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The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review.

The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components. Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations. A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

Biomarkers↗

Changes in diet and patterns of feeding activity of developing rats.

The purpose of this study was to determine the amount of milk and stock diet consumed by rats during postnatal development and the extent to which they feed in circadian rhythms when weaned naturally by their dams or when separated from their dams at age 21 days. One approach used in several experiments was to record feed bin weight losses at circadian intervals. The second approach was to analyze the stomach contents of rats killed at circadian intervals at representative ages. Contents were inspected, freeze-dried, weighed and assayed for fat by extraction with solvent. The difference in fat between rat milk solids and stock diet was the basis for estimating proportions of stock diet and milk. The results indicate that 1) natural weaning occurs progressively from 14 to 30 days after birth, with an accelerated phase between 18 and 25 days; 2) pups up to 8 days old and their dams feed mostly by light and darkness, respectively; 3) circadian variations in feeding are weak and inconsistent in 10 to 20 day old pups and their dams; 4) at 21 days pups and dams begin to feed mostly in darkness; 5) the proportions of food consumed by light and darkness approach those of the adult by age 29 days when rats are weaned naturally, and by 25 days when weaned at 21 days; and 6) progression into the nocturnal feeding pattern may be disturbed if larger litters are not provided with sufficient space.

Age Factors↗

A review of family and social determinants of children's eating patterns and diet quality.

With the growing problem of childhood obesity, recent research has begun to focus on family and social influences on children's eating patterns. Research has demonstrated that children's eating patterns are strongly influenced by characteristics of both the physical and social environment. With regard to the physical environment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater quantities when larger portions are provided. Additionally, characteristics of the social environment, including various socioeconomic and sociocultural factors such as parents' education, time constraints, and ethnicity influence the types of foods children eat. Mealtime structure is also an important factor related to children's eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also play a direct role in children's eating patterns through their behaviors, attitudes, and feeding styles. Interventions aimed at improving children's nutrition need to address the variety of social and physical factors that influence children's eating patterns.

Child↗

The defecation pattern and diet in patients with an ileum reservoir and anal anastomosis with a long efferent leg.

The dietary habits and defecation patterns of 12 patients were examined 8-34 months after total colectomy with mucosal proctectomy and the construction of an ileal reservoir attached to an anal anastomosis. The reservoir was provided with a long efferent leg (12 cm) through the anal canal. The patients were divided into two groups in accordance with the frequency of defecation--one with fewer than six defecations per 24 h and another with more than six defecations per 24 h. The fecal output, however, was not significantly different in the two groups. The fecal content of sodium and potassium was the same as in feces from conventional ileostomies. The dietary intake was insufficient in energy content, vitamins, minerals, and trace elements. Dietary supplement was recommended.

Adult↗

Dietary patterns and risk of nonfatal acute myocardial infarction in Costa Rican adults.

OBJECTIVE: To investigate the association between dietary patterns and risk of a first nonfatal acute myocardial infarction (MI) in Costa Rican adults. DESIGN: Population-based case-control study. SUBJECTS: A total of 496 incident MI cases and 518 population-based randomly selected controls matched to the cases by age (+/-5 years), gender, and county of residence. Subjects were interviewed with a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using multivariate conditional logistic regression adjusted for several recognized risk factors for MI. RESULTS: Two diet patterns were identified, 'vegetable' characterized by increased intake of vegetables and fruits, and 'staple', characterized by an increased use of palm oil for cooking, and intake of refined grains (mostly white rice and white bread), legumes, coffee, added sugar, and red meat. Compared to the lowest quintile of the staple diet pattern, the highest quintile was associated with an increased risk of MI (OR: 3.70, 95% CI: 2.30-5.97). Adjusting for potential confounders did not change the results (OR: 3.53, 95% CI: 1.98-6.31). Consistently, an increasing staple pattern score was associated with lower HDL cholesterol (P for trend <0.02) and alpha-linolenic acid in adipose tissue (P for trend <0.0001). The vegetable pattern was not associated with MI. CONCLUSIONS: The staple dietary pattern of Costa Rican adults is associated with low plasma HDL cholesterol, low alpha-linolenic acid in adipose tissue, and increased risk of MI.

Acute Disease↗

Alcohol drinking patterns and diet quality: the 1999-2000 National Health and Nutrition Examination Survey.

Associations between alcohol drinking and cardiovascular disease mortality could be confounded by diet if alcohol drinking and diet are related. Depending on the alcohol measure, alcohol-diet relations may or may not be observed. The authors examined associations between alcohol and diet quality (Healthy Eating Index (HEI) scores) using cross-sectional, nationally representative data from the 1999-2000 National Health and Nutrition Examination Survey. Weighted analyses included 3,729 participants aged > or =20 years. In adjusted analyses among current alcohol drinkers, as quantity increased from 1 to > or =3 drinks/drinking day, the mean HEI score decreased from 65.3 (95% confidence interval (CI): 63.4, 67.1) to 61.9 (95% CI: 60.5, 63.2). As frequency increased from the lowest quartile to the highest, the mean HEI score increased from 60.9 (95% CI: 58.7, 63.2) to 64.9 (95% CI: 63.4, 66.4). As average volume ((quantity x frequency)/365.25) increased from <1 drink/day to > or =3 drinks/day, the mean HEI score increased from 62.9 (95% CI: 61.2, 64.5) to 65.2 (95% CI: 62.7, 67.8). In stratified analyses, the lowest HEI score, 58.5 (95% CI: 55.5, 61.5), occurred among drinkers who consumed the highest quantity at the lowest frequency. Average volume of alcohol consumed is driven by and masks the contributions of its components. These results suggest the importance of measuring drinking patterns (quantity, frequency, and stratified combinations) in epidemiologic alcohol-diet studies.

Adult↗

Attained height of lacto-ovo vegetarian children and adolescents.

The relationship between diet and attained height was studied in children and adolescents in Southern California. Diet pattern was determined from an extensive food frequency questionnaire in 1765 Caucasian children of 7-18 years, attending state schools (452 m and 443 f) and Seventh-day Adventist schools (427 m and 443 f). The major difference in diet pattern between state and Adventist school children was in meat consumption. The Adventist children were split evenly between three categories of frequency in meat consumption (less than 1/week, 1/week-less than 1/d, and greater than or equal to 1/d), while 92 percent of state school children consumed meat daily. Vegetarians (those consuming meat less than 1/week) differed significantly in the consumption of other major food groups, such as fruit and vegetables. All school and diet subgroups were at or above the 50th percentile of the National Center for Health Statistics. Age-adjusted regression analysis showed that on average Adventist vegetarian children were taller than their meat-consuming classmates (2.5 and 2.0 cm for boys and girls, respectively). These results did not change materially when adjusting for other food groups. Nor did adjustment for parental height and socioeconomic factors in a sub-sample of 518 children. The results indicate that vegetarian children and adolescents on a balanced diet grow at least as tall as children who consume meat.

Adolescent↗

The bearing of diverse patterns of diet on growth and menarche in four ethnic groups of South African girls.

Anthropemetric and development studies were made on 4390 black rural and urban, coloured, Indian and white school girls of 6-17 years and a 24-h dietary recall recorded on subsamples. Mean weights and heights of non-white were lower at all ages than those of white girls. Prevalences of obesity (greater than or equal to 120% weight-for-height), were higher in black and coloured than in Indian and white girls, but mean percentage body fat was not significantly different at 17 years. Growth attained was in response to very different dietary patterns. However, this did not delay breast development, which occurred at much the same time in all groups. However, menstruation was delayed in black compared with coloured, Indian and white girls. Although breast development was present in all at 14 years, proportions (%) menstruating differed: 33 rural and urban black; 84 coloured; 93 Indian; 97 white. in non-menstruating girls of 8 years of age all had mean fat greater than 17% (the expected level of menstruation) and, except in black rural and coloured girls, this was greater than 22%, the critical level for regular ovulation. These studies throw doubt on the nutritional components as being wholly responsible for the delay of menarche, as breast development, the earliest sign of puberty in girls, is not delayed despite marked dietary differences. The emergence of obesity without dietary intervention in the 'poorest' of adolescent girls, further questions this hypothesis.

Adipose Tissue↗

The specific dynamic action of the omnivorous tortoise Kinixys spekii in relation to diet, feeding pattern, and gut passage.

The peak of the elevated oxygen consumption following feeding may be preabsorptive in some reptiles, possibly because of the up-regulation of gut function. The question of whether up-regulation has a substantial net cost and accounts for a large part of the cost of the specific dynamic action can be resolved by comparing the response to single and repeated meals. Oxygen consumption of the omnivorous tortoise Kinixys spekii was elevated for 3-4 d after a single meal, and the peak occurred while most food was still in the stomach. The cost of the specific dynamic action varied between diets, being 16%, 21%, and 30% of the energy absorbed from fungi, leaves, and millipedes, respectively, but was about 0.8 L O2 g-1 absorbed protein for all diets. The specific dynamic action doubled during continuous feeding on leaves and then accounted for 42% of the absorbed energy. The increase after repeated feeding shows that up-regulation of gut function can contribute little to the energy cost of the specific dynamic action in K. spekii; otherwise the cost would fall in subsequent meals.

Animals↗

Changing pattern of diet in Europe.

The traditional wide range in diet in Europe that was based on climate and geography are slowly being eroded as modern transport and communications bring wider ranges of foods to the markets, and as modern travel cultures are eroding the boundaries of palatability. Tradition and history are still important factors, and the climatic variations are still there. Public education programmes encourage those living in the more northern countries to adopt a diet more similar to that consumed in the Mediterranean area. The programmes are having some success. Unfortunately, however, cultural factors seem to be persuading those living in the south to eat a more northern diet with more meat and animal fat.

Diet Surveys↗

Diet preference and meal patterns of weanling pigs offered diets containing either spray-dried porcine plasma or dried skim milk.

Preference tests and meal pattern analyses were conducted to examine the feed intake response of weanling pigs to spray-dried porcine plasma (SDPP). In Exp. 1, 36 weanling pigs (mean +/- SD; 6.2 +/- .8 kg and 26 d of age) were allowed to choose between a SDPP diet (8.5% SDPP, 20% dried whey, 10% lactose, and .13% DL-methionine) and a dried skim milk (DSM) diet (20% each of DSM and dried whey) throughout 21 d postweaning. Twenty-eight pigs preferred the SDPP diet and seven pigs preferred the DSM diet. Preference for SDPP became apparent by d 2 (60% of total feed consumption) and increased (P < .01) to d 21 (71% of total feed consumption). Average daily feed consumption was 371 and 172 g for the SDPP and DSM diets, respectively (P < .01). The meal patterns of 16 weanling pigs (mean +/- SD; 7.2 +/- .3 kg and 26 d of age) offered either the SDPP or the DSM diet were examined in Exp. 2. On d 3, 7, and 14 postweaning, feeding behavior was observed continuously for 18 h (0600 to 2400). Time spent consuming feed and time between periods of feeding were recorded. Although the difference was not significant, pigs fed the SDPP diet consumed 27 and 6% (P = .38) more feed than pigs fed the DSM diet during the first 7 d and during the entire 21-d period, respectively. This difference was reflected in increased (P < .05) rate of feed consumption on d 3 and 7. Diet had no effect (P > .10) on meal size, the number of meals, or the percentage of time spent consuming feed. Weanling pigs prefer diets containing SDPP to those containing DSM, and the increased consumption of diets containing SDPP may be due to greater palatability.

Analysis of Variance↗

Assessment of dietary adequacy for an elderly population based on a Mediterranean model.

This study analysed whether at different energy levels, a varied diet based on Mediterranean Diet patterns would meet the RDIs for specific nutrients in a population > 65 y. Based on RDIs for elderly persons > 65 y for PRO, FAT CHO, phosphorus, calcium, magnesium, iron, zinc, vitamin C, B6, folate and fibre, menu models based on Mediterranean diet food patterns were calculated for the following calorie levels: 1400, 1500, 1600, 1700 and 1800 kcals. 15 menu variations for each calorie level were then created based on the previously calculated models. Utilising the Program for Alimentation and Nutrition (PAN) database, nutritional analysis was carried out for all menus and the mean nutrient values for a 2 week period were calculated for each calorie level. Intakes at all calorie levels provided adequate amounts of folate, phosphorus, iron and Vitamin B6. Intakes were low in all groups for Calcium, Zinc, Magnesium and Vitamin E, with the exception of the 1800 kcal level for Vitamin E. Results show that at low energy levels, meeting nutrient needs was difficult and that even at higher calorie intakes, contrary to what was expected, certain nutrients were found to be inadequate.

Aged↗