Adaptation and Predictive Utility of a Mediterranean Diet Screener Score: Israel-Mediterranean Diet Adherence Screener (I-MEDAS) -

Kathleen Abu-Saad ¹ Ronit Endevelt ^2,4 Rebecca Goldsmith ² Tal Shimony ³ Lesley Nitsan ³ Danit R. Shahar ⁵ Lital Keinan-Boker ^3,4 Arnona Ziv ⁶ Ofra Kalter-Leibovici ^1,7

¹Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Israel
²Nutrition Division, Ministry of Health, Israel
³Israel Center for Disease Control, Ministry of Health, Israel
⁴School of Public Health, University of Haifa, Israel
⁵Department of Public Health, Ben-Gurion University of the Negev, Israel
⁶Computer and Information Unit, Gertner Institute for Epidemiology and Health Policy Research, Israel
⁷Sackler Faculty of Medicine, Tel-Aviv University, Israel

Background: There is a substantial body of evidence supporting the health benefits of the Mediterranean diet, which has differing variations across the Mediterranean region. Abbreviated dietary screeners can be adapted and used to assess local Mediterranean diet adherence. We adapted the Spanish Mediterranean Diet Adherence Screener (MEDAS) for use in Israel, and tested the predictive utility of the adapted score for mortality.

Methods: A professional committee of nutritional policy makers, dieticians and researchers adapted MEDAS to create an Israeli Mediterranean diet screener (I-MEDAS) that reflected the local Mediterranean diet and national dietary recommendations. The Hadera District Study (HDS) was a population-based, prospective cohort study of adults in Israel. Food frequency questionnaire (FFQ) data from the HDS was used to calculate Mediterranean diet adherence according to the I-MEDAS score criteria and evaluate the score’s predictive utility. Mortality status was obtained from the national population registry. Cox proportional hazards regression models were used to test the predictive utility of the I-MEDAS score for all-cause mortality.

Results: The 14-item MEDAS was adapted to create a 17-item I-MEDAS. According to FFQ data from the HDS cohort (n=1092 adults; median [IQR] follow-up time=14 [12-15] years, 179 deaths), the median (IQR) I-MEDAS score was 8 (7-9). In multivariable analysis, every 1-point increase in the I-MEDAS score reduced the hazard of death by 12% (adjusted HR: 0.88; 95% CI: 0.80-0.97). The original MEDAS score was not significantly associated with mortality.

Conclusions: I-MEDAS reflects the local Mediterranean diet and national dietary recommendations in Israel. Mediterranean diet adherence in the HDS cohort was sub-optimal; however, I-MEDAS provides a tool for rapid, regular assessment to track trends and responses to public health campaigns. The I-MEDAS score demonstrated predictive utility for mortality in a population-based cohort of Israeli adults.