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Background/objectives: Europe has the highest level of alcohol consumption in the world. As drinking patterns are important determinants of the beneficial and harmful effects of alcohol consumption, we investigated alcohol consumption in relation to nutrient intake, place of consumption, education and body weight in a sample of adults from 10 European countries., Methods: A 24-h dietary recall interview was conducted on 13 025 men and 23 009 women, aged 35-74 years, from 27 centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Means and standard errors of alcohol consumption, adjusted for age, were calculated, stratified by gender and centre., Results: In many centres, higher level drinkers (males consuming >24 g of ethanol/day, equivalent to >2 standard drinks and females consuming >12 g of ethanol/day equivalent to >1 standard drink) obtained more energy from fat and protein and less from sugar than did abstainers. The proportion of energy from starch tended to be higher for male and lower for female higher level drinkers than for abstainers. Female higher level drinkers had a lower body mass index than did abstainers, whereas male higher level drinkers generally weighed more. Male higher level drinkers were less educated than abstainers in Mediterranean countries, but were more educated elsewhere. Female higher level drinkers were usually more educated than were abstainers. Outside the home, consumption (both genders) tended to be at friends' homes, particularly among men in Northern and Central Europe, and in bars in Spain., Conclusions: This study reveals clear geographical differences in drinking habits across Europe, and shows that the characteristics of different alcohol consumption categories also vary.

Objective: To describe dietary carbohydrate intakes and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study., Methods: Between 1995 and 2000, 36 034 subjects, aged between 35-74 years, were administered a standardized, 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes (g/day) of total carbohydrate, sugars, starch and fibre were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall., Results: Adjusted mean total carbohydrate intakes were highest in Italy and in the UK health-conscious cohort, and were lowest in Spain, Greece and France. Total fibre intakes were highest in the UK health-conscious cohort and lowest in Sweden and the UK general population. Bread contributed the highest proportion of carbohydrates (mainly starches) in every centre. Fruit consumption contributed a greater proportion of total carbohydrates (mainly sugars) among women than among men, and in southern centres compared with northern centres. Bread, fruits and vegetables represented the largest sources of fibre, but food sources varied considerably between centres. In stratified analyses, carbohydrate intakes tended to be higher among subjects who were physically active, never-smokers or non-drinkers of alcohol., Conclusions: Dietary carbohydrate intakes and in particular their food sources varied considerably between these 10 European countries. Intakes also varied according to gender and lifestyle factors. These data will form the basis for future aetiological analyses of the role of dietary carbohydrates in influencing health and disease.

Background: Dietary habits have long been associated with many manifestations of cardiovascular disease., Objective: We sought to investigate whether a diet enriched with fish and n-3 fatty acid consumption are associated with changes in the potential duration of the electrical action, as represented by the QT duration on a resting electrocardiogram, in a population-based sample of Greek adults., Design: During 2001 and 2002, we randomly enrolled 1514 men (18-87 y old) and 1528 women (18-89 y old) stratified by age and sex distribution (in the 2001 Greek census) from the Attica area, Greece. We studied several demographic, anthropometric, lifestyle, dietary, and bioclinical factors of the participants. Dietary habits (including fish consumption) were evaluated by using a validated food-frequency questionnaire. All subjects underwent electrocardiography with a 12-lead surface, in which, along with several other indexes, QT duration was measured, and the heart rate-corrected QT (QTc) was calculated (corrected by using Bazett's rate). The tested hypothesis was evaluated through multiple linear regression analysis, after control for physical activity status, sex, age, medication intake, and several other potential confounders., Results: Compared with fish nonconsumers, those who consumed >300 g fish/wk had a mean 13.6% lower QTc (P<0.01). These findings were confirmed after adjustment for age, sex, physical activity status, BMI, smoking habits, intake of nuts, and other confounders. Moreover, compared with fish nonconsumers, those who consumed >or=300 g fish/wk had a 29.2% lower likelihood of having QTc intervals >0.45 s (P=0.03)., Conclusions: Long-term consumption of fish is associated with lower QTc interval in free-eating people without any evidence of cardiovascular disease. Thus, fish intake seems to provide antiarrhythmic protection at a population level.

Background: The need to gain insight into prevailing eating patterns and their health effects is evident., Objective: This study aimed to identify dietary patterns and their relation to total mortality in older Dutch women., Design: A principal component analysis of 22 food groups was used to identify dietary patterns in 5427 women aged 60-69 y who were included in the Dutch European Prospective Investigation into Cancer and Nutrition-Elderly cohort (follow-up: approximately 8.2 y). Mortality ratios for 3 major principal components were assessed by using Cox proportional hazard analysis., Results: The most relevant principal components were a Mediterranean-like dietary pattern (high intakes of vegetable oils, pasta and rice, sauces, fish, and wine), a Traditional Dutch dinner dietary pattern (high intakes of meat, potatoes, vegetables, and alcoholic beverages), and a Healthy Traditional Dutch dietary pattern (healthy variant of the Traditional Dutch dinner dietary pattern; high intakes of vegetables, fruit, nonalcoholic drinks, dairy products, and potatoes). Differences in mean intakes between the highest and lowest tertiles of the 3 patterns were greatest for fruit, dairy products, potatoes, and alcoholic beverages. Consumption of Mediterranean foods, such as fish and oils, was relatively low overall. Two hundred seventy-seven deaths occurred in 44,667 person-years. Independent of age, education, and other lifestyle factors, only the Healthy Traditional dietary pattern score was associated with a lower mortality rate. Women in the highest tertile of this pattern experienced a 30% reduction in mortality risk., Conclusion: A Healthy Traditional Dutch diet, rather than a Mediterranean diet, appears beneficial for longevity and feasible for health promotion in older Dutch women. This diet is comparable with other reported healthy or prudent diets that have been shown to be protective against morbidity or mortality.

Background: The oxidative modification of low-density lipoprotein (LDL) has been suggested to be a key element in atherogenesis, while methylenetetrahydrofolate reductase (MTHFR) C677T mutation has been associated with the development of coronary heart disease. We evaluated whether adoption of a Mediterranean type of diet is associated with oxidized LDL levels, as well as the role of MTHFR C677T mutation in this relationship., Methods: We studied demographics, lifestyle, clinical, biochemical and genetic data from 322 men (46+/-13 years) and 252 women (45+/-14 years), without any clinical evidence of cardiovascular disease, from the Attica region, Greece (i.e. the ATTICA study). Among the other parameters we also measured oxidized (ox)-LDL levels, and the distribution of MTHFR. Adherence to the Mediterranean diet was evaluated by a special diet score., Results: The distribution of MTHFR genotypes was: 41% for homozygous normal (CC) genotype, 48% for heterozygous (CT) and 11% for homozygous mutant (TT) genotype. Ox-LDL levels were higher in TT as compared to CC and CT (70.8+/-26 vs. 51.0+/-26 vs. 63.7+/-24 mg/dl, p<0.001). Greater adherence to the Mediterranean diet was inversely associated with ox-LDL levels (standardized beta=-0.34, p<0.001), after controlling for several confounding variables; however, stratified analysis revealed that adherence to the Mediterranean diet was associated with lower ox-LDL levels in TT and CT individuals (standardized beta=-0.67, p=0.001 and standardized beta=-0.66, p=0.025, respectively), but not in CC (standardized beta=-0.18, p=0.10), after controlling for several potential confounders., Conclusion: The observed gene-to-diet interaction on ox-LDL concentrations may provide a pathophysiological explanation by which a Mediterranean type of diet could influence coronary risk in people with increased oxidative stress.

BACKGROUND: Epidemiological studies suggest a non-monotonic effect of alcohol consumption on cardiovascular risk, while there is strong evidence concerning the involvement of homocysteine levels on thrombosis. The aim of this work was to evaluate the association between usual ethanol consumption and homocysteine levels, in cardiovascular disease free adults. METHODS: From May 2001 to December 2002 we randomly enrolled 1514 adult men and 1528 women, without any evidence of cardiovascular disease, stratified by age - gender (census 2001), from the greater area of Athens, Greece. Among the variables ascertained we measured the daily ethanol consumption and plasma homocysteine concentrations. RESULTS: Data analysis revealed a J-shape association between ethanol intake (none, <12 gr, 12 - 24 gr, 25 - 48 gr, >48 gr per day) and total homocysteine levels (mean +/- standard deviation) among males (13 +/- 3 vs. 11 +/- 3 vs. 14 +/- 4 vs. 18 +/- 5 vs. 19 +/- 3 mumol/L, respectively, p < 0.01) and females (10 +/- 4 vs. 9 +/- 3 vs. 11 +/- 3 vs. 15 +/- 4 vs. 17 +/- 3 mumol/L, respectively, p < 0.01), after controlling for several potential confounders. The lowest homocysteine concentrations were observed with ethanol intake of < 12 gr/day (Bonferroni alpha* < 0.05). No differences were observed when we stratified our analysis by type of alcoholic beverage consumed. CONCLUSION: We observed a J-shape relationship between homocysteine concentrations and the amount of ethanol usually consumed.

In the context of the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC) we have conducted a cross-sectional study to determine the effect of demographic, lifestyle and nutritional factors of plant origin on retinol, alpha-tocopherol and gamma-tocopherol. Study subjects were a random sample of forty-five men and sixty-eight women, aged 30-82 years, from the Greek EPIC cohort of 27953 volunteers. Analyses were done using linear regression models with the vitamin blood levels as dependent variables, and BMI, the intake of selected food items, total energy intake and a set of demographic factors as independent variables. Women had significantly lower plasma retinol levels (P<0.006) than men. Both alpha- and gamma-tocopherol levels increased by approximately 5 % for every additional 5 years of age. Among dietary factors, intake of non-fruity vegetables was associated with increase, while intake of added lipids other than olive oil with decrease, of plasma retinol levels. BMI was positively associated with plasma gamma-tocopherol only, while none of the foods or food groups investigated significantly affected the plasma levels of either of the two tocopherols. These findings need to be confirmed before attempts are made to use them in the context of explanatory mechanistic processes.

Objective: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)., Design and Setting: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups., Subjects: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study., Results: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups., Conclusions: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

The objective of this study was to investigate the determinants of abstinence and drinking patterns among 14,367 Greeks. Participants older than 60, single and widowed men, as well as participants living outside the Greater Athens area were significantly more likely to abstain than to be "light to moderate" drinkers. In contrast, those at higher educational levels and those separated or divorced were less likely to abstain than their counterparts. With respect to excessive drinking, older people and those at higher educational levels were less likely to engage excessive drinking than their counterparts. Among men, subjects who were separated or divorced were more likely to drink excessively than those who were married. The results of our study help detect groups at high risk for diseases associated with high or low consumption of alcohol, and outline preventive strategies.

Objective: To examine the relationship between educational level, a powerful indicator of socioeconomic status in Greece, total cholesterol and HDL-cholesterol in a large sample of Greek adults., Methods: The study sample consisted of 11,645 subjects, 4,398 men and 7,247 women, aged 23-86 years, who voluntarily participated in the Greek component of the EPIC study during 1994-98. Educational attainment was divided into low, medium, and high. Linear regression analyses were performed, in men and women separately, using total and HDL-cholesterol as dependent variables and educational level as independent, while controlling for age., Results: Total blood cholesterol values are inversely associated with educational level in both genders, a pattern contrasting with that found 20 years ago. The association is more prominent among women. HDL-cholesterol values are inversely associated with educational level in men, whereas the association is less consistent in women.