Table 1.
Overview of the components of the adapted MDS and the adapted KIDMED for adolescents*
| Components | Criteria for scoring | Score | |
|---|---|---|---|
| Adapted Mediterranean Diet Score for Adolescents by Z-score method (zMDS_A) | 1. Fruits (excluding juices) nuts, seeds and olives 2. Vegetables (excluding potatoes) 3. Fish and seafood 4. Legumes (excluding fresh peas, sweet corn and broad beans) 5. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese. 8. Meat (including poultry) 9. Alcohol |
Mediterranean diet Z-scores of nine components, including seven positive and two negative (meat and alcohol) | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Quality Index for children and adolescents (KIDMED_A) | 1. Fruits 2. Vegetables 3. Fish and seafood 4. Fast food 5. Pulses (bean, lentils, chickpea, peas, broad beans) 6. Pasta, rice and potatoes 7. Cereals or grains for breakfast 8. Nuts 9. Olive oil 10. Breakfast 11. Dairy products: yoghurt, cheese and curd 12. Confectionery products for breakfast: baked goods or pastries 13. Sweets and candies |
Takes a piece of fruit or fruit juice every day = +1 Has a second fruit every day = +1 Has fresh or cooked vegetables regularly once/d = +1 Has fresh or cooked vegetables more than once/d = +1 Consumes fish regularly (at least 2–3 times/week) = +1 Goes to a fast-food (hamburger) restaurant more than once/week = −1 Likes pulses and eats them more than once/week = +1 Consumes pasta or rice almost every day (≥5 times/week) = +1 Has cereals or grains (bread, etc.) for breakfast = +1 Consumes nuts regularly (at least 2–3 times/week) = +1 Uses olive oil at home = +1 Skips breakfast = −1 Has a dairy product for breakfast (yoghurt, milk, etc.) = +1 Has commercially baked goods or pastries for breakfast = −1 Takes two yoghurts and/or some cheese (40 g) daily = +1 Takes sweets and candy several times every day = −1 |
Questions denoting a negative connotation with respect to the Mediterranean diet were assigned a value of −1, and those with a positive aspect, +1 (see criteria for scoring). The sums of the values (only if the criteria for scoring are met) from the administered test and the index range from −4 to 12, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents (MDS_A) | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese. 8. Meat (including poultry) 9. Alcohol |
Sex- and age- specific median intakes were used as cut-offs except for alcohol intake (given the age range of the adolescents, alcohol intake recommendation was set at 0 g). For components considered to be healthy (vegetables, legumes, fruit and nuts, cereals, fish, monounsaturated fat:saturated fat ratio and dairy products), intakes above the median score 1 and intakes below the median score 0. Meat and alcohol components were scored in the reverse as components presumed to be detrimental. Intakes above the median score 0 and intakes below the median score 1 | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents excluding alcohol (MDS_A_NA) | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese 8. Meat (including poultry) |
Sex- and age- specific median intakes were used as cut-offs. For components considered to be healthy (vegetables, legumes, fruit and nuts, cereals, fish, monounsaturated fat:saturated fat ratio and dairy products), intakes above the median score 1 and intakes below the median score 0. Meat component was scored in the reverse as a component presumed to be detrimental. Intakes above the median score 0 and intakes below the median score 1 | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents 8 components (MDS_A_NA_6P_2N) | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese 8. Meat (including poultry) |
Sex- and age- specific median intakes were used as cut-offs. For components considered to be healthy (vegetables, legumes, fruit and nuts, cereals, fish, monounsaturated fat:saturated fat ratio), intakes above the median score 1 and intakes below the median score 0. Meat and dairy products components were scored in the reverse as components presumed to be detrimental. Intakes above the median score 0 and intakes below the median score 1 | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents 9 components MDS_A_6P_3N | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese 8. Meat (including poultry) 9. Alcohol |
Sex- and age- specific median intakes were used as cut-offs except for alcohol intake (given the age range of the adolescents, alcohol intake recommendation was set at 0 g). For components considered to be healthy (vegetables, legumes, fruit and nuts, cereals, fish and monounsaturated fat:saturated fat ratio), intakes above the median score 1 and intakes below the median score 0. Meat, alcohol and dairy products components were scored in the reverse as components presumed to be detrimental. Intakes above the median score 0 and intakes below the median score 1 | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents excluding alcohol by Z-score method (zMDS_A_NA) | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese 8. Meat (including poultry) |
Mediterranean diet Z-scores of eight components, including seven positive and one negative (meat) | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents by Z-score method, energy adjusted (zEnMDS_A) | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese 8. Meat (including poultry) 9. Alcohol |
Mediterranean diet Z-scores of nine components including, seven positive and two negative (meat and alcohol). Each food item should be divided by total energy intake | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Score for Adolescents by Z-score method, energy adjusted (zEnMDS_A_NA) | 1. Vegetables (excluding potatoes) 2. Legumes (excluding fresh peas, sweet corn and broad beans) 3. Fruits (excluding juices) and nuts, seeds and olives 4. Cereals: bread and rolls, flour, cereals, rice and other cereals, pasta, potatoes 5. Fish and seafood 6. Monounsaturated fat:saturated fat ratio 7. Dairy products: white milk, buttermilk, yoghurt, fromage blanc and cheese 8. Meat (including poultry) |
Mediterranean diet Z-scores of eight components, including seven positive and one negative (meat). Each food item should be divided by total energy intake | The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Quality Index for children and adolescents excluding pulses and potatoes (KIDMED_A_NP) | 1. Fruits 2. Vegetables 3. Fish and seafood 4. Fast food 5. Pasta and rice 6. Cereals or grains for breakfast 7. Nuts 8. Olive oil 9. Breakfast 10. Dairy products: yoghurt, cheese and curd 11. Confectionery products for breakfast: baked goods or pastries 12. Sweets and candies |
Takes a fruit or fruit juice every day = +1 Has a second fruit every day = +1 Has fresh or cooked vegetables regularly once/d = +1 Has fresh or cooked vegetables more than once/d = +1 Consumes fish regularly (at least 2–3 times/week) = +1 Goes to a fast-food (hamburger) restaurant more than once/week = −1 Consumes pasta or rice almost every day (≥5 times/week) = +1 Has cereals or grains (bread, etc.) for breakfast = +1 Consumes nuts regularly (at least 2–3 times/week) = +1 Uses olive oil at home = +1 Skips breakfast = −1 Has a dairy product for breakfast (yoghurt, milk, etc.) = +1 Has commercially baked goods or pastries for breakfast = −1 Takes two yoghurts and/or some cheese (40 g) daily = +1 Takes sweets and candy several times every day −1 |
Questions denoting a negative connotation with respect to the Mediterranean diet were assigned a value of −1, and those with a positive aspect, +1 (see criteria for scoring). The sums of the values (only if the criteria for scoring are met) from the administered test and the index range from −4 to 11, with a higher score indicating higher adherence to Mediterranean diet |
| Adapted Mediterranean Diet Quality Index for children and adolescents excluding pulses, potatoes and fast food (KIDMED_A_NPH) | 1. Fruits 2. Vegetables 3. Fish and seafood 4. Pasta and rice 5. Cereals or grains for breakfast 6. Nuts 7. Olive oil 8. Breakfast 9. Dairy products: yoghurt, cheese and curd 10. Confectionery products for breakfast: baked goods or pastries |
Takes a fruit or fruit juice every day = +1 Has a second fruit every day = +1 Has fresh or cooked vegetables regularly once/d = +1 Has fresh or cooked vegetables more than once/d = +1 Consumes fish regularly (at least 2–3 times/week) = +1 Consumes pasta or rice almost every day (≥5 times/week) = +1 Has cereals or grains (bread, etc.) for breakfast = +1 Consumes nuts regularly (at least 2–3 times/week) = +1 Uses olive oil at home = +1 Skips breakfast = −1 Has a dairy product for breakfast (yoghurt, milk, etc.) = +1 Has commercially baked goods or pastries for breakfast = −1 Takes two yoghurts and/or some cheese (40 g) daily= +1 Takes sweets and candy several times every day −1 |
The sum of the values from the positive components and deducting the negative components, with a higher score indicating higher adherence to Mediterranean diet |
MDS, Mediterranean Diet Score; KIDMED, Mediterranean Diet Quality Index for children and adolescents.
*
Construct details of the abbreviated scores: _A, adolescents; _NA, no alcohol category included in score; _xP, number of positive categories included in score (x = number); _xN, number of negative categories included in score (x = number); _NP, no pulses category included in score; _NPH, no pulses and fast food category included in score.