Rena I. Kosti

The role of wine within the Mediterranean diet remains one of the most debated and paradoxical issues in nutritional epidemiology. Although moderate wine consumption, particularly alongside meals, has traditionally been incorporated into Mediterranean diet scores and has been associated with lower cardiovascular and all-cause mortality, alcohol is also an established carcinogen, with evidence of increased cancer risk even at relatively low levels of consumption. This apparent contradiction has renewed the debate over whether wine represents a genuine protective component of the Mediterranean diet or whether its observed associations reflect methodological and contextual factors. In this opinion paper, we critically examine emerging evidence on wine consumption, the Mediterranean dietary pattern and the Mediterranean alcohol-drinking pattern, with particular attention to the limitations of observational alcohol epidemiology, including abstainer-reference bias, reverse causation, exposure misclassification and the divergence between observational and Mendelian randomization evidence. Additionally, drawing on the concept of the traditional Mediterranean lifestyle, we further propose that moderation and synergy between lifestyle components may be more informative than the isolated attribution of health effects to individual foods or beverages. Thus, instead of searching for a “hidden virtue” in wine itself, the more relevant hypothesis may be that of a “hidden context”, whereby the health associations attributed to moderate wine consumption are inseparable from the broader Mediterranean lifestyle in which it is embedded.

Background: Given the rising global prevalence of dementia and its complex etiology, involving genetic and environmental risk factors, the aim of the present exploratory study was to investigate how offspring of individuals with dementia perceive genetic risk and the role of diet in dementia prevention. Methods: A mixed-methods study was conducted in Greece. Overall, 118 offspring completed an online questionnaire assessing demographics, risk perceptions, and dietary beliefs and practices in dementia risk reduction. Additionally, 22 semi-structured interviews explored dietary beliefs, practices, and influencing factors using framework analysis. Results: Most participants (76.3%) recognized diet’s role in dementia prevention, while 52.5% perceived offspring as having increased genetic risk; 40.7% reported making dietary changes to reduce disease risk. Healthcare professional consultation was the factor most strongly associated with dietary modification (OR = 26.61, 95% CI 7.47–94.76, p < 0.001). Qualitative findings showed that, while dementia was viewed as severe, personal susceptibility was often perceived as uncertain or distant. Key barriers, facilitators, and the role of self-efficacy in adopting healthier dietary practices were also explored. Conclusions: Our findings identify personalized dietary counselling and risk communication as priorities for evaluation in future intervention studies, aimed at supporting the implementation of dietary modifications and reducing the gap between knowledge and behavior in dementia risk reduction.

Background: Given the rising global prevalence of dementia and its complex etiology, involving genetic and environmental risk factors, the aim of the present exploratory study was to investigate how offspring of individuals with dementia perceive genetic risk and the role of diet in dementia prevention. Methods: A mixed-methods study was conducted in Greece. Overall, 118 offspring completed an online questionnaire as-sessing demographics, risk perceptions, and dietary beliefs and practices in dementia prevention. Additionally, 22 semi-structured interviews explored dietary beliefs, prac-tices, and influencing factors using framework analysis. Results: Most participants (76.3%), widely recognized diet's role in dementia prevention, while 52.5% perceived offspring as having increased genetic risk. 40.7% reported making dietary changes to reduce disease risk, with healthcare professional consultation being the strongest pre-dictor of dietary modifications (OR = 26.612, p < 0.001). Qualitative findings showed that while dementia was viewed as severe, personal susceptibility was often perceived as uncertain or distant. Key barriers, facilitators, and the role of self-efficacy in adopt-ing healthier dietary practices were also explored. Conclusions: Our findings highlight the importance of personalized dietary counselling and risk communication in demen-tia, to support the implementation of dietary modifications and reduce the gap be-tween knowledge and behavior in dementia prevention.

Objective: Temperament‐Based Treatment with Supports (TBT‐S) is an intensive treatment for patients with eating disorders (EDs) integrating neurobiological insights and family dimensions with the involvement of supports. Previous studies report high acceptability among both patients and their supports, and improvements in clinical outcomes and family functioning. The present study investigated acceptability and short‐term outcomes of TBT‐S intervention as adjunctive to ongoing, specialised treatment for anorexia nervosa (AN) in late adolescent and young adult patients and their supports. Method: Thirty‐two patients (mean age = 21.44, SD = 4.72), 29 mothers, and 22 fathers participated in eight TBT‐S interventions in Greece. ED symptomatology, patients' and supports' psychological distress, and supports' emotional and behavioural responses were assessed immediately before and after participation in TBT‐S intervention. Also, acceptability of TBT‐S intervention was assessed. Results: TBT‐S intervention was found to be highly acceptable among patients and their supports. Patients reported significant reductions in ED restraint symptomatology and depression. Mothers displayed significant reductions in depression, stress, criticism, and accommodating and enabling behaviours. Conversely, fathers displayed significant increases in depression and anxiety. Conclusions: TBT‐S intervention demonstrated high acceptability among patients and supports, and was associated with several short‐term outcomes as adjunctive to ongoing treatment for AN.

By conducting a narrative review of the scientific literature, the authors of this study sought to verify whether there were sufficient data to answer the following question: “Can wine positively or negatively influence the incidence and severity of disorders associated with gastrointestinal (GI) diseases?”. In this review, most of the studies considered tested different alcoholic beverages (other than wine), not always reporting in the conclusions the possible difference in the extent of symptoms. Although alcohol certainly plays a central role in influencing the oesophageal and gastric environment, no studies evaluating the role of alcohol as such were included, since the aim of the review was to understand whether wine can be moderately consumed by patients with gastrointestinal diseases. The analysis of studies selected from the main reference databases indicates that even moderate wine consumption can be a source of discomfort in subjects with the GI diseases included in this review (gastritis and gastroesophageal disease, gastrointestinal motility, inflammatory bowel disease, irritable bowel syndrome, and microscopic colitis). This does not mean that a certain percentage of patients cannot tolerate moderate amounts of alcoholic beverages; however, discussion with the family doctor or specialist is essential to identify the correct diet in which to include or exclude the consumption of wine. One of the limitations of this review is the low number of studies available, at least for some of the pathologies considered. It is important to emphasise, however, that some selected epidemiological studies, which include many subjects (even over 100,000), can provide useful information from a scientific point of view.

Background/Objectives: The COVID-19 pandemic has led to detrimental effects on diverse aspects of the mental and physical health of the general population worldwide. The elderly are more susceptible to COVID-19 infection compared to younger age groups. In this aspect, the purpose of the current survey is to evaluate the effect of the COVID-19 pandemic on the interrelationships among the sociodemographic and anthropometric characteristics, depressive behavior, quality of life, cognition status, physical activity and nutritional status of older adults. Methods: The present study constitutes a comparative, cross-sectional study of 4162 older adults (mean age ± standard deviation: 72.13 ± 8.1 years and 75.22 ± 8.2 years in the pre- and post-COVID-19 periods, respectively, and a male/female ratio of almost 1:1). We used validated questionnaires to assess depression, cognition function, quality of life, physical activity and nutritional status of the elderly in the pre-Covid and post-Covid periods. Relevant questionnaires were also used for collecting sociodemographic data, while anthropometric data were measured using standard protocols. Results: The present study finds that the COVID-19 pandemic influenced, in an independent manner, residence location, smoking status, overweight/obesity and abdominal obesity, depressive behavior, quality of life, cognition behavior, physical activity levels and nutritional status of the elderly. The COVID-19 pandemic was also related to employment and living status as well as family economic status. Nevertheless, the above three relationships were insignificant in the multivariate analysis. Conclusions: The COVID-19 pandemic exerted deleterious effects on several aspects of the mental and physical health of the elderly, which appeared to strongly persist in the post-Covid period. Future prospective population-based and well-organized surveys should be conducted to establish whether there is a causality long-term effect of the COVID-19 pandemic on diverse aspects of the mental and physical health of the elderly.

Background/Objectives: Home isolation measures during the COVID-19 lockdown periods may have influenced individuals’ lifestyles. The COVEAT study aimed to identify differences in children’s and their parents’ dietary behavior, children’s body weight and parental body mass index (BMI) between two lockdown periods implemented in Greece. Methods: In total, 61 participants (children 2–18 years and their parents) completed questionnaires about their lifestyle, body weight and height, and family socio-demographic data, during both lockdown periods (LDs) implemented in Greece (LD1 in March–May 2020; LD2 in December 2020–January 2021). Results: No significant differences in parents’ BMI and fluctuations in children’s/adolescents’ body weight and BMI were observed in LD2 compared to LD1. Regarding dietary behavior, in LD2 fewer parents were found to have dinner and prepared home meals and more families reported to order fast food. Furthermore, a significant decrease in the consumption of fresh and prepacked juices and an increase in fast-food consumption were observed for children/adolescents in LD2 compared to LD1. Conclusions: The findings of the COVEAT study indicate that each lockdown period had a different impact on children’s/adolescents’ and their parents’ dietary behavior, with less favorable changes observed in LD2, suggesting that the implementation of additional lockdowns may have had a negative impact on individuals’ lifestyles.

Background: Mediterranean diet (MD) constitutes a commonly examined dietary model. It includes a plethora of bioactive ingredients with strong antioxidant, anti-inflammatory, antithrombotic and anticancer properties. Several substantial studies support strong evidence that MD can exert preventing actions against human morbidity and mortality, promoting human well-being and quality of life. The present study aims to evaluate whether childhood MD compliance may be associated with socio-demographic, anthropometric, and lifestyle factors in children at the age of 6–9 years. Methods: This is a cross-sectional survey on 3875 children aged 6–9 years old with their matched mothers. Qualified questionnaires were used to evaluate and collect by one-to-one interviews with trained professionals the above data. Results: Elevated MD adherence was observed only in 22.2% of the enrolled children, while 37.5% of children maintained intermediate MD adherence and 40.3% of children adopted lower MD levels. Children MD compliance was related at an independent manner with maternal education level, childhood anthropometric factors such as Body Mass Index (BMI), Waist circumference to Height ratio (WtHR), quality of life, and exclusively breastfeeding behaviors after adjusting for several possible confounders (p ˂ 0.05). Conclusions: Elevated MD adherence of children aged 6–9 years old showed a lower obesity of overweight/obesity, including abdominal obesity. A higher maternal educational status and adopting exclusively breastfeeding practices were associated with greater levels of children’s MD adherence, promoting their quality of life and well-being. Based on the present results, future prospective surveys need to be performed to evaluate if there is a causality relation concerning this topic.

Background/Objectives Scientific evidence suggests that substituting non-fermented with fermented dairy products may confer cardiovascular health benefits. The role of fermented in relation to non-fermented dairy products on 20-year fatal/non-fatal cardiovascular disease (CVD) incidence was examined. Subjects/Methods In 2001–2002, n = 3042 free-of-CVD men and women from Attica, Greece, were recruited. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. CVD evaluation was performed in three follow-up time points at 5, 10 and 20 years, in n = 1988 participants (718 cases). Results Participants reported >2 servings/day of fermented dairy products had 1.5 times lower risk to develop CVD compared with their lower level of consumption. Multi-adjusted analysis revealed similar cardioprotective properties per 1 serving increase in dairy consumption of fermented dairy products (Hazard Ratio (HR) = 0.82, 95% Confidence Interval (95%CI) (0.58, 0.95)) as well as when the ratios of fermented:total dairy products (0.90, (0.53, 0.95)) and fermented:non-fermented dairy products (0.74, (0.39, 0.92)) were ≥0.76 and ≥2.5, respectively. The associations were more evident in case of impaired inflammation status. Replacing 1 serving of non-fermented with 1 equivalent serving of fermented dairy products reduced CVD risk (0.74, (0.53, 0.92)). Substitution of low-fat with whole-fat yogurt increased CVD risk (1.35, (1.02, 1.58)). Replacing cheese (any kind) with low-fat yogurt reduced CVD risk (all HRs<1) while with whole-fat yogurt no significance was observed. Conclusions Shift of guidelines to a daily pattern of dairy intake yet with an inclination towards emphasizing the consumption of fermented products is recommended.