title: VALIDATION OF A QUESTIONNAIRE TO MEASURE OVERALL MEDITERRANEAN LIFESTYLE HABITS FOR RESEARCH APPLICATION: THE MEDITERRANEAN LIFESTYLE INDEX (MEDLIFE).
abstract: BACKGROUND
  the Mediterranean Lifestyle index (MEDLIFE) was developed as a questionnaire to capture adherence to an overall Mediterranean healthy lifestyle. The reliability of the MEDLIFE as an independent questionnaire must be evaluated prior its use in research studies.
  
  
  OBJECTIVE
  to assess the inter-method reliability of the MEDLIFE as a short and independent research tool.
  
  
  METHODS
  the 28-item MEDLIFE questionnaire and a 142-item validated questionnaire (full-Q) from which we derived the 28-items MEDLIFE (MEDLIFE-derived) were administered simultaneously to 196 adults (mean age 41.4 ± 9.2 y) living in Madrid, Spain. The reliability was assessed by Kappa (k) statistics, intra-class correlation coefficients (ICC) and limits of agreement (LOA).
  
  
  RESULTS
  overall correlation between the two instruments was 0.626. MEDLIFE had an acceptable ability to rank participants by MEDLIFE-derived from full-Q (ICC = 0.544). Absolute agreement showed very good concordance for 10.7% of the items evaluated; good to moderate concordance for most items, and fair concordance for 32.1% of the items. Intake of sweets, processed meats, low-fat dairy products and cereals were overestimated by MEDLIFE. About 38%, 15%, 12% and 10% of participants who scored 1-point for those items in MEDLIFE also scored 1-point in the MEDLIFE-derived respectively. Bland Altman's analysis showed that LOA ranged from -4.66 to 7.45 (mean = 1.40).
  
  
  CONCLUSIONS
  the MEDLIFE is a valid instrument to measure overall adherence to the Mediterranean lifestyle in middle age adults from a Spanish population, and could be used as an independent questionnaire in clinical and epidemiological studies for such population. Its generalizability and predictive validity for clinical outcomes remains to be investigated.
authors: Department of Nutrition, Harvard T.H Chan School of Public Health, Boston. Area of Epidemiology and Populations Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid (Spain). Fundacion Science Health and Education.. msotosp@hsph.harvard.edu.
authors: Mercedes
authors: M
authors: Sotos-Prieto
authors: Area of Epidemiology and Populations Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid (Spain). Fundacion Science Health and Education.. msotosp@hsph.harvard.edu.
authors: Gloria
authors: G
authors: Santos-Beneit
authors: Area of Epidemiology and Populations Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid (Spain). Fundacion Science Health and Education.. msotosp@hsph.harvard.edu.
authors: Patricia
authors: P
authors: Bodega
authors: Area of Epidemiology and Populations Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid (Spain). Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London (UK).. msotosp@hsph.harvard.edu.
authors: Stuart
authors: S
authors: Pocock
authors: Department of Nutrition, Harvard T.H Chan School of Public Health, Boston.. msotosp@hsph.harvard.edu.
authors: Josiemer
authors: J
authors: Mattei
authors: Area of Epidemiology and Populations Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid (Spain). Friedman School of Nutrition Science and Policy, Tufts University, Boston MA (USA).. msotosp@hsph.harvard.edu.
authors: Jose Luis
authors: JL
authors: Peñalvo
mesh_terms: D000328:Adult; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D062486:Public Health Surveillance; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires