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Objective: To estimate the prevalence of frailty using five different instruments in a cohort of older adults and explore the association between frailty and various risk factors. Method: 1,867 participants aged 65 years and above were included in the current retrospective cross-sectional study. Frailty was operationalized according to the Fried definition, the FRAIL Scale, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Index (GFI). We explored the role of various frailty risk factors using logistic regression analyses. Results: The prevalence of frailty varied depending on the definition used (Fried definition = 4.1%, FRAIL Scale = 1.5%, FI = 19.7%, TFI = 24.5%, and GFI = 30.2%). The only risk factors consistently associated with frailty irrespectively of definition were education and age. Conclusion: The frailty prevalence reported in our study is similar or lower to that reported in other population studies. Qualitative differences between frailty definitions were observed. [ABSTRACT FROM AUTHOR]

The effect of smoking on energy balance and the underlying mechanisms are not fully understood. The aim of the present study is to examine the acute effect of smoking and its abstinence on energy intake, subjective feelings of appetite and related hormones. Fourteen healthy smokers participated in a randomized, crossover study consisting of two trials: the Cigarette trial (participants smoked two cigarettes of their brand within 15 min) and the Sham trial (they were asked to hold the cigarette as smoking, but without lighting it). After 45 min the participants were offered an ad libitum variety of snacks, and their intake was recorded. Blood samples were taken at fasting, before the ad libitum meal and 1 h after and were analyzed for obestatin, ghrelin, glucagon-like peptide-1, cholecystokinin and insulin levels. Subjective feelings of hunger, satiety and desired to eat, as well as smoking craving were evaluated by visual analog scales. Mean energy intake at the ad libitum meal was 825 ± 310 kcal in the Sham trial and 673 ± 245 kcal in the Cigarette trial (p = 0.010). No significant intervention effects were observed for the reported appetite feelings or the appetite-related hormones levels. In conclusion, smoking was found to have an acute effect on dietary intake; this was not explained by changes in the hormonal levels that were evaluated. More research is needed to confirm these results in more prolonged periods of abstinence and explore other pathways through which smoking and its abstinence affect energy balance. [ABSTRACT FROM AUTHOR]

Sleep duration and quality have been associated with many health outcomes, including weight management. We aimed to investigate the effect of self-reported sleep duration and quality on weight loss maintenance in participants of the MedWeight study, a registry of individuals that lost at least 10% of body weight in the past and either maintained the loss (maintainers: weight maintenance of at least 10% of initial weight loss) or regained it (regainers: weight ≥95% of their maximum body weight). Study participants included 528 volunteers (61% women). Sleep quantity referred to the reported duration of nocturnal sleep, as well as the frequency of mid-day naps during the last month. Sleep quality was assessed through the Athens Insomnia Scale (AIS). Reported sleep quantity was associated with weight maintenance status, but the association became non-significant when the AIS score entered the model. In specific, AIS was inversely associated with the likelihood of being a maintainer (OR=0.89 per AIS unit, 95% CI: 0.81 - 0.98), even after adjusting for potential confounders. Sex-specific analysis revealed that the association between the AIS score and maintenance status was evident in men but not in women. Future studies are needed to confirm these results in other population groups and reveal underlying mechanisms. [ABSTRACT FROM AUTHOR]

Aim of the present study was to evaluate the long-term effects of two obesity treatment modalities: lifestyle intervention coupled with surgery and lifestyle intervention coupled with low-energy diet. Material-Methods: A total of 32 morbidly obese women participated in the study. A group of them (n=15) underwent vertical banded gastroplasty and they were assigned to the lifestyle plus surgery group (LS-surgery). The rest of them (n=17) were assigned to the lifestyle plus low-energy-diet group (LS-diet). Results: The LS-surgery group lost significantly more weight after 12 months than the LS-diet group (46.4±3.0 kg vs. 18.5±3.0 kg, P<0.001) and this difference remained significant till the 36-month follow- up assessment. Conclusions: Even though the combination of intensive lifestyle intervention along with low-energy-diet resulted in weight loss and maintenance, this effect was less pronounced than the one achieved through the combination of lifestyle modification and surgery. [ABSTRACT FROM AUTHOR]

Background: The effect of seasonality in estimating population mean nutrient intake using a single dietary recall has not been fully explored. The present study aimed to evaluate variation in energy and nutrient intake using a single 24-h recall between two seasons (spring/summer and autumn/winter) in a sample of children and adolescents. Methods: A randomly selected subgroup ( n = 623) of a representative sample of 3–18-year-old Greek children and adolescents was used in the present analysis. Information on participants’ socio-demographic characteristics, body weight/height and dietary intake were collected through telephone interviews. Dietary assessment was based on two 24-h recalls (the first during the spring/summer season and the second 6 months later, during autumn/winter season). Results: Reported daily energy intake in spring/summer was 344 ± 130 kJ (82 ± 31 kcal) higher compared to the one in autumn/winter after adjusting for potential confounders ( P = 0.008). However, the contribution of the macronutrients to the total energy intake was not statistically different between the two periods and the same was also true for vitamin C and calcium. The results remained unchanged after excluding low energy reporters. Conclusions: The use of a second 24-h recall in a different season of the year does not confer additional information with regard to a population assessment of macronutrient contribution to the total energy intake in paediatric samples; its use appears to be justified in the light of a more accurate assessment of energy intake. [ABSTRACT FROM AUTHOR]

Marital status has been recognized as a significant health-influencing factor, including cardiovascular disease (CVD) risk. The aim of the present paper was to evaluate whether eating habits mediate the relationship between marital status and levels of CVD risk factors among apparently healthy men and women from the ATTICA Study. During 2001-2002, we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old) from the Attica area, Greece; the sampling was stratified by the age-gender distribution of the region. Participants underwent clinical, anthropometric and psychological assessment. Food consumption was assessed through a semi-quantitative food frequency questionnaire. Participants were classified as never married, married, divorced and widowed. Discriminant analysis revealed that vegetable consumption, followed by red meat, potatoes, poultry, and soft drinks were the factors with the higher discriminating ability among the food groups studied. In particular, dietary patterns of never married participants were characterized by the consumption of potatoes and red meat, those of married participants by nuts, legumes and fish, those of divorced participants by fruits, cereals and soft drinks, whereas those of widowed participants by dairy, vegetables, sweets and poultry. In addition, never married and divorced participants reported eating fast-foods more frequently and drink less alcohol compared to married or widowed participants. After controlling for potential confounders (i.e., age, gender, physical activity, anxiety score and smoking habits), the reported marital status of the participants was associated only with body mass index and total serum cholesterol levels. When the analysis was repeated after taking into account the information on dietary habits by creating four 'new' dietary-adjusted marital status groups, no significant association was revealed between marital status and body mass index and blood cholesterol levels. This finding implies that, in our population, eating patterns may explain the observed differences between marital status and selected CVD risk factors. [ABSTRACT FROM AUTHOR]

Previous research on the effects of running and swimming on areal bone mineral density (aBMD) is inconclusive. This study examined the putative roles of the type and intensity of exercise in this respect, by measuring aBMD (adjusted for age, weight, and height) of the total body and of various subregions in 52 males aged 17-30yr (21 runners, 16 swimmers, 15 controls). The athletes were Competing at either long-distance (‘endurance’, n = 17) or short-distance (‘sprint’, n = 20) events. Compared with controls, runners had significantly higher leg aBMD (+6.7%, p<0.05), while swimmers had significantly lower leg and total body aBMD (-9.8% and -7.0%, respectively, p<0.05). Endurance athletes had significantly lower total body aBMD than controls (-4.9%, p<0.05). Sprint athletes did not differ significantly from controls at any site, but they had significantly higher aBMD than endurance athletes throughout the skeleton (p<0.05). Compared with controls, endurance swimmers had significantly lower aBMD at the legs and total body (-14.8% and -10.4%, respectively, p<0.05), while sprint runners had significantly higher values for the legs, trunk, and total body (+8.0%, + 10.0%, and + 6.3 %, respectively, p < 0.05). Sprint swimmers and endurance runners did not differ from controls at any site or the total body. These results suggest that the type and intensity of exercise have independent and additive effects on bone density. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To investigate nutrition-related habits of Greek school-aged adolescents. DESIGN:: Epidemiological survey. SETTING AND SUBJECTS:: The study was part of the Health Behavior in School Aged Children (HBSC) survey. A representative sample of school-aged adolescents aged 11.5, 13.5, and 15.5?y was obtained. The final sample consisted of 4211 students (51.6% girls and 48.4% boys). They were asked to complete a translated form of the international HBSC questionnaire, including several thematic entities. The Unhealthy Food Choices Score (UFCS) was devised in order to evaluate the overall quality of reported eating habits of respondents; the higher the score, the lower the diet quality. RESULTS:: Among all students surveyed, 14.7% were reported to be on a diet to lose weight (girls: 19.5%; boys: 9.7%; P<0.001), and 22.9% were dissatisfied with their body weight but not on a diet. Girls were found to have lower UFCS values compared to boys (24.7±4.6 vs 24.1±4.5, P<0.001). Girls dissatisfied with their weight, but not on a diet, showed the highest UFCS values compared to both those on a diet and those not on a diet. TV viewing was positively associated with the consumption of sodas, crisps, cakes and pastries, and sweets and chocolates. CONCLUSIONS:: Dieting is becoming a major problem, especially among older girls. The findings of this study suggest that eating habits of Greek school-aged adolescents are in the process of changing from more traditional to more Westernized ones.European Journal of Clinical Nutrition (2004) 58, 580-586. doi:10.1038/sj.ejcn.1601849 [ABSTRACT FROM AUTHOR]

The aim of the present study, which was part of the Health Behavior in School Aged Children (HBSC) study, was to provide national estimates for overweight and obesity in Greek school-aged children and adolescents. A nationwide multistage procedure was followed to obtain a representative sample of children and adolescents aged 11.5, 13.5 and 15.5 y. The resultant sample consisted of 4299 students, 51.3% girls and 48.7% boys. Self-reported weight and height data were used. According to the body mass index cutoff points adopted by the International Obesity Task Force (IOTF), 9.1% of girls and 21.7% of boys were classified as overweight, and 1.2% of girls and 2.5% of boys as obese. Corresponding values using CDC growth charts were 8.1% of girls and 18.8% of boys for overweight, and 1.7% of girls and 5.8% of boys for obese. Compared to most other western countries, the prevalence of obesity is lower in Greek children aged 11-16 y. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the current prospective study was to examine the relationship between adherence to the Mediterranean diet and incident frailty.Study Design: 1075 Greek community-dwelling older adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present longitudinal analysis.Main Outcome Measures: Adherence to the Mediterranean diet was evaluated through the MedDietScore, calculated from the information participants provided on a validated food frequency questionnaire. Frailty was assessed using two multidomain tools: the Frailty Index (FI) and the Tilburg Frailty Indicator (TFI). Analysis of the incidence of frailty as a function of the baseline MedDietScore was performed using Cox proportional hazards models. Additionally, Generalized Estimating Equations (GEE) models were used to explore whether the baseline MedDietScore was associated with the change in the total number of frailty criteria met by participants over time. In testing for a dose-response association between Mediterranean diet and frailty, the MedDietScore was treated either as a continuous variable or as tertiles of low, medium and high adherence to MeDi.Results: 176 and 131 participants developed incident frailty, as measured with the FI and TFI respectively. Each unit of MedDietScore was associated with a 5% (ΗR 0.95, 95% CI 0.91-0.99, p = 0.012) and 10% (ΗR 0.90, 95% CI 0.86-0.95, p ≤ 0.001) decrease in the risk of incident frailty when measured with the FI and TFI respectively. Compared with participants reporting low adherence to the Mediterranean diet (lowest tertile), those with high adherence (highest tertile) had a 41% (ΗR 0.59, 95% CI 0.38-0.91, p = 0.017) and a 57% (ΗR 0.43, 95% CI 0.27-0.70, p ≤ 0.001) lower risk of incident frailty as measured with the FI and TFI respectively. After excluding from the analyses participants diagnosed with dementia at baseline or follow-up, the same results were obtained: each unit of MedDietScore was associated with a 5% (HR 0.95 CI 0.91-0.99, p = 0.023) and a 10% (HR 0.90 CI 0.86-0.94, p ≤ 0.001) decrease in the risk of incident frailty as measured with the FI and TFI respectively.Conclusions: The present longitudinal study showed that non-frail community-dwelling older adults with high adherence to the Mediterranean dietary pattern had a significantly lower incidence of frailty. [ABSTRACT FROM AUTHOR]

Fermented dairy products have recently gained popularity due to their purported health benefits, nevertheless, their role in ageing remains uncertain. This narrative review aims to evaluate evidence from observational (prospective) and interventional studies on the potential benefits of fermented dairy product consumption for musculoskeletal and mental health in older adults. Additionally, it seeks to determine whether any observed benefits surpass those of non-fermented dairy products and to identify directions for future research. Prospective studies support either favourable or neutral associations of fermented dairy products with outcomes of musculoskeletal health or neutral associations with mental health outcomes, whilst it remains unclear if the benefits observed with fermented dairy products go beyond those of the non-fermented dairy foods. Few interventional studies suggest overall favourable effects of yogurt and cheese on musculoskeletal health in older adults but given their small number (N = 6) and heterogeneity, they do not allow a clear assessment or definitive recommendations for fermented dairy intake. Interventional studies reporting mental health outcomes are largely lacking for this age group (N = 1). Given the very limited evidence for the effectiveness of fermented dairy products, future well-designed prospective and randomized controlled trials are needed to better understand their benefits (especially compared to those of non-fermented dairy foods), their characteristics and the quantities required to offer protection against musculoskeletal and/or mental health ageing. [ABSTRACT FROM AUTHOR]

Potential links between oxidative stress and the pathophysiology of Alzheimer's disease (AD) have been reported in the existing literature. Biological markers of oxidative stress, such as the reduced form of glutathione (GSH), may have a potential role as predictive biomarkers for AD development. The aim of the present study was to explore the longitudinal associations between plasma GSH and the risk of developing AD or cognitive decline, in a sample of community-dwelling, non-demented older adults. Participants from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present prospective study. The sample used in the analyses consisted of 391 non-demented individuals over the age of 64 (mean age = 73.85 years; SD = 5.06), with available baseline GSH measurements and longitudinal follow-up. Plasma GSH was treated both as a continuous variable and as tertiles in our analyses. Cox proportional hazards models were used to evaluate the hazard ratio (HR) for AD incidence as a function of baseline plasma GSH. Generalized estimating equations (GEE) models were deployed to explore the associations between baseline plasma GSH and the rate of change of performance scores on individual cognitive domains over time. Models were adjusted for age, years of education and sex. Supplementary exploratory models were also adjusted for mild cognitive impairment (MCI) at baseline, risk for malnutrition, physical activity and adherence to the Mediterranean dietary pattern. A total of 24 incident AD cases occurred during a mean (SD) of 2.99 (0.92) years of follow-up. Individuals in the highest GSH tertile group (highest baseline plasma GSH values) had a 70.1% lower risk for development of AD, compared to those in the lowest one [HR = 0.299 (0.093–0.959); p = 0.042], and also demonstrated a slower rate of decline of their executive functioning over time (5.2% of a standard deviation less decline in the executive composite score for each additional year of follow-up; p = 0.028). The test for trend was also significant suggesting a potential dose-response relationship. In the present study, higher baseline plasma GSH levels were associated with a decreased risk of developing AD and with a better preservation of executive functioning longitudinally. Image 1 • High glutathione was associated with a lower risk of developing Alzheimer's disease. • High glutathione was associated with slower deterioration of executive functioning. • Glutathione as a potential biomarker for Alzheimer's disease. • Glutathione may confer a protective effect against Alzheimer's disease. [ABSTRACT FROM AUTHOR]

To investigate whether aquatic athletes follow optimal dietary intake, 58 athletes, all members of the Greek national swimming and water polo teams, were tested. Dietary intake was assessed at the nutrient, food, and food group level using the 24-h recall method and a food frequency questionnaire. Mean energy intake for males and females was 14.3 and 8.5 MJ, respectively. Mean carbohydrate consumption for male and female athletes was 4.5 g/kg and 3.8 g/kg of body weight, respectively. Fat intake was 153 g for males and 79 g for females. A significant number of the athletes (71% of the males, 93% of the females) did not meet the Dietary Reference Intakes for at least one of the antioxidant vitamins. The data suggest that athletes of both genders consumed too much fat and too little carbohydrate. Insufficient fruit and vegetable intake was related to low intake of antioxidants. [ABSTRACT FROM AUTHOR]

Background: Eating frequency (EF) has been associated with generalized obesity. Aim: We aimed to prospectively investigate potential associations of frequency of eating episodes with regional fat layers. Design: EF was evaluated at baseline in 115 subjects free of clinically overt cardiovascular disease (54 ± 9.1 years, 70 women) in a prospective, observational study. Methods: Metabolic parameters known to be associated with dietary factors and anthropometric markers including ultrasound assessment of subcutaneous (Smin) and pre-peritoneal (Pmax) fat and their ratio Smin/Pmax (AFI) were evaluated at baseline and at follow-up, 5 years later. Results: EF at baseline positively correlated with Pmax, even after adjustment for potential confounders. EF above median was also an independent predictor for Pmax (beta coefficient=-0.192, P = 0.037) and AFI (beta coefficient = 0.199, P = 0.049) at follow up. Multivariable linear mixed models analysis demonstrated that subjects with increased EF presented a lower progression rate of Pmax (beta=-0.452, P = 0.006) and a higher progression rate of AFI (beta = 0.563, P = 0.003) over time, independently of age, sex, progression of BMI, energy intake, smoking and changes in parameters of glucose metabolism. Conclusions: High EF is associated with lower progression rate of pre-peritoneal fat accumulation. Future interventional studies should further investigate the clinical utility of these findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adiponectin, an adipose-derived hormone with central and peripheral actions, is involved in the regulation of energy homeostasis. Interactions between genetic and environmental factors have been associated with decrease in circulating adiponectin leading to obesity. AIM: We investigated whether variants of the ADIPOQ gene encoding adiponectin interact with diet to predict serum adiponectin concentration. METHODS: A cross-sectional study of healthy school-aged children of Greek origin (n = 991), aged 11.2 +/- 0.6 years was conducted in 2005-2006. DNA was genotyped for two SNPs [rs1501299 (n = 741) and rs17300539 (n = 713)] located in the ADIPOQ gene. Detailed dietary, behavioural, lifestyle, anthropometric and biochemical data were recorded for all participants. RESULTS: Both SNPs were in HWE. The rs1501299 (GG vs GT + TT) x fibre interaction was significantly associated with adiponectin concentration (P = 0.028). When fibre intake was low, GG homozygotes exhibited significantly higher adiponectin concentrations compared to T allele carriers (mean +/- SD = 5.1 +/- 2.7 vs 4.2 +/- 2.3; P = 0.020). CONCLUSIONS: In the present study, the rs1501299 x fibre interaction was significantly associated with adiponectin levels; in specific, GG homozygotes exhibited higher adiponectin levels compared to T carriers under conditions of lower fibre intake. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To examine whether skeletal adaptations to chronic non-weight-bearing exercise depend on the type of aquatic exercise (swimming or water polo) as well as on sex (men or women). DESIGN, SETTING, AND PARTICIPANTS:: This was a cross-sectional study at the Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. A total of 43 water polo players, 26 swimmers, and 30 sedentary individuals, aged 17 to 34 years, were recruited (52 men, 47 women). MAIN OUTCOME MEASURES:: Bone mineral content (BMC) and areal bone mineral density (aBMD) of the total body and of various subregions. RESULTS:: Compared with controls, swimmers had lower leg and total aBMD (P < 0.05), whereas water polo players had lower leg but higher arm and trunk aBMD (all P < 0.05). Swimmers and water polo athletes differed at the arms (men only), trunk, and total body (all higher in water polo players, at P < 0.05). Bone adaptations to water polo playing were unaffected by sex. Female swimmers, but not male swimmers, had 13% higher arm BMC than controls (P < 0.05), whereas male swimmers, but not female swimmers, had 12% lower leg BMC than controls (P < 0.05). CONCLUSIONS:: Athletes participating in long-term water polo playing and swimming have substantially different total and regional aBMD. The effect is not mediated by sex in water polo players; however, sex may mediate the differences between swimmers and controls. Whether the observed differences between athlete groups and sexes arise from different bone adaptations to activity or from other factors cannot be answered by the current data. CLINICAL RELEVANCE:: Water polo playing may be preferable over swimming for maintaining bone health; both types of aquatic exercise at the elite level of participation, however, have unfavorable effects on the lower limb bones. [ABSTRACT FROM AUTHOR]

Background: This study examined the differences between maintainers and regainers regarding obesity related eating behaviors. A secondary objective was to develop an eating behavior index predicting the likelihood of successful weight loss maintenance.Methods: The current cross-sectional evaluation conducted in Cyprus was part of the MedWeight (Greek) study. Eligible for participation were Cypriot (maintainers = 145; regainers = 87) adult men and women who reported being at least overweight (BMI ≥25 kg/m2) and experienced an intentional weight loss of ≥10% of their maximum lifetime weight, at least 1 year before participation. Among other assessments, weight-related behaviors were evaluated through Weight-Related Behaviors Index (WRBI).Results: Statistically significant differences between the two groups were observed regarding meals per day (P = 0.008), frequency of eating home cooked meals (P = 0.004) and WRBI total score (P = 0.022). Results from logistic regression models indicated that the odds of maintaining weight loss increase at 30% (Model 1: P < 0.05, Odds ratio 1.306, 1.095-1.556 95% C.I., Model 2: P < 0.05, OR 1.308, 1.097-1.560 95% C.I.) and at 38% after adjusting for physical activity (Model 3: P < 0.05, OR 1.377, 1.114-1.701 95% C.I..) for each point scored in WRBI total score.Conclusions: Eating more frequently home cooked meals and less eating away from home meals may be beneficially associated with weight loss maintenance. WRBI seems to be a useful tool when dealing with patients who have previously lost significant weight. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to evaluate the association between dietary vitamin D intake and 10‐year first fatal/nonfatal cardiovascular disease (CVD), conventional CVD risk factors and surrogate markers related to inflammation, coagulation, insulin resistance, liver and renal function. Methods: The ATTICA study was conducted during 2001–2012 including 1514 men and 1528 women (aged >18 years) from the greater Athens area, Greece. Dietary assessment was based on a validated semi‐quantitative food frequency questionnaire. Daily intake of vitamin D was calculated using a standardised food database. Follow‐up (2011–2012) was achieved in 2020 participants (n = 317 cases). Results: Ranking from first to third vitamin D tertile, CVD events were 24%, 17% and 12% for men (P = 0.002) and 14%, 10% and 11% for women (P = 0.59). Inverse associations between vitamin D and CVD in total sample [hazard ratio (HR) = 0.76 95% confidence interval (CI) = 0.60–0.97] and in men (HR = 0.66 95% CI = 0.49–0.89) were observed, and lost after adjusting for inflammation/coagulation markers; for women, no significant trends were observed. Regarding 10‐year onset of conventional risk factors, inverse associations of vitamin D with hypertension in men (HR = 0.62 95% CI = 0.39–0.99) and transition to metabolically unhealthy status in women (HR = 0.69 95% CI = 0.51–0.93) were observed. Significant inverse associations for C‐reactive protein, interleukin‐6 and fibrinogen in both sexes, whereas these were revealed only in women for insulin resistance. Conclusions: Contradicting the neutral/modest associations in vitamin‐D supplementation trials, increased food‐generated vitamin D may protect against hard and intermediate CVD endpoints, implying different paths between sexes. [ABSTRACT FROM AUTHOR]

Objective: Aging and menopause are associated with an adverse cardiometabolic profile, predisposing to cardiovascular disease. Diet may also affect their cardiometabolic risk. The aim of this study is to assess dietary habits and patterns of postmenopausal women and their association with adiposity measures, cardiometabolic parameters and subclinical atherosclerosis.Study Protocol: The study will include two parts. The first part consists of cross-sectional evaluation of 750 postmenopausal women recruited consecutively from the Menopause Unit of an academic hospital. Dietary intake will be assessed by a food frequency questionnaire. Nutrient and food group intake will be calculated and adherence to the Mediterranean diet and other dietary patterns will be evaluated. A-priori and a-posteriori defined dietary patterns will be tested for associations with major and minor outcome measures. The second part consists of a prospective follow-up of all women recruited at baseline and re-assessment of the same variables after 3 years. Adherence to predefined or a-posteriori defined dietary patterns over these 3 years will be evaluated in association with changes in obesity indices and lipid levels, as well as in the progression of subclinical atherosclerosis.Major Outcome Measures: Body mass index, lipid profile, carotid and femoral artery intima-media thickness and plaques.Minor Outcome Measures: Waist circumference, waist-to-hip ratio, abdominal fat layers, incident hypertension and diabetes, homeostasis model assessment of insulin resistance (HOMA-IR), c-reactive protein and markers of subclinical arterial disease, including flow-mediated dilation, pulse wave velocity, augmentation index and ankle-brachial index.Results: The study is expected to complete baseline enrolment by the end of 2018 and follow-up assessment by the end of 2021. The results of the study will address the question of whether dietary patterns and eating habits are associated with cardiometabolic risk as well as with accelerated subclinical arterial disease and arterial aging in postmenopausal women. [ABSTRACT FROM AUTHOR]

Background Sleep is crucial for cognition, particularly for memory, given its complex association with neurodegenerative processes. The aim of the present study was to examine the association between sleep quality as well as sleep duration and memory performance in a Greek elderly population. Setting Cross-sectional design in the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population representative study of Greek elderly (65 years or older). Methods Data from 1589 participants free of sleep medication were included. Sleep quality was estimated by using the Sleep Scale from the Medical Outcomes Study. An extensive neuropsychological assessment examining memory was administered to each participant. Linear regression analyses were used to examine whether sleep quality (higher score, poor quality) and/or sleep duration were associated with memory expressed in the form of a z-score. Age, sex, education, and body mass index were included as covariates. The main analyses were conducted first on the total sample, then with the exclusion of demented participants, and finally with the exclusion of both demented and participants with Mild Cognitive Impairment (MCI). We then conducted further analyses on the non-demented, non-MCI group, initially stratified by Apolipoprotein E -ε4 gene. We further examined the role of co-morbidities, as well as the association between sleep duration groups and memory. We also explored any interaction effect between sex and sleep quality/duration on memory. We then examined the associations between components of sleep measures and memory scores. Lastly, we examined the associations between sleep quality/duration and verbal/non-verbal memory separately. Results In the total sample, we noted significant associations between sleep duration and memory (B = −0.001, p ≤ 0.0001), but not for sleep quality and memory (B = −0.038, p = 0.121). After excluding the demented participants, the associations were significant for: sleep quality and memory (B = −0.054, p = 0.023), and sleep duration and memory (B = −0.001, p ≤ 0.0001). After excluding both the MCI and the demented subjects, the associations between sleep quality and memory (B = −0.065, p = 0.006), and sleep duration and memory (B = −0.001, p = 0.003) were still significant. The association between the sleep duration groups and memory function was also significant, such that poor memory performance was associated with the longer sleep duration group. The results remained significant even after controlling for the co-morbidities, as well as after adding in the model anxiety and depression as covariates. Associations between sleep quality and memory, and sleep duration and memory were present in the ApoE -ε4 non-carriers. The individual sleep questions that were probably shown to be driving the associations between sleep and memory were: time to fall asleep, sleep not quiet, getting enough sleep to feel rested upon waking in the morning, and getting the amount of sleep needed. Sleep duration was associated with both verbal and non-verbal memory, while sleep quality was only associated with verbal memory. Conclusion Poor sleep quality and longer sleep duration were linked to low memory performance, independent of demographic and clinical factors, in a large sample of cognitively healthy older Greek adults. Other parameters than sleep and memory measurements could play an important role on the association. Levels of melatonin, or circadian rhythms dysregulation might play a crucial role in the above associations. [ABSTRACT FROM AUTHOR]

Aim The aim of this work was to explore parents' and children's attitudes towards healthy eating and the free provision of a daily school meal in underprivileged areas of Greece. Methods Twenty focus groups were conducted in 14 schools. Eligible participants were children/adolescents and their parents, who were recipients of a food aid, healthy nutrition school-based programme. Their perceptions towards healthy eating and related barriers, experience of a school feeding programme, other nutrition intervention initiatives were qualitatively evaluated. Results Most of the parents referred to the Mediterranean diet as a healthy dietary pattern. Nearly all parents were aware of their effect as role models and commented on the benefits of eating together as a family, as well as on the importance of improving their own dietary habits. Parents reported using various methods to promote a healthy diet, as part of their parenting role. They perceived their role as difficult, as they have to deal with children's resistance, financial constraints arising from the current economic crisis in Greece and busy work schedules. All students perceived the school feeding programme as health-promoting, reflecting their parents' perceptions. Conclusion The present findings indicate that although the traditional Mediterranean diet was perceived by the majority of the adults as a health and traditional dietary pattern, parents reported several barriers related to its adoption. In particular, the most common barriers included financial difficulties, limited time for food preparation and children's resistance to consume healthy foods. [ABSTRACT FROM AUTHOR]

Purpose: Platelet-activating factor (PAF), a potent inflammatory mediator, is implicated in atherosclerosis. Its key biosynthetic enzymes are lyso-PAF acetyltransferases (lyso-PAF-AT), responsible for PAF synthesis through the remodeling route and a specific CDP-choline:1-alkyl-2-acetyl-sn-glycerol cholinephosphotransferase (PAF-CPT), responsible for its de novo biosynthesis. PAF acetylhydrolase (PAF-AH) and its extracellular isoform lipoprotein-associated phospholipase A catabolize PAF. The impact of diet on PAF metabolism is ill-defined. The aim was to investigate associations between PAF, its enzymes and dietary factors. Methods: One-hundred and six ( n = 106) healthy volunteers were recruited. Food-frequency questionnaires, dietary recalls, lifestyle and biochemical variables were collected. Food groups, macronutrient intake, a priori (MedDietScore) and a posteriori defined food patterns with PCA analysis, dietary antioxidant capacity (DAC), glycemic index (GI) and glycemic load were assessed. Results: PAF was inversely correlated with antioxidant-rich foods (herbal drinks and coffee), the DAC as well as a dietary pattern characterized by legumes, vegetables, poultry and fish (all Ps < 0.05). PAF was positively correlated to % fat intake. Lyso-PAF-AT was also negatively associated with healthy patterns (fruits, nuts and herbal drinks, and a pattern rich in olive oil and whole-wheat products), as well as the DAC and % monounsaturated fatty acids. PAF-CPT was negatively associated with GI and coffee intake and positively with dietary cholesterol. PAF-AH was negatively associated with coffee and positively associated with alcohol consumption (all Ps < 0.05). Conclusions: In conclusion, the DAC and healthy dietary patterns were inversely associated with PAF or its biosynthetic enzymes, suggesting potential new mechanisms of the diet-disease associations. [ABSTRACT FROM AUTHOR]

What is already known about this subject In the US, the National Weight Control Registry revealed lifestyle behaviours shared by weight loss maintainers. In the US and the UK, qualitative studies compared the experiences of weight loss maintainers and regainers., High rates of physical activity, a low-energy/low-fat diet, weight self-monitoring, breakfast consumption and flexible control of eating are well-established maintenance behaviours., What this study adds The Mediterranean lifestyle has not been studied relative to weight loss maintenance. This study focused on a sample of Greek maintainers and regainers., Maintainers emphasized home-cooked meals; their diet does not appear to be low-fat, as home-cooked Greek meals are rich in olive oil., Having a small dinner is a common strategy among maintainers. Health motives were not mentioned by maintainers. Maintainers, but not regainers, appeared to compensate for emotional eating., Weight loss maintenance is imperative to successful obesity treatment. We qualitatively explored lifestyle behaviours associated with weight regulation, in a sample of Greek volunteers who had lost weight and either maintained or regained it. A 10% intentional loss maintained for at least one year was considered successful maintenance. Volunteers ( n = 44, 41% men) formed eight focus groups, four of maintainers and four of regainers. Questions regarded weight loss, weight maintenance or regaining, and beliefs on weight maintenance and regaining. All discussions were tape recorded. Maintainers lost weight on their own, whereas regainers sought professional help. Maintainers exercised during both the loss and maintenance phases, whereas regainers showed inconsistent physical activity levels. Health motives for weight loss were mentioned only by regainers. Emotional eating was a common barrier, but only maintainers compensated for it. Maintainers continuously applied specific strategies to maintain their weight: emphasizing home-cooked meals, high eating frequency, a small dinner, portion size regulation, and sweets' intake regulation. Regainers considered the behaviours leading to weight loss different from their normal lifestyle, and resumed their old habits when the diet was over. However, both groups believed that for long-term success, lifestyle changes need to be permanent. [ABSTRACT FROM AUTHOR]

Abstract: Banana is a widely consumed fruit, which contains considerable amounts of potential prebiotic indigestible carbohydrates. In our randomised, controlled trial we aimed to evaluate the in vivo prebiotic effect of banana consumption on faecal microbiota. Thirty-four healthy women participated in the study, having Body Mass Index (BMI) 24–30 kg/m2, age 19–45 years, without history of gastrointestinal disease and no antibiotic and other medication use two months prior the initiation and during the study. All women were asked to maintain their usual dietary habits for 60 days and they were randomly assigned to consume twice a day a pre-meal snack, either one medium banana, or one cup of banana-flavoured drink or one cup of water (control group). Stool samples were collected at baseline, on days 30 and 60 of intervention for enumeration of total anaerobes, bifidobacteria and lactobacilli by plate count techniques, as well as for pH and short chain fatty acids (SCFAs) measurement. Gastrointestinal symptoms were also recorded. Mean bifidobacterial levels were increased only in the banana group both at 30 and 60 days of intervention, but this change did not reach a statistical significance. No significant overall differences in the total concentrations and molar ratios of SCFAs were detected according to dietary intervention. Analysis of the gastrointestinal symptoms records revealed significantly lower bloating levels in the banana group, compared to controls, at 26–35 days (p = 0.009) and 51–60 days (p = 0.010). Banana consumption had also no adverse effects on evacuation patterns. We concluded that daily consumption of bananas is a well-tolerated eating behaviour, which may induce bifidogenesis in healthy women experiencing body weight problems. [Copyright &y& Elsevier]

Objective: To investigate the long-term effects of the daily consumption of isoenergetic quantities of fresh banana, banana juice or water, as snacks, on energy intake and body weight in healthy women. Material-methods: Thirty-three pre-menopausal women aged 19-50 years old, having Body Mass Index between 24-30 kg/m², were randomly assigned to one of three intervention groups: "Banana", "Juice" and "Water". Volunteers were asked to consume on a daily basis for two months, 30 min before lunch and dinner, 120 g of fresh banana or 170 mL of banana juice or 170mL of water, respectively. Body weight and dietary intake were evaluated at baseline and at the end of the study. At the end of the study, self-reported changes in their appetite-related feelings, compared to the pre-intervention state, were also recorded. Results: Body weight ("Banana Group": 74,7±11,4 and 75,2±11,4 kg, "Juice Group": 68,9±7,7 and 69,5±7,4 kg, "Water Group" 73,8±6,9 and 74,3±7,4 kg, at pre- and post-intervention respectively, P=0,979) or energy intake values were not significantly different at the end of the intervention, compared to the pre-intervention levels, in any of the three groups; furthermore, no significant intervention effect was found for these outcomes. Participants in the "Banana Group" reported greater reduction in the feeling of hunger (P=0,052) and a greater increase in the feeling of fullness (P=0,028), compared to those in the "Juice Group". Conclusions: Daily consumption of banana and banana juice does not lead to an increase in body weight, finding suggesting that ad¬equate energy compensation takes place. [ABSTRACT FROM AUTHOR]

Background/Objectives:Height is a classic polygenic trait, with a number of genes underlying its variation. We evaluated the prospect of gene-to-diet interactions in a children's cohort, for the insulin-like growth factor II (IGF) rs680 polymorphism and height variation.Subjects/Methods:We screened 795 periadolescent children (424 girls) aged 10–11 years old from the Gene and Diet Attica Investigation (GENDAI) pediatric cohort for the IGF rs680 polymorphism (rs680).Results:Children homozygous for the common allele (GG) were taller (148.9±7.9 cm) compared with those with the A allele (148.1±7.9 cm), after adjusting for age, sex and dairy intake (β±s.e.: 2.1±0.95, P=0.026). A trend for rs680 × dairy intake interaction was also revealed (P=0.09). Stratification by IGF rs680 genotype revealed positive significant (P=0.014) association between dairy product intake and height in A-allele children adjusted for the same confounders. A daily increase of four dairy servings was associated with a 0.4 cm increase in height. On grouping dairy intake into low (1.9±0.7 servings per day) and high dairy product consumption (4.4±1.5 servings per day), children with the A allele who were high dairy product consumers were taller compared with the low dairy product consumers (148.8±7.9 vs 147.4±7.7 cm, respectively, P=0.05).Conclusions:A higher consumption of dairy products is associated with increased height depending on the rs680 IGF2 genotype. [ABSTRACT FROM AUTHOR]