Subjective Cognitive Decline as a predictor of Frailty in older adults: Hellenic Longitudinal Investigation of Aging and Diet study (HELIAD)

BACKGROUND

Subjective cognitive decline (SCD) is a self-evaluation of cognitive impairment, in the absence of observed objective cognitive deficits on a neuropsychological assessment. Frailty refers to a multidimensional syndrome where the individual has poor health including falls, disabilities, hospitalization, and vulnerability. Both terms are associated with cognitive decline and increased incidence of dementia. The present longitudinal study explored whether the detection of SCD can predict the development of frailty over time.

METHODS

The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) is an epidemiological, population-based study. From the original testing sample of 1,984 older Greek individuals (≥65 years old), 1,121 remained in the longitudinal analysis. Participants diagnosed with frailty, Mild Cognitive Impairment (MCI), dementia, severe depression, and anxiety, in the baseline assessment were excluded from the analysis (n=146), resulting in a total sample of 975 participants. The average follow-up interval was 3.1 years (SD=0.84 years). SCD was assessed in the baseline assessment with a series of eighteen questions. The questions regarding SCD were categorized according to cognitive domains. Frailty was assessed according to a phenotypic-physiologic (Fried's definition) and a multidomain approach (Frailty Index). Univariate and multivariate Cox regression analyses were used for exploring the role of SCD in developing frailty.

RESULTS

The proportion of individuals with frailty according to Fried's definition was greater compared to the Frailty Index. At follow-up according to Fried's definition, a greater proportion of cases with frailty was found in those who reported SCD complaints regarding orientation (OD) (HR=3.12 95% CI:1.45-6.73 p<0.004) or in those who reported at least three SCD complaints regarding their memory performance (SMC3) (HR=1.92 95% CI:1.05-3.52 p<0.035) at the baseline assessment. Subjective complaints regarding orientation were predictive of a greater hazard of frailty as defined by the Fried scale (HR=3.12 95% CI:1.45-6.73 p<0.004) and the Frailty Index (HR=3.59 95% CI:1.77-7.25 p<0.001).

CONCLUSION

Our findings demonstrate that healthy older adults who report SCD complaints regarding orientation or state that they have at least three memory complaints have a higher risk of developing frailty. Additionally, the number of participants with a clinical diagnosis of MCI or dementia, compared to individuals with normal aging, at follow-up was found to be significantly greater in cases with frailty according to both frailty definitions applied (p<0.001). Consequently, it is advisable to use screening questionnaires for SCD covering multiple cognitive domains in clinical practice for identifying and managing frailty, thus, implementing effective interventions to promote healthy aging.

Association between 9p21-23 Locus and Frailty in a Community-Dwelling Greek Population: Results from the Hellenic Longitudinal Investigation of Ageing and Diet

BACKGROUND

Frailty is a complex geriatric syndrome arising from a combination of genetic and environmental factors and is associated with adverse health outcomes and mortality. A recent study reported an association between variants of the 9p21-23 locus, associated with a number of age-related disorders, including Alzheimer's disease (AD), and frailty. Frailty has been associated with increased risk of developing AD and it has been proposed that frailty burden may modify AD clinical presentation. In view of the overlapping genetic architecture between the two disorders, it is noteworthy to conduct studies to uncover risk variants that contribute to both AD and frailty. The purpose of this study is to test the reproducibility of the association of 9p21-23 locus with frailty in a population that is ethnically different from previous work and in the context of multidimensional definitions of frailty that will allow us to examine the potential impact to domains pertaining to AD pathology.

METHODS

We operationalized frailty according two definitions and the corresponding instruments, the Frailty Index (FI) and the Tilburg Frailty Indicator (TFI) and we determined genotypes of eight alleles previously identified as risk increasing for frailty in 1172 community-dwelling older participants (57% females) from the HELIAD study with a mean age of 74 years old. We cross-sectionally investigated the association between risk alleles and frailty, as well as with specific components of each definition using linear regression analyses adjusted for age, sex and years of education.

RESULTS

Compared to non-carriers, carriers of rs7038172 C risk allele, were associated with a higher FI Score (β=0.089, p=0.002). Similarly, we found a positive association between the presence of at least one rs7038172 C variant and TFI score (β=0.053, p=0.04). Moreover, the rs7038172 variant was associated, irrespectively of dementia status, with the memory and psychological domain of FI and TFI, respectively.

CONCLUSION

Our study confirms the association of the rs7038172 C allele with the frailty syndrome in a Greek population and in the context of multidimensional definitions of frailty. Furthermore, we report novel associations between this allele and the memory domain of FI and the psychological domain of TFI, that includes memory problems on its components. Given that frailty burden has been shown to modify the AD clinical presentation, it is likely that rs7038172 C allele may accelerate the transition of AD or frailty to dementia Overall, our study corroborates the role of the 9p21-23 region in frailty development and draw potential links with AD pathology.

Objective and Subjective Measurements of Motor Function: Results from the HELIAD Study

BACKGROUND

Slow gait speed has recently emerged as a potential prodromal feature of cognitive decline and dementia. Besides objective measurements, subjective motor function (SMF) difficulties might be present prior to the manifestation of gait disorders.

OBJECTIVES

To examine the association of walking time and the presence of SMF with future cognitive decline in cognitively normal individuals.

DESIGN

Longitudinal study.

SETTINGS

Athens and Larissa, Greece.

PARTICIPANTS

931 cognitively normal individuals over the age of 64 with longitudinal follow-up from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD).

MEASUREMENTS

We used a simple chronometer for recording objective walking time (OWT) and SMF was assessed using a self-reported physical functioning questionnaire. Generalized estimating equations (GEE) models were deployed to explore the associations between baseline OWT and SMF difficulties and the rate of change of performance scores on individual cognitive domains over time. Models were adjusted for age, years of education and sex.

RESULTS

Each additional second of OWT was associated with 1.1% of a standard deviation more decline per year in the composite z-score, 1.6% in the memory z-score, 1.1% in the executive z-score and 1.8% in the attention-speed z-score. The presence of SMF difficulties was not associated with differential rates of decline in any cognitive domain.

CONCLUSION

Gait speed can be indicative of future cognitive decline adding credence to the notion that gait speed might serve as a simple and easily accessible clinical tool to identify a larger pool of at risk individuals and improve the detection of prodromal dementia.

Prevention of Alzheimer's Disease and Cognitive Decline with Diet and Lifestyle: Proceedings of the A. G. Leventis Foundation Conference

The A. G. Leventis Foundation International Conference, "Prevention of Alzheimer's Disease and Cognitive Decline with Diet and Lifestyle", was held on May 11-12th, 2022 in Nicosia, Cyprus. This conference examined the role of diet and lifestyle for the prevention and treatment of Alzheimer's Disease and other forms of cognitive decline. Speakers from leading academic institutions presented evidence on healthy dietary patterns, with a particular focus on the traditional Mediterranean diet (MedDiet), in association with cognitive outcomes, mainly cognitive decline, dementia, and Alzheimer's disease, from both observational and interventional studies. Moreover, future directions for the potential use of olive oil, rich in polyphenols, for its therapeutic use as a nutraceutical, as well as nutritional interventions with high-quality dietary patterns (i.e. MedDiet) that support existing primarily observational evidence for the prevention of cognitive decline, as well as challenges in designing rigorous clinical trials are summarized and discussed within the conference proceedings.

Sleep Quality and Duration as Determinants of Healthy Aging Trajectories: The HELIAD Study

BACKGROUND

The aging of global population has increased the scientific interest in the concept of healthy aging and its determinants.

AIM

The aim of this study was to investigate the association of sleep characteristics with trajectories of healthy aging.

DESIGN AND SETTING

Prospective observational study conducted in two cities, Maroussi and Larissa.

PARTICIPANTS

A total of 1226 older adults (≥65 years, 704 women) were selected through random sampling.

MEASUREMENTS

Sleep quality was assessed with the Sleep Index II, and sleep duration was self-reported. A healthy aging metric was introduced using an Item Response Theory approach based on validated questionnaires that assessed functionality. Four healthy aging trajectories were developed based on whether the healthy aging status of the participants was above (High) or below (Low) the median at baseline and follow-up, i.e., High-High, High-Low, Low-High, and Low-Low. The association of sleep characteristics with the trajectories was investigated using a multinomial logistic regression with the Low-Low group as reference, adjusting for potential confounders.

RESULTS

34.3% participants classified to the High-High group, 15.7% to the High-Low, 18.6% to the Low-High, and 31.4% to the Low-Low group. Better sleep quality was associated with the probability of belonging to the High-High group (p-value<0.001); while, long sleep duration was inversely associated with likelihood of being classified in the High-High group (p-value < 0.05).

CONCLUSION

Poor sleep quality and long sleep duration seem to have a significant negative association with healthy aging. Public health policies are needed to raise awareness about the importance of sleep characteristics on human health.

Weight-related behaviors and weight loss maintenance: a cross-sectional study in Cyprus

Background

This study examined the differences between maintainers and regainers regarding obesity related eating behaviors. A secondary objective was to develop an eating behavior index predicting the likelihood of successful weight loss maintenance.

Methods

The current cross-sectional evaluation conducted in Cyprus was part of the MedWeight (Greek) study. Eligible for participation were Cypriot (maintainers = 145; regainers = 87) adult men and women who reported being at least overweight (BMI ≥25 kg/m²) and experienced an intentional weight loss of ≥10% of their maximum lifetime weight, at least 1 year before participation. Among other assessments, weight-related behaviors were evaluated through Weight-Related Behaviors Index (WRBI).

Results

Statistically significant differences between the two groups were observed regarding meals per day (P = 0.008), frequency of eating home cooked meals (P = 0.004) and WRBI total score (P = 0.022). Results from logistic regression models indicated that the odds of maintaining weight loss increase at 30% (Model 1: P < 0.05, Odds ratio 1.306, 1.095–1.556 95% C.I., Model 2: P < 0.05, OR 1.308, 1.097–1.560 95% C.I.) and at 38% after adjusting for physical activity (Model 3: P < 0.05, OR 1.377, 1.114–1.701 95% C.I..) for each point scored in WRBI total score.

Conclusions

Eating more frequently home cooked meals and less eating away from home meals may be beneficially associated with weight loss maintenance. WRBI seems to be a useful tool when dealing with patients who have previously lost significant weight.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11153-5.

Plasma GSH levels and Alzheimer's disease. A prospective approach.: Results from the HELIAD study

BACKGROUND

Potential links between oxidative stress and the pathophysiology of Alzheimer's disease (AD) have been reported in the existing literature. Biological markers of oxidative stress, such as the reduced form of glutathione (GSH), may have a potential role as predictive biomarkers for AD development. The aim of the present study was to explore the longitudinal associations between plasma GSH and the risk of developing AD or cognitive decline, in a sample of community-dwelling, non-demented older adults.

METHODS

Participants from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present prospective study. The sample used in the analyses consisted of 391 non-demented individuals over the age of 64 (mean age = 73.85 years; SD = 5.06), with available baseline GSH measurements and longitudinal follow-up. Plasma GSH was treated both as a continuous variable and as tertiles in our analyses. Cox proportional hazards models were used to evaluate the hazard ratio (HR) for AD incidence as a function of baseline plasma GSH. Generalized estimating equations (GEE) models were deployed to explore the associations between baseline plasma GSH and the rate of change of performance scores on individual cognitive domains over time. Models were adjusted for age, years of education and sex. Supplementary exploratory models were also adjusted for mild cognitive impairment (MCI) at baseline, risk for malnutrition, physical activity and adherence to the Mediterranean dietary pattern.

RESULTS

A total of 24 incident AD cases occurred during a mean (SD) of 2.99 (0.92) years of follow-up. Individuals in the highest GSH tertile group (highest baseline plasma GSH values) had a 70.1% lower risk for development of AD, compared to those in the lowest one [HR = 0.299 (0.093-0.959); p = 0.042], and also demonstrated a slower rate of decline of their executive functioning over time (5.2% of a standard deviation less decline in the executive composite score for each additional year of follow-up; p = 0.028). The test for trend was also significant suggesting a potential dose-response relationship.

CONCLUSION

In the present study, higher baseline plasma GSH levels were associated with a decreased risk of developing AD and with a better preservation of executive functioning longitudinally.

The role of triglycerides-glucose index to predict 10-year first and recurrent cardiovascular disease events: a sex-based analysis from ATTICA and GREECS prospective studies

Background/Introduction

Triglycerides-glucose index (TyG) has been used in apparently healthy individuals to define insulin resistance and liver steatosis. Additionally, findings from very recent studies challenge the use of this index as a predictor of cardiovascular disease (CVD) onset as well as a marker of atherosclerosis in patients with established CVD.

Purpose

To evaluate the association between TyG and 10-year first or recurrent fatal/non fatal CVD event.

Methods

The samples from two prospective epidemiological studies implemented in Greece were used. In particular, in ATTICA study, in 2001–02, 1,514 men and 1,528 women (&gt;18 years) free of CVD, at baseline, living in greater Athens area, Greece, were enrolled and 10-year follow up was performed (2011–12) in 2,020 participants (n=317 cases). In GREECS study, in 2003–04 almost all consecutive 2,172 acute coronary syndrome (ACS) patients of 6 Greek hospitals were enrolled. In 2013–14, 10-year follow-up was performed in 1,918 participants. TyG was assessed at baseline using a standard formula.

Results

In ATTICA, ranking from 1st (i.e. &lt;8.0) to 3rd TyG tertile (i.e. &gt;8.6), 10-year first CVD incidence was 5.6%, 14.2% and 24.1% (p&lt;0.001); the respective man-to-woman incidence ratio was 1.86, 1.17 and 1.19. In GREECS, ranking from 1st (i.e. &lt;8.7) to 3rd TyG tertile (i.e. &gt;9.3), 10-year recurrent CVD incidence was 35.3%, 43.2% and 35.9% (p=0.11); the respective man-to-woman incidence ratio was 1.08, 0.99 and 1.23. Multi-adjusted Cox regression analysis in ATTICA study revealed that participants assigned in the 3rd TyG tertile had about 77% higher CVD risk compared with their 1st tertile counterparts [Hazard Ratio (HR)=1.77, 95% Confidence Interval (95% CI) (1.06, 2.96), p=0.02]; sex-based stratified analysis revealed that this association remained significant only in women [HR=2.29 95% CI (1.20, 4.38), p=0.01] while in case of men this association was borderline significant [HR=1.70 95% CI (0.95, 3.35), p=0.10]. The total correct classification rate was around 83–85% in all models and similar with models adjusted separately for triglycerides or glucose levels. Using the area under the Receiver Operation Characteristic ROC) curve (AUC) analysis TyG had the best discriminative ability in both sexes with a small advantage in favor of women and minor discrepancies with the commonly used –triglycerides and glucose– biomarkers (Women: AUCTyG=0.694, AUCtriglycerides=0.678, AUCglucose=0.601 / Men: AUCTyG=0.662, AUCtriglycerides=0.634, AUCglucose=0.623). In case of GREECS study, no significant trends were observed.

Conclusions

The findings here suggest a predictive role of TyG against long-term CVD onset which comes in line with recent works; yet its added value against conventional markers such as glucose and triglycerides was not confirmed. Additionally, no significant prognostic effect of TyG against CVD recurrence was observed challenging its clinical use in secondary prevention spectrum.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

The role of dietary vitamin D intake on 10-year cardiovascular disease incidence, intermediate cardiometabolic risk factors and surrogate markers: highlights from ATTICA prospective study

Background/Introduction

Increasing vitamin D intake through food supplements or fortification is far from revealing strong contribution to cardiac health. On the other side, the separate evaluation of dietary vitamin D intake with cardiac health is limited.

Purpose

The aim of the present work was to evaluate the association between dietary vitamin D intake and 10-year first fatal/non fatal CVD, conventional CVD risk factors and surrogate markers related with inflammation, coagulation, insulin resistance, liver and renal function.

Methods

ATTICA prospective study was conducted during 2001–2012 and included n=1,514 men and n=1,528 women (aged &gt;18 years old) from the greater Athens area, Greece. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Daily intake of vitamin D was calculated through standardized food database. Follow-up assessment of CVD (2011–2012) was achieved in n=2,020 participants (n=317 cases).

Results

Ranking from 1st to 3rd vitamin D tertile, CVD event was for men 24%, 17% and 12% (p=0.002) and for women 14%, 10% and 11% (p=0.59), respectively. Multiadjusted analysis revealed inverse associations between vitamin D and CVD in total sample [Hazard Ratio (HR)=0.76 95% Confidence Interval (95% CI) (0.60, 0.97)] and in men [HR=0.66 95% CI (0.49, 0.89)], lost after adjusting for inflammation/coagulation markers; for women no significant trends against hard CVD endpoints were observed. Regarding 10-year onset of conventional risk factors, inverse associations of vitamin D with hypertension in men [HR=0.62 95% CI (0.39, 0.99)] and transition to metabolically unhealthy status in women [HR=0.69 95% CI (0.51, 0.93)] were observed. Multiadjusted analyses revealed significant inverse associations for C-reactive protein, interleukin-6 and fibrinogen in both sexes while only in women for insulin resistance.

Conclusions

Contradicting the neutral/modest associations in vitamin D supplementation trials, the present work revealed that increased food-generated vitamin D may protect against hard and intermediate CVD endpoints implying the existence of different paths between sexes.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

A U-shape trend between total and red meat consumption and depressive symptomatology in apparently healthy women: highlights from the ATTICA prospective (2002–2012) study

Background/Introduction

Increasing amount of evidence currently suggests that in the context of vegetarianism, where meat is completely excluded from daily diet, the risk to develop depression-related symptoms is impressively high.

Purpose

The aim of the present work was to evaluate the association of meat consumption with prevalent depressive symptomatology in apparently healthy individuals.

Methods

ATTICA study was conducted during 2001–2012 including n=1,514 men and n=1,528 women (aged &gt;18 years old) from the greater of our region in Greece. At baseline, depressive symptomatology through Zung Self-Rating Depression Scale (range 20–80) and meat consumption (total meat, red, white and processed meat) through validated semi-quantitative food frequency questionnaire were assessed. Follow-up (2011–2012) was achieved in n=2,020 participants (n=317 cases); n=845 participants with complete psychological metrics were used for the primary analysis.

Results

Ranking from 1st to 3rd total meat consumption (low to high) tertiles, participants assigned in 2nd tertile had the lowest depressive-symptomatology scoring (p&lt;0.001). This trend was retained in multi-adjusted logistic regression analysis; participants reporting moderate total and red meat consumption had ∼20% lower likelihood to be depressed (i.e. Zung scale&lt;45) compared with their 1st tertile counterparts (Odds Ratio (OR)total meat 0.82, 95% Confidence Interval (95% CI) (0.60, 0.97) and ORred meat 0.79 95% CI (0.45, 0.96)). Non-linear associations were revealed; 2–3 serving/week total meat and 1–2 servings/week red meat presented the lowest odds of depressive symptomatology (all ps&lt;0.05). All aforementioned associations were more evident in women (all ps for sex-related interaction&lt;0.05).

Conclusions

The present findings generate the hypothesis that moderate total meat consumption and impressively, red meat may be more beneficial to prevent depressed mood and probably in turn hard CVD endpoints.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

P4410Normal weight central obesity and 10-year cardiovascular disease onset in apparently healthy males and females: the interacting effect of sex

Background/Introduction

The notion that standard weight–height tables are the proper way to determine high-risk groups for obesity-related disorders has been largely challenged, yet scarce data exist from the standpoint of sex.

Purpose

To evaluate the effect of combined weight and waist-circumference (WC) status on 10-year first fatal/non fatal cardiovascular disease (CVD) event in apparently healthy males and females.

Methods

A prospective study (2001–2012) was conducted in Greece with n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Follow-up assessment of CVD event (2011–2012) was achieved in n=2,020 participants (317 cases). Normal weight (NW) status was defined as body mass index (BMI) from 18.5kg/m2 to 25kg/m2 while central obesity as WC≥102cm for males and ≥88cm for females. NW central obesity (NWO) was defined as BMI within the normal range and abnormal WC.

Results

The prevalence of NWO reached 10% (n=302) with female:male ratio being close to 4:1 (p<0.001). Within NW group ∼25% of participants presented increased WC. Ten-year CVD incidence in NWO subjects reached 14.1% which was twice as high as the respective rate for NW participants without central obesity (7.4%) and followed by the 15.4% and 24.1% in overweight/obese participants without or with central obesity, respectively (p<0.001). The female:male CVD event rate ratio was 0.37, 0.77, 0.42, 0.64 ranking from NW participants without central obesity to NWO and overweight/obese without or with central obesity (p<0.001). Cox regression analysis revealed that NWO status was independently associated with 10-year CVD event (Hazard Ratio (HR)=1.87, 95% Confidence Interval (95% CI) 1.04, 3.37, p=0.03) when compared with their NW counterparts with normal WC, after adjusting for sociodemographic, clinical, lifestyle and biochemical factors (i.e. insulin resistance and systemic inflammation). When NWO subjects were set as reference group and compared with their overweight/obese counterparts with or without central obesity, no significant trends were observed (all ps>0.05). A significant interaction between sex and the combined weight and central obesity status was observed (p for interaction<0.001). Stratified analysis revealed that the aforementioned associations were retained only in NWO females (HR=2.35, 95% CI 1.15, 4.79, p=0.01) when compared with their NW counterparts without central obesity; in males the association did not reach the level of significance. C-statistics [C-index (95% CI)] revealed that within the NW range, WC-adjusted model had a better discriminative ability in females [0.810 (0.778, 0.842)] compared with males [0.789 (0.763, 0.810)] while a BMI-adjusted model seemed to discriminate better the CVD event in males [0.801 (0.772, 0.831)] than in females [0.762 (0.731, 0.798)].

Conclusion

Studies addressing the complex interaction between fat and BMI as well as its effect on CVD are demanded, yet with the potential to highlight sex-specific remarks.

Acknowledgement/Funding

The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

P5295Stable and temporal metabolically benign obesity and cardiovascular disease onset in males and females: the missing link with adiponectin

Background/Introduction

Metabolically healthy obesity (MHO) status has been recently conferred to be a transient condition with cohorts revealing that a considerable proportion, from 33% to 52%, lose their status over time.

Purpose

To evaluate the stability of MHO, its effect on 10-year first fatal/non fatal CVD onset and the mediating effect of adiponectin.

Methods

A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants; of them, n=317 incident cases were identified. Obesity was defined as body mass index≥30kg/m2 and healthy metabolic status as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Circulating adiponectin level was measured at baseline (4.0 (2.0) μg/mL).

Results

MHO prevalence reached 4.8% (n=146) (4.9% in males and 4.7% in females, p=0.198). 28.2% of obese participants presented a metabolically benign status at baseline. In the 5-year follow-up period, transition to metabolically unhealthy status was observed for 33% of MHO participants. Within the decade, almost half of MHO participants resulted as metabolically unhealthy obese. Unadjusted analysis revealed that stable vs. temporal MHO subjects had better lifestyle (i.e. higher adherence to Mediterranean diet and better physical activity status) at the recruitment (all ps<0.05). Temporal MHO subjects presented lower adiponectin values (2.8 (1.1) μg/mL) compared with their stable MHO counterparts (4.1 (1.9) μg/mL) (p<0.05). Multivariate Cox regression analysis revealed no significant discrepancies on 10-year CVD risk between MHO and metabolically healthy non-obese subjects (Hazard Ratio (HR)=0.95, 95% Confidence Interval (95% CI) 0.37, 2.08, p=0.32). Only the subset of temporal MHO subjects reached the level of significance (HR=1.43, 95% CI 1.02, 2.01, p=0.04). Stable MHO status was not independently associated with 10-year CVD risk (p>0.05). Low vs. high adiponectin level was associated with ∼1.3 times higher 10-year risk to move from MHO to metabolically unhealthy obesity status (HR=1.33 95% CI 1.10, 4.02). Sensitivity analyses revealed that adiponectin had a significant interacting effect on the examined associations (p for interaction=0.01); stratified analysis using the mean value of adiponectin to define the strata revealed that MHO (stable or temporal) status was positively associated with 10-year CVD event only in participants with low adiponectin levels i.e. below the mean value of 4.1 μg/mL (HR=1.45 95% CI 1.19, 3.68).

Conclusions

Weight management is needed to prevent cardiometabolic features even in participants with increased weight status with healthy metabolic status. It is noteworthy that adiponectin may be an underlying path of the stability and CVD risk corresponding to this intermediate condition probably related with insulin resistance and other relevant paths.

Acknowledgement/Funding

The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION): study design, cohort description, and preliminary data

Objectives: Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION) is a longitudinal ongoing study initiated in 2018 that takes place in the Cognitive Disorders Clinic of Aiginition Hospital of the National and Kapodistrian University of Athens. Its aim is to address several research questions concerning the preclinical and prodromal stage of Alzheimer's disease and explore potential markers for early detection, prediction, and primary prevention of dementia. Methods: We here present the design and the preliminary baseline characteristics of ALBION. The sample of our study consists of people aged over 50 who are concerned about their memory but are cognitively normal (CN) or have mild cognitive deficits. Each participant undergoes an extensive assessment including several demographic, medical, social, environmental, clinical, nutritional, neuropsychological determinants and lifestyle activities. Furthermore, we are collecting data from portable devices, neuroimaging techniques and biological samples (blood, stools, CSF). All participants are assessed annually for a period of 10 years. Results: In total, 47 participants have completed the initial evaluation up to date and are divided in two groups, CN individuals (N = 26) and MCI patients (N = 21), based on their cognitive status. The participants are, on average, 64 years old, 46.3% of the sample is male with an average of 12.73 years of education. MCI patients report more comorbidities and have a lower score in the MMSE test. Regarding APOE status, 2 participants are ε4 homozygotes and 10 ε4 heterozygotes. CSF analyses (Aβ42, Τ-tau, P-tau) revealed no differences between the two groups. Conclusion: The ALBION study offers an opportunity to explore preclinical dementia and identify new and tailored markers, particularly relating to lifestyle. Further investigation of these populations may provide a wider profile of the changes taking place in the preclinical phase of dementia, leading to potentially effective therapeutic and preventive strategies.

Prevalence and Risk Factors of Frailty in a Community-Dwelling Population: The HELIAD Study

Objective: To estimate the prevalence of frailty using five different instruments in a cohort of older adults and explore the association between frailty and various risk factors. Method: 1,867 participants aged 65 years and above were included in the current retrospective cross-sectional study. Frailty was operationalized according to the Fried definition, the FRAIL Scale, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Index (GFI). We explored the role of various frailty risk factors using logistic regression analyses. Results: The prevalence of frailty varied depending on the definition used (Fried definition = 4.1%, FRAIL Scale = 1.5%, FI = 19.7%, TFI = 24.5%, and GFI = 30.2%). The only risk factors consistently associated with frailty irrespectively of definition were education and age. Conclusion: The frailty prevalence reported in our study is similar or lower to that reported in other population studies. Qualitative differences between frailty definitions were observed.

Eating frequency predicts changes in regional body fat distribution in healthy adults

BACKGROUND

Eating frequency (EF) has been associated with generalized obesity.

AIM

We aimed to prospectively investigate potential associations of frequency of eating episodes with regional fat layers.

DESIGN

EF was evaluated at baseline in 115 subjects free of clinically overt cardiovascular disease (54 ± 9.1 years, 70 women) in a prospective, observational study.

METHODS

Metabolic parameters known to be associated with dietary factors and anthropometric markers including ultrasound assessment of subcutaneous (Smin) and pre-peritoneal (Pmax) fat and their ratio Smin/Pmax (AFI) were evaluated at baseline and at follow-up, 5 years later.

RESULTS

EF at baseline positively correlated with Pmax, even after adjustment for potential confounders. EF above median was also an independent predictor for Pmax (beta coefficient = -0.192, P = 0.037) and AFI (beta coefficient = 0.199, P = 0.049) at follow up. Multivariable linear mixed models analysis demonstrated that subjects with increased EF presented a lower progression rate of Pmax (beta = -0.452, P = 0.006) and a higher progression rate of AFI (beta = 0.563, P = 0.003) over time, independently of age, sex, progression of BMI, energy intake, smoking and changes in parameters of glucose metabolism.

CONCLUSIONS

High EF is associated with lower progression rate of pre-peritoneal fat accumulation. Future interventional studies should further investigate the clinical utility of these findings.

Dataset on the associations between sleep quality/duration and cognitive performance in cognitively healthy older adults

In the present data, we provide the details of the cross-sectional study examining the associations between sleep quality/sleep duration and cognitive performance. Data are from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). A total of 1484 older adults (65 y.o. or older) took part in the study. Sleep measurements were drawn from the sleep scale of the Medical Outcomes Study (MOS). Cognition was used as a z-score drawn by different tests. The domains examined were: executive function, visuo-spatial ability, language, attention- speed of processing, as well as the composite z-score of all the cognitive domains (including memory). Linear regression models were conducted to investigate the associations between sleep quality and cognition, and sleep duration and cognition as well. We also conducted linear regression analyses for the associations between sleep quality/duration and cognitive domains/composite cognitive score based on the status of the Apolipoprotein E-ε4 (ApoE-ε4) genotype. Analyses were performed excluding both the demented and the Mild Cognitive Impairment (MCI) participants. Adjustments conducted for multiple covariates. For further analyses and enhanced discussion, see original article: "Sleep quality and duration in relation to memory in the elderly: initial results from the Hellenic Longitudinal Investigation of Aging and Diet" by Tsapanou et al. [1].

Sleep quality and duration in relation to memory in the elderly: Initial results from the Hellenic Longitudinal Investigation of Aging and Diet

BACKGROUND

Sleep is crucial for cognition, particularly for memory, given its complex association with neurodegenerative processes. The aim of the present study was to examine the association between sleep quality as well as sleep duration and memory performance in a Greek elderly population.

SETTING

Cross-sectional design in the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population representative study of Greek elderly (65years or older).

METHODS

Data from 1589 participants free of sleep medication were included. Sleep quality was estimated by using the Sleep Scale from the Medical Outcomes Study. An extensive neuropsychological assessment examining memory was administered to each participant. Linear regression analyses were used to examine whether sleep quality (higher score, poor quality) and/or sleep duration were associated with memory expressed in the form of a z-score. Age, sex, education, and body mass index were included as covariates. The main analyses were conducted first on the total sample, then with the exclusion of demented participants, and finally with the exclusion of both demented and participants with Mild Cognitive Impairment (MCI). We then conducted further analyses on the non-demented, non-MCI group, initially stratified by Apolipoprotein E-ε4 gene. We further examined the role of co-morbidities, as well as the association between sleep duration groups and memory. We also explored any interaction effect between sex and sleep quality/duration on memory. We then examined the associations between components of sleep measures and memory scores. Lastly, we examined the associations between sleep quality/duration and verbal/non-verbal memory separately.

RESULTS

In the total sample, we noted significant associations between sleep duration and memory (B=-0.001, p≤0.0001), but not for sleep quality and memory (B=-0.038, p=0.121). After excluding the demented participants, the associations were significant for: sleep quality and memory (B=-0.054, p=0.023), and sleep duration and memory (B=-0.001, p≤0.0001). After excluding both the MCI and the demented subjects, the associations between sleep quality and memory (B=-0.065, p=0.006), and sleep duration and memory (B=-0.001, p=0.003) were still significant. The association between the sleep duration groups and memory function was also significant, such that poor memory performance was associated with the longer sleep duration group. The results remained significant even after controlling for the co-morbidities, as well as after adding in the model anxiety and depression as covariates. Associations between sleep quality and memory, and sleep duration and memory were present in the ApoE-ε4 non-carriers. The individual sleep questions that were probably shown to be driving the associations between sleep and memory were: time to fall asleep, sleep not quiet, getting enough sleep to feel rested upon waking in the morning, and getting the amount of sleep needed. Sleep duration was associated with both verbal and non-verbal memory, while sleep quality was only associated with verbal memory.

CONCLUSION

Poor sleep quality and longer sleep duration were linked to low memory performance, independent of demographic and clinical factors, in a large sample of cognitively healthy older Greek adults. Other parameters than sleep and memory measurements could play an important role on the association. Levels of melatonin, or circadian rhythms dysregulation might play a crucial role in the above associations.

Perceptions of parents and children, participating in a school-based feeding programme in disadvantaged areas in Greece: a qualitative study

AIM

The aim of this work was to explore parents' and children's attitudes towards healthy eating and the free provision of a daily school meal in underprivileged areas of Greece.

METHODS

Twenty focus groups were conducted in 14 schools. Eligible participants were children/adolescents and their parents, who were recipients of a food aid, healthy nutrition school-based programme. Their perceptions towards healthy eating and related barriers, experience of a school feeding programme, other nutrition intervention initiatives were qualitatively evaluated.

RESULTS

Most of the parents referred to the Mediterranean diet as a healthy dietary pattern. Nearly all parents were aware of their effect as role models and commented on the benefits of eating together as a family, as well as on the importance of improving their own dietary habits. Parents reported using various methods to promote a healthy diet, as part of their parenting role. They perceived their role as difficult, as they have to deal with children's resistance, financial constraints arising from the current economic crisis in Greece and busy work schedules. All students perceived the school feeding programme as health-promoting, reflecting their parents' perceptions.

CONCLUSION

The present findings indicate that although the traditional Mediterranean diet was perceived by the majority of the adults as a health and traditional dietary pattern, parents reported several barriers related to its adoption. In particular, the most common barriers included financial difficulties, limited time for food preparation and children's resistance to consume healthy foods.

Behaviours associated with weight loss maintenance and regaining in a Mediterranean population sample. A qualitative study

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

In the US, the National Weight Control Registry revealed lifestyle behaviours shared by weight loss maintainers. In the US and the UK, qualitative studies compared the experiences of weight loss maintainers and regainers. High rates of physical activity, a low-energy/low-fat diet, weight self-monitoring, breakfast consumption and flexible control of eating are well-established maintenance behaviours.

WHAT THIS STUDY ADDS

The Mediterranean lifestyle has not been studied relative to weight loss maintenance. This study focused on a sample of Greek maintainers and regainers. Maintainers emphasized home-cooked meals; their diet does not appear to be low-fat, as home-cooked Greek meals are rich in olive oil. Having a small dinner is a common strategy among maintainers. Health motives were not mentioned by maintainers. Maintainers, but not regainers, appeared to compensate for emotional eating. Weight loss maintenance is imperative to successful obesity treatment. We qualitatively explored lifestyle behaviours associated with weight regulation, in a sample of Greek volunteers who had lost weight and either maintained or regained it. A 10% intentional loss maintained for at least one year was considered successful maintenance. Volunteers (n = 44, 41% men) formed eight focus groups, four of maintainers and four of regainers. Questions regarded weight loss, weight maintenance or regaining, and beliefs on weight maintenance and regaining. All discussions were tape recorded. Maintainers lost weight on their own, whereas regainers sought professional help. Maintainers exercised during both the loss and maintenance phases, whereas regainers showed inconsistent physical activity levels. Health motives for weight loss were mentioned only by regainers. Emotional eating was a common barrier, but only maintainers compensated for it. Maintainers continuously applied specific strategies to maintain their weight: emphasizing home-cooked meals, high eating frequency, a small dinner, portion size regulation, and sweets' intake regulation. Regainers considered the behaviours leading to weight loss different from their normal lifestyle, and resumed their old habits when the diet was over. However, both groups believed that for long-term success, lifestyle changes need to be permanent.

Effect of different amounts of coffee on dietary intake and appetite of normal-weight and overweight/obese individuals

OBJECTIVE

To investigate the effects of different coffee amounts on dietary intake and appetite feelings in normal-weight and overweight/obese individuals.

DESIGN AND METHODS

Thirty-three volunteers (16 normal-weight, 17 overweight/obese) participated in three trials: they consumed a standard breakfast along with 200 ml of either coffee with 3 or 6 mg caffeine/kg body weight (Coffee 3 and Coffee 6, respectively), or water. At fasting and at standard time points for the 3 h following breakfast/drink consumption participants recorded their appetite feelings on visual analogue scales. At 180 min, participants consumed an ad libitum meal and the next day they recalled their food intake during the experimental day.

RESULTS

A significant intervention effect was found for the energy intake of the ad libitum meal (P = 0.05) and of the whole day (P = 0.02) only in overweight/obese individuals. Specifically, Coffee 6 resulted in a reduced energy intake during the ad libitum meal compared to Coffee 3 (P = 0.03) and in the total day compared to both water (P = 0.04) and Coffee 3 (P = 0.008). No effect was observed for the appetite feelings.

CONCLUSIONS

A moderate coffee amount can effectively reduce energy intake in the following meal and in the total day compared to lower or no coffee intake in overweight/obese participants.

Modelling eating practices in non-fatal acute coronary syndrome or stroke development: a case/case-control study

BACKGROUND AND AIMS

Although significant evidence exists regarding the role of specific foods and dietary patterns on the development of cardiovascular disease, the influence of eating practices has not been thoroughly examined and understood. The aim of the present work was to evaluate the independent role of eating practices on the likelihood of developing an acute coronary syndrome (ACS) or ischemic stroke.

METHODS AND RESULTS

During 2009-2010, 1000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke and 500 were population-based control subjects (250 age-sex matched one-for-one with ACS patients, and 250 age-sex matched one-for-one with stroke patients). Eating practices were evaluated using a special questionnaire. Socio-demographic, clinical, psychological, dietary and other lifestyle characteristics were also measured. After controlling for potential confounding factors, each 20 min prolongation of dinner-to-sleep time was associated with 10% lower likelihood of ischemic stroke (95%CI: 0.83-0.98). Furthermore, eating practices related to stress (i.e., eating while being stressed, eating while working at the same time, skipping a meal due to work obligations) were associated with higher likelihood of having an ACS. Finally, eating while watching television was associated with lower likelihood of having an ACS (OR: 0.46, 95%CI: 0.27-0.78) or stroke event (OR: 0.42, 95%CI: 0.23-0.77).

CONCLUSION

Results of this work, present novel information, indicating the significance of eating practices, in addition to dietary patterns, regarding the development of coronary heart disease and stroke, and could be used in the primary prevention of CVD.

Genetic variation within IL18 is associated with insulin levels, insulin resistance and postprandial measures

BACKGROUND AND AIMS

IL-18 expression is up-regulated in atherosclerotic plaques, and higher levels are seen in obese and Type 2 Diabetic individuals. More recently, a possible role for IL-18 in glucose and energy homeostasis has been suggested.

METHODS AND RESULTS

We investigated variation within the IL18 gene and its association with measures of obesity and the metabolic syndrome. Five IL18 tagging single nucleotide polymorphisms (rs1946519, rs2043055, rs549908, rs360729, rs3882891) were selected and genotyped in the Gene-Diet Attica Investigation on childhood obesity (GENDAI) (age range 10-14 yrs); in young European men in the second European Atherosclerosis Research offspring Study (EARSII), an offspring study (age range 18-28 yrs) and in a group of healthy women from the Greek Obese Women study (GrOW) (age range 18-74 yrs). Six common haplotypes were observed. In GrOW, Hap6 (Frequency-2.6%) was associated with higher insulin levels (p<0.0001), estimates of HOMA(-Insulin Resistance) (p<0.0001) and HOMA(-β-cell) (p<0.0001) compared to the common haplotype Hap1 (Frequency-33.2%). In EARSII, rs2043055 was associated with peak and area under the curve triglycerides (p=0.001 and p=0.002, respectively) after an oral fat tolerance test in 'cases' but not 'controls'. None of the haplotypes were associated with measures of body fatness in any of the studies.

CONCLUSION

Association of IL18 variation with insulin levels and estimates of insulin resistance were only observed in our adult study, suggesting that the effects of IL-18 are only associated with increasing age. Taken together with the association of IL18 variants with post-prandial measures, this provides support for IL-18 as a metabolic factor.

Effect of banana consumption on faecal microbiota: a randomised, controlled trial

Banana is a widely consumed fruit, which contains considerable amounts of potential prebiotic indigestible carbohydrates. In our randomised, controlled trial we aimed to evaluate the in vivo prebiotic effect of banana consumption on faecal microbiota. Thirty-four healthy women participated in the study, having Body Mass Index (BMI) 24-30 kg/m(2), age 19-45 years, without history of gastrointestinal disease and no antibiotic and other medication use two months prior the initiation and during the study. All women were asked to maintain their usual dietary habits for 60 days and they were randomly assigned to consume twice a day a pre-meal snack, either one medium banana, or one cup of banana-flavoured drink or one cup of water (control group). Stool samples were collected at baseline, on days 30 and 60 of intervention for enumeration of total anaerobes, bifidobacteria and lactobacilli by plate count techniques, as well as for pH and short chain fatty acids (SCFAs) measurement. Gastrointestinal symptoms were also recorded. Mean bifidobacterial levels were increased only in the banana group both at 30 and 60 days of intervention, but this change did not reach a statistical significance. No significant overall differences in the total concentrations and molar ratios of SCFAs were detected according to dietary intervention. Analysis of the gastrointestinal symptoms records revealed significantly lower bloating levels in the banana group, compared to controls, at 26-35 days (p = 0.009) and 51-60 days (p = 0.010). Banana consumption had also no adverse effects on evacuation patterns. We concluded that daily consumption of bananas is a well-tolerated eating behaviour, which may induce bifidogenesis in healthy women experiencing body weight problems.

Season-related variation in dietary recalls used in a paediatric population

BACKGROUND

The effect of seasonality in estimating population mean nutrient intake using a single dietary recall has not been fully explored. The present study aimed to evaluate variation in energy and nutrient intake using a single 24-h recall between two seasons (spring/summer and autumn/winter) in a sample of children and adolescents.

METHODS

  A randomly selected subgroup (n = 623) of a representative sample of 3-18-year-old Greek children and adolescents was used in the present analysis. Information on participants' socio-demographic characteristics, body weight/height and dietary intake were collected through telephone interviews. Dietary assessment was based on two 24-h recalls (the first during the spring/summer season and the second 6 months later, during autumn/winter season).

RESULTS

Reported daily energy intake in spring/summer was 344 ± 130 kJ (82 ± 31 kcal) higher compared to the one in autumn/winter after adjusting for potential confounders (P = 0.008). However, the contribution of the macronutrients to the total energy intake was not statistically different between the two periods and the same was also true for vitamin C and calcium. The results remained unchanged after excluding low energy reporters.

CONCLUSIONS

The use of a second 24-h recall in a different season of the year does not confer additional information with regard to a population assessment of macronutrient contribution to the total energy intake in paediatric samples; its use appears to be justified in the light of a more accurate assessment of energy intake.

APOE, CETP and LPL genes show strong association with lipid levels in Greek children

BACKGROUND AND AIMS

Studies have consistently demonstrated that variants in a number of candidate genes are significant determinants of lipid levels in adults. However, few studies have investigated the impact of these variants in children. Therefore, in the present investigation we examined the influence of ten common variants in the genes for lipoprotein lipase (LPL-S447X), cholesterol ester transfer protein (CETP-Taq1B) apolipoprotein (APO) E (epsilon2, epsilon3, epsilon4), APOA5 (-1131C>T and S19W), APOA4 (S347T) and APOC3 (-482C>T; 1100C>T and 3238G>C) on lipoprotein levels children from the Gene-Diet Attica Investigation on childhood obesity (GENDAI).

METHODS AND RESULTS

The ten variants selected were genotyped in 882 Greek children, mean age: 11.2+/-0.7 years (418 females and 464 males). Genotypes were assessed using TaqMan technology. Significantly higher total cholesterol (TC) (p=0.0001) and low-density lipoprotein cholesterol (LDL-C) (p<0.0001) were observed in APOE epsilon4 carriers compared to epsilon3/epsilon3 homozygotes and epsilon2 carriers. The association of APOE genotype with TC and high-density lipoprotein cholesterol (HDL-C) ratio (p=0.0008) was further modulated by body mass index. Carriers of the CETP TaqIB B2 allele had significantly higher HDL-C (p<0.0001) and significantly lower TC: HDL-C ratio (p<0.0001) compared to B1/B1 individuals. No significant associations were observed between APOA4, APOA5 and APOC3 variants and serum lipids.

CONCLUSION

This study demonstrates that these common variants are associated with lipid levels in this healthy paediatric cohort, suggesting that even in these young children there may be potential in predicting their lifelong exposure to an adverse lipid profile.

The type and intensity of exercise have independent and additive effects on bone mineral density

Previous research on the effects of running and swimming on areal bone mineral density (aBMD) is inconclusive. This study examined the putative roles of the type and intensity of exercise in this respect, by measuring aBMD (adjusted for age, weight, and height) of the total body and of various subregions in 52 males aged 17 - 30 yr (21 runners, 16 swimmers, 15 controls). The athletes were competing at either long-distance ("endurance", n = 17) or short-distance ("sprint", n = 20) events. Compared with controls, runners had significantly higher leg aBMD (+ 6.7 %, p < 0.05), while swimmers had significantly lower leg and total body aBMD (- 9.8 % and - 7.0 %, respectively, p < 0.05). Endurance athletes had significantly lower total body aBMD than controls (- 4.9 %, p < 0.05). Sprint athletes did not differ significantly from controls at any site, but they had significantly higher aBMD than endurance athletes throughout the skeleton (p < 0.05). Compared with controls, endurance swimmers had significantly lower aBMD at the legs and total body (- 14.8 % and - 10.4 %, respectively, p < 0.05), while sprint runners had significantly higher values for the legs, trunk, and total body (+ 8.0 %, + 10.0 %, and + 6.3 %, respectively, p < 0.05). Sprint swimmers and endurance runners did not differ from controls at any site or the total body. These results suggest that the type and intensity of exercise have independent and additive effects on bone density.

Dietary Intake and Nutritional Practices of Elite Greek Aquatic Athletes

To investigate whether aquatic athletes follow optimal dietary intake, 58 athletes, all members of the Greek national swimming and water polo teams, were tested. Dietary intake was assessed at the nutrient, food, and food group level using the 24-h recall method and a food frequency questionnaire. Mean energy intake for males and females was 14.3 and 8.5 MJ, respectively. Mean carbohydrate consumption for male and female athletes was 4.5 g/kg and 3.8 g/kg of body weight, respectively. Fat intake was 153 g for males and 79 g for females. A significant number of the athletes (71% of the males, 93% of the females) did not meet the Dietary Reference Intakes for at least one of the antioxidant vitamins. The data suggest that athletes of both genders consumed too much fat and too little carbohydrate. Insufficient fruit and vegetable intake was related to low intake of antioxidants.

Nutrition-related habits of Greek adolescents

OBJECTIVE

To investigate nutrition-related habits of Greek school-aged adolescents.

DESIGN

Epidemiological survey.

SETTING AND SUBJECTS

The study was part of the Health Behavior in School Aged Children (HBSC) survey. A representative sample of school-aged adolescents aged 11.5, 13.5, and 15.5 y was obtained. The final sample consisted of 4211 students (51.6% girls and 48.4% boys). They were asked to complete a translated form of the international HBSC questionnaire, including several thematic entities. The Unhealthy Food Choices Score (UFCS) was devised in order to evaluate the overall quality of reported eating habits of respondents; the higher the score, the lower the diet quality.

RESULTS

Among all students surveyed, 14.7% were reported to be on a diet to lose weight (girls: 19.5%; boys: 9.7%; P<0.001), and 22.9% were dissatisfied with their body weight but not on a diet. Girls were found to have lower UFCS values compared to boys (24.7 +/- 4.6 vs 24.1 +/- 4.5, P<0.001). Girls dissatisfied with their weight, but not on a diet, showed the highest UFCS values compared to both those on a diet and those not on a diet. TV viewing was positively associated with the consumption of sodas, crisps, cakes and pastries, and sweets and chocolates.

CONCLUSIONS

Dieting is becoming a major problem, especially among older girls. The findings of this study suggest that eating habits of Greek school-aged adolescents are in the process of changing from more traditional to more Westernized ones.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Prevalence of overweight and obesity in Greek school-aged children and adolescents

The aim of the present study, which was part of the Health Behavior in School Aged Children (HBSC) study, was to provide national estimates for overweight and obesity in Greek school-aged children and adolescents. A nationwide multistage procedure was followed to obtain a representative sample of children and adolescents aged 11.5, 13.5 and 15.5 y. The resultant sample consisted of 4299 students, 51.3% girls and 48.7% boys. Self-reported weight and height data were used. According to the body mass index cutoff points adopted by the International Obesity Task Force (IOTF), 9.1% of girls and 21.7% of boys were classified as overweight, and 1.2% of girls and 2.5% of boys as obese. Corresponding values using CDC growth charts were 8.1% of girls and 18.8% of boys for overweight, and 1.7% of girls and 5.8% of boys for obese. Compared to most other western countries, the prevalence of obesity is lower in Greek children aged 11-16 y.

The Q223R polymorphism of the leptin receptor gene is significantly associated with obesity and predicts a small percentage of body weight and body composition variability

Genetic variation at the leptin receptor gene locus may play an important role in the pathophysiology of human obesity, a leptin-resistant state. Previous studies exploring potential associations between leptin receptor gene polymorphisms and obesity have reported conflicting results. The aim of this study was to evaluate a genetically homogeneous population for associations between body composition variables and three common leptin receptor gene polymorphisms (K109R, Q223R, and K656N) that have potential functional significance as well as to assess the contributions of these polymorphisms to the variability of obesity. One hundred and eighteen consecutively enrolled subjects (62 women: mean age, 17.5 +/- 1.6 yr; body mass index range, 16.2-30.1; 56 men: mean age, 17.8 +/- 1.8 yr; body mass index range, 15.4-35.9) were genotyped for the three polymorphisms, and their body mass index, sum of 4 skinfolds, fat-free mass, percent fat mass, serum leptin levels, caloric intake, fat intake, and exercise patterns were determined. Allele frequencies were estimated by the gene-counting method, and genotype distributions between 89 normal weight (body mass index, < or =25 kg/m(2)) and 29 overweight-obese (body mass index, >25 kg/m(2)) subjects were compared using chi(2) test (using codominant, dominant, and recessive models). Analysis of covariance was also performed to evaluate associations between the polymorphisms and body composition variables after controlling for potential confounders. For the Q223R polymorphism, there was a higher prevalence of the R223 allele in the homozygous form among overweight-obese subjects vs. normal weight subjects (20.7% vs. 4.5%; P = 0.01). Furthermore, simple and multiple regression analyses revealed that the R223 allele in the homozygous form is a significant predictor of both body mass index (P = 0.015) and percent fat mass (P = 0.02) even after adjusting for age and gender and explains 4.5% of the variance in percent fat mass and 5% of the variance in body mass index. There was no significant difference in allele frequencies or genotype distributions for the K109R or K656N polymorphisms. These findings support the hypothesis that the Q223R polymorphism (but not the K109R or K656N polymorphism) of the leptin receptor gene is associated with obesity and predicts a small percentage of body weight and body composition variability in a genetically homogeneous population.

Body composition in dancers: the bioelectrical impedance method

PURPOSE

The aim of this study was to generate and validate a prediction equation for estimating the body composition in dancers using the bioelectrical impedance analysis (BIA) as a method of assessment.

METHODS

The fat-free mass (FFM) of 42 young female professional dance students was estimated by four different methods: dual x-ray absorptiometry (DXA), BIA, simple anthropometry, and skinfold thickness; DXA was used as a criterion method.

RESULTS

The dancers' FFM was 42.6 kg (SD: 3.3) and, on the average, body fat represented the 19.4% (SD: 4.3) of their body weight. Two dancer-specific BIA equations for the prediction of FFM (E(BIA)) were developed by multiple regression analysis using weight, height, resistance index, and triceps as predictor variables (E(BIA) and E(BIA-TRICEPS)). The validity of these equations as well as of those previously reported was assessed in two randomly selected subgroups of the initial study group, as described by the Bland-Altman analysis. The bias and the limits of agreement of the equations developed in the present study were lower than those resulting from the application of the previously used equations of Segal et al. and Hergenroeder et al. It was also found that, when validated against DXA, skinfolds measurements did not accurately predict body fatness in this group of young females.

CONCLUSION

The new equations allow for an accurate routine assessment of body composition in young female dancers by using the method of BIA. Further studies are needed for the cross-validation of the equations in various groups of dancers.