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The Mediterranean dietary pattern has been associated with a decreased risk of many degenerative diseases and cognitive function in particular; however, relevant information from Mediterranean regions, where the prototype Mediterranean diet is typically adhered to, have been very limited. Additionally, predefined Mediterranean diet (MeDi) scores with use of a priori cut-offs have been used very rarely, limiting comparisons between different populations and thus external validity of the associations. Finally, associations between individual components of MeDi (i.e., food groups, macronutrients) and particular aspects of cognitive performance have rarely been explored. We evaluated the association of adherence to an a priori defined Mediterranean dietary pattern and its components with dementia and specific aspects of cognitive function in a representative population cohort in Greece. Participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD), an on-going population-based study, exploring potential associations between diet and cognitive performance in a representative sample from Greek regions, were included in this analysis. Diagnosis of dementia was made by a full clinical and neuropsychological evaluation, while cognitive performance was assessed according to five cognitive domains (memory, language, attention-speed, executive functioning, visuospatial perception) and a composite cognitive score. Adherence to MeDi was evaluated by an a priori score (range 0-55), derived from a detailed food frequency questionnaire. Among 1,865 individuals (mean age 73±6 years, 41% male), 90 were diagnosed with dementia and 223 with mild cognitive impairment. Each unit increase in the Mediterranean dietary score (MedDietScore) was associated with a 10% decrease in the odds for dementia. Adherence to the MeDi was also associated with better performance in memory, language, visuospatial perception and the composite cognitive score; the associations were strongest for memory. Fish consumption was negatively associated with dementia and cognitive performance positively associated with non-refined cereal consumption. Our results suggest that adherence to the MeDi is associated with better cognitive performance and lower dementia rates in Greek elders. Thus, the MeDi in its a priori constructed prototype form may have cognitive benefits in traditional Mediterranean populations.

Nutrition is an important lifestyle factor that can modify the risk of future cognitive impairment and dementia. Some, but not conclusive, evidence (mostly from observational studies and infrequently from clinical trials) exists of a protective association between certain nutrients (eg, folate, flavonoids, vitamin D, and certain lipids) or food groups (eg, seafood, vegetables, and fruits, and potentially moderate alcohol and caffeine consumption) and cognitive outcomes in older people. For some nutrients and food groups, protection might be greater in individuals with either deficiencies in certain nutrients or a genetic predisposition to cognitive impairment. Identification of potentially different associations between such subgroups should be a priority for future research. At present, evidence of an association between nutrition and cognitive outcomes is somehow stronger for healthy dietary patterns, such as the Mediterranean-type diet, than for individual nutrients and food groups, possibly because of the cumulative beneficial effects of the many ingredients in these diets. Multidomain interventions (including a nutrition component) might also hold some promise for the prevention of cognitive impairment and dementia, but their effectiveness is still uncertain. Use of advanced technologies for nutrition assessment (eg, metabolomics and innovative methods of dietary intake assessment) and recently identified biomarkers of nutrition and neurobiological outcomes will be important to achieve this goal.

The aim of the present analysis was to evaluate the association of the Mediterranean diet (MeDi), smoking habits and physical activity with all-cause mortality in an Italian population during a 20-year follow-up study. A total of 1693 subjects aged 40–74 who enrolled in the study in 1991–5 were asked about dietary and other lifestyle information at baseline. Adherence to the MeDi was evaluated by the Mediterranean dietary score (MedDietScore). A healthy lifestyle score was computed by assigning 1 point each for a medium or high adherence to the MedDietScore, non-smoking and physical activity. Cox models were used to assess the associations between lifestyle factors and healthy lifestyle scores and all-cause mortality, adjusting for potential confounders. The final sample included 974 subjects with complete data and without chronic disease at baseline. During a median of 17·4 years of follow-up, 193 people died. Subjects with high adherence to the MedDietScore (hazard ratio (HR) 0·62, 95 % CI 0·43, 0·89)), non-smokers (HR 0·71, 95 % CI 0·51, 0·98) and physically active subjects (HR 0·55, 95 % CI 0·36, 0·82) were at low risk of death. Each point increase in the MedDietScore was associated with a significant 5 % reduction of death risk. Subjects with 1, 2 or 3 healthy lifestyle behaviours had a significantly 39, 56, and 73 % reduced risk of death, respectively. A high adherence to MeDi, non-smoking and physical activity were strongly associated with a reduced risk of all-cause mortality in healthy subjects after long-term follow-up. This reduction was even stronger when the healthy lifestyle behaviours were combined.

Purpose The dietary habits contributing to weight loss maintenance are not sufficiently understood. We studied weight loss maintainers in comparison with regainers, to identify the differentiating behaviors. Methods The MedWeight study is a Greek registry of weight loss maintainers and regainers. Participants had intentionally lost ≥10 % of their weight and either had maintained this loss for over a year, or had regained weight. Questionnaires on demographics and lifestyle habits were completed online. Dietary assessment was carried out by two telephone 24-h recalls. Results Present analysis focused on 361 participants (32 years old, 39 % men): 264 maintainers and 97 regainers. Energy and macronutrient intake did not differ by maintenance status (1770 ± 651 kcal in maintainers vs. 1845 ± 678 kcal in regainers, p  = 0.338), although protein intake per kg of body weight was higher in maintainers (1.02 ± 0.39 vs. 0.83 ± 0.28 g/kg in regainers, p  < 0.001). Physical activity energy expenditure was greater for maintainers in men (by 1380 kcal per week, p  = 0.016), but not women. Salty snacks, alcohol and regular soda were more frequently consumed by men regainers. Principal component analysis identified a healthy dietary pattern featuring mainly unprocessed cereal, fruit, vegetables, olive oil and low-fat dairy. Male maintainers were 4.6 times more likely to follow this healthy pattern compared to regainers (OR 4.6, 95 % CI 2.0–11.0). No similar finding was revealed in women. Other characteristics of maintainers but not of regainers were: involvement in meal preparation and eating at home for men, and a higher eating frequency and slower eating rate for women. Conclusions Men maintaining weight loss were much more likely to adhere to a healthy eating pattern. Eating at home, involvement in meal preparation, higher eating frequency and slower eating rate were also associated with maintenance. These lifestyle habits of successful maintainers provide target behaviors to improve obesity treatment.

Weight loss maintenance is crucial for obesity management, yet optimal dietary patterns for this period are not established. We aimed to explore the relationship between adherence to the Mediterranean diet and weight loss maintenance. Sample includes 565 adults (62 % women) of the MedWeight study. Eligible volunteers were those reporting intentional weight loss of ≥10 %, starting from a BMI ≥ 25 kg/m2, over 12 months prior to enrolment. Based on current weight, participants were characterised as maintainers (≤90 % maximum weight) or regainers (>95 % maximum weight). Socio-demographics and weight history were recorded. Dietary intake was assessed by two non-consecutive 24-h recalls within 10 d and analysed in energy, macronutrient and food group intakes. Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Score (MedDietScore) (range 0–55, greater scores showing higher adherence). Protein intake was higher in maintainers than in regainers (P < 0·001). When MedDietScore quartiles were considered, a linear trend for weight loss maintenance was revealed (P < 0·05). After adjustment for basic demographic characteristics, being in the third or fourth quartile of the MedDietScore (v. first) was associated with 2·30 (95 % CI 1·29, 4·09) and 1·88 (95 % CI 1·10, 3·22) increased odds of maintenance. Regarding individual MedDietScore components, only fruit intake is associated with increased odds for maintenance (1·03 (95 % CI 1·01, 1·06)). The leave-one-out approach revealed that at least six MedDietScore components were essential for the observed relationship. Higher adherence to the Mediterranean diet was associated with 2-fold increased likelihood of weight loss maintenance. Future studies should replicate these findings in non-Mediterranean populations as well.

Even though obese individuals often succeed with weight loss, long-term weight loss maintenance remains elusive. Dietary, lifestyle and psychosocial correlates of weight loss maintenance have been researched, yet the nature of maintenance is still poorly understood. Studying the neural processing of weight loss maintainers may provide a much-needed insight towards sustained obesity management. In this narrative review, we evaluate and critically discuss available evidence regarding the food-related neural responses of weight loss maintainers, as opposed to those of obese or lean persons. While research is still ongoing, available data indicate that following weight loss, maintainers exhibit persistent reward related feeling over food, similar to that of obese persons. However, unlike in obese persons, in maintainers, reward-related brain activity appears to be counteracted by subsequently heightened inhibition. These findings suggest that post-dieting, maintainers acquire a certain level of cognitive control which possibly protects them from weight regaining. The prefrontal cortex, as well as the limbic system, encompass key regions of interest for weight loss maintenance, and their contributions to long term successful weight loss should be further explored. Future possibilities and supportive theories are discussed.

The number of older adults is increasing rapidly. Malnutrition is a major problem in this age group, which may adversely affect health and quality of life. Several physiological, socioeconomic, and neuropsychological factors can lead to malnutrition. The aim of this study was to evaluate the nutritional status of community-dwelling older adults, and explore the associations of malnutrition risk with physiological, socioeconomic, and neuropsychological characteristics. This study is part of the Hellenic Longitudinal Investigation of Aging and Diet study, a cross-sectional observational study in Greece, and study participants were 1831 urban-dwelling elderly individuals (mean age: 73.1 ± 5.9 y; 40.8% men). Risk for malnutrition was assessed with the Determine Your Nutritional Health checklist. Data on age, sex, level of education, marital status, depression, cognitive performance, body mass index, total energy intake, and adherence to the Mediterranean diet were recorded. Correlations and multivariate analyses were performed between these variables and risk for malnutrition. The estimated prevalence of moderate and high nutritional risks was 34.8% and 29.4%, respectively. Risk for malnutrition was associated with marital status (unmarried), increased body mass index, male sex, lower level of education, lower cognitive performance, and lower adherence to the Mediterranean diet (P < 0.05). Nutritional screening should be performed frequently in all community-dwelling older adults. Health experts should perform nutritional screening in all community-dwelling older adults as part of secondary prevention, and nutrition counselling and support should be offered in those at risk for malnutrition. •Malnutrition is a significant problem in older age groups owing to the deteriorating health and quality of life of older people.•The prevalence of moderate and high nutritional risks was 34.8% and 29.4%, respectively.•Risk for malnutrition was associated with marital status, increased body mass index, male sex, lower level of education, cognitive performance, and adherence to the Mediterranean diet.

The role of social support in weight management is not fully understood, as more support has been linked to both favorable and unfavorable outcomes. We examined social support in relation to weight loss maintenance, comparing between maintainers and regainers of weight loss. The MedWeight study is a Greek registry of people who have intentionally lost ≥10 % of their weight and are either maintaining this loss for over a year (maintainers), or have regained weight (regainers). Demographics and lifestyle habits questionnaires are completed online. Dietary assessment is carried out by two telephone 24 h recalls. Perceived social support was assessed by validated scales examining support from family and friends regarding healthy eating and exercise. 289 maintainers and 122 regainers participated. Regainers received more support compared to maintainers. However, maintainers reported receiving compliments and active participation, whereas regainers receiving verbal instructions and encouragements. Maintainers who received diet support displayed improved dietary intakes, such as lower energy intake; regainers’ diet was unaffected by support. Positive, rather than instructive, support appears beneficial in weight loss maintenance.

Studies exploring the accuracy of equations calculating resting energy expenditure (REE) in patients with Crohn’s disease (CD) are lacking. The aim of this study was to investigate the accuracy of REE predictive equations against indirect calorimetry in CD patients. REE was measured using indirect calorimetry (mREE) after an overnight fasting. Fourteen predictive equations, with and without body composition analysis parameters, were compared with mREE using different body weight approaches. Body composition analysis was performed using dual X-ray absorptiometry. One hundred and eighty-six CD outpatients (102 males) with mean age 41·3 (sd 14·1) years and 37·6 % with active disease were evaluated. Mean mREE in the total sample was 7255 (sd 1854) kJ/day. All equations underpredicted REE and showed moderate correlations with mREE (Pearson’s r or Spearman’s rho 0·600–0·680 for current weight, all P-values < 0·001). Accuracy was low for all equations at the individual level (28–42 and 25–40 % for current and adjusted body weight, respectively, 19–33 % for equations including body composition parameters). At the group level, accuracy showed wide limits of agreement and proportional biases. Accuracy remained low when sample was studied according to disease activity, sex, BMI and medication use. All predictive equations underestimated REE and showed low accuracy. Indirect calorimetry remains the best method for estimating REE of patients with CD.

Maternal weight-status at various time-points may influence child obesity development, however the most critical time-point remains unidentified. We used data from the Healthy Growth Study, a cross-sectional study of 2666 Greek schoolchildren aged 9–13 years, exploring associations between childhood obesity and maternal weight-status at pre-pregnancy, during pregnancy/gestational weight gain, and at the child’s pre-adolescence. Logistic regression analyses examined associations between maternal weight-status being “below” or “above” the recommended cut-off points (WHO BMI thresholds or IOM cut-off points), at the three time-points, individually or combined into weight-status trajectory groups to determine the strongest associations with child obesity in pre-adolescence. Adjusted models found significant associations and the highest odds ratios [95% Confidence Intervals] for mothers affected by obesity before pregnancy (4.16 [2.47, 7.02]), those with excessive gestational weight gain during pregnancy (1.50 [1.08, 2.08]), and those affected by obesity at their child’s pre-adolescence (3.3 [2.29, 4.87]). When combining these weight-status groups, mothers who were above–above–below (3.24 [1.10, 9.55]), and above–above–above (3.07 [1.95, 4.85]) the healthy weight recommendation-based thresholds in each time-point, had a three-fold higher likelihood of child obesity, compared to the below–below–below trajectory group. Maternal obesity across all examined time-points was significantly associated with childhood obesity. Effective childhood obesity preventive initiatives should commence at pre-conception, targeting maternal weight throughout the life-course and childhood developmental stages.