Objective : To assess the influence of a specific dietary pattern on overall survival. Design : Cohort study. Setting : Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. Subjects : 182 elderly residents of the three villages. Main outcome measure : Overall mortality. Results : Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). Conclusion : A diet meeting currently understood health criteria does predict survival among people.

Objective: To translate the Perceived Stress Scale (versions PSS-4, -10 and -14) and to assess its psychometric properties in a sample of general Greek population. Methods: 941 individuals completed anonymously questionnaires comprising of PSS, the Depression Anxiety and Stress scale (DASS-21 version), and a list of stress-related symptoms. Psychometric properties of PSS were investigated by confirmatory factor analysis (construct validity), Cronbach’s alpha (reliability), and by investigating relations with the DASS-21 scores and the number of symptoms, across individuals’ characteristics. The two-factor structure of PSS-10 and PSS-14 was confirmed in our analysis. We found satisfactory Cronbach’s alpha values (0.82 for the full scale) for PSS-14 and PSS-10 and marginal satisfactory values for PSS-4 (0.69). PSS score exhibited high correlation coefficients with DASS-21 subscales scores, meaning stress (r = 0.64), depression (r = 0.61), and anxiety (r = 0.54). Women reported significantly more stress compared to men and divorced or widows compared to married or singled only. A strong significant (p < 0.001) positive correlation between the stress score and the number of self-reported symptoms was also noted. Conclusions: The Greek versions of the PSS-14 and PSS-10 exhibited satisfactory psychometric properties and their use for research and health care practice is warranted.

We examined the role of vascular function and inflammation in the development and failure to heal diabetic foot ulcers (DFUs). We followed 104 diabetic patients for a period of 18.4 ± 10.8 months. At the beginning of the study, we evaluated vascular reactivity and serum inflammatory cytokines and growth factors. DFUs developed in 30 (29%) patients. DFU patients had more severe neuropathy, higher white blood cell count, and lower endothelium-dependent and -independent vasodilation in the macrocirculation. Complete ulcer healing was achieved in 16 (53%) patients, whereas 13 (47%) patients did not heal. There were no differences in the above parameters between the two groups, but patients whose ulcers failed to heal had higher tumor necrosis factor-α, monocyte chemoattractant protein-1, matrix metallopeptidase 9 (MMP-9), and fibroblast growth factor 2 serum levels when compared with those who healed. Skin biopsy analysis showed that compared with control subjects, diabetic patients had increased immune cell infiltration, expression of MMP-9, and protein tyrosine phosphatase-1B (PTP1B), which negatively regulates the signaling of insulin, leptin, and growth factors. We conclude that increased inflammation, expression of MMP-9, PTP1B, and aberrant growth factor levels are the main factors associated with failure to heal DFUs. Targeting these factors may prove helpful in the management of DFUs.

BACKGROUND: We evaluated the reproducibility and relative validity of a 190-item semi-quantitative food frequency questionnaire (FFQ) to be used in a large prospective study in the Athens area of Greece. METHODS: In all, 42 men and 38 women, aged 25-67 years, completed two self-administered semi-quantitative FFQ spaced approximately 1 year apart. Within this 1-year interval, participants visited the study centre monthly and completed an interviewer-administered 24-hour diet recall questionnaire. We also collected two venous blood and three 24-hour urine samples from participants at randomly selected periods during the year between the two administrations of the dietary questionnaire. RESULTS: Mean values for intake of most nutrients assessed by the two FFQ were in good agreement while those assessed by the two different dietary methods were reasonably similar for most nutrients. Intraclass correlation coefficients for energy-adjusted nutrient intakes assessed by questionnaires one year apart averaged 0.57 (range 0.24-0.75) and were not substantially different between genders. Correlation coefficients between the energy-adjusted nutrients measured by repeated 24-hour recalls and the semi-quantitative FFQ ranged from 0.25 for beta-carotene and polyunsaturated fats to > 0.50 for saturated fats, cis-linoleic acid, calcium and phosphorus (average: 0.46 for men and 0.39 for women). Reliability and relative validity were very high for alcohol intake. Dietary intakes from the FFQ were significantly correlated to plasma levels of vitamin C, but not beta-carotene or cholesterol. Dietary protein intake assessed by both FFQ was correlated (0.36, 0.30) with average urinary nitrogen excretion levels from three 24-hour urine samples. CONCLUSIONS: These data indicate that the semi-quantitative FFQ is reproducible and provides a reasonably reliable measure of intake. Significant correlations between diet and an independent biochemical marker further corroborate the relative validity of our questionnaire in this Greek population.

Background: Experimental animal studies suggest that olive oil consumption, as contrasted to consumption of other fat types, does not enhance the occurrence of chemically induced mammary tumors, but human data are sparse. Furthermore, evidence is inconclusive concerning the role of food groups, as distinct from that of major nutrients, in the etiology of breast cancer in women. Purpose: This analysis was conducted to evaluate and quantify the effect of consumption of olive oil, margarine, and a range of food groups on the risk of breast cancer. Methods: Data from a comprehensive, semiquantitative food-frequency questionnaire administered to 820 women with breast cancer and 1548 control women from the study base were used to calculate odds ratios (ORs) and X statistics of linear trend for the consumption of olive oil, margarine, and a series of food groups classified in quintiles. Adjustment for the effects of reproductive risk factors, energy intake, and mutual confounding influences was implemented through unconditional logistic regression modeling. Results: Vegetable consumption and fruit consumption were independently associated with statistically significant reductions of breast cancer risk by 12% and 8%, respectively, per quintile increase; no significant associations were evident for the other food groups examined. Increased olive oil consumption was associated with significantly reduced breast cancer risk (OR = 0.75 [95% confidence interval = 0.57–0.98] for more than once a day versus once a day), whereas increased margarine consumption was associated with significantly increased risk (OR = 1.05 [95% confidence interval = 1.00–1.10] for an increment of four times a month). The olive oil association was apparently concentrated among postmenopausal women, but the relevant interaction term was not statistically significant; there was no suggestion of interaction with menopausal status for consumption of either vegetables, fruits, or margarine. Conclusions: Although major categories of macronutrients do not show significant associations with breast cancer risk in most studies, including the present one, vegetables and fruits are inversely, significantly, and strongly associated with this risk. There also is evidence that olive oil consumption may reduce the risk of breast cancer, whereas margarine intake appears to be associated with an elevated risk for the disease. [J Natl Cancer Inst 87:110-116, 1995]

Objective: We investigated the association between inflammation, microvascular reactivity, and the development of peripheral diabetic neuropathy. Research Design and Methods: We studied three groups: 55 healthy control subjects, 80 nonneuropathic patients, and 77 neuropathic diabetic patients. We also subdivided the neuropathic patients into a subgroup of 31 subjects with painless neuropathy and 46 with painful neuropathy. We measured the foot skin endothelium-dependent and -independent vasodilation, the nerve axon reflex-related vasodilation (NARV), and inflammatory cytokines and biochemical markers of endothelial function. Results: The endothelium-dependent and -independent vasodilation and NARV were lower in the neuropathic group (P < 0.05). NARV was further reduced in the subgroup of painless neuropathy when compared to painful neuropathy (P < 0.05). Compared to the other two groups, the neuropathic group also had higher serum levels of PDGF AA/BB (P < 0.05), RANTES (P < 0.01), leptin (P < 0.0001), osteoprotegerin (P < 0.01), G-CSF (P < 0.05), sE-Selectin (P < 0.01), sICAM (P < 0.0001), sVCAM (P < 0.001), CRP (P < 0.0001), TNFα (P < 0.05), and fibrinogen (P < 0.05). Patients with painful neuropathy had higher sICAM-1 (P < 0.05) and CRP levels (P < 0.01) when compared to painless neuropathy. No major changes in the above results were observed in 78 diabetic patients who were seen for a second visit 21 months after the first visit. Conclusions: Peripheral diabetic neuropathy is associated with increased biochemical markers of inflammation and endothelial dysfunction. Painful neuropathy is associated with further increase in inflammation and markers of endothelial dysfunction and preservation of the nerve axon reflex.