Proposal of a Mediterranean Diet Serving Score

PLoS One. 2015 Jun 2;10(6):e0128594. doi: 10.1371/journal.pone.0128594. eCollection 2015.


Background and aims: Numerous studies have demonstrated a relationship between Mediterranean Diet (MD) adherence and the prevention of cardiovascular diseases, cancer, and diabetes, etc. The study aim was to validate a novel instrument to measure MD adherence based on the consumption of food servings and food groups, and apply it in a female population from southern Spain and determining influential factors.

Methods and results: The study included 1,155 women aged 12-83 yrs, classified as adolescents, adults, and over-60-yr-olds. All completed a validated semi-quantitative food frequency questionnaire (FFQ). The Mediterranean Dietary Serving Score (MDSS) is based on the latest update of the Mediterranean Diet Pyramid, using the recommended consumption frequency of foods and food groups; the MDSS ranges from 0 to 24. The discriminative power or correct subject classification capacity of the MDSS was analyzed with the Receiver Operating Characteristic (ROC) curve, using the MDS as reference method. Predictive factors for higher MDSS adherence were determined with a logistic regression model, adjusting for age. According to ROC curve analysis, MDSS evidenced a significant discriminative capacity between adherents and non-adherents to the MD pattern (optimal cutoff point=13.50; sensitivity=74%; specificity=48%). The mean MDSS was 12.45 (2.69) and was significantly higher with older age (p<0.001). Logistic regression analysis showed highest MD adherence by over 60-year-olds with low BMI and no habit of eating between meals.

Conclusions: The MDSS is an updated, easy, valid, and accurate instrument to assess MD adherence based on the consumption of foods and food groups per meal, day, and week. It may be useful in future nutritional education programs to prevent the early onset of chronic non-transmittable diseases in younger populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Cardiovascular Diseases / prevention & control*
  • Child
  • Diet Surveys / statistics & numerical data*
  • Diet, Mediterranean*
  • Eating*
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Prognosis
  • ROC Curve
  • Spain
  • Surveys and Questionnaires
  • Young Adult

Grant support

This study was supported by the Spanish Ministry of Education and Science (FPU Program, AP2008-03703, PhD fellowship for Celia Monteagudo), the European Union Commission (QLK4-1999-01 422 and FOOD-CT-2004-506319), the Health Department of Granada City Council-University of Granada (Contract nº 2260), Andalusian Regional Government (Research Group AGR-255), Spain, the Spanish Ministry of Health and Consumer Affairs (Programme for Promotion of Biomedical Research and Health Sciences, Projects 11/01791, Red Predimed-RETIC RD06/0045/1004, and CIBEROBN CB12/03/30038), and a Grant of support to research groups no. 35/2011 (Balearic Islands Gov. and EU FEDER funds).