In rheumatoid arthritis (RA), diet quality and nutritional status have been shown to impact the disease activity and adherence to the Mediterranean diet (MD) has been suggested as an anti-inflammatory regime to improve disease status and reduce cardiovascular risk. The Mediterranean DiEt In Rheumatoid Arthritis (MADEIRA) was a single-blind (statistician), two-arm randomized clinical trial, investigating the effects of a 12-week lifestyle intervention, including a personalized isocaloric MD plan with the promotion of physical activity (PA), supported through a clinical decision support systems (CDSS) platform, versus usual care in women with RA. Forty adult women with RA on remission were randomly allocated (1:1 ratio) to either the intervention or the control arm. The intervention group received personalized MD plans and lifestyle consultation on improving PA levels, whereas the controls were given generic dietary and PA advice, based on the National Dietary Guidelines. The primary outcome was that the difference in the MD adherence and secondary outcomes included change in disease activity (DAS28), anthropometric indices (BodPod), dietary intake, PA, vitamin D concentrations, and blood lipid profiles after 12 weeks from the initiation of the trial. At 3 months post-baseline, participants in the MD arm exhibited greater adherence to the MD compared with the controls (p < 0.001), lower DAS28 (p < 0.001), favorable improvements in dietary intake (p = 0.001), PA (p = 0.002), body weight and body composition (p < 0.001), blood glucose (p = 0.005), and serum 1,25(OH)₂D concentrations (p < 0.001). The delivery of the MD and PA promotion through CDSS nudges in women with RA in an intensive manner improves the MD adherence and is associated with beneficial results regarding disease activity and cardiometabolic-related outcomes, compared with the usual care.

Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition—underweight or excess body weight—is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients.

Background: Multiple sclerosis (MS) is a chronic immune-mediated central nervous system disorder that affects females twice as often as males. MS patients show increased susceptibility to obesity and related cardiometabolic disorders, while diet may influence disease course. In the present randomized controlled study, we aimed to increase Mediterranean Diet (MedDiet) adherence in MS women and improve their nutritional status. Methods: Adult women with relapsing-remitting MS (n = 40) were randomly allocated to intervention (n = 20) or control group (n = 20). Individual dietary plans based on MedDiet together with nutritional consultation were provided to the intervention group. Controls received general lifestyle advice according to “National Dietary Guidelines”. Medical history, anthropometry, dietary records, and blood withdrawal were performed at baseline and at 3 months. Results: Compared to controls, the intervention group demonstrated greater MedDiet adherence (p < 0.001), which was negatively associated with cholesterol intake levels (p < 0.05). At 3 months, women following MedDiet had ameliorated body weight and body composition compared to baseline (p < 0.001). Serum 1,25(OH)2D was significantly higher in both study groups at 3 months (p < 0.001), but in the intervention group, the mean increment was twofold compared to controls (p < 0.001). Conclusion: Personalized nutritional intervention in MS patients may improve MedDiet adherence and nutritional status towards cardioprotective health outcomes.

ObjectiveThe study aimed to assess differences in dietary intake and growth of pre-schoolers and schoolchildren living in two limitary Greek islands; Samos, situated on the eastern border, and Corfu, situated on the western border.DesignCross-sectional two-site study.MethodsA total of 248 children aged 3–12 years from the two islands participated in the survey. Body weight and height were recorded and Z-scores were calculated. A 3 d food record was collected for each child, computer-analysed and compared with the Recommended Daily Allowances (RDA). Intakes ≤70 % of the RDA were considered inadequate.ResultsThe prevalence of overweight in participants from Samos and Corfu was 10·7 % and 6·5 % respectively, according to the Centers for Disease Control and Prevention growth charts. In Corfu, the diet comprised 52 % carbohydrate, 34 % fat and 14 % protein, all different from the composition of the Samian diet (42 % carbohydrate, 39 % fat, 19 % protein; P ≤ 0·05). Inadequacies in micronutrient intake were evident only in the diet of Samos and concerned folate and P of the pre-schoolers and biotin of the school-aged participants. The diet in Corfu was more similar to the overall Mediterranean pattern as well as that of Italian children. Growth and overweight trends in Corfu resembled the ones in Italy, whereas in Samos, similarities were identified with trends from Turkey.ConclusionsBorder areas at a distance from the mainland exhibit different dietary intakes compared with rest of the country; thus when designing nutrition surveys the setting should also include such limitary areas.

Bone calcium turnover is aggravated in pregnant women recommended to bed rest. In the present cross-sectional study, we aimed to clarify whether preterm neonates would benefit from calcium supplementation during pregnancy. Forty-two mothers (37.5 ± 6.7 years), recommended bed rest at home, and 42 preterm neonates (24–37 weeks gestational age) were enrolled. Neonates’ serum calcium was quantified at birth. Mothers’ calcium intake from foods and supplements during pregnancy was assessed. Serum 25-OH-D was measured in both mothers and neonates at birth. Results showed that mothers’ calcium intake from foods was significantly lower than the recommended daily reference value (p < 0.001), while total calcium intake including supplements was close to the calcium reference value of 1000 mg/day (p = 0.648). Neonates’ serum calcium concentration was significantly higher in mothers receiving calcium supplementation during pregnancy compared to mothers who did not (p < 0.001). A significant association between neonates’ serum calcium levels and mothers’ calcium supplementation was evident, even when adjusted to mothers’ age, pre-pregnancy BMI, gestational age, and neonates’ birth weight (beta = +0.460, p = 0.025). A statistically significant correlation between neonates’ and mothers’ serum 25-OH-D levels was found (r = 0.891, p < 0.001). In conclusion, calcium status in preterm neonates, born by bedridden women, could be enhanced after calcium supplementation during gestation.

Background/Objectives: Feeding and eating disorders (FEDs) constitute an important mental health problem today, especially among youngsters. The Sick, Control, One, Fat, Food (SCOFF) questionnaire was developed 25 years ago and remains the most frequently applied screening tool for FEDs among adults and youngsters. The aim of the present study was to translate and adapt the SCOFF questionnaire to the Greek language, using a tertiary-setting adolescent sample. Methods: A total of 167 adolescents (86 boys, 81 girls) admitted to the pediatric outpatient clinics of the Georgios Gennimatas and Hippokration General hospitals completed the SCOFF questionnaire. Anthropometric indices were measured and dietary intake was recorded. Results: A total of 74 adolescents (44.3% of the sample) were classified as engaging in disordered eating behaviors and as possible patients with FEDs based on the SCOFF questionnaire. No differences were noted in the dietary intake between adolescents who screened positive and those who screened negative for FEDs. The body mass index z-score and obesity status were greater among children screening positive for FEDs compared to those screening negative (p < 0.01). One patient who was later diagnosed with anorexia nervosa was detected as a possible FED case by the questionnaire. Conclusions: The present study revealed that more than two out of five adolescents attending a pediatric clinic exhibited disordered eating behavior. The use of the G-SCOFF questionnaire is feasible and effective for FED triage in the Greek tertiary pediatric setting.