Fasting ghrelin levels are decreased in obese subjects and are significantly related with insulin resistance and body mass index

© 2017 Dimitrios Papandreou, Christos Karavolias, Fotini Arvaniti, Eleana Kafeza, Fatima Sidawi. BACKGROUND: Ghrelin is a 28-amino acid peptide that predominantly produced by the stomach. Strong evidence indicates the effects of ghrelin in the regulation of metabolic functions and its potential role in the aetiology of obesity. AIM: The aim of this study was to investigate the relationship of ghrelin levels with obesity, insulin resistance and glucose in normal and obese subjects. METHODS: Thirteen normal (n = 13) and seven (n = 7) obese weight subjects aged 20-22 participated in the study. Fasting plasma ghrelin, insulin and glucose levels were measured after overnight fasting. HOMA-IR was calculated to evaluate insulin resistance. RESULTS: Ghrelin and insulin levels were found to be statistically significantly lower and higher in obese subjects (P \u3c 0.001), respectively. Glucose levels were clinically higher in obese subjects but not statistically significant. Fasting plasma ghrelin was negatively correlated with BMI (r = -0.77, P \u3c 0.001), fasting insulin levels (r = -0.55, P \u3c 0.001) and HOMA-IR (r = -0.66, P \u3c 0.001). There was no correlation between ghrelin and glucose. In multiple regression analysis, insulin levels (Beta: -2.66, 95% CI: -2.49, -2.78, P \u3c 0.001) HOMA-IR (Beta: -2.41, 95% CI: -2.33, -2.55, P \u3c 0.001) and BMI (Beta: -1.77, 95% CI: -1.66, -1.89, P \u3c 0.001) were significant independent determinants of fasting ghrelin. CONCLUSION: Obese subjects have low fasting ghrelin levels that they are significantly related to insulin resistance and body mass index. More prospective studies are needed to establish the role of ghrelin in the pathogenesis of human obesity

Epidemiology of asthma: the role of diet

OBJECTIVES: The role of diet on asthma has recently been investigated, and recognized as a potential risk factor. The aim of this work was to assess the correlation of diet with childhood asthma. METHODS: A cross-sectional analysis was performed on 700 children (323 male), 10-12 year-old, selected from schools located in Athens greater area. Children and their parents completed questionnaires that evaluated, among others, dietary habits. Asthma was defined according to the ISAAC criteria. Adherence to the Mediterranean diet was evaluated using the KIDMED score (Mediterranean Diet Quality Index for children and adolescents) (theoretical range 0-12). RESULTS: Prevalence of asthma symptoms was 27.6% (boys) and 20.4% (girls). Mean level of adherence to the Mediterranean diet was 4.8±1.9 (boys) and 4.8±2.0 (girls). Greater adherence to the Mediterranean diet was inversely associated with ever had wheeze (p=0.001), exercise wheeze (p=0.004), ever had diagnosed asthma (p=0.002) and any asthma symptoms (p=1 times/week). Salty snack consumption was positively associated with the hours of TV/videogames viewing (p=0.04) and inversely with the KidMed score (p=0.02). Moreover, consumption of salty snacks (>3 times/week vs. never/rare) was associated with 60% higher likelihood of having asthma symptoms (95%CI 0.90, 2.70), irrespective of potential confounders. Mean hours of TV/ videogames viewing was 2.2±1.3/day. The associations of salty snack eating and asthma were more prominent in children who watch TV or play video games > 2 hours / day. CONCLUSION: Overall dietary habits seem to be associated with asthma prevalence among children, whereas the association of specific foods on asthma symptomatology seems moderate. The promotion of healthy eating among children seems nessecary as it was never beforeΣΚΟΠΟΣ: Η σχέση της διατροφής με το άσθμα έχει κεντρίσει τα τελευταία χρόνια το ερευνητικό ενδιαφέρον. Σκοπός της παρούσας διατριβής ήταν να αποτιμήσει τις διατροφικές συνήθειες σε σχέση με τον επιπολασμό του άσθματος στην παιδική ηλικία. ΥΛΙΚΟ-ΜΕΘΟΔΟΣ: Στo πλαίσιo της επιδημιολογικής μελέτης PANACEA (Physical Activity, Nutrition and Allergies in Children Examined in Athens) συγκεντρώθηκε αντιπροσωπευτικό δείγμα 700 μαθητών (323 αγόρια και 377 κορίτσια) ηλικίας 10-12 ετών από την ευρύτερη περιοχή της Αττικής. Οι γονείς των παιδιών συμπλήρωσαν ερωτηματολόγια που αξιολογούσαν την ύπαρξη άσθματος και αλλεργίας (ερωτηματολόγιο ISAAC), τις διατροφικές τους συνήθειες (ερωτηματολόγιο συχνότητας καταγραφής τροφίμων), καθώς και στοιχεία για την σωματική τους ανάπτυξη. Η αποτίμηση της τήρησης της Μεσογειακής διατροφής πραγματοποιήθηκε με τη χρήση του διατροφικού δείκτη KIDMED (Mediterranean Diet Quality Index for children and adolescents, θεωρητικό εύρος 0-12). ΑΠΟΤΕΛΕΣΜΑΤΑ: Ο επιπολασμός συμπτωμάτων του άσθματος ήταν 27,6% στα αγόρια και 20,4% στα κορίτσια. Ο μέσος βαθμός υιοθέτησης της Μεσογειακής διατροφής ήταν 4,8±1,9 στα αγόρια και 4,8±2,0 στα κορίτσια. H μεγαλύτερη τήρηση της Μεσογειακής διατροφής (σκορ 8-12) συσχετίστηκε αντίστροφα με το ιστορικό συριγμού (p=0,001), τον συριγμό κατά την άσκηση (p=0,004), το ιστορικό άσθματος (p=0,002) και με τα συμπτώματα άσθματος (p3 φορές/εβδομάδα είχαν 60% μεγαλύτερη πιθανότητα να εμφανίσουν συμπτώματα άσθματος (95%ΔΕ: 0,9, 2,7) λαμβάνοντας υπόψη συγχυτικούς παράγοντες. Τα παιδιά τα οποία παρακολουθούσαν τηλεόραση ή έπαιζαν βιντεοπαιχνίδια περισσότερο από 2 ώρες ημερησίως και έτρωγαν αλμυρά μικρογεύματα σε εβδομαδιαία βάση (π.χ > 1-2 φορές /εβδομάδα) ήταν 1,48 φορές πιο πιθανό να παρουσιάσουν συμπτώματα άσθματος (95%ΔΕ: 1,21, 1,80). ΣΥΜΠΕΡΑΣΜΑ: Οι συνολικές διατροφικές συνήθειες φαίνεται να έχουν σημαντικό ρόλο στην εμφάνιση παιδικού βρογχικού άσθματος, ενώ μέτρια είναι η σχέση των επιμέρους τροφίμων. Η προαγωγή ενός υγιεινού διαιτολογίου στα παιδιά κρίνεται περισσότερο αναγκαία από ποτέ άλλοτε

Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore

Objective. We sought to evaluate the accuracy of a diet score in relation to hypertension, hypercholesterolemia, diabetes and obesity. Methods. A diet score (range 0-55) has been developed that assesses adherence to the Mediterranean diet. For the consumption of items presumed to be close to Mediterranean dietary pattern (non-refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes) scores 0 to 5 for never, rare, frequent, very frequent, weekly and daily consumption were assigned, while for the consumption of foods presumed to be away from this pattern (red meat and products, poultry and full fat dairy products) scores on a reverse scale were assigned. Positive and negative predictive values, in relation to hypertension, hypercholesterolemia, diabetes and obesity status of the ATTICA study participants (n=3042, enrolment 2001-02 in Athens metropolitan area, aged 18-89 years) were calculated and the 10-year CHD risk based on Framingham equations was estimated, too. Results. The positive predictive values of the score regarding hypertension, hypercholesterolemia, diabetes and obesity are: 45% (95% CI 43%-48%), 46% (95% CI 44%-49%), 12% (95% CI 11%-14%) and 33% (95% CI 30%-35%), while the negative predictive values are 86% (95% CI 85%-88%), 71% (95% CI 69%-74%), 98% (95% CI 97%-99%) and 97% (95% CI 96%-98%), respectively. Moreover, a 10-unit increase in the diet score is associated with 4% lower 10-year CHD risk (+/- 0.1%, p < 0.001). Conclusion. The proposed Mediterranean Diet Score may be useful in detecting individuals prone to the development of nutrition-related health conditions and cardiovascular disease. (C) 2006 Elsevier Inc. All rights reserved

Salty-snack eating, television or video-game viewing, and asthma symptoms among 10- to 12-year-old children: the PANACEA study

Background: Salty-snack consumption, as well as the amount of time children spend watching television or playing video games, have been implicated in the development of asthma; however, results are still conflicting. Objective: The aim of this work was to evaluate the association of salty-snack eating and television/video-game viewing with childhood asthma symptoms. Design: Cross-sectional study. Settings: Seven hundred children (323 male), 10 to 12 years old, from 18 schools located in the greater area of Athens were enrolled. Children and their parents completed questionnaires, which evaluated, among other things, dietary habits. Adherence to the Mediterranean diet was evaluated using the KIDMED (Mediterranean Diet Quality Index for Children and Adolescents) score. Statistical analysis: The association of children's characteristics with asthma symptoms was performed by calculating the odds ratios and corresponding 95% confidence intervals. Results: Overall lifetime prevalence of asthma symptoms was 23.7% (27.6% boys, 20.4% girls; P=0.03). Forty-eight percent of children reported salty-snack consumption (≥1 times/week). Salty-snack consumption was positively associated with the hours of television/video-game viewing (P=0.04) and inversely with the KIDMED score (P=0.02). Consumption of salty snacks (>3 times/week vs never/rare) was associated with a 4.8-times higher likelihood of having asthma symptoms (95% confidence interval: 1.50 to 15.8), irrespective of potential confounders. The associations of salty-snack eating and asthma symptoms were more prominent in children who watched television or played video games >2 hours/day. In addition, adherence to the Mediterranean diet was inversely associated with the likelihood of asthma symptoms. Conclusions: Unhealthy lifestyle behaviors, such as salty-snack eating and television/video-game viewing were strongly associated with the presence of asthma symptoms. Future interventions and public health messages should be focused on changing these behaviors from the early stages of life

Salty-Snack Eating, Television or Video-Game Viewing, and Asthma Symptoms among 10- to 12-Year-Old Children: The PANACEA Study

Background Salty-snack consumption, as well as the amount of time children spend watching television or playing video games, have been implicated in the development of asthma; however, results are still conflicting. Objective The aim of this work was to evaluate the association of salty-snack eating and television/video-game viewing with childhood asthma symptoms. Design Cross-sectional study. Settings Seven hundred children (323 male), 10 to 12 years old, from 18 schools located in the greater area of Athens were enrolled. Children and their parents completed questionnaires, which evaluated, among other things, dietary habits. Adherence to the Mediterranean diet was evaluated using the KIDMED (Mediterranean Diet Quality Index for Children and Adolescents) score. Statistical analysis The association of children’s characteristics with asthma symptoms was performed by calculating the odds ratios and corresponding 95% confidence intervals. Results Overall lifetime prevalence of asthma symptoms was 23.7% (27.6% boys, 20.4% girls;. P=0.03). Forty-eight percent of children reported salty-snack consumption (>= 1 times/week). Salty-snack consumption was positively associated with the hours of television/video-game viewing (P=0.04) and inversely with the KIDMED score (P=0.02). Consumption of salty snacks (>3 times/week vs never/rare) was associated with a 4.8-times higher likelihood of having asthma symptoms (95% confidence interval: 1.50 to 15.8), irrespective of potential confounders. The associations of salty-snack eating and asthma symptoms were more prominent in children who watched television or played video games >2 hours/day. In addition, adherence to the Mediterranean diet was inversely associated with the likelihood of asthma symptoms. Conclusions Unhealthy lifestyle behaviors, such as salty-snack eating and television/video-game viewing were strongly associated with the presence of asthma symptoms. Future interventions and public health messages should be focused on changing these behaviors from the early stages of life. J Am Diet Assoc. 2011;111:251-257

Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10-12 years old children: the PANACEA study

Epidemiological studies have shown several associations between asthma symptoms and dietary factors. The aim of this work was to evaluate the relationship between adherence to the Mediterranean diet and childhood asthma. A cross-sectional analysis was performed on 700 children (323 boys), 10-12 yr old, selected from 18 schools located in Athens greater area. Children and their parents completed questionnaires, which evaluated, among others, dietary habits. Asthma was defined according to ISAAC II criteria. Adherence to the Mediterranean diet was evaluated using the KIDMED score (theoretical range 0-12). Higher KIDMED score corresponds to greater adherence to the Mediterranean diet. Greater adherence to the Mediterranean diet was inversely associated with ever had wheeze (p = 0.001), exercise wheeze (p = 0.004), ever had diagnosed asthma (p = 0.002) and with any asthma symptoms (p < 0.001). One-unit increase in the KIDMED score was associated with 14% lower likelihood of having asthma symptoms (odds ratio = 0.86, 95% confidence interval 0.75-0.98), after adjusting for various confounders. No significant associations were found between asthma symptoms and consumption of fruits (p = 0.25), vegetables (p = 0.97), legumes (p = 0.76), cereals (p = 0.71), dairy (p = 0.61), salty snacks (p = 0.53), or margarine/butter (p = 0.42) consumption, while increased fish and meat intake was associated with less asthma symptoms (p = 0.04 and p = 0.01, respectively). Our findings suggest an inverse relationship between level of adherence to the Mediterranean diet and prevalence of asthma in school-aged children

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine