The current study aimed to evaluate the effect of fortified milk combined with a lifestyle and counselling programme on several CVD risk factors after a 3-month dietary intervention.

Hypercholesterolaemic adults were randomized to a group supplemented with low-fat milk that was enriched with phytosterols, α-linolenic and linoleic fatty acids, vitamins and antioxidants (enriched milk group, EMG: n 40), a placebo milk group (PMG: n 36) or a control group (CG: n 25). The EMG and PMG consumed respectively 500 ml of enriched milk or placebo milk daily and attended biweekly counselling sessions over a 3-month period.

Harokopio University, Athens, Greece.

A sample of 101 hypercholesterolemic adults aged 40–60 years.

Regarding lifestyle changes, total and saturated fat intakes decreased significantly in both intervention groups compared with the CG (P < 0·005). Furthermore, total steps were increased (P = 0·029) and BMI was decreased (P = 0·017) significantly in both intervention groups compared with the CG. Regarding biochemical indices, EPA content in erythrocyte membranes increased (P < 0·001) while serum C-reactive protein decreased (P = 0·003) significantly in both intervention groups compared with the CG. Finally, significant increases in plasma folic acid and vitamin B12 levels and a significant decrease in homocysteine levels were observed in the EMG compared with the PMG and CG (all P < 0·001). A favourable change in LDL cholesterol:HDL cholesterol was also observed in the EMG and tended to be significant compared with the PMG and CG (P = 0·066).

The present study showed that consumption of fortified milk accompanied with lifestyle counselling induces extra benefits in terms of LDL cholesterol:HDL cholesterol and serum homocysteine levels.

The present study aimed to evaluate the relationship between the consumption of selected food groups and insulin resistance, with an emphasis on sugar-sweetened beverages (SSB).

The present research is a large multicentre European study in adolescents, the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study).

Homeostasis model assessment–insulin resistance index (HOMA-IR) was calculated. Several anthropometric and lifestyle characteristics were recorded. Dietary assessment was conducted by using a short FFQ.

The participants were a subset of the original sample (n 546) with complete data on glucose, insulin and FFQ. All participants were recruited at schools.

Median (25th, 75th percentile) HOMA-IR was 0·62 (0·44, 0·87). Mean HOMA-IR was significantly higher among adolescents consuming brown bread ≤1 time/week than among those consuming 2–6 times/week (P = 0·011). Mean values of HOMA-IR were also higher in adolescents consuming SSB >5 times/week compared with those consuming less frequently, although a statistically significant difference was detected between those consuming SSB 5–6 times/week and 2–4 times/week (P = 0·049). Multiple linear regression analysis showed that only the frequency of SSB consumption was significantly associated with HOMA-IR after controlling for potential confounders. In particular, it was found that HOMA-IR levels were higher among adolescents consuming SSB 5–6 times/week and ≥1 time/d compared with those consuming ≤1 time/week by 0·281 and 0·191 units, respectively (P = 0·009 and 0·046, respectively).

The present study revealed that daily consumption of SSB was related with increased HOMA-IR in adolescents.

To build up sufficient knowledge of a ‘healthy diet’. Here, we report on the assessment of nutritional knowledge using a uniform method in a large sample of adolescents across Europe.

A cross-sectional study.

The European multicentre HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study conducted in 2006–2007 in ten cities in Austria, Belgium, France, Germany, Greece (one inland and one island city), Hungary, Italy, Spain and Sweden.

A total of 3546 adolescents (aged 12·5–17·5 years) completed a validated nutritional knowledge test (NKT). Socio-economic variables and anthropometric data were considered as potential confounders.

NKT scores increased with age and girls had higher scores compared with boys (62 % v. 59 %; P < 0·0001). Scores were approximately 10 % lower in ‘immigrant’ adolescents or in adolescents with ‘immigrant’ mothers. Misconceptions with respect to the sugar content in food or in beverages were found. Overall, there was no correlation between BMI values and NKT scores. After categorization according to BMI, scores increased significantly with BMI group only in boys. These differences disappeared after controlling for socio-economic status (SES). Smoking status and educational level of the mother influenced the NKT scores significantly in boys, as well as the educational levels of both parents in girls.

Nutritional knowledge was modest in our sample. Interventions should be focused on the lower SES segments of the population. They should be initiated at a younger age and should be combined with environmental prevention (e.g. healthy meals in school canteens).

To record the prevalence of overweight and obesity in urban primary-school children in relation to several socio-economic and demographic factors.

Cross-sectional.

A representative sample of 729 schoolchildren (379 male and 350 female), aged 9–13 years, stratified by parental educational level, was examined in the urban region of Athens. Weight and height were measured using standard procedures. The International Obesity Task Force thresholds were used for the definition of overweight and obesity. Several socio-economic and demographic data and the child’s ‘popularity’ score were also recorded with specifically designed standardized questionnaires.

The prevalence of overweight and obesity was 29·6 % and 11·1 %, respectively. Annual family income of €12 000–20 000 (OR = 1·58), residence ownership (OR = 1·63) and the grandmother as the child’s primary caregiver (OR = 1·38) were significantly associated with higher odds of childhood overweight and obesity. Non-Greek parental nationality (OR = 0·72) and higher ‘popularity’ scores of children (OR = 0·42) were significantly associated with lower odds of overweight and obesity. The grandmother as the child’s primary caregiver and an annual family income of €12 000–20 000 remained significantly associated with childhood overweight and obesity after adding all significant correlates of childhood overweight and obesity observed at the bivariate level in a multivariate regression model (OR = 1·51 and 1·61, respectively).

Among family income, residence ownership, child’s primary caregiver, parental nationality and popularity scores that were identified as significant correlates of childhood overweight and obesity at the bivariate level, lower family income and grandmother as the child’s primary caregiver were the only factors that remained significantly associated with childhood overweight and obesity at a multivariate level.

To develop an index that assesses the degree of adherence to existing diet–lifestyle recommendations for preschoolers (Preschoolers Diet–Lifestyle Index (PDL-Index)) and to investigate its association with obesity.

The PDL-Index was constructed using eleven components (i.e. questions regarding the frequency of consumption of selected foods/food groups, time spent on television watching and on moderate-to-vigorous physical activities).

Scores from 0 to 4 were assigned to all components of the index. The PDL-Index total score ranged from 0 to 44. Higher values of the PDL-Index indicate greater adherence to dietary and lifestyle recommendations for preschoolers or otherwise greater adherence to healthier dietary–lifestyle patterns.

As a validation procedure, a sample of 2287 preschoolers from Greece (GENESIS study) was used.

The participants following healthier diet–lifestyle patterns (third tertile of PDL-Index) were less likely to be obese or overweight/obese compared to those following unhealthy diet–lifestyle patterns (first tertile of PDL-Index). It was observed that a 1/44 unit increase in the score of the PDL-Index was associated with approximately 5 % and 3 % lower odds of being obese and overweight/obese, respectively. Statistically significant results were observed after adjusting for potential confounders.

The suggested PDL-Index could help public health policy makers in identifying vulnerable population subgroups and developing cost-effective, targeted intervention actions both in family and preschool settings. In addition, health-care professionals can use the PDL-Index to evaluate diet quality, lifestyle and risk for overweight/obesity at an individual level and counsel parents accordingly.

The objective of the present work was to quantify mothers’ misclassification of pre-school children’s weight status and to determine factors associated with the maternal misperception.

A representative sample of 2287 children aged 2–5 years was examined (GENESIS study). Mothers’ perceptions of their child’s weight status and the children’s and mothers’ anthropometric and other characteristics (sociodemographic and lifestyle) were recorded.

Almost 38 % of mothers underestimated their child’s weight status. The frequency of underestimation was much higher among ‘at risk of being overweight’ and ‘overweight’ children (88·3 % and 54·5 %, respectively) compared with ‘underweight/normal-weight’ children (18·0 %, P < 0·001). Multiple logistic regression modelling revealed that the likelihood of mothers’ underestimation of their child’s weight status was significantly higher in boys, in children engaging in physical activity for less than 3 h/week and in children whose mothers had low education status, compared with their counterparts. Moreover, the higher the BMI-for-age Z-score, the greater the odds that the mother would underestimate her child’s weight status.

The current study demonstrated that more than one-third of mothers misclassify their children’s weight status as being lower than the actual. Given that mother’s weight perception might be an important determinant of child’s body weight development, clinicians and health professionals should help mothers correctly classify their children’s weight status, which could potentially help in the early prevention of overweight and obesity.

The current paper aims to describe the characteristics of mothers failing to initiate breast-feeding, provide information on the factors contributing to longer duration of breast-feeding and identify the association of maternal obesity with both initiation and duration of breast-feeding in the Greek population.

Data from the cross-sectional GENESIS (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) study were used. Mothers were categorized by their pre-pregnancy BMI and their gestational weight gain according to guidelines from the Institute of Medicine.

Preschool children aged 1–5 years in five counties in Greece.

Preschoolers (n 2374) with full maternal anthropometric data before and during pregnancy and breast-feeding data.

A higher percentage of mothers with increased pre-pregnancy BMI or high gestational weight gain failed to initiate breast-feeding compared with their normal-weight counterparts. Obese mothers were 2·86 times more likely to fail in initiating breast-feeding in a multiple logistic regression model. Multiple linear regression analysis showed that among women initiating breast-feeding, those who were either underweight before pregnancy or smoked at the third trimester of pregnancy breast-fed their children for about 1·5 weeks less than their normal-weight or non-smoking counterparts, respectively. Similarly, multiparous women breast-fed their children for about 7 weeks less than uniparous women. In women who initiated breast-feeding, no significant differences in breast-feeding duration were found between women of different gestational weight gains.

Mothers with high pre-pregnancy BMI are less likely to initiate breast-feeding while high gestational weight gain has no effect on either the initiation or duration of breast-feeding in Greece.