title: The influence of energy standardisation on the alternate Mediterranean diet score and its association with mortality in the Multiethnic Cohort.
abstract: The alternate Mediterranean diet (aMED) score is an adaptation of the original Mediterranean diet score. Raw (aMED) and energy-standardised (aMED-e) versions have been used. How the diet scores and their association with health outcomes differ between the two versions is unclear. We examined differences in participants' total and component scores and compared the association of aMED and aMED-e with all-cause, CVD and cancer mortality. As part of the Multiethnic Cohort, 193 527 men and women aged 45-75 years from Hawaii and Los Angeles completed a baseline FFQ and were followed up for 13-18 years. The association of aMED and aMED-e with mortality was examined using Cox's regression, with adjustment for total energy intake. The correlation between aMED and aMED-e total scores was lower among people with higher BMI. Participants who were older, leaner, more educated and consumed less energy scored higher on aMED-e components compared with aMED, except for the red and processed meat and alcohol components. Men reporting more physical activity scored lower on most aMED-e components compared with aMED, whereas the opposite was observed for the meat component. Higher scores of both aMED and aMED-e were associated with lower risk of all-cause, CVD and cancer mortality. Although individuals may score differently with aMED and aMED-e, both scores show similar reductions in mortality risk for persons scoring high on the index scale. Either version can be used in studies of diet and mortality. Comparisons can be performed across studies using different versions of the score.
authors: 1Cancer Center,University of Hawaii at Manoa,Honolulu,HI 96813,USA.
authors: Yurii B
authors: http://orcid.org/0000-0001-5131-9618
authors: YB
authors: Shvetsov
authors: 2Division of Social and Behavioral Sciences,School of Public Health,University of Memphis,Memphis,TN 38152,USA.
authors: Brook E
authors: BE
authors: Harmon
authors: 3Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa,Honolulu,HI 96822,USA.
authors: Reynolette
authors: R
authors: Ettienne
authors: 1Cancer Center,University of Hawaii at Manoa,Honolulu,HI 96813,USA.
authors: Lynne R
authors: LR
authors: Wilkens
authors: 1Cancer Center,University of Hawaii at Manoa,Honolulu,HI 96813,USA.
authors: Loic
authors: L
authors: Le Marchand
authors: 1Cancer Center,University of Hawaii at Manoa,Honolulu,HI 96813,USA.
authors: Laurence N
authors: LN
authors: Kolonel
authors: 1Cancer Center,University of Hawaii at Manoa,Honolulu,HI 96813,USA.
authors: Carol J
authors: CJ
authors: Boushey
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D015331:Cohort Studies; D038441:Diet, Mediterranean; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D009765:Obesity / Q000150:complications* / Q000401:mortality; D050177:Overweight / Q000150:complications* / Q000401:mortality; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D057566:Self Report
keywords:  MDS Mediterranean dietary score;  MEC Multiethnic Cohort;  QFFQ quantitative FFQ;  aMED alternate Mediterranean diet score;  aMED-e energy-standardised alternate Mediterranean diet score; Diet scores; Energy intake; Mediterranean diet; Mortality