Lifestyle determinants of healthy ageing in a Mediterranean population: The multinational MEDIS study.

BACKGROUND: To evaluate modifiable, lifestyle risk factors of cardiovascular disease (CVD) among older adults, across ageing, in the Mediterranean area. METHODS: During 2005-2017, 3131 individuals from 26 Mediterranean islands of 5 countries, ≥65 years of age, were voluntarily enrolled. Anthropometrical, clinical and socio-demographic characteristics, dietary habits, lifestyle parameters were measured through standard procedures. Analyses were performed by year and across consecutive age groups of the participants. RESULTS: A decrease in the prevalence of current smoking (p < 0.001), engagement in physical activities (p = 0.001) and participation in social events (p = 0.001) for every year increase in age was found. Moderate alcohol drinking increased through ageing (p = 0.008), whereas adherence to Mediterranean diet remained stable, but adequate (p = 0.90). Trend analysis also revealed that a quadratic (U-shape) function better characterized the association between ageing and total cardiometabolic risk factors burden (p for trend <0.001). CONCLUSIONS: The gaps in the understanding of factors affecting longevity and healthy ageing remain; public health authorities and stakeholders should focus on the lifestyle determinants of healthy ageing, that seems to be an effective mean for improving older peoples' health.

Mediterranean diet and depression among older individuals: The multinational MEDIS study.

BACKGROUND: Depression has been linked to a large and growing economic and societal burden worldwide. In Europe, depression is one of the most frequent mental disorders across all age groups, but particularly in people aged 65 years and over, and higher depressive symptoms have been reported among individuals with chronic diseases (e.g., diabetes and heart disease). AIM: To evaluate the role of adherence to the Mediterranean diet (MedDiet) in depression in a sample of older people living in the Mediterranean basin. METHODS: Standard procedures were used to determine socio-demographic, lifestyle, and clinical characteristics of the participants, as well as their dietary habits, and depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Multi-adjusted logistic and linear regression analyses were carried out to evaluate the associations between participants' characteristics and depression. RESULTS: Participants classified as having mild or severe depression were less educated and physically active, and more diabetic, and they reported less adherence to the MedDiet. Adherence to the MedDiet was associated with the absence of depression [(OR, 95% CI): 0.65, 0.50-0.85]. In addition, daily tea drinking was also related to the absence of depression [(OR, 95% CI): 0.51, 0.40-0.65]. CONCLUSIONS: Greater adherence to the MedDiet and daily tea drinking seem to have a beneficial effect on depressive symptoms in older adults.

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.

Mediterranean lifestyle and cardiovascular disease prevention.

BACKGROUND: Adherence to a Mediterranean dietary pattern is a well-established protective factor against cardiovascular disease (CVD). However, diet quality is only one aspect of the overall healthy lifestyle adopted by Mediterranean populations. The latter has never been evaluated as a multi-factorial composite lifestyle. Thus, the aim of the present study was to provide a broader picture of the Mediterranean lifestyle and its effects on CVD risk, among elderly individuals. METHODS: During 2005-2015, 2,749 older (aged 65-100 years) from 21 Mediterranean islands (MEDIS) and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled onto the study. Dietary habits, physical activity status, socio-demographic characteristics, lifestyle parameters (sleep, smoking habits, social life and educational status) and clinical profile aspects were derived through standard procedures. RESULTS: The overall prevalence of the traditional CVD risk factors were 62.3% for hypertension, 22.3% for diabetes mellitus (type 2) and 47.7% for hypercholesterolemia. The presence of diabetes mellitus was positively predicted by the geriatric depression scale (GDS) [odds ratio (OR) =1.13, 95% confidence interval (CI): 1.02-1.25] and by an urban residential environment (OR =2.57, 95% CI: 1.10-6.06) after adjusting for several confounders. Presence of hypertension was predicted by increasing age (OR =1.07, 95% CI: 1.02-1.12), increasing body mass index (BMI) (OR =1.12, 95% CI: 1.04-1.21), the habit of midday sleep (OR =2.07, 95% CI: 1.07-4.02) and inversely predicted by the frequency of socializing with friends (OR =0.767, 95% CI: 0.616-0.955). The estimated score in the GDS was the only independent positive predictor for the presence of hypercholesterolemia (OR =1.10, 95% CI: 1.01-1.21). CONCLUSIONS: Lifestyle parameters such as social life, midday sleep (siesta) and residential environment are strongly associated with the presence of CVD risk factors in elderly and should be part of broader CVD prevention strategies to reduce the burden of the disease.

The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015).

OBJECTIVES: By the end of the 2000s, the economic situation in many European countries started to deteriorate, generating financial uncertainty, social insecurity and worse health status. The aim of the present study was to investigate how the recent financial crisis has affected the lifestyle health determinants and behaviours of older adults living in the Mediterranean islands. METHODS: From 2005 to 2015, a population-based, multi-stage convenience sampling method was used to voluntarily enrol 2749 older adults (50% men) from 20 Mediterranean islands and the rural area of the Mani peninsula. Lifestyle status was evaluated as the cumulative score of four components (range, 0 to 6), that is, smoking habits, diet quality (MedDietScore), depression status (Geriatric Depression Scale) and physical activity. RESULTS: Older Mediterranean people enrolled in the study from 2009 onwards showed social isolation and increased smoking, were more prone to depressive symptoms, and adopted less healthy dietary habits, as compared to their counterparts participating earlier in the study (p<0.05), irrespective of age, gender, several clinical characteristics, or socioeconomic status of the participants (an almost 50% adjusted increase in the lifestyle score from before 2009 to after 2009, p<0.001). CONCLUSIONS: A shift towards less healthy behaviours was noticeable after the economic crisis had commenced. Public health interventions should focus on older adults, particularly of lower socioeconomic levels, in order to effectively reduce the burden of cardiometabolic disease at the population level.

Is car use related with successful aging of older adults? Results from the multinational Mediterranean islands study.

PURPOSE: The aim of the present work was to evaluate the relation between car use and the level of successful aging of a random sample of older adults living in the Mediterranean basin. METHODS: During 2005-2011, 2749 older (aged 65-100 years) from 22 islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the Mediterranean islands cross-sectional study. Sociodemographics, medical conditions, and dietary and lifestyle habits were derived throughout standard procedures. Car use was recorded with a standard binary question. A successful aging index ranging from 0-10 was used. RESULTS: Older adults who used a car on regular basis had significantly higher levels of successful aging, as well as less prevalence of obesity and hypertension while were more physically active (P < .001). After adjusting for several confounders car use was still positively related with elderly islander's successful aging level (beta coefficient [95% confidence interval]: 0.65 [0.54-0.77]). CONCLUSIONS: In conclusion, the activity of car use seems to be an indicator of quality of life among older adults, as measured through successful aging.

Is Parental Longevity Associated With the Cardiovascular Risk and the Successful Aging of Their Offspring? Results From the Multinational MEDIS Study.

The aim of the present study was to evaluate the role of parental longevity and parental cardiovascular disease (CVD) history in CVD risk and successful aging of a random sample of older adults living in the Mediterranean basin and who participated in the MEDiterranean Islands (MEDIS) study. During 2005 to 2011, 2663 elders were voluntarily enrolled. A multidimensional successful aging index consisting of 10 components was used. Paternal and maternal longevity was defined as those older participants of whom both parents lived above the age of 90. The burden of CVD-related factors (CVD-RFs) was calculated as the total score of 4 major CVD-RFs (range 0-4). After adjustment, parental longevity was inversely associated with the burden of CVD-RFs ( P = .04). Moreover, parental longevity was positively associated with the older adults' successful aging score (ß-coefficient [95% confidence interval]: .38 [0.06-0.71]). Parent's long living was revealed as an important factor for successful aging and for reduced CVD risk, suggesting that further research is needed in the genetic predisposition of longevity.

Skeletal muscle mass and body fat in relation to successful ageing of older adults: The multi-national MEDIS study.

BACKGROUND: The determinants that promote successful ageing still remain unknown. The aim of the present work was to evaluate the role of skeletal muscle mass and body fat percentage (BF%), in the level of successful ageing. METHODS: during 2005-2011, 2663 older (aged 65-100 years) from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Appendicular skeletal muscle mass (ASM), skeletal muscle mass index (SMI) and BF% were calculated using population formulas. Dietary habits, energy intake, expenditure and energy balance were derived throughout standard procedures. A successful ageing index ranging from 0 to 10 was used. RESULTS: The mean ASM mass was 24±6.0kg, the SMI was 0.84±0.21 and the BF% was 44%. Females had lower SMI and higher BF% in comparison with males, respectively [(SMI: 0.66±0.09 vs. 1.03±0.11; BF%: 51% vs. 34%, (p<0.001)]. High successful agers had better rates in ASM (p=0.01), SMI (p<0.001) and BF% (p<0.001), compared with the medium and low successful ones. Changes in SMI [b-coefficient (95% CI):2.14 (1.57 to 2.71)] were positively associated with successful ageing, while changes in BF% [b-coefficient (95% CI): -0.04 (-0.05 to -0.03)] were inversely associated with successful ageing. Results from sensitivity analysis showed that the effects of variations on body composition were consistent, less pronounced in the positive energy balance group and more pronounced among the oldest old. CONCLUSIONS: Body composition changes seem to be associated with lower quality of life in the older adults, as measured through successful ageing.

Successful Aging among Elders Living in the Mani Continental Region vs. Insular Areas of the Mediterranean: the MEDIS Study.

To evaluate the role of geography i.e., continental vs. insular Mediterranean, on successful aging among older inhabitants. During 2005-2014, 2693 elderly (aged 65 to 100 years) individuals from 21 Mediterranean islands in Greece, Italy and Spain as well as Cyprus, Malta, and the rural region of Mani (southeast continental region of Greece keeping old-time traditions), were voluntarily recruited. Successful aging was evaluated using a validated index composed of 10 health-related socio-lifestyle and clinical characteristics. After accounting for age, sex, body mass index (BMI), physical activity, smoking habits, MedDietScore and access to health care services, the older inhabitants of islands were found to have a higher level of the successful aging index when compared to their counterparts in Mani (Beta=0.174, p<0.001); moreover, islanders exhibited slightly more years of "good" health (68.7 vs 68.4 years for Mani residents (p=0.99)). However, compared to the residents of Mani, islanders had 1.64 times higher odds (95%CI, 1.08-2.48) for having hypertension, 2.4-times higher odds (95%CI, 1.34-4.21) for having diabetes and 1.52 times higher odds (95%CI, 0.97-2.38) for having hypercholesterolemia. Engaging in physical activities and healthy dietary habits were the major determinants of healthy aging, among islanders as compared to their counterparts of continental Mani region. Elder residents of the continental Mani area enjoyed a better health status, whereas elder islanders had a higher level of successful aging; a finding which could be attributed to differences in lifestyle among elders.

Short term omega-3 polyunsaturated fatty acid supplementation induces favorable changes in right ventricle function and diastolic filling pressure in patients with chronic heart failure; A randomized clinical trial.

INTRODUCTION: Omega-3 polyunsaturated fatty acids (omega 3-PUFAs) seem to favorably affect cardiac hemodynamics and may benefit the clinical course of heart failure patients. The role of omega 3-PUFAs supplementation on the left and right ventricular function of patients with chronic compensated systolic heart failure, under optimal treatment, was studied. METHODS: 205 consecutive patients with chronic compensated heart failure, due to ischemic (IHF) or dilated cardiomyopathy (DCM)-NYHA classification I-III, under optimal medical treatment, were enrolled. Participants were 1-to-1 randomized on 1000 mg omega 3-PUFA supplementation or no supplementation, in a non-blinded fashion. Echocardiographic assessment was performed at first visit and 6 months after. Plasma BNP and serum creatinine levels were also measured. RESULTS: As compared with the control group, BNP levels in omega 3-PUFA intervention group were 34.6% lower (p=0.001); end-diastolic and end-systolic left ventricle dimensions were decreased by 2.5% (p=0.047) and 3.7% (p=0.01), maximum diameter of left atrium was decreased by 8.4% (p=0.004), left atrium ejection fraction was ameliorated by 6.03% (p=0.021) and as regards tissue Doppler parameters, TDI_Etv/Atv was decreased in omega 3-PUFA intervention group by 6.3% (p=0.038). Moreover, improvement in diastolic indices was more prominent in subjects with DCM as compared to IHF patients. CONCLUSION: Omega 3-PUFA supplementation was associated with improved left diastolic function and decreased BNP levels in patients with chronic heart failure. These findings suggest a beneficial role of omega 3-PUFAs on the hemodynamic course of patients with systolic heart failure.

The Role of Energy Balance in Successful Aging Among Elderly Individuals: The Multinational MEDIS Study.

OBJECTIVE: The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin. METHOD: During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used. RESULTS: After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = -0.21[-0.37, -0.05], as well as positive energy balance, b-coefficient [95% CI] = -0.21 [-0.37, -0.05], were inversely associated with successful aging. CONCLUSION: A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measured through successful aging.

Successful aging, dietary habits and health status of elderly individuals: a k-dimensional approach within the multi-national MEDIS study.

The definition and determinants of successful aging is still controversial. Although dietary habits have long been associated with aging, eating habits and behaviors have rarely been included in various proposed indices of successful aging. The aim of this work was to evaluate determinants of successful aging together with assessment of dietary habits in relation to healthcare facility use among elders living in the Mediterranean basin. During 2005-2011, 2663 elderly (aged 65-100 years) individuals from 21 Mediterranean islands and rural Mani region (Peloponnesus) were voluntarily enrolled in the study. A successful aging index ranging from a score of 0 to a score of 10 was constructed using 10 attributes, i.e., education, financial status, physical activity, body mass index, depression, participation in social activities with friends and family, number of yearly excursions, number of cardiovascular disease risk factors and adherence to the Mediterranean diet. The applied factor analysis on the components of the index extracted three main components for successful aging: psychosocial-economic, bioclinical and lifestyle; confirming the multiple dimensions of aging. After adjusting for confounders, a 1/10-unit increase in the successful aging index was associated with 0.8 less annual visits to healthcare centers (95% CI -1.3 to-0.2). Stratified analysis by gender revealed heterogeneity of factors predicting successful aging. These findings suggest that successful aging is a multidimensional and complex concept that exhibits gender heterogeneity. Annual use of health care services by the elders was found to be related to level of successful aging.

Factors associated with components of arterial pressure among older individuals (the multinational MEDIS study): the role of the Mediterranean diet and alcohol consumption.

The aim of this work was to evaluate factors associated with arterial blood pressure in a sample of older Mediterranean people without known cardiovascular disease. During 2005 to 2011, 2813 older (aged 65-100 years) individuals from 22 Mediterranean islands and the rural Mani region (Peloponnesus) voluntarily enrolled. Standard procedures were used to determine arterial BP and pulse pressure and for the evaluation of dietary habits (including tea and alcoholic beverages consumption), lifestyle, and anthropometric and clinical characteristics of the participants. Participants who reported low alcohol consumption (ie, 0-1 glasses per day) were less likely to have hypertension (odds ratio, 0.34; 95% confidence interval, 0.14-0.84) as compared with those who reported high alcohol consumption (ie, 5+ glasses per day). Adherence to the Mediterranean diet was inversely associated with mean arterial pressure (ß coefficient, -0.18; 95% confidence interval, -0.33 to -0.16). Alcohol drinking remains an important modifiable risk factor for hypertension. Adherence to the Mediterranean diet was associated with decreased arterial peripheral resistance.

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.

High relative environmental humidity is associated with diabetes among elders living in Mediterranean islands.

BACKGROUND: Climate variation has long been studied in relation to human health. The aim of the present work was to evaluate the relationship between environmental humidity, and air temperature with the prevalence of diabetes, among elderly islanders. METHODS: During 2005-2011, 1959 elderly (aged 65 to 100 years) individuals from 13 Mediterranean islands were enrolled. Socio-demographic, clinical and lifestyle factors were assessed using standard procedures. Diabetes was defined as fasting blood glucose levels > 125 mg/dl. Relative environmental humidity was measured as a percentage of air moisture and mean daily temperature in degrees Celsius. RESULTS: For the present analysis 713 men (74 ± 7 years) and 596 women (73 ± 7 years) with complete data were studied; 27% of both men and women had diabetes. The prevalence of diabetes was 42% in the elders living in high relative humidity areas (i.e., >70%) as compared with 24% among those living at low relative humidity residential areas (p < 0.001). After adjusting for age, sex and mean temperature, an increase in the area's relative humidity by 1 degree, increased the likelihood of having diabetes by 12% (OR = 1.12, 95% CI 1.05 to 1.20). No significant association was observed between mean temperature and diabetes (OR = 0.97, 95% CI 0.74, 1.26). CONCLUSIONS: A considerable proportion of elderly, especially those living in high relative humidity areas, had diabetes. Further research is needed to confirm this observation and to understand the underlying mechanisms.

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.

Cross-sectional relationship of a Mediterranean type diet to diastolic heart function in chronic heart failure patients.

Systolic and diastolic functions of both ventricles play a crucial role in the progression of chronic heart failure (CHF). As data about the role of dietary habits in ventricular dysfunction are lacking, we aimed to evaluate the relationship between biventricular diastolic and systolic function and dietary habits in patients with CHF. During 2007, 372 consecutive CHF patients were enrolled. Biventricular systolic and diastolic function was evaluated through echocardiography. Dietary habits were recorded using a food frequency questionnaire, and adherence to a Mediterranean diet was evaluated using the MedDietScore. The MedDietScore was positively correlated with log Smv, left atrial EF and V (p), and inversely correlated with log EA and log Emv/Amv levels (p < 0.05). After adjusting for potential confounders, only log E/A levels were inversely associated with the MedDietScore (p < 0.05). Following analysis per specific aliments, the log E/A ratio was inversely associated with fish intake and olive oil use; the log Emv/Amv ratio was inversely associated with fish intake; log Stv was positively associated with fish, olive oil and pasta intake; log LAKE was positively associated with olive oil use and alcohol drinking (all p < 0.05). This study demonstrated, in a cross-sectional design, a potential beneficial effect of a Mediterranean diet on biventricular systolic and diastolic function.

Role of right ventricular systolic function on long-term outcome in patients with newly diagnosed systolic heart failure.

BACKGROUND: Right ventricular (RV) systolic function has been recognized as a prognostic factor in endstage heart failure (HF) patients and in the present study we evaluated the effect of this dysfunction on prognosis in patients with newly-diagnosed systolic HF. METHODS AND RESULTS: We enrolled 180 consecutive patients with newly diagnosed systolic HF (ischemic or dilated cardiomyopathy). Echocardiographic evaluation was performed to assess biventricular function. Pulse-wave tissue Doppler imaging (TDI) readings were obtained from the lateral tricuspid annulus and the peak systolic annular velocity (Stv) was recorded. Patients were followed for a 2-year period and events (death or HF hospitalization) were recorded. During the follow-up, 79 patients (44%) had an adverse event. An inverse relationship was observed between the height of Stv and the probability of an event (odds ratio (OR) 0.716, 95% confidence interval (CI) 0.583-0.880, P=0.001), after controlling for potential confounders. Furthermore, creatinine clearance (CrCl) was inversely associated with the outcome: a 1-unit increase in CrCl was associated with a 0.98-times lower likelihood of having an event. When the analysis was stratified by CrCl < 60 ml/min or ≥ 60 ml/min, Stv predicted adverse events in both groups (CrCl < 60 ml/min: OR 0.62, 95%CI 0.39-0.98, P = 0.04; CrCl ≥ 60 ml/min: OR 0.78, 95%CI 0.61-1.01, P=0.06). CONCLUSIONS: Pulse-wave TDI readings of peak systolic velocity at the lateral tricuspid annulus, reflecting RV systolic function, has prognostic significance in newly-diagnosed systolic HF patients.

Correlates of low dietary energy reporting in free-living elderly: the MEDIS study.

OBJECTIVES: To evaluate the prevalence of low energy reporting (LER) and associations between LER and lifestyle, psychological and clinical parameters, in elderly people living in eastern Mediterranean islands. METHODS: 1190 men and women, aged 65-100 years, participated in this cross-sectional study. Socio-demographic, clinical and lifestyle characteristics were recorded for the study participants. Among others, the ratio of energy intake to estimated basal metabolic rate (EI/BMR) was calculated and was used for the assessment of LER. RESULTS: Prevalence of LER was 47.7%. Lower EI/BMR (i.e., higher risk for LER) was associated with older age (p=0.001), male sex (p<0.001), higher body mass index (BMI; p=0.04), lower adherence to the Mediterranean diet (p<0.001) and non-current smoking (p=0.007). The sex-specific analysis revealed that, lower EI/BMR values were associated with lower adherence to the Mediterranean diet and being non-current smoker in both men and women (p≤0.05), as well as with older age (p=0.01), higher BMI (p=0.02) and hypercholesterolemia (p=0.02), only in women. CONCLUSION: In elderly, several clinical and lifestyle factors seem to be related to LER, and they should be taken into account in their nutritional assessment.

Health care access and prevalence of the metabolic syndrome among elders living in high-altitude areas of the Mediterranean islands: the MEDIS study.

AIM: The aim of the present work was to evaluate the relationships between sociodemographic, clinical, and lifestyle characteristics and the presence of metabolic syndrome, among high and low altitude living elderly individuals without known CVD. METHODS: During 2005-2011, 1959 elderly (aged 65 to 100 years) individuals from 13 Mediterranean islands were enrolled. Sociodemographic, clinical, and lifestyle factors were assessed using standard procedures. Metabolic syndrome was defined according to the (Adult Treatment Panel) ATP III criteria. Mountainous areas were defined those more than 400 meters in height. RESULTS: For the present analysis 713 men and 596 women were studied; the prevalence of the metabolic syndrome was 29% (24% in men, 35% in women, p < 0.001). Furthermore, the prevalence of metabolic syndrome was 55% in the elders living in mountainous areas, as compared with 26% among those living at sea-level (p = 0.01). Similarly, the prevalence of hypertension, hypercholesterolemia, and obesity were higher in high altitude as compared with low altitude areas (all p-values < 0.01). After adjusting for various confounders, elders living in high altitude areas were 3.06-times more likely to have the metabolic syndrome than those living at sea-level (OR = 3.06, 95%CI 2.02-4.65). However, when the annual number of visits to health care centers was taken into account, the effect of altitude of living was not associated with the presence of the syndrome. CONCLUSIONS: A considerable proportion of mountainous living elderly had the metabolic syndrome. Public health actions need to be taken to reduce the burden of cardiometabolic disorders by enabling better access to health care, especially in remote mountainous rural areas.