Association between Siesta (Daytime Sleep), Dietary Patterns and the Presence of Metabolic Syndrome in Elderly Living in Mediterranean Area (Medis Study): The Moderating Effect of Gender.

OBJECTIVES: Several lifestyle parameters including diet, physical activity and sleep were associated in isolation with the presence of Metabolic Syndrome (MetS) in adults, to date there is a paucity of studies which evaluated their combined role aging populations and especially with respect to gender. Therefore, the aim of the present study was to provide a global consideration of the lifestyle factors associated with MetS among elderly individuals. DESIGN: Cross-sectional observational study. SETTING: 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. PARTICIPANTS: during 2005-2015, 2749 older (aged 65-100 years) from were voluntarily enrolled in the study. MEASUREMENTS: Dietary habits, energy intake, physical activity status, socio-demographic characteristics, lifestyle parameters (sleeping and smoking habits) and clinical profile aspects were derived through standard procedures. The presence of MetS was defined using the definition provided by NCEP ATP III (revised) and cluster analysis was used to identify overall dietary habit patterns. RESULTS: The overall prevalence of MetS in the study sample was 36.2%, but occurred more frequently in females (40.0% vs. 31.8%, respectively, p=0.03). Individuals with MetS were more likely to sleep during the day (89.4% vs. 76.8% respectively, p=0.039) and frequent 'siesta' was positively linked to the odds of MetS presence in females (Odds Ratio (OR) =3.43, 95% Confidence Intervals (CI): 1.08-10.9), but not for men (p=0.999). The lower carbohydrate (i.e., 45.2% of total daily energy, 120±16gr/day) dietary cluster was inversely associated with the odds for MetS presence, but only for men (OR=0.094, 95%CI: 0.010-0.883). CONCLUSIONS: Lifestyle parameters including sleep and diet quality are strongly associated with the presence of MetS in elderly cohort, but different their level of influence appears to be different, depending on gender. Further research is needed to better consider the role of lifestyle characteristics in the management of MetS in clinical practice.

Modelling nutritional services in relation to the health status of older individuals living on Mediterranean islands.

INTRODUCTION: The world's population is ageing and it has been suggested that improvements to health, wellbeing and lifespan can be attributed to improved standards of living, especially regarding diet and nutritional status. The impact of nutritional services provided by a dietician on an older population's health status has not been well evaluated or documented. This study sought to determine whether an association exists between available nutritional services and older people's health status in selected Greek islands and the Cyprus Republic. METHODS: During 2010, information on nutritional services provided in 9 Greek Islands and the Cyprus Republic was retrieved through interviews of almost all dieticians (n=88) working on these islands. The health status (ie prevalence of hypertension, diabetes, hypercholesterolemia, obesity) of the older population studied (aged >65 years) was retrieved from the Mediterranean Islands Study (MEDIS). RESULTS: The main reasons for an older person's visit to a dietician was for the treatment of diabetes (79%), hypercholesterolemia (75%) and obesity (70%); 90% of older individuals visited the dietician on a physician's recommendation and 45% of them completed their consultations. The longer the presence of a dietician on an island, the lower the likelihood of observing the prevalence of hypertension (OR=0.59, 95% CI=0.36-0.94), hypercholesterolemia (OR=0.66, 95%CI=0.46-0.95), diabetes (OR=0.77, 95%CI=0.61-0.96) and obesity (OR=0.66, 95%CI=0.45-0.95) above the median rate of the population studied. Financial concerns and a long distance from home to the dieticians' office were the major reasons for ceasing visits to the dietician. CONCLUSIONS: Enhancing nutritional services within the healthcare system may contribute to reducing the burden of disease among older adults and, consequently, improve their quality of life.

Nutrient intake in relation to central and overall obesity status among elderly people living in the Mediterranean islands: the MEDIS study.

BACKGROUND AND AIM: The aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders. METHODS AND RESULTS: During 2005-2007, 553 elderly men and 637 elderly women (mean age 74±7years) from eight Mediterranean islands in Greece and Cyprus, were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern. The prevalence of obesity was 27% in males and 39% in females (p<0.001), while 73% of males and 87% of females had central obesity. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese than in the non-obese participants (p<0.01). After adjusting for various confounders, a 1% increase in carbohydrate consumption was associated with a 12% (95% CI 0.78-0.99) lower likelihood of having central obesity, while a 1% increase in carbohydrate and protein consumption was associated with a 14% (95% CI 0.78-0.95) and 16% (95% CI 0.72-0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with a 15% (95% CI 0.77-0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90-0.98) lower likelihood of having central obesity. CONCLUSIONS: The presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with a lower likelihood of being obese and may help elderly people to preserve normal weight.

Long-term animal-protein consumption is associated with an increased prevalence of diabetes among the elderly: the Mediterranean Islands (MEDIS) study.

AIM: The role of animal-protein consumption on the prevalence of diabetes is not yet fully understood. For this reason, this study investigated the relationship between long-term animal-protein intake and diabetes in elderly individuals with no known cardiovascular disease. METHODS: During 2005-2007, 1190 men and women, aged 65-100 years, from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos were enrolled into the study. Diabetes was defined as fasting blood glucose ≥ 125 mg/dL or the use of antidiabetic medication. All participants were asked about their dietary habits through a semiquantitative food-frequency questionnaire. Assessment of protein and energy intakes was performed using food-composition tables. RESULTS: After adjusting for age, gender, obesity, history of hypertension, hypercholesterolaemia and dietary habits, a 5% increase in protein intake from meat and meat products was associated with a 34% (OR=1.338, 95% CI: 1.02-1.76) greater likelihood of diabetes, while a 5% increase in total protein intake was associated with a 29% (OR=1.288, 95% CI: 1.00-1.69) greater likelihood of diabetes. No significant associations between diabetes and protein intakes from vegetables and cereals were observed. CONCLUSION: Animal-protein consumption was associated with a higher prevalence of diabetes among the elderly, whereas protein intakes, especially from plant sources, within the recommended range appear to confer considerable protection. This suggests that reducing or controlling the burden of diabetes through dietary means in the elderly should include monitoring their daily protein intake.

Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly living in eastern Mediterranean islands: the MEDIS (MEDiterranean ISlands Elderly) study.

AIMS: To evaluate factors associated with depression in elderly. METHODS: During 2005-2007, 553 men and 637 women (aged 65 to 100 yrs) living in various Greek islands and in Cyprus participated in the study. The sampling was random and multistage (according to age sex distribution of the referent population). Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). RESULTS: Twenty five per cent of men and 35% of women were classified in the highest GDS category (i.e. GDS score > 10), indicating intense depressive symptoms, while 54% of men and 70% of women scored above the depression cut-off (i.e. GDS score > 5) indicating mild-to-severe depressive symptoms. Among the investigated characteristics, living in urban environment, physical inactivity and history of hypertension were correlated with the presence of depressive symptoms (p < 0.05), after adjusting for various confounders. Moreover, the consumption of fish, vegetables and cereals is more prevalent among people with low or moderate depression (p < 0.05). CONCLUSIONS: The prevalence of depression is quite high between elderly people living in Greek islands and Cyprus. Urban environment that may also interact with sedentarism and unhealthy dietary habits seems to promote depression in the studied population. Efforts to lower the prevalence of depression in the elderly should target on the aforementioned factors that employ functional impairment, social environment and dietary habits.

Prevalence of type 2 diabetes and physical activity status in elderly men and women from Cyprus (the MEDIS Study).

Our aim is to investigate the association of being physically active on the prevalence of Type 2 diabetes mellitus among elderly people. We enrolled 53 men and 97 women, aged 65 to 100, from various areas of Cyprus. Physical activity was evaluated through a validated questionnaire (the short International Physical Activity Questionnaire, IPAQ). Prevalence of diabetes was 26% in men and 18% in women, while 55% of men and 50% of women were reported as being moderately or vigorously active. Furthermore, 5% of the participants reported that they smoked, 4% had stopped smoking, and 8% reported alcohol consumption. People in the upper tertile of the IPAQ score were 0.26 times less likely to have diabetes (p < 0.05); on the other hand people in the lower tertile of the score were 1.7 times more likely to have diabetes (p < 0.05). Our findings support the notion of a beneficial effect of physical activity on the burden of diabetes in the elderly.

Obesity in byzantine and in modern era from a public health perspective.

Obesity is one of today's most serious and amplified public health problems. Surprisingly, obesity constituted a health problem through the Byzantine Empire (3rd to 15th century AD) as well; the extent of the problem was then very much alike to that one seen in modem industrialized and developing countries of today. In this report we perform an historical throwback in Byzantine years in order to explore the link regarding the aspects of obesity in these years and in modem era.

Cooking of meat and fish in Europe--results from the European Prospective Investigation into Cancer and Nutrition (EPIC).

OBJECTIVES: There is epidemiologic evidence that the consumption of fried, grilled or barbecued meat and fish that are well-done or browned may be associated with an increased cancer risk. These high-temperature cooking methods are thought to be surrogates for mutagens and carcinogens produced in meat and fish, eg heterocyclic amines or polycyclic hydrocarbons. Since data on food cooking methods are scarce, the aim of this study was to describe the variation in meat and fish cooking methods in different parts of Europe. DESIGN: Using a standardized 24 h recall from a sub-sample of the EPIC cohort (35 644 persons, 35-75 y old), mean daily intake of meat and fish prepared by different cooking methods and the relative contribution of the cooking methods to the overall cooking of meat and fish was calculated. RESULTS: Whereas frying was more often noted in northern Europe, roasting and stir frying were more often used in the south. Concerning high-temperature cooking methods, their frequency of application varies between 15% in the EPIC cohort of North-Italy and 49% in the cohort of The Netherlands. Average consumption of fried, grilled and barbecued meat and fish ranges from a low of 12 g/day in the centres in southern Spain to a high of 91 g/day in northern Spain. CONCLUSION: High variation in both the kind of meat/fish consumed as well as its cooking methods is observed within EPIC. In order to use this variation for the evaluation of the impact of cooking methods on cancer risk, a questionnaire on meat and fish cooking methods is being developed and could be applied in the whole EPIC cohort.

Food sources of carbohydrates in a European cohort of adults.

OBJECTIVE: To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Of the 27 redefined EPIC study centres, 19 contributed subjects of both genders and eight centres female participants only (men, women, after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total). Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software. The major sources of dietary carbohydrate were identified, and 16 food groups were examined. RESULTS: The 10 food groups contributing most carbohydrate were bread; fruit; milk and milk products; sweet buns, cakes and pies; potato; sugar and jam; pasta and rice; vegetables and legumes; crispbread; and fruit and vegetable juices. Consumption of fruits as well as vegetables and legumes was higher in southern compared with northern centres, while soft drinks consumption was higher in the north. Italian centres had high pasta and rice consumption, but breakfast cereal, potato, and sweet buns, cakes and pies were higher in northern centres. In Sweden, lower bread consumption was balanced with a higher consumption of crispbread, and with sweet buns, cakes and pies. Overall, men consumed higher amounts of vegetables and legumes, bread, soft drinks, potatoes, pasta and rice, breakfast cereal and sugar and jam than women, but fruit consumption appeared more frequent in women. CONCLUSION: The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region. When comparing and interpreting diet-disease relationships across populations, researchers need to consider all types of foods.

Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers.

BACKGROUND: We evaluated the reproducibility and relative validity of a 190-item semi-quantitative food frequency questionnaire (FFQ) to be used in a large prospective study in the Athens area of Greece. METHODS: In all, 42 men and 38 women, aged 25-67 years, completed two self-administered semi-quantitative FFQ spaced approximately 1 year apart. Within this 1-year interval, participants visited the study centre monthly and completed an interviewer-administered 24-hour diet recall questionnaire. We also collected two venous blood and three 24-hour urine samples from participants at randomly selected periods during the year between the two administrations of the dietary questionnaire. RESULTS: Mean values for intake of most nutrients assessed by the two FFQ were in good agreement while those assessed by the two different dietary methods were reasonably similar for most nutrients. Intraclass correlation coefficients for energy-adjusted nutrient intakes assessed by questionnaires one year apart averaged 0.57 (range 0.24-0.75) and were not substantially different between genders. Correlation coefficients between the energy-adjusted nutrients measured by repeated 24-hour recalls and the semi-quantitative FFQ ranged from 0.25 for beta-carotene and polyunsaturated fats to > 0.50 for saturated fats, cis-linoleic acid, calcium and phosphorus (average: 0.46 for men and 0.39 for women). Reliability and relative validity were very high for alcohol intake. Dietary intakes from the FFQ were significantly correlated to plasma levels of vitamin C, but not beta-carotene or cholesterol. Dietary protein intake assessed by both FFQ was correlated (0.36, 0.30) with average urinary nitrogen excretion levels from three 24-hour urine samples. CONCLUSIONS: These data indicate that the semi-quantitative FFQ is reproducible and provides a reasonably reliable measure of intake. Significant correlations between diet and an independent biochemical marker further corroborate the relative validity of our questionnaire in this Greek population.

Health and nutritional status of elderly Greek migrants to Melbourne, Australia.

The health (self-reported health conditions) and nutritional status (food and nutrient intake, nutritional biochemistry, anthropometry) of 189 elderly Greeks living in Melbourne, Australia were described and compared with 104 elderly Greeks living in a rural town in Greece (Spata) using a validated health and food frequency questionnaire. Spata was chosen because the traditional diet is maintained by the community and may act as a 'surrogate' measure of diets prevalent in Greece prior to the Melbourne sample's migration to Australia in the 1960s. This enabled identification of dietary trends that may be contributing to the deteriorating health of elderly migrant Greeks. Compared with Spata Greeks, Melbourne Greeks had significantly greater intakes of animal foods (meat), legumes, protein, margarine, polyunsaturated fats, beer and lower intakes of cereals, carbohydrates, wine and olive oil. The contribution of these dietary differences, as well as the influence of high storage-iron levels, impaired immunity and greater prevalence of obesity and abdominal fatness, to the increasing prevalence of heart disease and cancer (especially amongst women) requires further study.

Diet and overall survival in elderly people.

OBJECTIVE: To assess the influence of a specific dietary pattern on overall survival. DESIGN: Cohort study. SETTING: Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. SUBJECTS: 182 elderly residents of the three villages. MAIN OUTCOME MEASURE: Overall mortality. RESULTS: Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). CONCLUSION: A diet meeting currently understood health criteria does predict survival among people.

Diet and survival of elderly Greeks: a link to the past.

In 1988 and 1989, we investigated in three Greek villages the dietary patterns of 182 men and women aged > 70 y by using a validated semiquantitative food-frequency questionnaire and compared these dietary patterns with the traditional Greek diet as ascertained in the late 1950s by Keys and his colleagues. As in the traditional diet, olive oil dominated fat intake, total fat exceeded 35% of total energy intake, average daily consumption of fruits and vegetables exceeded 500 g, and average ethanol intake for men corresponded to two to three glasses of wine per day. In contrast, consumption of meat and meat products has substantially increased and intake of bread and other cereals has apparently declined. We observed no differences between the two periods with respect to consumption of legumes, eggs and egg products, and sugar confectionery. We have also attempted to assess whether a gradient of adherence to the traditional Greek diet can be identified in the diets of the study subjects, and whether it can subsequently predict total mortality. During a follow-up period of approximately 5 y, 53 deaths were observed. The risk of death was apparently higher among the minority of study subjects whose diet deviated substantially from the traditional Greek pattern, compared with the majority whose diet adhered closely to the traditional pattern.

Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers.

We evaluated the reproducibility and validity of a 190-item semiquantitative food frequency questionnaire (FFQ) to be used in a large prospective study in the Athens area of Greece. Eighty persons, 42 men and 38 women, ages 25-67 years, completed a self-administered FFQ, followed by monthly 24-hour diet recalls and then a second FFQ 1 year after the first. Correlation coefficients measuring the reproducibility and validity of the FFQ indicate that the questionnaire is reproducible and provides a reasonably reliable measure of intake for many nutrients over a period of 1 year.