Joanna Moschandreas

Mediterranean diet of Crete: foods and nutrient content.

OBJECTIVES To describe the traditional diet of Crete and evaluate the nutrient composition of 3 types of diet common in Crete by means of chemical analyses of composite food samples. To compare results with dietary analyses from a nutrient database developed at the University of Crete, Greece. DESIGN Three composite diet samples were obtained based on 7-day weighed food records representing the traditional Cretan Mediterranean diet (diet A), typical diet of present-day Greek adolescents (diet B), and fasting diet of the Eastern Orthodox church (diet C). Analyses were performed chemically and using a nutrient database. RESULTS Chemical analyses provided a definitive measure, for the first time, of the nutrient composition of the complete Greek diet as it was in the early 1960s. In comparing chemical analyses with nutrient database analyses, differences greater than 15% of the analyzed value were found in all 3 diets for cholesterol and some vitamins. The differences between analyzed and calculated values in total fat and saturated fat content were less than 15% in all diets. APPLICATIONS/CONCLUSIONS The present study provides 2 practical examples of the Mediterranean diet, which although widely publicized has rarely been analyzed chemically. Diet A has been shown to be related to the lowest rates for coronary heart disease and cancer mortality compared with the diets of the other populations of the Seven Countries study. As such, it could be recommended for health promotion and prevention of disease. Diet C contains even lower amounts of saturated fatty acids and would be excellent for patients with hypercholesterolemia. The high antioxidants in diet C probably maintain very low levels of low-density lipoprotein cholesterol. Dietary analyses of the Greek diet could be based on an operational database such as ours if further chemical analyses are performed on specific foods. These would result in improved precision of the database and possible extension into national food composition tables and a national dietary database.

Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme.

The effectiveness of a health and nutrition education programme, in changing certain chronic disease risk factors, was assessed after the 6 years intervention period was completed. The school-based intervention programme was applied to all children registered in the first grade (age 5.5-6.5 years) in 1992 in two counties of Crete, while the children from a third county served as a control group. In order to assess the effectiveness of the intervention, a variety of biological and behavioural parameters were measured before and following completion of the intervention in a randomly selected school-based sample of 602 intervention group (IG) and 444 control group (CG) pupils. At the end of the 6-year period, it was found that biochemical indices generally improved significantly more in the IG compared with the CG (mean change for IG v. CG was -0.27 v. -0.12 mmol/l for total cholesterol (TC); -0.07 v. +0.24 for TC:HDL and -0.13 v. +0.14 for LDL:HDL). Similarly, the changes observed in the anthropometric variables in the two groups were in favour of the IG (+3.68 v. +4.28 kg/m2 for BMI; +2.97 v. +4.47 mm for biceps skinfold). Total energy intake and consumption of total fat and saturated fat increased significantly less in the IG compared with the CG (+747.7 v. 1534.7 kJ (+178.7 v. +366.8 kcal); +5.9 v. +18.8 g and +0.8 v. +5.1 g respectively), while time devoted to leisure time physical activity and cardiovascular run test performance increased significantly more in the IG (+281 v. +174 min/week and +2.5 v. +1.2 stages respectively). The findings of the present study underline the importance of such programmes in health promotion and disease prevention. Although the long-term effects of these programmes can only be assessed by tracking this population through to adolescence and adulthood, these programmes seem to have the potential to lead to a healthier lifestyle and thus a reduction in risk factor levels.

Protective effect of exclusive breastfeeding against infections during infancy: a prospective study

Objective To prospectively investigate the effects of breastfeeding on the frequency and severity of infections in a well-defined infant population with adequate vaccination coverage and healthcare standards. Study design In a representative sample of 926 infants, successfully followed up for 12 months, feeding mode and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis and thrush, were recorded at 1, 3, 6, 9 and 12 months of life. Results Infants exclusively breastfed for 6 months, as per WHO recommendations, presented with fewer infectious episodes than their partially breastfed or non-breastfed peers and this protective effect persisted after adjustment for potential confounders for ARI (OR 0.58, 95% CI 0.36 to 0.92), AOM (OR 0.37, 95% CI 0.13 to 1.05) and thrush (OR 0.14, 95% CI 0.02 to 1.02). Prolonged exclusive breastfeeding was associated with fewer infectious episodes (rs=−0.07, p=0.019) and fewer admissions to hospital for infection (rs=−0.06, p=0.037) in the first year of life. Partial breastfeeding was not related to protective effect. Several confounding factors, including parental age and education, ethnicity, presence of other siblings, environmental tobacco smoke exposure and season of birth were demonstrated to have an effect on frequency of infections during infancy. Conclusions Findings from this large-scale prospective study in a well-defined infant population with adequate healthcare standards suggest that exclusive breastfeeding contributes to protection against common infections during infancy regarding and lessens the frequency and severity of infectious episodes. Partial breastfeeding did not seem to provide this protective effect.

Cross-Cultural Adaptation and Validation of the Voice Handicap Index Into Greek

The objective was to culturally adapt and validate the Voice Handicap Index (VHI) to the Greek language. The study design used was a psychometric analysis. The VHI was translated into Greek with cultural adaptations to accommodate certain words. The translated version was then completed by 67 subjects with various voice disorders and by a control group of 79 subjects. All the participants also completed a self-rating scale regarding the severity of their voice disorder. Statistical analyses demonstrated high internal consistency and high test-retest reliability both for the overall VHI score and for the functional, physical, and emotional domains of the VHI. A moderate correlation was found between the VHI and the self-rating severity scale. The subjects in the control group had lower scores compared to the subjects with voice disorders for the overall VHI score and for the three domains. Based on the internal consistency values and the test-retest reliability, the Greek version of VHI is a valid and reliable measure for use by Greek subjects with voice disorders.

Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design.

Background/purposeThe number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours.MethodsEXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used.ConclusionThe EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Depression and long chain n-3 fatty acids in adipose tissue in adults from Crete

Background:Only one study has investigated the relationship of essential fatty acids in the adipose tissue with depression in adults and suggested an inverse relationship between docosahexaenoic acid (22:6 n-3) (DHA) and depression.Objective:To examine the relation between adipose tissue polyunsaturated fatty acids especially n-3 and n-6 fatty acids, an index of long-term or habitual fatty acid intake, and depression in adults.Design:Cross-sectional study of healthy adults from the island of Crete.Setting:The Preventive Medicine and Nutrition Clinic, University of Crete, Greece.Subjects:A total of 130 healthy adults (59 males, 71 females) aged 22—58 years. The sample was a sub-sample of the Greek ApoEurope study group.Methods:Fatty acids were determined by gas chromatography in adipose tissue. Information about depression was obtained through the Zung Self-rating Depression Scale.Results:Adipose tissue DHA was inversely related with depression. Multiple linear regression analysis taking into account the possible confounding effect of age, gender, body mass index, smoking and educational level confirmed this association.Conclusions:The inverse relationship between adipose DHA and depression in adults, replicates findings of a previous study. This relationship indicates that a low long-term dietary intake of DHA is associated with an increased risk for depression in adults.Funding:The International Olive Oil Council and the DG XII of the European Union.

Oxidative stress, and iron and antioxidant status in elderly men: differences between the Mediterranean south (Crete) and northern Europe (Zutphen)

Background Oxidative stress may accelerate ageing and increase the risk of chronic diseases, such as coronary heart disease (CHD). We assessed differences in oxidative stress, and iron and antioxidant status between elderly men living in Mediterranean southern Europe (Crete, Greece) and northern Europe (Zutphen, The Netherlands). Design A cross-sectional study using data from two cohorts of the Seven Countries Study. Methods Non-fasting blood samples were drawn in 2000 from 105 men from Crete and 139 men from Zutphen, all aged 79 years or over. All assays were performed in the same laboratory. Results After multiple adjustments, serum levels of the markers of oxidative stress were lower in Cretan men than in men from Zutphen, as indicated by lower mean levels of hydroperoxides (33.2 versus 57.3 μmol/l; P = 0.005) and gamma-glutamyltransferase (20.3 versus 26.1 U/I; P = 0.003). The most pronounced difference in iron status was a twofold lower mean serum ferritin level in Cretan men (69.8 μg/I) compared with men from Zutphen (134.2 μg/I; P < 0.0001). Men from Crete had consistently higher plasma levels of major plasma antioxidants than the Zutphen men, including a nearly fourfold higher mean level of lycopene (15.3 versus 4.1 μg/100 ml; P < 0.0001). Conclusion Elderly men from Crete had consistently lower levels of the indicators of oxidative stress and iron status and higher concentrations of major antioxidants than men from Zutphen. These differences may contribute to the lower rate of CHD and total mortality that has been observed in this cohort of Cretan men.

Food and nutrient intakes of Greek (Cretan) adults. Recent data for food-based dietary guidelines in Greece.

The present study aimed to estimate current nutrient intake levels and food group consumption patterns in Greece using cut-off levels derived from the results of dietary recall interviews with 470 Cretan adults. It was found that the present-day Greek diet contains, in the main, adequate levels of fibre. In comparison with the traditional diet, however, the levels of saturated fat in the diet have greatly increased, particularly in younger adults. An association was found between low fruit and vegetable and low fibre intake and a fat intake that was mainly in the form of saturated fat, this being particularly evident in female subjects. Given the wide availability of olive oil, fish, fresh fruit and vegetables in Greece, the development of national dietary guidelines would be of great potential benefit, particularly to the younger generations.

Choice of Analytic Approach for Eye-Specific Outcomes: One Eye or Two?

PURPOSE To investigate the use of analytic approaches for eye-specific outcomes in ophthalmology publications. DESIGN A review of analytic approaches used in original research articles published in ophthalmology journals. METHODS All 161 research articles published in 5 ophthalmology journals in the first 2 months of 2008 were considered. Publications were categorized according to analytic approach: 1 eye selected, both eyes contribute, or per-individual outcome. Studies were considered suboptimal when criteria for eye selection were not provided or when measurements from both eyes were included without interocular correlation being considered. Visual impairment prevalence data were used to illustrate analytic approach choices. RESULTS Measurements from both eyes were included in 38% of the 112 studies that used statistical inferential techniques. In 31 (74%), there was no mention of possible correlation. Only 7% used statistical methods appropriate for correlated outcomes. In 35 studies (31%), measurements from 1 eye were selected; 31% of these did not provide selection criteria. In 67%, only univariate tests were used. A review of 47 articles published in 2011 produced similar findings. Characteristics of studies were not found to differ according whether the studies were suboptimal. Using a test appropriate for correlated outcomes resulted in a P value 3.5 times that obtained ignoring the correlation. CONCLUSIONS Between-eye correlation seems not to be assessed commonly in ophthalmology publications, although its knowledge aids the choice of analytic approach when eye-specific variables are of interest. Statistical methods appropriate for correlated ocular outcome data are not being applied widely.

Health and nutrition education in primary schools of Crete: follow-up changes in body mass index and overweight status.

The current study examines the long-term effects of a school-based ‘Health and Nutrition Education programme’ on body mass index (BMI) changes and the prevalence of overweight. The intervention group consisted of all pupils registered in the first grade of two counties of the island of Crete in 1992, while all pupils registered in a third county formed the control group. For evaluation purposes, a representative sample was examined at baseline (1992) following the 6-y intervention (1998) and 4 y after the programmes cessation (2002). The data presented here are based on pupils with full anthropometrical data in all three examination periods (284 intervention group pupils and 257 control group pupils). Former intervention group pupils had lower average BMI (by 0.7 kg/m2, s.e. 0.28, P=0.019) at the 10-y follow-up compared to the control group subjects, while no differences were detected in the prevalence of obesity between the two groups. The findings of the current study indicate that the beneficial effects of the programme on pupils’ BMI continue, to an extent, 4 years after its cessation. However, the lack of significant differences in the prevalence of overweight between the two groups indicates that the effects of the intervention may not be equally distributed in the population, with greater effects in certain subgroups and less or none in others.