Public Health Nutrition

Research paper

Design and development of an instrument to measure overall lifestyle habits for epidemiological research: the Mediterranean Lifestyle (MEDLIFE) index

Mercedes Sotos-Prietoa1a2 c1, Belén Moreno-Francoa3, Jose M Ordovása1a4, Montse Leóna5, Jose A Casasnovasa5 and Jose L Peñalvoa1

a1 Department of Epidemiology, Atherothrombosis, and Imaging, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain

a2 International SHE Foundation, 08037 Barcelona, Spain

a3 Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain

a4 Nutrition and Genomics Laboratory, Jean Mayer–USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA

a5 Cardiovascular Research Unit, Instituto Aragonés de Ciencias de la Salud (I+CS), Zaragoza, Spain


Objective To design and develop a questionnaire that can account for an individual’s adherence to a Mediterranean lifestyle including the assessment of diet and physical activity patterns, as well as social interaction.

Design The Mediterranean Lifestyle (MEDLIFE) index was created based on the current Spanish Mediterranean food guide pyramid. MEDLIFE is a twenty-eight-item derived index consisting of questions about food consumption (fifteen items), traditional Mediterranean dietary habits (seven items) and physical activity, rest and social interaction habits (six items). Linear regression models and Spearman rank correlation were fitted to assess content validity and internal consistency.

Setting A subset of participants in the Aragon Workers’ Health Study cohort (Zaragoza, Spain) provided the data for development of MEDLIFE.

Subjects Participants (n 988) of the Aragon Workers’ Health Study cohort in Spain.

Results Mean MEDLIFE score was 11·3 (sd 2·6; range: 0–28), and the quintile distribution of MEDLIFE score showed a significant association with each of the individual items as well as with specific nutrients and lifestyle indicators (intra-validity). We also quantified MEDLIFE correspondence with previously reported diet quality indices and found significant correlations (ρ range: 0·44–0·53; P<0·001) for the Alternate Healthy Eating Index, the Alternate Mediterranean Diet Index and Mediterranean Diet Adherence Screener.

Conclusions MEDLIFE is the first index to include an overall assessment of lifestyle habits. It is expected to be a more holistic tool to measure adherence to the Mediterranean lifestyle in epidemiological studies.

(Received October 08 2013)

(Revised May 14 2014)

(Accepted June 06 2014)


  • Diet quality;
  • Mediterranean diet;
  • Diet index;
  • Lifestyle


c1 Corresponding author: Email