The Chrono Med-Diet Score is based on eleven food categories, to determine the overall score, based on a daily to weekly intake:

  • fruit
  • vegetables
  • legumes
  • farinaceous products (i.e. bread, pasta, cookies)
  • grain cereals
  • fish
  • meat and meat products
  • milk and dairy products
  • extra-virgin olive oil
  • butter, margarine and lard
  • alcohol intake

Along these categories, two more were added to further characterize the eating habits and overall health status of the study participants:

  • the time of farinaceous products intake
  • the physical activity

A score of 2 points was given to the highest consumption of canonical Mediterranean Diet products (i.e., fruit, vegetables, legumes, fish, and olive oil), whereas a score of 1 point was assigned to the halfway category and a score of 0 points was given to the lowest intake for such products.

On the other hand, meat, meat products, milk and milk-derived products were assigned 2 points when eaten less than 1 time per day to 0 points when eaten more than 1.5 times per day.

Farinaceous products were given 2 points for consumption of one portion per day, whereas -1 point was assigned when eating more than 1.5 portions per day. Time of farinaceous consumption was also considered a standalone category. An intake by 3pm was given 1 point, while by 7pm it was assigned -1 point and -2 points if the farinaceous was eaten in the evening. The combined consumption in both lunch and dinner in the same day was given -4 points. Cereals were assigned 1 point per maximum intake and 0 points for consumption of less than 1 portion per day.

The use of fats such as butter, margarine and lard were assessed by assigning 1 point in case of occasional use, -1 point for frequent use and -2 points for referred regular use. Alcohol intake was carefully considered using alcohol units (1 alcohol unit = 12g of alcohol). A score of three points was assigned to a consumption of <1 U.A. per day, ranging to -2 points assigned to >3 U.A. per day. Regarding extra virgin olive oil (EVOO), the best score was assigned for regular use, whereas occasional use was awarded 0 points. Physical activity was considered following the WHO guidelines, ranging from a score of 3 points for regular physical activity to -3 points in case of rare to none referred activity.

The overall score ranged from -13 to 25 points, which indicated the best adherence to this new mixed rationale.

Taken together, our findings show that CMDS is a reliable, easy-to-use adherence questionnaire that contains important information on food, as well as lifestyle habits, in a modern approach. Results of this study are the first to consider type of food and its portions along with time of intake, creating a rapid and comprehensive score that can be administered in every setting at virtually no cost. The finding that, although a correlation between CMDS and MDS exists, the CMDS alone is associated with WC and metabolic derangement biomarkers, strengthens our hypothesis that the type of carbohydrates along with the time of their intake and physical activity are major actors in dumping adipogenesis and visceral fat depots.

In conclusion, the CMDS can be considered an easy-to-use instrument of personalized medicine to characterize conditions and behaviors that are the main responsible of adiposity-associated metabolic derangement.