Tonia Vassilakou

Background/Objectives: Obesity represents a major and growing economic challenge, yet evidence on its long-term economic burden and the potential value of sustained reductions in obesity prevalence remains limited in Greece. This study estimated the future economic burden of adult obesity in Greece and quantified the gross healthcare and societal costs avoided from alternative sustained reductions in obesity prevalence. Methods: A prevalence-based, top–down dynamic model was developed for the Greek adult population over 2026–2055. The analysis adopted a societal perspective and incorporated direct medical costs associated with obesity pharmacotherapy, bariatric surgery, and 36 obesity-related comorbidities, together with productivity losses from absenteeism and presenteeism. Adult population and obesity prevalence were projected using exponential smoothing, while population-attributable fractions (PAFs) linked obesity prevalence to comorbidity-related expenditure. The primary illustrative scenario assumed a hypothetical 5% annual relative reduction in adult obesity prevalence, rather than a 5% reduction in individual body weight. Potential gross costs avoided were estimated by comparing the projected obesity-attributable economic burden under this scenario with the corresponding burden under the status quo trajectory over the 2026–2055 modelling horizon. Costs were expressed in 2025 euros and discounted at 5% annually. Scenario, deterministic, and probabilistic sensitivity analyses were conducted. Results: Under the status quo, adult obesity prevalence was projected to increase from 29.24% in 2025 to 42.87% in 2055, while annual obesity-attributable costs increased from EUR 4.23 billion to EUR 5.11 billion. Direct medical costs accounted for 86.38% of cumulative expenditure. Under the 5% annual prevalence-reduction scenario, obesity prevalence declined to 6.28% by 2055, generating cumulative undiscounted gross costs avoided of EUR 71.12 billion and discounted gross costs avoided of EUR 29.25 billion. Probabilistic analysis produced discounted gross costs avoided of approximately EUR 27.85 billion, with a 95% uncertainty interval of EUR 23.83–31.61 billion. Conclusions: Adult obesity is projected to impose a substantial economic burden on Greece, with the findings illustrating the potential gross healthcare and societal costs avoided under hypothetical, sustained reductions in adult obesity prevalence, rather than the expected economic outcomes of specific interventions. These estimates are conditional on the assumed prevalence trajectories and do not establish the feasibility or cost-effectiveness of achieving such reductions.

The consumption of ultra-processed food (UPF) has increased globally and has been linked to chronic inflammation, metabolic dysfunction, and adverse health outcomes. Rheumatic and musculoskeletal diseases (RMDs) are characterized by chronic inflammation, and research has revealed that the consumption of UPF may influence disease outcomes. The present study aimed to assess UPF intake among patients with RMDs, translate and validate the short highly processed foods (sQ-HPF) questionnaire in the Greek language. A total of 152 patients with RMDs were included in the study. Of those, 50 patients and an additional 50 healthy controls were employed for the sQ-HPF validation study. Univariate and multivariable analyses were conducted to identify factors associated with UPF consumption among the total sample of patients with RMDs. For the validation of the sQ-HPF, internal consistency, criterion validity, agreement, and discriminatory ability were assessed. The overall median sQ-HPF-derived UPF estimate was 18.7% (Q1–Q3: 11.3–26.1), corresponding to an estimated UPF contribution of approximately one-fifth (1/5) of total daily food intake. Among patients with RMDs, older age, higher level of attained education –including secondary, tertiary and postgraduate studies– were associated with lower UPF consumption (p = 0.040, p = 0.013 and p = 0.014). On the other hand, being in a relationship was associated with greater sQ-HPF scores compared with being married (p = 0.043). The Greek version of the sQ-HPF demonstrated acceptable internal consistency (Cronbach’s α = 0.70), while factor loadings ranged from 0.029 to 0.562 across distinct food groups. UPF intake constitutes a substantial component of the dietary intake of both patients with RMDs and the general population. Given the growing evidence linking UPF intake with adverse health outcomes, strategies aimed at increasing awareness and reducing UPF intake may be particularly relevant for people with RMDs. Furthermore, the Greek version of the sQ-HPF demonstrated satisfactory validity and may serve as a practical tool for assessing UPF intake in the clinical and research settings.

Background: School violence is a major public health concern, with bullying alone affecting up to 50% of adolescents worldwide. Life skills-based programs have been proposed as a promising preventive approach, yet evidence for their effectiveness in secondary education remains limited. This systematic review and meta-analysis aims to synthesize the existing evidence on the effectiveness of life skills-based violence prevention programs among adolescents aged 12–18. Methods: A systematic literature search was conducted across five databases (PubMed, Scopus, ERIC, CINAHL, and PsycInfo) in accordance with PRISMA 2020 guidelines (INPLASY202650168). Interventional studies published between 2005 and 2025 that targeted secondary school students were eligible. Risk of bias was assessed using the Cochrane RoB2 (for RCTs/cRCTs) and ROBINS-I tools. A three-level random-effects meta-analytic model with Robust Variance Estimation was employed to pool Hedges’ g effect sizes. Results: Nineteen studies met the eligibility criteria, with 18 contributing 56 effect sizes to the meta-analysis. The pooled effect size was statistically significant (g = −0.2652, 95% CI [−0.4879, −0.0425], p = 0.0196), indicating an overall small reduction in violent behaviors. However, a high degree of variation in effects was observed across studies (Q(55) = 2263.58, p < 0.001; I² = 99.23%). None of the examined moderators—including outcome type, study design, and risk-of-bias tier—significantly explained this heterogeneity. The sensitivity analysis, excluding one highly influential study, yielded a smaller pooled effect (g = −0.1422, 95% CI [−0.2246, −0.00598]) while maintaining high heterogeneity (I² = 92.82%). Conclusions: Although life skills-based programs demonstrate a statistically significant overall average effect in reducing school violence among adolescents, this finding must be interpreted with extreme caution given the high degree of variation in effect sizes across contexts and the fact that prediction intervals span across zero. Because moderator analyses revealed no significant differences across intervention types, study designs, or outcome categories, no specific program type can be identified as consistently more effective. Future primary research must prioritize prospectively registered trials with multi-informant assessments to establish true intervention effectiveness.

Although the Mediterranean diet (MD) is widely recognized as a healthy dietary pattern, its potential role as a framework for sustainable urban gastronomy has received limited attention. This narrative review synthesizes evidence from nutrition, environmental studies, gastronomy, tourism, and urban food systems. The review explores MD’s sustainability dimensions, food waste and urban food systems, cultural heritage, and trends in urban gastronomy. The findings suggest that the MD is a strong model for sustainable urban food futures, combining nutritional adequacy, relatively low environmental impact, and socio-cultural legitimacy. Evidence indicates that Mediterranean-style dietary patterns are associated with lower greenhouse gas emissions, land use, energy use, and water consumption than Western diets, while also remaining comparatively affordable when based on staple plant foods. However, important challenges remain, including affordability, especially across vulnerable social groups; dependence on local supply systems; authenticity under tourism pressure; and the need for effective governance. Overall, the evidence suggests that the MD provides a useful framework for integrating health, sustainability, and cultural heritage objectives within urban food systems. Future research should focus on city-level implementation strategies, food service and restaurant sector practices, and hotel meal planning within urban MD frameworks.

(1) Background: Adolescence is a critical period for the development of health-related behaviors, including dietary habits and physical activity. This cross-sectional study examined the associations between participation in organized sports, nutrient intake, and body composition in a sample of Greek adolescents. (2) Methods: A total of 224 adolescents aged 12–18 years from schools in the Attica region, Greece, participated in the study. Physical activity and organized sports participation were assessed using a validated questionnaire. Body composition was estimated using bioelectrical impedance analysis, and dietary intake was evaluated using three-day self-reported food records analyzed with Cronometer^® nutrition analysis software. (3) Results: Boys had higher fat-free mass and basal metabolic rate and lower fat-mass percentage than girls. Organized sports participation was common and differed by sex, with boys reporting higher participation and greater adherence to physical activity recommendations than girls. Organized sports participation was associated with differences in selected nutrient intakes, particularly among late adolescents; however, several differences were attenuated when nutrient intake was standardized per 1000 kcal, suggesting that part of the observed pattern may reflect differences in total energy intake. (4) Conclusions: These cross-sectional findings suggest that age-defined adolescent stage and organized sports participation are associated with differences in sports involvement, body composition, and nutrient intake among Greek adolescents; however, causal relationships cannot be established, and the findings should be interpreted as associations.

Background/Objectives: Adolescents and university students appear to be at increased risk for internet addiction (IA), while disordered eating behavior (DEB) is common in these age groups. At the same time, adherence to the Mediterranean diet (MD) has declined in many countries. This study aimed to explore the potential association between IA, DEB and MD compliance among high school and university students. Methods: A total of 212 students aged 15–24 years participated in this cross-sectional study conducted in Greece. Data were collected via an online questionnaire including the Internet Addiction Test (IAT), KIDMED, and EAT-26 scales. Descriptive statistics, chi-square tests, and univariate and multivariate logistic regression analyses were performed. Results: Most participants demonstrated normal internet use (69.8%), while 23.1% showed mild IA and 7.1% moderate IA. Regarding dietary habits, 9.4% had low MD adherence, 52.8% moderate and 37.7% high adherence. A total of 15.6% scored above the EAT-26 cut-off, indicating risk for disordered eating behavior. IA was only significantly associated with urbanization (p = 0.014). MD adherence was not associated with gender, urbanization, financial or education status. Multivariate logistic regression showed that female gender (OR = 9.28, 95% CI: 2.10–40.91, p = 0.003) and moderate IA (OR = 6.70, 95% CI: 1.71–26.35, p = 0.006) were significant predictors of disordered eating, while educational status and MD adherence were not significant predictors. Conclusions: Moderate IA and female gender were strongly associated with an increased risk for disordered eating. Further qualitative and clinical studies are needed to better understand the interaction between IA, eating behaviors, and dietary patterns in young people.

Background: Diet is a crucial factor in both physical and mental health. Several studies in adult populations report that a healthy diet is negatively associated with depression; however, data among adolescents are scarce. Aim: The investigation of the correlation between the consumption of plant foods and depressive symptoms among adolescents. Materials and Methods: A systematic review of articles published over the last decade was conducted across five databases: PubMed, Cochrane, Embase, Scopus, and Google Scholar. Results: Fourteen studies were included in the analysis. Twelve studies reported a negative correlation between symptoms of depression in adolescents and consumption of certain plant foods. Two studies did not report significant correlations, while one study reported a weak positive correlation. Conclusions: Studies report that the consumption of plant foods and specific nutrients included in them is negatively associated with symptoms of depression in adolescents. Further research is needed to explore the relationship and the possible biological mechanisms between plant food consumption and depressive symptoms.

To evaluate interventions designed to improve transition to adult-oriented care for youth with chronic physical health problems. Methods: Electronic searches were conducted in PubMed, Google Scholar, EMBASE, and PsycINFO focusing on patient education and preparation, and their effect on the course and the follow-up of diseases, as well as on the quality of life of young people. Results: Seventeen studies met inclusion criteria. Educational programs, either hospital-based or Internet-based, and also workshops with a cognitive–behavioral approach seem to reflect positively on transition outcomes. Conclusions: This systematic review illustrates a map of interventions that enhance a successful transition of young chronic patients to adult health care. The findings suggest that educational programs, behavioral workshops, common medical appointments with pediatric and adult healthcare providers, training of the latter, and patient families are useful to transition experience. Transition programs should be developed with a long-term perspective preparing and empowering youth for the future.

This review describes the impact of current dietary patterns on health and food insecurity, emphasizing the need for a Planeterranean diet that boosts health and helps the environment. Current dietary patterns in most industrialized countries are both harmful for health and the environment and are connected to food waste despite existing policies to reduce it. Nutrition transition to Western-style diets, high in ultra-processed foods, increases environmental pressures and gas emissions. Sustainable diets promote biodiversity, reduce carbon footprints, support equity, and prioritize local, seasonal, organic, minimally processed, and culturally relevant foods. The Mediterranean diet and vegetarian diets constitute sustainable dietary patterns that benefit health and the planet. The “Planeterranean” perspective is a new scientific concept based on the Mediterranean diet, aiming to identify a sustainable food model based on locally available foods worldwide. The achievement of sustainable nutrition requires responsible agriculture, targeted policies, and community engagement. Universal guidelines must respect diverse cultures and regions, and a One Health approach is essential to improve well-being by ensuring food safety. This review critically evaluates the conceptual overlaps and limitations of these models and proposes directions for integrating sustainability and cultural aspects in policies and dietary recommendations.

Background/Objectives: Low levels of vitamins and minerals are linked to increased frailty, but the effectiveness of micronutrient supplementation remains debated. Methods: A systematic search of PubMed and Embase (end of search 10 June 2025) identified 21 randomized controlled trials from 33 articles assessing supplementation in frail individuals. Results: Regarding vitamin D supplementation, seven studies (2600 participants) reported all-cause mortality (pooled RR: 1.04, 95% CI: 0.83 to 1.31, I² = 35%) with moderate certainty of evidence, whereas only one study reported on the change in frailty levels. For multicomponent supplementation, four studies (180 participants) were identified on all-cause mortality, and two studies on change in frailty levels (pooled MD = −0.28, 95% CI: −0.71 to 0.16, I² = 0%) with very low certainty of evidence for both outcomes. Only one study investigated nicotinamide supplementation. Conclusions: Further research is needed to justify the prescription of micronutrient supplementation in this population. Future research in frailty should focus on longitudinal change in frailty levels, cognitive function, and functional measures.