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Objective: To investigate the association of Mediterranean food group consumption with successful aging (SA), among people more than 50 years old. Method: Dietary habits, as well as several bio-clinical characteristics of the Greek participants enrolled in the ATTICA ( n = 1,128 men and women from Athens metropolitan area) and the MEDIS ( n = 2,221 men and women from selected Greek islands) cohort studies were investigated in relation to SA; SA was measured using a validated 10-scale index. Results: Multivariate discriminant food group analysis revealed that legumes consumption, followed by vegetables, cereals, and poultry were associated with higher levels of SA index (explained variability: 7.9%), mainly among islanders, but not among mainland participants. Further analysis revealed that alcohol consumption was positively associated with SA for mainlanders (ATTICA study) but inversely for islanders (MEDIS study; all p 's < .05). Conclusion: The differential and hierarchical effect of various foods on SA and the diet-environmental interaction revealed in the present work may help health professionals to better understand the role of diet on SA, and to prioritize the nutritional needs of older people for better quality of life.

Objective: To analyse the food content in animated comic series addressed to young audiences both in terms of the kinds of foods presented and the cues accompanying them., Design: One hundred episodes of ten animated cartoon series with high television audience viewing (based on Average Minute Rating %) were reviewed and food items were classified into ten categories. In each episode, food cues (i.e. every mention of food, visual, oral or referring to foods consumed) was noted down and characterized as positive, negative or neutral. The rate of overall consumption and the food categories shown to be consumed were also recorded., Setting: Greece., Results: In ninety-four episodes one or more food cues were recorded; the total number of cues was 361, of which 209 referred to cues where food was shown or discussed and 152 referred to food items consumed. Out of the positive cues measured, almost half referred to sweets and snacks (sixty-one out of 125). Nevertheless, the majority of cues were of neutral character (n 213). Snacks, sweets and soft drinks were seen to be consumed in more episodes compared with other food categories. Moreover, in episodes where a higher frequency of food consumption was recorded, then consumption of sweets, snacks and soft drinks was significantly higher, with consumption of soft drinks often occurring in conjunction with that of snacks., Conclusions: Food cues are present in children's series, with an emphasis on sweets and snacks, which are projected in an attractive way, whether depicted, discussed or consumed, between cartoon characters.

The quality of carbohydrates in the diet, including whole grains, matters greatly to health. There is emerging evidence supporting various protective effects from whole grain consumption against certain chronic diseases. However, being free of disease is not a requirement for healthy ageing, as many older adults have one or more health conditions but, when well controlled, have little influence on their wellbeing. The present study aimed to evaluate the association between whole grain consumption on successful aging, through an analysis of a sample of n = 3349, over-50-years-old men and women participating in the ATTICA and MEDIS population-based cross-sectional studies. Successful aging was evaluated using the validated successful aging index (SAI, range 0-10) comprising of health-related social, lifestyle and clinical components. High whole grain intake was positively associated with SAI as compared with low (b ± SE: 0.278 ± 0.091, p = 0.002), whereas no significant associations were observed between moderate whole grain consumption and SAI ( p > 0.05). Increased whole grain intake has been associated with several health benefits, and, as is shown here, with higher successful aging levels. Therefore, consumption of whole grains should be encouraged, especially by replacing refined grains, without increasing total energy intake.

Purpose: Previous studies have reported associations between levels of protein and carbohydrate intake with several health outcomes. Yet, their effect on successful (or healthy) aging remains unknown. The purpose of the present work was to investigate the association of protein and carbohydrate intake levels with successful aging., Methods: A cross-sectional analysis was carried out on the participants of two epidemiological studies; the ATTICA and the MEDIS studies. Anthropometrical, clinical and socio-demographic characteristics, dietary habits, and lifestyle parameters were derived through standard procedures. Successful aging was evaluated using a validated index (SAI) composed of 10 health-related social, lifestyle and clinical characteristics., Results: SAI levels were lower in low protein-high carbohydrate diet group (B = - 0.08, p = 0.04), but higher in high protein-high carbohydrate group (B = 0.06, p = 0.04), as compared to low protein and low carbohydrate diet, in participants living in insular areas. Protein-carbohydrate diet was not associated with SAI (all p's > 0.05) among participants living in urban areas (p for diet-study interaction < 0.001)., Conclusions: A high protein diet seems to be beneficial for older islanders in terms of successful aging; stating a hypothesis for a potential diet-environmental interaction that may be related to the quality of foods consumed and, consequently the sources of nutrients.

Background: The role of diet and inflammation in successful ageing is not transparent, and as such, is still being investigated. The aim of the present work was to evaluate the inflammatory potential of dietary habits in the successful ageing of a random sample of older adults living in the Mediterranean basin and who participated in the MEDIS (MEDiterranean ISlands) study., Methods: During 2005-2016, 3,128 older adults (aged 65-100 years) from 24 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were enrolled in the study. A multidimensional successful ageing index consisting of 10 components was employed. A validated and reproducible Food Frequency Questionnaire (FFQ) was used to evaluate the dietary habits of the older adults. A nutrition anti-inflammatory (NAI) score based on the participants' specific dietary habits was assessed., Results: Participants with high NAI scores (proinflammatory nutrition) had a higher prevalence of hypercholesterolemia and lower levels of successful ageing. After adjusting for several confounders, the NAI score was associated with successful ageing (-0.03, 95% CI -0.5 to -0.006). Stratified analysis by gender and advanced age revealed heterogeneity in the NAI score, predicting successful ageing., Conclusions: The inflammatory potential of nutrition was reported as an important factor for successful ageing, suggesting that further research is needed on the role of anti- and proinflammatory dietary habits in healthy and successful ageing., (© 2017 S. Karger AG, Basel.)

Background: The determinants that promote successful ageing still remain unknown. The aim of the present work was to evaluate the role of skeletal muscle mass and body fat percentage (BF%), in the level of successful ageing., Methods: during 2005-2011, 2663 older (aged 65-100 years) from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Appendicular skeletal muscle mass (ASM), skeletal muscle mass index (SMI) and BF% were calculated using population formulas. Dietary habits, energy intake, expenditure and energy balance were derived throughout standard procedures. A successful ageing index ranging from 0 to 10 was used., Results: The mean ASM mass was 24±6.0kg, the SMI was 0.84±0.21 and the BF% was 44%. Females had lower SMI and higher BF% in comparison with males, respectively [(SMI: 0.66±0.09 vs. 1.03±0.11; BF%: 51% vs. 34%, (p<0.001)]. High successful agers had better rates in ASM (p=0.01), SMI (p<0.001) and BF% (p<0.001), compared with the medium and low successful ones. Changes in SMI [b-coefficient (95% CI):2.14 (1.57 to 2.71)] were positively associated with successful ageing, while changes in BF% [b-coefficient (95% CI): -0.04 (-0.05 to -0.03)] were inversely associated with successful ageing. Results from sensitivity analysis showed that the effects of variations on body composition were consistent, less pronounced in the positive energy balance group and more pronounced among the oldest old., Conclusions: Body composition changes seem to be associated with lower quality of life in the older adults, as measured through successful ageing., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin., Method: During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used., Results: After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = -0.21[-0.37, -0.05], as well as positive energy balance, b-coefficient [95% CI] = -0.21 [-0.37, -0.05], were inversely associated with successful aging., Conclusion: A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measured through successful aging., (© The Author(s) 2015.)

The definition and determinants of successful aging is still controversial. Although dietary habits have long been associated with aging, eating habits and behaviors have rarely been included in various proposed indices of successful aging. The aim of this work was to evaluate determinants of successful aging together with assessment of dietary habits in relation to healthcare facility use among elders living in the Mediterranean basin. During 2005-2011, 2663 elderly (aged 65-100 years) individuals from 21 Mediterranean islands and rural Mani region (Peloponnesus) were voluntarily enrolled in the study. A successful aging index ranging from a score of 0 to a score of 10 was constructed using 10 attributes, i.e., education, financial status, physical activity, body mass index, depression, participation in social activities with friends and family, number of yearly excursions, number of cardiovascular disease risk factors and adherence to the Mediterranean diet. The applied factor analysis on the components of the index extracted three main components for successful aging: psychosocial-economic, bioclinical and lifestyle; confirming the multiple dimensions of aging. After adjusting for confounders, a 1/10-unit increase in the successful aging index was associated with 0.8 less annual visits to healthcare centers (95% CI -1.3 to-0.2). Stratified analysis by gender revealed heterogeneity of factors predicting successful aging. These findings suggest that successful aging is a multidimensional and complex concept that exhibits gender heterogeneity. Annual use of health care services by the elders was found to be related to level of successful aging., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In the 1960s, the recorded dietary pattern of Southern European populations was typical of the traditional Mediterranean diet. However, diets have been rapidly changing. The aim of the current work was to examine the extent by which present food habits of inhabitants residing in various Mediterranean islands uphold past dietary traditions of the Mediterranean diet. A population-based, multi-stage sampling method was used to voluntarily enroll 876 men and 936 women (aged > 65 years) from 12 Mediterranean islands. Demographic, behavioral, clinical, and dietary data were collected. Principal component analysis derived fruits, vegetables, and greens as part of the main dietary pattern across most Mediterranean regions. Surprisingly, Crete had the highest frequency of fast-food and sweets consumption. Malta had the lowest frequency of fish and vegetable consumption and the lowest MedDietScore. As Mediterranean populations gradually move away from traditional dietary patterns, public-health efforts to preserve these diets are needed.

Objective: To quantify food consumption (based on food group classification) during several time periods in a sample of adolescents and to identify potential differences in food patterns between normal-weight and overweight participants., Design: Cross-sectional study. Participants were classified as normal weight and overweight/obese. Dietary intake was assessed by 3-day food records and analyzed at the food group level for 7 different time periods. To exploit the time dimension of the data and to further control for the influence of other covariates, the authors estimated a random effects regression model for panel data., Participants: One hundred twenty students., Setting: Two high schools., Results: In multivariate analysis, no statistically significant differences were found between normal-weight and overweight adolescents with regard to their consumption patterns throughout the day. However, compared to females, male participants had higher intake of all food groups with the exception of fruit, and adolescents engaging in vigorous exercise tended to consume more servings from all food groups during any given time period., Conclusions and Implications: No preferential use of some food or food groups in specific day periods was found among overweight compared to normal-weight high school students., (Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: To date, no published dietary indices have evaluated the overall effects of various dietary components, beliefs, and practices on the development of obesity in children., Objective: To develop a dietary index that contains dietary characteristics and practices implicated in the development of obesity., Methods: The proposed index (i.e., the E-KINDEX [Electronic Kids Dietary Index]) incorporates 3 subindices: (1) a food groups intake index (13 items), (2) an index related to eating beliefs and behaviors (8 items), and (3) an index that evaluates dietary practices (9 items). The theoretical overall score ranges from 1 (worst) to 87 (best). For validation of the E-KINDEX, multiple linear and logistic regression analyses were applied that had as dependent outcomes various body composition indices of 622 children (9-13 years) from the CYKIDS (Cyprus Kids) study. In all models, adjustments were made for age, gender, physical activity level, TV viewing time, socioeconomic status, breastfeeding, and parental obesity status., Results: The highest E-KINDEX category (>60 points) was associated with 85% less likelihood of a child being obese or overweight (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05-0.41) and 86% less likelihood of having a waist circumference ≥75th percentile (OR, 0.14; 95% CI, 0.05-0.43). The correct classification rate of E-KINDEX (C-statistic) against excess body fat percentage was 84% (CI, 0.74-0.94). Moreover, for a single SD increase in the index score (i.e., 7.81 units), a decrease of 2.31 ± 0.23 kg/m(2) in body mass index (BMI), of 2.23 ± 0.35 in percent of body fat (BF%), and of 2.16 ± 0.61 cm in waist circumference was observed. Similar results were found during 1-year follow-up of study participants. In particular, baseline E-KINDEX levels were inversely associated with children's BMI at 1-year follow-up (p = 0.024). Latent class analysis showed that the index has good discriminative value for only 68% of the total sample., Conclusion: The proposed E-KINDEX could be helpful in dietary assessment and in further research in the field of childhood obesity.

Background: The Mediterranean diet (MD) prototype is widely used as an educational tool in public health programmes; few studies, however, have been conducted on the adherence of children to this diet., Objective: To evaluate the quality of Cypriot children's diet by assessing the degree of adherence to the MD., Methods: A national cross-sectional study among 1140 children (mean age = 10.7 (SD 0.98) years), using stratified multistage sampling design, was conducted in primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative FFQ and the two supplementary questionnaires (a Food Groups Frequency Questionnaire and a Short Eating Habits Questionnaire). Adherence to the MD was assessed by the KIDMED index. The association between the frequencies of consumption of various food groups and the level of adherence to the MD (poor v. average v. good KIDMED score) was also evaluated. Multiple logistic regression analyses were used to adjust for potential confounders., Results: Only 6.7% of the sample was classified as high adherers of MD, whereas 37% had a poor KIDMED score. Multiple logistic regression analysis has shown that children with at least an average KIDMED score were more likely to eat frequently seafood and fish, legumes, nuts, bread, fruits, leafy vegetables, olives, low glycaemic index foods and unrefined foods. Effect size of associations was from medium to high., Conclusion: Higher adherence to MD is associated with better diet quality in children. The MD prototype may thus represent a useful educational tool for promotion of healthy eating habits in children.

Dietary modification is, in general, the preferred method when attempting reductions in blood pressure (BP) among adults. In children, however, few studies, have examined the relationship between dietary patterns and levels of BP, and the reported results are conflicting. The objective of this study was to investigate the association between levels of Foods E-KINDEX score and levels of BP in children. Measurements included BP, height, weight, and waist circumference. Diet quality was assessed by the Foods E-KINDEX diet score. The index includes 13 components that assess consumption frequency of 11 major food groups or foods, as well as two cooking techniques (fried and grilled foods). Its score ranges between 0 and 37. A subsample of 622 Cypriot children (mean age=11.7+/-0.83 years) from the CYKIDS national cross-sectional study was used. Logistic regression analysis was performed in order to examine the relationship of systolic BP, diastolic BP, and BP with diet quality (as assessed by the Foods E-KINDEX score). The median systolic BP and diastolic BP were 110 mm Hg (interquartile range [IQR]=100 to 120 mm Hg) and 68 mm Hg (IQR=60 to 70 mm Hg) for boys and 110 mm Hg (IQR=100 to 120 mm Hg) and 63 mm Hg (IQR=60 to 70 mm Hg) for girls, respectively. Mean Foods E-KINDEX score was 23.4+/-4.9 in boys and 24.3+/-4.8 in girls (P=0.487). Compared with children with a low diet score, those with at least an average Foods E-KINDEX score were 57% (odds ratio=0.43; 95% confidence interval: 0.19 to 0.98) less likely to have elevated systolic BP levels, regardless of various potential confounders. The Foods E-KINDEX score is independently associated with lower BP among healthy children. This finding might have implications in public health and should be further explored.

Background: The proportion of elderly is increasing worldwide. This trend is paralleled by an increase in chronic diseases, such as cardiovascular disease. A limited number of studies have investigated the effect of diet on cardiometabolic risk factors (such as hypertension, hypercholesterolemia, diabetes, obesity) in older populations, despite the fact that diet plays a significant role in elderly health. In this review, a summary of studies that have evaluated the effect of dietary habits on cardiovascular disease risk in elderly populations is presented., Methods: A search was made in available databases (PubMed and Scopus) looking for results from observational studies and clinical trials that assessed dietary habits on cardiovascular disease risk in elderly populations (>65 years old). Studies during the last decade were retrieved and summarized., Results: All eight of the reviewed observational studies and all three reviewed clinical trials performed in elderly populations reported an inverse association between healthy dietary patterns with cardiovascular disease risk and its predisposing markers., Conclusion: Dietary intervention strategies should be implemented in older adults, in order to prevent cardiovascular disease morbidity and mortality, and improve quality of life.

We investigated the association between parental dietary beliefs and behaviours (DBB) and those of their children behaviours. Data were derived from a national cross-sectional study using multistage sampling design, among 1140 children (9-13 years). Principal component analysis was employed to extract the main factors out of eight variables assessing children's dietary beliefs and behaviours (N=991); those eight factors were then regressed, on 16 dependent variables, describing different parental dietary beliefs and behaviours, adjusted for potential confounders. Three factors emerged as important in explaining the variance in children's dietary beliefs and behaviours: "guilty about eating" (factor 1), "concerned about own body weight" (factor 2) and "eating all my food" (factor 3). Children with types 1-3 behaviour: were 30% more likely to have parents who did not control what and how much their child ate, have parents who are 40% more likely to think that their child is overweight/obese and seem to have more availability of high fat foods, respectively. Breastfeeding was associated with the acquisition of positive dietary beliefs and behaviours by children, independently of child's age, gender, place of residence, socio-economic status, diet quality, and child's and parents' obesity status. We propose that parents are likely to exert their influence in shaping eating habits and subsequently obesity development in their children, by influencing their children's dietary beliefs and behaviours.

Background: Food choice in Greece follows a westernized model. We tried to identify the characteristics of clusters regarding food choice and behaviour in a large sample of Greek primary school students, in order to acknowledge some mediating parameters that need to be addressed when planning interventions to promote healthy nutrition., Methods: Cross-sectional study in 2439 fifth and sixth grade students from the Attica and Thessaloniki regions. Three self-administered questionnaires were distributed assessing food consumption, nutrition knowledge and factors associated with dietary change. Data were analysed using principal components analysis (PCA) and K-means cluster analysis., Results: A total of 28.4% (n = 592) of the students were identified as demonstrating 'unbalanced nutrition' whereas 44.8% (n = 1018) and 22.8% (n = 319) demonstrated 'balanced' and 'low food intake', respectively. With regards to nutrition knowledge, the clusters were as follows: medium (n = 319, 14.5%), good (n = 1788, 80.9%) and bad knowledge (n = 101, 4.57%) cluster. After analysing the results of PCA, three clusters were formed: A 'negative effect' (n = 561, 28.8%), a 'health oriented' (n = 777, 39.9%) and a 'reinforced' to eat fruits and vegetables (n = 506, 31.3%) group., Conclusions: The present study managed to identify clusters that correspond to food intake, nutrition knowledge and other factors associated with dietary behaviour and to describe their characteristics.

The scope of this study was to address the historical features underpinning the Greek variant of the Mediterranean diet and to examine whether relevant differences exist among dietary patterns followed in Greece prior to World War II and those recorded in the 1960s within the Seven Countries Study framework. For this purpose, archival data on family budgets were used to extract information on food availability and composition of the diets followed by two rural Greek populations prior to World War II. Results indicate that diets followed by rural Greeks in the nineteenth century and early twentieth century were characterized by a low availability of fat sources, olive oil included. Lipids represented 22-27% of the total available energy, saturated fatty acids accounted for less than 10% of the total energy, while monounsaturated fatty acids contributed 8-9% of the energy. Our results suggest that although the dietary patterns of the nineteenth century and early twentieth century are in line with the Cretan diet of the 1960s with regards to saturated fat intake, important differences can be traced with regards to total and monounsaturated fat intake. These findings suggest that the model of the Mediterranean diet represents a dietary pattern that has not persisted over a long time period in the region.

The aim of the study was to evaluate the effectiveness of an intervention program that combined nutrition education and prevention of disordered eating in a group of female professional dance students. Thirty-two dancers, aged 19-25 years, took part in the program. Evaluation was done by a series of questionnaires that participants were asked to complete on 3 occasions. Assessments of body composition and dietary intake were also performed. Significant improvements in nutrition knowledge as well as a decrease in abnormal eating behavior and dietary restraint were observed at post intervention. At 6-month follow-up, the positive effects were maintained and further benefits were recorded; only nutrition knowledge showed a minor decline. Participants who were at higher risk for adopting abnormal eating behavior benefited the most from the program. These findings encourage the implementation of intervention programs in groups of young women that experience particular pressures for controlling body weight.