Manolis Linardakis

The Effect of Protein and Glycemic Index on Children's Body Composition: The DiOGenes Randomized Study

OBJECTIVE: To investigate the effect of protein and glycemic index (GI) on body composition among European children in the randomized, 6-month dietary intervention DiOGenes (diet, obesity, and genes) family-based study. PATIENTS AND METHODS: In the study, 827 children (381 boys and 446 girls), aged 5 to 18 years, completed baseline examinations. Families with parents who lost ≥8% of their weight during an 8-week run-in low-calorie diet period were randomly assigned to 1 of 5 ad libitum diets: low protein (LP)/low glycemic index (LGI); LP/high GI (HGI); high protein (HP)/LGI; HP/HGI; and control diet. The target difference was 15 GI U between the LGI/HGI groups and 13 protein percentage points between the LP/HP groups. There were 658 children examined after 4 weeks. Advice on food-choice modification was provided at 6 visits during this period. No advice on weight loss was provided because the focus of the study was the ability of the diets to affect outcomes through appetite regulation. Anthropometric measurements and body composition were assessed at baseline, week 4, and week 26. RESULTS: In the study, 465 children (58.1%) completed all assessments. The achieved differences between the GI and protein groups were 2.3 GI U and 4.9 protein percentage points, respectively. The LP/HGI group increased body fat percentage significantly more than the other groups (P = .040; partial η2 = 0.039), and the percentage of overweight/obese children in the HP/LGI group decreased significantly during the intervention (P = .031). CONCLUSIONS: Neither GI nor protein had an isolated effect on body composition. However, the LP/HGI combination increased body fat, whereas the HP/LGI combination was protective against obesity in this sample of children.

Sugar-added beverages consumption among kindergarten children of Crete: effects on nutritional status and risk of obesity

ObjectiveTo assess the intake of sugar-added beverages such as soft drinks and commercially available fruit juices in kindergarten children, and to examine its association with obesity indices, physical activity levels and dietary habits.MethodsA total of 856 children aged 4–7 years living in Crete, Greece in 2004–5 were included in this cross-sectional study. Nutrient and food intake was assessed with the use of 3-day weighed food records. Body measurements were used in order to assess BMI and waist circumference, and moderate-to-vigorous physical activity was calculated with the use of a questionnaire.ResultsApproximately 59.8% of all children consumed sugar-added beverages on a daily basis. High intake of sugar-added beverages (> 250 g/day) was associated with low intakes of calcium (p < 0.001), vitamin A and E (p < 0.010), fruits and vegetables (p = 0.007), and milk and yogurt (p = 0.048). Compared to non or low consumers, high consumers of sugar-added beverages (> 250 g/day) had higher BMI levels and two times greater risk of being overweight and/or obese (OR:2.35, p = 0.023).ConclusionHigh intake of sugar-added beverages in kindergarten children is associated with poor eating habits and inadequate nutrient intake, as well as increased risk for developing childhood obesity.

Effects of Greek orthodox christian church fasting on serum lipids and obesity

BackgroundNo study to date has focused on the impact of Greek Orthodox Christian fasting on serum lipoproteins and obesity yet.Methods120 Greek adults were followed longitudinally for one year. Sixty fasted regularly in all fasting periods (fasters) and 60 did not fast at all (controls). The three major fasting periods under study were: Christmas (40 days), Lent (48 days) and Assumption (August, 15 days). A total of 6 measurements were made during one year including pre- and end-fasting blood collection, serum lipoprotein analyses and anthropometric measurements.ResultsStatistically significant end-fasting total and LDL cholesterol differences were found in fasters. Fasters compared to controls presented 12.5% lower end-total cholesterol (p < 0.001), 15.9% lower end-LDL cholesterol (p < 0.001) and 1.5% lower end-BMI (p < 0.001). The end- LDL/HDL ratio was lower in fasters (6.5%, p < 0.05) while the change in end- HDL cholesterol in fasters (4.6% decline) was not significant. Similar results were found when the pre- and end-fasting values of fasters were compared. No change was found in control subjects.ConclusionsAdherence to Greek Orthodox fasting periods contributes to a reduction in the blood lipid profile including a non-significant reduction in HDL cholesterol and possible impact on obesity.

Greek Orthodox fasting rituals: a hidden characteristic of the Mediterranean diet of Crete

The longevity and excellent health status of the population of Crete has been attributed to its lifestyle and dietary habits. The impact of Greek Orthodox Christian Church fasting on these dietary habits has never been studied. One hundred and twenty Greek Orthodox Christians living in Crete participated in a 1-year prospective study. One half of the subjects, who fasted regularly (fasters), and sixty non-faster controls were followed longitudinally for the three main fasting periods over 1 year; Christmas (40 d), Lent (48 d) and the Assumption (15 d). Pre- and end-holy days measurements were performed in each fasting period including: 24 h dietary recall, blood collection and anthropometric measurements. Based on the 24 h recall, fasters as compared with controls had lower intakes of end-holy days dietary cholesterol, total fat, saturated fatty acids, trans-fatty acids and protein (P < 0.001). Fasters presented a decrease of 753 kJ (180 kcal) in end-holy days energy intake (P < 0.05) compared with an increase of 573 kJ (137 kcal) in the controls (P < 0.05). Fasters had a decrease in end-holy days Ca intake (P < 0.001) and an increase in end-holy days total dietary fibre (P < 0.001) and folate (P < 0.05), attributed to their higher consumption of fruit and vegetables in end-holy periods (P < 0.001). There were no differences for other vitamins or minerals between pre- and end-holy periods in both groups except for vitamin B2. The Orthodox Christian dietary regulations are an important component of the Mediterranean diet of Crete characterised by low levels of dietary saturated fatty acids, high levels of fibre and folate, and a high consumption of fruit, vegetables and legumes.

Dietary and other lifestyle correlates of serum folate concentrations in a healthy adult population in Crete, Greece: a cross-sectional study

BackgroundFolate has emerged as a key nutrient for optimising health. Impaired folate status has been identified as a risk factor for cardiovascular disease, various types of cancers, and neurocognitive disorders. The study aimed at examining the distribution and determinants of serum folate concentrations in a healthy adult population in Crete, Greece.MethodsA cross-sectional sample of 486 healthy adults (250 men, 236 women) aged 39 ± 14 years, personnel of the Medical School and the University Hospital of Crete in Greece, was examined. Serum folate and vitamin B12 concentrations were measured by microbiological assay, and total homocysteine was determined fluorometrically and by high-pressure liquid chromatography. Lifestyle questionnaires were completed, and nutrient intakes and food consumption were assessed by 24-h dietary recalls. Multivariate analyses were performed using SPSS v10.1.ResultsThe geometric mean (95% confidence interval) concentrations of serum folate were 15.6 μmol/l (14.6–16.8) in men and 19.2 μmol/l (17.9–20.7) in women (p < 0.001). Inadequate folate levels (≤7 nmol/l) were present in 6.8% of men and 2.1% of women (p < 0.001). Approximately 76% of men and 87% of women did not meet the reference dietary intake for folate (400 μg/day). Serum folate was inversely related to total homocysteine levels (p < 0.001). Increased tobacco and coffee consumption were associated with lower folate concentrations (p < 0.05 for both) but these associations disappeared after controlling for nutrient intakes. In multivariate analysis, intakes of MUFA, fibre, calcium, magnesium, folate, and vitamins A, E, C, B1, and B6 were positively associated with serum folate. Consumption of potatoes, legumes, fruits, and vegetables were favourably related to the serum folate status.ConclusionSerum folate concentrations were associated with various demographic, lifestyle and dietary factors in healthy Cretan adults. Large-scale epidemiological studies should be conducted within the general Greek adult population to assess the prevalence of impaired folate status and further examine associations with dietary patterns and chronic disease risk. Considering the importance of folate in health maintenance, it is important to increase the publics awareness of modifiable lifestyle patterns and diet and tobacco use in particular, which may be associated with improved folate status.

Smoking status in relation to serum folate and dietary vitamin intake

ObjectiveCigarette smoke itself is an abundant source of free radicals and a major cause of oxidative stress, to which plasma antioxidants function as a vital protective and counterbalancing mechanism. The objective of this study was to investigate into the relationship between smoking status and serum and dietary micronutrient concentrations.DesignCross-sectional studySubjects – Setting502 farmers from the Valley of Messara in Crete were randomly selected and examined. Complete three-day and 24-hr recall questionnaires were collected along with anthropometrical, physical activity and clinical data from all participating subjects.ResultsAfter adjusting for age, gender and number of fasting days adhered to per year, current smokers were found to have a lower dietary intake of vitamin C (112.1 mg vs. 136.4 mg, p = 0.03), fibre (16.6 g vs. 19.1 g, p = 0.006) and fruits and vegetables (339 g vs. 412 g, p = 0.014), while dietary vitamin B1 intake was found to be higher (1.7 mg vs. 1.4 mg, p = 0.02) in comparison to non/ex smokers. Dietary intake of meat, folate and vitami A, E, B2, B6 and B12 did not differ between the groups. Controlling age, gender, fasting days and dietary micronutrient intake, serum folate levels were found to be lower among smokers (geometric mean 15.3 nmol/L vs. 17.7 nmol/L, p = 0.023), while serum iron and vitamin B12 levels were not affected by smoking status.ConclusionCurrent smoking status affects dietary nutrient intake as well as plasma folate levels. The above coherence between antioxidant depletion and reduced antioxidant intake may predispose smokers to the premature development of tobacco related mortality and morbidity.

Environmental tobacco smoke exposure in motor vehicles: a preliminary study.

Environmental tobacco smoke (ETS) contains over 3000 chemicals of which at least 50 are known or suspected to be human carcinogens, while over 200 are regarded as poisonous.1,2 Although passive smoking often occurs in private and public workplaces, with extensive research already conducted in hospitality venues, casinos, airplanes, airports and homes, to our knowledge there are insufficient data (if any) published on motor vehicle secondhand smoke (SHS) levels and no comparisons have been made with other areas where people are involuntarily exposed to ETS. Measurements of airborne respiratory particles under 2.5 μm (RSP2.5) in diameter were made using the TSI SidePak AM510 Personal Air Monitor during March 2005 in Crete, Greece. Respiratory particles of this size are not specific …

Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet.

Background Farmers from Crete as first studied within the framework of the Seven Countries Study, were historically known for holding the title of the ‘gold standard’ of health status globally and had a very low prevalence of both cardiovascular disease (CVD) and cancer. Taking the above into account we evaluated the changes in CVD risk factors among farmers in Crete, Greece and compared our findings with data from the 1960s. Design Cross-sectional. Methods Five hundred and two farmers (18–79 years old) from the Valley of Messara in Crete were randomly selected and examined in 2005. Complete clinical, biochemical, dietetic, anthropometrical and lifestyle CVD risk factors were assessed, matched and compared with published data from the 1960s. Results In comparison with 45 years ago, present day male farmers from Crete were found to have a 30% higher BMI (29.8 vs. 22.9 kg/m2, P [0.001) and a 16% higher total cholesterol level (239.6 vs. 206.9 mg/dl, P[ 0.001) and also a not so favourable daily dietary intake (increase in meat and saturated fat and decrease in fruit, P [0.001, respectively), while a significant reduction in systolic blood pressure and energy intake was noticed. In regards to changes in subcutaneous adipose tissue fatty acid composition, a decrease in monounsaturated (P [ 0.001) and an increase in saturated fatty acids (P[ 0.001) was also found elucidating the temporal change in dietary habits. Conclusion The populations lack of adherence to the Mediterranean diet, have led to the fact that currently farmers from Crete are likely to be at a higher risk for developing CVD in comparison with earlier generations.

Waist circumference as a screening tool for the identification of adolescents with the metabolic syndrome phenotype

OBJECTIVES Most published definitions of the metabolic syndrome (MetS) in children and adolescents include increased waist circumference (WC) in their criteria. To assess the clinical relevance of WC in identifying adolescents with the MetS phenotype and adverse fitness patterns, we divided a cohort of 15-year-old schoolchildren in quartiles for WC, and compared the subjects of the extreme quartiles for the presence of cardiovascular (CVD) risk factors, their clustering, insulin resistance and body fitness. POPULATION AND METHODS From the original cohort of 635 adolescents investigated for childhood CVD risk, anthropometric parameters, blood pressure, fitness indexes, and serum fasting glucose, insulin and lipids were analyzed in 105 adolescents of the highest (> or =75th percentile) and 102 of the lowest (< or =25th percentile) WC quartile. RESULTS Adolescents with WC > or =75th percentile presented with significantly higher fasting insulin (17+/-0.9 vs. 9.1+/-1.0 microIU/mL), triglycerides (78.0+/-3.4 vs. 62.3+/-3.3 mg/dL), LDL-cholesterol (106.8+/-2.8 vs. 96.1+/-2.8 mg/dL), homeostasis model assessment index (HOMA-IR) (3.29+/-1.8 vs. 1.81+/-0.2), systolic blood pressure (125.6+/-1.1 vs. 116.0+/-1.1 mm Hg), and diastolic blood pressure (78.0+/-0.9 vs. 71.5+/-0.9 mm Hg) and significantly lower HDL-cholesterol (46.2+/-1.2 vs. 53.4+/-1.1 mg/dL) and physical fitness as compared with their peers with WC < or =25th percentile. Clustering of three CVD factors pointing to a full MetS phenotype was found for 13.5% of the 15 year olds with WC>75th percentile. CONCLUSIONS Our findings suggest that WC > or =75th percentile is associated with the MetS phenotype and reduced activity in adolescence, and confirm the clinical relevance of WC as a tool for the identification of adolescents with increased CVD risk.

Fruit and vegetables consumption in relation to health and diet of medical students in Crete, Greece.

In Greece, prevalence of cardiovascular disease has been increasing during the last few decades. From a public health point of view, it is important to identify lifestyle practices associated with cardiovascular disease risk factors. As part of the Clinical Nutrition course at the University of Crete School of Medicine, 507 medical students (292 men, 215 women) were examined during the period 1995-2001. Individual 24-hour dietary recalls were taken, lifestyle questionnaires were completed, and anthropometric and serum lipid measurements were performed. Fruits and vegetables were consumed by 90% of men (370 +/- 275 g/day) and 94% of women (354 +/- 283 g/day). Among non/ex-smokers who ate fruit and vegetables, 41% consumed > or = 400 g/day, compared to 31% of current smokers (p = 0.05). The risk for high-density lipoprotein cholesterol (HDL-C) < 35 mg/dL, low-density lipoprotein cholesterol (LDL-C) > 130 mg/dL, and total cholesterol/HDL-C ratio (TC:HDL-C) > or = 5 decreased with increasing quartile of fruit and vegetables consumption (trend p < 0.01). Fruit and vegetable intake was favorably related to intake of dietary fiber, calcium, magnesium, potassium, folate, and vitamins C, E, A, B1 and B6, and inversely related to saturated and trans fatty acids and cholesterol. Prospective studies should be performed within the general young adult population to assess the long-term effects of fruit and vegetable consumption on chronic disease risk development.