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. 2025 Jun 14;44(1):199.
doi: 10.1186/s41043-025-00949-5.

Validity and reliability of the Turkish version of the chrono-med diet score (CMDS) for adult participants

Tevfik Koçak  1 , Emine Kocyigit  2 , Duygu Ağagündüz  3
Affiliations

Validity and reliability of the Turkish version of the chrono-med diet score (CMDS) for adult participants

Tevfik Koçak et al. J Health Popul Nutr. .

Abstract

Background: This study aimed to examine the validity and reliability of the Chrono-Med Diet Score (CMDS) to assess adherence to the Mediterranean diet in Turkish adults.

Methods: The methodological research conducted in Gümüşhane and Ordu from January to June 2024, including 592 individuals (62.3% women, 37.7% men, and the mean age 43.4 ± 10.6 years). Data were collected through face‒to‒face interview that contained socio-demographic characteristics, the CMDS, the Mediterranean Diet Adherence Screener (MEDAS), and 24-h dietary recall. Internal consistency reliability was assessed using Cronbach's alpha coefficient, while repeatability was examined using the test-retest method. Construct validity was assessed by the MEDAS, and components of the adapted CMDS obtained from the 24-h dietary recall were analyzed using confirmatory factor analysis. The content validity was assessed by the Paired samples t-test and Wilcoxon test. The Bland-Altman test with 95% limits of agreement was used to evaluate the agreement between sum of CMDS. The results were statistically evaluated at a p < 0.05 significance level.

Results: The content validity index of CMDS was 0.87. The overall Turkish version of CMDS had acceptable internal consistency (Cronbach's α = 0.853), thus indicating that the score was reliable. The Paired samples t test coefficients between each item and the overall questionnaire ranged from 0.234 to 1.000. A higher intake of olive oil and fish obtained from a 24-h dietary recall was associated with a higher CMDS quartile (p < 0.05). The MEDAS score was correlated with a higher CMDS quartile (p < 0.001). A moderate positive correlation was determined between total CMDS and MEDAS (r = 0.467; p < 0.001).

Conclusions: Our assessments of the CMDS, consisting of 13 items, in Türkiye demonstrate that it is a viable and reliable instrument to measure adherence to the Mediterranean diet for the adult population. The CMDS is more accurate than other Mediterranean diet scores as it questions about the amount of physical activity and grain products, which helps determine each participant's eating patterns and general health.

Keywords: Mediterranean diet; Nutrition; Reliability; Validity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ordu University Social Sciences and Humanities Ethics Committee (protocol number of meetings: 9, decisions: 2023-209, date: 07.12.2023), and the Helsinki Declaration principles were applied in the research. Before the survey commenced, all participants were briefed on the study’s details and provided their signatures on an informed consent form, confirming their voluntary involvement in the research. Competing interests: The authors declare no competing interests. Duygu Ağagündüz is a Section Editor for Journal of Health, Population and Nutrition.

Figures

Fig. 1
Fig. 1
Bland‒Altman plot showing the agreement for the two CMDS administrations. CMDS, Chrono-Med Diet Score
Fig. 2
Fig. 2
Association between the CMDS and MEDAS score. CMDS, Chrono-Med Diet Score; MEDAS, Mediterranean Diet Adherence Screener. The p value was obtained via Spearman correlation
See this image and copyright information in PMC

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