*2.2. Dietary Assessment*

A validated 131-item semi-quantitative Food Frequency Questionnaire (FFQ) [41] and the mMDS score [39] were used to quantify the firefighters' dietary intake patterns at baseline. The FFQ is a questionnaire previously developed by Yang et al. [39]. Two additional domains were added to the mMDS (nuts and legume consumption), and the score ranged between 0 = minimum adherence to the Mediterranean diet and 51 = maximum adherence to the Mediterranean diet. Because we had previously validated the mMDS in a Qualtrics survey with the Harvard FFQ [43] and more initial Indianapolis participants had complete FFQs, we calculated their mMDS score based on the FFQ and used a scaled value of the directly derived Qualtrics score for the Fishers firefighters who had not done an FFQ.
