Validation of the Mediterranean Eating Pattern for Americans II (MEPA II) Screener in a Chicago Population
Authors: Li Michelle , Tangney Christy C , Rasmussen Heather , Moss Olivia A , Cerwinske Leah A , Richards Candace L , Appelhans Brad 
Published: November 2023

Background

Screening tools that measure accordance or adherence to a Mediterranean diet have been validated in Spanish and Greek populations, but none have been validated in an American population.

Methods

In this study a new dietary screener called the Mediterranean Eating Pattern for Americans (MEPA II) was evaluated. MEPA II is an 18‐item screener that was refined from the original MEPA. MEPA II was designed to capture foods that are consistent with a Mediterranean dietary pattern but can be adopted within the American food culture. Convergence between MEPA II and 24‐hour diet recalls was assessed in U.S. adults participating in an ongoing study of purchasing habits known as SHoPPER or Study of Household Purchasing Patterns, Eating and Recreation. Multiple (3 or 4) non‐consecutive 24‐hour recalls using the automated multi‐pass method (Nutrition Data System for Research 2013–2015) were conducted by registered dietitians over a two‐week time period; additional recalls were conducted if the recall was acquired on an atypical day. Then the MEPA II screener was completed by participants on paper during the final interview. Nutrient analyses of key foods and nutrients reflecting a Mediterranean pattern were calculated for the averaged recalls and compared to calculated MEPA II scores from the screeners. Descriptive statistics and partial correlations were performed using SPSS version 22 (IBM, 2013).

Results

The sample included 69 participants (10 men, 59 women) living in the city of Chicago with an average (SD) age of 44 (14) years. The sample was ethnically diverse, with Black (61%), 7% Asian, 27% Caucasian, and multi‐ethnic (4.3%). Based on the average recalls, men reported 2509 (967) kilocalories, with 14.5 (3.6) % of calories from monounsaturated fats, 11.9 (2.7) % from polyunsaturated fats, and 11.4 (1.8) % from saturated fats, while % energy from carbohydrates was 43.7 (9.2). For women, the reported intakes were as follows: 1989 (558) kilocalories, with 13.3 (3.1) % of calories from monounsaturated fats, 8.2 (2.3) % from polyunsaturated fats, and 11.3 (2.9) % from saturated fats, while % energy from carbohydrates was 47.3 (8.0). The MEPA II screener scores ranged from 2 to 14, with a median of 10 and 25th and 75th percentiles of 8 and 12. Spearman correlations between MEPA II scores and nutrients derived from diet recalls were significant for multiple nutrients consistent with a Mediterranean dietary pattern: dietary fiber, rho=0.61 (p<0.0001); beta carotene, rho=0.44 (p <0.0001); vitamin C, rho=0.49 (p <0.0001); and total folate, rho=0.48 (p <0.0001). MEPA scores also were associated with intakes of selected foods consistent with this pattern‐‐‐‐whole grains, rho=0.46 (p <0.0001); fruit, rho=0.47 (p <0.0001); dark green vegetables, rho=0.40 (p=0.001); legumes, rho=0.45 (p <0.0001); and added sugars, rho=−0.39 (p=0.002).

Conclusions

The MEPA II screener reflects many foods and nutrients that comprise a Mediterranean pattern. Additional reliability and validity testing, especially with biomarkers of the key food components on MEPA II, will be needed before this tool can be used with confidence.

Support or Funding Information

Departmental Funding; R01HL117804‐01A1