Cretan Children Research Articles

Prevalence of dysphagia symptoms in Cretan children and adolescents with neurological disorders

ObjectivesDysphagia is defined as any feeding or swallowing dysfunction at one or more stages of digestion. This study aims to investigate the prevalence of dysphagia symptoms in children and adolescents with neurological disorders and its relationship with the specific characteristics of the subjects. MethodsUsing data from general hospital/paediatric department visits in Heraklion, Crete, Greece, a cross-sectional study design was implemented over a seven-month period (2017–18), and a total of 268 children and adolescents were recruited. Demographic data and medical profiles were recorded, focusing on the most obvious and frequent clinical features of feeding and swallowing disorders per stage (oral-OS, pharyngeal-PS, and oesophageal-ES). ResultsIn the sample, 54.9% were boys and the mean age was 5.9 years; the most prevalent International Statistical Classification of Diseases and Related Health Problems (ICD-10) disorder was mental and behavioural disorders (37.3%). The prevalence of dysphagia symptoms was 24.3% during the OS (95% CI: 19.0–29.9), 18.3% in the PS (95% CI: 14.0–23.2), and 20.1% in the ES (95% CI: 15.7–25.4). At least one symptom of dysphagia was observed during the OS, PS, and ES in 42.5% (95% CI: 36.7–48.5) of the sample. The presence of dysphagia seems to be related to lower age (Odds Ratio [OR] = 0.45, p < 0.001), higher ICD-10 comorbidity (OR = 1.89, p < 0.05), or medication use (OR = 2.31, p < 0.05). ConclusionsA high prevalence of dysphagia was found in children and adolescents with neurological disorders, while lower age, comorbidity, and medication use emerged as factors that required better management.

The metabolic syndrome among preschool and school age children and adolescents in Crete in the first decade of the 21st century.

In Greece as well as worldwide, studies on the prevalence of metabolic syndrome (MetS) in children/ adolescents began to take place in the second half of the 20 century. It was indicated that the prevalence of MetS is mostly predicted by the presence of obesity and particularly abdominal obesity. A previous Greek study showed that the prevalence of MetS was higher in overweight/obese children compared to normal weight controls. Recently, a Greek National Epidemiological Survey found a prevalence of high abdominal obesity among children 6-12 years old, higher than that recently reported from other European countries. Crete, a Greek island known for its favorable health status in the 1960s, experienced a rise in the prevalence of childhood obesity between 1982 and 2002, assumed to also be accompanied by increases in MetS prevalence. To our knowledge, only one previous study has examined the prevalence of MetS among Cretan children, this carried out during the period 2001-2003. Such studies are important from a public health perspective, since identification of MetS factors that predispose to morbidity could help public health professionals to develop more effective preventive measures. Therefore, this study aims to determine the prevalence of MetS in a school-based sample of school children and adolescents in Crete extending the above period to 2011.

Secular changes in anthropometric measurements and blood pressure in children of Crete, Greece, during 1992/93 and 2006/07

Objectives To examine secular changes in anthropometric measurements and blood pressure (BP) in 1st-grade children in Crete, Greece, during 1992/93 and 2006/07. Methods Children (aged 5.7–7.8 years) from two representative cross-sectional cohorts participated during 1992/93 ( n = 606) and 2006/07 ( n = 361). Body weight, body-mass-index (BMI), waist circumference (WC), waist-to-hip (WHpR) and waist-to-height (WHtR) ratios, BP, 20 m-shuttle-run test (20mSRT), and moderate-to-vigorous-physical-activity (MVPA) were assessed. Results There was a significant increase ( P < 0.01) in body weight (+ 10.2% and + 6.7%), BMI (+ 6.9% and + 4.0%), WC (+ 5.6% and + 5.1%), WHpR (+ 3.0% and + 3.4%), and WHtR (+ 4.2% and + 3.8%), for boys and girls, respectively, and in the proportion of overweight/obese boys (19.4% vs. 33.7%; P < 0.001) between 1992/93 and 2006/07. Both genders had decreased BP measurements in 2006/07 compared to 1992/93 ( P < 0.001). In both periods, BP was higher in obese compared to overweight and normal children ( P < 0.001), but there was no relationship between BP and physical activity (PA). Conclusions A substantial decrease in BP was observed in Cretan children over a 15-year period, despite a concurrent increase in obesity and anthropometric indices. This may be attributed to lifestyle and dietary changes and does not support the hypothesis that the obesity epidemic in children has resulted in proportionate increases in BP levels.

The Role of the Methylenetetrahydrofolate Reductase 677 and 1298 Polymorphisms in Cretan Children with Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL) is the most common form of malignancy in children. Recently, many studies have examined factors influencing both the susceptibility to ALL and the metabolism of widely used chemotherapeutic agents. These factors include, among others, single-nucleotide polymorphisms in various genes, such as the gene encoding for methylenetetrahydrofolate reductase (MTHFR), which has been proven polymorphic at the nucleotide positions 677 and 1298. Thirty-five children with ALL and 48 healthy adults of Cretan origin were genotyped for the presence of the MTHFR 677 and 1298 single-nucleotide polymorphisms. The possible correlation of the polymorphisms with the risk for ALL and the presence of methotrexate-induced toxicities were examined. No significant association between the MTHFR genotypes and the susceptibility to ALL was observed. A borderline statistically significant relationship was detected after methotrexate administration, between the C677T genotype (polymorphisms) and leukopenia (p = 0.050) and between the A1298C polymorphism and normal aspartate transaminase and alanine transaminase values (p = 0.065 and p = 0.053, respectively), which was strengthened for aspartate transaminase, after grouping the A1298A and A1298C genotypes together (p = 0.039). In our population the MTHFR C677T and A1298C polymorphisms are related with hematologic toxicity and hepatotoxicity, respectively, and could be suggested as prognostic factors for these adverse events.

Are children from Crete abandoning a Mediterranean diet?&#x0D;

Mediterranean countries such as Greece have experienced rapid social change in the last decade. These community changes affect nutritional habits and there is a tendency for the traditional healthy Mediterranean diet to be abandoned. The parents of children from one rural Greek village on Crete (Neapolis), and one rural village in Sweden (Kisa) were invited to their primary health care centers for an interview and to fill in a validated nutrition questionnaire, KidMed. There were no differences (p = 0.48) in total KidMed score between the Cretan and Swedish children, adjusted for gender and age. However, there were some significant differences in scores on certain KidMed questions. Parents of the Cretan children reported significantly higher daily use of olive oil at home and more regular nut consumption, but also more commercially baked goods or pastries for breakfast. The parents of Swedish children reported significantly higher use of cereals, grains or bread for breakfast. The mean BMIs were similar for the Cretan (Neapolis mean 16.8, 95% CI 13.5-23.0) and for the Swedish children (Kisa mean 17.4, 95% CI 13.7-25.5) The results suggest the possibility of changing nutritional habits, measurable among young children in rural areas. The study raises the question of whether Cretan children may have abandoned some aspects of the traditional Mediterranean diet. It may also be that Swedish children have changed their diet in favor of a more Mediterranean food choice. The major limitation of the study is the small sample size, and further, larger studies are warranted.

Twenty‐year dynamics in adiposity and blood lipids of Greek children: Regional differences in Crete persist

To examine whether secular trends in adiposity and blood lipid profile of Greek children manifested equally among individuals from urban and rural provinces. Cretan boys (aged 12.1+/-2.3 y) from urban and rural areas of Crete were recruited in 1982 (n=277 and 251, respectively) and 2002 (n=440 and 180, respectively). Height, weight, and body mass index (BMI), as well as plasma lipid concentrations were measured and compared across cohorts (1982 vs 2002) and regions (urban vs rural) by two-way analysis of covariance (adjusted for age) with interaction. Temporal changes in height (positive), weight (positive), and BMI (positive) manifested equally in children from urban and rural provinces, as no interaction was detected. Similar results were obtained for triacylglycerol (positive), low-density lipoprotein cholesterol (LDL-C, positive) and high-density lipoprotein cholesterol (negative) concentrations. A significant interaction was observed only for total cholesterol (TC), which increased from 1982 among rural (by 6.2%, p < 0.05) but not among urban boys. In all other instances, regional differences in 1982 persisted in 2002. More specifically, children from urban provinces were taller, heavier, and had higher BMI values than those from rural areas, while they also had higher LDL-C concentrations, whether nowadays or 20 y ago. Regional differences in TC in 1982 were not apparent in 2002. These findings suggest that changes in anthropometric characteristics and plasma lipids during the past 20 y have occurred largely in parallel among urban and rural Cretan children, and they emphasize the importance of developing a common national strategy for the prevention and treatment of childhood obesity in Greece.

Prevalence of Factor V Leiden and other thrombophilic traits among Cretan children with malignancy

The prevalence of thrombophilic traits, which might further enhance the risk of thrombotic complications in children treated for cancer, varies significantly among different populations. To evaluate the prevalence of common thrombophilic traits of the East Mediterranean Region, among native Cretan children treated for malignancy. Blood samples were consecutively collected from 31 native Cretan children treated for acute lymphoblastic leukaemia (n = 19) or other malignancies (n = 12) over 3 years. A molecular diagnosis based on the presence of Factor V Leiden (FVL), as well as on PT G20210A and MTHFR C677T mutation (in 14 patients) using PCR was applied. Patients who had central venous catheters (n = 29) were treated with an intensified thromboprophylaxis protocol that had been previously established in our institution. The prevalence of the FVL mutation was 19.4% (95% CI = 5-32). The allele frequency is estimated at 11.3% (95% CI: 3.5-19.1) which is higher than that reported for the population of the mainland of Greece. The prevalence of the PT G20210A and MTHFR C677T mutation was 14.3 and 71.4%, respectively (corresponding allele frequencies 7.1 and 50%, respectively). Only one patient developed thrombosis, having although no thrombophilic trait. Thrombophilic traits were relatively common in this group of native Cretan children treated for malignancy. Thromboprophylaxis should be considered in Cretan children in the presence of known acquired risk factors for thrombosis, but a larger prospective to study is first needed.

Secular trends in cardiovascular risk factors among school-aged boys from Crete, Greece, 1982-2002.

The aim of the present study was to examine secular trends in major cardiovascular disease (CVD) risk factors, that is, obesity and dyslipidaemia, among Cretan children during 1982-2002. Epidemiological survey. A total of 528 boys in 1982 and 620 boys in 2002, aged 12.1+/-0.1 y, were randomly selected from urban and rural regions throughout the county of Iraklio, Crete, Greece. Care was taken so that all procedures in 2002 closely matched those in 1982. Mean height, weight, and body mass index (BMI) were 1.1, 9.6, and 8.4% higher, respectively, in 2002 vs 1982 (P<0.001). The prevalence of overweight and obesity has risen by 63 and 202%, respectively (P<0.001). Contemporary children were found to have 3.6% higher total cholesterol (TC), 24.9% lower high-density lipoprotein-cholesterol (HDL-C), 25.3% higher low-density lipoprotein-cholesterol (LDL-C), 19.4% higher triacylglycerol, 36.6% higher TC/HDL-C ratio, and 60.3% higher LDL-C/HDL-C ratio compared with their peers in 1982 (P<0.003). These differences persisted even when adjusting for BMI (P<0.02). The proportion of children having abnormal lipid values was much greater nowadays than in the 1980s, yielding odds ratios of 1.4-8.8 (P<0.005). Results are indicative of a largely deteriorated CVD risk profile in Cretan children since 1982, and predict an unfavourable CVD morbidity and mortality for this population in the foreseeable future.

Association of adipose tissue arachidonic acid content with BMI and overweight status in children from Cyprus and Crete.

The relationships between n-3 and n-6 fatty acids in subcutaneous fat, BMI and overweight status were investigated in eighty-eight children from Crete and Cyprus. Overweight status, BMI and serum lipid levels were similar in children at both locations, but Cretan children had higher levels of total MUFA than Cypriot children (62.2 (sd 2.8) v. 52.2 (sd 2.8) % area, respectively, P<0.001) and consequently Cypriot children had higher levels of total saturated, polyunsaturated, trans, n-3 and n-6 fatty acids. Cypriot children had also higher levels of individual n-3 and n-6 fatty acids, specifically linoleic, alpha-linolenic and dihomo-gamma-linolenic acids. The variance of BMI was better explained (38.2 %) by adipose tissue arachidonic acid content than any other n-3 and n-6 fatty acids. Mean levels of arachidonic acid, dihomo-gamma-linolenic acid and docosahexaenoic acid were higher in overweight and obese subjects. All obese subjects fell in the 4th quartile of arachidonic acid levels, whereas 88.9 % of overweight subjects fell in the 3rd and 4th quartile of arachidonic acid. These results indicate positive associations between adipose tissue arachidonic acid and BMI and overweight status. Further research could clarify whether this association is causal.

Obesity indices in a cohort of primary school children in Crete: a six year prospective study.

To report on the body mass index (BMI), waist-to-hip ratio (WHR) and sum of skinfolds in a cohort of Cretan children and identify the factors associated with these indices. The present study was a follow-up study. Children were measured prospectively at ages 6, 9 and 12. Pupils came from 40 schools randomly selected from the 541 primary schools in three different provinces of Crete. 1046 pupils were examined at age 6. At age 9, a representative sample from the original cohort (n=579) was randomly selected for re-evaluation. At the age of 12, a sample of 831 pupils was re-examined, following similar procedures. Both during baseline and each subsequent follow-up, data were obtained on pupils' anthropometry, serum lipids, dietary intake, physical fitness and physical activity as well as their dietary and their health knowledge. Data on parents' anthropometry, age, occupation, educational level, and issues relating to health habits, attitudes and knowledge were also collected. Half of the obese children at age 6 were also obese at age 12. Cretan children had higher mean BMI than similar American cohorts. Compared to their American counterparts, Cretans had higher proportions of overweight in both genders across all ages tested. The endurance run test (ERT), an index of physical fitness, was positively associated with obesity indices. Sum of skinfolds related positively to serum LDL-C. Children from urban areas had higher skinfold sums than children from rural areas. Parental health-related hedonism related positively to children's BMI. It appears that these findings offer some support to the reported increasing prevalence of obesity among Greek children. Higher ERT, presumably reflecting higher physical activity, is associated with lower obesity. The relationship between degree of fatness and LDL-C appears to be evidenced at an early age in life. This relationship may relate to the reported VLDL and cholesteryl ester transfer protein elevations in obesity. The parental attitude of health-related hedonism appears to be linked with children's adiposity.