Table 1.
Components and scoring criteria for the dietary patterns evaluated: Trichopoulou Mediterranean diet (TMD) (37), Alternate Mediterranean diet (AMD) (38), Panagiotakos Mediterranean diet (PMD) (39), Healthy Eating Index 2015 (HEI) (40), Alternative Healthy Eating Index 2010 (AHEI) (30,41), American Heart Association (AHA) recommendations (42,43), and Dietary Approaches to Stop Hypertension 2005 (DASH) deit (44), and Plant-based diet score (PBD) (45).
| Diet Pattern | Components | Definition/Clarification | Dietary recommendation | Standard for maximum points | Standard for minimum points |
|---|---|---|---|---|---|
| TMD (maximum points=9) | All grains | Refined and non-refined grains | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) |
| Fruits and nuts | Fruits, fruit juices and nuts (e.g., almonds, walnuts, etc.) | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Vegetables | Potatoes and French fries not included | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Legumes | Lentils, chickpeas, beans, etc. | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Fish | Fish and seafood | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Red meat, processed meat, and organ meats products | Read meat, processed meat, and offal (e.g., hamburger, hot dog, deli meat, beef, organs, etc., chicken not included) | Discourage consumption | >than median intake (servings/day) (0 point) | <than median intake (servings/day) (1 points) | |
| Dairy | All dairy products (e.g., full fat and low fat) | Discourage consumption | >than median intake (servings/day) (0 point) | <than median intake (servings/day) (1 points) | |
| Fats | MUFA/SFA | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Alcoholic beverages | Wine, beer, liquor, etc. 100 mL = 12 g ethanol (g/day) | Moderate consumption | Males: 10-50 g/day (1 point) Females: 5-25 g/day (1 point) |
Males: ≤10 or ≥50 g/day (0 points) Females: 0 point if ≤5 or ≥25 g/day (0 points) |
|
| AMD (maximum points=9) | Whole grains | Whole grain (e.g., pasta, bread, etc.) | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) |
| Fruits | Fruits and fruit juices | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Vegetables | Potatoes and French fries not included | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Nuts | Nuts (e.g., almonds, walnuts, etc.) | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Legumes | Lentils, chickpeas, beans, etc. | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Fish | Fish and seafood | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Red meat, and processed meat | Read meat and processed meat (e.g., hamburger, hot dog, deli meat, beef, etc., chicken not included) | Discourage consumption | <than median intake (servings/day) (1 point) | >than median intake (servings/day) (0 points) | |
| Fats | MUFA/SFA | Encourage consumption | >than median intake (servings/day) (1 point) | <than median intake (servings/day) (0 points) | |
| Alcoholic beverages | Wine, beer, liquor, etc. 100 mL = 12 g ethanol (g/day) | Moderate consumption | Males: 1 point if 15-25g/day(1 point) Females: 1 point if 5-15g/day (1 point) |
Males: ≤15 or ≥25g/day (0 points) Females: ≤5 or ≥15g/day (0 points) |
|
| PMD (maximum points=55) | Whole grains | Whole grain (e.g., pasta, bread, etc.) | Encourage consumption | >32 servings/week (5 points) | No whole grains (0 points) |
| Potatoes | French fries not included | Encourage consumption | >18 servings/week (5 points) | No potatoes (0 points) | |
| Fruits | Fruits and fruit juices | Encourage consumption | >22 servings/week (5 points) | No fruits (0 points) | |
| Vegetables | Potatoes and French fries not included | Encourage consumption | >33 servings/week (5 points) | No vegetables (0 points) | |
| Legumes | Lentils, chickpeas, beans, etc. | Encourage consumption | >6 servings/week (5 points) | No legumes (0 points) | |
| Fish | Fish and seafood | Encourage consumption | >6 servings/week (5 points) | No fish (0 points) | |
| Red meat, and processed meat | Read meat and processed meat (e.g., hamburger, hot dog, deli meat, beef, etc., chicken not included) | Discourage consumption | ≤1 servings/week (5 points) | >10 (0 points) | |
| Poultry | Chicken | Discourage consumption | ≤3 servings/week (5 points) | >10 (0 points) | |
| Full fat dairy products | All full fat dairy products (e.g., cheese, yoghurt, full fat milk, etc.) | Discourage consumption | ≤10 servings/week (5 points) | >30 (0 points) | |
| Olive oil | Use of olive oil in cooking (times/week) | Encourage consumption | 7 times/week (5 points) | Never (0 points) | |
| Alcoholic beverages | Wine, beer, liquor, etc. 100 mL = 12 g ethanol (mL/day) | Moderate consumption | <300 mL/day (5 points) | >700 mL/day or no alcohol (0 points) | |
| HEI (maximum points=100) | Total fruit | Fruit and fruit juices | Encouraged | ≥0.8 c equivalents/1000 kcal (5 points) | No fruit (0 points) |
| Whole fruit | No fruit juices included | Encouraged | ≥0.4 c equivalents/1000 kcal (5 points) | No whole fruit (0 points) | |
| Vegetables | Including green, yellow, cruciferous, etc. | Encouraged | ≥1.1 c equivalents/1000 kcal (5 points) | No vegetables (0 points) | |
| Greens and beans | Legumes | Encouraged | ≥0.2 c equivalents/1000 kcal (5 points) | No greens and beans (0 points) | |
| Whole grains | Including pasta, bread, etc. | Encouraged | ≥1.5 oz equivalents/1000 kcal (10 points) | No whole grains (0 points) | |
| Dairy | Including low and high fat dairy | Encouraged | ≥1.3 c equivalents/1000 kcal (10 points) | No dairy (0 points) | |
| Total protein foods | Including read meat, processed meat, fish, poultry, legumes etc. | Encouraged | ≥2.5 oz equivalents/1000 kcal (5 points) | No protein foods (0 points) | |
| Seafood and plant proteins | Including fish, shellfish, nuts, legumes, soy products, etc. | Encouraged | ≥0.8 oz equivalents/1000 kcal (5 points) | No seafood or plant proteins (0 points) | |
| Fatty acids | Ratio of PUFAs and MUFAs fatty acids to SFAs | Encouraged | (PUFA+MUFA)/SFA≥2.5 (10 points) | (PUFA+MUFA)/SFA≤1.2 (0 points) | |
| Refined grains | Including white flour, white rice, white bread, etc. | Discouraged | ≤1.8 oz equivalents/1000 kcal (10 points) | ≥4.3 oz equivalents/1000 kcal (0 points) | |
| Sodium | Sodium intake | Discouraged | ≤1.1 g/1000 kcal (10 points) | ≥2.0 g/1000 kcal (0 points) | |
| Added sugars | Added sugars intake | Discouraged | ≤6.5% energy/1000 kcal (10 points) | ≥26% energy/1000 kcal (0 points) | |
| Saturated fats | Saturated fats intake | Discouraged | ≤8% energy/1000 kcal (10 points) | ≥16% energy/1000 kcal (0 points) | |
| AHEI (maximum points=100) | Fruit | No fruit juices included | Encouraged | ≥4 servings/day (10 points) | No vegetables (0 points) |
| Vegetables | Including green, yellow, cruciferous, etc. | Encouraged | ≥5 servings/day (10 points) | No fruit (0 points) | |
| Nuts and legumes | Nuts and legumes consumption | Encouraged | ≥1 servings/day (10 points) | No nuts and legumes (0 points) | |
| Whole grains | Including pasta, bread, etc. | Encouraged | Men: ≥90 g/day (10 points)Women: ≥75 g/day (10 points) | No whole grains (0 points) | |
| Sugar-sweetened beverages | Including high energy drinks and fruit juices | Discouraged | No sugar-sweetened beverages (10 points) | ≥8 oz/day (0 points) | |
| Red and processed meat | Including read meat, and processed meat | Discouraged | No red and processed meat (10 points) | ≥1.5 servings/day (0 points) | |
| Long chain omega-3 fats (EPA+DHA)a | EPA+DHA intake | Encouraged | ≥ 250 mg/day (10 points) | No EPA+DHA intake (0 points) | |
| PUFA | PUFAs intake | Encouraged | ≥ 10% energy (10 points) | ≤ 2% energy (0 points) | |
| Alcohol | Alcohol intake | Discouraged (moderate intake) | Men: 0.5-2.0 drinks/day (10 points) Women: 0.5-1.5 drinks/day (10 points) |
Men: ≥3.5 drinks/day (0 points) Women: ≥2.5 drinks/day (0 points) |
|
| Sodium | Sodium intake | Discouraged | Lowest decile (10 points) | Highest decile (0 points) | |
| AHA (maximum points=80) | Fruits and vegetables | No fruit juices included | Encouraged | ≥4.5 cups/day (10 points) | 0 cups/day (0 points) |
| Whole grain | Including pasta, bread, etc. | Encouraged | ≥3.0 oz-equivalents/day (10 points) | 0 oz-equivalents/day (0 points) | |
| Fish and shellfish | No breaded fish included | Encouraged | ≥2.0 servings/week (10 points) | 0 servings/week (0 points) | |
| Sugar-sweetened beverages | Including high energy drinks and fruit juices | Discouraged | ≤5.1 fluid oz/day (10 points) | >16 fluid oz/day (0 points) | |
| Sodium b | Sodium intake | Discouraged | ≤1.5 grams/day (10 points) | >4.5 grams/day (0 points) | |
| Nuts, seeds, and legumes | No soy products included | Encouraged | ≥4.0 servings/week (10 points) | 0 servings/week (0 points) | |
| Processed meat | No read meat included | Discouraged | ≤0.5 oz/day (10 points) | >1.8 oz/day (0 points) | |
| Saturated fata | Only SFAs included | Discouraged | ≤7.0% of total calories/day (10 points) | >15% of total calories/day (0 points) | |
| DASH (maximum points=40) | Total fruit | Fruit and fruit juices | Encouraged | Fifth quintile (5 points) | First quintile (1 point) |
| Vegetables | No legumes and soy products included | Encouraged | Fifth quintile (5 points) | First quintile (1 point) | |
| Nuts and legumes | Including legumes, nuts, and soy products | Encouraged | Fifth quintile (5 points) | First quintile (1 point) | |
| Whole grain | Including pasta, bread, etc. | Encouraged | Fifth quintile (5 points) | First quintile (1 point) | |
| Low-fat dairy | No high-fat dairy included | Encouraged | Fifth quintile (5 points) | First quintile (1 point) | |
| Red and processed meat | Including read meat, and processed meat | Discouraged | First quintile (5 points) | Fifth quintile (1 point) | |
| Sugar-sweetened beverages | Including high energy and carbonated drinks, and punch beverages | Discouraged | First quartile (5 points) | Fourth quartile (1 point) | |
| Sodium | Sodium intake | Discouraged | First quintile (5 points) | Fifth quintile (1 point) | |
| PBD (maximum points=60) | Vegetables | No legumes and soy products included | Encouraged | ≥2 servings/d (5 points) | <2 servings/d (1 point) |
| Total fruit | Fruit and fruit juices | Encouraged | ≥ 3 servings/d (5 points) | < 3 servings/d (1 point) | |
| Legumes | Legumes | Encouraged | ≥ 3 servings/week (5 points) | < 3 servings/week (1 point) | |
| All grain | Refined and non-refined grains | Encouraged | ≥ 2 servings/d (5 points) | < 2 servings/d (1 point) | |
| Potatoes | Potatoes and chips | Encouraged | ≥ 1 servings/d (5 points) | < 1 servings/d (1 point) | |
| Nuts | Nuts (e.g., almonds, walnuts, etc.) | Encouraged | ≥ 3 servings/week (5 points) | < 3 servings/week (1 point) | |
| Olive oil | Refined, extra-virgin, etc. | Encouraged | ≥ 4 tablespoons/d (5 points) | < 4 tablespoons/d (1 point) | |
| All meat and meat products | Red meat, meat, poultry, organs, etc. | Discouraged | ≤3 servings/week (5 points) | >3 servings/week (1 point) | |
| Animal fats | For cooking or as a spread (butter) | Discouraged | ≤3 servings/week (5 points) | >3 servings/week (1 point) | |
| Eggs | Egg consumption | Discouraged | ≤3 servings/week (5 points) | >3 servings/week (1 point) | |
| Fish and seafood | White fish, blue fish, mussels, shrimp, etc. | Discouraged | ≤3 servings/week (5 points) | >3 servings/week (1 point) | |
| Dairy products | High-fat and low-fat dairy | Discouraged | ≤1 servings/day (5 points) | >1 servings/day (1 point) |
Abbreviations: AHA, American Heart Association diet recommendations; AHEI, Alternate Healthy Eating Index; AMD, Alternate Mediterranean diet; DASH, Dietary Approaches to Stop Hypertension diet; DHA, docosahexaenoic omega-3 fatty acid; EPA, eicosapentaenoic omega-3 fatty acid; HEI, Healthy Eating Index; MUFA, monounsaturated fatty acids; PBD, Plant-based diet; PMD, Panagiotakos Mediterranean diet; PUFA, polyunsaturated fatty acids; SFA, saturated fatty acids; TMD, Trichopoulou Mediterranean diet.
a
Fats were energy-adjusted as nutrient densities.
b
Sodium intake was energy-adjusted using the residual method.