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Abstract: Aim: To determine the prevalence of metabolic syndrome in children and adolescents in Crete (Greece) and examine associations with diet quality and physical fitness. Subjects and Methods: A representative sample of 1,209 Cretan children and adolescents aged 3–17 1/2 years participated in this cross-sectional survey. The study took place in kindergartens, primary and secondary schools in the cities of Heraklion and Chania and kindergartens and schools in semi-urban and rural regions outside Heraklion. The metabolic syndrome was defined as the presence of ≥3 of: impaired fasting blood glucose, hypertension, abdominal obesity, hypertriglyceridaemia, and low HDL-cholesterol. Diet quality was assessed by the Healthy Eating Index score (USDA) and physical fitness by the 20-m shuttle run test. Results: Approximately 4% of Cretan children and adolescents assessed (4.2% of boys, 3.6% of girls) had three or more metabolic syndrome factors. Over 25% of the subjects had a “poor” diet, defined as Healthy Eating Index <51, and higher diet quality scores correlated with decreased mean body mass index, waist/height ratio, systolic blood pressure, total cholesterol, and number of metabolic syndrome risk factors present. Clustering of metabolic syndrome risk factors was also associated with decreased physical fitness, as well as increased body mass index, waist/height ratio and total cholesterol/HDL-cholesterol ratio. Conclusions: Presence of three or more factors related to the metabolic syndrome was strongly associated with poor diet quality and low physical fitness, as well as overweight, in Cretan children and adolescents. Health promotion strategies in childhood should encourage weight control, the establishment of healthier dietary patterns, and adequate physical activity, as a means of preventing the increase in the prevalence of this public health issue.

Purpose: The current study aims to examine the use of preventive and other health services among adults aged 50+ in eleven European countries. Methods: The data used were derived from 16,120 adults aged 50+ years participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Preventive Health Services Utilization score (PHSUs) and Health Care Services Utilization score (HCSUs) were assessed as a composite value from answers to 12 and 16 questions respectively, on a scale ranging from 0 to 100. Estimations were based on a complex study design. Results: Participants from Central European countries were found to have significantly higher mean PHSU and HCSU scores than their counterparts in Northern and Southern regions, (p&lt; 0.05) and also exhibited a greater gap between the two scores (29.3, 95% CI: 28.6–30.1). Overall mean PHSU score was 39.9 (95% CI: 39.4–40.4) and mean HCSU score 12.4 (95% CI: 12.2–12.7). Women have a higher mean PHSUs and HCSUs (p&lt; 0.001); as age increases, PHSUs falls and HCSUs rises (p&lt; 0.001). Better educated participants appear to have higher mean PHSUs and HCSUs (p&lt; 0.001). In addition, both of the above scores increase in the presence of chronic diseases (p&lt; 0.001). Conclusion: Strong correlation is seen between comorbidity, increasing age, educational level, and retirement on the one hand, and increased use of health services on the other hand. The use of health services is a major issue with regard to public health policy formulation.

Purpose: Multiple behavioral risk factors (MBRFs) related to lifestyle have been associated with non-communicable diseases, but there is limited evidence on their prevalence in undergraduate medical students and their association with academic performance. Methods: During 1989–2017, data from 1447 medical students of the University of Crete, Greece (mean age 21.8 ± 2.2 years), were analyzed. MBRFs assessed included smoking, high body weight, physical inactivity, risky alcohol consumption and low consumption of fruits and vegetables. Academic performance was based on the grades received in the mandatory Clinical Nutrition course and the overall medical degree (scale of 0–10). Results: Of the sample, 25.8% were smokers, 30.7% had high body weight, and 67.2% had low consumption of fruits and vegetables. Prevalence of having ‘no MBRFs’ and having ‘multiple clustering’ and ‘3+ factors’ was 15.8% and 12.3%, respectively. Men had almost twice the prevalence of multiple clustering compared with women (16.5% vs. 8.4%, p&lt; 0.001). Participants who had none compared with 3+ MBRFs had higher mean grades in the Clinical Nutrition course (6.34 vs. 5.94, p= 0.027, p= 0.003) and overall degree (7.39 vs. 7.22, p= 0.021, p= 0.002). As the number of MBRFs increased (from ‘none’ to ‘1,’ ‘2’ and ‘3+’ factors), the proportion of graduates receiving a distinction also decreased (6.1%, 3.3%, 3.3% and 0.0%, respectively, p= 0.001). Conclusion: Overall, high prevalence of MBRFs was observed in this sample of medical students, while MBRF clustering was prospectively inversely associated with academic performance. These findings highlight the need for preventive lifestyle strategies to improve these students’ behavioral risk factors and academic performance during their studies.

Aim: To explore adolescents’ perceptions of how the home environment promotes the intake of sugar-sweetened beverages (SSBs) and to identify the potential environmental cues that trigger SSB intake at home. Subjects and methods: Twenty-nine semi-structured interviews were conducted among adolescents, aged 15–19 years, residing in an urban area in Northwest Mexico. Thematic analysis was used to analyse the data. Results: Adolescents perceived that the availability of SSBs in the household increased their intake of SSBs. Availability of SSBs was facilitated mainly by taste preferences, ease of buying and beliefs that fruit-containing SSBs are healthy. Availability at home was considered important because SSBs were normally consumed with food during meals. Family influences and a lack of parental regulation were also regarded as factors promoting adolescents’ SSB intake at home. Drinking SSBs with food and having SSBs available at home were identified as habits that had been performed by participants’ families for many years. Conclusions: These findings provide insights into the role of the home and family environment in promoting SSB intake. Future interventions to reduce SSB intake in this sample of Mexican adolescents should address availability and facilitators of SSB intake at home, family influences and parental regulation.

Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe. Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators. Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p< 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p< 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24–3.48) and the third (ORs = 1.75; 95% CI 1.03–2.96) multiple regression models. In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population.

The Seven Countries’ Study showed that in the 1960s, participants in the island of Crete, Greece, had among the lowest cardiovascular (CVD) mortality rates in the world, but in recent years CVD rates in Crete have increased. This study aimed to assess changes in CVD-risk occurring since the Seven Countries’ Study. Secondary analysis was performed in two cohorts of men (aged 40–60 years) in Crete-Greece, in 1960 (Seven Countries’ Study’s participants) and 1997 (random sample of men of the same age and residence areas). The HeartScore was used to estimate the (1) 10-year CVD-risk and (2) 10-year CVD-risk based on body mass index (BMI), of 627 (1960 cohort) and 93 (1997 cohort) Cretan men. Between 1960 and 1997, 10-year CVD-risk (3.4 vs. 4.7%, P< 0.001) and risk based on BMI (1.6 vs. 3.0%, P< 0.001) increased by 38 and 88%, respectively. During this period, the proportion of overweight/obese participants (21.8 vs. 83.9%, P< 0.001) and participants with hypercholesterolemia (51.5 vs. 81.7%, P< 0.001), as well as physical inactivity (37.3 vs. 56.0%, P= 0.001) increased. The prevalence of high and very high CVD-risk (≥5%) almost doubled (+90%), mainly due to concomitant increases in total cholesterol levels (+84%, P< 0.001) during this period. CVD-risk increased between 1960 and 1997 in this population of Cretan men. Appropriate public health initiatives are needed to promote the traditional, health-promoting lifestyle of men in Crete observed in the 1960s in the Seven Countries’ Study.

Objective:Maintenance of weight loss and associated cardiovascular benefits after following energy-restricted diets is still a challenging field, and thorough investigation is needed. The present research aimed to determine the role of protein and gender in relation to two different intervention models related to food supply, in a weight maintenance trial.Subjects and Methods:The DiOGenes trial was a long-term, multicenter, randomized, dietary intervention study, conducted in eight European countries (Clinical Trials.gov, NCT00390637), focusing on assessing the effectiveness of weight maintenance over 6 months. This secondary analysis intended to evaluate the different benefits for weight maintenance and cardiometabolic markers of two dietary advice delivery models: “shop + instruction intervention” vs “instruction-alone intervention,” which were further categorized for gender and macronutrient intake.Results:The weight maintenance intervention based on different macronutrient intake showed, independently of the advice delivery model, in both sexes that higher protein consumption was more effective for weight stability, showing better results in obese women (low protein: 1.65 kg in males and 0.73 Kg in females vs high protein: 1.45 kg in males and -0.93 Kg in females) . Measurements concerning cardiovascular risk markers from subjects on both structured models produced similar trends in the subsequent follow-up period, with a lower rebound in women for most of the markers analyzed.Conclusion:The reported dietary benefits for weight sustainability should be ascribed to the macronutrient distribution (higher protein diets) rather than to the structured mode of delivery. Higher weight regain in males was noted, as well as a metabolic divergence attributable to the sex, with a better biochemical outcome in women.

The current study aims to assess the relationship between behavioral risk factors (BRFs) for chronic diseases and preventive health services utilization among European adults. We used data from 16,125 adults, aged 50+ years, from 11 countries participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Prevalence of BRFs (high body weight, smoking, physical inactivity and risky alcohol consumption) was examined in relation to preventive health services utilization, which was assessed via a 12-component score (PHSUs) (scale: 0–100). Estimations were based on the complex study design. Of the participants, 90.7% were seeing a general practitioner (GP) and 52.7% had 2+ BRFs. Adults with high body weight had lower odds of seeing a dentist (0.75, p< 0.05) or having sigmoidoscopy/colonoscopy (0.70, p< 0.05) and higher odds of receiving GP advice to exercise regularly (1.56, p< 0.05). Smokers had lower odds of having mammograms (0.76, p< 0.05), sigmoidoscopy/colonoscopy (0.72, p< 0.05) and being tested for hidden blood in stool (0.63, p< 0.05). Risky drinkers had lower odds of having mammograms (0.23, p< 0.05). Lower mean PHSUs were found for adults with high body weight (p= 0.001), smokers (p= 0.001) and risky drinkers (p= 0.008), while PHSUs did not differ by BRF clusters (p= 0.218). In adults with 2+ BRFs, Greece was the country with the lowest mean PHSUs (28.0, p< 0.05). Adults with high body weight, those who smoked and were risky drinkers used fewer preventive health services. Primary prevention programs should be developed to reduce BRF prevalence and promote preventive health services use in this population.

To assess the clustering of behavioral risk factors (BRFs) for chronic noncommunicable diseases and their association with biological factors and cardiorespiratory fitness levels among adolescents in Crete, Greece. Among 589 adolescents aged 14.0–16.6 years, five BRFs (smoking, physical inactivity, sedentary behavior, alcohol consumption, high body weight) were estimated, and a clustering score of 0, 1, 2 or 3+ BRFs was calculated. Biological factors (blood pressure, blood glucose, serum lipids) and cardiorespiratory fitness were also assessed, and their associations with BRFs were examined. Physical inactivity was the most prevalent risk factor (48.2 %), whereas smoking was the least prevalent (8.7 %). Approximately 11.4 % of the adolescents displayed none of the five BRFs, while 19.5 % displayed 3 + factors (boys: 23.2 %, girls: 16.3 %, p> 0.05). High body weight was related to almost all biological factors (p< 0.05), while cardiorespiratory fitness was related to all BRFs (p< 0.05). Compared to adolescents with no BRFs, adolescents with 3+ BRFs had higher mean levels of systolic blood pressure (BP) (122.5 vs. 116.8 mmHg, p= 0.001) and triglycerides (73.5 vs. 58.9 mg/dl, p= 0.006), and lower levels of HDL-cholesterol (47.1 vs. 53.5 mg/dl, p< 0.001) and cardiorespiratory fitness (2.8 vs. 4.8 stages, p< 0.001). Only 10 % of the adolescents with no BRFs had low cardiorespiratory fitness, in contrast to 44.8 % of the adolescents with 3+ factors (p< 0.001). Physical inactivity was the most prevalent individual risk factor, while one-fifth of the Cretan adolescents had an extended clustering of BRFs. Systolic BP, lipid levels and cardiorespiratory fitness were related to BRF clustering. Public health providers should adopt measures to improve these factors when designing health-care programs aimed at adolescents.

The aim of this study was to estimate the differences in prevalence of multiple behavioral risk factors (MBRFs) for chronic diseases in European adults, from eleven North, Central and South European countries. We used data from 26,656 adults, aged 50+ years, participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Physical inactivity, high body weight, smoking and risky alcohol consumption were assessed and estimated based on sampling weights, controlling for socioeconomic characteristics. 53.4 % of adults had 2+ MBRFs. Prevalence in the total sample was highest for physical inactivity (71.2 %) and lowest for smoking (18.1 %). The cluster of high body weight and physical inactivity had the highest prevalence of MBRFs (35.4 %), with higher prevalence in Southern Europe (p< 0.05). Smoking and alcohol consumption presented the greatest degree of clustering (observed to expected ratio = 2.44). Spain and Greece had the highest prevalence of clustering 2+ MBRFs, whereas Southern European countries had a higher mean number of MBRFs, compared to North and Central European regions (p< 0.05). Prevalence of MBRFs varied between countries, with Southern European countries engaging in more risky behaviors. Primary prevention programmes should be developed to reduce MBRFs in this population.

Abstract: Aim: To determine the prevalence of metabolic syndrome in children and adolescents in Crete (Greece) and examine associations with diet quality and physical fitness. Subjects and Methods: A representative sample of 1,209 Cretan children and adolescents aged 3–17 1/2 years participated in this cross-sectional survey. The study took place in kindergartens, primary and secondary schools in the cities of Heraklion and Chania and kindergartens and schools in semi-urban and rural regions outside Heraklion. The metabolic syndrome was defined as the presence of ≥3 of: impaired fasting blood glucose, hypertension, abdominal obesity, hypertriglyceridaemia, and low HDL-cholesterol. Diet quality was assessed by the Healthy Eating Index score (USDA) and physical fitness by the 20-m shuttle run test. Results: Approximately 4% of Cretan children and adolescents assessed (4.2% of boys, 3.6% of girls) had three or more metabolic syndrome factors. Over 25% of the subjects had a “poor” diet, defined as Healthy Eating Index <51, and higher diet quality scores correlated with decreased mean body mass index, waist/height ratio, systolic blood pressure, total cholesterol, and number of metabolic syndrome risk factors present. Clustering of metabolic syndrome risk factors was also associated with decreased physical fitness, as well as increased body mass index, waist/height ratio and total cholesterol/HDL-cholesterol ratio. Conclusions: Presence of three or more factors related to the metabolic syndrome was strongly associated with poor diet quality and low physical fitness, as well as overweight, in Cretan children and adolescents. Health promotion strategies in childhood should encourage weight control, the establishment of healthier dietary patterns, and adequate physical activity, as a means of preventing the increase in the prevalence of this public health issue.