Evangelos Polychronopoulos

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.

REPRODUCIBILITY AND VALIDITY OF AN EXTENSIVE SEMIQUANTITATIVE FOOD FREQUENCY QUESTIONNAIRE AMONG GREEK SCHOOL TEACHERS

We evaluated the reproducibility and validity of a 190-item semiquantitative food frequency questionnaire (FFQ) to be used in a large prospective study in the Athens area of Greece. Eighty persons, 42 men and 38 women, ages 25-67 years, completed a self-administered FFQ, followed by monthly 24-hour diet recalls and then a second FFQ 1 year after the first. Correlation coefficients measuring the reproducibility and validity of the FFQ indicate that the questionnaire is reproducible and provides a reasonably reliable measure of intake for many nutrients over a period of 1 year.

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.

Long-Term Fish Intake Is Associated With Less Severe Depressive Symptoms Among Elderly Men and Women The MEDIS (MEDiterranean ISlands Elderly) Epidemiological Study

Objective: This work aims at exploring the association between fish intake and depressive symptoms, in older adults. Method: During 2005-2007, 1,190 men and women (>65 years) free living in various Greek islands and in Cyprus participated in the study. Depressive symptoms were assessed using the validated Geriatric Depression Scale (GDS), and foods intake through a Food Frequency Questionnaire. Results: Almost 70% of the participants scored above the depressive cutoff (i.e., GDS score > 5), with women having higher values. People classified under the 1st tertile of GDS score (i.e., GDS ≤ 5) were more educated, physically active, and report higher fish consumption. One portion increase of fish consumption per week was associated with 0.58 times (95% confidence interval: 0.45-0.73) lower likelihood of having GDS score above the clinical threshold, after various adjustments were made. Discussion: These findings may assist public health policy makers in better preventing emotional disorders among the elderly by promoting healthier eating habits.

Repeatability and validation of a short, semi-quantitative food frequency questionnaire designed for older adults living in Mediterranean areas: the MEDIS-FFQ.

The aim of the present work was to evaluate the repeatability and the validity of a short food frequency questionnaire (FFQ) that could be used for older people living in Mediterranean areas. The semi-quantitative FFQ included questions regarding the frequency of consumption of the main food groups and beverages typically consumed in the Mediterranean areas as well as some questions regarding eating habits of older persons. During 2006–2007, for the repeatability assessment (within 10–30 days), 150 individuals (51 ± 17 yrs, 40% males) were studied, while another 190 individuals (74 ± 9 yrs, 52% males) were enrolled for the validation purposes. Agreement of the FFQ with the 3-day food records was evaluated using the Bland–Altman method and the Kendalls tau-b coefficient. Repeatability was tested using the Cohens kappa coefficient. Between 3-day food records and the FFQ, good agreement for alcohol (tau-b = 0.64, p < 0.001) was found, while moderate agreement for food and beverage groups of greens (tau-b = 0.32, p < 0.001), fruits (tau-b = 0.35, p < 0.001), cereals (tau-b = 0.61, p < 0.001), sweets (tau-b = 0.51, p < 0.001), and coffee (tau-b = 0.58, p < 0.001) was observed. Low, but still significant, agreement for fish (tau-b = 0.21, p = 0.001), legumes (tau-b = 0.23, p < 0.001), vegetables (tau-b = 0.23, p < 0.001), pasta (tau-b = 0.25, p < 0.001), potatoes (tau-b = 0.17, p = 0.006) and meat consumption (tau-b = 0.14, p < 0.001) were also found. The FFQ was also valid regarding the estimation of macronutrients and energy intake. Sensitivity analyses by sex, age category (≤ or > 75 yrs), and education status showed similar validity of the FFQ in each subgroup, except for elders older than 75 years. The repeatability of the FFQ was fair in all foods tested (Cohens kappa coefficients varied between 0.15–0.39, p-values < 0.05). The suggested FFQ seems to be a reasonably valid and repeatable measure of dietary intake and can be used in older persons living in the Mediterranean areas.

Diet, lifestyle factors and hypercholesterolemia in elderly men and women from Cyprus

BackgroundWe sought to investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and non-smoking on clinical status of 150 elderly people from Cyprus.MethodsThe study comprises individuals enrolled in surveys from Greece and Cyprus. This work includes 53 apparently men and 97 women, aged 65 to 100 years, from various areas of Cyprus. The cohort study was conducted between 2004 and 2005. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed (range 0–55) and then a healthy index was calculated that evaluated four lifestyle habits (range 0 – 4), i.e. non-smoking, alcohol intake, physical activity and adherence to the Mediterranean diet (i.e. above the median of the score).Results65% participants had hypercholesterolemia (total serum cholesterol > 200 mg/dl or use of lipid lowering agents). Moreover, 32% of the participants reported physically active, 5% reported smoking habits and 4% that they have stopped smoking during the past decade, while 8% reported alcohol drinking. A positive association was observed between prevalence of hypercholesterolemia and smoking habits (odds ratio = 4.3, p = 0.03), while an inverse association was observed between hypercholesterolemia, alcohol drinking (odds ratio = 0.3, p = 0.04) and adherence to a Mediterranean diet (odds ratio = 0.77, p = 0.02), controlled for age, sex, and other factors.ConclusionAdherence to a Mediterranean diet and healthful lifestyle is associated with reduced odds of having hypercholesterolemia among elderly people.

The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice

Metabolic syndrome is a collection of associated conditions such as dyslipidemia, high blood pressure, impaired glucose tolerance and tendency to develop fat around the abdomen. It is now well known that individuals with the metabolic syndrome are at high risk for atherosclerosis and, especially, coronary heart disease. However, it has been suggested that people with the metabolic syndrome may benefit from aggressive lifestyle modification, through diet and exercise. In this review we summarize scientific evidence regarding the effect of Mediterranean diet on the development of metabolic syndrome.

Long-term tea intake is associated with reduced prevalence of (type 2) diabetes mellitus among elderly people from Mediterranean islands: MEDIS epidemiological study.

Purpose We sought to evaluate the link between long-term tea intake and prevalence of type 2 diabetes mellitus, in a sample of elderly adults. Materials and Methods During 2005-2007, 300 men and women from Cyprus, 142 from Mitilini, 100 from Samothraki, 114 from Kefalonia, 131 from Crete, 150 from Corfu and 103 from Zakynthos (aged 65 to 100 years) were enrolled. Dietary habits (including tea consumption) were assessed through a food frequency questionnaire. Among various factors, fasting blood glucose was measured and prevalence of (type 2) diabetes mellitus was estimated. Results 54% of the participants reported that they consume tea at least once a week (mean intake 1.6 ± 1.1 cup/day). The majority of the participants (98%) reported green or black tea consumption. The participants reported that they consume tea for at least 30 years of their life. After adjusting for various confounders, tea intake was inversely associated with lower blood glucose levels (b ± SEM per 1 cup: - 5.9 ± 2.6 mg/dL, p = 0.02). Moreover, multiple logistic regression revealed that moderate tea consumption (1 - 2 cups/day) was associated with 70% (95% CI 41% to 86%) lower odds of having (type 2) diabetes, irrespective of age, sex, body mass, smoking, physical activity status, dietary habits and other clinical characteristics. Conclusion The presented findings suggest that long-term tea intake is associated with reduced levels of fasting blood glucose and lower prevalence of diabetes, in a cohort of elderly people living in Mediterranean islands.

Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study.

OBJECTIVE To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet. DESIGN Cross-sectional. SETTING Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status. SUBJECTS During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey. RESULTS Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P < 0.01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0.004), as well as financial status (P = 0.001). CONCLUSIONS Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

The relationship between smokers' motivation to quit and intensity of tobacco control at the population level: a comparison of five European countries

BackgroundSmoking prevalence differs significantly across Europe. In addition, there are considerable differences in tobacco control activities across European countries. The relationship between prevalence and policy is under-researched. The present analysis examines the motivation to change smoking behaviour across 5 different European countries that differ considerably in their tobacco control activities.MethodsA population-based, representative survey of 1750 smokers, aged 16–59, from 5 different European countries (Germany, Greece, Poland, Sweden, UK) was used. Demographic variables, smoking status and the motivation to stop smoking were assessed. Motivation was assessed as, first, intending to quit (using the stages of change plus a modified stage for Precontemplation), and second, the desire to quit.ResultsThe majority of smokers want to stop smoking (73.5%), while only 35.0% want to stop definitely. Across countries, 10.2% definitely do not want to stop.Most of the smokers can be categorised in the Precontemplation stage (between 62.6% and 77.7% depending on the country), one of the stages of change categories. The relationship between the stages of change and the country under examination is statistically significant (chi-square = 43.466, p < 0.001). In countries with a high level of tobacco control, the proportion of people in Precontemplation is lower than in countries with low tobacco control activity.ConclusionThere are differences in the stages of change between the countries under examination. However, the categorisation of the countries into low, medium and high tobacco control activity used in this analysis does not explain these differences. Most smokers want to stop smoking, but a high proportion cannot indicate a time-frame when this is going to happen. Tobacco control efforts or other kinds of support might encourage these smokers to actually try to stop. Longitudinal studies at the population level are needed to assess, relate or monitor tobacco control activities and the intention to stop.