Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study Adherence to the Mediterranean Diet and all-cause mortality risk in an elderly Italian population: Data from the ILSA study Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: a pilot randomised trial of different methods of delivering Mediterranean diet advice. Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study. Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study) Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC) Mediterranean diet impact on changes in abdominal fat and 10-year incidence of abdominal obesity in a Spanish population. Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease. Mediterranean diet and CHD: the Greek European Prospective Investigation into Cancer and Nutrition cohort. Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study Mediterranean diet and cognitive decline over time in an elderly Mediterranean population
Purpose Mediterranean-type dietary pattern has been associated with lower risk of cardiovascular ( CVD ) and other chronic diseases , primarily in Southern European population s. We examined whether Mediterranean diet score ( MDS ) is associated with total , CVD , coronary heart disease ( CHD ) and stroke mortality in a prospect i ve cohort study in three Eastern European population s. Methods A total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe ( HAPIEE ) study in the Czech Republic , Pol and and the Russian Federation were included in the analysis . Diet was assessed by food frequency question naire , and MDS was derived from consumption of nine groups of food using absolute cut-offs .  Mortality was ascertained by linkage with death registers . Results Over the median follow-up time of 7 years , 1314 participants died .  The proportion of participants with high adherence to Mediterranean diet was low ( 25 % ) . One st and ard deviation ( SD ) increase in the MDS ( equivalent to 2.2 point increase in the score ) was found to be inversely associated with death from all causes ( HR , 95 % CI 0.93 , 0.88–0.98 ) and CVD ( 0.90 , 0.81–0.99 ) even after multivariable adjustment . Inverse but statistically not significant link was found for CHD ( 0.90 , 0.78–1.03 ) and stroke ( 0.87 , 0.71–1.07 ) . The MDS effects were similar in each country cohort . Conclusion Higher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban population s. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean population Objective The aim of this study was to evaluate adherence to the Mediterranean Diet ( MD ) and its association with  all-cause mortality in an elderly Italian population . Design Data analysis of a longitudinal study of a representative , age stratified , population sample . Setting Study data is based upon the Italian Longitudinal Study on Aging ( ILSA ) a prospect i ve , community-based cohort study . The baseline evaluation was carried out in 1992 and the follow-up in 1996 and 2000.ParticipantParticipant food intake assessment was available at baseline for 4,232 subjects ; information on survival was available for 2,665 at the 2000 follow-up . Measurements  Adherence to the MD was evaluated with an a priori score based on the Mediterranean pyramid components . Cox proportional hazard models were used to assess the relationship between the MD score and all-cause mortality .  Six hundred and sixty five subjects had died  at the second follow-up ( identified up to the first and second follow-up together ; mean follow-up : 7.1±2.6 years ) . Results At the 2000 follow-up , adjusting for other confounding factors , participants with a high adherence to MD ( highest tertile of the MD score distribution ) had an all-cause mortality risk that was of 34 % lower with respect to the subjects with low adherence ( Hazard Ratio=0.66 ; 95 % CI : 0.49 - 0.90 ; p=0.0144 ) . Conclusion According to study results , a higher adherence to the MD was associated with a low all-cause mortality risk in an elderly Italian population BACKGROUND A Mediterranean diet has been shown to protect against coronary heart disease ( CHD ) . Adherence to a Mediterranean diet can be assessed using a Mediterranean diet score . The primary aim of this pilot study was to examine whether CHD patients in a Northern European population would adopt and maintain a Mediterranean diet , with a secondary aim of comparing the effectiveness of different method ologies aim ed at improving compliance . METHODS Sixty-one patients with a diagnosis of CHD were r and omised to one of three groups : either to receive conventional dietetic advice for CHD or advice to implement a Mediterranean-style diet using either behavioural counselling or nutritional counselling . Patients received a follow-up assessment at 6 months ( adoption ) and a subset of patients was followed up at 12 months ( maintenance ) . The primary outcome measure was the between-group difference in the mean change in Mediterranean diet score ( MDS ) . RESULTS The change in MDS was not significantly different between groups . However , all three groups reported a significant within-group increase in MDS ( P < 0.01 ) at 6 and 12 months follow-up . CONCLUSIONS All three groups made dietary changes towards a Mediterranean diet , but behavioural counselling did not have significant additional benefit over nutritional counselling in initiating and maintaining dietary change , and neither method offering specific Mediterranean diet advice had any significant benefit in terms of improvement in MDS over conventional dietetic practice BACKGROUND AND AIMS Adherence to Mediterranean diet ( MD ) is reportedly declining in the last decades . We aim ed to investigate the adherence to MD over the period 2005 - 2010 and exploring the possible role of the global economic crisis in accounting for the changing in the dietary habits in Italy . METHODS AND RESULTS Cross-sectional analysis in a population -based cohort study which r and omly recruited 21,001 southern Italian citizens enrolled within the Moli-sani study .  Food intake was determined by the Italian EPIC food frequency question naire .  Adherence to MD  was appraised by the  Italian Mediterranean Index ( IMI ) . A wealth score was derived to evaluate the economic position and used together with other socioeconomic indicators . Highest prevalence of adherence to MD  was observed during the years 2005 - 2006 ( 31.3 % ) while the prevalence dramatically fell down in the years 2007 - 2010 ( 18.3 % ; P<0.0001 ) . The decrease was stronger in the elderly , less affluent groups , and among those living in urban areas . Accordingly , we observed that in 2007 - 2010 socioeconomic indicators were strongly associated with higher adherence to MD  , whereas no association was detected in the years before the economic crisis began ; both wealth score and education were major determinants of high adherence to MD  with 31 % ( 95%CI : 18 - 46 % ) higher adherence to this pattern within the wealthier group compared to the less affluent category . CONCLUSION Adherence to MD  has considerably decreased over the last few years . In 2007 - 2010 socioeconomic indicators have become major determinants of adherence to MD , a fact likely linked to the economic downturn The Mediterranean diet ( MD ) is recognized as one of the healthiest dietary patterns and has benefits such as improving glycaemic control among patients with type 2 diabetes ( T2DM ) . Our aim is to assess the effectiveness of a multifactorial intervention to improve adherence to the MD , diet quality and biomedical parameters . The EMID study is a r and omized and controlled clinical trial with two parallel groups and a 12-month follow-up period . The study included 204 subjects between 25–70 years with T2DM . The participants were r and omized into intervention group ( IG ) and control group ( CG ) . Both groups received brief advice about healthy eating and physical activity . The IG participants additionally took part in a food workshop , five walks and received a smartphone application for three months . The population studied had a mean age of 60.6 years . At the 3-month follow-up visit , there were improvements in adherence to the MD and diet quality of 2.2 and 2.5 points , compared to the baseline visit , respectively , in favour of the IG . This tendency of the improvement was maintained , in favour of the IG , at the 12-month follow-up visit . In conclusion , the multifactorial intervention performed could improve adherence to the MD and diet quality among patients with T2DM Aims /hypothesisThe role of diet in the prevention of diabetes remains uncertain . The aim of this study was to investigate two different dietary aspects , i.e. adherence to the Mediterranean diet and glycaemic load ( GL ) , in relation to diabetes occurrence . Methods We analysed data from the Greek cohort of the population -based European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . From a total of 22,295 participants , actively followed for a median of 11.34 years , 2,330 cases of incident type 2 diabetes were recorded . All participants completed a vali date d , interviewer-administered semi-quantitative food frequency question naire at enrolment . From this information , we calculated a ten point Mediterranean diet score ( MDS ) , reflecting adherence to the traditional Mediterranean diet , as well as the dietary GL . We estimated HRs and the corresponding 95 % CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders . Results A higher MDS was inversely associated with diabetes risk ( HR 0.88 [ 95 % CI 0.78 , 0.99 ] for MDS ≥6 vs MDS ≤3 ) . GL was positively associated with diabetes ( HR 1.21 [ 95 % CI 1.05 , 1.40 ] for the highest vs the lowest GL quartile ) . A significant protection of about 20 % was found for a diet with a high MDS and a low GL . Conclusions /interpretationA low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes Abdominal obesity is a strong predictor of metabolic disorders . Prospect i ve data on the association between the Mediterranean diet and surrogate markers of abdominal adiposity are scarce . The present study evaluated the relationship between adherence to the Mediterranean diet and ( 1 ) changes in waist circumference ( WC ) and ( 2 ) 10-year incidence of abdominal obesity . We conducted a prospect i ve , population -based study in 3058 male and female Spaniards aged 25 - 74 years , followed from 2000 to 2009 .  Dietary intake and leisure-time physical activity levels were recorded using vali date d question naires . Weight , height and WC were measured . Adherence to the Mediterranean diet , determined using the previously vali date d REGICOR-Mediterranean diet score ( R-MDS ) , based on the distribution of population food intake and on the dietary recommendations ( MDS-rec ) , was negatively associated with WC gain ( P = 0.007 and 0.024 , respectively ) in fully adjusted models . In the multivariate logistic analysis , the odds of abdominal obesity incidence decreased across the tertiles of the R-MDS , but the association was not significant . In conclusion , adherence to the Mediterranean diet was associated with lower abdominal fat gain , but not with 10-year incidence of abdominal obesity OBJECTIVE We examined associations between two  Mediterranean diet ( MD ) adherence indexes ( the MD index , MDI , and the MD score , MDS ) and several blood biomarkers of diet and disease . SUBJECTS We studied 328 individuals from Catalonia ( Northeastern Spain ) , ages 18 - 75 , who provided fasting blood sample s , a subset of the 2346 individuals as part of a larger representative and r and om sample from the 1992 - 1993 Catalan Nutritional Survey . DESIGN AND METHOD Diet was measured using 24-h recalls . Biomarkers studied were plasma levels of beta-carotene , alpha-tocopherol , retinol , vitamins B12 , C and folates as well as serum total cholesterol , HDL cholesterol , LDL cholesterol and triglycerides . Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes , adjusting for potential confounders . RESULTS AND CONCLUSIONS Subjects with higher MD adherence , as measured by the two dietary indexes , had significantly higher plasma concentrations of beta-carotene , folates , vitamin C , alpha-tocopherol and HDL cholesterol . The most highly significant relationship was that between folates and the adherence to the MD Pattern , as determined by both indexes . These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern . This type of data not only informs the development of robust dietary adherence indexes , but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk Adherence to the Mediterranean diet ( MD ) has been reported to improve CHD prognosis and to be inversely associated with CHD mortality . The aim of the present study was to investigate the association of adherence to the MD with CHD incidence and mortality in the Greek European Prospect i ve Investigation into Cancer and Nutrition cohort , a population with traditional Mediterranean roots . In a general population sample of 23,929 adult men and women with no CVD or cancer at enrolment , a vali date d FFQ was interviewer-administered , sociodemographic , physical activity and other characteristics were recorded , and arterial blood pressure and anthropometric characteristics were measured . In a median period of 10 years , 636 incident CHD cases and 240 CHD deaths were recorded . Associations of adherence to the MD , operationalised through a nine-component score ( 0 , poor ; 9 , excellent ) , with CHD incidence and mortality were evaluated through Cox regression controlling for potentially confounding variables . A two-point increase in the MD score was associated with lower CHD mortality by 25 % ( 95 % CI 0.57 , 0.98 ) among women and 19 % ( 95 % CI 0.67 , 0.99 ) among men . The association of adherence to the MD with CHD incidence was again inverse , but weaker ( hazard ratios 0.85 ( 95 % CI 0.71 , 1.02 ) among women and 0.98 ( 95 % CI 0.87 , 1.10 ) among men ) . With respect to score components , only meat among men ( positively ) and fruits and nuts among women ( inversely ) were associated with both the incidence of and mortality from CHD . The MD , as an integral entity , is inversely associated with CHD incidence and , particularly , mortality Background Despite convincing evidence in the Mediterranean region , the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear . The population attributable fraction ( PAF ) of adherence to this diet is also unknown . Methods In the UK-based EPIC-Norfolk prospect i ve cohort , we evaluated habitual diets assessed at baseline ( 1993–1997 ) and during follow-up ( 1998–2000 ) using food-frequency question naires  ( n = 23,902 ) . We estimated a Mediterranean diet score ( MDS ) using cut-points projected from the Mediterranean dietary pyramid , and also three other pre-existing MDSs . Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates , we examined prospect i ve associations between each MDS with incident cardiovascular diseases ( CVD ) by 2009 and mortality by 2013 , and estimated PAF for each outcome attributable to low MDS . Results We observed 7606 incident CVD events ( 2818/100,000 person-years ) and 1714 CVD deaths ( 448/100,000 ) . The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes , with hazard ratios ( 95 % confidence intervals ) of 0.95 ( 0.92–0.97 ) per one st and ard deviation for incident CVD and 0.91 ( 0.87–0.96 ) for CVD mortality . Associations were similar for composite incident ischaemic heart disease and all-cause mortality . Other pre-existing MDSs showed similar , but more modest associations . PAF due to low dietary pyramid based MDS ( < 95th percentile ) was 3.9 % ( 1.3–6.5 % ) for total incident CVD and 12.5 % ( 4.5–20.6 % ) for CVD mortality . Conclusions Greater adherence to the Mediterranean diet was associated with lower CVD incidence and mortality  in the UK . This diet has an important population health impact for the prevention of CVD Abstract Purpose Evidence suggests that dietary patterns compatible with the traditional Mediterranean diet ( MD ) may protect against cognitive decline . We prospect ively assessed whether adherence to MD in the Mediterranean country of Greece is inversely associated with  cognitive decline in the elderly and whether any particular MD component may play a key role . Methods Elderly men and women ( N = 401 ) residing in the greater Athens area had dietary variables ascertained in 1994–1999 . Adherence to MD was represented by the MD score [ MDS , 0–3 ( low ) , 4–5 ( intermediate ) , 6–9 ( high ) ] . The mini-mental state examination ( MMSE ) was administered by trained professionals to individuals aged 65 years or older in 2004–2006 ( first assessment ) and re-administered in 2011–2012 ( second assessment ) . MMSE change ( cMMSE ) was categorized as : improved/unchanged ( cMMSE ≥ 0 ) , mildly lower ( cMMSE −1 to −4 ) or substantially lower ( cMMSE ≤ −5 ) . Associations were evaluated through multinomial logistic regression . Results Decline in MMSE performance was inversely associated with adherence to MD . For mild versus no decline , odds ratio ( OR ) comparing high to low MD adherence was 0.46 [ 95 % confidence interval ( CI ) 0.25–0.87 , p = 0.012 ] . For substantial versus no decline , OR comparing high to low MD adherence was 0.34 ( 95 % CI 0.13–0.89 , p = 0.025 ) . Among the nine MDS components , only vegetable consumption exhibited a significant inverse association with cognitive decline . Conclusions Closer adherence to the traditional MD is highly likely to protect against cognitive decline in this elderly Mediterranean population . Higher vegetable consumption appears to play a key role , possibly in synergy with additional components of the diet
The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality .
Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population .
OBJECTIVE The aim of this review was to evaluate the conceptual suitability , applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet ( MD ) .