Long-term prognostic value of LDL-C, HDL-C, lp(a) and TG levels on cardiovascular disease incidence, by body weight status, dietary habits and lipid-lowering treatment:the ATTICA epidemiological cohort study (2002–2012)

BACKGROUND: The link between blood lipids and cardiovascular disease (CVD) is complex. Our aim was to assess the differential effect of blood lipids on CVD risk according to age, sex, body weight, diet quality, use of lipid-lowering drugs and presence of hypercholesterolemia. METHODS: In this secondary analysis of the ATTICA prospective cohort study, serum blood lipids, i.e., total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and liproprotein(a) [Lp(a)], and sociodemographic, anthropometric, lifestyle and clinical parameters were evaluated at baseline (2001/2002) in 2020 CVD-free men and women. CVD incidence was recorded at the 10-year follow-up (2011/2012). RESULTS: All blood lipids assessed were univariately related to CVD risk; however, associations remained significant only for HDL-C and TG in multivariate models adjusted for age, sex, body mass index, smoking, Mediterranean Diet Score, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, use of lipid-lowering drugs, and family history of CVD [RR per 1 mg/dL (95% CI): 0.983 (0.967, 1.000) and 1.002 (1.001, 1.003), respectively]. In stratified analyses, TC and LDL-C predicted CVD risk in younger subjects, normal-weight subjects, and those not on lipid-lowering drugs, while HDL-C and TG were significant predictors in older subjects, those with low adherence to the Mediterranean diet, and hypercholesterolemic subjects; a significant effect on CVD risk was also observed for TG in males, overweight participants and lipid-lowering medication users and for Lp(a) in older subjects and females (all p ≤ 0.050). CONCLUSIONS: The impact of blood lipids on CVD risk differs according to several biological, lifestyle and clinical parameters

Serum levels of advanced glycation end-products (AGEs) and the decoy soluble receptor for AGEs (sRAGE) can discriminate non-alcoholic fatty liver disease in age-, sex- and BMI-matched normo-glycemic adults

Background: Non-alcoholic fatty liver disease (NAFLD) is a serious health problem affecting ~25% of the global population. While NAFLD pathogenesis is still unclear, multiple NAFLD parameters, including reduced insulin sensitivity, impaired glucose metabolism and increased oxidative stress are hypothesised to foster the formation of advance glycation end-products (AGEs). Given the link of AGEs with end organ damage, there is scope to examine the role of the AGE/RAGE axis activation in liver injury and NAFLD. Methods: Age, sex and body mass index matched normo-glycemic NAFLD adults (n = 58) and healthy controls (n = 58) were enrolled in the study. AGEs were analysed by liquid chromatography-mass spectrometry (CML, CEL), fluorescence (pentosidine, AGE fluorescence), colorimetry (fructosamine) and ELISA (sRAGE). Their association with liver function, inflammation, fibrosis and stage of NAFLD was examined. Results: Early and advanced glycation end-products, except Nε-carboxymethyl-L-lysine (CML), were 10–30% higher, sRAGE levels 1.7-fold lower, and glycation/sRAGE ratios 4-fold higher in the NAFLD cases compared to controls. While AGEs presented weak to moderate correlations with indices of liver function and damage (AST/ALT, HOMA-IR, TNF-α and TGF-β1), including sRAGE to characterize the AGEs/sRAGE axis strengthened the associations observed. High glycation/sRAGE ratios were associated with 1.3 to 14-fold likelihood of lower AST/ALT ratios. The sum of AGEs/sRAGE ratios accurately distinguished between healthy controls and NAFLD patients (area under the curve of 0.85). Elevated AGEs/sRAGE (>7.8 mmol/pmol) was associated with a 12-fold likelihood of the presence of NAFLD. Conclusion: These findings strengthen the involvement of AGEs-RAGE axis in liver injury and the pathogenesis of NAFLD

A Comparison of Flare Forecasting Methods. III. Systematic Behaviors of Operational Solar Flare Forecasting Systems

A workshop was recently held at Nagoya University (31 October – 02 November 2017), sponsored by the Center for International Collaborative Research, at the Institute for Space-Earth Environmental Research, Nagoya University, Japan, to quantitatively compare the performance of today’s operational solar flare forecasting facilities. Building upon Paper I of this series (Barnes et al. 2016), in Paper II (Leka et al. 2019) we described the participating methods for this latest comparison effort, the evaluation methodology, and presented quantitative comparisons. In this paper we focus on the behavior and performance of the methods when evaluated in the context of broad implementation differences. Acknowledging the short testing interval available and the small number of methods available, we do find that forecast performance: 1) appears to improve by including persistence or prior flare activity, region evolution, and a human “forecaster in the loop”; 2) is hurt by restricting data to disk-center observations; 3) may benefit from long-term statistics, but mostly when then combined with modern data sources and statistical approaches. These trends are arguably weak and must be viewed with numerous caveats, as discussed both here and in Paper II. Following this present work, we present in Paper IV a novel analysis method to evaluate temporal patterns of forecasting errors of both types (i.e., misses and false alarms; Park et al. 2019). Hence, most importantly, with this series of papers we demonstrate the techniques for facilitating comparisons in the interest of establishing performance-positive methodologies

Obtaining evidence base for the development of Feel4Diabetes intervention to prevent type 2 diabetes: a narrative literature review

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High Resolution MEMS Accelerometers to Estimate VO2 and Compare Running Mechanics between Highly Trained Inter-Collegiate and Untrained Runners

BACKGROUND: The purposes of this study were to determine the validity and reliability of high resolution accelerometers (HRA) relative to VO(2) and speed, and compare putative differences in HRA signal between trained (T) and untrained (UT) runners during treadmill locomotion. METHODOLOGY: Runners performed 2 incremental VO(2max) trials while wearing HRA. RMS of high frequency signal from three axes (VT, ML, AP) and the Euclidean resultant (RES) were compared to VO(2) to determine validity and reliability. Additionally, axial rms relative to speed, and ratio of axial accelerations to RES were compared between T and UT to determine if differences in running mechanics could be identified between the two groups. PRINCIPAL FINDINGS: Regression of RES was strongly related to VO(2), but T was different than UT (r = 0.96 vs 0.92; p<.001) for walking and running. During walking, only the ratio of ML and AP to RES were different between groups. For running, nearly all acceleration parameters were lower for T than UT, the exception being ratio of VT to RES, which was higher in T than UT. All of these differences during running were despite higher VO(2), O(2) cost, and lower RER in T vs UT, which resulted in no significant difference in energy expenditure between groups. CONCLUSIONS/SIGNFICANCE: These results indicate that HRA can accurately and reliably estimate VO(2) during treadmill locomotion, but differences exist between T and UT that should be considered when estimating energy expenditure. Differences in running mechanics between T and UT were identified, yet the importance of these differences remains to be determined

The impact of the mediterranean lifestyle on clinical and biochemical characteristics of patients with obstructive sleep apnea

Introduction and aim: Obstructive sleep apnea (OSA) is nowadays recognized as a major public health issue and its efficient management is under intense research. The aim of the present study was to explore whether the addition of a weight-loss Mediterranean diet (MD)/lifestyle (ML) intervention to OSA standard care, i.e. prescription of continuous positive airway pressure (CPAP), has an incremental effect on improving: (1) OSA severity and symptomatology, (2) patients’ cardiometabolic profile, and (3) markers of inflammation and oxidative stress, over the effect of standard care alone. Materials and methods: This was a randomized, parallel, controlled, single-blind clinical trial. Eligible candidates were adult, overweight, otherwise healthy patients with moderate-to-severe OSA [apnea-hypopnea index (AHI) ≥15 events/h], diagnosed through an overnight attended in-hospital polysomnography. Participants were blindly randomized to a standard care group (SCG), a MD group (MDG) or a ML group (MLG). All three study groups received standard care for OSA management, i.e. were prescribed with CPAP therapy. Additionally, the SCG received brief written healthy lifestyle advice, while intervention arms participated in an intensive 6-month behavioral intervention that consisted of seven 60-min group counselling sessions. Both intervention arms received counselling aiming at a 5-10% weight loss and an increase in the level of adherence to the MD. The MLG also received counselling on increasing physical activity and achieving adequate sleep duration and quality. Anthropometric indices, lifestyle habits, polysomnographic data, OSA symptoms, biochemical indices, blood pressure, the presence of the metabolic syndrome (MS), as well as inflammatory and oxidative stress markers, were evaluated both pre- and post-intervention. Results: A total of 187 patients were recruited and randomized (65-SCG, 62-MDG and 60-MLG). Seven patients were excluded post-randomization and 53/180 (29%) were lost to follow-up. According to intention to treat analysis (n=180), compared to the SCG, post-intervention age-, sex-, baseline- and CPAP use-adjusted AHI levels (events/h) were significantly lower in the MDG (mean difference: -18.0, P<0.001) and the MLG (mean difference: -21.2, P<0.001), and the differences remained significant after further adjustment for percent body-weight change (P=0.004 and P=0.008, respectively). Other respiratory event indices and symptoms of daytime sleepiness and insomnia were also significantly lower in intervention arms compared to the SCG (all P<0.050). The MLG only presented higher percent rapid-eye-movement sleep and lower degree of daytime sleepiness compared to the MDG (P=0.034 and P=0.014, respectively). Indices of glucose metabolism, blood lipids, liver enzymes and blood pressure improved only in intervention arms, and were significantly lower compared to the SCG post-intervention (all P<0.050). The age-, sex-, baseline- and CPAP use-adjusted relative risk (95% confidence interval) of MS was 0.58 (0.34-0.99) for the MDG and 0.30 (0.17-0.52) for the MLG, compared to the SCG. The MLG additionally presented a lower relative risk of MS compared to the MDG [0.52 (0.30-0.89)]. After further adjustment for percent body-weight change, a lower relative risk of MS was still evident for the MLG compared to the SCG (P=0.050). Moreover, compared to the SCG, post-intervention age-, sex-, baseline- and CPAP use-adjusted plasma high sensitivity C-reactive protein levels (mg/L) were lower in the MDG (mean difference: -1.33, P=0.039) and the MLG (mean difference: -1.68, P=0.007). The MLG also exhibited lower levels of urinary 8-iso prostaglandin F2a (ng/mg creatinine) compared to both the SCG (mean difference: -1.10, P<0.001) and the MDG (mean difference: -0.80, P=0.001), and the differences remained significant after further adjustment for percent body-weight change (P<0.001 and P<0.001, respectively). Results were similar in per-protocol analysis (n=127). Conclusions: The addition of a weight-loss MD/ML intervention to OSA standard care, i.e. CPAP prescription, has an incremental effect on reducing OSA severity and symptomatology, improving cardiometabolic indices and ameliorating inflammation and oxidative stress, over standard care alone. Behavioral interventions towards a modest weight loss through beneficial changes in lifestyle habits that do not require sophisticated equipment and can be feasible in all healthcare services could constitute a realistic and efficient plan for the management of OSA in clinical practice.Εισαγωγή και σκοπός: Η αποφρακτική άπνοια ύπνου (ΑΑΥ) έχει αναγνωρισθεί ως ένα σημαντικό πρόβλημα δημόσιας υγείας και η αντιμετώπισή της αποτελεί αντικείμενο εντατικής έρευνας. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση της υπεροχής του συνδυασμού μιας παρέμβασης απώλειας βάρους μέσω της Μεσογειακής δίαιτας (ΜΔ) ή του Μεσογειακού τρόπου ζωής (ΜΤΖ) και της συνήθους φροντίδας, δηλαδή της συνταγογράφησης συνεχούς θετικής πίεσης στους αεραγωγούς (CPAP), συγκριτικά με τη μεμονωμένη παροχή συνήθους φροντίδας, στη βελτίωση: (1) της βαρύτητας και της συμπτωματολογίας της ΑΑΥ, (2) του καρδιομεταβολικού προφίλ, και (3) δεικτών φλεγμονής και οξειδωτικού στρες. Υλικό και μέθοδος: Η μελέτη ήταν μια τυχαιοποιημένη, ελεγχόμενη, μονά τυφλή, κλινική δοκιμή. Συμπεριέλαβε ενήλικους, υπέρβαρους ασθενείς με μέτρια-σοβαρή επιβεβαιωμένη μέσω πολυυπνογραφίας ΑΑΥ [δείκτης απνοιών-υποπνοιών (ΔΑΥ) ≥15 επεισόδια/ώρα], χωρίς συνοδά νοσήματα. Οι συμμετέχοντες τυχαιοποιήθηκαν στην ομάδα συνήθους φροντίδας (ΟΣΦ), την ομάδα ΜΔ (ΟΜΔ) και την ομάδα ΜΤΖ (ΟΜΤΖ). Σε όλους τους συμμετέχοντες συνταγογραφήθηκε θεραπεία CPAP. Η ΟΣΦ έλαβε επιπλέον γραπτές γενικές οδηγίες για έναν υγιεινό τρόπο ζωής, ενώ οι ΟΜΔ και ΟΜΤΖ υποβλήθηκαν σε μια εντατική 6μηνη συμπεριφορική παρέμβαση, δομημένη σε 7 ομαδικές συνεδρίες διάρκειας 60 λεπτών. Βασικοί στόχοι της εντατικής παρέμβασης ήταν μία 5-10% απώλεια βάρους και η αύξηση της προσκόλλησης στη ΜΔ. Στην ΟΜΤΖ επιδιώχθηκε επιπλέον η ενίσχυση της σωματικής δραστηριότητας και η εξασφάλιση επαρκούς διάρκειας και ποιότητας ύπνου. Οι εθελοντές αξιολογήθηκαν ως προς ανθρωπομετρικές παραμέτρους, τις συνήθειες του τρόπου ζωής, πολυυπνογραφικά χαρακτηριστικά, τη συμπτωματολογία της ΑΑΥ, καρδιομεταβολικούς δείκτες, την παρουσία μεταβολικού συνδρόμου (ΜΣ), και δείκτες φλεγμονής και οξειδωτικούς στρες, στην αρχή και στο τέλος της μελέτης. Αποτελέσματα: Στη μελέτη συμμετείχαν 187 ασθενείς (65-ΟΣΦ, 62-ΟΜΔ και 60-ΟΜΤΖ). Επτά ασθενείς αποκλείστηκαν μετά την τυχαιοποίησή τους και 53/180 (29%) εγκατέλειψαν τη μελέτη. Σύμφωνα με την ανάλυση «πρόθεση για θεραπεία» (n=180), συγκριτικά με την ΟΣΦ, οι τιμές του ΔΑΥ (επεισόδια/ώρα), σταθμισμένες για την ηλικία, το φύλο, τα προ-παρέμβασης επίπεδα και τη χρήση CPAP, ήταν σημαντικά χαμηλότερες στην ΟΜΔ (μέση διαφορά: -18,0, P<0,001) και στην ΟΜΤΖ (μέση διαφορά: -21,2, P<0,001), και οι διαφορές παρέμειναν σημαντικές μετά από επιπρόσθετο έλεγχο για την ποσοστιαία αλλαγή βάρους (P=0,004 και P=0,008, αντιστοίχως). Άλλοι δείκτες αναπνευστικών επεισοδίων και ο βαθμός ημερήσιας υπνηλίας και αϋπνίας βρέθηκαν, επίσης, σημαντικά χαμηλότεροι στις δύο ομάδες εντατικής παρέμβασης σε σύγκριση με την ΟΣΦ (όλα τα P<0,050). Η ΟΜΤΖ παρουσίασε, επιπροσθέτως, υψηλότερο ποσοστό ύπνου ταχείας κίνησης ματιών και χαμηλότερο βαθμό ημερήσιας υπνηλίας σε σύγκριση με την ΟΜΔ (P=0,034 και P=0,014, αντιστοίχως). Oι δείκτες μεταβολισμού της γλυκόζης, τα λιπίδια του αίματος, τα ηπατικά ένζυμα και η αρτηριακή πίεση βελτιώθηκαν μόνο στις ομάδες εντατικής παρέμβασης και τα επίπεδά τους ήταν σημαντικά βελτιωμένα σε σύγκριση με την ΟΣΦ στο τέλος της μελέτης (όλα τα P<0,050). Ο σχετικός κίνδυνος (95% διάστημα εμπιστοσύνης) του ΜΣ ήταν 0,58 (0,34-0,99) για την ΟΜΔ και 0,30 (0,17-0,52) για την ΟΜΤΖ, σε σύγκριση με την ΟΣΦ, έπειτα από έλεγχο για την ηλικία, το φύλο, τα προ-παρέμβασης επίπεδα και τη χρήση CPAP. Η ΟΜΤΖ παρουσίασε επιπλέον χαμηλότερο σχετικό κίνδυνο ΜΣ σε σύγκριση με την ΟΜΔ [0,52 (0,30-0,89)]. Μετά από επιπρόσθετο έλεγχο για την ποσοστιαία αλλαγή βάρους, ο σχετικός κίνδυνος ΜΣ εξακολουθούσε να είναι χαμηλότερος στην ΟΜΤΖ σε σύγκριση με την ΟΣΦ (P=0,050). Παράλληλα, σε σύγκριση με την ΟΣΦ, οι σταθμισμένες για την ηλικία, το φύλο, τα προ-παρέμβασης επίπεδα και τη χρήση CPAP τιμές C-αντιδρώσας πρωτεΐνης υψηλής ευαισθησίας (mg/dL) ήταν χαμηλότερες στην ΟΜΔ (μέση διαφορά: -1,33, P=0,039) και στην ΟΜΤΖ (μέση διαφορά: -1,68, P=0,007). Επιπλέον, η ΟΜΤΖ παρουσίασε χαμηλότερα επίπεδα 8-ισο προσταγλανδίνης F2a στα ούρα (ng/mg κρεατινίνης), σε σύγκριση με την ΟΣΦ (μέση διαφορά: -1,10, P<0,001) και την ΟΜΔ (μέση διαφορά: -0,80, P=0,001), διαφορές που παρέμειναν σημαντικές ακόμα και μετά από επιπρόσθετο έλεγχο για την απώλεια βάρους (P<0,001 και P=0,001, αντιστοίχως). Τα αποτελέσματα ήταν παρόμοια στην ανάλυση βάσει πρωτοκόλλου (n=127). Συμπεράσματα: Ο συνδυασμός μιας παρέμβασης απώλειας βάρους βασισμένης στη ΜΔ ή στον ΜΤΖ με τη συνήθη φροντίδα της ΑΑΥ, δηλαδή τη συνταγογράφηση CPAP, οδηγεί σε μεγαλύτερες βελτιώσεις στη βαρύτητα και τη συμπτωματολογία της ΑΑΥ, στο καρδιομεταβολικό προφίλ και σε δείκτες φλεγμονής και οξειδωτικού στρες, συγκριτικά με τη μεμονωμένη παροχή συνήθους φροντίδας. Συμπεριφορικές παρεμβάσεις με κεντρικό άξονα την απώλεια βάρους μέσω ευεργετικών αλλαγών στις συνήθειες του τρόπου ζωής που δεν απαιτούν ειδικό εξοπλισμό και μπορούν να εφαρμοσθούν χωρίς ιδιαίτερο κόστος σε όλες τις δομές υγειονομικής φροντίδας, μπορούν να αποτελέσουν μια ρεαλιστική και αποτελεσματική στρατηγική για τη διαχείριση της ΑΑΥ στην κλινική πράξη

Obtaining evidence base for the development of Feel4Diabetes intervention to prevent type 2 diabetes - a narrative literature review

Background Feel4Diabetes was a school and community based intervention aiming to promote healthy lifestyle and tackle obesity for the prevention of type 2 diabetes among families in 6 European countries. We conducted this literature review in order to guide the development of evidence-based implementation of the Feel4Diabetes intervention. We focused on type 2 diabetes prevention strategies, including all the phases from risk identification to implementation and maintenance. Special focus was given to prevention among vulnerable groups and people under 45 years. Methods Scientific and grey literature published between January 2000 and January 2015 was searched for relevant studies using electronic databases. To present the literature review findings in a systematic way, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A complementary literature search from February 2015 to December 2018 was also conducted. Results The initial review included 27 studies with a follow-up >= 12 months and 9 studies with a follow-up >= 6 months and with a participant mean age <45 years. We found out that interventions should be targeted at people at risk to improve recruiting and intervention effectiveness. Screening questionnaires (primarily Finnish Diabetes Risk Score FINDRISC) and blood glucose measurement can both be used for screening; the method does not appear to affect intervention effectiveness. Screening and recruitment is time-consuming, especially when targeting lower socioeconomic status and age under 45 years. The intervention intensity is more important for effectiveness than the mode of delivery. Moderate changes in several lifestyle habits lead to good intervention results. A minimum of 3-year follow-up seemed to be required to show a reduction in diabetes risk in high-risk individuals. In participants <45 years, the achieved results in outcomes were less pronounced. The complementary review included 12 studies, with similar results regarding intervention targets and delivery modes, as well as clinical significance. Conclusion This narrative review highlighted several important aspects that subsequently guided the development of the Feel4Diabetes high-risk intervention. Research on diabetes prevention interventions targeted at younger adults or vulnerable population groups is still relatively scarce. Feel4Diabetes is a good example of a project aiming to fill this research gap.Peer reviewe

Mediterranean Diet and Diabetes: Prevention and Treatment

The aim of the present review is to examine current scientific knowledge on the association between the Mediterranean diet and diabetes mellitus (mostly type 2 diabetes). A definition of the Mediterranean diet and the tools widely used to evaluate adherence to this traditional diet (Mediterranean diet indices) are briefly presented. The review focuses on epidemiological data linking adherence to the Mediterranean diet with the risk of diabetes development, as well as evidence from interventional studies assessing the effect of the Mediterranean diet on diabetes control and the management of diabetes-related complications. The above mentioned data are explored on the basis of evaluating the Mediterranean diet as a whole dietary pattern, rather than focusing on the effect of its individual components. Possible protective mechanisms of the Mediterranean diet against diabetes are also briefly discussed

Mediterranean Diet and Diabetes: Prevention and Treatment

The aim of the present review is to examine current scientific knowledge on the association between the Mediterranean diet and diabetes mellitus (mostly type 2 diabetes). A definition of the Mediterranean diet and the tools widely used to evaluate adherence to this traditional diet (Mediterranean diet indices) are briefly presented. The review focuses on epidemiological data linking adherence to the Mediterranean diet with the risk of diabetes development, as well as evidence from interventional studies assessing the effect of the Mediterranean diet on diabetes control and the management of diabetes-related complications. The above mentioned data are explored on the basis of evaluating the Mediterranean diet as a whole dietary pattern, rather than focusing on the effect of its individual components. Possible protective mechanisms of the Mediterranean diet against diabetes are also briefly discussed