Public Health Nutrition

Marketing and communication

Quality of Internet information related to the Mediterranean diet

Reiko Hirasawaa1, Kazumi Saitoa1, Yoko Yachia1, Yoko Ibea1, Satoru Kodamaa1, Mihoko Asumia1, Chika Horikawaa1, Aki Saitoa1, Yoriko Heianzaa1, Kazuo Kondoa2, Hitoshi Shimanoa1 and Hirohito Sonea1 c1

a1 Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, 3-2-7 Miya-machi, Mito, Ibaraki 310-0015, Japan

a2 Institute of Environmental Science and Human Life, Ochanomizu University, Tokyo, Japan


Objective The present study aimed to evaluate the quality of Internet information on the Mediterranean diet and to determine the relationship between the quality of information and the website source.

Design Website sources were categorized as institutional, pharmaceutical, non-pharmaceutical commercial, charitable, support and alternative medicine. Content quality was evaluated using the DISCERN rating instrument, the Health On the Net Foundation's (HON) code principles, and Journal of the American Medical Association (JAMA) benchmarks. Readability was graded by the Flesch Reading Ease score and Flesch–Kincaid Grade Level score.

Setting The phrase ‘Mediterranean diet’ was entered as a search term into the six most commonly used English-language search engines.

Subjects The first thirty websites forthcoming by each engine were examined.

Results Of the 180 websites identified, thirty-two met our inclusion criteria. Distribution of the website sources was: institutional, n 8 (25 %); non-pharmaceutical commercial, n 12 (38 %); and support, n 12 (38 %). As evaluated by the DISCERN, thirty-one of the thirty-two websites were rated as fair to very poor. Non-pharmaceutical commercial sites scored significantly lower than institutional and support sites (P = 0·002). The mean Flesch Reading Ease score and mean Flesch–Kincaid Grade Level were 55·9 (fairly difficult) and 7·2, respectively. The Flesch–Kincaid Grade Level score determines the difficulty of material by measuring the length of words and sentences and converting the results into a grade level ranging from 0 to 12 (US grade level).

Conclusions Due to the poor quality of website information on the Mediterranean diet, patients or consumers who are interested in the Mediterranean diet should get advice from physicians or dietitians.

(Received February 04 2011)

(Accepted August 10 2011)

(Online publication September 19 2011)


c1 Corresponding author: Email