Analysis of the Feasibility and Validity of the Mediterranean Diet Adherence Screener in a Cohort of Veterans Undergoing a Lifestyle Change Intervention Open Access

Schafer, Elizabeth J. (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/fb4949591?locale=pt-BR%2A
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Abstract

Introduction: Among veterans enrolled in the Veteran Affairs Healthcare System, cardiovascular disease continues to be the leading cause of death even though it is primarily a preventable disease influenced by numerous modifiable dietary and lifestyle risk factors.1,2 The Mediterranean diet has been identified as an evidence-based diet for reducing cardiovascular disease (CVD) risk. The Mediterranean Diet Adherence Screener (MEDAS) has been used to determine adherence to this dietary pattern and is associated with improved CVD outcomes. However, limited validations studies have been conducted in the United States, especially in the context of lifestyle change programs like cardiac rehabilitation.

 

Methods: We examined MEDAS data in participants undergoing cardiac rehabilitation at the Atlanta VA Healthcare Systems. A paired T-Test was used to evaluate changes in the MEDAS score throughout the 12-week home-based cardiac rehabilitation study and McNamar’s tests evaluated whether individual-level questions improved throughout cardiac rehabilitation. Multivariable linear regressions were used to evaluate the association of MEDAS changes with cardiometabolic risk factors, controlling for age, sex, and smoking status.

 

Results: We examined data on 39 participants for this study: 94% male, 46% black, and the mean (SD) age was 63.7 (6.8) years old. We did not find any statistically significant differences between enrollment and completion MEDAS scores. There was a significant increase in the number of veterans who used olive oil as their main source of fat. Otherwise, in our analysis of individual questions, we found that for 7 of the 14 questions, veterans reported non-adherence at both baseline and follow-up periods (mean score of 0 for both time points). Furthermore, there was no statistically significant association between MEDAS score improvements and cardiometabolic risk factor changes before versus after program completion.

 

Conclusions: In this cohort of 39 individuals, we did not find a statistically significant association between changes in MEDAS scores and cardiac rehabilitation participants nor correlations between MEDAS changes and cardiometabolic risk factors. This contrasts with previous findings in Spain and does not support our use of MEDAS in a cohort of American veterans.  

Table of Contents

Table of Contents

Chapter 1: Background and Literature Review ..............................................................................................7

Increasing Prevalence of Cardiovascular Disease, especially amongst Veterans ...............................................7

Cardiovascular Disease Risk Factors.............................................................................................................8

Cardiovascular Risk Factors in Veterans........................................................................................................9

The Evolution of a Heart-Healthy Diet and the Mediterranean Diet ...............................................................10

Cardiac Rehabilitation as Secondary Prevention ...........................................................................................12

Barriers to Cardiac Rehabilitation ................................................................................................................13

Home-Based Cardiac Rehabilitation.............................................................................................................13

Measuring Nutrition in Cardiac Rehabilitation .............................................................................................14

Dietary Assessment Gap and Project Aims....................................................................................................16

Chapter 2: Analysis of the Feasibility and Validity of the Mediterranean Diet Adherence Screener in a Cohort of

Veterans Undergoing a Lifestyle Change Intervention....................................................................................18

Introduction ..............................................................................................................................................18 Methods.....................................................................................................................................................19 Results........................................................................................................................................................21 Discussion...................................................................................................................................................22

Figures and Tables........................................................................................................................................27

Bibliography ................................................................................................................................................30

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