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Studies exploring the accuracy of equations calculating resting energy expenditure (REE) in patients with Crohn’s disease (CD) are lacking. The aim of this study was to investigate the accuracy of REE predictive equations against indirect calorimetry in CD patients. REE was measured using indirect calorimetry (mREE) after an overnight fasting. Fourteen predictive equations, with and without body composition analysis parameters, were compared with mREE using different body weight approaches. Body composition analysis was performed using dual X-ray absorptiometry. One hundred and eighty-six CD outpatients (102 males) with mean age 41·3 (sd 14·1) years and 37·6 % with active disease were evaluated. Mean mREE in the total sample was 7255 (sd 1854) kJ/day. All equations underpredicted REE and showed moderate correlations with mREE (Pearson’s r or Spearman’s rho 0·600–0·680 for current weight, all P-values < 0·001). Accuracy was low for all equations at the individual level (28–42 and 25–40 % for current and adjusted body weight, respectively, 19–33 % for equations including body composition parameters). At the group level, accuracy showed wide limits of agreement and proportional biases. Accuracy remained low when sample was studied according to disease activity, sex, BMI and medication use. All predictive equations underestimated REE and showed low accuracy. Indirect calorimetry remains the best method for estimating REE of patients with CD.
Adhering to a Mediterranean diet (MD) is associated with reduced CVD risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet was a 12-month pilot parallel group RCT involving individuals aged ≥ 40 year, with low MD adherence, who were overweight, and had an estimated CVD risk ≥ 20 % over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64 %) were eligible. After 12 months, there was a retention rate of 69 % (peer support group 59 %; DSG 88 %; MSG 63 %). For all participants, increases in MDS were observed over 12 months (P < 0·001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards an MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.
To compare the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets in deterring 10-year CVD.
Prospective cohort (n 2020) with a 10-year follow-up period for the occurrence of combined (fatal or non-fatal) CVD incidence (International Classification of Diseases (ICD)-10). Baseline adherence to the Mediterranean and DASH diets was assessed via a semi-quantitative FFQ according to the MedDietScore and DASH scores, respectively.
Two thousand twenty individuals (mean age at baseline 45·2 (sd 14·0) years).
One-third of individuals in the lowest quartile of Mediterranean diet consumption, as compared with 3·1 % of those in the highest quartile, developed 10-year CVD (P < 0·0001). In contrast, individuals in the lowest and highest DASH diet quartiles exhibited similar 10-year CVD rates (n (%) of 10-year CVD in DASH diet quartiles 1 v. 4: 79 (14·7 %) v. 75 (15·3 %); P = 0·842). Following adjustment for demographic, lifestyle and clinical confounding factors, those in the highest Mediterranean diet quartile had a 4-fold reduced 10-year CVD risk (adjusted hazard ratio (HR) 4·52, 95 % CI 1·76, 11·63). However, individuals with highest DASH diet quartile scores did not differ from their lowest quartile counterparts in developing such events (adjusted HR 1·05, 95 % CI 0·69, 1·60).
High adherence to the Mediterranean diet, and not to the DASH diet, was associated with a lower risk of 10-year fatal and non-fatal CVD. Therefore, public health interventions aimed at enhancing adherence to the Mediterranean diet, rather than the DASH diet, may most effectively deter long-term CVD outcomes particularly in Mediterranean populations.
Life expectancy has increased leading to a concomitant increase in the population of older people. Malnutrition, a major problem in this age group, deteriorates their health and quality of life. The association between risk of malnutrition and dietary intake has not been investigated sufficiently. The aim of this study was to examine potential associations between risk of malnutrition and dietary intake in a representative cohort of adults ≥ 65 years old.
Materials and methods
1,831 older people (mean age 73.1 ± 5.9 years old) from the HELIAD study were included in the analyses. Risk of malnutrition was assessed with the “Determine your Nutritional Health” checklist. Total score of the questionnaire ranges from 1–21, with 0–2 indicating good nutritional status, 3–5 moderate nutritional risk and ≥ 6 high nutritional risk. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, validated for the Greek population, from which consumption of specific food groups (non-refined cereals, fruits, vegetables, legumes, fish, red meat, poultry, fish, dairy products, alcohol and sweets in servings/day) was estimated, as well as adherence to the Mediterranean diet, using a relevant a priori score.
35.8% of the participants were well-nourished, 34.8% were at moderate nutritional risk and 29.4% were at high nutritional risk. Total energy intake did not differ between the groups (1,984 ± 500 kcal/day for those well-nourished, 1,995 ± 537 kcal/day for those at moderate nutritional risk and 1,934 ± 566 kcal/day for those at high nutritional risk, p = 0.140). Well-nourished older people consumed per day more portions of vegetables, fruits, legumes, poultry, sweets and fewer portions of alcohol compared to those at moderate and high risk (all p < 0.05). Furthermore, adherence to the Mediterranean diet differed significantly between the groups, i.e. those well-nourished had greater adherence to the Mediterranean Diet compared to the other groups (p < 0.001).
Although energy intake did not differ between the groups, there were significant differences in quality of their diet, as this was depicted in specific food group intake and adherence to a healthy dietary pattern. Thus, health experts should also consider diet quality when screening malnutrition in this vulnerable age group.
Insomnia is the most prevalent sleep disorder and frequently co-occurs with obstructive sleep apnea (OSA), a chronic disease characterized by repetitive pauses of breathing during sleep due to obstructions of the upper airways. The link between lifestyle and sleep quantity and quality is an area of intensive research, however data exploring associations between lifestyle habits and insomnia symptoms are still scarce. The aim of the present study was to investigate the potential association between the level of adherence to the Mediterranean lifestyle (ML), a healthy lifestyle pattern incorporating the prudent Mediterranean diet, adequate physical activity and healthy sleep habits, and insomnia presence and severity. The study sample consisted of 243 adult patients with polysomnography-diagnosed OSA. Participants’ insomnia-related disorders were evaluated through the Athens Insomnia Scale (AIS), an 8-item index ranging from 0 (absence of any sleep-related problem) to 24 (severe degree of insomnia); AIS values of > 6 were used to establish the diagnosis of insomnia. All patients were evaluated with regard to anthropometric indices and lifestyle habits, and adherence to the ML was estimated through the MEDLIFE index, a 28-item index ranging from 0 to 28, with higher values indicating greater proximity to the healthy lifestyle of the Mediterranean region. An inverse correlation was observed between the MEDLIFE index and total AIS (rho = -0.22, p = 0.001), as well as most individual components of AIS, including difficulty in sleep induction (rho = -0.14, p = 0.03), awakenings during the night (rho = -0.2, p = 0.008), short sleep duration (rho = -0.16, p = 0.01), low quality of sleep (rho = -0.13, p = 0.05), low well-being during the day (rho = -0.16, p = 0.02), and low functioning capacity during the day (rho = -0.15, p = 0.02). Patients with insomnia (AIS > 6), compared to those without (AIS ≤ 6), exhibited lower MEDLIFE index values [13 (11–15) vs. 14 (12–15), P = 0.002], had more severe OSA as assessed by the apnea-hypopnea index (AHI) [55 (24–87) vs. 35 (17–57) events/hour, P < 0.001] and tended to have higher body mass index (BMI) [35.0 (30.6–39.7) vs. 32.4 (29.5–38.6) kg/m2, P = 0.06]. According to logistic regression analysis, MEDLIFE index was inversely associated with the presence of insomnia (OR: 0.89, 95%CI: 0.80–0.99, P = 0.04) after adjustment for age, sex, smoking, BMI, daily energy intake and AHI. In conclusion, a higher adherence to the ML is inversely associated with insomnia presence and severity in patients with obstructive sleep apnea. Future research should assess whether this association applies in other samples, as well as whether the ML could be an efficient therapeutic tool alleviating or treating insomnia symptoms.
Adequate intake of fruits and vegetables (F&V) has been long promoted as a public health priority based on the evidence supporting various health benefits attributed to these food groups. Their effects on reproductive outcomes, however, remain poorly explored. F&V intake has been positively associated with embryo quality in women undergoing in-vitro fertilization (IVF) but there is lack of data regarding potential associations with IVF final outcomes (clinical pregnancy and live birth). Thus, the aim of this study was to evaluate habitual F&V intake in relation to clinical pregnancy and live birth among women undergoing infertility treatment.
Materials and Methods
Nulliparous non-obese women [n = 244, 22–41 years old, body mass index (BMI) < 30 kg/m2] undergoing their first IVF cycle were recruited from an Assisted Conception Unit in Athens, Greece, between November 2013 and September 2016. Habitual F&V intake was estimated via a validated for the Greek population semi-quantitative food-frequency questionnaire and expressed in servings/day. Intermediate outcomes (i.e. oocyte yield and embryo quality measures) and clinical endpoints (implantation, clinical pregnancy and live birth) were prospectively recorded. Generalized linear models adjusting for age, ovarian stimulation protocol, BMI, physical activity, anxiety levels, infertility diagnosis, caloric intake and supplements use were used to test associations between F&V intake and IVF outcomes.
Overall, 229 women (93.9%) had an embryo transfer, 104 (42.6%) achieved a clinical pregnancy and 99 (40.5%) had a live birth. Women with a clinical pregnancy and live birth did not differ in age, BMI, smoking habits, physical activity or stress levels, compared to those who did not achieve pregnancy (all P > 0.05). Compared to women with IVF failure, those achieving clinical pregnancy and live birth reported consuming more fruits (median values: 1.77 vs. 1.49 servings/day and 1.77 vs. 1.41 servings/day, respectively) and more vegetables (1.79 vs. 1.37 servings/day and 1.89 vs. 1.36 servings/day, respectively), all P < 0.05. No significant association between F&V intake and IVF intermediate outcomes was recorded. The multivariable-adjusted relative risk (95% confidence interval) for clinical pregnancy for increasing intake of fruit and vegetable (servings/day, continuous) was 1.23 (1.06–1.44) and 1.25 (1.02–1.57), respectively, and for live birth it was 1.29 (1.10–1.51) and 1.36 (1.10–1.71), respectively.
Higher pre-treatment F&V was related to higher probability of clinical pregnancy and live birth among women undergoing IVF. These results highlight the importance of dietary influences on fertility and suggest the need for additional research on the effects of F&V intake on reproductive endpoints in women conceiving through infertility treatments.
Anti-inflammatory properties of olive oil are partly attributed to the inhibition of the Platelet-Activating Factor (PAF), a potent inflammatory mediator that is implicated in the initiation and prolongation of atherosclerosis. PAF inhibitors also exist in an extract from olive pomace that inhibits development and regression of atherosclerotic plaques in hypercholesterolemic rabbits. On the other hand, fish consumption is recommended for prevention of cardiovascular diseases, leading to a constantly increasing demand for fish supply, which is further enhanced by the rising consumers’ awareness. As a result a significant growth of aquaculture worldwide has been occurred, which among others strives for improving the nutritional value of the produced fish. Important breakthroughs have occurred in the replacement of fish oil, traditionally used, by plant oils in compounded fish feeds contributing to more nutritious fish products. Under this perspective, present work aimed to evaluate the cardioprotective properties of a novel seabream fed with olive pomace extract.
In this crossover study, thirty apparently healthy, men and women were randomly assigned in two diet sequences for 8-week duration (6-week washout period between them), consuming either normal or enriched with olive pomace fish, twice a week. The study was approved by the Bioethics Committee of Harokopio University. Dietary intake was assessed with a validated for the Greek population semi-quantitative food-frequency questionnaire. Lifestyle parameters, biochemical factors, P-selectin and Plasminogen-activator inhibitor-1 (PAI-1) levels were determined. In addition, ex-vivo platelet aggregation in platelet-rich plasma against PAF, ADP and thrombin were measured and the results expressed as EC50 values (the concentration of the agonist that cause 50% of maximum aggregation). Also, PAF key metabolic enzymes activities, responsible for PAF levels, were determined.
Concerning dietary habits and biochemical markers only total cholesterol revealed a small increase, within the normal range, after enriched fish consumption, compared to baseline levels. Both fishes resulted in higher EC50 (lower platelet sensitivity) values only against PAF without being differentiated (ptime = 0.02, ptrial = 0.9), while PAI-1 levels were only increased after normal fish consumption (p0–8 weeks = 0.01). The ratio of Lipoprotein-Associated-Phospholipase A2 (catabolic enzyme of PAF) to LDL and PAF-CDP-choline:cholinephosphotransferase (biosynthetic enzyme of PAF) were decreased after the enriched (p0–8 weeks = 0.003) and the normal (p0–8 weeks = 0.01) fish consumption, respectively.
Seabream fed with olive pomace seems to exhibit cardioprotective properties by decreasing platelet sensitivity against PAF and modulate PAF metabolism.
This research has been co-financed by the European Regional Development Fund of the EU and Greek national funds (project code:T1EDK-00687).
Malnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.
Lifestyle interventions remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD). This randomised controlled single-blind clinical trial investigated the effect of Mediterranean diet (MD) or Mediterranean lifestyle, along with weight loss, in NAFLD patients. In all, sixty-three overweight/obese patients (50 (sd 11) years, BMI=31·8 (sd 4·5) kg/m2, 68 % men) with ultrasonography-proven NAFLD (and elevated alanine aminotransferase (ALT) and/or γ-glutamyl transpeptidase (GGT) levels) were randomised to the following groups: (A) control group (CG), (B) Mediterranean diet group (MDG) or (C) Mediterranean lifestyle group (MLG). Participants of MDG and MLG attended seven 60-min group sessions for 6 months, aiming at weight loss and increasing adherence to MD. In the MLG, additional guidance for increasing physical activity and improving sleep habits were given. Patients in CG received only written information for a healthy lifestyle. At the end of 6 months, 88·8 % of participants completed the study. On the basis of intention-to-treat analysis, both MDG and MLG showed greater weight reduction and higher adherence to MD compared with the CG (all P<0·05) at the end of intervention. In addition, MLG increased vigorous exercise compared with the other two study groups (P<0·001) and mid-day rest/naps compared with CG (P=0·04). MLG showed significant improvements in ALT levels (i.e. ALT<40 U/l (P=0·03) and 50 % reduction of ALT levels (P=0·009)) and liver stiffness (P=0·004) compared with CG after adjusting for % weight loss and baseline values. MDG improved only liver stiffness compared with CG (P<0·001) after adjusting for the aforementioned variables. Small changes towards the Mediterranean lifestyle, along with weight loss, can be a treatment option for patients with NAFLD.
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