Development of a tool to assess the compliance of canteen menus with the Mediterranean Diet

Abstract The Mediterranean Diet (MD) is one of the healthiest food patterns associated with important health benefits. Acknowledging this, it’s important to understand how the dietary patterns of the consumers align with the MD. Over time, different authors have formulated several indexes for this purpose. However, current indexes lack standardization, and they only evaluate the quality of the diet of individuals to be used by health professionals and political decision-makers. Although there are indexes to assess the food options at the restaurants, none of them assess the menu compliance with the MD. Due to the importance of the food services in the food choices and dietary patterns of the consumers, this research developed an index to assess the alignment of the food availability with the MD key points. To address this gap, after reviewing the existing indexes in the literature, the authors created a tool that assesses the degree of compliance of menus with the MD - MedCIn. This index is divided into 4 dimensions, the first one assesses the availability (part A) and variety (part B) of the food/food groups. The second dimension assesses the nutritional quality of the menus based on the nutritional declaration, the third dimension assesses the food portions and culinary options, and the fourth dimension allows the verification of the previous information on site. Although the use of all dimensions allows for a more comprehensive menu evaluation, dimension one can be used as a first approach MD compliance. The index is meant to be applied in a 4-week cycle, though it can be adapted for each food service. Validation of this tool included construct validity, internal consistency and inter-rater reliability, all of which returned high values (alpha-Cronbach=0.88; Coheńs Kappa=0.92). The researchers consider this a reliable tool to easily assess compliance of menus with MD key points, allowing for the identification of issues to be addressed and improved