Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet.

BACKGROUND: Farmers from Crete as first studied within the framework of the Seven Countries Study, were historically known for holding the title of the 'gold standard' of health status globally and had a very low prevalence of both cardiovascular disease (CVD) and cancer. Taking the above into account we evaluated the changes in CVD risk factors among farmers in Crete, Greece and compared our findings with data from the 1960s. DESIGN: Cross-sectional. METHODS: Five hundred and two farmers (18-79 years old) from the Valley of Messara in Crete were randomly selected and examined in 2005. Complete clinical, biochemical, dietetic, anthropometrical and lifestyle CVD risk factors were assessed, matched and compared with published data from the 1960s. RESULTS: In comparison with 45 years ago, present day male farmers from Crete were found to have a 30% higher BMI (29.8 vs. 22.9 kg/m, P<0.001) and a 16% higher total cholesterol level (239.6 vs. 206.9 mg/dl, P<0.001) and also a not so favourable daily dietary intake (increase in meat and saturated fat and decrease in fruit, P<0.001, respectively), while a significant reduction in systolic blood pressure and energy intake was noticed. In regards to changes in subcutaneous adipose tissue fatty acid composition, a decrease in monounsaturated (P<0.001) and an increase in saturated fatty acids (P<0.001) was also found elucidating the temporal change in dietary habits. CONCLUSION: The population's lack of adherence to the Mediterranean diet, have led to the fact that currently farmers from Crete are likely to be at a higher risk for developing CVD in comparison with earlier generations.

The significant effect on musculoskeletal metabolism and bone density of the Eastern Mediterranean Christian Orthodox Church fasting.

OBJECTIVE: Nutritional disorders cause secondary osteoporosis as well as musculoskeletal metabolism dysfunction. The Christian Orthodox Church's fasting in Mediterranean countries such Greece and Cyprus, or M.C.O.C. diet consists of self-restraint from food and/or food categories for 180 ± 19 days of total, especially of animal protein and dairy products. This case-control study attempts to investigate the effect of this fasting pattern on musculoskeletal metabolism and bone density. DESIGN: One hundred fasters (or M.C.O.C. diet followers; 68 women and 32 men, mean 59 ± 6.5) with 32 years average fasting time and 100 non-fasters (66 females and 34 males, mean 58.1 ± 6.8; the control group of Mediterranean diet followers) over the age of 50, including menopausal women, were interviewed, as well as physically and laboratory examined along with DEXA measurements of the L2-4 vertebrae and hips. Nutrition data gathered through a 3-day food record during a non-fasting period, while energy intakes calculated on a daily food consumption basis. RESULTS: Given the overall low incidence of osteoporosis in the Mediterranean diet, it appears to be more than three times higher than that of M.C.O.C. diet despite the periodic restriction of food intake of animal origin into a slightly hypothermic pattern, which in turn is characterized by increased consumption of multicolored vegetable foods. CONCLUSIONS: Abstinence from dairy products and meat does not adversely affect musculoskeletal metabolism or bone density. M.C.O.C. diet seems to be "healthy" eating habit for the musculoskeletal system, as future studies expected to confirm.

Smoking habits of Greek preschool children's parents.

BACKGROUND: Smoking is Greece's largest public health threat. Greece has the highest adult smoking prevalence among all E.U countries, which in turn possibly predisposes Greek children and adolescents to smoke. The purpose of our study was to research into the smoking habits of preschool children's parents since children of that age could be vulnerable to parental negative role modeling and to investigate into the necessity of conducting a public health awareness programme aimed at the general population. METHODS: A cross-sectional study was performed on the parents of children enrolled in kindergarten in western Crete-Greece (2809 parents), and interviewed during the 2004-2005 Cretan school health promotion programme. RESULTS: 63% of households had at least one parent a current smoker and in 26% both parents were found to be current smokers. Smoking prevalence among adults with preschool children was estimated at 44% (52% of fathers and 36% of mothers). Paternal education and nationality were statistically significantly related to smoking (p < 0.001), unlike place of residence (p = 0.862) and level of maternal education (p = 0.132). CONCLUSION: Smoking prevalence is high even among parents with preschool children. Taking into account the parents' significant primary role in the children's upbringing and the effect that parental induced passive smoking has on children's health and health attitude; one can deduce that the health of Greek children is under threat. It is of major importance that educational and policy intervention measures are implemented to reduce such a situation that could contribute to promoting the initiation of smoking among Greek adolescents.

Effects of Greek Orthodox Christian Church fasting on serum lipids and obesity.

BACKGROUND: No study to date has focused on the impact of Greek Orthodox Christian fasting on serum lipoproteins and obesity yet. METHODS: 120 Greek adults were followed longitudinally for one year. Sixty fasted regularly in all fasting periods (fasters) and 60 did not fast at all (controls). The three major fasting periods under study were: Christmas (40 days), Lent (48 days) and Assumption (August, 15 days). A total of 6 measurements were made during one year including pre- and end-fasting blood collection, serum lipoprotein analyses and anthropometric measurements. RESULTS: Statistically significant end-fasting total and LDL cholesterol differences were found in fasters. Fasters compared to controls presented 12.5% lower end-total cholesterol (p < 0.001), 15.9% lower end-LDL cholesterol (p < 0.001) and 1.5% lower end-BMI (p < 0.001). The end- LDL/HDL ratio was lower in fasters (6.5%, p < 0.05) while the change in end- HDL cholesterol in fasters (4.6% decline) was not significant. Similar results were found when the pre- and end-fasting values of fasters were compared. No change was found in control subjects. CONCLUSIONS: Adherence to Greek Orthodox fasting periods contributes to a reduction in the blood lipid profile including a non-significant reduction in HDL cholesterol and possible impact on obesity.

Smoke-free hospitals in Greece: Personnel perceptions, compliance and smoking habit.

Smoke-free environments in Greece are scarce. Despite existent legislation that forbids smoking in all health care service centers, smoking is still evident. Using a random sample of hospital personnel from a large university hospital in Greece, we evaluated their smoking habits, perceptions and compliance towards hospital smoking regulations. 57.8% of the nursing personnel and 34.5% of medical/research staff were found to be current smokers (p < 0.05). Although 66% of the staff does not oppose the complete hospital smoking ban, 95% responded that they would prefer it to be partial. The above findings warrant the necessity for nurturing efforts to reduce smoking and increase the health professionals' awareness of their position as a role model to both patients and the society.

Smoking status in relation to serum folate and dietary vitamin intake.

OBJECTIVE: Cigarette smoke itself is an abundant source of free radicals and a major cause of oxidative stress, to which plasma antioxidants function as a vital protective and counterbalancing mechanism. The objective of this study was to investigate into the relationship between smoking status and serum and dietary micronutrient concentrations. DESIGN: Cross-sectional study SUBJECTS - SETTING: 502 farmers from the Valley of Messara in Crete were randomly selected and examined. Complete three-day and 24-hr recall questionnaires were collected along with anthropometrical, physical activity and clinical data from all participating subjects. RESULTS: After adjusting for age, gender and number of fasting days adhered to per year, current smokers were found to have a lower dietary intake of vitamin C (112.1 mg vs. 136.4 mg, p = 0.03), fibre (16.6 g vs. 19.1 g, p = 0.006) and fruits and vegetables (339 g vs. 412 g, p = 0.014), while dietary vitamin B1 intake was found to be higher (1.7 mg vs. 1.4 mg, p = 0.02) in comparison to non/ex smokers. Dietary intake of meat, folate and vitami A, E, B2, B6 and B12 did not differ between the groups. Controlling age, gender, fasting days and dietary micronutrient intake, serum folate levels were found to be lower among smokers (geometric mean 15.3 nmol/L vs. 17.7 nmol/L, p = 0.023), while serum iron and vitamin B12 levels were not affected by smoking status. CONCLUSION: Current smoking status affects dietary nutrient intake as well as plasma folate levels. The above coherence between antioxidant depletion and reduced antioxidant intake may predispose smokers to the premature development of tobacco related mortality and morbidity.

Biomarkers of passive smoking among Greek preschool children.

BACKGROUND: Greece has the highest adult smoking prevalence in the European Union, affecting not only those who smoke but also threatening the health of those who are involuntarily exposed to passive smoke, especially young Greek children. OBJECTIVE: The aim of this study was to quantify passive smoking biomarkers (serum nicotine and cotinine levels) among preschool children in Crete in relation to parental smoking habits. METHODS: All children enrolled in kindergarten in western Crete (1,757 preschool children and 2,809 parents) were interviewed during the 2004-2005 Cretan health promotion programme out of which a sample of 81 children was randomly selected according to parental smoking status and blood samples for cotinine and nicotine assay were taken. RESULTS: The geometric means of serum nicotine values in children with both parents current smokers and in those with both parents non-smokers were 0.71 ng/ml (95%CI 0.62, 0.80) and 0.59 ng/ml (95%CI 0.49, 0.69), respectively, (p=0.073). Cotinine geometric mean values were found at 1.69 ng/ml (95%CI 0.93, 3.06) and 0.15 ng/ml (95%CI 0.09, 0.28), respectively, (p<0.001). Girls with smoker parents had also greater cotinine geometric mean values than boys (3.35 versus 0.85 ng/ml, respectively, p=0.018). CONCLUSION: Our findings prove that Greek preschool children, especially young girls, are exposed to substantial levels of passive smoke which therefore stresses the need for immediate action so as to prevent the predisposition and early addiction of Greek preschool children to tobacco.

Greek Orthodox fasting rituals: a hidden characteristic of the Mediterranean diet of Crete.

The longevity and excellent health status of the population of Crete has been attributed to its lifestyle and dietary habits. The impact of Greek Orthodox Christian Church fasting on these dietary habits has never been studied. One hundred and twenty Greek Orthodox Christians living in Crete participated in a 1-year prospective study. One half of the subjects, who fasted regularly (fasters), and sixty non-faster controls were followed longitudinally for the three main fasting periods over 1 year; Christmas (40 d), Lent (48 d) and the Assumption (15 d). Pre- and end-holy days measurements were performed in each fasting period including: 24 h dietary recall, blood collection and anthropometric measurements. Based on the 24 h recall, fasters as compared with controls had lower intakes of end-holy days dietary cholesterol, total fat, saturated fatty acids, trans-fatty acids and protein (P < 0.001). Fasters presented a decrease of 753 kJ (180 kcal) in end-holy days energy intake (P < 0.05) compared with an increase of 573 kJ (137 kcal) in the controls (P < 0.05). Fasters had a decrease in end-holy days Ca intake (P < 0.001) and an increase in end-holy days total dietary fibre (P < 0.001) and folate (P < 0.05), attributed to their higher consumption of fruit and vegetables in end-holy periods (P < 0.001). There were no differences for other vitamins or minerals between pre- and end-holy periods in both groups except for vitamin B2. The Orthodox Christian dietary regulations are an important component of the Mediterranean diet of Crete characterised by low levels of dietary saturated fatty acids, high levels of fibre and folate, and a high consumption of fruit, vegetables and legumes.