Supplement: diet scores
Carbohydrate-restricted (CR) score
The carbohydrate-restricted (CR) score was developed to evaluate the effects of low-carbohydrate high-protein diets (LCHP) [1, 2]. The intake of protein and carbohydrates was energy adjusted according to the nutrient density method and divided into sex specific deciles. Protein intake was assigned a score from 1 to 10 according to the deciles, with the score 1 indicating the lowest intake of protein (Table 1). The intake of carbohydrates was scored in the same manner, but with a decreasing score from 10 to 1, with the score 10 indicating the lowest intake of carbohydrates. The sum of the scoring for protein and carbohydrates comprises the CR score ranging from 2 to 10, with a higher score indicating a diet low in carbohydrates and high in protein.
Table 1: Grading in the carbohydrate-restricted (CR) scoreCutoff scoring / Points
Carbohydrate intake / Highest to lowest decile / 1 to 10
Protein intake / Lowest to highest decile / 1 to 10
Score range / 2 to 20
Mediterranean diet score (MDS)
The traditional mediterranean diet is characterised by a high intake of vegetables, legumes, fruits, nuts, cereals and olive oil, rich in mono-unsaturated fatty acids (MUFAs), as well as a moderately high intake of alcohol and seafoods, such as fish, and a low intake of saturated fatty acids (SFAs), dairy products, meat and poultry. In the original mediterranean diet score (MDS) a sex-specific energy-adjusted intake above or below the median yielded a score of 1 for each of nine different subsets related to adherence to the a mediterranean diet. In addition, a score of 1 was added for women with an average consumption of alcohol between 5 and 25 grams of alcohol per day, and for men between 10 and 50 grams; altogether the resulting total score ranges from 0 to 10 . In this study modifications to the original MDS based on Swedish circumstances, as suggested by Sjögren, et al. , were used. The adaptations were: replacing intake of MUFAs with polyunsatured fatty acids (PUFAs) since the main food origins of MUFAs in the Swedish diet is not olive oil but other sources that are usually rich in SFAs. Furthermore, the consumption of nuts and legumes is low in the Swedish diet and, therefore, nuts were excluded from the score and legumes were pooled with vegetables. The resulting nine-point score ranged from 0 to 8, with a higher score indicating greater adherence to a mediterranean-like diet (Table 2).
Table 2: Grading in the modified mediterranean diet score (MDS)Cut-off scoring / Points
PUFAs/SFAs / over median / 1
Vegetables and legumes / over median / 1
Fruit / over median / 1
Cereals and potatoes / over median / 1
Fish / over median / 1
Meat and meat products / below median / 1
Milk and milk products / below median / 1
Alcohol / men: 10-50g/day, women 5-25g/day / 1
Score range / 0 to 8
Healthy diet indicator score (HDI)
The healthy diet indicator score (HDI) is based on the dietary guidelines from the World Health Organisation (WHO). It yields a score for adherence to recommendations of dietary intake of macronutrients, as well as intake of particular foods . The HDI score modified by Sjögren et al. for Swedish circumstances was used . The modified score consisted of 9 subsets regarding adherence to the national intake recommendations of PUFAs, SFAs, protein, total carbohydrates, sucrose, fibre, fruit/vegetables, cholesterol and fish (Table 3). The resulting score raned from -1 to 8, with a greater score indicating closer adherence to the national dietary recommendations.
Table 3 Grading of the healthy diet indicator score (HDI)Cut-off scoring / Points
PUFAs / 5–10 E% / 1
SFAs / 0–12 E% / 1
Protein / 10–20 E% / 1
Total carbohydrates / 50–70 E% / 1
Sucrose / more than 10E% / −1
Fibre / more than 3g/MJ / 1
Fruit and vegetables / more than 400g/day / 1
Cholesterol / less than 300mg/day / 1
Fish / more than 35g/day / 1
Score range / -1 to 8
1.Lagiou P, Sandin S, Weiderpass E et al. Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. J Intern Med. 2007;261:366-374.
2.Trichopoulou A, Psaltopoulou T, Orfanos P, Hsieh CC, Trichopoulos D. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr. 2007;61:575-581.
3.Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599-2608.
4.Sjogren P, Becker W, Warensjo E et al. Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden. Am J Clin Nutr. 2010;92:967-974.
5.Who J, Consultation FAOE. Diet, nutrition and the prevention of chronic diseases. WHO technical report series. 2003;916
6.Huijbregts P, Feskens E, Rasanen L et al. Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ. 1997;315:13-17.