Costas Christophi

Cyprus University of Technology · Cyprus International Institute for Environmental and Public Health (CII)

Research on the link between diet and multimorbidity is scarce, despite significant studies investigating the relationship between diet and individual chronic conditions. This study examines the association of dietary intake of macro- and micronutrients with multimorbidity in Cyprus's adult population. It was conducted as a cross-sectional study, w...

Importance: US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet. Objective: To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individ...

Background People’s dietary and lifestyle habits appeared to be influenced by restrictive measures imposed in response to the COVID-19 pandemic. This study aims to examine the differences in dietary and lifestyle habits during and after the lockdown measures in Cyprus. Methods Two online cross-sectional surveys were conducted, using a self-adminis...

Background Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide. The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs. Methods A cross-section...

Inhalation of nanoparticles emitted from toner-based printing equipment (TPE), such as laser printers and photocopiers, also known as PEPs, has been associated with systemic inflammation, hypertension, cardiovascular disease, respiratory disorders, and genotoxicity. Global serum metabolomics analysis in 19 healthy TPE operators found 52 dysregulate...

Background: People's dietary and lifestyle habits appeared to be influenced by restrictive measures imposed in response to the COVID-19 pandemic. This study examines the differences in dietary and lifestyle habits during and after the lockdown measures in Cyprus. Methods: Two online cross-sectional surveys were conducted, using a self-administer...

Cardiovascular disease is the leading cause of on-duty mortality among firefighters, with obesity as an important risk factor. However, little is known regarding the dietary patterns which are characteristic in this population and how these patterns relate to cardiometabolic outcomes. The aim of this study was to identify the dietary patterns of US...

There are knowledge gaps regarding healthy lifestyle (HLS) interventions in fire academy settings and also concerning the impacts of the pandemic on training. We enrolled fire recruits from two fire academies (A and B) in New England in early 2019 as the historical control group, and recruits from academies in New England (B) and Florida (C), respe...

Objectives United States (US) career firefighters represent a working population at high risk for chronic diseases that may benefit from a Mediterranean diet intervention at the public health level. The primary objective of this trial was to assess the effect of a Mediterranean diet nutrition intervention (MDNI) vs. a control group on a modified Me...

The study aims to explore the lifestyle profile of adult individuals with cardiovascular and endocrine diseases in Cyprus. Age and sex-specific analyses were applied. A representative sample of the general adult population was recruited during 2018-2019 using stratified sampling among the five government-controlled municipalities of the Republic of...

Objective This study investigated associations of adiposity and adiposity-related biomarkers with incident type 2 diabetes (T2D) among parous women. Methods Among women in the Diabetes Prevention Program (DPP) who reported a previous live birth, circulating biomarkers (leptin, adiponectin, sex hormone-binding globulin, and alanine aminotransferase...

Introduction Cardiovascular disease is the leading cause of on-duty fatalities among U.S. firefighters. Research has demonstrated that many modifiable risk factors are contributors to the high prevalence of cardiometabolic risk factors. The current study aimed to assess whether sleep is associated with cardiometabolic risk factors among Indianapoli...

Poor sleep is a relatively common condition with possibly serious adverse health consequences. Lack of sleep affects the endocrine, immune, and nervous systems. In Cyprus, there is no information about the quality of sleep in the population. The goal of this study was to assess the quality of sleep in the Cypriot population and evaluate its associa...

Objective: To investigate COVID-19 vaccine efficacy (VE) among healthcare workers (HCWs) in an ethnically diverse community healthcare system, during its initial immunization campaign. Methods: HCWs of the system were retrospectively included from the beginning of a COVID-19 vaccination program (December 16, 2020) until March 31, 2021. Those with a...

Objectives The Mediterranean lifestyle (MEDLIFE), as an overall lifestyle pattern rather than individual factors, may be associated with a lower prevalence of metabolic syndrome. The objective was to study the association of a validated MEDLIFE index with metabolic syndrome and its components among a non-Mediterranean working population. Methods A...

The COVID-19 pandemic is a serious global health emergency that could potentially have a significant impact on both somatic as well as psychological level. The aim of this study was to assess the prevalence of perceived stress in the general adult population of Cyprus during the first COVID-19 lockdown period. This was an internet-based cross-secti...

Objective This study aimed to analyze the adherence to the Mediterranean diet in the adult general population of Cyprus during the COVID-19 confinement. Methods This was an internet-based cross-sectional study which collected information about socioeconomic and demographic characteristics, adherence to the Mediterranean diet and other dietary deta...

Epidemiological studies have yielded conflicting results regarding climate and incident SARS-CoV-2 infection, and seasonality of infection rates is debated. Moreover, few studies have focused on COVD-19 deaths. We studied the association of average ambient temperature with subsequent COVID-19 mortality in the OECD countries and the individual Unite...

Background The association of antenatal depression with adverse pregnancy, birth, and postnatal outcomes has been an item of scientific interest over the last decades. However, the evidence that exists is controversial or limited. We previously found that one in five women in Kuwait experience antenatal depressive symptoms. Therefore, the aim of th...

Background & Aims The Mediterranean lifestyle (MEDLIFE), as an overall lifestyle pattern, may be associated with a lower prevalence of metabolic syndrome. We assessed the association of a validated MEDLIFE index with metabolic syndrome and its components in a non-Mediterranean working population. Methods A cross-sectional analysis was conducted at...

Objective To better understand COVID-19 transmission among healthcare workers (HCW), we investigated occupational and non-occupational risk factors associated with cumulative COVID-19 incidence among a Massachusetts HCW cohort. Design, setting, and participants The retrospective cohort study included adult HCWs in a single healthcare system from M...

Background Non-pharmacological interventions (NPI), including lockdowns, have been used to address the COVID-19 pandemic. We describe changes in the environment and lifestyle of school children in Cyprus before the lockdown and during school re-opening, and assess compliance to NPI, using the exposome concept. Methods During June 2020, parents com...

Background Healthcare workers (HCWs) and other essential workers are at risk of occupational infection during the COVID-19 pandemic. Several infection control strategies have been implemented. Evidence shows that universal masking can mitigate COVID-19 infection, though existing research is limited by secular trend bias. Aims To investigate the ef...

Introduction Sex hormone binding globulin (SHBG) levels are reported to be inversely associated with diabetes risk. It is unknown whether diabetes prevention interventions increase SHBG and whether resultant changes in SHBG affect diabetes risk. The purpose of this analysis was to determine whether intensive lifestyle intervention (ILS) or metformi...

The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of care...

Metabolomics is improving the understanding of the mechanisms of the health effects of diet. Previous research has identified several metabolites associated with the Mediterranean Diet (MedDiet), but knowledge about longitudinal changes in metabolic biomarkers after a MedDiet intervention is scarce. A subsample of 48 firefighters from a cluster-ran...

Objective To examine the adherence to the Mediterranean diet in the adult general population of Cyprus and assess its relationship with multi-morbidity. Design A representative sample of the adult population of Cyprus was selected in 2018–2019 using stratified sampling. Demographics, Mediterranean diet, smoking and physical activity, as well as th...

Background Multimorbidity is defined as the co-existence of two or more chronic conditions. As life expectancy is increasing so does the prevalence of multimorbidity. Our aim was to estimate the prevalence of multimorbidity in Cyprus and identify the most prevalent diseases. Methods A representative sample of n = 1140 individuals over 18 years old...

Background School closures were part of a series of non-pharmacological intervention (NPI) measures addressing the COVID-19 pandemic in Cyprus. We aimed to study changes in the environment, diet, behavior, personal hygiene, contacts, lifestyle choices and the degree of compliance to NPI measures by primary school children in Cyprus at school and at...

Purpose: To investigate changes in firefighter recruits' select health and fitness measurements, from academy training through the early probationary firefighter period. Methods: Firefighter recruits from two New England fire academies were followed prospectively from enrollment at the academy, to graduation after 15-16 week training programs, a...

Background Cardiovascular disease is prevalent among US firefighters. Obesity is known to be associated with an increased risk of CVD and it can be prevented by following a more Mediterranean style diet. The aim of this study was to identify the dietary patterns of US firefighters and assess how these patterns are associated with cardio-metabolic o...

Introduction Knowledge about factors associated with multi-morbidity in a given population has important implications for prevention, diagnosis, treatment, and prognosis strategies. Objectives To examine the association of Mediterranean diet with multi-morbidity in the adult general population of Cyprus. Methods A representative sample of n = 114...

Background: Healthcare workers (HCWs) and other essential workers are at risk for occupational infection during the COVID-19 pandemic. Several infection control strategies have been implemented. Particularly, evidence shows that universal masking can mitigate COVID-19 infection, though existing research is limited by secular trend bias. Aims: To in...

Background: Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes, however, there is a lack of standard European Union (EU) communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU...

Background Coronavirus 2019 disease (COVID-19) is caused by the virus SARS-CoV-2, transmissible both person-to-person and from contaminated surfaces. Early COVID-19 detection among healthcare workers (HCWs) is crucial for protecting patients and the healthcare workforce. Because of limited testing capacity, symptom-based screening may prioritize te...

Objective: Examine the association between healthy Mediterranean lifestyle practices and cardiovascular disease (CVD) risk factors among New England firefighter recruits. Methods: A MEDI-Lifestyle score was used to measure adherence to a Mediterranean lifestyle (not smoking, increased physical activity, high adherence to Mediterranean diet, non-...

Background

Background Obesity is a major risk factor for many chronic diseases, including reduced lung function. The role of polymorphisms of the adiponectin gene, though linked with cardiometabolic consequences of obesity, has not been studied in relation to lung function. Objectives The aim of this study is to examine polymorphisms in the ADIPOQ, ADIPOR1,...

The manifestation of elevated and sustained air temperature gradient profiles in urban dwellings represents an emerging planetary health phenomenon. There is currently limited evidence about the effect of elevated air temperatures on metabolic health. The aim of this work was to assess changes in metabolic and stress hormonal profiles during a shor...

Objective: A systematic literature review and meta-analysis was conducted on the association between firefighting and cancer. Methods: A comprehensive literature search of databases including Medline, EMBASE, Biosis, NIOSHTIC2, Web of Science, Cancerlit, and HealthStar, for the period between 1966 to January 2007, was conducted. We also retrieve...

Collecting dietary intake data is associated with challenges due to the subjective nature of self–administered instruments. Biomarkers may objectively estimate the consumption of specific dietary items or help assess compliance in dietary intervention studies. Our aim was to use a panel of plasma and urine biomarkers to assess the validity of self-...

Despite suggestive observational epidemiology and laboratory studies, there is limited experimental evidence regarding the effect of organic diet on human health. A cluster-randomized 40-day-organic (vs. 40-day-conventional) crossover trial was conducted among children (11-12 years old) from six schools in Cyprus. One restaurant provided all organi...

Background: Police academies need fit recruits to successfully engage in training activities. In a previous retrospective study, we documented that recruits with poor fitness at entry to the academy had significantly lower graduation rates, and we also suggested evidence-based entry-level fitness recommendations. Aims: To validate our findings i...

Objectives: Collecting dietary intake data is associated with challenges due to the subjective nature of self-administered instruments. In contrast, biomarkers of food intake can objectively estimate the consumption of specific dietary items or help assess compliance in intervention studies without self-reporting bias. Our aim was to evaluate urin...

Background/Objective Gestational diabetes mellitus (GDM) is a common pregnancy complication, with complex disease mechanisms, and several risk factors may contribute to its onset. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risk factors associated with GDM, evaluate whether there are indi...

AMSTAR tool for evaluation of quality of included meta-analyses. Note: Y: Yes, N: No, CA: Cannot Answer. Item 1: Was an ‘‘a priori” design provided? Item 2: Was there duplicate study selection and data extraction? Item 3: Was a comprehensive literature search performed? Item 4: Was the status of publication (i.e., grey literature) used as an inclus...

Analytical description of the 62 selected meta-analyses with observed and expected number of "positive" study datasets. Abbreviations: Random effects, summary odds ratio (95% CI) using random effects model; Largest effect, odds ratio (95% CI) of the largest study in the meta-analysis; Egger, p-value from Egger's regression asymmetry test for evalua...

Objectives A cross-sectional study was designed in two hospitals of Cyprus to: (i) examine the possible association between exposure to disinfectants/trihalomethanes (THM) with point of care glycosylated hemoglobin (HbA1c) levels among active nurses, and (ii) identify the main determinants of pre-diabetes metabolic risk among active nurses in Cypru...

Importance: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Robust evidence indicates an association of increased physical fitness with a lower risk of CVD events and improved longevity; however, few have studied simple, low-cost measures of functional status. Objective: To evaluate the association between push-up...

Evidence exists that the risk factors for depression in the antenatal and postnatal period may differ, but only a handful of studies looked at depression longitudinally. The aims of this study were (1) to estimate the prevalence of postnatal depressive symptoms in Kuwait where data about postnatal depression are scarce and identify its determinants...

Sudden cardiac death accounted for 42% of all firefighter duty-related fatalities over the last decade. This retrospective study analyzed available medical examiner records for duty-related firefighter fatalities among male firefighters 18 to 65 years of age that occurred between 1999 and 2014 and reported the pathoanatomic substrate for cardiac-re...

Context Despite sex differences in the onset and progression of CKD, it is unclear whether endogenous sex hormones are associated with kidney function among persons without chronic kidney disease (CKD). Research Design and Methods We conducted a secondary analysis of Diabetes Prevention Program (DPP) and its follow-up observational study, the DPP...

Purpose HbA1c levels are higher in African Americans (AA) than Non-Hispanic Whites (NHW). We investigated whether genetics could explain this difference in Diabetes Prevention Program (DPP) participants. Methods We tested 1) genetic variants causing hemoglobinopathies; 2) a genetic risk score (GRS) based on 60 variants associated with HbA1c from g...

Objective: To estimate the prevalence of antenatal depressive symptoms, identify relevant risk factors, and assess comorbid mental health problems, among pregnant women enrolled in a population based study. Methods: This was a secondary analysis of data collected from 1916 pregnant women who participated in the TRansgenerational Assessment of Ch...

HbA1c levels are higher in AA than NHW independent of glycemia. We investigated whether genetics could explain observed differences in HbA1c levels between AA and NHW DPP participants. We tested 1) genetic variants known to cause hemoglobinopathies; 2) a genetic risk score (GRS) based on 60 variants associated with HbA1c in the most recent genome-w...

Whether endogenous sex hormones are associated with chronic kidney disease (CKD) is not known. We conducted a secondary analysis of longitudinal data from the DPPOS, the follow-up study of the Diabetes Prevention Program (DPP), a randomized trial of diabetes prevention that assigned participants to placebo, metformin, or lifestyle intervention. Thi...

Background: Suboptimal recruit fitness may be a risk factor for poor performance, injury, illness, and lost time during police academy training. Aims: To assess the probability of successful completion and graduation from a police academy as a function of recruits' baseline fitness levels at the time of academy entry. Methods: Retrospective st...

Context The degree to which changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) relate to corresponding changes in plasma sex steroids is not known. Objective We examined whether changes in VAT and SAT areas assessed by computed tomography were associated with changes in sex hormones (dehydroepiandrosterone [DHEAS], test...

Objective: We examined the association of the Diabetes Prevention Program (DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the DPP Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. Research design and methods: The DPP lasted 2.8 years, followed b...

LVH has been widely recognized as an independent and significant predictor of CVD and SCD risk, with an increasing prognostic value on the accurate assessment of LVM. However, LVH definition along with LVM reference values, demonstrate wide variability among imaging modalities, technicians, indexing methods, institutions. In addition, currently aut...

Left ventricular (LV) mass is a strong predictor of cardiovascular disease (CVD) events; increased LV mass is common among US firefighters; and plays a major role in firefighter sudden cardiac death (SCD). We aim to identify significant predictors of LV mass among firefighters. Cross-sectional study of 400 career male firefighters selected by an en...

Abstract Background: Cardiovascular Disease (CVD) accounts for 45% of on-duty deaths in US fire service; cardiac enlargement is common among US firefighters; and plays a major role in firefighter sudden Cardiac Death (SCD). Objective: To estimate the prevalence of cardiac enlargement in US Firefighters by autopsies, echocardiography (ECHO) and Card...

Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disorder in the Western world, commonly diagnosed in the majority of obese patients with type 2 diabetes mellitus (T2DM). Metabolic disrupting chemicals with short half-lives, such as those of halogenated structure (trihalomethanes, THM) have been linked with hepatic insu...

We examined associations between intensive lifestyle intervention (ILS) and changes in testosterone and associations with mood among middle-aged men. Secondary analysis of men (n = 886) participating in the Diabetes Prevention Program which randomized glucose-intolerant, overweight men to ILS, metformin, or placebo between 1996-1999. Changes in t...

Purpose: The purpose of this study is to assess tobacco dependence among Cypriot adolescents and examine its association to cigarette consumption and attitudes towards smoking. Methods: The current study used cross-sectional data from the 2011 Cyprus Global Youth Tobacco Survey which adopted multistage cluster sampling methods to select adolesce...

Genome-wide association studies of glycemic traits have identified genetics variants that are associated with insulin resistance (IR) in the general population. It is unknown if people with genetic enrichment for these IR-variants respond differently to interventions that aim to improve insulin sensitivity. We built a genetic risk score based on 17...