Demosthenes B Panagiotakos

Hippokration General Hospital, Athens, Athínai, Attica, Greece

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Publications (719)2771.42 Total impact

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    ABSTRACT: Background: Smoking has long been positively associated with the development and progression of coronary heart disease. However, longitudinal cohort studies evaluating smoking habits among cardiac patients as well as the role of socio-demographic factors determining such behaviours are scarce and have been focused on primary care practice. Thus the aim of the present work was to examine the association of active smoking and behaviours and exposure to second-hand smoke, with the 10-year Acute Coronary Syndrome (ACS) prognosis, among cardiovascular patients. Methods: From October 2003 to September 2004, a sample of six Greek hospitals was selected and almost allconsecutive 2172 ACS patients were enrolled. In 2013-14, the 10-year follow-up was performed in 1918 participants (11 % loss to follow-up). Smoking habits at the time of entry to the study, as well as during the follow-up period were studied using a standard questionnaire. Results: Patients who had >60 pack-years of smoking had 57.8 % higher ACS mortality and 24.6 % higher risk for any ACS event. Nested model, adjusted only for age and sex, revealed that for every 30 pack-years of smoking increase, the associated ACS risk increased by 13 % (95 % CI 1.03, 1.30, p = 0.001). When further adjusted analysis, including several potential confounders, was applied the tested relationship was still significant (95 %CI 1.03, 1.30, p = 0.09). Accordingly, the risk for fatal ACS events increased by 8 % for every 30 pack-years of smoking increase (95 % CI 1.03, 1.63, p = 0.06). Moreover, 52 % of the patients reported being exposed to secondhand smoke and when further adjustments were made, it was revealed that they had 33 % (95 % CI 1.12, 1.60, p = 0.01) higher risk of having recurrent ACS events. Conclusions: Active smoking and second-hand smoke among cardiac patients still represent a substantial clinical burden. Thus, smoking cessation policies should be incorporated into the long-term therapeutic management.
    Tobacco Induced Diseases 12/2015; 13(1). DOI:10.1186/s12971-015-0063-6 · 1.39 Impact Factor
  • Paul Farajian · Grigoris Risvas · Demosthenes B Panagiotakos · Antonis Zampelas ·
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    ABSTRACT: Objective Excessive free sugars consumption has a possible role in health issues, diet quality and obesity development. The present cross-sectional study aimed to identify the major food sources of free sugars in Greek children’s diet and investigate possible associations of dietary patterns with free sugars intake. Design Anthropometric measurements and information on dietary and physical activity habits were obtained. Energy and free sugars intake coming from foods were estimated and principal components analysis was applied to identify dietary patterns. Setting The GRECO (Greek Childhood Obesity) study. Subjects Nationwide sample of 3089 children (aged 10–12 years). Results Adopting WHO criteria, 44·2 % of participants were categorized as having free sugars intake above 10 % of total energy intake. Mean contribution of free sugars to energy intake was 11·2 %, and the major food sources of free sugars differed from those of other childhood populations. Free sugars intake was not associated with overweight/obesity. Multiple linear regression analysis revealed that two lifestyle and dietary patterns, characterized by higher consumption of sweets, fast foods, fries, sugared drinks, frequently ordering/eating outside home and having meals in front of a screen (pattern 1) and higher consumption of whole fruits, 100 % fruit juices, vegetables, legumes and honey/jam (pattern 2), were positively associated with free sugars intake. Conclusions A large proportion of children exceeded the recommended cut-off and free sugars intake was associated with lifestyle patterns rather than single foods. Public health programmes aiming to reduce free sugars consumption should be tailored on promoting the correct dietary habits of specific childhood populations.
    Public Health Nutrition 11/2015; DOI:10.1017/S1368980015003146 · 2.68 Impact Factor
  • Matina Kouvari · Stefanos Tyrovolas · Demosthenes B. Panagiotakos ·

    Maturitas 11/2015; DOI:10.1016/j.maturitas.2015.11.006 · 2.94 Impact Factor
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    ABSTRACT: The aim of the this study was to establish age- and gender-specific physical fitness normative values and to compare percentiles and Z scores values in a large, nationwide sample of Greek children aged 6-18 years. From March 2014 to May 2014, a total of 424,328 boys and girls aged 6-18 years who attended school in Greece were enrolled. The studied sample was representative, in terms of age-sex distribution and geographical region. Physical fitness tests (i.e. 20 m shuttle run test (SRT), standing long jump, sit and reach, sit-ups, and 10 × 5 m SRT) were performed and used to calculate normative values, using the percentiles of the empirical distributions and the lambda, mu, and sigma statistical method. Normative values were presented as tabulated percentiles for five health-related fitness tests based on a large data set comprising 424,328 test performances. Boys typically scored higher than girls on cardiovascular endurance, muscular strength, muscular endurance, and speed/agility, but lower on flexibility (all p values <0.001). Older boys and girls had better performances than younger ones (p < 0.001). Physical fitness tests' performances tended to peak at around the age of 15 years in both sexes. The presented population-based data are the most up-to-date sex- and age-values for the health-related fitness of children and adolescents in Greece and can be used as standard values for fitness screening and surveillance systems and for comparisons among the same health-related fitness scores of children from other countries similar to Greece. Schools need to make efforts to improve the fitness level of the schoolchildren through the physical education curriculum to prevent cardiovascular risk.
    09/2015; DOI:10.1080/17461391.2015.1088577
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    ABSTRACT: Background: Soybean oil-based intravenous fat emulsion (IVFE) administered to preterm neonates can induce oxidative stress and inflammatory response, which are associated with severe complications of prematurity. This study aimed to test the hypothesis that administration of medium-chain triglyceride (MCT)/ω-3 polyunsaturated fatty acid (PUFA)-enriched IVFE in preterm neonates is associated with a cytokine and fatty acid (FA) profile consistent with attenuated inflammatory response. Patients/methods: In a double-blind randomized study, 60 preterm neonates (gestational age 26-32 weeks) were randomized to receive either MCT/ω-3 PUFA-enriched IVFE (intervention group) or soybean oil-based IVFE (control group). Serum biochemistry, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, α-tocopherol, and FAs were assessed at baseline, on day of life 15, and day of life 30 or at the end of intervention. Results: All cytokine levels changed significantly across the 3 time points, whereas the type of IVFE had a significant effect on final IL-6 and IL-8 levels, which were lower in the intervention group. The difference in final IL-6 and IL-8 levels remained significant after controlling for bronchopulmonary dysplasia and/or infection. α-Tocopherol and FA values changed significantly over time. MCT/ω-3 PUFA-enriched IVFE administration was associated with significantly higher α-tocopherol, eicosapentaenoic acid, docosahexaenoic acid, and ω-3 PUFAs and lower linolenic acid, total PUFA, and ω-6/ω-3 PUFA values compared with soybean oil-based IVFE. Both IVFEs were well tolerated. Conclusion: Compared with the soybean oil-based IVFE, the MCT/ω-3 PUFA-enriched IVFE is associated with a more favorable cytokine and FA profile consistent with attenuated inflammatory response in preterm neonates.
    Nutrition in Clinical Practice 09/2015; DOI:10.1177/0884533615602011 · 2.40 Impact Factor
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    ABSTRACT: Although hypertension, hypercholesterolemia and diabetes mellitus (DM) are recognized as major cardio-metabolic risk factors in primary Acute Coronary Syndrome (ACS) prevention, studies focusing on secondary ACS incidence are scarce. In the present study, the association between the aforementioned factors and 10-year ACS prognosis was evaluated. From October 2003 to September 2004 2,172 consecutive patients with ACS diagnosis, from 6 Greek hospitals, were enrolled. During 2013-14, the 10-year follow-up was performed in 1,918 participants. Baseline clinical factors were assessed through physical examination, medical records and pharmacological management. All-cause mortality and the development of fatal or non-fatal ACS events were recorded through medical records or hospital registries. Logistic regression models were applied to evaluate the impact of baseline clinical status on the ACS prognosis. The 10-year all cause and ACS mortality rate was 32.6 and 17.8%, respectively. Multi-adjusted analysis highlighted that, after taking into account various potential confounders, DM was the sole clinical factor associated with adverse effect on the 10-year ACS fatal incidence [Odds Ratio (OR)=1.35, 95% Confidence Interval (95% CI) 1.01, 1.80, p=0.04]. DM was the only clinical factor that aggravated ACS prognosis, whereas abnormal lipids profile and blood pressure did not seem to determine prognosis. Thus, glycaemic control may play a critical role in the secondary CVD prevention management of ACS patients.
    Current Vascular Pharmacology 09/2015; 13(999). DOI:10.2174/1570161113666150916093451 · 2.97 Impact Factor
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    ABSTRACT: Background: The traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids' profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study. Methods: From May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids' profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein-(a) levels were also measured. Results: The 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000-1.013), 1.006 (1.000-1.013), 1.002 (1.000-1.004), 1.038 (1.001-1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively). Conclusion: Elevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.
    Lipids in Health and Disease 09/2015; 14(1):108. DOI:10.1186/s12944-015-0101-7 · 2.22 Impact Factor
  • Demosthenes B. Panagiotakos ·

    Current Vascular Pharmacology 09/2015; 13(5). DOI:10.2174/157016111305150825124134 · 2.97 Impact Factor
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    ABSTRACT: The association between long-term coffee consumption and 10-year cardiovascular disease incidence among Acute Coronary Syndrome (ACS) patients was evaluated. From 2003 to 2004, 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed (88% participation rate) and recurrent fatal or non-fatal ACS was recorded. Baseline coffee consumption (cups/day) was assessed using a semi-quantitative Food Frequency Questionnaire. Multi adjusted analysis revealed that 1-2 cups of coffee/day versus no consumption had an adverse effect on the ACS incidence [odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.01, 1.79]. In subgroup analysis, with hypertension as strata, only the normotensive reached significance. Odds ratios for 1-2 and ≥3 cups relative to no consumption were [OR = 1.66, 95% CI 1.07, 2.60] and [OR = 1.86, 95% CI 1.06, 3.27], respectively, after controlling for potential confounders. Thus, avoidance of coffee may be of high importance to ameliorate disease prognosis among cardiac patients.
    International Journal of Food Sciences and Nutrition 08/2015; DOI:10.3109/09637486.2015.1077795 · 1.21 Impact Factor
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    ABSTRACT: Low socioeconomic status is associated with poorer cardiovascular health. The aim of the present work was to evaluate how social and economic factors influence modifiable cardiovascular disease risk factors and thus, acute coronary syndrome or ischemic stroke presence. One thousand participants were enrolled; 250 consecutive patients with a first acute coronary syndrome (83% were male, 60 ± 12 years old) and 250 control subjects, as well as 250 consecutive patients with a first ischemic stroke (56% were male, 77 ± 9 years old) and 250 control subjects. The control subjects were population-based and age-sex matched with the patients. Detailed information regarding their medical records, lifestyle characteristics, education level, financial status satisfaction, and type of occupation were recorded. After controlling for potential confounding factors, significant inverse associations were observed regarding financial status satisfaction and sedentary/mental type occupation with acute coronary syndrome or stroke presence, but not with the educational level. Nevertheless, further evaluation using path analysis, revealed quite different results, indicating that the education level influenced the type of occupation and financial satisfaction, hence affecting indirectly the likelihood of developing a cardiovascular disease event. Social and economic parameters interact with modifiable cardiovascular disease risk factors through multiple pathways. Copyright © 2015 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.
    08/2015; DOI:10.1016/j.gheart.2015.01.002
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    ABSTRACT: Central obesity is a strong risk factor for metabolic disorders and cardiometabolic diseases in children and adolescents. The aim of the present study was to evaluate the prevalence of central obesity and to determine its cross-sectional association with lifestyle habits in a sample of school-aged children in Greece. The study sample consisted of 124,113 children (9.9 ± 1.1 years old, 51 % boys) attending the third and fifth grade of primary school. Anthropometric measurements were performed by trained physical education teachers, and central obesity was defined as waist-to-height ratio ≥0.5. Children's lifestyle habits were assessed through 7-day recall questionnaires. Of the participating children, 33.4 % were classified as centrally obese. Central obesity was significantly more prevalent in boys than in girls (36.0 vs. 30.7 %, P < 0.001) and was present in 95 % of obese children, as well as in a significant percentage of overweight (69.5 %) and normal-weight ones (12.0 %). Children with central obesity, compared to their non-centrally obese counterparts, reported poorer dietary habits and were less physically active. According to multiple logistic regression analysis, frequent breakfast (OR 0.72, 95 % CI 0.69-0.75) and snack consumption (OR 0.70, 95 % CI 0.67-0.74), as well as frequent participation in sedentary activities (OR 1.10, 95 % CI 1.07-1.14), were the strongest lifestyle determinants of central obesity. Strategies for the prevention of central obesity and associated comorbidities are urgently needed, for both obese and non-obese children. Our results suggest the need for a shift towards a healthier environment for our children, with emphasis on specific lifestyle habits, such as regular meal consumption and low sedentariness.
    European Journal of Nutrition 08/2015; DOI:10.1007/s00394-015-1008-9 · 3.47 Impact Factor
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    ABSTRACT: To summarise the evidence about the efficacy of a Mediterranean diet on the management of type 2 diabetes and prediabetic states. A systematic review of all meta-analyses and randomised controlled trials (RCTs) that compared the Mediterranean diet with a control diet on the treatment of type 2 diabetes and prediabetic states was conducted. Electronic searches were carried out up to January 2015. Trials were included for meta-analyses if they had a control group treated with another diet, if they were of sufficient duration (at least 6 months), and if they had at least 30 participants in each arm. A random-effect model was used to pool data. Adults with or at risk for type 2 diabetes. Dietary patterns that described themselves as using a 'Mediterranean' dietary pattern. The outcomes were glycaemic control, cardiovascular risk factors and remission from the metabolic syndrome. From 2824 studies, 8 meta-analyses and 5 RCTs were eligible. A 'de novo' meta-analysis of 3 long-term (>6 months) RCTs of the Mediterranean diet and glycaemic control of diabetes favoured the Mediterranean diet as compared with lower fat diets. Another 'de novo' meta-analysis of two long-term RCTs showed a 49% increased probability of remission from the metabolic syndrome. 5 meta-analyses showed a favourable effect of the Mediterranean diet, as compared with other diets, on body weight, total cholesterol and high-density lipoprotein cholesterol. 2 meta-analyses demonstrated that higher adherence to the Mediterranean diet reduced the risk of future diabetes by 19-23%. The Mediterranean diet was associated with better glycaemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 08/2015; 5(8):e008222. DOI:10.1136/bmjopen-2015-008222 · 2.27 Impact Factor
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    ABSTRACT: Abstract 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 number 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 performed. 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 lower in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality on mental health.
    BMC Psychiatry 07/2015; · 2.21 Impact Factor
  • E Magriplis · P Farajian · G Risvas · D Panagiotakos · A Zampelas ·
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    ABSTRACT: A food index (FI) based on a priory knowledge was developed to assess the role of diet on overweight (OW) and obesity (OB) in school-aged children. This included «positive» and «negative» foods based on research evidence and food guidelines, with scores set accordingly. Statistical tests were used to strengthen the sensitivity of the index. The FI was validated using data from the GRECO study. The score ranged from 17 to 53.5 (mean 34.8 ± 5.01) and was inversely associated with body mass index (BMI) (-0.057 ± 0.02; 95% CI -0.098, -0.017) and waist circumference (WC) (-0.08 ± 0.03, 95% CI: -0.137, -0.022). Associations remained significant upon adjusting for age, gender and physical-inactivity (p = 0.02 ad 0.013, respectively). When stratified by gender, the association between FI and WC was not significant for boys (p = 0.08). The association with BMI remained significant for females and males (p = 0.047 and 0.037, respectively). The derived FI seems a valuable tool in detecting OW in children.
    International Journal of Food Sciences and Nutrition 07/2015; 66(6):1-10. DOI:10.3109/09637486.2015.1056109 · 1.21 Impact Factor
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    ABSTRACT: There is increasing interest in indexes that estimate the individual risk of developing a cardiovascular disease (CVD) event; the European Society of Cardiology (ESC), in the latest guidelines (2012) for CVD prevention, acknowledged the importance of risk evaluation through risk scores, i.e. the ESC SCORE (Systematic COronary Risk Estimation). However, there has been much discussion about the reliability of such CVD risk scores among different populations. The ESC SCORE is a CVD risk-specific tool for Europe, based on datasets from 12 European countries (Greece did not participate). In the mid-2000s the HellenicSCORE, a calibration of the ESC SCORE based on national mortality data and prevalence regarding risk factors as reported by the ATTICA study, was proposed for the Greek population and became a part of daily clinical practice. This validation of the HellenicSCORE was performed using the 10-year follow-up examination of the ATTICA study participants. Of the 3042 participants of the ATTICA study (enrolment 2001-2002), 2583 were contacted in the 10-year follow-up (2011-2012). The HellenicSCORE as calculated using participants' baseline characteristics was tested against the 10-year CVD event rates. The 10-year fatal or non-fatal CVD incidence rate was 15.7% (19.7% in men and 11.7% in women). The HellenicSCORE correctly predicted 95.6% of fatal CVD cases and 93.2% of the fatal and non-fatal CVD cases. No interactions with sex, age group or comorbidities were observed. The HellenicSCORE is a valid tool for CVD risk estimation in Greek subjects. The present work suggests a calibration methodology that could be used by other nations for CVD risk estimation.
    07/2015; 56(4):302-308.
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    ABSTRACT: The purpose of this work was to investigate the association between coffee drinking and diabetes development and potential mediation by oxidative stress and inflammatory biomarkers. In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) were selected to participate in the ATTICA study (Athens metropolitan area, Greece). A validated food-frequency questionnaire was used to assess coffee drinking (abstention, casual, habitual) and other lifestyle and dietary factors. Evaluation of oxidative stress and inflammatory markers was also performed. During 2011-2012, the 10-year follow-up of the ATTICA study was carried out. The outcome of interest in this work was incidence of type 2 diabetes, defined according to American Diabetes Association criteria. During follow-up, 191 incident cases of diabetes were documented (incidence 13.4% in men and 12.4% in women). After various adjustments, individuals who consumed ⩾250 ml of coffee (≈1.5cup) had 54% lower odds of developing diabetes (95% confidence interval: 0.24, 0.90), as compared with abstainers. A dose-response linear trend between coffee drinking and diabetes incidence was also observed (P for trend=0.017). When controlling for several oxidative stress and inflammatory biomarkers, the inverse association between habitual coffee drinking and diabetes was found to be mediated by serum amyloid-A levels. This work highlights the significance of long-term habitual coffee drinking against diabetes onset. The anti-inflammatory effect of several coffee components may be responsible for this protection.European Journal of Clinical Nutrition advance online publication, 1 July 2015; doi:10.1038/ejcn.2015.98.
    European journal of clinical nutrition 07/2015; 69(11). DOI:10.1038/ejcn.2015.98 · 2.71 Impact Factor
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    ABSTRACT: The purpose of this work was to investigate the potential mediating effect of oxidative stress, inflammation and coagulation on Mediterranean diet- diabetes link. In 2001-02, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study, where Athens is a major metropolis. A validated questionnaire was used to assess lifestyle and dietary factors. Adherence to Mediterranean diet was recorded using MedDietScore. Among others, oxidative stress and inflammatory biomarkers were recorded. During 2011-2012, the 10-year follow-up was performed. Diabetes incidence was defined according to American Diabetes Association criteria. 191 incident cases of diabetes were documented, yielding to an incidence of 12.9% (13.4% in men and 12.4% in women). Medium and high adherence were found to decrease diabetes risk by 49% (95%CI: 0.30, 0.88), and 62% (95%CI: 0.16, 0.88) respectively, compared to low adherence. A logarithmic trend between Mediterranean diet and diabetes incidence was also revealed (p for trend = 0.042). Individuals with abnormal waist circumference (>94 for men, >80 for women) were benefited the most. Wholegrain cereals, fruits and legumes had the greatest predictive ability. The anti-diabetic effect of Mediterranean diet was mediated by TNF-α, homocysteine and TAC. The reported results underline the role of Mediterranean diet as a promising dietary tool for the primary prevention of diabetes, by attenuating inflammation and fostering TAC; thus, this dietary pattern may have a therapeutic potential for a plethora of cardio-metabolic disorders, resulting from inflammation and/or oxidative stress. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 06/2015; DOI:10.1002/dmrr.2672 · 3.55 Impact Factor
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    ABSTRACT: The present study evaluated the association between long-term, exclusive olive oil consumption, in cooking preparation or as a dressing, and the 10-year (2004-2014) incidence of acute coronary syndrome (ACS) among cardiac patients. From October 2003 to September 2004, a sample of 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed in 1918 patients (88% participation rate). The development of fatal or nonfatal ACS was recorded through medical records or hospital registries. Among other dietary components, added fats (i.e. olive oil, butter, margarine and seed oils) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. Non-exclusive olive oil consumption on a daily basis was associated with an adverse effect on the ACS incidence after taking into account various potential confounders [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.05-1.86, P = 0.024]. However, significant interactions between olive oil consumption and body mass index (BMI) (P = 0.082) and educational level (P = 0.054) led to further stratified analysis. Using BMI as strata (i.e. ≤29.9 versus >29.9 kg m(-2) ), the above association remained significant only in obese patients (OR = 1.80, 95% CI = 1.03-3.12, P = 0.038), whereas, on examining the education status (i.e. ≤9 versus >9 years of school), a significant association was observed only among the higher educated patients (OR = 1.83, 95% CI = 1.01-3.32, P = 0.047). Exclusive use of olive oil, either as a salad dressing or in cooking, should be promoted through the dietary management of ACS patients, with the aim of reducing the likelihood of recurrent cardiac episodes. © 2015 The British Dietetic Association Ltd.
    Journal of Human Nutrition and Dietetics 06/2015; DOI:10.1111/jhn.12324 · 1.99 Impact Factor
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    ABSTRACT: Urine color (UC) is a practical tool for hydration assessment. The technique has been validated in adults, but has not been tested in children. The purpose of the study was to test the validity of the urine color scale in young, healthy boys and girls, as a marker of urine concentration, investigate its diagnostic ability of detecting hypohydration and examine the ability of children to self-assess UC. A total of 210 children participated (age: 8-14 years, body mass: 43.4 ± 12.6 kg, height: 1.49 ± 0.13 m, body fat: 25.2 ± 7.8 %). Data collection included: two single urine samples (first morning and before lunch) and 24-h sampling. Hydration status was assessed via urine osmolality (UOsmo) and UC via the eight-point color scale. Mean UC was 3 ± 1 and UOsmo 686 ± 223 mmol kg(-1). UC displayed a positive relationship as a predictor of UOsmo (R (2): 0.45, P < 0.001). Based on the receiver operating curve, UC has good overall classification ability for the three samples (area under the curve 85-92 %), with good sensitivity (92-98 %) and specificity (55-68 %) for detecting hypohydration. The overall accuracy of the self-assessment of UC in the morning or the noon samples ranged from 67 to 78 %. Further threshold analysis indicated that the optimal self-assessed UC threshold for hypohydration was ≥4. The classical eight-point urine color scale is a valid method to assess hydration in children of age 8-14 years, either by researchers or self-assessment.
    European Journal of Nutrition 04/2015; DOI:10.1007/s00394-015-0905-2 · 3.47 Impact Factor
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    ABSTRACT: The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin. During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used. After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = -0.21[-0.37, -0.05], as well as positive energy balance, b-coefficient [95% CI] = -0.21 [-0.37, -0.05], were inversely associated with successful aging. A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measured through successful aging. © The Author(s) 2015.
    Journal of Aging and Health 04/2015; 27(8). DOI:10.1177/0898264315583053 · 1.56 Impact Factor

Publication Stats

14k Citations
2,771.42 Total Impact Points


  • 2003-2015
    • Hippokration General Hospital, Athens
      Athínai, Attica, Greece
  • 2014
    • Bentham Science Publishers
      Ash Shāriqah, Ash Shāriqah, United Arab Emirates
  • 2001-2014
    • Harokopion University of Athens
      • Department of Nutrition and Dietetics
      Athínai, Attica, Greece
  • 2007-2012
    • Agricultural University of Athens
      • Department of Food Science and Technology
      Athínai, Attica, Greece
    • Hygeia Hospital
      Athínai, Attica, Greece
  • 2005-2012
    • Onassis Cardiac Surgery Center
      • Department of Cardiology
      Kallithea, Attica, Greece
  • 2004-2012
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • Technological Educational Institute of Piraeus
      Athínai, Attica, Greece
    • Κεντρική Κλινική Αθηνών
      Athínai, Attica, Greece
  • 2011
    • Saint Louis University
      • Department of Nutrition and Dietetics
      Сент-Луис, Michigan, United States
    • University of Ioannina
      • School of Medicine
      Yannina, Epirus, Greece
  • 2007-2011
    • University of Patras
      • Department of Paediatrics
      Rhion, West Greece, Greece
  • 2009
    • University of Crete
      • Division of Social Medicine
      Réthymnon, Kriti, Greece
  • 2005-2009
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
  • 2008
    • University General Hospital
      Houston, Texas, United States
  • 2007-2008
    • Attikon University Hospital
      • • Department of Cardiology
      • • Department of Internal Medicine IV
      Athínai, Attica, Greece
  • 2004-2008
    • Κωνσταντοπούλειο νοσοκομείο Νέας Ιωνίας (Η Αγία Όλγα)
      Athínai, Attica, Greece
  • 2003-2006
    • Georgetown University
      • Division of Cardiology
      Washington, Washington, D.C., United States
  • 2003-2004
    • Ευρωκλινική
      Athínai, Attica, Greece