Telephone counseling intervention improves dietary habits and metabolic parameters of patients with the metabolic syndrome: A randomized controlled trial

Aim: To evaluate the effectiveness of a telephone-delivered intervention in improving lifestyle habits and metabolic parameters in metabolic syndrome (MetSyn) patients compared to a similar face-to-face or a usual care intervention. Methods: Eighty-seven MetSyn patients recruited from the outpatient clinic of a major public hospital were randomly assigned to one of the three intervention groups: "usual care", "telephone" or "face-to-face". At the beginning of the study all patients were provided with a hypocaloric Mediterranean-type diet. Then, patients in the telephone group received 7 dietary counseling calls, patients in the face-to-face group participated in 7 one-to-one dietary counseling sessions, and patients in the usual care group received no other contact, until the end of the study, 6 months later. All patients underwent full medical and nutritional evaluation at the beginning and at the end of the intervention. Results: At the end of the intervention, 42% of the participants no longer had the MetSyn; resolution rates differed significantly between the groups (p = 0.024), with those in the face-to-face and telephone group exhibiting similar rates (52 and 54%, respectively, vs. 21% in the usual care group). Between-group analysis revealed that the face-to-face group achieved the greatest improvement in metabolic parameters, while the telephone group had the greatest improvement in dietary adherence compared to the usual care group. Conclusions: Telephone counseling may be an effective way for implementing behavioral counseling aiming at improving lifestyle habits to MetSyn patients

Eating habits in relations to anxiety symptoms among apparently healthy adults. A pattern analysis from the ATTICA Study

The effect of anxiety on dietary intake of humans has been investigated through a number of laboratory, clinical and cross-sectional studies; no prior study, however, has examined potential associations between anxiety and overall dietary patterns. Aim of the present work was to describe dietary patterns in relation to anxiety trait in a nationally representative sample of Greek adults from the ATTICA Study. A sample of 453 men and 400 women were randomly selected from various areas of Attica region, Greece. Anxiety levels were assessed through Spielberger State-Trait Anxiety Inventory. Dietary habits, socio-demographic and lifestyle characteristics were recorded for all participants. Principal component analysis was used for the extraction of dietary patterns. More anxious, compared to less anxious, men and women exhibited different dietary patterns. In particular, the "light" dietary patterns that were emerged in the less anxious men and women did not appear as distinct patterns among men and women in the upper anxiety tertile. In women, a "Western-type" diet explained two times greater variance of food intake of those in the upper-anxiety tertile, compared to their counterparts in the low tertile. A vegetarian pattern was found only among the less anxious women, who also exhibited the lowest consumption of red meat and sweets. Regression analysis supported and further elucidated previous results: after adjusting for potential confounders, sweets intake, as well as meat and products intake, were positively associated with anxiety score in females; in males a negative association was found with legumes/cereals intake. From a public health point of view, given the increased prevalence of anxiety and other mental disorders, these findings should be taken into account when designing and evaluating interventions for the general population. © 2008 Elsevier Ltd. All rights reserved

Promoting only the consumption of healthy foods may be an alternative stategy for treating patients with the metabolic syndrome

Objective: To evaluate the effectiveness of two lifestyle, interventional approaches on metabolic abnormalities and eating habits of patients with metabolic syndrome. Materials/Methods: This is a randomized controlled trial, involving a 6-month lifestyle intervention. Eighty-eight metabolic syndrome patients were randomized to one of the three groups: (i) Increase - Decrease group, (ii) Increase group, and (iii) Minimum intervention group. All patients received dietary and physical activity advice at baseline; patients in the first two groups also participated in individual counseling sessions. In the Increase - Decrease group, all recommended dietary and physical activity goals were targeted, whereas in the Increase group, only goals proposing an increase in dietary intake or physical activity were included. Patients received nutrition counseling through seven, one-to-one sessions, conducted every two weeks for the first 2 months, every month for the following 4 months. All participants underwent a full medical and nutritional assessment at baseline and at the end of the intervention. Results: At 6 months, BMI and waist circumference were improved in the Increase and the Increase - Decrease groups, compared to the Minimum Intervention group. Additionally, Increase - Decrease group reduced blood systolic (p = 0.017), diastolic pressure (p = 0.005) and glucose concentrations (p = 0.015). Forty eight percent, 32%, and 19% of the patients in the Increase - Decrease, Increase and Minimum Intervention groups, respectively, ceased to fulfill the criteria for the metabolic syndrome (p = 0.031). Conclusions: Promoting only the increase of the intake of healthy foods did not result in better outcome values compared to a conventional all-food approach. © 2012 Elsevier Inc

Development and reliability of questionnaires for the assessment of diet and physical activity behaviors in a multi-country sample in Europe the Feel4Diabetes Study

Background: Assessment of diet and physical activity and their determinants still remains a demanding task, especially when the objective is to evaluate the efficacy of lifestyle interventions. In the context of the Feel4Diabetes study (a European community based intervention study in families with school aged children and at high risk of developing diabetes), we aimed to develop questionnaires for the assessment of food-frequency and eating behaviors, and physical activity and sedentary behaviors in both parents and school-aged children and a questionnaire for overall family's energy balance-related behaviors. Methods: Questionnaires were developed to be used in 6 countries under standardized harmonization procedures and included questions regarding not only food intake and physical activity, but also questions of their determinants. A reliability study was conducted in 191 pairs of parents and their children (N = 191). Parents completed the questionnaires on two occasions, within a 1-2 week interval. Reliability was tested by the intra-class correlation coefficients (ICC) of test-retest. Results: Most of the questions in all questionnaires had excellent reliability, assessed as an ICC of > 0.810. Mean ICCs for food-frequency and eating behaviors questionnaires were 0.838 and 0.787, and for physical activity and sedentary behaviors questionnaires were 0.734 and 0.793, in adults and children respectively. Mean ICC for overall family's energy balance-related behaviors and their determinants was 0.659. Conclusion: The developed questionnaires showed acceptable reliability and may be valuable tools in the assessment of children's and parents' behaviors related to diet, physical activity, sedentary behavior and overall energy balance in school- A nd community-based interventions. © 2020 The Author(s)

The recalibrated HellenicSCORE based on newly derived risk factors from the Hellenic National Nutrition and Health Survey (HNNHS); the HellenicSCORE II

Background: Because of the increased burden of cardiovascular disease (CVD), country specific risk prediction models to forecast future CVD events and mortality are recommended, for primary prevention. The aim of this study was to recalibrate the HellenicSCORE, to accurately estimate the 10-year risk CVD mortality of Greek adults. Methods: Data from the Hellenic National Nutrition and Health Survey (HNNHS) were used (N = 1012; 37.9% males). Information on age, smoking, systolic blood pressure (SBP), and total blood cholesterol from adults >40 years of age were derived following validated health survey protocols. Individual scores were calculated using these data and beta-coefficients derived from ESC SCORE. Results: Both updated HellenicSCORE II charts had lower risk estimates compared to the older version and were closer to the ESC SCORE charts, particularly at the extremes. No significant age difference by sex was observed (mean 59.5 (SD 13.1) years in total) in the population. Women had a significant higher mean total cholesterol compared to men [212.9 (39.5) vs 204.6 (41.2) mg/dl, respectively; p = 0.0343], but smoking prevalence and mean SBP was significantly higher in men [p for all, <0.001]. The mean population HellenicSCORE II score level was between 5.6% (0.2) and 7.9% (3.2) depending on the chart used, with no significant sex differences. Conclusion: Although the HellenicSCORE II charts were lower, the mean population score was moderately high. This is of great importance because according to ESC guidelines, lifestyle intervention, and drug treatment should be based on an individuals’ total cardiovascular risk. © 2020 Hellenic Society of Cardiolog

Micronutrient dietary intakes and their food sources in adults: the Hellenic National Nutrition and Health Survey (HNNHS)

Background: The present study aimed to assess micronutrient intake among Greek adults and to identify the main food sources that contribute to it. Methods: Food consumption data from 2389 participants in the Hellenic National Nutrition and Health Survey (HNNHS), collected with 24-h recalls, was used to calculate micronutrient intakes. Usual nutrient intake was estimated according to the National Cancer Institute method. Nutrient adequacy was estimated using the estimated average requirement (EAR) cut-point method, when available, or adequate intake otherwise. The probability approach was used to determine iron intake adequacy in females of reproductive age. Food group contribution for each nutrient assessed was derived to identify their main food sources. Results: Almost all individuals had vitamin D intake below EAR, whereas vitamins A, E, K and C, as well as potassium intake, were also insufficient in a considerable percentage of the population (>70% in most age groups). Calcium intake was substantially below the EAR for females aged >50 years and males >70 years; the same for magnesium in males >70 years. Furthermore, 50% of females, including those of reproductive age, had intake of folate below EAR. More than 50% of the population (to 79%) exceeded the upper tolerable limit for sodium (2300 mg day−1). Food contribution analysis revealed that most vitamins were derived from low-quality foods (i.e. fast-food). Conclusions: A significant proportion of adults residing in Greece have low nutrient intake and poor food selections. These results provide guidance to public health policy makers for developing strategies to improve the dietary quality in Greece. © 2021 The British Dietetic Association Ltd

Dietary patterns and lifestyle characteristics in adults: results from the Hellenic National Nutrition and Health Survey (HNNHS)

Objectives: The objective of this study was to identify and describe different dietary patterns in a nationally representative sample of Greek adults and to assess potential associations with lifestyle characteristics. Study design: This was a cross-sectional study. Methods: Dietary patterns were derived by principal component analysis using individual dietary data (24-h recall) of 3552 participants of the Hellenic National Nutrition and Health Survey (HNNHS). Analysis of variance and chi-squared test were used to determine the lifestyle characteristics of the participants following each pattern. Results: Three dietary patterns were identified explaining 16.5% of variance; a traditional pattern, loading positively on olive oil, non-starchy vegetables, and cheese; a Western pattern, loading positively on refined grains, processed meats, and animal fats; and a prudent pattern, loading positively on fruits, whole grains, and yoghurt and negatively on fast food. A fourth, snack-type pattern, loading positively on sweets, salty snacks, and nuts, was identified in women. Primary crude results revealed an association between dietary patterns and socio-economic status. In multivariate analysis, highest adherence to the prudent pattern was associated with higher protein and unsaturated fat intake and lower energy and saturated fat intake (all P ≤ 0.05); the Western and traditional patterns were associated with higher energy and total and saturated fat intake. The traditional pattern was additionally associated with higher monounsaturated fatty acids intake, whereas the Western pattern, with higher alcohol intake (all P ≤ 0.001). Conclusions: These findings are valuable for understanding the dietary behaviors of adults in Greece and enabling more focused public health policies for the promotion of healthier food behaviors in the future. © 2019 The Royal Society for Public Healt