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Objective: The aim of this work was to investigate the association between consumption of dairy products and levels of various inflammatory markers among adults with no evidence of cardiovascular or other chronic disease., Methods: The ATTICA study is a cross-sectional survey that enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old) from the Attica region in Greece. Fasting blood samples were collected and dietary habits (including consumption of dairy products [i.e., milk, cheese, and yogurt]) were evaluated using a validated food frequency questionnaire., Results: We observed that C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) levels of individuals consuming between 11 and 14 servings of dairy products per week were almost 16%, 5%, and 12% lower, respectively, than in those consuming fewer than 8 servings (p < 0.05), while those consuming more than 14 servings per week had 29%, 9%, and 20% lower levels of CRP, IL-6, and TNF-α, respectively (p < 0.01), even after adjustments were made for age, gender, smoking, physical activity, body mass, dietary habits, and other potential confounders., Conclusion: We identified an inverse association between dairy products consumption and levels of various inflammatory markers among healthy adults. Additional clinical trials are needed to refute or confirm our findings.

The relationship between diet, sleep duration and cardiovascular disease (CVD) has not been well understood. The aim of the present study was to test the potential modifying role of sleep duration in the association between adherence to the Mediterranean-type diet (MD) and CVD risk. The study consisted of n = 313 initially free-of-CVD adults, from the ATTICA cohort study (2002–2022), with available information on sleep habits. Sleep habits were categorized as inadequate and adequate sleep duration (< or ≥7 h/day, respectively). In multi-adjusted analysis, MD adherence was inversely associated with CVD risk [Hazard Ratio-HR per 1/55 in MedDietScore: 0.80, 95% Confidence Interval-CI: 0.65, 0.98]. A significant interaction between sleep duration and MedDietScore was observed (p < 0.001). In subgroup analysis, the protective association between MD adherence and CVD risk was found only in participants who slept adequately, i.e., >7 h/day [HR:0.80, 95%CI: 0.65, 0.98]. Those who had a high adherence to the MD along with adequate sleep habits, had a 70% reduced 20-year CVD risk [HR:0.30, 95%CI: 0.11, 0.80], compared to those who had a low MD adherence and inadequate sleep habits. Sleep duration should be a part of an individual's lifestyle, together with dietary and other habits, to effectively evaluate CVD risk for future events. [ABSTRACT FROM AUTHOR]

Background: Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors. Methods: The ATTICA study is a population-based, prospective cohort (2002–2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0–88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria. Results: Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99). Conclusions: The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals. [ABSTRACT FROM AUTHOR]

Aim: Ikaria Island (North-East Aegean, Greece) has been recognized as one of the places with the highest life expectancy around the world (the Blues Zones). Risk factors in relation to 4-year all-cause mortality and cardiovascular disease (CVD) incidence in elders were studied. Methods: From June to October 2009, 330 men and 343 women, aged 65 to 100 years, were enrolled, and in June to July 2013, they were reevaluated. Results: Age-standardized, gender-specific, all-cause mortality rate was 790 deaths per 10 000 inhabitants, and causes of death were CVD (36%), cancer (21%), infection (10%), respiratory disease (2%), and other (31%). Incidence of CVDwas 520 cases per 10 000 men inhabitants and 320 cases per 10 000 women (P = .03). Age, male gender, heart rate, urea levels, left atrial maximum volume, left ventricular hypertrophy, thyroid-stimulating hormone, and moderate to severe depression were positively associated with mortality, whereas left ventricular ejection fraction as well as coffee and tea drinking, fruit intake, and exclusive olive oil use were inversely associated with CVD. Conclusion: Heart function markers in addition to antioxidant dietary factors were placed in this puzzle of CVD morbidity. [ABSTRACT FROM AUTHOR]

Cardiovascular disease ( CVD) remains the leading cause of morbidity and mortality worldwide, and educational level seems to be an important determinant of the disease occurrence. The aim of this work was to investigate the association between education status and 10-year incidence of CVD, controlling for various socio-demographic lifestyle and clinical factors. From May 2001 to December 2002, 1514 men and 1528 women (>18 years) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO- ICD-10 criteria. Education status was measured in years of schooling. The 10-year incidence of CVD was 15.7% [95% confidence intervals ( CI) 14.1%-17.4%], 19.7% in men and 11.7% in women ( Pgender < 0.001). Age-and gender-adjusted analyses revealed that those with low education (<9 years of schooling) were 1.52 times more likely (95% CI 1.03-2.23%) to have CVD compared with those with high education (>12 years of schooling). People in the low education group had higher prevalence of hypertension, diabetes and dyslipidaemias, were more likely to be smokers and sedentary, had less healthy dietary habits, as compared with those in the high education group. When controlling for participants' medical history, smoking, dietary and lifestyle habits, low education was no longer significantly associated with CVD, illustrating the mediating effect of clinical and behavioural factors in the link between education and disease. It was of interest that low education status interacted with alcohol drinking, enhancing the adverse effect of low education on CVD risk (relative risk 1.44, 95% CI 0.94%-2.20%), after various adjustments made. In this study, it was concluded that low educational level was associated with increased CVD risk. This was mainly explained by the intermediate association of low education with unhealthy choices that consequently worsen clinical status. [ABSTRACT FROM AUTHOR]

Abstract: Longevity is a very complex phenomenon, because many environmental, behavioral, socio-demographic and dietary factors influence the physiological pathways of aging and life-expectancy. Nutrition has been recognized to have an important impact on overall mortality and morbidity; and its role in extending life expectancy has been the object of extensive scientific research. This paper reviews the pathophysiological mechanisms that potentially link aging with diet and the scientific evidence supporting the anti-aging effect of the traditional Mediterranean diet, as well as of some specific foods. The diet and several of its components have additionally been shown to have beneficial effects on the co-morbidities typical of elderly populations. Furthermore, the epigenetic effects of diet on the aging process – through calorie restriction and the consumption of foods like red wine, orange juice, probiotics and prebiotics – have attracted scientific interest. Some, such as dark chocolate, red wine, nuts, beans, avocados are being promoted as anti-aging foods, due to their anti-oxidative and anti-inflammatory properties. Finally, an important moderator in the relationship between diet, longevity and human health remains the socio-economic status of individual, as a healthy diet, due to its higher cost, is closely related to higher financial and educational status. [Copyright &y& Elsevier]

Abstract: Background: The purpose of this study was to evaluate the impact of adherence to Mediterranean diet on serum uric acid (UA) levels in elderly individuals, without known cardiovascular disease. Methods: During 2009, 281 females (75±6years old) and 257 males (75±7years old) permanent inhabitants of the island, were voluntarily enrolled. A diet score that assesses the inherent characteristics of the Mediterranean diet (MedDietScore, range 0–55) was applied. Serum levels of UA were determined using an enzymatic colorimetric test through the uricase-peroxidase method. Hyperuricaemia was defined as UA>7mg/dL in males and 6mg/dL in females. Results: Prevalence of hyperuricaemia was 34% in males and 25% in females (p =0.02). Mean level of adherence to the Mediterranean diet was 35±2. Linear regression analysis revealed that MedDietScore was inversely associated with UA levels (b ±SE: −1.48±0.17, p <0.001) in the overall sample, after controlling for hypertension, hypercholesterolemia, diabetes mellitus, creatinine clearance, physical activity, and coffee consumption. When the analysis was stratified by gender, MedDietScore was inversely associated with UA levels in males (b ±SE: −1.10±0.42, p =0.009), but not in females (b ±SE: 0.04±0.41, p =0.92). Conclusion: Another cardioprotective effect of Mediterranean diet was revealed, through the modification of UA levels in elderly individuals. The potential different effect size as regards the relationship between diet and UA levels between genders, deserves further investigation. [Copyright &y& Elsevier]

Background. There are places around the world where people live longer and they are active past the age of 100 years, sharing common behavioral characteristics; these places (i.e., Sardinia in Italy, Okinawa in Japan, Loma Linda in California and Nicoya Peninsula in Costa Rica) have been named the "Blue Zones". Recently it was reported that people in Ikaria Island, Greece, have also one of the highest life expectancies in the world, and joined the "Blue Zones". The aim of this work work was to evaluate various demographic, lifestyle and psychological characteristics of very old (>80 years) people participated in Ikaria Study. Methods. During 2009, 1420 people (aged 30+) men and women from Ikaria Island, Greece, were voluntarily enrolled in the study. For this work, 89 males and 98 females over the age of 80 yrs were studied (13% of the sample). Socio-demographic, clinical, psychological and lifestyle characteristics were assessed using standard questionnaires and procedures. Results. A large proportion of the Ikaria Study's sample was over the age of 80; moreover, the percent of people over 90 were much higher than the European population average. The majority of the oldest old participants reported daily physical activities, healthy eating habits, avoidance of smoking, frequent socializing, mid-day naps and extremely low rates of depression. Conclusion. Modifiable risk factors, such as physical activity, diet, smoking cessation and mid-day naps, might depict the "secrets" of the long-livers; these findings suggest that the interaction of environmental, behavioral together with clinical characteristics may determine longevity. This concept must be further explored in order to understand how these factors relate and which are the most important in shaping prolonged life. [ABSTRACT FROM AUTHOR]

Aims. We evaluated the interaction effect between depressive symptoms and dietary habits on 30-day development of cardiovascular disease (CVD) (death or rehospitalization) in elderly, acute coronary syndrome (ACS) survivors. Methods. During 2006-2008, we recorded 277 nonfatal, consecutive ACS admissions (75 ± 6 years, 70% males, 70% had diagnosis of myocardial infarction) with complete 30-day follow-up. Assessment of recent depressive symptoms was based on the CES-D scale. Among sociodemographic, bioclinical, lifestyle characteristics, the MedDietScore that assesses the inherent characteristics of the Mediterranean diet was applied. Results. 22% of the ACS pts developed a CVD event during the first 30 days (14.8% rehospitalization and 9.4% death). Patients in the upper tertile of the CES-D scale (i.e., >18) had higher incidence of CVD events as compared with those in the lowest tertile (21% versus 8%, P = .01). Multiple logistic regression analysis revealed that 1- unit increase in CES-D was associated with 4% higher odds (95% CI 1.008-1.076, P = .01) of CVD events; however, when MedDietScore was entered in the model, CES-D lost its significance (P = .20). Conclusion. Short-term depressive symptoms are related to a worsen 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence. [ABSTRACT FROM AUTHOR]

We studied the association of physical activity and adherence to the Mediterranean diet, in total antioxidant capacity (TAC). A random sample of 1514 men and 1528 women was selected from Attica region. Physical activity was assessed with a translated version of the validated "International Physical Activity Questionnaire" (iPAQ), and dietary intake through a validated Food Frequency Questionnaire (FFQ). Adherence to the Mediterranean diet was assessed by the MedDietScore that incorporated the inherent characteristics of this diet. TAC was positively correlated with the degree of physical activity (P < .05). TAC was also positively correlated with MedDietScore (r = 0.24, P < .001). Stratified analysis by diet status revealed that the most beneficial results were observed to highly active people as compared to inactive, who also followed the Mediterranean diet (288 ± 70 μmol/L, 230 ± 50 μmol/L, resp.), after adjusting for various confounders. Increased physical activity and greater adherence to the Mediterranean diet were associated with increased total antioxidant capacity. [ABSTRACT FROM AUTHOR]

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

Background/Aims: The aim of the present work was to evaluate the association between exclusive olive oil consumption and the development of left ventricular systolic dysfunction (LVSD) in patients with a previous acute coronary syndrome (ACS). Methods: From 2006 to 2007, 651 consecutive ACS patients were enrolled. In 288 males (64 ± 13 years) and 75 females (71 ± 11 years), LVSD (ejection fraction <40%) developed after the cardiac event, and 221 males (62 ± 11 years) and 69 females (66 ± 11 years) were without LVSD (ejection fraction >50%). Detailed information regarding their clinical characteristics, anthropometric data, physical activity, smoking and dietary habits (including lipids use) were recorded. Results: 70% of the LVSD patients and 76% of the non-LVSD patients reported exclusive olive oil consumption. Multi-adjusted analysis revealed that exclusive olive oil consumption in post-ACS patients with a first cardiac episode was associated with a 65% (95% confidence interval 0.14–0.87) lower likelihood of developing LVSD after adjusting for various confounders. No significant association was observed among participants with a previous history of ACS. Conclusions: Exclusive, long-term olive oil consumption seems to offer significant protection against the development of LVSD in post-ACS patients. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background The purpose of the present work was to validate the MedDietScore by means of plasma fatty acid levels. Methods The study sample consisted of 189 men (44±13 years old) and 185 women (40±15 years old), randomly selected from the ATTICA study database. All participants completed a food frequency questionnaire (the EPIC-Greek FFQ), and a modified version of the MedDietScore (using weights) was then calculated to evaluate the level of adherence to the Mediterranean diet. Plasma and dietary fatty acids were measured. Results Correlation analysis revealed a strong positive relationship between the MedDietScore, monounsaturated fatty acids (P <0.001), monounsaturated fatty acids to saturated fatty acids (P <0.001), docosahexaenoic acid (22:6 n-3) (P <0.05) and n-3 fatty acids (P <0.001), and inverse correlations between the diet score and polyunsaturated fatty acids (comprised of the sum of n-3 and n-6 fatty acids) (P <0.001), saturated fatty acids (P <0.01), and total n-6 fatty acids (P <0.001). The effect size of the relationships between the weighted-MedDietScore and fatty acids was better than the relationships with the initial version of the diet score. Conclusions Our findings suggest that the modified MedDietScore is a valid measure of various plasma fatty acids, and may prove a useful tool in assessing diet quality of adults. [ABSTRACT FROM AUTHOR]

The 5-year incidence of cardiovascular disease (CVD) and its determinants, in a sample of men and women from Greece, was evaluated. From May 2001 to December 2002, 1514 men and 1528 women (> 18 years old) without any clinical evidence of CVD, living in the Attica area, Greece, were enrolled in the ATTICA study. In 2006, a group of experts performed the 5-year follow-up (941 of the 3042 (31%) participants were lost to follow-up). Development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) during the follow-up period was defined according to WHO-lCD-b criteria. The 5-year incidence of CVD was 11.0% in men and 6.1% in women (p<0.001); the case fatality rate was 1.6%. Multi-adjusted logistic regression analysis revealed that increased age (odds ratio per year = 1.09, p = 0.04), waist-to-hip ratio (odds ratio = 5.07, p=0.02), hypertension (odds ratio = 4.53, p = 0.001), diabetes (odds ratio = 4.53, p = 0.001) and C-reactive protein levels (odds ratio per 1 mg/dl = 1.31, p=0.02) were the most significant baseline bio-clinical predictors of CVD. Furthermore, an increased education level and greater adherence to the Mediterranean diet (among 35-65-year-old individuals) were associated with a lower CVD incidence (odds ratio per 3 years of school difference = 0.83, p < 0.001 and odds ratio per 1/55 units in diet score = 0.94, p < 0.001), irrespective of various potential confounders. In conclusion, aging, central fat, hypertension and diabetes, inflammation process, low social status and abstinence from a Mediterranean diet seem to predict CVD events within a 5-year period. [ABSTRACT FROM AUTHOR]

Objective: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample.Methods: Following a random multistage sampling, 1514 men (46+/-13 years old) and 1528 women (45+/-13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs.Results: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 +/- 8.2, 95%CI 30.2-31.04 vs. 26.9 +/- 6.3, 95%CI 26.05-27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men.Conclusion: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate if overweight and obese adults "close" to Mediterranean diet present better insulin, lipids profile and better pressure levels, compared to individuals close to a more Westernized diet. Methods: The ATTICA study is a population-based cohort that has randomly enrolled 3042 adult men and women, stratified by age — gender, from the greater area of Athens, during 2001-2002. Of them, in this work were have studied 1762 participants with excess body weight, meaning overweight (BMI: 25-29.9 kg/m²) and obese (BMI>30 kg/m²). 1064 were men and 698 women (20-89 years old). Adherence to Mediterranean diet was assessed through a diet-score that was based on a validated food-frequency questionnaire. Blood pressure was measured and also fasting glucose, insulin and blood lipids. Insulin sensitivity was also assessed by the homeostasis model assessment (HOMA) approach (glucose × insulin/22.5). Results: Individuals with excess bodyweight in the highest tertile of diet score, were more insulin sensitive than those in the lowest tertile (11.4% lower HOMA, p = 0.06), had 13% lower levels of total cholesterol (p = 0.001) and 3 mmHg decrease of systolic blood pressure levels (p < 0.001), when adjusted for age, sex and BMI. Multivariate analysis after taking into account several confounders demonstrated that insulin sensitivity, total cholesterol and systolic blood pressure were independently but only modestly correlated with Mediterranean diet in people with excess bodyweight. Conclusion: Adherence to Mediterranean diet is modeslty associated with a better insulin sensitivity, lower levels of total cholesterol and lower levels of systolic blood pressure in overweight and obese subjects. This may suggest that compared to general population, the beneficial effect of this diet in cardiovascular system of excess body weight people is limited. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We evaluated the prevalence of obesity in relation to adherence to a Mediterranean diet. Methods: We conducted a cross-sectional survey that randomly enrolled 1514 men (18 to 87 y old) and 1528 women (18 to 89 y old) with no history of cardiovascular disease. Anthropometric indices were measured and frequency of various foods consumed during a usual week was recorded. Adherence to a Mediterranean diet was assessed by a diet score that incorporated the inherent characteristics of this diet. Results: Prevalences of overweight and obesity were 53% and 20% in men and 31% and 15% in women. An inverse relation was observed between diet score, waist-to-hip ratio (r = −0.31, P < 0.001), and body mass index (r = −0.4, P < 0.001) after adjusting for sex and age. Greater adherence to the Mediterranean diet (i.e., highest tertile) was associated with a 51% lower odds of being obese (odds ratio 0.49, 95% confidence interval 0.42 to 0.56) and a 59% lower odds of having central obesity (odds ratio 0.41, 95% confidence 0.35 to 0.47) compared with a non-Mediterranean diet (i.e., lowest tertile) after controlling for age, sex, physical activity status, metabolism, and other variables. Conclusion: We observed an inverse relation between adherence to a Mediterranean dietary pattern and prevalence of obesity in a free-eating, population-based sample of men and women, irrespective of various potential confounders. [Copyright &y& Elsevier]

Abstract: Background and aim: We sought to investigate the relationship between fish consumption and the risk of developing non-fatal acute coronary syndromes (ACS) among current smokers. Methods and results: During 2000–2001, we conducted the CARDIO2000 case-control study that included patients hospitalized for a first event of ACS and matched (age, sex) individuals without clinical evidence of CHD (controls), from all the Greek regions. In the present analysis we studied data from 519 men (59±10years old) and 45 women (62±9years old) patients, as well as 444 men and 90 women controls, matched for age with the patients that reported current smoking. To evaluate the hypothesis tested we applied conditional logistic regression analysis after controlling for several potential confounders. Overall, 94% of controls and patients reported fish consumption at least once a week. Compared to low fish consumption (<60g/week), moderate (60–180g/week) intake was associated with 15% (p<0.05) lower risk of ACS, while increased (180–300g/week, or >300g/week) consumption was associated with 18% (p<0.05) and 19% (p=0.53) higher risk, respectively. Conclusion: Moderate fish consumption seems to moderate the deleterious effect of smoking on the occurrence of ACS. However, increased intake does not seem to confer any benefit on coronary risk. [Copyright &y& Elsevier]

Homocysteine levels are considered, by some investigators, as an independent factor of cardiovascular disease; however, others suggest that there is not a causal relationship. The aim of this work was to investigate the associations between homocysteine levels and several lifestyle-related factors. The ATTICA study is a population-based cohort that has randomly enrolled 1128 adult men and 1154 women, stratified by age and gender, from the greater area of Athens, during 2001–2002. Among several demographic, lifestyle, clinical and biochemical characteristics, we measured total plasma homocysteine levels. For the present analysis, we excluded people who had a history of cardiovascular disease. The factors that showed the strongest relationship with homocysteine levels, in both genders, even after adjusting for several potential confounders were: cigarette smoking (p=0.03), endurance exercise (inverse, p<0.05), fruit (inverse, p = 0.01) and vegetable intake (inverse, p = 0.04), and alcohol (p = 0.04) and coffee intake (p = 0.04). In conclusion, several lifestyle-related factors seem to be associated with homocysteine levels. However, the vast majority of the associations were weak when we adjusted for other co-factors. The latter may indicate the mutual confounding effect of various socio-demographic, anthropometric and other clinical characteristics on the relationship between homocysteine and cardiovascular risk. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000-2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3±8 vs. 59.7±10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multi-variate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women. [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver disease (NAFLD) is correlated with low-grade inflammation and dietary habits. Until today, there have been limited epidemiologic data assessing the role of diet's inflammatory potential on NAFLD. The aim was to evaluate the relationship between an anti-inflammatory diet, as reflected by the Dietary Anti-Inflammation Index (D-AII), and NAFLD among cardiovascular disease (CVD)-free adults. Methods: ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek population (Whites; age ⩾18 years; 1514 men and 1528 women). D-AII was calculated using a standard procedure. The baseline study captured various sociodemographic, lifestyle and clinical characteristics as well as hepatic markers. These were used to calculate four NAFLD assessment indices: triglyceride-glucose (TyG) index, fatty liver index (FLI), hepatic steatosis index (HSI), and NAFLD Fatty Liver Score (NAFLD-FLS). Specific cutoffs were applied to capture NAFLD. Results: D-AII showed a significant inverse association with NAFLD, applying the four indices with NAFLD cutoffs [odds ratio (OR) with 95% confidence interval (CI); TyG (0.95, 0.93–0.98); HSI (0.89, 0.86–0.92); FLI (0.88, 0.85–0.91); NAFLD-FLS (0.89, 0.86–0.92)], after adjusting for various confounders. Participants in the highest D-AII tertile had lower odds of having NAFLD, compared with those in the lowest D-AII tertile [(OR, 95% CI); TyG (0.33, 0.24–0.47); HSI (0.13, 0.08–0.23); FLI (0.05, 0.02–0.11); NAFLD-FLS (0.13, 0.07–0.23)]. Anti-inflammatory nutrition was related to lower odds of NAFLD among daily alcohol drinkers and individuals with metabolic syndrome. Conclusions: Anti-inflammatory diet is an important predictor of NAFLD among adults without pre-existing CVD. Adherence to a high anti-inflammatory diet seems to contribute to NAFLD prevention. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to assess the relationship between long-term fish consumption and short-term prognosis of patients who had an acute coronary syndrome. The multi-adjusted data analysis from a total of 214 men and 79 women patients showed that intake of fish, n−3 and n−6 fatty acids above 7 portions, 8.8 g and 13.2 g per week correspondingly, is associated with 83%, 83% and 79% reduction on the likelihood of recurrent events in a 30-day period after hospitalisation hospitalization (OR=0.17, 95%CI 0.04–0.80, OR=0.17, 95%CI 0.04–0.81, OR=0.21, 95%CI 0.05–0.97). Conclusively, an inverse relationship between long-term fish and fish oils consumption and short-term prognosis of patients who had had an ACS was observed, irrespective of various potential confounders. [Copyright &y& Elsevier]

Background/objectives The aim of the present work was to evaluate the association between the inflammatory potential of the diet and the 10-year cardiovascular disease (CVD) incidence in the ATTICA Study, and whether this is modified by the baseline presence or absence of metabolic syndrome (MetS). Methods During 2001–2002, 3042 healthy adults (1514 men and 1528 women) living in the greater area of Athens were voluntarily recruited to the ATTICA study. In 2011–2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD event was recorded using WHO-ICD-10 criteria and MetS was defined by the National Cholesterol Education Program Adult Treatment panel III (revised) definition. A proxy dietary anti-inflammatory index (D-AII) score computed using participants' diet records. Results The 10-year fatal or non-fatal CVD event rate was 157 cases/1000 participants. After adjusting for several confounding factors, an anti-inflammatory diet, as expressed by higher DII scores, was borderline associated with 10-year CVD incidence (OR 3rd tertile vs. 1st tertile = 0.98, 95%CI: 0.96–1.01). This inverse association was also verified among participants without MetS at baseline (OR 3rd tertile vs. 1st tertile = 0.97, 95%CI: 0.94–0.99), but not among participants with the MetS. Conclusions Results of the present work verified the protective effect of an anti-inflammatory diet towards the 10-year CVD incidence among participants without MetS. In contrast, the presence of MetS already at baseline seemed to impede this anti-inflammatory diet protective effect, which underlines the independent importance of MetS on CVD risk. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the mediating role of behavioral patterns, such as adherence to the Mediterranean diet and physical activity status, in the relationship between depression, anxiety, and the cardiovascular disease (CVD) risk score HellenicSCORE. Methods: In the context of the ATTICA study, a cross-sectional survey, 453 men (45 ± 13 years) and 400 women (44 ± 18 years), with complete psychological evaluation were studied. Participants were without any evidence of cardiovascular or other chronic disease. Depression was assessed with the Zung Self-Rating Depression Scale and anxious state by the Spielberger State Anxiety Inventory Scale. Physical activity was assessed using the International Physical Activity Questionnaire and adherence to the Mediterranean diet was assessed by the MedDietScore. Structural equation modeling methodology was implemented in the statistical analysis. Results: Five latent depression and anxiety factors were revealed and associated with CVD risk score through mediation of physical activity status and adherence to the Mediterranean diet with very good fit to the data (χ2/df ratio = 2.34; root mean square error of approximation = 0.021; 90% confidence interval, 0.020–0.022; comparative fit index = 0.951). Significant total effect on CVD risk was found for the “anxiety–worry” latent factor, and this effect was through the inverse relationship of “anxiety–worry” with MedDietScore (P = .002). Moreover, “positive feelings” latent construct was associated with lower CVD risk, and this seems to be through the higher adherence to the Mediterranean diet (P = .01). Conclusions: Adherence to the Mediterranean diet seems to mediate the unfavorable effect of depression and anxiety on CVD risk. [Copyright &y& Elsevier]

Abstract: Background: Blood lipids and inflammatory markers levels have been associated with the development and progression of atherosclerosis. As the association of inflammatory markers with plasma fatty acids has not been extensively evaluated and understood, we sought to investigate the associations between dietary and plasma fatty acids with various inflammation and coagulation markers. Methods: High sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), fibrinogen, and homocysteine were measured in serum of 374 free-living, healthy men and women, randomly selected from the ATTICA''s study database. Total plasma fatty acids were determined by gas chromatography. Dietary fatty acids were assessed through a semi-quantitative FFQ. Results: Multi-adjusted regression analyses revealed that plasma n-3 fatty acids were inversely associated with CRP, IL-6 and TNF-α; plasma n-6 fatty acids were inversely associated with CRP, IL-6 and fibrinogen; monounsaturated fatty acids were inversely associated with CRP and IL-6 (all p-values<0.05). Interestingly, the n-6/n-3 ratios exhibited the strongest positive correlations with all the markers studied. No associations were observed between dietary fatty acids and the investigated markers. Conclusions: Measurements of total plasma fatty acids could provide insights into the relationships between diet and atherosclerotic disease. Moreover, the n-6/n-3 ratio may constitute a predictor of low-grade inflammation and coagulation. [Copyright &y& Elsevier]

Abstract: Adiponectin is thought to exert anti-inflammatory actions. The aim of the present work was to evaluate the association of long-term adherence to the Mediterranean diet with adiponectin levels, in a sample of cardiovascular disease-free adults. In a random sub-sample of “ATTICA” study, 532 men and women, serum adiponectin was measured. Among several sociodemographic, clinical and biological factors, adherence to the Mediterranean diet was assessed by a special diet score (MedDietSCore) that incorporated the inherent characteristics of this traditional diet. Unadjusted analysis revealed that participants who were in the highest tertile of the diet score had an average 41% higher adiponectin levels, as compared to those who were in the lowest tertile (P<.001). Multiadjusted data analysis showed that compared to the highest tertile of diet score, participants in the middle or the lowest one had an average 0.99±0.22 (P=.001) and 1.05±0.27 μg/ml (P=.001) lower adiponectin levels after adjusting for age, sex and various bioclinical factors. Adherence to the Mediterranean diet was associated with an increase on adiponectin levels. This finding may partially explain beneficial effects of this traditional healthy diet on the cardiovascular system. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this work was to investigate the association between fish consumption and the development of non-fatal acute coronary syndromes (ACS), in a Mediterranean population. Methods: During 2000–2001, we randomly and stratified selected, from all Greek regions, 848 hospitalised patients (695 males, 58±10 years old and 153 females, 65±9 years old) who had a first event of ACS and 1078 paired, by region–sex–age, controls without any clinical symptoms or signs of coronary heart disease. Results: On multivariate logistic regression analysis and, after controlling for several potential confounders, we found that fish consumption less than 150 g/week was associated with 38% lower odds of developing ACS as compared to no consumption (odds ratio=0.62, P-value&#60;0.05). In contrast, moderate (150–300 g/week) and high (>300 g/week) fish consumption was not associated with the developing of the disease (odds ratios=1.10 and 1.01, respectively, P-value>0.1). The benefits from low fish consumption were also significant even amongst current smokers and diabetics. Conclusion: Moderate fish consumption was independently associated with a significant reduction in the odds of developing ACS. The strength and consistency of this finding has implications for public health and should be explored further. [Copyright &y& Elsevier]

Objective: The aim of this work was to investigate the associations between homocysteine levels and several lifestyle-related factors, in a population-based sample of Greek adults. Methods: During 2001–2002, we randomly enrolled 1128 men and 1154 women, from Athens area. The sampling was stratified by the age–gender distribution of the underlying population. Among several demographic, lifestyle, clinical and biochemical factors, we measured plasma total homocysteine levels. For the present analysis, we excluded people who had a history of cardiovascular disease. Results: Homocysteine values were higher in men as compared to women (14.5±6 vs. 10.8±3.5 μmol/l, p<0.001). Twenty-five percent of men and 15% of women had plasma homocysteine levels >14 μmol/l. Postmenopausal women had higher homocysteine levels (12.0±5.2 vs. 9.9±2.9 μmol/l, p<0.001). The lifestyle factors most strongly associated with plasma total homocysteine were number of cigarettes smoked (r=0.12, p=0.004), fruits (r=-0.12, p=0.006) and vegetables consumption (r=-0.15, p=0.02), alcohol (r=0.11, p=0.04) and coffee drinking (r=0.10, p=0.03). Additionally, aerobic exercise was related with lower homocysteine levels as compared to anaerobic or sedentary life (11.0±2.6 vs. 12.4±2.5 vs. 12.5±2.3 μmol/l, respectively, p=0.04). Multivariate analysis after adjusting for several potential confounders confirmed the previous associations. No relationship was observed of homocysteine with the Mediterranean diet score (r=0.02, p=0.85). Conclusions: Several lifestyle-related factors were associated with homocysteine levels. Identifying and understanding modifiable factors related to homocysteine, a possible risk factor for vascular disease, might be especially important for the public health. [Copyright &y& Elsevier]

Aims: To examine the association between dietary anti-inflammatory index (D-AII) and metabolic syndrome (MetS)prevalence, 10-year (2002-2012) diabetes, hypertension, hypercholesterolaemia incidence and 10-year transition from healthy (absence of all MetS traits, excluding waist circumference) to unhealthy metabolic status.Methods: In 2001-2002, n = 1514 men and n = 1528 women (>18 years old) in Athens, Greece, free of cardiovascular disease were recruited. MetS was defined according to the revised NCEP ATP III (2005) or the IDF criteria or the harmonized criteria. The validated D-AII was calculated using a standardized procedure (range 10-77).Results: Inverse associations were observed between D-AII and transition from healthy to unhealthy metabolic status (Odds Ratio (OR)3rd vs. 1st tertile = 0.88 95% Confidence Interval (95%CI)(0.73, 0.98)) and diabetes (OR3rd vs. 1st tertile = 0.55, 95%CI(0.29, 0.77)). In women, D-AII was inversely associated with transition from healthy to unhealthy metabolic status (OR3rd vs. 1st tertile = 0.55, 95%CI(0.26, 0.90), diabetes (OR3rd vs. 1st tertile = 0.41, 95%CI(0.18, 0.64) and hypertension (OR3rd vs. 1st tertile = 0.75, 95%CI(0.20, 0.95), yet only with diabetes incidence in men (OR3rd vs. 1st tertile = 0.62, 95%CI(0.38, 0.93).Conclusions: Diet with high anti-inflammatory load seems an effective preventive measure to retain a metabolically benign status, principally in terms of glycemic control. [ABSTRACT FROM AUTHOR]