Validity of the Mediterranean Diet and Culinary Index (MediCul) for Online Assessment of Adherence to the ‘Traditional’ Diet and Aspects of Cuisine in Older Adults

Abstract

The Mediterranean diet is associated with multiple health benefits. Yet, no tool has been specifically developed to assess adherence to the ‘traditional’ Mediterranean diet and cuisine within a Western cohort, and validated for online use. We tested the reliability and validity of online administration of the Mediterranean Diet and Culinary Index (MediCul) among middle-aged and older adults. Participants were recruited in January–March 2017 from the 45 and Up Study, completing MediCul twice. Test-retest reliability was assessed using the paired t-test, intra-class correlation coefficient (ICC) and Bland-Altman plot. Validity was tested against a three-day food record (FR)-derived MediCul score using Bland-Altman and nutrient trends across the MediCul score tertiles. Participants (n = 84; 60% female; 65.4 years (SD = 5.9)), were overweight (BMI 26.1; SD = 4.0) with 1.7 (SD = 1.5) chronic illnesses/conditions. Sequential MediCul tool scores were 56.1/100.0 and 56.8/100.0, respectively (t = −1.019; p = 0.311). Reliability via ICC (ICC = 0.86, 95% CI: 0.789, 0.910, p < 0.0001) and Bland-Altman was good. In Bland-Altman validity analyses, the tool over-reported FR MediCul score by 5.6 points with no systematic bias ((y = 8.7 − 0.06*x) (95% CI: −0.278, 0.158, p = 0.584)). Nutrient trends were identified for MediCul consistent with expected Mediterranean patterns. Online MediCul administration demonstrated good reliability and moderate validity for assessing adherence to a ‘traditional’ Mediterranean pattern among older Australians.

Evaluation of a Novel Tool for Screening Inadequate Food Intake in Age-Related Macular Degeneration Patients

“…To allow consistent comparison between the FFQ and SDQ-AMD, scoring criteria were developed. Scores and cut points were justified based on the Australian Dietary Guidelines [13] and existing literature on nutrition and AMD links (Online Supplementary Table S1) [5,7,13,. Food items included were total vegetables, dark green leafy vegetables, fruit, water, red meat, processed meat, fish/seafood, legumes, nuts, eggs, breads, cereals, select discretionary food and drinks, alcoholic beverages and fats and oil.…”

“…For alcohol, total alcohol intake in grams, rather than volume of alcohol consumed, was divided by one serve of alcohol (i.e., 10 g) [46]. For the SDQ-AMD, some additional data manipulation was required prior to applying score criteria, such as adjusting reported alcohol intake to reflect standard serves and converting reported weekly intake of specified discretionary items to daily intakes (Online Supplementary Table S1) [5,7,13,. For both FFQ and SDQ-AMD, appropriate scores from the scoring criteria were allocated based on serving intake, and total scores were recorded out of 30.…”

“…The Bland−Altman plot of difference illustrates that most mean difference scores lie within the 95% confidence interval and there was no significant bias between the scores as the mean score increased ((regression equation: y = 0.11 x − 2.60) (95% CI: −0.058, 0.275, p-value = 0.20)) ( Figure 2). Supplementary Table S1) [5,7,13,. Supplementary Table S1) [5,7,13,.…”

“…Just over half of the results showed negligible correlations (i.e., <0.30) [49]. On the other hand, a moderate positive correlation coefficient (0.57, p-value < 0.0001) was observed between survey total scores based on the scoring criteria (Online Supplementary Table S1) [5,7,13,. As correlation coefficients only indicate associations, a Bland-Altman plot of difference ( Figure 2) was used to assess agreement between the SDQ-AMD and FFQ [56].…”

“…As eye-care practitioners are one of the first points of contact for a patient when it comes to AMD, research into developing a rapid and easy dietary tool for use by eye-care practitioners is warranted. A short dietary questionnaire (SDQ-AMD) that has been modified from a validated survey [7] could assist eye-care practitioners with screening patients' overall diets for inadequate food intake and identifying those in need of dietary behavioural support via dietitian referral, where appropriate, and/or patient support networks such as the Macular Disease Foundation Australia (MDFA)-an Australian non-government organisation supporting those living with macular disease. As a multidisciplinary approach to healthcare has been widely encouraged for optimal patient outcomes, a similar approach is expected to benefit AMD patients [8].…”