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Kouvari M, Chrysohoou C, Damigou E, Barkas F, Kravvariti E, Liberopoulos E, Tsioufis C, Sfikakis PP, Pitsavos C, Panagiotakos D, Mantzoros CS. Non-invasive tools for liver steatosis and steatohepatitis predict incidence of diabetes, cardiovascular disease and mortality 20 years later: The ATTICA cohort study (2002-2022). Clin Nutr 2024; 43:900-908. [PMID: 38387279 DOI: 10.1016/j.clnu.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/11/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) or, as recently renamed, metabolic dysfunction-associated steatotic liver disease (MASLD), has common metabolic pathways with diabetes and cardiovascular disease (CVD). Non-invasive tools (NITs) for liver steatosis and steatohepatitis (MASH) were studied as potential predictors of diabetes, cardiovascular disease (CVD) and mortality over a 20-year period. METHODS In 2001-02, 3042 individuals from the Attica region of Greece were recruited randomly, and were stratified by subgroups of sex, age and region to reflect the general urban population in Athens, Greece. Validated NITs for hepatic steatosis (Hepatic Steatosis Index (HIS), Fatty Liver Index (FLI), Lipid Accumulation Product (LAP), NAFLD liver fat score (NAFLD-LFS)) and steatohepatitis (Index of non-alcoholic steatohepatitis (ION), aminotransferase-creatinine-clearance non-alcoholic steatohepatitis (acNASH)) were calculated. Incidence of diabetes, CVD and mortality were recorded 5, 10 and 20 years later. RESULTS Within a 20-year observation period, the diabetes and CVD incidence was 26.3% and 36.1%, respectively. All hepatic steatosis and steatohepatitis NITs were independently associated with diabetes incidence. ION and acNASH presented independent association with CVD incidence [(Hazard Ratio (HR)per 1 standard deviation (SD) = 1.33, 95% Confidence Interval (95% CI) (1.07, 1.99)) and (HRper 1 SD = 1.77, 95% CI (1.05, 2.59)), respectively]. NAFLD-LFS which is a steatosis NIT indicating features of steatohepatitis, was linked with increased CVD mortality (HRper 1 SD = 1.35, 95% CI (1.00, 2.30)) and all-cause mortality (HRper 1 SD = 1.43, 95% CI (1.08, 2.01)). Overall, steatohepatitis NITs (i.e., ION and acNASH) presented stronger associations with the outcomes of interest compared with steatosis NITs. Clinically important trends were observed in relation to diabetes and CVD incidence progressively over time, i.e. 5, 10 and 20 years after baseline. CONCLUSIONS Easily applicable and low-cost NITs representing steatohepatitis may be early predictors of diabetes and CVD onset. More importantly, these NITs increased the attributable risk conveyed by conventional CVD risk factors by 10%. Thus, their potential inclusion in clinical practice and guidelines should be studied further.
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Affiliation(s)
- Matina Kouvari
- Department of Medicine, Devision of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece.
| | - Christos S Mantzoros
- Department of Medicine, Devision of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA; Department of Medicine, Boston VA Healthcare System, Boston, MA, 02215, USA.
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Kouvari M, Valenzuela-Vallejo L, Axarloglou E, Verrastro O, Papatheodoridis G, Mingrone G, George J, Mantzoros CS. Thyroid function, adipokines and mitokines in metabolic dysfunction-associated steatohepatitis: A multi-centre biopsy-based observational study. Liver Int 2024; 44:848-864. [PMID: 38263703 DOI: 10.1111/liv.15847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND AIMS Thyroid axis is currently under investigation as a therapeutic target in metabolic dysfunction-associated steatotic liver disease (MASLD). Thyroid function was examined herein in the full spectrum of disease. METHODS Subjects were recruited and had liver biopsies in two Gastroenterology-Hepatology Clinics (Greece and Australia) and one Bariatric-Metabolic Surgery Clinic (Italy). The main working sample was n = 677 subjects with MASLD after excluding subjects with abnormal free thyroxine levels. Participants were classified according to thyroid-stimulating hormone (TSH) standard criteria: Subclinical hyperthyroidism (<0.4 uIU/mL); Euthyroidism with relatively low (0.4 to <2.5 uIU/mL); euthyroidism with relatively high (2.5-4.0 uIU/mL); subclinical hypothyroidism (>4 uIU/mL). RESULTS TSH as a continuous variable was positively associated with significant fibrosis (F ≥ 2), metabolic dysfunction-associated steatohepatitis (MASH) and at-risk MASH. Subclinical hypothyroidism was associated with fibrosis F ≥ 2 (odds ratio [OR] = 3.47, 95% confident interval [CI] [1.50, 8.05], p = .02), MASH (OR = 3.44, 95% CI [1.48, 7.98] p = .001) and at-risk MASH (OR = 3.88, 95% CI [1.76, 8.55], p = .001), before and after controlling for adiposity, central obesity, and insulin resistance. When leptin, adiponectin, or growth differentiation factor-15 were examined as moderators, significance was lost. Sex-specific analysis revealed a strong association between TSH and the presence of significant fibrosis among women, eliminated only when adipokines/mitokines were adjusted for. Restricted cubic spline analysis revealed associations between TSH and liver outcomes (p-values < .01) with inflection points for fibrosis F ≥ 2 being 2.49, for MASH being 2.67 and for at-risk MASH being 6.96. CONCLUSIONS These observations provide support for studies on the administration of thyroid hormone in MASLD therapeutics for subclinical hypothyroidism and liver-specific thyroid receptor agonists for subjects across the TSH continuum.
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Affiliation(s)
- Matina Kouvari
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Valenzuela-Vallejo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Evangelos Axarloglou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | | | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, USA
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Diamantis DV, Shalit A, Katsas K, Zioga E, Zota D, Kastorini CM, Veloudaki A, Kouvari M, Linos A. Improving Children's Lifestyle and Quality of Life through Synchronous Online Education: The Nutritional Adventures School-Based Program. Nutrients 2023; 15:5124. [PMID: 38140383 PMCID: PMC10745706 DOI: 10.3390/nu15245124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
The early introduction of effective nutritional educational programs is pivotal for instilling sustainable healthy behaviors. The present work aims to present a best practice example of a nutrition and overall lifestyle school-based training program, the Nutritional Adventures ("Diatrofoperipeteies"). Conducted during 2020-2022 in Greek primary schools, this synchronous, online educational initiative included two 1-school-hour activities with a nutrition instructor. Additionally, schools were randomly assigned to supplementary "at-home" supported-by-parents or "in-class" supported-by-educators educational activities. In total, n = 12,451 students of 84 primary schools participated. Parent-completed questionnaires were selected in the recruitment and post-intervention phase (40% participation rate); overall, the working sample was n = 1487 students. In the post-intervention phase, a significant increase in Mediterranean diet adherence was observed (KIDMED score: mean increment = 0.25 units; p < 0.001), particularly fruit and vegetable consumption. Time spent on physical activity increased, while screen time decreased. Students' total quality of life significantly improved (PedsQL; mean increment = 1.35 units; p < 0.001), including on all of its subscales (physical, emotional, social, and school function). Supplementary educational activities that were supported by educators rather than parents yielded a more favorable impact on students' lifestyle and quality of life. The Nutritional Adventures program can be regarded as a successful initiative in primary schools, yielding immediate advantages that extend beyond promoting healthy dietary habits.
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Affiliation(s)
- Dimitrios V. Diamantis
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | - Almog Shalit
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantinos Katsas
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelia Zioga
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | - Dina Zota
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | | | - Afroditi Veloudaki
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | - Matina Kouvari
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Athena Linos
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
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Damigou E, Faka A, Kouvari M, Anastasiou C, Kosti RI, Chalkias C, Panagiotakos D. Adherence to a Mediterranean type of diet in the world: a geographical analysis based on a systematic review of 57 studies with 1,125,560 participants. Int J Food Sci Nutr 2023; 74:799-813. [PMID: 37771002 DOI: 10.1080/09637486.2023.2262781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
This systematic review aimed to assess the level and time-trends of adherence to Mediterranean-type diets (MTD) among the general population, globally. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a comprehensive literature search of the MEDLINE and Scopus databases was carried out, until 04/09/2023, based on specific criteria. Fifty-seven studies with 1,125,560 apparently healthy adults from Europe (n = 37), US (n = 8), Asia (n = 8), Australia (n = 4) and Africa (n = 1) were included. Adherence to an MTD was moderate with a significant decline observed in the last decade. European countries, mainly driven by Mediterranean countries, showed higher adherence than other regions. Geographical analysis revealed that adherence to an MTD is related to both geographic location and socioeconomic status throughout the world.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Antigoni Faka
- Department of Geography, School of Environmental Sciences, Harokopio University, Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Costas Anastasiou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly Trikala, Greece
| | - Christos Chalkias
- Department of Geography, School of Environmental Sciences, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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Tsiampalis T, Kouvari M, Belitsi V, Kalantzi V, Androutsos O, Bonoti F, Panagiotakos DB, Kosti RI. Physicians' Words, Patients' Response: The Role of Healthcare Counselling in Enhancing Beneficial Lifestyle Modifications for Patients with Cardiometabolic Disorders: The IACT Cross-Sectional Study. Healthcare (Basel) 2023; 11:2982. [PMID: 37998474 PMCID: PMC10671259 DOI: 10.3390/healthcare11222982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
Background: Preventive cardiology aims to educate patients about risk factors and the importance of mitigating them through lifestyle adjustments and medications. However, long-term adherence to recommended interventions remains a significant challenge. This study explores how physician counselling contributes to successful behavior changes in various aspects of lifestyle. Methods: A cross-sectional study conducted in Greece in 2022-2023 included 1988 participants. Validated questionnaires assessed patients' characteristics, dietary habits, and lifestyle choices. Results: The findings revealed that patients who received lifestyle advice from physicians demonstrated increased compliance with the Mediterranean diet and a higher involvement in physical activity. Notably, they were also less likely to be non-smokers. Importantly, physicians' recommendations had a more pronounced association with adherence level to the Mediterranean diet compared to other lifestyle behaviors. Additionally, specific dietary components like cereal, legume, and red meat consumption were significantly associated with physicians' guidance. Conclusions: This study highlights the complex relationship between patients' cardiometabolic health, lifestyle decisions, and healthcare professionals' guidance. The substantial influence of physicians on Mediterranean diet adherence underscores the necessity for a multidisciplinary healthcare approach. Collaborative efforts involving physicians, dietitians, and fitness experts can offer comprehensive support to patients in navigating the intricate landscape of cardiometabolic health.
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Affiliation(s)
- Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Vasiliki Belitsi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Vasiliki Kalantzi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Fotini Bonoti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
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Valenzuela-Vallejo L, Chrysafi P, Kouvari M, Guatibonza-Garcia V, Mylonakis SC, Katsarou A, Verrastro O, Markakis G, Eslam M, Papatheodoridis G, Mingrone G, George J, Mantzoros CS. Circulating hormones in biopsy-proven steatotic liver disease and steatohepatitis: A Multicenter Observational Study. Metabolism 2023; 148:155694. [PMID: 37757973 DOI: 10.1016/j.metabol.2023.155694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The role of metabolic/inflammatory hormonal systems in metabolic dysfunction associated steatotic liver disease (MASLD) remains to be fully elucidated. PURPOSE To report the levels of the novel total and H-specific growth differentiation factor-15 (GDF-15) and other established hormonal systems and to describe hormonal patterns in controls and patients with MASLD and its stages. METHODS This is a multicenter study from two Gastroenterology-Hepatology Departments (Greece and Australia) and one Bariatric-Metabolic Surgery Department (Italy). Overall, n = 455 serum samples of patients with biopsy-proven MASLD (n = 374) and Controls (n = 81) were recruited. RESULTS We report for the first time that total and H-specific GDF-15 levels are higher in MASLD, at-risk metabolic dysfunction associated steatohepatitis (MASH), and severe fibrosis than in Controls. In addition, follistatin-like-3 (FSTL-3), free insulin-like growth factor-1 (IGF-1), leptin, and insulin levels were higher in MASLD patients than in Controls, while adiponectin levels were lower in MASLD subjects than in Controls. Activin-A, follistatin (FST), FSTL-3, and insulin levels significantly increased in severe fibrosis compared to no/mild fibrosis, while free IGF-1 decreased. In addition, adiponectin levels were lower in subjects without fibrosis vs. any fibrosis. Moreover, GDF-15 presented a strong positive association for the likelihood of having MASLD and at-risk MASH, while in adjusted analyses, FST and adiponectin showed inverse associations. Two different patterns of at-risk MASH were revealed through unsupervised analysis (total variation explained=54%). The most frequent pattern met in our sample (34.3%) was characterized by higher levels of total and H-specific GDF-15, follistatins, and activins, as well as low adiponectin levels. The second pattern revealed was characterized by high levels of free IGF-1, insulin, and leptin, with low levels of activin-A and adiponectin. Similar patterns were also generated in the case of overall MASLD. CONCLUSIONS Total and H-specific GDF-15 levels increase as MASLD severity progresses. FSTL-3, free IGF-1, leptin, and insulin are also higher, whereas adiponectin and activin-A levels are lower in the MASLD group than in Controls. Hormonal systems, including GDF-15, may not only be involved in the pathophysiology but could also prove useful for the diagnostic workup of MASLD and its stages and may potentially be of therapeutic value.
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Affiliation(s)
- Laura Valenzuela-Vallejo
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Pavlina Chrysafi
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Matina Kouvari
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Valentina Guatibonza-Garcia
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Sophia C Mylonakis
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Angeliki Katsarou
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Ornella Verrastro
- Department of Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgios Markakis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Geltrude Mingrone
- Department of Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
| | - Christos S Mantzoros
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America; Department of Medicine, Boston VA Healthcare System, Boston, MA 02130, United States of America
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Damigou E, Kouvari M, Chrysohoou C, Barkas F, Kravvariti E, Dalmyras D, Koutsogianni AD, Tsioufis C, Pitsavos C, Liberopoulos E, Sfikakis PP, Panagiotakos D. Diet Quality and Consumption of Healthy and Unhealthy Foods Measured via the Global Diet Quality Score in Relation to Cardiometabolic Outcomes in Apparently Healthy Adults from the Mediterranean Region: The ATTICA Epidemiological Cohort Study (2002-2022). Nutrients 2023; 15:4428. [PMID: 37892503 PMCID: PMC10610374 DOI: 10.3390/nu15204428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The Global Diet Quality Score (GDQS) is a novel food-based score that assesses both nutrient adequacy and chronic disease risk, by evaluating healthy (GDQS+) and unhealthy foods (GDQS-). The aim of this study was to evaluate the association among GDQS, GDQS+, and GDQS- against the 20-year risk of cardiometabolic outcomes in a Mediterranean population. The sample was n = 2169 initially free of cardiovascular disease (CVD) participants of the ATTICA study (2002-2022) that participated in the 20-year follow-up. The incidence of CVD, hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM) was defined according to WHO-ICD-10 criteria. The GDQS was computed based on previously published instructions. In multivariate analyses, a higher diet quality, per 1/49 of the GDQS, was associated with an 8% [95% Confidence Interval-CI: 6-9%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. A higher consumption of healthy foods, per 1/32 of GDQS+, was associated with a 9% [95% CI: 7-11%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. Contrarily, a lower consumption of unhealthy foods (GDQS-) was not associated with cardiometabolic events in the adjusted models (all p value< 0.05). In clinical practice or future public health actions to ameliorate dietary habits and prevent CVD and T2DM, more attention should be focused on healthy foods that should be included in our diets.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Dimitrios Dalmyras
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Amalia D. Koutsogianni
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
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Carmichael C, Schiffler T, Smith L, Moudatsou M, Tabaki I, Doñate-Martínez A, Alhambra-Borrás T, Kouvari M, Karnaki P, Gil-Salmeron A, Grabovac I. Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study. Int J Equity Health 2023; 22:206. [PMID: 37803317 PMCID: PMC10559410 DOI: 10.1186/s12939-023-02011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. METHODS We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. RESULTS Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. CONCLUSIONS The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. TRIAL REGISTRATION This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.
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Affiliation(s)
- Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
- School of Psychology, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
| | - Maria Moudatsou
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ioanna Tabaki
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ascensión Doñate-Martínez
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Tamara Alhambra-Borrás
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Matina Kouvari
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Pania Karnaki
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Linton Road, Oxford, OX2 6UD, UK
- International University of Valencia, Calle del Pintor Sorolla, 21, Valencia, 46002, Spain
| | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
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Kouvari M, Valenzuela-Vallejo L, Guatibonza-Garcia V, Polyzos SA, Deng Y, Kokkorakis M, Agraz M, Mylonakis SC, Katsarou A, Verrastro O, Markakis G, Eslam M, Papatheodoridis G, George J, Mingrone G, Mantzoros CS. Liver biopsy-based validation, confirmation and comparison of the diagnostic performance of established and novel non-invasive steatotic liver disease indexes: Results from a large multi-center study. Metabolism 2023; 147:155666. [PMID: 37527759 DOI: 10.1016/j.metabol.2023.155666] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Non-invasive tools (NIT) for metabolic-dysfunction associated liver disease (MASLD) screening or diagnosis need to be thoroughly validated using liver biopsies. PURPOSE To externally validate NITs designed to differentiate the presence or absence of liver steatosis as well as more advanced disease stages, to confirm fully validated indexes (n = 7 NITs), to fully validate partially validated indexes (n = 5 NITs), and to validate for the first time one new index (n = 1 NIT). METHODS This is a multi-center study from two Gastroenterology-Hepatology Departments (Greece and Australia) and one Bariatric-Metabolic Surgery Department (Italy). Overall, n = 455 serum samples of patients with biopsy-proven MASLD (n = 374, including 237 patients with metabolic-dysfunction associated steatohepatitis (MASH)) and Controls (n = 81) were recruited. A complete validation analysis was performed to differentiate the presence of MASLD vs. Controls, MASH vs. metabolic-dysfunction associated steatotic liver (MASL), histological features of MASH, and fibrosis stages. RESULTS The index of NASH (ION) demonstrated the highest differentiation ability for the presence of MASLD vs. Controls, with the area under the curve (AUC) being 0.894. For specific histological characterization of MASH, no NIT demonstrated adequate performance, while in the case of specific features of MASH, such as hepatocellular ballooning and lobular inflammation, ION demonstrated the best performance with AUC being close to or above 0.850. For fibrosis (F) classification, the highest AUC was reached by the aspartate aminotransferase to platelet ratio index (APRI) being ~0.850 yet only with the potential to differentiate the severe fibrosis stages (F3, F4) vs. mild or moderate fibrosis (F0-2) with an AUC > 0.900 in patients without T2DM. When we excluded patients with morbid obesity, the differentiation ability of APRI was improved, reaching AUC = 0.802 for differentiating the presence of fibrosis F2-4 vs. F0-1. The recommended by current guidelines index FIB-4 seemed to differentiate adequately between severe (i.e., F3-4) and mild or moderate fibrosis (F0-2) with an AUC = 0.820, yet this was not the case when FIB-4 was used to classify patients with fibrosis F2-4 vs. F0-1. Trying to improve the predictive value of all NITs, using Youden's methodology, to optimize the suggested cut-off points did not materially improve the results. CONCLUSIONS The validation of currently available NITs using biopsy-proven samples provides new evidence for their ability to differentiate between specific disease stages, histological features, and, most importantly, fibrosis grading. The overall performance of the examined NITs needs to be further improved for applications in the clinic.
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Affiliation(s)
- Matina Kouvari
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Laura Valenzuela-Vallejo
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Valentina Guatibonza-Garcia
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Stergios A Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Yixiang Deng
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Michail Kokkorakis
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Melih Agraz
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Sophia C Mylonakis
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Angeliki Katsarou
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Ornella Verrastro
- Department of Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgios Markakis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
| | - Geltrude Mingrone
- Department of Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christos S Mantzoros
- Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America; Department of Medicine, Boston VA Healthcare System, Boston, MA 02130, United States of America
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Belitsi V, Tsiampalis T, Kouvari M, Kalantzi V, Androutsos O, Bonoti F, Panagiotakos DB, Kosti RI. Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study. Life (Basel) 2023; 13:1880. [PMID: 37763284 PMCID: PMC10532979 DOI: 10.3390/life13091880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece. METHODS Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment. RESULTS Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91). CONCLUSION The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.
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Affiliation(s)
- Vasiliki Belitsi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Vasiliki Kalantzi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Fotini Bonoti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece; (V.B.); (T.T.); (V.K.); (O.A.); (F.B.)
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Kouvari M, Mylonakis SC, Katsarou A, Valenzuela-Vallejo L, Guatibonza-Garcia V, Kokkorakis M, Verrastro O, Angelini G, Markakis G, Eslam M, George J, Papatheodoridis G, Mingrone G, Mantzoros CS. The first external validation of the Dallas steatosis index in biopsy-proven Non-alcoholic fatty liver Disease: A multicenter study. Diabetes Res Clin Pract 2023; 203:110870. [PMID: 37567510 DOI: 10.1016/j.diabres.2023.110870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
AIMS A new non-invasive tool (NIT) for non-alcoholic fatty liver disease (NAFLD) proposed in 2022 by the multi-ethnic Dallas Heart Study, i.e. the Dallas Steatosis Index (DSI), was validated herein using for the first time the gold standard i.e. liver biopsy-proven NAFLD. METHODS This is a multicenter study based on samples and data from two Gastroenterology-Hepatology Clinics (Greece and Australia) and one Bariatric-Metabolic Surgery Clinic (Italy). Overall, n = 455 patients with biopsy-proven NAFLD (n = 374) and biopsy-proven controls (n = 81) were recruited. RESULTS The ability of DSI to correctly classify participants as NAFLD or controls was very good, reaching an Area Under the Curve (AUC) = 0.887. The cut-off point that could best differentiate the presence vs. absence of NAFLD corresponded to DSI = 0.0 (risk threshold: 50% | Sensitivity: 0.88; Positive Predictive Value (PPV): 93.0%; F1-score = 0.91). DSI demonstrated significantly better performance characteristics than other liver steatosis indexes. Decision curve analysis revealed that the benefit of DSI as a marker to indicate the need for invasive liver assessment was confirmed only when higher DSI values, i.e. ≥ 1.4, were used as risk thresholds. DSI performance to differentiate disease progression was inadequate (all AUCs < 0.700). CONCLUSIONS DSI is more useful for disease screening (NAFLD vs. controls) than to differentiate diseases stages or progression. The value of any inclusion of DSI to guidelines needs to be further studied.
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Affiliation(s)
- Matina Kouvari
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sophia C Mylonakis
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Angeliki Katsarou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laura Valenzuela-Vallejo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Michail Kokkorakis
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Georgios Markakis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | | | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Medicine, Boston VA Healthcare System, Boston, MA, USA.
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12
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Stefanakis K, Kokkinos A, Argyrakopoulou G, Konstantinidou SK, Simati S, Kouvari M, Kumar A, Kalra B, Kumar M, Bontozoglou N, Kyriakopoulou K, Mantzoros CS. Circulating levels of proglucagon-derived peptides are differentially regulated by the glucagon-like peptide-1 agonist liraglutide and the centrally acting naltrexone/bupropion and can predict future weight loss and metabolic improvements: A 6-month long interventional study. Diabetes Obes Metab 2023; 25:2561-2574. [PMID: 37246799 PMCID: PMC10524619 DOI: 10.1111/dom.15141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
AIM To investigate the changes of circulating levels of all proglucagon-derived peptides (PGDPs) in individuals with overweight or obesity receiving liraglutide (3 mg) or naltrexone/bupropion (32/360 mg), and to explore the association between induced changes in postprandial PGDP levels and body composition, as well as metabolic variables, after 3 and 6 months on treatment. MATERIALS AND METHODS Seventeen patients with obesity or with overweight and co-morbidities, but without diabetes, were assigned to receive once-daily oral naltrexone/bupropion 32/360 mg (n = 8) or once-daily subcutaneous liraglutide 3 mg (n = 9). Participants were assessed before treatment initiation and after 3 and 6 months on treatment. At the baseline and 3-month visits, participants underwent a 3-hour mixed meal tolerance test to measure fasting and postprandial levels of PGDPs, C-peptide, hunger and satiety. Clinical and biochemical indices of metabolic function, magnetic resonance-assessed liver steatosis and ultrasound-assessed liver stiffness were measured at each visit. RESULTS Both medications improved body weight and composition, carbohydrate and lipid metabolism, and liver fat and function. Naltrexone/bupropion produced a weight-independent increase in the levels of proglucagon (P < .001) and decreases in glucagon-like peptide-2 (GLP-2), glucagon and the major proglucagon fragment (P ≤ .01), whereas liraglutide markedly upregulated total glucagon-like peptide-1 (GLP-1) levels in a weight-independent manner (P = .04), and similarly downregulated the major proglucagon fragment, GLP-2 and glucagon (P < .01). PGDP levels at the 3-month visit were positively and independently correlated with improvements in fat mass, glycaemia, lipaemia and liver function, and negatively with reductions in fat-free mass, at both the 3- and 6-month visits. CONCLUSIONS PGDP levels in response to liraglutide and naltrexone/bupropion are associated with improvements in metabolism. Our study provides support for the administration of the downregulated members of the PGDP family as replacement therapy (e.g. glucagon), in addition to the medications currently in use that induced their downregulation (e.g. GLP-1), and future studies should explore whether the addition of other PGDPs (e.g. GLP-2) could offer additional benefits.
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Affiliation(s)
- Konstantinos Stefanakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Sofia K Konstantinidou
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- Diabetes and Obesity Unit, Athens Medical Center, Athens, Greece
| | - Stamatia Simati
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Matina Kouvari
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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13
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Schiffler T, Carmichael C, Smith L, Doñate-Martínez A, Alhambra-Borrás T, Varadé MR, Barrio Cortes J, Kouvari M, Karnaki P, Moudatsou M, Tabaki I, Gil-Salmeron A, Grabovac I. Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study. EClinicalMedicine 2023; 62:102095. [PMID: 37533422 PMCID: PMC10393536 DOI: 10.1016/j.eclinm.2023.102095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality-outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population. Methods In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach. Findings Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified. Interpretation Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context. Funding This study received funding from the European Union's Horizon 2020 Research and Innovation Programme under GA 965351.
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Affiliation(s)
- Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
| | - Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | | | | | - Miguel Rico Varadé
- General Directorate of Social Services, Council of Family, Youth and Social Policy, Community of Madrid, Madrid, Spain
| | - Jaime Barrio Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain
| | - Matina Kouvari
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Athens, Greece
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Athens, Greece
| | - Maria Moudatsou
- PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Athens, Greece
| | - Ioanna Tabaki
- PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Athens, Greece
| | | | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
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Stefanakis K, Kokkinos A, Simati S, Argyrakopoulou G, Konstantinidou SK, Kouvari M, Kumar A, Kalra B, Mantzoros CS. Circulating levels of all proglucagon-derived peptides are differentially regulated postprandially by obesity status and in response to high-fat meals vs. high-carbohydrate meals. Clin Nutr 2023; 42:1369-1378. [PMID: 37418844 DOI: 10.1016/j.clnu.2023.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND & AIMS We measured all proglucagon-derived peptides (PGDPs) levels in response to administration of three mixed meal tolerance tests (MMTs), examining differences in postprandial PGDP responses in subjects with leanness and obesity or between high-fat vs. high carbohydrate meals. METHODS We designed three physiology interventional studies, administering MMTs over a 180-min period to individuals without diabetes after an overnight fast. In Study 1, a 450 kcal MMT was administered to n = 4 normal weight and n = 9 individuals with obesity. In Study 2, a 600 kcal high-fat MMT was administered to n = 15 normal-weight and n = 15 individuals with obesity. In Study 3, n = 32 participants with obesity were assigned to receive a 600-kcal high-fat (n = 15) or an isocaloric high-carbohydrate MMT (n = 17). Fasting and postprandial levels of c-peptide and PGDPs (proglucagon, GLP-1, GLP-2, glicentin, oxyntomodulin, glucagon, major proglucagon fragment [MPGF]) were assessed. RESULTS In study 1, individuals with normal weight displayed elevated glicentin postprandial secretion compared with people with obesity (p = 0.002). Following a high-fat MMT with 33% higher energy content in study 2, all postprandial PGDPs levels were elevated (p-time<0.001), irrespective of weight status. In study 3, a prolonged postprandial upregulation of PGDPs during the high-fat MMT was observed in contrast with the acute, short-term (max 60 min) PGDP responses to a high-carbohydrate MMT (p-time∗meal<0.001). Across both studies 2 and 3, the postprandial responses of glucagon and MPGF were higher in subjects with male sex whereas glicentin was higher in subjects with female sex. CONCLUSIONS Fat and carbohydrate content of a meal can substantially affect the postprandial levels of PGDPs. Circulating levels of PGDPs are influenced by the energy content of the meal, and additionally, the presence of leanness or obesity affects circulating levels of select PGDPs. These results, which are to be confirmed by additional studies, expand our understanding of PGDP physiology in leanness and obesity. CLINICALTRIALS GOV REGISTRATION NUMBERS: (NCT04170010, NCT04430946, NCT04575194).
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Affiliation(s)
- Konstantinos Stefanakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens 11527, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens 11527, Greece
| | - Stamatia Simati
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens 11527, Greece
| | | | - Sofia K Konstantinidou
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens 11527, Greece; Diabetes and Obesity Unit, Athens Medical Center, Athens 15125, Greece
| | - Matina Kouvari
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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15
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Kouvari M, Diamantis DV, Katsas K, Radaios V, Veloudaki A, Linos A. Nutritional Value of Meals Designed for a School-Based Food Aid Program and Comparison with Similar Commercial Products: An Example of Good Practice from the DIATROFI Program. Children (Basel) 2023; 10:1268. [PMID: 37508765 PMCID: PMC10378201 DOI: 10.3390/children10071268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Providing meals of high nutritional value should be the principal objective of large-scale school-based food aid programs. This study aimed at highlighting the nutritional value of meals distributed in the school-based food assistance DIATROFI Program by comparing them to their commercially available counterparts. For the purpose of this study, n = 13 DIATROFI meals and n = 50 commercial products from the 2016-2017 school year, and n = 12 DIATROFI meals and n = 40 commercial products from the 2022-2023 school year were selected. The protein, carbohydrate, total sugar, dietary fiber, total fat, sodium/salt content, and fatty acid methyl ester profile of DIATROFI meals were estimated through recipe simulation and national/international food databases, and verified through laboratory analyses while the relevant information was extracted from the label for commercial products. As verified by laboratory analyses and in comparison with food labels, most DIATROFI meals had lower total fat, saturated fatty acid, and sugar content, and most had higher dietary fiber content during both years. Many recipes' nutrient profiles also improved over time. DIATROFI meals present significant advantages over available commercial products. Such tailored-made school meals can prove to be advantageous in terms of nutrition profile compared to commercially available, which have yet to be impacted by food reformulation.
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Affiliation(s)
- Matina Kouvari
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athen, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Dimitrios V Diamantis
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Konstantinos Katsas
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vasiliki Radaios
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Afroditi Veloudaki
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Athena Linos
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
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16
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Androutsos O, Tsiampalis T, Kouvari M, Manou M, Dimopoulou M, Georgiou A, Kosti RI, Charmandari E. Assessment of Diet Quality in Children and Adolescents with Overweight or Obesity in Greece. Children (Basel) 2023; 10:1261. [PMID: 37508758 PMCID: PMC10378587 DOI: 10.3390/children10071261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
The adoption of healthy nutritional habits constitutes one of the most important determinants of healthy growth and development in childhood. Few studies in Greece have examined children's diet quality using diet indices. The present study aimed to assess the diet quality of a large cohort of children and adolescents with overweight or obesity. Study participants (n = 1335), aged 2-18, were recruited through the Out-patient Clinic for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence, Aghia Sophia Children's Hospital, Athens, Greece. Anthropometric, socio-demographic, and behavioral data were collected using standard methods and equipment. The Diet Quality Index (DQI), which includes four subcomponents (i.e., dietary diversity, dietary quality, dietary equilibrium, and meal index), was calculated to assess each subject's diet quality. According to the results of this study, children's total DQI score was 63.1%. It was observed that 66.7% of the children had at least moderate diet quality (total DQI ≥ 59.34%). Boys had higher values of the total DQI and certain components of the DQI (i.e., dietary equilibrium score and meal index) compared to girls. Three out of ten children with overweight/obesity had poor diet quality (i.e., DQI ≤ 59.33). Younger children (2-5 years old) were found to have the lowest values of dietary equilibrium compared to older children (6-9 and 12-18 years old). Moreover, boys had higher values of the total DQI score and of specific components of this index (i.e., dietary equilibrium and meal index) compared to girls. Children living in urban areas had higher values in the dietary quality score compared to those living in rural areas. Children with overweight had higher values of the dietary quality score and the total DQI score compared to children with obesity. The present study highlighted that children and adolescents with overweight or obesity have poor diet quality. Multilevel and higher intensity interventions should be designed specifically for this group to achieve tangible outcomes.
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Affiliation(s)
- Odysseas Androutsos
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Thomas Tsiampalis
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Canberra, ACT 2617, Australia
| | - Maria Manou
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527 Athens, Greece
| | - Maria Dimopoulou
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Alexandra Georgiou
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527 Athens, Greece
| | - Rena I Kosti
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527 Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
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17
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Kouvari M, Sergi D, Zec M, Naumovski N. Editorial: Nutrition in prevention and management of non-alcoholic fatty liver disease. Front Nutr 2023; 10:1212363. [PMID: 37521411 PMCID: PMC10374431 DOI: 10.3389/fnut.2023.1212363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Matina Kouvari
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT, Australia
| | - Domenico Sergi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Manja Zec
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ, United States
| | - Nenad Naumovski
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT, Australia
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18
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Damigou E, Kouvari M, Panagiotakos D. The role of skeletal muscle mass on cardiovascular disease risk: an emerging role on modulating lipid profile. Curr Opin Cardiol 2023; 38:352-357. [PMID: 36928171 DOI: 10.1097/hco.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to present updated evidence on the role of skeletal muscle mass on cardiometabolic health. RECENT FINDINGS Increased lean, and especially skeletal, muscle mass has been associated with better cardiometabolic health in various epidemiological studies, even in younger age groups. In addition, the link between skeletal muscle mass and adult lipid profile is of interest. A preliminary analysis using the data from the ATTICA prospective cohort study (2002-2022) supports this association. SUMMARY Skeletal muscle mass has many metabolic functions (i.e., glucose, insulin and protein metabolism, mitochondrial function, arterial stiffness, inflammation, oxidative stress, brain function, hormone status). Given its associations with the lipid profile and overall cardiometabolic risk, skeletal muscle mass stands among the emerging risk factors for cardiovascular diseases. In addition to only using body mass index or fat distribution, more studies should evaluate lean mass and its prognostic and predictive ability regarding chronic diseases.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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19
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Damigou E, Kouvari M, Chrysohoou C, Barkas F, Kravvariti E, Pitsavos C, Skoumas J, Michelis E, Liberopoulos E, Tsioufis C, Sfikakis PP, Panagiotakos DB. Lifestyle Trajectories Are Associated with Incidence of Cardiovascular Disease: Highlights from the ATTICA Epidemiological Cohort Study (2002-2022). Life (Basel) 2023; 13:life13051142. [PMID: 37240787 DOI: 10.3390/life13051142] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to assess the trajectories of lifestyle characteristics and their association with 20-year cardiovascular disease (CVD) incidence. In 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants; of those, 1988 had complete data for CVD. The 20-year CVD incidence was 3600 cases/10,000 individuals; the man-to-woman ratio was 1.25, with the peak difference in the 35-45 age group (i.e., 2.1); however, a reversal of the trend was observed in the age-groups 55-65 and 65-75, with a resumption of an almost equal incidence in those >75 years. In multi-adjusted analysis, age, sex, abnormal waist circumference, hypercholesterolemia, hypertension, and diabetes were positively associated with 20-year CVD risk, explaining 56% of the excess CVD risk, whereas an additional 30% was attributed to lifestyle trajectories; being physically active throughout life-course and being close to the Mediterranean diet were protective, while continuous smoking was detrimental against CVD risk. Mediterranean diet adherence protected against CVD development even if not sustained, while quitting smoking or engaging in physical activities during the 20-year observation did not offer any significant protection. A life-course personalized approach that is cost-effective and long-term sustained is needed to prevent CVD burden.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Fotios Barkas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - John Skoumas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelinos Michelis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
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20
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Diamantis DV, Katsas K, Kalogiannis D, Kouvari M, Linos A. Health-Related Quality of Life in Childhood and Adolescence: The Interrelation with Level of Adherence to Mediterranean Diet and Dietary Trajectories: Highlights from the DIATROFI Program (2021-2022). Nutrients 2023; 15:nu15081829. [PMID: 37111048 PMCID: PMC10142042 DOI: 10.3390/nu15081829] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Children's dietary habits can have a key role in contributing to an improvement in their Health-Related Quality of Life (HRQoL). This study aims to assess the connection between Mediterranean diet adherence and HRQoL in a sample of Greek students, utilizing data from the DIATROFI program. The parents of 3774 students (mean age 7.8 (2.6) years) reported their children's HRQoL and level of adherence to the Mediterranean dietary pattern at the beginning and end of the 2021-2022 school year. At baseline, most students' adherence was characterized as moderate (55.2%) or high (25.1%). Students with moderate or high adherence tο the Mediterranean diet were less likely to report a total HRQoL below the median at baseline (OR = 0.56, 95%CI = 0.44, 0.70), along with all its dimensions (physical, emotional, social, and school functions). A one-unit improvement in KIDMED score (beginning-end of schoolyear) was associated with the likelihood of an improvement in total HRQoL (beginning-end of schoolyear) (OR = 1.09, 95%CI = 1.02, 1.17), emotional (OR = 1.09, 95%CI = 1.02, 1.17), and social functions (OR = 1.13, 95%CI = 1.05, 1.22), but not with physical and school functions. The health benefits of the Mediterranean diet in children may not be limited to disease prevention but also extend to their overall wellbeing.
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Affiliation(s)
- Dimitrios V Diamantis
- Institute of Preventive Medicine Environmental and Occupational Health PROLEPSIS, 15121 Athens, Greece
| | - Konstantinos Katsas
- Institute of Preventive Medicine Environmental and Occupational Health PROLEPSIS, 15121 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Kalogiannis
- Institute of Preventive Medicine Environmental and Occupational Health PROLEPSIS, 15121 Athens, Greece
| | - Matina Kouvari
- Institute of Preventive Medicine Environmental and Occupational Health PROLEPSIS, 15121 Athens, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Athena Linos
- Institute of Preventive Medicine Environmental and Occupational Health PROLEPSIS, 15121 Athens, Greece
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21
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Diamantis DV, Katsas K, Kastorini CM, Mugford L, Dalma N, Ramizi M, Papapanagiotou O, Veloudaki A, Linos A, Kouvari M. Older People in Emergencies; Addressing Food Insecurity, Health Status and Quality of Life: Evaluating the "365+ Days of Care" Program. Int J Environ Res Public Health 2023; 20:5235. [PMID: 37047851 PMCID: PMC10094139 DOI: 10.3390/ijerph20075235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
During emergencies, older adults stand among the most vulnerable, facing long-lasting food insecurity and overall health issues. The "365+ Days of Care" food aid program addressed food insecurity and poor quality of life among vulnerable older adults following a devastating wildfire in Greece. Our aim was to evaluate the program's efficiency, using a process evaluation framework and a partial cost-utility analysis. In total, n = 133 wildfire-hit residents (≥65 years) received daily tailored, pre-cooked meals and/or weekly food packages. The study outcomes were assessed from baseline to 12 months later. Focus groups and interviews (n = 30), researcher observations, and questionnaires were used to assess the beneficiaries' perception of the initiative. Within the 12-month follow-up period, food insecurity and malnutrition risk decreased, whereas Mediterranean diet adherence; quality of life; and physical, social, and mental health were improved (p < 0.05). A one-point increase in food insecurity was positively associated with improved quality of life, general health, limitation in activities, body pain, vitality, and pain/discomfort (p's < 0.05), and it was marginally associated with mobility, anxiety/depression, and self-evaluated health status (p's < 0.1). Quantitative and qualitative data characterized it as successful, acceptable, beneficial, and of high quality. The partial cost-utility ratio was one QALY gained per EUR 22.608. The utilization of well-designed food aid programs during emergencies can alleviate food insecurity and improve quality of life in older adults.
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Affiliation(s)
- Dimitrios V. Diamantis
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Konstantinos Katsas
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christina Maria Kastorini
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Lyndsey Mugford
- Department of History of Science, Faculty of Arts and Sciences, Harvard College, Cambridge, MA 02138, USA
| | - Nadia Dalma
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Marsellos Ramizi
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Ourania Papapanagiotou
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Afroditi Veloudaki
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Athena Linos
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
| | - Matina Kouvari
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece; (D.V.D.); (K.K.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
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22
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Kouvari M, M. D’Cunha N, Tsiampalis T, Zec M, Sergi D, Travica N, Marx W, McKune AJ, Panagiotakos DB, Naumovski N. Metabolically Healthy Overweight and Obesity, Transition to Metabolically Unhealthy Status and Cognitive Function: Results from the Framingham Offspring Study. Nutrients 2023; 15:nu15051289. [PMID: 36904288 PMCID: PMC10004783 DOI: 10.3390/nu15051289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
AIMS To evaluate the association between metabolically healthy overweight/obesity (MHO) status and longitudinal cognitive function while also considering the stability of the condition. METHODS In total, 2892 participants (mean age 60.7 (9.4) years) from Framingham Offspring Study completed health assessments every four years since 1971. Neuropsychological testing was repeated every four years starting from 1999 (Exam 7) to 2014 (Exam 9) (mean follow-up: 12.9 (3.5) years). Standardized neuropsychological tests were constructed into three factor scores (general cognitive performance, memory, processing speed/executive function). Healthy metabolic status was defined as the absence of all NCEP ATP III (2005) criteria (excluding waist circumference). MHO participants who scored positively for one or more of NCEP ATPIII parameters in the follow-up period were defined as unresilient MHO. RESULTS No significant difference on the change in cognitive function over time was observed between MHO and metabolically healthy normal weight (MHN) individuals (all p > 0.05). However, a lower processing speed/executive functioning scale score was observed in unresilient MHO participants compared to resilient MHO participants (β = -0.76; 95% CI = -1.44, -0.08; p = 0.030). CONCLUSIONS Retaining a healthy metabolic status over time represents a more important discriminant in shaping cognitive function compared to body weight alone.
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Affiliation(s)
- Matina Kouvari
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT 2617, Australia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Kallithea, Attica, Greece
| | - Nathan M. D’Cunha
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT 2617, Australia
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Kallithea, Attica, Greece
| | - Manja Zec
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ 85721, USA
| | - Domenico Sergi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Nikolaj Travica
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine (IMPACT), Deakin University, Barwon Health, Geelong, VIC 3220, Australia
| | - Wolfgang Marx
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine (IMPACT), Deakin University, Barwon Health, Geelong, VIC 3220, Australia
| | - Andrew J. McKune
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT 2617, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2601, Australia
- Discipline of Biokinetics, Exercise, and Leisure Sciences, School of Health Sciences, University of KwaZulu Natal, Durban 4000, South Africa
| | - Demosthenes B. Panagiotakos
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT 2617, Australia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Kallithea, Attica, Greece
| | - Nenad Naumovski
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT 2617, Australia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Kallithea, Attica, Greece
- Correspondence:
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23
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Kosti RI, Tsiampalis T, Kouvari M, Chrysohoou C, Georgousopoulou E, Pitsavos CS, Panagiotakos DB. The association of specific types of vegetables consumption with 10-year type II diabetes risk: Findings from the ATTICA cohort study. J Hum Nutr Diet 2023; 36:226-240. [PMID: 35770418 DOI: 10.1111/jhn.13056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The present study aimed to investigate the association between vegetable consumption, in total as well as per type/category, and 10-year type-2 diabetes mellitus (T2DM) incidence. METHODS The ATTICA study was conducted during 2001-2012 in 3042 apparently healthy adults living in Athens area, Greece. A detailed biochemical, clinical, and lifestyle evaluation was performed; vegetable consumption (total, per type) was evaluated through a validated semi-quantitative food frequency questionnaire. After excluding those with no complete information of diabetes status or those lost at the 10-year follow-up, data from 1485 participants were used for the current analysis. RESULTS After adjusting for several participants' characteristics, including overall dietary habits, it was observed that participants consuming at least 4 servings/day of vegetables had a 0.42-times lower risk of developing T2DM (hazard ratio [HR] = 0.42; 95% confidence interval [CI] = 0.29-0.61); the benefits of consumption were greater in women (HR = 0.29; 95% CI = 0.16-0.53) compared to men (HR = 0.56; 95% CI = 0.34-0.92). Only 33% of the sample consumed vegetables 4 servings/day. The most significant associations were observed for allium vegetables in women and for red/orange/yellow vegetables, as well as for legumes in men. CONCLUSIONS The intake of at least 4 servings/day of vegetables was associated with a considerably reduced risk of T2DM, independently of other dietary habits; underlying the need for further elaboration of current dietary recommendations at the population level.
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Affiliation(s)
- Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.,First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Medical School, Australian National University, Canberra, ACT, Australia
| | - Christos S Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, ACT, Australia
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Diamantis DV, Stavropoulou I, Katsas K, Mugford L, Linos A, Kouvari M. Assessing Quality of Life in First- and Second-Generation Immigrant Children and Adolescents; Highlights from the DIATROFI Food Aid and Healthy Nutrition Promotion Program. Int J Environ Res Public Health 2023; 20:ijerph20032471. [PMID: 36767854 PMCID: PMC9915206 DOI: 10.3390/ijerph20032471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 05/14/2023]
Abstract
To compare first- and second-immigrant pediatric populations with a non-immigrant pediatric population in terms of quality-of-life metrics, a cross-sectional analysis using data from the DIATROFI Program was implemented. In total, n = 2277 students (mean age: 9(4) years) from public schools in Greece participating in the 2020-2021 school year were analyzed. The students' immigration status (first-generation/second-generation) was defined as per the standard definition. The students' health related-quality of life (HRQoL) was assessed using a parental-perceived quality of life questionnaire. The sample included 4.8% first-generation and 21.2% second-generation immigrant students. Compared with non-immigrants, the first-generation immigrant students were more likely to have poor HRQoL (odds ratio (OR) = 2.82; 95% confidence interval (95%CI) = 11.75, 4.53), physical (OR = 1.91; 95%CI = 1.18, 3.10), social (OR = 1.94; 95%CI = 1.16, 3.22) and school function (OR = 2.52; 95%CI = 1.54, 4.13). Similar results were observed for second-generation immigrant students regarding HRQoL (OR = 1.68; 95%CI = 1.28, 2.21), physical (OR = 1.60; 95%CI = 1.23, 2.10) and school function (OR = 2.09; 95%CI = 1.58, 2.77). Children with one parent having a country of origin different that the country of residence had elevated odds of having poor emotional health (OR = 1.19; 95%CI = 0.87, 1.64). The family's affluency level was interrelated with the connection of poor HRQoL and immigration status. The immigrant students have a poorer quality of life depending on their immigration generation and irrespective of their socioeconomic background.
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Affiliation(s)
- Dimitrios V. Diamantis
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece
| | - Iliana Stavropoulou
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece
| | - Konstantinos Katsas
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Lyndsey Mugford
- Department of History of Science, Faculty of Arts and Sciences, Harvard College, Cambridge, MA 02138, USA
| | - Athena Linos
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece
| | - Matina Kouvari
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15121 Athens, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
- Correspondence:
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25
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Kouvari M, Damigou E, Florentin M, Kosti RI, Chrysohoou C, Pitsavos CS, Panagiotakos DB. Egg Consumption, Cardiovascular Disease and Cardiometabolic Risk Factors: The Interaction with Saturated Fatty Acids. Results from the ATTICA Cohort Study (2002-2012). Nutrients 2022; 14:nu14245291. [PMID: 36558450 PMCID: PMC9783240 DOI: 10.3390/nu14245291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose: To examine the association of egg intake with 10-year risk of cardiovascular disease (CVD) and other cardiometabolic risk factors in a sample of individuals of Mediterranean origin. Methods: In 2001−2002, n = 1514 men and n = 1528 women (>18 years old) from the greater Athens area, Greece, were enrolled. Information on any egg intake, eaten as a whole, partly or in recipes was assessed via a validated semi-quantitative food frequency questionnaire. Follow-up for CVD evaluation (2011−2012) was achieved in n = 2020 participants (n = 317 CVD cases). Results: Ranking from lowest (<1 serving/week) to intermediate (1−4 servings/week) and high (4−7 servings/week) egg consumption tertiles, lower CVD incidence was observed (18%, 9% and 8%, respectively, p-for-trend = 0.004). Unadjusted analysis revealed that 1−3 eggs/week and 4−7 eggs/week were associated with a 60% and 75%, respectively, lower risk of developing CVD compared with the reference group (<1 egg/week). When adjusting for sociodemographic, lifestyle and clinical factors, significance was retained only for 1−3 eggs/week (hazard ratio (HR) = 0.53, 95% confidence interval (95% CI) = 0.28, 1.00). When total saturated fatty acid (SFA) intake was taken into account, this inverse association was non-significant. Multi-adjusted analysis revealed that in participants of low SFA intake, 1 serving/day increase in egg intake resulted in 45% lower risk of developing CVD. In the case of higher SFA consumption, only 1−3 eggs/week seemed to protect against CVD (HR = 0.25, 95% CI = 0.07, 0.86). In the case of intermediate cardiometabolic disorders, no significant trend was observed. Conclusions: Overall dietary habits principally in terms of SFA intake may be detrimental to define the role of eggs in cardiac health.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17272 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17272 Athens, Greece
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45221 Ioannina, Greece
- Correspondence: (M.F.); (D.B.P.)
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 38221 Trikala, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Christos S. Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17272 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Correspondence: (M.F.); (D.B.P.)
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26
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Mikhailidis DP, Kouvari M, Pangiotakos DB. Gout Flares and Intercritical Gout: Do they Play a Significant Role in Predicting Cardiovascular Events? Curr Vasc Pharmacol 2022; 20:463-464. [PMID: 36125817 DOI: 10.2174/1570161120666220920121448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Dimitri P Mikhailidis
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London Medical School, University College London (UCL), Department of Clinical Biochemistry, Royal Free Hospital Campus (UCL), London, WC1 6BT, UK
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT, 2601, Australia.,Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT, 2617, Australia
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27
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Schiffler T, Carmichael C, Gil-Salmeron A, Kouvari M, Karnaki P, Grabovac I. Barriers to access cancer prevention services for the homeless population in four European countries. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People experiencing homelessness (PEH) are known to have increased burden of cancer and higher cancer-related mortality when compared to the general population. These outcomes are linked to a variety of etiological factors, as well as the existence of significant barriers in accessing cancer prevention services. The aim of this study was to better understand current practices and knowledge relating to cancer prevention among PEH, health professionals and social care workers.
Methods
During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Data were collected in Austria, Greece, Spain and the UK through semi-structured interviews. Interviews were transcribed verbatim and thematically analyzed in accordance with the approach set out by Saldaña (2021).
Results
In total, 69 interviews were conducted with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Two overarching themes relating to the research question were identified, namely (a) experiences and understanding of cancer prevention and treatment, and (b) considerations for program intervention. While cancer was a major source of concern, tailored cancer prevention programs for the homeless population were described as effectively non-existent, and very few homeless participants recalled being invited to a screening appointment. Health professionals also indicated that because of barriers to health care, opportunities for the early diagnosis of cancer among PEH were often being missed.
Conclusions
The results indicate that PEH have limited knowledge around the importance of cancer prevention programs, and that more focused input on the part of health and social care services is required in this area. Culturally sensitive and person-centered approaches should be adopted to facilitate access to cancer prevention for PEH.
Key messages
• Specialized cancer prevention and health care pathways that take account of the living conditions and support needs of PEH should be established to improve health and cancer-related outcomes.
• Cancer prevention programs should focus on improving health literacy by using accessible and tailored approaches, both for PEH and those that work directly with the homeless population.
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Affiliation(s)
- T Schiffler
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna , Vienna, Austria
| | - C Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University , Cambridge, UK
| | - A Gil-Salmeron
- International Foundation for Integrated Care , Oxford, UK
| | - M Kouvari
- PROLEPSIS Institute , Athens, Greece
| | - P Karnaki
- PROLEPSIS Institute , Athens, Greece
| | - I Grabovac
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna , Vienna, Austria
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Schiffler T, Carmichael C, Lehner L, Gil-Salmeron A, Kouvari M, Karnaki P, Grabovac I. Barriers and facilitators to healthcare access for homeless people in four European countries. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People experiencing homelessness (PEH) have higher prevalence of adverse health outcomes and premature mortality compared to the general population, and often experience significant barriers in accessing healthcare services. This study aimed to better understand the health needs of PEH, as well as to identify the barriers and facilitators to their timely and equitable access to health services from the perspective of PEH and relevant health professionals and social care workers.
Methods
During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Semi-structured interviews were conducted across four European settings (Austria, Greece, Spain and the UK). Interviews were audio-recorded, transcribed verbatim and analyzed according to the inductive thematic approach set out by Saldaña (2021).
Results
In total, 69 interviews were completed with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Three overarching themes relating to the research question were identified: (a) Health needs of people experiencing homelessness; (b) Barriers to access healthcare services and (c) Facilitators to access healthcare services. Overall, the general health of PEH was depicted as extremely poor and mainstream health services were portrayed as ill-equipped to respond to the needs of this population, with many organizational and system-level barriers noted. Tailored approaches to care, and in particular involving trusted professionals in the delivery of care, were identified as a key strategy for overcoming existing barriers.
Conclusions
While a number of context-specific findings were identified, results indicated there to be a high degree of overlap and consistency in the health needs of PEH, and in the barriers and facilitators that exist when accessing healthcare across four different healthcare systems.
Key messages
• Homelessness is a determinant of health that is linked to poor health outcomes. Tailored approaches that draw upon trusting relationships have the potential to overcome this problem.
• The array of identified barriers indicates that general healthcare services are not currently structured in a way that facilitates timely and equitable access and appropriate care for PEH.
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Affiliation(s)
- T Schiffler
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna , Vienna, Austria
| | - C Carmichael
- Centre for Health, Performance, Wellbeing, Anglia Ruskin University , Cambridge, UK
| | - L Lehner
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna , Vienna, Austria
- Ambermed, Diakonie Refugee Services , Vienna, Austria
| | - A Gil-Salmeron
- International Foundation for Integrated Care , Oxford, UK
| | - M Kouvari
- PROLEPSIS Institute , Athens, Greece
| | - P Karnaki
- PROLEPSIS Institute , Athens, Greece
| | - I Grabovac
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna , Vienna, Austria
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29
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Kouvari M, Polyzos SA, Chrysohoou C, Skoumas J, Pitsavos C, Mantzoros C, Panagiotakos DB. Low muscle mass is linked with presence of non-alcoholic fatty liver disease irrespective to central obesity: highlights from a prospective epidemiological study in Greece. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The association between sarcopenia and nonalcoholic fatty liver (NAFL) is highlighted in recent epidemiological studies, although results remain inconsistent.
Purpose
This study aimed to examine the association of low skeletal muscle mass with NAFL as well as the potential mediating effect of waist circumference on the examined association.
Methods
At baseline, 3,042 participants from the Attica region of Greece were recruited. NAFL was assessed through hepatic steatosis index (HSI). Skeletal muscle mass index (SMI) was indirectly calculated using a standard validated procedure.
Results
Ranking from 1st to 3rd SMI tertiles NAFL rate was 45%, 33% and 22%, respectively (p<0.001). Multi-adjusted logistic regression analysis revealed that participants assigned in the 2nd (Odds Ratio (OR): 0.50, 95% Confidence Interval (95% CI): 0.41–0.61)) and 3rd SMI tertile had 50% and 76% (OR: 0.24, 95% CI: 0.19–0.29) lower likelihood to have NAFL compared with their 1st tertile counterparts. This association remained robust after multiple adjustments; however, significance was marginally lost, when waist circumference was added to the model. Subsequently, a multi-adjusted dose-response analysis between SMI and NAFL was performed in the total sample, as well as in the subcategories of normal and abnormal waist circumference. In the total sample, a significant inverse association between SMI and NAFL was observed [OR (per 2 points increase in SMI) = 0.94 (95% CI: 0.92–0.95); p=0.001]. When categorized by waist circumference, participants with moderate/high SMI and normal waist circumference had the lowest NAFL rates (24.3%). Those with low SMI and normal waist circumference and those with moderate/high SMI and abnormal waist circumference had similar rates of NAFL (47.4% and 50.3%, respectively; p=0.25). Participants with both low SMI and abnormal waist circumference presented the highest NAFL rate (60.5%), which was significantly higher compared with the rest subgroups (p<0.001). These findings were confirmed in multi-adjusted analysis to assess NAFL odds per case: participants with adnormal waist, [OR (per 2 points increase in SMI) = 0.97 (95% CI: 0.94–1.00)] vs. participants with normal waist [OR (per 2 points increase in SMI) = 0.89 (95% CI: 0.84–0.95)].
Conclusions
Increasing SMI was associated with lower rates of NAFL independently to abdominal obesity, whereas the two interact as key determinants of NAFL.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Hellenic Society of Cardiology
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Affiliation(s)
- M Kouvari
- Harokopio University , Athens , Greece
| | - S A Polyzos
- Aristotle University of Thessaloniki, Aristo , Thessaloniki , Greece
| | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - J Skoumas
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - C Mantzoros
- Beth Israel Deaconess Medical Center & Harvard Medical School , Boston , United States of America
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Mamalaki E, Poulimeneas D, Tsiampalis T, Kouvari M, Karipidou M, Bathrellou E, Collins CE, Panagiotakos DB, Yannakoulia M. The effectiveness of technology-based interventions for weight loss maintenance: A systematic review of randomized controlled trials with meta-analysis. Obes Rev 2022; 23:e13483. [PMID: 35686875 DOI: 10.1111/obr.13483] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze randomized controlled trials on the effects of technology-based interventions for maintenance of lost weight. METHODS A systematic literature search was performed to identify randomized controlled trials with at least one intervention arm delivered through the internet or mobile application, published in English until September 2021. Weight change at the end of the weight loss maintenance phase was considered the primary outcome. RESULTS Twelve manuscripts with 2941 adults were included in the review; 10 studies were meta-analyzed. Included interventions had a duration of 3-30 months and were tested compared with minimum interventions (no contact with the study staff or intervention with only a limited number of features) or in-person groups. Technology-based interventions resulted in similar weight regain when compared with minimum interventions (ES = -0.07 kg; 95% CI = [-0.57, 0.42]; p = 0.770). However, when compared with in-person interventions, technology-based interventions were found to lead in significantly higher weight regain (ES = 1.36 kg; 95% CI = [0.29, 2.43]; p = 0.010). CONCLUSION Web- and app-based interventions for weight loss maintenance produced similar results with minimum interventions and resulted in greater weight regain compared with in-person interventions. Appropriate interventions for weight loss maintenance provide benefits against weight regain, only when provided in-person.
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Affiliation(s)
- Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Melina Karipidou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Kallithea, Greece
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31
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Kouvari M, Tsiampalis T, Kosti RI, Naumovski N, Chrysohoou C, Skoumas J, Pitsavos CS, Panagiotakos DB, Mantzoros CS. Quality of plant-based diets is associated with liver steatosis, which predicts type 2 diabetes incidence ten years later: results from the ATTICA prospective epidemiological study. Clin Nutr 2022; 41:2094-2102. [DOI: 10.1016/j.clnu.2022.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
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32
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D’Cunha NM, Sergi D, Lane MM, Naumovski N, Gamage E, Rajendran A, Kouvari M, Gauci S, Dissanayka T, Marx W, Travica N. The Effects of Dietary Advanced Glycation End-Products on Neurocognitive and Mental Disorders. Nutrients 2022; 14:nu14122421. [PMID: 35745150 PMCID: PMC9227209 DOI: 10.3390/nu14122421] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Advanced glycation end products (AGEs) are glycated proteins or lipids formed endogenously in the human body or consumed through diet. Ultra-processed foods and some culinary techniques, such as dry cooking methods, represent the main sources and drivers of dietary AGEs. Tissue accumulation of AGEs has been associated with cellular aging and implicated in various age-related diseases, including type-2 diabetes and cardiovascular disease. The current review summarizes the literature examining the associations between AGEs and neurocognitive and mental health disorders. Studies indicate that elevated circulating AGEs are cross-sectionally associated with poorer cognitive function and longitudinally increase the risk of developing dementia. Additionally, preliminary studies show that higher skin AGE accumulation may be associated with mental disorders, particularly depression and schizophrenia. Potential mechanisms underpinning the effects of AGEs include elevated oxidative stress and neuroinflammation, which are both key pathogenetic mechanisms underlying neurodegeneration and mental disorders. Decreasing dietary intake of AGEs may improve neurological and mental disorder outcomes. However, more sophisticated prospective studies and analytical approaches are required to verify directionality and the extent to which AGEs represent a mediator linking unhealthy dietary patterns with cognitive and mental disorders.
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Affiliation(s)
- Nathan M. D’Cunha
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia (N.N.); (M.K.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Domenico Sergi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Melissa M. Lane
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (M.M.L.); (E.G.); (A.R.); (T.D.); (W.M.)
| | - Nenad Naumovski
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia (N.N.); (M.K.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
- Department of Nutrition-Dietetics, Harokopio University, 17671 Athens, Greece
| | - Elizabeth Gamage
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (M.M.L.); (E.G.); (A.R.); (T.D.); (W.M.)
| | - Anushri Rajendran
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (M.M.L.); (E.G.); (A.R.); (T.D.); (W.M.)
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Waurn Ponds, VIC 3216, Australia
| | - Matina Kouvari
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia (N.N.); (M.K.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
- Department of Nutrition-Dietetics, Harokopio University, 17671 Athens, Greece
| | - Sarah Gauci
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia;
- Heart and Mind Research, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Thusharika Dissanayka
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (M.M.L.); (E.G.); (A.R.); (T.D.); (W.M.)
| | - Wolfgang Marx
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (M.M.L.); (E.G.); (A.R.); (T.D.); (W.M.)
| | - Nikolaj Travica
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (M.M.L.); (E.G.); (A.R.); (T.D.); (W.M.)
- Correspondence:
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Kouvari M, Tsiampalis T, Chrysohoou C, Georgousopoulou E, Skoumas J, Mantzoros CS, Pitsavos CS, Panagiotakos DB. Quality of plant-based diets in relation to 10-year cardiovascular disease risk: the ATTICA cohort study. Eur J Nutr 2022; 61:2639-2649. [DOI: 10.1007/s00394-022-02831-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/04/2022] [Indexed: 02/06/2023]
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Kouvari M, Polyzos SA, Chrysohoou C, Skoumas J, Pitsavos CS, Panagiotakos DB, Mantzoros CS. Skeletal Muscle Mass and Abdominal Obesity are Independent Predictors of Hepatic Steatosis and Interact to Predict Ten-Year Cardiovascular Disease Incidence: Data from the ATTICA Cohort Study. Clin Nutr 2022; 41:1281-1289. [DOI: 10.1016/j.clnu.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
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Kouvari M, Chrysohoou C, Skoumas J, Pitsavos C, Panagiotakos DB, Mantzoros CS. The presence of NAFLD influences the transition of metabolically healthy to metabolically unhealthy obesity and the ten-year cardiovascular disease risk: A population-based cohort study. Metabolism 2022; 128:154893. [PMID: 34600906 DOI: 10.1016/j.metabol.2021.154893] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND/OBJECTIVES We evaluated the role of the presence of non-alcoholic fatty liver disease (NAFLD) at baseline in the transition from metabolically healthy to metabolically unhealthy obesity (MHO to MUO) ten years later. METHODS A prospective cohort study (ATTICA study, Greece) was performed between 2002 and 2012 studying a sample from the greater metropolitan Athens area. In total, 1514 (49·8%) men and 1528 (50.2%) women (aged >18 years old) free-of-CVD were included. Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices. Follow-up CVD assessment (2011-2012) was achieved in n = 2020 participants (n = 317 cases). RESULTS NAFLD prevalence among MHO participants ranged from 29% to 39% according to the specific NAFLD score used. MHO participants who developed metabolically unhealthy status had about two times higher odds to have NAFLD at baseline compared with their metabolically healthy normal weight counterparts whereas stable MHO was not associated significantly with NAFLD. Moreover, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio = 2.90 95% Confidence Interval (1.35, 5.40)) in comparison to their non-NAFLD MHO counterparts. Further analysis revealed that in the obese, NAFLD indices and not simply visceral adiposity increased significantly the ability of metabolic status (using standard definition) to predict long-term CVD incidence. CONCLUSIONS Considering NAFLD, even when assessed using validated indices only, in the clinical assessment of apparently healthy obese individuals predicts who is to develop MUO and contributes independently and more accurately to defining future cardiometabolic risk.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Greece, Greece
| | - John Skoumas
- First Cardiology Clinic, School of Medicine, University of Athens, Greece, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Greece, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia.
| | - Christos S Mantzoros
- Department of Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Kouvari M, Karipidou M, Tsiampalis T, Mamalaki E, Poulimeneas D, Bathrellou E, Panagiotakos D, Yannakoulia M. Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e30675. [PMID: 35156934 PMCID: PMC8887634 DOI: 10.2196/30675] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Melina Karipidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Bochenek H, Krga I, Sergi D, Kouvari M, Zec M, Naumovski N. Dietary patterns, caloric restrictions for management of cardiovascular disease and cancer; a brief review. Rev Cardiovasc Med 2022; 23:41. [DOI: 10.31083/j.rcm2301041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/06/2022] Open
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Kouvari M, Chrysohoou C, Georgousopoulou E, Skoumas J, Pitsavos C, Panagiotakos DB. Ultra-processed foods and ten-year cardiovascular disease incidence in a Mediterranean population: results from a population-based cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Although cardiovascular disease (CVD) guidelines emphasize consuming minimally processed foods, such as fruits, vegetables, whole grain products, nuts and seeds, less attention has been given to the importance of minimizing ultra-processed foods, probably due to the paucity of studies that exist.
Purpose
The aim of the present work was to investigate the association between the consumption of ultra-processed foods and ten-year first fatal/non fatal CVD event in a sample from Greece.
Methods
A prospective study was conducted during 2001–2012 studying n=1,514 men and n=1,528 women (>18 years old) free of CVD. Baseline dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Ultra-processed foods were defined according to a standardized procedure and included among others sweets and desserts, beverages, salty snacks, breakfast cereals and fast foods. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Cox proportional hazards models were constructed to determine the multiadjusted association between ultra-processed food intake (energy-adjusted servings per week) and incident fatal/non fatal CVD.
Results
On average, participants consumed about 15 servings of ultra-processed foods per week. Ranking from 1st to 3rd ultra-processed food consumption tertile (low to high level of intake) CVD incidence was 8.1%, 12.2%, 16.6% (p=0.006). Each additional weekly serving of ultra-processed food was associated with 10% higher CVD risk within the decade (Hazard Ratio (HR)=1.10, 95% Confidence Interval (95% CI) (1.02, 1.21), p=0.04). This association was reexamined according to participants' level of adherence to a cardiac friendly dietary pattern i.e. Mediterranean diet (defined through MedDietScore, range 1–55). In particular, the aggravating effect of ultra-processed foods was retained and only slightly attenuated even in the subset of participants with moderate to high level of adherence to Mediterranean diet (defined as MedDietScore>27) (HRper 1 serving/week=1.08, 95% CI (0.98, 1.19), p=0.09). On the other side, it became even stronger in case of low level of adherence to this pattern (HRper 1 serving/week=1.19, 95% CI (1.12, 1.25), p=0.02).
Conclusions
Current findings support that even in a population with Mediterranean origins and easy access to healthy least processed choices, systematic consumption of ultra-processed foods on a weekly basis was associated with increased risk of hard CVD events. Tailor-made public health initiatives and nutrition policies are demanded to promote healthy and sustainable dietary patterns with less-processed foods of high nutritional value.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - J Skoumas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Kouvari M, Tsiampalis T, Chrysohoou C, Georgousopoulou E, Skoumas J, Mantzoros CS, Pitsavos C, Panagiotakos DB. The quality of plant-based dietary patterns affects the ten-year cardiovascular disease risk of participants with non-alcoholic fatty liver disease: highlights from a population-based cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Some plant-based diets like the Mediterranean diet have been suggested to have a beneficial impact on liver disease. However, the quality of plant-based diets – in general – varies.
Purpose
The association between plant-based diet indices and non-alcoholic fatty liver disease (NAFLD) as well as their interaction on ten-year cardiovascular disease incidence was examined.
Methods
A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Healthy metabolic status was defines as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants (n=317 cases). Overall, healthful and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were created through a standard procedure; hPDI was principally characterized by increased consumption of fruits/vegetables, whole grains, nuts, legumes, oils, tea/coffee while uPDI was related with increased intake of juices, sweetened beverages, refined grains, potatoes and sweets. NAFLD was defined according to validated liver steatosis indices.
Results
In total, n=707 (35%) participants presented NAFLD at baseline. Ranking from 1st to 3rd PDI tertile, NAFLD prevalence was 40.3%, 35.6% and 30.9%, respectively (p=0.04). Multiadjusted analysis revealed significant inverse associations between PDI and NAFLD prevalence [Odds Ratio (OR) (3rd vs. 1st tertile)=0.60 95% Confidence Interval (95% CI) (0.35, 0.92)] as well as hPDI [OR (3rd vs. 1st tertile) = 0.75 95% CI (0.64, 0.89)]. On the other side, increased uPDI had a positive association with NAFLD prevalence [OR (3rd vs. 1st hPDI tertile) = 1.22 95% CI (1.05, 1.34)]. NAFLD predicted CVD in multi-adjusted model [Hazard Ratio (HR) = 1.35, 95% CI (1.08, 2.10)]. Subgroup analyses according to participants' adherence to overall, healthy and unhealthy plant-based patterns revealed that this observation remained significant in the following cases: participants in the 1st PDI tertile, [HR=1.40, 95% CI (1.15, 2.09)] and participants in the 1st hPDI tertile [HR=1.47, 95% CI (1.22, 2.12)].
Conclusions
Lower adherence to plant-based diet was associated with substantially higher long-term CVD risk for a NAFLD individual. Most importantly, the healthy or unhealthy food choices within this pattern seemed to determine liver steatosis progression and in turn cardiometabolic health.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | | | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - J Skoumas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C S Mantzoros
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Kouvari M, Chrysohoou C, Georgousopoulou E, Skoumas J, Pitsavos C, Panagiotakos DB. A-posteriori protein-rich dietary patterns and their association with ten-year transition to metabolically unhealthy status: highlights from a population-based cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The role of dietary protein on cardiometabolic health remains complex influenced by concomitant changes in overall diet composition. The quality of protein sources is currently suggested as more detrimental than the level of consumption itself.
Purpose
The association between different protein-rich dietary patterns and 10-year transition to metabolically unhealthy status in a sample from Greece was evaluated.
Methods
A prospective study was conducted during 2001–2012 studying n=1,514 men and n=1,528 women (>18 years old) free of CVD. Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. Baseline dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Dietary protein was calculated through standardized food database. Follow-up cardiometabolic assessment (2011–2012) was achieved in n=2,020 participants. Protein-rich dietary patterns were derived through factor analysis in the subsample of participants with high daily protein intake (>15% of total energy intake corresponding to the median consumption level). Patterns were named according to food scores that correlated most with the factor (scores>0.5).
Results
Overall, six of ten participants lost their metabolically healthy status within a decade. Multiadjusted analysis revealed an inverse yet non-significant association between total energy-standardized protein intake and transition to metabolically unhealthy status [Odds ratio (OR) (high vs. low protein intake)=0.59, 95% Confidence Interval (95% CI) (0.32, 1.10), p=0.09]. Factor analysis extracted three protein-rich dietary patterns, explained 55% of the total variation in intake. Factor A was characterized by increased consumption of processed meet, unprocessed red meat and eggs, factor B was characterized by increased consumption of nuts and seeds, legumes, whole grain products and fish while factor C was characterized by increased consumption of dairy products, poultry and vegetables. Multiadjusted logistic regression analysis revealed that factor B had the strongest protective effect against 10-year transition to metabolically unhealthy status [ORper 1 point increase in factor B score=0.74, 95% CI (0.60, 0.85), p=0.01] followed by a marginally protective effect of factor C [ORper 1 point increase in factor C score=0.89, 95% CI (0.73, 1.05), p=0.07]. Participants with higher adherence to factor A had an increased likelihood to lose their metabolically healthy status [ORper 1 point increase in factor A score=1.15, 95% CI (1.02, 1.30), p=0.04].
Conclusions
The present work confirms that within an increased level of dietary protein intake, different cardiometabolic outcomes were observed according to the quality of protein food sources consumed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - J Skoumas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Kouvari M, Chrysohoou C, Georgousopoulou E, Skoumas J, Pitsavos C, Panagiotakos DB, Mantzoros CS. Liver steatosis, metabolically healthy obesity and ten-year cardiovascular disease risk: results from a population based cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Inclusion of non-alcoholic fatty liver disease (NAFLD) as a component of metabolic syndrome (MetS) and/or a criterion for defining metabolically healthy vs. unhealthy obese (MHO vs MUO) status remains to be decided.
Purpose
The present work evaluated the role of NAFLD at baseline in the transition of MHO to MUO status, and its role in predicting cardiovascular disease (CVD) incidence ten years later.
Methods
A prospective longitudinal study was performed between 2001 and 2012 studying 1,514 (49·8%) men and 1,528 (50.2%) women (>18 years old) free of CVD at baseline and residing in the greater Athens area, Greece. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices.
Results
Among obese participants, MHO prevalence was 9.8% (n=277). Only half of the MHO subjects retained their metabolically healthy status one decade later. NAFLD was an important predictor of this transition; MHO participants with NAFLD at baseline had about two times higher odds to develop unhealthy metabolic status compared with their non-NAFLD counterparts. Subsequently, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio=2.90 95%Confidence Interval (1.35, 5.40)) in contrast to their non-NAFLD MHO counterparts. C-statistics revealed that NAFLD significantly increased the discriminative ability of the standardly defined metabolic status (p for C-index change=0.002), yet in the total sample its contribution to the model seemed to be similar with the common metric of central obesity i.e. waist circumference (CNAFLD=0.711 vs. Cwc=0.710). When the analysis was restricted to the obese subset, it was revealed that the discriminative ability of the model adjusted for NAFLD was significantly higher compared with the one adjusted for waist circumference (CNAFLD=0.719 vs. Cwc=0.702).
Conclusions
Taking under consideration NAFLD – via validated indices – in the clinical assessment of an apparently healthy obese individual contributes to better defining future risk of conversion to metabolically unhealthy obesity and future cardiometabolic risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - J Skoumas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - C S Mantzoros
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
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Katsiki N, Kouvari M, Panagiotakos DB, Borghi C, Chrysohoou C, Mikhailidis DP, Pitsavos C. The association between serum uric acid levels and 10-year cardiovascular disease incidence: results from the ATTICA prospective study. Rev Cardiovasc Med 2021; 22:991-1001. [PMID: 34565100 DOI: 10.31083/j.rcm2203108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/24/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022] Open
Abstract
Limited data suggests possible gender-specific association between serum uric acid (SUA) and cardiovascular disease (CVD) incidence. The aim of the present analysis was to evaluate the association between SUA levels and 10-year CVD incidence (2002-2012) in the ATTICA study participants. Overall, 1687 apparently healthy volunteers, with SUA measurements, residing in the greater metropolitan Athens area (Greece), were included. Multivariable Cox-regression models were used to estimate the hazard ratios for SUA in relation to 10-year CVD incidence. Receiver operating curve analysis was conducted to detect optimal SUA cut-off values. Participants in the 2nd and 3rd SUA tertile had 29 and 73% higher 10-year CVD incidence compared with those in the 1st tertile (p < 0.001). In gender-specific analysis, only in women SUA was independently associated with CVD incidence; women in the 3rd SUA tertile had 79% greater 10-year CVD event risk compared to their 1st tertile counterparts. Obese in the 3rd SUA tertile had 2-times higher CVD incidence compared to those in the 1st tertile. Similar findings were observed in metabolically healthy (vs. unhealthy) and metabolically healthy obese. SUA thresholds best predicting 10-year CVD incidence was 5.05 and 4.15 mg/dL (0.30 and 0.25 mmol/L) in men and women, respectively. In conclusion, increased SUA levels were independently related to 10-year CVD event rate in women, obese and metabolically healthy individuals. SUA could predict 10-year CVD incidence even at low levels. Further studies are warranted to identify SUA cut-off values that may improve the detection of individuals at higher CVD risk in clinical practice.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, 54621 Thessaloniki, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, 15772 Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), NW3 2QG London, UK
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, 15772 Athens, Greece
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Kouvari M, Tsiampalis T, Chrysohoou C, Georgousopoulou E, Notara V, Souliotis K, Psaltopoulou T, Yannakoulia M, Pitsavos C, Panagiotakos DB. A Mediterranean diet microsimulation modeling in relation to cardiovascular disease burden: the ATTICA and GREECS epidemiological studies. Eur J Clin Nutr 2021; 76:434-441. [PMID: 34230628 DOI: 10.1038/s41430-021-00967-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet. SUBJECTS/METHODS An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. RESULTS Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect). CONCLUSIONS This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,School of Medicine, The University of Notre Dame, Sydney, Australia.,Medical School, Australian National University, Canberra, Australia
| | - Venetia Notara
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. .,Faculty of Health, University of Canberra, Canberra, Australia.
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Panagiotakos DB, Kouvari M. Fish and cardiovascular disease prevention: time for a closer collaboration between basic science and clinical research. Cardiovasc Res 2021; 117:e94-e96. [PMID: 34179949 DOI: 10.1093/cvr/cvab186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, Australia
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, Australia
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Kouvari M, Tsiampalis T, Chrysohoou C, Notara V, Georgousopoulou E, Skoumas J, Pitsavos C, Panagiotakos DB. A diet-related microsimulation modelling approach in the context of cardiovascular disease prevention: the ATTICA and GREECS epidemiological studies. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].
Background/Introduction: Among all behaviors, nutrition makes the largest contribution to cardiovascular disease (CVD) morbidity across Europe. Purpose: The aim of the present work was to quantify the changes in 10-year CVD onset or recurrence or mortality, in relation to transitioning from low to higher level of adherence to Mediterranean diet. Methods: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of level of adherence to Mediterranean diet were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. Results: Improving the level of adherence to the Mediterranean diet, even in 10% of the population, a significant relative percentage reduction was observed in the 10-year risk for CVD onset, recurrence and mortality, with the observed reductions being higher among women. In particular, at least 851 first CVD events, 374 recurrent CVD events and 205 CVD deaths per 100,000 of population could be averted or delayed. Additionally, Mediterranean diet clustering revealed that high consumption of fruits, vegetables, whole wheat products and legumes was more important than low consumption of meat and full fat dairy products against CVD. Conclusion: This microsimulation process confirms the added value of Mediterranean diet in primary and secondary CVD prevention having great achievements even with small modifications on a population basis, while challenges the orientation of a Mediterranean-diet intervention giving higher weights to plant-based part.
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | | | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Notara
- Harokopio University, Athens, Greece
| | | | - J Skoumas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Kouvari M, Chrysohoou C, Georgousopoulou E, Skoumas J, Pitsavos C, Panagiotakos DB. Application of non-HDL cholesterol for cardiovascular risk prediction in apparently healthy men and women: Results from the ATTICA prospective epidemiological study. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].
Background/Introduction: Consistent evidence exists for a causal association between blood cholesterol and cardiovascular disease (CVD) yet alternative lipid markers are still discussed. To this issue, non-High Density Lipoprotein (non-HDL) cholesterol offers a simple way to analyze the total amount of pro-atherogenic lipoproteins containing apolipoprotein B100. Purpose: The aim of the present work was to evaluate the 10-year first fatal/non fatal CVD incidence related to non-HDL cholesterol on the basis of existing thresholds suggested by the European Society of Cardiology (ESC) in a sample with prevalent CVD. Methods: ATTICA study was conducted during 2001-2012 including n = 1,514 men and n = 1,528 women (aged >18 years old) from the greater Athens area, Greece. Baseline serum blood lipids profile was measured. Non-HDL cholesterol was evaluated according to the formula "total cholesterol minus HDL cholesterol" and the following categories were used: <100 mg/dL; 100 to <145 mg/dL; 145 to <185 mg/dL; 185 to <220 mg/dL, and ≥220 mg/dL. Ten-year follow up was performed (2011-12) in 2,020 participants (n = 317 cases, man-to-woman CVD incidence ratio = 1.66). Results: About 42% of women had non-HDL values within the range of 100 to <145 mg/dL while in case of men about one third of them had non-HDL values within the range of 100 to 185mg/dL. Ranking from low to high non-HDL cholesterol CVD incidence was 5.3%, 13.3%, 18.0%, 20.0% and 28.9%. The man-to-woman age-standardized CVD incidence ratio was 1.50, 1.93, 1.37, 1.24, 1.64, respectively; indicating a steep rise in CVD incidence rate in favor of men when non-HDL cholesterol levels reached the 2nd category levels (i.e. 100 to <145 mg/dL) while women seemed to present CVD incidence rates closer to their men counterparts in case of higher non-HDL cholesterol values (i.e. 145 to <220 mg/dL). Multi-adjusted Cox regression analysis revealed that 30mg/dL increase in non-HDL cholesterol values corresponded to 34% higher risk to develop CVD within the decade (Hazard ratio (HR)=1.34, 95% Confidence Interval (95%CI) (1.00, 1.81)). The association remained significant only in case of men (p for gender interaction = 0.01); HR = 1.45, 95%CI (1.09, 1.95). Additionally, when the categorical non-HDL variable was used, its independent aggravating effect on CVD outcome reached the level of significance only for non-HDL cholesterol values >220mg/dL; HR5th vs. 1st category = 1.95, 95%CI (1.10, 4.30). Sex-based stratified analysis revealed significance only in men and particularly HR5th vs. 1st category = 3.14, 95%CI (1.26, 5.10). In case of women the aggravating effect was retained yet without reaching the level of significance. Conclusion: Even if non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic CVD, its use in daily clinical practice is challenged. These outcomes could be useful for physician–patient communication about primary prevention strategies.
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - J Skoumas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Tsiampalis T, Faka A, Kouvari M, Psaltopoulou T, Pitsavos C, Chalkias C, Panagiotakos DB. The impact of socioeconomic and environmental determinants on Mediterranean diet adherence: a municipal-level spatial analysis in Athens metropolitan area, Greece. Int J Food Sci Nutr 2021; 72:259-270. [PMID: 32657627 DOI: 10.1080/09637486.2020.1791057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to identify the geographical variability, the socio-economic and the environmental determinants of adherence to the Mediterranean diet in a general population sample. Level of adherence to the Mediterranean diet was estimated by the ATTICA epidemiological study for 2,749 participants, while socio-economic, demographic, and environmental characteristics were provided by official national and international databases. Higher adherence to the Mediterranean diet was detected in areas with a greater proportion of females and older people, with lower unemployment rate and immigrant population, as well as, in areas covered at a greater extent by green and with higher frequency of supermarkets and street markets. The present findings provide evidence for policy makers to better understand how layers of influence intersect to shape individuals' eating habits, while they may also contribute in identifying areas of emerging interventions needed.
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Affiliation(s)
- Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Antigoni Faka
- Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | | | - Christos Chalkias
- Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
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Hansen KW, Peytz N, Blokstra A, Bojesen SE, Celis-Morales C, Chrysohoou C, Clays E, De Bacquer D, Galatius S, Gray SR, Ho F, Kavousi M, Koolhaas CM, Kouvari M, Løchen ML, Marques-Vidal P, Osler M, Panagiotakos D, Pell JP, Sulo G, Tell GS, Vassiliou V, Verschuren WMM, Prescott E. Association of fatal myocardial infarction with past level of physical activity: a pooled analysis of cohort studies. Eur J Prev Cardiol 2021; 28:1590-1598. [PMID: 33564885 DOI: 10.1093/eurjpc/zwaa146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 12/21/2022]
Abstract
AIMS To assess the association between past level of physical activity (PA) and risk for death during the acute phase of myocardial infarction (MI) in a pooled analysis of cohort studies. METHODS AND RESULTS European cohorts including participants with a baseline assessment of PA, conventional cardiovascular (CV) risk factors, and available follow-up on MI and death were eligible. Patients with an incident MI were included. Leisure-time PA was grouped as sedentary (<7 MET-hours), low (7-16 MET-hours), moderate (16.1-32 MET-hours), or high (>32 MET-hours) based on calculated net weekly energy expenditure. The main outcome measures were instant and 28-day case fatality of MI. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate random-effects models. Adjustments for age, sex, CV risk factors, alcohol consumption, and socioeconomic status were made. From 10 cohorts including a total of 1 495 254 participants, 28 140 patients with an incident MI comprised the study population. A total of 4976 (17.7%) died within 28 days-of these 3101 (62.3%) were classified as instant fatal MI. Compared with sedentary individuals, those with a higher level of PA had lower adjusted odds of instant fatal MI: low PA [OR, 0.79 (95% CI, 0.60-1.04)], moderate PA [0.67 (0.51-0.89)], and high PA [0.55 (0.40-0.76)]. Similar results were found for 28-day fatal MI: low PA [0.85 (0.71-1.03)], moderate PA [0.64 (0.51-0.80)], and high PA [0.72 (0.51-1.00)]. A low-to-moderate degree of heterogeneity was detected in the analysis of instant fatal MI (I2 = 47.3%), but not in that of 28-day fatal MI (I2 = 0.0%). CONCLUSION A moderate-to-high level of PA was associated with a lower risk of instant and 28-day death in relation to a MI.
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Affiliation(s)
- Kim Wadt Hansen
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Bispebjerg Bakke 23, Building 67, 1st floor, DK-2400 Copenhagen, Denmark
| | - Nina Peytz
- Department of Clinical Medicine, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Anneke Blokstra
- Department of Life Course and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Stig E Bojesen
- Department of Clinical Medicine, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Carlos Celis-Morales
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Els Clays
- Department of Public Health and Primary Care, University Ghent, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, University Ghent, Ghent, Belgium
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Bispebjerg Bakke 23, Building 67, 1st floor, DK-2400 Copenhagen, Denmark
| | - Stuart R Gray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Frederick Ho
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Chantal M Koolhaas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matina Kouvari
- Department of Nutrition - Dietetics, School of Health Science and Education, Harokopio University of Athens, Athens, Greece
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | - Demosthenes Panagiotakos
- Department of Nutrition - Dietetics, School of Health Science and Education, Harokopio University of Athens, Athens, Greece
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gerhard Sulo
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vassilios Vassiliou
- Norwich Medical School, University of East Anglia, Norwich and Imperial College London, UK
| | - W M Monique Verschuren
- Department of Life Course and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Bispebjerg Bakke 23, Building 67, 1st floor, DK-2400 Copenhagen, Denmark
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Kouvari M, Panagiotakos DB, Chrysohoou C, Georgousopoulou EN, Yannakoulia M, Tousoulis D, Pitsavos C. Dairy products, surrogate markers, and cardiovascular disease; a sex-specific analysis from the ATTICA prospective study. Nutr Metab Cardiovasc Dis 2020; 30:2194-2206. [PMID: 32988722 DOI: 10.1016/j.numecd.2020.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Dairy products are a very diverse food group with multiple effects on the cardiac health of men and women. The aim of this work was to evaluate the sex-specific association between dairy products (total and subtypes) and 10-year first fatal/nonfatal cardiovascular disease (CVD) incidence. METHODS AND RESULTS In 2001-2002, n = 1514 men and n = 1528 women (>18 years old) from greater Athens area, Greece, were enrolled. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Dairy product consumption was examined in relation to 10-year CVD incidence. Follow-up (2011-2012) was achieved in n = 2020 participants (n = 317 CVD cases). Ranking from lowest (<1 serving/day) to highest (>2 servings/day) total dairy intake, CVD incidence in men was 17.8%, 15.0%, and 10.9% (p = 0.41), while in women it was 14%, 6.0%, and 5.7% (p = 0.02). Multiadjusted analysis revealed that total dairy intake protected against CVD only in women [Hazard Ratio (HR) = 0.48 and 95% Confidence Interval (95% CI) (0.23, 0.90)], irrespective of the fat content. Further analysis revealed that only fermented products (yogurt and cheese), protected against CVD. For per 200 g/day yogurt consumption, CVD risk was 20%-30% lower with this claim being more evident in women, while for per 30 g/day cheese intake, about 5% lower risk was observed particularly in men. As for butter, nonsignificant associations were highlighted. These associations were mainly retained in the case of hepatic steatosis, insulin resistance, and systemic inflammation. CONCLUSIONS This work provides incentives for researchers to elucidate the diversity of ingredients and mechanisms through which dairy products exert their effect on cardiac health separately for men and women.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Canberra, Australia.
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi N Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; School of Medicine, The University of Notre Dame, Sydney, Australia; Medical School, Australian National University, Canberra, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
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Kouvari M, Panagiotakos D, Chrysohoou C, Georgousopoulou E, Pitsavos C, Tousoulis D. Healthful and unhealthful plant-based dietary patterns and their role on 10-year transition to metabolically unhealthy status in obese participants of the ATTICA prospective (2002–2012) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Plant-based diets have been widely promoted for their protective role on cardiometabolic health. However, in the recent literature it is highly suggested that the quality of plant-based diets varies.
Purpose
The association between plant-based diet indices and 10-year transition to metabolically unhealthy status in metabolically healthy obese (MHO) individuals was assessed.
Methods
A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Healthy metabolic status was defines as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants (n=317 cases). Overall, healthful and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were created through a standard procedure; hPDI was principally characterized by increased consumption of fruits/vegetables, whole grains, nuts, legumes, oils, tea/coffee while uPDI was related with increased intake of juices, sweetened beverages, refined grains, potatoes and sweets.
Results
MHO prevalence reached 4.8% (n=146) (4.9% in men and 4.7% in women, p=0.198). 28.2% of obese participants presented a metabolically benign status. Within the decade, almost half of MHO participants resulted as metabolically unhealthy obese (45% in men and 54% in women, p=0.04). Ranking from 1st to 3rd PDI tertile, transition to metabolically unhealthy status was for men, 63%, 48% and 22% (p<0.001) and for women 67%, 58% and 34% (p<0.001). Multiadjusted analysis revealed significant inverse associations between PDI and 10-year transition to metabolically unhealthy status for men [Hazard Ratio (HR) (3rd vs. 1st tertile)=0.63 95% Confidence Interval (95% CI) (0.41, 0.95)] yet –borderline significantly– for women [HR (3rd vs. 1st PDI tertile) = 0.82 95% CI (0.67, 1.09)]. When the indices for quality of plant-based patterns were used (hPDI and uPDI), only participants assigned to the higher level of adherence to healthful plant-based pattern retained their metabolically healthy profile with this relation being stronger in women; [HR (3rd vs. 1st hPDI tertile) = 0.55 95% CI (0.37, 0.84), for women] and [HR (3rd vs. 1st hPDI tertile) = 0.79 95% CI (0.64, 1.03), for men]. Similarly, the aggravating effect of high adherence to less healthful plant-based food choices was higher for women [HR (3rd vs. 1st uPDI tertile) = 1.68 95% CI (1.23, 1.99)].
Conclusions
Higher adherence to plant-based diet was associated with substantially higher likelihood for an obese individual to long-term retain its healthy metabolic status. Most importantly, the healthy or unhealthy food choices within this pattern seemed to determine cardiometabolic status with stronger remarks in women.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].
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Affiliation(s)
- M Kouvari
- Harokopio University, Athens, Greece
| | | | - C Chrysohoou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - C Pitsavos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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