Costas A. Anastasiou

Prevalence and determinants of exclusive breastfeeding during hospital stay in the area of Athens, Greece

AIM To assess breastfeeding practices, focusing on the prevalence and the determinants of exclusive breastfeeding during hospital stay. METHODS A cross-sectional study of 1603 healthy women, who delivered healthy infants weighing more than 2500 g, was conducted in the area of Athens, Greece. Participants completed a self-administered questionnaire on the day they were discharged from the maternity ward. Classification of breastfeeding and recall period from birth to discharge were in accordance with the WHO criteria. Hierarchical logistic regression analysis was used to study determinants of exclusive breastfeeding initiation. RESULTS Breastfeeding initiation was reported by 96.1% of the participants. However, exclusive breastfeeding was initiated only in 19.1% and predominant breastfeeding in 7.2% of the cases. The univariate analysis showed that maternal younger age, low educational level, unemployment, vaginal delivery, infant birthweight >3000 g, multiparity, early initiation of breastfeeding, rooming-in and awareness on the existence of breastfeeding centres were associated with higher rates of exclusive breastfeeding. Logistic regression analysis revealed that rooming-in (OR 3.72, p<0.01), demand feeding (OR 2.18, p<0.01), type of delivery (OR 1.61, p<0.01) and the source of information received about breastfeeding are more important determinants of exclusive breastfeeding than the socio-demographic parameters. CONCLUSIONS Exclusive breastfeeding during hospital stay in the area of Athens is low. Demand feeding and rooming-in positively influence exclusive breastfeeding initiation, while caesarean section and information by mass media have a negative impact.

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).

Physical Activity Status and Acute Coronary Syndromes Survival The GREECS (Greek Study of Acute Coronary Syndromes) Study

OBJECTIVES We sought to evaluate the association between physical activity levels and the clinical outcome at presentation, as well as the 30-day prognosis of hospitalized patients with acute coronary syndromes (ACS). BACKGROUND Regular physical activity has been associated with decreased risk of coronary heart disease. However, less is known about the effects of life-long physical activity on ACS prognosis. METHODS From October 2003 to September 2004, a sample of 6 hospitals located in urban and rural Greek regions were selected, and almost all of their ACS patients were enrolled into the study (2,172 patients were included in the study; 76% men and 24% women). Logistic regression models were applied to evaluate the effect of physical activity status (as assessed using the International Physical Activity Questionnaire) on in-hospital mortality and the 30-day outcome of cardiovascular events (death or rehospitalization due to cardiovascular disease). RESULTS An inverse association was observed between the level of physical activity and troponin I levels at presentation (p = 0.01). Moreover, after taking into account various potential confounders, physical activity was associated with a 0.56-fold (95% confidence interval [CI] 0.32 to 0.90) lower odds of in-hospital mortality and a 0.80-fold (95% CI 0.50 to 0.99) lower odds of cardiovascular events within the first month after discharge. CONCLUSION In conclusion, physical activity is associated with a reduced severity of ACS, reduced in-hospital mortality rates, and improved short-term prognosis.

Sodium Replacement and Plasma Sodium Drop During Exercise in the Heat When Fluid Intake Matches Fluid Loss

CONTEXT Sodium replacement during prolonged exercise in the heat may be critically important to maintaining fluid and electrolyte balance and muscle contractility. OBJECTIVE To examine the effectiveness of sodium-containing sports drinks in preventing hyponatremia and muscle cramping during prolonged exercise in the heat. DESIGN Randomized crossover study. PATIENTS OR OTHER PARTICIPANTS Thirteen active men. INTERVENTION(S) Participants completed 4 trials of an exercise protocol in the heat (30 degrees C) consisting of 3 hours of exercise (alternating 30 minutes of walking and cycling at a heart rate of 130 and 140 beats per minute, respectively); a set of standing calf raises (8 sets of 30 repetitions); and 45 minutes of steep, brisk walking (5.5 km x h(-1) on a 12% grade). During exercise, participants consumed fluids to match body mass loss. A different drink was consumed for each trial: carbohydrate-electrolyte drink containing 36.2 mmol/L sodium (HNa), carbohydrate-electrolyte drink containing 19.9 mmol/L sodium (LNa), mineral water (W), and colored and flavored distilled water (PL). MAIN OUTCOME MEASURE(S) Serum sodium, plasma osmolality, plasma volume changes, and muscle cramping frequency. RESULTS During both HNa and LNa trials, serum sodium remained relatively constant (serum sodium concentration at the end of the protocol was 137.3 mmol/L and 136.7 mmol/L, respectively). However, a clear decrease was observed in W (134.5 +/- 0.8 mmol/L) and PL (134.4 +/- 0.8 mmol/L) trials compared with HNa and LNa trials (P < .05). The same trends were observed for plasma osmolality (P < .05). Albeit not significant, plasma volume was preserved during the HNa and LNa trials, but a reduction of 2.5% was observed in the W and PL trials. None of the volunteers experienced cramping. CONCLUSIONS The data suggest that sodium intake during prolonged exercise in the heat plays a significant role in preventing sodium losses that may lead to hyponatremia when fluid intake matches sweat losses.

Mediterranean diet and other lifestyle factors in relation to 20-year all-cause mortality: a cohort study in an Italian population

The aim of the present analysis was to evaluate the association of the Mediterranean diet (MeDi), smoking habits and physical activity with all-cause mortality in an Italian population during a 20-year follow-up study. A total of 1693 subjects aged 40-74 who enrolled in the study in 1991-5 were asked about dietary and other lifestyle information at baseline. Adherence to the MeDi was evaluated by the Mediterranean dietary score (MedDietScore). A healthy lifestyle score was computed by assigning 1 point each for a medium or high adherence to the MedDietScore, non-smoking and physical activity. Cox models were used to assess the associations between lifestyle factors and healthy lifestyle scores and all-cause mortality, adjusting for potential confounders. The final sample included 974 subjects with complete data and without chronic disease at baseline. During a median of 17·4 years of follow-up, 193 people died. Subjects with high adherence to the MedDietScore (hazard ratio (HR) 0·62, 95 % CI 0·43, 0·89)), non-smokers (HR 0·71, 95 % CI 0·51, 0·98) and physically active subjects (HR 0·55, 95 % CI 0·36, 0·82) were at low risk of death. Each point increase in the MedDietScore was associated with a significant 5 % reduction of death risk. Subjects with 1, 2 or 3 healthy lifestyle behaviours had a significantly 39, 56, and 73 % reduced risk of death, respectively. A high adherence to MeDi, non-smoking and physical activity were strongly associated with a reduced risk of all-cause mortality in healthy subjects after long-term follow-up. This reduction was even stronger when the healthy lifestyle behaviours were combined.

Diabetes mellitus is associated with increased intramyocellular triglyceride, but not diglyceride, content in obese humans

It has been suggested that intramyocellular diglycerides may be associated with insulin resistance and thus may be linked to the pathophysiology of diabetes. We aimed to investigate intramyocellular diglyceride as well as triglyceride levels in diabetic subjects and to explore a possible association with glycemic control. The participants of the study were 30 obese subjects stratified according to the presence of diabetes into nondiabetic obese (n = 19) and diabetic obese (n = 11). Intramyocellular triglycerides and diglycerides were determined in biopsies from the vastus lateralis muscle under fasting conditions. Glycemic control and insulin resistance were assessed by an oral glucose tolerance test and the homeostatic model, respectively. Higher levels of intramyocellular triglycerides were observed in the diabetic obese group compared with the nondiabetic obese group (66.67 +/- 23.75 vs 18.35 +/- 4.42 nmol.mg(-1) dry tissue, respectively; P < .05). Diglyceride levels were not significantly different between the study groups (1.65 +/- 0.27 vs 1.94 +/- 0.65 nmol.mg(-1) dry tissue, respectively). Monounsaturated fatty acids represented the major constituent of intramyocellular triglycerides in both groups, whereas diglycerides contained mainly saturated fatty acids. A significant correlation was found between intramyocellular levels of triglycerides, but not diglycerides, and glycemic control, expressed as the area under the glucose curve (r = 0.417, P < .05). No correlations were found between intramyocellular levels of both lipid classes and insulin resistance. Our data support a relationship between glycemic control and intramyocellular triglycerides, but not diglycerides. The total flux of fatty acids toward esterification may be a much more important factor in the pathophysiology of diabetes.

Weight regaining: From statistics and behaviors to physiology and metabolism

Achieving maintenance of weight loss is crucial to combat obesity. However, most individuals tend to regain weight. Data from successful maintainers show that they remain vigilant and constantly apply techniques to oppose the course of regaining. On the other hand, current advances in obesity research show that the reduced obese state is a state of altered physiology in terms of energy balance. This review describes the physiological adaptations occurring after weight loss that predispose to regaining. Specifically, changes regarding body composition, hormonal background, energy expenditure and control of food intake are discussed. Moreover, metabolites that can act as regain predictors and dietary techniques to oppose regaining are presented.

Vitamin D and Cognition: An Update of the Current Evidence

The active form vitamin D is a seco-steroid with multiple neurotrophic and neuroprotective functions in the central nervous system. Robust evidence from studies in animals suggests that vitamin D deficiency may impair brain physiological functioning causing anatomical and behavioral adverse effects. On the other hand, vitamin D has been found to be protective against biological processes associated with Alzheimers disease and cognition, including amyloid-β deposition, inflammation, calcium homeostasis, and corticosteroid-induced perturbations in cortical areas and the hippocampus. Human studies that examined the relationship between vitamin D status and cognitive function have provided inconclusive results. The majority of cross-sectional and longitudinal studies suggest a potentially protective association, whereas results from clinical trials are mostly negative, or at best, controversial. We review these studies in humans, with particular emphasis on randomized and observational prospective ones.

Mediterranean diet and cognitive health: Initial results from the Hellenic Longitudinal Investigation of Ageing and Diet

Background The Mediterranean dietary pattern has been associated with a decreased risk of many degenerative diseases and cognitive function in particular; however, relevant information from Mediterranean regions, where the prototype Mediterranean diet is typically adhered to, have been very limited. Additionally, predefined Mediterranean diet (MeDi) scores with use of a priori cut-offs have been used very rarely, limiting comparisons between different populations and thus external validity of the associations. Finally, associations between individual components of MeDi (i.e., food groups, macronutrients) and particular aspects of cognitive performance have rarely been explored. We evaluated the association of adherence to an a priori defined Mediterranean dietary pattern and its components with dementia and specific aspects of cognitive function in a representative population cohort in Greece. Methods Participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD), an on-going population-based study, exploring potential associations between diet and cognitive performance in a representative sample from Greek regions, were included in this analysis. Diagnosis of dementia was made by a full clinical and neuropsychological evaluation, while cognitive performance was assessed according to five cognitive domains (memory, language, attention-speed, executive functioning, visuospatial perception) and a composite cognitive score. Adherence to MeDi was evaluated by an a priori score (range 0–55), derived from a detailed food frequency questionnaire. Results Among 1,865 individuals (mean age 73±6 years, 41% male), 90 were diagnosed with dementia and 223 with mild cognitive impairment. Each unit increase in the Mediterranean dietary score (MedDietScore) was associated with a 10% decrease in the odds for dementia. Adherence to the MeDi was also associated with better performance in memory, language, visuospatial perception and the composite cognitive score; the associations were strongest for memory. Fish consumption was negatively associated with dementia and cognitive performance positively associated with non-refined cereal consumption. Conclusions Our results suggest that adherence to the MeDi is associated with better cognitive performance and lower dementia rates in Greek elders. Thus, the MeDi in its a priori constructed prototype form may have cognitive benefits in traditional Mediterranean populations.

Lifestyle intervention leading to moderate weight loss normalizes postprandial triacylglycerolemia despite persisting obesity.

Obesity is associated with impaired postprandial triacylglycerolemia, an independent risk factor for cardiovascular disease. Given that obesity is hard to treat, efforts should focus on treating its comorbidities. We aimed to investigate whether moderate weight loss normalizes postprandial triacylglycerol (TAG) concentrations, in the absence of the acute effects of negative energy balance. For this purpose, postprandial lipemia was investigated in eight obese but otherwise healthy, sedentary men (age: 41.3 ± 4.1 years, BMI: 36.5 ± 1.6 kg·m−2), once before and again after a 10% weight loss followed by ≥4 weeks of weight maintenance, and was compared with that of eight age‐matched healthy lean men (BMI: 24.7 ± 0.6 kg·m−2). Dietary intervention consisted of reduced carbohydrate and saturated fat intake and increased monounsaturated fat intake. Obese volunteers were advised to increase physical activity using pedometers to record daily activity. Postprandial triacylglycerolemia after weight loss was reduced by 27–46% (P < 0.05), and became similar to that of lean men despite persisting obesity (BMI after weight loss: 32.9 ± 1.5 kg·m−2). Reduction in postprandial TAG responses was inversely correlated with the decrease in postprandial insulin sensitivity index (ISI) after weight loss (r = −0.714, P = 0.047). We conclude that moderate weight loss induced by a low‐carbohydrate and saturated fat diet and a slight increase in daily physical activity normalizes postprandial triacylglycerolemia in obese men, independently of acute diet‐induced negative energy balance, and possibly through enhancement of insulin action.