Mary Yannakoulia

Methodology of dietary assessment in athletes: concepts and pitfalls.

Purpose of reviewEvaluation of an athletes diet is important in both clinical practice and research. The main purpose of this review is to provide health professionals with guidance regarding the special issues that are likely to be encountered when assessing the dietary intake of sportspersons. Recent findingsA number of methods may be used for the dietary assessment of individuals and/or groups of athletes, including retrospective (diet recall, food-frequency questionnaire, and diet history) and prospective (diet record, duplicate portion) techniques. A 3-4-day estimated diet record is the most widely used approach, but collection of single or multiple diet recalls is also common. Care must be taken, however, to ensure that days of diet monitoring accurately reflect usual food consumption during the period of interest. Under-reporting of habitual energy intake is widespread among athletes, and its magnitude should be carefully addressed when interpreting the results of dietary assessment. Other issues, specifically related to sportspersons, that are often neglected include adequacy of standard portion sizes, frequency of snacking, fluid intake, supplement use, weight-control practices, and seasonality of sport activities and food consumption. SummaryThere are subtle methodological differences in the dietary assessment of athletes and non-athletes, which, when taken into consideration, may substantially increase the quality of intake data and optimise the outcome of dietary intervention.

Management of the Metabolic Syndrome and Type 2 Diabetes Through Lifestyle Modification

Sustainable lifestyle modifications in diet and physical activity are the initial, and often the primary, component in the management of diabetes and the metabolic syndrome. An energy-prudent diet, coupled with moderate levels of physical activity, favorably affects several parameters of the metabolic syndrome and delays the onset of diabetic complications. Weight loss, albeit not an absolute prerequisite for improvement, is a major determinant and maximizes effectiveness. Adopting a healthy lifestyle pattern requires a series of long-term behavioral changes, but evidence to date indicates low long-term adherence to diet and physical activity recommendations. This calls for greater research and public health efforts focusing on strategies to facilitate behavior modification.

Total Zinc Intake May Modify the Glucose-Raising Effect of a Zinc Transporter (SLC30A8) Variant: A 14-Cohort Meta-analysis

OBJECTIVE Many genetic variants have been associated with glucose homeostasis and type 2 diabetes in genome-wide association studies. Zinc is an essential micronutrient that is important for β-cell function and glucose homeostasis. We tested the hypothesis that zinc intake could influence the glucose-raising effect of specific variants. RESEARCH DESIGN AND METHODS We conducted a 14-cohort meta-analysis to assess the interaction of 20 genetic variants known to be related to glycemic traits and zinc metabolism with dietary zinc intake (food sources) and a 5-cohort meta-analysis to assess the interaction with total zinc intake (food sources and supplements) on fasting glucose levels among individuals of European ancestry without diabetes. RESULTS We observed a significant association of total zinc intake with lower fasting glucose levels (β-coefficient ± SE per 1 mg/day of zinc intake: −0.0012 ± 0.0003 mmol/L, summary P value = 0.0003), while the association of dietary zinc intake was not significant. We identified a nominally significant interaction between total zinc intake and the SLC30A8 rs11558471 variant on fasting glucose levels (β-coefficient ± SE per A allele for 1 mg/day of greater total zinc intake: −0.0017 ± 0.0006 mmol/L, summary interaction P value = 0.005); this result suggests a stronger inverse association between total zinc intake and fasting glucose in individuals carrying the glucose-raising A allele compared with individuals who do not carry it. None of the other interaction tests were statistically significant. CONCLUSIONS Our results suggest that higher total zinc intake may attenuate the glucose-raising effect of the rs11558471 SLC30A8 (zinc transporter) variant. Our findings also support evidence for the association of higher total zinc intake with lower fasting glucose levels.

Association of Eating Frequency with Body Fatness in Pre‐ and Postmenopausal Women

Objective: To examine associations between eating frequency (EF) and body fatness in pre‐ and postmenopausal women, after excluding potential low‐energy reporters.

Association Between Family Divorce and Children's BMI and Meal Patterns: The GENDAI Study

The aim of this work was to explore the associations between family factors, including divorce, and childrens overweight as well as eating and physical activity patterns in a population‐based sample of healthy school‐aged children. In this cross‐sectional study, 1,138 children (53% girls; age: 11.2 ± 0.7 years) from elementary schools in the Attica region participated. Their parents provided sociodemographic information, including their marital status. Overweight status classification was based on weight and height measurements and BMI evaluation. Children completed a physical activity checklist and a questionnaire on meal patterns and eating behaviors. The Eating Style score was calculated: the higher the score, the more frequent a child was engaged in less‐structured feeding practices promoting food intake for reasons other than hunger. Analysis revealed significant association between family divorce and childrens overweight: compared with children of married parents, those of divorced had significantly higher BMI levels (20.0 ± 3.6 kg/m2 vs. 21.3 ± 3.4 kg/m2, respectively, P = 0.007). Controlling for socioeconomic and physical activity factors, divorce remains a significant predictor of a higher BMI, along with older age, higher fathers and mothers BMI, less children in the family, and more minutes of daily screen time. Children who had experienced a divorce in their family also reported higher Eating Style score, even after adjusting for potential confounders. In conclusion, in this sample of fifth and sixth graders, unfavorable family circumstances have been associated with childrens overweight, as well as with aspects of their eating behavior, namely eating style in relation to conditions around food consumption and hunger, independent of other socioeconomic factors.

Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery.

The present study was designed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance, dietary, and physical activity habits and eating behavior of patients following vertical banded gastroplasty (VBG). Thirty severely obese female volunteers were included in the study and they were randomly assigned to one of two intervention groups: usual care (UC) or lifestyle intervention (LS) group. Patients were followed for 3 years postoperatively. Outcome measures included weight loss, dietary habits, physical activity level (PAL), and eating behavior changes. Weight was significantly lower in the LS group after 12 months (84.4 ± 3.9 kg vs. 98.4 ± 4.4 kg, P < 0.05), 24 months (83.0 ± 3.3 vs. 101.9 ± 5.3 kg, P < 0.05), and 36 months following surgery (84.2 ± 3.3 vs. 102.5 ± 3.5 kg, P < 0.05). Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing. With regard to eating behavior, the LS group scored significantly better in total Dutch Eating Behavior Questionnaire (DEBQ), Restraint Eating and External Eating scales at all postoperative time points. Similarly, significant differences were found between the two groups in dietary intake. These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery. The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity.

Eating Frequency and Overweight and Obesity in Children and Adolescents: A Meta-analysis

OBJECTIVES: To determine the effect of eating frequency on body weight status in children and adolescents. METHODS: In this meta-analysis, original observational studies published to October 2011 were selected through a literature search in the PubMed database. The reference list of the retrieved articles was also used to identify relevant articles; researchers were contacted when needed. Selected studies were published in English, and they reported on the effect of eating frequency on overweight/obesity in children and adolescents. Pooled effect sizes were calculated using a random effects model. RESULTS: Ten cross-sectional studies and 1 case-control study (21 substudies in total), comprising 18 849 participants (aged 2–19 years), were included in the analysis. Their combined effect revealed that the highest category of eating frequency, as compared with the lowest, was associated with a beneficial effect regarding body weight status in children and adolescents (odds ratio [OR] = 0.78, log OR = –0.24, 95% confidence interval [CI] –0.41 to –0.06). The observed beneficial effect remained significant in boys (OR = 0.76, log OR = –0.27, 95% CI –0.47 to –0.06), but not in girls (OR = 0.96, log OR = –0.04, 95% CI –0.40 to 0.32) (P for sex differences = 0.14). CONCLUSIONS: Higher eating frequency was associated with lower body weight status in children and adolescents, mainly in boys. Clinical trials are warranted to confirm this inverse association, evaluate its clinical applicability, and support a public health recommendation; more studies are also needed to further investigate any sex-related differences, and most importantly, the biological mechanisms.

Caffeinated Coffee Does Not Acutely Affect Energy Intake, Appetite, or Inflammation but Prevents Serum Cortisol Concentrations from Falling in Healthy Men

Our aim in this crossover study was to investigate the acute effects of caffeinated and decaffeinated coffee consumption on appetite feelings, energy intake, and appetite-, inflammation-, stress-, and glucose metabolism-related markers. Sixteen healthy men (age range, 21-39 y; BMI range, 19.7-28.6 kg/m(2)) received in a random order on 3 separate occasions a standard breakfast snack with 200 mL of either caffeinated coffee (3 mg caffeine/kg body weight), decaffeinated coffee, or water (control). Before intervention (-15 min) and at standard time points following breakfast consumption (0, 15, 30, 60, 90, 120, 150, and 180 min), participants recorded their appetite feelings and we collected blood samples for measurements of circulating glucose, insulin, cortisol, and appetite- and inflammation-related markers. At 180 min, participants consumed a meal ad libitum. The appetite-related ratings, the appetite plasma hormonal responses as well as the plasma glucose, serum insulin, and plasma and serum inflammatory marker responses did not show an overall intervention effect or a time x intervention interaction. Ad libitum energy intake did not differ among the 3 interventions. However, a significant intervention effect (P = 0.04) and a time x intervention interaction (P-interaction = 0.02) were found for serum cortisol; cortisol concentrations were significantly higher following the caffeinated coffee intervention, compared to control, at 60 min and thereafter. In conclusion, the usually consumed amount of caffeinated coffee does not have short-term effects on appetite, energy intake, glucose metabolism, and inflammatory markers, but it increases circulating cortisol concentrations in healthy men.

Five-year incidence of obesity and its determinants: the ATTICA Study

OBJECTIVES To evaluate the 5-year incidence of obesity in a sample of CVD-free adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals. METHODS Men (n 1514) and women (n 1528) (>18 years) without any clinical evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multistage and included information about various sociodemographic, lifestyle (diet, exercise and smoking), biochemical and clinical characteristics. In 2006, the 5-year follow-up was performed through telephone calls or personal visits. Data from the 1364 participants are analysed in the present work. RESULTS The 5-year incidence of obesity was 21.8 % in men and 11.9 % in women. The ratio of men to women revealed that more men than women developed obesity, while more women than men became overweight during the follow-up period. It was found that men were 1.6 times more likely to develop obesity compared with women; abnormal waist circumference, smoking habits and the presence of hypercholesterolaemia increased the risk for developing obesity, irrespective of age and baseline lifestyle characteristics of the participants. In the multivariate analysis, no association was detected between adherence to a Mediterranean diet and incidence of obesity in initially normal-weight individuals. CONCLUSIONS Obesity remains a serious health problem for the Greek population; the alarming rates of excess body weight continue to increase. Preventive measures should be urgently addressed, targeting particularly those with metabolic risk factors.

Low Energy Reporting Related to Lifestyle, Clinical, and Psychosocial Factors in a Randomly Selected Population Sample of Greek Adults: The ATTICA Study

Objective: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample. Methods: Following a random multistage sampling, 1514 men (46±13 years old) and 1528 women (45±13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs. Results: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 ± 8.2, 95%CI 30.2–31.04 vs. 26.9 ± 6.3, 95%CI 26.05–27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men. Conclusion: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures.