Matina Kouvari

Red meat consumption and healthy ageing: A review.

According to World Health Organization older individuals is the fastest growing age-group around the globe, thanks to the tremendous improvements in medical and pharmaceutical therapies, as well as in quality of life. Unfortunately, this raise in life span is accompanied by significant increase in disease burden, and consequent economical costs. Lifestyle modifications and effective prevention strategies have shown considerable benefits as regards the development of age-oriented chronic diseases. Among lifestyle factors, nutrition is a key component for achieving good health. Nevertheless, this parameter has insufficiently been investigated in older people. This is a rather important scientific gap, considering the westernization of nutritional habits observed the last few decades, with high red meat consumption and its processed products being an indispensable part. Moreover, its adverse impact in cardiovascular disease and cancer has been extensively investigated, while in recent literature, interest has been remarkably oriented towards its subtypes (i.e., fresh and processed); however, outcomes as regards the older population are controversial with a variety of them proposing moderation of red meat mainly the processed type, whilst others recognizing fresh red meat, especially the lean type, an important source of high quality protein so as to manage muscle tissue loss, a common implication of advanced-age discount. The aim of the present review was to present an overview of studies which have investigated the association between red meat and its subtypes, with chronic diseases, in middle and advanced age individuals.

The Mediterranean and other Dietary Patterns in Secondary Cardiovascular Disease Prevention: A Review

Cardiovascular Disease (CVD) remains the leading cause of death and disability worldwide, with increased hospital discharge rates, causing a serious public health issue and an economic burden. Recent demographic transitions, including ageing of the population, low fertility, urbanization and shift towards unhealthy behaviours have resulted in an increase in the prevalence of cardiometabolic disorders (i.e. hypertension, obesity, diabetes). According to the reports of international organisations, a substantial number of heart attacks could have been prevented through lifestyle modifications (i.e. diet, physical activity, smoking cessation). Regarding secondary prevention, it is well documented that effective cardiovascular rehabilitation requires a multidisciplinary approach, including medical treatment, as well as lifestyle changes. Diet has been recognised as one of the most important modifiable and preventable factors, being undoubtedly beneficial in primary prevention, as well as among cardiac patients. However, studies among CVD patients are scarce, and with inconclusive results. The most studied dietary pattern is the Mediterranean-type diet, with several observational studies and clinical trials demonstrating its protective role against recurrent cardiac events, whereas evidence regarding other well-known models, including Western-type, Vegetarian, Asian-type and Dietary Approaches to Stop Hypertension (DASH) diet, are more limited. The aim of this review was to present an overview of the most prevalent dietary patterns and their role in the secondary CVD prevention and management.

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 (p < 0.05) and a decrease in the health assessment questionnaire for rheumatoid arthritis score (p < 0.05) 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 (p < 0.05). 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.

Diabetes Mellitus, Hypertension and Hypercholesterolemia in Relation to the 10-Year ACS Prognosis; the GREECS Study.

Although hypertension, hypercholesterolemia and diabetes mellitus (DM) are recognized as major cardio-metabolic risk factors in primary Acute Coronary Syndrome (ACS) prevention, studies focusing on secondary ACS incidence are scarce. In the present study, the association between the aforementioned factors and 10-year ACS prognosis was evaluated. From October 2003 to September 2004 2,172 consecutive patients with ACS diagnosis, from 6 Greek hospitals, were enrolled. During 2013-14, the 10-year follow-up was performed in 1,918 participants. Baseline clinical factors were assessed through physical examination, medical records and pharmacological management. All-cause mortality and the development of fatal or non-fatal ACS events were recorded through medical records or hospital registries. Logistic regression models were applied to evaluate the impact of baseline clinical status on the ACS prognosis. The 10-year all cause and ACS mortality rate was 32.6 and 17.8%, respectively. Multi-adjusted analysis highlighted that, after taking into account various potential confounders, DM was the sole clinical factor associated with adverse effect on the 10-year ACS fatal incidence [Odds Ratio (OR)=1.35, 95% Confidence Interval (95% CI) 1.01, 1.80, p=0.04]. DM was the only clinical factor that aggravated ACS prognosis, whereas abnormal lipids profile and blood pressure did not seem to determine prognosis. Thus, glycaemic control may play a critical role in the secondary CVD prevention management of ACS patients.

Exclusive olive oil consumption and 10-year (2004-2014) acute coronary syndrome incidence among cardiac patients: the GREECS observational study.

BACKGROUND The present study evaluated the association between long-term, exclusive olive oil consumption, in cooking preparation or as a dressing, and the 10-year (2004-2014) incidence of acute coronary syndrome (ACS) among cardiac patients. METHODS From October 2003 to September 2004, a sample of 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed in 1918 patients (88% participation rate). The development of fatal or nonfatal ACS was recorded through medical records or hospital registries. Among other dietary components, added fats (i.e. olive oil, butter, margarine and seed oils) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. RESULTS Non-exclusive olive oil consumption on a daily basis was associated with an adverse effect on the ACS incidence after taking into account various potential confounders [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.05-1.86, P = 0.024]. However, significant interactions between olive oil consumption and body mass index (BMI) (P = 0.082) and educational level (P = 0.054) led to further stratified analysis. Using BMI as strata (i.e. ≤29.9 versus >29.9 kg m(-2)), the above association remained significant only in obese patients (OR = 1.80, 95% CI = 1.03-3.12, P = 0.038), whereas, on examining the education status (i.e. ≤9 versus >9 years of school), a significant association was observed only among the higher educated patients (OR = 1.83, 95% CI = 1.01-3.32, P = 0.047). CONCLUSIONS Exclusive use of olive oil, either as a salad dressing or in cooking, should be promoted through the dietary management of ACS patients, with the aim of reducing the likelihood of recurrent cardiac episodes.

The role of coffee consumption on the 10-year (2004–2014) Acute Coronary Syndrome (ACS) incidence among cardiac patients: the GREECS observational study

Abstract The association between long-term coffee consumption and 10-year cardiovascular disease incidence among Acute Coronary Syndrome (ACS) patients was evaluated. From 2003 to 2004, 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013–2014, the 10-year follow-up was performed (88% participation rate) and recurrent fatal or non-fatal ACS was recorded. Baseline coffee consumption (cups/day) was assessed using a semi-quantitative Food Frequency Questionnaire. Multi adjusted analysis revealed that 1–2 cups of coffee/day versus no consumption had an adverse effect on the ACS incidence [odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.01, 1.79]. In subgroup analysis, with hypertension as strata, only the normotensive reached significance. Odds ratios for 1–2 and ≥3 cups relative to no consumption were [OR = 1.66, 95% CI 1.07, 2.60] and [OR = 1.86, 95% CI 1.06, 3.27], respectively, after controlling for potential confounders. Thus, avoidance of coffee may be of high importance to ameliorate disease prognosis among cardiac patients.

Diabetes mellitus associated with processed and unprocessed red meat: an overview

Abstract According to American Diabetes Association “as many as 1 in 3 American adults will have diabetes by 2050” imposing a serious burden on healthcare services and highlighting a substantial need to reduce “new-cases” incidence. Diabetes is inextricably linked to diet, in the prevention-spectrum. Red-meat-intake has been positively associated with reduced glycemic control. However, divergence exists among meat subtypes (i.e. fresh and processed) and the magnitude of their impact on diabetes development. The present overview attempted to summarize the latest data regarding red-meat subtypes on the examined association. Four meta-analysis and 10 prospective studies, focusing on the role of fresh and processed red meat in diabetes prevention, were selected. All of studies highlighted the aggravating role of processed meat-products in diabetes incidence, while fresh meat reached significance in only half of them. Therefore, the contribution of fresh red meat on diabetes remains inconclusive. Valid conclusions seem more robust concerning processed-meat-consumption.

Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths:

The recognition of cardiovascular disease (CVD) as a “male” privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.

Depressive symptomatology in relation to 10-year (2004–2014) acute coronary syndrome incidence; the moderating role of diet and financial status

BACKGROUND The association between depression status and 10-year cardiovascular disease (CVD) incidence among acute coronary syndrome (ACS) patients, in relation to nutritional and financial status, was evaluated. METHODS From October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 Greek hospitals was enrolled. In 2013-14, the 10-year follow-up was performed. Depressive symptoms were evaluated using the validated CES-D score (range 0-60). Adherence to Mediterranean diet was assessed through MedDietScore (range 0-55) and financial status was determined by the annual income. RESULTS Ranking from the 1st to 3rd CES-D tertile, recurrent fatal/non fatal ACS rates were 33%, 37% and 42%, respectively (p=0.006). Multiple logistic regression models revealed an adverse association of severe depression status (i.e. 3rd tertile) compared to no depression (i.e. 1st tertile) [odds ratio (OR)=1.31, 95% confidence interval (95% CI) 1.01, 1.69]. When controlling for financial status, the relationship between depression and ACS prognosis remained marginally significant; while subgroup analysis revealed that only patients with low/moderate income were negatively affected [OR=1.36, 95% CI 0.98, 1.88]. Further stratified analysis, by MedDietScore group, was applied; the above association remained significant only in patients with low compliance to this dietary pattern [OR=1.68, 95% CI 1.10, 2.18]. CONCLUSIONS ACS coexisting with severe depression status seems to result in adverse disease outcomes while financial status and Mediterranean diet are proposed as potential moderators. Public health programs should focus on vulnerable groups and minimize depressive symptoms through appropriate medical treatment and lifestyle interventions, so as to ameliorate the disease prognosis in clinical and community levels.

The Mediterranean and other Dietary Patterns in Secondary Cardiovascular

Cardiovascular Disease (CVD) remains the leading cause of death and disability worldwide, with increased hospital discharge rates, causing a serious public health issue and an economic burden. Recent demographic transitions, including ageing of the population, low fertility, urbanization and shift towards unhealthy behaviours have resulted in an increase in the prevalence of cardiometabolic disorders (i.e. hypertension, obesity, diabetes). According to the reports of international organisations, a substantial number of heart attacks could have been prevented through lifestyle modifications (i.e. diet, physical activity, smoking cessation). Regarding secondary prevention, it is well documented that effective cardiovascular rehabilitation requires a multidisciplinary approach, including medical treatment, as well as lifestyle changes. Diet has been recognised as one of the most important modifiable and preventable factors, being undoubtedly beneficial in primary prevention, as well as among cardiac patients. However, studies among CVD patients are scarce, and with inconclusive results. The most studied dietary pattern is the Mediterranean-type diet, with several observational studies and clinical trials demonstrating its protective role against recurrent cardiac events, whereas evidence regarding other well-known models, including Western-type, Vegetarian, Asian-type and Dietary Approaches to Stop Hypertension (DASH) diet, are more limited. The aim of this review was to present an overview of the most prevalent dietary patterns and their role in the secondary CVD prevention and management.