What is the Mediterranean Diet Score (MDS)? A Comprehensive Guide to Adherence

October 16, 2025 •

4 min read

Studies consistently show that a higher adherence to the Mediterranean diet is associated with a significantly reduced risk of chronic diseases such as cardiovascular disease and type 2 diabetes. But beyond the general principles, what is the Mediterranean Diet Score (MDS), and how is it used to quantify this level of adherence and assess its health implications?

Quick Summary

The Mediterranean Diet Score (MDS) is a tool used by researchers and clinicians to measure how closely an individual's eating habits align with the Mediterranean dietary pattern. Different versions of the score exist, which assign points for consuming beneficial foods and fewer points for detrimental ones.

Key Points

Definition: The Mediterranean Diet Score (MDS) is a tool for measuring how closely an individual follows the Mediterranean diet pattern, assigning points based on consumption frequency of various food groups.
Multiple Versions: There is no single universal MDS; several validated versions exist, including the original Trichopoulou score, the MedDiet Score, and the MEDAS, each with different scoring methods and item lists.
Core Components: Most MDS versions reward higher intake of fruits, vegetables, legumes, nuts, whole grains, fish, and olive oil, while penalizing high intake of red meat, processed foods, and sweets.
Calculation Method: Scoring can be binary (0 or 1 point) based on sex-specific medians, graded (0-5 points), or based on absolute consumption frequencies.
Interpretation: Higher MDS scores indicate greater adherence to the Mediterranean diet and are strongly associated with a lower risk of chronic diseases like cardiovascular disease, type 2 diabetes, and certain cancers.
Research Significance: The MDS is a vital research tool used in epidemiological studies and clinical trials to assess diet quality and its impact on health outcomes.
Limitations: Some MDS versions, especially older ones, may rely on potentially biased self-reported data and may not be fully adaptable to non-Mediterranean cultures without modification.

What is the Mediterranean Diet Score (MDS)?

The Mediterranean Diet Score (MDS) is a research tool developed to measure how closely a person's diet matches the traditional eating patterns of the Mediterranean region, particularly in the 1960s. It assesses the overall dietary pattern, not just single nutrients, to study its potential health effects. Researchers use it to quantify diet adherence and link it to various health outcomes, such as cardiovascular disease and cognitive function. Multiple versions of the MDS have been developed to suit different populations and research goals.

The Origins of the Mediterranean Diet Score

A foundational version of the MDS was proposed by Trichopoulou et al. in 1995, based on nine key Mediterranean diet components. This initial score measured adherence against sex-specific median consumption levels in a study population, giving points for high intake of beneficial foods and low intake of detrimental ones. This median-based approach had limitations as it depended heavily on the study population. To address this, other versions using absolute, predefined cut-off points were developed for more consistent measurement across studies.

How Different MDS Versions are Calculated

MDS calculation varies by version but involves summing points based on the frequency of consuming specific food groups. Common MDS variations include:

Trichopoulou et al. 9-Item Score: Uses a binary (0 or 1 point) system relative to the sample's median consumption for nine food categories. Beneficial items include vegetables, legumes, fruits and nuts, cereals, and fish, while detrimental ones are meat, poultry, and dairy. Moderate alcohol also gets a point.
The MedDiet Score (Panagiotakos et al.): An 11-item score with a graded system (0 to 5 points) based on monthly consumption frequency. The maximum score is 55, with higher scores indicating better adherence. Developed in Greece, it's used in studies on diet and cardiovascular risk.
The Mediterranean Diet Adherence Screener (MEDAS): A 14-item questionnaire used in the PREDIMED trial, scoring 0 or 1 per item. It's a simplified clinical tool, with high adherence typically defined as a score of 10 or more.

Key Components of the Mediterranean Diet Score

Most MDS calculations focus on a consistent set of food groups. High scores are linked to high consumption of:

Fruits, vegetables, legumes, and nuts: Providing fiber, vitamins, minerals, and antioxidants.
Olive oil: A primary fat source rich in monounsaturated fats.
Whole grains and cereals: Prioritized over refined options.
Fish and seafood: Consumed moderately for omega-3 fatty acids.

A high score also means lower consumption of:

Red meat and processed meats: Typically consumed in very small amounts.
Sweets and baked goods: Limited intake.
Full-fat dairy products: Consumed in low to moderate amounts.

Interpreting the Mediterranean Diet Score

MDS interpretation depends on the version used and its score range. Scores are often categorized into low, moderate, or high adherence using quartiles or cut-offs. A high score indicates a healthful diet and is consistently linked to reduced risks of chronic diseases and increased longevity. The extent of risk reduction varies based on factors and specific health outcomes. For example, one study found a higher MDS was inversely associated with total and cardiovascular disease (CVD) deaths.

Comparison of Different Mediterranean Diet Scores

Here's a comparison of three common MDS versions:


Feature	Trichopoulou et al. MDS	MedDiet Score (Panagiotakos et al.)	Mediterranean Diet Adherence Screener (MEDAS)
Number of Items	9	11	14
Scoring Range	0-9	0-55	0-14
Scoring Method	Binary (0 or 1 point) based on sex-specific medians	Graded (0-5 points) based on monthly servings	Binary (0 or 1 point) based on specific frequencies
Primary Use Case	Epidemiological research; cohort studies	Clinical and epidemiological research in Mediterranean regions	Clinical practice, PREDIMED trial
Key Food Components	Vegetables, legumes, fruit+nuts, cereals, fish, meat, dairy, fat ratio, alcohol	Non-refined cereals, potatoes, fruits, vegetables, legumes, fish, red meat, poultry, full-fat dairy, olive oil, alcohol	Olive oil, vegetables, fruits, red meat, butter, sugary drinks, legumes, fish, sweets, nuts, sofrito
Pros	Simple, widely-used for comparative research	Graded scale offers higher sensitivity to consumption differences	Quick, easy to administer in clinical settings
Cons	Score is relative to the study population's diet	Monthly frequency can be challenging for users to recall accurately	Simplified scoring may miss nuances of adherence

The Significance and Limitations of MDS

The MDS is a valuable tool for understanding the broader health impacts of dietary patterns. Research using MDS has confirmed the health benefits of the Mediterranean diet and influenced public health recommendations. A high MDS is linked to positive health markers like lower BMI, blood pressure, and inflammation. However, limitations exist, including reliance on potentially biased self-reported data from FFQs. Some scores also don't fully account for regional variations or overconsumption of certain foods. Modified versions have been created to be more culturally sensitive and address methodological issues.

Conclusion

The Mediterranean Diet Score (MDS) quantifies adherence to the healthful Mediterranean dietary pattern, allowing researchers to link this eating style to significant health benefits. Various versions exist, such as the 9-item score and the 14-item MEDAS, all measuring intake of key food groups. Knowing which score is used is vital for interpreting research. The MDS highlights the importance of focusing on broad dietary patterns for optimal health. Aiming for a high MDS is a proven strategy for promoting longevity and reducing chronic disease risk.

Outbound link recommendation: Definitions and potential health benefits of the Mediterranean diet: a forum article

Frequently Asked Questions

A high Mediterranean Diet Score indicates a high level of adherence to the traditional Mediterranean diet pattern. This is strongly associated with numerous health benefits, including a lower risk of cardiovascular disease, certain cancers, and better metabolic health.

Yes, several versions of the Mediterranean Diet Score exist. Examples include the original 9-item score by Trichopoulou et al., the 11-item MedDiet score by Panagiotakos et al., and the 14-item Mediterranean Diet Adherence Screener (MEDAS), each with different scoring ranges and criteria.

The specific food groups vary slightly by the score used, but typically include fruits, vegetables, legumes, nuts, whole grains, fish, olive oil (beneficial), and red meat, poultry, full-fat dairy, and sweets (detrimental or moderate).

Some versions, like the original Trichopoulou MDS, use sex-specific median intake levels of a study population (relative), while others, such as MEDAS, use predefined absolute consumption cut-offs (e.g., servings per week).

In many versions, moderate consumption of alcohol (often wine with meals) contributes positively to the score. However, non-drinkers and heavy drinkers typically receive a low or zero score for this component.

Yes, modified versions of the MDS have been adapted and used in various non-Mediterranean populations, such as in the US and Eastern Europe. These modifications often account for local dietary habits and food availability.

The MEDAS is a simplified 14-item questionnaire used to quickly assess adherence to the Mediterranean diet, famously used in the PREDIMED trial. It provides a score ranging from 0 to 14, with higher scores indicating better adherence.

Numerous studies show that a high MDS is linked to a reduced risk of cardiovascular disease, type 2 diabetes, obesity, certain cancers (including breast and colorectal), and neurological disorders like cognitive decline and depression.