Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Background: In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors’ profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. Presentation of the Hypothesis: This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. Implications of the hypothesis tested: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different subpopulations in order to establish a definite relationship. A comprehensive approach based on the aspects of biosocial life may result in more accurate CVD risk management

Lifestyle and health determinants of cardiovascular disease among Greek older adults living in Eastern Aegean Islands: An adventure within the MEDIS study.

OBJECTIVE: The aim of the present study was to evaluate lifestyle and health determinants of cardiovascular disease (CVD) risk among Greek elderly residents living in Eastern Aegean islands, in both Greece and Turkey. METHODS: Under the context of the MEDIS study, 724 older adults (aged 65 to 100 years) from 8 Eastern Aegean Sea Greek islands (n=100 living in Samothrace, 142 in Lesvos, 150 in Limnos, 76 in Ikaria, 52 in Kassos, 149 in Rhodes and Karpathos) and from Turkey (n=55older adults of Greek origin living on Gökçeada Island) were voluntarily recruited. Overall cardiometabolic risk was measured as the sum (range 0-4) of four common CVD risk factors (hypertension, diabetes, dyslipidemia and obesity). RESULTS: Greek islanders had higher CVD scores compared to Greeks of Gökçeada (1.9±1.1 vs 1.4±1.0 risk factors / participant, p<0.001). Further analysis revealed that the diet of Greek islanders was similar to the traditional Mediterranean diet; however, these individuals demonstrated 2-times higher odds (95% CI, 1.04-3.87) for having hypertension, 1.53-times higher odds (95% CI, 0.66-3.54) for having diabetes, 3.29-times higher odds (95% CI, 1.58-6.81) for having hypercholesterolemia; whereas they had 0.78-times lower odds (95% CI, 0.40-1.52) for being obese, compared to elderly Greek adults living on Gökçeada. CONCLUSIONS: Overall, CVD risk seems to be low among Eastern Aegean Islanders; certain differences in CVD risk factors exist between Greek islanders and their counterparts living in Gökçeada, and those differences may be attributed to various environmental, cultural and lifestyle factors

High sodium intake of children through ‘hidden’ food sources and its association with the Mediterranean diet: the GRECO study

Objectives: Sodium is the mineral that has been, mainly, linked to hypertension and cardiovascular disease. It is found naturally in many foods, but is also used in the food industry and manufacturing. Identification of total sodium intake, as well as ‘hidden’ sodium intake from food sources early in life is necessary. Methods: Four thousand, five hundred and eighty children aged 10–12 years were enrolled, in a cross-sectional, population-based survey. Among other measurements, dietary data were obtained by a semi-quantitative food frequency questionnaire, and sodium intake was calculated. High sodium consumption was considered an intake over 2200 mg/day. Adherence to the Mediterranean dietary pattern was evaluated using the Mediterranean Diet Quality Index for children and adolescent score (KIDMED score). Results: Twenty-three percent of Greek children had sodium intake which exceeded the 2200 mg/day recommendation, excluding salt added at table and during cooking. Sodium intake was found elevated in children with moderate and high adherence to the Mediterranean Diet. Additionally, 1 unit increase in KIDMED score (i.e. higher adherence) was associated with 10% [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07–1.13] increased likelihood of consuming sodium above the median intake (i.e. >1500 mg/day). Thirty-four percent of sodium intake from ‘hidden’ sources came from bread, processed cereals and white cheese. Conclusions: Greek children have an elevated sodium intake from ‘hidden’ sources and main contributors are foods which are recommended to be consumed on a daily basis according to the Mediterranean Diet Pyramid. These findings should induce manufacturers to reduce the amount of sodium added during processing of ‘healthy’ foods, especially bread and cheese

Natriuretic peptides and integrated risk assessment for cardiovascular disease. an individual-participant-data meta-analysis

BACKGROUND: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment. METHODS: In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7·5%, and ≥7·5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure. FINDINGS: We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1·56-1·98) for the combination of coronary heart disease and stroke and 2·00 (1·77-2·26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0·012 (0·010-0·014) and a net reclassification improvement of 0·027 (0·019-0·036) for the combination of coronary heart disease and stroke and a C-index increase of 0·019 (0·016-0·022) and a net reclassification improvement of 0·028 (0·019-0·038) for the combination of coronary heart disease, stroke, and heart failure. INTERPRETATION: In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention

Skeletal muscle mass and body fat in relation to successful ageing of older adults: The multi-national MEDIS study

BACKGROUND: The determinants that promote successful ageing still remain unknown. The aim of the present work was to evaluate the role of skeletal muscle mass and body fat percentage (BF%), in the level of successful ageing. METHODS: during 2005-2011, 2663 older (aged 65-100 years) from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Appendicular skeletal muscle mass (ASM), skeletal muscle mass index (SMI) and BF% were calculated using population formulas. Dietary habits, energy intake, expenditure and energy balance were derived throughout standard procedures. A successful ageing index ranging from 0 to 10 was used. RESULTS: The mean ASM mass was 24±6.0kg, the SMI was 0.84±0.21 and the BF% was 44%. Females had lower SMI and higher BF% in comparison with males, respectively [(SMI: 0.66±0.09 vs. 1.03±0.11; BF%: 51% vs. 34%, (p<0.001)]. High successful agers had better rates in ASM (p=0.01), SMI (p<0.001) and BF% (p<0.001), compared with the medium and low successful ones. Changes in SMI [b-coefficient (95% CI):2.14 (1.57 to 2.71)] were positively associated with successful ageing, while changes in BF% [b-coefficient (95% CI): -0.04 (-0.05 to -0.03)] were inversely associated with successful ageing. Results from sensitivity analysis showed that the effects of variations on body composition were consistent, less pronounced in the positive energy balance group and more pronounced among the oldest old. CONCLUSIONS: Body composition changes seem to be associated with lower quality of life in the older adults, as measured through successful ageing

Social marketing and healthy eating : Findings from young people in Greece

This document is the Accepted Manuscript version. The final publication is available at Springer via http://dx.doi.org/10.1007/s12208-013-0112-xGreece has high rates of obesity and non-communicable diseases owing to poor dietary choices. This research provides lessons for social marketing to tackle the severe nutrition-related problems in this country by obtaining insight into the eating behaviour of young adults aged 18–23. Also, the main behavioural theories used to inform the research are critically discussed. The research was conducted in Athens. Nine focus groups with young adults from eight educational institutions were conducted and fifty-nine participants’ views towards eating habits, healthy eating and the factors that affect their food choices were explored. The study found that the participants adopted unhealthier nutritional habits after enrolment. Motivations for healthy eating were good health, appearance and psychological consequences, while barriers included lack of time, fast-food availability and taste, peer pressure, lack of knowledge and lack of family support. Participants reported lack of supportive environments when deciding on food choices. Based on the findings, recommendations about the development of the basic 4Ps of the marketing mix, as well as of a fifth P, for Policy are proposedPeer reviewe

Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project

Background: Recent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/ spirituality and sense of coherence with depression. Methods: A total of 220 subjects of the SPILI III cohort (1988-2012) attending a primary care setting in the town of Spili on rural Crete represented the target group. All participants underwent a standardized procedure. Validated questionnaires were used to evaluate sense of coherence, depression levels and religious and spiritual beliefs. A multiple linear regression analysis of the Beck Depression Inventory Scale (BDI) in relation to demographic characteristics, scores on the Royal Free Interview for Spiritual and Religious Beliefs scale (RFI-SRB) and Sense of Coherence scale (SOC) was used. Results: A significant inverse association was found between BDI and RFI-SRB scale (B-coef=-0.6999, p<0.001), as well as among BDI and SOC scale (B-coef=-0.556, p<0.001). Conclusions: The findings of the current observational study indicate that highly religious participants are less likely to score high in the depression scale. Furthermore, participants with high SOC scored significantly low in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality in mental health

Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project

Background: Recent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/ spirituality and sense of coherence with depression. Methods: A total of 220 subjects of the SPILI III cohort (1988-2012) attending a primary care setting in the town of Spili on rural Crete represented the target group. All participants underwent a standardized procedure. Validated questionnaires were used to evaluate sense of coherence, depression levels and religious and spiritual beliefs. A multiple linear regression analysis of the Beck Depression Inventory Scale (BDI) in relation to demographic characteristics, scores on the Royal Free Interview for Spiritual and Religious Beliefs scale (RFI-SRB) and Sense of Coherence scale (SOC) was used. Results: A significant inverse association was found between BDI and RFI-SRB scale (B-coef=-0.6999, p<0.001), as well as among BDI and SOC scale (B-coef=-0.556, p<0.001). Conclusions: The findings of the current observational study indicate that highly religious participants are less likely to score high in the depression scale. Furthermore, participants with high SOC scored significantly low in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality in mental health

Tocotrienols, health and ageing: A systematic review

Objectives A systematic review of studies was undertaken to evaluate the potential effect of intake of tocotrienols or circulating levels of tocotrienols on parameters associated with successful ageing, specifically in relation to cognitive function, osteoporosis and DNA damage. Methods Following PRISMA guidelines a systematic review of epidemiological observational studies and clinical trials was undertaken. Inclusion criteria included all English language publications in the databases PubMed and Scopus, through to the end of July 2016. Results Evidence from prospective and case-control studies suggested that increased blood levels of tocotrienols were associated with favorable cognitive function outcomes. A clinical trial of tocotrienol supplementation for 6 months suggested a beneficial effect of intake on DNA damage rates, but only in elderly people. Regarding osteoporosis, only in vitro studies with cultures of human bone cells were identified, and these demonstrated significant inhibition of osteoclast activity and promotion of osteoblast activity. Conclusions Research in middle-aged and elderly humans suggests that tocotrienols have a potential beneficial anti-ageing action with respect to cognitive impairment and DNA damage. Clinical trials are required to elucidate these effects