Association of fructose consumption with prevalence of functional gastrointestinal disorders manifestations: results from Hellenic National Nutrition and Health Survey (HNNHS).

The study aimed to assess the total prevalence of functional gastrointestinal disorders (FGID), and separately, irritable bowel syndrome (IBS) among adults and to determine their potential association with fructose consumption. Data from the Hellenic National Nutrition and Health Survey were included (3798 adults; 58·9 % females). Information regarding FGID symptomatology was assessed using self-reported physician diagnosis questionnaires the reliability of which were screened using the ROME III, in a sample of the population. Fructose intake was estimated from 24 h recalls, and the MedDiet score was used to assess adherence to the Mediterranean diet. The prevalence of FGID symptomatology was 20·2 %, while 8·2 % had IBS (representing 40·2 % of total FGID). The likelihood of FGID was 28 % higher (95 %CI: 1·03-1·6) and of IBS 49 % (95 %CI: 1·08-2·05) in individuals with higher fructose intake than with lower intake (3rd tertile compared with 1st). When area of residence was accounted for, individuals residing in the Greek islands had a significantly lower probability of FGID and IBS compared with those residing in Mainland and the main Metropolitan areas, with Islanders also achieving a higher MedDiet score and lower added sugar intake, comparatively to inhabitants of the main metropolitan areas. FGID and IBS symptomatology was most prominent among individuals with higher fructose consumption, and this was most conspicuous in areas with a lower Mediterranean diet adherence, suggesting that the dietary source of fructose rather than total fructose should be examined in relation to FGID.

From Q/Non-Q Myocardial Infarction to STEMI/NSTEMI: Why It's Time to Consider Another Simplified Dichotomy; a Narrative Literature Review.

Acute coronary syndromes (ACSs) are classified as ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) based on the presence of guideline-recommended ST-segment elevation (STE) criteria on the electrocardiogram (ECG). STEMI is associated with acute total coronary occlusion (ATO) and transmural myocardial necrosis and is managed with emergent reperfusion therapy, and NSTEMI is supposedly synonymous with subendocardial myocardial infarction without ATO. However, coronary angiograms reveal that a significant proportion of patients with NSTEMI have ATO. Here, we review articles that studied the frequency and cardiovascular outcomes of ATO in NSTEMI patients compared with those without ATO. We discuss ECG patterns of patients with suspected acute myocardial infarction that do not fulfill STEMI criteria but are associated with ATO. Under-recognition of these atypical patterns results in delays to reperfusion therapy. We also advocate revision of the current STEMI/NSTEMI paradigm because consideration of STE, by itself, out of context of other clinical and ECG features, leads to the ECG diagnosis of STEMI when the ECG actually represents a mimic ["Pseudo-STEMI"], and suggest renaming the ACSs classification as the Occlusion Myocardial Infarction (OMI)/Non-Occlusion Myocardial Infarction (NOMI) paradigm.

WITHDRAWN: Prevalence and factors associated with smoking in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS).

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.hjc.2022.05.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

WITHDRAWN: Prevalence and factors associated with smoking in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS).

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.hjc.2022.05.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents.

Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2-18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2-11 years and 384 adolescents 12-18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.

Micronutrient dietary intakes and their food sources in adults: the Hellenic National Nutrition and Health Survey (HNNHS).

BACKGROUND: The present study aimed to assess micronutrient intake among Greek adults and to identify the main food sources that contribute to it. METHODS: Food consumption data from 2389 participants in the Hellenic National Nutrition and Health Survey (HNNHS), collected with 24-h recalls, was used to calculate micronutrient intakes. Usual nutrient intake was estimated according to the National Cancer Institute method. Nutrient adequacy was estimated using the estimated average requirement (EAR) cut-point method, when available, or adequate intake otherwise. The probability approach was used to determine iron intake adequacy in females of reproductive age. Food group contribution for each nutrient assessed was derived to identify their main food sources. RESULTS: Almost all individuals had vitamin D intake below EAR, whereas vitamins A, E, K and C, as well as potassium intake, were also insufficient in a considerable percentage of the population (>70% in most age groups). Calcium intake was substantially below the EAR for females aged >50 years and males >70 years; the same for magnesium in males >70 years. Furthermore, 50% of females, including those of reproductive age, had intake of folate below EAR. More than 50% of the population (to 79%) exceeded the upper tolerable limit for sodium (2300 mg day-1 ). Food contribution analysis revealed that most vitamins were derived from low-quality foods (i.e. fast-food). CONCLUSIONS: A significant proportion of adults residing in Greece have low nutrient intake and poor food selections. These results provide guidance to public health policy makers for developing strategies to improve the dietary quality in Greece.

Sociodemographic and lifestyle determinants of depressive symptoms in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS).

BACKGROUND: The aim of this study was to assess depressive symptomatology prevalence among Greek adults amidst the financial crisis and to explore the association between depressive symptoms and sociodemographic and lifestyle factors. METHODS: The Hellenic National Nutrition and Health Survey including a nationally representative adult sample (3,675 adults; 48.7% males) was used. Trained personnel gathered information on sociodemographic and anthropometric characteristics and lifestyle status. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and clinically relevant depressive symptomatology was defined as PHQ-9 score≥10, or on anti-depressant medication. Associations between depressive symptoms and the assessed factors were estimated using stratified multivariable logistic regression. RESULTS: The prevalence of clinically relevant depression was 9.4%. In the regression, female sex, marital status (widowed vs. married), financial difficulties (yes vs. no), professional status (employed vs. unemployed), body mass index status (overweight/obese vs. normal weight), and smoking status (current and ex-smokers vs. never smokers) were significant, with an increased likelihood for depressive symptomatology in all variables, other than employment. LIMITATIONS: The cross-sectional nature of the study does not allow detection of changes over time. Furthermore, it does not allow determining the presence of a temporal relationship between depression and the sociodemographic and lifestyle variables that we tested. CONCLUSION: This study estimates a high prevalence of depressive symptoms among adults during the Greek financial crisis and points out important associations of depressive symptoms with different sociodemographic determinants and lifestyle factors, and provides policy health makers valuable information in their efforts to deal with this epidemic.

Micronutrient intakes and their food sources among Greek children and adolescents.

OBJECTIVE: To assess the usual dietary intake of twenty micronutrients and to identify their food sources in a representative sample of Greek children and adolescents. DESIGN: Cross-sectional data from the Hellenic National Nutrition and Health Survey (HNNHS). Vitamin and mineral intakes were estimated from two 24 h dietary recalls by sex and age groups. Estimates were calculated using the National Research Council method and the statistical software package Stata13 to account for within- and between-person variations. The prevalence of nutrients' inadequacy among sample was estimated using the estimated average requirement (EAR) cut-point method. The contribution of food groups to nutrient intake was estimated to identify micronutrients food sources. SETTING: Greece. PARTICIPANTS: Children and adolescents aged 1-19 years (n 577) who provided sufficient and plausible 24-h recalls. RESULTS: A substantial percentage of children and adolescents had insufficient intakes of numerous micronutrients. Usual intake of vitamins D, K and potassium was inadequate in practically all individuals. Vitamin A, folate, Ca and Mg were also insufficient to a considerable percentage, especially in girls aged 14-18 years. Pantothenic acid was highlighted as nutrient of interest since only one out of ten boys 9-13 years and girls 14-19 years had intake above the EAR. Data demonstrated that food groups highly ranked in energy contribution were not necessarily important sources of micronutrients. CONCLUSIONS: Results suggest that micronutrient density of Greek children and adolescents' diet should be improved. These findings might be used by public health policy-makers to help young people optimise their food choices in Greece.

Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS).

Hypertension is a major risk of cardiovascular diseases. This study's aim was to examine associations between hypertension and a priori known lifestyle risk factors, including weight status and Mediterranean diet adherence. The study included a representative sample of the adult population (N = 3775 (40.8% males)), from the Hellenic National Nutrition and Health Survey (HNNHS), which took place from September 2013 to May 2015. Demographic and anthropometric data were collected using validated questionnaires, and blood pressure (BP) measurements were performed for the two main metropolitan areas (N = 1040; 41.1%). Hypertension diagnosis was according to the International Classification of Diseases (ICD-10) guidelines. Weighted proportions, extended Mantel-Haenszel (M-H) analyses, and multiple logistic regressions (for the survey data) were performed. Mean systolic BP (SBP) and diastolic BP (DBP) were 118.6 mmHg and 72.2 mmHg respectively, with both values being higher in males compared to females in all age groups (p < 0.001). Study participants with hyperlipidemia or diabetes, and those overweight, were almost twice as likely to be hypertensives, with the odds increasing to 4 for those obese (p for all, < 0.05). Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% (OR: 0.64; 95% CI: 0.439, 0.943), and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension. The presence of hypertension is clustered with comorbidities, but is significantly associated with modifiable risk factors, including Mediterranean diet and weight status, underlining the need for personalized medical nutritional treatment.

Intake and contribution of food groups to vitamin D intake in a representative sample of adult Greek population.

OBJECTIVES: Globally, vitamin D intake from food and supplements is low, consistent with the high prevalence of low serum 25-hydroxyvitamin D concentration. The aims of this study were to assess vitamin D intake and major relevant food contributors among Greek adults and to propose subsequent policies for intervention. METHODS: Vitamin D from diet and supplements was estimated in adults (≥19 y of age) from two 24-h recalls using the Automated Multiple-Pass Method (vitamin D from food intake) and a drug and supplement questionnaire (vitamin D supplements). Over- and underreporters were identified using the Goldberg cutoff. The final analysis included 2218 individuals. The National Research Council method was used to account for within- and between-person variation. Vitamin D food intake adequacy was estimated based on the estimated average requirement (EAR) of 10 mcg/d, set by the Institute of Medicine. Major foods contributing to intake were identified and the effect on meeting EAR, of a potential food fortification example was examined. RESULTS: Median vitamin D intake from food ranged from 1.16 to 1.72 and 1.01 to 1.26mcg/d in different age groups in men and women, respectively. Major food sources of vitamin D were fish (46%), meat (15%), and cereals (12%); however, >90% of the population in all age groups failed to meet the EAR, even when supplemental use was accounted for (~5% of the population consumed supplements). CONCLUSION: Overall vitamin D intake is below the average requirements. Public health policies to increase the consumption of foods high in vitamin D or food fortification may significantly reduce the percentage of individuals who do not meet the recommendations.

Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS).

BACKGROUND AND AIMS: Empirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults. METHODS AND RESULTS: Adult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30-0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02-2.26). No association was found between the Prudent pattern and CVD outcomes. CONCLUSION: The variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting.

Association of serum vitamin D status with dietary intake and sun exposure in adults.

BACKGROUND & AIMS: Serum 25(OH)D deficiency is becoming an epidemic. The aim was to assess vitamin D status of the adult Greek population in relation to intake, sun exposure and other factors, using data from the Hellenic National Nutrition and Health Survey (HNNHS). METHODS: Data from 1084 adult participants (37.8% males) were analyzed. Vitamin D intake was assessed using 24-h recalls. Serum 25(OH)D concentration was evaluated and related to anthropometric measurements and other covariates including supplements used, by sex. Variables significantly associated with 25(OH)D < 20 ng/ml were assessed using simple and multiple logistic regression. RESULTS: Median vitamin D intake from food was 1.23 mcg/day (0.60, 2.44), with 9.1% consuming supplements. Median serum 25(OH)D was 16.72 ng/ml, with no sex differences (P = 0.923). The odds of having 25(OH)D < 20 ng/ml significantly decreased with being very active (OR 0.55, 95% CI 0.35, 0.98), increasing length of sun exposure [1-3 h/day (OR 0.59, 95% CI 0.44, 0.80), >3 h/day (OR 0.36, 95% CI 0.24, 0.55)], and skin colour [light to medium skin (OR 0.47, 95% CI 0.24, 0.91), fairly dark skin colour (OR 0.34, 95% CI 0.17, 0.67) and dark or very dark skin colour (OR 0.34, 95% CI 0.15, 0.75)], compared to respective baseline levels. The odds significantly increased with obesity (OR 1.95, 95% CI 1.24, 3.08), and spring season of blood sample collection (OR 1.75, 95% CI 1.22, 2.50). CONCLUSIONS: Vitamin D deficiency is highly prevalent in Greek adults. Relevant public health policies are highly recommended, which could include vitamin D fortification. and suggestion for increased but safe sun exposure.

Prevalence of hyperlipidaemia in adults and its relation to the Mediterranean diet: the Hellenic National Nutrition and Health Survey (HNNHS).

OBJECTIVES: A long-term abnormal blood lipid profile increases the risk of cardiovascular disease (CVD). A probable protective role may be played by the Mediterranean diet. The aim of this study was to assess prevalence of dyslipidaemia, assess blood lipid status and treatment and examine the association between blood lipids, dyslipidaemia and Mediterranean diet. METHODS: Data were from the Hellenic National Nutrition and Health Survey (HNNHS). Data from 3775 adults (40.8% males) were obtained by trained personnel and disease status was categorized according to the International Classification of Diseases codes (10th version). Blood lipid measurements were obtained from a subsample (N = 1080, mean age 40.1 years; 37.8% male). The Mediterranean diet score (MedDiet score) was calculated from 24-h recalls. The relationships between higher MedDiet score (>23), lipid levels and status were examined using linearized multiple linear and logistic regressions, respectively. RESULTS: In total, 20.7% of the population was dyslipidaemic, with 59.0% (no sex differences) receiving treatment, and 46.6% of the treated having a normal lipid profile. Lipid status awareness was 35.5% (64.5% unaware). Males aged 19-39 had higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, and lower high-density lipoprotein cholesterol levels than females (in mg/dl; p for all <0.05); these were significantly higher in overweight and obese individuals in all age groups, except high-density lipoprotein cholesterol (p for all <0.001). Higher MedDiet score was associated with significantly lower low-density lipoprotein cholesterol in the pooled sample (-6.39 mg/dl; 95% confidence interval (CI): -12.60, 0.17), in all males (-10.61 mg/dl; 95% CI: -19.89, -1.34) and in overweight and obese males (-15.6 mg/dl; 95% CI: -29.25, -1.94). CONCLUSION: This study underlines the abnormal lipid profile in the young, mostly male, population who are highly unaware and under-treated.

Frequency and Quantity of Egg Intake Is Not Associated with Dyslipidemia: The Hellenic National Nutrition and Health Survey (HNNHS).

BACKGROUND: Gaps remain on the safety of egg intake on cardiovascular health, setting the study's aim to investigate the association between quantity and frequency of egg consumption, with established dyslipidemia. METHODS: Study participants (N = 3558, 40.3% males) included individuals from the Hellenic National and Nutrition Health Survey (HNNHS), of national representation. Quantity and frequency of egg consumption was determined. Minimally adjusted, multivariable logistic and linear analysis were used to assess egg consumption and dyslipidemia. RESULTS: The more frequent egg consumption compared to no or rare egg consumption significantly decreased the odds of dyslipidemia in the minimally adjusted (Odds Ratio (OR) for frequency: 0.83; 95% Confidence Interval (CI): 0.752, 0.904; OR for quantified frequency: 0.87; 95% CI: 0.796, 0.963) and the fully adjusted models (OR for frequency: 0.80; 95% CI: 0.718, 0.887; OR for quantified frequency: 0.85; 95%CI: 0.759, 0.945). Level of serum cholesterol and LDL-c were significantly lower with higher frequency and quantified frequency of egg consumption in all models. CONCLUSION: Eggs do not increase the risk of dyslipidemia and can be consumed as part of a healthy diet that is high in fiber and low in saturated fat, without excessive energy intake, by all individuals.

Aims, design and preliminary findings of the Hellenic National Nutrition and Health Survey (HNNHS).

BACKGROUND: The aim of the Hellenic National Nutrition and Health Survey was to assess nutritional intake, health status and various behaviors in a representative sample of the Greek population. METHODS: Data collection took place from 01.09.2013 to 31.05.2015. Random stratified sampling was performed by (a) geographical density criteria of Greece (7 regions), (b) age group of the reference population (< 19, 20-64 and > 65 years) and (c) gender distribution. The final population enrolled included (throughout Greece), 4574 individuals (42.5% men; 57.5% women of who 47.2% were from Athens metropolitan area, 18.5% from Central Macedonia, and the remaining 34% almost equally scattered throughout the country (p for the comparisons with official statistics by region, age group and sex > 0.7). Questionnaires developed were based on extensive review of the literature, following a validation procedure when necessary. RESULTS: Preliminary analyses revealed that 32% of the adult population were overweight and 15.5% were obese, with significant gender differences in total and per age group (p < 0.001, for all). The majority of the adult population reported being active smokers (50.4%) or regular alcohol consumers (72.4%); with significant gender differences (p < 0.001, for all). Prevalence of hyperlipidemia was 16.7%, cardiovascular disease 13.9%, hypertension 13.3%, thyroid disease 13.8%, and Diabetes Mellitus 3.6%. Significant gender and age group differences were found in various diseases. CONCLUSIONS: Study's preliminary results provide valuable information about the Hellenic population's health. Findings from this survey could be used to detect disease risk factors for public health prevention policies and programs.

Cardiovascular disease in Greece; the latest evidence on risk factors.

Cardiovascular disease (CVD) is a significant and ever-growing problem in Europe, accounting for nearly 45% of all deaths and leading to significant morbidity. Greece is one of the European Union member states that top the list of deaths due to ischemic heart disease and stroke, a fact that is mainly attributed to unfavorable changes in modifiable risk factors. The aim of this review is to examine the latest evidence on the most important CVD risk factors. According to studies conducted during the last two decades, the prevalence of arterial hypertension, hypercholesterolemia, diabetes mellitus, and obesity remained relatively stable or increased. The decrease in the prevalence of active smokers and the increase in physical activity, during the last few years, are the main favorable risk modifications in the Greek population. Nevertheless, citizens of Greece seem to gradually adopt unhealthy dietary habits by moving away from Mediterranean diet, as issue that is intensified after the outbreak of the Greek debt crisis. Furthermore, the inability of some patients to afford their medications and the possible health care deficiencies as well as the increasing prevalence of depression may make the situation even worse. During the financial crisis, CVD mortality seems to have remained unaffected, but there is evidence that the incidence of cardiovascular events is increasing. More effort is needed to control established and emerging CVD risk factors among the Greek population.