A. Kafatos

The Effect of Protein and Glycemic Index on Children's Body Composition: The DiOGenes Randomized Study

OBJECTIVE: To investigate the effect of protein and glycemic index (GI) on body composition among European children in the randomized, 6-month dietary intervention DiOGenes (diet, obesity, and genes) family-based study. PATIENTS AND METHODS: In the study, 827 children (381 boys and 446 girls), aged 5 to 18 years, completed baseline examinations. Families with parents who lost ≥8% of their weight during an 8-week run-in low-calorie diet period were randomly assigned to 1 of 5 ad libitum diets: low protein (LP)/low glycemic index (LGI); LP/high GI (HGI); high protein (HP)/LGI; HP/HGI; and control diet. The target difference was 15 GI U between the LGI/HGI groups and 13 protein percentage points between the LP/HP groups. There were 658 children examined after 4 weeks. Advice on food-choice modification was provided at 6 visits during this period. No advice on weight loss was provided because the focus of the study was the ability of the diets to affect outcomes through appetite regulation. Anthropometric measurements and body composition were assessed at baseline, week 4, and week 26. RESULTS: In the study, 465 children (58.1%) completed all assessments. The achieved differences between the GI and protein groups were 2.3 GI U and 4.9 protein percentage points, respectively. The LP/HGI group increased body fat percentage significantly more than the other groups (P = .040; partial η2 = 0.039), and the percentage of overweight/obese children in the HP/LGI group decreased significantly during the intervention (P = .031). CONCLUSIONS: Neither GI nor protein had an isolated effect on body composition. However, the LP/HGI combination increased body fat, whereas the HP/LGI combination was protective against obesity in this sample of children.

Weight loss maintenance in overweight subjects on ad libitum diets with high or low protein content and glycemic index: the DIOGENES trial 12-month results.

Background:A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce.Objective:The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year.Method:After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27 kg m−2) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period.Results:During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0–4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups.Conclusion:A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months.

Relation of PON1 and CYP1A1 genetic polymorphisms to clinical findings in a cross-sectional study of a Greek rural population professionally exposed to pesticides

Allelic variants of CYP1A1 and PON1 have been extensively studied as susceptibility factors in toxic response, although little is known about the role of these variants as risk factors for the plethora of diseases appearing in the human population. In this study we investigated the hypothesis of correlation of CYP1A1 and PON1 enzymes with the incidence of various medical examination findings in a Greek rural population professionally exposed to a variety of pesticides. The medical history of 492 individuals, randomly selected for the total population of 42,000, was acquired by interviews and their genotype determined for the CYP1A1*2A, PON1 M/L and PON1 Q/R polymorphisms. The assessment of exposure to pesticides of the population was verified by analytical methods. Analysis of the genetic data revealed that the allele frequencies of PON1 R, M and CYP1A1*2A alleles were 0.243, 0.39 and 0.107 respectively. The CYP1A1*2A polymorphism was found to have significant association with chronic obstructive pneumonopathy (p=0.045), peripheral circulatory problems (trend p=0.042), arteritis (p=0.022), allergies (trend p=0.046), hemorrhoids (trend p=0.026), allergic dermatitis (p=0.0016) and miscarriages (p=0.012). The PON1 Q/R polymorphism was found to have significant association with hypertension (p=0.046) and chronic constipation (p=0.028) whereas, the L/M polymorphism, with diabetes (p=0.036), arteritis (trend p=0.022) and hemorrhoids (trend p=0.027). Our results demonstrated an association between the CYP1A1/PON1 polymorphisms and several medical examination findings, thus indicating the possible involvement of the human detoxification system to health effects in a rural population exposed professionally to pesticides.

Circulating ACE is a predictor of weight loss maintenance not only in overweight and obese women, but also in men.

BACKGROUND:Circulating angiotensin-converting enzyme (ACE) was identified as a predictor of weight loss maintenance in overweight/obese women of the Diogenes project.OBJECTIVE:To investigate whether ACE acted also as a predictor in men of the Diogenes study and to compare it with that in women.DESIGN:Subjects, who lost ⩾8% of body weight induced by low-caloric diet in an 8-week weight loss period, were assigned to weight loss maintenance with dietary intervention for 6 months.SUBJECTS:125 overweight/obese healthy men from eight European countries who completed whole intervention.MEASUREMENTS:Concentrations and activity of serum ACE at baseline and after the 8-week weight loss, in addition to anthropometric and physiological parameters.RESULTS:Serum ACE concentration decreased by 11.3±10.6% during the weight loss period in men. A greater reduction is associated with less body weight regain during the maintenance period (r=0.227, P=0.012). ACE change was able to predict a weight regain ⩽20% after 6 months, with an odds ratio of 1.59 (95% confidence interval (CI): 1.09–2.33, P=0.016) for every 10% reduction, which was independent of body mass index and weight loss. The prediction power was weaker in men than in women, but without a significant sex difference (P=0.137). In pooled subjects (N=218), the odds ratio was 1.96 (95% CI: 1.46–2.64, P<0.001).CONCLUSIONS:A greater reduction of ACE during weight loss is favorable for weight maintenance in both men and women. This can offer useful information for personalized advice to improve weight loss maintenance. It also confirms the role of ACE in the metabolic pathways of weight regulation.

Does adherence to the Mediterranean diet have a protective effect against active and passive smoking

OBJECTIVE To investigate the existing evidence about whether adherence to the Mediterranean diet may have a role as an effect modifier of active and passive smoking on human health. STUDY DESIGN Review. METHODS An overview of emerging evidence and published studies that cover the interaction between the Mediterranean diet and smoking. RESULTS Both epidemiological and laboratory studies have shown that the Mediterranean diet has a protective effect against biochemical and molecular processes that lead to cancer, cardiovascular disease and respiratory illness. Based on the high daily intake of vitamins and antioxidants, the Mediterranean diet is comprised of a number of compounds that could alter certain outcomes related to smoking. Studies have indicated that certain diseases attributable to smoking, such as lung cancer, asthma and cardiovascular disease, are inversely associated with certain antioxidants and lipids. CONCLUSIONS The literature indicates that the existence of a partial interaction between adherence to the Mediterranean diet and the health effects of smoking is possible. Further research is needed to lead to a conclusive statement on this hypothesis.

A multicentre weight loss study using a low- calorie diet over 8 weeks: regional differences in efficacy across eight European cities

PRINCIPLES The efficacy of low-calorie diets (LCDs) has not been investigated in large-scale studies or among people from different regions, who are perhaps unaccustomed to such methods of losing weight. The aim of the present study was to investigate changes in obesity measures among overweight/obese adults from eight European cities (from Northern, Central and Southern Europe) during the 8-week LCD phase of the DiOGenes study (2006-2007), a family-based, randomised, controlled dietary intervention. METHODS 938 overweight/obese adults completed baseline examinations and underwent an 8-week LCD, providing 3.3-4.2 MJ/day to replace all meals. Anthropometric measurements and body composition were assessed at baseline and post-LCD. RESULTS 773 (82.4%) adults (mean age, 43.1 y) completed the LCD successfully. The highest drop-out rate was observed in Southern (24.9%) and the lowest in Northern (13.3%) European cities. Overall, the LCD induced favourable changes in all outcomes, including an approximate 11.0% reduction in body weight and body fat percentage. Changes in outcomes differed significantly between regions, with North- and Central-European cities generally achieving higher percentage reductions in most anthropometric measurements assessed. Nonetheless, participants in Southern Europe reduced their body fat percentage significantly more than participants in Northern Europe (-11.8 vs. -9.5%, P = 0.017). CONCLUSIONS The LCD significantly improved anthropometric and body composition measurements in all cities participating in DiOGenes.

Biomarker evaluation of Greek adolescents' exposure to secondhand smoke.

Exposure to secondhand smoke (SHS) is a significant threat to public health, and represents a danger for both the development and health status of children and adolescents. Taking the above into account, our aim was to quantify Greek adolescents’ exposure to SHS using serum cotinine levels. During 2006, 341 adolescents aged 13-17 were randomly selected from high schools in Heraklion and agreed to participate as part of the European Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Blood samples were drawn from a random sample of 106 adolescents, while serum cotinine/nicotine concentrations were measured by Gas Chromatography—Mass Spectrometry (GC-MS). The mean levels of serum cotinine and nicotine were calculated at 1.60 ± 2.18 ng/mL and 4.48 ± 4.00 ng/mL, respectively, while 97.7% of the non-smoker adolescents were found to have measureable levels of serum cotinine indicating exposure to SHS. The analysis revealed that their paternal (p = .001) and maternal smoking habits (p = .018) as also the existence of a younger brother or sister (p = .008) were the main modifiers of SHS exposure during adolescence. Conclusively, almost all of the measured Greek adolescents were exposed to SHS, even when their parents were non-smokers. This finding indicates the need for both community and school-based educational programmes as also the implementation of a comprehensive ban on smoking in public places.

Risk factors for ischaemic heart disease in a Cretan rural population: a twelve year follow-up study

BackgroundCrete has been of great epidemiological interest ever since the publication of the Seven Countries Study. In 1988 a well-defined area of rural Crete was studied, with only scarce signs of coronary heart disease (CHD) despite the unfavorable risk profile. The same population was re-examined twelve years later aiming to describe the trends of CHD risk factors over time and discuss some key points on the natural course of coronary heart disease in a rural population of Crete.Methods and ResultsWe re-examined 200 subjects (80.7% of those still living in the area, 62.4 ± 17.0 years old). The prevalence of risk factors for CHD was high with 65.9% of men and 65.1% of women being hypertensive, 14.3% of men and 16.5% of women being diabetic, 44% of men being active smokers and more than 40% of both sexes having hyperlipidaemia. Accordingly, 77.5% of the population had a calculated Framingham Risk Score (FRS) ≥ 15%, significantly higher compared to baseline (p < 0.001). The overall occurrence rate for CHD events was calculated at 7.1 per 1000 person-years (95% confidence interval: 6.8–7.3).ConclusionThe study confirms the unfavorable risk factor profile of a well defined rural population in Crete. Its actual effect on the observed incidence of coronary events in Cretans remains yet to be defined.

Antibiotics prescription for indigent patients in primary care

Objective : A drug use evaluation focusing on prescribed antibiotics among Greek indigent and Social Security patients.Method: Four hundred and forty‐six indigent patients insured by Social Care and 332 patients insured under Social Security Funds were interviewed and their prescription records reviewed.Results: Although 88·5% of indigent patients stated that they had received instructions on antibiotic use and had understood these instructions, only 45·9% could correctly repeat these instructions. Only 9·9% read the enclosed leaflets and 59·4% reported asking the pharmacist for advice, 54·1% of these patients were unaware of the dosage of their medication, and the length of treatment was only written in 13% of cases. The most common diseases among indigent patients were respiratory infection (11·7%) and dental problems (10·1%). The latter ranked 11th among the insured patients (3·7%). Tuberculosis (3·3%) was still one of the most common diseases among the indigent patients. Overall, 30·9% of the prescribed daily defined dose (DDD) of medication for the indigent patients were for cardiovascular drugs (16·9% of the cost), 19·5% were for nervous system drugs (8·9% of the cost), 13·5% for gastrointestinal tract drugs (14·1% of the cost) and only 4·3% were antibiotics (but 16·9% of the cost). The most frequently prescribed antimicrobials were penicillins (45·6%), cephalosporins (19·7%), macrolides (12·6%) and quinolones (9·6%). Antituberculous agents made up 13·7% of the antibiotic prescriptions. The most widely prescribed antibiotics were amoxycillin+clavulanate (19·3%), amoxycillin (7·9%), cefaclor (5·6%), clarythromycin (5·1%) and rifampicin+isoniazid (6·3%).Conclusion: The present study emphasizes the need for more information on drug use among indigent patients and their information needs.

Does adherence to the Mediterranean diet modify the impact of smoking on health

Takahashi et al. attributed the ‘Japanese smoking paradox’ to dietary factors, among others.1 They suggested that differences in intake of total fat, animal fat, cholesterol and saturated fatty acids, as well as alcohol consumption, may explain the differences in lung cancer mortality risk between the USA and Japan. In addition, they depicted null differences in intake of fruit, vegetables, antioxidants and micronutrients between Japan and the USA, which could not explain their noted differences. As first noticed almost 50 years ago during the Seven Countries Study (SCS), and as corroborated during follow up at 10, 25 and 40 years, the rural populations of Japan and Crete were found to have lower coronary heart disease (CHD) mortality rates than 14 cohorts from other European countries and the USA. Furthermore, CHD and lung cancer mortality rates were found to be higher in Northern European and Northern American cohorts compared with Southern European and Japanese cohorts in the same study. This was attributed to dietary and lifestyle factors (through which the Mediterranean diet first became renowned), while additional research indicated that absolute lung cancer mortality was positively associated with average dietary intake of saturated fat, which was lowest in both the Mediterranean and Japanese diets.6 Dietary data from the SCS, however, provide some evidence for the benefits of the Japanese diet, compared with the US diet, that the authors do not seem to have considered. In the 1960s, average daily intake of vegetables (198 g/day vs 171 g/day) and alcohol (22 g/day vs 6 g/day) was higher among Japanese men compared with their North American counterparts. Intake of <25 g ethanol/day has been associated with reduced, albeit not significantly, lung cancer mortality among Japanese men compared with non-consumers.8 Takahashi et al.’s data regarding lower intake of fruit (34 g/day vs 233 g/day) and total fat (11% vs 39%), compared with the US diet, are in agreement with the SCS. Furthermore, the lower intake of saturated fatty acids (3% vs 18%) in the Japanese diet during the 1960s can be justified by the lower consumption of meat (8 g/day vs 273 g/day), dairy products and pastries during that period.7–9 Epidemiological studies have indicated that diets rich in fruit and vegetables protect against lung cancer.10 The Mediterranean diet is more protective against lung cancer than the traditional Japanese diet mentioned by Takahashi et al.1 High in fruits, vegetables, nuts, legumes and olive oil, the Mediterranean diet is a prominent source of macronutrients, antioxidants (i.e. vitamin C, vitamin E, beta carotene, glutathione, phytoestrogens, folate and selenium) and mono-unsaturated fat, while low in saturated fat and cholesterol, thus combining all the factors that could act as an ‘effect modifier’ on the impact of cigarette smoking on health.11 Taking the above into account, it is highly plausible that just as the Japanese smoking paradox is attributed to dietary habits, a similar situation may exist among populations that adhere to the Mediterranean diet. Consequently, further research is warranted to investigate this hypothesis, which could have a significant impact on public health.