Demosthenes B. Panagiotakos

Diet, Exercise and the Metabolic Syndrome

The metabolic syndrome is a combination of metabolic disorders, such as dyslipidemia, hypertension, impaired glucose tolerance, compensatory hyperinsulinemia and the tendency to develop fat around the abdomen. Individuals with the metabolic syndrome are at high risk for atherosclerosis and, consequently, cardiovascular disease. However, as a result of several epidemiologic studies and some clinical trials, it has been suggested that people with the metabolic syndrome may benefit from intensive lifestyle modifications including dietary changes and adopting a physically more active lifestyle. In this review we summarize the effects of diet and physical activity on the development of the metabolic syndrome.

The relationship between dietary habits, blood glucose and insulin levels among people without cardiovascular disease and type 2 diabetes; the ATTICA study.

BACKGROUNDnDiet has long been associated with a risk of insulin resistance and poor glycemic control. We sought to investigate the association between food groups and indices of glycemic control in adults without type 2 diabetes and cardiovascular disease.nnnMETHODSnDuring 2001 - 2002 we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old) without evidence of cardiovascular disease from the Attica area of Greece. Of them, 118 men and 92 women were excluded from the present analysis due to a history of diabetes mellitus (type 2). Fasting blood glucose and insulin levels were measured, while dietary habits were evaluated through a semi-quantitative food frequency questionnaire.nnnRESULTSnRed meat consumption was positively associated with hyperglycemia (p = 0.04), hyperinsulinemia (p = 0.04), and HOMA levels (p = 0.03), even after adjusting for BMI and various other potential confounders. The intake of fruits, vegetables, legumes, yogurt and other dairy products was not associated with levels of glycemic control indices.nnnCONCLUSIONSnA higher consumption of red meat and its products may aggravate hyperinsulinemia and insulin resistance in non-diabetic people.

The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies

Rheumatoid arthritis is a progressive autoimmune disease characterised by severely swollen and painful joints. To compliment pharmacotherapy, people living with rheumatoid arthritis often turn to dietary interventions such as the Mediterranean diet. The aim of the present systematic review is to discuss the effects of the Mediterranean diet on the management and prevention of rheumatoid arthritis in human prospective studies. Four studies met the inclusion criteria, including two intervention studies reporting improvement in the pain visual analogue scale (pu2009<u20090.05) and a decrease in the health assessment questionnaire for rheumatoid arthritis score (pu2009<u20090.05) in the Mediterranean diet groups. Only one study reported a reduction in the 28 joint count disease activity score for rheumatoid arthritis for the Mediterranean diet group (pu2009<u20090.05). This review has identified beneficial effects of the Mediterranean diet in reducing pain and increasing physical function in people living with rheumatoid arthritis. However, there is currently insufficient evidence to support widespread recommendation of the Mediterranean diet for prevention of rheumatoid arthritis.

The Prognostic Significance of Serum Glucose Levels After the Onset of Ventricular Arrhythmia on In-Hospital Mortality of Patients with Acute Coronary Syndrome

BACKGROUNDnSeveral studies have illustrated the role played by serum glucose levels in cardiovascular morbidity and mortality in general and, more particularly, after an acute coronary event.nnnAIMnThe aim of this study was to evaluate the impact of serum potassium and glucose levels on in-hospital mortality in patients with ischemic heart disease, who exhibited severe ventricular arrhythmia.nnnMETHODSnWe enrolled 162 consecutive patients who were referred to our institution for an acute coronary event and presented with sustained ventricular tachycardia or ventricular fibrillation during the first 24 hours of hospitalization. Serum potassium and glucose levels were measured in all patients at the onset of tachycardia and after 2, 4, 6, 12, 36, 48 hours.nnnRESULTSnDuring hospitalization, 23 out of 162 patients died (61% males). Serum glucose levels at the onset of the arrhythmia, as well as after 2, 12, 36 and 48 hours, were higher in the deceased (onset: 228.8 +/- 108 vs. 158 +/- 68 mg/dl, p = 0.0001, 2 h: 182 +/- 109 vs. 149 +/- 59 mg/dl, p = 0.03, 12 h: 155.5 +/- 72 vs. 128 +/- 48 mg/dl, p = 0.025, 36 h: 163.8 +/- 63 vs.116 +/- 42 mg/dl, p = 0.002, and 48 h: 138 +/- 64 vs. 122 +/- 42 mg/dl, p = 0.05, respectively), even after adjustment for age, sex, diabetes, left ventricular ejection fraction, type of acute coronary syndrome and site of infarction and medication intake. There was no difference in serum potassium levels between the deceased and survivors.nnnCONCLUSIONnSerum glucose levels at the onset of arrhythmia and 2, 36 and 48 hours later seem to have prognostic significance for in-hospital mortality in patients hospitalized for an acute coronary event, who exhibit severe ventricular arrhythmia.

Effect of long-term nutraceutical and dietary supplement use on cognition in the elderly: a 10-year systematic review of randomised controlled trials

Nutraceuticals have generated interest as a way to mitigate the cognitive decline in older adults. The aim of this systematic review was to determine the evidence for these claims from the scientific literature in randomised, double-blinded, controlled trials (duration: ≥1 year; participants: n≥100; age(mean): ≥65 years). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched four electronic databases (PubMed, Scopus, CINAHL and Web of Science) and identified twenty-five studies published between the 15·June·2006 and 14·June·2016. Interventions included B-vitamins, n-3 fatty acids, antioxidant vitamins and herbs. Of the B-vitamin studies, four found benefits to cognition with supplementation. The first of these B-vitamin studies, in individuals with mild cognitive impairment (n 266; duration=2 years), included benefit to executive function (P=0·015) and improvements in the Mini-Mental State Examination (MMSE) among participants with baseline homocysteine above 11·3 µmol/l (P<0·001). In the same sample, the second study found cognitive benefits of B-vitamins dependent on the higher baseline plasma n-3 fatty acid status. The third B-vitamin study (n 900; duration=2 years) reported improved performance in immediate (P=0·046) and delayed recall (P=0·013), whereas the fourth study (n 856; duration=2 years) reported slower rate of cognitive decline in the MMSE (P=0·05). One study investigating DHA treatment (n 402; duration=1·5 years) revealed the slower rate of cognitive change in apoE e4 non-carriers (P=0·03). As only five included studies revealed notable benefits, presently based on the specific compounds explored here, there is not compelling evidence to support the use nutraceuticals to improve cognition in the elderly. Future long-term trials of nutraceuticals should investigate interactions with lifestyle, blood biomarkers and genetic risk factors.

The effects of grape and red wine polyphenols on gut microbiota – A systematic review

There is a growing body of evidence implicating the gut microbiome role in overall human health. Bacterial species belonging to the genera Lactobacillus and Bifidobacterium are generally considered to be beneficial and are commonly used in probiotic applications, whereas increases in some genera including Clostridum, Eubacterium and Bacteroides are implicated in negative health outcomes. Dietary polyphenols are bioactive compounds that have been found to increase the numbers of beneficial bacteria and antimicrobial actions against pathogenic bacteria, however most studies have been conducted in animal models or in-vitro colonic models. The aim of this systematic review was to provide an overview of recent trials on the effect of dietary grape and red wine polyphenols on the gut microbiota in humans. Following PRISMA guidelines, a systematic review was conducted of electronic databases (PubMed, CINAHL, Cochrane Library, Wed of Science and Scopus) to identify human intervention trials examining the effect of grape or wine polyphenols on gut microbiota. Seven trials met the inclusion criteria. One study looked at changes in gut microbiota following the ingestion of de-alcoholised red wine or red wine, and six studies referred to gut microbiota as intermediates in formation of phenolic metabolites. All studies confirmed that ingested polyphenols from grape and red wine, were modulated by gut microbiota, increasing numbers of polyphenolic metabolites which were found in blood, urine, ileal fluid and faeces. Intake of polyphenols derived from grape and red wine can modulate gut microbiota and contribute to beneficial microbial ecology that can enhance human health benefits. Additionally, grape and red wine polyphenols were modulated by the gut microbiota and there is a potential for a two-way relationship between the gut microbiota and polyphenolic compounds. Nevertheless, additional research is required to fully understand the complex relationship between gut microbiota and dietary polyphenols before any health claims can be made in relation to human health.

Lifestyle determinants of healthy ageing in a Mediterranean population: The multinational MEDIS study

Background: To evaluate modifiable, lifestyle risk factors of cardiovascular disease (CVD) among older adults, across ageing, in the Mediterranean area. Methods: During 2005–2017, 3131 individuals from 26 Mediterranean islands of 5 countries, ≥65 years of age, were voluntarily enrolled. Anthropometrical, clinical and socio‐demographic characteristics, dietary habits, lifestyle parameters were measured through standard procedures. Analyses were performed by year and across consecutive age groups of the participants. Results: A decrease in the prevalence of current smoking (p < 0.001), engagement in physical activities (p = 0.001) and participation in social events (p = 0.001) for every year increase in age was found. Moderate alcohol drinking increased through ageing (p = 0.008), whereas adherence to Mediterranean diet remained stable, but adequate (p = 0.90). Trend analysis also revealed that a quadratic (U‐shape) function better characterized the association between ageing and total cardiometabolic risk factors burden (p for trend <0.001). Conclusions: The gaps in the understanding of factors affecting longevity and healthy ageing remain; public health authorities and stakeholders should focus on the lifestyle determinants of healthy ageing, that seems to be an effective mean for improving older peoples health. HighlightsLife expectancy has increased among Mediterranean people.Prevalence of smoking, physical activity and socializing decreased with ageing.Prevalence of obesity and hypercholesterolemia decreased with ageing.The relation between age and total cardiometabolic score was inverse.Healthy ageing strategies should be promoted.

Beer, wine consumption, and 10-year CVD incidence: the ATTICA study

Background/objectivesLow/moderate alcohol consumption seems to be protective against cardiovascular disease (CVD). This study aimed to investigate the association of wine/beer consumption with the 10-year CVD incidence.Subjects/methodsDuring 2001–2002, 3042 CVD-free adults consented to participate in the ATTICA study; of them 2583 completed the 10-year follow-up (85% participation rate), but precise information about fatal/nonfatal CVD incidence (myocardial infarction, angina pectoris, cardiac ischemia, heart failure, chronic arrhythmias, and stroke) was available in 2020 participants (overall retention rate 66%). Alcohol/ethanol intake and the alcoholic beverages consumed were assessed; participants were categorized into three groups (no use; ≤1 glass/week; >1 glass/week).ResultsAlcohol drinking was reported by 56% of the participants who did not develop a CVD event and 49% of those who had (pu2009=u20090.04); whereas ethanol intake was 14u2009±u200916u2009g among those who did not had an event vs. 21u2009±u200918u2009g among those who had a CVD event (pu2009<u20090.001). A strong inverse and similar association between low wine/beer intake (≤1 glass/week) and the risk of developing CVD was observed [HR: 0.40, 95% confidence interval (CI): 0.17–0.98; and HR: 0.43, 95% CI: 0.20–0.93, respectively], as compared to abstention. No significant association was found in participants exceeding drinking 1 glass/week compared with abstainers. Compared to <2u2009g/day ethanol intake, participants who reported 2–10, 10–20, and >20u2009g/day had CVD-risk HRs (95% CI) of 0.60 (0.40–0.98), 1.22 (0.60–1.14), and 1.81 (0.70–4.61), respectively.ConclusionsThis study revealed similar results of low wine/beer consumption against CVD incidence, mainly due to its implication on low-grade chronic inflammation.

The mediating role of Mediterranean diet on the association between Lp(a) levels and cardiovascular disease risk: A 10-year follow-up of the ATTICA study

OBJECTIVEnΤo evaluate the combined modifying effect of dietary habits and/or features of healthy aging, on the lipoprotein-alpha [Lp(a)] and CVD risk association.nnnDESIGN AND METHODSnΤhe ATTICA is a prospective, population-based study conducted in the greater metropolitan area of Athens (Attica, Greece). During 2001-2002, 3042 CVD-free adults (men/women: 1514/1528, 18-89u202fyears) agreed to participate. In 2011-2012, the 10-year study follow-up was performed, recording the fatal/non-fatal CVD incidence in 2020 participants (mean follow-up: 8.41u202fyears). Various bio-clinical characteristics [including low-density lipoprotein-cholesterol (LDL-C), Lp(a)] were derived through standard procedures. Dietary habits were assessed through the MedDietScore (an index assessing adherence to the Mediterranean diet with theoretical range 0-55). A validated successful aging index (SAI), ranging from 0 to 10, was used to assess healthy aging.nnnRESULTSnLp(a) levels were positively associated with 10-year CVD incidence (Hazard Ratio: 1.02, 95%CI 1.01-1.04); when MedDietScore was included in the model the observed association between Lp(a) levels and CVD risk disappeared (1.00, 95%CI 0.98-1.01), and a mediating effect of Mediterranean diet was revealed (Sobels test pu202f<u202f0.001). In the model that included both MedDietScore and SAI, the interaction effect of these two features on 10-year CVD risk was highly protective (pu202f<u202f0.001), whereas the association between Lp(a) levels and CVD risk was further mediated (Sobels test pu202f<u202f0.001).nnnCONCLUSIONSnAdherence to a healthy dietary pattern, like the Mediterranean diet seems to mediate the association between Lp(a) with CVD risk whereas a successful aging together with a healthy diet seems to further explain the previously mentioned association.

Olive oil consumption and 10-year (2002–2012) cardiovascular disease incidence: the ATTICA study

PurposeOlive oil, being rich in mono-unsaturated fatty acids and anti-inflammatory compounds, may have protective effects against cardiovascular disease (CVD). The aim of the present work was to examine the association of olive oil consumption with the 10-year CVD incidence in adults without pre-existing CVD.MethodsThe ATTICA Study is a prospective, population-based study conducted in the greater metropolitan area of Athens (Attica, Greece). During 2001–2002, 3042 CVD-free adults (1514 men and 1528 women) were voluntarily recruited to the ATTICA study. Among various dietary habits, consumption of olive oil and other fats/oils was assessed at baseline; participants were classified into three groups (no use; mixed use; and exclusive use of olive oil). In 2011–2012, the 10-year study follow-up was performed, recording the fatal/non-fatal CVD incidence in 2020 participants (mean follow-up duration: 8.41xa0years).ResultsAfter controlling for various covariates, an inverse association between exclusive olive oil use and the risk of developing CVD was observed (relative risk 0.07, 95% CI: 0.01–0.66) compared to those not consuming olive oil. Further adjustment for fibrinogen plasma levels (among various inflammatory markers) showed a significant mediation effect on the previous association.ConclusionsThese findings support exclusive olive oil consumption, a key component of the Mediterranean diet, for the primary CVD prevention, in adults without pre-existing disease. Circulating fibrinogen levels appear to play a mediating role in this relationship.