The Mediterranean Diet Adherence Screener (MEDAS) is a validated 14-item questionnaire designed to assess how closely an individual follows a traditional Mediterranean diet. Developed from the PREDIMED (PREvención con DIeta MEDiterránea) trial, the MEDAS provides a practical snapshot of dietary habits. Individuals receive one or zero points for each item based on their food consumption frequency and other factors, resulting in a total score between 0 and 14. This score helps categorize adherence levels and identify areas for improvement.
Interpreting your MEDAS score: Low, Moderate, and High Adherence
For the 14-item MEDAS questionnaire, scores are typically categorized into three levels based on major study criteria:
- Low Adherence (Score 0-5): This range indicates significant deviation from the Mediterranean diet's core principles. Individuals likely consume fewer recommended foods like fruits, vegetables, nuts, and fish and more red meat and processed items. Substantial dietary changes are suggested to gain the full health benefits.
- Moderate Adherence (Score 6-9): A moderate score suggests fair adherence, incorporating some key Mediterranean foods and habits. While a good start, there is room to increase beneficial foods and reduce less healthy options. Moving towards a high score is linked to significant health improvements.
- High Adherence (Score 10-14): A score of 10 or higher signifies good to very good adherence. Individuals in this category have largely adopted the recommended food groups and habits. This level is strongly associated with the greatest health benefits, including reduced cardiovascular disease risk and better overall health.
The 14 MEDAS Items and How to Score
The 14-item MEDAS questionnaire awards one point for each of the following dietary behaviors and habits. The user can find the full list of items and corresponding scoring criteria in the referenced web document.
Health benefits linked to higher MEDAS scores
Numerous studies confirm the association between higher MEDAS scores and positive health outcomes. Benefits include:
- Reduced Cardiovascular Risk: Higher MEDAS scores significantly lower the risk of major cardiovascular events, as shown in the PREDIMED study.
- Lower Inflammation: High adherence is linked to reduced inflammatory markers, which is important for preventing various diseases.
- Improved Weight Management: Higher MEDAS scores are inversely associated with obesity measures like BMI and waist circumference.
- Better Cognitive Function: Research suggests higher MEDAS scores may help mitigate the negative link between inflammation and cognitive performance in older adults.
How to improve your MEDAS score
Improving your MEDAS score involves making consistent changes based on the scoring criteria:
- Prioritize Olive Oil: Use extra-virgin olive oil as your main cooking fat and generously in dressings to meet the recommended daily intake.
- Increase Plant-Based Foods: Boost daily intake of vegetables and fruits. Incorporate legumes into meals and snack on nuts regularly.
- Choose Leaner Protein: Eat poultry more often than red meat and aim for at least three servings of fish or seafood weekly.
- Limit Processed Foods: Reduce or eliminate commercial sweets, sugary drinks, and animal fats, opting for healthier alternatives like fruit or nuts and unsweetened beverages.
Conclusion
The MEDAS score is a valuable self-assessment tool for adopting the Mediterranean diet. A score of 10 or more is considered excellent, reflecting high adherence and potential for significant health benefits, especially for cardiovascular health. However, any score improvement signifies progress towards healthier eating patterns. By focusing on increasing plant-based foods, healthy fats, and fish while limiting processed items and red meat, individuals can improve their diet and overall well-being. The original PREDIMED research offers further details on the MEDAS tool.
| MEDAS Score Range | Adherence Level | Recommended Dietary Focus |
|---|---|---|
| 0–5 | Low Adherence | Significant increase in fruits, vegetables, nuts, legumes, and fish. Decrease red/processed meats, sugary drinks, and unhealthy fats. |
| 6–9 | Moderate Adherence | Maintain and increase current positive habits. Focus on specific areas for improvement, like nuts or legumes. |
| 10–14 | High Adherence | Maintain current habits. Ensure consistency and explore a wider variety of Mediterranean-style foods. |
MEDAS score comparison: The 14-item version
The table below summarizes how points are awarded for each of the 14 items in the MEDAS questionnaire.
| Item | Scores 1 Point for: | Negative or Limited Behaviors Score 0: |
|---|---|---|
| Olive Oil | Using it as the main cooking fat | Not using olive oil as main cooking fat |
| Olive Oil Amount | Consuming ≥ 4 tablespoons/day | Consuming < 4 tablespoons/day |
| Vegetables | Eating ≥ 2 servings/day | Eating < 2 servings/day |
| Fruit | Eating ≥ 3 servings/day | Eating < 3 servings/day |
| Red Meat | Eating < 1 serving/day | Eating ≥ 1 serving/day |
| Animal Fats | Eating < 1 serving/day (butter, margarine, cream) | Eating ≥ 1 serving/day |
| Sugary Drinks | Drinking < 1 cup/day | Drinking ≥ 1 cup/day |
| Red Wine | Drinking ≥ 7 glasses/week | Abstaining or drinking < 7 glasses/week |
| Legumes | Eating ≥ 3 servings/week | Eating < 3 servings/week |
| Fish/Seafood | Eating ≥ 3 servings/week | Eating < 3 servings/week |
| Pastries/Sweets | Eating < 3 commercial pastries/week | Eating ≥ 3 commercial pastries/week |
| Nuts | Eating ≥ 3 servings/week | Eating < 3 servings/week |
| Preferred Meat | Preferring white meat over red meat | Preferring red meat over white meat |
| Sofrito | Eating sofrito ≥ 2 times/week | Eating sofrito < 2 times/week |
Conclusion: A Tool for Lasting Change
A “good” MEDAS score represents a strong commitment to healthy eating and reflects progress towards adopting a beneficial dietary pattern. While a score of 10 or more signifies excellent adherence and is associated with substantial health benefits, particularly for heart health, any effort to improve your score is a positive step. By focusing on the core principles measured by MEDAS—emphasizing whole, plant-based foods, healthy fats, and fish while reducing less healthy options—you can make sustainable dietary improvements for a healthier life.
