The Relationship of Adherence to the Mediterranean Diet with Disease Activity and Quality of Life in Crohn's Disease Patients.

Background and Objectives: Emerging evidence is placing the Mediterranean diet (MD) in the spotlight as a potential dietary model that could benefit inflammatory bowel disease (IBD) patients in terms of prevention and progress of the disease. The main aim of the present study is to shed some light on the relationship between the adherence to the MD and the degree of disease activity, as well as the quality of life in patients with Crohn's disease (CD). Materials and Methods: An administered questionnaire was used to assess and record a number of parameters, including recent medical and weight history, anthropometric characteristics, disease activity (in remission or active disease), and quality of life of both male and female CD patients. Moreover, the level of compliance of the participants to the Mediterranean diet model was evaluated and its relationship with disease activity and quality of life was investigated. Results: Adherence to the MD was significantly higher in patients with inactive disease than in those with active disease (p = 0.019). According to the correlation analysis conducted, adherence to the MD was negatively correlated with disease activity (p = 0.039) and positively correlated with quality of life (QoL) (p = 0.046) of the participants. Intake of fruits, vegetables, and dairy products was significantly higher in remission patients (p = 0.046, p = 0.001, p = 0.041, respectively). Conclusions: We conclude, according to the findings of the study, that adherence to the MD is associated with disease activity and QoL in patients with CD. Future research should focus on MD intervention studies on IBD patients in order to assess its effect on modulating disease activity/course and related inflammatory biomarkers.

Exploring the Role of Self-Efficacy in Maintaining Healthy Lifestyle Habits among Patients with Cardiometabolic Diseases; Findings from the Multi-Center IACT Cross-Sectional Study.

(1) Background: Cardiometabolic disease progression can be delayed if patients engage in healthy lifestyle behaviors, adherence to which is highly influenced by psychosocial factors. The present study aimed at investigating the association of self-efficacy with the adherence level to healthy lifestyle behaviors among patients with cardiometabolic diseases in Greece. (2) Methods: 1988 patients (1180 females) with cardiometabolic diseases participated. Anthropometric, demographic, socioeconomic, clinical, and lifestyle characteristics were recorded. Patients were also asked to evaluate their efficacy to comply with healthy lifestyle behaviors. (3) Results: The majority exhibited unhealthy lifestyle behaviors. A subgroup demonstrated elevated self-efficacy in maintaining healthy habits despite facing diverse psychosocial challenges. Individuals with higher educational attainment, socioeconomic status, and rural/semi-urban residency had significantly elevated self-efficacy. Those with heightened self-efficacy exhibited significantly lower BMI and reduced prevalence of certain health conditions. Self-efficacy significantly influenced adherence to the Mediterranean diet, physical activity engagement, and smoking cessation, even in challenging circumstances. (4) Conclusions: This study represented an innovative approach in examining the role of self-efficacy in shaping health behaviors and outcomes within a Greek population. By integrating specific psychosocial circumstances into the analysis, valuable insights were provided into the contextual factors influencing self-efficacy and adherence to healthy lifestyle behaviors.

The Effect of Shift Working on Dietary Patterns of Healthcare Practitioners during the COVID-19 Pandemic: A Cross-Sectional Study.

Background and Objectives: Health professionals' working schedules often do not allow them to follow a balanced way of life, and the nature of their work can affect their weight and eating habits. The aim of the present study is to shed some light on the impact of night shift working on the dietary practices of healthcare practitioners in Greece. Materials and Methods: This was a cross-sectional study. With the use of an administered questionnaire several parameters were assessed, including anthropometric characteristics, weight history, as well as nutritional habits of the same group of participants during night shifts and when at regular working hours. Moreover, nutritional beliefs of the subjects were recorded, as well as the level of adherence to the Mediterranean diet. Results: It was observed that in all food groups, including water, used to compare the nutritional patterns of the participants during night shifts and when working regular hours, statistical differences were noted (p = 0.001). Furthermore, the participants who reported a higher adherence to the Mediterranean diet and self-reported healthier nutritional habits, had a statistically lower weight compared to the participants that rarely followed the specific model or reported unhealthier eating routine (p = 0.010 and p = 0.015, respectively). Conclusions: We conclude that shift-working healthcare professionals are associated with disturbed eating behaviours leading to the high consumption of unhealthy food. The implementation of interventions that will concentrate on educating health workers on balanced nutrition and improving physical environment (i.e., food availability, healthier food choices) seems to be of great importance.

Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus?

BACKGROUND: Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus. METHODS: a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords. RESULTS: in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others. CONCLUSION: up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.

Nutritional Considerations in Colorectal Surgery in Diverting Ileostomy Patients: A Review.

Colorectal surgery often results in a temporary or permanent ileostomy construction. The general nutritional status and intake of patients with an ileostomy have not received much attention and scientific evidence is lacking. Nutritional complications associated with ileostomy formation and colonic exclusion include fluid (dehydration) and electrolyte abnormalities (mainly hyponatremia), impaired renal function occurring from plasma volume depletion, and reduced energy absorption due to the role of the large bowel in energy assimilation. People with ileostomies frequently avoid specific foods, due to concerns of possible malfunction or food blockages of their stoma, which may produce a negative effect on their overall dietary intake and nutritional status. The present article reviews the existing literature on nutritional considerations for those with an ileostomy and discusses measures to optimize overall nutritional status of this category of patients.

The Effect of Fat Supplementation on the Appearance of Symptoms Associated With Dumping Syndrome in Patients Having Undergone Gastric Surgery: Preliminary Results.

BACKGROUND/OBJECTIVES: Data on the effect of dietary fat on dumping syndrome (DS) symptoms are limited. The aim of this study was to assess the effect of the addition of fat to a carbohydrate meal on the appearance of DS symptoms and glycemic response, in patients who had undergone gastric surgery. SUBJECTS/METHODS: This was an interventional crossover study. Patients scheduled for gastric surgical procedures related to DS at two surgical units of two public hospitals (General University Hospital of Larissa and General Hospital of Larissa) were considered for study inclusion. Patients presenting symptoms suggestive of diagnosis (n = 12), after the ingestion of a carbohydrate meal, were used as both intervention and control groups. During the intervention process, a fat supplement was added to the carbohydrate meal that was previously used for diagnosis. Glycemic response and the amount and intensity of DS symptoms provoked by the two meals were assessed at both appointments. RESULTS: Blood glucose levels were significantly lower in the group that consumed the added fat meal compared with the group that consumed the carbohydrate meal 60 minutes after ingestion (p = 0.028). Furthermore, a significant reduction was noted in the amount of late dumping symptoms (p = 0.021) and the intensity of both early and late dumping symptoms (p = 0.007 and p = 0.012 respectively), after fat addition.  Conclusions: Incorporating fat into a carbohydrate meal seems to attenuate postprandial blood glucose rises and reduce the amount and intensity of DS symptoms, in patients who had undergone gastric surgery.

Adherence to the Mediterranean Diet during Pregnancy: Associations with Sociodemographic and Anthropometric Parameters, Perinatal Outcomes, and Breastfeeding Practices.

Background and Objectives: The Mediterranean diet (MD) has been recognized as a beneficial nutritional pattern that promotes human health, decreasing the risks of a variety of human disorders and pathological states, including adverse pregnancy outcomes. In this aspect, the current survey aimed to assess the potential association of compliance with the MD during gestation with various sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Materials and Methods: This was a cross-sectional study performed on 5688 pregnant women from 10 distinctive Greek areas. Face-to-face interviews with qualified questionnaires and thorough retrievals of medical records were performed to collect data concerning the participants' sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Results: Elevated compliance with the MD during pregnancy was independently related with older age, higher educational status, and better economic status as well as decreased incidences of pre-pregnancy overweight/obesity and excess gestational weight gain and a lower likelihood of gestational diabetes. Moreover, greater adherence to the MD was independently associated with an increased prevalence of delivering vaginally and a greater prevalence of exclusive breastfeeding for at least 16 weeks postpartum. Conclusions: A higher level of compliance with the MD for the period of gestation was associated with several favorable lifestyle factors that may promote maternal health. Further studies with a prospective design as well as studies exploring the potential effects of maternal compliance with the MD for the period of pregnancy on the health of children should be performed. Future studies should also be extended beyond the MD by assessing the potential beneficial effects of adopting a Mediterranean lifestyle on maternal and child health.

Changes in body weight and body composition during the menstrual cycle.

OBJECTIVES: The general perception is that menstrual cycle is a factor related to body weight and body composition fluctuations in women. The lack of a standardized methodology of the so far conducted studies has led to controversial results. The aim of the current study is to identify if there are any changes in body weight and body composition during the menstrual cycle. METHODS: In the current study measurements of body weight, circumferences, skinfolds and body composition with bioelectrical impedance analysis were conducted twice per week in 42 women during their menstrual cycle. RESULTS: Body weight was found to be statistically significantly higher during menstruation compared to the first week of the menstrual cycle by 0.450 kg, which could be attributed to a statistically significant increase of 0.474 kg observed in extracellular water. No other statistically significant changes were observed regarding body composition. CONCLUSIONS: An increase of approximately 0.5 kg was observed during women's menstrual cycle, mostly due to extracellular fluid retention at menstruation days. These findings could be taken into account to interpret body weight and composition periodic fluctuations in women of reproductive age.

Objective Measurements of Physical Function to Predict Survival in Patients with Metastatic Cancer.

BACKGROUND/OBJECTIVES: Physician-reported performance status (PS) constitutes the established method for stratifying oncologic patients in therapeutic decision-making. Objective measurements of physical function may further refine prognostication. SUBJECTS/METHODS: In this prospective observational study, 103 patients with metastatic cancer who were referred for systemic therapy initiation were evaluated. PS was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and five objective physical function measurements (handgrip strength [HGS], chair stand test [CST], timed up and go [TUG] test, 4-m gait speed [GS] test, and short physical performance battery [SPPB] test). Overall survival and treatment complications were recorded from the medical records. RESULTS: Patients with low PS according to ECOG-PS (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.84, 7.80), HGS (HR: 2.37, 95% CI: 1.24, 4.55), SPPB (HR: 3.43, 95% CI: 1.55, 7.57), GS (HR: 3.03, 95% CI: 1.44, 6.38), and TUG (HR: 5.16, 95% CI: 2.19, 12.14) had shorter overall survival after adjustment for sex, age, symptomatology, comorbidity, percentage of weight loss, and tumor localization. CONCLUSIONS: Among the studied objective physical function measurements, HGS, SPPB, GS, and TUG were independent predictors of survival in a sample of patients with metastatic cancer, with TUG showing the highest effect size.

Earlier Age at Menarche Is Associated with Body Fat and Negative Body Image in Adult Life.

Earlier age at menarche is one of the well-documented antecedents of a range of adverse health effects in adulthood including obesity and psychopathological effects. Yet, few researchers have examined the potential association of menarcheal age with body fat distribution, self-perception, and body image. We retrospectively tested a sample (N = 392) of adult women (18-80 years) to examine the associations of age at menarche with body composition and body image indices. Analyses of covariance and multivariable logistic and linear regression were fitted adjusting for age, physical activity level, smoking, and alcohol consumption. Further adjustment was made for body mass index (BMI) and percentage of fat mass. Earlier age at menarche was associated with slightly increased odds of higher BMI and abdominal fat percentage; of note is the positive correlation with lower body composition indices including hip and calf circumferences/skinfolds. Additionally, earlier age at menarche was associated with higher scores in the negative body image scales, namely overweight preoccupation and self-classified weight, whereas lower risks were found for higher scores in the positive body image scales, namely appearance evaluation and body area satisfaction scales. These findings remained significant after correcting for body fat percentage. The present results showed positive associations for earlier age at menarche with gross indices of obesity with the associations mainly confined to distribution of body fat in the lower part of the body, whereas an increased risk of negative body image was also found. Future research could refine our understanding of the biological and psychological mechanisms underlying these associations.

Αssessment of Dietary Intake and Nutritional Status of Former Opioid Users Undergoing Detoxification Process.

RATIONALE: Opioid dependence is often associated with impaired nutritional status, weight changes, nutritional deficiencies, and increased sugar consumption. Scientific quantified data on the dietary habits and intake of such patients are sparse. METHODS: This was a cross-sectional study. The study was conducted among 60 male and female former heroin addicts, who sought detoxification at the OKANA replacement therapy unit, in a public university hospital. All patients were treated for their addiction with buprenorfine/naloxone in combination with counseling. With the use of an administered questionnaire, several parameters were assessed and recorded, including nutritional habits, anthropometric characteristics, recent weight and medical history, and physical activity level of the participants. Additionally, a three-day dietary recall was performed and quantified with the aid of nutritional analysis software. The results were compared with the macronutrient requirements, calculated total energy expenditure, and the population reference intake (PRI) of the participants. Finally, the level of compliance of the participants to the Mediterranean diet model was assessed using the Mediterranean diet score tool. RESULTS: The vast majority of the participants (77%) had a normal BMI of 18.5-25, and 15% were categorized as underweight (<18.5). Furthermore, 63% of the patients reported a mean unintended weight reduction of 9 kg over the last three months. Regarding mean energy and protein intake, no significant differences between reported intake and calculated requirements were recorded. Sugar consumption was high since it reached 20% of the total energy intake. Micronutrient intake was significantly lower for vitamins K, E, and C and potassium compared with the PRI (p=0.034, p=0.001, p=0.046, and p=0.001, respectively). Finally, a low adherence of the participants to the Mediterranean diet model was observed since 38% scored ≤15 and 62% ≤ 30 on the Mediterranean diet score tool. CONCLUSIONS: According to the results of the study, the general nutritional status of this category of patients seems to be impaired, presenting an apparent weight reduction and an inadequate intake of some micronutrients and displaying disturbed eating behaviors. Further data on the field are required to build a future evidence base. Dietary assessment and individualized nutritional counseling, when necessary, might need to be incorporated into the typical clinical management of this patient category to avoid nutritional deficiencies and improve the withdrawal process.

Foodborne botulism: A brief review of cases transmitted by cheese products (Review).

Food safety constitutes a basic priority for public health. Foodborne botulism occurs worldwide; it is an acute paralytic disease caused by the consumption of food containing the botulinum toxin. Growing consumer demand for cheese products could result in increased exposure of the population to this toxin, and thus the risk of foodborne botulism. The majority of cases of botulism caused by dairy products are related to cheese products specifically. Epidemic outbreaks and isolated cases have been reported over time. Domestically canned foods are still among the primary causes of the disease. Cheese products are not regularly involved in botulism incidents; it is however, necessary to take control measures for manufacturing and domestic preparation due to the high risk of occurrence of this particular disease. The aim of this review is to discuss foodborne botulism caused by cheese products, providing a brief epidemiological history, and to examine certain control measures that should be taken throughout the production process to better protect public health.

Use of Fortified Bread for Addressing Vitamin D Deficiency.

Vitamin D deficiency due to inadequate sun exposure and/or inadequate intake from food is very common worldwide, consisting a major public health problem. As prolonged exposure to ultraviolet radiation involves risks, food fortification of staple foods emerges as a favorable solution for addressing vitamin D deficiency. Bread is a suitable candidate for fortification as it is consumed often and is the main carbohydrate source in European countries.The purpose of this study was the evaluation of the bioavailability of vitamin D from a fortified Greek-type bread that was developed as a means for addressing vitamin D deficiency, by comparing the absorption curve of vitamin D in fortified bread in relation to that of plain vitamin supplementation. Two groups of clinically healthy volunteers consumed 25,000 international units (IU) of vitamin D3 (cholecalciferol) either in fortified bread (Group A) or in a plain supplement form (Group B). The baseline plasma concentrations of cholecalciferol were 8.1 ± 6.0 ng/mL and 6.8 ± 3.4 ng/mL in Groups A and B, respectively. After 12, 24, and 48 h, the concentrations of cholecalciferol in Group A were 16.7 ± 4.8, 15.3 ± 8.3 and 11.9 ± 6.0 ng/mL, respectively, and in Group B, 15.2 ± 3.3, 11.6 ± 2.4, and 9.6 ± 3.6 ng/mL, respectively. In both groups, the concentrations of cholecalciferol at 12 and 24 h were significantly higher than the baseline concentrations (p < 0.01). There were no statistically significant differences between the concentrations of cholecalciferol between Groups A and B, at each time point.Cholecalciferol is bioavailable from Greek-type fortified bread and bread could be used for addressing vitamin D deficiency.

The effect of a diverting ileostomy formation on nutritional status and energy intake of patients undergoing colorectal surgery.

BACKGROUND AND AIMS: The effects of ileostomy construction and colonic bypass on the general nutritional status of the patients have not yet received much attention. The aim of the present study was to assess the effect of a diverting ileostomy formation, on the nutritional intake, body composition and nutritional status biochemical markers of patients with a newly formed ileostomy. METHODS: This was an observational study. Patients scheduled for elective rectosigmoid resection at a surgical unit of a public university hospital, were considered for study inclusion. Patients in whom a diverting ileostomy was created were assigned to the ileostomy group (n = 41), and patients who underwent rectosigmoid resection without requiring a diverting ileostomy served as a control group (n = 37). Anthropometric characteristics, body composition, dietary intake and biochemical markers representative of nutritional status were assessed preoperatively and at 40 days postdischarge (NCT02036346). RESULTS: Anthropometric and body composition characteristics (weight, BMI and body fat percentage) significantly declined from 75 to 71.6 kg, 26.9 to 25.6 kg/m2 and 28.6 to 25.6% respectively (p = 0.001 for all) in the ileostomy group, between the preoperative stage and 40 days postdischarge from the hospital. Furthermore, a significant reduction in mean daily energy intake from 1871 to 1713 kcal/day (p = 0.046) was observed in the ileostomy group 40 days after discharge compared to preoperative assessment. No significant changes in the above measured parameters were observed in the non-ileostomy group. CONCLUSION: Diverting ileostomy can have a negative effect on general nutritional status and dietary intake of patients, during the first postoperative period. Nutritional assessment might need to be included in the routine clinical management of this patient category to prevent weight loss and impaired energy intake.

Administration of an Oral Hydration Solution Prevents Electrolyte and Fluid Disturbances and Reduces Readmissions in Patients With a Diverting Ileostomy After Colorectal Surgery: A Prospective, Randomized, Controlled Trial.

BACKGROUND: Patients with a newly formed ileostomy often develop electrolyte abnormalities and dehydration. OBJECTIVE: The study assessed the prophylactic effect of an isotonic hydration solution on dehydration and electrolyte abnormalities in patients with a newly formed ileostomy. DESIGN: This was a prospective, randomized, controlled trial (NCT02036346). SETTINGS: The study was conducted at a single surgical unit of a public university hospital. PATIENTS: Patients scheduled for elective rectosigmoid resection were considered for study inclusion. INTERVENTION: Patients in whom a diverting ileostomy was created were randomly assigned to the intervention group (n = 39), which received an oral isotonic glucose-sodium hydration solution for 40 days postdischarge and the control group (n = 41) which did not receive an intervention. The 2 groups were compared with a group of patients who underwent rectosigmoid resection without diverting ileostomy (n = 37). MAIN OUTCOME MEASURES: Serum electrolyte and renal function markers were assessed preoperatively and at 20 and 40 days postdischarge. RESULTS: At 20 days postdischarge, the serum sodium of the control group appeared lower than the serum sodium of the intervention group and the nonileostomy group (p = 0.007). At the same time point, urea and creatinine levels of the control group were higher than the urea and creatinine levels of the other 2 groups (p = 0.01 and p = 0.02). At 40 days postdischarge, mean sodium and renal function markers improved in the control group, but sodium and creatinine continued to differ in comparison with the intervention and nonileostomy groups (p = 0.01 and p = 0.04). The readmission rate for fluid and electrolyte abnormalities was higher in the control group (24%) than in the other 2 groups, where no rehospitalization for such a reason was required (p = 0.001). LIMITATIONS: The study was limited by its single-center design. CONCLUSION: An oral isotonic drink postdischarge can have a prophylactic effect on patients with a newly formed ileostomy, preventing readmission for fluid and electrolyte abnormalities. See Video Abstract at http://links.lww.com/DCR/A603.