Abstract:
Background: Micronutrient deficiencies remain a public health concern globally and in the
Middle East, including Lebanon. The Modified Mediterranean Prime Screen (MMPS), adapted
to Lebanese diets, helps assess micronutrient intake. While validated in women of reproductive
age, its use in the general adult population is yet to be examined.
Objective: To evaluate the validity and reproducibility of the MMPS in assessing micronutrient
intake among Lebanese adults aged 18-64 years, using a validated semi-quantitative Food
Frequency Questionnaire (FFQ) as the reference method.
Methods: A total of 214 participants were recruited from two medical and one educational
centers in Lebanon. Both the MMPS and the FFQ were administered at baseline to assess
micronutrient intake, with the MMPS repeated after 3 weeks to 6 months to assess
reproducibility. Intraclass correlation coefficients (ICCs) were calculated to evaluate both testretest
reliability and agreement between tools. Nutrient intakes were also energy-adjusted, and
Bland-Altman analyses were conducted to assess agreement. Results: A total of 214 Lebanese adults participated (65.4% female; mean age 38.9 ± 13.4
years). The MMPS demonstrated moderate to good reproducibility, with adjusted ICCs ranging
from 0.317 (vitamin A) to 0.705 (niacin). Highest reproducibility was observed for niacin,
vitamin D, and riboflavin. Validity against the FFQ was moderate for calcium (ICC = 0.557) and
iron (ICC = 0.435), and lower for zinc, folate, sodium, and most vitamins, including A, D, and
B-complex. Bland-Altman plots supported moderate agreement for calcium, iron, folate, sodium,
and zinc, but poor agreement for vitamin A and riboflavin.
Conclusion: While the MMPS demonstrated moderate reproducibility and validity for select
micronutrients, its limited accuracy for others and structural constraints suggest it should be used
cautiously and only as a preliminary screening tool in time-limited settings. Further refinement
and validation are needed before wider application.
