Katerina-Maria Kontouli

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.

Orthorexia nervosa (ON) is an atypical eating disorder marked by persistent preoccupation with consuming only ‘pure’ or healthy foods, coupled with harmful compulsive behaviors. Rheumatic and musculoskeletal diseases (RMDs) are a broad group of conditions, characterized by pain and inflammation, affecting the joints and other connective tissues. Nutritional factors have been shown to exert a substantial influence on the development of these pathologies; however, orthorexic tendencies have not yet been studied among RMDs. This cross-sectional study recruited 367 patients from the Department of Rheumatology and Clinical Immunology at the University General Hospital, situated in Larissa. Patients were interviewed during their regular appointments in order to assess orthorexic tendencies. ON was evaluated using the Düsseldorf Orthorexia Scale (DOS), and linear regression analyses were performed. Although the presence of ON was relatively uncommon among patients with RMDs (2.2%), women (β = 2.41, 95% CI: 1.16, 3.65, p = 0.0002) and patients with systemic lupus erythematosus (β = 2.01, 95% CI: 0.39, 3.64, p = 0.02) or fibromyalgia syndrome (β = 8.17, 95% CI: 2.61, 13.73, p = 0.004) were at a greater risk for ON. On the other hand, patients with idiopathic inflammatory myopathies demonstrated a reduced propensity for orthorexic tendencies (β=-2.39, 95% CI: -4.70, -0.09, p = 0.04). Although ON demonstrates a low prevalence among patients with RMDs, certain diagnoses are associated with a higher propensity for orthorexia. Identifying ON is important for improved disease outcomes, metabolic function, and patients’ quality of life.

Introduction/objectives To evaluate the prevalence of malnutrition in patients with rheumatic and musculoskeletal diseases (RMDs) using two distinct assessment methods and identify factors contributing to malnutrition. Methods A cross-sectional design was adopted on patients with RMDs from the Department of Rheumatology and Clinical Immunology, University General Hospital, Larissa, Greece. Three hundred and forty-seven consecutive patients were assessed for malnutrition using two different methods: the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Subjective Global Assessment (SGA). Statistical analyses included univariate and multivariate logistic regression models to identify factors associated with malnutrition, as well as ordinal logistic regression models to evaluate predictors of malnutrition severity. Results According to the GLIM criteria, malnutrition was identified in 54.5% of patients, compared to 13.8% using the SGA. Appetite loss, body fat percentage, and overweight/obesity status emerged as strong independent predictors of malnutrition. Other variables, including hypoalbuminemia, glucocorticoid use, gender, and dysphagia, showed associations depending on the assessment method utilized. No notable relations were observed regarding the reason for hospital admission, other blood parameters, disease duration, or length of hospital stay. Conclusions Malnutrition is highly prevalent among patients with RMDs. The present findings support the frequent screening of patients with RMDs for malnutrition, emphasizing the need to include objective assessments of muscle mass and appetite in the evaluation process. Such an approach may inform future research on targeted nutritional interventions and has the potential to shape clinical guidelines aimed at improving patient outcomes. Key Points • Malnutrition is a recognized complication in patients with RMDs, often exacerbated by chronic inflammation. • There is no universally accepted gold-standard method for assessing malnutrition in RMDs. • Appetite loss, body fat, and overweight/obesity status are independent factors associated with malnutrition.

Objective To estimate the prevalence of pregnant women screened positive for night eating syndrome (NES) (also known as night, nighttime, overnight, and nocturnal eating syndrome) and identify possible associated factors. Methods Using a cross-sectional design, 125 pregnant women attending the obstetric outpatient clinics of two university departments in Thessaloniki, Greece, were recruited between December 2021 and February 2023. Anthropometric measurements were collected and all participants completed the Greek version of the Night Eating Questionnaire (NEQ). The latter is a validated tool for NES screening. Two NEQ score thresholds were applied for positive NES screening, one at ≥25 and a stricter one at ≥30. Results In the pregnant women sample, 8% demonstrated NEQ scores of ≥25 and 1% of ≥30. No differences were detected in NEQ scores according to gestational trimesters (Kruskal-Wallis test, p = 0.748). In contrast, excessive gestational weight gain (GWG)–according to the Institute of Medicine recommendations–was associated with greater rates of NEQ scores ≥25 (chi-squared test, p = 0.011). Women who had conceived via assisted reproductive techniques (ART) exhibited lower NEQ scores compared to those who had conceived naturally (Mann Whitney U test, p = 0.004). In the multivariable model, maternal obesity was associated with positive NES screening. Conclusions The prevalence of NES among pregnant women appears to be low. Excessive GWG and mode of conception seem to be associated with positive NES screening among pregnant women.

Symptoms related to difficulty in swallowing and bolus transfer from the oral towards the gastric cavity have been collectively termed “dysphagia”. The etiology, gravity and complications of dysphagia warrant a rigorous, often multidisciplinary diagnostic evaluation and individualized management. The present study aimed to evaluate the prevalence of dysphagia among patients with rheumatic and musculoskeletal diseases (RMDs) and identify associated risk factors. This cross-sectional study included 340 consecutive patients diagnosed with RMDs from the Department of Rheumatology and Clinical Immunology situated at the Larissa University General Hospital. Dysphagia was assessed using the Eating Assessment Tool-10 (EAT-10). Univariate and multivariate analyses were performed to explore the associations between dysphagia, specific rheumatic diagnoses, and other contributing clinical and demographic factors. Based on the EAT-10, dysphagia was identified in 35% of the patients, with the most commonly reported issues being difficulty in swallowing solid foods and the sensation of food sticking in the throat. Patients with systemic sclerosis, primary Sjögren’s syndrome, and rheumatoid arthritis were significantly more likely to develop swallowing difficulties. Furthermore, low serum albumin levels, increasing age, and the presence of gastroesophageal reflux were identified as independent predictors of dysphagia. Both overweight/obesity and a diagnosis of axial spondyloarthritis were negatively associated with dysphagia. Age and years since diagnosis were positively correlated with an EAT-10 score ≥ 3, while body mass index and body fat percentage showed negative correlations. Swallowing dysfunction is prevalent among patients with RMDs, particularly in those with specific rheumatic diagnoses. Given its impact on nutritional status and overall quality of life, routine dysphagia screening in clinical settings is essential for the timely identification and management of the condition.

Sarcopenia is characterized by loss of muscle mass and reduced muscle function, presenting various adverse events, especially when inflammation is present. The present study aimed to determine the prevalence of sarcopenia and sarcopenic obesity among patients with rheumatic and musculoskeletal diseases (RMDs) and identify the risk for sarcopenia using two screening tools the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) and the Mini Sarcopenia Risk Assessment (MSRA). In this single-center cross-sectional study, 220 consecutive patients visiting the Department of Rheumatology and Clinical Immunology at the University General Hospital of Larissa were interviewed. The EWGSOP criteria were used for the diagnosis of sarcopenia, while sensitivity, specificity, positive predictive values, number needed to screen, and positive and negative likelihood ratios were used to validate the diagnostic validity of the SARC-F and the MSRA. Univariate and multivariate logistic regression analyses were also applied to model the relationship between sarcopenia and other variables. In the total sample, 15.9% of patients were diagnosed with sarcopenia and one patient with sarcopenic obesity. The SARC-F (sensitivity 22.2%, specificity 75.6%), the 5-item (sensitivity 88.9%, specificity 18.9%), and the 7-item MSRA (sensitivity 91.7%, specificity 9.2%) presented poor clinical performance when used for screening alone. Univariate logistic regression analyses showed that underweight status, systemic sclerosis and appetite loss are strong contributors to sarcopenia diagnosis. Sarcopenia is prevalent among RMDs, and screening is essential within RMD clinics. None of the screening tools (SARC-F and MSRA) can stand alone in assessing sarcopenia in patients with RMDs. More research is required to understand sarcopenia in RMDs and validate the wide-using screening tools.

Many studies have shown that COVID-19 caused many problems in mental health. This paper presents the results of the Cyprus sample, part of the global initiative named “The Collaborative Outcomes Study on Health and Functioning during Infection Times” (COH-FIT). Methods: The study took place from April 2019 to January 2022, using the Greek version of the online standard COH-FIT questionnaire on 917 Cypriot adults. Weighted t-tests were applied to test the differences between pre-pandemic and intra-pandemic scores using the anesrake package. Results: Participant responses indicated a significant negative impact of the pandemic on measures of mental health (−7.55; 95% CI: −9.01 to −6.07), with worsening in the scores for anxiety (12.05; 95% CI: 9.33 to 14.77), well-being (−11.06; 95% CI: −12.69 to −9.45) and depression (4.60; 95% CI: 2.06 to 7.14). Similar negative effects were observed for feelings of anger (12.92; 95% CI: 10.54 to 15.29), helplessness (9.66; 95% CI: 7.25 to 12.07), fear (22.25; 95% CI: 19.25 to 25.26), and loneliness (12.52; 95% CI: 9.94 to15.11). Increased use of social media (0.89; 95% CI: 0.71 to 1.09), internet (0.86; 95% CI: 0.67 to 1.04), and substance consumption (0.06; 95% CI: 0.00 to 0.11) were reported, along with a significant decrease in physical health (−3.45; 95% CI: −4.59 to −2.32), self-care (−7.10; 95% CI: −9.00 to −5.20), and social function (−11.27; 95% CI: −13.19 to −9.35), including support (−0.72; 95% CI: −1.09 to −0.34) and family function (−7.97; 95% CI: −9.90 to −6.05). Conclusions: The COVID-19 pandemic significantly affected the daily life and emotional well-being of Cypriots. Identifying factors that influence vulnerability and resilience is essential to prioritize mental health support and address the long-term effects of the pandemic.