We thank Dr. Elvira Alvarez Stehle [1] for her interest in our work reporting the association between a Mediterranean diet and a fatty liver in women with overweight and obesity [2].
Although deviations from the original protocol were found in the PREDIMED trial, they do not affect the validation of the MEDAS questionnaire. Schröder et al. [3] did, in fact, validate MEDAS against a 137-item semiquantitative FFQ using baseline data from PREDIMED prior to randomization. Certainly, the validation of MEDAS against an FFQ has several limitations. As Schröder et al. stated in their work [3], the similar designs of FFQ and MEDAS may have caused an overestimation of the accuracy of MEDAS given the likely between-method correlation of the errors.
More recently, García-Conesa et al. [4] performed a validation study of MEDAS using small samples of subjects from different Mediterranean and non-Mediterranean countries. They compared the results obtained from MEDAS with those obtained from a 3 day dietary record. In addition to confirming the reliability of the MEDAS questionnaire, they found a good agreement between the two methods, with values similar to, and in some cases greater than, those reported by Schröder et al. [3]. They found low agreement between the two methods for some food items, but this could be due to the difficulty of quantifying a weekly consumption using a 3 day dietary record. This limitation can be overcome by using multiple 7 day dietary records.
We thus believe that the MEDAS questionnaire remains a useful and reliable tool for rapidly assessing adherence to the Mediterranean diet.
Author Contributions
Writing—original draft preparation, A.L., G.B. and A.B.; S.B., L.V. and M.P. agreed this reply. All authors have read and agreed to the published version of the manuscript.
Conflicts of Interest
The authors declare no conflict of interest.
References
- Alvarez Stehle, E. Comment on Leone et al. Association between Mediterranean Diet and Fatty Liver in Women with Overweight and Obesity. Nutrients 2022, 14, 3771. Nutrients 2023, 15, 1139. [Google Scholar] [CrossRef]
- Leone, A.; Bertoli, S.; Bedogni, G.; Vignati, L.; Pellizzari, M.; Battezzati, A. Association between Mediterranean Diet and Fatty Liver in Women with Overweight and Obesity. Nutrients 2022, 14, 3771. [Google Scholar] [CrossRef] [PubMed]
- Schröder, H.; Fitó, M.; Estruch, R.; Martínez-González, M.A.; Corella, D.; Salas-Salvadó, J.; Lamuela-Raventós, R.; Ros, E.; Salaverría, I.; Fiol, M.; et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J. Nutr. 2011, 141, 1140–1145. [Google Scholar] [CrossRef] [PubMed]
- García-Conesa, M.T.; Philippou, E.; Pafilas, C.; Massaro, M.; Quarta, S.; Andrade, V.; Jorge, R.; Chervenkov, M.; Ivanova, T.; Dimitrova, D.; et al. 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. [Google Scholar] [CrossRef] [PubMed]
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