Correction: Multimorbidity and food insecurity in adults: A systematic review and meta-analysis.

[This corrects the article DOI: 10.1371/journal.pone.0288063.].

The association between dietary intake of macro- and micronutrients and multimorbidity: a cross-sectional study in Cyprus.

Research on the link between diet and multimorbidity is scarce, despite significant studies investigating the relationship between diet and individual chronic conditions. This study examines the association of dietary intake of macro- and micronutrients with multimorbidity in Cyprus's adult population. It was conducted as a cross-sectional study, with data collected using a standardised questionnaire between May 2018 and June 2019. The questionnaire included sociodemographic information, anthropometrics, medical history, dietary habits, sleep quality, smoking habits, and physical activity. The participants were selected using a stratified sampling method from adults residing in the five government-controlled municipalities of the Republic of Cyprus. The study included 1137 adults with a mean age of 40⋅8 years, of whom 26 % had multimorbidity. Individuals with multimorbidity consumed higher levels of sodium (P = 0⋅009) and vitamin A (P = 0⋅010) compared to those without multimorbidity. Additionally, higher fibre and sodium intake were also observed in individuals with at least one chronic disease of the circulatory system or endocrine system, compared to those with no chronic diseases in these systems (P < 0⋅05). Logistic regression models revealed that individuals with ≥2 chronic diseases compared to 0 or 1 chronic disease had higher fat intake (OR = 1⋅06, 95 % CI: 1⋅02, 1⋅10), higher iron intake (OR = 1⋅05, 95 % CI: 1⋅01, 1⋅09), lower mono-unsaturated fat intake (OR = 0⋅91, 95 % CI: 0⋅86, 0⋅96), and lower zinc intake (OR = 0⋅98, 95 % CI: 0⋅96, 0⋅99). Future research should replicate these results to further explore the intricate relationships between nutrient intake and multimorbidity. Our study's findings suggest that specific dietary components may contribute to preventing and managing multimorbidity.

Meal Frequency and Multi-Morbidity in a Cypriot Population: A Cross-Sectional Study.

Data regarding the effect of specific dietary behaviors, such as meal frequency, on multi-morbidity are scarce. Therefore, the objective of this study was to examine the effect of meal frequency on multi-morbidity in a Cypriot population. A representative sample of 1255 adults >18 years old was surveyed during 2022-2023. Data regarding sociodemographic characteristics, multi-morbidity, and meal frequency consumption were collected through validated questionnaires. Diseases were listed according to the International Classification of Diseases, 10th Revision [ICD-10]. Statistical analysis was conducted using SPSS Statistics v.19.0. Responders who consumed more than three meals and snacks daily had a higher probability of multi-morbidity [OR: 1.505 [95% CI: 1.505-2.069]] compared with those who consumed three or fewer meals and snacks daily. The relation was not statistically significant after adjusting for age and gender and for socioeconomic characteristics. Furthermore, participants who consumed more than three snacks per day had a 1.776 [AOR: 1.616 [95% CI: 1.054-2.476]] higher risk of having multi-morbidity compared with participants who did not consume any snack or consumed one snack per day. The findings suggest that people with multi-morbidity have a higher risk when consuming three or more snacks per day regardless of age, gender, and socioeconomic characteristics.

Multimorbidity and food insecurity in adults: A systematic review and meta-analysis.

Food insecurity is one of the main factors affecting multimorbidity. Previous studies have shown that food insecurity may lead to multimorbidity due to person's inability to consume nutritious diet. However, considering that multimorbidity may cause work-related disabilities and an unstable income, others support the possible effect that multimorbidity has on food insecurity. The purpose of this systematic review and meta-analysis is to examine the relationship between food insecurity and multimorbidity in adults. A systematic literature review of studies was performed using the PubMed, EBSCO and SCOPUS for all articles including adults ≥ 18-year-old with multimorbidity living in developed countries published from August 5th until December 7th 2022. Meta-analysis was performed considering results from the fully adjusted model. The methodological quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. This systematic review was not registered. This research received no specific grant from any funding agency. Four cross-sectional studies involving 45,404 participants were included in order to investigate the possible impact that food insecurity has on multimorbidity. The study findings showed an increased probability of multimorbidity 1.55 (95% CI:1.31-1.79, p<0.001, I2 = 44.1%) among people with food insecurity. Conversely, three of the included studies, involving 81,080 participants concluded that people with multimorbidity, have 2.58 (95% CI: 1.66-3.49, p<0.001, I2 = 89.7%) times higher odds to present food insecurity. This systematic review and meta-analysis provide evidence of a reverse association between food insecurity and multimorbidity. Further cross-sectional studies must be conducted in order to elucidate the association between multimorbidity and food insecurity across age groups and between the two genders.

The Effect of Mastic Chios Supplementation in Inflammatory Bowel Disease: A Systematic Literature Review.

Mastic Chios is a natural treasure of Greece that offers many potential benefits in various disorders due its antioxidant and anti-inflammatory properties. This systematic review aimed to investigate the effect of Mastic Chios supplementation in inflammatory bowel disease (IBD). A systematic search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across PubMed/Medline and EBSCO databases until February 2023. Clinical studies that examined individuals of any age being diagnosed with IBD as well as preclinical studies using animals with experimental colitis were considered eligible for inclusion. Studies included were assessed for methodological quality. Eight articles were eligible for inclusion, with seven conducted in Greece and one study in Iran. Most of the studies were randomized controlled trials (RCTs) and one was a pilot study. The intervention period varied between 3 and 7 days for animal studies and 4 weeks to 6 months for human studies. Mastic Chios supplementation varied between 2.2 and 2.8 g/day for clinical studies. The majority of studies concluded that Mastic Chios has significant antioxidant and inflammatory effects in IBD. This systematic review suggests that Mastic Chios may have a positive effect on the regulation and management of IBD. However, more high-quality clinical trials are needed to provide reliable and concrete conclusions about the effectiveness of Mastic Chios in this population. Such studies will further support the use of Mastic Chios as a reliable therapeutic option for IBD.

Change of Dietary and Lifestyle Habits during and after the COVID-19 Lockdown in Cyprus: An Analysis of Two Observational Studies.

Background: People's dietary and lifestyle habits appeared to be influenced by restrictive measures imposed in response to the COVID-19 pandemic. This study examines the differences in dietary and lifestyle habits during and after the lockdown measures in Cyprus. Methods: Two online cross-sectional surveys were conducted, using a self-administered, anonymous questionnaire to collect information on sociodemographic and anthropometric characteristics, smoking habits, physical activity, and dietary habits. The first survey was conducted between 6 April 2020 and 20 June 2020 (during national lockdown) while the second survey was conducted between 27 October 2021 and 20 January 2022 (post-lockdown). Results: A total of 2503 individuals participated in the study. A higher consumption of fruits, vegetables, legumes/pulses, fish, and poultry was identified during lockdown compared to the period after the lockdown. Moreover, a greater daily intake of olive oil and a lower consumption of alcohol was found during the confinement period compared to the post-confinement period. During lockdown, most participants (43.0%) never or rarely used delivery services, while the largest proportion of the participants after lockdown used delivery services 1−3 times per month (37.0%) (p < 0.001). During lockdown, around 66% of the participants were physically active, compared to 55.5% after lockdown (p < 0.001). Furthermore, when compared to those with a normal BMI, more overweight and obese respondents ordered food 1−2 times per week in both periods (p < 0.001). Conclusions: Dietary and lifestyle habits of the participants were healthier throughout the lockdown period than after the end of the restrictive measures due to the COVID-19 pandemic. It is critical to encourage the Cypriot population to maintain the healthy dietary and lifestyle habits established during the lockdown in their daily lives after the confinement.

A systematic review of meta-research studies finds substantial methodological heterogeneity in citation analyses to monitor evidence-based research.

OBJECTIVES: This systematic review aimed to identify the characteristics and application of citation analyses in evaluating the justification, design, and placement of the research results of clinical health studies in the context of earlier similar studies. STUDY DESIGN AND SETTING: We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Methodology Register for meta-research studies. We included meta-research studies assessing whether researchers used earlier similar studies and/or systematic reviews of such studies to inform the justification or design of a new study, whether researchers used systematic reviews to inform the interpretation of new results, and meta-research studies assessing whether redundant studies were published within a specific area. The results are presented as a narrative synthesis. RESULTS: A total of 27 studies were included. How authors of citation analyses define their outcomes appears rather arbitrary, as does how the reference of a landmark review or adherence to reporting guidelines was expected to contribute to the initiation, justification, design, or contextualization of relevant clinical trials. CONCLUSION: Continued and improved efforts to promote evidence-based research are needed, including clearly defined and justified outcomes in meta-research studies to monitor the implementation of an evidence-based approach.

The relation of dietary components with severity of obstructive sleep apnea in Cypriot patients: A randomized, stratified epidemiological study.

BACKGROUND: Obstructive Sleep Apnea (OSA) is considered a public health problem and its prevalence is increasing at an epidemic rate. The aim of this study was to examine whether individual nutrients (macronutrients, antioxidant vitamins) rather than energy restriction may potentially affect OSA severity in a representative population of Cyprus. METHODS: A total sample of 303 adults (>18 years old) with Cypriot citizenship and permanently residing in Cyprus were randomly selected. Selected patients have completed the food frequency questionnaire, and a physical activity questionnaire and underwent a sleep study to assess OSA severity. RESULTS: Overall, 303 patients were included in this study, 169 (55.8%) had mild OSA (apnea-hypopnea index-AHI <15) and the remaining 83 (27.4%) had moderate to severe OSA (AHI>15). The mean age of all patients was 55.7 years old. Patients with moderate to severe OSA had significant higher BMI levels, higher consumption of calories, higher hip circumference, waist circumference, waist-hip ratio and neck circumference and higher consumption of folic acid compared with the patients with mild OSA (p<0.05). CONCLUSIONS: The findings suggest that increased energy intake regardless diet macronutrient composition is positively associated with OSA severity whereas higher folic acid intake seems to have a protective role.

Late-Night Overeating or Low-Quality Food Choices Late at Night Are Associated with Subclinical Vascular Damage in Patients at Increased Cardiovascular Risk.

Late-night overeating (LNO) is associated with several cardiovascular disease (CVD) risk factors. Limited data exist regarding the association between late-night (LN) systematic food consumption, LNO, and LN poor food quality with subclinical vascular damage (SVD) which precedes the onset of CVD. This study aimed to investigate the above associations with SVD in a large sample of adults, free of established CVD, with one or more CVD risk factors. In total, 901 adults (45.2% males) underwent anthropometric, dietary (through two 24 h dietary recalls) and vascular assessment. LN systematic eating was defined as consumption of food after 19:00 h in both dietary recalls and LNO was defined as systematic consumption of >40% of daily total energy intake (dTEI) after 19:00 h. Systematic LN food consumption was inversely associated with diastolic blood pressure (DBP) (−1.44 95% C.I. (−2.76, −0.12)) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, smoking, BMI and dTEI. LNO was positively associated with existence of carotid plaques (1.70 95% C.I. (1.07, 2.68)), while LN increased consumption of red meat, refined grains and wine and low consumption of whole wheat grains was positively associated with Aix (Augmentation Index) (0.84 95% C.I. (0.09, 1.59)), after adjusting for all the mentioned confounders. Systematic LN eating is associated with lower DBP while systematic LNO and consumption of poor-quality food late at night, is associated with SVD. Further research is needed to define more accurately the impact of LN eating habits on vascular health.

The Effect of Early Time-Restricted Feeding on Glycemic Profile in Adults: A Systematic Review of Interventional Studies.

BACKGROUND: Early time-restricted feeding (eTRF) is a new dietary strategy, involving extended fasting (≥14h) from mid- afternoon onwards with or without calorie restriction. Most of the published studies indicate controversial effects on several glycemic markers. AIM : To evaluate the effect of non-calorie restricted eTRF on the glycemic profile of adults. METHOD: this systematic review was designed according to PRISMA guidelines. Pubmed/ Medline, the Cochrane library and EBSCO electronic databases were systematically searched for eligible clinical trials. Studies with eTRF or with daily fasting regimens that presented all the characteristics of eTRF were selected and compared with regular diet schedules or delayed time-restricted feeding. Blood glucose and insulin markers were extracted from each study as the main outcome measures. RESULTS: Five articles including 67 adult subjects in total were selected. The period of intervention varied between 3 days to 5 weeks. Three of the included studies were diet- controlled for weight maintenance, whereas the other two studies allowed for free living. Quality assessment identified two studies of low and three studies of high risk of bias. two studies showed clear positive effects of eTRF on both glucose and insulin markers, including fasting glucose levels, muscle glucose intake, glucose iAUC responses insulin levels, and insulin resistance (p<0.05). Two other studies showed beneficial effects on glucose markers only (fasting glucose, 24h mean glucose levels, and iAUC responses, p<0.05) and the fifth study showed positive effects on insulin markers only (insulin resistance, p<0.05). CONCLUSIONS: eTRF seems to have positive effects on the glycemic profile mainly in healthy individuals with normal BMI. However, other factors should also be taken into account to address overweight, obese, and prediabetic individuals. Further research is required to clarify better the effectiveness of eTRF among individuals with different characteristics.

Examining the associations between a posteriori dietary patterns and obesity indexes: Systematic review of observational studies.

BACKGROUND: Few reports on the association of population-derived dietary patterns with excess body weight, using the approach of a systematic review currently exist. AIM: The aim of the present systematic review was to identify dietary patterns associated with body mass index (BMI), body weight (BW)/BMI change, weight status and weight loss maintenance status. METHODS: Using MEDLINE (via PubMed) and EBSCO Host databases, we systematically reviewed studies from 1980 to 2020, which included men and women, aged ≥18 years. Primary outcome was BMI or the longitudinal change of individuals' BW or BMI, or weight status (normal weight/overweight/obesity) or weight loss maintenance status. We included observational studies, with or without a prospective design. Studies which met the inclusion criteria were evaluated based on the Newcastle-Ottawa Scale; only a posteriori dietary patterns were evaluated. RESULTS: Twenty-six studies were eligible for inclusion in the current analysis. The results indicate a relationship between adherence to a lacto-vegetarian dietary pattern, characterized by high intake of fruits, vegetables, whole grains, unprocessed cereals, dairy and low intake of high-fat foods and sweets, and longitudinal change of individuals' BW or BMI, or the risk of overweight/obesity. CONCLUSIONS: Promotion of this healthy dietary pattern, as an alternative to focusing on specific nutrients or foods, may be a promising approach to be included in future long-term weight maintenance interventions.

The association between binge eating disorder and weight management in overweight and obese adults: A systematic literature review.

Aim: Weight loss is shown to improve obesity-related health problems as long as it is maintained for a long term. The purpose of this systematic review was to investigate the association between binge eating disorder and weight management in overweight and obese adults. Methods: A systematic search following the preferred reporting items for systematic reviews and meta-analyses guidelines was conducted across PubMed, Ebsco and Cochrane Library from inception through December 2020 to identify studies that assessed the association between binge eating disorder and weight management (e.g., weight loss, weight gain and weight loss maintenance) in overweight and obese adults. We included studies that examined adults (≥18 years old) being overweight and obese with and without binge eating behaviour. Two authors independently screened and evaluated studies for methodological quality. Results: Nine articles were selected, including 3685 participants. Three of the included studies were randomised control trials and the remaining were observational studies. The majority of the studies included support that people who have binge eating disorder may have an additional barrier maintaining their weight loss compared to people who do not suffer from binge eating disorder. Conclusion: Our systematic review revealed that binge eating disorder may have a negative association with weight loss maintenance. Further well-conducted prospective cohort studies and randomised clinical trials are required to investigate the possible mechanisms and whether any such mechanisms are modifiable. These will lead us to more efficient strategies targeting weight management.

Personality Traits and Weight Loss Maintenance: A Cross-Sectional Study.

Purpose: This cross-sectional study was based on the Cypriot cohort of the MedWeight study and examined differences between maintainers and regainers regarding personality traits. Methods: Participants were men and women who reported being at least overweight and experienced an intentional weight loss of ≥10% of their maximum weight, at least 1 year before participation. Assessment of personality, diet and physical activity was conducted through validated questionnaires and with 24 h recalls. Results: Findings from logistic regression analysis indicated that the odds of maintaining weight loss increased to 50% for agreeableness and decreased to 20 and 7% for perseverance and motor impulsiveness, respectively. Conclusion: Specific aspects of personality and impulsivity are relevant to weight loss maintenance and need to be considered when developing weight management interventions.

The purchase of the Diabetic Healthy Food Basket in Cyprus results in cost savings: is it affordable among the low-income population?

OBJECTIVE: The main objective was to assess the cost, acceptability and affordability of the Cypriot Diabetic Healthy Food Basket (DHFB). DESIGN: The development of DHFB was based on the Cypriot HFB with adjustments based on the nutritional guidelines for diabetes as developed by the American Diabetes Association (ADA) and information retrieved through the questionnaires. Two DHFB were constructed for adult women and adult men (±40 years) diagnosed with diabetes. Affordability was defined as the cost of DHFB as a percentage of the Guaranteed Minimum Income (GMI). SETTING: Cyprus. PARTICIPANTS: 422 diabetic patients aged 18-87 years from different socioeconomic backgrounds. RESULTS: DHFB consists of eight food categories, similar to Cypriot HFB, but different specific food items. The total monthly budget for a diabetic woman is about 15 % (25·68 Euros less) lower compared with HFB, and the relative percentage for a diabetic man is about 16 % (37·58 Euros less). The total monthly budget for a diabetic woman is about 30 % lower (60·32 Euros less) compared with that of a diabetic man. For low-income adults receiving GMI, the proportion of income that would need to be spent on DHFB ranges from around 30 to 42 % for women and men, respectively. CONCLUSIONS: The cost of DHFB is lower compared with HFB, meaning that nutritional treatment based on the practice guidelines for diabetes could be a cost-efficient therapy for these patients. DHFB is still not affordable among low-income persons.

The effect of protein diets in postmenopausal women with osteoporosis: Systematic review of randomized controlled trials.

The main objective of this systematic review was to examine the effectiveness of protein supplementation through diet or dietary supplements on osteoporosis in postmenopausal women as evidenced by randomized controlled trials (RCTs). Five RCTs were included using dietary protein (N = 2), protein supplements (N = 2), and proteins through diet and supplements (N = 1). A total of 677 postmenopausal woman were included, all diagnosed with osteoporosis (T score < -2.5) and aged between 50 and 80 years. Results have found that combined protein administration through diet, mainly from animal sources and supplemental proteins (whey proteins, 86 g/d PRO including 6 g WPI), for a short period of time (up to 12 months) may positively affect osteoporosis in postmenopausal women. In addition, a positive effect can also be achieved by the single administration of a 250 mg/d supplement in which 10 g was WPI for a six-month period. In this review, it is shown that both combined administration of proteins through diet and supplements and single administration through protein supplements may reduce the risk of fracture in postmenopausal osteoporotic women. In contrast, dietary proteins alone, in doses similar to and/or higher than the RDA values, may not have any positive effect on treating osteoporosis.

Effect of Vitamin D Supplementation in Prostate Cancer: A Systematic Review of Randomized Control Trials.

Vitamin D is important in many cellular functions including cell cycling and proliferation, differentiation, and apoptosis. Via the induction of cell cycle arrest and/or apoptosis, vitamin D inhibits normal prostatic epithelial cells growth. Review the evidence of the effect of vitamin D supplementation on prostate cancer (PC) biomarkers and patient survival and assess optimal dosage, formulation and duration. Pubmed, Medline and Ebsco Host databases were systematically searched for relevant literature. 8 Randomized Controlled Trials were included in this review. All studies, besides one, were of high methodological quality. 4 studies used calcitriol (0,5-45 µg/weekly), 2 studies have used vitamin D3 (150-1000 µg/daily) and 2 other studies have used 1α-hydroxy Vitamin D2 (10 µg/ daily or weekly). Duration of supplementation varied between 28 days up to 18.3 months. Two studies had positive effects on prostate specific antigen (PSA) (p < .05), 1 study had a significant positive effect on median survival (p < .05) and 1 study showed a significant reduction of vitamin D receptor (VDR) expression (p < .05). The remaining studies showed negative or no effect on PC characteristics, clinical outcomes and/or survival. Current evidence suggests that vitamin D supplementation in conjunction with standard of care (e.g. chemotherapy, radiation therapy) may confer clinical benefits such as a decrease in serum PSA levels and VDR expression but further research is required to ascertain these results. Calcitriol supplementation in doses ranging from 250-1000 mg for 3-8 weeks or a lower dose of 45 mg for 18.3 months, appear most beneficial regarding outcomes of PC progression and survival.

The Effects of Vitamin D Supplementation in Newly Diagnosed Type 1 Diabetes Patients: Systematic Review of Randomized Controlled Trials.

AIM: The aim of this study was to examine the effects of vitamin D supplementation in patients newly diagnosed with type 1 diabetes (T1D) assessed by insulin needs and changes in glycemic indices, as evidenced by randomized controlled trials (RCTs). METHODS: A total of 7 RCTs were retrieved from PubMed/Medline and EBSCO databases by MeSH term search, and were reviewed systematically. The RCTs included examined the effects of alphacalcidole (n = 2), cholecalciferol (n = 2), and calcitriol (n = 3) supplementation on changes in daily insulin dose (DID), fasting Cpeptide (FCP), stimulated C-peptide (SCP), and HbA1c. In total, 287 individuals, diagnosed with T1D within a period of 4 weeks to 1 year and aged between 5 to 38 years, were examined. RESULTS: Significant positive effects on DID, FCP, and SCP levels were observed after supplementation with alphacalcidole and cholecalciferol, whereas supplementation with calcitriol showed no effect. CONCLUSIONS: Vitamin D supplementation in the form of alphacalcidole and cholecalciferol appears to be beneficial in the treatment of T1D patients by attenuating the natural history of the disease.

Do low-income Cypriots experience food stress? The cost of a healthy food basket relative to guaranteed minimum income in Nicosia, Cyprus.

AIM: The aim of the present study was to assess the cost, acceptability and affordability of the healthy food basket (HFB) among low-income families in Cyprus. METHODS: HFBs were constructed based on the National Guidelines for Nutrition and Exercise for six different types of households. Acceptability was tested through focus groups. Affordability was defined as the cost of the HFB as a percentage of the guaranteed minimum income (GMI). The value of the GMI is set to be equal to €480 for a single individual and increases with the size of the recipient unit in accordance with the Organization for Economic Co-operation and Development equivalence scales. The Ministry of Labour estimates that, on average, nearly 50% of the GMI is required for food. RESULTS: The total monthly budget for HFB is 0.80, 1.11, 1.27, 1.28, 1.44 and 1.48 times higher than the GMI budget for food among different types of households in Cyprus (a single woman, a single man, a couple, a single woman with two children, a single man with two children and a couple with two children, respectively). In particular, a family with two children on GMI would need to spend a large proportion of their income on the HFB (71.68%). CONCLUSIONS: The GMI scheme appears not to consider the cost of healthy food, and thus, families on welfare payments in Cyprus are at a high risk of experiencing food stress. Therefore, additional research is required to measure the cost of the six HFBs in various settings.

Developing a food basket for fulfilling physical and non-physical needs in Cyprus. Is it affordable?

Background: An acceptable and affordable food basket (FB) is necessary to meet not only physical (healthy) needs but also the non-physical needs of individuals and communities. FBs were developed based on the Cypriot national food-based dietary guidelines for six types of household: single woman (±40 years), single man (±40 years), a couple (±40 years) without children, single woman (±40 years) with two children (10-year-old boy and 14-year-old girl), single man (±40 years) with two children and a couple (±40 years) with two children. Non-physical needs (kitchen equipment, physical activity and other related functions of food) were added to the baskets. The cost, acceptability and feasibility of FB were examined through the focus group discussions. Affordability was defined as the cost of the each basket as a percentage of household income (Guaranteed Minimum Income [GMI]). The budget for healthy food has the highest proportion in the total food budget (83-89%) compared with the other components. The part of the budget required for other functions of food is small compared with that of healthy food and ranged between 4.7 and 6.7% of the total monthly budget. For low-income families, the proportion of income that needs to be spent on the FB for physical needs and FB for physical and non-physical needs ranged from around 39 to 72% and 47 to 81%, respectively. The FB fulfilling physical and non-physical needs is not affordable among the low-income families (mainly with children) receiving the GMI scheme in Cyprus.