Evaluation of Mediterranean diet adherence scores: a systematic review.

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). DESIGN: This was a systematic review to identify original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. Electronic searches were carried out on the international databases MEDLINE, Scopus, Web of Science and EMBASE (from January 1980 to 31 December 2015). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The study included original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. The studies where MD adherence scores were administered but did not bring forward any evidence about their performance related to conceptual suitability, applicability or psychometric properties were excluded. DATA EXTRACTION: Information relating to the scales was extracted in accordance with the quality criteria defined by the Scientific Advisory Committee of the Medical Outcomes Trust for measurement of health results and the quality criteria recommended by Terwee: (1) conceptual, (2) applicability and (3) psychometric properties. Three authors independently extracted information from eligible studies. RESULTS: Twenty-seven studies were identified as meeting the inclusion criteria, yielding 28 MD adherence scores. The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality. The scores developed by Panagiotakos et al, Buckland et al and Sotos-Prieto et al showed the highest levels of evidence. CONCLUSIONS: Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population. However, further information is required regarding existing scores. In addition, new instruments with greater conceptual and methodological rigour should be developed and evaluated for their psychometric properties.

Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life and Life Satisfaction among Older Adults.

OBJECTIVES: Evaluate the relationship between adherence to the Mediterranean diet and health-related quality of life and degree of life satisfaction among older adults. DESIGN AND SETTING: Cross-sectional descriptive study. PARTICIPANTS: A total of 351 people older than 60 years participated in the study. MEASUREMENTS: The Mediterranean Diet Score (MDS) was calculated to assess the degree of adherence to the MD. MD adherence was related to health-related quality of life using the Short Form Healthy Survey (SF-12) questionnaire, to life satisfaction using the Satisfaction with Life Scale (SWLS), and to sociodemographic, clinical and lifestyle variables. Multiple logistic regression models were used to analyse this relationship. RESULTS: Mediterranean diet adherence was related to health- related quality of life. Participants with better adherence to the MD were more physically active (p=0.01) and had better health-related quality of life (p<0.05) and lower consumption of alcoholic beverages (p=0.04). The age-adjusted model showed a significant association between the MD and mental function for both sexes and with physical function only for men. The fully adjusted model showed a direct relationship between the MD and life satisfaction of women (p>0.05) but not for that of men (p=0.31). CONCLUSIONS: The adherence to the MD is directly associated with the self-perceived physical and mental function of both sexes and with the life satisfaction of women. Further studies in older adult populations should be performed to obtain conclusive results on the MD effect on health-related quality of life, including wellness indicators.