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Article

Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region

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Research Group on Quality, Safety and Bioactivity of Plant Foods, Campus de Espinardo, Centro de Edafologia y Biologia Aplicada del Segura-Consejo Superior de Investigaciones Científicas (CEBAS-CSIC), P.O. Box 164, 30100 Murcia, Spain
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Department of Life and Health Sciences, University of Nicosia, 1700 Nicosia, Cyprus
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National Research Council (CNR) Institute of Clinical Physiology, 73100 Lecce, Italy
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Laboratory of Biochemistry and Molecular Biology, Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy
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Polytechnic Institute of Santarém, School of Agriculture, 2001-904 Santarém, Portugal
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Life Quality Research Centre (CIEQV), IPSantarém/IPLeiria, 2040-413 Rio Maior, Portugal
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Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
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Slow Food in Bulgaria, 9 Pierre De Geytre St. bl. 3, 1113 Sofia, Bulgaria
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Faculty of Veterinary Medicine, University of Forestry, 1797 Sofia, Bulgaria
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Department of Plant and Fungal Diversity and Resources, Institute of Biodiversity and Ecosystem Research, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
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Faculty of Medical Sciences, University Goce Delcev, str. Krste Misirkov, No. 10-A, POB 201, 2000 Stip, North Macedonia
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Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
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Author to whom correspondence should be addressed.
Nutrients 2020, 12(10), 2960; https://doi.org/10.3390/nu12102960
Received: 11 September 2020 / Revised: 22 September 2020 / Accepted: 24 September 2020 / Published: 27 September 2020
(This article belongs to the Special Issue Dietary Assessment in Human Health and Disease)
This study provides comprehensive validation of the 14-item Mediterranean Diet Adherence Screener (14-MEDAS) in an adult population from Greece (GR), Portugal (PT), Italy (IT), Spain (SP), Cyprus (CY), Republic of North Macedonia (NMK), and Bulgaria (BG). A moderate association between the 14-MEDAS and the reference food diary was estimated for the entire population (Pearson r = 0.573, p-value < 0.001; Intraclass Correlation Coefficient (ICC) = 0.692, p-value < 0.001) with the strongest correlation found in GR, followed by PT, IT, SP, and CY. These results were supported by kappa statistics in GR, PT, IT, and SP with ≥50% of food items exhibiting a fair or better agreement. Bland–Altman analyses showed an overestimation of the 14-MEDAS score in the whole population (0.79 ± 1.81, 95%Confidence Interval (CI) 0.61, 0.96), but this value was variable across countries, with GR, NMK, and BG exhibiting the lowest bias. Taking all analyses together, the validation achieved slightly better results in the Mediterranean countries but a definitive validation ranking order was not evident. Considering growing evidence of the shift from Mediterranean Diet (MD) adherence and of the importance of culture in making food choices it is crucial that we further improve validation protocols with specific applications to measure and compare MD adherence across countries and to relate it to the health status of a specific population. View Full-Text
Keywords: Mediterranean Diet; validation; dietary health benefits; dietary assessment; food frequency questionnaire; body mass index; diet quality; diet adherence; survey instruments; Southern Europe; dietary assessment Mediterranean Diet; validation; dietary health benefits; dietary assessment; food frequency questionnaire; body mass index; diet quality; diet adherence; survey instruments; Southern Europe; dietary assessment
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MDPI and ACS Style

García-Conesa, M.-T.; Philippou, E.; Pafilas, C.; Massaro, M.; Quarta, S.; Andrade, V.; Jorge, R.; Chervenkov, M.; Ivanova, T.; Dimitrova, D.; Maksimova, V.; Smilkov, K.; Ackova, D.G.; Miloseva, L.; Ruskovska, T.; Deligiannidou, G.E.; Kontogiorgis, C.A.; Pinto, P. Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region. Nutrients 2020, 12, 2960. https://doi.org/10.3390/nu12102960

AMA Style

García-Conesa M-T, Philippou E, Pafilas C, Massaro M, Quarta S, Andrade V, Jorge R, Chervenkov M, Ivanova T, Dimitrova D, Maksimova V, Smilkov K, Ackova DG, Miloseva L, Ruskovska T, Deligiannidou GE, Kontogiorgis CA, Pinto P. Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region. Nutrients. 2020; 12(10):2960. https://doi.org/10.3390/nu12102960

Chicago/Turabian Style

García-Conesa, María-Teresa, Elena Philippou, Christos Pafilas, Marika Massaro, Stefano Quarta, Vanda Andrade, Rui Jorge, Mihail Chervenkov, Teodora Ivanova, Dessislava Dimitrova, Viktorija Maksimova, Katarina Smilkov, Darinka G. Ackova, Lence Miloseva, Tatjana Ruskovska, Georgia E. Deligiannidou, Christos A. Kontogiorgis, and Paula Pinto. 2020. "Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region" Nutrients 12, no. 10: 2960. https://doi.org/10.3390/nu12102960

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