Depression and adipose and serum cholesteryl ester polyunsaturated fatty acids in the survivors of the seven countries study population of Crete

BACKGROUND

Studies have shown that depression relates to biomarkers of both short- and long-term polyunsaturated fatty acid (PUFA) intake. However, it is not known which of these two biomarkers has the closest relationship to depression.

OBJECTIVE

To examine the relationship of depression with both adipose tissue and serum cholesteryl ester PUFA and to assess the importance of each of these two biomarkers in relating to depression.

DESIGN

Cross-sectional study of healthy elderly men from the island of Crete.

SETTING

The Preventive Medicine and Nutrition Clinic, University of Crete, Greece.

SUBJECTS

A total of 150 males, aged 80-96 years. The subjects were survivors of the Greek Seven Countries Study group.

METHODS

Fatty acids were determined by gas chromatography in adipose tissue and serum cholesteryl esters. Information about depression was obtained through the use of the short form of the Geriatric Depression Scale (GDS-15).

RESULTS

Regression analysis showed that depression related positively to age and serum cholesteryl ester arachidonic/docosahexaenoic fatty acid ratio. The only significant unadjusted correlation between depression and serum cholesteryl ester and adipose fatty acids was with adipose alpha-linolenic acid (ALA) (r = -0.31, P < 0.01). Depressed males (GDS-15 > 5) had lower adipose ALA and sum n-3 fatty acids than non-depressed ones. There were no significant differences between depressed and non-depressed males in serum cholesteryl ester fatty acids. When adipose tissue ALA was included as one of the independent measures in the regression model, the observed positive relation between GDS-15 depression and cholesteryl ester arachidonic/docosahexaenoic ratio failed to persist. Instead, there was a negative relationship between GDS-15 depression and adipose tissue ALA.

CONCLUSIONS

It appears that the fatty acids of the adipose tissue are better predictors of depression than those of serum cholesteryl esters. This indicates that depression relates more strongly to long-term than to short-term fatty acid intake. The reason for this may be the reported slow rate of deposition of dietary PUFA to the brain.

Depression and long chain n-3 fatty acids in adipose tissue in adults from Crete

BACKGROUND

Only one study has investigated the relationship of essential fatty acids in the adipose tissue with depression in adults and suggested an inverse relationship between docosahexaenoic acid (22:6 n-3) (DHA) and depression.

OBJECTIVE

To examine the relation between adipose tissue polyunsaturated fatty acids especially n-3 and n-6 fatty acids, an index of long-term or habitual fatty acid intake, and depression in adults.

DESIGN

Cross-sectional study of healthy adults from the island of Crete.

SETTING

The Preventive Medicine and Nutrition Clinic, University of Crete, Greece.

SUBJECTS

A total of 130 healthy adults (59 males, 71 females) aged 22-58 years. The sample was a sub-sample of the Greek ApoEurope study group.

METHODS

Fatty acids were determined by gas chromatography in adipose tissue. Information about depression was obtained through the Zung Self-rating Depression Scale.

RESULTS

Adipose tissue DHA was inversely related with depression. Multiple linear regression analysis taking into account the possible confounding effect of age, gender, body mass index, smoking and educational level confirmed this association.

CONCLUSIONS

The inverse relationship between adipose DHA and depression in adults, replicates findings of a previous study. This relationship indicates that a low long-term dietary intake of DHA is associated with an increased risk for depression in adults.

Prevalence and socio-demographic associations of undernutrition and obesity among preschool children in Cyprus

OBJECTIVE

To estimate the prevalence of undernutrition and obesity in preschool children in Cyprus and identify possible associations.

DESIGN

Cross-sectional study.

SETTING

Private and public nursery schools.

SUBJECTS

A representative sample (n=1412) stratified by age, gender, district and area of residence.

INTERVENTIONS

Weight (kg) and height (cm) were obtained and BMI (kg/m2) was calculated. Z scores for weight-for-age, height-for-age, and weight-for-height were calculated using the cutoffs from the CDC/WHO 1978 reference. Socio-demographic associations with nutritional status were examined in a logistic regression analysis.

RESULTS

The prevalence of undernutrition (WHO definition, Z-scores <-2) was low. Specifically the prevalence of underweight was 2.3%, wasting 2.8%, and stunting 1.1%. Undernutrition was associated with a low birth weight (LBW); odds ratio (OR) for underweight 4.1 (95% CI: 1.4, 12.2), P=0.012, stunting 5.2 (95% CI: 1.1, 23.3), P=0.033, and wasting 4.2 (95% CI: 1.3, 14.3), P=0.021. The prevalence of obesity (IOTF definition) was higher than undernutrition, and increased with age: 1.3% in 2 y olds to 10.4% in 6 y olds. Overweight and obesity prevalence were higher in rural (16.1%) than urban children (12.8%; P=0.046). Obesity in preschool children was associated with paternal obesity, OR 3.24 (95% CI: 1.59, 6.61), P=0.001, and maternal obesity 3.91 (95% CI: 1.78, 8.59), P=0.001. A birth weight (BW)> or =4000 g was associated with obesity compared to a BW between 2501 and 3000 g, OR 7.63 (95% CI: 1.91, 30.52), P=0.004.

CONCLUSIONS

The prevalence of undernutrition among preschool children in Cyprus was low but obesity prevalence was higher. Parental obesity and high BW were significantly associated with obesity while LBW was associated with undernutrition in preschool children.

Health and nutrition education in primary schools of Crete: follow-up changes in body mass index and overweight status

The current study examines the long-term effects of a school-based 'Health and Nutrition Education programme' on body mass index (BMI) changes and the prevalence of overweight. The intervention group consisted of all pupils registered in the first grade of two counties of the island of Crete in 1992, while all pupils registered in a third county formed the control group. For evaluation purposes, a representative sample was examined at baseline (1992) following the 6-y intervention (1998) and 4 y after the programme's cessation (2002). The data presented here are based on pupils with full anthropometrical data in all three examination periods (284 intervention group pupils and 257 control group pupils). Former intervention group pupils had lower average BMI (by 0.7 kg/m2, s.e. 0.28, P = 0.019) at the 10-y follow-up compared to the control group subjects, while no differences were detected in the prevalence of obesity between the two groups. The findings of the current study indicate that the beneficial effects of the programme on pupils' BMI continue, to an extent, 4 years after its cessation. However, the lack of significant differences in the prevalence of overweight between the two groups indicates that the effects of the intervention may not be equally distributed in the population, with greater effects in certain subgroups and less or none in others.

International conference on the healthy effect of virgin olive oil

1. Ageing represents a great concern in developed countries because the number of people involved and the pathologies related with it, like atherosclerosis, morbus Parkinson, Alzheimer's disease, vascular dementia, cognitive decline, diabetes and cancer. 2. Epidemiological studies suggest that a Mediterranean diet (which is rich in virgin olive oil) decreases the risk of cardiovascular disease. 3. The Mediterranean diet, rich in virgin olive oil, improves the major risk factors for cardiovascular disease, such as the lipoprotein profile, blood pressure, glucose metabolism and antithrombotic profile. Endothelial function, inflammation and oxidative stress are also positively modulated. Some of these effects are attributed to minor components of virgin olive oil. Therefore, the definition of the Mediterranean diet should include virgin olive oil. 4. Different observational studies conducted in humans have shown that the intake of monounsaturated fat may be protective against age-related cognitive decline and Alzheimer's disease. 5. Microconstituents from virgin olive oil are bioavailable in humans and have shown antioxidant properties and capacity to improve endothelial function. Furthermore they are also able to modify the haemostasis, showing antithrombotic properties. 6. In countries where the populations fulfilled a typical Mediterranean diet, such as Spain, Greece and Italy, where virgin olive oil is the principal source of fat, cancer incidence rates are lower than in northern European countries. 7. The protective effect of virgin olive oil can be most important in the first decades of life, which suggests that the dietetic benefit of virgin olive oil intake should be initiated before puberty, and maintained through life. 8. The more recent studies consistently support that the Mediterranean diet, based in virgin olive oil, is compatible with a healthier ageing and increased longevity. However, despite the significant advances of the recent years, the final proof about the specific mechanisms and contributing role of the different components of virgin olive oil to its beneficial effects requires further investigations.

Preferential loss of 5S and 28S rDNA genes in human adipose tissue during ageing

Loss of genomic rDNA has been associated with cellular and organismal ageing. The rDNA locus in humans comprises multiple copies of the 5.8S, 28S and 18S genes. Aim of the present study was to test the effect of aging on the copy number of the three rDNA genes individually in post-mitotic human tissue. We utilized real time polymerase chain reaction relative quantification to measure the copy number of 5.8S, 28S and 18S rDNA genes individually. We obtained adipose tissue from 120 male individuals aged from 9 to 94 years. The available data of each subject corresponding to the time of tissue sampling included: age, height, weight and calculated body mass index. Each rDNA gene was directly tested with Pearson correlation against age and body mass index. We found a significant negative correlation of the gene copy of 5.8S (P < 0.001) and 28S (P < 0.003) with age. Interestingly 18S gene copy displayed a different pattern with no statistically significant correlation with age. Conversely, we observed a significant negative correlation of the 18S gene copy with body mass index (P = 0.004) and a marginally non-significant negative correlation of the 5.8S (P = 0.097) gene copy with body mass index. In summary our results indicate that the rDNA recombination events in humans can be differentially targeted and regulated in response to ageing and/or fat accumulation. The proposed model generates possible implications regarding the effects of each rDNA gene loss in cell function as well as the mechanism of recombination targeting.

Short-term predictors of overweight in early adolescence

OBJECTIVE

To identify short-term predictors of risk for overweight in early adolescence in a sample of Caucasian origin subjects, in Cyprus.

SUBJECTS

A total of 357 subjects (178 males) with baseline age 11.5+/-0.4 y were re-evaluated after a mean of 1.6+/-0.5 y.

MEASUREMENTS

Body weight and height, calculated body mass index (BMI), and blood pressure at baseline and follow-up. Serum lipids were determined at baseline. Obesity and overweight were defined at baseline and follow-up, according to the International Obesity Task Force data set. Socioeconomic class was determined. Self-reported parental weight and height were used to calculate the parental BMI. BMI tracking and changes in BMI categories were calculated (with 95% confidence interval (CI)). The future risk of overweight in baseline normal weight subjects was predicted using logistic regression analyses, where only normal weight subjects at baseline were included.

RESULTS

More males remained in the overweight or obese category than females: 86.7% (95% CI: 73.2, 94.9) vs 71.8% (95% CI: 55.1, 85.0), respectively, P=0.03. The identified predictors for future overweight were paternal obesity, odds ratio (OR): 7.1 (95% CI: 1.3, 38.0), systolic blood pressure >95th percentile, OR: 8.9 (95% CI: 1.9, 41.7), high triglyceride levels, OR: 4.2 (95% CI: 1.0, 16.9) and low HDL-cholesterol levels, OR: 7.6 (95% CI: 1.7, 34.3).

CONCLUSIONS

Triglycerides and HDL-cholesterol levels have been proved predictors for overweight in early adolescence for the first time. The different sex pattern in BMI tracking observed, and also the different environmental influences on future overweight risk compared to other studies, indicate that local circumstances should be considered when implementing national intervention strategies for the prevention of obesity.

Abdominal vs buttock adipose fat: relationships with children's serum lipid levels

OBJECTIVE

To explore the extent to which the reported unfavorable fatty acid content of abdominal depots in adults is also true for children. In addition, the present study aims to assess the relative importance of abdominal vs buttock adipose tissue fat in the prediction of serum lipid levels in children.

DESIGN

A cross-sectional study of children from the island of Crete.

SETTING

The study was conducted between October 1999 and January 2000 in the Municipality of St Nikolas, Crete.

SUBJECTS

A total of 475 children (aged 11-18) participated in the study. Data were obtained on children's anthropometry, serum lipids, physical activity and abdominal and buttock adipose tissue fatty acids. In total 138 children (aged 11-16) had complete data in all of the variables studied.

RESULTS

Abdominal depots have elevated proportions of saturated fatty acids (P<0.001) and trans fatty acids (P<0.001), and reduced proportions of monounsaturated (P<0.001) and polyunsaturated fatty acids (P<0.001) in comparison to buttock depots. Buttock adipose tissue monounsaturated fat correlated negatively to serum LDL-C (P<0.05). Abdominal adipose tissue polyunsaturated fat had negative correlations with serum total cholesterol (P<0.05) and LDL-C (P<0.05). Regression analyses indicated that children's serum total cholesterol (P<0.05) and LDL-C (P<0.05) were inversely related to abdominal adipose tissue polyunsaturated fat. Body mass index was positively related to serum triglycerides (P<0.01) and LDL-C (P<0.01), and negatively to serum HDL-C (P<0.05). Age was negatively related to serum HDL-C (P<0.05).

CONCLUSIONS

It appears that, similar to adults, children's fatty acid composition of abdominal adipose tissue is less favorable than that of the buttock. Abdominal depots have elevated proportions of saturated fatty acids and reduced proportions of monounsaturated and polyunsaturated fat in comparison to buttock depots. Moreover, children's abdominal depots appear to have higher trans fatty acid contents than buttock depots. Children's adipose polyunsaturated fat, a biomarker of long-term polyunsaturated fatty acid intake, is inversely related to serum total cholesterol and LDL-C. It appears that abdominal adipose tissue fatty acids are more strongly related to serum lipids than buttock adipose tissue fatty acids. This may be attributed to the reported higher lipolysis rates in abdominal as opposed to buttock depots.

SPONSORSHIP

Funding was provided by the Municipality of St Nikolas, Crete, Greece.

Depression and adipose essential polyunsaturated fatty acids

The objective of the present study was to investigate the relation between adipose tissue polyunsaturated fatty acids, an index of long-term or habitual fatty acid dietary intake, and depression. The sample consisted of 247 healthy adults (146 males, 101 females) from the island of Crete. The number of subjects with complete data on all variables studied was 139. Subjects were examined at the Preventive Medicine and Nutrition Clinic of the University of Crete. Depression was assessed through the use of the Zung Self-rating Depression Scale. Mildly depressed subjects had significantly reduced (-34.6%) adipose tissue docosahexaenoic acid (DHA) levels than non-depressed subjects. Multiple linear regression analysis indicated that depression related negatively to adipose tissue DHA levels. In line with the findings of other studies, the observed negative relation between adipose tissue DHA and depression, in the present study, appears to indicate increasing long-term dietary DHA intakes with decreasing depression. This is the first literature report of a relation between adipose tissue DHA and depression. Depression has been reported to be associated with increased cytokine production, such as IL-1, IL-2, IL-6, INF-gamma and INF-alpha. On the other hand, fish oil and omega-3 fatty acids have been reported to inhibit cytokine synthesis. The observed negative relation between adipose DHA and depression, therefore, may stem from the inhibiting effect of DHA on cytokine synthesis.

Extra virgin olive oil phenols and markers of oxidation in Greek smokers: a randomized cross-over study

OBJECTIVE

To examine the effect of a low phenol olive oil and high phenol olive oil on markers of oxidation and plasma susceptibility to oxidation in normolipaemic smokers.

DESIGN

Randomized single-blind cross-over trial with two intervention periods.

SETTING

The Medical School and University Hospital of the University of Crete, Heraklion, Crete, Greece.

SUBJECTS

Twenty-five healthy males and females completed the study.

INTERVENTIONS

Each intervention was of three weeks duration and intervention periods were separated by a two week washout. Seventy grams of extra virgin olive oil was supplied to each subject per day in the intervention periods. The olive oils supplied differed in their phenol content by 18.6 mg/day. Two fasting venous blood samples were taken at the end of each intervention period.

RESULTS

The markers of antioxidant capacity measured in fasting plasma samples (total plasma resistance to oxidation, concentrations of protein carbonyl as a marker of protein oxidation, malondialdehyde and lipid hydroperoxides as markers of lipid oxidation and the ferric reducing ability of plasma) did not differ significantly between the low and high phenol olive oil diets.

CONCLUSIONS

No effect of olive oil phenols on markers of oxidation in smokers was detected. It may be that the natural concentrations of phenols in olive oil are too low to produce an effect in the post-absorptive phase. Possible reasons for period effects and interactions between diet and administration period need attention to aid further cross-over trials of this kind.

SPONSORSHIP

Unilever Research Vlaardingen, The Netherlands.

The high-fat Greek diet: a recipe for all?

OBJECTIVE

To examine critically the published results of dietary surveys on the fat content of the Greek diet, and to assess its evolution and its relationship to the health of the Greeks. To consider the implications of these findings for current views on the nature and health implications of the traditional Mediterranean diet and how best to define it for use in modern policy making.

DESIGN

A systematic review of the literature on food consumption in Greece.

SETTING

Greece.

RESULTS

The first fully published data on the fat content of the Greek diet-the Seven Countries Survey-relates only to a small number of adult males in Crete and Corfu; the legitimacy of extrapolating these results to the rest of Greece is questioned. Earlier studies and chemical validation of intakes point to a lower fat content of the traditional diet than that inferred for Crete. Nearly all later surveys relate only to urban groups in Athens (mostly case-control hospital-based samples) and a variety of non-representative Cretan groups. Only two studies are larger and more representative, but one uses FAO food balance-sheets to reflect the national diet, and the other surveyed school-age children in three out of the 52 Greek counties. Unfortunately recent dietary studies have proved unreliable, given the continuing lack of national food composition tables with survey methods which proved inaccurate for dietary fat content. A progressive upward trend in total and saturated fat intake appears to have occurred with all health indicators in relation to fat indicating remarkable increases in adult and childhood obesity with attendant progressive deterioration in cardiovascular mortality and its risk factors, ie hypertension and diabetes. These data emphasise the need to alter current nutritional advice in Greece, particularly when it focuses on the promotion of olive oil and a high-fat diet.

CONCLUSIONS

The findings reaffirm low-moderate fat policies for optimum health, within which olive oil can be an important component of the diet.

Obesity in children and adolescents in Cyprus. Prevalence and predisposing factors

OBJECTIVE

To estimate the prevalence of childhood and adolescent obesity in Cyprus and define possible associated risk factors.

STUDY DESIGN

Cross-sectional study of a representative sample of children 6-17 y of age performed during October 1999 to June 2000.

METHODS

Anthropometric data were taken using standard methods, from 2467 children. Certain diet and physical activities as well as other socioeconomic family parameters were assessed with the aid of a questionnaire. Obesity and overweight were defined using both the National Health and Nutrition Examination Survey (NHANES) I definition and the newer International Obesity Task Force (IOTF) definition. Logistic regression analyses were performed to estimate the influence of various parameters.

RESULTS

The prevalence of obesity in males was 10.3% and in females 9.1% using the NHANES I definition and 6.9 and 5.7%, respectively, using the IOTF definition. The percentages presented a decreasing trend with age. There were an additional 16.9% of males and 13.1% of females defined as overweight with the NHANES I definition and 18.8 and 17.0%, respectively, using the IOTF definition. The most significant associated factor for obesity was parental obesity status. The odds ratio for offspring obesity when both parents were obese ranged from 11.34 (95% CI 1.83-75.50) in females 6 to 11-y-old to 18.09 (95% CI 2.06-158.81) for males 12 to 17-y-old.

CONCLUSIONS

The prevalence of childhood and adolescent obesity was estimated for the first time in a representative sample from Cyprus, and this rate is comparable to that observed in North America. These results indicate the need for individual and population measures for the treatment and prevention of pediatric obesity. The rate of obesity differs significantly depending on the method of estimation.

Prostate cancer vs hyperplasia: relationships with prostatic and adipose tissue fatty acid composition

The objective of the present study was to study whether adipose tissue and prostatic tissue fatty acid composition differentiates between prostate cancer and benign hyperplasia patients. In addition, the present investigation aimed at exploring the extent to which prostatic tissue fatty acid composition differentiates between prostate-confined cancer and extraprostatic disease including possible metastasis. The subjects were 71 male patients from the island of Crete. Half the patients (n=35) had been diagnosed with benign hyperplasia of the prostate, half with prostatic malignancy (n=36). Patients were examined at the outpatient clinic of the urology unit, University Hospital, Medical School, University of Crete. Relative to benign hyperplasia patients, cancer patients had elevated adipose tissue saturated and reduced monounsaturated fatty acid levels. Cancer patients had reduced prostate tissue stearic to oleic acid ratios and stearic acid levels as opposed to hyperplasia patients. The most pronounced difference between cancer patients and hyperplasia patients was a 3-fold elevated prostatic palmitoleic acid in the former group. Relative to benign hyperplasia patients, cancer patients had reduced prostate tissue arachidonic and docosahexaenoic acid levels. Finally, there was a significantly reduced omega-3/omega-6 polyunsaturated fatty acid ratio in the prostate cancer patient as opposed to the benign hyperplasia group. The pronounced elevations in prostatic tissue palmitoleic acid in cancer patients highlight a possible role of this fatty acid in neoplastic processes. The decreased arachidonic acid levels in cancer patients possibly stem from enhanced metabolism of arachidonic acid via lipoxygenase and cyclooxygenase pathways, and the formation of derivatives such as 5-HETE, 15-HETE, 12(S)-HETE and PGE(2).

Adipose fat quality vs. quantity: relationships with children's serum lipid levels

BACKGROUND

There is a controversy as to the relative importance of obesity vs quality of dietary fat in the prediction of serum lipoproteins in children. A reason for this is an apparent lack of studies implementing biomarkers of long-term dietary fat intake among children. The objective of the present study was to assess the relative contribution of degree of obesity, fat centrality, and quality of adipose tissue fat in the prediction of serum lipids in 12-year-old children.

METHODS

Pupils came from 40 schools randomly selected among 541 primary schools in three different provinces of the island of Crete. One thousand forty-six pupils were examined at age 6. At age 9, a representative sample from the original cohort (n = 579) was randomly selected for reevaluation. At the age of 12, a representative sample of 831 pupils was reexamined. At ages 6, 9, and 12, serum lipid measures were obtained from 941, 458, and 791 children, respectively. At age 12, data were obtained on pupils' anthropometry, serum lipids, dietary intake, physical fitness, and physical activity. Adipose tissue fatty acid data were obtained from a subsample of 194 children at age 12.

RESULTS

Regression analyses indicated that children's serum triglycerides related positively to body mass index and waist-hip ratio (WHR). Serum HDL-C related negatively to WHR and positively to endurance run test, an index of physical fitness. Dietary fatty acids, assessed by a single administration of 3-day weighed-food records, did not relate to serum lipids. However, serum HDL-C related negatively to sum of adipose polyunsaturated fatty acids, a measure of long-term polyunsaturated fat intake.

CONCLUSIONS

It appears that obesity and fat centrality are stronger predictors of children's serum lipids than the quality of long-term dietary fat intake or adipose tissue fatty acid composition. It is possible that this finding may relate to the particular subcutaneous depot studied. It is suggested that future studies study abdominal rather than buttock adipose tissue fatty acid composition in relation to children's serum lipid levels.

Reference growth curves for cypriot children 6 to 17 years of age

OBJECTIVE

The purpose of the study was to present smoothed percentiles for body weight and height, waist circumference, and body mass index (BMI) in Cypriot children and to compare their BMI 85th and 95th percentiles with those of children in other countries.

RESEARCH METHODS AND PROCEDURES

The study was a cross-sectional study, including a representative sample of 2472 healthy children (49.1% boys) in Cyprus ages 6 to 17 years, who were evaluated during the 1999-2000 school year. Body weight and height and waist circumference were measured using standard procedures. BMI was calculated as weight in kilograms per height in square meters. Smoothed, sex-specific percentiles for these variables were calculated using polynomial regression models. Crude weight, height, waist, and BMI percentile values are presented in sex-specific tables and smoothed percentile curves are presented in charts. The 85th and 95th percentiles for BMI were compared with measurements from other countries, because of the concern of the upper limits of BMI in respect to the evaluation of obesity.

RESULTS

The 85th and 95th BMI percentile values are higher in Cypriot boys than in Swedish and Iranian boys through all ages and in girls ages 6 to 15 years, whereas after the age of 15 years, both Swedish and Iranian girls' percentiles are equalized with their Cypriot peers.

DISCUSSION

Weight, height, waist circumference, and BMI values and charts are presented for the first time for Cypriot children and adolescents. Much concern should be addressed to the observation that for the majority of the Cypriot sample, the upper BMI limits are higher than the peers of developing and developed countries.

Mediterranean diet of Crete: foods and nutrient content

OBJECTIVES

To describe the traditional diet of Crete and evaluate the nutrient composition of 3 types of diet common in Crete by means of chemical analyses of composite food samples. To compare results with dietary analyses from a nutrient database developed at the University of Crete, Greece.

DESIGN

Three composite diet samples were obtained based on 7-day weighed food records representing the traditional Cretan Mediterranean diet (diet A), typical diet of present-day Greek adolescents (diet B), and fasting diet of the Eastern Orthodox church (diet C). Analyses were performed chemically and using a nutrient database.

RESULTS

Chemical analyses provided a definitive measure, for the first time, of the nutrient composition of the complete Greek diet as it was in the early 1960s. In comparing chemical analyses with nutrient database analyses, differences greater than 15% of the analyzed value were found in all 3 diets for cholesterol and some vitamins. The differences between analyzed and calculated values in total fat and saturated fat content were less than 15% in all diets.

APPLICATIONS/CONCLUSIONS

The present study provides 2 practical examples of the Mediterranean diet, which although widely publicized has rarely been analyzed chemically. Diet A has been shown to be related to the lowest rates for coronary heart disease and cancer mortality compared with the diets of the other populations of the Seven Countries study. As such, it could be recommended for health promotion and prevention of disease. Diet C contains even lower amounts of saturated fatty acids and would be excellent for patients with hypercholesterolemia. The high antioxidants in diet C probably maintain very low levels of low-density lipoprotein cholesterol. Dietary analyses of the Greek diet could be based on an operational database such as ours if further chemical analyses are performed on specific foods. These would result in improved precision of the database and possible extension into national food composition tables and a national dietary database.

Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index

BACKGROUND

Visceral adipose tissue is associated with increased risk for cardiovascular disease risk factors and morbidity from cardiovascular diseases. Waist measurement and waist-to-height ratio (WHtR) have been used as proxy measures of visceral adipose tissue, mainly in adults.

OBJECTIVE

To validate body mass index (BMI), waist circumference and WHtR as predictors for the presence of cardiovascular disease risk factors in children of Greek-Cypriot origin.

SUBJECTS AND METHODS

A total of 1,037 boys and 950 girls with mean age 11.4+/-0.4 y were evaluated. Dependent variables for the study were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholestrol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and systolic (SBP) and diastolic (DBP) blood pressure.

RESULTS

When children were divided into two groups according to the 75th percentile for BMI, waist circumference and WHtR, all dependent variables had higher mean values in the highest percentile groups in WHtR groups and almost all variables in BMI and waist circumference groups. Adjusted odds ratios for predicting pathological values of cardiovascular disease risk factors were slightly higher for the highest WHtR group for predicting lipid and lipoprotein pathological values and for the highest BMI groups in predicting high blood pressure measurement. Using stepwise multiple regression analysis to explain the variance of the dependent variables, waist circumference was the most significant predictor for all variables both for boys and girls, whereas BMI had the lowest predictive value for the detection of cardiovascular disease risk factors.

CONCLUSION

Waist circumference and WHtR are better predictors of cardiovascular disease risk factors in children than BMI. Further studies are necessary to determine the cutoff points for these indices for an accurate prediction of risk factors.

Apolipoprotein E serum concentration and polymorphism in six European countries: the ApoEurope Project

As part of the ApoEurope Project, the apolipoprotein E (apo E) serum concentration and polymorphism were determined in 6934 healthy subjects aged 25-64 years recruited in six European countries: Finland; France; Greece; Northern Ireland; Portugal and Spain. Age and sex influenced apo E concentration with concentrations being significantly higher in men than in women for those aged between 25 and 44 years. The age effect differed between the sexes after the age of 44 years, displaying a linear increase in women and a plateau in men. As expected, the serum apo E concentration was highest in varepsilon2 carriers and lowest in varepsilon4 carriers in each country with a significantly higher frequency of the varepsilon4 allele in the northern regions. The main finding of this study was a clear increasing North-South gradient in serum apo E concentration independent of age, sex and apo E genotype. In subjects aged <45 years and with the varepsilon3/varepsilon3 genotype, apo E concentration was higher in the South-East (Greece) as compared to the North by 20% for men and 32% for women. In addition to the genetic polymorphism, the geographical area is an important factor to take into account when studying serum apo E concentration in multicentre studies and defining reference values.

Drug utilization and nutrition patterns among children from indigent and emigrant families in Crete, Greece

AIM

To examine pharmaceutical needs, prescribed drugs, knowledge about pharmacotherapy and dietary patterns among indigent children.

PATIENTS

101 children (< or =18 y old), typically poor, from low-income families and emigrants coming back home from other countries, registered under Social Care in Chania, Crete. The control group comprised 81 Social Security insured children (< or =18 y old). The length of the study was from January 1995 to December 1997.

RESULTS

The socio-demographic profile of the Social Care children reveals a no schooling rate of 9.7% vs 0% of the control group. The most common disease diagnosed in the indigent children was bronchitis (18.5%) compared with respiratory infection (14.6%) in the control group. Tuberculosis was diagnosed in 2.0% of the Social Care indigent children and in none of the insured children. The most frequently prescribed drug category in both groups as Defined Daily Doses (D.D.D.) was for the respiratory system (32.4% vs 21.2%), while antibiotics were the most expensive (41.6% in the indigent vs 54.9% in the control group). Only 27.4% of Social Care indigent patients, versus 51.2% of insured patients, understood the instructions regarding the proper use of their drugs. Regarding the dietary patterns, significant differences were found in the consumption of breakfast every day (73.7% vs 87.7%), red meat > or =4 per week (0% vs 6.3%) and fruits often (60.1% vs 75.0%).

CONCLUSION

The present study emphasises the need for more information on drug use and the necessity for a continuing health educational intervention among indigent children.

Obesity indices in a cohort of primary school children in Crete: a six year prospective study

OBJECTIVE

To report on the body mass index (BMI), waist-to-hip ratio (WHR) and sum of skinfolds in a cohort of Cretan children and identify the factors associated with these indices.

DESIGN

The present study was a follow-up study. Children were measured prospectively at ages 6, 9 and 12.

SUBJECTS

Pupils came from 40 schools randomly selected from the 541 primary schools in three different provinces of Crete. 1046 pupils were examined at age 6. At age 9, a representative sample from the original cohort (n=579) was randomly selected for re-evaluation. At the age of 12, a sample of 831 pupils was re-examined, following similar procedures.

MEASUREMENTS

Both during baseline and each subsequent follow-up, data were obtained on pupils' anthropometry, serum lipids, dietary intake, physical fitness and physical activity as well as their dietary and their health knowledge. Data on parents' anthropometry, age, occupation, educational level, and issues relating to health habits, attitudes and knowledge were also collected.

RESULTS

Half of the obese children at age 6 were also obese at age 12. Cretan children had higher mean BMI than similar American cohorts. Compared to their American counterparts, Cretans had higher proportions of overweight in both genders across all ages tested. The endurance run test (ERT), an index of physical fitness, was positively associated with obesity indices. Sum of skinfolds related positively to serum LDL-C. Children from urban areas had higher skinfold sums than children from rural areas. Parental health-related hedonism related positively to children's BMI.

CONCLUSION

It appears that these findings offer some support to the reported increasing prevalence of obesity among Greek children. Higher ERT, presumably reflecting higher physical activity, is associated with lower obesity. The relationship between degree of fatness and LDL-C appears to be evidenced at an early age in life. This relationship may relate to the reported VLDL and cholesteryl ester transfer protein elevations in obesity. The parental attitude of health-related hedonism appears to be linked with children's adiposity.