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      Agreement among Mediterranean Diet Pattern Adherence Indexes: MCC-Spain Study

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      1 , 2 , 3 , 2 , 4 , 5 , * , 2 , 4 , 5 , 6 , 7 , 8 , 2 , 9 , 10 , 4 , 5 , 2 , 11 , 2 , 12 , 2 , 13 , 2 , 14 , 1 , 2 , 15 , 2 , 16 ,   2 , 17 , 2 , 6 , 18 , 2 , 19 , 4 , 5 , 2 , 20 , 21 , 2 , 12 , 2 , 6 , 18 , 22 , 2 , 6 , 18 , 22 , 2 , 9 , 2 , 4 , 5
      Nutrients
      MDPI
      adherence, Mediterranean diet pattern, indexes, agreement

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          Abstract

          There are many different methods used to measure the degree of adherence to a Mediterranean diet (MD), limiting comparison and interpretation of their results. The concordance between different methodologies has been questioned and their evaluation recommended. The aim of this study was to evaluate the agreement among five indexes that measure adherence to a Mediterranean dietary pattern. The study population included healthy adults selected in the Multi-Case Control Spain (MCC-Spain) study recruited in 12 provinces. A total of 3640 controls were matched to cases by age and sex. To reach the aim, the following scores of adherence to a Mediterranean dietary pattern were calculated: Mediterranean diet score (MDS), alternative Mediterranean diet (aMED), relative Mediterranean diet (rMED), dietary score (DS) and literature-based adherence score (LBAS). The relative frequency of subjects with a high level of adherence to a MD varied from 22% (aMED index) to 37.2% (DS index). Similarly, a high variability was observed for the prevalence of a low level of MD: from 24% (rMED) to 38.4% (aMED). The correlation among MDS, aMED and rMED indexes was moderate, except for MDS and aMED with a high coefficient of correlation 0.75 (95% CI 0.74–0.77). The Cohen’s Kappa coefficient among indexes showed a moderate–fair concordance, except for MDS and aMED with a 0.56 (95% CI 0.55–0.59) and 0.67 (95% CI 0.66–0.68) using linear and quadratic weighting, respectively. The existing MD adherence indexes measured the same, although they were based on different constructing algorithms and varied in the food groups included, leading to a different classification of subjects. Therefore, concordance between these indexes was moderate or low.

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          Most cited references12

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          Dietary patterns: from nutritional epidemiologic analysis to national guidelines.

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            Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study.

            No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29-69 years, recruited in 1992-1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.
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              Adherence to the Mediterranean diet is associated with lower abdominal adiposity in European men and women.

              Given the lack of consistent evidence of the relationship between Mediterranean dietary patterns and body fat, we assessed the cross-sectional association between adherence to a modified Mediterranean diet, BMI, and waist circumference (WC). A total of 497,308 individuals (70.7% women) aged 25-70 y from 10 European countries participated in this study. Diet was assessed at baseline using detailed validated country-specific questionnaires, and anthropometrical measurements were collected using standardized procedures. The association between the degree of adherence to the modified-Mediterranean Diet Score (mMDS) (including high consumption of vegetables, legumes, fruits and nuts, cereals, fish and seafood, and unsaturated:saturated fatty acids ratio; moderate alcohol intake; and low consumption of meat and meat products and dairy products) and BMI (kg.m(-2)) or WC (cm) was modeled through mixed-effects linear regression, controlling for potential confounders. Overall, the mMDS was not significantly associated with BMI. Higher adherence to the Mediterranean diet was significantly associated with lower WC, for a given BMI, in both men (-0.09; 95% CI -0.14 to -0.04) and women (-0.06; 95% CI -0.10 to -0.01). The association was stronger in men (-0.20; 95% CI -0.23 to -0.17) and women (-0.17; 95% CI -0.21 to -0.13) from Northern European countries. Despite the observed heterogeneity among regions, results of this study suggest that adherence to a modified Mediterranean diet, high in foods of vegetable origin and unsaturated fatty acids, is associated with lower abdominal adiposity measured by WC in European men and women.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                26 February 2019
                March 2019
                : 11
                : 3
                : 488
                Affiliations
                [1 ]Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain; rocioolmedo@ 123456ugr.es (R.O.-R.); macarenalozano@ 123456ugr.es (M.L.-L.)
                [2 ]Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; vdavb@ 123456unileon.es (V.D.-B.); acastello@ 123456externos.isciii.es (A.C.); epicss-san@ 123456euskadi.eus (P.A.); trinidad.dierssen@ 123456unican.es (T.D.-S.); mp.guevara.eslava@ 123456navarra.es (M.G.); fernandeztguillermo@ 123456uniovi.es (G.F.-T.); juan.alguacil@ 123456dbasp.uhu.es (J.A.); rosana.peiro@ 123456uv.es (R.P.); jmhuerta.carm@ 123456gmail.com (J.M.H.); esther.gracia@ 123456isglobal.org (E.G.-L.); nuria.aragones@ 123456salud.madrid.org (N.A.); martasolans@ 123456gmail.com (M.S.); ines.gomez@ 123456unican.es (I.G.-A.); gemma.castano@ 123456isglobal.org (G.C.-V.); manolis.kogevinas@ 123456isglobal.org (M.K.); mpollan@ 123456isciii.es (M.P.); vmars@ 123456unileon.es (V.M.)
                [3 ]Inst Invest Biosanitaria Ibs GRANADA, 18071 Granada, Spain
                [4 ]The Research Group in Gene-Environment and Health Interactions (GIIGAS), University of León, 24071 León, Spain; ajmolt@ 123456unileon.es (A.J.M.d.l.T.); tferv@ 123456unileon.es (T.F.-V.)
                [5 ]Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain
                [6 ]ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain; dora.romaguera@ 123456isglobal.org
                [7 ]Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Universitario Son Espases, Unidad de Investigación, I-1. Carretera de Valldemossa, 79, 07120 Palma de Mallorca, Spain
                [8 ]CIBER Fisiopatología de la Obesidad y la Nutrición (CIBER-OBN), 28029 Madrid, Spain
                [9 ]Cancer Epidemiology Unit, National Centre for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain
                [10 ]Faculty of Medicine, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
                [11 ]Public Health Division of Guipuzkoa, BioDonostia Research Institute, 20014 San Sebastian, Spain
                [12 ]Universidad de Cantabria—IDIVAL, 39011 Santander, Spain
                [13 ]Instituto de Salud Pública de Navarra, IdiSNA, 31003 Pamplona, Spain
                [14 ]Instituto de Oncología IUOPA (Instituto Universitario de Oncología del Principado de Asturias), University of Oviedo, 33003 Oviedo, Spain
                [15 ]Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad de Huelva, 21071 Huelva, Spain
                [16 ]Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana FISABIO-Salud Pública, 46020 Valencia, Spain
                [17 ]Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30007 Murcia, Spain
                [18 ]Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
                [19 ]Epidemiology Section, Public Health Division, Department of Health of Madrid, 28035 Madrid, Spain
                [20 ]Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Campus Montilivi, 17003 Girona, Spain
                [21 ]Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, 17004 Girona, Spain
                [22 ]IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
                Author notes
                [* ]Correspondence: carmen12go@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-0054-6700
                https://orcid.org/0000-0001-8888-395X
                https://orcid.org/0000-0001-9242-6364
                https://orcid.org/0000-0002-9637-3869
                https://orcid.org/0000-0002-9049-3026
                https://orcid.org/0000-0002-2397-0435
                https://orcid.org/0000-0001-8793-8314
                https://orcid.org/0000-0003-4468-1816
                https://orcid.org/0000-0003-0552-2804
                Article
                nutrients-11-00488
                10.3390/nu11030488
                6471750
                30813581
                14c7d478-1d3a-48df-b63d-3356a9b4297b
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 January 2019
                : 21 February 2019
                Categories
                Article

                Nutrition & Dietetics
                adherence,mediterranean diet pattern,indexes,agreement
                Nutrition & Dietetics
                adherence, mediterranean diet pattern, indexes, agreement

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