Adaptation and predictive utility of a Mediterranean diet screener score

Kathleen Abu-Saad, Ronit Endevelt, Rebecca Goldsmith, Tal Shimony, Lesley Nitsan, Danit R. Shahar, Lital Keinan-Boker, Arnona Ziv, Ofra Kalter-Leibovici

Research output: Contribution to journalArticlepeer-review


Background & aims: 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 adherence to the local Mediterranean diet variant. We aimed to describe the process of adapting the Spanish Mediterranean Diet Adherence Screener (MEDAS) for use in Israel, and to test 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 less strongly associated with mortality, and lost significance after adjustment for potential confounders. Conclusions: I-MEDAS reflects the local Mediterranean diet and national dietary recommendations in Israel. The I-MEDAS score, calculated from FFQ data, demonstrated predictive utility for mortality in a population-based cohort of adults.

Original languageEnglish
Pages (from-to)2928-2935
Number of pages8
JournalClinical Nutrition
Issue number6
StatePublished - Dec 2019

Bibliographical note

Publisher Copyright:
© 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism


  • Dietary screener
  • Israel
  • Local adaptation
  • Mediterranean diet score
  • Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics


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