title: Similar prediction of total mortality, diabetes incidence and cardiovascular events using relative- and absolute-component Mediterranean diet score: the SUN cohort.
abstract: OBJECTIVE
  Accumulated evidence supports the effectiveness of Mediterranean-type diets (MeDiet) in reducing mortality and preventing several chronic diseases. Widely used scores to assess adherence to MeDiet are based on specific sample characteristics; alternatively, they might be built according to absolute/normative cut-off points for the consumption of specific food groups (pre-defined servings/day or/week). The aim of this study was to compare sample-specific MeDiet adherence scores (MDS) versus absolute-normative scores (Mediterranean Diet Adherence Screener - MEDAS) on their association with macronutrient intake, total mortality and incidence of chronic diseases.
  
  
  METHODS
  SUN (Seguimiento Universidad de Navarra) dynamic prospective cohort study (60.5% women; mean age 38.4 years).
  
  
  RESULTS
  In cross-sectional analyses (n=20,155) we evaluated macronutrient distribution according to MDS (based on 136-item FFQ), MEDAS (based on 13 questions), and variants of both. In prospective analyses (n=9109; mean follow-up: 6.2 years), we evaluated disease incidence or mortality. Adherence to MeDiet increased with age and, as expected, was associated with higher fiber intake, lower total fat intake but higher monounsaturated/saturated fat ratio, using all scores. Among subjects initially free of cancer, diabetes, and cardiovascular disease (CVD), adherence to MeDiet appraised with an absolute-normative score (MEDAS) similarly predicted macronutrient distribution and disease incidence or mortality (diabetes incidence, CVD or all-cause mortality), when compared to a sample-specific score based on 136-item FFQ (MDS).
  
  
  CONCLUSIONS
  Adherence to MeDiet was associated with a decreased incidence of a composite outcome including diabetes incidence, cardiovascular events incidence or all-cause mortality.
authors.affiliation: Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via F. Scaduto 6/c, 90144 Palermo, Italy.
authors.forename: L J
authors.initials: LJ
authors.lastname: Domínguez
authors.forename: M
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.forename: C
authors.initials: C
authors.lastname: de la Fuente-Arrillaga
authors.forename: E
authors.initials: E
authors.lastname: Toledo
authors.forename: J J
authors.initials: JJ
authors.lastname: Beunza
authors.forename: M
authors.initials: M
authors.lastname: Barbagallo
authors.forename: M A
authors.initials: MA
authors.lastname: Martínez-González
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000401:mortality* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000401:mortality* / Q000517:prevention & control; D038441:Diet, Mediterranean; D004043:Dietary Fiber / Q000008:administration & dosage; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009043:Motor Activity; D015596:Nutrition Assessment; D010349:Patient Compliance; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D004043:Dietary Fiber; D005229:Fatty Acids, Monounsaturated