Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care.

Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.

AMY1 diploid copy number among end-stage renal disease patients.

PURPOSE: The salivary amylase gene (AMY1) copy number variation (CNV) is increased as a human adaptation to starch-enriched nutritional patterns. The purpose of this study was to evaluate the relationship between AMY1 CNV, dietary starch consumption, and anthropometric indices among a known population with elevated cardiovascular risk, being end-stage renal disease (ESRD) patients. METHODS: A total of 43 ESRD patients were recruited based on the following inclusion criteria: being (1) adults, (2) on hemodialysis for more than 3 months, (3) able to communicate effectively, and (4) willing to participate. Anthropometric measurements were performed, dietary intake was recorded via food-frequency questionnaires, and AMY1 CNV was quantified in blood samples DNA via real-time PCR. RESULTS: Median AMY1 CNV was 4.0 (2.0-17.0). A total of 21 patients had an even, and 22 had an odd AMY1 copy number (CN). Independent samples t tests revealed that AMY1-odd diploid CN is associated with increased body weight, waist and hip circumferences, and fat mass compared to the respective even diploid CN carrier group. No differences were observed for BMI or nutritional intake. Multiple regression analysis revealed that AMY1-odd diploid CN was positively associated with increased hip circumference (ß = 7.87, 95% CI = 0.34 to 15.39) and absolute fat mass (ß = 6.66, 95% CI = 0.98 to 12.34); however, after applying the Bonferroni correction for multiplicity, all regression analyses lost their significance. CONCLUSIONS: AMY1-odd diploid CN appears to be associated with selected adiposity variables among hemodialysis patients. However, more research is needed to verify this finding in this population with known increased cardiovascular risk.

Exploring Patients' Experiences After Chronic Kidney Disease Diagnosis: A Qualitative Study.

Chronic kidney disease (CKD) diagnosis is often associated with stress, depression, and major lifestyle changes. The aim of this qualitative study was to explore patients' experiences of living with CKD. A non-random purposeful sampling strategy was used to recruit 10 patients with CKD undergoing hemodialysis, from a tertiary care hospital in Crete, Greece. Semi-structured, face-to-face interviews were conducted with open-ended questions aiming to assess different aspects of their life after CKD diagnosis. Four main themes were revealed portraying participants' experience, including facing a new reality, 2) confronting changes, 3) finding ways to cope, and 4) continuing life.

Disease Activity, Functional Ability and Nutritional Status in Patients with Rheumatoid Arthritis: An Observational Study in Greece.

AIM: The aim of the present pilot study was to assess differences in the nutritional status, Mediterranean diet (MD) adherence, and functional ability among patients with rheumatoid arthritis (RA), according to disease activity. METHODS: A total of 48 patients with RA, outpatients of a hospital in Athens, Greece were recruited. Disease activity was evaluated with DAS28, functional status with the Health Assessment Questionnaire (HAQ), MD adherence with the MedDietScore and malnutrition with the patient-generated subjective global assessment (PG-SGA). RESULTS: A relationship was noted between DAS28 and HAQ, indicating a reduced functional status with increased RA activity. Although MD adherence differed between DAS28 categories, no specific differences were noted in the PG-SGA or the MedDietScore in the post-hoc analyses. According to the PG-SGA, no need for nutritional intervention was noted among participants. CONCLUSIONS: The origin of the participants might have reduced the differences between MD adherence and DAS28. In parallel, the PG-SGA does not appear sensitive in detecting muscle-related malnutrition among patients with RA.

Nutritional status in hemodialysis patients is inversely related to depression and introversion.

Although hemodialysis (HD) is a life-sustaining treatment for the majority of patients with end-stage renal disease, it may adversely affect their psychological status. Depression is highly prevalent among these patients, and it is associated with malnutrition, morbidity and mortality. Recent studies have demonstrated that depression is positively associated with neuroticism and introversion in HD patients. The aim of the present study was to explore the relationship between depression, personality traits (extraversion-introversion, neuroticism, psychoticism) and nutritional status among HD patients. Fifty-two HD patients were assessed via questionnaires for depression (CES-D) and personality traits (EYSENCK, EPQ). Nutritional assessment was conducted through bioelectrical impedance analysis (BIA) and anthropometry measurements (height, post-dialysis weight). The study revealed novel significant correlations. Both post-dialysis weight and phase angle were negatively related to introversion (r = -0.314, p < 0.05 and r = -0.542, p < 0.01, respectively) and depression (r = -0.456, p < 0.01 and r = -0.467, p < 0.01, respectively). This study demonstrates that both depression and introversion are inversely related to adequate nourishment in HD patients and suggests that personality plays an important role in the nutritional status of these patients.

Food insecurity increases the risk of malnutrition among community-dwelling older adults.

OBJECTIVES: To assess the prevalence of malnutrition and food insecurity (uncertainty, or limited ability to acquire acceptable foods through socially acceptable ways), among non-hospitalised, non-institutionalised, community-dwelling older adults, and to identify possible dietary, socioeconomic and health factors associated with them. STUDY DESIGN: Cross-sectional, with 207 older adult participants inhabitants of Thessaloniki and Kavala, Greece. A medical diagnosis was not a criterion for exclusion from participation. MAIN OUTCOME MEASURES: Malnutrition risk (combined categories of "at risk of malnutrition" and "malnourished" by the Mini-Nutritional Assessment tool) and food insecurity (assessed by the Household Food Insecurity Access Scale). RESULTS: Participants had a mean age of 72.4 ± 8.5 years; 43.5% were male and 56.5% female. The prevalence of malnutrition was 5.3%, and 48.3% were "at risk of malnutrition". The group of participants assessed as being at risk of malnutrition were significantly older, smoked, had a lower body mass index and a smaller waist circumference, reported single partnership status, and exhibited reduced appetite. Some degree of food insecurity was apparent in 69% of the participants. Food insecurity was associated with lack of higher education, reduced monthly income and low adherence to the Mediterranean diet. Additionally, food insecurity as compared with food security increased the risk of malnutrition (OR 2.63, 95% CI 1.21-5.75; p = 0.015) in the multivariate analysis. CONCLUSIONS: Given the financial difficulties experienced by the Greek older adult population over the last decade, a large proportion of them are at risk of malnutrition and experience some degree of food insecurity. With the two conditions being interrelated, early identification and management of both malnutrition and food insecurity are essential for public health and healthy ageing.

Through the Patients' Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care.

Chronic kidney disease is a condition that affects both the physical and mental abilities of patients. Nursing care is of pivotal importance, in particular when end-stage renal disease (ESRD) patients are concerned, since the quality of the provided care may severely influence the patient's quality of life. This is why it is important to explore patient experiences concerning the rendered care. However, limited up-to-date studies have addressed this issue. The aim of the present study was to stress the experiences of ESRD patients concerning the provided nursing care in the hemodialysis unit at the University Hospital in Heraklion, Crete. A qualitative methodological approach was used, based on the principles of phenomenological epistemology. Semi-structured interviews were conducted, and open-ended questions were applied to record how patients experienced the rendered care during dialysis. The recorded data were analyzed via qualitative content analysis, which revealed three main themes: 'Physical Care', 'Psychological Support' and 'Education'. Patients' views were conceptualized into sub-themes within each main theme. The interviews revealed the varied and distinct views of ESRD patients, indicating that the rendered care should be individualized.

A systematic review and meta-analysis of weight status among adolescents in Cyprus: scrutinizing the data for the years 2000-2010.

OBJECTIVE: The aim of the present study was to evaluate by pooled and sensitivity analyses all available data on adolescent overweight/obesity in Cyprus. DESIGN: A thorough literature search determined the studies to be examined using Cypriot adolescent samples aged 10-18 years old, with weight status in each sex classified according to the IOTF criteria, published between the years 2001-2011. Eight studies were retrieved, but three fulfilled the criteria for the sensitivity analyses. RESULTS: The pooled prevalence of obesity was 9.8% in boys (n = 6081). The pooled analysis classified 6.1% (n = 3886) of girls as obese, whereas a higher prevalence was observed by the sensitivity analysis 6.4% (n = 1956, p ≤ 0.001). The boys' prevalence of overweight was 19.3% and the girls' 17.1%. Between sexes, boys demonstrated a higher prevalence of obesity and overweight (p ≤ 0.001 for both). The cumulative analyses demonstrated an increase in the prevalence of overweight/obesity until the year 2005 and thereafter a plateauing in boys and a slight decrease in girls in a non-linear manner. CONCLUSION: Approximately 1/3 of adolescent boys and 1/4 of adolescent girls in Cyprus were overweight/obese during the previous decade.