Validation of the English Version of the 14-Item Mediterranean Diet Adherence Screener of the PREDIMED Study, in People at High Cardiovascular Risk in the UK

Angeliki Papadaki; Laura Johnson; Zoi Toumpakari; Clare England; Manmita Rai; Stu Toms; Chris Penfold; Itziar Zazpe; Miguel A Martínez-González; Gene Feder

doi:10.3390/nu10020138

Validation of the English Version of the 14-Item Mediterranean Diet Adherence Screener of the PREDIMED Study, in People at High Cardiovascular Risk in the UK

Nutrients. 2018 Jan 28;10(2):138. doi: 10.3390/nu10020138.

Authors

Angeliki Papadaki^{1

2}, Laura Johnson³, Zoi Toumpakari⁴, Clare England^{5

6}, Manmita Rai⁷, Stu Toms⁸, Chris Penfold⁹, Itziar Zazpe^{10

11}, Miguel A Martínez-González^{12

13}, Gene Feder¹⁴

Affiliations

¹ Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK. angeliki.papadaki@bristol.ac.uk.
² NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK. angeliki.papadaki@bristol.ac.uk.
³ Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK. laura.johnson@bristol.ac.uk.
⁴ Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK. z.toumpakari@bristol.ac.uk.
⁵ Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK. clare.england@bristol.ac.uk.
⁶ NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK. clare.england@bristol.ac.uk.
⁷ NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK. manmita.rai@bristol.ac.uk.
⁸ NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK. stu.toms@bristol.ac.uk.
⁹ NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK. chris.penfold@bristol.ac.uk.
¹⁰ Department of Nutrition, Food Sciences and Physiology, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain. izazpe@unav.es.
¹¹ Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain. izazpe@unav.es.
¹² Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain. mamartinez@unav.es.
¹³ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA. mamartinez@unav.es.
¹⁴ Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK. gene.feder@bristol.ac.uk.

Abstract

The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial for assessment and immediate feedback. This instrument (MEDAS) was administered to 96 adults with a high cardiovascular risk (66% women, mean age 68.3 ± 6.0 years), recruited from general practices in Bristol, UK. Participants then completed a 3-day estimated food record, and the MEDAS was administered again one month later. A MedDiet score (range = 0-14) was calculated from the MEDAS' administrations and food record to assess concurrent validity and test-retest reliability. Predictive validity was assessed by examining the association of the MEDAS-derived score with cardiometabolic risk factors and dietary intakes derived from the food records. The MEDAS-derived MedDiet score was higher by 1.47 points compared to food records (5.47 vs.4.00, p < 0.001), correlated moderately with the record-derived score (r = 0.50, p < 0.001; ICC = 0.53, p < 0.001) and there was borderline fair agreement between the two methods (κ = 0.19, 95% CI 0.07-0.31, p = 0.002; 95% limits of agreement -2.2, 5.1). Exact agreement within score categories and gross misclassificationwere 45.8% and 21.9%, respectively. The distribution of dietary intakes, reported on the food records by the MEDAS-derived total MedDiet score, was in the expected direction, but no association was observed with cardiometabolic risk factors. The two administrations of the MEDAS produced similar mean total MedDiet scores (5.5 vs. 5.4, p = 0.706), which were correlated (r and ICC = 0.69, p < 0.001) and agreed fairly (κ = 0.38, 95% CI 0.24-0.52, p < 0.001; 95% limits of agreement -3.1, 3.2). The English version of the MEDAS has acceptable accuracy and reliability for assessing MedDiet adherence among individuals with a high cardiovascular risk, in the UK, and can be used to rank individuals according to MedDiet adherence in research and practice.

Keywords: Mediterranean diet; Mediterranean diet score; accuracy; cardiovascular risk; reliability; validity.

Publication types

Validation Study

MeSH terms

Aged
Aged, 80 and over
Blood Pressure
Body Mass Index
Cardiovascular Diseases / epidemiology*
Cholesterol / blood
Diet, Mediterranean*
Female
Humans
Linear Models
Male
Middle Aged
Patient Compliance*
Reproducibility of Results
Risk Factors
Socioeconomic Factors
Surveys and Questionnaires
Triglycerides / blood
United Kingdom / epidemiology

Substances

Triglycerides
Cholesterol