ( 3 ) monounsaturated fatty acid (MUFA)/saturated fatty acid ( SFA ) ratio , and decreases in ( 4 ) sweets and pastries consumption , ( 5 ) and meat consumption . Univariate and multivariate logistic regression analyses were used to examine associations between the c and i date predictors and likelihood of attaining optimum dietary change ( improved adherence to a MeDiet  ) . Results Among men , positive changes toward better compliance with the MeDiet  were more frequent among non-diabetics , and among those with worse dietary habits at baseline ( higher consumption of meat , higher SFA intake , lower consumption of fruit and vegetables ) . Among women , marital status ( married ) and worse baseline dietary habits ( high in meats , low in fruits and vegetables ) were the strongest predictors of success in improving adherence to the MeDiet . Conclusions Some participant characteristics ( marital status and baseline dietary habits ) could contribute to predicting the likelihood of achieving dietary goals in interventions aim ed to improve adherence to a MeDiet , and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling OBJECTIVE To study the association between adherence to the Mediterranean dietary pattern ( MDP ) and risk of developing type 2 diabetes , across European countries . RESEARCH DESIGN AND METHODS We established a case-cohort study including 11,994 incident type 2 diabetic case subjects and a stratified subcohort of 15,798 participants selected from a total cohort of 340,234 participants with 3.99 million person-years of follow-up , from eight European cohorts participating in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study . The  relative Mediterranean diet score ( rMED ) ( score range 0–18 ) was used to assess adherence to MDP on the basis of reported consumption of nine dietary components characteristic of the Mediterranean diet . Cox proportional hazards regression , modified for the case-cohort design , was used to estimate the association between rMED and risk of type 2 diabetes , adjusting for confounders . RESULTS The multiple adjusted hazard ratios of type 2 diabetes among individuals with medium ( rMED 7–10 points ) and high adherence to MDP ( rMED 11–18 points ) were 0.93 ( 95 % CI 0.86–1.01 ) and 0.88 ( 0.79–0.97 ) , respectively , compared with individuals with low adherence to MDP ( 0–6 points ) ( P for trend 0.013 ) . The association between rMED and type 2 diabetes was attenuated in people < 50 years of age , in obese participants , and when the alcohol , meat , and olive oil components were excluded from the score . CONCLUSIONS In this large prospect i ve study , adherence to the MDP , as defined by rMED , was associated with a small reduction in the risk of developing type 2 diabetes  in this European population Objective To assess the relation between adherence to a Mediterranean diet and the incidence of diabetes  among initially healthy participants . Design Prospect i ve cohort study with estimates of relative risk adjusted for sex , age , years of university education , total energy intake , body mass index , physical activity , sedentary habits , smoking , family history of diabetes , and personal history of hypertension . Setting Spanish university department . Participants 13 380 Spanish university graduates without diabetes at baseline followed up for a median of 4.4 years . Main outcome measures Dietary habits assessed at baseline with a vali date d 136 item food frequency question naire and scored on a nine point index . New cases of diabetes confirmed through medical reports and an additional detailed question naire posted to those who self reported a new diagnosis of diabetes by a doctor during follow-up . Confirmed cases of type 2 diabetes . Results Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes . The incidence rate ratios adjusted for sex and age were 0.41 ( 95 % confidence interval 0.19 to 0.87 ) for those with moderate adherence ( score 3 - 6 ) and 0.17 ( 0.04 to 0.75 ) for those with the highest adherence ( score 7 - 9 ) compared with those with low adherence ( score < 3 ) . In the fully adjusted analyses the results were similar . A two point increase in the score was associated with a 35 % relative reduction in the risk of diabetes ( incidence rate ratio 0.65 , 0.44 to 0.95 ) , with a significant inverse linear trend ( P=0.04 ) in the multivariate analysis . Conclusion Adherence to a Mediterranean diet is associated with a reduced risk of diabetes BACKGROUND In Mediterranean countries , adherence to a traditional Mediterranean dietary pattern ( MedDiet ) is associated with better cognitive function and reduced dementia risk . It is unclear if similar benefits exist in non-Mediterranean regions . OBJECTIVES The aims of this study were to examine associations between MedDiet adherence and cognitive function in an older UK population and to investigate whether associations differed between individuals with high compared with low cardiovascular disease ( CVD ) risk . METHODS We conducted an analysis in 8009 older individuals with dietary data at Health Check 1 ( 1993 - 1997 ) and cognitive function data at Health Check 3 ( 2006 - 2011 ) of the European Prospect i ve Investigation into Cancer and Nutrition-Norfolk ( EPIC-Norfolk ) . Associations were explored between MedDiet adherence and global and domain-specific cognitive test scores and risk of poor cognitive performance in the entire cohort , and when stratified according to CVD risk status . RESULTS Higher MedDiet adherence defined by the Pyramid MedDiet score was associated with better global cognition ( β ± SE = -0.012 ± 0.002 ; P < 0.001 ) , verbal episodic memory ( β ± SE = -0.009 ± 0.002 ; P < 0.001 ) , and simple processing speed ( β ± SE = -0.002 ± 0.001 ; P = 0.013 ) . Lower risk of poor verbal episodic memory ( OR : 0.784 ; 95 % CI : 0.641 , 0.959 ; P = 0.018 ) , complex processing speed ( OR : 0.739 ; 95 % CI : 0.601 , 0.907 ; P = 0.004 ) , and prospect i ve memory ( OR : 0.841 ; 95 % CI : 0.724 , 0.977 ; P = 0.023 ) was also observed for the highest compared with the lowest Pyramid MedDiet tertiles . The effect of a 1-point increase in Pyramid score on global cognitive function was equivalent to 1.7 fewer years of cognitive aging . MedDiet adherence defined by the Mediterranean Diet Adherence Screener ( MEDAS ) score ( mapped through the use of both binary and continuous scoring ) showed similar , albeit less consistent , associations . In stratified analyses , associations were evident in individuals at higher CVD risk only ( P < 0.05 ) . CONCLUSIONS Higher adherence to the MedDiet is associated with better cognitive function and lower risk of poor cognition in older UK adults . This evidence underpins the development of interventions to enhance MedDiet adherence , particularly in individuals at higher CVD risk , aim ing to reduce the risk of age-related cognitive decline in non-Mediterranean population Objective The aim of this study was to evaluate adherence to the Mediterranean Diet ( MD ) and its association with  all-cause mortality in an elderly Italian population . Design Data analysis of a longitudinal study of a representative , age stratified , population sample . Setting Study data is based upon the Italian Longitudinal Study on Aging ( ILSA ) a prospect i ve , community-based cohort study . The baseline evaluation was carried out in 1992 and the follow-up in 1996 and 2000.ParticipantParticipant food intake assessment was available at baseline for 4,232 subjects ; information on survival was available for 2,665 at the 2000 follow-up . Measurements  Adherence to the MD was evaluated with an a priori score based on the Mediterranean pyramid components . Cox proportional hazard models were used to assess the relationship between the MD score and all-cause mortality .  Six hundred and sixty five subjects had died  at the second follow-up ( identified up to the first and second follow-up together ; mean follow-up : 7.1±2.6 years ) . Results At the 2000 follow-up , adjusting for other confounding factors , participants with a high adherence to MD ( highest tertile of the MD score distribution ) had an all-cause mortality risk that was of 34 % lower with respect to the subjects with low adherence ( Hazard Ratio=0.66 ; 95 % CI : 0.49 - 0.90 ; p=0.0144 ) . Conclusion According to study results , a higher adherence to the MD was associated with a low all-cause mortality risk in an elderly Italian population BACKGROUND AND AIMS Adherence to Mediterranean diet ( MD ) is reportedly declining in the last decades . We aim ed to investigate the adherence to MD over the period 2005 - 2010 and exploring the possible role of the global economic crisis in accounting for the changing in the dietary habits in Italy . METHODS AND RESULTS Cross-sectional analysis in a population -based cohort study which r and omly recruited 21,001 southern Italian citizens enrolled within the Moli-sani study .  Food intake was determined by the Italian EPIC food frequency question naire .  Adherence to MD  was appraised by the  Italian Mediterranean Index ( IMI ) . A wealth score was derived to evaluate the economic position and used together with other socioeconomic indicators . Highest prevalence of adherence to MD  was observed during the years 2005 - 2006 ( 31.3 % ) while the prevalence dramatically fell down in the years 2007 - 2010 ( 18.3 % ; P<0.0001 ) . The decrease was stronger in the elderly , less affluent groups , and among those living in urban areas . Accordingly , we observed that in 2007 - 2010 socioeconomic indicators were strongly associated with higher adherence to MD  , whereas no association was detected in the years before the economic crisis began ; both wealth score and education were major determinants of high adherence to MD  with 31 % ( 95%CI : 18 - 46 % ) higher adherence to this pattern within the wealthier group compared to the less affluent category . CONCLUSION Adherence to MD  has considerably decreased over the last few years . In 2007 - 2010 socioeconomic indicators have become major determinants of adherence to MD , a fact likely linked to the economic downturn Abstract Purpose Evidence suggests that dietary patterns compatible with the traditional Mediterranean diet ( MD ) may protect against cognitive decline . We prospect ively assessed whether adherence to MD in the Mediterranean country of Greece is inversely associated with  cognitive decline in the elderly and whether any particular MD component may play a key role . Methods Elderly men and women ( N = 401 ) residing in the greater Athens area had dietary variables ascertained in 1994–1999 . Adherence to MD was represented by the MD score [ MDS , 0–3 ( low ) , 4–5 ( intermediate ) , 6–9 ( high ) ] . The mini-mental state examination ( MMSE ) was administered by trained professionals to individuals aged 65 years or older in 2004–2006 ( first assessment ) and re-administered in 2011–2012 ( second assessment ) . MMSE change ( cMMSE ) was categorized as : improved/unchanged ( cMMSE ≥ 0 ) , mildly lower ( cMMSE −1 to −4 ) or substantially lower ( cMMSE ≤ −5 ) . Associations were evaluated through multinomial logistic regression . Results Decline in MMSE performance was inversely associated with adherence to MD . For mild versus no decline , odds ratio ( OR ) comparing high to low MD adherence was 0.46 [ 95 % confidence interval ( CI ) 0.25–0.87 , p = 0.012 ] . For substantial versus no decline , OR comparing high to low MD adherence was 0.34 ( 95 % CI 0.13–0.89 , p = 0.025 ) . Among the nine MDS components , only vegetable consumption exhibited a significant inverse association with cognitive decline . Conclusions Closer adherence to the traditional MD is highly likely to protect against cognitive decline in this elderly Mediterranean population . Higher vegetable consumption appears to play a key role , possibly in synergy with additional components of the diet OBJECTIVE The Mediterranean dietary pattern improves cardiovascular disease factors . More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss . The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss . METHODS A total of 1406 obese subjects ( body mass index , 31+/-5kg/m(2 ) ) , aged 20 - 65 y , from a Mediterranean area in southeast Spain were subjected to a  weight-reduction program . To evaluate effectiveness , weight loss , body fat distribution , biochemical variables , blood pressure changes , mean duration of treatment , percentage of attrition , and the ability to fulfill a Mediterranean diet pattern were assessed . To determine the main barriers to losing weight , a " Barriers to Weight Loss " checklist was completed . RESULTS The behavioral therapy program was effective for the treatment of obesity . The average weight loss was 7.7 kg . The duration of treatment was 34 wk . Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program , and all the variables studied were significantly improved . Attrition was 4 - 9 % , with the main reason being stress ( 37 % ) . Main obstacles to weight loss were " losing motivation , " being " prone to stress-related eating , " and being liable to eat when bored . Recording food intake and assisting group therapy were also important tools for losing weight ( P < or = 0.05 ) . CONCLUSIONS Dietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice . Nutrition professionals should encourage their patients to record food intake and to attend group therapy OBJECTIVE The objective of the present study was to evaluate the effectiveness of an educational programme on healthy alimentation , carried out in day-care centres and aim ed at the parents of children from 1 to 2 years of age , regarding the acquisition of healthy eating habits among themselves and their children . DESIGN We performed a multicentre , multidisciplinary , r and omized controlled study in a community setting . SETTING The EniM study ( nutritional intervention study among children from Mataró ) was performed in twelve day-care centres in Mataró ( Spain ) . Centres were r and omized into a control group ( CG ) and an intervention group ( IG ) . IG received four or five educational workshops on diet , CG did not have workshops . SUBJECTS Children , not exclusively breast-fed , from 1 to 2 years of age , in the participating day-care centres and the persons responsible for their alimentation ( mother or father ) . RESULTS Thirty-five per cent of the IG did not attend the minimum of three workshops and were excluded . The CG included seventy-four children and seventy-two parents and the IG seventy-five children and sixty-seven parents . Both groups were comparable at baseline . Basal adherence to the Mediterranean diet was 56·4 % in parents ( Gerber index ) and 7·7 points in children ( Kidmed test ) . At 8 months , Mediterranean diet adherence had improved in the IG by 5·8 points in the Gerber index ( P=0·01 ) and 0·6 points in the Kidmed test ( P=0·02 ) compared with the CG . CONCLUSIONS This educational intervention performed in parents at the key period of incorporation of a 1 - 2-year-old child to the family table showed significant increases in adherence of the parents to the Mediterranean diet , suggesting future improvement in different indicators of health and an expected influence on the diet of their children The aim of the present study was to assess reproducibility and relative validity of a self-administered FFQ used in the PREDIMED Study , a clinical trial for primary prevention of CVD by Mediterranean diet in a population at high cardiovascular risk . The FFQ was administered twice ( FFQ1 and FFQ2 ) to explore reproducibility at 1 year . Four 3 d dietary records ( DR ) were used as reference to explore validity ; participants therefore recorded their food intake over 12 d in the course of 1 year . The degree of misclassification in the FFQ was also evaluated by a contingency table of quintiles comparing the information from the FFQ2 and the DR . A total of 158 men and women ( aged 55 - 80 years ) were asked not to modify their dietary habits during the study period . Reproducibility for food groups , energy and nutrient intake , explored by the Pearson correlation coefficient ( r ) ranged 0.50 - 0.82 , and the intraclass correlation coefficient ( ICC ) ranged from 0.63 to 0.90 . The FFQ2 tended to report higher energy and nutrient intake than the DR . The validity indices of the FFQ in relation to the DR for food groups and energy and nutrient intake ranged ( r ) from 0.24 to 0.72 , while the range of the ICC was between 0.40 and 0.84 . With regard to food groups , 68 - 83 % of individuals were in the same or adjacent quintile in both methods , a figure which decreased to 55 - 75 % for energy and nutrient intake . We concluded that FFQ measurements had good reproducibility and a relative validity similar to those of FFQ used in other prospect i ve studies Objective : We sought to determine the relationship of greater adherence to Mediterranean diet ( MeD ) and likelihood of incident cognitive impairment ( ICI ) and evaluate the interaction of race and vascular risk factors . Methods : A prospect i ve , population -based , cohort of individuals enrolled in the Reasons for Geographic and Racial Differences in Stroke ( REGARDS ) Study 2003–2007 , excluding participants with history of stroke , impaired cognitive status at baseline , and missing data on Food Frequency Question naires ( FFQ ) , was evaluated . Adherence to a MeD ( scored as 0–9 ) was computed from FFQ . Cognitive status was evaluated at baseline and annually during a mean follow-up period of 4.0 ± 1.5 years using Six-item-Screener . Results : ICI was identified in 1,248 ( 7 % ) out of 17,478 individuals fulfilling the inclusion criteria . Higher adherence to MeD was associated with lower likelihood of ICI before ( odds ratio [lsqb]OR[rsqb ] 0.89 ; 95 % confidence interval [lsqb]CI[rsqb ] 0.79–1.00 ) and after adjustment for potential confounders ( OR 0.87 ; 95 % CI 0.76–1.00 ) including demographic characteristics , environmental factors , vascular risk factors , depressive symptoms , and self-reported health status . There was no interaction between race ( p = 0.2928 ) and association of adherence to MeD with cognitive status . However , we identified a strong interaction of diabetes mellitus ( p = 0.0134 ) on the relationship of adherence to MeD with ICI ; high adherence to MeD was associated with a lower likelihood of ICI in nondiabetic participants ( OR 0.81 ; 95 % CI 0.70–0.94 ; p = 0.0066 ) but not in diabetic individuals ( OR 1.27 ; 95 % CI 0.95–1.71 ; p = 0.1063 ) . Conclusions : Higher adherence to MeD was associated with a lower likelihood of ICI independent of potential confounders . This association was moderated by presence of diabetes mellitus
The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality .
Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population .
OBJECTIVE The aim of this review was to evaluate the conceptual suitability , applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet ( MD ) .