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BackgroundIt has been claimed that COVID-19 vaccination is associated with excess mortality during the COVID-19 pandemic, a claim that contributes to vaccine hesitancy. We examined whether all-cause mortality has actually increased in Cyprus during the first two pandemic years, and whether any increases are associated with vaccination rates.MethodsWe calculated weekly excess mortality for Cyprus between January 2020 and June 2022, overall and by age group, using both a Distributed Lag Nonlinear Model (DLNM) adjusted for mean daily temperature, and the EuroMOMO algorithm. Excess deaths were regressed on the weekly number of confirmed COVID-19 deaths and on weekly first-dose vaccinations, also using a DLNM to explore the lag-response dimension.Results552 excess deaths were observed in Cyprus during the study period (95%CI: 508–597) as opposed to 1306 confirmed COVID-19 deaths. No association between excess deaths and vaccination rates was found overall and for any age group except 18-49 years, among whom 1.09 excess deaths (95%CI: 0.27–1.91) per 10,000 vaccinations were estimated during the first 8 weeks post-vaccination. However, detailed cause-of-death examination identified just two such deaths potentially linked to vaccination, therefore this association is spurious and attributable to random error.ConclusionsExcess mortality was moderately increased in Cyprus during the COVID-19 pandemic, primarily as a result of laboratory-confirmed COVID-19 deaths. No relationship was found between vaccination rates and all-cause mortality, demonstrating the excellent safety profile of COVID-19 vaccines.

Introduction Radiation protection knowledge is essential for medical personnel in ensuring that the possible risks do not outweigh the benefits of diagnostic imaging. This study aimed to assess the radiation protection knowledge of radiographers in Cyprus. Methods A cross-sectional study was carried out among radiographers in Cyprus through the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. The study was a quantitative descriptive analysis, using a questionnaire with 22 multiple-choice questions. Analysis of the data was done using the statistical software Stata, by performing mean knowledge score comparisons by different participants’ characteristics, using t-test and analysis of variance test. Statistical significance was assumed as a p-value Results The answers provided for each question indicate that some areas of radiation protection are less known compared to others, as there is quite a wide range of correct-to-incorrect ratios. The analysis based on participant characteristics in relation to overall radiation effects knowledge, identified important determinants, namely the workplace of the participant (p = 0.006), the type of work licence the participant held at the time of the questionnaire (p = 0.024), and the years of clinical experience of the participant (p = 0.021). Conclusion The study showed that the levels of knowledge in radiation protection are of a very good standard. However, work is needed to clarify the specifics of dose limits and the national radiation protection legislation with regards to informing patients about the possible effects of ionising radiation. Implications for practice The study results indicate the importance of educating radiographers about the requirements of national radiation protection legislation and how this new knowledge can be linked with practise.

Retrieving high-quality endogenous ancient DNA (aDNA) poses several challenges, including low molecular copy number, high rates of fragmentation, damage at read termini, and potential presence of exogenous contaminant DNA. All these factors complicate a reliable reconstruction of consensus aDNA sequences in reads from high-throughput sequencing platforms. Here, we report findings from a thorough evaluation of two alternative tools (ANGSD and schmutzi) aimed at overcoming these issues and constructing high-quality ancient mitogenomes. Raw genomic data (BAM/FASTQ) from a total of 17 previously published whole ancient human genomes ranging from the 14th to the 7th millennium BCE were retrieved and mitochondrial consensus sequences were reconstructed using different quality filters, with their accuracy measured and compared. Moreover, the influence of different sequence parameters (number of reads, sequenced bases, mean coverage, and rate of deamination and contamination) as predictors of derived sequence quality was evaluated. Complete mitogenomes were successfully reconstructed for all ancient samples, and for the majority of them, filtering substantially improved mtDNA consensus calling and haplogroup prediction. Overall, the schmutzi pipeline, which estimates and takes into consideration exogenous contamination, appeared to have the edge over the much faster and user-friendly alternative method (ANGSD) in moderate to high coverage samples (>1,000,000 reads). ANGSD, however, through its read termini trimming filter, showed better capabilities in calling the consensus sequence from low-quality samples. Among all the predictors of overall sample quality examined, the strongest correlation was found for the available number of sequence reads and bases. In the process, we report a previously unassigned haplogroup (U3b) for an Early Chalcolithic individual from Southern Anatolia/Northern Levant.

The COVID-19 lockdown has had a significant impact on people’s lives worldwide. This study aimed to investigate the effect of personality on chrononutrition during the COVID-19 lockdown. Using a cross-sectional design, a convenient sample of 543 adults in Qatar completed an online questionnaire using validated tools to assess personality and chrononutrition behaviors during the first COVID-19 lockdown. Participants scoring high in openness were more likely to eat at night (mean difference (MD) = 0.41, 95% confidence interval (CI): 0.10, 0.72) compared to those scoring high in agreeableness, while those scoring high in extraversion and openness had a shorter eating window (MD = −76.6, 95%CI: −146.3, −6.93 and MD = −29.8, 95%CI: −56.5, −3.01, respectively). Participants high in extraversion had longer evening latency (MD = 66.3, 95%CI: 25.4, 107.3) and evening eating (MD = −62.0, 95%CI: −114.0, −9.0) compared those high in agreeableness. Participants high in conscientiousness showed evidence of first eating event misalignment during the weekend (MD = 22.0, 95%CI: 0.15, 43.9) and last eating event misalignment during weekdays (MD = −27.8, 95%CI: −47.3, −8.41) compared to those high in agreeableness. Lastly, participants high in openness showed evidence of eating window misalignment during the weekend (MD = 30.6, 95%CI: 5.01, 56.2). This study suggests that personality traits can inform personalized nutritional approaches when aiming for healthy habits during unexpected periods, such as the COVID-19 pandemic.

This work was supported by the University of Nicosia Medical School (internal funding)., Achilleos S, Quattrocchi A, Gabel J, Heraclides A, Kolokotroni O, Constantinou C, Pagola Ugarte M, Nicolaou N, Rodriguez-Llanes JM, Bennett CM, Bogatyreva E, Schernhammer E, Zimmermann C, Costa AJL, Lobato JCP, Fernandes NM, Semedo-Aguiar AP, Jaramillo Ramirez GI, Martin Garzon OD, Mortensen LH, Critchley JA, Goldsmith LP, Denissov G, Rüütel K, Le Meur N, Kandelaki L, Tsiklauri S, O'Donnell J, Oza A, Kaufman Z, Zucker I, Ambrosio G, Stracci F, Hagen TP, Erzen I, Klepac P, Arcos González P, Fernández Camporro Á, Burström B, Pidmurniak N, Verstiuk O, Huang Q, Mehta NK, Polemitis A, Charalambous A, Demetriou CA.

PBL tutors in medical schools worldwide are a diverse population of faculty (subject-expertise, employment status and tutoring experience). Tutors often receive a common initial training program followed by structured support. This study aims to understand tutor motivation, challenges and support needed, the relationship between them and whether a common training and support program is understood as effective. Tutor data (n =50) were analyzed based on age, gender, background, experience, employment status and campus location. Interestingly, the study revealed some evidence that a challenge for tutors is what disrupts their motivation and thus a relevant support mechanism is needed in order to re-establish or maintain this motivation. Specifically, the motivator “interaction with students” correlated with challenges “management of group dynamics”, “student adherence with PBL rules” and “professional behavior of students” whilst motivator “educational value of PBL” correlated with “student adherence with PBL rules”, “professional behavior of students” and “student information and expectations of PBL”. Further, tutors benefited from peer-reviews and opportunities to provide feedback whilst, their needs diverged in terms of content and assessment-related support, motivation and management of group dynamics. Thus, implementation of a framework for restructuring the tutor support system is necessary paving the way for an individualized support system.

The coronavirus pandemic (COVID-19) resulted in lockdowns and social distancing measures enforced by governments. Using a cross-sectional design, this study aimed to identify changes in adherence to the Mediterranean diet (MD) and physical activity (PA) and associations with personality, during lockdown in Qatar. A sample of 543 participants was recruited online between April and May 2020. Results showed a reduction in Mediterranean diet (MD) adherence during lockdown (5.9 ± 0.08) compared to before lockdown (6.1 ± 0.08) (p ˂ 0.001). Although there was an increase in the percentage of participants who consumed ≥4 tablespoons olive oil per day (9% vs 12%; p ˂ 0.001), vegetables (54.3% vs 58.7%; p = 0.005), legumes (11.8% vs 15.3%; p = 0.007) and sofrito (70.9% vs 77.3%; p ˂ 0.001), there was also a significant decrease in the percentage of participants who consumed fresh fruit (39.4% vs 15.8%; p ˂ 0.001) and fish/seafood (5.9% vs 3.9%; p = 0.035) and an increase in saturated fat consumption (45.9% vs 53.8%; p ˂ 0.001), during lockdown compared to before lockdown. Participants who scored high in the extraversion personality dimension had a higher MD adherence (B = 0.84; 95% CI = 0.04, 1.64; p = 0.039) before lockdown compared to participants who scored high in the agreeableness personality dimension, although this difference did not reach statistical significance during lockdown. Those who scored high in openness had the lowest change in MD adherence score (B = -0.31; 95% CI = -0.58, -0.04; p = 0.026). Total PA (B = -506.26; 95% CI = -678.60, -333.92; p ˂ 0.001), vigorous activity (B = -155.95; 95% CI = -274.64, - 38.21; p = 0.010), moderate activity (B = -93.04; 95% CI = -148.07, -38.01; p = 0.010) and walking (B = -257.27; 95% CI = -337.87, -176.67; p ˂ 0.001) were decreased during lockdown, while sitting was increased compared to before lockdown (B = 940.91, 95% CI = 831.9, 1049.90; p ˂ 0.001). Openness was positively associated with all PA (B = 562.2; 95% CI = 62.7, 106.7; p = 0.027), including walking (B = 241.7; 95 % CI = 29.4, 454.0; p = 0.026) and negatively associated with sitting (B= -303.4; 95% CI = -590.0; -16.8; p = 0.038) when compared to those with high agreeableness scores, before lockdown. During lockdown, the time spent sitting was lower in those with high scores on neuroticism when compared to those with high agreeableness scores (B= -619.5; 95 % CI = -1215,-23.9; p = 0.042). Differential changes in lifestyle habits by personality dimensions during lockdown, suggest the need to tailor lifestyle interventions based on people’s personality types, for more effective lifestyle change.

University students represent a highly active group in terms of their social activity in the community and in the propagation of information on social media. We aimed to map the knowledge, attitudes, and perceptions of University students in Cyprus about severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19) to guide targeted future measures and information campaigns. We used a cross-sectional online survey targeting all students in conventional, not distance-learning, programs in five major universities in the Republic of Cyprus. Students were invited to participate through the respective Studies and Student Welfare Office of each institution. The survey was made available in English and Greek on REDCap. Participation was voluntary and anonymous. The questionnaire was developed based on a consensus to cover the main factual information directed by official channels toward the general public in Cyprus at the time of the survey. In addition to sociodemographic information (N = 8), the self-administered questionnaire consisted of 19 questions, assessing the knowledge regarding the characteristics of SARS-CoV-2 and COVID-19, infection prevention and control measures (N = 10), perceptions related to COVID-19, for instance, whether strict travel measures are necessary (N = 4), and attitudes toward a hypothetical person infected (N = 2). Furthermore, participants were asked to provide their own assessment of their knowledge about COVID-19 and specifically with regard to the main symptoms and ways of transmission (N = 3). The number of students who completed the survey was 3,641 (41% studying Health/Life Sciences). Amongst them, 68.8% responded correctly to at least 60% of knowledge-related questions. Misconceptions were identified in 30%. Only 29.1% expressed a positive attitude toward a hypothetical person with COVID-19 without projecting judgment (9.2%) or blame (38%). Odds of expressing a positive attitude increased by 18% (95% CI 13–24%; p < 0.001) per unit increase in knowledge. Postgraduate level education was predictive of better knowledge (odds ratio (OR) 1.81; 95% CI 1.34–2.46; p < 0.001 among doctoral students] and positive attitude [OR 1.35; 95% CI 1.01–1.80; p = 0.04). In this study, we show that specific knowledge gaps and misconceptions exist among University students about SARS-CoV-2 and COVID-19 and their prevalence is associated with negative attitudes toward people with COVID-19. Our findings highlight the integrated nature of knowledge and attitude and suggest that improvements to the former could contribute to improvements in the latter.

BackgroundThe COVID-19 pandemic and the widespread adoption of virus control measures have inevitably disrupted efforts to address lifestyle risk factors for non-communicable diseases (NCD). This study aimed to explore the effects of COVID-19 lockdown on all lifestyle medicine pillars, namely diet, physical activity, sleep, stress, social support and use of risky substances.MethodsThis was a cross-sectional study on a convenient sample of adults who resided in Cyprus during the Spring 2020 lockdown. Participants completed an anonymous online questionnaire comprised of six validated tools regarding the following lifestyle behaviours before and during lockdown: adherence to the Mediterranean diet, physical activity, stress and social support levels, sleep pattern and use of risky substances such as smoking and alcohol. Paired before and during lockdown comparisons for each lifestyle pillar were undertaken using Wilcoxon Signed-Rank test and Bowker symmetry Test where response was numerical (non-parametric data) and categorical respectively. Furthermore, stratified analyses for sociodemographic characteristics were performed.ResultsOut of 745 participants, 74% were female and median age was 39 years. Overall participants reported significantly higher perceived stress score (22 v 25,p p p p p trend = 0.03 and ConclusionVarious lifestyle factors were adversely affected by the COVID-19 lockdown in Cyprus. Evidence from this study supports development of holistic lifestyle interventions during and following the pandemic to reduce short and long-term NCD risks by building on lifestyle behaviour strengths and addressing longstanding and emerging gaps and needs.

Background This study aimed to explore socioeconomic factors associated with obesity in the Republic of Cyprus. Methods We interviewed 3021 Greek-Cypriots aged 25-64 years through a multistage survey. We collected self-reported information on demographics, health behaviours (physical activity, smoking, alcohol consumption and dietary intake), socio-economic characteristics (educational attainment, household income and occupational social class) and anthropometric measurements. Obesity was defined as body mass index ≥30 kg/m2. For the association between obesity and each socio-economic indicator, we conducted sex-specific Poisson's regression with robust variance, adjusting for all demographics and health-related behaviours, reporting adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results The prevalence of obesity was 22% and 17% among men and women, respectively. There was a significant trend of higher obesity prevalence with increasing age as well as with being widowed in both genders and being a refugee in men. Obesity prevalence decreased with increasing educational attainment (postgraduate vs. none/gymnasium: a PRmen=0.45; 95%CI=0.25-0.82; a PRwomen=0.41; 95%CI=0.18-0.95; p-trends€4000/month vs. ≤€1000/month: a PRmen=0.45; 95%CI=0.26-0.81; a PRwomen=0.45; 95%CI=0.22-0.92; p-trends Conclusions The current study highlights striking social inequalities in obesity among Cypriot men and women, characterised by a linear decrease in obesity prevalence each step up the socioeconomic hierarchy. We recommend that comprehensive and multifaceted public health interventions are considered to address income and education-related barriers resulting in higher obesity rates among specific population sub-groups. Key messages Among Greek Cypriot adults, obesity affects almost one in five whilst obesity prevalence shows gender-specific social inequalities. When investigating social inequalities in health, the choice of socioeconomic indicators should reflect the context of the population and gender-specific differences.

Background A national breast cancer (BC) screening programme, targeting women 50-69 years old, was introduced in Cyprus in 2007. This study aims to assess rural/urban differences in BC incidence, tumour stage at diagnosis (TSD) and mortality, since 2004 and since the introduction of the screening programme. Methods Data were obtained for 6589 new cases of BC (diagnosis 2004-2016) from a national population-based cancer registry (1998-today) in Cyprus. TSD was recorded according to the Surveillance, Epidemiology, and End Results categories. We defined late TSD as regional or distant stage. Unknown stages were excluded. We linked cases to the population census data and place of residence (rural/urban) and calculated incidence and mortality rate ratios (RR) by place of residence. We conducted logistic regression to measure the association between place of residence and TSD or mortality, adjusting for sex, age, ethnicity, smoking and marital status. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results Since 2004, 54.7% of BC cases were diagnosed at localised stage, 40.6% at regional stage and 4.7% at distant stage. Incidence, but not mortality, rate for all BC was higher in urban than in rural areas (RRincidece=1.22;95%CI=1.51-1.28 and RRmortality=1.10;95%CI=0.97-1.24). Rural place of residence was associated with higher odds of late TSD (aOR=1.34; 95%CI=1.15-1.58) and death (aOR=1.36; 95%CI=1.11-1.68). After the introduction of the screening programme, for the targeted age group, rural place of residence was still associated with higher odds of late TSD (aOR=1.31; 95%C= 1.03-1.67), but not with death (p > 0.05). Conclusions Even though BC incidence is higher in urban than in rural areas, women residing in rural areas had higher odds of late TSD and death. The introduction of the national BC screening programme only slightly reduced geographical inequalities in TSD. Further studies are needed to understand and reduce the role of inequalities in TSD. Key messages Rural/Urban inequalities in TSD are evident among BC cases in Cyprus, diagnosed between 2004 and 2016. The introduction of the national BC screening programme reduced but did not overcome geographical inequalities in TSD.

Background Despite widespread adoption of lockdown by governments in the COVID-19 response, research on how it affects the individual pillars of Lifestyle Medicine is limited. We aimed to explore the effects of COVID-19 lockdown on healthy eating, physical activity, sleep, stress, social support and use of risky substances. Methods This was a cross-sectional study on a convenient sample of adults who resided in Cyprus during the lockdown. An anonymous questionnaire was completed online in Greek or English comprised of five validated tools in relation to their behaviours before and during the lockdown. We compared median values for each variable/tool before and during lockdown, using Wilcoxon Signed Rank test, and performed stratified analyses for sociodemographic characteristics. Results Out of 745 respondents, 74% were female and median age was 39. Overall scores showed significantly increased sleep quality difficulty (4 v 5, p Conclusions Many aspects of lifestyle were adversely affected by lockdown in Cyprus. As people return to their pre-lockdown routines, the outcomes described provide data to inform the design of lifestyle interventions that support changing or maintaining lifestyle habits. Such interventions can then help decrease people's risk for future poor health outcomes, including the risk for COVID-19 infection. Key messages This study describes aspects of lifestyle affected by the Cyprus COVID-19 lockdown, significant when considering future lockdowns and pre-, during or post-lockdown healthful lifestyle interventions. The outcomes provide data to inform the design of lifestyle interventions to support changing or maintaining healthy lifestyle habits.

During the first quarter of 2020 the world is experiencing a pandemic of Severe Acute Respiratory Syndrome‑Coronavirus‑2 (SARS‑CoV‑2), a novel beta coronavirus that is responsible for the 2019 novel coronavirus disease (COVID‐19). The COVID‐19 pandemic revealed that healthcare systems around the world were not prepared to deal with either the direct effects of the pandemic or with the indirect effects that are imposed on the health of patients with chronic disorders such as cancer patients. Some challenges and dilemmas currently faced during the pandemic include the management of cancer patients during the treatment and follow‐up phases, the assessment of the safety of treatments currently used for the management of SARS‑CoV‑2 for use in cancer patients, the development of psychoeducation and emotional support for cancer patients and the safe conduct of clinical trials involving participation of cancer patients. Evidence from the literature supports the need for the urgent development of a holistic contingency plan which will include clear guidelines for the protection and comprehensive care of cancer patients. The implementation of such a plan is expected to have many beneficial effects by mainly minimizing the increased morbidity and mortality of cancer patients that could result as an adverse consequence of the COVID‐19 or future pandemics., The COVID‐19 pandemic has revealed that health care systems around the world were not prepared to deal with either the direct effects of the pandemic or with the indirect effects that are imposed on the health of cancer patients. The evidence from the literature supports that the development of a contingency plan is as urgent as ever to minimise the increased morbidity and mortality of cancer patients that could result as a consequence of the current COVID‐19 pandemic or any other future pandemics.

Huntington disease (HD) is most prevalent among populations of western European descent and isolated populations where founder effects may operate. The aim of this study was to examine the epidemiology of HD in Cyprus, an island in southern Europe with extensive western European colonization in the past. All registered HD patients in the Cyprus, since 1994, were included. Detailed pedigrees and clinical information were recorded and maps, showing the geographic distribution of HD, were constructed. Requests for genetic testing were also examined. The project identified 58 clinically manifested cases of HD belonging to 19 families. The 16 families of Cypriot origin were concentrated in a confined geographical cluster in southeast Cyprus. In 2015, prevalence of symptomatic HD was 4.64/100 000 population, while incidence was 0.12/100 000 person-years. Prevalence displayed a marked increase during the past 20 years. Disease characteristics of HD patients were similar to those reported in western European populations. Lastly, the uptake of predictive and/or prenatal testing was limited. HD disease characteristics, incidence and prevalence in Cyprus were comparable to western European populations. Together with the geographical clustering observed, these results support the possibility for a relatively recent founder effect of HD in Cyprus, potentially of western European origin.

Growing evidence suggests that personality traits play a role in obesity and cardiometabolic health. In addition, irregularity of food intake has emerged as a potential risk factor for obesity, cardiovascular disease, and metabolic syndrome. Recent studies suggest that when we eat, termed "chrono-nutrition," may be as important to what we eat. This concept covers 3 aspects: 1) irregularity of energy intake in meals (varying amounts of energy intake throughout the day and at different times from one day to the next), 2) frequency (number of meals per day), and 3) timing of food intake (actual time of day). A narrative review was conducted to identify literature evaluating the effect of personality on chrono-nutrition and subsequently obesity and cardiometabolic health. The search focused on research published since 2000 in MEDLINE using the search terms "personality," "chrono-nutrition," "cardiometabolic," "BMI," "obesity," and "metabolic rate." Findings indicate an inverse relation between conscientiousness and obesity, with people who are more conscientious having a lower risk of obesity. Furthermore, time of day of energy intake has been linked to obesity, since meals consumed in the evening have been associated with lower resting metabolic rate. Inconsistent timing and frequency of meals have also been linked to increased body weight and worse cardiometabolic health. Together, the data indicate that eating meals at the same time every day at regular intervals might be the reason why those who score high in conscientiousness are able to maintain a healthier weight. Despite the reviewed observational evidence, there is an apparent gap in the existing literature on the interplay between personality, chrono-nutrition, and obesity and particularly on how dietary interventions should be designed considering different personality traits. Future research is needed to clarify this association and how it interacts with other factors, thus elucidating the role of chrono-nutrition in health.

Background and aim A high intake of dairy has been linked to lower risk of type 2 diabetes (T2D). The relationship between dairy intake and glucose metabolism is still not well understood. The aim of this study was to investigate the relation between the intake of total dairy and dairy subgroups and T2D and measures of glucose metabolism. Methods and results A total of 5953 Danish men and women aged 30–60 years without baseline diabetes or cardiovascular diseases were included in this prospective analysis. The dairy intake at baseline was categorised into low-fat dairy, full-fat dairy, milk and milk products, cheese and fermented dairy. Fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), HbA 1c , insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B) were considered at 5-year follow-up. In the maximally-adjusted model (demographics, lifestyle factors, dietary factors and waist), cheese intake was inversely associated with 2hPG ( β = −0.048, 95% CI −0.095; −0.001). Fermented dairy intake was inversely associated with FPG ( β = −0.028, 95% CI −0.048; −0.008) and HbA 1c ( β = −0.016, 95% CI −0.030; −0.001). Total dairy intake and the dairy subgroups were not related to HOMA-IR and HOMA-B in the maximally-adjusted model. Furthermore, there was no significant association between intake of total dairy or any of the dairy subgroups and incidence of T2D. Conclusion Our data suggest a modest beneficial effect of cheese and fermented dairy on glucose regulation measures; however, this did not translate into a significant association with incident T2D.

Aims: Skeletal muscle is a major metabolic organ and plays important roles in glucose metabolism, insulin sensitivity and insulin action. Muscle telomere length reflects the myocyte's exposure to harmful environmental factors. Leukocyte telomere length is considered a marker of muscle telomere length and is used in epidemiologic studies to assess associations with ageing-related diseases where muscle physiology is important. However, the extent to which leucocyte and muscle telomere length are correlated is unknown, as are their relative correlations with glucose and insulin concentrations. The purpose of this study was to determine the extent of these relationships. Methods: Leucocyte and muscle telomere length were measured by quantitative real-time polymerase chain reaction in participants from the Malmo Exercise Intervention (n = 27) and the Prevalence, Prediction and Prevention of Diabetes-Botnia studies (n = 31). Participants in both studies were free from Type 2 diabetes. We assessed the association between leucocyte telomere length, muscle telomere length and metabolic traits using Spearmen correlations and multivariate linear regression. Bland-Altman analysis was used to assess agreement between leucocyte and muscle telomere length. Results: In age-, study-, diabetes family history- and sex-adjusted models, leucocyte and muscle telomere length were positively correlated (r = 0.39, 95% CI 0.15-0.59). Leucocyte telomere length was inversely associated with 2-h glucose concentrations (r = -0.58, 95% CI -1.0 to -0.16), but there was no correlation between muscle telomere length and 2-h glucose concentrations (r = 0.05, 95% CI -0.35 to 0.46) or between leucocyte or muscle telomere length with other metabolic traits. Conclusions: In summary, the current study supports the use of leucocyte telomere length as a proxy for muscle telomere length in epidemiological studies of Type 2 diabetes aetiology. (Less)

Purpose: We aimed to examine the association between intake of different subgroups of dairy products and blood pressure and incident hypertension 10 years later, adjusting for confounding factors. Methods: We studied 1,750 British men and women from the 1946 British birth cohort from 1989 to 1999 (age 43 and 53 years, respectively). Diet was assessed by 5-day food diaries using photographs in the estimation of portion size. Systolic (sbp) and diastolic (dbp) blood pressure and prevalent hypertension were assessed at age 43 and 53 years. Linear regression and logistic regression were used to examine 10-year blood pressure levels and incident hypertension by baseline dairy intake. Results: There was a weak non-significant trend of a protective effect of total dairy intake on blood pressure and incident hypertension, but no evidence for a dose-response relationship (OR for incident hypertension: 0.88 (95% CI 0.68;1.14) 2nd vs. 1st tertile and 0.93 (95% CI 0.72;1.18) 3rd vs. 1st tertile). Higher intake of low-fat and fermented dairy was linked to a higher sbp but in a nonlinear manner. Adjustment for other dietary factors, health behaviours and BMI attenuated these associations. Conclusions: Total dairy intake and specific dairy subgroups were not associated with blood pressure and incident hypertension among a representative sample of British adults after adjustment for confounding factors

OBJECTIVE To investigate the effect of psychosocial stress at work on risk of type 2 diabetes, adjusting for conventional risk factors, among a sample of British, white-collar, middle-aged men and women. RESEARCH DESIGN AND METHODS This was a prospective analysis (1991–2004) from the Whitehall II cohort study. The current sample consists of 5,895 Caucasian middle-aged civil servants free from diabetes at baseline. Type 2 diabetes was ascertained by an oral glucose tolerance test supplemented by self-reports at baseline and four consecutive waves of data collection including two screening phases. The job strain and iso-strain models were used to assess psychosocial work stress. RESULTS Iso-strain in the workplace was associated with a twofold higher risk of type 2 diabetes in age-adjusted analysis in women but not in men (hazard ratio 1.94 [95% CI 1.17–3.21). This effect remained robust to adjustment for socioeconomic position and outside work stressors and was only attenuated by 20% after adjustment for health behaviors, obesity, and other type 2 diabetes risk factors. CONCLUSIONS Psychosocial work stress was an independent predictor of type 2 diabetes among women after a 15-year follow-up. This association was not explained by potential confounding and mediating factors. More evidence from prospective studies using the same work stress models is needed to support the current findings and provide further information on sex differences.

Summary Aim. To determine whether food allergy affects overall dietary intake and food choices in Cypriot primary school children. Methods. As part of the first epidemiological study in Cyprus on food allergy in primary school children, two 24-hour recalls (one from a week and one from a weekend day) of twenty-eight food allergic children (21 girls) and thirty healthy children (20 girls) aged 6-11 years old, were analysed and compared regarding their macro- and micronutrient content, food choices and meal distribution. Results. Significant differences between the two subgroups of children were estimated regarding the total energy intake and macronutrients, where food allergic children were found to consume in lower quantities, as well as for calcium, niacin, fiber and vitamin E. Food allergic children were also found to avoid combining foods from the various food groups in their meals, and to prefer specific food products from each category, whereas they consumed higher amounts of sugar and fructose. Conclusion. Food allergy in Cypriot food allergic children impacts on both the quality and quantity of food choices, probably due to lack of nutritional education regarding proper elimination diet and alternative nutrient sources.

AIMS/HYPOTHESIS: Recent evidence links the soluble urokinase plasminogen activator receptor (suPAR), a stable biomarker of systemic immune activation, to several chronic diseases, including type 2 diabetes. suPAR is also associated with adiposity and smoking. We hypothesised that this biomarker would be linked to incident type 2 diabetes in individuals with impaired glucose regulation and that this association would be modified by smoking and body weight status.METHODS: The study included 1,933 participants with impaired glucose regulation, who were drawn from the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) and for whom data on suPAR, BMI and smoking were available. Logistic regression analysis was used to estimate the odds for incident type 2 diabetes per twofold increase in suPAR levels. Interactions between both smoking and body weight status and suPAR were tested.RESULTS: During a 3-year follow-up (599 incident diabetes cases), there was a 48% overall increase in the odds of developing type 2 diabetes per twofold increase in suPAR (p = 0.006). This association was modified by body weight status in overweight, but not in obese individuals (OR 2.36, 95% CI 1.48, 3.76 in overweight group), and by smoking status (OR 2.05, 95% CI 1.20, 3.51 in non-smokers). After adjustment for other diabetes risk factors, the association between suPAR and type 2 diabetes was attenuated in the whole sample and among non-smokers, but remained robust among overweight participants.CONCLUSIONS/INTERPRETATION: suPAR may be a good novel biomarker for systemic sub-clinical inflammation and immune activation linked to incident type 2 diabetes risk in overweight individuals and non-smokers. The observed interactions with adiposity and smoking should be investigated further.

Net reclassification improvement (NRI) has received much attention for comparing risk prediction models, and might be preferable over the area under the receiver operating characteristics (ROC) curve to indicate changes in predictive ability. We investigated the influence of the choice of risk cut-offs and number of risk categories on the NRI. Using data of the European Prospective Investigation into Cancer and Nutrition-Potsdam study, three diabetes prediction models were compared according to ROC area and NRI with varying cut-offs for two and three risk categories and varying numbers of risk categories. When compared with a basic model, including age, anthropometry, and hypertension status, a model extension by waist circumference improved discrimination from 0.720 to 0.831 (0.111 [0.097-0.125]) while increase in ROC-AUC from 0.831 to 0.836 (0.006 [0.002-0.009]) indicated moderate improvement when additionally considering diet and physical activity. However, NRI based on these two model comparisons varied with varying cut-offs for two (range: 5.59-23.20%; -0.79 to 4.09%) and three risk categories (20.37-40.15%; 1.22-4.34%). This variation was more pronounced in the model extension showing a larger difference in ROC-AUC. NRI increased with increasing numbers of categories from minimum NRIs of 18.41 and 0.46% to approximately category-free NRIs of 79.61 and 19.22%, but not monotonically. There was a similar pattern for this increase in both model comparisons. In conclusion, the choice of risk cut-offs and number of categories has a substantial impact on NRI. A limited number of categories should only be used if categories have strong clinical importance.

Background and aim Despite the enormous burden of Huntington’s disease (HD) on the quality of life (QoL) of patients, there is limited evidence on this topic. Given the high prevalence of the disease in Cyprus, the aim of this cross-sectional study was to assess QoL among Cypriot HD patients. Methods The Euro EQ-5D-3L questionnaire was used. Measures were taken to allow participation of patients at advanced stages and patients unable to visit the clinic. Thirty-four patients were interviewed (46% of the Cypriot HD patient population). Results Ability of patients to care for themselves and to carry out usual activities were reported to be most severely affected (41.2% and 44.1% replying “Severe Problems” respectively). Mobility and psychosocial well-being were also affected but to a lesser extent (42.5% and 14.7% replying “Severe Problems”). Interestingly, in the anxiety/depression scale, 77.8% of asymptomatic patients reported “Some Problems”. Half of the patients did not experience pain or discomfort but 44.1% reported “Some Problems”. In multivariate ordinal regression analyses, age at onset and disease duration significantly impacted on mobility and self-care. Number of repeat alleles was a third determining factor on the ability to self-care and disease duration was the only significant determinant of ability to perform usual activities. No significant determinants were evidenced for Pain/Discomfort and Anxiety/Depression (Table 1). Conclusions Age at onset and disease duration were found to severely affect the QoL of Cypriot HD patients, and more specifically their mobility, ability to self-care and perform usual activities. The percentage of patients reporting “Some Problems” in the Pain/Discomfort category can be explained by the direct translation of the word as presented in the questionnaire, indicating the need for language specific instruments. Perhaps more noteworthy is the phychosocial burden on even asymptomatic patients, which needs to be acknowledged and managed to improve their quality of life.

Background and aim Huntington’s disease (HD) is a fully penetrant, mainly adult-onset, autosomal dominant disorder. HD is caused by repetitions of the triplet CAG in chr 4 (4p16.3), which are pathogenic if ≥36. Globally, the prevalence is highest among populations of western European descent. In more isolated populations the origin of HD is usually a result of founder effects, which can give rise to higher than normal prevalence as well as geographical clustering. Our aim was to conduct a detailed epidemiological investigation of HD in the island of Cyprus. Methods All registered Greek Cypriot HD patients were analysed from 1984 onwards. Detailed pedigrees and maps, examining the geographic distribution of the disorder, were constructed. Results Eighty confirmed cases of HD were identified since 1984 belonging to 16 independent families concentrated in a small cluster spanning the Famagusta and Larnaca districts. Three cases were juvenile HD (JHD). In 2015 the prevalence was 7.61/100,000, and the incidence 0.12/100.000. The crude average annual incidence from 1984 to 2015 was 0.26/100000 (95% CI: 0.20–0.34). The 5-, 10-, and 15-year survival probability was 85.2%, 63.0% and 40.7% respectively, with average disease duration of 12.2 years, excluding JHD. The average age at onset was 44.2 years and the average number of CAG repeats in the mutant allele was 44. Paternal inheritance had in general a more adverse disease profile. The age at onset was found to decrease significantly over decades and with increasing number of CAG repeats. Conclusions Cyprus has HD prevalence and incidence higher than other southern European countries, making the possibility for a founder effect very likely. The geographical clustering observed points to a very likely western European origin of the disease, given the strong presence of such populations in the affected region during the middle-ages. Disease characteristics such as the median number of CAG repeats, age at onset and disease duration are comparable to other countries.

Objective The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. Methods A hospital-based case–control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. Results The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64–2.31) in women and 1.40 [1.01–1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17–1.57]) and waist-to-height ratio (1.29 [1.12–1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50–0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88–1.15]) nor in men (0.74 [0.52–1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥0.88 in women and ≥0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. Conclusion Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries. Objectif Examiner l'association entre l'obesite et le diabete de type 2 en Afrique subsaharienne (ASS). Methodes Etude cas-temoins basee sur l'hopital en milieu urbain au Ghana, portant sur 1221 adultes (542 cas et 679 temoins) investiguant sur l'incidence des parametres anthropometriques (indice de masse corporelle [IMC], tour de taille, tour des hanches [HC], rapport ceinture-hanche et rapport ceinture-taille dans le diabete. La regression logistique a ete utilisee pour l'analyse. Le pouvoir discriminant et des seuils specifiques aux populations pour le diabete ont ete identifies par des courbes caracteristiques «receiver operating». Resultats La plus forte association avec le diabete a ete observee pour le rapport ceinture-hanches: les rapports de cotes (odds ratios) ajustes pour l’âge par une difference de 1 ecart-type etaient de 1,95 (intervalle de confiance [IC] a 95%: 1,64 a 2,31) chez les femmes et 1,40 [1,01 a 1,94] chez les hommes. De plus, chez les femmes, les chances de diabete augmentent avec un tour de taille (1,35 [1,17 a 1,57]) et un rapport ceinture-taille (1,29 [1,12 a 1,50]) plus eleves. Chez les hommes, cela n’etait pas perceptible. Au contraire, le tour de hanches etait inversement associe (0,69 [0,50 a 0,95]). L’IMC n’etait ni associe au diabete chez les femmes (1,01 [0,88 a 1,15]), ni chez les hommes (0,74 [0,52 a 1,04]). Chez les deux sexes, le rapport ceinture-hanche a montre la meilleure capacite discriminative pour le diabete dans cette population et les seuils optimaux etaient de 0,88 chez les femmes et 0,90 chez les hommes. Les seuils recommandes pour l’IMC et le tour de taille ont une faible capacite predictive. Conclusion Nos resultats suggerent que les mesures de l'obesite centrale plutot que generale se rapportent au diabete de type 2 en ASS. Il reste a verifier dans de grandes etudes epidemiologiques de population si les objectifs anthropometriques de la prevention de l'obesite en ASS different de ceux des pays developpes. Objetivo Examinar las asociaciones entre la obesidad y la diabetes tipo 2 en Africa subsahariana (ASS). Metodos Estudio hospitalario de casos y controles en zonas urbanas de Ghana con 1221 adultos (542 casos y 679 controles) para investigar el papel de los parametros antropometricos (indice de masa corporal (IMC), circunferencia de la cintura, circunferencia de la cadera [CC], el indice cintura-cadera y el indice de cintura-altura en diabetes. El analisis se realizo mediante una regresion logistica. El poder discriminatorio y los puntos de corte poblacionales especificos para diabetes se identificaron mediante curvas ROC caracteristicas. Resultados La mayor asociacion con diabetes se observaba con el indice cintura-cadera, la razon de probabilidades ajustada por edad con una desviacion estandar de diferencia era de 1.95 (IC 95%: 1.64–2.31) en mujeres y 1.40 [1.01–1.94] en hombres. Tambien, entre mujeres, la probabilidad de diabetes aumentaba con una mayor circunferencia de la cintura (1.35 [1.17–1.57]) y el indice cintura-altura (1.29 [1.12–1.50]). Entre hombres esta relacion no era discernible. Mas bien la circunferencia de la cadera estaba inversamente relacionada (0.69 [0.50–0.95]). El IMC no estaba asociado ni con la diabetes en mujeres (1.01 [0.88–1.15]) ni en hombres (0.74 [0.52–1.04]). En ambos generos, el indice cintura-cadera mostro la mayor habilidad discriminatoria para diabetes en esta poblacion y los puntos de corte optimos eran ≥0.88 en mujeres y ≥0.90 en hombres. Los puntos de corte recomendados para IMC y la circunferencia de la cintura tenian una capacidad vaticinadora pobre. Conclusion Nuestros hallazgos sugieren que las medidas de obesidad central, mas que las de obesidad general estan relacionadas con la diabetes tipo 2 en ASS. Aun ha de verificarse, mediante estudios epidemiologicos en poblaciones mas amplias, si los objetivos antropometricos de prevencion de la obesidad en ASS son diferentes a aquellos en paises desarrollados.

Background Social mobility (movement up or down the social hierarchy) and social accumulation (accumulating social advantage or disadvantage) across the life course have been shown to affect adult health. There is no evidence on how these processes simultaneously affect adult overweight and obesity. Methods Cross-sectional analysis using data from phase 5 of the Whitehall II study (1997–1999), including retrospective information on past socioeconomic position (SEP) for 4598 participants (44–69 years). The effect of social mobility and social accumulation, from childhood social class to educational attainment to current employment grade, on prevalent adult overweight and obesity was examined. Results Upwardly socially mobile participants did not have lower prevalence of overweight and obesity compared to the socially stable at low SEP (62.3 vs 63.9% in women). Downwardly socially mobile participants had higher prevalence of overweight and obesity than the socially stable at high SEP (52.0% vs 36.1% in women). The odds of adult overweight and obesity increased with social accumulation of disadvantage. Among women, one life phase in low SEP was associated with 61% higher odds (OR 1.61; 95% CI 1.05 to 2.47), two phases low with 66% higher odds (1.66; 1.14 to 2.42) and all phases low with 2.6 times the odds (2.61; 1.79 to 3.78) of overweight and obesity compared to women with all phases in high SEP. Conclusions Social mobility and social accumulation can operate simultaneously across the life course. Prevention of downward social mobility and social accumulation of disadvantage could reduce the overall prevalence of adult overweight and obesity.

OBJECTIVE To investigate the effect of psychosocial stress at work on risk of type 2 diabetes, adjusting for conventional risk factors, among a sample of British, white-collar, middle-aged men and women. RESEARCH DESIGN AND METHODS This was a prospective analysis (1991–2004) from the Whitehall II cohort study. The current sample consists of 5,895 Caucasian middle-aged civil servants free from diabetes at baseline. Type 2 diabetes was ascertained by an oral glucose tolerance test supplemented by self-reports at baseline and four consecutive waves of data collection including two screening phases. The job strain and iso-strain models were used to assess psychosocial work stress. RESULTS Iso-strain in the workplace was associated with a twofold higher risk of type 2 diabetes in age-adjusted analysis in women but not in men (hazard ratio 1.94 [95% CI 1.17–3.21). This effect remained robust to adjustment for socioeconomic position and outside work stressors and was only attenuated by 20% after adjustment for health behaviors, obesity, and other type 2 diabetes risk factors. CONCLUSIONS Psychosocial work stress was an independent predictor of type 2 diabetes among women after a 15-year follow-up. This association was not explained by potential confounding and mediating factors. More evidence from prospective studies using the same work stress models is needed to support the current findings and provide further information on sex differences.

Objectives: To investigate the effect of father’s social class on central and general obesity in adulthood. To test the role of educational attainment and adult health behaviours as mediators in this association. Methods: BMI, Waist-hip-ratio, smoking status, alcohol consumption, leisure-time physical activity and dietary intake (semi-quantitative food-frequency questionnaire) were assessed at phase 5 (1997–1998) of the Whitehall II cohort study. We used retrospective data on educational attainment and father’s social class. Our study sample was 4598 participants (3364 men, 1234 women) aged 44–69, with a valid obesity measure and information on father’s social class and educational attainment. Results: Father’s social class was inversely associated with adult life central (Waist-hip-ratio) and general (BMI) obesity in women but not in men. For example, mean BMI difference between the highest and lowest childhood social class was 2.04 kg/m2 (95% confidence intervals: 0.90; 3.18). These associations remained robust to adjustment for adult life socioeconomic position. Adjusting for educational attainment resulted in a reduction of 10–15% in the difference in mean obesity measures between lowest and highest father’s social class. In our fully adjusted model, adult life health behaviours did not provide further attenuation of the effect of father’s social class on adult obesity. Conclusion: We provide evidence for an independent effect of father’s social class on adult central and general obesity in women, which is not explained by educational attainment and an unhealthy lifestyle in adulthood. Policies aiming at reducing inequalities in obesity should tackle the problem of social inequality early in life.

Introduction: Huntington’s disease (HD) has profound motor, behavioural and cognitive symptoms. Despite the enormous burden of this disease on the quality of life (QoL) of patients and their families, there is very limited evidence on this topic. Considering the severity of HD patients, and the high prevalence in Cyprus more studies are needed to assess QoL among Cypriot patients, in order to improve our knowledge about their living conditions and to assist the management of this condition. Project Aim: The aim of this cross-sectional study is to assess QoL among Cypriot patients with HD, using a standardized health-related QoL questionnaire. Materials and Methods: A generic QoL questionnaire was used, namely EQ-5D, which is a standardised instrument for use as a measure of health outcomes and is applicable to a wide range of health conditions. The study was conducted with 34 patients, which represented 46% of the Cypriot HD patient population. Results: Ability of patients to care for themselves and to carry out usual activities were reported to be most severely affected (37.5% and 40.6% replying “Severe Problems” respectively). Mobility and psychosocial well-being were also affected to a lesser extent (25.0% and 15.6% replying “Severe Problems”). Interestingly, in the anxiety/depression scale, 77.8% of asymptomatic patients reported “Some Problems”. Half of the patients did not experience pain or discomfort but 40.6% reported “Some Problems” and 6.3% reported “Severe Problems”. The Health Status as perceived by the patients was found to be moderately to severely affected. In multivariate ordinal regression analyses, age at onset and disease duration significantly impacted on self-care. In addition, disease duration was significantly associated with mobility, self-care and usual activities scales. No significant determinants were evidenced for Pain/Discomfort and Anxiety/Depression. Lastly, age of onset was found to be the only significant determinant of the cumulative QoL score (Range=5-15). Conclusions: Age at onset and disease duration were found to severely affect the QoL of Cypriot HD patients, and more specifically their mobility, ability to self-care and perform usual activities. The percentage of patients reporting “Some Problems” in the Pain/Discomfort category can be explained by the direct translation of the word as presented in the questionnaire, indicating the need for language specific instruments. Perhaps more noteworthy is the phychosocial burden on even asymptomatic patients, which needs to be acknowledged and managed to improve their quality of life.

Recently, considerable attention has been given to beverage intake as a source of calories which may be linked to pediatric obesity. The purpose of our study was to evaluate the beverage intake in school children and adolescents aged 7 to 15 years old.Six hundred and seven (607) out of 655 children participated in the study. One hundred percent fruit juice were classified those beverages that contain 100% fruit juice, without sweetener. Sweetened sugar beverages (SSBs) were included (fruit drinks sweetened fruit juice, fruit-flavored drink or drink that contained fruit juice in part, sweeten soft drinks, coffee, and tea).Around 84% of subjects consumed water while 81% of children who were included in the analysis consumed milk, 49.5% consumed 100% fruit juice, and 79.4 % SSBs. Whole milk was consumed by 40.9% of school children. Skim milk and 1% milk were consumed by 3.6% and 4.7% of the children, respectively. Children and adolescents consuming SSBs were 2.57 (95% CI: 1.06, 3.38) times more likely to become obese compared to normal peers.Sugar beverage drinks but not 100% fruit juices and milk are associated with obesity. Further studies investigating the relationship among beverage consumption, total energy intake, and development of overweight are needed.

Introduction: Parkinson's disease (PD) is a neurodegenerative disorder affecting a substantial proportion of the elderly Cypriot population. The objective of this study was to evaluate PD risk variants that have been identified previously in Genome Wide Association Studies (GWAS) and to find environmental factors that are predictors for PD onset in the Cypriot population. Methods: A case-control study was conducted with a total of 235 PD patients and 464 healthy controls of Greek-Cypriot ethnicity. Demographic and lifestyle characteristics, exposure to PD risk factors and clinical data were collected. Moreover, 13 previously GWAS-identified PD risk variants were genotyped. Univariate and multivariate regression analyses examined the association between a number of environmental and genetic factors and PD. Results: Multivariable regression analysis revealed that exposure to both pesticides and other toxic substances (P = 0.03), severe head injury accompanied with fainting (P = 0.001), nuts consumption (P = 0.004), red meat consumption (P = 0.02), and soft drinks consumption (P = 0.008) were increasing the risk for PD, whereas cumulative smoking (P = 0.02), and fish consumption (P = 0.02) were decreasing the risk for PD. Five out of the 13 tested SNPs (rs12185268, rs6599389, rs356220, rs13312, and rs17649553) were confirmed to be nominally significantly associated (P < 0.05) with PD risk in the Cypriot population. Conclusions: Collectively, this case-control study has shed some light on the nature of PD epidemiology in Cyprus, by demonstrating a number of genetic and environmental determinants of PD in the Cypriot population.

BACKGROUND Despite evidence supporting an involvement of mitochondrial dysfunction in the pathogenesis of some neurodegenerative disorders, there are inconsistent findings concerning mitochondrial haplogroups and their association to neurodegenerative disorders, including idiopathic Parkinson's disease (PD). METHODS To test this hypothesis for the Greek-Cypriot population, a cohort of 230 PD patients and 457 healthy matched controls were recruited. Mitochondrial haplogroup distributions for cases and controls were determined. Association tests were carried out between mitochondrial haplogroups and PD. RESULTS Mitochondrial haplogroup U was associated with a reduced PD risk in the Cypriot population. After pooling mitochondrial haplogroups together into haplogroup clusters and superclusters, association tests demonstrated a significantly protective effect of mitochondrial haplogroup cluster N (xR) and supercluster LMN for PD risk only in females. In addition, for female PD cases belonging to UKJT and R (xH, xUKJT) haplogroup, the odds of having a later age of onset of PD were 13 and 15 times respectively higher than the odds for female cases with an H haplogroup. CONCLUSION Statistically significant associations regarding PD risk and PD age of onset were mostly detected for females thus suggesting that gender is a risk modifier between mitochondrial haplogroups and PD status / PD age of onset. The biological mechanisms behind this gender specificity remain to be determined.