The Chrono Med-Diet Score (CMDS) project was born after careful consideration of the beneficial role of the Mediterranean Diet, which is inscribed on the representative list of the Intangible Cultural Heritage of Humanity from the UNESCO, and the current scientific literature. The Mediterranean Diet has been established as a significant contributor to reduce mortality from all causes, especially cardiovascular disease, obesity, MetS, diabetes, and other chronic cardiometabolic conditions.

The original MedDiet was highly characterized by significant consumption of vegetables and fruit associated with balance weekly intake of whole grains, legumes, nuts, seeds, aromatic herbs, and extra-virgin olive oil (EVOO) as the most significant source of fat.

Currently, far from the original MedDiet, eating patterns have changed. Typical meals (breakfast, lunch, and dinner) are difficult to be clearly identified during the day because skipping meals and snacking have become more frequent, even in subjects with medical-assisted eating patterns and dietings. These eating styles can have various effects on cardiometabolic health, particularly obesity, lipid profile, insulin resistance, and blood pressure.

There are several ways to identify adherence to MedDiet, starting from the original pyramid, then ranging from general descriptions, a priori scoring systems, a posteriori dietary patterns or the characterizations based on food and nutrient content. Over the last few years, a priori scores have emerged as the most popular ones, being the easiest to correlate with primary dietary outcomes. The adherence score is consequently calculated as the sum of points awarded for better intakes of well-being products, while negative or no points are allocated for health-harming food or habits. These scores were mainly focused on the study of the eating patterns of subjects involved, nonetheless failed to link these habits to clinical outcomes, especially regarding visceral adiposity.

Among the proposed scores, the MedDiet Score (MDS) developed by Trichopoulou et al. has been considered one of the most significant scores, as well as the MEDI-LITE, proposed by Sofi et al. Both MDS and MEDI-LITE were very relatable to the MedDiet pyramid and for the prediction of the adherence to the Mediterranean Diet Pattern.

In the CMDS project, we verified whether existing validated MedDiet scores could be associated with visceral adiposity. Failing to find a significant association with adiposity, we proposed the validation of a new, easy-to-use adherence questionnaire, the Chrono Med-Diet score (CMDS). The term Chrono represents the main novelty in our score: the timing of the day in which farinaceous products are consumed, as well as the time dedicated to physical activity are the focus of our study.