Adherence to the Mediterranean diet is linked to reduced psychopathology in female celiac disease patients.

Celiac disease (CD) is a chronic enteropathy, affecting approximately 1% of the population worldwide with a higher prevalence in women. Recent studies demonstrate that CD is associated with an increased prevalence of psychopathology. The present study was undertaken to investigate the relationship between adherence to the Mediterranean Diet (MD) and psychopathological symptoms among CD patients, since the MD is a physical and mental health protective dietary regimen, which can easily be rendered gluten-free. A total of 134 CD patients (28 males and 106 females) were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R), and MD adherence was calculated using the Mediterranean Dietary Serving Score (MDSS). As regards psychopathological symptoms, female patients presented with statistically significant higher depression and anxiety than males. The majority of patients (64.9%) had low adherence to the MD (MDSS <14) with a mean score of 9.44 ± 3.26 and 9.14 ± 3.07 for men and women, respectively, out of a total of 24 points. High MD adherence was observed in 35.7% of the male and 34.9% of the female patients, with a mean score of 16.40 ± 2.63 and 16.35 ± 2.12, respectively. Interestingly, MD adherence was inversely associated with the intensity of several psychopathological symptoms in female patients, which represented the majority of the sample. The results of the study underline the need to encourage CD patients to adapt to a Mediterranean-style GFD.

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease.

Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0−55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and >115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69−0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

Nutritional Assessment of Greek Liver Cirrhosis Patients: Mini Nutritional Assessment Predicts Mortality.

Malnutrition is highly prevalent in liver cirrhosis (LC). It increases as the severity of the disease progresses and it is related to poor survival. The objectives of the study were the nutritional assessment of Greek LC patients, using various nutritional assessment and screening tools, and the comparison of their predictive value for mortality. In total, 137 (77 male) consecutive LC patients (median age: 67 years) were assessed with subjective global assessment (SGA) and mini nutritional assessment (MNA) questionnaires, anthropometrics, handgrip strength (HGS) tests, and bioelectric impedance analysis (BIA), in comparison to a control group of 148 healthy people. Disease severity was assessed using the model for end-stage liver disease (MELD) scores. Patients were followed up for a median of 19 months. Survival curves were calculated using the Kaplan-Meier method. In total, 60% and 43% of patients were of adequate nutritional status by SGA and MNA, respectively, which was confirmed by most anthropometric measurements. MNA and SGA scores correlated significantly with anthropometrics and BIA-derived parameters. Besides the MELD score, mid-arm circumference (MAC), triceps skinfold (TSF), BIA's phase angle (Pha), and MNA predicted mortality in cirrhotic patients. The nutritional assessment demonstrated an unexpectedly high prevalence of well-nourished LC patients. MNA was a strong predictor of mortality.

Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care.

Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.

AMY1 diploid copy number among end-stage renal disease patients.

PURPOSE: The salivary amylase gene (AMY1) copy number variation (CNV) is increased as a human adaptation to starch-enriched nutritional patterns. The purpose of this study was to evaluate the relationship between AMY1 CNV, dietary starch consumption, and anthropometric indices among a known population with elevated cardiovascular risk, being end-stage renal disease (ESRD) patients. METHODS: A total of 43 ESRD patients were recruited based on the following inclusion criteria: being (1) adults, (2) on hemodialysis for more than 3 months, (3) able to communicate effectively, and (4) willing to participate. Anthropometric measurements were performed, dietary intake was recorded via food-frequency questionnaires, and AMY1 CNV was quantified in blood samples DNA via real-time PCR. RESULTS: Median AMY1 CNV was 4.0 (2.0-17.0). A total of 21 patients had an even, and 22 had an odd AMY1 copy number (CN). Independent samples t tests revealed that AMY1-odd diploid CN is associated with increased body weight, waist and hip circumferences, and fat mass compared to the respective even diploid CN carrier group. No differences were observed for BMI or nutritional intake. Multiple regression analysis revealed that AMY1-odd diploid CN was positively associated with increased hip circumference (ß = 7.87, 95% CI = 0.34 to 15.39) and absolute fat mass (ß = 6.66, 95% CI = 0.98 to 12.34); however, after applying the Bonferroni correction for multiplicity, all regression analyses lost their significance. CONCLUSIONS: AMY1-odd diploid CN appears to be associated with selected adiposity variables among hemodialysis patients. However, more research is needed to verify this finding in this population with known increased cardiovascular risk.

Exploring Patients' Experiences After Chronic Kidney Disease Diagnosis: A Qualitative Study.

Chronic kidney disease (CKD) diagnosis is often associated with stress, depression, and major lifestyle changes. The aim of this qualitative study was to explore patients' experiences of living with CKD. A non-random purposeful sampling strategy was used to recruit 10 patients with CKD undergoing hemodialysis, from a tertiary care hospital in Crete, Greece. Semi-structured, face-to-face interviews were conducted with open-ended questions aiming to assess different aspects of their life after CKD diagnosis. Four main themes were revealed portraying participants' experience, including facing a new reality, 2) confronting changes, 3) finding ways to cope, and 4) continuing life.

Disease Activity, Functional Ability and Nutritional Status in Patients with Rheumatoid Arthritis: An Observational Study in Greece.

AIM: The aim of the present pilot study was to assess differences in the nutritional status, Mediterranean diet (MD) adherence, and functional ability among patients with rheumatoid arthritis (RA), according to disease activity. METHODS: A total of 48 patients with RA, outpatients of a hospital in Athens, Greece were recruited. Disease activity was evaluated with DAS28, functional status with the Health Assessment Questionnaire (HAQ), MD adherence with the MedDietScore and malnutrition with the patient-generated subjective global assessment (PG-SGA). RESULTS: A relationship was noted between DAS28 and HAQ, indicating a reduced functional status with increased RA activity. Although MD adherence differed between DAS28 categories, no specific differences were noted in the PG-SGA or the MedDietScore in the post-hoc analyses. According to the PG-SGA, no need for nutritional intervention was noted among participants. CONCLUSIONS: The origin of the participants might have reduced the differences between MD adherence and DAS28. In parallel, the PG-SGA does not appear sensitive in detecting muscle-related malnutrition among patients with RA.

The Association Between Handgrip Strength and Predialysis Serum Sodium Level in Patients With Chronic Kidney Disease Stage 5D.

Purpose: Handgrip strength (HGS) is a useful tool for the systematic assessment of muscle function related to nutritional status. Reduced HGS has been associated with adverse clinical outcomes in chronic kidney disease (CKD) stage 5D patients. In the same patients, predialysis low serum sodium (sNa) has been associated with malnutrition and mortality. Here, we investigated the role of predialysis sNa on muscle function in CKD-5D patients. Methods: We evaluated 45 patients on hemodialysis (HD) and 28 patients on peritoneal dialysis (PD) with HGS measurement, bioimpedance analysis, anthropometric measures, and malnutrition inflammation score (MIS). According to established diagnostic criteria, reduced HGS was defined as strength below 30 and 20 Kg in men and women, respectively. Predialysis sNa values were defined as the mean of all predialysis measurements during the preceding 6 months. Data analysis was performed separately for each of the HD and PD groups. Results: The proportions of reduced HGS did not differ between the HD (66%) and PD (54%) groups, respectively. Patients in the HD group as compared to those in the PD group had higher serum albumin and potassium and mid-arm muscle circumference and lower residual renal function (RRF) and residual urine volume. Multivariate logistic analysis, after controlling for muscle mass, nutritional biomarkers, MIS, fluid overload and RRF, showed that for every 1 mmol/l increase of sNa the odds of reduced HGS was decreased by 60% (OR = 0.40, 95% CI: 0.16-0.99) and 42% (OR = 0.58, 95% CI: 0.36-0.93) in HD and PD patients, respectively. However, stratified analysis indicated that lower sNa levels predicted reduced HGS in individuals with a background of malnutrition, inflammation, overhydration and less preserved RRF, representing unfavorable conditions strongly related to muscle wasting in the dialysis setting. Conclusions: Predialysis sNa is a strong and independent determinant of HGS, a reliable nutritional marker in CKD-5D stage patients. However, according to our findings, lower sNa levels appear to be a marker of underlying unfavorable conditions that are heavily associated with reduced HGS, rather than a causal determinant of reduced HGS. Whether optimizing sNa levels improves patient muscle performance requires further investigations.

Nutritional status in hemodialysis patients is inversely related to depression and introversion.

Although hemodialysis (HD) is a life-sustaining treatment for the majority of patients with end-stage renal disease, it may adversely affect their psychological status. Depression is highly prevalent among these patients, and it is associated with malnutrition, morbidity and mortality. Recent studies have demonstrated that depression is positively associated with neuroticism and introversion in HD patients. The aim of the present study was to explore the relationship between depression, personality traits (extraversion-introversion, neuroticism, psychoticism) and nutritional status among HD patients. Fifty-two HD patients were assessed via questionnaires for depression (CES-D) and personality traits (EYSENCK, EPQ). Nutritional assessment was conducted through bioelectrical impedance analysis (BIA) and anthropometry measurements (height, post-dialysis weight). The study revealed novel significant correlations. Both post-dialysis weight and phase angle were negatively related to introversion (r = -0.314, p < 0.05 and r = -0.542, p < 0.01, respectively) and depression (r = -0.456, p < 0.01 and r = -0.467, p < 0.01, respectively). This study demonstrates that both depression and introversion are inversely related to adequate nourishment in HD patients and suggests that personality plays an important role in the nutritional status of these patients.

Food insecurity increases the risk of malnutrition among community-dwelling older adults.

OBJECTIVES: To assess the prevalence of malnutrition and food insecurity (uncertainty, or limited ability to acquire acceptable foods through socially acceptable ways), among non-hospitalised, non-institutionalised, community-dwelling older adults, and to identify possible dietary, socioeconomic and health factors associated with them. STUDY DESIGN: Cross-sectional, with 207 older adult participants inhabitants of Thessaloniki and Kavala, Greece. A medical diagnosis was not a criterion for exclusion from participation. MAIN OUTCOME MEASURES: Malnutrition risk (combined categories of "at risk of malnutrition" and "malnourished" by the Mini-Nutritional Assessment tool) and food insecurity (assessed by the Household Food Insecurity Access Scale). RESULTS: Participants had a mean age of 72.4 ± 8.5 years; 43.5% were male and 56.5% female. The prevalence of malnutrition was 5.3%, and 48.3% were "at risk of malnutrition". The group of participants assessed as being at risk of malnutrition were significantly older, smoked, had a lower body mass index and a smaller waist circumference, reported single partnership status, and exhibited reduced appetite. Some degree of food insecurity was apparent in 69% of the participants. Food insecurity was associated with lack of higher education, reduced monthly income and low adherence to the Mediterranean diet. Additionally, food insecurity as compared with food security increased the risk of malnutrition (OR 2.63, 95% CI 1.21-5.75; p = 0.015) in the multivariate analysis. CONCLUSIONS: Given the financial difficulties experienced by the Greek older adult population over the last decade, a large proportion of them are at risk of malnutrition and experience some degree of food insecurity. With the two conditions being interrelated, early identification and management of both malnutrition and food insecurity are essential for public health and healthy ageing.

Food addiction, orthorexia, and food-related stress among dietetics students.

PURPOSE: Health sciences, and in particular Nutrition and Dietetics students, have been shown to exhibit an increased prevalence of disordered eating. The aim of the present cross-sectional study was to evaluate other specified feeding and eating disorders (OSFEDs), including stress-related eating, food addiction, and orthorexia, in relation to the dietary intake, among nutrition/dietetics students. METHODS: A total of 176 undergraduate students from a Department of Nutrition and Dietetics, in Greece, participated in the study. Dietary intake was recorded, and the prevalence of Eating and Appraisal Due to Emotion and Stress (EADES), food addiction (with the modified Yale Food Addition scale mYFAS), and orthorexia were assessed. Chi-square and t tests were performed between sexes, orthorexic and non-orthorexic students, as well as between food-addicted and non-addicted participants. Multiple linear regression analysis assessed relationships between energy intake, BMI or waist circumference, and the food-related psychometric scales. RESULTS: Among participating students, 4.5% had food addiction and 68.2% demonstrated orthorexia. No differences were observed between men and women, concerning the prevalence of food addiction and orthorexia, the sum of mYFAS symptoms, or individual EADES factors. Orthorexic students exhibited increased BMI, reduced energy, and saturated fat intake. In addition, orthorexic men consumed more vegetables. Multiple linear regression analysis revealed that orthorexic behavior was associated with increased BMI, waist circumference and energy intake. Lower BMI was associated with increasing ability to cope with emotion-and-stress-related eating and increasing appraisal of ability and resources to cope with emotions and stress. Emotion-and-stress-related eating was negatively associated with BMI. Appraisal of ability and resources to cope with emotions and stress was associated with the energy intake. Finally, age was positively correlated with the appraisal of outside stressors/influences, indicating increased ability to cope with outside stressors among older students. CONCLUSIONS: The study shows that despite the suggested interventions, the problem of OSFEDs among nutrition and dietetics students is still valid. Regular screening, counseling, and education is needed to reduce its prevalence. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Through the Patients' Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care.

Chronic kidney disease is a condition that affects both the physical and mental abilities of patients. Nursing care is of pivotal importance, in particular when end-stage renal disease (ESRD) patients are concerned, since the quality of the provided care may severely influence the patient's quality of life. This is why it is important to explore patient experiences concerning the rendered care. However, limited up-to-date studies have addressed this issue. The aim of the present study was to stress the experiences of ESRD patients concerning the provided nursing care in the hemodialysis unit at the University Hospital in Heraklion, Crete. A qualitative methodological approach was used, based on the principles of phenomenological epistemology. Semi-structured interviews were conducted, and open-ended questions were applied to record how patients experienced the rendered care during dialysis. The recorded data were analyzed via qualitative content analysis, which revealed three main themes: 'Physical Care', 'Psychological Support' and 'Education'. Patients' views were conceptualized into sub-themes within each main theme. The interviews revealed the varied and distinct views of ESRD patients, indicating that the rendered care should be individualized.

Adiponectin and end-stage renal disease.

Adiponectin (ADPN) is an adipokine with significant anti-inflammatory, insulin-sensitizing and anti-atherogenic properties, which is generally associated with a beneficial cardiometabolic profile. Paradoxically, end-stage renal disease (ESRD) is characterized by markedly increased plasma ADPN levels and increased cardiovascular risk. In spite of the cardioprotective properties attributed to adiponectin, cardiovascular complications remain the main cause of mortality in the ESRD population. Furthermore, these patients have enhanced chronic inflammation, increased insulin resistance and persistent protein-energy wasting. Studies of the impact of ADPN on clinical outcomes among ESRD patients have so far yielded contradictory results. This review article summarizes the current knowledge on ADPN functions and explores the role of ADPN in ESRD patients, with specific focus on inflammation, insulin resistance, cardiovascular disease and wasting.

Associations of adiponectin and leptin levels with protein-energy wasting, in end stage renal disease patients.

OBJECTIVE: The aim of the study was to examine the prevalence of protein-energy wasting (PEW) in hemodialysis (HD) and peritoneal dialysis (PD) patients in our center and determine whether adiponectin and leptin are involved in the development of PEW. DESIGN: Prospective (18 months). SETTING: University Hospital of Heraklion, Crete, Greece. SUBJECTS: Seventy-four end-stage-renal-disease patients, 47 on HD and 27 on PD. MAIN OUTCOME MEASURES: At three sequential time points (baseline, 6 and 18 months) anthropometric, nutritional and inflammatory status data were collected. Serum adiponectin and leptin were also assessed at each time point. Patients were allocated to 3 strata according to PEW severity (0, 1-2 and ≥3 criteria for PEW). RESULTS: Adiponectin and leptin levels were greater among PD compared to HD patients (p≤0.035). Adiponectin levels were incrementally greater across increasing strata of PEW (p≤0.002). Leptin showed the opposite trend, with lower levels in malnourished patients and higher levels in patients with zero PEW criteria (p≤0.042). Alterations of adiponectin levels during the observation period were dependent on PEW stratum (p≤0.021) and mode of dialysis (p≤0.002), after adjustment for age, dialysis vintage, gender and fat mass index. Particularly, adiponectin levels increased over time in HD patients with ≥3 criteria for PEW, whereas adiponectin levels decreased in PD patients with ≥3 criteria for PEW throughout the study. Leptin alterations over time were not affected by dialysis mode or PEW stratification. CONCLUSIONS: Our study provides evidence that increased adiponectin and decreased leptin levels are independently associated with PEW and thus, poor prognosis.

A systematic review and meta-analysis of weight status among adolescents in Cyprus: scrutinizing the data for the years 2000-2010.

OBJECTIVE: The aim of the present study was to evaluate by pooled and sensitivity analyses all available data on adolescent overweight/obesity in Cyprus. DESIGN: A thorough literature search determined the studies to be examined using Cypriot adolescent samples aged 10-18 years old, with weight status in each sex classified according to the IOTF criteria, published between the years 2001-2011. Eight studies were retrieved, but three fulfilled the criteria for the sensitivity analyses. RESULTS: The pooled prevalence of obesity was 9.8% in boys (n = 6081). The pooled analysis classified 6.1% (n = 3886) of girls as obese, whereas a higher prevalence was observed by the sensitivity analysis 6.4% (n = 1956, p ≤ 0.001). The boys' prevalence of overweight was 19.3% and the girls' 17.1%. Between sexes, boys demonstrated a higher prevalence of obesity and overweight (p ≤ 0.001 for both). The cumulative analyses demonstrated an increase in the prevalence of overweight/obesity until the year 2005 and thereafter a plateauing in boys and a slight decrease in girls in a non-linear manner. CONCLUSION: Approximately 1/3 of adolescent boys and 1/4 of adolescent girls in Cyprus were overweight/obese during the previous decade.

A longitudinal study of nutritional and inflammatory status in patients on dialysis.

OBJECTIVE: Several anthropometric, laboratory and bioelectrical impedance parameters of nutritional status and inflammation are often used as prognostic indices in patients on dialysis. Their longitudinal assessment is necessary for the estimation of their true prognostic value. We aim to estimate this prognostic value in better-nourished dialysis patients, which are commonly under-represented in pertinent studies. METHODS: The design is a prospective case series. Pertinent parameters were studied three times during a 20-month period in 47 haemodialysis (HD) and 27 peritoneal dialysis (PD) patients with a low malnutrition-inflammation score (MIS). Mortality rate was assessed three years after the initial evaluation. Correlation coefficients were calculated between mortality rate, the studied parameters and their alteration. RESULTS: Serum albumin of less than 40 g/l was strongly correlated with mortality risk. The alteration of studied parameters during a short period of time does not allow for long-term prediction of mortality risk. CONCLUSION: Serum albumin had the strongest predictive value of all the pertinent parameters in the study. Thus, better conjugate clinical and laboratory measurements should be developed for patients on PD, as well as for those with a relatively low MIS.

The role of serum magnesium and calcium on the association between adiponectin levels and all-cause mortality in end-stage renal disease patients.

BACKGROUND: Adiponectin (ADPN) is the most abundant adipocyte-specific cytokine that plays an important role in energy homeostasis by regulating lipid and glucose metabolism. Studies of the impact of ADPN on clinical outcomes have yielded contradictory results so far. Here, we examined the association of ADPN with serum magnesium (s-Mg) and calcium (s-Ca) levels and explored the possibility whether these two factors could modify the relationship between ADPN and all-cause mortality in patients with end-stage renal disease. METHODOLOGY/PRINCIPAL FINDINGS: After baseline assessment, 47 hemodialysis and 27 peritoneal dialysis patients were followed- up for a median period of 50 months. S-Mg and s-Ca levels emerged as positive and negative predictors of ADPN levels, respectively. During the follow-up period 18 deaths occurred. There was a significant 4% increased risk for all-cause mortality for each 1-µg/ml increment of ADPN (crude HR, 1.04; 95% CI, 1.01-1.07), even after adjustment for s-Mg and s-Ca levels, dialysis mode, age, albumin and C-reactive protein. Cox analysis stratified by s-Mg levels (below and above the median value of 2.45 mg/dl) and s-Ca levels (below and above the median value of 9.3 mg/dl), revealed ADPN as an independent predictor of total mortality only in the low s-Mg and high s-Ca groups. Furthermore, low s-Mg and high s-Ca levels were independently associated with malnutrition, inflammation, arterial stiffening and risk of death. CONCLUSIONS/SIGNIFICANCE: The predictive value of ADPN in all-cause mortality in end-stage renal disease patients appears to be critically dependent on s-Mg and s-Ca levels. Conversely, s-Mg and s-Ca may impact on clinical outcomes by directly modifying the ADPN's bioactivity.