ATTICA Epidemiological Study Research Articles

The impact of socioeconomic and environmental determinants on Mediterranean diet adherence: a municipal-level spatial analysis in Athens metropolitan area, Greece

The aim of this study was to identify the geographical variability, the socio-economic and the environmental determinants of adherence to the Mediterranean diet in a general population sample. Level of adherence to the Mediterranean diet was estimated by the ATTICA epidemiological study for 2,749 participants, while socio-economic, demographic, and environmental characteristics were provided by official national and international databases. Higher adherence to the Mediterranean diet was detected in areas with a greater proportion of females and older people, with lower unemployment rate and immigrant population, as well as, in areas covered at a greater extent by green and with higher frequency of supermarkets and street markets. The present findings provide evidence for policy makers to better understand how layers of influence intersect to shape individuals’ eating habits, while they may also contribute in identifying areas of emerging interventions needed.

Missing-data analysis: socio- demographic, clinical and lifestyle determinants of low response rate on self- reported psychological and nutrition related multi- item instruments in the context of the ATTICA epidemiological study

BackgroundMissing data is a common problem in epidemiological studies, while it becomes more critical, when the missing data concern a multi-item instrument, since lack of information in even one of its items, leads to the inability to calculate the total score of the instrument. The aim was to investigate the socio-demographic, lifestyle and clinical determinants of low response rate in two self- rating multi item scales, estimating the individuals’ nutritional habits and psychological disorders, as well as, to compare different missing data handling techniques regarding the imputation of missing values in this context.MethodsThe sample from ATTICA epidemiological study was used, with complete baseline information (2001–2002) regarding their demographic characteristics [n = 2194 subjects (1364 men: 64 years old (SD = 12 years) and 830 women: 66 years old (SD = 12 years))]. Adherence to the Mediterranean diet and depressive symptomatology were assessed at baseline, with the MedDietScore scale and the Zung’s Self- rating Depression Scale (SDS), respectively. Logistic and Poisson regression analysis were used, in order to explore the low response’s determinants in each scale. Seven missing data handling techniques were compared in terms of the estimated regression coefficients and their standard errors, under different scenarios of missingness, in the context of a multivariable logistic regression model examining the association of each scale with the participants’ likelihood of being hypertensive.ResultsOlder age, lower educational level, poorer health status and unhealthy lifestyle habits, were found to be significant determinants of high nonresponse rates, both in the MedDietScore scale and the Zung’s SDS. Female participants were more likely to have missing data in the items of the MedDietScore scale, while a significantly higher number of missing items in the depression scale was found for male participants. Concerning the analysis of such data, multiple imputation was found to be the most effective technique, even when the number of missing items was large.ConclusionsThe present work augments prior evidence that higher non-response to health surveys is significantly affected by responders’ background characteristics, while it gives rise to research towards unrevealed paths behind this claim, especially in the era of nutritional epidemiology.

The association of animal and plant protein with successful ageing: a combined analysis of MEDIS and ATTICA epidemiological studies.

The aim of the present study was to investigate the differences between the consumption of plant-based v. animal-based protein-rich diets on successful ageing, as well as to identify the optimal combination of dietary protein intake for facilitating successful ageing in people aged >50 years. A combined analysis was conducted in older adults of the ATTICA and MEDIS population-based cross-sectional studies. Anthropometrical, clinical and sociodemographic characteristics, lifestyle parameters, dietary habits and level of protein intake were derived through standard procedures. Successful ageing was evaluated using the validated Successful Aging Index (SAI) composed of ten health-related social, lifestyle and clinical characteristics. Athens area and twenty Greek islands. A total of 3349 Greek women and men over 50 years old. Participants with high consumption of plant proteins were more likely to be male, physically active, with higher daily energy intake, higher adherence to the Mediterranean diet and higher level of SAI (P < 0·001). Participants with 'Low animal & High plant' and 'High animal & High plant' protein consumption had a 6 and 7 % higher SAI score, respectively, compared with the other participants (P < 0·001). In contrast, 'Low animal & Low plant' and 'High animal & Low plant' protein intake was negatively associated with SAI as compared to the combination of all other consumption categories (P < 0·02). The consumption of a plant-based protein-rich diet seems to be a beneficial nutritional choice that should be promoted and encouraged to older people since it may benefit both individual's health and prolong successful ageing.

Adherence to a DASH-style diet and cardiovascular disease risk: The 10-year follow-up of the ATTICA study.

Recent findings suggest a protective role of the DASH dietary pattern on cardiovascular disease (CVD) incidence and mortality. In this direction, we aimed at investigating the relationship between adherence to a DASH-style diet and CVD risk in a Greek cohort. This sub-sample from the ATTICA epidemiological study consisted of 669 adults with a complete dietary profile at baseline, adequate to calculate DASH-diet score, and complete 10-year follow-up (2002-2012). Demographic, clinical and lifestyle parameters were thoroughly assessed at baseline and CVD incidence was recorded upon medical records at follow-up. Adherence to the DASH-style diet was assessed by a DASH-style diet score developed for the study (range 9-45). Mean value (SD) of the DASH-diet score was 27.1 (5.1) (range 13-41). Adherence to a DASH-style diet was associated neither with the 10-year CVD risk nor with baseline clinical parameters. Multiple regression analysis revealed that, after appropriate adjustments, only age (46% increase per 5-life-years) and BMI (9.7% increase per unit of BMI) were associated with 10-year CVD events. In this small cohort of a Mediterranean population, a cardioprotective effect of a DASH-style diet was not detected.

The Association between Whole Grain Products Consumption and Successful Aging: A Combined Analysis of MEDIS and ATTICA Epidemiological Studies.

The quality of carbohydrates in the diet, including whole grains, matters greatly to health. There is emerging evidence supporting various protective effects from whole grain consumption against certain chronic diseases. However, being free of disease is not a requirement for healthy ageing, as many older adults have one or more health conditions but, when well controlled, have little influence on their wellbeing. The present study aimed to evaluate the association between whole grain consumption on successful aging, through an analysis of a sample of n = 3349, over-50-years-old men and women participating in the ATTICA and MEDIS population-based cross-sectional studies. Successful aging was evaluated using the validated successful aging index (SAI, range 0–10) comprising of health-related social, lifestyle and clinical components. High whole grain intake was positively associated with SAI as compared with low (b ± SE: 0.278 ± 0.091, p = 0.002), whereas no significant associations were observed between moderate whole grain consumption and SAI (p > 0.05). Increased whole grain intake has been associated with several health benefits, and, as is shown here, with higher successful aging levels. Therefore, consumption of whole grains should be encouraged, especially by replacing refined grains, without increasing total energy intake.

Diet, Exercise, and C-Reactive Protein Levels in People With Abdominal Obesity: The ATTICA Epidemiological Study

We evaluated the association of physical activity and diet with C-reactive protein (CRP) levels among subjects with abdominal obesity. During 2001-2002, we enrolled 625 men (18 to 87 years old) and 712 women (18 to 89 years old) with abdominal obesity (waist-to-hip ratio > or =0.95 in men and > or =0.8 in women) from the Attica area, Greece. The sampling was stratified by the age-gender distribution of the region (census 2001). Among several variables, we also measured plasma high-sensitivity CRP, physical activity status, dietary habits, blood lipids, and blood pressure levels. Adherence to the Mediterranean diet was evaluated through a diet score (0 to 55) that assessed the inherent characteristics of the diet. Compared with those with low CRP levels, subjects with high CRP levels (ie, >3.0 mg/L) were physically inactive (P = .01), were less likely to adopt the Mediterranean diet (P = .008), had higher glucose levels, had a higher prevalence of hypertension, had a lower high-density lipoprotein cholesterol, and had increased smoking habits and higher anthropometric indices (all P < .05). Moreover, adoption of the Mediterranean diet in combination with medium physical activity seems to reduce the likelihood of having high CRP levels by 72% (P = .018), irrespective of smoking and various clinical and biological characteristics. Among subjects with abdominal obesity, low-grade systemic inflammation appears to be associated with the adoption of an unfavorable lifestyle, including physical inactivity and unhealthy dietary habits, as well as increased blood pressure levels and low high-density lipoprotein cholesterol.

Association between plasma inflammatory markers and irrational beliefs; the ATTICA epidemiological study

Objective Recent research data suggest that inflammation and/or depression are associated with the development and progression of cardiovascular disease (CVD). Considering that depression may arise as a response to irrational beliefs according to the Ellis model of psychological disturbances and therapy, we sought to evaluate whether irrational beliefs are associated with plasma inflammatory factors in cardiovascular disease-free people. Method From May 2001 to December 2002 we randomly enrolled 453 men (23–69 years old) and 400 women (24–71 years old) stratified by age and gender. C-reactive protein, interleukin-6, serum amyloid-A, tumor necrosis factor-α and white blood cells were measured in all participants. Detailed dietary characteristics of these people were assessed through a validated food frequency questionnaire. Subjects completed also the irrational beliefs inventory (IBI), which is a brief self-report measure consistent with the Ellis model of psychological disturbance and therapy and the Zung's Depression questionnaire. Results The IBI scores were similar in men and women (53 ± 11 vs. 53 ± 10, p = 0.83). IBI score was positively correlated with C-reactive protein (rho = 0.14, p = 0. 02), interleukin-6 (rho = 0.11, p = 0.02), tumor necrosis factor-α (rho = 0.21, p = 0.014) and white blood cell counts (rho = 0.14, p = 0.02). These associations were confirmed even after adjusting for age, sex, years of school, body mass index, physical activity status, depression level and food items consumed by the participants. Conclusion These findings indicate that irrational beliefs are associated with increased inflammation process, among apparently healthy individuals.

Lack of association between the C825T polymorphism in G-protein beta-3 subunit and arterial blood pressure levels in cardiovascular disease free individuals: the ATTICA epidemiological study

Lack of association between the C825T polymorphism in G-protein beta-3 subunit and arterial blood pressure levels in cardiovascular disease free individuals: the ATTICA epidemiological study

The effect of physical activity on lipoprotein levels: The attica epidemiological study

The effect of physical activity on lipoprotein levels: The attica epidemiological study