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The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review

Published online by Cambridge University Press:  02 January 2007

Anna Bach ,
Lluís Serra-Majem ,
Josep L Carrasco ,
Blanca Roman ,
Joy Ngo ,
Isabel Bertomeu  and
Biel Obrador
Anna Bach*
Affiliation:
Foundation for the Advancement of the Mediterranean Diet, University of Barcelona Science Park, Spain Biostatistics, Department of Public Health, University of Barcelona, Spain
Lluís Serra-Majem
Affiliation:
Foundation for the Advancement of the Mediterranean Diet, University of Barcelona Science Park, Spain Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Spain
Josep L Carrasco
Affiliation:
Biostatistics, Department of Public Health, University of Barcelona, Spain
Blanca Roman
Affiliation:
Foundation for the Advancement of the Mediterranean Diet, University of Barcelona Science Park, Spain
Joy Ngo
Affiliation:
Foundation for the Advancement of the Mediterranean Diet, University of Barcelona Science Park, Spain
Isabel Bertomeu
Affiliation:
Foundation for the Advancement of the Mediterranean Diet, University of Barcelona Science Park, Spain
Biel Obrador
Affiliation:
Faculty of Biology, University of Barcelona, Spain
*
*Corresponding author: Email [email protected]
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Abstract

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The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components.

Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations.

A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

Keywords

Mediterranean dietDietary patternMediterranean diet adherenceMediterranean diet scoresMediterranean diet indexes
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 1a , February 2006 , pp. 132 - 146
Copyright
Copyright © The Authors 2006

References

1Keys, A, Menotti, A, Karvonen, M. The diet and 15-year death rate in the Seven Countries study. American Journal of Epidemiology 1986; 124: 903–15.Google Scholar
2Nestle, M. Mediterranean diets: historical and research overview. American Journal of Clinical Nutrition 1995; 61: 1313S–20S.CrossRefGoogle ScholarPubMed
3De Lorgeril, M, Salen, P, Martin, J, Monjaud, I, Delaye, J, Mamelle, N. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779–85.CrossRefGoogle ScholarPubMed
4Ryan, M, McInerney, D, Owens, D, Collins, P, Johnson, A, Tomkin, G. Diabetes and the Mediterranean diet: beneficial effects of oleic acid. Quarterly Journal of Medicine 2000; 93: 85–91.CrossRefGoogle ScholarPubMed
5Ferrara, L, Raimondi, S, D'Episcopo, L, Guilda, L, Dello Russo, A, Marotta, T. Olive oil and reduced need for antihypertensive medications. Archives of Internal Medicine 2000; 160: 837–42.CrossRefGoogle ScholarPubMed
6Joshipura, KJ, Ascherio, A, Manson, JE, Stampfer, MJ, Rimm, EB, Speizer, FE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. Journal of the American Medical Association 1999; 282: 1233–9.CrossRefGoogle ScholarPubMed
7Trichopoulou, A, Georgiou, E, Bassiakos, Y, Lipworth, L, Lagiou, P, Proukakis, C, et al. Energy intake and monounsaturated fat in relation to bone mineral density among women and men in Greece. Preventive Medicine 1997; 26: 395–400.CrossRefGoogle ScholarPubMed
8Bosetti, C, Gallus, S, Trichopoulou, A, Talamini, R, Franceschi, S, Negri, E, et al. Influence of the Mediterranean diet on the risk of cancers of the upper aerodigestive tract. Cancer Epidemiology, Biomarkers & Prevention 2003; 12: 1091–4.Google Scholar
9Matelas, A, Zampelas, A, Stavrinos, V, Wolinky, I. The Mediterranean Diet: Constituents and Health Promotion. Boca Raton, FL: CRC Press. 2000.Google Scholar
10Serra-Majem, L, Helsing, E. Changing patterns of fat intake in Mediterranean countries. European Journal of Clinical Nutrition 1993; 47: 1S–100S.Google Scholar
11Willett, W, Sacks, F, Trichopoulou, A, Drescher, G, Ferro-Luzzi, A, Helsing, E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. American Journal of Clinical Nutrition 1995; 61: 1402S–6S.Google Scholar
12WCRF Nutrition and the Prevention of Cancer: A Global Perspective, Washington, DC: World Cancer Research Fund and American Institute for Cancer Prevention. 1997.Google Scholar
13WHO Diet, Nutrition and the Prevention of Chronic Diseases, Geneva: World Health Organization. 2003.Google Scholar
14Hu, F, Rimm, E, Stampfer, M. Prospective study of major dietary patterns and risk of coronary heart disease in men. American Journal of Clinical Nutrition 2000; 72: 912–21.CrossRefGoogle ScholarPubMed
15Trichopoulos, D, Lagiou, P. Dietary patterns and mortality. British Journal of Nutrition 2001; 85: 133–4.CrossRefGoogle ScholarPubMed
16Hu, F. Dietary pattern analysis: a new direction in nutritional epidemiology. Current Opinion in Lipidology 2002; 13: 3–9.CrossRefGoogle ScholarPubMed
17Trichopoulou, A, Kouris-Blazos, A, Wahlquivist, M, Gnardellis, D, Lagiou, P, Polychronopoulos, E, et al. Diet and overall survival in elderly people. British Medical Journal 1995; 311: 1457–60.CrossRefGoogle ScholarPubMed
18Costacou, T, Bamia, C, Ferrari, P, Riboli, E, Trichopoulos, D, Trichopoulou, A. Tracing the Mediterranean diet through principal components and cluster analyses in the Greek population. European Journal of Clinical Nutrition 2003; 57: 1378–85.Google Scholar
19Osler, M, Schrool, M. Diet and mortality in a cohort of elderly people in a north European community. International Journal of Epidemiology 1997; 26: 155–9.Google Scholar
20Trichopoulou, A, Costacou, T, Bamia, C, Trichopoulos, D. Adherence to a Mediterranean diet and survival in a Greek population. New England Journal of Medicine 2003; 348: 2599–608.CrossRefGoogle Scholar
21Psaltopoulou, T, Naska, A, Orfanos, P, Trichopoulos, D, Mountokalakis, T, Trichopoulou, A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) Study. American Journal of Clinical Nutrition 2004; 80: 1012–18.CrossRefGoogle ScholarPubMed
22Trichopoulou, A, Bamia, C, Trichopoulos, D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Archives of Internal Medicine 2005; 165: 929–35.CrossRefGoogle ScholarPubMed
23Kouris-Blazos, A, Gnardellis, C, Wahlqvist, M, Trichopoulos, D, Lukito, W, Trichopoulou, A. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. British Journal of Nutrition 1999; 82: 57–61.Google Scholar
24Woo, J, Woo, K, Leung, S. The Mediterranean score of dietary habits in Chinese populations in four different geographical areas. European Journal of Clinical Nutrition 2001; 55: 215–20.CrossRefGoogle ScholarPubMed
25Lasheras, C, Fernandez, S, Patternson, . Mediterranean diet and age with respect to overall survival in institutionalised, non-smoking elderly people. American Journal of Clinical Nutrition 2000; 71: 987–92.Google Scholar
26González, C, Argílaga, S, Agudo, A, Amiano, P, Barricarte, A, Beguiristain, JM, et al. Sociodemographic differences in adherence to the Mediterranean dietary pattern in Spanish populations. Gaceta Sanitaria 2002; 16: 214–21.CrossRefGoogle Scholar
27Schröder, H, Marrugat, J, Vila, J, Covas, M, Elosua, R. Adherence to the traditional mediterranean diet is inversely associated with body mass index and obesity in Spanish population. Journal of Nutrition 2004; 134: 3355–61.CrossRefGoogle Scholar
28Knoops, K, De Groot, L, Kromhout, D, Perrin, A, Moreiras-Varela, O, Menotti, A, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women. Journal of the American Medical Association 2004; 292: 1433–9.CrossRefGoogle ScholarPubMed
29Van Staveren, W, De Groot, L, Haveman-Nies, A. The SENECA study: potentials and problems in relating diet to survival over 10 years. Public Health Nutrition 2002; 5: 901–5.CrossRefGoogle ScholarPubMed
30Trichopoulou, A, Orfanos, P, Norat, T, Bueno-de-Mesquita, B, Ooke, MC, Peeters, PH. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. British Medical Journal 2005; 330: 991–7.CrossRefGoogle ScholarPubMed
31Trichopoulos, D, Lagiou, P. Mediterranean diet and overall mortality differences in the European Union. Public Health Nutrition 2004; 7: 949–51.CrossRefGoogle ScholarPubMed
32Bilenko, N, Fraser, D, Vardi, H, Shai, I, Shahar, D. Mediterranean diet and cardiovascular diseases in an Israeli population. Preventive Medicine 2005; 40: 299–305.Google Scholar
33Martínez-González, M, Fernández-Jarne, E, Serrano-Martínez, M, Marti, A, Martínez, J, Martín-Moreno, J. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. European Journal of Nutrition 2002; 41: 153–60.CrossRefGoogle ScholarPubMed
34Serra-Majem, L, Ribas, L, Ngo, J, Ortega, R, García, A, Pérez-Rogrigo, C, et al. Food youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutrition 2004; 7: 931–5.CrossRefGoogle ScholarPubMed
35Goulet, J, Lamarche, B, Nadeau, G, Lemieux, S. Effect of a nutritional intervention promoting the Mediterranean food pattern on plasma lipids, lipoproteins and body weight in healthy French-Canadian women. Atherosclerosis 2003; 170: 115–24.Google Scholar
36Panagiotakos, D, Pitsavos, C, Polychronopoulos, E, Chrysohoou, C, Zampelas, A, Trichopoulou, A. Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review. Medical Science Monitor 2004; 10: 193–8.Google Scholar
37Patterson, RE, Haines, PS, Popkin, BM. Diet quality index: capturing a multidimensional behaviour. Journal of the American Dietetic Association 1994; 94: 57–64.CrossRefGoogle Scholar
38Gerber, M. Qualitative methods to evaluate Mediterranean diet in adults. Public Health Nutrition 2006; 9: 147–51.Google Scholar
39Ciccarone, E, Di Castelnuovo, A, Salcuni, M, Siani, A, Giacco, A, Donati, M, et al. A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with type 2 diabetes. Journal of Thrombosis and Haemostasis 2003; 1: 1744–52.CrossRefGoogle ScholarPubMed
40Sanchez-Villegas, A, Martinez, J, de Irala, J, Martínez-González, M. Determinants of the adherence to an ‘a priori’ defined Mediterranean dietary pattern. European Journal of Nutrition 2002; 41: 249–57.CrossRefGoogle Scholar
41Tur, J, Romaguera, D, Pons, A. Adherence to the Mediterranean dietary pattern among the population of the Balearic Islands. British Journal of Nutrition 2004; 92: 341–6.Google Scholar
42Alberti-Fidanza, A, Fidanza, F, Chiuchiu, M, Verducci, G, Fruttini, D. Dietary studies on two rural Italian population groups of the Seven Countries Study. 3. Trend of food and nutrient intake from 1960 to 1991. European Journal of Clinical Nutrition 1999; 53: 854–60.Google Scholar
43Fuentes-Bol, M. La dieta mediterránea: su evolución. In: Serra-Majem, L, Ngo, J, eds. Qué es la Dieta Mediterránea? Fundación para el desarrollo de la Dieta Mediterránea. Barcelona: Nexus Editions, 2002; 60–73.Google Scholar
44Kant, A. Dietary patterns and health outcomes. Journal of the American Dietetic Association 2004; 104: 615–36.CrossRefGoogle ScholarPubMed
45Hu, F. The Mediterranean diet and mortality–olive oil and beyond. New England Journal of Medicine 2003; 348: 2595–6.Google Scholar
46Serra-Majem, L, Roman, B, Estruch, R. Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutrition Reviews 2006; 64: 531–52.CrossRefGoogle ScholarPubMed
47Serra-Majem, L, Trichopoulou, A, Ngo, J, Cervera, P, García, A, La Vecchia, C. Does the definition of the Mediterranean diet need to be updated? Public Health Nutrition 2004; 7: 927–9.CrossRefGoogle ScholarPubMed
48Trichopoulou, A, Naska, A, Antoniou, A, Friel, S, Trygg, K, Turrini, A. Vegetable and fruit: the evidence in their favour and the public health perspective. International Journal for Vitamin and Nutrition Research 2003; 73: 63–9.Google Scholar
49Jacques, P, Tucker, K. Are dietary patterns useful for understanding the role of diet in chronic disease? European Journal of Clinical Nutriton 2001; 73: 1–2.Google Scholar
50Alberti-Fidanza, A, Findanza, F. Mediterranean Adequacy Index of Italian diets. Public Health Nutrition 2004; 7: 937–41.CrossRefGoogle ScholarPubMed