Validity of the Mediterranean Diet and Culinary Index (MediCul) for Online Assessment of Adherence to the 'Traditional' Diet and Aspects of Cuisine in Older Adults

Sue Radd-Vagenas; Maria A Fiatarone Singh; Kenneth Daniel; Yian Noble; Nidhi Jain; Fiona O'Leary; Yorgi Mavros; Megan Heffernan; Jacinda Meiklejohn; Yareni Guerrero; Tiffany Chau; Perminder S Sachdev; Henry Brodaty; Victoria M Flood

doi:10.3390/nu10121913

Validity of the Mediterranean Diet and Culinary Index (MediCul) for Online Assessment of Adherence to the 'Traditional' Diet and Aspects of Cuisine in Older Adults

Nutrients. 2018 Dec 4;10(12):1913. doi: 10.3390/nu10121913.

Authors

Sue Radd-Vagenas¹, Maria A Fiatarone Singh^{2

3}, Kenneth Daniel⁴, Yian Noble⁵, Nidhi Jain⁶, Fiona O'Leary⁷, Yorgi Mavros⁸, Megan Heffernan⁹, Jacinda Meiklejohn¹⁰, Yareni Guerrero¹¹, Tiffany Chau¹², Perminder S Sachdev^{13

14}, Henry Brodaty^{15

16}, Victoria M Flood^{17

18}

Affiliations

¹ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. sue.radd-vagenas@sydney.edu.au.
² The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. maria.fiataronesingh@sydney.edu.au.
³ The University of Sydney, Sydney Medical School, Camperdown, NSW 2006, Australia and Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA. maria.fiataronesingh@sydney.edu.au.
⁴ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. kenneth.daniel@sydney.edu.au.
⁵ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. yian.noble@sydney.edu.au.
⁶ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. nidhi.jain@sydney.edu.au.
⁷ The University of Sydney, Nutrition and Dietetics Group, School of Life and Environmental Science, Faculty of Science and The Charles Perkins Centre, Camperdown, NSW 2006, Australia. fiona.oleary@sydney.edu.au.
⁸ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. yorgi.mavros@sydney.edu.au.
⁹ Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia. meganh@unsw.edu.au.
¹⁰ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. jacinda.meiklejohn@sydney.edu.au.
¹¹ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. yareni.guerrero@sydney.edu.au.
¹² Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia. tiffany.chau@unsw.edu.au.
¹³ Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia. p.sachdev@unsw.edu.au.
¹⁴ Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW 2052, Australia. p.sachdev@unsw.edu.au.
¹⁵ Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia. h.brodaty@unsw.edu.au.
¹⁶ Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW 2052, Australia. h.brodaty@unsw.edu.au.
¹⁷ The University of Sydney, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Faculty of Health Sciences, Lidcombe, NSW 2141, Australia. vicki.flood@sydney.edu.au.
¹⁸ Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia. vicki.flood@sydney.edu.au.

Abstract

The Mediterranean diet is associated with multiple health benefits. Yet, no tool has been specifically developed to assess adherence to the 'traditional' Mediterranean diet and cuisine within a Western cohort, and validated for online use. We tested the reliability and validity of online administration of the Mediterranean Diet and Culinary Index (MediCul) among middle-aged and older adults. Participants were recruited in January⁻March 2017 from the 45 and Up Study, completing MediCul twice. Test-retest reliability was assessed using the paired t-test, intra-class correlation coefficient (ICC) and Bland-Altman plot. Validity was tested against a three-day food record (FR)-derived MediCul score using Bland-Altman and nutrient trends across the MediCul score tertiles. Participants (n = 84; 60% female; 65.4 years (SD = 5.9)), were overweight (BMI 26.1; SD = 4.0) with 1.7 (SD = 1.5) chronic illnesses/conditions. Sequential MediCul tool scores were 56.1/100.0 and 56.8/100.0, respectively (t = -1.019; p = 0.311). Reliability via ICC (ICC = 0.86, 95% CI: 0.789, 0.910, p < 0.0001) and Bland-Altman was good. In Bland-Altman validity analyses, the tool over-reported FR MediCul score by 5.6 points with no systematic bias ((y = 8.7 - 0.06*x) (95% CI: -0.278, 0.158, p = 0.584)). Nutrient trends were identified for MediCul consistent with expected Mediterranean patterns. Online MediCul administration demonstrated good reliability and moderate validity for assessing adherence to a 'traditional' Mediterranean pattern among older Australians.

Keywords: Mediterranean diet; Mediterranean dietary pattern; dietary assessment; index tool; reliability; repeatability; score; traditional; validity.

MeSH terms

Aged
Biomedical Research / standards
Cross-Sectional Studies
Diet Records*
Diet Surveys / methods
Diet Surveys / standards*
Diet, Mediterranean*
Female
Humans
Internet
Male
Middle Aged
Patient Compliance*
Reproducibility of Results

Grants and funding

APP1095097/National Health and Medical Research Council