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Concurrent and construct validity of Mediterranean diet scores as assessed by an FFQ

  • Alejandra A Benítez-Arciniega (a1) (a2) (a3), Michelle A Mendez (a4) (a5), Jose M Baena-Díez (a6), Maria-Asunción Rovira Martori (a1) (a3), Cristina Soler (a7), Jaume Marrugat (a3) (a5) (a7), Maria-Isabel Covas (a1) (a2) (a3), Hector Sanz (a7), Alba Llopis (a1) and Helmut Schröder (a1) (a2) (a3)
  • DOI:
  • Published online: 11 July 2011

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.


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.


Gerona, Spain.


A total of 107 consecutively selected participants from a population-based cross-sectional survey.


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.


The FFQ provides valid estimates of diet quality as assessed by the mMDS and MLDS.

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