Comparison and convergent validity of five Mediterranean dietary indexes applied to Brazilian adults and older adults: data from a population-based study (2015 ISA-Nutrition)

Author(s)

Bastos, Amalia A. ; Felix, Paula V. ; Castro, Michelle A. ; Fisberg, Regina M. ; Silva, Antonio A. M. ; Yannakoulia, Mary ; Ribeiro, Sandra M. L.

• Document type: Journal article
• Source: JOURNAL OF NUTRITIONAL SCIENCE; v. 12, p. 10-pg., 2023-01-26.

Abstract

Different dietary indexes are proposed to investigate adherence to the Mediterranean diet (MD). However, they are based on different methodologies, and limited research has compared them to each other, particularly in non-Mediterranean populations. We aimed to compare five indexes intended to measure adherence to the MD. The sample was composed of adults and older adults (n 1187) from 2015 ISA-Nutrition, a cross-sectional population-based study in Sao Paulo, SP, Brazil. Dietary data obtained through two 24-h dietary recalls (24HDR) from which the Mediterranean diet scale (MDS), Mediterranean diet Score (MedDietscore), Mediterranean dietary pattern (MDP), Mediterranean Adequacy Index (MAI) and Mediterranean-Style Dietary Pattern Score (MSDPS) were calculated. The correlations and agreements between them were analysed by Spearman's correlation and linearly weighted Cohen's Kappa coefficients, respectively. Confirmatory factor analyses (CFAs) were applied to investigate their convergent validity. The highest correlations were found between MDP and MAI (r = 0 center dot 76; 95% CI 0 center dot 74-0 center dot 79) and between MDP and MDS (r = 0 center dot 72; 95% CI 0 center dot 69-0 center dot 75). The greatest agreements observed were moderate, between MDP v. MAI (kappa = 0 center dot 57, P < 0 center dot 001) and MDP v. MDS (kappa = 0 center dot 48, P < 0 center dot 001). The goodness-of-fit of CFA for MedDietscore (RMSEA = 0 center dot 033, 90% CI 0 center dot 02-0 center dot 042; SRMR = 0 center dot 042) and MSDPS (RMSEA = 0 center dot 028, 90% CI 0 center dot 019-0 center dot 037; SRMR = 0 center dot 031) had acceptable values for absolute fit indices. Vegetables, olive oil, MUFA:SFA ratio and cereals with legumes were more relevant to characterise the MD (factor loadings >= 0 center dot 50). The MDS, MAI and MDP classified the population similarly, but the MedDietscore showed better performances in evaluating adherence to the MD. These results provided guidance for the most appropriate Mediterranean dietary index to be applied in non-Mediterranean populations. (AU)

• FAPESP's process: 17/05125-7 - Lifestyle, biochemical and genetic markers as cardiometabolic risk factors: Health Survey in São Paulo City
• Grantee: Regina Mara Fisberg
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 12/22113-9 - Biochemical indicators of micronutrient status and usual intakes of residents from the City of São Paulo - ISA-Capital Survey 2013
• Grantee: Regina Mara Fisberg
• Support Opportunities: Regular Research Grants
• FAPESP's process: 19/24213-0 - Common mental disorders, adherence to the Mediterranean dietary pattern and lipid profile in older adults living in the city of São Paulo in 2003, 2008 and 2015
• Grantee: Amália Almeida Bastos
• Support Opportunities: Scholarships in Brazil - Doctorate