Prevalence of Overweight and Obesity and Associated Diet-Related Behaviours and Habits in a Representative Sample of Adolescents in Greece

Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages

Systematic review of Mendelian randomization studies on risk of cancer

Abstract Background We aimed to map and describe the current state of Mendelian randomization (MR) literature on cancer risk and to identify associations supported by robust evidence. Methods We searched PubMed and Scopus up to 06/10/2020 for MR studies investigating the association of any genetically predicted risk factor with cancer risk. We categorized the reported associations based on a priori designed levels of evidence supporting a causal association into four categories, namely robust, probable, suggestive, and insufficient, based on the significance and concordance of the main MR analysis results and at least one of the MR-Egger, weighed median, MRPRESSO, and multivariable MR analyses. Associations not presenting any of the aforementioned sensitivity analyses were not graded. Results We included 190 publications reporting on 4667 MR analyses. Most analyses (3200; 68.6%) were not accompanied by any of the assessed sensitivity analyses. Of the 1467 evaluable analyses, 87 (5.9%) were supported by robust, 275 (18.7%) by probable, and 89 (6.1%) by suggestive evidence. The most prominent robust associations were observed for anthropometric indices with risk of breast, kidney, and endometrial cancers; circulating telomere length with risk of kidney, lung, osteosarcoma, skin, thyroid, and hematological cancers; sex steroid hormones and risk of breast and endometrial cancer; and lipids with risk of breast, endometrial, and ovarian cancer. Conclusions Despite the large amount of research on genetically predicted risk factors for cancer risk, limited associations are supported by robust evidence for causality. Most associations did not present a MR sensitivity analysis and were thus non-evaluable. Future research should focus on more thorough assessment of sensitivity MR analyses and on more transparent reporting. </jats:sec

Medstraum : design and operation of the first zero-emission fast catamaran

The paper deals with the design, construction and the early operation of the worldwide 1 st battery driven high-speed catamaran passenger ferry MS Medstraum. The paper elaborates on unique issues of the design process, on the superior hydrodynamic performance, on the modular construction of vessel and on the land-based electrical/charging installation. MS Medstraum was built by Fjellstrand AS and was launched in early June 2022. After successful sea trials that superseded the expectations of designers, builders and operators, achieving a maximum speed of over 27 knots, it started operations in the Stavanger/Norway area in late September 2022. The prototype character of MS Medstraum led to its selection as “Ship of the Year 2022” at the major international maritime exhibition SMM 2022 (September 2022, Hamburg). The presented research is in the frame of the H2020 funded project “TrAM – Transport: Advanced and Modular” (www.tramproject.eu)

Prevalence and determinants of sex-specific dietary supplement use in a greek cohort

We describe the profile of dietary supplement use and its correlates in the Epirus Health Study cohort, which consists of 1237 adults (60.5% women) residing in urban north-west Greece. The association between dietary supplement use and demographic characteristics, lifestyle behaviors, personal medical history and clinical measurements was assessed using logistic regression models, separately for women and men. The overall prevalence of dietary supplement use was 31.4%, and it was higher in women (37.3%) compared to men (22.4%; p-value = 4.2−08). Based on multivariable logistic regression models, dietary supplement use in women was associated with age (positively until middle-age and slightly negatively afterwards), the presence of a chronic health condition (OR = 1.71; 95% CI, 1.18–2.46), lost/removed teeth (OR = 0.52; 95% CI, 0.35–0.78) and diastolic blood pressure (OR per 5 mmHg increase =0.84; 95% CI, 0.73–0.96); body mass index and worse general health status were borderline inversely associated. In men, dietary supplement use was positively associated with being employed (OR = 2.53; 95% CI, 1.21–5.29). A considerable proportion of our sample used dietary supplements, and the associated factors differed between women and men

Intake of dietary supplements and survival/progression among cancer patients: A systematic review and meta-Analysis

Εισαγωγή: Μετά τη διάγνωση του καρκίνου, πολλοί ασθενείς ξεκινούν την κατανάλωση συμπληρωμάτων διατροφής, αλλά δεν υπάρχουν επαρκείς ενδείξεις για την αποτελεσματικότητά τους απέναντι στην ολική θνησιμότητα, στη θνησιμότητα από καρκίνο και στην υποτροπή της ασθένειας. Πραγματοποιήσαμε συστηματική ανασκόπηση και μετα-ανάλυση μελετών παρατήρησης και τυχαιοποιημένων κλινικών δοκιμών ώστε να αποσαφηνίσουμε τη σχέση μεταξύ της κατανάλωσης συμπληρωμάτων διατροφής που ξεκινά μετά τη διάγνωση του καρκίνου και των προαναφερθέντων εκβάσεων. Επικεντρωθήκαμε σε συμπληρώματα αντιοξειδωτικών (α-τοκοφερόλη, β-καροτένιο, λουτεΐνη, λυκοπένιο, σελήνιο, βιταμίνες Α, C, Ε, ψευδάργυρος), ασβεστίου, πολυβιταμινών και βιταμίνης D. Μέθοδοι: Πραγματοποιήσαμε αναζήτηση της υπάρχουσας βιβλιογραφίας μέσω των ηλεκτρονικών βάσεων PubMed και Cochrane Library μέχρι τον Απρίλιο του 2019. Η αξιολόγηση των μελετών έγινε με χρήση της κλίμακας Newcastle-Ottawa και του εργαλείου της Cochrane Collaboration ανάλογα τον ερευνητικό σχεδιασμό. Για τις μελέτες παρατήρησης, πραγματοποιήσαμε μετα-ανάλυση ανά συμπλήρωμα για όλους τους τύπους καρκίνου και, στη συνέχεια, ξεχωριστές αναλύσεις για επιζώντες καρκίνου μαστού και καρκίνου παχέος εντέρου. Δεν ήταν δυνατή η διεξαγωγή μετα-ανάλυσης μόνο με τις τυχαιοποιημένες κλινικές δοκιμές εξ’ αιτίας του μικρού αριθμού διαθέσιμων δημοσιεύσεων, οπότε διεξήχθη αρχικά συστηματική ανασκόπηση και, έπειτα, μετα-ανάλυση χρησιμοποιώντας και τους 2 ερευνητικούς σχεδιασμούς, όταν είχαμε τουλάχιστον 2 μελέτες παρατήρησης και 2 κλινικές δοκιμές ανά συμπλήρωμα. Οι συνοπτικές εκτιμήσεις κινδύνου υπολογίστηκαν με χρήση μοντέλων τυχαίων επιδράσεων. Η ετερογένεια μεταξύ των μελετών διερευνήθηκε με χρήση του στατιστικού κριτηρίου Q και του δείκτη Higgins I2, ενώ το σφάλμα δημοσίευσης εκτιμήθηκε με χρήση γραφημάτων «φουγάρου» και του κριτηρίου του Egger. Αποτελέσματα: Βρέθηκαν 16 μελέτες παρατήρησης με συνολικό δείγμα 32.017 επιζώντες καρκίνου που παρακολουθήθηκαν από 1,8 μέχρι 13,1 χρόνια, κατά μέσο όρο, και 11 τυχαιοποιημένες κλινικές δοκιμές με 4.025 συμμετέχοντες στις ομάδες θεραπείας και 3.398 συμμετέχοντες στις ομάδες ελέγχου με διάμεσο χρόνο παρακολούθησης από 1,5 μέχρι 6,6 χρόνια. Σύμφωνα με τα αποτελέσματα της μετα-ανάλυσης των μελετών παρατήρησης, η κατανάλωση συμπληρωμάτων ασβεστίου μετά τη διάγνωση του καρκίνου ήταν προστατευτικός παράγοντας ενάντια στην ολική θνησιμότητα (AΚ=0,88, 95% ΔΕ: 0,77-1) και στη θνησιμότητα από καρκίνο (AΚ=0,71, 95% ΔΕ: 0,53-0,95), όπως και η βιταμίνη D απέναντι στην ολική θνησιμότητα (AΚ=0,84, 95% ΔΕ: 0,74-0,97) σε σύγκριση με τη μη κατανάλωση μετά τη διάγνωση. Η βιταμίνη D συνέχισε να λειτουργεί προστατευτικά και μετά τη σύνθεση των αποτελεσμάτων και των 2 ερευνητικών σχεδιασμών (AΚ=0,86, 95% ΔΕ: 0,76-0,99). Στους επιζώντες καρκίνου μαστού, η κατανάλωση συμπληρωμάτων βιταμίνης C (AΚ=0,79, 95% ΔΕ: 0,68-0,92), βιταμίνης D (AΚ=0,85, 95% ΔΕ: 0,72-0,99) και βιταμίνης Ε (AΚ=0,76, 95% ΔΕ: 0,64-0,90) μετά τη διάγνωση, μείωσαν τον κίνδυνο θνησιμότητας από οποιοδήποτε αίτιο, ενώ τα συμπληρώματα πολυβιταμινών (AΚ=0,79, 95% ΔΕ: 0,64-0,97), βιταμίνης C (AΚ=0,76, 95% ΔΕ: 0,64-0,91) και βιταμίνης Ε (AΚ=0,69, 95% ΔΕ: 0,55-0,85) μείωσαν τον κίνδυνο υποτροπής του καρκίνου σε σχέση με την απουσία κατανάλωσης μετά τη διάγνωση. Στους επιζώντες καρκίνου του παχέος εντέρου, η κατανάλωση συμπληρωμάτων ασβεστίου μετά τη διάγνωση συνδέθηκε με μειωμένο κίνδυνο θνησιμότητας (AΚ=0,66, 95% ΔΕ: 0,47-0,94) από καρκίνο του παχέος εντέρου σε σχέση με τη μη κατανάλωση μετά τη διάγνωση. Σε γενικές γραμμές, δεν παρατηρήσαμε μεγάλη ετερογένεια μεταξύ των μελετών, ενώ δεν είχαμε ενδείξεις για σφάλμα δημοσίευσης. Συμπέρασμα: Η κατανάλωση συμπληρωμάτων ασβεστίου και ορισμένων βιταμινών, όπως οι βιταμίνες C, D, E και οι πολυβιταμίνες, μετά τη διάγνωση του καρκίνου φαίνεται πως λειτουργεί προστατευτικά απέναντι στην επιδείνωση της ασθένειας. Ωστόσο, τα αποτελέσματά μας βασίστηκαν σε μικρό αριθμό μελετών. Τα ευρήματά μας, αν επιβεβαιωθούν από μελλοντικές μελέτες, μπορούν να καθοδηγήσουν τους επιζώντες καρκίνου οι οποίοι επιθυμούν να αλλάξουν τις διατροφικές τους συνήθειες ώστε να βελτιώσουν την πρόγνωση της ασθένειάς τους.Introduction: After diagnosis, cancer survivors initiate dietary supplement intake, but there is not adequate evidence whether this dietary habit affects total mortality, cancer mortality, and/or recurrence of the disease. We performed a systematic review and meta-analysis of observational studies and randomized clinical trials to elucidate the relationship of post-diagnosis dietary supplement use and the aforementioned outcomes among cancer survivors. We focused on antioxidants (alpha-tocopherol, beta-carotene, lutein, lycopene, selenium, vitamins A, C, E, zinc), calcium, multivitamins, and vitamin D. Methods: We performed a comprehensive literature search using the electronic databases PubMed and Cochrane Library until April 2019. Assessment quality was carried out through the Newcastle-Ottawa scale and Cochrane Collaboration’s tool for each study design. For observational studies, we conducted a meta-analysis for each supplement including all cancer types and, afterwards, separate analyses for breast cancer survivors and colorectal cancer survivors were performed. We could not perform meta-analysis for randomized clinical trials alone due to the small number of available publications. Therefore, we proceeded on a systematic review and we further combined results of both study designs when we had at least 2 observational studies and 2 clinical trials available per supplement. Risk estimates were combined using random-effects models. Heterogeneity between studies was investigated using Q statistic and Higgins I2, and publication bias was assessed through funnel plots and Egger’s test. Results: We found 16 observational studies including 32,017 cancer survivors followed for 1.8 to 13.1 years, on average, and 11 randomized clinical trials including 4,025 supplement users and 3,398 controls with a median follow-up from 1.5 to 6.6 years. According to meta-analysis of observational studies, calcium supplementation after cancer diagnosis was a protective factor against all-cause mortality (HR=0.88, 95% CI: 0.77-1.00), and cancer mortality (HR=0.71, 95% CI: 0.53-0.95) as well as vitamin D against total mortality (HR=0.84, 95% CI: 0.74-0.97) compared with no supplementation. Vitamin D remained a protective factor against total mortality after combining results from both study designs (HR=0.86, 95% CI: 0.76-0.99). Among breast cancer survivors, post-diagnosis supplementation of vitamin C (HR=0.79, 95% CI: 0.68-0.92), vitamin D (HR=0.85, 95% CI: 0.72-0.99), and vitamin E (HR=0.76, 95% CI: 0.64-0.90) reduced the risk of all-cause mortality, while multivitamins (HR=0.79, 95% CI: 0.64-0.97), vitamin C (HR=0.76, 95% CI: 0.64-0.91), and vitamin E (HR=0.69, 95% CI: 0.55-0.85) reduced the risk of cancer recurrence compared with no post-diagnosis supplementation. Among colorectal cancer survivors, calcium supplementation after diagnosis was related with lower risk (HR=0.66, 95% CI: 0.47-0.94) of colorectal cancer mortality in contrast to no supplement use. Heterogeneity between studies was not substantial, and we did not observe the presence of publication bias. Conclusion: We found evidence for an association between calcium and certain vitamins supplementation, such as vitamins C, D, E, and multivitamins, after cancer diagnosis and progression of the disease. However, our results were based on a small number of studies. Our findings, if replicated in future research studies, will provide important guidance for cancer survivors who are actively seeking diet changes to improve their prognosis

Diet-Related Behaviors and Diet Quality among School-Aged Adolescents Living in Greece

Prevalence of diet-related behaviors (i.e., breakfast consumption, eating with the family) and their association with a 17-point diet quality score, constructed on the basis of reported frequency (in days/week) of vegetable, fruit, sweets and sugar-sweetened beverages consumption, was investigated among 3525 adolescents (51.5% girls) aged 11, 13 and 15 years, who were participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) cross-sectional study, during 2018. Almost one-third (32.9%) of the sample had breakfast &le;1 day/weekdays, 20.2% rarely ate with the family, 26.1% had a meal while watching TV &ge;5 days/week, 31.7% had a snack in front of a screen &ge;5 days/week and 24.1% ate in fast-food restaurants at least once/week. Multivariable ordinal logistic regression revealed that eating breakfast &le;1 day/weekdays compared to 4&ndash;5 days/weekdays (Odds ratio (OR): 1.56, 95% con-fidence interval (CI): 1.34&ndash;1.82), eating rarely with the family compared to almost every day (OR: 1.35, 95% CI: 1.13&ndash;1.60) and eating in fast-food restaurants &ge;2 times/week vs. rarely (OR: 4.59, 95% CI: 3.14&ndash;6.70) were associated with higher odds of having poor diet quality. High frequency of having meals/snacks in front of a screen/TV was also associated with poor diet quality. Efforts to prevent or modify these behaviors during adolescence may contribute to healthier diet

Parental hesitancy towards the established childhood vaccination programmes in the COVID-19 era: assessing the drivers of a challenging public health concern

1) Background: Vaccine hesitancy remains a major public health concern. The reasons behind this attitude are complex and warrant careful consideration, especially in the context of the COVID-19 era. The purpose of this study was to estimate vaccine hesitancy towards the established childhood immunization programmes in a non-random sample of Greek parents and explore possible links with important drivers of this phenomenon. 2) Methods: An online self-administered questionnaire was used from October 2020 to April 2021 to collect socio-demographic, lifestyle and health status data and evaluate knowledge, views and attitudes of the Greek population on COVID-19 pandemic-related issues. Parents were further asked to complete the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. 3) Results: A total of 1,095 parents participated in the study with a mean age of 50 years (SD 9.5 years). The hesitancy against the established childhood vaccinations was estimated at 8.9% (95% CI, 7.3-10.8%). Married status, higher education and income were negatively correlated with hesitancy, whereas positive correlations were found for stress and depressive symptoms and current smoking. Variables related to proper awareness, sound knowledge and trust to authorities regarding the COVID-19 pandemic were strongly associated with being less hesitant against the established childhood vaccination programmes. 4) Conclusion: The estimated parental hesitancy against the established childhood vaccinations is worrying. Variables related to good awareness and knowledge towards COVID-19 pandemic were strongly associated with being less hesitant against childhood vaccinations. Since controversy surrounding COVID-19 vaccinations may decrease parents’ confidence in routine childhood vaccinations, appreciating the complex reasons behind vaccine hesitancy may inform public health policies to overcome barriers and increase vaccine acceptance

Systematic review of Mendelian randomization studies on risk of cancer

Background We aimed to map and describe the current state of Mendelian randomization (MR) literature on cancer risk and to identify associations supported by robust evidence. Methods We searched PubMed and Scopus up to 06/10/2020 for MR studies investigating the association of any genetically predicted risk factor with cancer risk. We categorized the reported associations based on a priori designed levels of evidence supporting a causal association into four categories, namely robust, probable, suggestive, and insufficient, based on the significance and concordance of the main MR analysis results and at least one of the MR-Egger, weighed median, MRPRESSO, and multivariable MR analyses. Associations not presenting any of the aforementioned sensitivity analyses were not graded. Results We included 190 publications reporting on 4667 MR analyses. Most analyses (3200; 68.6%) were not accompanied by any of the assessed sensitivity analyses. Of the 1467 evaluable analyses, 87 (5.9%) were supported by robust, 275 (18.7%) by probable, and 89 (6.1%) by suggestive evidence. The most prominent robust associations were observed for anthropometric indices with risk of breast, kidney, and endometrial cancers; circulating telomere length with risk of kidney, lung, osteosarcoma, skin, thyroid, and hematological cancers; sex steroid hormones and risk of breast and endometrial cancer; and lipids with risk of breast, endometrial, and ovarian cancer. Conclusions Despite the large amount of research on genetically predicted risk factors for cancer risk, limited associations are supported by robust evidence for causality. Most associations did not present a MR sensitivity analysis and were thus non-evaluable. Future research should focus on more thorough assessment of sensitivity MR analyses and on more transparent reporting

Prevalence of Overweight and Obesity and Associated Diet-Related Behaviours and Habits in a Representative Sample of Adolescents in Greece

Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages