Search Results (36)

Background/Objectives: To assess the association between early pregnancy carbohydrate quality, as measured by the Carbohydrate Quality Index (CQI), and the risk of delivering a large-for-gestational-age (LGA) infant in a Mediterranean pregnant cohort of northern Greece. Methods: We analyzed singleton pregnancies from the BORN 2020 prospective cohort in Greece. Dietary intake was assessed via a validated food frequency questionnaire, and CQI was computed from glycemic index, fiber density, whole-to-refined grain ratio, and solid-to-liquid carbohydrate ratio. Multivariable logistic regression was used to estimate the association between CQI (in tertiles) and LGA risk, defined as birthweight >90th percentile. Results: Among the 797 participants, 152 (19.1%) delivered LGA infants, and 117 (14.7%) were diagnosed with GDM. Of those with GDM, 23 (19.7%) delivered LGA infants. In the total population, higher maternal weight (p < 0.001), height (p = 0.006), and pre-pregnancy BMI (p = 0.004) were significantly associated with LGA. A greater proportion of women with LGA had a BMI > 25 (p = 0.007). In the GDM subgroup, maternal height remained significantly higher in those who delivered LGA infants (p = 0.017). In multivariable models, moderate CQI was consistently associated with increased odds of LGA across all models (Model 1: aOR = 1.60 (95% CI: 1.03–2.50), p = 0.037, Model 2: aOR = 1.57 (95% CI: 1.01–2.46), p = 0.046, Model 3: aOR = 1.58 (95% CI: 1.01–2.47), p = 0.044, Model 4 aOR: 1.70; 95% CI: 1.08–2.72; p = 0.023), whereas high CQI was not. In the GDM subgroup, a significant association between high CQI and increased LGA risk was observed in less adjusted models (Model 1 aOR: 6.74; 95% CI: 1.32–56.66; p = 0.039, Model 2 aOR: 6.64; 95% CI: 1.27–57.48; p = 0.044), but this was attenuated and became non-significant in the fully adjusted model (aOR: 3.05; 95% CI: 0.47–30.22; p = 0.28). When examining CQI components individually, no consistent associations were observed. Notably, a higher intake of low-quality carbohydrates (≥50% of energy intake) was significantly associated with increased LGA risk in the total population (aOR: 4.25; 95% CI: 1.53–11.67; p = 0.005). Conclusions: Higher early pregnancy intake of low-quality carbohydrates was associated with an elevated risk of LGA in the general population. However, CQI itself showed a non-linear and inconsistent relationship with LGA, with moderate, but not high, CQI linked to increased risk, particularly in GDM pregnancies, where associations were lost after adjustment. Both carbohydrate quality and quantity evaluations are essential, particularly in high-risk groups, to inform dietary guidance in pregnancy. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is a major pregnancy complication with rising global prevalence. The Mediterranean Diet (MD) has shown metabolic benefits, but total adherence scores may obscure meaningful variation in dietary quality. This study aimed to investigate whether specific dietary patterns, identified within the MD framework, and their glycemic load (GL) are associated with GDM risk. Methods: This prospective cohort is part of the BORN2020 longitudinal study on pregnant women in Greece; dietary intake was assessed using a validated food frequency questionnaire (FFQ) at two time points (pre-pregnancy and during pregnancy). MD adherence was categorized by Trichopoulou score tertiles. GL was calculated for food groups using glycemic index (GI) reference values and carbohydrate content. Dietary patterns were identified using factor analysis. Logistic regression models estimated adjusted odds ratios (aORs) for GDM risk, stratified by MD adherence and time period, controlling for maternal, lifestyle, and clinical confounders. Results: In total, 797 pregnant women were included. Total MD adherence was not significantly associated with GDM risk. However, both food-specific GLs and dietary patterns with distinct dominant foods were predictive. GL from boiled greens/salads was consistently protective (aOR range: 0.09–0.19, p < 0.05). Patterns high in tea, coffee, and herbal infusions before pregnancy were linked to increased GDM risk (aOR = 1.96, 95% CI: 1.31–3.02, p = 0.001), as were patterns rich in fresh juice, vegetables, fruits, legumes, and olive oil during pregnancy (aOR = 2.91, 95% CI: 1.50–6.24, p = 0.003). A pattern dominated by sugary sweets, cold cuts, animal fats, and refined products was inversely associated with GDM (aOR = 0.34, 95% CI: 0.17–0.64, p = 0.001). A pattern characterized by sugar alternatives was associated with higher risk for GDM (aOR = 4.94, 95% CI: 1.48–19.36, p = 0.014). These associations were supported by high statistical power (power = 1). Conclusions: Within the context of the MD, evaluating both the glycemic impact of specific food groups and identifying risk-associated dietary patterns provides greater insight into GDM risk than overall MD adherence scores alone. Full article

Background/Objectives: Pre-conception health behaviors may influence the risk of gestational diabetes mellitus (GDM), but evidence on the joint effects of physical activity (PA) and dietary patterns remains limited. This study investigated the associations between pre-conception PA and GDM risk and explored their interaction with adherence to a Mediterranean diet (MD). Methods: This analysis used data from the BORN2020 cohort, which included pregnant women in Greece (2020–2022). Pre-conception PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), expressed as the metabolic equivalent of task (MET)-min/week and categorized into quartiles. Adherence to the MD was assessed via the Trichopoulou score and then grouped into tertiles. Multivariable logistic regression models were computed, accounting for sociodemographic and clinical covariates, including sedentary time and post-lunch nap frequency. Results: In total, 524 women were included and 13.9% (n = 73) were diagnosed with GDM. Women who developed GDM were significantly older (mean age 34.41 vs. 31.98 years, p < 0.0001), were more likely to be >35 years old (46.6% vs. 26.6%, p < 0.001), had higher pre-pregnancy BMI (median 24.6 vs. 22.7 kg/m², p = 0.014), and were more likely to be obese (23.3% vs. 11.8%, p = 0.012). No significant association was observed between total pre-conception PA and GDM risk. Compared to the lowest PA quartile, women in the medium (aOR = 0.80, 95% CI: 0.45–1.40), high (aOR = 1.12, 95% CI: 0.52–2.39), and very high (aOR = 1.10, 95% CI: 0.50–2.38) PA quartiles showed no significant differences in GDM risk. PA, when modeled as a continuous variable, showed no significant trend (aOR = 0.99, 95% CI: 0.99–1.00; p-trend = 0.61). A joint analysis of PA and MD adherence also yielded no significant associations overall. However, in very small BMI-stratified subgroups, a low level of PA combined with very high MD adherence in normal-weight women was associated with increased GDM risk (aOR = 14.06, 95% CI: 1.55–165.54, p = 0.022), while in obese women, very high levels of PA and medium MD adherence showed a potentially protective effect (aOR = 0.006, 95% CI: 8.43 × 10⁻⁶–0.42, p = 0.048). These subgroup findings require cautious interpretation, due to the limited size of the sample set and wide confidence intervals. Conclusions: In this cohort, pre-conception PA, either alone or in combination with MD adherence, was not a reliable predictor of GDM. While our subgroup signals are hypothesis-generating, they do not yet support changes to clinical risk stratification. Future large-scale and interventional studies should investigate combined lifestyle interventions before conception to clarify the potential synergistic effects on GDM prevention. Full article

Background: Trimethylamine N-oxide (TMAO) is a gut- and food-derived molecule. Elevated TMAO concentrations have been associated with an increased risk of cardiovascular disease (CVD) and all-cause mortality, highlighting its significance as a potential biomarker for adverse health outcomes. Given these associations, it is hypothesized that lifestyle interventions, such as healthy dietary patterns and exercise, could reduce TMAO concentrations. The aim of this systematic–narrative hybrid literature review was to evaluate the relationship between various lifestyle interventions and TMAO. Methods: MEDLINE (via PubMed^®), Scopus^®, and grey literature were searched until July 2024 for eligible clinical trials. Case reports, case series, case studies and observational studies were excluded, as well as studies that investigated food products, nutraceuticals, dietary supplements or have been conducted in the pediatric population. Results: In total, 27 studies were included in this review. While some dietary interventions, such as plant-based, high-dairy, very low-calorie ketogenic diet or the Mediterranean diet, were associated with lower TMAO concentrations, others—including high-protein and high-fat diets—were linked to an increase in TMAO concentrations. Studies that incorporated a combination of nutrition and exercise-based intervention presented neutral results. Conclusions: The relationship between dietary interventions and TMAO concentration remains controversial. While certain interventions show promise in reducing TMAO levels, others yield mixed or contradictory outcomes. Further research, including well-structured RCTs, is needed to investigate the aforementioned associations. Full article

The available literature reports inconclusive findings regarding the frequency of organic food consumption and cancer incidence. This systematic review evaluated the effect of the frequency of organic food consumption on overall and site-specific cancer risk. Four electronic databases (PubMed, Scopus, Web of Science Core Collection, and Embase), the gray literature, and the reference lists of the included reports were searched for eligible studies. Study screening, data abstraction, and risk of bias assessment were performed by two independent examiners. Hazard ratios (HRs) and 95% confidence intervals using a random effects model were utilized to synthesize the available data from the included studies. There was no difference between the two interventions regarding overall cancer (HR = 0.93, 95% CI: 0.78–1.12), breast cancer (HR = 1.01, 95% CI: 0.81–1.26), colorectal cancer (HR = 1.01, 95% CI: 0.93–1.10), and non-Hodgkin lymphoma risks (HR = 0.70, 95% CI: 0.17–2.94). The findings suggest that the overall and site-specific cancer risk are not associated with the frequency of consumption of organic foods. Further research is necessary to provide more evidence for the role of organic food consumption on the incidence of cancer using homogeneous methodologies to define the frequency of organic food consumption. Full article

Background/Objectives: The effect of maternal macronutrient composition on the risk of large for gestational age (LGA) neonates among women with gestational diabetes mellitus (GDM) is not well understood. This study aimed to investigate these associations in a pregnant cohort in Northern Greece, considering both pre-pregnancy and early pregnancy dietary intake, and stratifying women by pre-pregnancy body mass index (BMI). Methods: From a total of 797 eligible pregnant women, the 117 (14.7%) who developed GDM (and thus were included in the study) completed the validated Food Frequency Questionnaires (FFQs). Macronutrient intake was assessed for the six months before pregnancy and until mid-gestation, prior to the oral glucose tolerance test. Data were compared with European Food Safety Authority (EFSA) guidelines, and participants were stratified by pre-pregnancy BMI (normal vs. overweight/obese). Multivariate logistic regression was used to estimate adjusted odds ratios (aORs) for LGA risk. Results: In normal-BMI women with GDM, higher dietary fiber (aOR = 1.39) and vegetable protein (aOR = 1.61) intake before pregnancy were both significantly associated with an increased risk of LGA. During early pregnancy, the elevated risk from vegetable protein persisted (aOR = 1.51). Among overweight/obese women, no significant pre-pregnancy associations were observed. However, during early pregnancy, a higher percentage of total carbohydrate intake was linked to increased LGA risk (aOR = 1.11), while maintaining saturated fatty acids “as low as possible” reduced the odds of LGA (aOR = 0.71). Elevated vegetable protein intake also increased LGA risk (aOR = 1.61). Conclusions: Maternal macronutrient intake prior to and during early pregnancy may influence LGA risk in GDM, with distinct patterns according to pre-pregnancy BMI. These findings underscore the importance of tailoring dietary recommendations—especially regarding fiber, vegetable protein, carbohydrates, and saturated fat—to mitigate the risk of LGA in women with GDM. Full article

Background/Objectives: Maternal amino acid intake and its biological value may influence glucose regulation and insulin sensitivity, impacting the risk of developing gestational diabetes mellitus (GDM). This study aimed to evaluate the association between amino acid intake from maternal diet before and during pregnancy and the risk of GDM. Methods: This study is part of the ongoing BORN2020 epidemiological Greek cohort. A validated semi-quantitative Food Frequency Questionnaire (FFQ) was used. Amino acid intakes were quantified from the FFQ responses. A multinomial logistic regression model, with adjustments made for maternal characteristics, lifestyle habits, and pregnancy-specific factors, was used. Results: A total of 797 pregnant women were recruited, of which 14.7% developed GDM. Higher cysteine intake during pregnancy was associated with an increase in GDM risk (adjusted odds ratio [aOR]: 5.75; 95% confidence interval [CI]: 1.42–23.46), corresponding to a 476% increase in risk. Additionally, higher intakes of aspartic acid (aOR: 1.32; 95% CI: 1.05–1.66), isoleucine (aOR: 1.48; 95% CI: 1.03–2.14), phenylalanine (aOR: 1.6; 95% CI: 1.04–2.45), and threonine (aOR: 1.56; 95% CI: 1.0–2.43) during pregnancy were also associated with increased GDM risk. Furthermore, total essential amino acid (EAA) (aOR: 1.04; 95% CI: 1.0–1.09) and non-essential amino acid (NEAA) (aOR: 1.05; 95% CI: 1.0–1.1) intakes during pregnancy were also linked to an increased risk of GDM. A secondary dose–response analysis affected by timing of assessment revealed that higher intake levels of specific amino acids showed a more pronounced risk. Conclusions: Optimizing the balance of certain amino acids during pregnancy may guide personalized nutritional interventions to mitigate GDM risk. Full article

Background/Objectives: Limited evidence links maternal macronutrient intake to gestational diabetes mellitus (GDM) risk. Therefore, we evaluated these intakes both before and during pregnancy, comparing macronutrient data against the European Food and Safety Authorities’ (EFSA) Dietary Reference Values (DRVs). Methods: Data were prospectively collected from the Greek BORN2020 epidemiologic pregnant cohort, which included 797 pregnant women, of whom 14.7% were diagnosed with GDM. A multinomial logistic regression model assessed the association between macronutrient intake and GDM, adjusting for maternal, lifestyle, and pregnancy-related factors. Results: Women with GDM had higher maternal age (34.15 ± 4.48 vs. 32.1 ± 4.89 years), higher pre-pregnancy BMI (median 23.7 vs. 22.7 kg/m²), and were more likely to smoke during mid-gestation (17.95% vs. 8.82%). Pre-pregnancy energy intake exceeding EFSA recommendations was associated with increased GDM risk (aOR = 1.99, 95%CI: 1.37–2.86). During mid-gestation, higher dietary fiber intake (aOR = 1.05, 95%CI: 1.00–1.10), higher protein intake (aOR = 1.02, 95% CI: 1.00–1.04), and higher protein percentage of energy intake (aOR = 1.08, 95%CI: 1.01–1.17) were all significantly associated with increased GDM risk. Changes from pre-pregnancy to pregnancy showed significant increases in dietary fiber intake (aOR = 1.07, 95%CI: 1.04–1.10), protein (aOR = 1.00, 95%CI: 1.00–1.01), fat (aOR = 1.00, 95%CI: 1.00–1.01), vegetable protein (aOR = 1.01, 95%CI: 1.00–1.03), animal protein (aOR = 1.00, 95%CI: 1.00–1.01), and monounsaturated fatty acid (MUFA) intake (aOR = 1.01, 95%CI: 1.00–1.02), all of which were associated with increased GDM risk. Conclusions: Energy intake above upper levels set by EFSA, as well as increased protein, MUFA, and fiber intake, although beneficial in balanced intakes, may negatively affect gestation by increasing GDM likelihood when consumed beyond requirements. Full article

Vascular aging, marked by alterations in the structure and function of blood vessels, including heightened arterial stiffness and impaired endothelial function, is linked to a higher likelihood of developing cardiovascular and age-associated pathological conditions. Oxidative stress and inflammation are key stimulation factors in vascular aging. Engaging in healthy dietary habits could enhance the functioning of blood vessels. The aim of this study was to conduct a literature review of the evidence regarding the relationship between food regimens, nutraceuticals, and dietary supplements and vascular health. A search of electronic databases, including PubMed, Scopus, and Web of Science Core Collection, was performed. Experimental and observational studies evaluating the association between food groups, nutraceuticals, supplements, and endothelial function and/or arterial stiffness were deemed eligible for this narrative review. Based on the current body of the included studies, food groups, nutraceuticals, and dietary supplements may not demonstrate superiority over placebos in enhancing markers of vascular health. To obtain more reliable evidence on the effectiveness of interventions in vascular health, additional RCTs with larger sample sizes, extended follow-up periods, and multi-center participation are necessary. Enhancing the credibility of these RCTs requires better control of dietary variables and more precise measurement of vascular health markers. Full article

Introduction–Background: Data from experimental trials show that Crocus sativus L. (saffron) is considered to improve glycemia, lipid profile, and blood pressure and reduce oxidative stress. So far, clinical trials have been conducted in individuals with metabolic syndrome and Diabetes Mellitus type 2 (DMT-2). The purpose of this study is to assess the effectiveness of saffron in individuals with Diabetes Mellitus type 1 (DMT-1). Patients–Methods: 61 individuals with DMT-1, mean age 48 years old (48.3 ± 14.6), 26 females (42.6%) were randomized to receive a new oral supplement in sachets containing probiotics, prebiotics, magnesium, and Crocus sativus L. extract or placebo containing probiotics, prebiotics and magnesium daily for 6 months. Glycemic control was assessed with a continuous glucose monitoring system and laboratory measurement of HbA1c and lipid profile was also examined. Blood pressure at baseline and end of intervention was also measured. Individuals were either on a continuous subcutaneous insulin infusion with an insulin pump or in multiple daily injection regimens. Diabetes distress and satiety were assessed through a questionnaire and body composition was assessed with bioelectrical impedance. Results: At the end of the intervention, the two groups differed significantly only in serum triglycerides (p = 0.049). After 6 months of treatment, a significant reduction in the active group was observed in glycated hemoglobin (p = 0.046) and serum triglycerides (p = 0.021) compared to baseline. The other primary endpoints (glycemic control, lipid profile, blood pressure) did not differ within the groups from baseline to end of intervention, and there was no significant difference between the two groups. Diabetes distress score improved significantly only in the active group (p = 0.044), suggesting an overall improvement in diabetes disease burden in these individuals but that was not significant enough between the two groups. Conclusions: A probiotic supplement with saffron extract improves serum triglycerides in well-controlled people with DMT-1 and may potentially be a valuable adjunct for enhancing glycemic control. Full article

Background: This study investigates the efficacy of Front-of-Pack Nutrition Labels (FOPNLs) as a cost-effective tool for improving dietary choices among Greek consumers. The purpose of the study was to investigate Greek customers’ preferences and comprehension of commonly used European FOPNL schemes. Methods: The Hellenic Food Authority and the Agricultural University of Athens performed a representative online survey in March 2022, titled “The Role of Nutritional Labelling in Public Perception and Food Procurement.” Consumers responded to a questionnaire separated into two parts. Part one included (i) personal, sociodemographic information, and (ii) subjective opinions on the FOPNL schemes, and part two comprised (iii) an objective understanding of NutriScore and NutrInform Battery, using 15 different foods. Participants were randomly allocated to these groups, and general mixed models were used for analysis. Results: A total of 1389 adults completed the first part of the survey, and 74.8% completed the second part. The Multiple Traffic Lights scheme was the preferred FOPNL, chosen by 48.4% of respondents, compared to 19.7% for NutrInform Battery and 12.3% for NutriScore. However, the mean objective assessment score was highest for NutriScore (5.8 ± 2.3) compared to NutrInform Battery (5.4 ± 1.9). Conclusion: The results highlight the necessity for comprehensive nutrition education programs by showing a considerable gap between subjective preferences and an objective understanding of nutrition labels. Full article

Understanding how maternal micronutrient intake and dietary habits impact gestational diabetes mellitus (GDM) is crucial. Data from 797 pregnant women were prospectively analyzed to assess GDM status with the oral glucose tolerance test (OGTT). Nutritional intake was evaluated using a validated food frequency questionnaire (FFQ) across two periods: Period A, covering 6 months before pregnancy, and Period B, from pregnancy onset to mid-gestation (24 weeks). Micronutrient intakes were compared against the European Food Safety Authority (EFSA) dietary reference values (DRVs) and were used to estimate the mean adequacy ratio (MAR) to assess dietary adequacy. GDM was diagnosed in 14.7% (n = 117) of women with the characteristics of a higher mean maternal age (MA) and pre-pregnancy body mass index (BMI). Out of the 13 vitamins assessed, biotin, folate, niacin, and pantothenic acid were found significantly higher in the GDM group, as did iron, magnesium, manganese, phosphorus, and zinc from the 10 minerals. The results were influenced by the timing of the assessment. Importantly, MAR was higher during pregnancy and was found to increase the risk of GDM by 1% (95%CI: 1, 1.02). A sensitivity analysis revealed that reducing MAR significantly raised the GDM risk by 68% (95%CI: 1.02, 2.79). No association was revealed between adherence to the Mediterranean diet (MD) and GDM risk. These findings highlight areas for further investigation into whether dietary modifications involving these specific micronutrients could effectively influence GDM outcomes. Full article

Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disorder, is closely associated with insulin resistance, obesity, and metabolic syndromes. A body of research has proposed that olive oil, a basic component of the Mediterranean diet with antioxidant and anti-inflammatory properties, may alleviate metabolic disturbances and retard the progression of NAFLD. We conducted a systematic review and meta-analysis to assess the effectiveness of olive oil intake in people with NAFLD. We systematically searched the major electronic databases (PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials), as well as grey literature sources, to identify randomized controlled trials (RCTs) investigating the effects of olive oil consumption on biochemical and anthropometric parameters of individuals with NAFLD. The quality of the studies was evaluated using the risk-of-bias tool 2.0 (RoB 2). The mean difference (MD) and the 95% confidence interval (CI) were calculated using fixed-effects and random-effects models. Seven RCTs involving 515 subjects were included in the analysis. In the random-effects model, no statistically significant differences were identified with respect to alanine transaminase (MD = −1.83 IU/L, 95% CI: −5.85, 2.19 IU/L, p = 0.37, I² = 69%) and aspartate transaminase (MD = −1.65 IU/L, 95% CI: −4.48, 1.17 IU/L, p = 0.25, I² = 72%) levels or waist circumference values (MD = −0.23 cm, 95% CI: −1.23, 0.76 cm, p = 0.65, I² = 0%). However, a significant effect on body mass index was observed (MD = −0.57 kg/m², 95% CI: −1.08, −0.06 kg/m², p = 0.03, I² = 51%) for subjects who received olive oil compared to those who received an alternative diet or placebo. The findings of the present meta-analysis suggest a modestly positive impact of olive oil intake on body weight in people with NAFLD. Full article

Early vascular aging is related to various cardiovascular diseases including hypertension, coronary heart disease, and stroke. Healthful lifestyle practices and interventions, including dietary regimens and consistent aerobic exercise, exert favorable modulation on these processes, thereby diminishing the risk of cardiovascular disease with advancing age. The principal objective of this review was to conduct a comprehensive evaluation and synthesis of the available literature regarding the effectiveness of different diets on vascular health, such as arterial stiffness and endothelial function. To conduct this review, a thorough search of electronic databases including PubMed, Scopus, and Web of Science Core Collection was carried out. Based on the existing evidence, the Mediterranean, Dietary Approaches to Stop Hypertension, and low-calorie diets may have a beneficial effect on vascular health. However, more randomized controlled trials with sufficient sample sizes, longer follow-ups, rigorous methodologies, and, possibly, head-to-head comparisons between the different diets are needed to shed light on this topic. Full article