Publications by authors named "Maria Hassapidou"

40 Publications

Exploring associations between children's obesogenic behaviours and local environment using big data.

JMIR Mhealth Uhealth 2021 Mar 19. Epub 2021 Mar 19.

Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University, University CampusBox 323, THESSALONIKI, GR.

Background: Obesity is a major public health problem globally and in Europe, while the prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast-food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems to objectively measure the effect of living environment parameters on obesogenic behaviours and obesity. The H2020 project "BigO: Big Data Against Childhood Obesity" (http://bigoprogram.eu) aims to tackle childhood obesity by creating new sources of evidence based on big data.

Objective: This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data exploration of objective obesity related behaviours and local environment based on the data recorded using the BigO mHealth app.

Methods: OPdashboard allows for (i) the real time monitoring of children's obesogenic behaviours in a city area, (ii) the extraction of associations between them and the local environment and, (iii) the evaluation of an intervention in time. More than 3700 children, from 33 schools and 2 clinics, in 5 European cities have been monitored using a custom-made mobile application for the extraction of behavioural patterns through the capturing of accelerometer and geolocation data, while online databases were assessed in order to have a description of the environment.

Results: The preliminary association outcomes in two European cities, namely Thessaloniki in Greece and Stockholm in Sweden, indicate a correlation between children's eating and physical activity behaviours and the availability of food related places or sport facilities close to schools. In addition, OPdashboard was used to assess the modification of children's physical activity as the result of the health policies applied for the deceleration of the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease on physical activity was statistically significant, while in the suburbs a slight increase was observed. Those findings suggest the importance of the availability of open spaces on children's behavioural change. The above analyses act as initial investigations using the OPdashboard. Additional factors must be incorporated in order to optimize its use and have a clearer understanding of the results.

Conclusions: The paper describes in detail the OPdashboard which is exposed as a web interface (http://bigo.med.auth.gr:3838/). Its functionality was evaluated during a focus group with experts on public health, where its potential on the better understanding of the interplay between children's obesogenic behaviours and the environment was underlined.
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http://dx.doi.org/10.2196/26290DOI Listing
March 2021

European Guidelines for Obesity Management in Adults with a Very Low-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis.

Obes Facts 2021 21;14(2):222-245. Epub 2021 Apr 21.

Dipartimento di Medicina, Università degli Studi di Padova, Padova, Italy.

Background: The very low-calorie ketogenic diet (VLCKD) has been recently proposed as an appealing nutritional strategy for obesity management. The VLCKD is characterized by a low carbohydrate content (<50 g/day), 1-1.5 g of protein/kg of ideal body weight, 15-30 g of fat/day, and a daily intake of about 500-800 calories.

Objectives: The aim of the current document is to suggest a common protocol for VLCKD and to summarize the existing literature on its efficacy in weight management and weight-related comorbidities, as well as the possible side effects.

Methods: This document has been prepared in adherence with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Literature searches, study selection, methodology development, and quality appraisal were performed independently by 2 authors and the data were collated by means of a meta-analysis and narrative synthesis.

Results: Of the 645 articles retrieved, 15 studies met the inclusion criteria and were reviewed, revealing 4 main findings. First, the VLCKD was shown to result in a significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. Second, when compared with other weight loss interventions of the same duration, the VLCKD showed a major effect on reduction of body weight, fat mass, waist circumference, total cholesterol and triglyceridemia as well as improved insulin resistance. Third, although the VLCKD also resulted in a significant reduction of glycemia, HbA1c, and LDL cholesterol, these changes were similar to those obtained with other weight loss interventions. Finally, the VLCKD can be considered a safe nutritional approach under a health professional's supervision since the most common side effects are usually clinically mild and easily to manage and recovery is often spontaneous.

Conclusions: The VLCKD can be recommended as an effective dietary treatment for individuals with obesity after considering potential contra-indications and keeping in mind that any dietary treatment has to be personalized. Prospero Registry: The assessment of the efficacy of VLCKD on body weight, body composition, glycemic and lipid parameters in overweight and obese subjects: a meta-analysis (CRD42020205189).
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http://dx.doi.org/10.1159/000515381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138199PMC
April 2021

Vitamin D status, vitamin D intake, and sunlight exposure in adults adhering or not to periodic religious fasting for decades.

Int J Food Sci Nutr 2021 Feb 17:1-8. Epub 2021 Feb 17.

Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, Heraklion, Greece.

We investigated whether periodic abstinence from foods of animal origin and a conservative lifestyle, with reduced sunlight exposure, affect vitamin D status. In a cross-sectional design, we measured the serum 25-hydroxyvitamin D concentration and assessed dietary vitamin D intake and sunlight exposure in 200 adults adhering to religious fasting for decades and in 200 non-fasters, with no differences between groups in bone mineral density. Fasters showed lower 25-hydroxyvitamin D concentration than non-fasters in winter and spring. Vitamin D intake and some indices of sunlight exposure (including two related to winter and spring) were lower in fasters, and 378 of the 400 participants exhibited vitamin D insufficiency or deficiency. In conclusion, individuals following a religious lifestyle had lower vitamin D intake, sunlight exposure and, at times, serum 25-hydroxyvitamin D concentration than controls, although these differences did not impact bone health.
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http://dx.doi.org/10.1080/09637486.2021.1887821DOI Listing
February 2021

The importance of protein intake in master marathon runners.

Nutrition 2021 06 15;86:111154. Epub 2021 Jan 15.

Department of Nutrition Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Sindos, Thessaloniki, Greece.

Objectives: The aim of this study was to investigate the relationships between protein intake (during the tapering period and the race), marathon performance, body composition, acute race-induced changes, and selected metabolic- and muscle damage-related blood biomarkers in recreational master runners.

Methods: In 58 experienced master runners (58.28 y ± 1.07 y, 174.06 cm ± 0.72 cm, 78.51 kg ± 0.76 kg body mass, 21.38% ± 0.52% body fat, mean ± SEM), nutritional intake was evaluated 1 wk before the race and during the marathon. Body composition was evaluated before and 2 h after the race. Blood samples were collected at the same time points.

Results: Body fat and lean body mass (LBM) were significantly reduced after the marathon (P < 0.01; η: 0.311-0.888). Significant negative correlations were observed between energy intake from carbohydrates and proteins (expressed per LBM), marathon performance, and race-induced changes of blood metabolic-muscle damage indices (P < 0.05; r: -0.522 to -0.789). Positive correlations were observed between energy from carbohydrates and proteins per LBM, and body mass and LBM changes (P < 0.05; r: 0.485-0.814). The specific contribution of protein intakes per LBM (beta coefficient: -0.789 to 0.615) on race-induced changes of body composition and blood markers was the same as that of carbohydrate intakes per LBM (beta coefficient: -0.777 to 0.559).

Conclusions: Marathon-induced changes in body composition and metabolic blood indices are highly related to protein intake, either during the tapering period or during the race, with runners experiencing the lowest changes when consuming higher protein intakes.
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http://dx.doi.org/10.1016/j.nut.2021.111154DOI Listing
June 2021

Dietetic management of obesity in Europe: gaps in current practice.

Eur J Clin Nutr 2021 Jan 4. Epub 2021 Jan 4.

Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece.

Despite substantial attention to dietary interventions on the management of obesity, there are no consensus guidelines for dietetic management of obesity in Europe. Two surveys among European dietitians have demonstrated inconsistencies in the approaches recommended within national obesity treatment guidelines. Only a small number of the guidelines include concrete actionable targets for recommended energy deficit, weight loss and weight-loss maintenance. On the other hand, dietitians frequently use 5-15% weight loss as their intervention outcome. However, they fail to monitor changes in body composition beyond weight status and to successfully monitor and prevent weight regain. Europewide guidelines on the dietary treatment of obesity are an overdue requirement for consistent dietetic practice.
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http://dx.doi.org/10.1038/s41430-020-00820-2DOI Listing
January 2021

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017.

Obes Facts 2021 22;14(1):32-44. Epub 2020 Dec 22.

National Institute of Health Dr Ricardo Jorge I.P., Lisbon, Portugal.

Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing.

Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI).

Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration.

Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night.

Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.
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http://dx.doi.org/10.1159/000511263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983588PMC
December 2020

Dietary protein intake from different animal and plant sources plays a minor role in the bone health of adults with or without intermittent fasting for decades.

Int J Food Sci Nutr 2020 Dec 7:1-9. Epub 2020 Dec 7.

Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, Heraklion, Greece.

We examined whether bone health is related to protein intake from different sources by utilising a distinct, rare dietary pattern: avoidance of animal foods for approximately half of the year according to Christian Orthodox Church fasting. Four-hundred adults, of whom 200 had been following religious fasting for a median of 15 years and 200 were non-fasters, underwent anthropometry, measurements of bone mineral density (BMD) and bone mineral content (BMC), and completed a food frequency questionnaire. Groups did not differ significantly in anthropometric measures, BMD, or BMC. Fasters had higher consumption of seafood and lower consumption of red meat, poultry-eggs, dairy products, and grains-cereals than non-fasters. Protein intake from these food groups exhibited similar differences; overall, fasters had lower protein intake than non-fasters. BMD and BMC were positively, though weakly, correlated with red meat and poultry-egg consumption. Thus, protein intake seems to play a minor (if any) role in bone health.
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http://dx.doi.org/10.1080/09637486.2020.1856795DOI Listing
December 2020

BigO: A public health decision support system for measuring obesogenic behaviors of children in relation to their local environment.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:5864-5867

Obesity is a complex disease and its prevalence depends on multiple factors related to the local socioeconomic, cultural and urban context of individuals. Many obesity prevention strategies and policies, however, are horizontal measures that do not depend on context-specific evidence. In this paper we present an overview of BigO (http://bigoprogram.eu), a system designed to collect objective behavioral data from children and adolescent populations as well as their environment in order to support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. We present an overview of the data acquisition, indicator extraction, data exploration and analysis components of the BigO system, as well as an account of its preliminary pilot application in 33 schools and 2 clinics in four European countries, involving over 4,200 participants.
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http://dx.doi.org/10.1109/EMBC44109.2020.9175361DOI Listing
July 2020

Gender and Exercise in Relation to Obesity in Greek Elderly Population.

Int J Environ Res Public Health 2020 09 9;17(18). Epub 2020 Sep 9.

Department of Nutritional Sciences & Dietetics, International Hellenic University, 57400 Thessaloniki, Greece.

Purpose: The prevalence of sarcopenic obesity is increasing in older adults (>65 years) and older. Sarcopenic obesity is also related to reduced muscle synthesis, due to low physical activity levels. The purpose of the present study is to investigate possible risk factors, and effects of habitual activity status on different types of obesity in an elderly population.

Methods: One hundred and two (n = 102) free living participants, aged >60 years, were randomly selected from Rehabilitation Centers for the Elderly in Thessaloniki and from municipal gymnasiums of Thessaloniki, Greece with a mean age of 68.11 ± 6.40 years. The response rate of the participants was 51%. For the purpose of this study, all the participants selected were healthy and did not receive any medication. Specifically, 46 subjects (19 men and 27 women) were members of Rehabilitation Centers for the Elderly in Thessaloniki, while 56 individuals (31 men and 25 women were members of the municipal gymnasiums of Thessaloniki and exercised 2 to 3 times per week). Anthropometric measurements were taken for all subjects. Body composition was assessed with bioelectrical impedance. Body Mass Index (BMI) was categorized according to the World Health Organization (WHO) (2000) standards. Central obesity was defined as a waist circumference of >102 cm in men and >88 cm in women. All participants completed a specific questionnaire regarding their health status, physical activity and previous weight status. Risk of sarcopenic obesity was diagnosed in the participants with co-existing sarcopenia and obesity resulting in high fat mass concurrent with low lean body mass.

Results: Women had more than double risk of developing abdominal obesity (OR:2.133, 95% CI: 0.963-4.725) compared to men. More specifically, 69.6% of the elders who did not exercise regularly had central obesity (men: 52.6% and women: 81.5%), while 38.2% of the exercised elders (men: 36.7% and women: 40%) had central obesity. Sedentary elders demonstrated an increased risk of obesity according to body fat (%BF) (OR: 1.259, 95% CI: 0.576-2.750), double the risk of obesity according to body mass (OR: 2.074, 95% CI: 0.765-5.622), and triple the risk of having central obesity (OR: 3.701, 95% CI: 1.612-8.494) compared to those who exercised. Conclusion Exercise appears to have a protective role against all modes of obesity and thus possibly against obesity-related co-morbidities in the elderly.
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http://dx.doi.org/10.3390/ijerph17186575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557396PMC
September 2020

The Specific Impact of Nutrition and Physical Activity on Adolescents' Body Composition and Energy Balance.

Res Q Exerc Sport 2020 Aug 27:1-11. Epub 2020 Aug 27.

International Hellenic University.

: The aim of the present study was to identify the contribution of nutrition, physical activity (PA), and total energy intake and expenditure on body weight and composition in adolescents. : Body composition, PA, and dietary intakes from 904 Greek adolescents (446 boys and 458 girls; Age: 14.6 ± 1.5 yrs), were evaluated. All participants were assigned into three groups according to their age-sex adjusted Fat Mass Index: (A) Normal weight (N; = 503), (B) Overweight (OW; = 253), and (C) Obese (O; = 148). : Significant differences were found for body weight and composition, basal metabolic rate (BMR) expressed per kg of body mass (normal weight children exhibited the highest values), physical-total energy expenditure, and energy balances between the groups (η: 0.138 to 0.657; < .05). In contrast, no differences were found for macronutrients' and total energy intakes, food consumption and quality (η: 0.002 to 0.099; > .05) between the three examined groups. Strong, negative correlations were observed between body weight, body fat percentage, PA, and total energy expenditure (r: -0.311 to -0.810; < .001). Lower, negative correlations were found between body weight, body fat percentage, and macronutrients' daily intakes (r:-0.235 to -0.432; < .05). BMR and total energy expenditure had strong, negative relative strengths for the determination of body weight and fat percentage. : In conclusion, it seems that BMR, PA, and total daily energy expenditure expressed per body weight and not the nutritional and total energy intakes, were the primary determinant parameters of body composition and weight in adolescents.
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http://dx.doi.org/10.1080/02701367.2020.1773374DOI Listing
August 2020

Anthropometric and Biochemical Markers as Possible Indicators of Left Ventricular Abnormal Geometric Pattern and Function Impairment in Obese Normotensive Children.

Diagnostics (Basel) 2020 Jul 10;10(7). Epub 2020 Jul 10.

2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA General Hospital, 54636 Thessaloniki, Greece.

Εmerging data indicate that various effects of obesity on the cardiovascular system can be evident during childhood. The aim of this study was to detect early changes in left ventricular structure and function in obese normotensive children and explore possible associations of these changes with anthropometric and biochemical parameters. Normotensive 8-11-year-old obese and normal weight children were included in the study. They all underwent anthropometric measurements, laboratory tests, and echocardiography study by conventional and tissue Doppler to assess geometric pattern and function of left ventricle. Statistically significant differences in most anthropometric and metabolic parameters were noticed between groups. Obese children showed higher left ventricular mass index (LVMI) (40.05 ± 9.44 vs. 28.31 ± 6.22), lower E/A ratio (1.76 ± 0.33 vs. 2.08 ± 0.56), and higher E/e' (6.04 ± 1.13 vs. 5.43 ± 0.96) compared to lean peers. Waist-to-height ratio and hs-CRP correlated significantly with E/A in the obese group. Left ventricular hypertrophy was present in 47.2% of obese children and eccentric was the prominent type. Waist-to-height ratio and serum cortisol levels in plasma increased the odds of having any type of abnormal ventricular geometric pattern. Echocardiographic evaluation of left ventricle and diastolic function could be considered for obese normotensive children based on waist-to-height ratio, hs-CRP, and serum cortisol.
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http://dx.doi.org/10.3390/diagnostics10070468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400506PMC
July 2020

The significant effect on musculoskeletal metabolism and bone density of the Eastern Mediterranean Christian Orthodox Church fasting.

Eur J Clin Nutr 2020 12 1;74(12):1736-1742. Epub 2020 Jun 1.

Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, Heraklion, Greece.

Objective: Nutritional disorders cause secondary osteoporosis as well as musculoskeletal metabolism dysfunction. The Christian Orthodox Church's fasting in Mediterranean countries such Greece and Cyprus, or M.C.O.C. diet consists of self-restraint from food and/or food categories for 180 ± 19 days of total, especially of animal protein and dairy products. This case-control study attempts to investigate the effect of this fasting pattern on musculoskeletal metabolism and bone density.

Design: One hundred fasters (or M.C.O.C. diet followers; 68 women and 32 men, mean 59 ± 6.5) with 32 years average fasting time and 100 non-fasters (66 females and 34 males, mean 58.1 ± 6.8; the control group of Mediterranean diet followers) over the age of 50, including menopausal women, were interviewed, as well as physically and laboratory examined along with DEXA measurements of the L2-4 vertebrae and hips. Nutrition data gathered through a 3-day food record during a non-fasting period, while energy intakes calculated on a daily food consumption basis.

Results: Given the overall low incidence of osteoporosis in the Mediterranean diet, it appears to be more than three times higher than that of M.C.O.C. diet despite the periodic restriction of food intake of animal origin into a slightly hypothermic pattern, which in turn is characterized by increased consumption of multicolored vegetable foods.

Conclusions: Abstinence from dairy products and meat does not adversely affect musculoskeletal metabolism or bone density. M.C.O.C. diet seems to be "healthy" eating habit for the musculoskeletal system, as future studies expected to confirm.
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http://dx.doi.org/10.1038/s41430-020-0667-7DOI Listing
December 2020

Bone status of young adults with periodic avoidance of dairy products since childhood.

Eur J Pediatr 2020 Apr 23;179(4):645-651. Epub 2019 Dec 23.

Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, Heraklion, Greece.

Proper nutrition throughout childhood and adolescence is crucial for normal bone development. We investigated whether adherence to Christian Orthodox Church fasting is characterized by periodic avoidance of animal foods (including dairy products), since childhood affects stature or bone health in young adults. This cross-sectional study included 200 healthy men and women, aged 18-35, of whom 100 had been following religious fasting for a median of 14 years, starting at the age of 10, and 100 were non-fasters. Measurements included body height; bone mineral density and bone mineral content at the lumbar spine, right hip, left hip, right femoral neck, and left femoral neck; prevalence of bone fracture; serum biochemical parameters; food and nutrient intake; and physical activity and smoking habits. Fasters did not differ from non-fasters in anthropometric measures (including height), bone mineral density and content, or prevalence of low bone mineral density at any of the five sites measured; number of bone fractures; or serum calcium or 25-hydroxyvitamin D concentrations (P > 0.05). Fasters had lower daily calcium and protein intakes, as well as lower dairy consumption than non-fasters. Groups did not differ in physical activity, and fasters smoked less than non-fasters.Conclusion: Despite lower calcium intake and lower dairy product consumption, individuals adhering to religious fasting since childhood did not differ in height, bone mineral density and content, or prevalence of fractures from controls. Therefore, periodic abstention from dairy and, generally, animal products since childhood does not seem to compromise bone health in young adults.What is Known: • Bone health is an important determinant of overall health and longevity. • Proper nutrition throughout childhood and adolescence is crucial for normal bone development. • Adequate intake of dairy products is considered important due to their high calcium content.What is New: • Young adults with limited calcium intake and dairy product consumption, due to adherence to the fasting rules of the Christian Orthodox Church since childhood, do not differ in height or indices of bone health from non-fasting controls.
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http://dx.doi.org/10.1007/s00431-019-03542-1DOI Listing
April 2020

Correction to: Effect of periodic abstinence from dairy products for approximately half of the year on bone health in adults following the Christian Orthodox Church fasting rules for decades.

Arch Osteoporos 2019 Nov 14;14(1):108. Epub 2019 Nov 14.

Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, Heraklion, Greece.

The original version of this article, published on 27 June 2019, unfortunately contained a mistake.
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http://dx.doi.org/10.1007/s11657-019-0636-8DOI Listing
November 2019

The Nutrition Health Alliance (NutriHeAl) Study: A Randomized, Controlled, Nutritional Intervention Based on Mediterranean Diet in Greek Municipalities.

J Am Coll Nutr 2020 May-Jun;39(4):338-344. Epub 2019 Sep 16.

Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.

The aim of this study was to evaluate the effects of Mediterranean diet on weight loss in a large population in a municipality setting. A 6-month nutritional intervention was implemented in 50 randomly selected municipalities in Greece. In each municipality, approximately 180 overweight or obese patients were recruited and randomly assigned to an intervention group (n = 4500) or to a control group (n = 4500); 1816 and 2210 patients, respectively, completed the study. At baseline, the intervention group attended a 20-minute session where they received recommendations to follow a personalized, slightly hypocaloric, Mediterranean-type diet. The diet was adjusted every 2 weeks. The control group was provided with a leaflet on healthy nutrition and Mediterranean diet. Adherence to Mediterranean diet was evaluated with the Mediterranean diet score (MedDietScore). Subjects in the intervention group were less frequently males and current smokers, had higher body mass index, and followed a healthier diet at baseline than subjects in the control group. In the intervention group, weight, waist circumference, and body fat percentage decreased. In the control group, weight and waist circumference increased. In the intervention group, 48.8% of subjects lost > 5% of body weight compared with 4.2% in the control group ( < 0.001). The MedDietScore increased in the intervention group and did not change in the control group. Independent predictors of loss > 5% of body weight were the decrease in intake of full-fat dairy products and alcohol and the increase in intake of vegetables, in MedDietScore, in walking and in consuming breakfast. Lifestyle change programs focusing on the adoption of Mediterranean diet with frequent monitoring can be implemented successfully in everyday clinical practice. However, retention rates in such programs need to be improved.
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http://dx.doi.org/10.1080/07315724.2019.1660928DOI Listing
September 2019

Effect of periodic abstinence from dairy products for approximately half of the year on bone health in adults following the Christian Orthodox Church fasting rules for decades.

Arch Osteoporos 2019 06 27;14(1):68. Epub 2019 Jun 27.

Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, Heraklion, Greece.

Christian Orthodox Church (COC) fasting is characterized by periodic abstinence from animal foods (including dairy products). We found that, despite this, older individuals adhering to COC fasting for decades did not differ in bone mineral density, bone mineral content, or prevalence of osteoporosis at five sites from non-fasting controls.

Purpose: The present observational study investigated whether adherence to COC fasting, characterized by periodic abstinence from animal foods (including dairy products), affects bone health and the prevalence of osteoporosis in older individuals.

Methods: Participants were 200 men and women, of whom 100 had been following the fasting rules of the COC for a median of 31 years and 100 were non-fasters, all aged 50 to 78 years. Participants underwent measurements of bone mineral density (BMD) and bone mineral content (BMC) at the lumbar spine, right hip, left hip, right femoral neck, and left femoral neck; completed a 3-day food intake record and food frequency questionnaire; and provided blood samples for biochemical measurements.

Results: Fasters did not differ from non-fasters in demographic characteristics, anthropometric measures, BMD, BMC, or prevalence of osteopenia or osteoporosis at any of the five sites measured (P > 0.05). Fasters had lower daily calcium intake than non-fasters (median 532 vs 659 mg, P = 0.010), daily protein intake (0.67 vs 0.71 g/kg, P = 0.028), and consumption of dairy and soy products (10.3 vs 15.3 servings per week, P < 0.001). Groups did not differ in serum calcium, vitamin D, or urea concentrations.

Conclusions: Despite lower calcium intake and lower consumption of dairy and soy products, older individuals adhering to COC fasting did not differ in BMD, BMC, or prevalence of osteoporosis from controls. Thus, periodic abstinence from dairy and, generally, animal products does not seem to compromise bone health in older individuals.
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http://dx.doi.org/10.1007/s11657-019-0625-yDOI Listing
June 2019

Prevalence of Severe Obesity among Primary School Children in 21 European Countries.

Obes Facts 2019 26;12(2):244-258. Epub 2019 Apr 26.

Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.

Background: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published.

Objectives: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI.

Method: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child's age and mother's educational level, were performed in a select group of countries.

Results: A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7-1.3 and 0.7-1.5, respectively) to 5.5% (95% CI 4.9-6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6-9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child's age did not show a clear pattern. Severe obesity was more common among children whose mother's educational level was lower.

Conclusions: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.
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http://dx.doi.org/10.1159/000500436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547273PMC
February 2020

Good practice criteria for childhood obesity prevention in kindergartens and schools-elaboration, content and use.

Eur J Public Health 2018 12;28(6):1029-1034

University of Physical Education, Budapest, Hungary.

Background: In accordance with the policy actions that address childhood overweight and obesity at European level and as a contribution to the EU Action Plan on Childhood Obesity 2014-20, a Joint Action on Nutrition and Physical Activity (JANPA) was established. As part of JANPA work package 6, an evaluation framework to identify good practices, targeting childhood obesity prevention in kindergartens and schools, was developed. This article describes the WP 6 JANPA framework of good practice criteria and its development, compares it to other frameworks and discusses its potential for future use.

Methods: Based on the analysis of scientific literature, a set of 47 potential good practice criteria was drafted, that was then revised and complemented through a series of online Delphi consultations.

Results: A final list of 48 good practice criteria (9 of which were rated as core criteria) was developed and grouped into three categories: intervention characteristics (n = 17), implementation (n = 17) and monitoring and evaluation (n = 14).

Conclusion: The identified JANPA framework of good practice criteria complements the existing frameworks by focussing on kindergarten- and school-based initiatives and provides guidance for evaluators, programme planners and decision makers bearing in mind that a one-size-fits-all approach is inadequate. To ensure the effectiveness of future practices, programme planners should endeavour to meet at least the nine JANPA core criteria.
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http://dx.doi.org/10.1093/eurpub/cky129DOI Listing
December 2018

Nutritional Routine of Tae Kwon Do Athletes Prior to Competition: What Is the Impact of Weight Control Practices?

J Am Coll Nutr 2017 Aug 19;36(6):448-454. Epub 2017 Jun 19.

a Department of Nutrition and Dietetics , Technological Institute of Thessaloniki , Greece, Thessaloniki , Greece.

Objective: The purpose of the present study was to investigate and assess the common dietary and weight management strategies of Tae Kwon Do (TKD) athletes prior to national competitions, as well as to examine the relationships between these strategies and body weight reduction and sensation of physical condition.

Methods: Sixty (n = 60) TKD athletes, 23 women (19.4 ± 2.9 years) and 37 men (20.4 ± 3.6 years), with at least 12.1 ± 3.1 years of experience, participated in the present study. The athletes recorded their dietary intake and physical activity for 3 training days and on a competition day. Bioelectrical impedance was used for body composition estimation.

Results: Male athletes consumed 1918 ± 685 kcal/24 hours and 1974 ± 669 kcal/24 hours on training and competition days, respectively, and women 1814 ± 446 kcal/24 hours and 1700 ± 439 kcal/24 hours. TKD athletes had significant negative energy balance (48.6% ± 17.8% to 60.3% ± 26.9%; p < 0.05), with the majority of macro- and micronutritional elements being lower than the recommended values, with significant differences between them, as well as within groups, between weekdays and weekend days (p < 0.05). Females lost most of their weight 2 weeks before the games (3.50 ± 1.00 kg), and males lost most of their weight 3 weeks before (3.16 ± 2.48 kg). The majority of TKD athletes were guided by their coaches for weight management strategies. No significant correlations were found between any body composition variable, weight loss, and any nutritional intake at any time point (p > 0.05).

Conclusions: These data suggest that the methods of TKD athletes for rapid weight loss are guided by unspecialized professionals, leading to significant malnutrition, because certain deficiencies in both macro- and micronutrient content are present, with no guaranteed specific reduction of their body mass.
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http://dx.doi.org/10.1080/07315724.2017.1319305DOI Listing
August 2017

Sodium and Potassium Intake in Healthy Adults in Thessaloniki Greater Metropolitan Area-The Salt Intake in Northern Greece (SING) Study.

Nutrients 2017 Apr 22;9(4). Epub 2017 Apr 22.

Division of Health Sciences (Mental Health & Wellbeing), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.

A reduction in population sodium (as salt) consumption is a global health priority, as well as one of the most cost-effective strategies to reduce the burden of cardiovascular disease. High potassium intake is also recommended to reduce cardiovascular disease. To establish effective policies for setting targets and monitoring effectiveness within each country, the current level of consumption should be known. Greece lacks data on actual sodium and potassium intake. The aim of the present study was therefore to assess dietary salt (using sodium as biomarker) and potassium intakes in a sample of healthy adults in northern Greece, and to determine whether adherence to a Mediterranean diet is related to different sodium intakes or sodium-to-potassium ratio. A cross-sectional survey was carried out in the Thessaloniki greater metropolitan area (northern Greece) ( = 252, aged 18-75 years, 45.2% males). Participants' dietary sodium and potassium intakes were determined by 24-hour urinary sodium and potassium excretions. In addition, we estimated their adherence to Mediterranean diet by the use of an 11-item MedDietScore (range 0-55). The mean sodium excretion was 175 (SD 72) mmol/day, equivalent to 4220 (1745) mg of sodium or 10.7 (4.4) g of salt per day, and the potassium excretion was 65 (25) mmol/day, equivalent to 3303 (1247) mg per day. Men had higher sodium and potassium excretions compared to women. Only 5.6% of the sample had salt intake <5 g/day, which is the target intake recommended by the World Health Organization. Mean sodium-to-potassium excretion ratio was 2.82 (1.07). There was no significant difference in salt or potassium intake or their ratio across MedDietScore quartiles. No significant relationships were found between salt intake and adherence to a Mediterranean diet, suggesting that the perception of the health benefits of the Mediterranean diet does not hold when referring to salt consumption. These results suggest the need for a larger, nation-wide survey on salt intake in Greece and underline the importance of continuation of salt reduction initiatives in Greece.
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http://dx.doi.org/10.3390/nu9040417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409756PMC
April 2017

Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010.

BMC Public Health 2017 01 28;17(1):126. Epub 2017 Jan 28.

First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, Thessaloniki, 54636, Greece.

Background: In children, abdominal obesity is a better predictor of the presence of cardiovascular risk factors than body mass index (BMI)-defined obesity. We aimed to evaluate the prevalence of abdominal obesity in the Greek pediatric population and to assess the impact of residence on the prevalence of both BMI-defined and abdominal obesity.

Methods: In the context of the Childhood Obesity Surveillance Initiative of the World Health Organization (WHO) Regional Office for Europe, a national representative sample of 7.0-7.9 and 9.0-9.9-year-old children was evaluated (n = 2,531 and 2,700, respectively). Overweight and obesity according to BMI were estimated using both the WHO and International Obesity Task Force cut-off points. Abdominal obesity was defined as waist circumference/height ratio >0.5.

Results: The prevalence of abdominal obesity did not differ between 7-year-old boys and girls (25.2 and 25.3%, respectively; p = NS). Among 9-year-old children, abdominal obesity was more prevalent in boys than in girls (33.2 and 28.2%, respectively; p = 0.005). Among normal weight and overweight children, the prevalence of abdominal obesity was 1.6-6.8 and 21.8-49.1%, respectively. The prevalence of abdominal and BMI-defined obesity did not differ between children living in the mainland, in Crete and in other islands except in 7-year-old girls, where the prevalence of BMI-defined obesity was highest in those living in Crete, intermediate in those living in other islands and lowest in those living in the mainland. In 9-year-old boys and in 7- and 9-year-old girls, the prevalence of abdominal obesity was highest in children living in Athens and lowest in children living in Thessaloniki, whereas children living in other cities and in villages showed intermediate rates. The prevalence of abdominal obesity in 7-year-old boys and the prevalence of BMI-defined obesity did not differ between children living in cities and villages.

Conclusions: The prevalence of pediatric abdominal obesity in Greece is among the highest worldwide. Boys and children living in the capital are at higher risk for becoming obese. Given that abdominal obesity is more prevalent than BMI-defined obesity and appears to be more sensitive in identifying cardiovascular risk, measurement of waist circumference might have to be incorporated in the screening for childhood obesity.
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http://dx.doi.org/10.1186/s12889-017-4061-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5273825PMC
January 2017

Relationships Between Alcohol Consumption, Smoking Status and Food Habits in Greek Adolescents. Vascular Implications for the Future.

Curr Vasc Pharmacol 2017 ;15(2):167-173

Department of Nutrition and Dietetics, Technological Educational Institute of Thessaloniki, P.O. Box 141, 57400, Thessaloniki, Greece.

Background: Addictive behaviours in adolescents such as alcohol consumption and smoking are rapidly increasing worldwide.

Objective: No previous study has examined smoking status and alcohol consumption in adolescents of Northern Greece in relation to their food habits. Therefore, we assessed the smoking status and alcohol consumption, as well the food habits, of this population.

Method: Adolescents (495 boys and 508 girls) aged 15±1 years old and 15±2 years old respectively, completed questionnaires regarding smoking, alcohol and food habits.

Results: Tobacco use and alcohol consumption were reported by 9.2% and 48.1% of them, respectively. Of those that drank alcohol, 13.9% were also smokers. Older adolescents were more likely to consume foods high in fat and sugar, low in vitamins and minerals as well as foods, considered by them to be less healthy and prepared in a less healthy way. Moreover, smoker adolescents were less likely to choose foods considered to be healthy and prepared in a healthy way, whereas they were more likely to choose foods high in fat content.

Conclusions: Both smoking and alcohol consumption may affect cardiovascular risk and the vasculature. Poor lifestyle (and risk of vascular events) can start at an early age.
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http://dx.doi.org/10.2174/1570161114666161024123357DOI Listing
December 2017

Obese Patients with Type 2 Diabetes on Conventional Versus Intensive Insulin Therapy: Efficacy of Low-Calorie Dietary Intervention.

Adv Ther 2016 Mar 17;33(3):447-59. Epub 2016 Feb 17.

Diabetes Center, Papageorgiou General Hospital, Thessaloniki, Greece.

Introduction: The aim of this prospective study was to assess the results of a standard low-calorie dietary intervention (7.5 MJ/day) on body weight (BW) and the metabolic profile of obese patients with type 2 diabetes mellitus (T2DM) on intensive insulin therapy (IIT: 4 insulin injections/day) versus conventional insulin therapy (CIT: 2/3 insulin injections/day).

Methods: A total of 60 patients (n = 60, 23 males and 37 postmenopausal females) were recruited and categorized into two groups according to the scheme of insulin treatment. Thirty were on IIT (13 males and 17 females) and an equal number on CIT (10 males and 20 females). BW, body mass index (BMI), HbA1c, and metabolic parameters were compared at 6 and 12 months after baseline.

Results: Significant reductions were observed in the BW, BMI, HbA1c (p ≤ 0.001 for all) and cholesterol (p ≤ 0.05) at 6 months post-intervention. At 1 year, median BW reduction was 4.5 kg (3.3, 5.8) for patients on IIT and 4.8 kg (3.6, 7.0) for those on CIT. The 12-month dietary intervention increased prevalence of normoglycemia in the IIT group and reduced the prevalence of obesity prevalence among the CIT participants (all p < 0.001). CIT patients with BW reduction ≥5.0% demonstrated 11-fold greater chances of being normoglycemic (odds ratio 11.3, 95% CI 1.1-110.5). BW reduction ≥7.0% was associated with CIT, being overweight, and having normal HDLc, LDLc, and cholesterol levels. A reduction in BW between 5.0% and 6.9% was associated with IIT, normoglycemia, and obesity.

Conclusion: A 12-month 1800-kcal dietary intervention achieved significant BW and HbA1c reductions irrespectively of insulin regimen. CIT was associated with BW reduction greater than 8.0%, whereas IIT was associated with higher rates of normoglycemia.
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http://dx.doi.org/10.1007/s12325-016-0300-2DOI Listing
March 2016

Childhood Obesity Is a Chronic Disease Demanding Specific Health Care--a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO).

Obes Facts 2015 16;8(5):342-9. Epub 2015 Oct 16.

Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.

Childhood obesity is one of the greatest health challenges of the 21st century. The EASO COTF is convinced that classifying obesity as a chronic disease in children and adolescents is a crucial step for increasing individual and societal awareness, and for improving early diagnosis and intervention. Such a classification will enhance the development of novel preventive and treatment approaches, health care policies and systems, and the education of healthcare workers. The management of obesity prior to the appearance of co-morbidities may prevent their escalation into significant medical and psychosocial problems, and reduce their economic and societal impact. Childhood is a unique window of opportunity to influence lifetime effects on health, quality of life, prevention of non-communicable chronic diseases and disabilities. The Convention on the Rights of the Child by UNICEF states that parties shall strive to ensure that no child is deprived of his or her right of access to health care services. The EASO COTF is aiming to address these issues via educational activities for health care workers, identification of research agendas, and the promotion of collaborations among clinicians, researchers, health institutions, organizations and states across Europe.
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http://dx.doi.org/10.1159/000441483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644867PMC
June 2016

Prevalence of overweight and obesity in preschool children in Thessaloniki, Greece.

Hormones (Athens) 2015 Oct-Dec;14(4):615-22

Department of Endocrinology, Diabetes & Metabolism, "Agios Pavlos" Hospital, Thessaloniki, Greece.

Objective: Data on obesity in preschoolers are scarce in Greece, a country particularly affected by the obesity epidemic. The present study aimed to assess overweight and obesity prevalence of preschoolers in Thessaloniki, Greece, by using three different standards for defining childhood overweight and obesity.

Design: One thousand two hundred and fifty (1250) preschool children (657 boys and 593 girls) aged 2.0-6.0 years old from all public municipality kindergartens of Thessaloniki, Greece, participated in this cross-sectional survey conducted from 2009 to 2010.Body weight and height were measured and detailed anthropometry measurement was undertaken. BMI was classified to weight categories based on the CDC (US Centers for Disease Control and Prevention), IOTF (the International Obesity Task Force) and WHO (the World Health Organization) references.

Results: Rates of excess body weight varied significantly according to the different international criteria: IOTF: overweight (including obesity) 21.2%, obesity 5.8%;CDC: overweight (including obesity) 30.5%, obesity 13.5%; and WHO: overweight (including obesity) 32.6%, obesity 5%. Boys and older children were particularly affected.

Conclusions: Overweight prevalence is high in Greek preschoolers and varies significantly according to the different criteria used, from 21.2% (IOTF reference) to 32.6% (CDC reference).
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http://dx.doi.org/10.14310/horm.2002.1601DOI Listing
November 2016

A systematic review and meta-analysis of weight status among adolescents in Cyprus: scrutinizing the data for the years 2000-2010.

Hormones (Athens) 2014 Oct-Dec;13(4):543-51. Epub 2014 Nov 5.

Objective: The aim of the present study was to evaluate by pooled and sensitivity analyses all available data on adolescent overweight/obesity in Cyprus.

Design: A thorough literature search determined the studies to be examined using Cypriot adolescent samples aged 10-18 years old, with weight status in each sex classified according to the IOTF criteria, published between the years 2001-2011. Eight studies were retrieved, but three fulfilled the criteria for the sensitivity analyses.

Results: The pooled prevalence of obesity was 9.8% in boys (n = 6081). The pooled analysis classified 6.1% (n = 3886) of girls as obese, whereas a higher prevalence was observed by the sensitivity analysis 6.4% (n = 1956, p ≤ 0.001). The boys' prevalence of overweight was 19.3% and the girls' 17.1%. Between sexes, boys demonstrated a higher prevalence of obesity and overweight (p ≤ 0.001 for both). The cumulative analyses demonstrated an increase in the prevalence of overweight/obesity until the year 2005 and thereafter a plateauing in boys and a slight decrease in girls in a non-linear manner.

Conclusion: Approximately 1/3 of adolescent boys and 1/4 of adolescent girls in Cyprus were overweight/obese during the previous decade.
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http://dx.doi.org/10.14310/horm.2002.1511DOI Listing
October 2015

WHO European Childhood Obesity Surveillance Initiative: School nutrition environment and body mass index in primary schools.

Int J Environ Res Public Health 2014 Oct 30;11(11):11261-85. Epub 2014 Oct 30.

Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention.

Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries.

Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated.

Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed.

Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.
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http://dx.doi.org/10.3390/ijerph111111261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245612PMC
October 2014

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010.

BMC Public Health 2014 Aug 7;14:806. Epub 2014 Aug 7.

Division of Noncommunicable Diseases and Life-course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Ø, Denmark.

Background: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010.

Methods: Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses.

Results: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from -0.4 to +0.3) and BMI-for-age Z-scores (range: from -0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway.

Conclusions: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.
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http://dx.doi.org/10.1186/1471-2458-14-806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289284PMC
August 2014