Hellenic National Nutrition Research Articles

Association of fructose consumption with prevalence of functional gastrointestinal disorders manifestations: results from Hellenic National Nutrition and Health Survey (HNNHS).

The study aimed to assess the total prevalence of functional gastrointestinal disorders (FGID), and separately, irritable bowel syndrome (IBS) among adults and to determine their potential association with fructose consumption. Data from the Hellenic National Nutrition and Health Survey were included (3798 adults; 58·9 % females). Information regarding FGID symptomatology was assessed using self-reported physician diagnosis questionnaires the reliability of which were screened using the ROME III, in a sample of the population. Fructose intake was estimated from 24 h recalls, and the MedDiet score was used to assess adherence to the Mediterranean diet. The prevalence of FGID symptomatology was 20·2 %, while 8·2 % had IBS (representing 40·2 % of total FGID). The likelihood of FGID was 28 % higher (95 %CI: 1·03-1·6) and of IBS 49 % (95 %CI: 1·08-2·05) in individuals with higher fructose intake than with lower intake (3rd tertile compared with 1st). When area of residence was accounted for, individuals residing in the Greek islands had a significantly lower probability of FGID and IBS compared with those residing in Mainland and the main Metropolitan areas, with Islanders also achieving a higher MedDiet score and lower added sugar intake, comparatively to inhabitants of the main metropolitan areas. FGID and IBS symptomatology was most prominent among individuals with higher fructose consumption, and this was most conspicuous in areas with a lower Mediterranean diet adherence, suggesting that the dietary source of fructose rather than total fructose should be examined in relation to FGID.

Nitrite and nitrate intake from processed meat is associated with elevated diastolic blood pressure (DBP)

Processed meat consumption has been linked to high blood pressure (BP), a key risk factor for cardiovascular disease (CVD), but gaps remain with regards to the ingredients which contribute to this association. This study, therefore, aimed to examine the association between nitrite and nitrate intake from processed meat with diastolic (DBP) and systolic (SBP) blood pressure, while accounting for sodium intake. Dietary nitrite and nitrate intake from processed meat, assessed as total nitrite equivalent, was estimated for 1774 adult, processed meat consumers (≥18 years, 55.1% females) who had enrolled in the Hellenic National Nutrition and Health Survey (HNNHS). To avoid selection and reverse causality bias, associations with measured DBP and SBP were considered instead of self-reported data of hypertension presence. Participants were divided by tertile of dietary nitrite intake and by level of dietary guideline adherence for sodium (<1500; 1500-2300; ≥2300). Multiple regression models were used to examine associations with SBP and DBP, including an interaction term of nitrite with dietary sodium intake, for potential synergy. Overall, DBP increased by 3.05mmHg (95% CI: 0, 6.06), per tertile increase in nitrite intake and 4.41mmHg (95% CI: 0.17, 8.64) per level increase in sodium intake, when the interaction effect between nitrite and total sodium intakes was accounted for. By considering the significant synergistic effect of the two factors, DBP finally increased by 0.94 mgHg overall and 2.24 mgHg for subjects in the third tertile compared to those in the first. Also, a rise in total sodium intake of approximately 800mg, above 1500mg, caused a 2.30 mgHg increase in DBP. No significant correlations were found with SBP. Higher nitrite and nitrate intake from processed meats contributed to the increase of DBP, but the interaction effect with total sodium intake levels should be accounted for to properly interpret the findings.

Factors Associated with Breastfeeding Initiation and Duration in Greece: Data from the Hellenic National Nutrition and Health Survey.

Despite its well-documented benefits, breastfeeding rates and duration worldwide do not meet the recommended goals set by the World Health Organization. Data on infant feeding, socio-demographic, lifestyle and perinatal factors were used from 490 mothers (and 958 children), participants at the Hellenic National Nutrition and Health Survey between 2013-2015. Clustered multiple logistic regression and multilevel mixed-model regression analyses were performed to identify factors associated with breastfeeding initiation and duration, respectively. Maternal lower education [Odds Ratio (OR): 2.29, 95% Confidence intervals (95% CI): 1.30-4.04; p = 0.004], smoking during pregnancy (OR: 3.08, 95% CI: 1.64-5.77; p &lt; 0.001), caesarean section (OR = 3.26, 95% CI: 1.83-5.83; p &lt; 0.001), prematurity (OR = 2.74, 95% CI: 1.40-5.37; p = 0.003) and higher birth order (OR = 1.30, 95% CI: 1.04-1.62; p = 0.020) were associated with increased odds of not initiating breastfeeding. Living in rural areas [beta coefficient b = -27.93, p = 0.043], smoking during pregnancy (b = -64.47, p &lt; 0.001), caesarean section (b = -28.76, p = 0.046) and prematurity (b = -46.67, p = 0.048) were significantly associated with shorter breastfeeding duration. Children born chronologically closer to the survey were more likely to breastfeed and for longer periods. Educational promotion and enhancement of breastfeeding awareness that account for maternal exposures are required. Prevention of prematurity and avoidance of unnecessary caesarean section is crucial, while additional breastfeeding support is needed when preterm birth occurs, or caesarean section cannot be avoided.

Risk Assessment of Nitrite and Nitrate Intake from Processed Meat Products: Results from the Hellenic National Nutrition and Health Survey (HNNHS).

Long-term exposure to a high nitrite and nitrate intake through processed meat is of concern, as it has been related to adverse health effects. Individual consumption data from 2152 participants (46.7% males) in the Hellenic National Nutrition and Health Survey (HNNHS) were linked with current Maximum Permitted Levels (MPLs) to calculate exposure to nitrite and nitrate from processed meat products (assessed as nitrite equivalent), evaluate potential risk and identify the major contributors. Processed meat intakes were determined by combining data from 24 h recalls and frequency of consumption reported in Food Propensity Questionnaires (FPQs). Median exposure was estimated to be within safe levels for all population groups. However, 6.6% (n = 143) of the consumers exceeded the Acceptable Daily Intake (ADI) of nitrite (0.07 mg/kg bw/day), of which 20.3% were children aged 0–9 years (N = 29) (15.3% of all children participants in the study, N = 190). In total, pork meat was the major contributor (41.5%), followed by turkey meat (32.7%) and sausages (23.8%), although contribution variations were found among age groups. The outcomes are of public health concern, especially exposure among children, and future research is warranted to evaluate possible associations with health effects, by using more refined occurrence data if available.

Prevalence and factors associated with smoking in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

BackgroundThe aim of this study was to assess smoking prevalence among Greek adults and in sub-populations with specific sociodemographic and lifestyle determinants. Moreover, to explore the association between smoking and weight status and specific stress-related states. MethodsData from 3,820 adults (47.5% males), included in the Hellenic National Nutrition and Health Survey, were used. Information was obtained on sociodemographic, lifestyle, anthropometric factors, and stress-related states. Results were obtained using survey-specific analysis. ResultsSmoking prevalence was 33.5% in total and was significantly higher in males 39.1% (95%CI: 36.3%–41.8%) compared to females 29.4% (95%CI: 27.4%–31.6%; p < 0.001). Smoking prevalence was higher among those that slept <6 h, consumed daily coffee and alcohol, as well as chronic stress and depressive symptomatology. Moreover, 72.9% of Greek adults were exposed to passive smoke. The odds of having chronic stress, depressive symptomatology, sleep problems, and financial difficulties were higher for current smokers, whereas the odds for overweight/obesity increased only among ex-smokers. Chronic pain was associated with both current and ex-smoking status. ConclusionsThis study highlights important sociodemographic and lifestyle factors associated with smoking and underlines associations of ever-smoking with weight status and stress-related states, providing health policymakers valuable information for more effective results.

Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents.

Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.

Micronutrient dietary intakes and their food sources in adults: the Hellenic National Nutrition and Health Survey (HNNHS)

AbstractBackgroundThe present study aimed to assess micronutrient intake among Greek adults and to identify the main food sources that contribute to it.MethodsFood consumption data from 2389 participants in the Hellenic National Nutrition and Health Survey (HNNHS), collected with 24‐h recalls, was used to calculate micronutrient intakes. Usual nutrient intake was estimated according to the National Cancer Institute method. Nutrient adequacy was estimated using the estimated average requirement (EAR) cut‐point method, when available, or adequate intake otherwise. The probability approach was used to determine iron intake adequacy in females of reproductive age. Food group contribution for each nutrient assessed was derived to identify their main food sources.ResultsAlmost all individuals had vitamin D intake below EAR, whereas vitamins A, E, K and C, as well as potassium intake, were also insufficient in a considerable percentage of the population (&gt;70% in most age groups). Calcium intake was substantially below the EAR for females aged &gt;50 years and males &gt;70 years; the same for magnesium in males &gt;70 years. Furthermore, 50% of females, including those of reproductive age, had intake of folate below EAR. More than 50% of the population (to 79%) exceeded the upper tolerable limit for sodium (2300 mg day−1). Food contribution analysis revealed that most vitamins were derived from low‐quality foods (i.e. fast‐food).ConclusionsA significant proportion of adults residing in Greece have low nutrient intake and poor food selections. These results provide guidance to public health policy makers for developing strategies to improve the dietary quality in Greece.

Dietary Intake Assessment of Pre-Packed Graviera Cheese in Greece and Nutritional Characterization Using the Nutri-Score Front of Pack Label Scheme.

Gravieras are ‘gruyere’ type hard cheeses with a variety of different products and the second highest consumption in Greece. In this study, we present a dietary intake assessment and a nutritional characterization of pre-packed graviera products sold in the Greek market using Nutri-Score Front of Pack Label (FoPL). The nutrient contents of 92 pre-packed graviera products were combined with daily individual consumption data extracted from the Hellenic National Nutrition Health Survey (n = 93), attempting to evaluate the contribution of graviera’s consumption to the Greek diet. The analysis of nutrients’ intake as a Reference Intake (RI) percentage ranked saturated fat first on the nutrients’ intake list, with RI percentage ranging from 36.1 to 109.2% for the 95th percentile of consumption. The respective % RI for energy, total fat, carbohydrates, sugars, proteins and salt ranged from 12.7–20.7%, 21.6–50.4%, 0–3.1%, 0–6.1%, 37–57.1% and 6.3–42%. Nutri-Score classified 1% of the products to C—light orange class, 62% to D—orange and 37% to E—dark orange, while no products were classified to A—dark green or B—green classes. The comparison between the Nutri-Score classification and the nutrients’ intake assessment, also separately conducted within the classes, showed a higher salt intake after the consumption of products classified as D—orange and E—dark orange.

Prevalence of type 2 diabetes mellitus in a representative sample of Greek adults and its association with modifiable risk factors: results from the Hellenic National Nutrition and Health Survey

ObjectiveDiabetes mellitus is a disease associated with many complications leading to premature death. The aim of this study was to estimate prevalence of type 2 diabetes (T2D), and the proportion of the population unaware of the condition, in association with modifiable risk factors. Study designData from the Hellenic National Nutrition and Health Survey were used (n = 3773 adults, 40.8% men) and were obtained by trained personnel. MethodsDiabetes mellitus disease status was categorized as per the International Classification of Diseases codes (10th version). A subsample from the two main metropolitan areas was used to assess T2D and impaired fasting glucose (IFG) (n = 990; 38.2% men) from plasma analysis. ResultsThe prevalence of T2D in the population was 5.2% in total, reaching 13.7% in adults aged >60 years (no sex differences). IFG was observed in 27.3% of adults in the two metropolitan areas, and 40% were unaware of having T2D in this subsample. The likelihood of having T2D significantly increased with age and body weight, whereas it decreased with higher educational level and physical activity (P for all <0.001). ConclusionThe high T2D prevalence in adults, especially among the older age-groups, suggests a major public health problem in Greece.

Sociodemographic and lifestyle determinants of depressive symptoms in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

BackgroundThe aim of this study was to assess depressive symptomatology prevalence among Greek adults amidst the financial crisis and to explore the association between depressive symptoms and sociodemographic and lifestyle factors. MethodsThe Hellenic National Nutrition and Health Survey including a nationally representative adult sample (3,675 adults; 48.7% males) was used. Trained personnel gathered information on sociodemographic and anthropometric characteristics and lifestyle status. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and clinically relevant depressive symptomatology was defined as PHQ-9 score≥10, or on anti-depressant medication. Associations between depressive symptoms and the assessed factors were estimated using stratified multivariable logistic regression. ResultsThe prevalence of clinically relevant depression was 9.4%. In the regression, female sex, marital status (widowed vs. married), financial difficulties (yes vs. no), professional status (employed vs. unemployed), body mass index status (overweight/obese vs. normal weight), and smoking status (current and ex-smokers vs. never smokers) were significant, with an increased likelihood for depressive symptomatology in all variables, other than employment. LimitationsThe cross-sectional nature of the study does not allow detection of changes over time. Furthermore, it does not allow determining the presence of a temporal relationship between depression and the sociodemographic and lifestyle variables that we tested. ConclusionThis study estimates a high prevalence of depressive symptoms among adults during the Greek financial crisis and points out important associations of depressive symptoms with different sociodemographic determinants and lifestyle factors, and provides policy health makers valuable information in their efforts to deal with this epidemic.

Validation of a Food Propensity Questionnaire for the Hellenic National Nutrition and Health Survey (HNNHS) and Results on This Population's Adherence to Key Food-Group Nutritional Guidelines.

Background: Food propensity questionnaires (FPQs) are means of dietary assessment in nutritional epidemiology, which provide valuable information for long term intakes and food group consumption. These tools, however, may be subjected to misreporting and need to be validated against standard quantitative methods. Aim: The aim of this study was to examine the validity of the qualitative FPQ developed to assess the dietary habits of the general population in Greece during the Hellenic National Nutrition and Health Survey (HNNHS) and to assess the population’s intake of specific food groups in relation to guidelines. Methods: Validation analysis was based on 3796 [1543 men (42.82%) and 2253 women (57.18%)] participants of the HNNHS in relation to two interviewer-administered 24 h recalls (24 hR). Participants were asked to report the frequency of their dietary intake, using the FPQ provided. Correlations and significance between methods were assessed via Spearman correlation and a Two-sample Wilcoxon rank-sum (Mann-Whitney) test, respectively. Agreement between the FPQ and the 24 hR was performed using the Bland–Altman test and differences between the FPQ’s shown intakes and the recommended intakes by the Dietary Guidelines for Greek Adults were calculated. Results: Medium to weak correlations, but statistically significant (p < 0.05), were observed for most food groups between 24 hR and the FPQ; medium for fruits, dairy products, drinks, and spirits (ranging from ρ = 0.371 to ρ = 0.461; highest for drinks and spirits) and weak for vegetables, meat, fish, eggs, starch foods, sweets, nuts, fats and oils, and fast food (ρ = 0.111 to ρ = 0.290; lowest for starch foods). A non-significant correlation was found for legumes (ρ = 0.070). The mean intake agreement (Bland–Altman analysis) between the FPQ and the 24 hR was 96.08% and ranged from 94.43 to 99.34% for the 14 food groups under examination. When food group intakes were compared to guidelines, results showed that the population’s dietary intake was below the guidelines for fruits, vegetables, whole grains, fish, and legumes. On the other hand, it was above the guidelines for most of the “unhealthy” food groups, in particular, fast food, sweets, drinks and spirits, red meat, and sweets. Conclusions: The specific FPQ provides valid information on major food groups and can be used to examine long term dietary patterns in nutritional studies. Ιn addition, dietary intakes of Greek adults are problematic and initiatives at the public health level are necessary.

The Implementation of Eating Healthy Program in Early Childhood

&#x0D; &#x0D; &#x0D; Eating habits develop during the first years of a child's life, children learn what, when, and how much to eat through direct experience with food and by observing the eating habits of others. The aim of this study is to get a clear picture of the Eating program Healthy, starting from the planning, implementation, supervision, and evaluation as a case study of nutrition education; to get information about the advantages, disadvantages and effects of implementing a healthy eating program for children. This research was conducted through a case study with qualitative data analysed using Miles and Huberman techniques. Sample of children in Ananda Islāmic School Kindergarten. The results showed the Healthy Eating program could be implemented well, the diet was quite varied and could be considered a healthy and nutritious food. The visible impact is the emotion of pleasure experienced by children, children become fond of eating vegetables, and make children disciplined and responsible. Inadequate results were found due to the limitations of an adequate kitchen for cooking healthy food, such as cooking activities still carried out by the cook himself at the Foundation's house which is located not far from the school place; use of melamine and plastic cutlery for food; the spoon and fork used already uses aluminium material but still does not match its size; does not involve nutritionists.&#x0D; Keywords: Early Childhood, Eating Healthy Program&#x0D;

Micronutrient intakes and their food sources among Greek children and adolescents.

To assess the usual dietary intake of twenty micronutrients and to identify their food sources in a representative sample of Greek children and adolescents. Cross-sectional data from the Hellenic National Nutrition and Health Survey (HNNHS). Vitamin and mineral intakes were estimated from two 24 h dietary recalls by sex and age groups. Estimates were calculated using the National Research Council method and the statistical software package Stata13 to account for within- and between-person variations. The prevalence of nutrients' inadequacy among sample was estimated using the estimated average requirement (EAR) cut-point method. The contribution of food groups to nutrient intake was estimated to identify micronutrients food sources. Greece. Children and adolescents aged 1-19 years (n 577) who provided sufficient and plausible 24-h recalls. A substantial percentage of children and adolescents had insufficient intakes of numerous micronutrients. Usual intake of vitamins D, K and potassium was inadequate in practically all individuals. Vitamin A, folate, Ca and Mg were also insufficient to a considerable percentage, especially in girls aged 14-18 years. Pantothenic acid was highlighted as nutrient of interest since only one out of ten boys 9-13 years and girls 14-19 years had intake above the EAR. Data demonstrated that food groups highly ranked in energy contribution were not necessarily important sources of micronutrients. Results suggest that micronutrient density of Greek children and adolescents' diet should be improved. These findings might be used by public health policy-makers to help young people optimise their food choices in Greece.

The recalibrated HellenicSCORE based on newly derived risk factors from the Hellenic National Nutrition and Health Survey (HNNHS); the HellenicSCORE II

BackgroundBecause of the increased burden of cardiovascular disease (CVD), country specific risk prediction models to forecast future CVD events and mortality are recommended, for primary prevention. The aim of this study was to recalibrate the HellenicSCORE, to accurately estimate the 10-year risk CVD mortality of Greek adults. MethodsData from the Hellenic National Nutrition and Health Survey (HNNHS) were used (N = 1012; 37.9% males). Information on age, smoking, systolic blood pressure (SBP), and total blood cholesterol from adults >40 years of age were derived following validated health survey protocols. Individual scores were calculated using these data and beta-coefficients derived from ESC SCORE. ResultsBoth updated HellenicSCORE II charts had lower risk estimates compared to the older version and were closer to the ESC SCORE charts, particularly at the extremes. No significant age difference by sex was observed (mean 59.5 (SD 13.1) years in total) in the population. Women had a significant higher mean total cholesterol compared to men [212.9 (39.5) vs 204.6 (41.2) mg/dl, respectively; p = 0.0343], but smoking prevalence and mean SBP was significantly higher in men [p for all, <0.001]. The mean population HellenicSCORE II score level was between 5.6% (0.2) and 7.9% (3.2) depending on the chart used, with no significant sex differences. ConclusionAlthough the HellenicSCORE II charts were lower, the mean population score was moderately high. This is of great importance because according to ESC guidelines, lifestyle intervention, and drug treatment should be based on an individuals’ total cardiovascular risk.

Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS).

Hypertension is a major risk of cardiovascular diseases. This study’s aim was to examine associations between hypertension and a priori known lifestyle risk factors, including weight status and Mediterranean diet adherence. The study included a representative sample of the adult population (N = 3775 (40.8% males)), from the Hellenic National Nutrition and Health Survey (HNNHS), which took place from September 2013 to May 2015. Demographic and anthropometric data were collected using validated questionnaires, and blood pressure (BP) measurements were performed for the two main metropolitan areas (N = 1040; 41.1%). Hypertension diagnosis was according to the International Classification of Diseases (ICD-10) guidelines. Weighted proportions, extended Mantel–Haenszel (M–H) analyses, and multiple logistic regressions (for the survey data) were performed. Mean systolic BP (SBP) and diastolic BP (DBP) were 118.6 mmHg and 72.2 mmHg respectively, with both values being higher in males compared to females in all age groups (p < 0.001). Study participants with hyperlipidemia or diabetes, and those overweight, were almost twice as likely to be hypertensives, with the odds increasing to 4 for those obese (p for all, < 0.05). Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% (OR: 0.64; 95% CI: 0.439, 0.943), and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension. The presence of hypertension is clustered with comorbidities, but is significantly associated with modifiable risk factors, including Mediterranean diet and weight status, underlining the need for personalized medical nutritional treatment.

Association of serum vitamin D status with dietary intake and sun exposure in adults

Serum 25(OH)D deficiency is becoming an epidemic. The aim was to assess vitamin D status of the adult Greek population in relation to intake, sun exposure and other factors, using data from the Hellenic National Nutrition and Health Survey (HNNHS). Data from 1084 adult participants (37.8% males) were analyzed. Vitamin D intake was assessed using 24-h recalls. Serum 25(OH)D concentration was evaluated and related to anthropometric measurements and other covariates including supplements used, by sex. Variables significantly associated with 25(OH)D<20ng/ml were assessed using simple and multiple logistic regression. Median vitamin D intake from food was 1.23 mcg/day (0.60, 2.44), with 9.1% consuming supplements. Median serum 25(OH)D was 16.72ng/ml, with no sex differences (P=0.923). The odds of having 25(OH)D<20ng/ml significantly decreased with being very active (OR 0.55, 95% CI 0.35, 0.98), increasing length of sun exposure [1-3h/day (OR 0.59, 95% CI 0.44, 0.80), >3h/day (OR 0.36, 95% CI 0.24, 0.55)], and skin colour [light to medium skin (OR 0.47, 95% CI 0.24, 0.91), fairly dark skin colour (OR 0.34, 95% CI 0.17, 0.67) and dark or very dark skin colour (OR 0.34, 95% CI 0.15, 0.75)], compared to respective baseline levels. The odds significantly increased with obesity (OR 1.95, 95% CI 1.24, 3.08), and spring season of blood sample collection (OR 1.75, 95% CI 1.22, 2.50). Vitamin D deficiency is highly prevalent in Greek adults. Relevant public health policies are highly recommended, which could include vitamin D fortification. and suggestion for increased but safe sun exposure.

Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

Background and aimsEmpirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults. Methods and resultsAdult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30–0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02–2.26). No association was found between the Prudent pattern and CVD outcomes. ConclusionThe variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting.

Prevalence of hyperlipidaemia in adults and its relation to the Mediterranean diet: the Hellenic National Nutrition and Health Survey (HNNHS).

A long-term abnormal blood lipid profile increases the risk of cardiovascular disease (CVD). A probable protective role may be played by the Mediterranean diet. The aim of this study was to assess prevalence of dyslipidaemia, assess blood lipid status and treatment and examine the association between blood lipids, dyslipidaemia and Mediterranean diet. Data were from the Hellenic National Nutrition and Health Survey (HNNHS). Data from 3775 adults (40.8% males) were obtained by trained personnel and disease status was categorized according to the International Classification of Diseases codes (10th version). Blood lipid measurements were obtained from a subsample (N = 1080, mean age 40.1 years; 37.8% male). The Mediterranean diet score (MedDiet score) was calculated from 24-h recalls. The relationships between higher MedDiet score (>23), lipid levels and status were examined using linearized multiple linear and logistic regressions, respectively. In total, 20.7% of the population was dyslipidaemic, with 59.0% (no sex differences) receiving treatment, and 46.6% of the treated having a normal lipid profile. Lipid status awareness was 35.5% (64.5% unaware). Males aged 19-39 had higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, and lower high-density lipoprotein cholesterol levels than females (in mg/dl; p for all <0.05); these were significantly higher in overweight and obese individuals in all age groups, except high-density lipoprotein cholesterol (p for all <0.001). Higher MedDiet score was associated with significantly lower low-density lipoprotein cholesterol in the pooled sample (-6.39 mg/dl; 95% confidence interval (CI): -12.60, 0.17), in all males (-10.61 mg/dl; 95% CI: -19.89, -1.34) and in overweight and obese males (-15.6 mg/dl; 95% CI: -29.25, -1.94). This study underlines the abnormal lipid profile in the young, mostly male, population who are highly unaware and under-treated.

Dietary patterns and lifestyle characteristics in adults: results from the Hellenic National Nutrition and Health Survey (HNNHS)

ObjectivesThe objective of this study was to identify and describe different dietary patterns in a nationally representative sample of Greek adults and to assess potential associations with lifestyle characteristics. Study designThis was a cross-sectional study. MethodsDietary patterns were derived by principal component analysis using individual dietary data (24-h recall) of 3552 participants of the Hellenic National Nutrition and Health Survey (HNNHS). Analysis of variance and chi-squared test were used to determine the lifestyle characteristics of the participants following each pattern. ResultsThree dietary patterns were identified explaining 16.5% of variance; a traditional pattern, loading positively on olive oil, non-starchy vegetables, and cheese; a Western pattern, loading positively on refined grains, processed meats, and animal fats; and a prudent pattern, loading positively on fruits, whole grains, and yoghurt and negatively on fast food. A fourth, snack-type pattern, loading positively on sweets, salty snacks, and nuts, was identified in women. Primary crude results revealed an association between dietary patterns and socio-economic status. In multivariate analysis, highest adherence to the prudent pattern was associated with higher protein and unsaturated fat intake and lower energy and saturated fat intake (all P ≤ 0.05); the Western and traditional patterns were associated with higher energy and total and saturated fat intake. The traditional pattern was additionally associated with higher monounsaturated fatty acids intake, whereas the Western pattern, with higher alcohol intake (all P ≤ 0.001). ConclusionsThese findings are valuable for understanding the dietary behaviors of adults in Greece and enabling more focused public health policies for the promotion of healthier food behaviors in the future.

Frequency and Quantity of Egg Intake Is Not Associated with Dyslipidemia: The Hellenic National Nutrition and Health Survey (HNNHS).

Background: Gaps remain on the safety of egg intake on cardiovascular health, setting the study’s aim to investigate the association between quantity and frequency of egg consumption, with established dyslipidemia. Methods: Study participants (N = 3558, 40.3% males) included individuals from the Hellenic National and Nutrition Health Survey (HNNHS), of national representation. Quantity and frequency of egg consumption was determined. Minimally adjusted, multivariable logistic and linear analysis were used to assess egg consumption and dyslipidemia. Results: The more frequent egg consumption compared to no or rare egg consumption significantly decreased the odds of dyslipidemia in the minimally adjusted (Odds Ratio (OR) for frequency: 0.83; 95% Confidence Interval (CI): 0.752, 0.904; OR for quantified frequency: 0.87; 95% CI: 0.796, 0.963) and the fully adjusted models (OR for frequency: 0.80; 95% CI: 0.718, 0.887; OR for quantified frequency: 0.85; 95%CI: 0.759, 0.945). Level of serum cholesterol and LDL-c were significantly lower with higher frequency and quantified frequency of egg consumption in all models. Conclusion: Eggs do not increase the risk of dyslipidemia and can be consumed as part of a healthy diet that is high in fiber and low in saturated fat, without excessive energy intake, by all individuals.