Changes in the Dietary Habits of the Greek EPIC Cohort Participants during a 14-Year Follow-Up Period (1997-2011)

Association between clinical and laboratory factors and response to sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes: a retrospective observational study

BACKGROUND

This study aimed to investigate the association between clinical and laboratory parameters and response to therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2D).

RESEARCH DESIGN AND METHODS

We retrospectively analyzed the medical records of people with T2D in whom SGLT2i was started. Clinical and laboratory parameters were recorded before, 3 and 6 months after starting treatment. Specific criteria were applied to classify participants into good and poor responders in terms of weight loss (primary outcome) and glycemic control (secondary outcome), separately.

RESULTS

Fifty individuals (64% men) with a mean age of 65.8 ± 8.5 years were included in the analysis. 86% and 64% of the participants were classified into good response categories for glycemic control and weight loss, respectively. Good responders in terms of glycemic control had lower high-density lipoprotein cholesterol levels at baseline compared to poor responders (43.3 vs 57.4 mg/dl, p = 0.044). In the logistic regression analysis, a higher baseline weight was associated with a better response to therapy in terms of weight loss (p = 0.04).

CONCLUSIONS

Our findings suggest that specific clinical and laboratory parameters are associated with response to SGLT2i treatment and can contribute to a more personalized approach to T2D care.

A diet-wide association study for liver cancer risk: findings from a prospective cohort study in Chinese men

Dietary factors have been extensively investigated as possible risk factors for liver cancer, but the evidence is inconclusive. Our study systematically assessed the association between 142 foods and nutrients and liver cancer risk in a Chinese population using a diet-wide association study. Based on data from 59,844 men in the Shanghai Men's Health Study (SMHS), we assessed the diet intake by dietary questionnaires. Cox regression was used to quantify the association between each food and nutrient and liver cancer risk. A false discovery rate (FDR) of 0.05 was used to select the foods and nutrients for validation. In the cohort, 431 liver cancer cases were identified during 712,373 person-years of follow-up. Retinol (HR per 1 SD increment = 1.09, 95% CI: 1.03-1.14) was associated with a higher risk of liver cancer, whereas onions (HR per 1 SD increment = 0.67, 95% CI: 0.54-0.84) and manganese (HR per 1 SD increment = 0.85, 95% CI: 0.78-0.94) were inversely associated with liver cancer risk. In the replication analysis, estimates for these foods and nutrients were similar in magnitude and direction. Our findings confirm that retinol, onions and manganese were associated with liver cancer risk, which provides reliable evidence between diet and liver cancer development.

High fish intake rich in n-3 polyunsaturated fatty acids reduces cardiovascular disease incidence in healthy adults: The ATTICA cohort study (2002-2022)

Background: The long-term effects of high fish intake rich in n-3 fatty acids for deterring cardiovascular disease (CVD) and related adverse outcomes in healthy individuals have not been yet elucidated.

Purpose: To evaluate the association between total seafood, as well as small fish, intake on 10- and 20-year CVD incidence and mortality in healthy adults.

Methods: A prospective cohort study (n = 2,020) was conducted in healthy community dwelling adults in Athens, Greece, selected following age- and sex-based random multistage sampling (mean ± SD age at baseline: 45.2 ± 14.0 years). Seafood (high (>2 servings/week) vs. low (≤2 servings/week) intake), including small fish rich in n-3 fatty acids (high (>1 serving/week) vs. low (≤1 serving/week) intake), consumption was evaluated by semi-quantitative food frequency questionnaire at baseline. The occurrence of non-fatal and/or fatal CVD events (ICD-10) was assessed during 10- and 20-year follow-up periods.

Results: Only 32.7% and 9.6% of participants had high seafood and small fish intakes, respectively. Participants with high seafood intake had 27% decreased 10-year CVD risk (adj. HR:0.73; 95% CI:0.55-0.98) and 74% lower attributable mortality (adj. HR:0.26; 95% CI:0.11-0.58). Participants with high seafood intake also sustained a 24% lower 20-year risk of CVD mortality (adj. HR: 0.76; 95% CI: 0.55-0.98). Moreover, participants with high small fish intake had a lower 10-year CVD risk and 76% decreased risk of 10-year CVD mortality (adj. HR:0.24; 95% CI:0.06-0.99), even among normotensive individuals (adj. HR:0.31; 95% CI:0.13-0.73). When analogous analyses focused on 20-year CVD incidence and mortality, similar but not significant associations were observed (all p-values >0.10).

Conclusion: High intake of seafood, and particularly small fish rich in n-3 fatty acids, was associated with a lower risk of 10-year fatal and non-fatal CVD. Thus, public health interventions aimed at enhancing small fish consumption may most effectively deter long-term CVD outcomes, particularly among low risk normotensive individuals.

Mediterranean Diet, Ketogenic Diet or MIND Diet for Aging Populations with Cognitive Decline: A Systematic Review

(1) Background: Compelling evidence shows that dietary patterns can slow the rate of cognitive decline, suggesting diet is a promising preventive measure against dementia. (2) Objective: This systematic review summarizes the evidence of three dietary patterns, the Mediterranean diet, the ketogenic diet and the MIND diet, for the prevention of cognitive decline. (3) Methods: A systematic search was conducted in major electronic databases (PubMed, ScienceDirect and Web of Science) up until 31 January 2022, using the key search terms "Mediterranean diet", "ketogenic diet", "MIND diet", "dementia", "cognition" and "aging". A statistical analysis was performed using RoB 2 and the Jadad scale to assess the risk of bias and methodological quality in randomized controlled trials. (4) Results: Only RCTs were included in this study; there were eleven studies (n = 2609 participants) of the Mediterranean diet, seven studies (n = 313) of the ketogenic diet and one study (n = 37) of the MIND diet. The participants' cognitive statuses were normal in seven studies, ten studies included patients with mild cognitive impairments and two studies included Alzheimer's disease patients. (5) Conclusion: All three dietary interventions have been shown to slow the rate of cognitive decline in the included studies. The Mediterranean diet was shown to be beneficial for global cognition after 10 weeks of adherence, the ketogenic diet had a beneficial effect for patients with diabetes mellitus and improved verbal recognition, while the MIND diet showed benefits in obese patients, improving working memory, verbal recognition, memory and attention.

Increased Adherence to a Mediterranean Diet Is Associated with Reduced Low-Grade Inflammation after a 12.7-Year Period: Results from the Moli-sani Study

BACKGROUND

There is little knowledge on the association of changes over time in adherence to a Mediterranean diet (MD) with changes in modifiable cardiovascular disease (CVD) risk factors and of markers of low-grade inflammation.

OBJECTIVE

To evaluate the association between long-term changes in MD adherence and concurrent changes in established CVD risk factors and in markers of low-grade inflammation among adult Italians.

DESIGN

A prospective cohort study was conducted. Dietary and health data were obtained both at baseline (2005-2010) and at follow-up (2017-2020). Adherence to the MD was estimated by a Mediterranean Diet Score ranging from zero to nine points, and the exposure was change in this score measured after a median 12.7-year period.

PARTICIPANTS/SETTING

This study included a subgroup of 897 men and 1,126 women aged ≥35 years at enrolment in the Moli-sani Study (n = 24,325).

MAIN OUTCOME MEASURES

Changes in two composite z scores, including nine established CVD risk factors (eg, serum lipid levels and blood pressure) and four inflammatory markers (including C-reactive protein), respectively, were measured both at enrolment and after the same 12.7-year period.

STATISTICAL ANALYSES PERFORMED

Multivariable-adjusted linear regression models were used.

RESULTS

In a multivariable-adjusted analysis, an increased Mediterranean Diet Score over time was associated with decreased levels in the Inflammatory score (β = -0.372, 95% CI -0.720 to -0.025), but had little or no influence on the CVD risk score (β = -0.200, 95% CI -0.752 to 0.351), compared with individuals who had decreased their MD adherence. Among individual food groups/nutrients included in the Mediterranean Diet Score, an increased intake of monounsaturated over saturated fats over time was associated with lower CVD Risk Score, whereas increased consumption of cereals was inversely linked to the Inflammatory Score, compared with the reduced consumption group.

CONCLUSIONS

An increased adherence to a traditional MD over time was associated with reduced low-grade inflammation. These findings suggest the potential of a traditional Mediterranean eating pattern to help reduce the long-term risk of inflammation-related chronic diseases in an ageing population.

Consumer attitudes toward dairy products from sheep and goats: A cross-continental perspective

This study aimed to assess consumer knowledge, attitudes, and perceptions toward dairy products from sheep and goats. A web-based survey was conducted in Latin America (Mexico and Chile), Europe (Italy, Spain, Greece, and Denmark), and Asia (Bangladesh). From March to June 2021, adult participants answered an online survey available in 5 languages. In total, 1,879 surveys were completed. Categorical and ordinal data were analyzed as frequencies and percentages. To determine the relationship between the variables for purchasing and consumption behaviors of respondents who declared that they consume dairy products, a multiple correspondence analysis was carried out. Most completed surveys were from Mexico and Italy (30% and 33.7%, respectively). Most respondents were between 18 and 29 yr old, female, highly educated, and employed. The majority of respondents (70.8%) declared that they consume dairy products from small ruminants. Consumers preferred products from both sheep and goats (49.4%); however, it was observed that in Mexico, Denmark, and Bangladesh, more than 50% preferred goat dairy products. The most-consumed products were mature and fresh cheeses. Mature cheese was the most-preferred product in Chile; in Mexico, Italy, Greece, and Denmark, it was fresh cheese. Unlike the rest of the countries, in Bangladesh, dairy product consumption from small ruminants was observed by more than 30% of respondents. In Mexico, a higher percentage of people do not consume sheep or goat dairy products because they are unfamiliar with them. In Mexico, Chile, and Bangladesh, limited market availability was also a variable responsible for nonconsumption. In European and Asian countries, sheep and goat dairy products are not consumed because consumers dislike them, in addition to a greater awareness of sustainability and climate change issues. The multiple correspondence analysis defined 5 dimensions. Dimension 1 was associated with the geographic location of the respondent (country and continent), the type of milk (sheep or goat), and the consideration of well-being and health as characteristics associated with the consumption of dairy products from small ruminants. Dimension 2 was associated with the respondent's country of origin and the frequency of consumption. Dimension 3 was associated with gender, education, and employment status. Dimension 4 was associated with the respondent's age, the association of the "healthy" concept of sheep and goat dairy products, and the consideration of the nutritional benefits of dairy as responsible for considering them healthy. Dimension 5 was associated with a "strong smell and taste" of sheep and goat dairy products. This study showed that consumer attitudes toward dairy products from sheep and goats vary between continents. In conclusion, results showed consumer interest in animal welfare and environmental impact issues related to small ruminant farming as well as a general attraction to local products. It seems that these factors contribute to consumers' perception of the quality of dairy products, so the industry and select farmers should carefully consider incorporating them into their supply chain.

Nutrition Transition in Europe: East-West Dimensions in the Last 30 Years—A Narrative Review

The current review aims to summarize published research on nutrition transition patterns (depicting changes in dietary consumption) in European populations over the last three decades (1990–2020), with a focus on East-West regional comparisons. Pubmed and Google-Scholar databases were searched for articles providing information on repeated dietary intakes in populations living in countries across Europe, published between January 1990 and July 2021. From the identified 18,031 articles, 62 were found eligible for review (17 from Eastern and 45 from Western European populations). Overall, both in Eastern and Western Europe, there have been pronounced changes in dietary consumption patterns over the last three decades characterized by reductions in average reported intakes of sugar, carbohydrates and saturated fats and increases in reported fruit and vegetable consumption. There has also been a tendency toward a reduction in traditional foods, such as fish, observed in some Mediterranean countries. Overall, these data suggests that European countries have undergone a nutrition transition toward adopting healthier dietary behaviors. These processes occurred already in the period 1990–2000 in many Western European, and in the last decades have been also spreading throughout Eastern European countries. Firm conclusions are hampered by the lack of standardized methodologies depicting changes in dietary intakes over time and the limited coverage of the full variety of European populations. Future studies based on standardized dietary assessment methods and representative for the whole range of populations across Europe are warranted to allow monitoring trends in nutrition transition within and among European countries.

Today’s Mediterranean Diet in Greece: Findings from the National Health and Nutrition Survey—HYDRIA (2013–2014)

Background: This study aimed to investigate the food and macronutrient intake of the population in Greece and evaluate its adherence to the Greek traditional Mediterranean diet. Methods: Adults over 18 years old (n = 4011) were included from the 2013–2014 National Health and Nutrition survey—HYDRIA. Dietary intake was collected using two 24-h recall interviews and a nonquantitative food frequency questionnaire. Macronutrient intakes were calculated using an updated version of the Greek FCT. Results: Only 28.3% of the adult population had high adherence to the Greek traditional Mediterranean diet, with a higher percentage (39.7%) observed for participants over 65 years compared to those under 65 years (25.5%). Differences in adherence to the MD were observed among the four geographical regions in Greece. Younger adults had a higher intake of meat, cereals, alcoholic and nonalcoholic beverages, and sugar products than older individuals who consumed more vegetables, fruits, legumes, dairy, fish, and lipids (mainly from olive oil). Adults do not meet the international dietary recommendations for the intake of several foods and macronutrients. Conclusions: The adult Greek population, especially younger people, has headed away from the Greek traditional Mediterranean diet. These observations indicate potential detrimental consequences in terms of morbidity and mortality.

Sustainable diets & medicinal aromatic plants in Greece: Perspectives towards climate change

In recent years, climate change continuously concerns the scientific community about its effects on agrobiodiversity, food safety and human health. Remodeling to sustainable diets and lifestyles is proved to be the most radical need to tackle this grave phenomenon. The goals of this commentary are to present the Greek traditional Mediterranean diet as a principal sustainable diet, to emphasize the role of Medicinal and Aromatic Plants in Greece as indispensable components of this healthy dietary pattern, and to discuss the potential results of climate change at their phytochemical content. Moreover, the impact of climate challenge at the occurrence of Greek MAPs and their survival is also described. Multiple approaches for addressing this challenge are proposed, as well as recommendations for specific actions with a focus on Greek traditional Mediterranean diet and MAPs of Greece.

Dietary Habits of Older Adults in Serbia: Findings From the National Health Survey

Objectives: Adults aged 65 years and older comprise one fifth of the Serbian population. Many of them have multiple, often diet-related comorbidities. We aimed to investigate their dietary habits by comparing them with younger adults' and to determine the relation of the differing ones to demographic, socioeconomic and health factors. Methods: We performed a secondary analysis of 2013 Serbian National Health Survey data on 14,082 adults. Binary logistic regression was used to determine dietary habits associated with older age (≥65 years) compared to younger age (18-64 years) and to assess their independent predictors in older adults. Results: Older adults more often reported everyday breakfast (OR = 2.085, 95%CI = 1.622-2.680) and brown/wholegrain bread consumption (OR = 1.681, 95% CI = 1.537-1.839), while using margarine (OR = 0.578, 95%CI = 0.397-0.839), discretionary salt (sometimes: OR = 0.648, 95%CI = 0.596-0.705, almost always: OR = 0.522, 95%CI = 0.445-0.614) and consuming fish (two or more times a week: OR = 0.465, 95%CI = 0.383-0.566) less frequently than younger adults. This was mainly positively related to urban environment, affluence, higher education and poor health. Conclusion: Using nationally representative data, we found that older adults reported healthier dietary habits compared to younger adults, which requires timely public health action.