Antigone Kouris-Blazos

Diet and overall survival in elderly people

Abstract Objective: To assess the influence of a specific dietary pattern on overall survival. Design: Cohort study. Setting: Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. Subjects: 182 elderly residents of the three villages. Main outcome measure: Overall mortality. Results: Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). Conclusion: A diet meeting currently understood health criteria does predict survival among people.

Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia

A prospective cohort study, involving 141 Anglo-Celts and 189 Greek-Australians of both sexes aged 70 years or more, was undertaken in Melbourne, Australia. The objective was to evaluate whether adherence to the principles of the Mediterranean diet affects survival of elderly people in developed non-Mediterranean countries. Diet was assessed using an extensive validated questionnaire on food intake. A one unit increase in a diet score, devised a priori on the basis of eight key features of the traditional common diet in the Mediterranean region, was associated with a 17% reduction in overall mortality (two-tailed P value 0.07). Mortality reduction with increasing diet score was at least as evident among Anglo-Celts as among Greek-Australians. We conclude that a diet that adheres to the principles of the traditional Mediterranean diet is associated with longer survival among Australians of either Greek or Anglo-Celtic origin.

Skin Wrinkling: Can Food Make a Difference?

Objectives: This study addressed whether food and nutrient intakes were correlated with skin wrinkling in a sun-exposed site. Methods: 177 Greek-born subjects living in Melbourne (GRM), 69 Greek subjects living in rural Greece (GRG), 48 Anglo-Celtic Australian (ACA) elderly living in Melbourne and 159 Swedish subjects living in Sweden (SWE) participating in the International Union of Nutritional Sciences IUNS [Food Habits in Later Lifersqb; study had their dietary intakes measured and their skin assessed. Food and nutrient intakes were assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Skin wrinkling was measured using a cutaneous microtopographic method. Results: SWE elderly had the least skin wrinkling in a sun-exposed site, followed by GRM, GRG and ACA. Correlation analyses on the pooled data and using the major food groups suggested that there may be less actinic skin damage with a higher intake of vegetables (rs=−0.31, p<0.0001), olive oil (rs=−0.29, p<0.0001), fish (rs=−0.24, p<0.0001) and legumes (rs=−0.16, p<0.0001), and lower intakes of butter (rs=0.46, p<0.0001) and margarine (rs=0.24, p<0.001), milk products (rs=0.16, p<0.01) and sugar products (rs=0.12, p<0.01). Similar findings were obtained using regression analyses, except fish was no longer significant; 32% of the variance for actinic skin damage was predicted by six out of the ten major food groups. In particular, a high intake of vegetables, legumes and olive oil appeared to be protective against cutaneous actinic damage (collectively explaining 20% of the variance); a high intake of meat, dairy and butter appeared to be adverse (explaining <5% of the variance). Prunes, apples and tea explained 34% of variance amongst ACA. Conclusion: This study illustrates that skin wrinkling in a sun-exposed site in older people of various ethnic backgrounds may be influenced by the types of foods consumed.

Diet and survival of elderly Greeks : a link to the past

In 1988 and 1989, we investigated in three Greek villages the dietary patterns of 182 men and women aged > 70 y by using a validated semiquantitative food-frequency questionnaire and compared these dietary patterns with the traditional Greek diet as ascertained in the late 1950s by Keys and his colleagues. As in the traditional diet, olive oil dominated fat intake, total fat exceeded 35% of total energy intake, average daily consumption of fruits and vegetables exceeded 500 g, and average ethanol intake for men corresponded to two to three glasses of wine per day. In contrast, consumption of meat and meat products has substantially increased and intake of bread and other cereals has apparently declined. We observed no differences between the two periods with respect to consumption of legumes, eggs and egg products, and sugar confectionery. We have also attempted to assess whether a gradient of adherence to the traditional Greek diet can be identified in the diets of the study subjects, and whether it can subsequently predict total mortality. During a follow-up period of approximately 5 y, 53 deaths were observed. The risk of death was apparently higher among the minority of study subjects whose diet deviated substantially from the traditional Greek pattern, compared with the majority whose diet adhered closely to the traditional pattern.

Health benefits of legumes and pulses with a focus on Australian sweet lupins.

BACKGROUND AND OBJECTIVESnThe 68th United Nations General Assembly declared 2016 the International Year of Pulses. Therefore it is timely to review the current evidence of the benefits of legumes for human health with a focus on Australian sweet lupins.nnnMETHODS AND STUDY DESIGNnMedline, Pubmed, Cochrane library were searched to identify cross-sectional/epidemiological studies, randomised controlled trials (RCTs) and systematic reviews.nnnRESULTSnThe strongest evidence appears to be for links between eating legumes and reduced risk of colorectal cancer as well as eating soy foods and reduced LDL cholesterol. However, epidemiological studies and RCTs suggest that replacing several meat-based meals a week with legumes can have a positive impact on longevity, diabetes, cardiovascular disease and weight management, potentially via favourable effects on the gut microbiome. Sweet lupins are unique among legumes with one of the highest combined amounts of digestible plant protein (38%) and dietary fibre (30%). Unlike other legumes, their low amount of anti-nutritional factors negates the need for soaking/cooking and they can therefore be eaten uncooked. Sweet lupins may lower blood pressure, improve blood lipids and insulin sensitivity and favourably alter the gut microbiome. There is growing interest in pulses, especially sweet lupins, as ingredients to improve the nutritional value of baked goods (particularly gluten free) and to create novel products to replace meat.nnnCONCLUSIONnLegumes form part of most traditional diets. They, including sweet lupins, can play a useful role in health maintenance.

Low All-Cause Mortality Despite High Cardiovascular Risk in Elderly Greek-Born Australians: Attenuating Potential of Diet?

Elderly Greek-born Australians (GA) consistently show lower rates of all-cause and CVD mortality compared with Australian-born. Paradoxically, however, this is in spite of a higher prevalence of CVD risk factors. This paper reviews the findings from the Food Habits in Later Life (FHILL) study, other studies on Greek migrants to Australia and clinical studies investigating dietary mechanisms which may explain the morbidity mortality paradox. The FHILL study collected data between 1988 and 1991 on diet, health and psycho-social variables on 818 people aged 70 and over from Sweden, Greece, Australia (Greeks and Anglo-Celts), Japan and were followed up for 5-7 years to determine survival status. The FHILL study was the first to develop a score which captured the key features of a traditional plant-based Mediterranean diet pattern (MDPS). A higher score improved overall survival in both Greek and non-Greek elderly reducing the risk of death by 50% after 5-7 years. Of the 5 cohorts studied, elderly GA had the lowest risk of death, even though they had the highest rates of obesity and other CVD risk factors (developed in the early years of migration with the introduction of energy dense foods). GA appeared to be getting away with these CVD risk factors because of their continued adherence in old age to a Mediterranean diet, especially legumes. We propose that the Mediterranean diet may, in part, be operating to reduce the risk of death and attenuate established CVD risk factors in GA by beneficially altering the gut microbiome and its metabolites.

Wellness management through Web-based programmes.

We established a Web-based programme called the ‘Wellness Online Program’ or WOLP. The programme runs for six weeks. It aims to help individuals manage their own wellness regardless of geographical location. WOLP is based on a holistic approach to health and consists of six wellness dimensions: physical (exercise and diet), emotional, social, intellectual, spiritual and occupational. A total of 150 volunteers from the general public were recruited online for this study and data were collected at three intervals: at the beginning of the programme (week 1), mid-programme (week 3) and at the end of the programme (week 6). Ninety of the participants (60%) completed the six-week programme. Acceptance of WOLP, measured by the frequency of individual usage, increased from the start to the end of the programme. Overall personal wellness management improved after six weeks on the wellness programme (5–10%). The study shows that personal wellness management, which had been demonstrated in the narrower confines of the corporate sector, is also possible in the public domain.

Evolution of Mediterranean diets and cuisine: concepts and definitions

BACKGROUND AND OBJECTIVESnThe Mediterranean diet has been demonstrated to provide a range of health benefits in observational and clinical trials and adopted by various dietary guidelines. However, a broad range of definitions exist impeding synthesis across trials. This review aims to provide a historical description of Mediterranean diets, from the ancient to the modern, to inform future educational and diet index tool development representing the traditional Mediterranean diet.nnnMETHODS AND STUDY DESIGNnNine databases were searched from inception to July 2015 to identify papers defining the Mediterranean diet. The definition accepted by the United Nations Educational, Scientific and Cultural Organization (UNESCO) was also reviewed.nnnRESULTSnThe traditional Mediterranean diet is described as high in unprocessed plant foods (grains, vegetables, fruits, legumes, nuts/seeds and extra virgin olive oil), moderate in fish/shellfish and wine and low in meat, dairy, eggs, animal fats and discretionary foods. Additional elements relating to cuisine and eating habits identified in this review include frequent intake of home cooked meals; use of moist, lower temperature, cooking methods; eating main meals in company; reduced snacking occasions; fasting practice; ownership of a vegetable garden; use of traditional foods and combinations; and napping after the midday meal.nnnCONCLUSIONSnScope exists for future tools to incorporate additional elements of the traditional Mediterranean diet to improve the quality, consistency, and synthesis of ongoing research on the Mediterranean diet.

Nutrition and health informatics

The Internet is playing an increasingly important role in the lives of people across the globe. The areas of nutrition and health are among the fastest growing areas of interest on the Internet, and are the main topics many people search for when ‘surfing’ the Internet. As the information age progresses, consumers will become more health literate and health professionals will have to ensure they can provide advice as to how their patients can find reliable web sites among the many misleading and biased sites on the Internet. This paper predicts the role the Internet will soon play in everyday life, and provides a guide to assessing the reliability of health and nutrition web sites.