Mediterranean Diet Score
Summary:
9-Unit dietary score
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proposed by Trichopoulou et al (1995)
score of 0 or 1 for each 9 catagories below
 Vegetables: 4 or more servings a day
 Legumes: 1 or more servings a week
 Fruit: 3 or more servings a day
 Nuts and seeds: 1 or more servings a week
 Whole grains: 1 or more servings a day
 Fish: 4 or more servings a week
 Fats: More unsaturated fats, such as olive oil, than saturated fats, such as
butter.
 Alcohol: 1/2 to 1 drink a day for women; 1 to 2 for men
 Red and processed meat: Fewer than 2 servings a day for women, fewer than 3
a day for men
 Totals of six or higher are the range of highest benefit.
 Scores less than four indicate lowest benefit
 High scores correspond to high adherence to the Mediterranean dietary pattern (score's range:
0–9).
Assessed Outcomes: metabolic syndrome (Kastorini et al.), mortality (Sofi et al); stroke (Demarin et al),
cancer (Cout E et al.), cardiovascular disease (Gardener et al), weight management (Trichopoulou et al ),
inflammation (Thomazella et al)
Kastorini C-M, et al. The Effect of Mediterranean Diet on Metabolic Syndrome and its Components. Journal of the
American College of Cardiology. 2011 57 (11): 1299–1313.
Sofi F, et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008
Demarin V, et al. Mediterranean diet in healthy lifestyle and prevention of stroke. Acta Clin Croat. 2011;50(1): 6777.
Cout E et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer. 2011; 104(9): 1493-9
Gardener H et al. Mediterranean-style diet and risk of ischemic stroke, myocardial stroke, myocardial infraction
and vascular death: the Northern Manhattan Study. Am J Clin Nutr. 2011; 94(6): 1458-64.
Trichopoulou A et al. Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European
Prospective Investigation into Cancer and Nutrition Study. AJCN. 2005; 82(5): 935-940.
Thomazella MC et al. Effects of high adherence to Mediterranean or low-fat diets in medicated secondary
prevention paitents. Am J Cardiol. 2011; 108(11):1523-9.
Healthy Eating Index (HEI)
Summary:
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Measure of diet quality that assesses conformance to Federal dietary guidance.
Originally created by the U.S. Department of Agriculture (USDA) in 1995.
Release of new Dietary Guidelines for Americans in 2005 motivated a revision of the HEI.
The food group standards are based on the recommendations found in MyPyramid
Healthy Eating Index−2005 components and standards for scoring1
www.cnpp.usda.gov/HealthyEatingIndex.htm.
Assessed Outcomes: weight management (Guo X et al), inflammation (Ford ES et al), cancer (Reddy et
al), cardiovascular (McCullough et al),
Guo X et al. Healthy Eating Index and Obesity. Euro J of Clin Nutr. 2004; 58: 1580-1586.
Healthy Eating Index and C-reactive protein concertration: findings from the National Health and Nutrition
Examination Survey III, 1988-1994. Euro J of Clin Nutr. 2004; 59: 278-283
Reddy J, et al. Index-base Dieatary Patterns and Risk of Colorectal Cancer. Am J of Epi. 2008; 168(1): 38-48.
McCullough et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men.
AJCN. 2000; 72(5): 1233-1231.
Ratio of Ingested Saturated Fat and Cholesterol to Calories (RISCC)
Summary:
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The RISCC score is a dietary monitoring tool for clinical trials that assesses the hyperlipidemic
potential of a diet.
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RISCC rating condenses the saturated fat, cholesterol, and energy intakes into 1 value,
which summarizes the serum lipoprotein-raising potential of a diet.
Stability ratings over time provides evidence for stability of background dietary patterns.
Assessed Outcomes: cardiovascular (Kostapanos M et al), hypercholesterolemia (Harold E et al).
Kostapanos M et al. Dose-depended effect of rosuvastatin treatment on HDL-subfraction phenotype in
patients with primary hyperlipidemia. JCPI. 2009. 14(1):5-13.
Harold E et al. Effectiveness and Tolerability of Ezetimibe in Patients with Primary Hypercholesterolemia:
Pooled analysis of two phase II studies. Clinical Therapeutics. 2001; 23(8): 1290-30
Low Carbohydrate Diet Score
Summary: The low carb diet score is used to assess adherence to a low carb diet by using parameters of
carbohydrate, fat, protein, animal-protein, animal-fat, vegetable-protein, vegetable-fat intake as
percentages of total energy intake. See table below.
Table taken from Halton et al. N Engl J Med. 2006.
Outcomes: T2DM in men and women, coronary heart disease risk, hypertension
Halton TL, Willett WC, Liu S, et al. Low-Carbohydrate-Diet Score and the Risk of Coronary Heart Disease in Women.
N Engl J Med. 2006; 355:1991-2002.
Halton TL, Liu S, Manson JE, Hu FB. Low-carbohydrate-diet score and risk of type 2 diabetes in women. Am J Clin
Nutr. 2008. 87(2):339-346.
Koning L, Fung TT, Liao X, et al. Low-carbohydrate diet scores and risk of type 2 diabetes in men. Am J Clin Nutr.
2011.
Diet Quality Index-Revised
Summary: Assesses 10 recommendation categories in the United States (categories below), each
category worth up to 10 points for a total possible score of 100
1. Total fat, _ 30% of energy intake
2: Saturated fat, _ 10% of energy
3: Dietary cholesterol, _ 300 mg/d
4: 2–4 Servings fruit/d
5: 3–5 Servings vegetables/d
6: 6–11 Servings grains/d
7: Calcium intake, % AI for age
8: Iron intake, % 1989 RDA for age
9: Dietary diversity (grains, fruits, vegetables, and meats and dairy divided into subcategories. Points are
accumulated for each ¼ serving/day of a given food group. Ultimately, each of the four food groups can
receive a total of 2.5 points, thus 10 points total)
10: Dietary moderation (added sugar, discretionary fat, alcohol, and sodium)
Outcomes: This index has been validated in the Health Professional’s Follow Up Study between FFQ’s,
24 HR, and serum biomarkers of intake. This score is typically used as a measure of overall diet quality
and diet diversity in various populations. Not used often.
Newby PK, Hu FB, Rimm EB, Smith-Warner SA, et al. Reproducibility and validity of the Diet Quality Index Revised
as assessed by use of a food-frequency questionnaire. Am J Clin Nutr. 2003;78:941–9.
Dietary Modification Index
Summary: Based on 6 categories developed from the AHA guidelines (cholesterol, trans fat, saturated
fat intake) or national guidelines. Each category is scored based off cutpoints and included in a
corresponding quintile of intake, with quintile 5 being the most favorable (healthy). The scores are then
added together, and a higher score reflects better adherence to a healthy diet. See Table below for
categorical breakdowns.
Outcomes: The DMI has been used to assess risk of incident cardiovascular disease or heart failure in
postmenopausal women in the WHI cohort.
Belin R, Greenland P, Allison M, Martin L, et al. Diet Quality and the Risk of Cardiovascular Disease: The
Women’s Health Initiative (WHI). Am J Clin Nutr. 2011;94:49-57.