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Niu J, Li B, Zhang Q, Chen G, Papadaki A. Exploring the traditional Chinese diet and its association with health status-a systematic review. Nutr Rev 2024:nuae013. [PMID: 38452296 DOI: 10.1093/nutrit/nuae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
CONTEXT Increased adherence to a traditional Chinese diet (TCD) could reduce the increasing prevalence of noncommunicable diseases. Currently, there is no consistent definition of the TCD in the literature, and its associations with health outcomes have not yet been identified. OBJECTIVE This systematic review aimed to assess the definition of the TCD, in the literature, and to evaluate whether the TCD, as described, is associated with health outcomes. DATA SOURCES Fourteen databases were searched up to April 25, 2022. DATA EXTRACTION Three reviewers (in pairs) independently screened and extracted data. A modified risk-of-bias tool was used to assess the quality of the studies assessing the TCD definition; the Newcastle-Ottawa Scale and the Cochrane Risk-of-Bias tool were used to assess the quality of the observational studies and randomized controlled trials assessing associations between the TCD and health outcomes. DATA ANALYSIS Ninety-nine studies were identified that assessed the TCD definition. In at least 75% of the studies, rice and leafy vegetables were consistently reported as food groups that characterize the TCD; the most frequently cited food items were white rice, spinach, bokchoy, and cabbage. Fish and seafood, pork, and pork products were consistently reported in studies exclusively referring to the TCD consumed in southern China (n = 21 studies), whereas wheat and wheat products were commonly reported in studies focusing on northern China (n = 14 studies). Fifteen studies reported on the quantities of food groups that are characteristic of the TCD, but their findings were inconsistent. Of the 99 studies, 54 assessed associations with health outcomes. The TCD was overall inversely associated with obesity risk and weight gain, while relationships between the TCD and other health outcomes were inconsistent. CONCLUSION Further studies are needed to determine the quantities of foods consumed in the TCD and to establish a consistent definition for further exploration of the TCD's potential role in preventing non-communicable diseases.
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Affiliation(s)
- Jizhao Niu
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Qing Zhang
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Ge Chen
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Papadaki A, Wakeham M, Ali B, Armstrong MEG, Willis P, Cameron A. Accessing Meals on Wheels: A qualitative study exploring the experiences of service users and people who refer them to the service. Health Expect 2023; 27:e13943. [PMCID: PMC10729527 DOI: 10.1111/hex.13943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 04/28/2024] Open
Abstract
Aims This study aimed to explore the perceptions of Meals on Wheels (MoWs) service users (SUs), and people who refer them to MoWs (‘referrers’), with accessing and commencing the service in England, the barriers that might hinder service uptake, and what information would be valued when considering accessing the service. Methods Semistructured interviews were conducted in May–July 2022 with seven SUs and 21 referrers, recruited from four MoWs providers across England. Data were analysed using inductive thematic analysis. Results Participants indicated various pathways into the service, but referrers (family members) were more likely to be the ones enquiring about, and commencing, MoWs for SUs. Once an enquiry about MoWs had been made, the service was perceived as straightforward to set up. However, existing preconceptions and stereotypes were perceived to act as barriers to accessing MoWs. Information that participants deemed important to have available when deciding on whether to access MoWs related to the meals, the specific services provided, the reliability and flexibility of delivery and the cost of services. Conclusion These findings could inform MoWs service providers' public awareness strategies about MoWs, to facilitate referrals to the service for adults with care and support needs. Patient or Public Contribution An advisory group of people with lived experience of MoWs (users of the service and their family referrers) extensively discussed the findings of the research and advised on the implications and future dissemination steps.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
| | - Mary Wakeham
- Centre for Exercise, Nutrition and Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
- Centre for Research in Health and Social CareUniversity of BristolBristolUK
| | - Becky Ali
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | | | - Paul Willis
- Centre for Research in Health and Social CareUniversity of BristolBristolUK
| | - Ailsa Cameron
- Centre for Research in Health and Social CareUniversity of BristolBristolUK
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O'Malley CL, Lake AA, Moore HJ, Gray N, Bradford C, Petrokofsky C, Papadaki A, Spence S, Lloyd S, Chang M, Townshend TG. Regulatory mechanisms to create healthier environments: planning appeals and hot food takeaways in England. Perspect Public Health 2023; 143:313-323. [PMID: 37572038 PMCID: PMC10683341 DOI: 10.1177/17579139231187492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
AIMS To explore existing regulatory mechanisms to restrict hot food takeaway (HFT) outlets through further understanding processes at local and national levels. METHODS The Planning Appeals Portal was utilised to identify recent HFT appeal cases across England between December 2016 and March 2020. Eight case study sites were identified using a purposive sampling technique and interviews carried out with 12 professionals involved in planning and health to explore perceptions of and including factors that may impact on the HFT appeal process. Additionally, documents applicable to each case were analysed and a survey completed by seven Local Authority (LA) health professionals. To confirm findings, interpretation meetings were conducted with participants and a wider group of planning and public health professionals, including a representative from the Planning Inspectorate. RESULTS Eight case study sites were identified, and 12 interviews conducted. Participants perceived that LAs would be better able to work on HFT appeal cases if professionals had a good understanding of the planning process/the application of local planning policy and supplementary planning documents; adequate time and capacity to deal with appeals cases; access to accurate, robust, and up to date information; support and commitment from elected members and senior management; good lines of communication with local groups/communities interested in the appeal; information and resources that are accessible and easy to interpret across professional groups. CONCLUSIONS Communication across professional groups appeared to be a key factor in successfully defending decisions. Understanding the impact of takeaway outlets on health and communities in the long term was also important. To create a more robust appeals case and facilitate responsiveness, professionals involved in an appeal should know where to locate current records and statistical data. The enthusiasm of staff and support from senior management/elected officials will play a significant role in driving these agendas forward.
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Affiliation(s)
- C L O'Malley
- Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK c.o'
| | - A A Lake
- Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - H J Moore
- Fuse, the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - N Gray
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - C Bradford
- Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | | | - A Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - S Spence
- Fuse, the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - S Lloyd
- Fuse, the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Public Health South Tees, Middlesbrough, UK
| | - M Chang
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - T G Townshend
- Fuse, the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Architecture, Planning & Landscape, Newcastle University, Newcastle upon Tyne, UK
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Chen G, Leary S, Niu J, Perry R, Papadaki A. The Role of the Mediterranean Diet in Breast Cancer Survivorship: A Systematic Review and Meta-Analysis of Observational Studies and Randomised Controlled Trials. Nutrients 2023; 15:2099. [PMID: 37432242 DOI: 10.3390/nu15092099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
Female breast cancer is the most frequently diagnosed cancer. The long-term survival rates for this disease have increased; however, the unique demand for high-quality healthcare to improve breast-cancer survivorship are commonly unmet. The Mediterranean diet (MD) is associated with reduced breast-cancer risk and various health-related benefits in the general population, but its effect on breast-cancer survivors remains uncertain. The objective of this systematic review and meta-analysis was to assess current evidence from randomised controlled trials (RCTs) and observational studies (cohort, cross-sectional and case-control) regarding the effect of the MD on survival, quality of life (QoL) and health-related outcomes in female breast-cancer survivors. MEDLINE, EMBASE, Web of Science and the Cochrane library were searched for studies published before and including April 2022. Two reviewers independently screened the literature and completed the data extraction and risk-of-bias assessment. Eleven studies (fifteen reports) were included, including two RCTs, four cohort and five cross-sectional studies. The meta-analysis of the cohort studies showed strong evidence of an inverse association between high adherence to the MD and all-cause mortality (hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.66-0.93, I2: 0%, Grading of Recommendations Assessment, Development and Evaluation (GRADE) = low certainty of evidence) and non-breast-cancer mortality (HR 0.67, 95% CI 0.50-0.90, I2: 0%, GRADE = very low certainty of evidence). The associations between high adherence to the MD and QoL and health-related parameters were not consistent. These findings highlight the potential of adherence to the MD to reduce the risk of mortality. Future research with better study designs, as well as more consistent measurements of QoL and MD adherence, taking into account changes in MD adherence over time and population subgroups, is needed to provide more robust evidence on the survival, QoL and health-related outcomes in BC survivors.
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Affiliation(s)
- Ge Chen
- Bristol Dental School, University of Bristol, Bristol BS2 8AE, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol BS8 2BN, UK
| | - Sam Leary
- Bristol Dental School, University of Bristol, Bristol BS2 8AE, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol BS8 2BN, UK
| | - Jizhao Niu
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
| | - Rachel Perry
- Bristol Medical School (Cardiovascular Surgery and Vascular Biology), University of Bristol, Bristol BS2 8HW, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
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Vidal-Ostos F, Ramos-Lopez O, Jebb SA, Papadaki A, Pfeiffer AFH, Handjieva-Darlenska T, Kunešová M, Blaak EE, Astrup A, Martinez JA. Dietary protein and the glycemic index handle insulin resistance within a nutritional program for avoiding weight regain after energy-restricted induced weight loss. Nutr Metab (Lond) 2022; 19:71. [PMID: 36261843 PMCID: PMC9583584 DOI: 10.1186/s12986-022-00707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background and aim The role of dietary protein and glycemic index on insulin resistance (based on TyG index) within a nutritional program for weight loss and weight maintenance was examined. Methods This study analyzed 744 adults with overweight/obesity within the DIOGenes project. Patients who lost at least 8% of their initial weight (0–8 weeks) after a low-calorie diet (LCD) were randomly assigned to one of five ad libitum diets designed for weight maintenance (8–34 weeks): high/low protein (HP/LP) and high/low glycemic index (HGI/LGI), plus a control. The complete nutritional program (0–34 weeks) included both LCD plus the randomized diets intervention. The TyG index was tested as marker of body mass composition and insulin resistance. Results In comparison with the LP/HGI diet, the HP/LGI diet induced a greater BMI loss (p < 0.05). ∆TyG was positively associated with resistance to BMI loss (β = 0.343, p = 0.042) during the weight maintenance stage. In patients who followed the HP/LGI diet, TyG (after LCD) correlated with greater BMI loss in the 8–34 weeks period (r = −0.256; p < 0.05) and during the 0–34 weeks intervention (r = −0.222, p < 0.05) periods. ΔTyG1 value was associated with ΔBMI2 (β = 0.932; p = 0.045) concerning the HP/LGI diet. Conclusions A HP/LGI diet is beneficial not only for weight maintenance after a LCD, but is also related to IR amelioration as assessed by TyG index changes. Registration Clinical Trials NCT00390637. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-022-00707-y.
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Affiliation(s)
| | - Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Universidad 14418, UABC, Parque Internacional Industrial Tijuana, 22390, Tijuana, B.C., Mexico.
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Charité Universitätsmedizin Berlin, German Center of Diabetes Research, DZD, Berlin, Germany
| | | | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Ellen E Blaak
- Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Arne Astrup
- Obesity and Nutrition Science, Novo Nordisk Fonden, Tuborg Havnevej 15, 2900, Hellerup, Denmark
| | - J Alfredo Martinez
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.,CIBERobn Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain.,Precision Nutrition Program, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
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Papadaki A, Ali B, Cameron A, Armstrong MEG, Isaacs P, Thomas KS, Gadbois EA, Willis P. 'It's not just about the dinner; it's about everything else that we do': A qualitative study exploring how Meals on Wheels meet the needs of self-isolating adults during COVID-19. Health Soc Care Community 2022; 30:e2012-e2021. [PMID: 34766667 PMCID: PMC8652984 DOI: 10.1111/hsc.13634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
Meals on Wheels (MoWs), a service offered by local authorities in England, deliver meals to older, housebound and/or vulnerable adults, who might otherwise not be able to acquire and prepare their own meals. Research suggests that MoWs provide benefits beyond nutrition. Little is known about the actual interactions between service providers and clients, particularly during the COVID-19 pandemic. The aim of this small-scale, formative study was to explore MoWs service providers' experiences and their perceptions around the benefits and challenges faced by the service, and understand how these experiences changed during the first UK national lockdown. Semi-structured interviews were conducted in September 2020 with 18 service providers of MoWs (drivers who deliver the meals, service coordinators and managers) in two local authorities in England, and analysed thematically. Participants indicated that benefits of the service encompassed those to clients (e.g. welfare checks, encouraging independence and identifying and addressing isolation and loneliness), employees (e.g. sense of pride, rewarding relationships with clients) and the wider community (e.g. reducing pressures on families), and described MoWs as the 'fourth emergency service' (e.g. being the first responders to emergency situations). Participants identified several challenges faced by the MoWs service, including organisational challenges (e.g. funding cuts and closures, lack of appropriate publicity to raise awareness of the service) and restrictions on time spent with clients. The pandemic and lockdown resulted in increased demand on resources, concerns about client and staff wellbeing and uncertainty about how the service will cope if lockdowns continue. These findings provide important insights regarding the wide benefits of MoWs and the challenges the service faces, which can be used as the formative research base to guide future interventions and policies to protect vulnerable adults, not only during the COVID-19 pandemic, but beyond.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Becky Ali
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
| | - Ailsa Cameron
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Paul Isaacs
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Kali S. Thomas
- U.S. Department of Veterans Affairs Medical CenterProvidenceRhode IslandUSA
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Emily A. Gadbois
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Paul Willis
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
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Valerino-Perea S, Armstrong MEG, Papadaki A. Adherence to a traditional Mexican diet and non-communicable disease-related outcomes: secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey. Br J Nutr 2022; 129:1-14. [PMID: 35876036 PMCID: PMC10011591 DOI: 10.1017/s0007114522002331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
This study evaluated the association between adherence to a traditional Mexican diet (TMexD) and obesity, diabetes and CVD-related outcomes in secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey 2018-2019. Data from 10 180 Mexican adults were included, collected via visits to randomly selected households by trained personnel. Adherence to the TMexD (characterised by mostly plant-based foods like maize, legumes and vegetables) was measured through an adapted version of a recently developed TMexD index, using FFQ data. Outcomes included obesity (anthropometric measurements), diabetes (biomarkers and diagnosis) and CVD (lipid biomarkers, blood pressure, hypertension diagnosis and CVD event diagnosis) variables. Percentage differences and OR for presenting non-communicable disease (NCD)-related outcomes (with 95 % CI) were measured using multiple linear and logistic regression, respectively, adjusted for relevant covariates. Sensitivity analyses were conducted according to sex, excluding people with an NCD diagnosis and using multiple imputation. In fully adjusted models, high, compared with low, TMexD adherence was associated with lower insulin (-9·8 %; 95 % CI (-16·0, -3·3)), LDL-cholesterol (-4·3 %; 95 % CI (-6·9, -1·5)), non-HDL-cholesterol (-3·9 %; 95 % CI (-6·1, -1·7)) and total cholesterol (-3·5 %; 95 % CI (-5·2, -1·8)) concentrations. Men and those with no NCD diagnosis had overall stronger associations. Effect sizes were smaller, and associations weakened in multiple imputation models. No other associations were observed. While results may have been limited due to the adaptation of a previously developed index, the results highlight the potential association between the TMexD and lower insulin and cholesterol concentrations in Mexican adults.
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Affiliation(s)
- Selene Valerino-Perea
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
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Valerino-Perea S, Armstrong M, Papadaki A. The Traditional Mexican Diet and Its Association With Non-communicable Disease-Related Outcomes: Analysis of a Nationally Representative Survey. Curr Dev Nutr 2022. [PMCID: PMC9193388 DOI: 10.1093/cdn/nzac054.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To evaluate the association between adherence to the traditional Mexican diet (TMexD) and cardiovascular disease (CVD), obesity, and diabetes-related outcomes. Methods Secondary data analysis of the 2018–19 Mexican National Health and Nutrition Survey, including cross-sectional data from 10,180 adults collected by trained personnel via visits to randomly selected households. Adherence to the TMexD was measured using a validated food frequency questionnaire and an adapted TMexD index, developed by systematically reviewing the literature and consulting expert opinion. Outcomes included CVD biomarkers and diagnosis, hypertension values and diagnosis, anthropometric measurements, and diabetes biomarkers and diagnosis. The percentage differences and odds ratios for presenting non-communicable disease (NCD)-related outcomes (with 95% confidence intervals [CI]), were calculated using multiple linear and logistic regression, adjusting for relevant variables. Sensitivity analyses were conducted using multiple imputation, according to sex, and excluding people with an NCD diagnosis. Results High, compared to low, TMexD adherence was associated with lower total cholesterol (−3.5%; 95% CI: −5.2, −1.8), low-density lipoprotein-cholesterol (−4.3%; 95% CI −6.9, −1.5), non-high-density lipoprotein-cholesterol (−3.9%; 95% CI: −6.1, −1.7), and insulin (−9.8%; 95% CI: −16.0, −3.3) concentrations (p < 0.004) in fully adjusted models. Weaker associations were observed in multiple imputation models, whereas men and adults with no NCD diagnosis had stronger associations. No other associations were observed. Conclusions TMexD adherence was associated with a favorable profile for some NCD-related outcomes, highlighting the potential of the TMexD in reducing the risk of some NCD-related outcomes in Mexican adults. Funding Sources This research was funded by Consejo Nacional de Ciencia y Tecnología (CONACYT). CONACYT had no role in the design, analysis or writing of this abstract.
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Hoi A, Toor S, Monk J, Chang J, Koelmeyer R, Papadaki A, Peters J, Vincent F, Ooi J, Morand EF. POS0774 ANTI-Sm AUTOANTIBODIES IDENTIFY A PHENOTYPE OF SEVERE SLE WITH AN ASSOCIATED SERUM BIOMARKER PROFILE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAntibodies to Smith (Sm) have been described as one of the most specific autoantibodies for systemic lupus erythematosus (SLE). Other than its association with lupus nephritis, there is, however, limited understanding of its clinical significance1,2.ObjectivesTo describe clinical associations and serum protein profiles of anti-Sm positivity in SLE.MethodsPatients fulfilling SLE classification criteria who were followed longitudinally in a prospective multicentre cohort were studied according to their baseline anti-Sm antibody status. Comparison between Sm+ and Sm- patients was made using descriptive statistics. Clinical associations of Sm positivity with patient disease characteristics were studied using logistic regression. In a subset, 211 serum analytes were measured using Quantibody, Luminex and ELISA assays. Associations between serum proteins and Sm positivity were studied using Least Absolute Shrinkage and Selection Operator (LASSO) penalised regression, adjusting for demographics (age, sex, ethnicity) and medication useResults383 patients were studied with median (IQR) follow-up of 4.9 (2,9) years; 65 (17%) had positive anti-Sm antibodies. Sm+ patients were significantly more likely to be of non-European ancestry (OR 2.73, 95% CI 1.55-4.82, p<0.001), and to be positive for anti-dsDNA antibodies (OR 2.8, 95% CI 2.3-3.4, p<0.001), anti-RNP antibodies (OR 15.7, 95% CI 13.9-17.8, p<0.001), direct anti-globulin test (OR 2.36, 95% CI 2.07-2.7, p<0.001) and hypocomplementemia (OR 7.73, 95% CI 5.1-11.7, p<0.001). Sm+ patients were significantly more likely to have active disease during the observation period in a range of organ domains, including mucocutaneous, renal, vasculitis and fever.More Sm+ patients had episodes of High Disease Activity Status (HDAS, SLEDAI-2K ≧10)3 (OR 3.07, 95% CI 1.70-5.54, p<0.001) and persistent active disease (time-adjusted mean SLEDAI-2K > 4) (OR 3.23. 95% CI 1.84-5.70, p<0.001). Conversely, fewer Sm+ patients attained LLDAS for ≥50% observed time (19.7% vs 41.8%, p=0.002). Sm+ patients were more likely to be treated with glucocorticoids, immunosuppressants, and rituximab. There was no significant difference in damage accrual between Sm + and Sm - patients.In serum protein analysis (n=197, 29 Sm+), LASSO modelling retained 3 proteins associated with Sm+ status, CXCL13, IL1RL1 and FLT1, along with Asian ethnicity and age. In analysis including pairwise interaction between predictors, 28 Sm+ associated proteins were identified, including CCL4, VCAM1, IL1RL1, Fcg R IIB/C, TDGF1, CEACAM1, TIMP1, BMP5, GDF15, and TNFRSF17.ConclusionAnti-Sm autoantibodies, present in 17% of SLE patients, were strongly associated with classical disease manifestations, more severe disease activity, and a specific serological and proteomic profile. These findings suggest anti-Sm+ SLE as a specific disease subset.References[1]Barada, FA., B.S. Andrews, J.S. Davis, R.P. Taylor, Antibodies to Sm in patients with systemic lupus erythematosus. Correlation of Sm antibody titers with disease activity and other laboratory parameters. Arthritis Rheum, 1981. 24:1236-1244[2]Arroyo-Avilla, M, Y. Santiago-Casas, G.McGwin, R.S. Cantor, M. Petri, R. Ramsey-Goldman, J.D. Reveille, R.P.Kimberly, G.S. Alarcon, L.M.Vila, E.E. Brown. Clinical Associations of anti-Smith antibodies in PROFILE: a multi-ethnic lupus cohort. 2015. 34:1217-1223[3]Koelmeyer, R., H.T. Nim, M. Nikpour, Y.B. Sun, A. Kao, O. Guenther, E. Morand, and A. Hoi, High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus. Lupus Sci Med, 2020. 7(1).AcknowledgementsI would like to acknowledge participants and clinicians involved with the Australian Lupus Registry & BiobankDisclosure of InterestsNone declared
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Angelidi AM, Papadaki A, Nolen-Doerr E, Boutari C, Mantzoros CS. The effect of dietary patterns on non-alcoholic fatty liver disease diagnosed by biopsy or magnetic resonance in adults: a systematic review of randomised controlled trials. Metabolism 2022; 129:155136. [PMID: 35032545 DOI: 10.1016/j.metabol.2022.155136] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023]
Abstract
Adhering to specific dietary patterns might hold promise as a lifestyle modification treatment of non-alcoholic fatty liver disease (NAFLD). The aim of this systematic review was to examine the effect of dietary patterns on changes in hepatic fat content, liver enzymes and metabolic syndrome components. We searched Pubmed, Embase, CINAHL and Web of Science for randomised controlled trials published in English until April 2020, comparing a specific dietary pattern with no treatment, usual care, or a different diet in adults with NAFLD. Studies were included if NAFLD had been diagnosed using biopsy, magnetic resonance imaging, or proton magnetic resonance spectroscopy. Data from three trials in adults with NAFLD but without diabetes (n = 128; mean age 49.9 ± 5.0 years, range 42-55 years) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 33%, 38% and 29% of domains, respectively. There was moderate evidence that a low-carbohydrate, compared to a low-calorie diet (-27%, P = 0.008, one study, n = 18) and the Mediterranean, compared to a low-fat, high-carbohydrate diet (-4.4%, P = 0.030, one study, n = 12) result in greater reductions in hepatic fat content, but no such evidence was found for the Fatty Liver in Obesity dietary pattern (based on the principles of the Mediterranean diet), compared to the American Heart Association diet (-0.6%, P = 0.706, one study, n = 98). No between-group differences were reported for other outcomes across studies. A post hoc analysis, including two eligible studies assessing the effect of the Mediterranean, compared to a low-fat diet, irrespective of baseline presence of diabetes, showed strong evidence that the Mediterranean diet reduces hepatic fat content (-4.1%, 95% CI = -5.8 to -2.3, P < 0.001; I2 = 0%) and triglyceride concentrations (-16.9 mg/dL, 95% CI = -26.3 to -7.7, P < 0.001; I2 = 0%). Well-designed, adequately powered and rigorous randomised controlled trials are needed to provide robust evidence on the effect of these dietary patterns, but also other whole dietary approaches, on NAFLD progression.
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Affiliation(s)
- Angeliki M Angelidi
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Endocrinology, Boston VA Healthcare System, Boston, MA, USA
| | - Angeliki Papadaki
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
| | - Eric Nolen-Doerr
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Chrysoula Boutari
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christos S Mantzoros
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Endocrinology, Boston VA Healthcare System, Boston, MA, USA
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11
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McAleese D, Linardakis M, Papadaki A. Quality and Presence of Behaviour Change Techniques in Mobile Apps for the Mediterranean Diet: A Content Analysis of Android Google Play and Apple App Store Apps. Nutrients 2022; 14:1290. [PMID: 35334947 PMCID: PMC8950036 DOI: 10.3390/nu14061290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
Smartphone apps might represent an opportunity to promote adherence to the Mediterranean diet (MedDiet). This study aimed to evaluate the quality of commercially available apps for the MedDiet and the presence of behavioural change techniques (BCTs) used by these apps. A systematic search was conducted on the Apple App and Google Play stores in November 2021. Apps were included if they provided information on the MedDiet or if their objective was to promote a healthy lifestyle through adherence to the MedDiet. Eligible apps were independently evaluated by two reviewers with regard to their quality (engagement, functionality, aesthetics and information quality) using the 5-point Mobile App Rating Scale (MARS; with higher scores indicating higher quality), and the presence of BCTs using an established 26-item BCT taxonomy. Of the 55 analysed apps, 52 (94.5%) were free, 50 (90.9%) provided recipe ideas, 29 (52.7%) provided meal plans, and 22 (40%) provided information on the health benefits of the MedDiet. The overall quality mean MARS score was 2.84 (standard deviation (SD) = 0.42), with functionality being the highest scored MARS domain (mean = 3.58, SD = 0.44) and engagement the lowest (mean = 2.29, SD = 0.61). The average number of BCTs in the analysed apps was 2.3 (SD = 1.4; range: 0-6 per app). The number of BCTs was positively correlated with app information quality (rrho = 0.269, p = 0.047), overall MARS score (rrho = 0.267, p = 0.049), app subjective quality (rrho = 0.326, p = 0.015) and app-specific quality (rrho = 0.351, p = 0.009). These findings suggest that currently available apps might provide information on the MedDiet, but the incorporation of more BCTs is warranted to maximise the potential for behaviour change towards the MedDiet.
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Affiliation(s)
- Daniel McAleese
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford OX3 7DQ, UK
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
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12
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Azizan NA, Papadaki A, Su TT, Jalaludin MY, Mohammadi S, Dahlui M, Nahar Azmi Mohamed M, Majid HA. Facilitators and Barriers to Implementing Healthy School Canteen Intervention among Malaysian Adolescents: A Qualitative Study. Nutrients 2021; 13:nu13093078. [PMID: 34578955 PMCID: PMC8471853 DOI: 10.3390/nu13093078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022] Open
Abstract
This study evaluated implementing a school-based intervention to promote healthier dietary habits in the school environment among Malaysian adolescents using qualitative methods. This qualitative study was conducted in four secondary schools in Perak and Selangor (two urban and two rural schools) that received the intervention (either training or training and food subsidy). A total of eight focus groups (68 students aged 15 years old) and 16 in-depth interviews were conducted with canteen operators, school convenience shop operators, school teachers and school principals in each school. Thematic analysis was used to analyse the qualitative data to identify suitable themes. We found several initiatives and changes by the schools’ stakeholders to change to a healthy school canteen programme. The stakeholders also noticed the students’ food preferences that influence healthy food intake in canteens and convenience shops. The food vendors and school administrators also found that subsidising healthy meals might encourage healthy eating. Among barriers to implementing healthy school initiatives were the student’s perception of healthy food and their eating habits, which also affect the food vendors’ profit if they want to implement a healthy canteen. The school-based intervention has the potential to promotes healthier eating among school adolescents. Continuous training and monitoring of canteen operators and convenience shops are needed, including building partnerships and educating the students on healthy eating to cultivate healthy eating habits.
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Affiliation(s)
- Nurul Ain Azizan
- Center of Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (N.A.A.); (T.T.S.); (S.M.); (M.D.)
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam 13200, Malaysia
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
| | - Tin Tin Su
- Center of Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (N.A.A.); (T.T.S.); (S.M.); (M.D.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya 47500, Malaysia
| | - Muhammad Yazid Jalaludin
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Shooka Mohammadi
- Center of Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (N.A.A.); (T.T.S.); (S.M.); (M.D.)
| | - Maznah Dahlui
- Center of Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (N.A.A.); (T.T.S.); (S.M.); (M.D.)
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Hazreen Abdul Majid
- Center of Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (N.A.A.); (T.T.S.); (S.M.); (M.D.)
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
- Correspondence:
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Moutou KE, England C, Gutteridge C, Toumpakari Z, McArdle PD, Papadaki A. Exploring dietitians' practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study. J Hum Nutr Diet 2021; 35:179-190. [PMID: 34370332 DOI: 10.1111/jhn.12939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines. METHODS Semi-structured interviews were conducted with 12 UK-registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis. RESULTS Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low-carbohydrate, low-fat, low-glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient-centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence. CONCLUSIONS The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management.
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Affiliation(s)
- Konstantina E Moutou
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Callum Gutteridge
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Zoi Toumpakari
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Paul D McArdle
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Angeliki Papadaki
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Vega-Salas MJ, Caro P, Johnson L, Papadaki A. Socio-economic inequalities in dietary intake in Chile: a systematic review. Public Health Nutr 2021; 25:1-16. [PMID: 34247696 PMCID: PMC9991770 DOI: 10.1017/s1368980021002937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/02/2021] [Accepted: 07/07/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Understanding the socio-economic inequalities in dietary intake is crucial when addressing the socio-economic gradient in obesity rates and non-communicable diseases. We aimed to systematically assess the association between socio-economic position (SEP) and dietary intake in Chile. DESIGN We searched for peer-reviewed and grey literature from inception until 31 December 2019 in PubMed, Scopus, PsycINFO, Web of Sciences and LILACS databases. Observational studies published in English and Spanish, reporting the comparison of at least one dietary factor between at least two groups of different SEP in the general Chilean population, were selected. Two researchers independently conducted data searches, screening and extraction and assessed study quality using an adaptation of the Newcastle Ottawa Quality Assessment Scale. RESULTS Twenty-one articles (from eighteen studies) were included. Study quality was considered low, medium and high for 24, 52 and 24 % of articles, respectively. Moderate-to-large associations indicated lower intake of fruit and vegetables, dairy products and fish/seafood and higher pulses consumption among adults of lower SEP. Variable evidence of association was found for energy intake and macronutrients, in both children and adults. CONCLUSIONS Our findings highlight some socio-economic inequalities in diets in Chile, evidencing an overall less healthy food consumption among the lower SEP groups. New policies to reduce these inequalities should tackle the unequal distribution of factors affecting healthy eating among the lower SEP groups. These findings also provide important insights for developing strategies to reduce dietary inequalities in Chile and other countries that have undergone similar nutritional transitions.
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Affiliation(s)
- María Jesús Vega-Salas
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, BristolBS8 1TZ, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, BristolBS8 1TZ, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, BristolBS8 1TZ, UK
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15
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Borboudaki L, Linardakis M, Markaki AM, Papadaki A, Trichopoulou A, Philalithis A. Health service utilization among adults aged 50+ across eleven European countries (the SHARE study 2004/5). J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01173-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Mohammadi S, Su TT, Papadaki A, Jalaludin MY, Dahlui M, Mohamed MNA, Jago R, Toumpakari Z, Johnson L, Majid HA. Perceptions of eating practices and physical activity among Malaysian adolescents in secondary schools: a qualitative study with multi-stakeholders. Public Health Nutr 2021; 24:2273-2285. [PMID: 32744217 PMCID: PMC10195509 DOI: 10.1017/s1368980020002293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/09/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents. DESIGN A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data. SETTING Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia. PARTICIPANTS Focus groups were conducted with seventy-six adolescents aged 13-14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators. RESULTS Stakeholders thought that adolescents' misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers' commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA. CONCLUSIONS These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents.
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Affiliation(s)
- Shooka Mohammadi
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Tin Tin Su
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway47500, Malaysia
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Muhammad Yazid Jalaludin
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Maznah Dahlui
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Jawa Timur60115, Indonesia
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17
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González-Gil EM, Huybrechts I, Aguilera CM, Béghin L, Breidenassel C, Gesteiro E, González-Gross M, de Henauw S, Kersting M, Donne CL, Manios Y, Marcos A, Meirhaeghe A, De Miguel-Etayo P, Molina-Hidalgo C, Molnár D, Papadaki A, Widhalm K, Moreno LA, Bel-Serrat S. Cardiometabolic Risk is Positively Associated with Underreporting and Inversely Associated with Overreporting of Energy Intake Among European Adolescents: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. J Nutr 2021; 151:675-684. [PMID: 33484148 DOI: 10.1093/jn/nxaa389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/08/2020] [Accepted: 11/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dietary misreporting is the main limitation of dietary assessments and has been associated with BMI during youth. However there are no prior studies assessing misreporting and cardiometabolic risks (CMRs) in adolescence. OBJECTIVES To examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias in the association between CMR and energy intake (EI) driven by dietary misreporting. METHODS Two 24-hour dietary recalls were obtained from 1512 European adolescents (54.8% girls) aged 12.5-17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), the sum of 4 skinfold thicknesses, diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) measurements were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio were analyzed. A sex- and age-specific clustered CMR score (n = 364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status, and physical activity. RESULTS Underreporting (24.8% adolescents) was significantly (P < 0.05) associated with a higher WC, waist-to-height ratio (WHeR), and sum of skinfold thickness, whereas overreporting (23.4% adolescents) was significantly associated with a lower WC, WHeR, sum of skinfold thickness, and SBP. Associations between CMR factors and EI were significantly affected by misreporting, considering various approaches. Significant, positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for the sum of skinfold thickness, SBP, and CMR score. The associations between EI and DBP and CRF did not remain significant after adjusting for misreporting. CONCLUSIONS CMR factors differed among misreporting groups, and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than was BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations.
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Affiliation(s)
- Esther M González-Gil
- Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research, Universidad de Granada, Granada, Spain
- Growth, Exercise, Nutrition and Development Research (GENUD) Group, University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red (CIBER). Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Inge Huybrechts
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Concepción M Aguilera
- Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research, Universidad de Granada, Granada, Spain
- Centro de Investigacion Biomedica en Red (CIBER). Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Laurent Béghin
- University Lille, Inserm, Centre Hospitalier Universitarie (CHU) Lille, Clinical Investigation Center, Lille, France
- University Lille, Inserm, Institute for Translational Research in Inflammation, Lille, France
| | - Christina Breidenassel
- ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
- Institut of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
| | - Eva Gesteiro
- ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marcela González-Gross
- Centro de Investigacion Biomedica en Red (CIBER). Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
- Institut of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
| | - Stefaan de Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mathilde Kersting
- Research Department of Child Nutrition, Pediatric University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Cinzia Le Donne
- Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, Rome, Italy
| | - Yannis Manios
- Department of Nutrition, Harokopio University of Athens, Athens, Greece
| | - Ascensión Marcos
- Institute of Food Science, Technology and Nutrition, Spanish National Research Council, Madrid, Spain
| | - Aline Meirhaeghe
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1167, Institut Pasteur de Lille, Lille, France
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development Research (GENUD) Group, University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red (CIBER). Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Cristina Molina-Hidalgo
- Evaluacion funcional y fisiologia del ejercicio. Ciencia y tecnologia de la salud (EFFECTS 262) Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Angeliki Papadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Kurt Widhalm
- Medicine University Vienna, Department of Pediatrics, Division of Gastroenterolgy and Hepatology, Vienna, Austria
- Austrian Academic Institute for Clinical Nutrition, Vienna, Austria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research (GENUD) Group, University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red (CIBER). Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Silvia Bel-Serrat
- Growth, Exercise, Nutrition and Development Research (GENUD) Group, University of Zaragoza, Zaragoza, Spain
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Papadaki A, Nolen-Doerr E, Mantzoros CS. The Effect of the Mediterranean Diet on Metabolic Health: A Systematic Review and Meta-Analysis of Controlled Trials in Adults. Nutrients 2020; 12:nu12113342. [PMID: 33143083 PMCID: PMC7692768 DOI: 10.3390/nu12113342] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
The Mediterranean diet (MD) may provide metabolic benefits but no systematic review to date has examined its effect on a multitude of outcomes related to metabolic health. This systematic review with meta-analysis (International Prospective Register of Systematic Reviews, PROSPERO; number CRD42019141459) aimed to examine the MD’s effect on metabolic syndrome (MetSyn) incidence, components and risk factors (primary outcomes), and incidence and/or mortality from MetSyn-related comorbidities and receipt of pharmacologic treatment for MetSyn components and comorbidities (secondary outcomes). We searched Pubmed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science for controlled trials published until June 2019, comparing the MD with no treatment, usual care, or different diets in adults. Studies not published in English and not promoting the whole MD were excluded. Two authors independently extracted data and assessed risk of bias using the Cochrane Collaboration’s and Risk of Bias in non-randomised studies (ROBINS-I) tools. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effects meta-analyses, subgroup analyses and meta-regressions were performed, and heterogeneity was quantified using the I2 statistic. We identified 2654 reports and included 84 articles reporting 57 trials (n = 36,983). In random effects meta-analyses, the MD resulted in greater beneficial changes in 18 of 28 MetSyn components and risk factors (body weight, body mass index, waist circumference, systolic and diastolic blood pressure, glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR) index, total-, low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol, triglycerides, alanine transaminase, hepatic fat mass, C-reactive protein, interleukin-6, tumour necrosis factor-a, and flow-mediated dilatation) and lower risk of cardiovascular disease incidence (risk ratio (RR) = 0.61, 95% confidence intervals (CI) 0.42–0.80; I2 = 0%), and stroke (RR = 0.67, 95% CI 0.35–0.98; I2 = 0%). Only six studies reported effects on pharmacotherapy use, and pooled analysis indicated no differences between diet groups. Lack of consistency in comparator groups and other study characteristics across studies resulted in high heterogeneity for some outcomes, which could not be considerably explained by meta-regressions. However, a consistent direction of beneficial effect of the MD was observed for the vast majority of outcomes examined. Findings support MD’s beneficial effect on all components and most risk factors of the MetSyn, in addition to cardiovascular disease and stroke incidence. More studies are needed to establish effects on other clinical outcomes and use of pharmacotherapy for MetSyn components and comorbidities. Despite the high levels of heterogeneity for some outcomes, this meta-analysis enabled the comparison of findings across studies and the examination of consistency of effects. The consistent direction of effect, suggesting the MD’s benefits on metabolic health, supports the need to promote this dietary pattern to adult populations.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Eric Nolen-Doerr
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
- Department of Endocrinology, Boston VA Healthcare System, Boston, MA 02130, USA
| | - Christos S. Mantzoros
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
- Department of Endocrinology, Boston VA Healthcare System, Boston, MA 02130, USA
- Correspondence: ; Tel.: +1-(0)617-667-8636
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Mohammadi S, Su TT, Jalaludin MY, Dahlui M, Azmi Mohamed MN, Papadaki A, Jago R, Toumpakari Z, Majid HA. School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol. Front Public Health 2020; 8:549637. [PMID: 33072694 PMCID: PMC7536333 DOI: 10.3389/fpubh.2020.549637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling “red flag” foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell “green flag” food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
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Affiliation(s)
- Shooka Mohammadi
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia.,South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Hazreen A Majid
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia.,Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Valerino-Perea S, Lara-Castor L, Armstrong MEG, Papadaki A. Definition of the Traditional Mexican Diet and Its Role in Health: A Systematic Review. Nutrients 2019; 11:E2803. [PMID: 31744179 PMCID: PMC6893605 DOI: 10.3390/nu11112803] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/05/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
Promoting traditional diets could potentially reduce the current high rates of non-communicable diseases (NCDs) globally. While the traditional Mexican diet (TMexD) could be specifically promoted in Mexico, a concise definition of the TMexD and evidence of its association with NCDs are needed before its promotion. To evaluate what constitutes this diet pattern, we aimed to systematically review, for the first time, how the TMexD has been described in the literature to date. A secondary aim was to examine whether the TMexD, as described by available definitions, is associated with NCD outcomes. We searched for records describing a whole TMexD up to July 2019 in 12 electronic databases, reference lists, a relevant journal, and by contacting experts on the topic. We reported the results using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included 61 records for the definition of the diet and six for the association with NCD outcomes. The food groups characterising the TMexD that were consistently mentioned in all the study subgroups were grains and tubers, legumes, and vegetables; specific foods included maize, beans, chile, squash, tomato, and onion. Other groups also mentioned, although with lesser frequency, were maize products, fruits, beverages, fish and seafood, meats, sweets and sweeteners, and herbs and condiments. Only a few studies reported on the frequency of consumption or the amounts in which these foods were consumed in the TMexD. It was not possible to reach strong conclusions for the association between adherence to the TMexD and NCD outcomes. The TMexD was weakly associated with developing breast cancer, not associated with triglyceride levels, and inconsistently associated with obesity and diabetes outcomes. However, results were limited by the small number of studies (n = 6), of which most were of observational nature and evaluated diets using different TMexD definitions. These findings provide systematically identified evidence of the characteristics of the TMexD. More studies are needed to ascertain the exact quantities by which foods were consumed in the TMexD in order to establish whether this dietary pattern is associated with health and should be promoted within the Mexican population.
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Affiliation(s)
- Selene Valerino-Perea
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK; (M.E.G.A.); (A.P.)
| | - Laura Lara-Castor
- Friedman School of Nutrition Science and Policy at Tufts, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA;
| | - Miranda Elaine Glynis Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK; (M.E.G.A.); (A.P.)
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK; (M.E.G.A.); (A.P.)
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Langford R, Jago R, White J, Moore L, Papadaki A, Hollingworth W, Metcalfe C, Ward D, Campbell R, Wells S, Kipping R. A physical activity, nutrition and oral health intervention in nursery settings: process evaluation of the NAP SACC UK feasibility cluster RCT. BMC Public Health 2019; 19:865. [PMID: 31269926 PMCID: PMC6609387 DOI: 10.1186/s12889-019-7102-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA. A feasibility randomised controlled trial was conducted in England to adapt the intervention to the UK context. An embedded process evaluation focused on three key questions. 1. Was it feasible and acceptable to implement the intervention as planned? 2. How did the intervention affect staff and parent mediators? 3. Were the trial design and methods acceptable? METHODS Twelve nurseries in south-west England were recruited and randomised to intervention or control. The intervention comprised: NAP SACC UK Partner (Health Visitor) support to nurseries to review practice and policies against best practice, and then set goals to improve physical activity, nutrition and oral health; two staff training workshops; and a web-based parent support element. The process evaluation comprised: observations of Partner training (n = 1), Partner/manager meetings (n = 5) and staff workshops (n = 10); semi-structured interviews with Partners (n = 4), managers (n = 12), staff (n = 4) and parents (n = 20); analysis of self-assessment forms, goal setting forms and Partner logbooks; and assessment of staff and parent knowledge, motivation and self-efficacy mediators. RESULTS Overall, NAP SACC UK was feasible to implement and acceptable to nursery staff, managers, Partners and parents. The intervention was implemented as planned in five of the six intervention nurseries. Partners and managers appreciated the opportunity to review and improve nursery practices and valued the relationship forged between them. Staff rated the training workshops highly, despite attending outside of working hours. Most goals set by nurseries were achieved. However, Partners raised concerns about Health Visitors' capacity to deliver the intervention in any subsequent roll out. Mediator scores improved in all but two areas in intervention staff and parents, with decreases or minimal changes in the control group. The web-based parent element was not well used and should be removed from any subsequent trial. The trial methods were acceptable to managers, staff, Partners and parents. CONCLUSIONS Implementing and evaluating a physical activity and nutrition intervention in nursery settings is feasible and acceptable. A full RCT of NAP SACC UK (with appropriate modifications) is warranted. TRIAL REGISTRATION ISRCTN16287377 (10 Apr 2015).
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Affiliation(s)
- Rebecca Langford
- DECIPHer, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Social Science Complex, 8 Priory Rd, Bristol, BS8 1TZ UK
| | - James White
- Centre for Trials Research, DECIPHer, College of Biomedical and Life Sciences, Cardiff University, 4th Floor Health Park, Cardiff, CF14 4YS UK
| | - Laurence Moore
- Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Social Science Complex, 8 Priory Rd, Bristol, BS8 1TZ UK
| | - William Hollingworth
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS UK
| | - Dianne Ward
- Department of Nutrition, Gillings School of Global Public Health, Centre for Health promotion and Disease Prevention, University of North Carolina, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC 27514 USA
| | - Rona Campbell
- DECIPHer, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS UK
| | - Sian Wells
- DECIPHer, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS UK
| | - Ruth Kipping
- DECIPHer, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS UK
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Kipping R, Langford R, Brockman R, Wells S, Metcalfe C, Papadaki A, White J, Hollingworth W, Moore L, Ward D, Campbell R, Kadir B, Tinner L, Er V, Dias K, Busse H, Collingwood J, Nicholson A, Johnson L, Jago R. Child-care self-assessment to improve physical activity, oral health and nutrition for 2- to 4-year-olds: a feasibility cluster RCT. Public Health Res 2019. [DOI: 10.3310/phr07130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background
The Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention has shown evidence of effectiveness in the USA but not been adapted or assessed for effectiveness in the UK.
Objectives
To evaluate the feasibility and acceptability of implementing NAP SACC in the UK.
Design
Adaptation and development of NAP SACC and feasibility cluster randomised controlled trial (RCT) including process and economic evaluations. Substudies assessed mediator questionnaire test–retest reliability and feasibility of food photography methods.
Setting
Nurseries, staff and parents in North Somerset, Cardiff, Gloucestershire and Bristol.
Participants
Development – 15 early years/public health staff and health visitors, 12 nursery managers and 31 parents. RCT – 12 nurseries and 31 staff, four partners and 168 children/parents. Mediator substudy – 82 parents and 69 nursery staff. Food photography substudy – four nurseries, 18 staff and 51 children.
Intervention
NAP SACC UK partners supported nurseries to review policies and practices and set goals to improve nutrition, oral health and physical activity (PA) over 5 months. Two workshops were delivered to nursery staff by local experts. A home component [website, short message service (SMS) and e-mails] supported parents. The control arm continued with usual practice.
Main outcome measures
Feasibility and acceptability of the intervention and methods according to prespecified criteria.
Data sources
Qualitative data to adapt the intervention. Measurements with children, parents and staff at baseline and post intervention (8–10 months after baseline). Interviews with nursery managers, staff, parents and NAP SACC UK partners; observations of training, workshops and meetings. Nursery environment observation, nursery Review and Reflect score, and resource log. Child height and weight, accelerometer-determined PA and sedentary time, screen time and dietary outcomes using the Child and Diet Evaluation Tool. Staff and parent questionnaires of knowledge, motivation and self-efficacy. Child quality of life and nursery, family and health-care costs. Food photography of everything consumed by individual children and staff questionnaire to assess acceptability.
Results
Thirty-two per cent (12/38) of nurseries and 35.3% (168/476) of children were recruited; no nurseries withdrew. The intervention was delivered in five out of six nurseries, with high levels of fidelity and acceptability. Partners found it feasible but had concerns about workload. The child loss to follow-up rate was 14.2%. There was suggestion of promise in intervention compared with control nurseries post intervention for snacks, screen time, proportion overweight or obese and accelerometer-measured total PA and moderate to vigorous PA. Many parental and nursery knowledge and motivation mediators improved. The average cost of delivering the intervention was £1184 per nursery excluding partner training, and the average cost per child was £27. Fourteen per cent of parents used the home component and the mediator questionnaire had good internal consistency and test–retest reliability. Photography of food was acceptable and feasible.
Limitations
Following nursery leavers was difficult. Accelerometer data, diet data and environmental assessment would have been more reliable with 2 days of data.
Conclusions
The NAP SACC UK intervention and methods were found to be feasible and acceptable to participants, except for the home component. There was sufficient suggestion of promise to justify a definitive trial.
Future work
A multicentre cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of NAP SACC UK has been funded by NIHR and will start in July 2019 (PHR NIHR 127551).
Trial registration
Current Controlled Trials ISRCTN16287377.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health
Research programme and will be published in full in Public Health
Research; Vol. 7, No. 13. See the NIHR Journals Library website
for further project information. Funding was also provided by the North
Somerset and Gloucestershire Councils, Development and Evaluation of Complex
Interventions for Public Health Improvement (DECIPHer) (MR/KO232331/1), and
the Elizabeth Blackwell Institute.
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Affiliation(s)
- Ruth Kipping
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Langford
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rowan Brockman
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Wells
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - James White
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Dianne Ward
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rona Campbell
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bryar Kadir
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Laura Tinner
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vanessa Er
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Kaiseree Dias
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Heide Busse
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Papadaki A, Martínez-González MÁ, Alonso-Gómez A, Rekondo J, Salas-Salvadó J, Corella D, Ros E, Fitó M, Estruch R, Lapetra J, García-Rodriguez A, Fiol M, Serra-Majem L, Pintó X, Ruiz-Canela M, Bulló M, Serra-Mir M, Sorlí JV, Arós F. Mediterranean diet and risk of heart failure: results from the PREDIMED randomized controlled trial. Eur J Heart Fail 2017;19:1179-1185. doi: 10.1002/ejhf.750. Eur J Heart Fail 2019; 21:389-391. [PMID: 30883998 DOI: 10.1002/ejhf.1346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Er V, Dias KI, Papadaki A, White J, Wells S, Ward DS, Metcalfe C, Jago R, Kipping R. Association of diet in nurseries and physical activity with zBMI in 2-4-year olds in England: a cross-sectional study. BMC Public Health 2018; 18:1262. [PMID: 30428858 PMCID: PMC6236905 DOI: 10.1186/s12889-018-6138-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity tracks into adulthood with detrimental effects on health. We aimed to examine the relationships of diet in childcare settings and daily physical activity (PA) of preschoolers with body mass index z-score (z-BMI). METHODS We conducted a cross-sectional study of 150 children aged 2-4-years participating in the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) UK study to examine the associations of their diet in childcare settings and daily PA with z-BMI. Dietary intake was observed and recorded by fieldworkers using a validated tick-list food questionnaire and diet quality was assessed based on adherence to Children's Food Trust (CFT) guidelines. PA was measured using accelerometers. We derived z-BMI scores using the UK 1990 and International Obesity Taskforce growth reference charts. Multilevel regression models were used to estimate associations between diet and PA with z-BMI separately, adjusted for age, gender, ethnicity, parental education level and clustering. RESULTS Among children who consumed one main meal or snack at childcare, 34.4% and 74.3% met the standards on fruits and vegetables and high sugar or fat snacks, respectively. Adherence to CFT guidelines was not associated with zBMI. Only 11.4% of children met recommended UK guidelines of three hours per day of physical activity. Minutes spent in light PA (β = 0.08, 95% CI = 0.01, 0.15) and active time (β = 0.07, 95% CI = 0.01, 0.12) were positively associated with UK 1990 zBMI scores. CONCLUSIONS The low proportion of children meeting the standards on fruits and vegetables and high sugar or fat snacks and recommended physical activity levels highlight the need for more work to support nurseries and parents to improve preschool children's diet and activity. In our exploratory analyses, we found children with higher zBMI were more physically active which could be attributed to fat-free mass or chance finding and so requires replication in a larger study. TRIAL REGISTRATION ISRCTN16287377 . Registered 12 June 2014.
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Affiliation(s)
- Vanessa Er
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Kaiseree Ioni Dias
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - James White
- Centre for Trials Research, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF144YS, UK
| | - Sian Wells
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Dianne Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Ruth Kipping
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Malakou E, Linardakis M, Armstrong MEG, Zannidi D, Foster C, Johnson L, Papadaki A. The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2018; 10:nu10111577. [PMID: 30366431 PMCID: PMC6267322 DOI: 10.3390/nu10111577] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022] Open
Abstract
Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration’s tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (−3.68 kg, 95% CI (confidence intervals) −5.48, −1.89), body mass index (−0.64 kg/m2, 95% CI −1.10, −0.18), waist circumference (−1.62 cm, 95% CI −2.58, −0.66), systolic (−0.83 mmHg, 95% CI −1.57, −0.09) and diastolic blood pressure (−1.96 mmHg, 95% CI −2.57, −1.35), HOMA-IR index (−0.90, 95% CI −1.22, −0.58), blood glucose (−7.32 mg/dL, 95% CI −9.82, −4.82), triglycerides (−18.47 mg/dL, 95% CI −20.13, −16.80), total cholesterol (−6.30 mg/dL, 95% CI −9.59, −3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk.
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Affiliation(s)
- Evangelia Malakou
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion 71003, Crete, Greece.
| | - Miranda Elaine Glynis Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Dimitra Zannidi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Eleftheriou Venizelou 70, Kallithea 176 76, Athens, Greece.
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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26
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Vozikaki M, Papadaki A, Linardakis M, Philalithis A. Loneliness among older European adults: results from the survey of health, aging and retirement in Europe. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0916-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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27
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Johnson L, Toumpakari Z, Papadaki A. Social Gradients and Physical Activity Trends in an Obesogenic Dietary Pattern: Cross-Sectional Analysis of the UK National Diet and Nutrition Survey 2008-2014. Nutrients 2018; 10:E388. [PMID: 29565283 PMCID: PMC5946173 DOI: 10.3390/nu10040388] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 01/02/2023] Open
Abstract
An energy-dense, high-fat, low-fibre dietary pattern has been prospectively associated with the development of obesity in childhood but is population-specific, which limits translating the pattern into interventions. We explored the generalisability and correlates of this obesogenic dietary pattern in the UK National Diet and Nutrition Survey (NDNS) for the first time. Data came from participants (n = 4636 children and n = 4738 adults) with 4-day food diaries in NDNS 2008-2014. Reduced rank regression was applied to 51 food groups to explain variation in energy density, fibre and fat intake. Consistency of the pattern in population subgroups (according to sex, age, occupation and income) was compared with the whole sample pattern using coefficients of congruence (COC). Pattern correlates (sociodemographic, survey year, physical activity and eating related behaviours) were explored using multiple linear regression. Food group loadings were similar to the previously identified obesogenic dietary pattern and were generalisable across all sub-groups (COC: 0.93-0.99). An obesogenic diet was associated with eating takeaways, being omnivorous, a manual household occupation and lower household income in both adults and children (p < 0.0001). Dieting for weight loss, being older, more physically active and less sedentary was associated with a less obesogenic diet among adults (p < 0.0001). Future experimental studies should investigate if changes in this obesogenic pattern could be used to monitor the effectiveness of obesity prevention policies or develop personalised interventions.
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Affiliation(s)
- Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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28
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Andriessen C, Christensen P, Vestergaard Nielsen L, Ritz C, Astrup A, Meinert Larsen T, Martinez JA, Saris WHM, van Baak MA, Papadaki A, Kunesova M, Jebb S, Blundell J, Lawton C, Raben A. Weight loss decreases self-reported appetite and alters food preferences in overweight and obese adults: Observational data from the DiOGenes study. Appetite 2018; 125:314-322. [PMID: 29471068 DOI: 10.1016/j.appet.2018.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022]
Abstract
People with obesity often struggle to maintain their weight loss after a weight loss period. Furthermore, the effect of weight loss on appetite and food preferences remains unclear. Hence this study investigated the effect of weight loss on subjective appetite and food preferences in healthy, overweight and obese volunteers. A subgroup of adult participants (n = 123) from the Diet Obesity and Genes (DiOGenes) study (subgroup A) was recruited from across six European countries. Participants lost ≥8% of initial body weight during an 8-week low calorie diet (LCD). Subjective appetite and food preferences were measured before and after the LCD, in response to a standardized meal test, using visual analogue rating scales (VAS) and the Leeds Food Choice Questionnaire (FCQ). After the LCD, participants reported increased fullness (p < 0.05), decreased desire to eat (p < 0.05) and decreased prospective consumption (p < 0.05) after consuming the test meal. An interaction effect (visit x time) was found for hunger ratings (p < 0.05). Area under the curve (AUC) for hunger, desire to eat and prospective consumption was decreased by 18.1%, 20.2% and 21.1% respectively whereas AUC for fullness increased by 13.9%. Preference for low-energy products measured by the Food Preference Checklist (FPC) decreased by 1.9% before the test meal and by 13.5% after the test meal (p < 0.05). High-carbohydrate and high-fat preference decreased by 11.4% and 16.2% before the test meal and by 17.4% and 22.7% after the meal (p < 0.05). No other effects were observed. These results suggest that LCD induced weight loss decreases the appetite perceptions of overweight volunteers whilst decreasing their preference for high-fat-, high-carbohydrate-, and low-energy products.
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Affiliation(s)
- Charlotte Andriessen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark; Department of Human Nutrition, Wageningen University, The Netherlands.
| | - Pia Christensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | | | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | | | - J Alfredo Martinez
- Center for Nutrition Research, University of Navarra, Pamplona, CIBERobn, Fisiopatología de la Obesidady Nutrición, Madrid, Spain.
| | - Wim H M Saris
- Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands.
| | - Marleen A van Baak
- Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands.
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom; Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece.
| | - Marie Kunesova
- Institute of Endocrinology, Obesity Management Centre, Prague, Czech Republic.
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - John Blundell
- School of Psychology, University of Leeds, Leeds, United Kingdom.
| | - Clare Lawton
- School of Psychology, University of Leeds, Leeds, United Kingdom.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
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29
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Papadaki A, Johnson L, Toumpakari Z, England C, Rai M, Toms S, Penfold C, Zazpe I, Martínez-González MA, Feder G. Validation of the English Version of the 14-Item Mediterranean Diet Adherence Screener of the PREDIMED Study, in People at High Cardiovascular Risk in the UK. Nutrients 2018; 10:E138. [PMID: 29382082 PMCID: PMC5852714 DOI: 10.3390/nu10020138] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/16/2018] [Accepted: 01/25/2018] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial for assessment and immediate feedback. This instrument (MEDAS) was administered to 96 adults with a high cardiovascular risk (66% women, mean age 68.3 ± 6.0 years), recruited from general practices in Bristol, UK. Participants then completed a 3-day estimated food record, and the MEDAS was administered again one month later. A MedDiet score (range = 0-14) was calculated from the MEDAS' administrations and food record to assess concurrent validity and test-retest reliability. Predictive validity was assessed by examining the association of the MEDAS-derived score with cardiometabolic risk factors and dietary intakes derived from the food records. The MEDAS-derived MedDiet score was higher by 1.47 points compared to food records (5.47 vs.4.00, p < 0.001), correlated moderately with the record-derived score (r = 0.50, p < 0.001; ICC = 0.53, p < 0.001) and there was borderline fair agreement between the two methods (κ = 0.19, 95% CI 0.07-0.31, p = 0.002; 95% limits of agreement -2.2, 5.1). Exact agreement within score categories and gross misclassificationwere 45.8% and 21.9%, respectively. The distribution of dietary intakes, reported on the food records by the MEDAS-derived total MedDiet score, was in the expected direction, but no association was observed with cardiometabolic risk factors. The two administrations of the MEDAS produced similar mean total MedDiet scores (5.5 vs. 5.4, p = 0.706), which were correlated (r and ICC = 0.69, p < 0.001) and agreed fairly (κ = 0.38, 95% CI 0.24-0.52, p < 0.001; 95% limits of agreement -3.1, 3.2). The English version of the MEDAS has acceptable accuracy and reliability for assessing MedDiet adherence among individuals with a high cardiovascular risk, in the UK, and can be used to rank individuals according to MedDiet adherence in research and practice.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK.
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Clare England
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK.
| | - Manmita Rai
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK.
| | - Stu Toms
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK.
| | - Chris Penfold
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Lower Maudlin Street, BristolBS1 2LY, UK.
| | - Itziar Zazpe
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain.
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain.
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK.
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30
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Papazachariou L, Papagregoriou G, Hadjipanagi D, Demosthenous P, Voskarides K, Koutsofti C, Stylianou K, Ioannou P, Xydakis D, Tzanakis I, Papadaki A, Kallivretakis N, Nikolakakis N, Perysinaki G, Gale DP, Diamantopoulos A, Goudas P, Goumenos D, Soloukides A, Boletis I, Melexopoulou C, Georgaki E, Frysira E, Komianou F, Grekas D, Paliouras C, Alivanis P, Vergoulas G, Pierides A, Daphnis E, Deltas C. Frequent COL4 mutations in familial microhematuria accompanied by later-onset Alport nephropathy due to focal segmental glomerulosclerosis. Clin Genet 2017. [PMID: 28632965 DOI: 10.1111/cge.13077] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Familial microscopic hematuria (FMH) is associated with a genetically heterogeneous group of conditions including the collagen-IV nephropathies, the heritable C3/CFHR5 nephropathy and the glomerulopathy with fibronectin deposits. The clinical course varies widely, ranging from isolated benign familial hematuria to end-stage renal disease (ESRD) later in life. We investigated 24 families using next generation sequencing (NGS) for 5 genes: COL4A3, COL4A4, COL4A5, CFHR5 and FN1. In 17 families (71%), we found 15 pathogenic mutations in COL4A3/A4/A5, 9 of them novel. In 5 families patients inherited classical AS with hemizygous X-linked COL4A5 mutations. Even more patients developed later-onset Alport-related nephropathy having inherited heterozygous COL4A3/A4 mutations that cause thin basement membranes. Amongst 62 heterozygous or hemizygous patients, 8 (13%) reached ESRD, while 25% of patients with heterozygous COL4A3/A4 mutations, aged >50-years, reached ESRD. In conclusion, COL4A mutations comprise a frequent cause of FMH. Heterozygous COL4A3/A4 mutations predispose to renal function impairment, supporting that thin basement membrane nephropathy is not always benign. The molecular diagnosis is essential for differentiating the X-linked from the autosomal recessive and dominant inheritance. Finally, NGS technology is established as the gold standard for the diagnosis of FMH and associated collagen-IV glomerulopathies, frequently averting the need for invasive renal biopsies.
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Affiliation(s)
- L Papazachariou
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - G Papagregoriou
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - D Hadjipanagi
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - P Demosthenous
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - K Voskarides
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - C Koutsofti
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - K Stylianou
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - P Ioannou
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - D Xydakis
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - I Tzanakis
- Department of Nephrology, General Hospital of Chania, Crete, Greece
| | - A Papadaki
- Department of Nephrology, General Hospital of Chania, Crete, Greece
| | - N Kallivretakis
- Department of Nephrology, General Hospital of Chania, Crete, Greece
| | - N Nikolakakis
- Division of Nephrology, General Hospital of Rethymno, Crete, Greece
| | - G Perysinaki
- Division of Nephrology, General Hospital of Rethymno, Crete, Greece
| | - D P Gale
- UCL Division of Medicine and Centre for Nephrology, University College London, London, UK
| | | | - P Goudas
- IATOS Dialysis Unit, Patra, Greece
| | - D Goumenos
- Department of Nephrology, Medical School, University of Patras, Patra, Greece
| | - A Soloukides
- Protypo Nefrologiko Athinon Dialysis Center, Athens, Greece
| | - I Boletis
- Department of Nephrology, Laikon Hospital, Athens, Greece
| | - C Melexopoulou
- Department of Nephrology, Laikon Hospital, Athens, Greece
| | - E Georgaki
- Pediatric Nephrology Unit, "IASO" Children's Hospital, Athens, Greece
| | - E Frysira
- Department of Pediatrics, Athens University Medical School, Agia Sophia Children's Hospital, Athens, Greece
| | - F Komianou
- Department of Medical Genetics, Athens University Medical School, Agia Sophia Children's Hospital, Athens, Greece
| | - D Grekas
- University Hospital AXEPA, Thessaloniki, Greece
| | - C Paliouras
- Department of Nephrology, General Hospital of Rhodes, Rhodes, Greece
| | - P Alivanis
- Department of Nephrology, General Hospital of Rhodes, Rhodes, Greece
| | - G Vergoulas
- Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - A Pierides
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus.,Department of Nephrology, Hippocrateon Hospital, Nicosia, Cyprus
| | - E Daphnis
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - C Deltas
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
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31
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Papadaki A, Martinez JA. Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake. Ann Intern Med 2017; 166:377-378. [PMID: 28265658 DOI: 10.7326/l16-0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Angeliki Papadaki
- From University of Bristol, Bristol, United Kingdom, and CIBERobn Nutrición, University of Navarra, Pamplona, Spain
| | - J Alfredo Martinez
- From University of Bristol, Bristol, United Kingdom, and CIBERobn Nutrición, University of Navarra, Pamplona, Spain
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32
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Papadaki A, Martínez-González MÁ, Alonso-Gómez A, Rekondo J, Salas-Salvadó J, Corella D, Ros E, Fitó M, Estruch R, Lapetra J, García-Rodriguez A, Fiol M, Serra-Majem L, Pintó X, Ruiz-Canela M, Bulló M, Serra-Mir M, Sorlí JV, Arós F. Mediterranean diet and risk of heart failure: results from the PREDIMED randomized controlled trial. Eur J Heart Fail 2017; 19:1179-1185. [PMID: 28133855 DOI: 10.1002/ejhf.750] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/10/2016] [Accepted: 12/13/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to evaluate the effect of the Mediterranean diet (MedDiet) on the incidence of heart failure (HF), a pre-specified secondary outcome in the PREDIMED (PREvención con DIeta MEDiterránea) primary nutrition-intervention prevention trial. METHODS AND RESULTS Participants at high risk of cardiovascular disease were randomly assigned to one of three diets: MedDiet supplemented with extra-virgin olive oil (EVOO), MedDiet supplemented with nuts, or a low-fat control diet. Incident HF was ascertained by a Committee for Adjudication of events blinded to group allocation. Among 7403 participants without prevalent HF followed for a median of 4.8 years, we observed 29 new HF cases in the MedDiet with EVOO group, 33 in the MedDiet with nuts group, and 32 in the control group. No significant association with HF incidence was found for the MedDiet with EVOO and MedDiet with nuts, compared with the control group [hazard ratio (HR) 0.68; 95% confidence interval (CI) 0.41-1.13, and HR 0.92; 95% CI 0.56-1.49, respectively]. CONCLUSION In this sample of adults at high cardiovascular risk, the MedDiet did not result in lower HF incidence. However, this pre-specified secondary analysis may have been underpowered to provide valid conclusions. Further randomized controlled trials with HF as a primary outcome are needed to better assess the effect of the MedDiet on HF risk. TRIAL REGISTRATION ISRCTN35739639.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Faculty of Medicine, IdiSNA, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Angel Alonso-Gómez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - Javier Rekondo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Montse Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - José Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | | | - Miquel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Palma Institut of Health Research (IdISPa), Hospital Son Espases, Palma de Mallorca, Spain
| | - Lluís Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Xavier Pintó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - Miguel Ruiz-Canela
- University of Navarra, Department of Preventive Medicine and Public Health, Faculty of Medicine, IdiSNA, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Monica Bulló
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain
| | - Mercè Serra-Mir
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jose V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Fernando Arós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, University Hospital Araba, Vitoria, Spain
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Papadaki A, Thanasoulias A, Pound R, Sebire SJ, Jago R. Employees' Expectations of Internet-Based, Workplace Interventions Promoting the Mediterranean Diet: A Qualitative Study. J Nutr Educ Behav 2016; 48:706-715.e1. [PMID: 27692630 DOI: 10.1016/j.jneb.2016.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/23/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Explore employees' perceptions of ability to follow the Mediterranean diet (MedDiet), preferences for setting goals if asked to follow the MedDiet, and expectations of an Internet-based, workplace MedDiet intervention. DESIGN Seven focus groups to guide intervention development. SETTING Four workplaces (business/professional services, government branches) in Southwest England. PARTICIPANTS Employees (n = 29, 51.7% women), ages 24-58 years. PHENOMENON OF INTEREST Ability to follow the MedDiet; preferences for goal-setting if asked to follow the MedDiet; intervention content. ANALYSIS Data were analyzed with the use of thematic analysis. RESULTS Participants perceived that adhering to some MedDiet recommendations would be challenging and highlighted cost, taste, and cooking skills as adherence barriers. Behavior change preferences included a tailored approach to goal-setting, reviewing goal progress via a website/smartphone app, and receiving expert feedback via an app/website/text/face-to-face session. Desirable features of an Internet-based MedDiet application included recipes, interactivity, nutritional information, shopping tips, cost-saving information, and a companion smartphone app. Engaging in social support was deemed important to facilitate adherence. CONCLUSIONS AND IMPLICATIONS An Internet-based, workplace MedDiet intervention should address adherence barriers, utilize a tailored approach to setting and reviewing goals, and activate social support to facilitate adherence. These findings provide insights to planning to promote the MedDiet in non-Mediterranean regions.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom.
| | - Andreas Thanasoulias
- Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Rachael Pound
- Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Simon J Sebire
- Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
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Kipping R, Jago R, Metcalfe C, White J, Papadaki A, Campbell R, Hollingworth W, Ward D, Wells S, Brockman R, Nicholson A, Moore L. NAP SACC UK: protocol for a feasibility cluster randomised controlled trial in nurseries and at home to increase physical activity and healthy eating in children aged 2-4 years. BMJ Open 2016; 6:e010622. [PMID: 27053273 PMCID: PMC4823443 DOI: 10.1136/bmjopen-2015-010622] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Systematic reviews have identified the lack of intervention studies with young children to prevent obesity. This feasibility study examines the feasibility and acceptability of adapting the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention in the UK to inform a full-scale trial. METHODS AND ANALYSIS A feasibility cluster randomised controlled trial in 12 nurseries in England, with 6 randomly assigned to the adapted NAP SACC UK intervention: nursery staff will receive training and support from an NAP SACC UK Partner to review the nursery environment (nutrition, physical activity, sedentary behaviours and oral health) and set goals for making changes. Parents will be invited to participate in a digital media-based home component to set goals for making changes in the home. As this is a feasibility study, the sample size was not based on a power calculation but will indicate the likely response rates and intracluster correlations. Measures will be assessed at baseline and 8-10 months later. We will estimate the recruitment rate of nurseries and children and adherence to the intervention and data. Nursery measurements will include the Environmental Policy Assessment and Observation score and the nursery staff's review of the nursery environment. Child measurements will include height and weight to calculate z-score body mass index (zBMI), accelerometer-determined minutes of moderate-to-vigorous physical activity per day and sedentary time, and diet using the Child and Diet Evaluation Tool. Questionnaires with nursery staff and parents will measure mediators. A process evaluation will assess fidelity of intervention delivery and views of participants. ETHICS AND DISSEMINATION Ethical approval for this study was given by Wales 3 NHS Research Ethics Committee. Findings will be made available through publication in peer-reviewed journals, at conferences and to participants via the University of Bristol website. Data will be available from the University of Bristol Research Data Repository. TRIAL REGISTRATION NUMBER ISRCTN16287377.
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Affiliation(s)
- R Kipping
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - C Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK Bristol Randomised Trials Collaboration, Bristol, UK
| | - J White
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - A Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - S Wells
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Brockman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - A Nicholson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - L Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Vanhelst J, Béghin L, Duhamel A, Manios Y, Molnar D, De Henauw S, Moreno LA, Ortega FB, Sjöström M, Widhalm K, Gottrand F, Moreno LA, Gottrand F, De Henauw S, González-Gross M, Gilbert C, Kafatos A, Moreno LA, Libersa C, De Henauw S, Sánchez J, Gottrand F, Kersting M, Sjöstrom M, Molnár D, González-Gross M, Dallongeville J, Gilbert C, Hall G, Maes L, Scalfi L, Meléndez P, Moreno LA, Fleta J, Casajús JA, Rodríguez G, Tomás C, Mesana MI, Vicente-Rodríguez G, Villarroya A, Gil CM, Ara I, Revenga J, Lachen C, Alvira JF, Bueno G, Lázaro A, Bueno O, León JF, Garagorri JM, Bueno M, Rey López JP, Iglesia I, Velasco P, Bel S, Marcos A, Wärnberg J, Nova E, Gómez S, Díaz EL, Romeo J, Veses A, Puertollano MA, Zapatera B, Pozo T, Martínez D, Beghin L, Libersa C, Gottrand F, Iliescu C, Von Berlepsch J, Kersting M, Sichert-Hellert W, Koeppen E, Molnar D, Erhardt E, Csernus K, Török K, Bokor S, Angster M, Nagy E, Kovács O, Repásy J, Kafatos A, Codrington C, Plada M, Papadaki A, Sarri K, Viskadourou A, Hatzis C, Kiriakakis M, Tsibinos G, Vardavas C, Sbokos M, Protoyeraki E, Fasoulaki M, Stehle P, Pietrzik K, González-Gross M, Breidenassel C, Spinneker A, Al-Tahan J, Segoviano M, Berchtold A, Bierschbach C, Blatzheim E, Schuch A, Pickert P, Castillo MJ, Gutiérrez Á, Ortega FB, Ruiz JR, Artero EG, España-Romero V, Jiménez-Pavón D, Chillón P, Cuenca-García M, Arcella D, Azzini E, Barrison E, Bevilacqua N, Buonocore P, Catasta G, Censi L, Ciarapica D, D'Acapito P, Ferrari M, Galfo M, Le Donne C, Leclercq C, Maiani G, Mauro B, Mistura L, Pasquali A, Piccinelli R, Polito A, Spada R, Sette S, Zaccaria M, Scalfi L, Vitaglione P, Montagnese C, De Bourdeaudhuij I, De Henauw S, De Vriendt T, Maes L, Matthys C, Vereecken C, de Maeyer M, Ottevaere C, Huybrechts I, Widhalm K, Phillipp K, Dietrich S, Kubelka B, Boriss-Riedl M, Manios Y, Grammatikaki E, Bouloubasi Z, Cook TL, Eleutheriou S, Consta O, Moschonis G, Katsaroli I, Kraniou G, Papoutsou S, Keke D, Petraki I, Bellou E, Tanagra S, Kallianoti K, Argyropoulou D, Kondaki K, Tsikrika S, Karaiskos C, Dallongeville J, Meirhaeghe A, Sjöstrom M, Bergman P, Hagströmer M, Hallström L, Hallberg M, Poortvliet E, Wärnberg J, Rizzo N, Beckman L, Wennlöf AH, Patterson E, Kwak L, Cernerud L, Tillgren P, Sörensen S, Sánchez-Molero J, Picó E, Navarro M, Viadel B, Carreres JE, Merino G, Sanjuán R, Lorente M, Sánchez MJ, Castelló S, Gilbert C, Thomas S, Allchurch E, Burguess P, Hall G, Astrom A, Sverkén A, Broberg A, Masson A, Lehoux C, Brabant P, Pate P, Fontaine L, Sebok A, Kuti T, Hegyi A, Maldonado C, Llorente A, García E, von Fircks H, Hallberg ML, Messerer M, Larsson M, Fredriksson H, Adamsson V, Börjesson I, Fernández L, Smillie L, Wills J, González-Gross M, Meléndez A, Benito PJ, Calderón J, Jiménez-Pavón D, Valtueña J, Navarro P, Urzanqui A, Albers U, Pedrero R, Gómez Lorente JJ. Physical Activity Is Associated with Attention Capacity in Adolescents. J Pediatr 2016; 168:126-131.e2. [PMID: 26480921 DOI: 10.1016/j.jpeds.2015.09.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 08/13/2015] [Accepted: 09/08/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents. STUDY DESIGN The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity. RESULTS After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA. CONCLUSION These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.
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Affiliation(s)
- Jérémy Vanhelst
- University of Lille, INSERM, CHU Lille, LIRIC, UMR995, F-59000, Lille, France; CHU Lille, INSERM, CIC-PT-1403, F-59000, Lille, France.
| | - Laurent Béghin
- University of Lille, INSERM, CHU Lille, LIRIC, UMR995, F-59000, Lille, France; CHU Lille, INSERM, CIC-PT-1403, F-59000, Lille, France
| | - Alain Duhamel
- Department of Biostatistics, University of Lille, Lille, France
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Denes Molnar
- Department of Pediatrics, Pécs University, Pécs, Hungary
| | - Sefaan De Henauw
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Luis A Moreno
- Growth, Exercise, Nutrition, and Development Research Group, Escuela Universitaria de Ciencias de la Salud, Zaragoza University, Zaragoza, Spain
| | - Francisco B Ortega
- School of Sport Sciences, University of Granada, Granada, Spain; Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Michael Sjöström
- Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Kurt Widhalm
- Department of Pediatrics, Paracelsus Private Medical University of Salzburg, Salzburg, Austria
| | - Frédéric Gottrand
- University of Lille, INSERM, CHU Lille, LIRIC, UMR995, F-59000, Lille, France
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Park H, Papadaki A. Nutritional value of foods sold in vending machines in a UK University: Formative, cross-sectional research to inform an environmental intervention. Appetite 2015; 96:517-525. [PMID: 26527253 DOI: 10.1016/j.appet.2015.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
Vending machine use has been associated with low dietary quality among children but there is limited evidence on its role in food habits of University students. We aimed to examine the nutritional value of foods sold in vending machines in a UK University and conduct formative research to investigate differences in food intake and body weight by vending machine use among 137 University students. The nutrient content of snacks and beverages available at nine campus vending machines was assessed by direct observation in May 2014. Participants (mean age 22.5 years; 54% males) subsequently completed a self-administered questionnaire to assess vending machine behaviours and food intake. Self-reported weight and height were collected. Vending machine snacks were generally high in sugar, fat and saturated fat, whereas most beverages were high in sugar. Seventy three participants (53.3%) used vending machines more than once per week and 82.2% (n 60) of vending machine users used them to snack between meals. Vending machine accessibility was positively correlated with vending machine use (r = 0.209, P = 0.015). Vending machine users, compared to non-users, reported a significantly higher weekly consumption of savoury snacks (5.2 vs. 2.8, P = 0.014), fruit juice (6.5 vs. 4.3, P = 0.035), soft drinks (5.1 vs. 1.9, P = 0.006), meat products (8.3 vs. 5.6, P = 0.029) and microwave meals (2.0 vs. 1.3, P = 0.020). No between-group differences were found in body weight. Most foods available from vending machines in this UK University were of low nutritional quality. In this sample of University students, vending machine users displayed several unfavourable dietary behaviours, compared to non-users. Findings can be used to inform the development of an environmental intervention that will focus on vending machines to improve dietary behaviours in University students in the UK.
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Affiliation(s)
- Hanla Park
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
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Linardakis M, Papadaki A, Smpokos E, Micheli K, Vozikaki M, Philalithis A. Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004-2005. Prev Chronic Dis 2015; 12:E149. [PMID: 26378895 PMCID: PMC4576501 DOI: 10.5888/pcd12.150134] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Noncommunicable diseases are the leading cause of illness and death worldwide; behavioral risk factors (BRFs) contribute to these diseases. We assessed the presence of multiple BRFs among European adults according to their physical and mental health status. METHODS We used data from 26,026 adults aged 50 years or older from 11 countries that participated in the Survey of Health, Ageing and Retirement in Europe (2004-2005). BRFs (overweight or obesity, smoking, physical inactivity, and risky alcohol consumption) were assessed according to physical health (ie, presence of chronic diseases, disease symptoms, or limitations in activities of daily living) and mental health (depression) through multiple regression estimations. RESULTS Overweight or obesity in men and physical inactivity in women were the most prevalent BRFs. Compared with physically active adults, physically inactive adults had a higher mean number of chronic diseases (1.33 vs 1.26) and chronic disease symptoms (1.55 vs 1.47). Risky alcohol consumption (≥4 servings of an alcohol beverage ≥3 times a week) was associated with a higher mean depression score (2.84 vs 2.47). Compared with adults with 0 or 1 BRF, adults with 2 or more BRFs had significantly higher odds of having 1 or more chronic diseases (men: 1.52; women: 1.73) and functional limitations (men: 1.65; women: 1.79) and higher prevalence of high blood pressure (37.8% vs 28.2). Belgian adults with BRFs had the highest mean number of chronic diseases or functional limitations among those who were overweight or obese and the highest mean number of chronic diseases and disease symptoms among those who smoked and were physically inactive. CONCLUSION We found revealed significant positive associations between BRFs and poor health among middle-aged and older European adults. Primary health care intervention programs should focus on developing ways to reduce BRF prevalence in this population.
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Affiliation(s)
- Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion 71003, Crete, Greece.
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, United Kingdom, and Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Emmanouil Smpokos
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Katerina Micheli
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Maria Vozikaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Anastas Philalithis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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Linardakis M, Papadaki A, Smpokos E, Micheli K, Vozikaki M, Philalithis A. Relationship of behavioral risk factors for chronic diseases and preventive health services utilization among adults, aged 50+, from eleven European countries. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0683-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Navas-Carretero S, Holst C, Saris WH, van Baak MA, Jebb SA, Kafatos A, Papadaki A, Pfeiffer AFH, Handjieva-Darlenska T, Hlavaty P, Stender S, Larsen TM, Astrup A, Martinez JA. The Impact of Gender and Protein Intake on the Success of Weight Maintenance and Associated Cardiovascular Risk Benefits, Independent of the Mode of Food Provision: The DiOGenes Randomized Trial. J Am Coll Nutr 2015; 35:20-30. [PMID: 25826291 DOI: 10.1080/07315724.2014.948642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Maintenance of weight loss and associated cardiovascular benefits after following energy-restricted diets is still a challenging field, and thorough investigation is needed. The present research aimed to determine the role of protein and gender in relation to two different intervention models related to food supply, in a weight maintenance trial. SUBJECTS AND METHODS The DiOGenes trial was a long-term, multicenter, randomized, dietary intervention study, conducted in eight European countries (Clinical Trials.gov, NCT00390637), focusing on assessing the effectiveness of weight maintenance over 6 months. This secondary analysis intended to evaluate the different benefits for weight maintenance and cardiometabolic markers of two dietary advice delivery models: "shop + instruction intervention" vs "instruction-alone intervention," which were further categorized for gender and macronutrient intake. RESULTS The weight maintenance intervention based on different macronutrient intake showed, independently of the advice delivery model, in both sexes that higher protein consumption was more effective for weight stability, showing better results in obese women (low protein: 1.65 kg in males and 0.73 Kg in females vs high protein: 1.45 kg in males and -0.93 Kg in females) . Measurements concerning cardiovascular risk markers from subjects on both structured models produced similar trends in the subsequent follow-up period, with a lower rebound in women for most of the markers analyzed. CONCLUSION The reported dietary benefits for weight sustainability should be ascribed to the macronutrient distribution (higher protein diets) rather than to the structured mode of delivery. Higher weight regain in males was noted, as well as a metabolic divergence attributable to the sex, with a better biochemical outcome in women.
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Affiliation(s)
- Santiago Navas-Carretero
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,b CIBERobn Physiopathology of Obesity and Nutrition , Madrid , SPAIN
| | - Claus Holst
- e University of Copenhagen , Copenhagen , DENMARK.,f Institute of Preventive Medicine, Copenhagen University Hospital , Copenhagen , DENMARK
| | - Wim H Saris
- g NUTRIM, School for Nutrition, Toxicology and Metabolism, Department of Human Biology, Maastricht University Medical Centre , Maastricht , THE NETHERLANDS
| | - Marleen A van Baak
- g NUTRIM, School for Nutrition, Toxicology and Metabolism, Department of Human Biology, Maastricht University Medical Centre , Maastricht , THE NETHERLANDS
| | - Susan A Jebb
- h The Medical Research Council, Human Nutrition Research, Elsie Widdowson Laboratory , Cambridge , UNITED KINGDOM
| | - Anthony Kafatos
- i Department of Social Medicine, Preventive Medicine, and Nutrition Clinic , University of Crete , Heraklion , Crete , GREECE
| | - Angeliki Papadaki
- i Department of Social Medicine, Preventive Medicine, and Nutrition Clinic , University of Crete , Heraklion , Crete , GREECE.,j Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol , Bristol , UNITED KINGDOM
| | - Andreas F H Pfeiffer
- k Department of Clinical Nutrition , German Institute of Human Nutrition Potsdam-Rehbrücke , Nuthetal , GERMANY.,l Department of Endocrinology, Diabetes, and Nutrition , Charité Universitätsmedizin Berlin , Berlin , GERMANY
| | - Teodora Handjieva-Darlenska
- m Department of Human Nutrition, Dietetics and Metabolic Diseases , National Transport Hospital , Sofia , BULGARIA
| | - Petr Hlavaty
- n Obesity Management Center, Institute of Endocrinology , Prague , CZECH REPUBLIC
| | - Steen Stender
- d Department of Clinical Biochemistry, Gentofte Hospital , University of Copenhagen , Copenhagen , DENMARK
| | - Thomas M Larsen
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,c Department of Human Nutrition, Faculty of Life Sciences , University of Copenhagen , Copenhagen , DENMARK
| | - Arne Astrup
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,c Department of Human Nutrition, Faculty of Life Sciences , University of Copenhagen , Copenhagen , DENMARK
| | - J Alfredo Martinez
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,b CIBERobn Physiopathology of Obesity and Nutrition , Madrid , SPAIN
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Papadaki A, Wood L, Sebire SJ, Jago R. Adherence to the Mediterranean diet among employees in South West England: Formative research to inform a web-based, work-place nutrition intervention. Prev Med Rep 2015; 2:223-8. [PMID: 26844075 PMCID: PMC4721278 DOI: 10.1016/j.pmedr.2015.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study is to assess internet usage patterns and adherence to the Mediterranean diet among employees in South West England, UK and their differences by personal characteristics. Method A cross-sectional survey was conducted in 2014 among 590 adults (428 women, 162 men, mean age 43.8 years), employees of four work-place settings. Mediterranean diet adherence was assessed using a validated food frequency questionnaire. Adherence differences were assessed by gender, marital status, education, number of children and food shopping and preparation responsibility. Results On average, participants reported moderate adherence to the Mediterranean diet. Higher adherence was reported for alcohol, vegetables, cereals and fruit. Few participants achieved high adherence to the Mediterranean diet recommendations for legumes (5.3%), fish (3.2%), dairy products (4.8%), red meat (11.9%), poultry (11.1%) and olive oil (18.2%). A higher Mediterranean diet score was reported among participants who were married/cohabiting, those with higher education attainment and shared responsibility for food preparation. Conclusion Improvement in the consumption of several Mediterranean diet components is needed to increase adherence in this sample of adults. The findings have the potential to inform the development of a web-based intervention that will focus on these foods to promote the Mediterranean diet in work-place settings in South West England. Moderate overall adherence to the Mediterranean diet was reported. Higher adherence was reported for alcohol, vegetables, cereals and fruit. Few participants achieved high adherence for legumes, fish and dairy products. Few participants achieved high adherence for red meat, poultry and olive oil. Change in these foods' consumption is needed to increase Mediterranean diet adherence.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Lesley Wood
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Simon J Sebire
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Roos E, Pajunen T, Ray C, Lynch C, Kristiansdottir ÁG, Halldorsson TI, Thorsdottir I, te Velde SJ, Krawinkel M, Behrendt I, de Almeida MDV, Franchini B, Papadaki A, Moschandreas J, Ribič CH, Petrova S, Duleva V, Simčič I, Yngve A. Does eating family meals and having the television on during dinner correlate with overweight? A sub-study of the PRO GREENS project, looking at children from nine European countries. Public Health Nutr 2014; 17:2528-36. [PMID: 24642340 PMCID: PMC10282415 DOI: 10.1017/s1368980013002954] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/31/2013] [Accepted: 10/02/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Family meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe. DESIGN Cross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education. SETTING Schools in Northern European (Sweden, the Netherlands, Iceland, Germany and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project. SUBJECTS Children aged 10-12 years in (n 6316). RESULTS In the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner. CONCLUSIONS The associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies.
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Affiliation(s)
- Eva Roos
- Folkhälsan Research Center, Paasikivenkatu 4, 00250 Helsinki, Finland
- Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tuuli Pajunen
- Folkhälsan Research Center, Paasikivenkatu 4, 00250 Helsinki, Finland
| | - Carola Ray
- Folkhälsan Research Center, Paasikivenkatu 4, 00250 Helsinki, Finland
- Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Christel Lynch
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ása Gudrun Kristiansdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland & Landspitali University Hospital, Reykjavik, Iceland
| | - Thorhallur I Halldorsson
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland & Landspitali University Hospital, Reykjavik, Iceland
| | - Inga Thorsdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland & Landspitali University Hospital, Reykjavik, Iceland
| | - Saskia J te Velde
- EMGO Institute for Health and Care Research and the Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael Krawinkel
- Institute of Nutritional Sciences, Unit for International Nutrition, Faculty of Agricultural Nutrition, Environmental Sciences and Home Economics, Justus-Liebig-University, Giessen, Germany
| | - Isabel Behrendt
- Institute of Nutritional Sciences, Unit for International Nutrition, Faculty of Agricultural Nutrition, Environmental Sciences and Home Economics, Justus-Liebig-University, Giessen, Germany
| | | | - Bela Franchini
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Angeliki Papadaki
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna Moschandreas
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
| | | | - Stefka Petrova
- National Center for Public Health Protection, Sofia, Bulgaria
| | - Vesselka Duleva
- National Center for Public Health Protection, Sofia, Bulgaria
| | - Irena Simčič
- National Education Institute of the Republic of Slovenia, Ljubljana, Slovenia
| | - Agneta Yngve
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Örebro, Sweden
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42
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Lynch C, Kristjansdottir AG, te Velde SJ, Lien N, Roos E, Thorsdottir I, Krawinkel M, de Almeida MDV, Papadaki A, Hlastan Ribic C, Petrova S, Ehrenblad B, Halldorsson TI, Poortvliet E, Yngve A. Fruit and vegetable consumption in a sample of 11-year-old children in ten European countries--the PRO GREENS cross-sectional survey. Public Health Nutr 2014; 17:2436-44. [PMID: 25023091 PMCID: PMC10282338 DOI: 10.1017/s1368980014001347] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/13/2014] [Accepted: 05/25/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines. DESIGN Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol. SETTING Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries. SUBJECTS A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project. RESULTS The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8-37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded). CONCLUSIONS Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.
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Affiliation(s)
- Christel Lynch
- Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, SE 141 83 Huddinge, Stockholm, Sweden
| | - Asa Gudrun Kristjansdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland & Landspitali University Hospital, Reykjavik, Iceland
| | - Saskia J te Velde
- EMGO Institute for Health and Care Research and Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eva Roos
- Folkhälsan Research Center, Helsinki, Finland
- Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Inga Thorsdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland & Landspitali University Hospital, Reykjavik, Iceland
| | - Michael Krawinkel
- Institute of Nutritional Sciences, Unit for International Nutrition, Faculty of Agricultural Nutrition, Environmental Sciences and Home Economics, Justus-Liebig University, Giessen, Germany
| | | | - Angeliki Papadaki
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - Stefka Petrova
- National Center for Public Health Protection, Sofia, Bulgaria
| | - Bettina Ehrenblad
- Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, SE 141 83 Huddinge, Stockholm, Sweden
| | - Thorhallur I Halldorsson
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland & Landspitali University Hospital, Reykjavik, Iceland
| | - Eric Poortvliet
- Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, SE 141 83 Huddinge, Stockholm, Sweden
| | - Agneta Yngve
- Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, SE 141 83 Huddinge, Stockholm, Sweden
- School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Örebro, Sweden
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43
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Cooke R, Papadaki A. Nutrition label use mediates the positive relationship between nutrition knowledge and attitudes towards healthy eating with dietary quality among university students in the UK. Appetite 2014; 83:297-303. [PMID: 25218881 DOI: 10.1016/j.appet.2014.08.039] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/01/2014] [Accepted: 08/20/2014] [Indexed: 12/31/2022]
Abstract
The aim of this study was to investigate whether nutrition knowledge and attitudes towards healthy eating are predictors of nutrition label use (NLU) and dietary quality in a diverse sample of university students in the UK. An online cross-sectional survey was conducted in 2013 among 500 students (mean age 24.9 years; 75% females) in 37 UK universities. Nutrition knowledge, attitudes, NLU and dietary quality were assessed using previously validated questionnaires. The majority of participants met dietary recommendations for fat, added sugar and fast food intake, and failed to meet recommendations for calcium, fibre, fruit and vegetable and dairy product intake, resulting in a median dietary quality score of 2.0 (score range = 0-8). Nutrition knowledge differed according to gender, age, body mass index (BMI), nationality and NLU. Attitudes towards healthy eating differed according to BMI and NLU and dietary quality differed according to gender. Nutrition knowledge and attitudes were significant predictors of NLU and dietary quality, with NLU mediating the latter relationship, whereas NLU, when controlled for knowledge and attitudes, negatively predicted dietary quality but did not have a significant independent relationship with diet. Future nutrition interventions to improve dietary quality in this sample of UK university students should focus on improving nutrition knowledge and attitudes towards healthy eating.
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Affiliation(s)
- Rachel Cooke
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
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44
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Papadaki A, Linardakis M, Plada M, Larsen TM, Damsgaard CT, van Baak MA, Jebb S, Pfeiffer AFH, Martinez JA, Handjieva-Darlenska T, Kunešová M, Holst C, Saris WHM, Astrup A, Kafatos A. Impact of weight loss and maintenance with ad libitum diets varying in protein and glycemic index content on metabolic syndrome. Nutrition 2013; 30:410-7. [PMID: 24369912 DOI: 10.1016/j.nut.2013.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We investigated the effects of weight loss and maintenance with diets that varied with regard to protein content and glycemic index (GI) on metabolic syndrome (MetSyn) status. METHODS Secondary analyses were performed within the Diet, Obesity and Genes (DiOGenes) study (2006-2008), a randomized controlled dietary intervention. Nine hundred and thirty-eight overweight and obese adults from eight European countries entered an 8-wk low-calorie-diet period. Seven hundred and seventy-three adults who lost at least 8% of their body weights were randomized to one of five ad libitum diets for 6 mo: 1) low-protein (LP)/low-GI (LGI); 2) LP/high-GI (HGI); 3) high-protein (HP)/LGI; 4) HP/HGI; and 5) control diet. MetSyn prevalence and a standardized MetSyn score were assessed at baseline, after the low-calorie diet, and after the intervention. RESULTS Weight loss among participants while on the low-calorie diet significantly reduced MetSyn prevalence (33.9% versus 15.9%; P < 0.001) and MetSyn score (-1.48 versus -4.45; P < 0.001). During weight maintenance, significant changes in MetSyn score were observed between the groups, with the highest increase detected in the LP/HGI group (P = 0.039, partial η(2) = 0.023). Protein, GI, and their interaction did not have isolated effects on study outcomes. CONCLUSIONS Neither protein nor GI affected MetSyn status in this sample of European overweight and obese adults. However, a diet with a combination of an increased protein-to-carbohydrate ratio with low-GI foods had beneficial effects on MetSyn factors.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK; Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece.
| | - Manolis Linardakis
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
| | - Maria Plada
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
| | - Thomas M Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Marleen A van Baak
- Department of Human Biology, Nutrition and Toxicology Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Susan Jebb
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Andreas F H Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany, and Charité Universitätsmedizin Berlin, Department of Endocrinology, Diabetes and Nutrition, Berlin, Germany
| | - J Alfredo Martinez
- Department of Physiology and Nutrition, CIBERobn, University of Navarra, Pamplona, Spain
| | - Teodora Handjieva-Darlenska
- Department of Human Nutrition, Dietetics and Metabolic Diseases, National Multiprofile Transport Hospital, Sofia, Bulgaria
| | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Claus Holst
- Institute of Preventive Medicine, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Wim H M Saris
- Department of Human Biology, Nutrition and Toxicology Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Anthony Kafatos
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
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45
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Linardakis M, Papadaki A, Smpokos E, Komninos Y, Philalithis A. Multiple behavioral risk factors for chronic diseases in adults aged 50+: regional differences across eleven European countries. J Public Health (Oxf) 2013. [DOI: 10.1007/s10389-013-0597-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Linardakis M, Smpokos E, Papadaki A, Komninos ID, Tzanakis N, Philalithis A. Prevalence of multiple behavioral risk factors for chronic diseases in adults aged 50+, from eleven European countries - the SHARE study (2004). Prev Med 2013; 57:168-72. [PMID: 23707812 DOI: 10.1016/j.ypmed.2013.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/30/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate the prevalence and the associations between multiple behavioral risk factors (MBRFs) for chronic diseases in European adults. METHOD Data from 26,743 individuals, aged 50+years, participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) (2004/05) were used. MBRFs included physical inactivity, high body weight, smoking habits and risky alcohol consumption. Estimations were based on weights according to the complex sampling design. RESULTS In total, 71.2% of individuals were physically inactive, while 59.8% had high body weight. 53.4% had 2+ MBRFs, while males presented higher prevalence of MBRF clusters than females (P < 0.001). Females displayed lower odds of increased alcohol consumption (OR = 0.16, P < 0.001) and higher odds of physical inactivity (OR = 1.47, P < 0.001) than males. Individuals who lived alone, compared to living with a partner and those with more, compared to fewer education years, exhibited a significantly higher and lower, respectively, mean MBRF score (P < 0.001). CONCLUSION The prevalence of MBRFs was considerably high in this sample of European adults, while not living alone and having higher education may prove protective. These findings could be used for the design of primary healthcare programs by health professionals.
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Affiliation(s)
- Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece.
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47
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Kostoglou-Athanassiou I, Tzanavari A, Basdragianni D, Papadaki A, Dadiras N, Athanassiou P. FRI0238 The effect of rituximab on lipid levels in patients with rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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48
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Damsgaard CT, Papadaki A, Jensen SM, Ritz C, Dalskov SM, Hlavaty P, Saris WHM, Martinez JA, Handjieva-Darlenska T, Andersen MR, Stender S, Larsen TM, Astrup A, Mølgaard C, Michaelsen KF. Higher protein diets consumed ad libitum improve cardiovascular risk markers in children of overweight parents from eight European countries. J Nutr 2013; 143:810-7. [PMID: 23596158 DOI: 10.3945/jn.112.173427] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary strategies to improve early cardiovascular markers in overweight children are needed. We investigated the effect of dietary protein and glycemic index (GI) on cardiovascular markers and metabolic syndrome (MetS) scores in 5- to 18-y-old children of overweight/obese parents from 8 European centers. Families were randomized to 1 of 5 diets consumed ad libitum: high protein (HP) or low protein (LP) combined with high GI (HGI) or low GI (LGI), or a control diet. At 6 centers, families received dietary instruction (instruction centers); at 2 centers, free foods were also provided (supermarket centers). Diet, anthropometry, blood pressure, and serum cardiovascular markers (lipid profile, glucose regulation, and inflammation) were measured in 253 children at baseline, 1 mo, and/or 6 mo. Protein intake was higher in the HP groups (19.9 ± 1.3% energy) than in the LP groups at 6 mo (16.8 ± 1.2% energy) (P = 0.001). The GI was 4.0 points lower (95% CI: 2.1, 6.1) in the LGI compared with the HGI groups (P < 0.001). In the supermarket centers, the HP and LP groups differed more in protein intake than did the groups in the instruction centers (P = 0.009), indicating better compliance. The HP diets evoked a 2.7-cm (95% CI: 0.9, 5.1) smaller waist circumference and a 0.25-mmol/L (95% CI: 0.09, 0.41) lower serum LDL cholesterol compared with the LP diets at 6 mo (P < 0.007). In a separate supermarket center analysis, the HP compared with LP diets reduced waist circumference (P = 0.004), blood pressure (P < 0.01), serum insulin (P = 0.013), and homeostasis model of assessment-insulin resistance (P = 0.016). In the instruction centers, the HP compared with the LP diets reduced LDL cholesterol (P = 0.004). No consistent effect of GI was seen and the MetS scores were not affected. In conclusion, increased protein intake improved cardiovascular markers in high-risk children, particularly in those undergoing most intensive intervention.
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Affiliation(s)
- Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
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Smpokos EA, Linardakis M, Papadaki A, Theodorou AS, Havenetidis K, Kafatos A. Differences in energy and nutrient-intake among Greek children between 1992/93 and 2006/07. J Hum Nutr Diet 2013; 27 Suppl 2:230-8. [DOI: 10.1111/jhn.12122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. A. Smpokos
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic; Faculty of Medicine; University of Crete; Heraklion Greece
| | - M. Linardakis
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic; Faculty of Medicine; University of Crete; Heraklion Greece
| | - A. Papadaki
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic; Faculty of Medicine; University of Crete; Heraklion Greece
- Centre For Exercise, Nutrition and Health Sciences; School for Policy Studies; University of Bristol; Bristol UK
| | - A. S. Theodorou
- Faculty of Physical Education & Sport Science; Kapodistrian University of Athens; Athens Greece
| | - K. Havenetidis
- Human Performance - Rehabilitation Laboratory; Faculty of Physical and Cultural Education; Hellenic Army Academy; Vari Greece
| | - A. Kafatos
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic; Faculty of Medicine; University of Crete; Heraklion Greece
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50
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Astrup A, Damsgaard CT, Papadaki A, Jensen SM, Dalskov S, Hlavaty P, Saris WH, Martinez JA, Handjieva‐Darlenska T, Rohr‐Andersen M, Stender S, Larsen TM, Mølgaard C, Michaelsen KF. 1 The use of an ad libitum higher‐protein, low‐glycemic index diet in overweight children: the Diogenes Study. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.249.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arne Astrup
- Nutrition, Exercise & SportsUniversity of CopenhagenFrederiksbergDenmark
| | | | | | - Signe M Jensen
- Nutrition, Exercise & SportsUniversity of CopenhagenFrederiksbergDenmark
| | | | - Petr Hlavaty
- Obesity ManagementEndocrinologyPragueCzech Republic
| | | | | | | | | | - Steen Stender
- Clinical BiochemistryGentofte HospitalGentofteDenmark
| | - Thomas M Larsen
- Nutrition, Exercise & SportsUniversity of CopenhagenFrederiksbergDenmark
| | - Christian Mølgaard
- Nutrition, Exercise & SportsUniversity of CopenhagenFrederiksbergDenmark
| | - Kim F Michaelsen
- Nutrition, Exercise & SportsUniversity of CopenhagenFrederiksbergDenmark
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