Unhealthy diet is a modifiable risk factor leading to subclinical arterial damage (SAD), high BP and CVD. It was aimed to investigate the possible associations of dietary patterns (DPs) with SAD in adults having multiple CVD risk factors.

Dietary intake was evaluated through two 24-h dietary recalls and principal component analysis was used to identify DPs. Oscillometry, applanation tonometry with pulse wave analysis and carotid ultrasound were used to assess peripheral and aortic BP, arterial stiffness and pressure wave reflections.

Laiko University Hospital, Athens, Greece.

A total of 470 individuals (53·1 ± 14·2 years) with CVD risk factors were enrolled.

A pattern characterised by increased consumption of whole-grain cereals, white meat and reduced consumption of sugar was positively associated with common carotid compliance (β = 0·01, 95 % CI 0·00, 0·01), whereas a pattern high in refined cereals, red and processed meat was positively associated with brachial but not aortic systolic pressure (β = 1·76, 95 % CI 0·11, 3·42) and mean arterial pressure (MAP) (β = 1·18, 95 % CI 0·02, −2·38). Low consumption of low-fat dairy products, high consumption of full-fat cheese and butter was positively associated with MAP (β = 0·97, 95 % CI 0·01, 1·95). Increased consumption of vegetables, fruits, fresh juices, fish and seafood was inversely associated with augmentation index (AIx) (β = -1·01, 95 % CI -1·93, −0·09).

Consumption of whole grains, white meat, fruits/vegetables, fish/seafood and avoidance of sugar was associated with improved SAD. Preference in refined grains, red/processed meat, high-fat cheese/butter and low intake of low-fat dairy products were associated with BP elevation. Future studies are needed to confirm the present findings.

To examine the associations between the level of adherence to the Mediterranean diet (MedDiet) with obesity, insulin resistance (IR), metabolic syndrome (MetS) and its components in schoolchildren.

The Healthy Growth Study was a large epidemiological cross-sectional study.

School children who were enrolled in primary schools in four counties covering the northern, southern, western and central part of Greece were invited to participate.

The study was conducted with a representative sample of 9–13-year-old schoolchildren (n 1972) with complete data. This study applied the KIDMed score to determine ‘poor’ (≤3), ‘medium’ (4-7) and ‘high’ (≥8) adherence of children to the MedDiet. The research hypothesis was examined using multivariate logistic regression models, controlling for potential confounders.

The percentage of children with ‘poor’, ‘medium’ and ‘high’ adherence to the MedDiet was 64·8 %, 34·2 % and 1 %, respectively. Furthermore, the prevalence of obesity, IR and MetS was 11·6 %, 28·8 % and 3·4 %, respectively. Logistic regression analyses revealed that ‘poor’ adherence to the MedDiet was associated with an increased likelihood for central obesity (OR 1·31; 95 % CI 1·01, 1·73), hypertriglyceridaemia (OR 2·80; 95 % CI 1·05, 7·46) and IR (OR 1·31; 95 % CI 1·05, 1·64), even after adjusting for several potential confounders.

The present study showed that approximately two-thirds of the examined sample of schoolchildren in Greece have ‘poor’ adherence to the MedDiet, which also increases the likelihood for central obesity, hypertriglyceridaemia and IR. Prospective studies are needed to confirm whether these are cause–effect associations.

To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change.

A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children’s body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used.

Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain).

A sample of 6268 preschoolers aged 3·5–5·5 years (51·9 % boys).

There was no intervention effect on the change in children’s BMI percentile. However, parents’ underestimation of their children’s actual weight status, parental overweight and mothers’ pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children’s BMI percentile in multivariate modelling.

As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children’s weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.

(i) Describe the development of a multipurpose Cardio-Med survey tool (CMST) comprising a semi-quantitative FFQ designed to measure dietary intake in multicultural patients with or at high risk of CVD and (ii) report pilot evaluation of test–retest reliability and validity of the FFQ in measuring energy and nutrient intakes.

The CMST was developed to identify CVD risk factors and assess diet quality over 1 year using an FFQ. Design of the ninety-three-item FFQ involved developing food portion photographs, and a list of foods appropriate for the Australian multicultural population allowing the capture of adherence to a Mediterranean diet pattern. The FFQ was administered twice, 2 weeks apart to assess test–retest reliability, whilst validity was assessed by comparison of the FFQ with a 3-d food record (3DFR).

The Northern Hospital and St Vincent’s Hospital, Melbourne, Australia.

Thirty-eight participants aged 34–81 years with CVD or at high risk.

Test–retest reliability of the FFQ was good: intraclass correlation coefficient (ICC) ranged from 0·52 (Na) to 0·88 (alcohol) (mean 0·79), with energy and 70 % of measured nutrients being above 0·75. Validity was moderate: ICC ranged from 0·08 (Na) to 0·94 (alcohol) (mean 0·59), with energy and 85 % of measured nutrients being above 0·5. Bland–Altman plots demonstrated good levels of agreement between the FFQ and 3DFR for carbohydrates, protein, alcohol, vitamin D and Na.

The CMST FFQ demonstrated good test–retest reliability and moderate validity for measuring dietary energy and nutrients in a multicultural Australian cardiology population.

There is an increasing focus on lifestyle as a factor in the pathogenesis of mental health disorders; however, this has been relatively underexplored in child populations. This study aimed to assess the relationships between behavioural lifestyle factors and emotional functioning in a large, population-representative sample of schoolchildren in Greece.

A representative sample of 2,240 schoolchildren, aged 9–13 years, participated in the Healthy Growth Study during 2007–2010. Emotional functioning was measured using the Dartmouth COOP Functional Health Assessment charts/World Organization of Family Doctors Charts. A score of 3 or higher out of 5 indicated poorer emotional functioning. Participants self-reported dietary intake via three 24-h dietary recalls; fruit, vegetable and soft drink consumption were the dietary variables of interest. Participants’ self-reported daily time spent in moderate to vigorous physical activity, and watching TV or playing video games were used to assess physical activity and sedentary behaviour.

In fully adjusted models, females were at a greater risk of experiencing impaired emotional functioning compared to males (OR 1.76, 95%CI 1.44, 2.15, p < 0.01). Overweight/obesity compared to normal body weight (OR 1.52, 95%CI 1.31, 1.77, p < 0.01) was associated with poorer emotional functioning. Three hours or more of daily average physical activity compared to less than one hour (OR 0.59, 95%CI 0.40, 0.86, p < 0.01) was associated with improved emotional functioning. Consuming soft drinks compared to non-consumption (OR 1.24, 95%CI 1.02, 1.51) was associated with poorer emotional functioning; this became non-significant after corrections for multiple comparisons were made. Clustering of municipalities was accounted for in all models.

Whilst findings were cross-sectional and causality cannot be inferred, this study highlights the interdependence of emotional and physical functioning in schoolchildren. This points to the potential for targeting shared risk factors for both physical chronic diseases and emotional and mental health conditions among children. Further longitudinal evidence will identify the potential for such shared intervention targets. Adopting a comprehensive, integrated approach to children’s emotional, mental, and physical health is warranted.

To identify possibly independent associations of perinatal, sociodemographic and lifestyle factors with childhood total and visceral body fat.

A representative sample of 2655 schoolchildren (9–13 years) participated in the Healthy Growth Study, a cross-sectional epidemiological study.

Seventy-seven primary schools in four large regions in Greece.

A sample of 1228 children having full data on total and visceral fat mass levels, as well as on anthropometric, dietary, physical activity, physical examination, socio-economic and perinatal indices, was examined.

Maternal (OR=3·03 and 1·77) and paternal obesity (OR=1·62 and 1·78), maternal smoking during pregnancy (OR=1·72 and 1·93) and rapid infant weight gain (OR=1·42 and 1·96) were significantly and positively associated with children’s increased total and visceral fat mass levels, respectively. Children’s television watching for >2 h/d (OR=1·40) and maternal pre-pregnancy obesity (OR=2·46) were associated with children’s increased total and visceral fat mass level, respectively. Furthermore, increased children’s physical activity (OR=0·66 and 0·47) were significantly and negatively associated with children’s total and visceral fat mass levels, respectively. Lastly, both father’s age >46 years (OR=0·57) and higher maternal educational level (OR=0·45) were associated with children’s increased total visceral fat mass level.

Parental sociodemographic characteristics, perinatal indices and pre-adolescent lifestyle behaviours were associated with children’s abnormal levels of total and visceral fat mass. Any future programme for childhood prevention either from the perinatal age or at late childhood should take these indices into consideration.

To characterise clusters of individuals based on adherence to dietary recommendations and to determine whether changes in Healthy Eating Index (HEI) scores in response to a personalised nutrition (PN) intervention varied between clusters.

Food4Me study participants were clustered according to whether their baseline dietary intakes met European dietary recommendations. Changes in HEI scores between baseline and month 6 were compared between clusters and stratified by whether individuals received generalised or PN advice.

Pan-European, Internet-based, 6-month randomised controlled trial.

Adults aged 18–79 years (n 1480).

Individuals in cluster 1 (C1) met all recommended intakes except for red meat, those in cluster 2 (C2) met two recommendations, and those in cluster 3 (C3) and cluster 4 (C4) met one recommendation each. C1 had higher intakes of white fish, beans and lentils and low-fat dairy products and lower percentage energy intake from SFA (P<0·05). C2 consumed less chips and pizza and fried foods than C3 and C4 (P<0·05). C1 were lighter, had lower BMI and waist circumference than C3 and were more physically active than C4 (P<0·05). More individuals in C4 were smokers and wanted to lose weight than in C1 (P<0·05). Individuals who received PN advice in C4 reported greater improvements in HEI compared with C3 and C1 (P<0·05).

The cluster where the fewest recommendations were met (C4) reported greater improvements in HEI following a 6-month trial of PN whereas there was no difference between clusters for those randomised to the Control, non-personalised dietary intervention.

To characterise participants who dropped out of the Food4Me Proof-of-Principle study.

The Food4Me study was an Internet-based, 6-month, four-arm, randomised controlled trial. The control group received generalised dietary and lifestyle recommendations, whereas participants randomised to three different levels of personalised nutrition (PN) received advice based on dietary, phenotypic and/or genotypic data, respectively (with either more or less frequent feedback).

Seven recruitment sites: UK, Ireland, The Netherlands, Germany, Spain, Poland and Greece.

Adults aged 18–79 years (n 1607).

A total of 337 (21 %) participants dropped out during the intervention. At baseline, dropouts had higher BMI (0·5 kg/m2; P<0·001). Attrition did not differ significantly between individuals receiving generalised dietary guidelines (Control) and those randomised to PN. Participants were more likely to drop out (OR; 95 % CI) if they received more frequent feedback (1·81; 1·36, 2·41; P<0·001), were female (1·38; 1·06, 1·78; P=0·015), less than 45 years old (2·57; 1·95, 3·39; P<0·001) and obese (2·25; 1·47, 3·43; P<0·001). Attrition was more likely in participants who reported an interest in losing weight (1·53; 1·19, 1·97; P<0·001) or skipping meals (1·75; 1·16, 2·65; P=0·008), and less likely if participants claimed to eat healthily frequently (0·62; 0·45, 0·86; P=0·003).

Attrition did not differ between participants receiving generalised or PN advice but more frequent feedback was related to attrition for those randomised to PN interventions. Better strategies are required to minimise dropouts among younger and obese individuals participating in PN interventions and more frequent feedback may be an unnecessary burden.

To investigate the magnitude and country-specific differences in underestimation of children’s weight status by children and their parents in Europe and to further explore its associations with family characteristics and sociodemographic factors.

Children’s weight and height were objectively measured. Parental anthropometric and sociodemographic data were self-reported. Children and their parents were asked to comment on children’s weight status based on five-point Likert-type scales, ranging from ‘I am much too thin’ to ‘I am much too fat’ (children) and ‘My child’s weight is way too little’ to ‘My child’s weight is way too much’ (parents). These data were combined with children’s actual weight status, in order to assess underestimation of children’s weight status by children themselves and by their parents, respectively. Chi-square tests and multilevel logistic regression analyses were conducted to examine the aims of the current study.

Eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

A school-based survey among 6113 children aged 10–12 years and their parents.

In the total sample, 42·9 % of overweight/obese children and 27·6 % of parents of overweight/obese children underestimated their and their children’s weight status, respectively. A higher likelihood for this underestimation of weight status by children and their parents was observed in Eastern and Southern compared with Central/Northern countries. Overweight or obese parents (OR=1·81; 95 % CI 1·39, 2·35 and OR=1·78, 95 % CI 1·22, 2·60), parents of boys (OR=1·32; 95 % CI 1·05, 1·67) and children from overweight/obese (OR=1·60; 95 % CI 1·29, 1·98 and OR=1·76; 95 % CI 1·29, 2·41) or unemployed parents (OR=1·53; 95 % CI 1·22, 1·92) were more likely to underestimate children’s weight status.

Children of overweight or obese parents, those from Eastern and Southern Europe, boys, younger children and children with unemployed parents were more likely to underestimate their actual weight status. Overweight or obese parents and parents of boys were more likely to underestimate the actual weight status of their children. In obesity prevention such underestimation may be a barrier for behavioural change.