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Inclusion of dietary assessment in cardiovascular disease risk estimation models increases the accuracy of estimations and reduces classification bias
e68
Abstracts / Clinical Nutrition ESPEN 13 (2016) e55ee74
respective fat percentage, 21.9 % (±4.6), 18.9 % (±5.4) and 19.5 % (±2.4), correlated significantly with the biggest waist circumference (p<0.01), and classified wrestlers as normal rather than overweight. The basic biochemical parameters ranged within normal levels, nevertheless urine specific gravity assigned good hydration status to 3 out of 21 athletes. Nutritional assessment showed that protein intake was 1.3g/kg for basketball players, 1.8g/kg for cyclists and 1.8g/kg for wrestlers, while carbohydrate intake was 4.1, 4.6 and 4.3g/kg respectively in daily basis, but even nil during training. Conclusions: Wrestlers, even though displaying high BMI, have fat percentage within normal range, indicative of increased muscle mass as compared with athletes of the other two categories. The findings also show that most athletes do not receive the adequate amount of fluids and carbohydrates and these practices may prove unfavorable to their performance. IMPLEMENTATION OF A MUNICIPALITY-BASED INTERVENTION PROGRAM AIMING TO IMPROVE DIETARY AND PHYSICAL ACTIVITY HABITS OF SCHOOL-AGED CHILDREN AND THEIR FAMILIES. RESULTS OF THE PAIDEIATROFI PROGRAM Helena Stamou 1, Konstantina Voulgari 2, Eftychia Apostolidou 3, Vladlena Khudokonenko 3, George Moschonis 3, Yannis Manios 3. 1 Paideiatrofi, Athens, Greece; 2 Nostus Communications and Events, Voula, Greece; 3 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece Introduction: Several studies have highlighted the importance of interventions aiming to improve children’s dietary and physical activity habits when they are extended to the wider social and physical environment of children. Aim: To promote favorable changes in dietary and physical activity habits of school-aged children and their families. Materials and methods: During the school year 2014-2015, the PAIDEIATROFI intervention program organized and implemented several events that were aiming to improve children’s dietary and physical activity habits, such as cooking lessons, movement festivals and walks for the entire family. The effectiveness of the intervention was assessed via measurements of body weight and height in children attending the 2nd to 5th grades of primary schools and via the completion of questionnaires by parents regarding their children’s dietary and physical activity habits. Results: Full data were collected from 404 children and their parents (55% intervention group, 53% girls). The intervention group children reduced to a greater extent their mean TV viewing time by 13.2 minutes/day (95% C.I: -21.4 to -4.5) compared to the control group (P¼0.047). The changes observed in vegetables’ consumption were not found to differ significantly between the intervention and control groups. Nevertheless, a greater increase in vegetables’ consumption (i.e. by 0.33 portions/day) was observed for children participating in cooking events taking place in their municipality (irrespective of “treatment arm”) compared to non-participants (P¼0.004). Conclusions: The present study showed that events implemented, within the municipality, that are aiming to decrease sedentary behaviors can be effective, especially if these events are combined with relevant ones implemented within schools. Furthermore, the present study showed that although vegetables’ consumption can increase via relevant events implemented at municipality level, their extension to schools can enhance their effectiveness even more. NUTRITIONAL STATUS OF GREEK CIRRHOTIC PATIENTS Maria Christodoulaki 1, Rania Chaireti 1, Josef Galanos 1, Dimitra SifakiAikaterini Mantaka 3, Mairi Koulentaki 3, Anastasia Pistolla 2, 1 1 Markaki . Department of Nutrition & Dietetics, Technological Educational Institute of Crete, Siteia, Crete, Greece; 2 Clinic of family and Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; 3 Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Heraklion, Crete, Greece Introduction: Prognosis of cirrhotic patients is related to their nutritional status. Protein-energy malnutrition is not always recognized by attending physicians. Aim: We aimed to assess the nutritional status of Greek cirrhotic patients Materials and methods: We studied 101 cirrhotic patients (48 compensated, 52 females), median age 67.07 (31-88) years and 71 healthy controls
(35 females), median age 66.04 (37-94) years. Cirrhosis etiology was viral hepatitis, NASH, PBC, AIH, ASH and cryptogenic. Patients with hepatic encephalopathy or active alcohol drinking were not included in the study. Nutritional assessment included Body mass index (BMI), anthropometry, handgrip strength, bio-impedance analysis (BIA), the mini nutritional assessment (MNA) questionnaire, the SGA score and the MUST score evaluation. MELD score was calculated to assess the severity of liver disease. Comparisons were made by Student’s T-test and Fisher’s probability test. All tests were made at a 0.05 level of significance. Results: Median MELD score was 14.6 (SD 2.43). MUST score and SGA score also differ significantly between groups (p<0.001). Strongly negative correlations between MELD & MNA (rho¼0.87, p¼0.01), MELD and phase angle (4) (rho¼ -0.80, p¼0.01) and MELD & handgrip (rho¼-0.79, p<0.001) were found. Conclusion: BMI and most anthropometric measurements, did not detect the protein malnutrition of Greek cirrhotic patients. MUST, SGA, MNA, BIA, and handgrip were all found sensitive tools for its detection. COMPLIANCE OF PEDIATRIC PATIENTS WITH REFRACTORY EPILEPSY TO KETOGENIC/MODIFIED ATKINS DIET Sofia Zouganeli 1, Euaggelia Tasiou 1, Melpomeni Giorgi 2, Maria Tsirouda 2, Artemis Stefanede 2, Argirios Dinopoulos 2. 1 Department of Clinical Nutrition, “Attikon” University Hospital, Athens, Greece; 2 3rd Pediatric Clinic, “Attikon” University Hospital, Athens, Greece Introduction: The administration of ketogenic (KD) or Modified Atkins (MAD) diet in the treatment of childhood refractory epilepsy is often associated with compliance problems. Aim: Assessment of the compliance rate to the KD or MAD in children with refractory epilepsy. Materials and methods: 22 children with drug-resistant epilepsy of different etiologies treated with KD or MAD since 2008 were included. The 4:1 KD was administered in 14 patients, the 3:1 KD in 2 patients and the MAD in 6 patients. The initiation of the diet was performed under clinical observation in the hospital. Somatometric traits, blood-test values, a logbook of glucose and ketone plasma levels, fluid intake, and incidence of vomiting and seizure frequency were recorded. Alongside, parents were trained by a specialized dietitian (oral and written instructions/information leaflets were distributed). Follow-up visits were performed one month after initiation of the diet and in a three-month base afterwards. Off-schedule visits, phone calls and e-mails where used as needed in order to provide further advice or clarifications. In addition, a meeting among parents and the ketogenic diet medical team was held. Results: Out of 22 patients, 16 are still under KD or MAD presenting improvement in seizure control. The compliance rate was high even among those who discontinued the diet. The parents distrust towards the effectiveness of the diet and the difficulty in fully understanding all of its aspects were the main reasons leading to poor compliance. Conclusions: The continuous training and encouragement of parents are key factors for achieving good compliance to the diet and therefore enhancing its effectiveness. The parents meeting led to a significant improvement in compliance. INCLUSION OF DIETARY ASSESSMENT IN CARDIOVASCULAR DISEASE RISK ESTIMATION MODELS INCREASES THE ACCURACY OF ESTIMATIONS AND REDUCES CLASSIFICATION BIAS Ekavi N. Georgoysopoulou 1, Demosthenes B. Panagiotakos 1, Christos Pitsavos 2, Christina Chrysohoou 2, Konstantina Masoura 2, Emmanouil Kampaxis 2, Ioannis Skoumas 2, Dimitrios Tousoulis 2, Christodoulos Stefanadis 2. 1 Harokopio University, Greece; 2 Hippokration Hospital, University of Athens, Greece Introduction: Cardiovascular disease risk estimation models have become more popular in everyday clinical practice, but there is still more research needed to optimize the models’ validity. Aim: The aim of this work was to explore the role of dietary assessment in the estimation accuracy of CVD risk models. Materials and methods: the ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). Adherence to Mediterranean diet was
Abstracts / Clinical Nutrition ESPEN 13 (2016) e55ee74
assessed using the MedDietScore (range 0-55). During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the Attica study (15% lost-to-follow-up). The individual CVD risk was estimated with the use of HellenicSCORE, the dietary assessment through the MedDietScore. The observed risk was used in order to investigate the risk estimation of the nested models. Results: The МedDietScore and the HellenicSCORE were significant predictors of the 10-year CVD risk, even after adjusting for several confounders (p<0.05). The misclassification bias of the HellenicSCORE was 13.8%. The MedDietScore was associated with reduced misclassification rates (p<0.001), by explaining 6.1% of the bias. Conclusions: Inclusion of dietary assessment, as well as other lifestyle parameters, could increase the correct classification rates and thus reduce the CVD burden. DAIRY PRODUCTS CONSUMPTION IS ASSOCIATED WITH 10-YEAR CARDIOVASCULAR DISEASE RISK, IN APPARENTLY HEALTHY ADULTS: THE ATTICA STUDY Panagiotakos 1, Christos Ekavi Georgousopoulou 1, Demosthenes Pitsavos 2, Christina Chrysohoou 2, Georgia-Maria Kouli 1, Emmanouil Kampaxis 2, John Skoumas 2, Dimitrios Tousoulis 2, Christodoulos Stefanadis 2. 1 Harokopio University, Greece; 2 Hippokration Hospital, University of Athens, Greece Introduction: the 10-year incidence of cardiovascular disease (CVD) in relation to dairy products consumption, especially taking into account the differences in recommended consumption between the two genders. Aim: Aim of this work was to assess the role of dairy consumption on 10year CVD risk. Materials and methods: The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). In 2011-12, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to WHO-ICD-10 criteria. Dairy consumption was evaluated through semiquantitative Food Frequency Questionnaire and information was gathered regarding the dairy portions consumed per week. Dairy consumption was associated with the 10-year incidence of CVD, using multi-adjusted survival models, in order to elucidate its role on CVD risk. Results: The consumption of dairy portions per week differed between non-CVD events and CVD events (12±5 vs. 10±5 respectively, p¼0.02), as well as between males and females (11±5 vs. 12±5 respectively, p¼0.001). However, when adjusting for potential confounders (i.e., age, sex, physical activity status, smoking, educational level, body mass index, C-reactive protein’s levels, hypertension, diabetes and hypercholesterolemia), the portions of dairy products consumed per week were not associated with CVD risk (RR¼0.977, 95%CI: 0.918-1.04). Although, when gender was used as strata for stratified analysis, it was revealed that women could reduce the CVD risk by 9% for every extra portion of dairy consumed per week, (RR¼0.91, 95%, CI: 0.81-1.02), whereas this association was not consistent for men (RR¼1.003, 95%CI: 0.924-1.088). Conclusions: Increased dairy products consumption was proved beneficial only for women, as regards CVD risk, whereas the dairy consumption was not associated with CVD incidence for men, suggesting that there exists a different effect of the specific dietary habit on males and females. Therefore, sex-specific recommendations on dairy consumption would be preferable for the prevention of CVD. METABOLIC OPERATION
DEFICIENCIES
AFTER
A
RESTRICTIVE
BARIATRIC
Nikolaos Kochylas, Michalis Tsimaras, Vasiliki Ziozia, Basilios Tsagkalidis, Dimitrios Lapatsanis. “Evaggelismos” General Hospital, Athens, Greece Introduction: Bariatric surgery has resulted in an effective and long term loss of excess weight in morbidly obese patients with a simultaneous improvement of their metabolic profile. Another aspect of bariatric surgery is the malabsorption of vitamins that requires the administration of supplements.
e69
Aim: To ascertain the incidence of metabolic deficiencies after a restrictive bariatric operation (gastric sleeve or plication). Materials and methods: Retrospective study of morbidly obese patients that underwent a restrictive bariatric operation in the years 2010-2013. Levels of folic acid, B12, ferritin and serum protein were measured 3,6 and 9 months postoperatively. Patients with preoperative deficiencies in the above were excluded. 108 patients were included in the study. In cases of deficiency, supplements were administered. Results: Out of 108 patients, 20 (19,4 %) presented low folic acid levels, 3 (2,7%) low B12, 12(11%), low ferritin and 6(5,5%) low serum protein levels. The abnormalities presented mostly at 3 months and tended to improve at 6 and 9 months. 1 case proved refractory to folic acid administration, 1 to iron administration and 1 case of B12 deficiency endured because of patient noncompliance to parenteral administration. Conclusions: Restrictive bariatric operations are followed by a drop of consumed calories and fat but also by vitamin deficiencies, especially water soluble, to a degree that requires supplementation. It is pending whether it is because of changes to the anatomy and physiology of the GI tract or because of changes in eating habits. In any case the monitoring and support of a dietician is imperative to ensure a balanced diet and a healthy weight loss. FACTORS AFFECTING THE DIETARY CHOICES IN SCHOOL-AGE CHILDREN Maria Sioki Pediatrician, Postgraduate Student 1, Mary Yiannakoulia Associate Professor 2, Petros Skapinakis Associate Professor 3, Dimitris Niakas 4. 1 Hellenic Open University, Greece; 2 Department of Dietetics e Nutrition, Harokopio University, Athens, Greece; 3 Medical School, University of Ioannina, Ioannina, Greece; 4 Faculty of Social Sciences, Hellenic Open University, Patras, Greece Introduction: Food choices are mirrored to dietary intake and they are motivated by food preferences. Individual and environmental factors influence school-age children’s food choices. Aim: Aim of the study was to evaluate food intake and preferences (in second to fourth grade students) as well as self-efficacy for healthy food choices (fifth and sixth grade students) school-aged children in Lamia area. Materials and methods: 178 students (102 students of second, third, fourth grade and 76 students of fifth, sixth grade). All participants completed a questionnaire with illustrated twelve pair questions on food (healthy vs. unhealthy foods) as well as a self-efficasy questionnaire regarding healthy eating. Results: Statistically significant correlations were found between intake and preferences; boys reported statistically significant higher values in unhealthy preference index and marginally significantly higher values in unhealthy eating index compared to girls (p¼0,010 and p¼0,055 respectively). On the other hand, girls showed significantly higher rates of selfefficacy than boys (p¼0,023). Simple regression analysis revealed that sex (b¼0,309, p¼0,023), class (b¼-0,234, p¼0,023), body mass index (BMI) (b¼-0,174, p¼0,024) and environmental factors (health issues, b¼0,078, p¼0,034, parents, b¼0,076 , p¼0,026, peers, b¼- 0,062, p¼0,029, television commercials, b¼0,084, p¼0,017, cooking techniques, b¼0,054, p¼0,033 taste/odor of vegetables, b¼-0,019, p¼0.050) are statistically significant factors affecting self-efficacy. Conclusions: Interventions aiming at increasing self-efficacy towards healthy eating need to take into account sex-related factors. COGNITIVE FUNCTION, DIET AND LIFESTYLE FACTORS: A REGRESSION TREE ANALYSIS Costas A. Anastasiou 1, Mary H. Emmanouil Magklis 1, Kosmidis 2, Efthimios Dardiotis 3, Giorgos M. Hadjigeorgiou 3, Nicolaos Scarmeas 4, Yannakoulia Mary 1. 1 Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou str., Kallithea, Greece; 2 Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece; 3 School of Medicine, University of Thessaly, Greece; 4 Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Greece Introduction: Dietary patterns have been associated with cognitive performance and decline in the elderly. Classification and Regression Trees (CART) may offer an attractive alternative regarding limitations
Abstracts / Clinical Nutrition ESPEN 13 (2016) e55ee74
respective fat percentage, 21.9 % (±4.6), 18.9 % (±5.4) and 19.5 % (±2.4), correlated significantly with the biggest waist circumference (p<0.01), and classified wrestlers as normal rather than overweight. The basic biochemical parameters ranged within normal levels, nevertheless urine specific gravity assigned good hydration status to 3 out of 21 athletes. Nutritional assessment showed that protein intake was 1.3g/kg for basketball players, 1.8g/kg for cyclists and 1.8g/kg for wrestlers, while carbohydrate intake was 4.1, 4.6 and 4.3g/kg respectively in daily basis, but even nil during training. Conclusions: Wrestlers, even though displaying high BMI, have fat percentage within normal range, indicative of increased muscle mass as compared with athletes of the other two categories. The findings also show that most athletes do not receive the adequate amount of fluids and carbohydrates and these practices may prove unfavorable to their performance. IMPLEMENTATION OF A MUNICIPALITY-BASED INTERVENTION PROGRAM AIMING TO IMPROVE DIETARY AND PHYSICAL ACTIVITY HABITS OF SCHOOL-AGED CHILDREN AND THEIR FAMILIES. RESULTS OF THE PAIDEIATROFI PROGRAM Helena Stamou 1, Konstantina Voulgari 2, Eftychia Apostolidou 3, Vladlena Khudokonenko 3, George Moschonis 3, Yannis Manios 3. 1 Paideiatrofi, Athens, Greece; 2 Nostus Communications and Events, Voula, Greece; 3 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece Introduction: Several studies have highlighted the importance of interventions aiming to improve children’s dietary and physical activity habits when they are extended to the wider social and physical environment of children. Aim: To promote favorable changes in dietary and physical activity habits of school-aged children and their families. Materials and methods: During the school year 2014-2015, the PAIDEIATROFI intervention program organized and implemented several events that were aiming to improve children’s dietary and physical activity habits, such as cooking lessons, movement festivals and walks for the entire family. The effectiveness of the intervention was assessed via measurements of body weight and height in children attending the 2nd to 5th grades of primary schools and via the completion of questionnaires by parents regarding their children’s dietary and physical activity habits. Results: Full data were collected from 404 children and their parents (55% intervention group, 53% girls). The intervention group children reduced to a greater extent their mean TV viewing time by 13.2 minutes/day (95% C.I: -21.4 to -4.5) compared to the control group (P¼0.047). The changes observed in vegetables’ consumption were not found to differ significantly between the intervention and control groups. Nevertheless, a greater increase in vegetables’ consumption (i.e. by 0.33 portions/day) was observed for children participating in cooking events taking place in their municipality (irrespective of “treatment arm”) compared to non-participants (P¼0.004). Conclusions: The present study showed that events implemented, within the municipality, that are aiming to decrease sedentary behaviors can be effective, especially if these events are combined with relevant ones implemented within schools. Furthermore, the present study showed that although vegetables’ consumption can increase via relevant events implemented at municipality level, their extension to schools can enhance their effectiveness even more. NUTRITIONAL STATUS OF GREEK CIRRHOTIC PATIENTS Maria Christodoulaki 1, Rania Chaireti 1, Josef Galanos 1, Dimitra SifakiAikaterini Mantaka 3, Mairi Koulentaki 3, Anastasia Pistolla 2, 1 1 Markaki . Department of Nutrition & Dietetics, Technological Educational Institute of Crete, Siteia, Crete, Greece; 2 Clinic of family and Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; 3 Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Heraklion, Crete, Greece Introduction: Prognosis of cirrhotic patients is related to their nutritional status. Protein-energy malnutrition is not always recognized by attending physicians. Aim: We aimed to assess the nutritional status of Greek cirrhotic patients Materials and methods: We studied 101 cirrhotic patients (48 compensated, 52 females), median age 67.07 (31-88) years and 71 healthy controls
(35 females), median age 66.04 (37-94) years. Cirrhosis etiology was viral hepatitis, NASH, PBC, AIH, ASH and cryptogenic. Patients with hepatic encephalopathy or active alcohol drinking were not included in the study. Nutritional assessment included Body mass index (BMI), anthropometry, handgrip strength, bio-impedance analysis (BIA), the mini nutritional assessment (MNA) questionnaire, the SGA score and the MUST score evaluation. MELD score was calculated to assess the severity of liver disease. Comparisons were made by Student’s T-test and Fisher’s probability test. All tests were made at a 0.05 level of significance. Results: Median MELD score was 14.6 (SD 2.43). MUST score and SGA score also differ significantly between groups (p<0.001). Strongly negative correlations between MELD & MNA (rho¼0.87, p¼0.01), MELD and phase angle (4) (rho¼ -0.80, p¼0.01) and MELD & handgrip (rho¼-0.79, p<0.001) were found. Conclusion: BMI and most anthropometric measurements, did not detect the protein malnutrition of Greek cirrhotic patients. MUST, SGA, MNA, BIA, and handgrip were all found sensitive tools for its detection. COMPLIANCE OF PEDIATRIC PATIENTS WITH REFRACTORY EPILEPSY TO KETOGENIC/MODIFIED ATKINS DIET Sofia Zouganeli 1, Euaggelia Tasiou 1, Melpomeni Giorgi 2, Maria Tsirouda 2, Artemis Stefanede 2, Argirios Dinopoulos 2. 1 Department of Clinical Nutrition, “Attikon” University Hospital, Athens, Greece; 2 3rd Pediatric Clinic, “Attikon” University Hospital, Athens, Greece Introduction: The administration of ketogenic (KD) or Modified Atkins (MAD) diet in the treatment of childhood refractory epilepsy is often associated with compliance problems. Aim: Assessment of the compliance rate to the KD or MAD in children with refractory epilepsy. Materials and methods: 22 children with drug-resistant epilepsy of different etiologies treated with KD or MAD since 2008 were included. The 4:1 KD was administered in 14 patients, the 3:1 KD in 2 patients and the MAD in 6 patients. The initiation of the diet was performed under clinical observation in the hospital. Somatometric traits, blood-test values, a logbook of glucose and ketone plasma levels, fluid intake, and incidence of vomiting and seizure frequency were recorded. Alongside, parents were trained by a specialized dietitian (oral and written instructions/information leaflets were distributed). Follow-up visits were performed one month after initiation of the diet and in a three-month base afterwards. Off-schedule visits, phone calls and e-mails where used as needed in order to provide further advice or clarifications. In addition, a meeting among parents and the ketogenic diet medical team was held. Results: Out of 22 patients, 16 are still under KD or MAD presenting improvement in seizure control. The compliance rate was high even among those who discontinued the diet. The parents distrust towards the effectiveness of the diet and the difficulty in fully understanding all of its aspects were the main reasons leading to poor compliance. Conclusions: The continuous training and encouragement of parents are key factors for achieving good compliance to the diet and therefore enhancing its effectiveness. The parents meeting led to a significant improvement in compliance. INCLUSION OF DIETARY ASSESSMENT IN CARDIOVASCULAR DISEASE RISK ESTIMATION MODELS INCREASES THE ACCURACY OF ESTIMATIONS AND REDUCES CLASSIFICATION BIAS Ekavi N. Georgoysopoulou 1, Demosthenes B. Panagiotakos 1, Christos Pitsavos 2, Christina Chrysohoou 2, Konstantina Masoura 2, Emmanouil Kampaxis 2, Ioannis Skoumas 2, Dimitrios Tousoulis 2, Christodoulos Stefanadis 2. 1 Harokopio University, Greece; 2 Hippokration Hospital, University of Athens, Greece Introduction: Cardiovascular disease risk estimation models have become more popular in everyday clinical practice, but there is still more research needed to optimize the models’ validity. Aim: The aim of this work was to explore the role of dietary assessment in the estimation accuracy of CVD risk models. Materials and methods: the ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). Adherence to Mediterranean diet was
Abstracts / Clinical Nutrition ESPEN 13 (2016) e55ee74
assessed using the MedDietScore (range 0-55). During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the Attica study (15% lost-to-follow-up). The individual CVD risk was estimated with the use of HellenicSCORE, the dietary assessment through the MedDietScore. The observed risk was used in order to investigate the risk estimation of the nested models. Results: The МedDietScore and the HellenicSCORE were significant predictors of the 10-year CVD risk, even after adjusting for several confounders (p<0.05). The misclassification bias of the HellenicSCORE was 13.8%. The MedDietScore was associated with reduced misclassification rates (p<0.001), by explaining 6.1% of the bias. Conclusions: Inclusion of dietary assessment, as well as other lifestyle parameters, could increase the correct classification rates and thus reduce the CVD burden. DAIRY PRODUCTS CONSUMPTION IS ASSOCIATED WITH 10-YEAR CARDIOVASCULAR DISEASE RISK, IN APPARENTLY HEALTHY ADULTS: THE ATTICA STUDY Panagiotakos 1, Christos Ekavi Georgousopoulou 1, Demosthenes Pitsavos 2, Christina Chrysohoou 2, Georgia-Maria Kouli 1, Emmanouil Kampaxis 2, John Skoumas 2, Dimitrios Tousoulis 2, Christodoulos Stefanadis 2. 1 Harokopio University, Greece; 2 Hippokration Hospital, University of Athens, Greece Introduction: the 10-year incidence of cardiovascular disease (CVD) in relation to dairy products consumption, especially taking into account the differences in recommended consumption between the two genders. Aim: Aim of this work was to assess the role of dairy consumption on 10year CVD risk. Materials and methods: The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). In 2011-12, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to WHO-ICD-10 criteria. Dairy consumption was evaluated through semiquantitative Food Frequency Questionnaire and information was gathered regarding the dairy portions consumed per week. Dairy consumption was associated with the 10-year incidence of CVD, using multi-adjusted survival models, in order to elucidate its role on CVD risk. Results: The consumption of dairy portions per week differed between non-CVD events and CVD events (12±5 vs. 10±5 respectively, p¼0.02), as well as between males and females (11±5 vs. 12±5 respectively, p¼0.001). However, when adjusting for potential confounders (i.e., age, sex, physical activity status, smoking, educational level, body mass index, C-reactive protein’s levels, hypertension, diabetes and hypercholesterolemia), the portions of dairy products consumed per week were not associated with CVD risk (RR¼0.977, 95%CI: 0.918-1.04). Although, when gender was used as strata for stratified analysis, it was revealed that women could reduce the CVD risk by 9% for every extra portion of dairy consumed per week, (RR¼0.91, 95%, CI: 0.81-1.02), whereas this association was not consistent for men (RR¼1.003, 95%CI: 0.924-1.088). Conclusions: Increased dairy products consumption was proved beneficial only for women, as regards CVD risk, whereas the dairy consumption was not associated with CVD incidence for men, suggesting that there exists a different effect of the specific dietary habit on males and females. Therefore, sex-specific recommendations on dairy consumption would be preferable for the prevention of CVD. METABOLIC OPERATION
DEFICIENCIES
AFTER
A
RESTRICTIVE
BARIATRIC
Nikolaos Kochylas, Michalis Tsimaras, Vasiliki Ziozia, Basilios Tsagkalidis, Dimitrios Lapatsanis. “Evaggelismos” General Hospital, Athens, Greece Introduction: Bariatric surgery has resulted in an effective and long term loss of excess weight in morbidly obese patients with a simultaneous improvement of their metabolic profile. Another aspect of bariatric surgery is the malabsorption of vitamins that requires the administration of supplements.
e69
Aim: To ascertain the incidence of metabolic deficiencies after a restrictive bariatric operation (gastric sleeve or plication). Materials and methods: Retrospective study of morbidly obese patients that underwent a restrictive bariatric operation in the years 2010-2013. Levels of folic acid, B12, ferritin and serum protein were measured 3,6 and 9 months postoperatively. Patients with preoperative deficiencies in the above were excluded. 108 patients were included in the study. In cases of deficiency, supplements were administered. Results: Out of 108 patients, 20 (19,4 %) presented low folic acid levels, 3 (2,7%) low B12, 12(11%), low ferritin and 6(5,5%) low serum protein levels. The abnormalities presented mostly at 3 months and tended to improve at 6 and 9 months. 1 case proved refractory to folic acid administration, 1 to iron administration and 1 case of B12 deficiency endured because of patient noncompliance to parenteral administration. Conclusions: Restrictive bariatric operations are followed by a drop of consumed calories and fat but also by vitamin deficiencies, especially water soluble, to a degree that requires supplementation. It is pending whether it is because of changes to the anatomy and physiology of the GI tract or because of changes in eating habits. In any case the monitoring and support of a dietician is imperative to ensure a balanced diet and a healthy weight loss. FACTORS AFFECTING THE DIETARY CHOICES IN SCHOOL-AGE CHILDREN Maria Sioki Pediatrician, Postgraduate Student 1, Mary Yiannakoulia Associate Professor 2, Petros Skapinakis Associate Professor 3, Dimitris Niakas 4. 1 Hellenic Open University, Greece; 2 Department of Dietetics e Nutrition, Harokopio University, Athens, Greece; 3 Medical School, University of Ioannina, Ioannina, Greece; 4 Faculty of Social Sciences, Hellenic Open University, Patras, Greece Introduction: Food choices are mirrored to dietary intake and they are motivated by food preferences. Individual and environmental factors influence school-age children’s food choices. Aim: Aim of the study was to evaluate food intake and preferences (in second to fourth grade students) as well as self-efficacy for healthy food choices (fifth and sixth grade students) school-aged children in Lamia area. Materials and methods: 178 students (102 students of second, third, fourth grade and 76 students of fifth, sixth grade). All participants completed a questionnaire with illustrated twelve pair questions on food (healthy vs. unhealthy foods) as well as a self-efficasy questionnaire regarding healthy eating. Results: Statistically significant correlations were found between intake and preferences; boys reported statistically significant higher values in unhealthy preference index and marginally significantly higher values in unhealthy eating index compared to girls (p¼0,010 and p¼0,055 respectively). On the other hand, girls showed significantly higher rates of selfefficacy than boys (p¼0,023). Simple regression analysis revealed that sex (b¼0,309, p¼0,023), class (b¼-0,234, p¼0,023), body mass index (BMI) (b¼-0,174, p¼0,024) and environmental factors (health issues, b¼0,078, p¼0,034, parents, b¼0,076 , p¼0,026, peers, b¼- 0,062, p¼0,029, television commercials, b¼0,084, p¼0,017, cooking techniques, b¼0,054, p¼0,033 taste/odor of vegetables, b¼-0,019, p¼0.050) are statistically significant factors affecting self-efficacy. Conclusions: Interventions aiming at increasing self-efficacy towards healthy eating need to take into account sex-related factors. COGNITIVE FUNCTION, DIET AND LIFESTYLE FACTORS: A REGRESSION TREE ANALYSIS Costas A. Anastasiou 1, Mary H. Emmanouil Magklis 1, Kosmidis 2, Efthimios Dardiotis 3, Giorgos M. Hadjigeorgiou 3, Nicolaos Scarmeas 4, Yannakoulia Mary 1. 1 Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou str., Kallithea, Greece; 2 Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece; 3 School of Medicine, University of Thessaly, Greece; 4 Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Greece Introduction: Dietary patterns have been associated with cognitive performance and decline in the elderly. Classification and Regression Trees (CART) may offer an attractive alternative regarding limitations