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Nutrients. 2019 Feb 26;11(3). pii: E488. doi: 10.3390/nu11030488.

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

Author information

1
Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain. rocioolmedo@ugr.es.
2
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. rocioolmedo@ugr.es.
3
Inst Invest Biosanitaria Ibs GRANADA, 18071 Granada, Spain. rocioolmedo@ugr.es.
4
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. carmen12go@gmail.com.
5
The Research Group in Gene-Environment and Health Interactions (GIIGAS), University of León, 24071 León, Spain. carmen12go@gmail.com.
6
Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain. carmen12go@gmail.com.
7
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. vdavb@unileon.es.
8
The Research Group in Gene-Environment and Health Interactions (GIIGAS), University of León, 24071 León, Spain. vdavb@unileon.es.
9
Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain. vdavb@unileon.es.
10
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain. dora.romaguera@isglobal.org.
11
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. dora.romaguera@isglobal.org.
12
CIBER Fisiopatología de la Obesidad y la Nutrición (CIBER-OBN), 28029 Madrid, Spain. dora.romaguera@isglobal.org.
13
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. acastello@externos.isciii.es.
14
Cancer Epidemiology Unit, National Centre for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain. acastello@externos.isciii.es.
15
Faculty of Medicine, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain. acastello@externos.isciii.es.
16
The Research Group in Gene-Environment and Health Interactions (GIIGAS), University of León, 24071 León, Spain. ajmolt@unileon.es.
17
Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain. ajmolt@unileon.es.
18
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. epicss-san@euskadi.eus.
19
Public Health Division of Guipuzkoa, BioDonostia Research Institute, 20014 San Sebastian, Spain. epicss-san@euskadi.eus.
20
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. trinidad.dierssen@unican.es.
21
Universidad de Cantabria-IDIVAL, 39011 Santander, Spain. trinidad.dierssen@unican.es.
22
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. mp.guevara.eslava@navarra.es.
23
Instituto de Salud Pública de Navarra, IdiSNA, 31003 Pamplona, Spain. mp.guevara.eslava@navarra.es.
24
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. fernandeztguillermo@uniovi.es.
25
Instituto de Oncología IUOPA (Instituto Universitario de Oncología del Principado de Asturias), University of Oviedo, 33003 Oviedo, Spain. fernandeztguillermo@uniovi.es.
26
Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain. macarenalozano@ugr.es.
27
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. juan.alguacil@dbasp.uhu.es.
28
Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad de Huelva, 21071 Huelva, Spain. juan.alguacil@dbasp.uhu.es.
29
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. rosana.peiro@uv.es.
30
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana FISABIO-Salud Pública, 46020 Valencia, Spain. rosana.peiro@uv.es.
31
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. jmhuerta.carm@gmail.com.
32
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30007 Murcia, Spain. jmhuerta.carm@gmail.com.
33
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. esther.gracia@isglobal.org.
34
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain. esther.gracia@isglobal.org.
35
Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain. esther.gracia@isglobal.org.
36
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. nuria.aragones@salud.madrid.org.
37
Epidemiology Section, Public Health Division, Department of Health of Madrid, 28035 Madrid, Spain. nuria.aragones@salud.madrid.org.
38
The Research Group in Gene-Environment and Health Interactions (GIIGAS), University of León, 24071 León, Spain. tferv@unileon.es.
39
Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain. tferv@unileon.es.
40
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. martasolans@gmail.com.
41
Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Campus Montilivi, 17003 Girona, Spain. martasolans@gmail.com.
42
Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, 17004 Girona, Spain. martasolans@gmail.com.
43
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. ines.gomez@unican.es.
44
Universidad de Cantabria-IDIVAL, 39011 Santander, Spain. ines.gomez@unican.es.
45
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. gemma.castano@isglobal.org.
46
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain. gemma.castano@isglobal.org.
47
Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain. gemma.castano@isglobal.org.
48
IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain. gemma.castano@isglobal.org.
49
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. manolis.kogevinas@isglobal.org.
50
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain. manolis.kogevinas@isglobal.org.
51
Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain. manolis.kogevinas@isglobal.org.
52
IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain. manolis.kogevinas@isglobal.org.
53
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. mpollan@isciii.es.
54
Cancer Epidemiology Unit, National Centre for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029 Madrid, Spain. mpollan@isciii.es.
55
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain. vmars@unileon.es.
56
The Research Group in Gene-Environment and Health Interactions (GIIGAS), University of León, 24071 León, Spain. vmars@unileon.es.
57
Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain. vmars@unileon.es.

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.

KEYWORDS:

Mediterranean diet pattern; adherence; agreement; indexes

PMID:
30813581
DOI:
10.3390/nu11030488
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