Quality, but not cost, of diet is associated with 5-year incidence of CVD: the ATTICA study.

OBJECTIVE: The aim of the present work was to calculate the current cost of the Mediterranean diet in Greece and to evaluate the role of diet cost in the development of cardiovascular events after a 5-year follow-up. DESIGN: Cross-sectional. Cost of diet was measured in €/week based on common Greek dietary choices, while baseline dietary habits were assessed through a semi-quantitative FFQ (Greek-EPIC). The Mediterranean Diet Score (MedDietScore) was applied to assess overall adherence to this pattern using scores of eleven food variables and alcohol, according to the principles of the Mediterranean diet. SETTING: Five-year follow-up of the ATTICA study, a nutrition and health survey of a representative, free-living sample of the Greek population resident in the province of Attica, where Athens is a major metropolis. SUBJECTS: From 2001 to 2002, 1514 men and 1528 women (aged >18 years) without known CVD were enrolled. In 2006, the 5-year follow-up was performed. RESULTS: The weekly cost of participants' diets varied from 5·35 to 83·57 €/week in men (mean 25·45 (sd 6·80) €/week) and from 10·89 to 55·49 €/week in women (mean 25·63 (sd 6·30) €/week). Diet cost was correlated marginally to MedDietScore (r = 0·060, P = 0·05) as well as being associated with history of hypercholesterolaemia (mean (sd), yes v. no: 24·90 (5·73) v. 25·82 (6·95) €/week, P = 0·027), physical activity (mean (sd), yes v. no: 26·42 (6·90) v. 24·82 (6·20) €/week, P < 0·001) and current smoking (mean (sd), yes v. no: 24·99 (6·40) v. 25·98 (6·70) €/week, P = 0·017). No significant association was found between diet cost and 5-year incidence of CVD (hazard ratio = 1·021, 95 % CI 0·965, 1·081). However, adherence to the traditional Mediterranean diet was inversely associated with the development of CVD (relative risk per 1-unit increase in MedDietScore = 0·92, 95 % CI 0·89, 0·94) after adjustment for various potential confounders including diet cost. CONCLUSIONS: Quality but not cost of the diet is associated with the development of CVD.

Estimating the 10-year risk of cardiovascular disease and its economic consequences, by the level of adherence to the Mediterranean diet: the ATTICA study.

In this study this traditional diet was assessed in relation to coronary heart disease risk and its economic consequences, in a cross-sectional study with economic analysis. From May 2001 to December 2002 we randomly enrolled 1,514 adult men and 1,528 women, without any clinical evidence of cardiovascular disease. Adherence to the Mediterranean diet was ascertained through a food-frequency questionnaire and a special diet score that incorporated the inherent characteristics of this dietary pattern. The 10-year absolute risk for coronary heart disease was derived from the Framingham equations. Persons with a 10-year risk greater than 10% were considered as potential hospitalized patients. The health care cost of hospitalization due to an event was estimated in 690euro per patient. Of the participants who were "closer" to the Mediterranean diet (i.e., above the median diet score) and of those "away" from this dietary pattern, 4.2% and 39.8%, respectively, had a 10-year coronary risk greater than 10% (P < .001). Moreover, participants "closer" to the Mediterranean diet had a 43% (odds ratio = 0.57, 95% confidence interval 0.38 to 0.86) lower likelihood of having a 10-year coronary risk greater than 10%, after adjusting for potential confounders. Total health care cost was estimated to be 336.720euro in those who were "away" and 35.880euro in those who were closer to this diet pattern. Life-years lost due to disability was 6.8 in those who were "away" and 0.9 in those "close" to this pattern. The incremental cost-effectiveness ratio was 50.989euro (i.e., the additive health care cost due to an unhealthy diet for each year lost). The implementation of the Mediterranean dietary pattern may lead to an improvement in life expectancy, a net gain to health, and a reduction in total lifetime costs.

Effect of traditional Greek Mediterranean meals on platelet aggregation in normal subjects and in patients with type 2 diabetes mellitus.

Patients with type 2 diabetes mellitus have increased risk of cardiovascular disease. Epidemiological studies have shown a correlation between diet and incidence of coronary heart disease. The aim of the study is to determine the effect of a traditional Greek Mediterranean diet on platelet aggregation induced by ADP, arachidonic acid (AA), and especially platelet-activating factor (PAF) on patients with type 2 diabetes mellitus as well as on healthy volunteers. The patients were randomized into two subgroups, A and B. The lipid extracts from traditional Greek Mediterranean-type meals were tested in in vivo for their ability to reduce PAF- or thrombin-induced platelet aggregation. The meals with the most potent anti-aggregating activity were chosen for the diet of both subgroup A and healthy subjects and consumed for a period of 28 days, whereas subgroup B kept to their regular diet that was followed before entering the study. Platelet-rich plasma was isolated before and after the diet, and the ability of platelets to aggregate under the aggregating factors was tested. One-month consumption of diet resulted in a significant reduction in PAF- and ADP-induced aggregation of platelets in both groups of healthy volunteers (PAF and ADP, P < .05) and subgroup A (PAF, P < .001; ADP, P < .05), whereas the AA-induced aggregation was not affected. No effect was observed in subgroup B, which followed the standard diet. Thus the consumption of a traditional Greek Mediterranean diet even for a short period can reduce platelet activity in patients suffering from type 2 diabetes mellitus and in healthy subjects.

Constituents of red wine other than alcohol improve endothelial function in patients with coronary artery disease.

BACKGROUND: Several studies suggest that red wine is beneficial in coronary artery disease (CAD). Although the long-term effect of moderate red wine consumption on endothelial function is currently under investigation, there is little knowledge about its effect on postprandial endothelial function and haemostatic factors. The aim of the present study was to investigate the postprandial effects of alcohol content and the antioxidants of red wine on endothelial function and fibrinogen levels in CAD patients. METHODS: Fifteen males with angiographically documented CAD were recruited for the study. All volunteers ingested 250 ml of either red wine or de-alcoholized red wine on two different days. Blood samples (for analysis of fibrinogen and blood lipids) were collected and flow-mediated dilatation (FMD) was determined before and 30, 60 and 90 min following consumption of each beverage RESULTS: FMD was higher following the consumption of de-alcoholized red wine [type of wine effect, P=0.05 repeated measures analysis of variance (ANOVA)]. Furthermore, the pattern of the response was different between the two beverages, as FMD increased following the ingestion of de-alcoholized red wine, but it decreased after consumption of regular red wine (type of wine by time interaction effect, P=0.006 repeated measures ANOVA). Fibrinogen concentrations were unaltered CONCLUSIONS: Acute ingestion of red wine without alcohol led to higher FMD than ingestion of regular red wine in CAD patients. The acute effect of red wine on endothelial function may be different than its long-term effect and it could be attributed to its constituents other than alcohol.

Identifying nutritionally vulnerable groups in case of emergencies: experience from the Athens 1999 earthquake.

During emergency situations in developing countries, young children have been identified as the most nutritionally vulnerable group. Comparatively less is known regarding nutritional risk of individuals in well-nourished societies hit by a major disaster. The aim of the present study, therefore, was to assess the nutritional status of Greek people who were left homeless after the Athens 1999 earthquake. A total of 225 volunteers from two camps were surveyed for dietary intake information and surrogate measures of nutritional status. Energy consumption and anthropometric indices of the children and adolescents revealed no sign of undernourishment. On the other hand, adults and the elderly consumed considerably less energy than that required for long-term preservation of health. Short-term energy and protein deficits, however, did not jeopardise their nutritional status as it might have expected, on the basis of high body mass indexes and normal haematological and biochemical profiles that were documented. In conclusion, the results of the present study indicate that nutritional risk in the acute phase after a major emergency in a previously well-nourished population is rather low. This is especially true for younger individuals, probably due to increased provision from the family and the community. Nevertheless, older persons may face increased risk as the situation is prolonged.

Reported eating behavior and attitudes improvement after a nutrition intervention program in a group of young female dancers.

The aim of the study was to evaluate the effectiveness of an intervention program that combined nutrition education and prevention of disordered eating in a group of female professional dance students. Thirty-two dancers, aged 19-25 years, took part in the program. Evaluation was done by a series of questionnaires that participants were asked to complete on 3 occasions. Assessments of body composition and dietary intake were also performed. Significant improvements in nutrition knowledge as well as a decrease in abnormal eating behavior and dietary restraint were observed at post intervention. At 6-month follow-up, the positive effects were maintained and further benefits were recorded; only nutrition knowledge showed a minor decline. Participants who were at higher risk for adopting abnormal eating behavior benefited the most from the program. These findings encourage the implementation of intervention programs in groups of young women that experience particular pressures for controlling body weight.