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Aims. The purpose of this paper is to explore the link between symptoms of depression and the prevalence of cardiovascular risk factors in older adults. Methods. During 2005, 136 older men and 164 women from various parts of Cyprus agreed to participate in the study. The sampling was random and multistage (according to age-sex distribution of the referent population). All participants were living in the community and not in institutions. Among several socio-demographic, bioclinical, lifestyle and dietary characteristics, depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS). Results. Participants without signs of depression, typically, have fewer cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes and obesity) than those with moderate or severe symptoms. Even when behavioural variables (e.g. diet, smoking, exercise) are statistically controlled, participants that are higher than others on depression are more likely to have hypertension and/or hypercholesterolemia than those with lower scores. Every one-unit increase in GDS score (range 0-15) is associated with a 12% higher likelihood of having an additional cardiovascular disease risk factor. Conclusions. Symptoms of depression are positively associated with the number of cardiovascular risk factors in 'healthy' older adults, irrespective of lifestyle behaviours (e.g. smoking, dietary intake and physical activity). Relevance to clinical practice. Healthcare providers should consider the implications of both the presence and nature of this relationship in their continuing care of older adults. [ABSTRACT FROM AUTHOR]

Introduction: The world's population is ageing and it has been suggested that improvements to health, wellbeing and lifespan can be attributed to improved standards of living, especially regarding diet and nutritional status. The impact of nutritional services provided by a dietician on an older population's health status has not been well evaluated or documented. This study sought to determine whether an association exists between available nutritional services and older people's health status in selected Greek islands and the Cyprus Republic., Methods: During 2010, information on nutritional services provided in 9 Greek Islands and the Cyprus Republic was retrieved through interviews of almost all dieticians (n=88) working on these islands. The health status (ie prevalence of hypertension, diabetes, hypercholesterolemia, obesity) of the older population studied (aged >65 years) was retrieved from the Mediterranean Islands Study (MEDIS)., Results: The main reasons for an older person's visit to a dietician was for the treatment of diabetes (79%), hypercholesterolemia (75%) and obesity (70%); 90% of older individuals visited the dietician on a physician's recommendation and 45% of them completed their consultations. The longer the presence of a dietician on an island, the lower the likelihood of observing the prevalence of hypertension (OR=0.59, 95% CI=0.36-0.94), hypercholesterolemia (OR=0.66, 95%CI=0.46-0.95), diabetes (OR=0.77, 95%CI=0.61-0.96) and obesity (OR=0.66, 95%CI=0.45-0.95) above the median rate of the population studied. Financial concerns and a long distance from home to the dieticians' office were the major reasons for ceasing visits to the dietician., Conclusions: Enhancing nutritional services within the healthcare system may contribute to reducing the burden of disease among older adults and, consequently, improve their quality of life.

Aim: The role of animal-protein consumption on the prevalence of diabetes is not yet fully understood. For this reason, this study investigated the relationship between long-term animal-protein intake and diabetes in elderly individuals with no known cardiovascular disease., Methods: During 2005-2007, 1190 men and women, aged 65-100 years, from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos were enrolled into the study. Diabetes was defined as fasting blood glucose ≥ 125 mg/dL or the use of antidiabetic medication. All participants were asked about their dietary habits through a semiquantitative food-frequency questionnaire. Assessment of protein and energy intakes was performed using food-composition tables., Results: After adjusting for age, gender, obesity, history of hypertension, hypercholesterolaemia and dietary habits, a 5% increase in protein intake from meat and meat products was associated with a 34% (OR=1.338, 95% CI: 1.02-1.76) greater likelihood of diabetes, while a 5% increase in total protein intake was associated with a 29% (OR=1.288, 95% CI: 1.00-1.69) greater likelihood of diabetes. No significant associations between diabetes and protein intakes from vegetables and cereals were observed., Conclusion: Animal-protein consumption was associated with a higher prevalence of diabetes among the elderly, whereas protein intakes, especially from plant sources, within the recommended range appear to confer considerable protection. This suggests that reducing or controlling the burden of diabetes through dietary means in the elderly should include monitoring their daily protein intake., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background & Aims: Inflammatory marker levels have long been associated with obesity status in adult populations, but relevant data are scarce in children, especially in diverse races. The aim of this study was thus to examine the association between overall and central obesity and C-reactive protein (CRP) levels in Cypriot children of Greek ancestry., Methods: Eighty three children (9.2 ± 1.7 years) were studied. Body mass index (BMI) was calculated according to the age-sex specific International Obesity Task Force (IOTF) criteria while body fat percentage (BF%) was measured via leg-to-leg bioelectric impedance (BIA). Central obesity was defined as waist circumference ≥ 75 th percentile. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. An inflammatory foods' index, composed of nine foods/food groups, was also calculated. CRP levels were measured using a high-sensitivity (hs) immunoassay., Results: Obese children, children with excess BF% and children with WC ≥ 75 th percentile were 7.35, 6.84 and 7.81 times (P < 0.05) respectively more likely to have hs-CRP levels ≥ 0.10 mg/dL; a high score of the dietary inflammation index was positively associated with CRP levels., Conclusions: Obesity is associated with increased hs-CRP levels in 6-12 year-old children, a finding that supports the inflammation-obesity hypothesis at an early stage of life. Furthermore, frequent consumption of inflammatory foods is positively related to CRP levels., (Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: There is some evidence regarding the association between adherence to the Mediterranean diet (MD) and obesity among adults; to our knowledge, however, no relevant data exist for children. We investigated the association between adherence to the MD and obesity status in children., Methods: A national cross-sectional study among 1140 children (mean age 10.7+/-0.98 y) was carried out in Cyprus using stratified multistage sampling design. Body mass index was calculated according to International Obesity Task Force criteria, from parental reference. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for children and adolescents (KIDMED diet score). To test the research hypothesis, a logistic regression analysis was applied with two dependent variable categories of obesity status, normal weight (NW) versus overweight/obese (OW/OB), and the three categories of the KIDMED score independently, after controlling for several potential confounders., Results: Compared with low MD adherers, children with a high KIDMED score were 80% less likely to be OW/OB (95% confidence interval 0.041-0.976), adjusted for age, gender, parental obesity status, parental educational level, and dietary beliefs and behaviors (model 2). When physical activity was taken into account, however, the aforementioned relation was not significant (model 3; odds ratio 0.20, 95% confidence interval 0.021-1.86). Furthermore, male gender, maternal obesity, and dietary beliefs and behaviors emerged as more significant in predicting obesity in children compared with their KIDMED score., Conclusion: Adherence to the MD is inversely associated with obesity in this sample of 9- to 13-y-old children; however, other behaviors, and in particular physical activity, maternal obesity, dietary beliefs and behaviors, seem to be more significant.

Objective: To develop an index that assesses the degree of adherence to nutritional recommendations for older adults (Elderly Dietary Index [EDI]) and investigate its association with risk factors related to cardiovascular disease (CVD)., Methods: The EDI was constructed using 10 components (ie, questions about the consumption frequency of meat, fish, fruits, vegetables, grains, legumes, olive oil, and alcohol as well as the type of bread and dairy products) according to the Modified MyPyramid for Older Adults and select features of the traditional Mediterranean diet. Scores from 1 to 4 were assigned to all components of the index. The EDI total score had a range between 10 and 40. As a validation procedure, a sample of 668 elderly individuals without known CVD (the MEDIS Study) was used to evaluate the associations between the proposed index and various health outcomes., Results: The overall mean EDI score was 29.2+/-3.5. This score implies that study participants were 73% (ie, 29.2/40) adherent to the nutritional recommendations that the EDI evaluates. Regarding the conventional CVD risk factors, it was found that a 1 unit increase in the EDI score is associated with almost 10% lower odds of being obese or hypertensive or having at least one of the investigated CVD risk factors (P<0.001) after controlling for potential confounders., Conclusions: The suggested EDI may be a useful tool for public health policymakers and other health care professionals to assess diet quality and health status (especially concerning the risk for developing CVD) in older adults.

Background: Dietary and lifestyle behaviors at young ages have been associated with the development of various chronic diseases. Schools are regarded as an excellent setting for lifestyle modification; there is a lack, however, of published dietary data in Cypriot school children. Thus, the objective of this work was to describe lifestyle characteristics of a representative segment of Cypriot school children and provide implications for school health education., Methods: The CYKIDS (Cyprus Kids Study) is a national, cross-sectional study conducted among 1140 school children (10.7 +/- 0.98 years). Sampling was stratified and multistage in 24 primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire and three supplementary questionnaires, assessing dietary patterns and behaviors. Adherence to the Mediterranean diet was evaluated by the KIDMED index (Mediterranean Diet Quality Index for children and adolescents). Physical activity was assessed by a 32-item, semi-quantitative questionnaire., Results: Analysis revealed that 6.7% of the children were classified as high adherers, whereas 37% as low adherers to the Mediterranean diet. About 20% of boys and 25% of girls reported "not having breakfast on most days of the week", while more than 80% of the children reported having meals with the family at least 5 times/week. Some food-related behaviors, such as intake of breakfast, were associated with socio-demographic factors, mostly with gender and the geomorphological characteristics of the living milieu. With respect to physical activity, boys reported higher levels compared to girls, however, one fourth of children did not report any kind of physical activity., Conclusion: A large percentage of Cypriot school children have a diet of low quality and inadequate physical activity. Public health policy makers should urgently focus their attention to primary school children and design school health education programs that target the areas that need attention in order to reduce the future burden of metabolic disorders and chronic diseases.

Obesity status differs by socio-demographic factors, but data for Cyprus are scarce. An in-depth understanding of this relationship may be useful in designing public health programmes. The objective of the present study is to estimate overweight and obesity (OW/OB) prevalence among children and adults in Cyprus and identify related socio-demographic variables. National cross-sectional study of 1140 children (mean age 11 +/- 0.98 years) and their parents (mean age 42.5 +/- 5.8 years, total n = 1954). Obesity was defined according to the World Health Organization classification for adults and according to IOTF (International Obesity Task Force) criteria for children. Overweight and obesity prevalence among girls was 18.3% and 2.9%, respectively, while in boys, 19.0% and 6.0%. Among parents, OW/OB prevalence was, respectively, women, 22.6% and 5.8%; men, 47.1% and 14.1%. Logistic regression analysis in both children and adults revealed that the most important socio-demographic predictors of obesity status are factors of built environment. Higher prevalence of OW/OB was observed in adults living in a house as opposed to an apartment, in older adults, in younger children, and in men, irrespective of age. There is a severe obesity problem in the Cypriot population; almost one in two adults and at least one in four preadolescent children are overweight or obese. Prevalence of OW/OB was related to socio-demographic factors, especially among adults and women.

Background: A sedentary lifestyle among children is becoming increasingly common and has been linked to future risk of degenerative diseases. Urban residence has been suggested to be a contributing factor to a less active lifestyle; however, not all available studies support this link. In the present study we examined the physical activity patterns and sedentary behaviours of children living in urban and rural areas of Cyprus, where major demographic shifts have occurred the last decades., Methods: We studied 1140 children (531 boys; 609 girls), aged 10-12 years, registered in 24 selected elementary public schools from five urban and rural districts of Cyprus. Children completed a semi-quantitative physical activity questionnaire regarding frequency and duration of everyday physical and sedentary activities. Weight and height of the children, as well as demographic and socioeconomic information was collected from children and their guardians., Results: Rural children reported being slightly more active after school and occupied weekly with outdoors chores compared to urban children, who on the other hand reported engaging in sports on a weekly basis more than their rural peers (all p < 0.10). However, the average weekly time spent by urban and rural children on vigorous (8.6 +/- 4.7 and 9.1 +/- 4.8 h/w, respectively; p = 0.193) or moderate-to-vigorous (14.9 +/- 7.6 and 15.2 +/- 7.6 h/w, respectively; p = 0.612) activities, as well as total screen time, were not different. The distribution of children with regards to most other physical activity and inactivity pursuits was similar between urban and rural areas., Conclusion: We found no substantial differences in the physical activity habits and sedentary behaviours among children living in urban and rural areas of Cyprus. Hence public health awareness directed to enhance physical activity and decrease sedentary lifestyle among youngsters should focus equally to urban and rural children.

Our aim is to investigate the association of being physically active on the prevalence of Type 2 diabetes mellitus among elderly people. We enrolled 53 men and 97 women, aged 65 to 100, from various areas of Cyprus. Physical activity was evaluated through a validated questionnaire (the short International Physical Activity Questionnaire, IPAQ). Prevalence of diabetes was 26% in men and 18% in women, while 55% of men and 50% of women were reported as being moderately or vigorously active. Furthermore, 5% of the participants reported that they smoked, 4% had stopped smoking, and 8% reported alcohol consumption. People in the upper tertile of the IPAQ score were 0.26 times less likely to have diabetes (p < 0.05); on the other hand people in the lower tertile of the score were 1.7 times more likely to have diabetes (p < 0.05). Our findings support the notion of a beneficial effect of physical activity on the burden of diabetes in the elderly.

Background: We sought to investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and non-smoking on clinical status of 150 elderly people from Cyprus., Methods: The study comprises individuals enrolled in surveys from Greece and Cyprus. This work includes 53 apparently men and 97 women, aged 65 to 100 years, from various areas of Cyprus. The cohort study was conducted between 2004 and 2005. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed (range 0-55) and then a healthy index was calculated that evaluated four lifestyle habits (range 0-4), i.e. non-smoking, alcohol intake, physical activity and adherence to the Mediterranean diet (i.e. above the median of the score)., Results: 65% participants had hypercholesterolemia (total serum cholesterol > 200 mg/dl or use of lipid lowering agents). Moreover, 32% of the participants reported physically active, 5% reported smoking habits and 4% that they have stopped smoking during the past decade, while 8% reported alcohol drinking. A positive association was observed between prevalence of hypercholesterolemia and smoking habits (odds ratio = 4.3, p = 0.03), while an inverse association was observed between hypercholesterolemia, alcohol drinking (odds ratio = 0.3, p = 0.04) and adherence to a Mediterranean diet (odds ratio = 0.77, p = 0.02), controlled for age, sex, and other factors., Conclusion: Adherence to a Mediterranean diet and healthful lifestyle is associated with reduced odds of having hypercholesterolemia among elderly people.