The J-shape association of ethanol intake with total homocysteine concentrations: the ATTICA study

BACKGROUND: Epidemiological studies suggest a non-monotonic effect of alcohol consumption on cardiovascular risk, while there is strong evidence concerning the involvement of homocysteine levels on thrombosis. The aim of this work was to evaluate the association between usual ethanol consumption and homocysteine levels, in cardiovascular disease free adults. METHODS: From May 2001 to December 2002 we randomly enrolled 1514 adult men and 1528 women, without any evidence of cardiovascular disease, stratified by age – gender (census 2001), from the greater area of Athens, Greece. Among the variables ascertained we measured the daily ethanol consumption and plasma homocysteine concentrations. RESULTS: Data analysis revealed a J-shape association between ethanol intake (none, <12 gr, 12 – 24 gr, 25 – 48 gr, >48 gr per day) and total homocysteine levels (mean ± standard deviation) among males (13 ± 3 vs. 11 ± 3 vs. 14 ± 4 vs. 18 ± 5 vs. 19 ± 3 μmol/L, respectively, p < 0.01) and females (10 ± 4 vs. 9 ± 3 vs. 11 ± 3 vs. 15 ± 4 vs. 17 ± 3 μmol/L, respectively, p < 0.01), after controlling for several potential confounders. The lowest homocysteine concentrations were observed with ethanol intake of < 12 gr/day (Bonferroni α* < 0.05). No differences were observed when we stratified our analysis by type of alcoholic beverage consumed. CONCLUSION: We observed a J-shape relationship between homocysteine concentrations and the amount of ethanol usually consumed

Effect of differently fed farmed gilthead sea bream consumption on platelet aggregation and circulating haemostatic markers among apparently healthy adults:A double-blind randomized crossover trial

Fish consumption beneficially affects coagulation markers. Few dietary intervention studies have investigated differently fed farmed fish against these cardio-metabolic risk factors in humans. This double-blind randomized crossover trial evaluated differently fed farmed gilthead sea bream consumption against platelet aggregation and circulating haemostatic markers among apparently healthy adults. Subjects aged 30–65 years, with a body mass index 24.0–31.0 kg/m2, consuming less than 150 g cooked fish per week, were recruited in Attica, Greece. Participants were randomized (n = 38, 1:1) to one of two sequences; consumption of fish fed with fish oil diet (conventional fish, CF)/fish fed with olive pomace-enriched diet (enriched fish, EF) versus EF/CF. The primary outcomes were ex vivo human platelet aggregation and circulating plasminogen activator inhibitor-1 (PAI-1) and P-selectin (sP-selectin) concentrations. EF consumption had no significant effect on platelet sensitivity or haemostatic markers compared to CF. Platelet sensitivity to platelet-activating factor (PAF) decreased after CF consumption during the second period (p p < 0.01 for both). Based on current findings, consumption of enriched farmed gilthead sea bream had no greater effect on coagulation markers in adults compared to the conventionally fed fish

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 (&gt;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 multicentre development and evaluation of a dietetic referral score for nutritional risk in sick infants

Background &amp; aims: Unrecognized nutritional issues may delay recovery in hospitalized infants. It has been proposed that nutritional risk screening should be performed at hospital admission, but few tools include infants. The aim of this study was to develop and test a tool to identify sick infants in need of dietetic input. Methods: Hospitalised infants were recruited from hospitals in the United Kingdom (UK), Greece and Iran. Weight, skinfold thickness and mid upper arm circumference (MUAC) were measured, with detailed dietetic assessment in the UK and Greece. Simple screening questions were used in the UK cohort to formulate a score (infant early nutrition warning score-iNEWS) which was then validated in the Greek and Iranian groups. Results: After dietetic assessment, 20 (9.6%) UK and 22 (22%) Greek infants were rated as needing dietetic input. Underweight, poor weight gain/loss and reduced intake were all independent predictors of perceived need for dietetic input in stepwise multivariate regression analysis. The score based on these items (iNEWS), had 84% sensitivity, 91% specificity and 49% positive predictive value to predict need for dietetic input in the UK cohort. In the Greek cohort this was 86%, 78% and 53% respectively. In all three countries, infants with high iNEWS had significantly lower average skinfold thickness (between −1 and −1.8 SD, p &lt; 0.0001) and MUAC (between −1.8 and −2 SD, p &lt; 0.0001) than those at low risk. Conclusions: iNEWS, a simple nutritional risk tool, identifies most hospitalised infants who need dietetic input. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03323957

La comunicación entre el paciente oncológico y los profesionales. El cuestionario de comunicación de la EORTC

The aims of the present work are to introduce to the field of communication between the cancer patient and the professionals, to remark the positive influence communication may have on the patient, and to present the EORTC communication questionnaire. Communication between patient and professional is a key element in the support that is offered to cancer patients. It is important to consider different professionals communicate with cancer patients. There is a need of research in communication between patients and professionals. Two main models of patient care are presented: Paternalistic and Patient-Centered Cancer Care. Patient-Centered Care includes Patient- Centered Communication - PCC. The relation between communication and other PROs - Quality of Life, Information and Satisfaction with Care - is presented. There are cross-cultural differences in communication that could be related to the model of patient care. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is developing a questionnaire to assess communication between cancer patient and the professionals. This Communication questionnaire mainly assesses professionals’ behaviors. Cultural aspects have a key role in the development of the EORTC questionnaire. This instrument is based on the Patient- Centered Communication – PCC model. The EORTC QLQ-COMU26 is presented. It includes six scales and four individual items. The three phases of the questionnaire development process are described. At the present moment the EORTC QLQ-COMU26 is being field-tested in a larger international study (phase IV), to ensure it is an appropriate and psychometrically valid instrument.Este trabajo pretende introducir el área de la comunicación entre el paciente oncológico y los profesionales, y destacar el impacto que tiene en el paciente. Además, se presenta el cuestionario de comunicación de la EORTC. La comunicación entre el paciente y los profesionales es uno de los elementos claves del soporte que se ofrece a dichos pacientes. En dicha comunicación participan un rango importante de profesionales. Hay una necesidad de realizar más investigación sobre la comunicación. Se presentan dos modelos principales de atención al paciente: el Paternalista y el de Atención Centrada en el Paciente con cáncer. Este último lleva asociada la Comunicación Centrada en el Paciente - CCP. Se revisa la relación entre comunicación y otros PRO: Calidad de Vida, información, y Satisfacción con los Cuidados. Existen diferencias culturales en comunicación que pueden estar relacionadas con el modelo de atención al paciente. El Grupo de Calidad de Vida de la Organización Europea para la Investigación y Tratamiento del Cáncer-EORTC está desarrollando una escala de comunicación entre el paciente oncológico y los profesionales. La mayoría del contenido de dicho cuestionario se centra en las conductas de los profesionales. Los aspectos culturales tienen un papel fundamental en el desarrollo del instrumento. El cuestionario se basa en el modelo de Comunicación Centrada en el Paciente – CCP. Se presenta el cuestionario EORTC QLQ-COMU26, que consta de seis escalas y cuatro ítems individuales. Se describen las tres primeras fases que se han dado en su creación. En la actualidad su funcionamiento psicométrico se está valorando en un estudio internacional

A High Polyphenol Diet Improves Psychological Well-Being: The Polyphenol Intervention Trial (PPhIT)

Mental ill health is currently one of the leading causes of disease burden worldwide. A growing body of data has emerged supporting the role of diet, especially polyphenols, which have anxiolytic and antidepressant-like properties. The aim of the present study was to assess the effect of a high polyphenol diet (HPD) compared to a low polyphenol diet (LPD) on aspects of psychological well-being in the Polyphenol Intervention Trial (PPhIT). Ninety-nine mildly hypertensive participants aged 40&ndash;65 years were enrolled in a four-week LPD washout period and then randomised to either an LPD or an HPD for eight weeks. Both at baseline and the end of intervention, participants&rsquo; lifestyle and psychological well-being were assessed. The participants in the HPD group reported a decrease in depressive symptoms, as assessed by the Beck Depression Inventory-II, and an improvement in physical component and mental health component scores as assessed with 36-Item Short Form Survey. No differences in anxiety, stress, self-esteem or body image perception were observed. In summary, the study findings suggest that the adoption of a polyphenol-rich diet could potentially lead to beneficial effects including a reduction in depressive symptoms and improvements in general mental health status and physical health in hypertensive participants

The potential role of adipose tissue hormones (leptin and adiponectin) in osteopenia of perimenopausal women

Fat mass is an important determinant of bone density, but the mechanism involved in this relation is uncertain. Leptin and adiponectin, as circulating peptides of adipocyte origin, are potential contributors to this relation. The aim of the present study was to investigate the potential role of leptin and adiponectin in mediating fat mass effects on the skeleton of perimenopausal women. The sample of the present study was composed of 84 perimenopausal women, with age range 42 - 68 years. Fifty five women were postmenopausal with mean years since menopause 3.3 y. Lumbar spine bone mineral density (BMDL2 - L4) and total body bone mineral content (TBBMC) were measured with Dual X-ray absorbtiometry, leptin levels with enzyme - linked immunosorbent assay (ELISA) and adiponectin levels with radioimmunoassay (RIA). Additionally, the body composition of the participants was estimated with BIA method, and several hormones were measured. Due to lack of a published equation for the prediction of Greek, perimenopausal women’s body composition, we developed and validated a new equation, in a random sample of 60 Greek women, with age range 42 - 65 years. Dual X- ray absorptiometry was used as the reference method. The new equation that was developed for the estimation of FFM was the following: FFM (kg) = 17,825 + 0,380 (height2 / Resistance) + 0,172 x weight - 0,156 x age and explained the 88.4% of FFM variation (R2= 0.884), with a standard error of estimate (SEE) equal to 1.89 kg. According to the validation, the bias of FFM estimation was not statistically significant (p= 0.281) and the limits of agreement (± 2SD) of acceptable validity. According to the results of the study, it was shown that serum leptin levels were negatively correlated with BMD (β= -0.005, p= 0.027) and TBBMC (β= -14.32, p= 0.013). The above correlation was observed only when serum insulin levels were included, as an independent variable, in the regression analysis model. Adiponectin was not significantly correlated with BMDL2 - L4 nor with TBBMC, either in the presence or absence of insulin. In conclusion, the adipocyte hormones leptin and adiponectin do not seem to contribute as fat mediators to increased bone mass, in perimenopausal women. Adiponectin does not appear to exert any effect on bone mass, while the negative correlation among leptin and bone mass may be attributed to a more complicated circuit of events between hormones, sympathetic system and fat distribution, during this period of women’s life, rather than to the body fat content only.Η λιπώδης μάζα αποτελεί καθοριστικό παράγοντα της οστικής πυκνότητας, αλλά οι μηχανισμοί που εμπλέκονται στη σχέση αυτή παραμένουν αβέβαιοι. Η λεπτίνη και η αντιπονεκτίνη, ως κυκλοφορούντα πεπτίδια παραγόμενα από το λιπώδη ιστό, μεσολαβούν πιθανόν στην παραπάνω σχέση. Σκοπός της παρούσας εργασίας ήταν η διερεύνηση του πιθανού ρόλου της λεπτίνης και της αντιπονεκτίνης ως διαμεσολαβητές των επιδράσεων της λιπώδους μάζας στο σκελετό περιεμμηνοπαυσιακών γυναικών. Το δείγμα της μελέτης αποτελούνταν από 84 περιεμμηνοπαυσιακές γυναίκες με εύρος ηλικιών 42 - 68 έτη. Από αυτές, 55 ήταν μετεμμηνοπαυσιακές, με μέσο χρόνο εμμηνόπαυσης 3,3 έτη. Με τη μέθοδο της απορροφησιομετρίας ακτίνων- Χ διπλής ενέργειας (DXA), μετρήθηκε η οστική πυκνότητα στην οσφυϊκή μοίρα της σπονδυλικής στήλης (ΒΜDΟ2-Ο4), καθώς και η ολική περιεκτικότητα των οστών σε ανόργανα στοιχεία (TBBMC). Οι συγκεντρώσεις της λεπτίνης προσδιορίστηκαν με τη μέθοδο ELISA και της αντιπονεκτίνης με τη ραδιοανοσολογική μέθοδο (RΙΑ). Επιπρόσθετα εκτιμήθηκαν η σύσταση σώματος, με τη μέθοδο της Βιοηλεκτρικής Εμπέδησης (BIA) και οι συγκεντρώσεις διαφόρων ορμονών. Για να εκτιμήσουμε το σωματικό λίπος των ατόμων με τη μέθοδο BIA και λόγω έλλειψης κάποιας δημοσιευμένης εξίσωσης για την εκτίμηση της σύστασης σώματος περιεμμηνοπαυσιακών γυναικών, ελληνικής καταγωγής, αναπτύξαμε μία νέα εξίσωση και στη συνέχεια ελέγξαμε την αξιοπιστία της, σε ένα τυχαίο δείγμα 60 γυναικών, ηλικιακού εύρους 42 - 65 ετών. Ως μέθοδος αναφοράς χρησιμοποιήθηκε η DXA. Η νέα εξίσωση που αναπτύχθηκε για την εκτίμηση της FFM ήταν η ακόλουθη: FFM (kg) = 17,825 + 0,380 (ύψος2 / R) + 0,172 x βάρος - 0,156 x ηλικία και ερμήνευε το 88.4% της διακύμανσης της άλιπης μάζας σώματος (R2= 0,884), με τυπικό σφάλμα εκτίμησης (SEE) ίσο με 1,89 kg. Σύμφωνα με τον έλεγχο αξιοπιστίας, το συστηματικό σφάλμα (bias) στην εκτίμηση της FFM δεν ήταν στατιστικά σημαντικό (p= 0,281) και τα όρια συμφωνίας (limits of agreement) (± 2 SD) ήταν αποδεκτής αξιοπιστίας. Σύμφωνα με τα αποτελέσματα, η λεπτίνη συσχετιζόταν αρνητικά με την ΒΜDΟ2-Ο4 (β= -0,005, p= 0,027) και την TBBMC (β= -14,32 p= 0,013). Η παραπάνω συσχέτιση ήταν σημαντική μόνο όταν τα επίπεδα ινσουλίνης συμπεριλαμβάνονταν στις ανεξάρτητες μεταβλητές των υποδειγμάτων της πολλαπλής παλινδρόμησης. Η αντιπονεκτίνη δε παρουσίαζε σημαντική συσχέτιση με την ΒΜDΟ2-Ο4 ή την TBBMC, τόσο κατά την παρουσία, αλλά και την απουσία της ινσουλίνης από τις ανεξάρτητες μεταβλητές. Συμπερασματικά, οι ορμόνες του λιπώδους ιστού, λεπτίνη και αντιπονεκτίνη δε φαίνεται να συνεισφέρουν ως διαμεσολαβητές της θετικής επίδρασης του λίπους στην οστική μάζα, στις περιεμμηνοπαυσιακές γυναίκες. Η αντιπονεκτίνη φαίνεται πως δεν ασκεί καμία επίδραση στην οστική μάζα, ενώ η αρνητική συσχέτιση ανάμεσα στη λεπτίνη και την οστική μάζα μπορεί να αποδοθεί σε μία περίπλοκη αλληλουχία γεγονότων και αλληλεπιδράσεων μεταξύ των ορμονών, του συμπαθητικού συστήματος και της κατανομής του σωματικού λίπους, που σημειώνονται σε αυτήν την περίοδο της ζωής των γυναικών και όχι μόνο στο σωματικό λίπος

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