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Abdel-Aal NM, Kamil RM, Tayel DI, Hamed RH, Ragab MM, Abd El-Azeim AS. Impact of adding Mediterranean diet to aerobic and strengthening exercise program on pain, inflammation, and muscle performance in females with rheumatoid arthritis: a randomized controlled trial. Physiother Theory Pract 2024:1-17. [PMID: 38804549 DOI: 10.1080/09593985.2024.2358122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND People with rheumatoid arthritis (RA) frequently use dietary interventions such as Mediterranean diet (MedDiet) and exercises to complement pharmacotherapy. OBJECTIVE To investigate the effect of adding MedDiet to a designed exercise program on quadriceps and hamstrings muscles performance, pain, C-reactive protein (CRP), handgrip strength, bodyweight, and function in females with RA. METHODS Sixty females were allocated randomly to the MedDiet plus exercise program (n = 30) or exercise program only (n = 30). The interventions continued for 6 months followed by 6 months of follow-up with no intervention. The primary outcome was the quadriceps and hamstrings muscles performance (agonist-antagonist ratio). The secondary outcomes were visual analog scale (VAS) for pain, CRP blood marker for inflammation, handheld dynamometer for handgrip strength, Health AssessmentQuestionnaire disability index (HAQ-DI) for function, and body weight. All outcomes were measured at baseline, 6-month post-intervention, and 12 months from baseline as a follow-up. RESULTS The MedDiet group showed statistically significant improvements in all the measured outcomes than the control group (p < .05) after 6 and 12 months. After 6 months of intervention, the mean±SD for agonist-antagonist ratio, pain, and HAQ-DI were 84.59 ± 5.33 and 69.92 ± 5.56 (p < .001, ƞ2 = 0.65), 42.33 ± 8.98 and 54.33 ± 10.06 (p < .001, ƞ2 = 0.3), 1.13 ± 0.48 and 1.9 ± 0.59 (p < .001, ƞ2 = 0.34) in the MedDiet and control groups, respectively. CONCLUSION Adding MedDiet to aerobic and strengthening exercise program improved quadriceps and hamstrings muscles performance, pain, functional ability, CRP, handgrip strength, and body weight. Consequently, Mediterranean diet should be considered as adjunctive therapy in treating females with RA.
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Affiliation(s)
- Nabil M Abdel-Aal
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ragia M Kamil
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Dalia I Tayel
- Department of Nutrition, High institute of public health Alexander University, Alexandria, Egypt
| | - Rania H Hamed
- Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
| | - Mohamed M Ragab
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Alshaymaa S Abd El-Azeim
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Teraž K, Šimunič B, Peskar M, Marusic U, Pišot S, Šlosar L, Gasparini M, Pišot R. Functional characteristics and subjective disease perception in patients with COVID-19 two months after hospital discharge. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1209900. [PMID: 37546579 PMCID: PMC10401436 DOI: 10.3389/fresc.2023.1209900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
Introduction Although early inpatient and post-hospital rehabilitation is recognized as necessary, not all COVID-19 patients have access to rehabilitation. There are no published reports in the literature that investigate the outcomes of patients who do not receive rehabilitation after COVID-19. Our aim was to evaluate possible improvements in determinate functional and psychological parameters in COVID-19 patients two months after their hospital discharge. Methods On both time points various motor, cognitive, and clinical measurements such as body composition, tensiomyography, blood pressure, spirometry, grip strength test, Timed Up and Go test, gait speed, 30-second chair-stand test, and Montreal Cognitive Assessment, were performed. Additionally, questionnaires such as the SARC-CalF test, Edmonton frail scale, International Physical Activity questionnaire andThe Mediterranean Lifestyle index were conducted to assess lifestyle characteristics. Results A total of 39 patients (87.2% male; mean age of 59.1 ± 10.3 years), who were hospitalized due to COVID-19 at the Izola General Hospital (IGH), Slovenia between December 2020 and April 2021, were included. Patients were assessed at two time points (T1 and T2): T1 was taken after receiving a negative COVID-19 test and T2 was taken two months after T1. After two months of self-rehabilitation, we have detected a BMI increase (p < .001), fat free mass increase (p < .001), better Edmonton frail scale (p < .001), SARC-CalF score (p = .014) and MoCA score (p = .014). There were no detected changes in lifestyle habits nor in physical performance tests. Discussion It is already known that COVID-19 has long-term negative consequences regardless of the stage of the disease. Our findings support the notion that patients cannot fully regain all their functions within a two-month period without receiving structured or supervised rehabilitation. Therefore, it is crucial to offer patients comprehensive and structured rehabilitation that incorporates clinical, cognitive, and motor exercises.
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Affiliation(s)
- Kaja Teraž
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Manca Peskar
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Biological Psychology and Neuroergonomics, Department of Psychology and Ergonomics, Faculty V: Mechanical Engineering and Transport Systems, Technische Universität Berlin, Berlin, Germany
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea – ECM, Maribor, Slovenia
| | - Saša Pišot
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Luka Šlosar
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea – ECM, Maribor, Slovenia
| | - Malden Gasparini
- Department of General Surgery, General Hospital Izola, Izola, Slovenia
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
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Poklar Vatovec T, Jenko Pražnikar Z, Petelin A. Adherence and Sociodemographic Determinants of Adherence to the Mediterranean Diet among Slovenian Adults and the Elderly. Nutrients 2023; 15:3219. [PMID: 37513637 PMCID: PMC10384731 DOI: 10.3390/nu15143219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The Mediterranean diet (MD) is considered a model for good health, and is promoted worldwide as one of the healthiest dietary patterns. Despite the MD's health benefits, the literature suggests that adherence to the MD tends to be in decline in most populations worldwide, including those in the Mediterranean region. The aim of this study was to investigate adherence to the MD, and its main sociodemographic and lifestyle factors, in the Slovenian population. Using a nationwide cross-sectional food consumption survey (SI.Menu), data were collected from a general questionnaire, from the 14-item MD adherence screener (14-MEDAS score), and from a questionnaire on the dietary habits of 850 adults and elderly people. The mean MEDAS score for the total study sample was 5.6 (SD 2.1), indicating a low adherence to the MD among the Slovenian population. The adherence to the MD was higher among women (OR = 1.534; 95% Cl 1.156-2.034), those with a university degree (OR = 1.527; 1.098-2.125; compared to those with no university degree), those who lived in a suburb or city (OR = 1.511; 1.016-2.249; OR = 1.568; 1.122-2.191; compared with those who lived in a village), non-smokers (OR = 1.561; 1.380-1.830; compared with smokers), and those who lived in the western part of Slovenia (OR = 1.558; 1.170-2.074; compared with those who lived in eastern Slovenia). Adherence to the MD in the Slovenian population is low, and is strongly related to educational level, gender, geographic region, place of residence, and smoking status. The frequency of the consumption of different food groups is also closely related.
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Affiliation(s)
- Tamara Poklar Vatovec
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
| | - Zala Jenko Pražnikar
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
| | - Ana Petelin
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
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Kendel Jovanović G, Janković S, Pavičić ŽeŽelj S. The effect of nutritional and lifestyle education intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of Croatian school children. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2023.1019849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
IntroductionNutrition education during adolescence has proven effective in increasing knowledge, attitudes, and practices in the diet. The Mediterranean diet has proven health benefits and is proposed as a model of a sustainable diet that is beneficial for health and the environment. Its promotion with the educational program can have a significant effect on improvements in nutrition knowledge, diet quality, and nutritive status of adolescents for their healthy adulthood.ObjectiveThis study aimed to investigate the effect of the educational program on the nutrition knowledge, diet quality, lifestyle, and nutritional status of school children from the littoral part of Croatia.MethodsAn education-based intervention study was carried out on 2,709 schoolchildren aged 10–12 years (educated/control group: 2617/92). The questionnaire about sociodemographic, anthropometric, dietary, physical activity, screen time, sleep habits, and nutrition knowledge was assessed at the baseline and after a 6- to 9-month follow-up for the medium-term effect of education. Nutrition knowledge was provided after 3 weeks for the short-term education effect assessment.ResultsEducated schoolchildren achieved a significant increase in nutrition knowledge (+75.5%), expressed as a short-term effect of the education and maintained at the 6- to 9-month follow-up (+66.8%, p < 0.001). Follow-up of children significantly improved their nutritional status (underweight −56.6%, normal weight 24.8%, overweight −22.1%, and obesity −57.5%) and physical activity engagement (+13.2%). The proportion of children with a diet highly adhering to the Mediterranean diet significantly doubled (+105.0). Those children with the highest nutrition knowledge at the follow-up significantly improved their nutritional status (+218.9%), participated in organized sports (+204.7%), and had a diet that highly adhered to the MD (+291.8%).ConclusionA significantly good medium-term effect of education-based nutrition and lifestyle intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of schoolchildren aged 10–12 years was shown. The educational program promoted a Mediterranean diet and lifestyle as a healthy and sustainable way of living, important for children's future health and wellbeing. New research-based approaches are needed for making children more aware and capable of handling the complexity of sustainable living.
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Adherence to the Mediterranean lifestyle pattern is associated with favorable weight loss outcomes: the MedWeight study. Nutr Res 2022; 108:73-81. [PMID: 36403536 DOI: 10.1016/j.nutres.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P < .001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.
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Montero-Sandiego E, Ferrer-Cascales R, Ruiz-Robledillo N, Costa-López B, Alcocer-Bruno C, Albaladejo-Blázquez N. Assessment Strategies to Evaluate the Mediterranean Lifestyle: A Systematic Review. Nutrients 2022; 14:nu14194179. [PMID: 36235832 PMCID: PMC9571868 DOI: 10.3390/nu14194179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
The Mediterranean Lifestyle (MLS) has been related to better health and quality of life. However, there is no consensus on how to assess this lifestyle. The main objective of this work was to systematically review the methodology used in different studies on the evaluation of the MLS. The specific objectives were (1) to analyze the MLS components evaluated in previous studies, (2) to explore the assessment instruments available for the analysis of the MLS, and (3) to identify the psychometric properties of these instruments. The search was carried out using the PubMed, Scopus, Web of Science, and ScienceDirect databases with the purpose of identifying those published articles in which the MLS was assessed. The review included 26 studies linked to the assessment of the MLS. Of these studies, only four exclusively used a tool to analyze MLS components globally. These studies included two questionnaires and three different indexes. None of them, however, evaluated all of the recognized MLS components, and food preparation was the least frequently evaluated component. Given the clear importance of analyzing MLS adherence and the lack of consensus in previous research, an evaluation tool needs to be created to comprehensively assess all of the MLS dimensions by means of appropriate psychometric properties.
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Effects of Cardiac Rehabilitation and Diet Counselling on Adherence to the Mediterranean Lifestyle in Patients after Myocardial Infarction. Nutrients 2022; 14:nu14194048. [PMID: 36235701 PMCID: PMC9572874 DOI: 10.3390/nu14194048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 02/06/2023] Open
Abstract
Adherence to the Mediterranean lifestyle—as captured by the Medlife Index Questionnaire (i.e., encompassing a Mediterranean diet as well as other aspects of healthy living, such as food preparation, physical activity, and socializing)—has been associated with reduced cardiovascular events in healthy individuals. In the present study, we sought to determine the adherence to, and the effect of comprehensive cardiac rehabilitation on, Mediterranean lifestyle adherence in patients after myocardial infarction. We included 121 patients (mean age, 55 years; women, 37%) undergoing comprehensive cardiac rehabilitation—i.e., exercise training 3 times per week for 12 weeks plus dedicated workshops promoting the Mediterranean lifestyle. Before and after cardiac rehabilitation, patients completed the Medlife Index Questionnaire. High baseline adherence was associated with favourable glucose (5.39 vs. 6.1 mmol/L; p < 0.001), triglycerides (1.1 vs. 1.5 mmol/L; p = 0.002), and HDL cholesterol levels (1.32 vs. 1.12 mmol/L; p = 0.032). More importantly, the Medlife Score significantly improved following comprehensive cardiac rehabilitation in patients with low baseline adherence (from 13.8 to 16.7 points; p < 0.001), but not in patients with high baseline adherence (from 19.4 to 18.8 points; p = 0.205). Our findings suggested that Mediterranean lifestyle promotion during cardiac rehabilitation improved adherence to the Mediterranean lifestyle, especially in low-adherence patients.
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Gerić M, Matković K, Gajski G, Rumbak I, Štancl P, Karlić R, Bituh M. Adherence to Mediterranean Diet in Croatia: Lessons Learned Today for a Brighter Tomorrow. Nutrients 2022; 14:nu14183725. [PMID: 36145100 PMCID: PMC9504207 DOI: 10.3390/nu14183725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Non-communicable diseases (NCD) and lifestyle, particularly diet, have a close relationship. Based on the recent statistics, Croatian men and women lead in European overweight lists, which implies pessimistic prognosis in terms of incidence and prevalence of NCDs in the future. One of the possible solutions to overcome weight problems is turn to traditional balanced and sustainable diets, such as the Mediterranean diet. In this study, we assessed adherence towards Mediterranean diet using a validated questionnaire in an online survey and associated adherence scores with several demographic and anthropometric data. Based on the results of a validated Mediterranean Diet Adherence Screener (N = 3326), we assessed the adherence score to be 7.6 ± 2.5. The score tended to depend on sex, residence, age, education, income, and body mass index (BMI); indeed, women, residents of a coastal part of the country, older volunteers, those possessing a higher education degree, those with higher income, and those with lower BMI were associated with higher scores. As income was one of the significant findings related to higher adherence scores, we developed a dietary plan complying with Mediterranean diet principles that, on average, costed less than the average traditional balanced diet menu. Taken together, this study brought new findings regarding target groups who need to be encouraged to make lifestyle changes, and highlighted the first steps on how to make them.
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Affiliation(s)
- Marko Gerić
- Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10 000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-14682500
| | - Katarina Matković
- Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10 000 Zagreb, Croatia
| | - Goran Gajski
- Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10 000 Zagreb, Croatia
| | - Ivana Rumbak
- Faculty of Food Technology and Biotechnology, University of Zagreb, 10 000 Zagreb, Croatia
| | - Paula Štancl
- Faculty of Science, University of Zagreb, 10 000 Zagreb, Croatia
| | - Rosa Karlić
- Faculty of Science, University of Zagreb, 10 000 Zagreb, Croatia
| | - Martina Bituh
- Faculty of Food Technology and Biotechnology, University of Zagreb, 10 000 Zagreb, Croatia
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Hershey MS, Sanchez-Villegas A, Sotos-Prieto M, Fernandez-Montero A, Pano O, Lahortiga-Ramos F, Martínez-González MÁ, Ruiz-Canela M. The Mediterranean Lifestyle and the Risk of Depression in Middle-Aged Adults. J Nutr 2022; 152:227-234. [PMID: 34549288 DOI: 10.1093/jn/nxab333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Recent evidence has indicated a greater number of protective factors are associated with a greater decreased risk for depression and depressive symptoms compared with individual factors alone. Moreover, adherence to healthy modifiable lifestyle behaviors may lower the risk of depression regardless of underlying genetic risk. OBJECTIVES We longitudinally evaluated the association of the Mediterranean lifestyle (MEDLIFE) with the risk of depression. METHODS We prospectively analyzed data from 15,279 participants (6089 men and 9190 women, mean age 37 y) in the Seguimiento Universidad de Navarra cohort. The MEDLIFE index is composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, each of which was assigned 0 or 1 point. Final scores ranged from 0 to 28 points and were categorized into quartiles of MEDLIFE adherence. Cox proportional regression models determined the association of total MEDLIFE adherence, each item, and block with incident depression. RESULTS After a mean follow-up of 11.7 y, 912 (6%) incident cases of depression were reported. The mean ± SD final score for MEDLIFE adherence was 11.9 ± 2.7 points. The multivariable model showed that compared with the first quartile, the second and third quartiles of MEDLIFE adherence were significantly associated with a decreased relative risk for incident depression (HR: 0.82; 95% CI: 0.69, 0.96 and HR: 0.74; 95% CI: 0.61, 0.89, respectively). The fourth quartile did not show a statistically significant association with incident depression (HR: 0.89; 95% CI: 0.73, 1.09). CONCLUSIONS MEDLIFE adherence may decrease the risk of depression in a Spanish cohort of university graduates. Given no clear association was observed among the highest MEDLIFE adherence, future studies are warranted to better understand the nature of this association. Evidence on MEDLIFE, beyond the Mediterranean diet, may contribute toward more effective prevention strategies for depression.
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Affiliation(s)
- Maria S Hershey
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | - Almudena Sanchez-Villegas
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.,Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Mercedes Sotos-Prieto
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
| | - Alejandro Fernandez-Montero
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,Department of Occupational Medicine, University of Navarra, Av. Pío XII, 36, Pamplona, Spain
| | - Octavio Pano
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | | | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.,Department of Nutrition, Harvard T. H. Chan School, Boston, MA, USA
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
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The Outcome of COVID-19 Lockdown on Changes in Body Mass Index and Lifestyle among Croatian Schoolchildren: A Cross-Sectional Study. Nutrients 2021; 13:nu13113788. [PMID: 34836045 PMCID: PMC8624838 DOI: 10.3390/nu13113788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/15/2022] Open
Abstract
Globally, the COVID-19 pandemic altered adults' and children's lifestyles and habits, causing an increase in body weight. Adolescents are sensitive to habit changes and, because of their insufficient capacity to deal with the unexpected COVID-19 changes, were at greater risk of noncommunicable disease development due to the consequences of adopting unhealthy habits. The survey aimed to reveal the changes in nutritional status and lifestyle habits of school children in Croatia and to assess their nutrition knowledge and emotional state and feelings about COVID-19 lockdown. Self-reported data from 1370 school children aged 10 to 15 years were obtained to examine the influence of the lockdown on their nutritional status, lifestyle and emotional status, and to assess their nutrition knowledge. The study revealed that the COVID-19 lockdown has caused an increase in the proportion of overweight and obesity among Croatian school children who changed their lifestyle habits towards being less physically active, spending more time using screen-based media and revealing potential psychological distress. However, the schoolchildren had a high adherence to the Mediterranean diet assessed with the Mediterranean Diet Quality Index for children and adolescents KIDMED index and had good nutrition knowledge. Public health programs promoting a healthy lifestyle and involving the whole family, in a school environment, could provide children with a healthy adulthood.
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Mediterranean diet scoring systems: understanding the evolution and applications for Mediterranean and non-Mediterranean countries. Br J Nutr 2021; 128:1371-1392. [PMID: 34289917 DOI: 10.1017/s0007114521002476] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Mediterranean diet (MedD) is a flexible dietary pattern which has such variability that has led to inconsistencies in definitions and assessment. The purpose of this narrative review is to evaluate scoring systems in a cultural and geographic context, from Mediterranean and non-Mediterranean countries, for comparison and application. The early MedD scoring systems (i.e. Trichopoulou's MedD Scale (T-MDS) and alternative MedD Scale (aMed)) are widely applied throughout the world but use population-specific median cut-offs which limit interpretation and cross-study comparisons. The T-MDS and aMed also do not account for non-traditional MedD foods which are consumed in greater quantities than when the scoring systems were developed. Scoring systems developed after the MedD pyramid publication in 2011 have generally used these recommendations as a basis for food group intake cut-offs, incorporating more foods/food groups as negative components, and some have included dietary and lifestyle behaviours. The different approaches to MedD assessment have created much variability in the foods/food group components included in scoring systems. Assessments that include dietary and lifestyle behaviours may reflect the nutrition transition occurring in Mediterranean countries and better guide clinical intervention approaches. While the new scoring systems are theorised to better capture MedD adherence and behaviours, comparisons are sparse in the literature and none exists outside of Europe. Consensus on food and dietary behaviours to include as well as the methodology for assigning points in MedD scoring systems is needed to advance our understanding of MedD and health relationships to promote public health messaging and clinical application.
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Quattrini S, Pampaloni B, Cianferotti L, Fossi C, Ottanelli S, Gronchi G, Duradoni M, Di Tommaso M, Dubini V, Brandi ML. Mediterranean diet adherence and dietary calcium intake in a group of pregnant women: Results of an Italian survey. Food Sci Nutr 2021; 9:3426-3435. [PMID: 34262703 PMCID: PMC8269676 DOI: 10.1002/fsn3.2233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022] Open
Abstract
Pregnancy is a delicate phase in woman's life that could become a risk factor for osteoporosis in pregnant women who do not meet recommended nutrient standards, especially for calcium and vitamin D. Mediterranean diet (MD) has been demonstrated to be beneficial for adequate nutrient intake. This article aims to evaluate the MD adherence and dietary calcium intake in a group of pregnant Italian women and to investigate how these are linked to each other and to fast glycemia at first trimester of pregnancy. Two hundred and seventy-nine pregnant women were recruited at the gynecology units of two hospitals in Florence. Socio-demographic, clinical information, and results of the first trimester blood sample analysis were collected. Two questionnaires, validated for evaluation of MD adherence and calcium intake, were administered to the pregnant women. Approximately 60% of the women had a high level of MD adherence, with a mean dietary calcium intake of 870.3 ± 335.3. In women with higher MD adherence level, fast glycemia resulted lower. Calcium intake was lower than Population Rate Intake for the Italian population (1,200 mg/daily) and was positively correlated to MD adherence score. The MD proved to be nutritious, as it was related to a higher calcium intake in this group of Italian women.
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Affiliation(s)
- Sara Quattrini
- Department of Experimental and Clinical biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Barbara Pampaloni
- Department of Experimental and Clinical biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Luisella Cianferotti
- Department of Experimental and Clinical biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Caterina Fossi
- Department of Experimental and Clinical biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Silva Ottanelli
- Department of Experimental and Clinical biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Giorgio Gronchi
- Department of Neurosciences, Psychology, Drug Research, and Child Health (Section of Psychology)University of FlorenceFlorenceItaly
| | - Mirko Duradoni
- Department of Information EngineeringUniversity of FlorenceFlorenceItaly
| | | | - Valeria Dubini
- Direttore Unità Funzionale Complessa – Attività Territoriali e Presidio P. PalagiUSL Toscana CentroFlorenceItaly
| | - Maria Luisa Brandi
- Department of Experimental and Clinical biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
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Mata-Fernández A, Hershey MS, Pastrana-Delgado JC, Sotos-Prieto M, Ruiz-Canela M, Kales SN, Martínez-González MA, Fernandez-Montero A. A Mediterranean lifestyle reduces the risk of cardiovascular disease in the "Seguimiento Universidad de Navarra" (SUN) cohort. Nutr Metab Cardiovasc Dis 2021; 31:1728-1737. [PMID: 33895077 DOI: 10.1016/j.numecd.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS A healthy lifestyle is essential to prevent cardiovascular disease (CVD). However, beyond dietary habits, there is a scarcity of studies comprehensively assessing the typical traditional Mediterranean lifestyle with a multi-dimensional index. We assessed the association between the Mediterranean lifestyle (measured with the MEDLIFE index including diet, physical activity, and other lifestyle factors) and the incidence of CVD. METHODS AND RESULTS The "Seguimiento Universidad de Navarra" (SUN) project is a prospective, dynamic and multipurpose cohort of Spanish university graduates. We calculated a MEDLIFE score, composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, for 18,631 participants by assigning 1 point for each typical Mediterranean lifestyle factor achieved, for a theoretically possible final score ranging from 0 to 28 points. During an average follow-up of 11.5 years, 172 CVD cases (myocardial infarction, stroke or cardiovascular death) were observed. An inverse association between the MEDLIFE score and the risk of primary cardiovascular events was observed, with multivariable-adjusted hazard ratio (HR) = 0.50; (95% confidence interval, 0.31-0.81) for the highest MEDLIFE scores (14-23 points) compared to the lowest scores (0-9 points), p (trend) = 0.004. CONCLUSION A higher level of adherence to the Mediterranean lifestyle was significantly associated with a lower risk of CVD in a Spanish cohort. Public health strategies should promote the Mediterranean lifestyle to preserve cardiovascular health.
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Affiliation(s)
- Arancha Mata-Fernández
- University of Navarra, Emergency Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria S Hershey
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Juan C Pastrana-Delgado
- University of Navarra, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Miguel Ruiz-Canela
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Miguel A Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; Department of Nutrition, Harvard T.H Chan School, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; University of Navarra, Department of Occupational Medicine, Pamplona, Spain.
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14
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The Mediterranean lifestyle (MEDLIFE) index and metabolic syndrome in a non-Mediterranean working population. Clin Nutr 2021; 40:2494-2503. [PMID: 33932793 DOI: 10.1016/j.clnu.2021.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/02/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS The Mediterranean lifestyle (MEDLIFE), as an overall lifestyle pattern, may be associated with a lower prevalence of metabolic syndrome. We assessed the association of a validated MEDLIFE index with metabolic syndrome and its components in a non-Mediterranean working population. METHODS A cross-sectional analysis was conducted at baseline among 249 US career firefighters in Feeding America's Bravest 2016-2018. The MEDLIFE index consisted of 26 items on food consumption, dietary habits, physical activity, rest, and social interactions that scored 0 or 1 point. Thus, total scores could range from 0 to 26 points. Multivariable logistic regression models were used to determine the associations across tertiles of MEDLIFE adherence with metabolic syndrome and each of its individual components. Multivariable linear models further assessed each component as a continuous outcome. RESULTS The prevalence of metabolic syndrome was 17.7%. Participants with higher MEDLIFE adherence (T3: 11-17 points) had 71% lower odds of having metabolic syndrome compared to those with lower MEDLIFE adherence (T1: 2-7 points) (OR = 0.29; 95%CI: 0.10 to 0.90, p for trend = 0.04). Furthermore, significant inverse associations were found for T3 versus T1 on abdominal obesity (OR = 0.42; 95%CI: 0.18 to 0.99, p for trend = 0.07) and hypertriglyceridemia (OR = 0.24; 95%CI: 0.09 to 0.63, p for trend = 0.002). Significant inverse associations for continuous outcomes included total-cholesterol (total-c), low-density lipoprotein (LDL) cholesterol, and total-c:high-density lipoprotein (HDL) cholesterol (p for trend <0.05). CONCLUSION Higher adherence to traditional Mediterranean lifestyle habits, as measured by a comprehensive MEDLIFE index, was associated with a lower prevalence of metabolic syndrome and a more favorable cardiometabolic profile in a non-Mediterranean working population. Future studies employing the MEDLIFE index in other populations are warranted to support this hypothesis.
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Portero de la Cruz S, Cebrino J. Trends in Diet Quality and Related Sociodemographic, Health, and Occupational Characteristics among Workers in Spain: Results from Three Consecutive National Health Surveys (2006-2017). Nutrients 2021; 13:522. [PMID: 33562746 PMCID: PMC7915096 DOI: 10.3390/nu13020522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/22/2022] Open
Abstract
Poor dietary practices are commonly reported in working populations from different economic sectors, resulting in increased absenteeism and a decrease in productivity. The aims of this study were to describe the frequency of food consumption and diet quality in workers aged ≥16 years from 2006 to 2017 in Spain and to evaluate the factors associated with diet quality. A nationwide cross-sectional study was carried out among workers using data from the Spanish National Health Surveys in 2006 (n = 11,068), 2011 (n = 7497) and 2017 (n = 8890). Sociodemographic, occupational, and health-related variables were used as well as diet quality data. A multiple linear regression was performed to determine the characteristics related to overall diet quality. The percentage of workers who consumed vegetables, at most, once or twice per week decreased from 2006 to 2017 (p < 0.001). A lower diet quality score was related to the consumption of tobacco and alcohol and being aged ≥25 years old, while a higher diet quality score was linked to being a woman, having Spanish nationality, receiving optimal perceived social support, being physically active in one's main occupation, doing leisure-time physical activity, and the type of contract.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal S/N, 14071 Córdoba, Spain;
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani S/N, 41009 Seville, Spain
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The Association Between the Mediterranean Lifestyle Index and All-Cause Mortality in the Seguimiento Universidad de Navarra Cohort. Am J Prev Med 2020; 59:e239-e248. [PMID: 33220762 DOI: 10.1016/j.amepre.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/22/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Overall lifestyle patterns rather than individual factors may exert greater reductions on chronic disease risk and mortality. The objective is to study the association between a Mediterranean lifestyle index and all-cause and cause-specific mortality. METHODS Investigators analyzed data from 20,494 participants in the Seguimiento Universidad de Navarra cohort in 2019. The Mediterranean lifestyle index is composed of 28 items on food consumption, dietary habits, physical activity, rest, and social interactions that score 0 or 1 point; scores theoretically could range from 0 to 28 points. RESULTS After a median follow-up of 12.1 years, 407 deaths were observed. In the multivariable-adjusted model, high adherence (>14 points) to the Mediterranean lifestyle was associated with a 41% relative reduction in all-cause mortality (hazard ratio=0.59, 95% CI=0.42, 0.83) compared with low adherence (3-10 points, p<0.001 for trend). For each additional point, the multivariable hazard ratios for all-cause mortality were 0.95 (95% CI=0.89, 1.02) for food consumption; 1.00 (95% CI=0.92, 1.08) for dietary habits; and 0.73 (95% CI=0.66, 0.80) for physical activity, rest, social habits, and conviviality. Significant interaction with age at last contact (p<0.001) suggested a lower risk for each additional point among participants aged ≥50 years (hazard ratio=0.50, 95% CI=0.34, 0.74), whereas no association was found for participants aged <50 years (hazard ratio=1.15, 95% CI=0.54, 2.44). CONCLUSIONS Adherence to a Mediterranean lifestyle may reduce the risk of mortality in a Spanish cohort of university graduates. Inverse associations were found for the overall Mediterranean lifestyle score and lifestyle block, whereas no associations were observed for the dietary blocks. Future research should consider the Mediterranean lifestyle beyond the Mediterranean diet in different populations for the promotion of healthy longevity. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02669602.
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Kenđel Jovanović G, Mrakovcic-Sutic I, Pavičić Žeželj S, Šuša B, Rahelić D, Klobučar Majanović S. The Efficacy of an Energy-Restricted Anti-Inflammatory Diet for the Management of Obesity in Younger Adults. Nutrients 2020; 12:nu12113583. [PMID: 33266499 PMCID: PMC7700374 DOI: 10.3390/nu12113583] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
There is growing evidence of the dietary impact on obesity-induced low-grade chronic inflammation and the associated chronic non-communicable diseases modification. We determined changes in body composition and cardiometabolic and inflammatory status of participants with obesity after 24 weeks of a dietary intervention based on an energy-reduced anti-inflammatory diet and examined the relationship of these changes with changes in the inflammatory potential of the diet. The anthropometric and body composition parameters of 81 participants (average age of 43 years, 74 women) were assessed. Metabolic status was determined using the glycemic and lipid statuses, and the cardiometabolic index and inflammatory status were determined using the concentration of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α). The inflammatory potential of the diet was assessed using the Dietary Inflammatory Index (DII®). Intervention with an anti-inflammatory diet resulted in a significant reduction in body weight and visceral adipose tissue and caused improvements in the participants’ cardiometabolic and inflammatory statuses. The anti-inflammatory diet was shown to be effective regarding obesity management. The study data could advance current scientific knowledge in the field of inflammation and diet, provide guidelines for obesity management, and find its application in routine clinical practice.
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Affiliation(s)
- Gordana Kenđel Jovanović
- Department of Health Ecology, Teaching Institute of Public Health of Primorsko-goranska County, Krešimirova 52a, 51000 Rijeka, Croatia;
- Correspondence: ; Tel.: +358-51-358-751
| | - Ines Mrakovcic-Sutic
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia;
| | - Sandra Pavičić Žeželj
- Department of Health Ecology, Teaching Institute of Public Health of Primorsko-goranska County, Krešimirova 52a, 51000 Rijeka, Croatia;
- Department of Health Ecology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Branislav Šuša
- General Hospital Pula, Santoriova 24a, 52100 Pula, Croatia;
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Šalata ul. 2, 10000 Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Sanja Klobučar Majanović
- Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia;
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
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Eating Behaviour and Physical Fitness in 10-Year-Old Children Attending General Education and Sports Classes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186467. [PMID: 32899483 PMCID: PMC7559846 DOI: 10.3390/ijerph17186467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/23/2023]
Abstract
The aim of this study was to evaluate the body mass index (BMI), selected eating behaviour and physical fitness of children aged 10 years attending general education and sports classes in Siedlce. Subject children were 272 girls and boys mean aged 10.8-years attending general education (GC) and sports classes (SC). Survey questionnaires consisted of 18 questions about eating behaviour and physical activity. The BMI was determined for each child and compared with reference percentile charts. Eurofit testing was used to measure physical fitness. Increased physical fitness was positively correlated with beneficial eating behaviour among children. SC children showed significantly more frequent dietary intakes of milk, dairy products, poultry, fish, wholegrain bread, groats and vegetables when compared to GC ones. However, significantly more GC children ate red meat more frequently along with snacking on confectionery and savouries than SC ones. Most subjects fell within correct BMI percentile ranges. Underweight was more frequent in SC children at 12.85% than in GC children 9.88%. Overweight and obesity was most often observed in GC children (respectively 19.73% and 5.51%) compared to SC ones (respectively 14.37% and 3.8%). SC children achieved significantly better results in the Eurofit tests. The highest levels of physical fitness and most favourable BMIs and eating behaviour were observed more often among SC children than GC ones. The results confirmed the beneficial health effects of physical fitness for children.
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Obradovic Salcin L, Karin Z, Miljanovic Damjanovic V, Ostojic M, Vrdoljak A, Gilic B, Sekulic D, Lang-Morovic M, Markic J, Sajber D. Physical Activity, Body Mass, and Adherence to the Mediterranean Diet in Preschool Children: A Cross-Sectional Analysis in the Split-Dalmatia County (Croatia). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183237. [PMID: 31487822 PMCID: PMC6765942 DOI: 10.3390/ijerph16183237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 01/29/2023]
Abstract
Physical activity, body mass, and dietary habits are known to be important determinants of overall health status, but there is an evident lack of studies that examine these issues specifically in preschool children. The aim of this study was to identify associations that may exist between adhering to the Mediterranean diet (MD), levels of physical activity (PA), and body composition indices in apparently healthy preschool children from southern Croatia. Participants were 5- to 6-year-old preschoolers from the Mediterranean part of the country (the Split-Dalmatia County; n = 260, 126 females). Adherence to the MD was observed by the Mediterranean Diet Quality Index (KIDMED), PA level was evaluated by the Preschool-age Children’s Physical Activity Questionnaire (Pre-PAQ), and responses were collected from the parents. The participants’ waist circumferences (in cm), waist-to-hip ratios, and body mass index (in kg/m2, and in a z-score calculated relative to the normative value for age and sex) were used as indicators of body composition. All children were of the same age and tested over a one-month period of the same year as a part of the regular examination undertaken before attending elementary school. With only 6% of the children having a low KIDMED score, adherence to the MD was high. MD adherence was higher in girls (Chi-square = 15.31, p < 0.01) and children who live on the coast of the Adriatic Sea (Chi-square = 18.51, p < 0.01). A mixed effects logistic regression (with kindergarten as random factor) identified sedentary activity to be negatively associated with MD adherence (OR per point: 0.65, 95% CI: 0.44–0.91). High adherence to the MD in the studied sample may be attributed to regulated feeding in kindergarten. Considering that most Croatian elementary schools do not provide food to their students, MD adherence should be investigated later in life and also in other parts of the country where the MD is culturally less prevalent.
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Affiliation(s)
- Lejla Obradovic Salcin
- Clinic for Physical Medicine and Rehabilitation, University Hospital Mostar, Bosnia and Herzegovina, 88000 Mostar, Bosnia and Herzegovina
- Faculty of Health Sciences, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Zeljka Karin
- Teaching Institute of Public Health of Split Dalmatian County, 21000 Split, Croatia
| | - Vesna Miljanovic Damjanovic
- Clinic for Physical Medicine and Rehabilitation, University Hospital Mostar, Bosnia and Herzegovina, 88000 Mostar, Bosnia and Herzegovina
- Faculty of Health Sciences, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Marko Ostojic
- Clinic for Physical Medicine and Rehabilitation, University Hospital Mostar, Bosnia and Herzegovina, 88000 Mostar, Bosnia and Herzegovina
| | - Andrea Vrdoljak
- Teaching Institute of Public Health of Split Dalmatian County, 21000 Split, Croatia
| | - Barbara Gilic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia.
| | - Maja Lang-Morovic
- Croatian Institute of Public Health, Health Promotion Division, 10000 Zagreb, Croatia
| | - Josko Markic
- Department of Pediatrics, University Hospital of Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Dorica Sajber
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia
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Social life characteristics in relation to adherence to the Mediterranean diet in older adults: findings from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study. Public Health Nutr 2019; 23:439-445. [PMID: 31439074 DOI: 10.1017/s1368980019002350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study aimed to explore the associations between social life and adherence to a healthy dietary pattern, the Mediterranean diet (MD), in a population-representative cohort of older people. DESIGN Cross-sectional study. Adherence to the MD was evaluated by an a priori score; tertiles of the score, indicating low, medium and high adherence, were used in the analyses. Social life was assessed by a questionnaire evaluating participation in leisure-time activities and the number of social contacts; primary occupation was also recorded and job characteristics were further explored. SETTING Community-dwelling older adults. PARTICIPANTS Adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study (n 1933; age range 65-99 years). RESULTS Each unit increase in the number of social contacts/month and in the frequency score of intellectual, social and physical activities was associated with a 1·6, 6·8, 4·8 and 13·7 % increase in the likelihood of a participant being in the high MD adherence group, respectively. The analysis by age group revealed that younger elderly participants had a 1·4, 8·4 and 11·3 % higher likelihood to be in the high adherence group for each unit increase in the number of social contacts/month and in the frequency score of engagement in intellectual and physical activities, respectively. Similar associations were found for older elderly participants with high compared with low MD adherence, except for the intellectual activities. CONCLUSIONS The present results suggest that high MD adherence is associated with good social life, suggesting a clustering of health-promoting lifestyle factors in older adults.
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