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Validity of the energy-restricted Mediterranean Diet Adherence Screener

Autores: Schroder, H. (Autor de correspondencia); Zomeno, M. D.; Martínez González, Miguel Ángel; Salas-Salvadó, J.; Corella, D.; Vioque, J.; Romaguera, D.; Martínez Hernández, Alfredo; Tinahones, F. J.; López-Miranda, J.; Estruch, R.; Bueno-Cavanillas, A.; Alonso-Gómez, A. M.; Tur, J. A.; Warnberg, J.; Serra-Majem, L.; Martín, V.; Vázquez, C.; Lapetra, J.; Pinto, X.; Vidal, J.; Daimiel, L.; Gaforio, J. J.; Matía-Martín, P.; Ros, E.; Lassale, C.; Ruiz-Canela, Miguel; Babio, N.; Sorli, J. V.; García-Arellano, A.; Díaz-López, A.; Fitó, M.; Castaner, O.; PREDIMED-Plus Investigators
Título de la revista: CLINICAL NUTRITION
ISSN: 0261-5614
Volumen: 40
Número: 8
Páginas: 4971 - 4979
Fecha de publicación: 2021
Background: Short dietary assessment tools can be useful to estimate food intake and diet quality in large-scale epidemiological studies with time constraints. Objective: To determine the concurrent validity of the 17-item energy-restricted Mediterranean Adherence Screener (er-MEDAS) used in the PREDIMED (PREvencion con DIeta MEDiterranea)-Plus trial and to analyse its capacity to detect 1-year changes in diet and cardiometabolic risk factors. Methods: Validation study nested in the PREDIMED-Plus (n = 6760, 55-75 years). Dietary data were collected by the 17-item er-MEDAS and a 143-item validated semiquantitative food frequency questionnaire (FFQ) at baseline and after 1-year intervention. Cardiometabolic risk markers were measured at both time points. A Mediterranean diet (MedDiet) score was derived from both instruments. Concurrent validity was evaluated by Pearson and intra-class correlation coefficients (ICC) and Bland and Altman limits of agreement. Construct validity was evaluated by assessing 1-year changes in FFQ-reported dietary intake and cardiometabolic profile changes in relation to changes in er-MEDAS. Results: A moderate to good correlation between the MedDiet score calculated by both measurement instruments was found: r = 0.61 and ICC = 0.60 (both p < 0.001). Agreement of each of the er-MEDAS items ranged from 55.4% to 85.0% with a moderate mean concordance (kappa = 0.41). Between baseline and 1-year follow-up, energy intake measured by the FFQ decreased by 242 kcal, while Mediterranean food consumption increased in participants with the highest increase in the er-MEDAS MedDiet score. An increase in the er-MEDAS MedDiet score ratings was associated with a decrease in BMI, waist circumference, triglycerides, fasting glucose, diastolic blood pressure, and triglycerides/HDL-cholesterol ratio (p < 0.001 for all), and with an increase in HDL-cholesterol (p = 0.006). Conclusion: The er-MEDAS shows a modest to good concurrent validity compared with FFQ data. It shows acceptable construct validity, as a greater er-MEDAS score was associated with more favourable dietary and cardiometabolic profiles over time.