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Background: The potential association between temporal dimensions of eating and cognition/cognitive declines has been poorly investigated so far., Objectives: The aim of this study was to examine relationships among eating frequency, timing and time window, and cognitive performance and novel Alzheimer disease (AD) biomarkers in cognitively healthy and mildly cognitively impaired middle-aged and older adults., Methods: Cross-sectional data were derived from the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration (ALBION) cohort study, including people aged 40 y or older who have a positive family history of cognitive disorder or cognition-related concerns. Cognitive performance was assessed by a battery of neuropsychological tests. Amyloid β (Αβ42), a biomarker of AD-related pathology, was measured in cerebrospinal fluid. Eating frequency, timing, and the eating time window between the first and the last meal were estimated using time-related information recorded in four 24-h recalls., Results: Study participants had, on average, 5.3 ± 1.2 eating episodes per day, consumed at 8:20 ± 1.3 and 21:14 ± 1.3 h their first and their last eating episode, respectively, while their eating time window was 12.9 ± 1.6 h. Eating frequency, but not eating time window, was positively associated with global cognition, executive and language performance even after controlling for age, sex, education, BMI, and Mediterranean diet. Increasing eating frequency by 1 eating episode per day was associated with 0.169 higher global z-score. Furthermore, compared with ≤4, having 5-6 or >6 eating episodes per day was associated with better global and memory z-scores. Time of last eating episode was also positively associated with language performance. No associations were detected among eating frequency, timing and window, and AD pathology., Conclusions: An eating pattern characterized by less frequent eating and/or by earlier times is present in individuals with worse cognitive performance. Our results shed light on the relevance of temporal eating patterns as potential early markers of behavioral or metabolic changes related to AD pathology., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

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/m 2 ) 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.

Background: The number of older adults is increasing rapidly. Malnutrition is a major problem in this age group, which may adversely affect health and quality of life. Several physiological, socioeconomic, and neuropsychological factors can lead to malnutrition., Objectives: The aim of this study was to evaluate the nutritional status of community-dwelling older adults, and explore the associations of malnutrition risk with physiological, socioeconomic, and neuropsychological characteristics., Methods: This study is part of the Hellenic Longitudinal Investigation of Aging and Diet study, a cross-sectional observational study in Greece, and study participants were 1831 urban-dwelling elderly individuals (mean age: 73.1 ± 5.9 y; 40.8% men). Risk for malnutrition was assessed with the Determine Your Nutritional Health checklist. Data on age, sex, level of education, marital status, depression, cognitive performance, body mass index, total energy intake, and adherence to the Mediterranean diet were recorded. Correlations and multivariate analyses were performed between these variables and risk for malnutrition., Results: The estimated prevalence of moderate and high nutritional risks was 34.8% and 29.4%, respectively. Risk for malnutrition was associated with marital status (unmarried), increased body mass index, male sex, lower level of education, lower cognitive performance, and lower adherence to the Mediterranean diet (P < 0.05)., Conclusions: Nutritional screening should be performed frequently in all community-dwelling older adults. Health experts should perform nutritional screening in all community-dwelling older adults as part of secondary prevention, and nutrition counselling and support should be offered in those at risk for malnutrition., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Nutrition is a modifiable factor affecting the quality of life and independence of older people. The physiological, psychological and social changes during aging affect their dietary choices. Many older adults have inadequate energy and protein intake. Carbohydrate intake and intake of total lipids, in terms of contribution to total energy intake, generally are within the recommended levels, but a decline in overall energy intake as well as the limited variety of micronutrient-dense foods that older people tend to consume result in an inadequate intake of several micronutrients. Adherence to healthy dietary patterns has been described as only moderate among older adults. Health-care practitioners should educate older people and promote healthy diets, in particular adequate energy and protein intake., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: The aim of this work was to explore associations between a priori and a posteriori dietary patterns and obesity indices in a sample of postmenopausal women., Study Design and Methods: The present cross-sectional study involved 481 postmenopausal women, aged 57.7 ± 7.4 years (range 32-77 years), recruited consecutively from the Menopause Clinic of a major public hospital. Basic demographic information, medical history and lifestyle data including physical activity were collected from study participants. Dietary intake was assessed through a validated food frequency questionnaire. A posteriori dietary patterns were identified using Principal Component Analysis. Adherence to an a priori dietary pattern, the Mediterranean dietary pattern, was evaluated through the Mediterranean Dietary Score (MedDietScore)., Main Outcome Measures: BMI, waist circumference, waist-to-height ratio., Results: Overweight and obese women constituted 39.5% and 29.1% of the sample respectively. Multiple linear regression analysis showed that the Dietary Component 2 (characterized by high consumption of unrefined cereals and legumes and low consumption of refined cereals) was negatively associated with BMI (beta = -0.104, p = 0.057), waist circumference (beta = -0.120, p = 0.019) and waist-to-height ratio (beta = -0.105, p = 0.038). Another dietary pattern, characterized by high consumption of red meat and potatoes and low consumption of nuts and coffee/tea, was positively associated with ΒΜΙ (beta = 0.191, p < 0.001), waist circumference (beta = 0.225, p < 0.001) and waist-to-height ratio (beta = -0.237, p < 0.001). The associations were independent of age, years since menopause, energy intake and physical exercise. Negative associations were also found between the MedDietScore and the obesity indices, which became, however, non-significant when implausible energy reports were excluded from the analyses., Conclusions: Our results indicate that different dietary patterns are positively or negatively associated with obesity in postmenopausal women. Early interventions targeting dietary habits are of major importance for promoting health in this age group., (Copyright © 2018 Elsevier B.V. All rights reserved.)

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., (© The Author 2017. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

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., (© 2016 John Wiley & Sons Ltd.)

Background: Cross-sectional evidence indicates that eating frequency correlates with blood pressure, hypertension, and related target organ damage. The aim of the present study was to prospectively assess eating frequency as a predictor of arteriosclerosis progression and new onset hypertension over a follow-up period of 5 years in adults without cardiovascular disease., Methods: Eating frequency among other dietary parameters was evaluated in 115 nondiabetic study participants from a general population sample (54 ± 9.1 years, 45 women) at a baseline visit. Metabolic parameters known to be associated with eating frequency, markers of arteriosclerosis, including augmentation index, pulse wave velocity, SBP, and DBP were evaluated in all volunteers at baseline and after a 5-year follow-up., Results: By applying linear mixed models analysis, it was found that a high eating frequency at baseline significantly correlated with the rate of progression of pulse wave velocity (β = 0.521, P = 0.004), augmentation index (β = 0.503, P = 0.01), SBP (β = 0.694, P < 0.001), and DBP (β = 0.477, P = 0.009) and the incidence of new onset hypertension (odds ratio = 8.89, P < 0.001). After adjustment traditional cardiovascular risk factors, heart rate, homeostasis model assessment index of insulin resistance and total energy intake, the associations with augmentation index, SBP, DBP, and new onset hypertension remained significant., Conclusion: In a population of nondiabetic adults without cardiovascular disease, eating frequency is associated with the rate of progression of wave reflections, blood pressure and of new onset hypertension. Interventional studies should confirm these data and possibly further assess the utility of eating behavior in the prevention of new onset hypertension and related target organ damage.

Objective: To explore factors affecting children's and adolescents' diet quality, in the framework of a food aid and promotion of healthy nutrition programme implemented in areas of low socio-economic status of Greece, during the current financial crisis., Design: From a total of 162 schools participating in the programme during 2012-2013, we gathered 15 897 questionnaires recording sociodemographic characteristics, lifestyle parameters and dietary habits of children and their families. As a measure of socio-economic status, the Family Affluence Scale (FAS) was used; whereas for the assessment of diet quality, the KIDMED score was computed. Associations between KIDMED and FAS, physical activity and socio-economic parameters were examined using regression and classification-regression tree analysis (CART)., Results: The higher the FAS score, the greater the percentage of children and adolescents who reported to consume, on a daily basis, fruits and vegetables, dairy products and breakfast (P<0·001). Results from CART showed that children and adolescents in the medium or high FAS groups had higher KIDMED score, compared with those in the low FAS group. For those in the low FAS group, KIDMED score is expected to increase by 12·4 % when they spend more than 0·25 h/week in sports activities. The respective threshold for the medium and high FAS groups is 1·75 h/week, while education of the mother and father affected KIDMED score significantly as well., Conclusions: Diet quality is strongly influenced by socio-economic parameters in children and adolescents living in economically disadvantaged areas of Greece, so that lower family affluence is associated with worse diet quality.

Mediterranean diet is a term used to describe the traditional eating habits of people in Crete, South Italy and other Mediterranean countries. It is a predominantly plant-based diet, with olive oil being the main type of added fat. There are many observational studies exploring the potential association between adherence to the Mediterranean diet and cognitive decline. The present review focuses on longitudinal studies with repeated cognitive assessments. It also evaluates evidence on behaviors related to the Mediterranean way of living, that have been shown to be associated with cognition, namely social interaction, participation in leisure activities, including physical activities, and sleep quality. The synergistic association-effect of these lifestyle behaviors, including diet, is unknown. Lifestyle patterns may constitute a new research and public health perspective., (Copyright © 2014 Elsevier B.V. All rights reserved.)

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.

Background and Aims: Although significant evidence exists regarding the role of specific foods and dietary patterns on the development of cardiovascular disease, the influence of eating practices has not been thoroughly examined and understood. The aim of the present work was to evaluate the independent role of eating practices on the likelihood of developing an acute coronary syndrome (ACS) or ischemic stroke., Methods and Results: During 2009-2010, 1000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke and 500 were population-based control subjects (250 age-sex matched one-for-one with ACS patients, and 250 age-sex matched one-for-one with stroke patients). Eating practices were evaluated using a special questionnaire. Socio-demographic, clinical, psychological, dietary and other lifestyle characteristics were also measured. After controlling for potential confounding factors, each 20 min prolongation of dinner-to-sleep time was associated with 10% lower likelihood of ischemic stroke (95%CI: 0.83-0.98). Furthermore, eating practices related to stress (i.e., eating while being stressed, eating while working at the same time, skipping a meal due to work obligations) were associated with higher likelihood of having an ACS. Finally, eating while watching television was associated with lower likelihood of having an ACS (OR: 0.46, 95%CI: 0.27-0.78) or stroke event (OR: 0.42, 95%CI: 0.23-0.77)., Conclusion: Results of this work, present novel information, indicating the significance of eating practices, in addition to dietary patterns, regarding the development of coronary heart disease and stroke, and could be used in the primary prevention of CVD., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: To evaluate the effectiveness of two lifestyle, interventional approaches on metabolic abnormalities and eating habits of patients with metabolic syndrome., Materials/methods: This is a randomized controlled trial, involving a 6-month lifestyle intervention. Eighty-eight metabolic syndrome patients were randomized to one of the three groups: (i) "Increase - Decrease" group, (ii) "Increase" group, and (iii) "Minimum intervention" group. All patients received dietary and physical activity advice at baseline; patients in the first two groups also participated in individual counseling sessions. In the "Increase - Decrease" group, all recommended dietary and physical activity goals were targeted, whereas in the "Increase" group, only goals proposing an increase in dietary intake or physical activity were included. Patients received nutrition counseling through seven, one-to-one sessions, conducted every two weeks for the first 2 months, every month for the following 4 months. All participants underwent a full medical and nutritional assessment at baseline and at the end of the intervention., Results: At 6 months, BMI and waist circumference were improved in the "Increase" and the "Increase - Decrease" groups, compared to the "Minimum Intervention" group. Additionally, "Increase - Decrease" group reduced blood systolic (p=0.017), diastolic pressure (p=0.005) and glucose concentrations (p=0.015). Forty eight percent, 32%, and 19% of the patients in the "Increase - Decrease", "Increase" and "Minimum Intervention" groups, respectively, ceased to fulfill the criteria for the metabolic syndrome (p=0.031)., Conclusions: Promoting only the increase of the intake of healthy foods did not result in better outcome values compared to a conventional all-food approach., (Copyright © 2012 Elsevier Inc. All rights reserved.)

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: Patients with the metabolic syndrome (MetS) can suffer from poor metabolic parameters through lack of adherence to requisite lifestyle changes in dietary and physical activity. Usually, interventions in MetS patients are infrequent face-to-face consultations. The low frequency or absence of counseling interviews leads to a shortage of information and motivation to adhere to the recommended lifestyle changes. Telephone interventions could be an additional low-cost tool for effective interventions., Aim: To evaluate the effectiveness of telephone intervention in improving lifestyle habits and metabolic parameters in MetS patients compared with similar face-to-face or a usual care interventions., Methods: Eighty-seven MetS patients recruited from the outpatient clinic of a major public hospital were randomly assigned to one of the three intervention groups: "usual care", "telephone" or "face-to-face". At the beginning of the study, all patients were provided with a hypocaloric Mediterranean-type diet. Afterwards, patients in the telephone group received 7 dietary counseling calls, patients in the face-to-face group participated in 7 one-to-one dietary counseling sessions, while patients in the usual care group received no other contact until the end of the study, 6 months later. All patients underwent full medical and nutritional evaluation at the beginning and at the end of the intervention., Results: At the end of the intervention, 42% of the participants no longer showed symptoms of MetS; the reduction rates differed significantly between the groups (p = 0.024), with those in the face-to-face and telephone group exhibiting similar rates (52% and 54%, respectively, vs. 21% in the usual care group). Between-group analysis revealed that the face-to-face group achieved the greatest improvement in metabolic parameters, while the telephone group had the greatest improvement in dietary adherence compared with the usual care group., Conclusions: Telephone counseling is an effective way to implement behavioral counseling to improve lifestyle habits in MetS patients.

Objective: To evaluate potential associations between diet- and physical activity-related lifestyle patterns and obesity indices in a cohort of children., Study Design: Dietary and physical activity information and anthropometric indices were collected from 1138 children (53% girls; age, 11.2 ± 0.7 years). Dietary intake was evaluated with two 24-hour recalls, which were analyzed for nutrient and food intake, eating frequency, and meal quality. Principal component analysis was used to extract salient lifestyle patterns., Results: Five lifestyle behavioral patterns were identified. The "dinner, cooked meals and vegetables pattern," a multidimensional lifestyle pattern including the consumption of vegetables, cooked meals, and eating dinner, was negatively associated with all obesity indices, even after adjustment for potential confounders and exclusion of low energy reporters. A "high fiber pattern," representing high consumption of whole-grain cereals, legumes, and low intake of sugar-sweetened beverages was negatively correlated with obesity indices; when the analysis included only acceptable energy reporters, these associations became non-significant, except for triceps skinfolds., Conclusions: Our findings are supportive of the synergistic or conditional effects of distinct lifestyle-related behaviors on obesity. Although these results are hypothesis-generating and need replication, they suggest potential preventive approaches, interventional approaches, or both to combat childhood obesity., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Background: Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored., Objective: To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population, Design: Cross-sectional study. Data were collected from May through July 2007., Subjects: The sample consisted of 1,305 children and adolescents (ages 3 to 18 years)., Main Outcome Measures: Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters., Statistical Analysis: Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders., Results: Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized beta=-.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis., Conclusions: Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents., (Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

The effect of anxiety on dietary intake of humans has been investigated through a number of laboratory, clinical and cross-sectional studies; no prior study, however, has examined potential associations between anxiety and overall dietary patterns. Aim of the present work was to describe dietary patterns in relation to anxiety trait in a nationally representative sample of Greek adults from the ATTICA Study. A sample of 453 men and 400 women were randomly selected from various areas of Attica region, Greece. Anxiety levels were assessed through Spielberger State-Trait Anxiety Inventory. Dietary habits, socio-demographic and lifestyle characteristics were recorded for all participants. Principal component analysis was used for the extraction of dietary patterns. More anxious, compared to less anxious, men and women exhibited different dietary patterns. In particular, the "light" dietary patterns that were emerged in the less anxious men and women did not appear as distinct patterns among men and women in the upper anxiety tertile. In women, a "Western-type" diet explained two times greater variance of food intake of those in the upper-anxiety tertile, compared to their counterparts in the low tertile. A vegetarian pattern was found only among the less anxious women, who also exhibited the lowest consumption of red meat and sweets. Regression analysis supported and further elucidated previous results: after adjusting for potential confounders, sweets intake, as well as meat and products intake, were positively associated with anxiety score in females; in males a negative association was found with legumes/cereals intake. From a public health point of view, given the increased prevalence of anxiety and other mental disorders, these findings should be taken into account when designing and evaluating interventions for the general population.

The aim of this work was to explore the associations between family factors, including divorce, and children's 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 children's overweight: compared with children of married parents, those of divorced had significantly higher BMI levels (20.0 +/- 3.6 kg/m(2) vs. 21.3 +/- 3.4 kg/m(2), 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 father's and mother's 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 children's 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.

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.

In light of the potential beneficial effects of adiponectin on insulin resistance, metabolic syndrome, and cardiovascular risk, it is becoming increasingly important to identify all modifiable factors, including dietary patterns, that may affect circulating adiponectin concentrations. The aim of the present study was to explore potential associations between dietary patterns and plasma adiponectin levels using principal component analysis (PCA) in a sample of apparently healthy adult Mediterranean women. Two hundred twenty women were enrolled in this study. Anthropometric and body composition measurements were performed in all subjects. Blood samples were taken, and adiponectin concentrations were measured. Food intake was evaluated by 3-day food diaries, and PCA was used for the identification of the participants' dietary patterns. The PCA identified 10 dietary components explaining 82% of the total variance in food intake. Bivariate correlation between circulating adiponectin levels and dietary components revealed a positive significant association only with the first component that was characterized by high intake of whole-grain cereals and low-fat dairy products as well as low intake of refined cereals (P = .04). This association remained unchanged after controlling for potential confounders (standardized beta coefficient = 0.18, P = .03). A dietary pattern characteristic of consumption of alcoholic beverages was found to be marginally related to adiponectin levels in the multivariate model (standardized beta coefficient = 0.14, P = .10). Our data indicate that a dietary pattern characterized by a high consumption of whole-grain cereals and low-fat dairy products is modestly positively associated with adiponectin concentrations.

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.

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.