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Benitez-Arciniega, Alejandra A.; Mendez, Michelle A.; Baena-Diez, Jose M.; Rovira Martori, Maria-Asuncion; Soler, Cristina; Marrugat, Jaume; Covas, Maria-Isabel; Sanz, Hector; Llopis, Alba; & Schroder, Helmut, on behalf of the REGICOR and HERMES Investigators (2011). Concurrent and Construct Validity of Mediterranean Diet Scores as Assessed by an FFQ. Public Health Nutrition, 14(11), 2015-2021.


OBJECTIVE: The aim of the present study was to assess the concurrent and construct validity of two diet-quality indices, a modified Mediterranean diet score (mMDS) and a Mediterranean-like diet score (MLDS) additionally incorporating unhealthy food choices, as determined by an FFQ.
DESIGN: A validation study assessing FFQ intake estimates compared with ten or more unannounced 24 h recalls. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Bland-Altman plots and the limits of agreement method were used to assess the between-method agreement of scores. Construct validity was shown using associations between nutrient intakes derived from multiple 24 h recalls and the mMDS and MLDS derived from the FFQ.
SETTING: Gerona, Spain.
SUBJECTS: A total of 107 consecutively selected participants from a population-based cross-sectional survey.
RESULTS: Pearson's correlations for the energy-adjusted mMDS and MLDS compared with multiple recalls were 0.48 and 0.62, respectively. The average FFQ energy-adjusted mMDS and MLDS were 102 % and 98 % of the recall-based mMDS and MLDS estimates, respectively. The FFQ under- and overestimated dietary recall estimates of the energy-adjusted MLDS by 28 % and 25 %, respectively, with slightly wider boundaries for the mMDS (31 % and 34 %). The ICC, which assesses absolute agreement, was similar to Pearson's correlations (mMDS = 0.48 and MLDS = 0.61). The mean differences between methods were similar across the range of average ratings for both scores, indicating the absence of bias. The FFQ-derived mMDS and MLDS correlated in the anticipated directions with intakes of eleven (73.3 %) and thirteen of fifteen nutrients (86.7 %), respectively.
CONCLUSIONS: The FFQ provides valid estimates of diet quality as assessed by the mMDS and MLDS.


Reference Type

Journal Article

Year Published


Journal Title

Public Health Nutrition


Benitez-Arciniega, Alejandra A.
Mendez, Michelle A.
Baena-Diez, Jose M.
Rovira Martori, Maria-Asuncion
Soler, Cristina
Marrugat, Jaume
Covas, Maria-Isabel
Sanz, Hector
Llopis, Alba
Schroder, Helmut, on behalf of the REGICOR and HERMES Investigators