ARS | Publication request: The development of the Mediterranean-Style Dietary Pattern Score and its application to the American diet in the Framingham Offspring Cohort

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: March 9, 2009
Publication Date: June 1, 2009
Citation: Rumawas, M.E., Dwyer, J.T., Mckeown, N.M., Meigs, J.B., Rogers, G., Jacques, P. 2009. The development of the Mediterranean-Style Dietary Pattern Score and its application to the American diet in the Framingham Offspring Cohort. Journal of Nutrition. 139:1150-1156.

Interpretive Summary: Dietary recommendations promoting healthy dietary patterns e.g., the Mediterranean-style diet that are rich in whole-grain foods, legumes, vegetables and fruits, and limited intakes of full-fat dairy products, sweets and red meat are an emerging approach for the prevention of type 2 diabetes mellitus and cardiovascular disease in the U.S. Diet scores can serve as useful tools to assess a population’s adherence to a Mediterranean-style diet and to study the health benefits of this diet pattern. We have developed a new Mediterranean-Style Dietary Pattern Score (MSDPS) based on the recommended intakes of foods in the traditional Mediterranean-style dietary pattern as defined by the Mediterranean diet pyramid. In the present paper, we describe the development of the MSDPS and to examine the content validity of this score. We applied the MSDPS to dietary data collected and tested the content validity of the score against selected nutrients known to be associated with the Mediterranean-style dietary pattern. We found participants with a higher MSDPS were more likely to be women, older, multivitamin users, to have lower BMI’s and waist circumferences, and less likely to be current smokers. The MSDPS demonstrated content validity through expected positive associations with dietary fiber, n-3 fatty acids, antioxidant vitamins, calcium, magnesium and potassium, and inverse associations with added sugar, glycemic index, saturated fat, trans-fat and n-6 to n-3 fatty acid ratio. The results demonstrated that the MSDPS is a useful instrument to measure the overall diet quality according to the principles of a Mediterranean-style dietary pattern.

Technical Abstract: Previous Mediterranean diet scores were simple to apply but may not be appropriate for non-Mediterranean populations. We developed a Mediterranean-Style Dietary Pattern Score (MSDPS) to assess the conformity of an individual’s diet to a traditional Mediterranean-style diet. The MSDPS is based on the recommended intakes of 13 food groups in the Mediterranean diet pyramid. Each food group is scored from 0 - 10 depending on the degree of correspondence with recommendations. Exceeding the recommendations results in a lower score proportional to the degree of over-consumption. The sum of the component scores is standardized to a 0 – 100 scale and weighted by the proportion of energy consumed from Mediterranean diet foods. We applied the MSDPS to dietary data collected at the seventh examination of the Framingham Offspring Cohort and tested the content validity of the score against selected nutrients known to be associated with the Mediterranean-style dietary pattern. The mean MSDPS was 24.8 (range 3.1 – 60.7). Participants with a higher MSDPS were more likely to be women, older, multivitamin users, to have lower BMI’s and waist circumferences, and less likely to be current smokers. The MSDPS demonstrated content validity through expected positive associations with dietary fiber, n-3 fatty acids, antioxidant vitamins, calcium, magnesium and potassium, and inverse associations with added sugar, glycemic index, saturated fat, trans-fat and n-6 to n-3 fatty acid ratio. The MSDPS is a useful instrument to measure the overall diet quality according to the principles of a Mediterranean-style dietary pattern.