Abstract:
Rationale: Non-communicable diseases (NCDs) are a leading cause of mortality in
Lebanon, with diet playing a significant role in their prevention. Due to the high burden
of NCDs, accurate and culturally appropriate dietary assessment tools are needed. The
Modified Mediterranean Prime Screen (MMPS), a culture-specific dietary screener, was
developed to assess dietary intake associated with NCD risk in adults in Lebanon.
Methods: This study aimed to validate the MMPS against a reference Food Frequency
Questionnaire (FFQ) to evaluate its reproducibility and agreement in assessing diet
quality indices such as the Mediterranean Diet Score (MDS) and Dietary Approaches to
Stop Hypertension (DASH). Reproducibility and agreement were assessed through
Intraclass Correlation Coefficients (ICCs) and Cohen’s Kappa (κ). Results: The study included 214 adults (65% females, mean age 38.9 ± 13.4 years). For
the MDS components, the FFQ demonstrated excellent reproducibility for vegetables
and legumes and good to moderate for all the other components except for fruits (poor
reproducibility). The MMPS also showed excellent reproducibility for fish and good to
moderate reproducibility for all the other components except for cereals (poor
reproducibility). Agreement between FFQ and MMPS was good to moderate for all food
groups, however it was poor for the MDS total score (ICC = 0.435). For DASH
components, Cohen’s Kappa between FFQ1 and FFQ2 ranged from fair (fruits, κ =
0.357) to excellent (sweetened beverages, κ = 0.857). Reproducibility of the MMPS was
stronger, particularly for whole grains (κ = 0.761) and red and processed meats (κ =
0.685). In contrast, agreement between FFQ and MMPS was highest for sweetened
beverages (κ = 0.481) but slight to fair for most other components.
Conclusion: The MMPS demonstrated moderate reproducibility and poor agreement in
estimating key dietary quality indices, including the MDS and DASH.
