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.

Hiromeri: a specialty ham of Cyprus--historical evidence, culinary and cultural perspectives.

Hiromeri is a specialty ham of Cyprus, made of smoked pork leg that is matured in wine. Until now there has been no systematic effort to present historical evidence that will support the Cypriot authenticity of this product. In this article, the historical evidence from sixteenth to twentieth centuries, referring to the production and trade of hiromeri in Cyprus, is presented. The evidence is drawn from archival testimony, travelers' descriptions, old history books, and essays on agricultural production. Moreover, a description of the hiromeri production process as well as past and current culinary uses and customs associated with its production and consumption are presented.

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.

Dietary patterns analysis using data mining method. An application to data from the CYKIDS study.

Data mining is a computational method that permits the extraction of patterns from large databases. We applied the data mining approach in data from 1140 children (9-13 years), in order to derive dietary habits related to children's obesity status. Rules emerged via data mining approach revealed the detrimental influence of the increased consumption of soft dinks, delicatessen meat, sweets, fried and junk food. For example, frequent (3-5 times/week) consumption of all these foods increases the risk for being obese by 75%, whereas in children who have a similar dietary pattern, but eat >2 times/week fish and seafood the risk for obesity is reduced by 33%. In conclusion patterns revealed from data mining technique refer to specific groups of children and demonstrate the effect on the risk associated with obesity status when a single dietary habit might be modified. Thus, a more individualized approach when translating public health messages could be achieved.

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.

Overview of depression: epidemiology and implications for community nursing practice.

Depressive disorders are among the most common psychological conditions currently affecting individuals living in the Westernized world. Yet, available data indicate that fewer than one third of adults with depression obtain appropriate professional treatment. This is attributed, among other reasons, to the under-recognition of the problem by health professionals, including district nurses. In order to improve recognition of the problem, it is imperative for nurses and especially those working in community settings, to appreciate the importance of prompt diagnosis which presumes both an understanding and knowledge of basic aspects of the problem and, an understanding of their role in dealing with depression. This overview presents epidemiological data and identifies the potential consequences of depression on daily functioning and other aspects of life among adults in Westernized countries, aiming to raise awareness and sensitize district nurses about the issue The article discusses how the role of district nurses can be enhanced to improve recognition rates.

Use of dietary indexes among children in developed countries.

In this article, we review studies that have used dietary indexes to assess different aspects of diet in relation to health outcomes and sociodemographic factors in childhood populations of developed countries. Eighty-four papers published from 1980 to mid-2010 including 90 unique dietary indexes were reviewed. Seventy-two indexes were developed (or have been adapted) specifically for childhood populations; 38 of these were used to assess diet-disease associations, mostly of diet and obesity. In the majority of these studies, small inverse associations between dietary indexes and obesity indexes were shown. Children who were younger, female, and from high-income families had better dietary quality scores. Forty-nine indexes (of 90) were compared with other aspects of dietary intakes or behaviors, with correlations ranging from very low to modest (∼r = 0.05-0.50). Only 2 validation studies compared an index with nutritional biomarkers, and correlations were quite weak for most plasma nutrients (P < 0.10). Overall, a large number of indexes have been created and used, but the majority of studies are descriptive. Fewer analytic studies on index-health associations have been performed, and most analyses insufficiently adjusted for confounders. Thus, prospective and intervention research in diverse populations is needed to further test these tools. In conclusion, indexes are potentially useful methods for dietary assessment, because they offer valuable information on overall dietary patterns in children. However, understanding the advantages and limitations when applying them in research and public health settings is important, and more research is needed to further develop their utility.

The role of folic acid in prevention and treatment of depression: an overview of existing evidence and implications for practice.

OBJECTIVES: Folic acid is a promising nutrient in relation to augmentation of depression treatment efficiency. Our aim is to present an overview of the potential ways in which folic acid may be associated with depression. METHODS: Search in the databases of PubMed, ProQuest, HEAL- LINK, and HighWire, as well as the Search Engine Google. RESULTS: Data on the correlation of folic acid deficiency and depression is presented along with plausible mechanisms that may account for this association. Secondly, the role of folic acid in the treatment of depression is depicted giving emphasis to the potential of folic acid to enhance patients' responsivess to medication and the therapeutic outcome. DISCUSSION: There is not enough data to justify prescription of folic acid as an aid in patients with severe or chronic depression or mood disorders. However, folic acid levels should be examined in individuals at increased risk for folic acid deficiency or in patients who do not respond to pharmaceutical treatment.

The role of nurses in the prevention and management of obesity.

This paper examines the current scientific knowledge on the relationship between diet and obesity, and considers the implications for nursing practice. It focuses on the main nutritional elements that have been identified as significant in the prevention and management of obesity. Research findings reveal the important role of specific dietary habits and patterns and their influence on obesity; particularly on childhood obesity. This paper discusses the nursing implications in relation to the prevention and management of obesity.

C-reactive protein levels are associated with adiposity and a high inflammatory foods index in mountainous Cypriot children.

BACKGROUND & AIMS: Inflammatory marker levels have long been associated with obesity status in adult populations, but relevant data are scarce in children, especially in diverse races. The aim of this study was thus to examine the association between overall and central obesity and C-reactive protein (CRP) levels in Cypriot children of Greek ancestry. METHODS: Eighty three children (9.2 ± 1.7 years) were studied. Body mass index (BMI) was calculated according to the age-sex specific International Obesity Task Force (IOTF) criteria while body fat percentage (BF%) was measured via leg-to-leg bioelectric impedance (BIA). Central obesity was defined as waist circumference ≥ 75 th percentile. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. An inflammatory foods' index, composed of nine foods/food groups, was also calculated. CRP levels were measured using a high-sensitivity (hs) immunoassay. RESULTS: Obese children, children with excess BF% and children with WC ≥ 75 th percentile were 7.35, 6.84 and 7.81 times (P < 0.05) respectively more likely to have hs-CRP levels ≥ 0.10 mg/dL; a high score of the dietary inflammation index was positively associated with CRP levels. CONCLUSIONS: Obesity is associated with increased hs-CRP levels in 6-12 year-old children, a finding that supports the inflammation-obesity hypothesis at an early stage of life. Furthermore, frequent consumption of inflammatory foods is positively related to CRP levels.

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.

Children's physical activity, TV watching and obesity in Cyprus: the CYKIDS study.

BACKGROUND: Even though there is a severe obesity problem in Cyprus, information about the contribution of predisposing lifestyle factors is limited. Our aim was to investigate the relationship between physical activity (PA), sedentary behaviour and various obesity indices [i.e. body mass index (BMI), waist circumference (WC), percentage of body fat (BF%) and 'total & abdominal obesity' (TAO)]. METHODS: A national cross-sectional study of 1140 children (mean age = 10.7 +/- 0.98 years) selected by multistage sampling in Cyprus was conducted during 2004-05. Children completed a 32-item, semi-quantitative PA questionnaire, which assessed organized and free-time PA and sedentary behaviours. Weight, height and WC were collected from a random sub-sample of 622 children and obesity was defined by IOTF criteria. Body fat percentage was calculated, and TAO status was computed based on obesity status and WC [i.e. (i) both BMI/WC, (ii) either BMI/WC abnormal and (iii) both BMI/WC abnormal]. Linear and logistic regression analyses with obesity indices as dependent variables were applied after adjusting for several potential confounders. RESULTS: Only variables describing sedentary behaviours were retained in the final regression models in both boys and girls. Girls who spent >or=4 h/day on TV and DVD watching were almost three times more likely to be overweight or obese [OR = 2.84 (95% CI 1.08-7.47)], three times more likely to have WC >or=75th percentile [OR = 3.25 (95% CI 1.06-9.98)] and 3.5 times more likely to have >or=30% body fat [OR = 3.63 (95% CI 1.01-12.98)], while in boys, even though the same variable was retained in almost all final models, it did not reach statistical significance. CONCLUSION: Sedentary behaviours such as TV watching may be more important predictors of children's various obesity indices than PA behaviours. Interventions targeting sedentary behaviours, such as TV watching, may help in the prevention and treatment of obesity among Cypriot children.

Physical activity mediates the protective effect of the Mediterranean diet on children's obesity status: The CYKIDS study.

OBJECTIVE: There is some evidence regarding the association between adherence to the Mediterranean diet (MD) and obesity among adults; to our knowledge, however, no relevant data exist for children. We investigated the association between adherence to the MD and obesity status in children. METHODS: A national cross-sectional study among 1140 children (mean age 10.7+/-0.98 y) was carried out in Cyprus using stratified multistage sampling design. Body mass index was calculated according to International Obesity Task Force criteria, from parental reference. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for children and adolescents (KIDMED diet score). To test the research hypothesis, a logistic regression analysis was applied with two dependent variable categories of obesity status, normal weight (NW) versus overweight/obese (OW/OB), and the three categories of the KIDMED score independently, after controlling for several potential confounders. RESULTS: Compared with low MD adherers, children with a high KIDMED score were 80% less likely to be OW/OB (95% confidence interval 0.041-0.976), adjusted for age, gender, parental obesity status, parental educational level, and dietary beliefs and behaviors (model 2). When physical activity was taken into account, however, the aforementioned relation was not significant (model 3; odds ratio 0.20, 95% confidence interval 0.021-1.86). Furthermore, male gender, maternal obesity, and dietary beliefs and behaviors emerged as more significant in predicting obesity in children compared with their KIDMED score. CONCLUSION: Adherence to the MD is inversely associated with obesity in this sample of 9- to 13-y-old children; however, other behaviors, and in particular physical activity, maternal obesity, dietary beliefs and behaviors, seem to be more significant.

Review of epidemiology of depression and implications for community nursing practice.

Depression is regarded as one of the most common mental disorders, but available data point out that only less than one third of adults with depression obtain appropriate professional treatment. This is attributed (amongst other reasons) to the under-recognition of the problem by the health professionals including the general practice nurses. In order to improve recognition rates it is imperative that nurses and especially those working at community settings appreciate the importance of prompt diagnosis which, on one hand presumes an understanding and knowledge of basic aspects of the problem and on the other hand an understanding of their role. This overview presents basic epidemiological data and the potential consequences on daily functioning and other aspects of life that depression may have as to become aware and sensitive regarding to depressive clients. It also discusses the role of nurses in the community, in order to improve recognition rates.

Foods E-KINDEX: a dietary index associated with reduced blood pressure levels among young children: the CYKIDS study.

Dietary modification is, in general, the preferred method when attempting reductions in blood pressure (BP) among adults. In children, however, few studies, have examined the relationship between dietary patterns and levels of BP, and the reported results are conflicting. The objective of this study was to investigate the association between levels of Foods E-KINDEX score and levels of BP in children. Measurements included BP, height, weight, and waist circumference. Diet quality was assessed by the Foods E-KINDEX diet score. The index includes 13 components that assess consumption frequency of 11 major food groups or foods, as well as two cooking techniques (fried and grilled foods). Its score ranges between 0 and 37. A subsample of 622 Cypriot children (mean age=11.7+/-0.83 years) from the CYKIDS national cross-sectional study was used. Logistic regression analysis was performed in order to examine the relationship of systolic BP, diastolic BP, and BP with diet quality (as assessed by the Foods E-KINDEX score). The median systolic BP and diastolic BP were 110 mm Hg (interquartile range [IQR]=100 to 120 mm Hg) and 68 mm Hg (IQR=60 to 70 mm Hg) for boys and 110 mm Hg (IQR=100 to 120 mm Hg) and 63 mm Hg (IQR=60 to 70 mm Hg) for girls, respectively. Mean Foods E-KINDEX score was 23.4+/-4.9 in boys and 24.3+/-4.8 in girls (P=0.487). Compared with children with a low diet score, those with at least an average Foods E-KINDEX score were 57% (odds ratio=0.43; 95% confidence interval: 0.19 to 0.98) less likely to have elevated systolic BP levels, regardless of various potential confounders. The Foods E-KINDEX score is independently associated with lower BP among healthy children. This finding might have implications in public health and should be further explored.

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.

Physical activity patterns among preadolescent children in Cyprus: the CYKIDS study.

PURPOSE: The purpose of this study was to summarize patterns of correlations between variables and reduce a large number of variables to a smaller number of factors. METHODS: During 2005 we conducted a national, cross-sectional, multistage study among 1140 children (mean age=10.70+/-0.98). Principal component analysis was employed to extract the main factors out of 21 variables assessing children's duration of physical and sedentary activities. RESULTS: Eight factors emerged as important, explaining 63% of the total variance in children's PA patterns. The combined explained variance of 3 factors for exercise was 24.1% (PA and sports after school [11.6%]; home and outside home chores, aerobics, gymnastics, sports [6.8%]; Sports for All, after-school activities [except sports] [5.7%]) and of 5 factors for sedentary activities was 38.9% (video, electronic games, and computers [10.2%]; watching TV, video, and DVD [9.5%]; homework and private lessons [7.3%]; theater cinema, use of mobile phone [6.2%]; afternoon sleep, less private lessons [5.8%]). Further analyses of the emerged factors by gender showed that boys, on a daily basis, are engaged in higher duration in physical activity and sports after school (factor 1) and in electronic games and computers (factor 2), whereas they are engaged in lower durations in factor 4 type behavior (homework and private lessons) and factor 6 type behavior (theater cinema, use of mobile phone). CONCLUSION: Use of the above factors will inform further research and enable researchers to identify potential differences in physical and sedentary activities patterns by various environmental and sociodemographic variables. Furthermore, associations of factors by gender may inform public health programs.

Urbanization influences dietary habits of Cypriot children: the CYKIDS study.

OBJECTIVES: Nutrition transition and urbanization have been linked to the adoption of a Western diet. An increasing number of Cypriot have abandoned their traditional eating habits and replaced them with a more westernized diet. Therefore, we aimed to examine the relationship between dietary habits of preadolescent children in Cyprus and their place of residence, with reference to nutrition transition. METHODS: CYKIDS is a national, cross-sectional study, among 1140 children (10.7 +/- 0.98 years). Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire Adherence to the Mediterranean diet was evaluated by the KIDMED index. Logistic regression and bivariate analyses were used for data analysis. RESULTS: Differences between children from urban and rural areas were not major, but it was found that children from rural areas consumed more traditional foods, were less likely to eat fast food [OR = 0.66, 95% CI (0.49-0.88)] and more likely to have meals with the family [OR = 2.49, 95% CI (1.62-3.81)]. CONCLUSIONS: The minor differences relating the dietary patterns to the place of residence reflect the changes in eating habits and the abandonment of the traditional Mediterranean diet, which may be attributed to the nutrition transition and urbanization phenomena.

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.

Nutritional approaches in tackling hypertension.

There is sufficient evidence to suggest that dietary approaches may help to prevent and control high blood pressure. This review focuses on the main dietary approaches for which there is ample scientific data regarding the prevention and management of hypertension: i.e. moderate use of sodium, alcohol, an increased potassium intake, plant fibers, calcium (and dairy products) and adherence to healthy dietary patterns such as Dietary Approaches to Stop Hypertension and the Mediterranean diet; in addition, the study also presents evidence regarding other nutritional factors which may possibly be associated with levels of blood pressure, but for which there is as yet insufficient current scientific evidence to support the issue of specific dietary recommendations. Finally, further implications for community nursing practice are discussed.