The association of animal and plant protein with successful ageing: a combined analysis of MEDIS and ATTICA epidemiological studies.

OBJECTIVE: The aim of the present study was to investigate the differences between the consumption of plant-based v. animal-based protein-rich diets on successful ageing, as well as to identify the optimal combination of dietary protein intake for facilitating successful ageing in people aged >50 years. DESIGN: A combined analysis was conducted in older adults of the ATTICA and MEDIS population-based cross-sectional studies. Anthropometrical, clinical and sociodemographic characteristics, lifestyle parameters, dietary habits and level of protein intake were derived through standard procedures. Successful ageing was evaluated using the validated Successful Aging Index (SAI) composed of ten health-related social, lifestyle and clinical characteristics. SETTING: Athens area and twenty Greek islands. PARTICIPANTS: A total of 3349 Greek women and men over 50 years old. RESULTS: Participants with high consumption of plant proteins were more likely to be male, physically active, with higher daily energy intake, higher adherence to the Mediterranean diet and higher level of SAI (P < 0·001). Participants with 'Low animal & High plant' and 'High animal & High plant' protein consumption had a 6 and 7 % higher SAI score, respectively, compared with the other participants (P < 0·001). In contrast, 'Low animal & Low plant' and 'High animal & Low plant' protein intake was negatively associated with SAI as compared to the combination of all other consumption categories (P < 0·02). CONCLUSIONS: The consumption of a plant-based protein-rich diet seems to be a beneficial nutritional choice that should be promoted and encouraged to older people since it may benefit both individual's health and prolong successful ageing.

Body Weight of Cartoon Characters in Children Series Is Associated to Food Consumption, Attractiveness, and Physical Activity Engagement.

BACKGROUND: Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance. METHOD: One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative. RESULTS: Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves. CONCLUSION: Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight.

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 of protein and carbohydrate intake with successful aging: a combined analysis of two epidemiological studies.

PURPOSE: Previous studies have reported associations between levels of protein and carbohydrate intake with several health outcomes. Yet, their effect on successful (or healthy) aging remains unknown. The purpose of the present work was to investigate the association of protein and carbohydrate intake levels with successful aging. METHODS: A cross-sectional analysis was carried out on the participants of two epidemiological studies; the ATTICA and the MEDIS studies. Anthropometrical, clinical and socio-demographic characteristics, dietary habits, and lifestyle parameters were derived through standard procedures. Successful aging was evaluated using a validated index (SAI) composed of 10 health-related social, lifestyle and clinical characteristics. RESULTS: SAI levels were lower in low protein-high carbohydrate diet group (B = - 0.08, p = 0.04), but higher in high protein-high carbohydrate group (B = 0.06, p = 0.04), as compared to low protein and low carbohydrate diet, in participants living in insular areas. Protein-carbohydrate diet was not associated with SAI (all p's > 0.05) among participants living in urban areas (p for diet-study interaction < 0.001). CONCLUSIONS: A high protein diet seems to be beneficial for older islanders in terms of successful aging; stating a hypothesis for a potential diet-environmental interaction that may be related to the quality of foods consumed and, consequently the sources of nutrients.

Food consumption and related messages in animated comic series addressed to children and adolescents.

OBJECTIVE: To analyse the food content in animated comic series addressed to young audiences both in terms of the kinds of foods presented and the cues accompanying them. DESIGN: One hundred episodes of ten animated cartoon series with high television audience viewing (based on Average Minute Rating %) were reviewed and food items were classified into ten categories. In each episode, food cues (i.e. every mention of food, visual, oral or referring to foods consumed) was noted down and characterized as positive, negative or neutral. The rate of overall consumption and the food categories shown to be consumed were also recorded. SETTING: Greece. RESULTS: In ninety-four episodes one or more food cues were recorded; the total number of cues was 361, of which 209 referred to cues where food was shown or discussed and 152 referred to food items consumed. Out of the positive cues measured, almost half referred to sweets and snacks (sixty-one out of 125). Nevertheless, the majority of cues were of neutral character (n 213). Snacks, sweets and soft drinks were seen to be consumed in more episodes compared with other food categories. Moreover, in episodes where a higher frequency of food consumption was recorded, then consumption of sweets, snacks and soft drinks was significantly higher, with consumption of soft drinks often occurring in conjunction with that of snacks. CONCLUSIONS: Food cues are present in children's series, with an emphasis on sweets and snacks, which are projected in an attractive way, whether depicted, discussed or consumed, between cartoon characters.

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.

Traditional low-alcoholic and non-alcoholic fermented beverages consumed in European countries: a neglected food group.

Fermented beverages hold a long tradition and contribution to the nutrition of many societies and cultures worldwide. Traditional fermentation has been empirically developed in ancient times as a process of raw food preservation and at the same time production of new foods with different sensorial characteristics, such as texture, flavour and aroma, as well as nutritional value. Low-alcoholic fermented beverages (LAFB) and non-alcoholic fermented beverages (NAFB) represent a subgroup of fermented beverages that have received rather little attention by consumers and scientists alike, especially with regard to their types and traditional uses in European societies. A literature review was undertaken and research articles, review papers and textbooks were searched in order to retrieve data regarding the dietary role, nutrient composition, health benefits and other relevant aspects of diverse ethnic LAFB and NAFB consumed by European populations. A variety of traditional LAFB and NAFB consumed in European regions, such as kefir, kvass, kombucha and hardaliye, are presented. Milk-based LAFB and NAFB are also available on the market, often characterised as 'functional' foods on the basis of their probiotic culture content. Future research should focus on elucidating the dietary role and nutritional value of traditional and 'functional' LAFB and NAFB, their potential health benefits and consumption trends in European countries. Such data will allow for LAFB and NAFB to be included in national food composition tables.

Breakfast intake is associated with nutritional status, Mediterranean diet adherence, serum iron and fasting glucose: the CYFamilies study.

OBJECTIVE: To assess the association of breakfast intake with Mediterranean diet adherence, physical activity levels, obesity, selected cardiovascular risk markers and Fe status. DESIGN: Cross-sectional study. BMI, body fat percentage and waist circumference were assessed. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. Blood tests to assess blood lipids, high-sensitivity C-reactive protein, fasting glucose, serum Fe and ferritin, as well as Hb, were performed. SETTING: Primary-school children of the Troodos mountainous area in Cyprus. SUBJECTS: Eighty-three Cypriot children (mean age 9·2 (sd 1·7) years). RESULTS: Compared with breakfast skippers, regular breakfast eaters were 40 % more likely to have a KIDMED score higher by one point on average (OR=1·41; 95 % CI 1·08, 1·84) after accounting for obesity levels and other confounders. Breakfast skippers, on the other hand, were by about 14 % more likely to have a body fat percentage value higher by one unit, as well as higher values for both BMI and waist circumference. The relationship was significantly strengthened when combining body fat percentage and waist circumference into a composite variable (OR=0·20; 95 % CI 0·06, 0·69). Fasting glucose was inversely correlated to breakfast intake in descriptive analyses, whereas serum Fe was positively correlated to breakfast intake after considering age, gender and diet quality. The latter relationship disappeared, however, after considering physical activity levels. CONCLUSIONS: Cypriot children who take breakfast regularly exhibit a higher adherence to the Mediterranean diet and have higher serum Fe concentrations and lower BMI, waist circumference, body fat percentage and fasting glucose levels, compared with children who skip breakfast. Public health professionals, educators and parents should prioritize on actions that will motivate children to regularly eat breakfast.

Breast milk fat concentration and fatty acid pattern during the first six months in exclusively breastfeeding Greek women.

PURPOSE: To determine fat and fatty acid (FA) profile of Greek mother's milk during the first 6 months of exclusive breastfeeding and to examine their correlation with dietary and other maternal characteristics. METHODS: Milk samples and dietary records were obtained by mothers at 1st (n = 64), 3rd (n = 39), and 6th (n = 24) month postpartum. Fatty acid methylesters were separated and quantified by gas chromatography (GC/FID) and fat concentration by the creamatocrit method. RESULTS: At the 3 time points, milk fat concentration ranged between 26.3 and 30.2 g/l (p > 0.05). Milk's FA composition was expressed as weight percentage (% wt/wt of all FAs detected with a C6 to C22 chain length). Maternal macronutrient and FA dietary intake, as well as the FAs' profile in maternal milk, remained constant over the 6 months. Saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) represented approx. 46, 35, and 18 % of all FAs, while ω6 and ω3 PUFA were 17.4 and 0.8 %, respectively. Body weight gain during pregnancy was positively related to breast milk's concentration in SFA (p < 0.01) and negatively to milk's concentration in MUFA (p < 0.01). Age and parity were also independent factors affecting the FA profile in maternal milk. A strong positive effect was found during the first month postpartum, between mother's PUFA intake and the concentration of PUFA, ω3 fatty acids, docosahexaenoic and linoleic acid (LA) in the milk, while MUFA intake was strongly correlated with the concentration of PUFA, ω6 fatty acids, and LA. CONCLUSION: This study is among few in literature to determine FA profile of breast milk in European populations and verified certain dietary factors that influence this profile. Maternal PUFA and MUFA intake were found to be important factors affecting breast milk's FA profile.

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.

The role of diet in prevention and management of type 2 diabetes: implications for public health.

The aim of this review is to examine the current scientific knowledge on the relationship between diet and Type 2 diabetes and consider further implications for public health. The review focuses on the main nutritional elements which have been identified as significant in the prevention and management of Type 2 diabetes. Research findings on the role of carbohydrate, fiber, alcohol, and individual fatty acids are discussed, while the role of specific micro-nutrients and the influence of obesity are comprehensively presented. The association between dietary habits and Type 2 diabetes etiology and management is also reviewed, in order to examine the positive effects of adherence to a healthy dietary pattern, including the plausible role of the Mediterranean diet.

E-KINDEX: a dietary screening tool to assess children's obesogenic dietary habits.

BACKGROUND: To date, no published dietary indices have evaluated the overall effects of various dietary components, beliefs, and practices on the development of obesity in children. OBJECTIVE: To develop a dietary index that contains dietary characteristics and practices implicated in the development of obesity. METHODS: The proposed index (i.e., the E-KINDEX [Electronic Kids Dietary Index]) incorporates 3 subindices: (1) a food groups intake index (13 items), (2) an index related to eating beliefs and behaviors (8 items), and (3) an index that evaluates dietary practices (9 items). The theoretical overall score ranges from 1 (worst) to 87 (best). For validation of the E-KINDEX, multiple linear and logistic regression analyses were applied that had as dependent outcomes various body composition indices of 622 children (9-13 years) from the CYKIDS (Cyprus Kids) study. In all models, adjustments were made for age, gender, physical activity level, TV viewing time, socioeconomic status, breastfeeding, and parental obesity status. RESULTS: The highest E-KINDEX category (>60 points) was associated with 85% less likelihood of a child being obese or overweight (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05-0.41) and 86% less likelihood of having a waist circumference ≥75th percentile (OR, 0.14; 95% CI, 0.05-0.43). The correct classification rate of E-KINDEX (C-statistic) against excess body fat percentage was 84% (CI, 0.74-0.94). Moreover, for a single SD increase in the index score (i.e., 7.81 units), a decrease of 2.31 ± 0.23 kg/m(2) in body mass index (BMI), of 2.23 ± 0.35 in percent of body fat (BF%), and of 2.16 ± 0.61 cm in waist circumference was observed. Similar results were found during 1-year follow-up of study participants. In particular, baseline E-KINDEX levels were inversely associated with children's BMI at 1-year follow-up (p = 0.024). Latent class analysis showed that the index has good discriminative value for only 68% of the total sample. CONCLUSION: The proposed E-KINDEX could be helpful in dietary assessment and in further research in the field of childhood obesity.

Breast milk tocopherol content during the first six months in exclusively breastfeeding Greek women.

PURPOSE: To determine tocopherol and fat content of Greek mother's milk during the first 6 months of exclusive breastfeeding and correlate with maternal diet characteristics. METHODS: Milk samples and dietary records were obtained by mothers at 1st (n = 64), 3rd (n = 39) and 6th (n = 23) month postpartum. Milk tocopherol content was determined by high-performance liquid chromatography method (HPLC) and fat content by the crematocrit method. RESULTS: Milk's α-tocopherol content at 1st, 3rd and 6th month postpartum was 8.3 ± 3.4, 8.1 ± 4.2 and 8.5 ± 4.7 µmol/L, while total tocopherol values were 8.9 ± 3.6, 8.7 ± 4.6 and 9.5 ± 5.6 µmol/L, respectively, and were closely related to milk's fat content. No significant differences were observed for α- and total tocopherol content in breast milk among the three time points. Maternal vitamin E dietary intake was 7.2 ± 3.7, 6.8 ± 3.5 and 10.9 ± 5.2 mg/day at 1st, 3rd and 6th month postpartum, respectively. Though vitamin E dietary intake was less than the recommended one, vitamin E content in breast milk was considered sufficient for infant needs. Milk tocopherol content was found to be associated only with mothers' total fat and saturated fat dietary intake. CONCLUSION: This study is among few in literature to determine tocopherol content of breast milk in European women and detect dietary factors that may influence its values. The only maternal dietary characteristic to affect breast milk tocopherol content was mothers' total fat intake, while tocopherol intake seems to have no effect.

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.

A critical review of current evidence, perspectives and research implications of diet-related traditions of the Eastern Christian Orthodox Church on dietary intakes and health consequences.

Certain dietary guidelines that provide for a type of periodic vegetarianism, during a total period of 180–200 days in a year, are prescribed for symbolic and spiritual reasons in the Eastern Christian Orthodox Church (ECOC); however, its potential implication on health has only recently begun to be investigated. We aimed to review evidence on the potential association of ECOC's dietary guidelines to health and disease indices, and to explore research and dietetics' practice perspectives. Eleven publications were identified, providing data from prospective, cross-sectional, and case–control studies conducted among adults, and from one cross-sectional study among children. Data retrieved suggest that, compared with non-fasters, adult and child fasters enjoy better dietary quality and have healthier blood lipid profiles. The available evidence, however, is very limited and further investigation is warranted. It is being deemed important that dieticians and health professionals are able to exploit this dietary scheme of periodic vegetarianism and advise the ECOC adherents on how to further improve their meal planning.

The association between the level of adherence to the Mediterranean diet and successful aging: An analysis of the ATTICA and MEDIS (MEDiterranean Islands Study) epidemiological studies.

AIM: The aim of the present work was to evaluate the association between the level of adherence to the Mediterranean diet and successful aging, taking into consideration the overall dietary pattern, rather than individual foods, among middle-aged and older individuals. METHODS: A harmonized dataset of middle-aged and older participants (>50 years old) from the ATTICA (n = 1,128) and MEDIS (n = 2,221) population-based cross-sectional studies was used. Socio-demographic, anthropometric, clinical and lifestyle characteristics were measured in both studies and harmonized using standardized procedures. Level of adherence to the Mediterranean diet was evaluated using the MedDietScore (range 0-55, "Low" adherence <34, "High">38). Successful aging was evaluated using the validated successful aging index (SAI, range 0-10) comprising of health-related, social, lifestyle and clinical characteristics. RESULTS: Adherence to the Mediterranean diet was positively associated with SAI (b ± SE "High" vs. "Low": 1.094 ± 0.130, p < 0.001 and "Moderate" vs "Low": 0.476 ± 0.156, p = 0.003). CONCLUSION: Higher adherence to the Mediterranean diet was independently associated with a higher level of successful aging. Mediterranean diet or dietary patterns that are close to this pattern, should be actively promoted and encouraged to middle aged and older people to achieve successful aging.

Level of adherence to the Mediterranean diet among children from Cyprus: the CYKIDS study.

BACKGROUND: The Mediterranean diet (MD) prototype is widely used as an educational tool in public health programmes; few studies, however, have been conducted on the adherence of children to this diet. OBJECTIVE: To evaluate the quality of Cypriot children's diet by assessing the degree of adherence to the MD. METHODS: A national cross-sectional study among 1140 children (mean age = 10.7 (SD 0.98) years), using stratified multistage sampling design, was conducted in primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative FFQ and the two supplementary questionnaires (a Food Groups Frequency Questionnaire and a Short Eating Habits Questionnaire). Adherence to the MD was assessed by the KIDMED index. The association between the frequencies of consumption of various food groups and the level of adherence to the MD (poor v. average v. good KIDMED score) was also evaluated. Multiple logistic regression analyses were used to adjust for potential confounders. RESULTS: Only 6.7% of the sample was classified as high adherers of MD, whereas 37% had a poor KIDMED score. Multiple logistic regression analysis has shown that children with at least an average KIDMED score were more likely to eat frequently seafood and fish, legumes, nuts, bread, fruits, leafy vegetables, olives, low glycaemic index foods and unrefined foods. Effect size of associations was from medium to high. CONCLUSION: Higher adherence to MD is associated with better diet quality in children. The MD prototype may thus represent a useful educational tool for promotion of healthy eating habits in children.

Dietary and other lifestyle characteristics of Cypriot school children: results from the nationwide CYKIDS study.

BACKGROUND: Dietary and lifestyle behaviors at young ages have been associated with the development of various chronic diseases. Schools are regarded as an excellent setting for lifestyle modification; there is a lack, however, of published dietary data in Cypriot school children. Thus, the objective of this work was to describe lifestyle characteristics of a representative segment of Cypriot school children and provide implications for school health education. METHODS: The CYKIDS (Cyprus Kids Study) is a national, cross-sectional study conducted among 1140 school children (10.7 +/- 0.98 years). Sampling was stratified and multistage in 24 primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire and three supplementary questionnaires, assessing dietary patterns and behaviors. Adherence to the Mediterranean diet was evaluated by the KIDMED index (Mediterranean Diet Quality Index for children and adolescents). Physical activity was assessed by a 32-item, semi-quantitative questionnaire. RESULTS: Analysis revealed that 6.7% of the children were classified as high adherers, whereas 37% as low adherers to the Mediterranean diet. About 20% of boys and 25% of girls reported "not having breakfast on most days of the week", while more than 80% of the children reported having meals with the family at least 5 times/week. Some food-related behaviors, such as intake of breakfast, were associated with socio-demographic factors, mostly with gender and the geomorphological characteristics of the living milieu. With respect to physical activity, boys reported higher levels compared to girls, however, one fourth of children did not report any kind of physical activity. CONCLUSION: A large percentage of Cypriot school children have a diet of low quality and inadequate physical activity. Public health policy makers should urgently focus their attention to primary school children and design school health education programs that target the areas that need attention in order to reduce the future burden of metabolic disorders and chronic diseases.