Translation and cross-cultural adaptation of 14-item Mediterranean Diet Adherence Screener and low-fat diet adherence questionnaire

Background and aims: The Mediterranean diet and the low-fat diet are recognized as cardioprotective dietary patterns, and the use of validated instruments that quickly identify adherence to these diets is very useful in the daily practice of the nutritionist. Our aim was to translate and cross-culturally adapt the 14-point Mediterranean Diet Adherence Screener (MEDAS) and a 9-item quantitative score of compliance with the low-fat diet (low-fat diet questionnaire) to the Brazilian Portuguese language. Methods: The process of translation and cultural adaptation was conducted in six stages: initial translation, synthesis of translations, back-translation, proof of cross-cultural equivalence, pre -final version testing, and final evaluation of the cultural adaptation process. Interviews and assessments were administered to 30 nutritionists, and to 51 healthy participants and 50 individuals at cardiovascular risk. MEDAS ranges from 0 (minimum) to 14 (maximum) points and a total score > 10 points was considered for high adherence to MedDiet. Low-fat diet questionnaire ranges from 0 (minimum) to 9 (maximum) points and a total score > 6 points was considered for high adherence to a diet restricted in fat. Results: MEDAS and low-fat diet questionnaire were translated, synthetized and then back-translated, and few grammatical and/or semantic changes were required. About 24 participants suggested at least one modification in low-fat diet questionnaire's questions/terms, and 28 participants suggested at least one change in MEDAS items. The process produced a valid version of both the MEDAS and low-fat diet questionnaire in the Brazilian Portuguese language. Participants showed an average MEDAS questionnaire of 5.3 +/- 2.5 points, and an average low-fat diet questionnaire of 5.9 +/- 1.9 points. Nutritionists showed higher means of low-fat diet scores when compared to healthy and at high cardiovascular risk individuals (7.1 +/- 1.3, 5.6 +/- 2 and 5.4 +/- 1.9, respectively [P 0.0001]) but not for MEDAS questionnaire. With a cutoff of 10 points, 2.3% (95% CI 0.78-6.52) of the participants showed high adherence to MedDiet based on MEDAS score, and with a cutoff of >6 points, 58% (95% CI 49.5-66.1) of the participants showed high adherence to a diet restricted in fat based on the low-fat diet questionnaire. Conclusions: MEDAS and low-fat diet questionnaire were successfully translated to the Portuguese language. Regarding the results from questionnaires applied to our sample, in general, poor adherence was found for both Mediterranean and low-fat diet. (c) 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.