Adherence to the Mediterranean Diet and Successful aging in Greeks living in Greece and abroad: the epidemiological Mediterranean Islands Study (MEDIS).

Background: Whether older immigrant populations from the Mediterranean region, continue to follow the MD long after they immigrated is not known. Aim: Compare adherence to the MD and successful aging levels between Greeks living in Greece (GG) and Greeks living abroad (GA). Methods: Anthropometrical, clinical, psychological, sociodemographic, dietary and lifestyle parameters were assessed in a cross-sectional manner in a sample of 252 GG and 252 GA. Mediterranean Diet Score (MedDietScore range 0-55) was used to assess adherence to the MD. Successful aging was evaluated with the validated successful aging index (SAI range 0-10). Results: GA presented higher adherence to MD (p < 0.001); they were consuming significantly more cereals, legumes, vegetables, and fruits compared to GG. GG consumed significantly more dairy (3.8 ± 2.9 vs. 1.9 ± 2.2, p < 0.001) and potatoes (2.4 ± 1.6 vs. 1.9 ± 1.5, p < 0.001) compared to GA. Meat (p = 0.27), poultry (p = 0.72), fish (p = 0.68), olive oil (p = 0.16) and alcohol consumption (p = 0.05) were comparable between the two groups (all p's > 0.05). MedDietScore was positively associated with SAI among both groups after adjusting for possible confounders (0.041 ± 0.014, p = 0.003 GG and 0.153 ± 0.035, p < 0.001 GA). Also, legumes, cereals, fruits and vegetables were found to be beneficial for successful aging. Conclusion: Adherence to the MD is associated with higher levels of successful aging among people of the same genetic background living in different environments. However, traditional dietary habits are gradually abandoned in their native countries, when, at the same time, are considered cultural heritage and preserved accordingly among immigrants.

The Association of Dietary Habits and Lifestyle Characteristics with Successful Aging among Older Greek Origin Individuals Living in France, Canada, and Greece: The Epidemiological Mediterranean Islands Study (MEDIS).

The aim of the present work was to investigate the association of dietary habits and lifestyle characteristics with successful aging among native Greeks and Greeks of Diaspora (Canada and France). During 2005-2019, 2,434 Greek men and women, living in Greece, in France, and in Canada, over 65 years of age were enrolled voluntarily in the study. Anthropometric, clinical and socio-demographic characteristics, dietary habits, and lifestyle parameters were derived through standard procedures, while successful aging was evaluated using the validated Successful Aging Index (SAI, range 0-10). The SAI of the overall sample was 2.8 ± 1.4. Greeks of Diaspora had higher SAI levels compared to their counterparts in Greece (p's < .001). However, there was no difference between Greeks of Canada and these of France (p > .05). Actually, Greeks of Diaspora had almost 1.9 units higher SAI compared to native Greeks (p < .001). Work and financial status, dietary and lifestyle behaviors (i.e., physical activity, smoking habits), and several clinical characteristics (i.e., history of hypertension and hypercholesterolemia) were statistically different between the three groups (all p's < .05). Greeks of Diaspora had higher SAI levels, probably because of their healthier lifestyle practices, which mainly depend on their traditions and cultural background of their homelands and living conditions in the host countries.

Waist-to-Height Ratio Outperforms Classic Anthropometric Indices in Predicting Successful Aging in Older Adults; an Analysis of the ATTICA and MEDIS Epidemiological Studies.

Background/Study context: The aim of the present work was to investigate the association of Waist-to-Height Ratio (WHtR) with Successful Aging (SA) status and compare it to classic anthropometric indices, among middle-aged and older individuals.Methods: Among various socio-demographic, clinical and lifestyle characteristics, height, weight, waist circumference (WC), Waist-to-Hip Ratio (WHR) and WHtR of the Greek participants, over 50 years old, enrolled in the ATTICA (n = 1,128) and the MEDIS (n = 2,221) in relation to SA; SA was evaluated using the validated Successful Aging Index (SAI, range 0-10) comprising of health-related, social, lifestyle, and clinical parameters.Results: WHtR was inversely associated with SAI with every 0.1-unit increase, lowering SAI by almost 0.5 units (b-coefficient±SE: -4.71 ± 0.26; 95%CI: -5.21, -4.20). Also, WHtR was more strongly associated with SAI (b = -0.352), surpassing the effect of age and sex (b = -0.347 and 0.11, respectively). With respect to the other anthropometric indices (weight, height, WC, WHR), WHtR exhibited the highest explanatory ability (Adjusted R2 = 0.345); the higher the adjusted R2 the higher explanatory ability.Conclusions: WHtR was revealed as the best determinant of successful aging, with respect to other anthropometric indices (weight, height, WC, WHR). The present findings are of significant public health importance for better understanding the role of body mass distribution on the aging process.

The Association between Green and Black Tea Consumption on Successful Aging: A Combined Analysis of the ATTICA and MEDiterranean ISlands (MEDIS) Epidemiological Studies.

Tea is one of the most-widely consumed beverages in the world with a number of different beneficial health effects, mainly ascribed to the polyphenolic content of the tea catechins. The aim of this study was to examine the consumption of green, black, or no tea, in relation to the previously validated successful ageing index (SAI; higher values "healthier" ageing) in a combined analysis of adults aged >50 years old from the ATTICA (n = 1128 adults from Athens, Greece metropolitan area) and the MEDiterranean Islands Study (MEDIS) (n = 2221 adults from various Greek island and Mani) studies. After adjusting for age, sex, smoking, and coffee consumption, green tea was positively associated with SAI (b ± SE: 0.225 ± 0.055, p < 0.001), while black tea was negatively associated with SAI (unstandardized b coefficient ± Standard error: -0.807 ± 0.054, p < 0.001). Green tea (vs black tea) consumption, had higher odds of a SAI of over 3.58 out of 10 (OR: 1.77, 95% CI: 1.38-2.28). Green tea consumption was also associated with higher levels of physical activity (p < 0.001) and reduced likelihood of hypertension (p = 0.006) compared with black tea. Two possible mechanisms are that green tea possesses high levels of catechins such as (-)-epigallocatechin 3-gallate and l-theanine compared with black tea. Therefore, the present analysis supports both the role of green tea constituents in successful ageing, as well as its role as an important component of an overall healthy diet in adults aged 50 years and over from these two epidemiological studies.

Anti-Inflammatory Nutrition and Successful Ageing in Elderly Individuals: The Multinational MEDIS Study.

BACKGROUND: The role of diet and inflammation in successful ageing is not transparent, and as such, is still being investigated. The aim of the present work was to evaluate the inflammatory potential of dietary habits in the successful ageing of a random sample of older adults living in the Mediterranean basin and who participated in the MEDIS (MEDiterranean ISlands) study. METHODS: During 2005-2016, 3,128 older adults (aged 65-100 years) from 24 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were enrolled in the study. A multidimensional successful ageing index consisting of 10 components was employed. A validated and reproducible Food Frequency Questionnaire (FFQ) was used to evaluate the dietary habits of the older adults. A nutrition anti-inflammatory (NAI) score based on the participants' specific dietary habits was assessed. RESULTS: Participants with high NAI scores (proinflammatory nutrition) had a higher prevalence of hypercholesterolemia and lower levels of successful ageing. After adjusting for several confounders, the NAI score was associated with successful ageing (-0.03, 95% CI -0.5 to -0.006). Stratified analysis by gender and advanced age revealed heterogeneity in the NAI score, predicting successful ageing. CONCLUSIONS: The inflammatory potential of nutrition was reported as an important factor for successful ageing, suggesting that further research is needed on the role of anti- and proinflammatory dietary habits in healthy and successful ageing.

Depressive symptoms in postmenopausal women: results from the MEDIS Study.

Data regarding the factors associated with depressive symptoms are limited, especially in postmenopausal women. The aim of this study was to investigate to what extent depressive symptoms were present in postmenopausal women, to explore characteristics associated with depressive symptoms and to determine if time since menopause was independently associated with depressive symptoms. Data collected within the Mediterranean Islands (MEDIS) Study, a health and nutrition survey of elderly people living on Mediterranean islands was used. A total of 851 postmenopausal women living in various Greek islands, Cyprus, and Malta participated in the study. Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Age-adjusted logistic regression analysis showed that a year's increase in the time since menopause increased the likelihood of postmenopausal women having severe depressive symptoms by 3% (odds ratio [OR] per 1 year = 1.03, 95% CI 1.001-1.05). This positive association was also evident when other potential confounding factors (i.e, living conditions, financial status, physical activity, adherence to the Mediterranean diet, smoking habits, and several clinical conditions) were also taken into account in multivariable analyses. Primary health care practitioners and public health care authorities could use the findings of this study to identify depressive symptoms early in postmenopausal women.

The role of number of meals, coffee intake, salt and type of cookware on colorectal cancer development in the context of the Mediterranean diet.

OBJECTIVE: To investigate the association between dietary behaviours and colorectal cancer (CRC) in the context of the Mediterranean diet. DESIGN: Case-control study. SETTING: All patients (cases) were recruited from Saint Savvas Cancer Hospital and Alexandra General Hospital in Athens, Greece. Controls were voluntarily selected from the general population and matched to cases by age group (±10 years) and sex. SUBJECTS: Two hundred and fifty cases with newly diagnosed CRC (mean age 63 (sd 12) years, 59·6 % males) and 250 controls matched on age and sex were studied. A standardized questionnaire assessing sociodemographic, clinical, lifestyle, dietary characteristics and nutritional behaviours was applied. Multiple logistic regression analysis was used to evaluate the aforementioned factors in addition to the MedDietScore (an index that evaluates adherence to the Mediterranean diet) on CRC development. RESULTS: The higher the daily number of meals, the lower the likelihood of having CRC (OR = 0·74, 95 % CI 0·61, 0·89); coffee drinking was associated with higher likelihood of having CRC (OR = 3·27, 95 % CI 1·09, 9·8); the use of non-stick cookware was positively associated with CRC (OR = 1·57, 95 % CI 1·02, 2·4). However, these associations slightly lost their significance when adherence to the Mediterranean diet was taken into account. Moreover, a 1/75 increase in the modified-MedDietScore plus the aforementioned nutritional behaviours was associated with 13 % lower odds (95 % CI 0·83, 0·91, P < 0·001) of having CRC. CONCLUSIONS: Nutritional behaviours in addition to dietary habits should be taken into account in detecting individuals prone to the development of CRC.

The mediating effect of Mediterranean diet on the relation between smoking and colorectal cancer: a case-control study.

BACKGROUND: The protective role of Mediterranean diet (MD) and the detrimental effect of smoking on colorectal cancer (CRC) have already been shown. The aim of this work was to evaluate the potential mediating effect of MD on the association between the aforementioned factor (smoking) and CRC. METHODS: It is a case-control study. Two hundred fifty consecutive patients with CRC (63 ± 12 years, 59% males) and 250 age-sex group-matched controls, both from the area of Attica, were studied. Various socio-demographic, clinical, lifestyle (including detailed smoking habits) and dietary characteristics were measured. Adherence to the MD was evaluated using the MedDietScore (theoretical range 0-55). RESULTS: Each unit increase in the MedDietScore was associated with 13% lower likelihood of CRC (P < 0.001). Smoking habits were associated with 2.9-fold the likelihood of CRC among participants who were away from the MD (i.e. MedDietScore < 29) and with 2.1-fold the likelihood of CRC among those who were close to the MD (P < 0.05). CONCLUSIONS: Adherence to the MD was associated with a less detrimental association of smoking habits with CRC, suggesting indirect benefits of adherence to this dietary pattern with regards to CRC morbidity and mortality.

Are current dietary habits in Mediterranean islands a reflection of the past? Results from the MEDIS study.

In the 1960s, the recorded dietary pattern of Southern European populations was typical of the traditional Mediterranean diet. However, diets have been rapidly changing. The aim of the current work was to examine the extent by which present food habits of inhabitants residing in various Mediterranean islands uphold past dietary traditions of the Mediterranean diet. A population-based, multi-stage sampling method was used to voluntarily enroll 876 men and 936 women (aged > 65 years) from 12 Mediterranean islands. Demographic, behavioral, clinical, and dietary data were collected. Principal component analysis derived fruits, vegetables, and greens as part of the main dietary pattern across most Mediterranean regions. Surprisingly, Crete had the highest frequency of fast-food and sweets consumption. Malta had the lowest frequency of fish and vegetable consumption and the lowest MedDietScore. As Mediterranean populations gradually move away from traditional dietary patterns, public-health efforts to preserve these diets are needed.

Alcohol consumption and colorectal cancer in a Mediterranean population: a case-control study.

BACKGROUND: Alcohol is considered to be a cocarcinogen or a tumor promoter, and various studies have shown a linear dose-dependent association between alcohol consumption and colorectal cancer. However, a few studies suggest that moderate alcohol consumption may have a protective effect, similar to that in cardiovascular disease. OBJECTIVE: The aim of this study was to evaluate the relationship of colorectal cancer to quantity and type of alcohol consumed. DESIGN: This was case-control study. SETTINGS: The study was conducted in the area of Attica, Greece. PARTICIPANTS: A total of 250 consecutive patients with a first diagnosis of colorectal cancer were matched for age group and sex with 250 controls recruited from the community. The mean age was 63 (SD, 12) years for the patient group (147 men, 59%; 103 women, 41%) and 55 (SD, 13) years for the control group (112 men; 44.8%; 138 women, 55.2%). MAIN OUTCOME MEASURES: Questionnaires were administered by trained interviewers to assess sociodemographic, clinical, and lifestyle characteristics, in addition to dietary habits and quantity and type of alcoholic beverages usually consumed during the preceding year. Adherence to the Mediterranean diet was evaluated with the MedDietScore (theoretical range, 0-55). RESULTS: With intake of less than 12 g of alcohol per day as the reference, moderate alcohol intake (12-35 g/day) was associated with a significantly decreased likelihood of colorectal cancer in men (OR, 0.35; 95% CI, 0.16-0.74) and in women (OR, 0.40; 95% CI, 0.18-0.91). High alcohol intake (more than 48 g/day) was associated with an increased likelihood, which was significant in men (OR, 3.45; 95% CI, 1.35-8.83) but not in women (OR, 3.40; 95% CI, 0.50-22.92). Drinking red wine was associated with reduced odds of colorectal cancer, significant in men (OR, 0.47; 95% CI, 0.23-0.96) but not in women (OR, 0.54; 95% CI, 0.23-1.30). None of the associations between other beverage types and colorectal cancer were significant. Adherence to the Mediterranean diet was independently associated with lower odds of colorectal cancer overall (p < 0.001), in men (OR, 0.90; 95% CI, 0.83-0.97), and in women (OR, 0.87; 95% CI, 0.80-0.94). LIMITATIONS: The major limitations of this study included the inability of a case-control design to determine causation and the potential for recall bias. CONCLUSIONS: The association between quantity of alcohol consumed and the presence of colorectal cancer followed a J-shaped curve. While demonstrating the detrimental effect of consuming large amounts of alcohol, the results of this study suggest that moderate alcohol consumption exerts a protective effect on colorectal cancer in both men and women, possibly related to the effects of red wine.

A classification and regression tree analysis for the evaluation of the role of nutritional services on cardiovascular disease risk status of older people living in Greek islands and Cyprus.

INTRODUCTION: The purpose of this study was to evaluate, with classification-regression tree analysis, the structure of the associations between nutritional and health care services and the cumulative prevalence of the classical cardiovascular disease (CVD) risk factors of older individuals living in Greek islands and Cyprus. METHODS: During 2005-2009, 744 men and 742 women (>65 years) from nine Greek islands and Cyprus Republic were voluntarily enrolled in the Mediterranean Islands study; various socio-demographic, clinical and lifestyle characteristics were recorded. Moreover, information regarding practising dieticians (n = 88) and nutritional services provided in these islands was also recorded. RESULTS: Both medical and nutrition services act more effectively to elders' cardiovascular health. For example, older individuals living in areas with nutritional services' support for at least five years, with collaboration between dieticians and physicians, reduced the CVD risk factors (CVD RF) burden by 42%. Whereas, in areas with dietetic support less than five years, but more than two, the presence of advanced health care system seemed to control the CVD RF burden to the population average. CONCLUSIONS: Despite the fact that the present work shares some limitations mainly because of its cross-sectional design, the classification and regression tree approach has clearly demonstrated the interrelation between nutritional services and the health care system towards achieving benefits among the elders' quality of life.

Risk and predictive factors of hypoalbuminemia in cancer patients following extensive abdominal surgery despite total parenteral nutritional support.

Postoperative hypoalbuminemia is associated with adverse outcomes, particularly in cancer patients. The risk and predictors of hypoalbuminemia in cancer patients following extensive abdominal surgery (EAS), despite total parenteral nutrition (TPN) support, were evaluated. A prospective cohort study (n = 115) was conducted in patients with gastrointestinal and/or urogenital malignancies following extensive (n = 81) or moderate (n = 34) abdominal surgery (mean age ± standard deviation: 66.0 ± 11.7 years). EAS patients received daily TPN, including 200 mL of 5% human albumin solution. Serum albumin (SA) levels and hypoalbuminemia (SA < 3.5 g/dL) were assessed daily. EAS patients had an elevated risk of hypoalbuminemia during the first postoperative week [relative risk (RR): 3.12; 95% confidence interval (95% CI): 1.64-5.91]. Postoperative hypoalbuminemia was associated with surgery duration (RR: 1.76; 95% CI: 1.32-2.36), preoperative SA (RR: 0.24; 95% CI: 0.11-0.55), blood (RR: 1.46; 95% CI: 1.04-2.04) and Ringer's lactated solution (RR: 1.52; 95% CI: 1.12-2.07) volumes transfused intra-operatively. Therefore, despite TPN, cancer patients who underwent EAS had an elevated risk of postoperative hypoalbuminemia. Additional tailored nutritional support among this group is necessary to deter adverse clinical outcomes.

Postoperative hypoproteinemia in cancer patients following extensive abdominal surgery despite parenteral nutritional support.

Determination of the predictors of hypoproteinemia among cancer patients following extensive surgery may enhance their nutritional management and clinical outcome. This study evaluated the predictive factors of postoperative hypoproteinemia among cancer patients following extensive abdominal surgery. An age- and gender-matched case-control study (n = 115) was conducted among cancer patients undergoing extensive (cases; n = 81) and moderate (controls; n = 34) abdominal surgery. Case patients received total parenteral nutrition (TPN), including 3 units of fresh frozen plasma and 200 mL 5% human albumin solution, for 8 postoperative days (POD). Case patients had lower mean total serum protein (TSP) levels throughout POD 8 (F value = 13.81; P = 0.001). Despite TPN, cases had greatest mean (±SD) TSP percent change on POD 1 (-24.6% ± 13.0, vs. -12.6% ± 9.2; P < 0.0001) and did not regain preoperative levels (POD 8: -14.3% ± 12.5 vs. 6.9% ± 13.4; P = 0.006). The likelihood of hypoproteinemia in this group was greatest on POD 3 (OR = 30.57; 95% CI 5.44-171.83). Multivariate regression analyses indicated that the determinants of postoperative hypoproteinemia were age [Adjusted OR (AOR) = 1.04; 95% CI 1.00-1.08), preoperative TSP (AOR = 0.46; 95% CI 0.23-0.92), and extensive surgery (AOR = 2.65; 95% CI 1.01-6.95). Tailored nutritional support, regarding extent of surgery, preoperative TSP, and patient age are needed to deter the occurrence of postoperative hypoproteinemia and consequent adverse surgical outcome among cancer patients.

Validity of dietary patterns derived in nutrition surveys using a priori and a posteriori multivariate statistical methods.

AIM: To evaluate the validity of dietary patterns derived using both a priori and a posteriori methods. METHOD: Five hundred individuals (46 ± 16 years, 40% males) completed a valid 76-food item food frequency questionnaire and a 3-day dairy. The MedDietScore was used to a priori assess the adherence to the Mediterranean diet, while principal components and cluster analysis were used as the a posteriori methods. RESULTS: Both the a priori and a posteriori methods used led to relatively low-validity dietary patterns. However, the level of validity reached significance in many cases and, also, varied by the type of validation method used (i.e. Bland and Altman, non-parametric criteria, etc.). CONCLUSION: The aforementioned findings may suggest that the use of both a priori and a posteriori pattern analysis in nutrition surveys should be made with conscious thought and further research is needed in order to establish robust methodologies to assess the validity of patterns.

The implications of nutrition services within the health care system on the quality of life and longevity, in developed countries: a re-analysis of 38 studies.

BACKGROUND: The United Nations' Global Population Pyramid is undertaking a shift from pyramid to cube. The concomitant decline in fertility and mortality rates produces a higher portion of older people, and, thus, an increased number of deaths due to cancer and cardiovascular disease (CVD). Limited studies have investigated the effect of health care services on longevity. In this work, findings from studies throughout the world are presented and re-analysed in order to evaluate the effect of health care services on population's health status. METHODS: Studies that have assessed the associations of nutritional and other health care services (i.e., physicians supply, technical support, inter-collaboration) on longevity and health status were retrieved (searches in PubMed, EMBASE, Scopus, up to January 2010), and summarized here. RESULTS: Few studies, mostly located in the US and the UK, have evaluated the role of health care services on population's health status. The majority of the studies reported a beneficial association between the frequency of physicians and mortality, while some other studies reported weak or no associations between physician's supply and longevity. Also nutritional services (screening) seem to promote better clinical outcome. CONCLUSION: Although very few data are available, it seems that there is a positive correlation between the quality and quantity of health care services and longevity. Strong primary health care seems to be effective on the population's health outcome. Active health policy and enhancement of health and nutritional services within the health care system may contribute to improved population's health and their overall quality of life.

Successful aging and lifestyle comparison of Greeks living in Greece and abroad: the epidemiological Mediterranean Islands Study (MEDIS).

OBJECTIVES: Comparing lifestyle and successful aging between Greeks living in Greece (GG) and Greeks living abroad (GA) using a multidimensional model of successful aging including both biomedical and non-medical components. METHODS: Anthropometric, clinical, psychological, socio-demographic, dietary and lifestyle parameters were assessed in a random sample of 252 GG and 252 GA. Successful aging was evaluated using the validated successful aging index (SAI range 0-10). RESULTS: GA had better financial and educational status and scored higher in all social activity parameters (p's < 0.05). GA were more likely to be physically active (p < 0.001), had higher adherence to the Mediterranean diet (p < 0.001) and were less likely to be smoking (p = 0.008). Depression was more evident among GG compared to GA (p < 0.001). GA was aging significantly more successfully than GG (p < 0.001). Men irrespective of location were aging significantly more successfully than women (p < 0.05). CONCLUSION: Place of residence and personal choices significantly affect the level of healthy aging among people with similar genetic backgrounds.

Influence of Omega-3 Fatty Acid-Rich Fish Oils on Hyperlipidemia: Effect of Eel, Sardine, Trout, and Cod Oils on Hyperlipidemic Mice.

Dyslipidemia is one of the most important cardiovascular disease (CVD) risk factors. Polyunsaturated fatty acids (FAs), and especially omega-3 FAs, could significantly contribute to the management of dyslipidemia and the prevention of CVD. The anti-hyperlipidemic effect of selected fish oils (eel, sardine, trout, cod liver) was comparatively evaluated in a high fat diet (HFD)-fed mouse model. At the end of 30 days on the HFD, all animals were hyperlipidemic and were switched to a diet consisting of 90% standard rodent chow plus 10% of oil from eel, sardine, cod liver, or trout. At the end of 60 days on these diets, blood glucose, total blood cholesterol, triglycerides (TGs), and high density lipoprotein (HDL) were quantitated. All diets, except sardine and standard rodent chow, showed statistically significant decreases in blood glucose from day 30 to 90. Total blood cholesterol decreased in all diets except the HFD group, which was continued on this diet until the end of the study. Eel and cod liver oil diets showed significant decreases in TGs. All dietary groups showed a decrease in HDL, but only the trout and standard chow groups exhibited statistically significant decreases. The fish oils tested here for effects on hyperlipidemia vary in per cent of omega-3 FAs and omega-6/-3 FA ratios as determined by gas chromatography Overall, smoked eel was the best source of omega-3 FA, with a balance of omega-6 FA, that ameliorated HFD-induced mixed hyperlipidemia.

Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study.

OBJECTIVE: To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet. DESIGN: Cross-sectional. SETTING: Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status. SUBJECTS: During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey. RESULTS: Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P < 0.01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0.004), as well as financial status (P = 0.001). CONCLUSIONS: Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

Dietary meat fats and burden of cardiovascular disease risk factors, in the elderly: a report from the MEDIS study.

Dietary fats have long been associated with human health, and especially cardiovascular disease (CVD). Some observational studies have shown that reduction in dietary fats, and particularly cholesterol is associated with lower cardiovascular risk; however, other prospective studies or randomized controlled trials of dietary fat reduction or modification have shown varying results on CVD morbidity and mortality. In this work we evaluated the relationships between dietary fats and a cluster of CVD risk factors (i.e., diabetes, obesity, hypercholesterolemia, hypertension), among elderly individuals without known CVD. In particular, dietary and clinical data from 1486 elderly (aged 65 to 100 years) men and women living in Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Syros, Naxos, Corfu and Zakynthos islands, and participated in the MEDIS study, were analysed. Data analysis revealed that 18.5% of males and 33.3% of females had three or four cardiovascular disease risk factors; the major source of fat was olive oil (mean intake for men and women 50.0 +/- 19.3 g/day and 46.0 +/- 16.8 g/day, p < 0.001). In addition it was observed that a 5% increase in energy adjusted fat intake from meat was associated with a 21% increase in the likelihood of having one additional CVD risk factor (95%CI 6%-39%); no significant associations were observed regarding the other types of fat consumed by the elderly participants. These findings may state a hypothesis that the consumption of fat only from meat or its products seems to increase the burden of CVD risk factors among CVD-free, elderly people.

The 'secrets' of the long livers in Mediterranean islands: the MEDIS study.

BACKGROUND: The aim of the present work was to evaluate various socio-demographic, clinical, lifestyle and psychological characteristics of elderly (> 65 years) and very elderly (> 90 years) individuals without known cardiovascular disease. METHODS: During 2005-7, 1190 elderly (aged > 65) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were randomly enrolled. Socio-demographic, clinical, psychological and lifestyle factors were assessed using standard questionnaires and procedures. RESULTS: From all islands, the proportion of males aged 65-80, 80-90 and > 90 years was 71.8, 24.8 and 3.4%, respectively. The proportion of women, for the same age categories, was 80.4, 17.9 and 1.7%, respectively. Walking and other activities significantly declined with age (P < 0.001); however, nearly one in five participants over the age of 90 years remained physically active. Current smoking significantly declined in males as age increased (P < 0.001). All participants above the age of 90 years reported sleeping at noon. The proportion of participants living alone differs significantly (P < 0.001) across the three age groups. However, considerably more women live alone (men vs. women living alone: aged 65-80 years 12 vs. 37%; 80-90 years 16 vs. 55%; > 90 years 52 vs. 55%). Dietary characteristics of The Mediterranean Islands Study (MEDIS) sample display a favourable adherence to dietary recommendations (Mediterranean diet). CONCLUSION: A favourable adherence to the Mediterranean diet, mid-day naps and smoking cessation with an increase in age was characteristic of our elderly population. Future research should further evaluate whether the aforementioned characteristics are associated with longevity beyond the average life expectancy.