Antonia-Leda Matalas

Dietary habits and cardiovascular disease risk in middle-aged and elderly populations: a review of evidence

Background The proportion of elderly is increasing worldwide. This trend is paralleled by an increase in chronic diseases, such as cardiovascular disease. A limited number of studies have investigated the effect of diet on cardiometabolic risk factors (such as hypertension, hypercholesterolemia, diabetes, obesity) in older populations, despite the fact that diet plays a significant role in elderly health. In this review, a summary of studies that have evaluated the effect of dietary habits on cardiovascular disease risk in elderly populations is presented. Methods A search was made in available databases (PubMed and Scopus) looking for results from observational studies and clinical trials that assessed dietary habits on cardiovascular disease risk in elderly populations (>65 years old). Studies during the last decade were retrieved and summarized. Results All eight of the reviewed observational studies and all three reviewed clinical trials performed in elderly populations reported an inverse association between healthy dietary patterns with cardiovascular disease risk and its predisposing markers. Conclusion Dietary intervention strategies should be implemented in older adults, in order to prevent cardiovascular disease morbidity and mortality, and improve quality of life.

Level of adherence to the Mediterranean diet among children from Cyprus: the CYKIDS study

BACKGROUND The Mediterranean diet (MD) prototype is widely used as an educational tool in public health programmes; few studies, however, have been conducted on the adherence of children to this diet. OBJECTIVE To evaluate the quality of Cypriot childrens diet by assessing the degree of adherence to the MD. METHODS A national cross-sectional study among 1140 children (mean age = 10.7 (SD 0.98) years), using stratified multistage sampling design, was conducted in primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative FFQ and the two supplementary questionnaires (a Food Groups Frequency Questionnaire and a Short Eating Habits Questionnaire). Adherence to the MD was assessed by the KIDMED index. The association between the frequencies of consumption of various food groups and the level of adherence to the MD (poor v. average v. good KIDMED score) was also evaluated. Multiple logistic regression analyses were used to adjust for potential confounders. RESULTS Only 6.7% of the sample was classified as high adherers of MD, whereas 37% had a poor KIDMED score. Multiple logistic regression analysis has shown that children with at least an average KIDMED score were more likely to eat frequently seafood and fish, legumes, nuts, bread, fruits, leafy vegetables, olives, low glycaemic index foods and unrefined foods. Effect size of associations was from medium to high. CONCLUSION Higher adherence to MD is associated with better diet quality in children. The MD prototype may thus represent a useful educational tool for promotion of healthy eating habits in children.

Physical activity mediates the protective effect of the Mediterranean diet on children's obesity status: The CYKIDS study

OBJECTIVE There is some evidence regarding the association between adherence to the Mediterranean diet (MD) and obesity among adults; to our knowledge, however, no relevant data exist for children. We investigated the association between adherence to the MD and obesity status in children. METHODS A national cross-sectional study among 1140 children (mean age 10.7+/-0.98 y) was carried out in Cyprus using stratified multistage sampling design. Body mass index was calculated according to International Obesity Task Force criteria, from parental reference. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for children and adolescents (KIDMED diet score). To test the research hypothesis, a logistic regression analysis was applied with two dependent variable categories of obesity status, normal weight (NW) versus overweight/obese (OW/OB), and the three categories of the KIDMED score independently, after controlling for several potential confounders. RESULTS Compared with low MD adherers, children with a high KIDMED score were 80% less likely to be OW/OB (95% confidence interval 0.041-0.976), adjusted for age, gender, parental obesity status, parental educational level, and dietary beliefs and behaviors (model 2). When physical activity was taken into account, however, the aforementioned relation was not significant (model 3; odds ratio 0.20, 95% confidence interval 0.021-1.86). Furthermore, male gender, maternal obesity, and dietary beliefs and behaviors emerged as more significant in predicting obesity in children compared with their KIDMED score. CONCLUSION Adherence to the MD is inversely associated with obesity in this sample of 9- to 13-y-old children; however, other behaviors, and in particular physical activity, maternal obesity, dietary beliefs and behaviors, seem to be more significant.

Changes in free radical generation and antioxidant capacity during ultramarathon foot race

Background  Exhaustive exercise has been implicated in the generation of reactive oxygen species, resulting in oxidative stress. We studied the effect of a long‐distance, endurance exercise on oxidative stress parameters in athletes who participated in the ultramarathon race Spartathlon (246 km).

Disordered eating attitudes: An emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Successful aging, dietary habits and health status of elderly individuals: a k-dimensional approach within the multi-national MEDIS study.

The definition and determinants of successful aging is still controversial. Although dietary habits have long been associated with aging, eating habits and behaviors have rarely been included in various proposed indices of successful aging. The aim of this work was to evaluate determinants of successful aging together with assessment of dietary habits in relation to healthcare facility use among elders living in the Mediterranean basin. During 2005-2011, 2663 elderly (aged 65-100 years) individuals from 21 Mediterranean islands and rural Mani region (Peloponnesus) were voluntarily enrolled in the study. A successful aging index ranging from a score of 0 to a score of 10 was constructed using 10 attributes, i.e., education, financial status, physical activity, body mass index, depression, participation in social activities with friends and family, number of yearly excursions, number of cardiovascular disease risk factors and adherence to the Mediterranean diet. The applied factor analysis on the components of the index extracted three main components for successful aging: psychosocial-economic, bioclinical and lifestyle; confirming the multiple dimensions of aging. After adjusting for confounders, a 1/10-unit increase in the successful aging index was associated with 0.8 less annual visits to healthcare centers (95% CI -1.3 to-0.2). Stratified analysis by gender revealed heterogeneity of factors predicting successful aging. These findings suggest that successful aging is a multidimensional and complex concept that exhibits gender heterogeneity. Annual use of health care services by the elders was found to be related to level of successful aging.

The Role of Diet in Prevention and Management of Type 2 Diabetes: Implications for Public Health

The aim of this review is to examine the current scientific knowledge on the relationship between diet and Type 2 diabetes and consider further implications for public health. The review focuses on the main nutritional elements which have been identified as significant in the prevention and management of Type 2 diabetes. Research findings on the role of carbohydrate, fiber, alcohol, and individual fatty acids are discussed, while the role of specific micro-nutrients and the influence of obesity are comprehensively presented. The association between dietary habits and Type 2 diabetes etiology and management is also reviewed, in order to examine the positive effects of adherence to a healthy dietary pattern, including the plausible role of the Mediterranean diet.

Foods E-KINDEX: a dietary index associated with reduced blood pressure levels among young children: the CYKIDS study.

Dietary modification is, in general, the preferred method when attempting reductions in blood pressure (BP) among adults. In children, however, few studies, have examined the relationship between dietary patterns and levels of BP, and the reported results are conflicting. The objective of this study was to investigate the association between levels of Foods E-KINDEX score and levels of BP in children. Measurements included BP, height, weight, and waist circumference. Diet quality was assessed by the Foods E-KINDEX diet score. The index includes 13 components that assess consumption frequency of 11 major food groups or foods, as well as two cooking techniques (fried and grilled foods). Its score ranges between 0 and 37. A subsample of 622 Cypriot children (mean age=11.7+/-0.83 years) from the CYKIDS national cross-sectional study was used. Logistic regression analysis was performed in order to examine the relationship of systolic BP, diastolic BP, and BP with diet quality (as assessed by the Foods E-KINDEX score). The median systolic BP and diastolic BP were 110 mm Hg (interquartile range [IQR]=100 to 120 mm Hg) and 68 mm Hg (IQR=60 to 70 mm Hg) for boys and 110 mm Hg (IQR=100 to 120 mm Hg) and 63 mm Hg (IQR=60 to 70 mm Hg) for girls, respectively. Mean Foods E-KINDEX score was 23.4+/-4.9 in boys and 24.3+/-4.8 in girls (P=0.487). Compared with children with a low diet score, those with at least an average Foods E-KINDEX score were 57% (odds ratio=0.43; 95% confidence interval: 0.19 to 0.98) less likely to have elevated systolic BP levels, regardless of various potential confounders. The Foods E-KINDEX score is independently associated with lower BP among healthy children. This finding might have implications in public health and should be further explored.

Overweight and obesity in preadolescent children and their parents in Cyprus: prevalence and associated socio-demographic factors – the CYKIDS study

Obesity status differs by socio‐demographic factors, but data for Cyprus are scarce. An in‐depth understanding of this relationship may be useful in designing public health programmes. The objective of the present study is to estimate overweight and obesity (OW/OB) prevalence among children and adults in Cyprus and identify related socio‐demographic variables. National cross‐sectional study of 1140 children (mean age 11 ± 0.98 years) and their parents (mean age 42.5 ± 5.8 years, total n = 1954). Obesity was defined according to the World Health Organization classification for adults and according to IOTF (International Obesity Task Force) criteria for children. Overweight and obesity prevalence among girls was 18.3% and 2.9%, respectively, while in boys, 19.0% and 6.0%. Among parents, OW/OB prevalence was, respectively, women, 22.6% and 5.8%; men, 47.1% and 14.1%. Logistic regression analysis in both children and adults revealed that the most important socio‐demographic predictors of obesity status are factors of built environment. Higher prevalence of OW/OB was observed in adults living in a house as opposed to an apartment, in older adults, in younger children, and in men, irrespective of age. There is a severe obesity problem in the Cypriot population; almost one in two adults and at least one in four preadolescent children are overweight or obese. Prevalence of OW/OB was related to socio‐demographic factors, especially among adults and women.

The ‘secrets’ of the long livers in Mediterranean islands: the MEDIS study

BACKGROUND The aim of the present work was to evaluate various socio-demographic, clinical, lifestyle and psychological characteristics of elderly (> 65 years) and very elderly (> 90 years) individuals without known cardiovascular disease. METHODS During 2005-7, 1190 elderly (aged > 65) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were randomly enrolled. Socio-demographic, clinical, psychological and lifestyle factors were assessed using standard questionnaires and procedures. RESULTS From all islands, the proportion of males aged 65-80, 80-90 and > 90 years was 71.8, 24.8 and 3.4%, respectively. The proportion of women, for the same age categories, was 80.4, 17.9 and 1.7%, respectively. Walking and other activities significantly declined with age (P < 0.001); however, nearly one in five participants over the age of 90 years remained physically active. Current smoking significantly declined in males as age increased (P < 0.001). All participants above the age of 90 years reported sleeping at noon. The proportion of participants living alone differs significantly (P < 0.001) across the three age groups. However, considerably more women live alone (men vs. women living alone: aged 65-80 years 12 vs. 37%; 80-90 years 16 vs. 55%; > 90 years 52 vs. 55%). Dietary characteristics of The Mediterranean Islands Study (MEDIS) sample display a favourable adherence to dietary recommendations (Mediterranean diet). CONCLUSION A favourable adherence to the Mediterranean diet, mid-day naps and smoking cessation with an increase in age was characteristic of our elderly population. Future research should further evaluate whether the aforementioned characteristics are associated with longevity beyond the average life expectancy.