The use of composite scores to assess adherence to dietary patterns: the Mediterranean diet case

Angeliki Papadaki, Manolis Linardakis

Research output: Chapter in Book/Report/Conference proceedingChapter in a book

3 Citations (Scopus)


The association of diet with chronic disease has been well documented, and in recent years, research interest has focused on the investigation of whole dietary patterns, instead of single nutrients, for the prevention, and/or treatment of several diseases. The Mediterranean diet is recommended to the Western world as a dietary pattern that is both palatable and healthy, and that can be easily incorporated within a modern lifestyle. Although it is difficult to establish a definition of the ‘typical’ traditional Mediterranean diet, Mediterranean dietary patterns share eight characteristics that differentiate them from American and northern European food cultures. In particular: a high ratio of monounsaturated to saturated fat (MUFA:SFA); high intake of vegetables; fruits, nuts and seeds; legumes/ pulses; (mainly unrefined) cereals; a low-to-moderate intake of dairy products; low intake of meat, meat products and poultry; and moderate alcohol consumption. In 1995, the use of an 8-unit ‘a priori’ dietary score to assess adherence to the Mediterranean diet was proposed, based on the above characteristics of this dietary pattern. This score was later revised to account for fish consumption, the intake of which in the Mediterranean diet was moderate-to-high. Since then, several studies have used adaptations of the original Mediterranean Diet Score, and found significant inverse associations between adherence and overall mortality, disease risk, and biomarkers of health, as well as positive associations with survival. Further, the score has been utilised to detect dietary improvements in nutrition intervention studies. The purpose of this chapter is to describe and investigate the use of the original score and its adaptations in research studies, present the findings of studies utilising such indexes, and discuss validity and reliability issues for dietary assessment purposes. Suggestions for researchers wishing to employ Mediterranean diet indexes to investigate associations with chronic disease and assess adherence to the Mediterranean diet in the future will also be provided.
Original languageEnglish
Title of host publicationAppetite and Nutritional Assessment, Nutrition and Diet Research
EditorsSJ Ellsworth, RC Schuster
Place of PublicationNew York
PublisherNova Science Publishers, Inc
Number of pages70
Publication statusPublished - 2009

Publication series

NameAppetite and Nutritional Assessment, Nutrition and Diet Research Progress Series


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