Development and reliability of questionnaires for the assessment of diet and physical activity behaviors in a multi-country sample in Europe the Feel4Diabetes Study.

BACKGROUND: Assessment of diet and physical activity and their determinants still remains a demanding task, especially when the objective is to evaluate the efficacy of lifestyle interventions. In the context of the Feel4Diabetes study (a European community based intervention study in families with school aged children and at high risk of developing diabetes), we aimed to develop questionnaires for the assessment of food-frequency and eating behaviors, and physical activity and sedentary behaviors in both parents and school-aged children and a questionnaire for overall family's energy balance-related behaviors. METHODS: Questionnaires were developed to be used in 6 countries under standardized harmonization procedures and included questions regarding not only food intake and physical activity, but also questions of their determinants. A reliability study was conducted in 191 pairs of parents and their children (N = 191). Parents completed the questionnaires on two occasions, within a 1-2 week interval. Reliability was tested by the intra-class correlation coefficients (ICC) of test-retest. RESULTS: Most of the questions in all questionnaires had excellent reliability, assessed as an ICC of > 0.810. Mean ICCs for food-frequency and eating behaviors questionnaires were 0.838 and 0.787, and for physical activity and sedentary behaviors questionnaires were 0.734 and 0.793, in adults and children respectively. Mean ICC for overall family's energy balance-related behaviors and their determinants was 0.659. CONCLUSION: The developed questionnaires showed acceptable reliability and may be valuable tools in the assessment of children's and parents' behaviors related to diet, physical activity, sedentary behavior and overall energy balance in school- and community-based interventions.

Lifestyle intervention in the management of metabolic syndrome: could we improve adherence issues?

Current guidelines for the treatment of the metabolic syndrome (MetSyn) propose lifestyle changes (diet and physical activity) as a first-line intervention. However, few studies have been conducted thus far in this field. Weight loss has been recognized as an important issue in the management of MetSyn, in addition to exercise training. Moreover, improvement in MetSyn parameters was sustained only when changes in lifestyle were maintained, rendering maintenance as an important treatment issue. Multiple follow-up booster sessions proved more effective in maintaining lifestyle changes than one counseling session at the end of follow-up. Several behavioral techniques have also been used to improve patients' adherence. Although most of these were found effective in achieving short-term adherence to the dietary regimen (and exercise treatment), the evidence is limited regarding specific strategies that are most helpful, in the context of a structured, tailored MetSyn intervention, for the long-term maintenance of lifestyle changes.

Validation of the Greek Version of the Diabetes Management Self-Efficacy Scale (GR-DMSES).

INTRODUCTION: Self-efficacy has been found to have a direct relation with self-care in diabetes. Several tools have been developed and used for evaluating self-efficacy of diabetic patients, the most widely used being the Diabetes Management Self-Efficacy Scale (DMSES). The aim of the present study was to translate, culturally adapt, and validate the Greek DMSES (GR-DMSES) in order for it to be used in the ATTICA pilot study of the SmartCare EU-funded project. METHODS: Using standard procedures, the original version of DMSES was translated and culturally adapted into Greek. Content validity was assessed by an expert panel with the calculation of a content validity index of the overall scale. Α convenient sample was recruited to complete the questionnaire. Psychometric testing of the produced instrument included internal consistency test (Cronbach's alpha), construct validity (factor analysis), and stability (intraclass correlation coefficient). RESULTS: One hundred and sixteen patients, aged 36-86 years, with type 2 diabetes (T2D) participated in the study. There were no items excluded from the original scale after the content validity procedure. The coefficient Cronbach's alpha for the internal consistency was 0.93 and the intraclass correlation coefficient for the stability with a 5-week time interval was 0.87 (P < 0.001). Factor analysis yielded four factors related to diet, medical therapy, medication and feet check, and physical activity. CONCLUSION: The findings supported that the GR-DMSES was reliable and valid in measuring self-efficacy related to diabetes self-management, thus providing a quick and easy-to-use tool for health professionals dealing with Greek adults with T2D.

Weight loss maintenance in relation to locus of control: The MedWeight study.

Locus of control, i.e. the degree of an individual's belief on the control of his/her life, has been related to many health outcomes, including weight loss in overweight/obese individuals. No information is available on the impact of locus of control in maintaining weight loss. We aimed to investigate the effect of locus of control in weight loss maintenance and explore potential associations with lifestyle factors. Study participants included 239 individuals (41% males) who had lost at least 10% of body weight in the past and either maintained the loss (maintainers: weight maintenance of at least 10% of initial weight) or regained it (regainers). Locus of control was defined by a relevant multi-dimensional scale; participants were categorised to internals and externals, based on "internal" and "others" sub-scales. A significant interaction was found between locus of control and weight loss maintenance status (p < 0.001), with internals being more likely to be maintainers. Regainers had a more external orientation, compared to maintainers. Weight loss methods differ between groups, with internals reporting loosing weight by themselves more frequently, while externals reporting loosing weight mainly with the aid of an expert. Weight cycling of 2-3 kg in a typical year was reported more frequently in internals. Total and vigorous physical activity, as well as total hobbies score were associated with an internal profile, while sedentary activities with an external profile. No differences were found in dietary intake between internals and externals. Our results suggest that weight loss maintenance is associated with an internal locus of control. Individualised treatment, according to locus of control, may increase weight loss maintenance rates in former overweight/obese individuals.

Telephone counseling intervention improves dietary habits and metabolic parameters of patients with the metabolic syndrome: a randomized controlled trial.

BACKGROUND: Patients with the metabolic syndrome (MetS) can suffer from poor metabolic parameters through lack of adherence to requisite lifestyle changes in dietary and physical activity. Usually, interventions in MetS patients are infrequent face-to-face consultations. The low frequency or absence of counseling interviews leads to a shortage of information and motivation to adhere to the recommended lifestyle changes. Telephone interventions could be an additional low-cost tool for effective interventions. AIM: To evaluate the effectiveness of telephone intervention in improving lifestyle habits and metabolic parameters in MetS patients compared with similar face-to-face or a usual care interventions. METHODS: Eighty-seven MetS patients recruited from the outpatient clinic of a major public hospital were randomly assigned to one of the three intervention groups: "usual care", "telephone" or "face-to-face". At the beginning of the study, all patients were provided with a hypocaloric Mediterranean-type diet. Afterwards, patients in the telephone group received 7 dietary counseling calls, patients in the face-to-face group participated in 7 one-to-one dietary counseling sessions, while patients in the usual care group received no other contact until the end of the study, 6 months later. All patients underwent full medical and nutritional evaluation at the beginning and at the end of the intervention. RESULTS: At the end of the intervention, 42% of the participants no longer showed symptoms of MetS; the reduction rates differed significantly between the groups (p = 0.024), with those in the face-to-face and telephone group exhibiting similar rates (52% and 54%, respectively, vs. 21% in the usual care group). Between-group analysis revealed that the face-to-face group achieved the greatest improvement in metabolic parameters, while the telephone group had the greatest improvement in dietary adherence compared with the usual care group. CONCLUSIONS: Telephone counseling is an effective way to implement behavioral counseling to improve lifestyle habits in MetS patients.

Promoting only the consumption of healthy foods may be an alternative stategy for treating patients with the metabolic syndrome.

OBJECTIVE: To evaluate the effectiveness of two lifestyle, interventional approaches on metabolic abnormalities and eating habits of patients with metabolic syndrome. MATERIALS/METHODS: This is a randomized controlled trial, involving a 6-month lifestyle intervention. Eighty-eight metabolic syndrome patients were randomized to one of the three groups: (i) "Increase - Decrease" group, (ii) "Increase" group, and (iii) "Minimum intervention" group. All patients received dietary and physical activity advice at baseline; patients in the first two groups also participated in individual counseling sessions. In the "Increase - Decrease" group, all recommended dietary and physical activity goals were targeted, whereas in the "Increase" group, only goals proposing an increase in dietary intake or physical activity were included. Patients received nutrition counseling through seven, one-to-one sessions, conducted every two weeks for the first 2 months, every month for the following 4 months. All participants underwent a full medical and nutritional assessment at baseline and at the end of the intervention. RESULTS: At 6 months, BMI and waist circumference were improved in the "Increase" and the "Increase - Decrease" groups, compared to the "Minimum Intervention" group. Additionally, "Increase - Decrease" group reduced blood systolic (p=0.017), diastolic pressure (p=0.005) and glucose concentrations (p=0.015). Forty eight percent, 32%, and 19% of the patients in the "Increase - Decrease", "Increase" and "Minimum Intervention" groups, respectively, ceased to fulfill the criteria for the metabolic syndrome (p=0.031). CONCLUSIONS: Promoting only the increase of the intake of healthy foods did not result in better outcome values compared to a conventional all-food approach.

Eating habits in relations to anxiety symptoms among apparently healthy adults. A pattern analysis from the ATTICA Study.

The effect of anxiety on dietary intake of humans has been investigated through a number of laboratory, clinical and cross-sectional studies; no prior study, however, has examined potential associations between anxiety and overall dietary patterns. Aim of the present work was to describe dietary patterns in relation to anxiety trait in a nationally representative sample of Greek adults from the ATTICA Study. A sample of 453 men and 400 women were randomly selected from various areas of Attica region, Greece. Anxiety levels were assessed through Spielberger State-Trait Anxiety Inventory. Dietary habits, socio-demographic and lifestyle characteristics were recorded for all participants. Principal component analysis was used for the extraction of dietary patterns. More anxious, compared to less anxious, men and women exhibited different dietary patterns. In particular, the "light" dietary patterns that were emerged in the less anxious men and women did not appear as distinct patterns among men and women in the upper anxiety tertile. In women, a "Western-type" diet explained two times greater variance of food intake of those in the upper-anxiety tertile, compared to their counterparts in the low tertile. A vegetarian pattern was found only among the less anxious women, who also exhibited the lowest consumption of red meat and sweets. Regression analysis supported and further elucidated previous results: after adjusting for potential confounders, sweets intake, as well as meat and products intake, were positively associated with anxiety score in females; in males a negative association was found with legumes/cereals intake. From a public health point of view, given the increased prevalence of anxiety and other mental disorders, these findings should be taken into account when designing and evaluating interventions for the general population.

Dietary factors associated with plasma high molecular weight and total adiponectin levels in apparently healthy women.

OBJECTIVE: Our aim was to investigate associations between dietary factors and high molecular weight (HMW) as well as total adiponectin in a sample of apparently healthy adult Mediterranean women. DESIGN AND METHODS: Two hundred and twenty women were enrolled in this study. Anthropometric and body composition measurements were performed in all subjects. Fasting blood samples were taken; HMW and total adiponectin concentrations were measured. Food intake was evaluated using 3-day food records. The frequency of consumption of several food groups was approximately quantified in terms of number of servings per day. Furthermore, dietary intakes of betaine, choline, and free choline were estimated. RESULTS: Women in the highest HMW adiponectin tertile had higher fruit intake compared with those with lower levels, after adjusting for potential confounders (P=0.04). On the contrary, dietary betaine and choline intakes were not different among HMW adiponectin tertiles. In linear models, fruit consumption, controlling for biological and lifestyle variables, was significantly related to HMW adiponectin (partial r=0.15, P=0.04), but the association with total adiponectin did not reach statistical significance (partial r=0.11, P=0.12). A significant negative correlation between total adiponectin and refined cereals was also observed (partial r=-0.16, P=0.03). DISCUSSION: This is the first study that evaluates associations between dietary factors and HMW adiponectin levels. The associations found are moderate and indicate that, after multivariate adjustment, fruit consumption is related to HMW adiponectin in both linear and nonlinear models.