Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study.

BACKGROUND: The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents. METHODS: Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5-7) and non-ideal (0-4). RESULTS: A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]). CONCLUSION: Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.

The Association of Maternal Weight Status throughout the Life-Course with the Development of Childhood Obesity: A Secondary Analysis of the Healthy Growth Study Data.

Maternal weight-status at various time-points may influence child obesity development, however the most critical time-point remains unidentified. We used data from the Healthy Growth Study, a cross-sectional study of 2666 Greek schoolchildren aged 9-13 years, exploring associations between childhood obesity and maternal weight-status at pre-pregnancy, during pregnancy/gestational weight gain, and at the child's pre-adolescence. Logistic regression analyses examined associations between maternal weight-status being "below" or "above" the recommended cut-off points (WHO BMI thresholds or IOM cut-off points), at the three time-points, individually or combined into weight-status trajectory groups to determine the strongest associations with child obesity in pre-adolescence. Adjusted models found significant associations and the highest odds ratios [95% Confidence Intervals] for mothers affected by obesity before pregnancy (4.16 [2.47, 7.02]), those with excessive gestational weight gain during pregnancy (1.50 [1.08, 2.08]), and those affected by obesity at their child's pre-adolescence (3.3 [2.29, 4.87]). When combining these weight-status groups, mothers who were above-above-below (3.24 [1.10, 9.55]), and above-above-above (3.07 [1.95, 4.85]) the healthy weight recommendation-based thresholds in each time-point, had a three-fold higher likelihood of child obesity, compared to the below-below-below trajectory group. Maternal obesity across all examined time-points was significantly associated with childhood obesity. Effective childhood obesity preventive initiatives should commence at pre-conception, targeting maternal weight throughout the life-course and childhood developmental stages.

An educational intervention to improve health and nutrition literacy in hypertensive patients in Greece.

BACKGROUND: Suboptimal control of blood pressure (BP) is a public health challenge in Greece. This educational intervention attempts to improve health literacy (HL) and nutrition literacy (NL) in primary healthcare (PHC) patients with hypertension (HTN). MATERIALS AND METHODS: This was a proof-of-concept (PoC) educational intervention. Twenty-four patients with HTN and low or medium levels of HL agreed to participate in this 6-week educational intervention. The program was delivered by a general practitioner (GP) in group A and by a qualified nurse in group B. Group C was the control group. The levels of HL of NL, adherence to the Mediterranean diet, and perceived stress were assessed using the European Health Literacy Survey Questionnaire 16 (HLS_EU_Q16) and part B (reading a medication label) of the High Blood Pressure-Health Literacy Scale (HBP-HLS), the Nutrition Literacy Scale-Greek (NLS-Gr), the Mediterranean Diet Adherence Screener (MEDAS), and the Perceived Stress Scale (PSS-14), respectively, together with certain socioeconomic, dietary, and lifestyle characteristics. The Kruskal-Wallis and Wilcoxon nonparametric, the Chi-square, and the McNemar-Bowker tests were used. The analysis was done with the STATA software, version 14 (MP & Associates, Sparta, Greece). RESULTS: No statistically significant differences were found in the total score of HL and NL before and after the intervention; however, the results indicate a slight improvement in HL and NL levels in the two intervention groups, together with small improvements in knowledge and behaviors related to HTN and dietary salt. A trend of improvement in the MEDAS levels in the GP's group and the HBP-HLS levels in the nurse's group was also reported. CONCLUSION: A slight improvement in HL and NL levels in the two intervention groups has been reported, and the changes, however, were not statistically significant.

Parental BMI and country classification by Gross National Income are stronger determinants of prospective BMI deterioration compared to perinatal risk factors at pre-adolescence: Feel4Diabetes Study.

OBJECTIVES: This study aimed to evaluate all known risk factors, from perinatal to adolescence and identify those predominantly related with prospective BMI deterioration. METHODS: Prospective data analysis from the European Feel4Diabetes-study involving 12,211 children from six countries. Details on perinatal and sociodemographic characteristics were collected by parental self-reported questionnaires. Children's anthropometric data were measured by research personnel. Associations between risk factors and children's BMI deterioration (i.e increase) from baseline (mean age 8.2 ± 0.98 years) to the 2-year follow-up (10.3 ± 1.0 years) were explored by applying logistic regression analyses. RESULTS: Univariate analysis revealed that all known risk factors for early overweight/obesity development, remained dominant in prospective BMI deterioration. When multivariate analysis was applied including additional variables such as parents' current BMI status, family socio-demographic characteristics and country economic classification based on Gross National Income, most perinatal risk factors were no longer significant. Multivariate analysis revealed that pre-pregnancy maternal overweight/obesity (OR, 95%CI: 2.71, 1.67-4.38), early introduction of solid foods (2.54, 1.21-5.31), parental current BMI status (3.53, 2.17-5.72) and country economic classification (low income: 4.67, 2.20-9.93; under austerity measures: 6.78, 3.18-14.48) were the only parameters associated with higher odds for children's BMI deterioration from the study baseline to 2-year follow-up after adjusting for children's gender. CONCLUSIONS: The most predominant risk factors influencing children's prospective BMI deterioration were parental BMI and country economic classification as compared to perinatal. These findings should guide public health initiatives aiming to tackle the childhood obesity epidemic and social inequalities on a European level.

The Association of Lifestyle Patterns with Prediabetes in Adults from Families at High Risk for Type 2 Diabetes in Europe: The Feel4Diabetes Study.

The increasing prevalence of prediabetes globally does not bode well for the growing epidemic of type 2 diabetes (T2D) and its complications. Yet there is a lack of studies regarding lifestyle patterns (LPs) and their association with prediabetes. The present study aimed to examine the association of different LPs with the existence of prediabetes in adults from families at high risk for T2D in Europe. In total, 2759 adults (66.3% females) from six European countries were included in this cross-sectional analysis using data from the baseline assessment of the Feel4Diabetes study. Anthropometric, sociodemographic, dietary and behavioral data were assessed, and fasting blood glucose measurements were also obtained. LPs were derived via principal component analysis. Two LPs were derived, explaining 32% of the total variation. LP 1 was characterized by breakfast consumption, high consumption of fruits and berries, vegetables and nuts and seeds, and low consumption of salty snacks and soft drinks with sugar, while LP 2 was characterized by high consumption of salty and sweet snacks, soft drinks with sugar and juice with sugar and sedentary behavior. After adjusting for various confounders, LP 2 was positively associated with the existence of prediabetes (odds ratio = 1.02, 95% CI 1.01-1.04), while LP 1 was not significantly associated with prediabetes. Understanding LPs would provide necessary evidence for planning intervention and education strategies for prediabetes and T2D.

Likelihood of obesity in early and late childhood based on growth trajectory during infancy.

BACKGROUND: Childhood obesity rates have reached epidemic levels with Mediterranean countries reporting among the highest numbers globally. Evidence suggests early life factors, including infant growth rate, increase the likelihood of obesity later in childhood. However, optimal rates of infant growth associated with lower odds of future obesity still remain undetermined. The study aim was to determine the optimal infant growth rate associated with a lower likelihood of childhood overweight and obesity. METHODS: Perinatal and anthropometric data collected from 1778 Greek preschool (2-5 years old) and 2294 Greek preadolescent (10-12 years old) children participating in the ToyBox and the Healthy Growth Study (HGS) respectively, was combined for examination. Logistic regression models and receiver operating curves were used to determine the association between infant growth rate and development of childhood overweight and obesity, as well as optimal infant growth rate, respectively. RESULTS: Rapid weight gain during the first 6 months of life was positively associated with overweight and obesity in preadolescent children (OR:1.36, 95% CI: 1.13-1.63). Optimal cut-off points for several infancy growth rate indices (i.e., WAZ, WLZ, HAZ, BAZ) associated with a lower likelihood of overweight and obesity in preschool years and preadolescence were also identified. CONCLUSIONS: The current findings could possibly set the basis for healthcare professionals and families to better monitor, assess, and control infant growth rates, thus providing another obesity prevention strategy from early life. These findings, however, and the recommended optimal cut-offs need to be confirmed through further prospective research.

Optimizing diet and nutrition for cancer survivors: A review.

The number of cancer survivors is increasing and they are often highly motivated to search for information about nutrition and about physical activity in order to try to improve their treatment outcomes, quality of life and overall survival. In the light of these concerns, the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) as well as the American Cancer Society recommend a largely plant-based diet with limited consumption of red and processed meat, and limited consumption of alcohol, as well as the maintenance of a healthy weight throughout life and regular engagement in physical activity. There is a need for well-designed large observational and intervention studies to shed more light on the association between diet and cancer survivorship, and to suggest additional means for the secondary prevention of cancer.

Whole Grain Consumption and Breast Cancer: A Case-Control Study in Women.

OBJECTIVE: Whole grain consumption has long been associated with human health. However, its relationship with breast cancer remains not well understood and appreciated. The aim of this work was to evaluate the association between whole grain consumption and breast cancer in women. METHODS: A case-control study was designed. Two hundred and fifty consecutive, newly diagnosed breast cancer female patients (56 ± 12 years) and 250 one-to-one age-matched controls were enrolled. A standardized, validated questionnaire assessing various sociodemographic, clinical, lifestyle, and dietary characteristics was applied through face-to-face interviews. Moreover, data on regular consumption of whole grains (i.e., never/rarely, 1-6 times/week, >7 times/week) were recorded. Overall dietary habits were assessed through the level of adherence to the Mediterranean diet using the MedDietScore (theoretical range 0-55). RESULTS: Whole grain consumption of more than 7 times/week was associated with a 0.49-fold (odds ratio = 0.49; 95% confidence interval, 0.29, 0.82) lower likelihood of having breast cancer, after adjustments were made. CONCLUSIONS: This study suggested that whole grain consumption more than 7 times/week was consistently associated with reduced risk of breast cancer.

Dietary patterns and breast cancer: a case-control study in women.

PURPOSE: Since dietary habits have been associated with breast cancer, the tested research hypothesis was the associations between food patterns, as derived through multivariate methods, and breast cancer. METHODS: In a case-control study, Two-hundred and fifty consecutive, newly diagnosed breast cancer female patients (56 ± 12 years) and 250 one-to-one age-matched, healthy controls were studied. A standardized, validated questionnaire assessing various socio-demographic, clinical, lifestyle, and dietary characteristics was applied through face-to-face interviews. Factor analysis, with principal components method, was applied to extract dietary patterns from 86 foods or food groups consumption reported by the controls. RESULTS: Three components were derived explaining 43% of the total variation in consumption. Component 1 was characterized by the consumption of potatoes, red meat and its products, poultry and white meat, dairy products, use of margarine/butter in cooking or at the table, consumption of sausages, fried food as well as grilled meat or fish; component 2 was characterized by the consumption of whole grains, fruits, and vegetables; and component 3 was characterized by olive oil and fish consumption. After adjusting for various confounders, components 2 and 3 were favorably associated with the absence of having breast cancer [odds ratio (OR) 0.60, 95% CI 0.47-0.75 and OR 0.81, 95% CI 0.66-0.99, respectively], while component 1 was not significantly associated with the disease. CONCLUSIONS: Adherence to healthy dietary patterns (including whole grains, fruits, and vegetables, olive oil, and fish) seems to be favorable in not having breast cancer, among middle-aged women.

Meat consumption and breast cancer: a case-control study in women.

BACKGROUND: The relationship between meat intake and breast cancer has been inconsistent . OBJECTIVE: The aim of this work was to evaluate the association between meat intake and breast cancer, in women. DESIGN: A case-control study with 250 consecutive, newly diagnosed breast-cancer-female-patients (56 ± 12 years) and 250, one-to-one age-matched controls was conducted. A standardized, validated questionnaire assessing various socio-demographic, clinical, lifestyle and dietary characteristics was applied through face-to-face interviews. Data on consumption of red, white, processed and grilled meat were also recorded. Overall dietary habits were assessed through the level of adherence to the Mediterranean diet using the MedDietScore (theoretical range 0-55). RESULTS: Processed meat intake, even for 1-2 times/week,was associated with a 2.7-fold (OR= 2.65, 95% CI 1.36, 5.14) (p= 0.004) higher likelihood of having breast cancer, while daily intake increased the likelihood by a 2.8-fold (OR = 2.81, 95% CI 1.13, 6.96) (p = 0.026), after various adjustments made. Red, white and grilled meat intake was not significantly associated with the outcome when the same adjustments were made. CONCLUSIONS: This study suggested that only daily processed-meat intake was consistently associated with increased odds of breast-cancer.

Diet and breast cancer: a systematic review.

Breast cancer occurs as a result between genes-diet interactions. Concerning diet, only alcohol is widely recognized for being most consistently associated with breast cancer risk. The purpose of this review is to report through a systematic way the current scientific evidence relating breast cancer and diet, through original-research studies published in English language during the last decade, assessing the consumption of specific foodstuffs/food-nutrients in relation to the disease. The available literature suggests that soy food intake seems to be inversely associated with the disease, while no association seems to be reported for dietary carbohydrates and dietary fiber intake. The consumption of dietary fat, is probably suggestive of an increase in breast cancer risk, while studies evaluating the role of fruit/vegetable, meat as well as dietary patterns and breast cancer risk, provide inconsistent results. Diet seems to be modestly associated with the disease, highlighting the need for more studies to be conducted.

Adherence to the Mediterranean diet is associated with lower likelihood of breast cancer: a case-control study.

Mediterranean diet has long been associated with human health. However, its relationship with breast cancer remains not well understood and appreciated. The aim of this work was to evaluate the association between adherence to the Mediterranean diet and its inherent constituents, with breast-cancer. Two-hundred-and-fifty consecutive, newly diagnosed breast-cancer female patients (56 ± 12 yr) and 250, 1-to-1 age-matched with the patients, controls, were studied. A standardized, validated questionnaire assessing various sociodemographic, clinical, lifestyle, and dietary characteristics, was applied through face-to-face interviews. Adherence to the Mediterranean diet was evaluated using the 11-components MedDietScore (theoretical range 0-55). Multiple logistic regression was applied to test the research hypothesis, whereas discriminant analysis was used to explore the strength of each component in relation to the outcome. One unit increase in the MedDietScore (i.e., greater adherence to the Mediterranean diet) was associated with 9% lower likelihood of having breast cancer (odds ratio = 0.91; 95% confidence interval, 0.86, 0.97). Decomposition of the MedDietScore revealed that the most important components and with beneficial effect were nonrefined cereals, vegetables, fruits, and alcohol, followed by red meat, but with unfavorable effect. A dietary recommendation for healthy eating, close to the Mediterranean dietary pattern, seems promising for breast cancer prevention.

Soy food consumption and breast cancer.

Breast cancer is the most frequently diagnosed cancer in female worldwide and occurs as an interaction of genes and diet. As regards diet numerous studies all over the world have associated the disease with many foods and nutrients including soy and its compounds. Soy food and soy products are rich in phytoestrogens, naturally occurring hormone-like compounds with weak estrogenic effects. Despite inconsistencies in the available data, an inverse association between soy food consumption and breast cancer is likely. However, it seems that this correlation is more obvious in Asian rather than Western populations, where the consumption of soy is already higher. Moreover, the vast majority of studies that demonstrate this inverse association are case-control studies, a fact that should be taken into account. In this review, the current scientific evidence relating breast cancer and soy consumption is reported through a systematic way.

Aims, design and methods of a case-control study for the assessment of the role of dietary habits, eating behaviors and environmental factors, on the development of breast cancer.

In this work the aims, methodology and procedures of a case-control study that was developed for assessing the role of dietary habits, eating behaviors and environmental factors on the development of breast cancer, is presented. During 2010-2012, 250 consecutive women patients, newly diagnosed with breast cancer and 250 population-based, healthy subjects (controls) age-matched to the cases, were enrolled. Socio-demographic, dietary, psychological, lifestyle as well as environmental characteristics (i.e., exposure to pollution, pesticides, electromagnetic fields and radon) were recorded through face-to-face interviews with the participants. Dietary habits and eating behaviors were evaluated with a special questionnaire that had been developed for the study, and was found relatively valid and reliable.