Middle Eastern Mediterranean diet (MEMD) is a traditional plant-based diet that is distinguished from others’ regions of the
Mediterranean by many meals. Although Mediterranean diet is well studied, data about MEMD is scarce. A photographic food atlas
was required to validate portion sizes of a variety of foods consumed in the MEM region.
Four hundred food items characterizing MEMD were photographed and validated. Food items were prepared by a professional
cook, then, they were photographed as a series of photos of increasing portion size. For validation of portion size estimation, 45
individuals aged 20- 50 years were recruited to assess 25 representative food-photo series for each item. The validity was
analyzed using Pearson test or Spearman test. While, mean differences and the standard deviations (SD) between sizes of the
estimated portions and the actual served portion sizes were calculated.
A photographic atlas of foods commonly consumed in MEM was developed. It was consisted of a total of 1002 photos and 400 types of
foods and traditional dishes. Results of validation stage showed that correlation between estimated portion size of real food and
its photo, was strong for 7 items (such as pita bread, milk, labneh, tomatoes), moderate for 12 items (such as meat, chicken,
grapes) and weak for 6 items such as seeds (p<0.01) when estimation with ‘gm’ or ‘ml’ were recorded. Underestimation was
prevalent for food items quantified when using ‘gm’ or ‘ml’ as a unit of measurement. In contrast, when household measurements
were used, the participants tended to overestimate the food’s portion sizes.
The photographic atlas for the first time has introduced food items representing MEMD to a wide range of participants. Validation
process has suggested that people with less nutritional knowledge, illiterate and confused about MEMD complexity may benefit
from such a tool in estimating their portion size. Furthermore, the photographic atlas may help in assessing adherence to MEMD
more accurately especially if integrated with other standard methods (i.e. FFQ), however, additional assessment of its application
may include a larger variety of food items and larger and more heterogeneous groups of participants.