Page 71 - Palupa Medical LTD

Transcription

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7th Cyprus Dietetic and Nutrition
Association Conference with
International Participation
a p y : N u triti
www.cydadiet.org
Theme: Diet Therapy:
Nutrition Throughout the field of Healthcare
29 November - 2 December 2012
(29 November open for the public)
Hilton Park Hotel
Nicosia - Cyprus
Final Programme & Book of Abstracts
Organized by:
Under the auspices of:
Ministry of Health
Cyprus Presidency of the Council
of the European Union 2012
Cyprus Registration Board for
Food Technologists, Food Scientists
and Dietitians
CyDΝA is a member of the:
European Federation of
the Associations of Dietitians
With the participation of:
Atherosclerosis Society of Northern Greece
CyDΝA Food and Nutrition Conference & Exhibition
The scientific programme offers 27 CPE
on
Table of contents
Page
1. Greetings by the Chair of the Conference .............................................................. 4
2. Greetings by the Minister of Health ................................................................................ 5
3. Committees & Organisation................................................................................................. 7
4. Cyprus Dietetic and Nutrition Association Background .................................. 8
5. Sponsors .............................................................................................................................................. 9
6. Conference Information ........................................................................................................ 10
7. Speakers Details ........................................................................................................................... 11,12
8. Program at a Glance ............................................................................................................... 13
9. Analytical Program .................................................................................................................... 14-18
10. Abstracts ......................................................................................................................................... 20-67
11. Posters /Announcements .................................................................................................... 68-73
12. Exhibition Plan ............................................................................................................................. 74-75
13. Index .................................................................................................................................................. 76
3.
Message from the Conference Chair, CyDNA President
Dear friends and colleagues,
It is a privilege for us to welcome colleagues and friends to the 7th International Conference «Diet therapy:
Nutrition throughout the field of healthcare».
The conference is held under the auspices and support of the Ministry of Health and the Cyprus Registration
Board for Food Scientists, Food Technologists and Dietitians. We are very honoured to welcome for the first
time the participation and cooperation of the Atherosclerosis Society of Northern Greece as well as the presence
of the European Federation of the Associations of Dietitians and the American Academy of Nutrition and Dietetics.
Our goal is to ensure the complete success of our upcoming international conference.
The highlight of our Congress is without doubt the scientific program. The CyDNA Scientific Program Committee
has devoted substantial time and effort in developing a program which explores new directions in nutrition
and dietetics and debates topics with high profile experts from across the world. With submitted papers accepted
into the program, stimulating lead sessions, invited plenary talks, interactive workshops, symposia/satellite and
sponsored sessions, our conference reflects the diversity, innovation and commitment of our achievements in
the dietetics world. We expect from the Conference to provide a greater understanding of how the profession
practices all over the world. It is also the perfect opportunity to meet with international and local colleagues.
Complementing the scientific program are the workshops, sponsored seminars, food demonstration and the
popular trade exhibition.
The conference’s scientific program is scheduled so as to offer multiplicity of subjects in order to emphasize
the role of the dietitian in the whole spectrum of health and community and the necessity to be considered
an indispensable member of the health care team and the health care providers. Our theme, Diet therapy:
Nutrition throughout the field of healthcare leads to Medical Nutrition Therapy (MNT). MNT is an acknowledged
term under nutrition terminology. MNT is an essential component of comprehensive health care. Individuals
with a variety of conditions and illnesses can improve their health and quality of life by receiving medical
nutrition therapy. During an MNT intervention, dietitians counsel clients/patients on behavioural and lifestyle
changes required to impact long-term eating habits and health. Medical Nutrition Therapy includes: performing
a comprehensive nutrition assessment; determining the nutrition diagnosis; planning and implementing a
nutrition intervention using evidence based nutrition practice guidelines; monitoring and evaluating an individual’s
progress over subsequent visits with the dietitian.
Therefore the topics presented in the conference have been selected to give a broad and in depth overview
of a number of contemporary and traditional topics in dietetics and nutrition. The conference is addressed
mainly to dietetic/nutrition professionals but also to physicians, trainees, nurses, dietetic/nutrition students and
other health professionals. The conference is very proud to offer 27 CPEUs by the Commission on Dietetic
Registration (EA001). The Continuing Professional Education is very valuable and is encouraged by CyDNA
through the Continuing Professional Education Units for professional development and reassurance of high
level of dietetic/nutrition practice in Cyprus.
Thank you in particular to our speakers and sponsors for their invaluable contribution and support. We trust
that the conference delivers an interactive, highly involved and stimulating program, while providing you with
the opportunity to network with your professional and industry colleagues. We are looking forward to seeing
you at the conference and we hope that you will find it educational, stimulating, with a great opportunity to
network with other health professionals.
A conference of this extent would not be possible without the hard work and dedication of our Planning
Committees, members’ support and of course our industry partners, supporters, sponsors and exhibitors.
On behalf of the CyDNA 2012 Planning Committee (Organizing and Scientific), we thank you for your participation in the 7th CyDNA International Conference of Dietetics and CyDNA wishes you memorable experiences from this conference.
The 7th CyDNA conference will give you new dynamism and vision into the future of dietetics.
Dr. Eleni P. Andreou, RD, LD CyDNA Conference Chair, 2012
President of the Cyprus Dietetic & Nutrition Association
4.
Message from the Cyprus Minister of Health, Dr. Androulla Agrotou
«Νους υγιής εν σώματι υγιεί»!
Η σπουδαία αυτή διαπίστωση των Αρχαίων Ελλήνων, χιλιάδες χρόνια πριν, η οποία επιβεβαιώνεται από επιστημονικές
έρευνες μέσα από τις οποίες καταδεικνύεται η απόλυτη συσχέτιση του υγιούς σώματος με το υγιές μυαλό, έχει δυστυχώς
θυσιαστεί στο βωμό του σύγχρονου τρόπου ζωής και των λανθασμένων συνηθειών διατροφής, που έχουν οδηγήσει
στην αύξηση των ασθενειών.
Είναι για αυτόν ακριβώς το λόγο που οφείλουμε επιτέλους να αποδώσουμε την πρέπουσα προσοχή στο θέμα της ορθής
διατροφής και της υγείας μέσω της πρόληψης.
Η ορθή διατροφή αποτελεί έναν από τους πιο βασικούς παράγοντες που συμβάλλουν στη διατήρηση της υγείας του
ανθρώπου, στην πρόληψη και αντιμετώπιση ασθενειών.
Το Υπουργείο Υγείας αναγνωρίζοντας τη σημασία που έχει η ορθή διατροφή στη ζωή μας, θεωρεί υποχρέωση του να
αγγίζει το θέμα της διατροφής με τέτοιο τρόπο που να ευαισθητοποιεί τον κάθε πολίτη, ούτως ώστε έτσι να εμπλουτίσει
τις γνώσεις του αλλά και να θέσει σε εφαρμογή απλούς κανόνες διατροφής που τον προστατεύουν από ασθένειες που
μας απειλούν καθημερινά.
Αυτή η προσπάθεια ωστόσο, για να είναι πετυχημένη, πρέπει να έχει άξιους συμπαραστάτες τόσο τα κοινωνικά σύνολα
όσο και τον απλό άνθρωπο. Οι όποιες προσπάθειες καταβάλει το Υπουργείο θα φέρουν τα επιθυμητά αποτελέσματα,
μόνο στην περίπτωση που ο καθένας από εμάς κάνει το θέμα της σωστής διατροφής στόχο και συνήθεια του.
Πρέπει να περάσουμε άμεσα από την θεωρία στην πράξη και να κάνουμε ότι είναι δυνατό για να επιστρέψουμε στις
ρίζες μας, οι οποίες στην προκειμένη περίπτωση δεν είναι άλλες από τον Μεσογειακό τρόπο διατροφής.
Χαιρετίζω λοιπόν τις εργασίες του 7ου Συνεδρίου Διαιτολογίας, το οποίο καταπιάνεται με το θέμα της ορθής διατροφής
σε όλες του τις πτυχές. Είμαι βέβαιη πως με τις συζητήσεις και τις αποφάσεις σας θα συμβάλετε στον μέγιστο δυνατό
βαθμό, στις προσπάθειες που καταβάλλονται για την υιοθέτηση ενός πιο υγιεινού τρόπου ζωής, μέσω της ορθής
διατροφής και της πρόληψης. Σε αυτή την προσπάθεια θα έχετε στενό συμπαραστάτη το Υπουργείο Υγείας.
Σας εύχομαι κάθε επιτυχία.
Dr Antroulla Agrotou
Cyprus Ministrer of Health
5.
2012
Theme: «Diet Therapy: Nutrition Throughout the field of Healthcare».
Sessions of the Conference
• Cardiovascular disease
• Gastrointestinal and hepatic disorders
• Announcements
• Weight management and metabolic diseases
• Professional development and education
• Cancer
• Evidence Based Practice
• Workshop
6.
Conference Committee
Andreou Eleni
Chair
Philippou Christiana
Treasurer
Chappa Georgia
Constandinidou Nicoletta
Economou Mary
Kakouri Stella
Kalli Procopis
Ntorzi Nikoletta
Pahita Anna
Piki Vasiliki
Tsokkou Panayiota
Vassilopoulou Emilia
Scientific Committee
Andreou Eleni Philippou Christiana
Chappa Georgia
Kalli Procopis
Efthimiadis Apostolos
Hassapidou Maria
Financial Committee
Andreou Eleni Philippou Christiana
Chappa Georgia
Kalli Procopis
CyDNA Board
Dr Andreou Eleni Dr Philippou Christiana
Michaelidou Polly
Kalli Procopis
Dr Philippou Elena
Georgiou Kyriacos
Tsokkou Panayiota
President
Vice President
Secretary
Treasurer
Assistant Secretary
Member
Member
• CyDNA is a member of EFAD and ICDA
Conference Secretariat
Tel.: +357 22713780 - Fax: +357 22869744
E-mail: [email protected]
2 Leonidou & Acropoleos Ave., 2007 Strovolos
Nicosia - Cyprus
Conference Website
www.cydadiet.org
7.
Cyprus Dietetic and Nutrition
Association Background
History
1991- “Cyprus Association of Food Scientists/ Technologists and Dietitians “Food
Scientists, Food Technologists and Dietitians were grouped together due to the
small number of the professionals of the different specialisation’s working in Cyprus
at that time. “Food” and its relation to the different professions, and the need to
be established as professionals in Cyprus brought them together.
1996 - Submission for approval and approval of “the Law for Registration of Dietitians,
Food Technologists/Scientists in Cyprus [N31(I)/96]” by Cyprus House of Representatives.
The Ministry of Health appoints the Registration Board for Food Scientists/Technologists and Dietitians in Cyprus every three years where all the dietitians are required
to be registered according to the Cyprus law (N31(I)/96).
3 April 1999 - “Cyprus Dietetic Association” became an autonomous association
and split from the previous association due to the large number of members of the
different disciplines in Cyprus and the realisation of the different educational and
professional goals.
2003 CyDA became member of the EFAD/ ICDA
17January 2007- Change of the name of the association to “Cyprus Dietetic and
Nutrition Association”
CyDNA members: 200 active members, 24 students, 5 subscribers, 1 honorary.
Goals
• Promotion, education and protection of the public health and prevention of
certain diseases through sound nutritional habits promotion of the profession of
dietetics in the hospital/clinical setting, industry, education, media, agriculture,
research and private sector.
• Promotion of high educational standards for the science and practice of dietetics
in order to protect the profession of dietetics.
• Establishment of the association as the only Professional Body in Cyprus for Dietitians /
Clinical Dietitians / Nutritionists.
• Enforcement of and obedience to the Laws/Bylaws and the Code of Ethics.
• Acknowledgement of CyDNA by other International Dietetic Associations and /
or Medical Associations.
• International Networking.
MISSION:
VISION:
VALUES:
8.
Guidance, empowerment and reinforcement of the dietetic
and nutrition professionals in Cyprus
The members of CyDNA are the most reliable and valid
scientists in the subjects of diet and nutrition
- Members
- Cooperation
- Diversity
- Leadership
- Code of Ethics/ Integrity
- Education
- Social & Cultural Responsibility
Sponsors
Gold
Classic
Supporters
PHARMAVET LTD
M.A. PEAKPERFORMANCE1 LTD
9.
General Conference Information
Information & Registration Desk
All participants must register. A Registration Desk will be operating throughout the
duration of the conference. The Registration Desk will also be operating as an Information
Desk for any information or assistance participants may require during the conference. All
conference documents will be included in your bags. The badge of each participant
gives access to all sessions, exhibition and coffee breaks.
Registration Fees
Registration Fees include attendance to all sessions, entrance to the exhibition
area, coffee breaks, conference material and certificate of attendance.
Exhibition Area
An exhibition will be running throughout the duration of the conference in LEDRA B.
Language
The official language of the conference is English.
Cyprus Night: Is igia- “εις υγεία” - To your health!
The Cyprus Night will take place at Ayia Anna Traditional Tavern on Friday, 30th of
November 2012 at 21:00. Vouchers for the Cyprus Night can be purchased from
the Registration Desk at the price of €42
Gala Dinner
The Gala Dinner will take place at the Hilton Park Hotel on Saturady, 1st of December
2012, at 20:30.Vouchers for the Gala Dinner can be purchased from the Registration
Desk at the price of €50
10.
Speakers Details
Α/Α
Speaker
Country
E-mail
1
Agathangelou Petros, MD
Cardiology, President of the Cyprus Society of
Cardiology
Cyprus
[email protected]
2
Andreou Eleni, RD, LD, DProf (Clinical Dietitian,
President of the Cyprus Dietetic & Nutrition
Association, Assistant Professor University of Nicosia)
Cyprus
[email protected]
3
Antoniou Pavlos, MD (Gastroenterologist Hepatologist)
Cyprus
[email protected]
4
Avraamides Panayiotis, BSc (Hons), MB BS
(Lond), FRCP(Lond), FRCP(Edin), MRCPI,
FESC, (Director, Cardiology Department,
Limassol General Hospital)
Cyprus
[email protected]
5
De Looy Anne, BSc (Hons) PhD PGDipDiet
RD FBDA, (Professor of Dietetics, University of
Plymouth)
United
Kingdom
[email protected]
6
Efthimiadis Apostolos, (Professor of
Cardiology, Aristotle University of Thessaloniki)
Greece
[email protected]
7
Escott – Stump Sylvia, MA, RD, LDN
(Director, Dietetic Internship, East Carolina
University)
United
States of
America
[email protected]
8
Hassapidou Maria
Greece
Professor of Nutrition and Dietetics, Department
of Nutrition and Dietetics, Alexander Technological
Educational Institute, Thessaloniki, Greece
[email protected]
9
Heraclides Alexandros, BSc (Hons), MSc,
MSc, PhD (Lecturer in Nutrition, Epidemiology
and Biostatistics at the Univeristy of Nicosia)
Cyprus
[email protected]
10
Ioannou Elina, BSc, MSc, RD
Clinical Dietitian, Cyprus Ministry of Health
Cyprus
[email protected]
11
Kakouri Ioannou Eleni, BSc, Ph.D.
Chief Chemist, Head of Quality Assurance and
Risk Assessment Units of the State General
Laboratory (SGL) of Cyprus
Cyprus
[email protected]
12
Kountouri Stalo, CPD, RD
Clinical Dietitian, General Hospital of Famagusta
Cyprus
[email protected]
13
Kyprianou Theodoros, MD, PhD, EDIC
Head, Multidisciplinary Intensive Care Unit,
Nicosia General Hospital
Cyprus
[email protected]
14
Kyriakidou Stella
Psychologist, Member of the Parliament
Cyprus
[email protected]
15
Kyriakidou Evi, BSc, MSc, RD
Nutrition Support Dietitian, Barts Health NHS
Trust
Cyprus/
United
Kingdom
[email protected]
16
Lappa Fotini, BSc (Hons), MSc
Dietician – Nutritionist with specialization in
Sports Nutrition, Lecturere in Nutrition (Intercollege
and the University of Nicosia)
Cyprus
[email protected]
17
Loizou Despo, BSc (Hons), SRD
Clinical Dietitian, Nutritionist, Home Economics
Counselor and Teacher
Cyprus
[email protected]
18
Madden Angela, PhD, RD
Professional Lead for Dietetics
University of Hertfordshire’s
United
Kingdom
[email protected]
19
McClinchy Jane, MSc by Research, Registered
Dietitian, Fellow of the Higher Education Academy
United
Kingdom
[email protected]
20
Papandreou Dimitris, PhD, M.S., M.Ed., R.D
Assistant Professor of Nutrition, Department of
Life and Health Sciences
Cyprus
[email protected]
21
Papamichael Demetres, MB BS FRCP (Director,
Dept., of Medical Oncology)
Cyprus
[email protected]
11.
12.
Α/Α
Speaker
Country
E-mail
22
Papadopoulou Katerina
(President of ACHDAC Adult Congenital Heart
Defects Association Cyprus)
Cyprus
[email protected]
23
Papadopoulou Nicoleta, MS, RD, CDN (Clinical Cyprus
Dietitian)
[email protected]
24
Pavlidou Sofia, MD (Scientific Collaborator,
Aristotle University of Thessaloniki, Secretary of
Atherosclerosis Society of Northern Greece)
Greece
[email protected]
25
Philippou Charidemou Christiana, RD, DProf
(Vice President of CyDNA, Clinical Dietitian and
sports nutritionist)
Cyprus
[email protected]
26
Philpot Ursula, BSc (hons) , MSc, PGCHE,
RD, (Chair of the British Dietetic Association’s
Mental Health Group Advanced Practice Dietitian
and Senior Lecturer- Eating disorders)
United
Kingdom
[email protected]
27
Risvas Grigoris, PhD (Dietician – Public Health Greece
Nutritionist)
[email protected]
28
Sanders Tom, BSC, PhD, DSc, RPHNutr,
(Professor of Nutrition & Dietetics, King’s College
London)
United
Kingdom
[email protected]
29
Wakil Elie, DIPLOME D’ETAT FRANCAIS DE
DOCTEUR EN PHARMACIE / “Human
Relations” Specialist
Cyprus
[email protected]
30
Yamasaki – Patrikiou Edna, MD, MSc, PhD
Cyprus
(Head, Department of Life and Health Sciences,
University of Nicosia / Associate Professor,
University of Nicosia)
[email protected]
31
Yiakoumi Ioannis, BSc, MSc
Lecturer, Intercollege
Cyprus
[email protected]
32
Zampelas Antonis, BsC, Msc, PhD, (Professor
in Human Nutrition, University of Athens)
Greece
[email protected]
Programme at a Glance
Time
Thursday, 29 November 2012
18:00 - 18:30
Registrations
18:30 - 20:30
Panel open for the public (session in Greek)
Friday, 30 November 2012
07:15 - 08:00
Registrations
Session 1: Cardiovascular disease
08:00 - 09:00
Panel 1: Mediterranean diet and cardiovascular disease
09:00 - 10:00
Panel 2: Eat well, love better, move more: treatment of cardiometabolic syndrome
10:00 - 10:30
Special Event: Nutrigenomics and genetics and nutrition
10:30 - 11:30
Opening Ceremony / Opening of the exhibition
Coffee Break
11:30 - 12:00
12:00 - 13:00
Keynote Speech: Integrated dietary intervention to reduce risk of cardiovascular
disease
Lunch
13:30 - 14:15
14:15 - 15:15
Keynote Speech: Impact of the amount & composition of dietary fat and
carbohydrate on metabolic syndrome & cardio vascular disease risk
Session 2: Gastrointestinal and hepatic disorders
15:15 - 16:15
Culinary demonstration
Coffee Break
16:15 - 16:30
16:30 - 17:30
Keynote Speech: Medical Nutrition Therapy: Standardized language – making it
international
17:30 - 19:00
Panel 3: Gastrointestinal Disorders and Nutrition
21:00
Cyprus Night: Is igia- “εις υγεία” - To your health!
Saturday, 1 December 2012
08:00 - 08:30
Registrations
08:30 - 09:30
Session 3: Announcements (Oral Presentations-OP, Poster Presentations-PP)
Coffee Break
09:30 - 10:00
10:00 - 12:00
Session 4: Weight management and metabolic diseases
12:00 - 13:00
Satellite Symposium by Lanitis
Lunch
13:00 - 14:30
14:30 - 15:30
Session 5: Professional development and education
15:30 - 16:30
Panel 4: Professional development and education
Coffee Break
16:30 - 17:00
17:00 - 18:00
Engaging Current and Future Practitioners to Apply Ethical Actions in Practice
Session 6: Cancer
18:00 - 19:00
Panel 5: The state of the science: evidence to support diet and physical activity
recommendations for cancer prevention
20:30
Gala Dinner
08:00
Registrations
Sunday, 2 December 2012
Session 7: Evidence Based Practice
08:00 - 09:15
Panel 6: Novelties in Nutrition
09:15 - 10:30
Panel 7: Bridging the Guideline–Practice Gap: The Critical Care Experience
10:30 - 11:30
Session 4 : (continues) Weight management and metabolic diseases
Coffee Break & sandwich
11:30 - 12:00
Session 6: (continues) Cancer
12:00 - 13:00
Panel 8: Cancer: Myths and realities
13:00 - 15:00
Session 8: Workshop
15:00 - 15:15
Closing Ceremony
13.
27 CPE
Theme: ‘Diet Therapy: Nutrition Throughout the field of healthcare’
Sessions:
• Cardiovascular disease
• Gastrointestinal and hepatic disorders
• Announcements
• Weight management and metabolic diseases
• Professional development and education
• Cancer
• Evidence Based Practice
• Workshop
Scientific Programme
Thursday, 29 November 2012 (open for the public)
18:00 - 18:30
Registrations
18:30 - 20:30
Panel open for the public (session in Greek)
Η διατροφή του Κυπρίου και η σχέση της με την πρόληψη των καρδιοπαθειών,
Δρ Ελένη Ανδρέου, RD
(The Cypriot diet and its relation to the prevention of heart disease, Dr. Eleni Andreou)
Μύθοι και αλήθειες σχετικά με τη διατροφή. Τι πραγματικά ωφελεί την καρδιά μας;
Δρ Σοφία Παυλίδου
(Myths and truths about nutrition. What really is good for our heart? Dr. Sofia Pavlidou)
Μεσογειακή δίαιτα και καρδιαγγειακά νοσήματα, Δρ Μαρία Χασαπίδου
(Mediterranean diet and cardiovascular disease, Dr. Maria Hassapidou)
Καρδιοπάθεια - τρόπος ζωής για το άτομο με καρδιοπάθειες, η φωνή του ασθενή,
Κατερίνα Παπαδοπούλου
Χαιρετισμός από τον Πρόεδρο της Καρδιολογικής Εταιρείας, Δρ Πέτρο Αγαθάγγελου
(Heart disease - lifestyle for the person with heart disease, the voice of the patient, Katerina Papadopoulou)
(Address by the President of the Cardiology Society, Dr. Petros Agathangelou)
Moderator: Nikoletta Ntorzi
CPE level: II
CPE credit: 2
Sponsored by: Becel pro.activ.
Friday, 30 November 201
07:15 - 08:00
Registrations
SESSION 1: Cardiovascular disease
8:00 - 9:00
Panel 1: Mediterranean diet and cardiovascular disease
Mediterranean diet and effect on cardiovascular disease, Dr Panicos Avraamides, MD
09:00 - 10:00
The latest on ω-3 fatty acids: from cardiovascular diseases to mood disorders,
Prof Antonis Zampelas
Moderator: Eleni Andreou
CPE level: I
14.
CPE credit: 1
Panel 2: Eat well, love better, move more: treatment of cardiometabolic syndrome
Role of nutrition and exercise in the treatment of metabolic syndrome, Nicoleta Papadopoulou, RD
Cardiometabolic risk factors, Dr Apostolos Efthimiadis, MD
Moderator: Christiana Philippou
CPE level: II
CPE credit:1
10:00 - 10:30
Special Event: Nutrigenomics and genetics and nutrition
Nutrigenetics and nutrigenomics: Scientific breakthrough, but what is the benefit for public
health nutrition and everyday dietetic practice? Dr Alexandros Heraclides
Moderator: Emilia Vassilopoulou CPE leve: I
CPE credit: ½
10:30 - 11:30
Opening Ceremony / Opening of the exhibition:
Addresses by
President of Cyprus Dietetic and Nutrition Association, Dr Eleni P. Andreou
President of Cyprus Registration Board for Food Scientists, Food Technologists and
Dietitians, Dr Phroso Hadjilouca
President of Atherosclerosis Society of Northern Greece, Dr Apostolos Efthimiadis
President of European Federation of the Associations of Dietitians, Prof Anne de Looy
President of Academy of Nutrition and Dietetics, Sylvia Escott Stump
Cyprus Minister of Health, Dr Androulla Agrotou
Moderator: Nikoletta Ntorzi
CPE level: III
CPE credit:1
11:30-12:00
Coffee Break
12:00 - 13:00
Keynote speaker: Prof Tom Sanders
Integrated dietary intervention to reduce risk of cardiovascular disease
Moderator: Georgia Chappa
CPE level: III
CPE credit: 1
13:00 - 14:15 Lunch
14:15 - 15:15
Impact of the amount & composition of dietary fat and carbohydrate on metabolic
syndrome & cardiovascular disease risk, Prof Tom Sanders
Moderator: Georgia Chappa
CPE level: II
CPE credit: 1
SESSION 2: Gastrointestinal and hepatic disorders
15:15 - 16:15
Satellite Symposium by Alkis M. Hadjikyriacos (Frou Frou Biscuits) Public Ltd:
Culinary demonstration
Fiber: small changes, big difference, Ioannis Yiakoumis, chef & Fotini Lappa
CPE level: III
CPE credit:1
16:15 - 16:30
Coffee Break
16:30 - 17:30
Keynote speaker: Sylvia Escott Stump, RD,LDN
Medical Nutrition Therapy: Standardized language – making it international
CPE level: II
CPE credit: 1
17:30 - 19:00
Panel 3: Gastrointestinal Disorders and Nutrition
Celiac disease toolkit: Guiding your patients to a global treatment, Dr Pavlos Antoniou, MD
Dysphagia Nutrition Management, Sylvia Escott Stump, RD,LDN
New directions in lactose intolerance: moving from science to solutions, Dr Dimitris Papandreou
CPE level: II
CPE credit: 1 ½
21:00 Cyprus Night: Is igia- “εις υγεία” - To your health!
15.
Saturday, 1 December 2012
08:00 - 8:30 Registrations
SESSION 3: Announcements (Oral Presentations-OP, Poster Presentations-PP)
8:30 - 9:30
Poster Session / Announcements/ Oral Presentations
OP01
FTO GENE AND BODY MASS INDEX IN YOUNG EUROPEAN CHILDREN: DO
PHYSICAL ACTIVITY LEVELS INFLUENCE THE EFFECT OF THE RISK GENOTYPE?,
Anna Christina Koni, Guan Wan1, Mark Baile1, Robert Scott, Licia Iacoviello, Alfonso
Siani, Paola Russo, Fabio Lauria, Michael Tornaritis, Charalambos Hadjigeorgiou, Toomas
Veidebaum, Kenn Konstabel, Staffan Marild, Gabriele Eiben, Luis Moreno, Jose Casajus,
Wolfgang Ahrens, Karin Bammann, Eva Kovacs, Denes Molnar, Stefaan De Henauw,
Krishna Vyncke, Yannis Pitsiladis, FACSM; on behalf of the IDEFICS Consortium.
OP02
IMPACT OF BREAKFAST CONSUMPTION ON DIET QUALITY AND HEALTH
OUTCOMES IN CYPRIOT CHILDREN
Papoutsou S, Briassoulis G, Chadgigeorgiou Ch, Savva SC, Solea T, Hebestreit A, Pala
V, Sieri S, Kourides Y, Kafatos A & Tornaritis M
OP03
A NATIONAL STUDY OF THE DIETARY INTAKE OF CYPRIOT CHILDREN AND
ADOLESCENTS AGED 6-18 YEARS AMD THE EFFECT OF MOTHER’S EDUCATIONAL
STATUS AND CHILDREN’S WEIGHT STATUS ON ADHERENCE TO NUTRITIONAL
RECOMMENDATIONS
E Philippou, MJ Tornaritis, C Hadjigeorgiou, YA Kourides, A Panayi and SC Savva
OP04
A PIONEER NUTRACEUTICAL FORMULA (PLP10) FOR THE TREATMENT OF
RELAPSING REMITING MULTIBLE SCLEROSIS: A RANDOMIZED, DOUBLE BLIND
PLECEBO-CONTROLLED PROOF-OF-CONCEPT CLINICAL TRIAL
Ioannis S. Patrikios, George N. Loukaides, Evangelia E. Ntzani & Marios C. Pantzaris
OP05
EFFECTS OF AN INTERVENTION AND MAINTENANCE WEIGHT LOSS DIET WITH
AND WITHOUT EXERCISE ON ANTHROPOMETRIC INDICES IN OVERWEIGHT AND
OBESE HEALTHY WOMEN.
Andreou E, Philippou C, Papandreou D.
OP06
EXPANSION OF CYPRUS FOOD COMPOSITION TABLES
S.Yiannopoulos, Μ. Christodoulidou, K.Kontoghorghe, E. Kakouri and P. Kanari
CPE level: I
PP01
COMPARISON OF THE ASSOCIATION BETWEEN DIFFERENT OBESITY MEASURES
AND TYPE 2 DIABETES IN A CYPRIOT POPULATION
Andreou N., Heraclides A., Andreou E.
PP02
EMOTIONAL EATING AS A COMMON BARRIER DURING WEIGHT LOSS AND WEIGHT
LOSS MAINTENANCE: FOCUS GROUPS RESULTS
Y. Koutras, K. Mouliou, E. Karfopoulou, M. Yannakoulia
CPE credit: 1
Moderator: Prokopis Kallis
CPE level: I
CPE credit: 1
9:30 - 10:00 Coffee Break
SESSION 4: Weight management and metabolic diseases
16.
10:00-12:00
Eating disorders workshop: Anorexia & Bulimia, Ursula Philpot, RD
Moderator: Panayiota Tsokkou
CPE level: II
12:00 - 13:00
Satellite Symposium by Lanitis:
Nutrition Policies for Obesity Prevention, Prof Antonis Zampelas
Intervention programs for the prevention of childhood obesity at the community level,
Dr Grigoris Risvas
Moderator: Nicoletta Constandinidou
CPE level: II
CPE credit:1
13:00-14:30
Lunch
CPE credit: 2
SESSION 5: Professional development and education
14:30 - 15:30
Importance and value of being assertive, Dr Elie Wakil (open discussion)
Moderator: Anna Pahita
CPE level: II
15:30 - 16:30
Panel 4: Professional development and education
Food - A-Pedia, Despo Loizou, RD
The Role of the Multidisciplinary team in giving nutritional advice, Jane McClinchy, RD
Moderator: Christiana Philippou
CPE level: I
CPE credit: 1
16:30 - 17:00
Coffee Break
17:00 - 18:00
Speakers: Prof Anne de Looy, RD
Moderator: Stella Kakouri
CPE level: III
CPE credit: 1
CPE credit: 1
SESSION 6: Cancer
18:00 - 19:00
Panel 5: The state of the science: evidence to support diet and physical activity
recommendations for cancer prevention
Bowel cancer and treatment, Dr Demetres Papamichael, MD
Bowel cancer and nutrition intervention, Stalo Kountouri, RD, CPD
Moderator: Nikoleta Ntorzi
CPE level: I
CPE credit: 1
20:30 Gala Dinner
Sunday, 2 December 2012
08:00
Registrations
SESSION 7: Evidence Based Practice
08:00 - 09:15
Panel 6: Novelties in Nutrition
Labeling of foodstuffs, nutrition and health claims - an EU perspective,
Dr Eleni Ioannou-Kakouri
Caffeine and Cognitive Function, Dr Edna Yamasaki, MD
Non-alcoholic fatty liver disease / NASH, Dr Angela Madden, RD
Moderator: Panayiota Tsokkou
CPE level: II
09:15 - 10:30
Panel 7: Bridging the Guideline–Practice Gap: The Critical Care Experience
The critical care experience in ICU, Dr Theodoros Kyprianou, MD
Nutrition in critical illness: from theory to daily practice, Elina Ioannou, RD
Nutrition and Trauma (presentation of case studies), Evi Kyriakidou RD
Moderator: Mary Economou
CPE level: II
CPE credit: 1 ¼
CPE credit:1 ¼
SESSION 4 : (continues) Weight management and metabolic diseases
10:30 - 11:30
Nutritional screening using MUST -workshop/interactive presentation
Dr Angela Madden, RD
Moderator: Nicoletta Constandinidou
CPE level: II
CPE credit: 1
11:30 - 12:00 Coffee Break and Sandwich
17.
SESSION 6: (continues) Cancer
12:00 -13:00
Panel 8: Cancer: Myths and realities
Myths and realities about cancer –the psychology’s aspect, Stella Kyriakidou
Myths and realities about cancer –the nutrition aspect, Dr Christiana Philippou, RD
Moderator: Vasiliki Piki
CPE level: II
CPE credit:1
SESSION 8: Workshop
18.
13:00 - 15:00
Workshop: Nutrition Care Process, Jane McClinchy, RD
15:00-15:15
Closing ceremony
Exhibition CPE credit: 1
Poster CPE credit: 1
CPE level: II
CPE credit: 2
Total CPE: 27
Abstracts
• The information presented is according to those given by the authors
• Objectives presented for CPE purposes
20.
Dr Andreou Eleni, RD, LD, DProf, FHEA
President of Cyprus Dietetic and Nutrition Association, Clinical Dietitian
Assistant Professor University of Nicosia
Abstract Title
Η διατροφή του Κυπρίου και η σχέση της με την πρόληψη των καρδιοπαθειών
(“The Cyprus diet and its relation to the prevention of heart disease”)
(Part of panel Open for the Public – session in Greek)
Objectives
1. To evaluate the obesity prevalence and dietary/nutritional practices and habits in adult population in Cyprus.
2. To present the correlation between nutritional habits of Cypriot adults, level of physical activity and biochemical
indicators (ie, blod sugar, cholesterol, triglycerides, HDL, LDL levels).
3. To present Nutritional Guidelines for the Cypriot Population.
Learning Outcome Assessment: Participant evaluation of program
Description (Focus Statement)
This presentation for the public is an overview of the epidemiological study of obesity and the determination
of the nutritional habits of the Cypriots adults performed by the Cyprus Dietetic and Nutrition Association for
the years 2005-2009. The study is showing the epidemic problem of overweight and obesity in Cyprus and the
current relation of the nutritional habits of Cypriots with the Mediterranean diet.
Abstract
Many studies have been done for the past and evolution of the Cypriots nutritional habits through the centuries.
Dietary habits or changes give evidence for the environment, the status of civilization and the cultural morals
of people. Taking into account that “Mediterranean diet” is considered to be the “ideal” diet, it would be very
interesting to present the nutritional habits of our ancestors in Cyprus, during the prehistoric times.
In the epidemiological cross-sectional study of Cyprus Dietetic and Nutrition Association, 1001 Cypriot adults
of the ages 18-80y participated and were investigated in the study conducted between 2005-2009. The samples
were selected randomly with a stratified method and with the range of 51.5% females and 48.5% males. They
were interviewed with the use of a self-developed validated questionnaire (physical activity, health condition,
medical history, nutritional habits) that included a quantitative food frequency questionnaire and a three-day
dietary recall. Specific features of lifestyle patterns and nutritional habits, anthropometric indices (weight, waist
circumference, body fat analysis with the use of Bioelectrical Impedance Analysis-BIA, Body Mass Index-BMI)
and biochemical indices (FBC, homocysteine, Insulin, Glucose, Fat lipid profile, Uric Acid, Urea, Creatinine,
Liver Enzymes, Iron, Phosphorus, Magnesium, CRP, Ferritin) were evaluated.
The study was critically reviewed and given approval by the Cyprus Bioethics Committee. The results presented
are the final and they are derived from the representative sample of 1001 subjects for which a full statistical
analysis was carried out. The combined percentage of Obese and Overweight people in the Cypriot population
is 75.7% for men and 52.9% for women. The percentage of overweight people in Cyprus is 36% and the
percentage of obese persons is 27.8%. The correlation between the BMI level and the various percentages of
the weight classification for both men and women is shown in Table 1.
Table 1. Percentage of Obesity in Cypriots
Class
BMI
% Men
% Women
% Total
Underweight
<20
2,1
10,5
6,4
Normal
20-25
22,2
36,6
29,6
Overweight
25-30
46,9
26,0
36,1
Obese
> 30
28,8
26,9
27,8
Mean Value(of BMI)
28,14
26,67
27,38
Standard Deviation
4,36
6,09
5,37
Prevalence rates of overweight and obese adults.
Males (n=485) (%)
Females (n=516) (%)
Total (n=1001) (%)
359 (35.8)
Normal
117 (24.3)
242 (47)
Overweight
227 (46.9)
134 (26)
Obese
151 (28.8)
Chi-square test for differences between gender
140 (27)
x 2,
361 (36.0)
291 (28.2)
P = 0.507
21.
Assessment of the health risks associated with overweight and obesity in adults should be based on BMI and
waist circumference as follows:
BMI classification
Low Waist
Circumference
High Waist
Circumference
Very High Waist
Circumference
Overweight
no increased risk
increased risk
high risk
Obesity
increased risk
high risk
very high risk
• for men, waist circumference of less than 94 cm is low, 94-102 cm is high and more than102 cm is very high
• for women, waist circumference of less than 80 cm is low, 80-88 cm is high and more than 88 cm is very high.
The studied presented showed the following results as far as concern the waist circumference (WC):
MEN
Mean Value
S.D
WC
96,8
13,6
WOMEN
Mean Value
S.D
WC
87,2
13,6
Summary of anthropometric characteristics of all subjects (n=1001).
Age (y)
Normal (n=361)
Overweight (n=362) Obese (n=279)
P value
36.2 ± 11.07
44.8 ± 12.6
0.277
43.6 ± 14.7
Height (cm)
163 ± 70
164 ± 13.7
162 ± 11.9
0.548
Weight (kg)
60.2 ± 8.3
76 ± 8.2*
94 ± 13.6*
0.001
BMI (kg/m2)
21.2 ± 1.5
26.3 ± 1.7*
34.7 ± 3.2*
0.001
WC (cm)
74 ± 7.8
91 ± 8.5*
105 ± 12*
0.001
Data presented as mean± S.E
Statistically significant (P ˂ 0.05)
*Statistically significant difference between normal and overweight and normal and obese group.
Abbr: BMI=body mass index, WC=waist circumference
Table 3 indicates the average values arranged by sex for the following clinical lab test indicators: Glucose,
Cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (LDL), Triglycerides, Iron, CRP and
Insulin.
Table 3. Clinical Lab Test Results
Men
Women Reference values
Glucose (fasting)
95.7
88.3
60-110 mg/dL
Cholesterol (total)
212
216
< 200 mg/dL
LDL
138
139
< 130 mg/dL
HDL
46.1
58.1
> 40 mg/dL
Triglycerides
140
94
< 150 mg/dL
Iron
99.2
86.7
53-167 mg/mL
CRP
0.49
0.44
< 1.0 mg/L
Insulin
9.0
8.9
2.6-24.9 IU/mL
Summary of Biochemical characteristics of participated subjects (n=1001).
22.
Parameters**
Normal (n=361)
Overweight (n=362) Obese (n= 279) P value
TC (mg/dl)
201 ± 41
229 ± 44*
223 ± 43*
0.001
HDL (mg/dl)
58.4 ± 13.5
51 ± 12
50 ± 11.5
0.188
LDL (mg/dl)
90.7 ± 34.2
91 ± 36.2*
93.9 ± 34*
0.005
TC/HDL (ratio)
3.4
4.49
4.46
0.067
Glucose (mg/dl) 84.6 ± 22.2
92.3 ± 19.6*
93 ± 17*
0.007
Triglycerides
(mg/dl)
121 ± 96*
141± 83*
0.001
78.2 ± 45.4
**Adjusted for age and gender
Abbr: TC=total cholesterol, HDL=high density lipoprotein, LDL= low density lipoprotein
A major part of the study investigated the nutritional habits of the Cypriot adult population. In the specific question if breakfast and/or a midmorning snack was consumed, 24,2% of the subjects reported that they take
breakfast only, 11,1% mid-morning snack only, 61% had both, and 3,7% had neither breakfast nor a mid-morning snack. The choices for breakfast were as followed: 94.3% of the sample consumed milk with sugar free
cereals with fiber, 91,7% milk, 86,8% milk with egg and bread, 83,8% bread with honey/marmalade, 76,0%
bread with butter/margarine and honey/jam. The most popular foods for mid-morning snack were: 79,7% for
fresh fruit, 74,7% for bakery goods, 79,2% for sandwich, 61,7% for “other” and, 48,8% for coffee. The meals
eaten per day were 2.7 ± 0.9 and the number of snacks per day were 1.9 ± 1.12, where the numbers after the
± sign indicate one standard deviation. According to the study 76,8% of the participants eat breakfast regularly,
76,9% eat lunch, 60,8% eat dinner and 39,9% eat intermediate meals. Tables 4 and 5 indicate how often the
Cypriot adults prepare meals at home and how often they eat prepared meals, respectively. The study showed
that 98.3% of adults in Cyprus use olive oil in salads or with pulses/beans, and 0.5% of them vegetable seed
oil. The majority of Cypriots use olive oil in cooking (62.3%), 29% use another type of vegetable oil, 2,6% do
not use oil, 2,6% don’t know what oil they use, 3.1% don’t cook at home, and 0.4% use butter. The majority of
Cypriot adults drink either 1-4 glasses (35.2%) of water, or 5-8 glasses of water (37.3%). Furthermore, 25.3%
drink >8 glasses of water and only 2.2% drink 0 glasses per day. The large variety of answers with regard to
consumption of water is related to the seasonal nature of water consumption. 57.2% of the subjects consume
only the salt used in cooking, 33.9% add salt after cooking, 2.9% use lo-salt, 4% do not use any salt and
1.7%, and don’t use salt but use flavouring cubes instead. Also, 8% were drinking whole fat milk, 55.5% semi
skimmed milk and 18.6% skimmed milk.
Summary of Dietary and lifestyle characteristics of subjects.
Parameters**
Normal (n=361)
Overweight (n=362) Obese (n=279)
P value
Red meat
(servings/d)
0.8 ± 0.7
2.2 ± 0.9
4.4 ± 1.1
0.391
Fish
(servings/d)
0.47 ± 0.1
0.5 ± 0.2
0.4 ± 0.2
0.437
Vegetables
(servings/d)
4.2 ± 1.5
1.1 ± 1.1*
0.7 ± 0.8 *
0.003
Fruits
(servings/d)
3.2 ± 1.6
1.2 ± 1.2*
0.5 ± 0.9 *
0.001
Alcohol (g/d)
29 ± 5.1
55 ± 4.9*
54 ± 4.8 *
0.001
Smoking
(cig/d)
5 ± 2.7
12 ± 2.6*
15 ± 3 *
0.001
Exercise (Met
x h/d)
6 ± 0.7
3.8 ± 0.7*
3.5 ± 0.6 *
0.001
**Adjusted for age, gender and energy intake
Obesity and overweight rates are highly prevalent in Cyprus. High-calorie meals and snacks and sedentary
lifestyle are among the main reasons for accumulation of body fat in Cypriot adults. Cypriots need to control
their snacks and to include more physical activity programs in their daily lifestyle schedules.
1. Cypriots are generally overweight
2. Cypriot men are in worse shape than Cypriot women
3. Cypriot women care more about their weight than men (NOTE for us: In the future we might want to
investigate the age dependence of this statement)
4. Cypriots generally avoid physical exercise
5. Cypriots undervalue the importance of regular exercise
6. Cypriots are well-informed about nutritional issues
7. Obesity and overweight contribute to health problems such as dyslipidemia, lower back pain and joint pain
REFERENCES
1) Andreou E, Hajigeorgiou PG, Kyriakou K, Avraam Th, Chappa G, Kallis P, Lazarou Ch, Philippou Ch
Christoforou C, Kokkinofta R, Dioghenous C Savva SC, Kafatos A, Zampelas A, Papandreou D. Risk factors
of obesity in a 1001 Cypriot adults: An epidemiological study. Hipokkratia Journal
2) World Health Organization. Reducing Risks, Promoting Healthy Life. World Health Report 2002, Geneva.
23.
3) Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Chadjigeorgiou C, Kafatos A.
4) Reference growth curves for Cypriot children 6 to 17 years of age. Obes Res. 2001; 9: 754-762.
5) Pitsavos C, Panagiotakos D, Antonoulas A, Zombolos S, Kogias Y, Mantas Y, et al. Epidemiology of acute
coronary syndromes in a Mediterranean country; aims, design and baseline characteristics of the Greek study
of acute coronary syndromes (GREECS).BMC Public Health. 2005; 16: 5-23.
6) World Health Organization. Prevention of Cardiovascular Disease 2007, Geneva.
7) Wang YC, Colditz GA, Kuntz KM. Forecasting the obesity epidemic in the aging U.S. population. Obesity
(Silver Spring). 2007; 15: 2855–2865.
8) Belahsen R, Rguibi M. Population health and Mediterranean diet in southern Mediterranean countries.
Public Health Nutr. 2006; 9:1130–1135.
9) Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G. Abdominal adipose tissue distribution,
obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men
born in 1931. Br Med J. 1984; 288: 1401–1404.
10) Lean MEJ, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight
management. BMJ. 1995; 311:158–161.
11) Yoon YS, Oh SW, Baik HW, Park HS, Kim WY. Alcohol consumption and the metabolic syndrome in Korean
adults: the 1998 Korean National Health and Nutrition Examination Survey. Am J Clin Nutr. 2004; 80:217–224.
Speaker’s Details:
Name: Eleni P. Andreou
Degrees/Credentials: RD, LD, DProf, FHEA
Position Title: President of Cyprus Dietetic and Nutrition Association, Clinical Dietitian, Assistan Professor,
University of Nicosia
Employer Address: 48 Themistokli Dervi 48, Off. 207, Athienitis Centennial Bldg, 1066 Nicosia
Contact Address: 48 Themistokli Dervi 48, Off. 207, Athienitis Centennial Bldg, 1066 Nicosia
Phone/Fax/Email: 00357 22 452288/ 00357 22452292/ [email protected]
Dr Antoniou Pavlos, MD
Gastroenterologist - Hepatologist
Abstract Title:
Celiac disease toolkit: Guiding your patients to a global treatment
(Part of Panel: Gastrointestinal Disorders and Nutrition)
Objectives
1. To identify the importance of Nutrition Intervention for the treatment of celiac disease
2. To determine the multifactorial elements of the treatment of celiac disease
3. To provide medical nutrition therapy (MNT) guidelines for celiac disease to promote optimal health, prevent
and treat malabsorption/malnutrition and other comorbidities, and improve quality of life
Learning Outcome Assessment
Sensitivity to gluten results in a wide spectrum of manifestations triggered by ingestion of the gluten-containing
grains – wheat, barley and rye. As the most common presentation of this disorder in genetically predisposed
individuals, coeliac disease (CD) presents with a set of diverse clinical features, which typically includes fatigue,
delayed growth, weight loss, diarrhea, anemia, osteoporosis and depression. Improved understanding of
pathogenic pathways that underlie coeliac disease has led to development of multiple new therapeutic
approaches, some of which have reached clinical studies. It may be especially important to provide optimum
aids and eventually alternatives to the gluten-free diet for those with mild or no symptoms for whom the motivation
to be gluten-free may be less
Celiac disease is a genetic disorder affecting children and adults. People with celiac disease are unable to eat
foods that contain gluten, which is found in wheat and other grains. In people with celiac disease, gluten sets
off an autoimmune reaction that causes the destruction of the villi in the small intestine. People with celiac disease
produce antibodies that attack the intestine, causing damage and illness. Untreated celiac disease can be life
threatening. Celiacs are more likely to be afflicted with problems relating to malabsorption, including osteoporosis
24.
tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, internal hemorrhaging,
organ disorders (gall bladder, liver, and spleen), and gynecological disorders. Untreated celiac disease has
also been linked an increased risk of certain types of cancer, especially intestinal lymphoma.
Abstract:
Sensitivity to gluten results in a wide spectrum of manifestations triggered by ingestion of the gluten-containing grains – wheat, barley and rye. As the most common presentation of this disorder in genetically
predisposed individuals, coeliac disease (CD) presents with a set of diverse clinical features, which typically
includes fatigue, delayed growth, weight loss, diarrhea, anemia, osteoporosis and depression.[1-4]
When coeliac disease is suspected, serological testing(IgA anti tTg and anti-endomysial antibody) and duodenal biopsies are required to confirm the diagnosis. [5]
A number of routine blood tests should be carried out to identify nutritional deficiencies including haemoglobin, B12, folic acid, iron, serum albumin, and calcium. These should be measured at diagnosis, during
symptomatic relapse, and during pregnancy. It is also reasonable to perform these routinely at annual
follow-up. [6-7]
Currently, adherence to a gluten-free diet is considered as the first line and indeed only therapy for coeliac
disease, which has been proven to relieve the symptoms in most cases and effectively prevent potential
complications.
Dietary Treatment
(a) Gluten Exclusion: The cornerstone of therapy is adherence to a gluten free diet (GFD). This means
the exclusion of foods containing wheat, rye, barley and oats, although the toxicity of oats is still debated.
The avoidance of these cereals is a formidable task as they are found in bread, biscuits, cakes, pastries,
breakfast cereals, pasta, beer and most soups, sauces and puddings.
Patients may supplement their diet with commercial gluten-free products that are available on prescription
by gastroenterologists and dietitians and include gluten-free flour, bread, biscuits, and pasta. Seventy per
cent of adults and a greater proportion of children, respond promptly to a GFD, showing improvement of
symptoms within weeks or days. Histological improvement usually takes many months to occur.[8-9]
(b) Total vs Partial Gluten Exclusion: The risk of developing small intestinal lymphoma is increased in
patients with CD who ingest a diet that contains gluten. Nutritional deficiencies are also more likely to occur.
It has been shown that early introduction of a gluten-free diet decreases the subsequent risk of developing
autoimmune disorders, particularly diabetes mellitus. Good dietary compliance should reduce the risk of
osteoporosis in later life. [10]
(c) Need For Life-Long Treatment: Adolescents may stop their diet in the mistaken belief that they have
“grown out of” their CD. Should the diagnosis be in any doubt, a gluten challenge and repeat jejunal biopsy
should be undertaken; if the diagnosis is established life-long treatment should be recommended.[11]
(d) Dietary Supplements: Many patients will be found to be suffering from dietary deficiencies at the time
of diagnosis, the commonest being iron, folic acid, calcium and vitamin B12. Although these usually resolve
spontaneously once on a GFD, it seems reasonable to ensure rapid correction with appropriate supplements.
(e) Bone Abnormalities: Many individuals have osteopenia. It is usual practice to consider bone densitometry scanning on presentation which may be repeated after one to two years of dietary therapy if the initial
value is low. Osteoporosis in post-menopausal women may warrant hormone replacement therapy and the
use of bisphosphonates in some individuals. Calcium supplementation to achieve an intake of 1500mg a
day may be considered.
Follow-Up
In patients with a satisfactory response to diet, specialist outpatient follow-up should ideally be at six to twelve
month intervals to assess symptomatic improvement, nutritional state, dietary compliance and to check routine blood tests. A check small intestinal biopsy four to six months after initiating treatment should be performed.[12-13]
It is important to review patients at times of stress, whether this be physical or emotional. Pregnancy is a particularly important time which may lead to deterioration in symptoms or asymptomatic nutritional deficiencies.
Low levels of folic acid have been associated with miscarriage and foetal neural tube defects and so should
be carefully monitored. Patients who are contemplating conception should supplement their diet with folic acid
as they are prone to folic acid deficiency.
Because of the possible long term complications of disease, such as lymphoma and bone disease, it is
strongly recommended that life-long follow-up be maintained.[14]
All these concerns along with ineffectiveness in some cases have warranted the development of alternative
and complementary approaches to dietary treatment. Improved understanding of pathogenic pathways that
underlie coeliac disease has led to development of multiple new therapeutic approaches, some of which have
reached clinical studies. It may be especially important to provide optimum aids and eventually alternatives
to the gluten-free diet for those with mild or no symptoms for whom the motivation to be gluten-free may be
less.[15-16]
25.
References
1) Green PH, Cellier C. Celiac disease. N Engl J Med 2007; 357: 1731–43.
2) Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009; 373: 1480–93.
3) Rubio-Tapia A, Murray JA. Celiac disease. CurrOpinGastroenterol 2010; 26: 116–22.
4) Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population.
Gastroenterology 2005; 128: S74–8.
5) van derWindt DA, Jellema P, Mulder CJ, et al. Diagnostic testing for celiac disease among patients with
among patients with abdominal symptoms: a systematic review. JAMA 2010; 303: 1738–46.
6) Sollid LM, Lundin KE. Diagnosis and treatment of celiac disease. Mucosal Immunol 2009; 2: 3–7.
7) Abdulkarim AS, Murray JA. Review article: the diagnosis of coeliac disease. Aliment Pharmacol Ther 2003;
17: 987 –95.
8) See J, Murray JA. Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin
Pract2006; 21: 1–15.
9) Peraaho M, Kaukinen K, Paasikivi K, et al. Wheat-starch-based gluten-free products in the treatment of
newly detected coeliac disease: prospective and randomized study. Aliment Pharmacol Ther 2003; 17: 587–
94.
10) Lee A, Newman JM. Celiac diet: its impact on quality of life. J Am Diet Assoc 2003; 103: 1533–5.
11) Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with
coeliac disease. Aliment Pharmacol Ther 2009; 30: 315–30.
12) Bardella MT, Velio P, Cesana BM, et al. Coeliac disease: a histological follow-up study. Histopathology
2007; 50: 465–71.
13) Rubio-Tapia A, Rahim MW, See JA, et al. Mucosal recovery and mortality in adults with celiac disease after
treatment with a gluten-free diet. Am J Gastroenterol 2010; 105: 1412–20.
14) Holmes GK, Prior P, Lane MR, et al. Malignancy in coeliac disease–effect of a gluten free diet. Gut 1989;
30: 333–8.
15) Lerner A. New therapeutic strategies for celiac disease. Autoimmun Rev 2010; 9: 144–7.
16) Sollid LM, Khosla C. Future therapeutic options for celiac disease. Nat Clin Pract Gastroenterol Hepatol
2005; 2: 140–7.
Name: Dr Antoniou Pavlos
Degree/Credentials: MD
Position Title: Gastroenterologist - Hepatologist
Employer Address: Hippocrateon Private Hospital, Psaron 6-12, T.K. 27509, 2408, Nicosia - Cyprus
Contact Address: Hippocrateon Private Hospital, Psaron 6-12, T.K. 27509, 2408, Nicosia - Cyprus
Phone/Fax/Email Address: +35722356565, +357 22351938, [email protected]
Dr Avraamides Panayiotis, BSc (Hons), MB BS (Lond), FRCP(Lond), FRCP(Edin), MRCPI, FESC
Director, Cardiology Department, Limassol General Hospital
Abstract Title
Mediterranean diet and effect on cardiovascular disease
(Part of panel: Mediterranean diet and cardiovascular disease)
Objectives:
1. Understand the evidence behind the link between the Mediterranean diet and heart disease
2. Understand which individual components of the diet are incriminated
Abstract:
26.
The Mediterranean diet has been found to be protective from coronary heart disease. Interest in the diet
started with the results of the Seven Countries Study which began in 1958. This demonstrated reduced mortality
from coronary heart disease in southern Europe compared to northern Europe. Since then there has been
an explosion of research around the subject. The session will attempt to clarify this topic by looking at the
evidence and the individual components of the diet.
Name: Dr Panayiotis Avdramides
Degree/ Credentials: BSc (Hons), MB BS (Lond), FRCP(Lond), FRCP(Edin), MRCPI, FESC
Position Title: Director, Cardiology Department, Limassol General Hospital
Employer Address: Cardiology Department, Limassol General Hospital
Contact Address: P.O.Box. 25473, 1310, Nicosia, Cyprus
Email Address: [email protected]
Prof De Looy Anne, BSc (Hons) PhD PGDipDiet RD FBDA
Professor of Dietetics, University of Plymouth
Abstract Title
Objectives
1. Justify the need for standards against which ethical actions in practice can be judged
2. Discuss the requirement for reflective practice and its relationship with ethical behaviour
3. Evaluate the extent and nature of ethical codes of practice
4. Describe and discuss the way competence for the successful engagement of dietitians may be demonstrated.
1. Justify the need for standards against which ethical actions in practice can be judged
The delegate will be able to recount the various standards for practice that have been established through the
European Federation of the Associations of dietitians. Further they will be able to show how each standard is
required to demonstrate safe and ethical care.
2. Discuss the requirement for reflective practice and its relationship with ethical behaviour
The delegate will be able to describe reflective practice and critically evaluate why this very powerful tool is so
important for professionals to use as they self-evaluate their own practice.
3.Evaluate the extent and nature of ethical codes of practice
Using several different ethical codes the delegate will be able to evaluate the individual components and
also justify why they are required and how a more balance ethical code can be maintained, monitored and
reviewed.
Dietitians and all other healthcare practitioners continually interact with vulnerable people for example due to
ill-health or their age. It is therefore critical that they undertake their work in a way that does not threaten or in
anyway cause distress to the individuals in their care. Ethical behaviour is therefore fundamental to all dietitians do. This lecture will investigate the standards against which dietitians can judge their day to day activities
and investigate ethical codes as well as how these can be monitored for continuing safe and high quality care.
Abstract
Ethical decisions face dietitians every professional working day of their lives, when deciding about initiating
enteral feeding (ADA, 2008; Beyeler et al,1999), treating obese patients (Pace et al, 1991), cancer patients
(Hobenshield et al 2012) or genetics related care (Kauwell, 2003) to name but a few. Three key players have a
role to play in the ethical actions that dietitians undertake and they are the practitioner themselves, the Professional
Association acting together with regulatory procedures in their country and Higher Education Institutes (HEIs).
The European Federation of the Associations of Dietitians (EFAD) has adopted three key documents to guide
and support all Associations and dietitians practising in Europe. These documents should augment and act
as benchmarks for dietitians acting in their own countries. The European Academic and Practitioner Standards
for Dietetics (EFAD, 2005) defines the fundamental knowledge set that all dietitians in Europe should obtain
before they begin to practice in the field of dietetics. For example regarding professionalism in dietetics it says
all students should have:
• A Knowledge of the legal and ethical boundaries together with the professional and personal scope of their
practice
• And, Understand the obligation to maintain fitness to practice and the need for career-long and self-directed
learning
It is the role of Higher Education to ensure that these standards are being met and in a survey undertaken of
those institutions teaching future dietitians about 20% still did not include ethical considerations in their curricular
27.
(de Looy et al, 2010; EFAD, 2005). Yet, practise within a Code of Ethics is essential for all dietitians as a key
emphasis is on doing no harm and ensuring safety for the clients.
The European Dietetic Competences and their Performance Indicators (EFAD, 2009) define the ability of the
newly qualified dietitian to practice and apply knowledge safely when giving advice on nutrition to clients,
healthcare professionals and others. A key competence is at 4.1 and this together with the performance indicators
(how the competence is to be demonstrated) is given below:
4.1 Identify and manage ethical dilemmas that
arise within professional relationships.
• Respects individuals and their rights regardless
of race, religious beliefs, colour, gender,
physical and/or mental disability, marital status,
family status, economic status, education level,
age, ancestry or sexual orientation.
• Respects the dignity and privacy of
individuals.
• Obtains informed consent as required prior to
providing services.
• Serves the best interests of the individual and
their needs.
These competences should provide both the educators in Higher Education an end point for the students
wishing to become a dietitian as well as provide the employer of the dietitian with the reassurance that during
employment the new dietitian is able to safely advise and implement a diet that will cause no harm to the client.
Finally a National Dietetic Association should have an Ethical code for dietitians which is formally introduced
during the education of students and is the code by which all dietitians will practice. EFAD adopted in 2006 the
International Code of Ethics and all Associations of Dietitians in Europe will have a code which is implemented
in their own country. The code of good practice which accompanies the International code says this;
Continued competence and professional accountability
• Ensure accountability to the public
• Accept responsibility for ensuring practice meets legislative requirements
• Maintain continued competence by being responsible for lifelong learning and engaging in self-development.
But in a survey of the members of the International Federation of Dietetic Associations codes of (ethical) conduct
were declared in 15 of 20 European member countries.
A professional dietitian does not rely on the knowledge and skills they obtained during their initial education
as providing an ethically safe level of service. Knowledge and skills obtained during initial education need to
be continually reviewed and revised and this requires constant updating or Lifelong Learning (LLL). To judge
whether a practicing dietitian remains competent the employer and the clients will expect that the dietitian
continues to demonstrate and improve their competence throughout their working lives. Many European
countries require the dietitian to formally remain competent and demonstrate this to retain their credentials
or registration so here the responsibility is for the dietitian and the ‘competent authority’ or the professional
association working together. EFAD through the Thematic Network for Dietitians (DIETS2) is currently working
towards a LLL strategy for EFAD and competences for advanced practice. All of these topics will be considered
in the presentation.
References
1) American Dietetic Association (ADA) Position of the American Dietetic Association: Ethical and legal issues
in nutrition, hydration and feeding. J Amer Diet Assoc 108:873- 882
2) Beyeler K, Schiller MR, Wolf KN and Grant HK (1999) Clinical dietitians’ perceptions of ethical decisions.
J Amer Diet Assoc 99:A77
3) De Looy AE, Naumann E, Govers E, Jager MJ, Liddell J, Maramba IDC and Cuervo M (2010) Thematic Network
DIETS mapping dietetic education in Europe 2006-2009 comparisons to the European Academic and Practitioner
Standards for Dietetics. Act diet.14 (3):109-119
4) EFAD (2006) International Code of Ethics at www.efad.org
5) EFAD (2005) European Academic and Practitioner Standards for Dietetics at www.efad.org
6) EFAD (2009) European Dietetic competences and their performance indicators. at www.efad.org.
7) Hobensheild S, Kletas V and Nathoo AN (2012) Ethical issues in nutrition support of the cancer patient.
Series of podcasts accessed at www.dietitians.ca/knowledge-centre/learning-on-demand July 2012
8) Kauwell GPA (2003) A genomic approach to dietetic practice: are you ready? Top Clin Nutr 18:81-91
9) Pace PW, Bolton MP and Reeves RS (1991) Ethics of obesity treatment: implications for dietitians. J Amer
28.
Diet Assoc 91:1258-60
Name: Anne de Looy
Degrees/Credentials: BSc (Hons) PhD PGDipDiet RD FBDA
Position Title: Professor of Dietetics, University of Plymouth
Employer Address: School of Health Professions, University of Plymouth
Contact Address: Peninsula Allied Health Care, Derriford Road, Devon , PL6 8BH
Phone/Email: +44 1752 588888, [email protected]
Prof Efthimiadis Apostolos, MD
Professor of Cardiology, Aristotle University of Thessaloniki
Abstract Title
Cardiometabolic Risk Factors
(Part of Panel:Eat well, love better, move more: treatment of cardiometabolic syndrome)
Objectives
1. To identify the Cardometabolic risk factors and relate them to Nutrition
2. To determine the efficacy of a weight loss and physical activity intervention on the adverse health risks of
severe obesity.
3. To determine whether WC predicts diabetes and cardiovascular disease (CVD) beyond that explained by
BMI and commonly obtained cardiometabolic risk factors including blood pressure, lipoproteins, and glucose.
Abstract
Despite any therapeutical interventions cardiovascular disease (CVD) remains the leading cause of death in
the USA. The revolution of statins caused a significant reduction in cardiovascular events but still a 19.8%
of patients under statin therapy experiences one cardiovascular episode in 5 years. This has to do with the
global Cardiometabolic Risk (CMR).
Global Cardiometabolic Risk represents the overall risk of developing type 2 diabetes and/or cardiovascular
disease (including MI and stroke), which is due to a cluster of modifiable risk factors/markers. These include
classical risk factors such as smoking, high LDL, hypertension, elevated blood glucose and emerging risk factors closely related to abdominal obesity (especially intra-abdominal adiposity), such as insulin resistance, low
HDL, high triglycerides and inflammatory markers.
All the above emerging risk factors are related to central (intra-abdominal) obesity whose prevalence is about
to rise even more in the future years. Central obesity is considered even now a world epidemic problem. It is
an independent prognostic factor for developing cardiovascular disease and there is evidence to be related to
sudden cardiac death and the development of diabetes mellitus.
In 2001 the amount of money expended per capita in Great Britain was >37% for the obese people, that is
1.000 $/person more than a non-obese. The economic burden of obesity is attributed in: type 2 Diabetes,
hyperlipidemia, arterial hypertension, cardiovascular disease. Why is that? Because we strongly prefer the
sedentary type of lifestyle: no physical exercise and fast food ( junk food).
Thus, the management of obesity and other cardiometabolic risk factors seems to be rather important today.
The corner stone to manage a patient with cardiometabolic risk factors is to start with a holistic approach and
manage everyone individually. Lifestyle change is the first one to begin to manage the cardiometabolic risk
factors. Weight loss based on a balanced diet, regular physical exercise and smoking cessation may help
initially. Improvement of lipidemic profile, glycemic profile and blood pressure control by special medication is
the next step for the management of cardiometabolic risk. Regular follow up of the patient is essential for his
compliance and monitoring any adverse events.
The cardiometabolic risk is attributed to the clustering of risk factors in the obese people.Thus it is the
consequence of metabolic syndrome whose prevalence is about to increase due to the global economic crisis
which leads to cheap bad quality food.We have to manage individually every patient and looking for other risk
factors. Lifestyle change and medication is needed. We also have to give special attention and emphasize in
the prevention of obesity to the general population (Physicians,Medical Societies).
Name: Prof. Efthimiadis Apostolos
Degrees/Credentials: Professor of Cardiology
Position Title: Professor of Cardiology, Aristotle University of Thessaloniki / President Atherosclerosis
Society of Northern Greece
Contact Address: Morkentaou 8, 54622, Thessaloniki, Greece
Phone/Fax/Email: +306945955182, [email protected]
29.
Escott – Stump Sylvia, MA, RD, LDN
Director, Dietetic Internship, East Carolina University
A. Abstract Title
Medical Nutrition Therapy: Standardized language – making it international (Keynote Speaker)
Objectives
1. Discuss the importance of using standardized language and the nutrition care process in any environment.
2. Identify at least one behavioral change they will make after the seminar.
Participant evaluation of program
Self-assessment about the appropriate use of IDNT and the nutrition care process
Adoption of common nutrition practices and terminology supports more effective outcomes. Health care payers,
medical team members, and administrators will be able to identify the true cost-benefit of dietitian services
when similar steps and terminology cross international borders of care.
Abstract
Changes in nutritional intake, appetite or weight are essential components of nutrition assessment. Malnutrition is associated with depression of the immune system, impaired wound healing, muscle wasting, longer
lengths of hospital stay, higher treatment costs, and increased mortality; screening and implementation of
published best-practice guidelines may effectively reduce hospital malnutrition and save costs (Barker et al, 2011.)
Yet, nutrition problems can be noted in other settings: excessive or inadequate meal intake, reduced appetite,
dysphagia, dependence on non-oral nutrition support, changes in weight, altered fluid intake, exposure to food
allergens or unsafe foods, decline in functional capacity, hospitalization, altered mood, reduced social
activity or cognitive
performance, even inadequate growth. With application of standardized language and terminology, dietitians
can assess and intervene in hospitals, home care, child care centers, intensive care, even community health
clinics. The four-step nutrition care process (NCP) promotes effective data assessment, followed by the selection
of key nutrition diagnoses (problems), interventions, monitoring and evaluation. Writing an accurate P-E-S
statement with the Problem (nutrition diagnosis), its Etiology (cause) and Signs and symptoms (measurable
indicators) mandates deep critical thinking by the qualified dietitian. Several countries are in the process of
validating or adopting the standardized terminology. The Netherlands, United States, Canada, Great Britain,
and Australia have made great strides; other countries have begun translating the terminology. Adoption of
common terminology supports effective outcomes. Health care payers, medical team members, and administrators
will be able to identify the true cost-benefit of dietitian services when similar terminology crosses international
borders of care.
References:
1) ADA. Nutrition Care Process and Model Part 1: The 2008 Update. J. Am Diet Assoc. 2008; 108: 1113-1117.
2) ADA. Nutrition Care Process Part II: Using the International Dietetics and Nutrition Terminology to
Document the Nutrition Care Process. J. Am Diet Assoc. 2008; 108: 1287-1293.
3) Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and
the healthcare system. Int J Environ Res Public Health 2011; 8:514-27.
4) Hakel-Smith N, Lewis N, Eskridge K. Orientation to Nutrition Care Process Standards Improves Nutrition
Care Documentation by Nutrition Practitioners. J. Am Diet Assoc. 2005; 105: 1582-1589.
5) Lacey K, Pritchett E. Nutrition Care Process and Model: ADA Adopts Road Map to Quality Care and Outcomes
Management. J. Am Diet Assoc. 2003; 103: 1061-1072.
6) Mathieu J, Foust M, Ouellette P. Implementing Nutrition Diagnosis, Step Two in the Nutrition Care Process and Model: Challenges and Lessons Learned in Two Health Care Facilities. J Am Diet. Assoc. 2005; 105:
1636-1640.
7) McCarthy, M. A Renal Nutrition Forum Series with Practice-Based Examples of the Nutrition Care Process
(NCP): What’s Happening Among Dialysis Providers? Renal Nutrition Forum 2010; 29.1: 12-13.
30.
B. Abstract Title
Dysphagia Nutrition Management (Part of panel: Gastrointestinal and hepatic disorders)
Objectives
1. Participants will be able to recognize the nutritional risks of dysphagia.
2. Participants will be able to identify aspects of dysphagia that can be managed by dietary changes.
3. Participants will be able to address hydration challenges associated with dysphagia.
Participant evaluation of program
Self-assessment about the nutritional risks of dysphagia; dietary and hydration measures for dysphagia.
40-60% of geriatric patients in nursing homes experience dysphagia; 15-30% of patients in acute & rehabilitation
may also have difficulty swallowing. Proper assessment and nutritional interventions can prevent choking or
aspiration incidents. In addition, progressive use of the 3-stage Dysphagia Diet can alleviate the need for
long-term enteral tube feeding in many patients.
Abstract
Difficulty in swallowing results from a neurological, mechanical/structural, or behavioral disorder or condition
and requires alterations in food and liquid consistencies. Dietitians must be able to work with the medical team
to prevent aspiration and choking in vulnerable patients. It is important to establish Dysphagia Policies, Diet
Manual content, and a Task Force including Registered Dietitians, Speech Therapists, Nursing, Physician and
Food Service Management. The most severe restriction is Level 3 – Dysphagia Pureed, graduating through
mechanically altered foods back to a regular diet when possible.
References:
1) Dining Skills Manual, Academy of Nutrition and Dietetics
2) Dysphagia Severity Rating Scale (adapted from Waxman et al, 1990.) Available at http://www.nature.com/
gimo/contents/pt1/fig_tab/gimo95_T6.html
3) Gee AC et al. Nutrition Support and Therapy in Patients with Head and Neck Squamous Cell Carcinomas.
Curr Gastroenterol Rep. 2012 Jun 29.
4) National Dysphagia Diet: Standardization for Optimal Care, Academy of Nutrition and Dietetics, 2003
Name: Escott – Stump Sylvia
Degrees/Credentials: MA, RD, LDN
Position Title: Director, Dietetic Internship, East Carolina University
Employer Address: Mailstop 505, Rivers Building, Greenville, NC 27858
Contact Address: 2405 Royal Drive, Winterville, NC 28590
Phone/Fax/Email: 252-353-5116, Fax 252-328-4276, [email protected]
Prof Hassapidou Maria
Professor of Nutrition and Dietetics, Department of Nutrition and Dietetics,
Alexander Technological Educational Institute, Thessaloniki, Greece
Abstract Title
Μεσογειακή δίαιτα και καρδιαγγειακά νοσήματα
(Mediterranean Diet and Cardiovascular Disease)
Objectives
1.Know the basic characteristics of the Mediterranean diet
2.Understand the role of the Med diet in the prevention and treatment of cardiovascular diseases
3.Learn basic dietary practises for a healthier life
31.
Abstract
The Mediterranean diet is well known internationally as a health promoting dietary model, starting from the
results of the “seven countries” study by Ancel Keys in the 1960’s, in which the populations of the Mediterranean
countries were found to have lower coronary heart disease mortality rate, with Greece having the lowest compared
to the other populations of the study.
The Mediterranean diet is traditionally followed by people in the different countries bordering the Mediterranean
Sea. It is characterized by a high consumption of fruit, vegetables, legumes, and complex carbohydrates, with
a moderate consumption of fish, low consumption of meat and meat products, and moderate consumption of milk
and dairy products.The consumption of olive oil ιs the main source of fats and a low-to-moderate amount of
wine is consumed during meals.
The Lyon Heart Study showed that the Mediterranean diet was more effective than a low fat diet in secondary
prevention of cardiac events. Since then, several prospective studies in the last 30 years in a large number of
subjects from around the world have shown that the Mediterranean diet provides significant and consistent
protection from total and cardiovascular mortality.
These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like
dietary pattern for primary prevention of cardiovascular diseases. A recent systematic review and meta-analysis
by F.Sofi et al (2010) on benefits of adherence to the Mediterranean diet on health showed that a 2-point increase in
adherence to the Mediterranean diet was associated with a significant improvement in health status, as seen
by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of
or mortality from cancer (6%), and incidence of Parkinson’s disease and Alzheimer’s disease (13%)..
In conclusion individuals who adhere to the principles of the traditional Mediterranean diet end to have a
longer life-span due to lower incidence of morbid conditions such as cardiovascular disease, the metabolic
syndrome, hypertension ,hyperlipidemias. It should be noted though that not only nutrition but a healthy lifestyle
including healthy weight and physical activity is needed to prolong the human life-span.
References:
1) Hassapidou M., Manoukas G.(1993)Tocopherol and tocotrenol composition of olive oil. Journal of the Science
of Food and Agriculture, 61, 277-280.
2) Hassapidou M., Fotiadou E., Maglara E. and Papadopoulou SK. (2006)
Energy intake, diet composition, energy expenditure and body fatness of adolescents in Northern Greece.
Obesity, 14, 5, 855-862.
3) López-Miranda V.,Soto-Montenegro ML.,Vera G.,Herradón E.,Desco M., Abalo R.(2012) Resveratrol: a
neuroprotective polyphenol in the Mediterranean diet. Rev neurol., 16,54(6),349-56.
4) Sofi F.,Abbate R., Gensini GF., Casini A. (2010)Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr, 92(5),1189-96
5) Panagiotakos D., Pitsavos C., Chrysohoou C., Palliou K., Lentzas I., Skoumas I., Stefanadis C (2009). Dietary
patterns and 5-year incidence of cardiovascular disease: a multivariate analysis of the ATTICA study. Nutr
Metab Cardiovasc Dis. , 19(4),253-63.
Name: Hassapidou Maria
Position Title: Professor of Nutrition and Dietetics, Department of Nutrition and Dietetics, Alexander
Technological Educational Institute, Thessaloniki, Greece
Employer Address: ATEITH, Thessaloniki, Greece
Contact Address: Riga Fereou 10, 55535 ,Thessaloniki,Greece
Email: [email protected]
Dr Heraclides Alexandros, BSc (Hons), MSc, MSc, PhD
Lecturer in Nutrition, Epidemiology and Biostatistics at the Univeristy of Nicosia
Abstract Title
Nutrigenetics and nutrigenomics: Scientific breakthrough, but what is the benefit for public health
nutrition and everyday dietetic practise?
(Part of Special Event: Nutrigenomics and genetics and nutrition)
32.
Objectives
1. Understand the scientific concept of nutrigenetics and nutrigenomics.
2. Appreciate the complex ethical aspect surrounding the application of nutrigenetics and nutrigenomics to
human populations.
3. Appreciate how nutrigenetics and nutrigenomics can help improve public health nutrition and everyday
dietetics practice and realize the obstacles faced for that.
As of 2003, when the human genome was decoded, the face of science in general has dramatically changed
and genetic research gained huge attention in all disciplines of health sciences, including nutritional sciences.
The field of nutritional genomics studies interactions between diet and the human genome, which may open
new horizons for personalized nutrition and identification of high-risk individuals. As science progresses,
nutritionists and dietitians must be familiar with these concepts and how they are involved in their everyday
practice.
Abstract
Nutritional genomics, which includes the disciplines of nutrigenetics and nutrigenomics, aim at studying the
complex interactions between nutrients (as well as specific foods and whole diets) and the genome.
Nutrigenomics is the study of genome-wide influences of nutrition, where nutrients are thought of as dietary
signals detected by cells, influencing gene expression and metabolite production. In simpler words,
nutrigenomics studies how nutrients influence the functioning of our genes at the molecular level. Nutrigenetics
on the other hand is the study of the incluence of specific genes on physiological responses to nutrients. In
simpler words, nutrigenetics studies how our genetic makeup influences diet-disease associations. The
contemporary nutritionist/dietitian has a huge task in front of him/her, which is to comprehend the above concepts
and try to apply them in his/her everyday practice. In order for this to be achieved, the ethical considerations of
nutritional genomics need to be clearly understood. These include ethical/cultural/religious barriers to genetic
research in general by certain groups within a society, as well as the practical difficulties in passing health
messages involving genetic concepts to individuals. The first point here refers to how certain individuals and
groups of individuals within a society may be offended by any type of genetic research (including nutritional
genomics) as this may be perceived as ‘playing God’. At the individual level, some patients may strongly oppose
the collection of any genetic sample from them and thus application of nutritional genomics is impossible for
such individuals. At the population level, organized groups may systematically oppose the conducting of any
kind of nutritional genomics research thus spreading the wrong message to the society and influencing negatively
the public opinion. The second point mentioned above concerns ethical issues in translating evidence from
nutritional genomics research to individuals and groups of individuals who are not, a priori, misconceived
about this scientific field. These ethical considerations include difficulties from the side of the individual in
understanding basic concepts of nutritional genomics such as genetic predisposition or genetic vulnerability or
resilience. The main issue here is whether giving health messages involving genetic information to people, will
do more harm than good. Research on both the scientific part of the nutritional genomics field and the ethical
aspects surrounding it, is in its infancy and lots of work is currently under way on generating new evidence on
gene-diet interactions and the best way that such evidence is communicated to popuations and individuals.
References:
1) Fenech M, El-Sohemy A, Cahill L, Ferguson RL, et al. Nutrigenetics and Nutrigenomics: Viewpoints on the
Current Status and Applications in Nutrition Research and Practice. Nutrigenet Nutrigenomics (2011) 4. 69–89
2) Korthals M. Coevolution of nutrigenomics and society: ethical considerations. Am J Clin Nutr (2011) 94
(suppl). 2025S–9S
3) Mariman MCE. Nutrigenomics and nutrigenetics: the ‘omics’ revolution in nutritional science. Biotechnol.
Appl. Biochem. (2006) 44, 119–128
4) Muller M, Kersten S. Nutrigenomics: goals and strategies. Nat Rev Genet (2003) 4. 315-322
5) Mutch MD, Wahli W, Williamson G. Nutrigenomics and nutrigenetics: the emerging faces of nutrition.
FASEB J (2005) 19. 1602–1616
Name: Heraklides Alexandros
Degrees/Credentials: BSc (Hons) Biology; MSc Nutrition; MSc Health and Society; PhD Epidemiology and
Public Health
Position Title: Lecturer in Nutrition, Epidemiology and Biostatistics at the Univeristy of Nicosia / Visiting
Scientist at the German Institute of Human Nutrition, Potsdam Rehbrucke
Employer Address: University of Nicosia, 46 Makedonitissis Avenue, 1700 Nicosia, Cyprus
Contact Address: Flat 202, Archiepiskopou Leontiou 17A, 2407, Engomi, Cyprus
Mob Phone/Email: 99091764, [email protected], [email protected]
33.
Ioannou Elina, BSc, MSc
Clinical Dietitian, Cyprus Ministry of Health
Abstract Title
Nutrition in critical illness: from theory to daily practice
(Part of panel: Bridging the Guideline-Practice Gap: The Critical Care Experience)
Objectives
1.Have a better and complete understanding of the nutrition guidelines used in the hospitalised setting and
the ICU in particular.
2. Learn how to implement knowledge in daily practice.
Nutrition in critical illness plays a major role in the final outcome of a hospitalised patient. Aim of this presentation
is to analyse the guidelines on nutrition in the hospitalised setting.
Special reference on nutrition in theICU patients will be made. Screening patients and making the correct
dietetic intervention is of critical importance. The attendee will learn how to make a judgement based on the
daily circumstances and the individual needs of a patient in order to achieve the optimal outcome.
Clinical dietitians and professionals involved in the nutrition therapy of critically ill patients are called to have
a thorough knowledge of the nutrition support therapy guidelines. The analytic presentation of the guidelines,
the limitations and contraindications and the handouts to be given can be a helpful tool in enabling the attendees
to implement knowledge to daily practice.
Abstract
Malnutrition is a common problem affecting a large number of hospitalized patients and is very often not
recognized. It also affects recovery from surgery or illness, and increases the incidence and severity of infection.
The major significance of nutritional support in the hospitalized setting has been firmly established over the
last three decades. Nutrition support has three main objectives: to preserve lean body mass, to maintain immune
function and to avert metabolic complications. ASPEN describes Nutrition Support Therapy as “The provision
of oral, enteral and parenteral nutrients to treat and to prevent malnutrition, to maintain or restore optimal
nutrition status and health”.
Basic objective of this presentation is to offer the professional who works in the demanding environment
of a hospital or a health care unit a review of the bibliography and the basic guidelines on both enteral and
parenteral nutrition. We are going to go over the guidelines of major societies (ASPEN, ESPEN). Patient
selection (screening tools for detecting malnourished patients), formula selection, feeding tube management,
feeding protocols, monitoring tolerance and complications, are some of the topics to be analyzed. Moreover,
we are going to go over the indications and limitations of all enteral feeding routes: nasogastric, nasojejunal,
percutaneous endoscopic gastrostomy and jejunostomy. The indications and the contraindications for
parenteral nutrition are also to be discussed. An outline of the nutrition support in special diseases such as
diseases of the GI tract, diabetic and renal patients and ICU patients will also be made.
In conclusion, we are going to refer to some of the basic problems occurring in the daily practice nowadays in
Cyprus, especially in periods of financial crisis. The judgment of the healthcare professional should be based
on the individual circumstances of the patient and should be based on the recommendations of the international
guidelines to the maximum extent possible.
References:
1) Kreymann K.G. et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clinical Nutrition 2006; 25;
210-223
2) Pearce C.B. And Duncan H.D. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomyQ: its indications and limitations. J Postgrad Med 2002; 78: 198-204
3) McClave S.A. et al.. Guidelines for the Provision and Assesment of Nutrition Support Therapy in the Adult
Critically Ill Patient, J Parenteral and Enteral Nutrition 2009; 33(3): 277-316
Name: Ioannou Elina
Degrees/Credentials: BSc Dietetics and Nutrition, MSc Public Health Nutrition from Harokopio University
Athens
Position Title: Clinical Dietitian, Cyprus Ministry of Health
Employer Address: Limassol General Hospital, P.O.Box: 56060, 3304, Limassol
Contact Address: 33 Ippokratous Street, Flat 201, 2325, Nicosia
Phone/Fax/Email: +357 25801124 / +357 25305783 / [email protected]
34.
Dr Kakouri Eleni, BSc, Ph.D.
Chief Chemist, Head of Quality Assurance and Risk Assessment Units
of the State General Laboratory (SGL) of Cyprus
Abstract Title
Labeling of Foodstuffs, Nutrition and Health Claims – An EU perspective
Part of panel: Novelties in Nutrition)
Objectives
1. To be more informed and more selective in the choices of packaged food.
2. To be well informed about the nutrition and health claims
3. To learn about the differences between nutrition and health claims.
In the Cyprus and others countries market are sometimes advertised food products with misleading nutrition
and health claims. So a better knowledge in this field will help too much in the consumers choices
All the above will imrove the practical but also the scientific knowledge in the field
Abstract
The requirements and practical aspects and perspectives of the recent European Union (EU) legislation concerning
labeling of foodstuffs and relevant consumer information, nutrition and health claims will be discussed. More
specifically, the requirements of the new Regulation (EU) No 1169/2011 on the provisions of food information
to consumers considerably changes existing EU legislation on food labeling from 13 December 2014 i.e.:
Directive 2000/13/EC concerning labeling ,presentation and advertising of foodstuffs and Directive 90/496/
EEC concerning nutrition labeling for foodstuffs. Furthermore the Regulation (EU) No 1924/2006 on nutrition
and health claims made on foods gives a special emphasis to conditions for the use of nutrition and health
claims, scientific substantiation of health claims and the need for their authorization by the European Safety
Authority. A reference will be made to EU list of authorized health claims.
References:
1) REGULATION (EU) No 1169/2011 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL on the
provision of food information to consumers, amending Regulations (EC) No 1924/2006 and (EC) No 1925/2006
of the European Parliament and of the Council, and repealing Commission Directive 87/250/EEC, Council
Directive 90/496/EEC, Commission Directive 1999/10/EC, Directive 2000/13/EC of the European Parliament
and of the Council, Commission Directives 2002/67/EC and 2008/5/EC and Commission Regulation (EC) No
608/2004
2) REGULATION (EC) No 1924/2006 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL on nutrition
and health claims made on foods
3) DIRECTIVE 2000/13/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCI on the approximation
of the laws of the Member States relating to the labelling,presentation and advertising of foodstuffs.
4) EFSA webpage with list of authorized health claims: http://www.efsa.europa.eu/en/ndaclaims13/docs/
ndaart13ref03.pdf
Name: Dr. Kakouri Eleni
Degrees/Credentials: BSc, Ph.D.
Position Title: Chief Chemist, Head of Quality Assurance and Risk Assessment Units of the State General
Laboratory (SGL) of Cyprus
Employer Address: 44 Kimonos Street, 1451 Nicosia, Cyprus
Contact Address: State General Laboratory, ,44 Kimonos Street, 1451 Nicosia, Cyprus
Phone/Fax/Email: +35722809120, +35722316434,[email protected]
35.
Kountouri Stalo, CPD, R.D
Clinical Dietitian, General Hospital of Famagusta
Abstract Title
Bowel cancer and nutrition intervention
(Part of panel: The state of the science: evidence to support diet and physical activity recommendations for cancer prevention)
Objectives
1. Identify the risk factors of bowel cancer
2. Determine the role of a clinical dietitian regarding prevention and treatment of bowel cancer
To identify the risk factors of bowel cancer and what we can do as health care professionals to prevent it.
Through the presentation the attendees will be educated on how a clinical dietitian can help to prevent the
formation of a bowel tumor and also how to interfere with the bowel cancer treatment.
Abstract
Colorectal cancer is the second leading cause of cancer death among American. The risk of colorectal cancer
is increased in those with a family history of colorectal cancer or a history of adenomatous polyps, a precursor
lesion for colon cancer. It is estimated that one third of the cancer deaths each year in the US can be attributed
to nutrition and other lifestyle factors. The majority of these incidences could be prevented. Overweight and
obesity increase the risk of colorectal cancer in men and women, especially when there is high waist to hip
circumference. Physical activity has a positive impact on colon cancer. A moderate activity on a regular basis
decreases the risk of colon cancer, where a vigorous activity might have an even greater impact. Number of
studies agrees that the high consumption of red and processed meat can increase the risk of bowel cancer.
This might be happening due to the grilling process which produces carcinogens. Also there is a positive
correlation between high fiber intake, especially from whole grains and colorectal cancer. A diet high in fruits,
vegetables and whole grains is related with a decrease risk in colorectal cancer. Even though some studies
suggest that vitamin D and calcium may lower the risk of the specific type of cancer, the American Cancer
Society does not recommend the use of calcium supplement or high consumption of dairy foods. It is
recommended to get the RDA of calcium through food sources and not exceed the recommended level.
High calcium intake has been associated with an increase risk of prostate cancer. Alcohol consumption can
increase the risk of several cancers including colon and rectum especially among men.
The treatment of colon cancer might be different for every patient considering the stage and the location
of the cancer and also the risks and benefits associated with each one. The treatment can be a surgery,
chemotherapy or radiation or a combination and is decided by the physician and the patient. Depending on
the treatment, different side effects could appear. These include fatigue, constipation, diarrhea, temporary or
permanent colostomy, sores in the mouth, low appetite, difficult in swallowing and tiredness. A clinical dietitian
should provide medical nutrition therapy (MNT) guidelines to manage symptoms, preventing weight loss and
maintaining optimal nutritional status during cancer treatment.
A survivor cancer patient is at risk of other primary cancers. The survivor should be educated on lifestyle
changes and dietary recommendations in order to prevent the formation of new tumors.
References
1) www.cancer.org
2) Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and
racial disparities on premature cancer deaths. CA Cancer J Clin. 2011; 61: 212-236.
3) Ning Y, Wang L, Giovannucci EL. A quantitative analysis of body mass index and colorectal cancer: findings
from 56 observational studies. Obes Rev. 2010; 11: 19-30.
4) Norat T, Chan D, Lau R, Aune D, Vieira R. The Associations Between Food, Nutrition and Physical Activity
and the Risk of Colorectal Cancer. WCRF/AICR Systematic Literature Review Continuous Update Project
Report. London: World Cancer Research Fund/American Institute for Cancer Research; 2010.
5) Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a
prospectively studied cohort of U.S. adults. N Engl J Med. 2003; 348: 1625-1638.
6) Martinez ME, Giovannucci E, Spiegelman D, Hunter DJ, Willett WC, Colditz GA. Leisure-time physical activity,
body size, and colon cancer in women. Nurses’ Health Study Research Group. J Natl Cancer Inst. 1997; 89:
948-955.
36.
7) Wolin KY, Yan Y, Colditz GA. Physical activity and risk of colon adenoma: a meta-analysis. Br J Cancer.
2011; 104: 882-885.
8) Slattery ML, Edwards SL, Ma KN, Friedman GD, Potter JD. Physical activity and colon cancer: a public
health perspective. Ann Epidemiol. 1997; 7: 137-145.
9) Huxley RR, Ansary-Moghaddam A, Clifton P, Czernichow S, Parr CL, Woodward M. The impact of dietary
and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence.
Int J Cancer. 2009; 125: 171-180.
10) Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and
fatal prostate cancer. Cancer Epidemiol Biomarkers Prev. 2006; 15: 203-210.
11) Chan DS, Lau R, Aune D, et al. Red and processed meat and colorectal cancer incidence: meta-analysis
of prospective studies.PLoS One. 2011; 6: e20456.
12) International Agency for Research on Cancer. Cruciferous vegetables, isothiocyanates and indoles. Lyon,
France: IARC Press;2004.
13) Schatzkin A, Mouw T, Park Y, et al. Dietary fiber and whole-grain consumption in relation to colorectal
cancer in the NIH-AARP Diet and Health Study. Am J Clin Nutr. 2007; 85: 1353-1360.
14) Nomura AM, Hankin JH, Henderson BE, et al. Dietary fiber and colorectal cancer risk: the multiethnic
cohort study. Cancer Causes Control. 2007; 18: 753-764.
15) Bingham SA, Day NE, Luben R, et al. Dietary fibre in food and protection against colorectal cancer in the
European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. Lancet. 2003;
361: 1496-1501.
16) Randi G, Edefonti V, Ferraroni M, La Vecchia C, Decarli A. Dietary patterns and the risk of colorectal
cancer and adenomas. Nutr Rev. 2010; 68: 389-408.
17) Chung M, Balk EM, Brendel M, et al. Vitamin D and calcium: a systematic review of health outcomes. Evid
Rep Technol Assess (Full Rep). 2009;( 183): 1-420.
18) Aune D, Lau R, Chan DS, et al. Dairy products and colorectal cancer risk: a systematic review
and meta-analysis of cohort studies [published online ahead of print May 26, 2011]. Ann Oncol.
19) CA: A Cancer Journal for Clinicians. Volume 62, Issue 1, pages 30–67, January/February 2012
20) http://www.oncologynutrition.org
21) http://nfcr.org
22) http://www.cdc.gov
23) https://www.caring4cancer.com
Name: Kountouri Stalo
Degrees/Credentials: CPD, R.D
Position Title: Clinical Dietitian
Employer Address: General Hospital of Famagusta
Contact Address: 3 Th. Georgiade Str. 2123, Nicosia, Cyprus
Phone/ Email: 99-541021, [email protected]
Dr Kyprianou Theodoros, MD, PhD EDIC
Head, Multidisciplinary Intensive Care Unit, Nicosia General Hospital
Abstract Title
Are guidelines for the critically ill patient nutritional assessment and plan being transferred to
practice?
Objectives
1. Understand the basic elements of guidelines on nutrition of the critically ill adult patients
37.
2. Identify the difficulties and challenges, critical illness poses on optimum nutritional assessment and planning
3. Learn about strategies / practices could be used and attitudes to be adopted
Evidence based guidelines addressing the difficulties and challenges critical illness poses on optimum nutritional
assessment and planning, do exist. Implementation of these guidelines, however, has been problematic and
not uniform due to inherent problems of the ICU environment, personnel attitudes and resistance to change.
Understanding the nature of these obstacles would enable the attendees to bridge theory and practice.
5 MCQ (best answer) asked during the presentation and assessed either through voting electronic system or
through “hands raising”.
Abstract
Accurate determination of energy needs in hospitalized patients is vital because under-feeding / overfeeding
are both associated with complications. Also feeding regimens / route as well as composition and special patients
groups needs are all important, especially in critically ill patients where complications and inter-relations are
many. REE-predictive equations have been developed based on actual energy expenditure using indirect
calorimetry. The accuracy of these equations in groups such as elderly, obese, critically ill, malnourished patients has been questioned. Practice of nutritional support in critically ill patients is consequently suffering from
inconsistencies and empiricism. Methods to overcome problems are discussed.
References:
1) Joseph Bullata et al: Accurate Determination of Energy Needs in Hospitalized Patients. J. Am. Diet. Assoc.
Vol.107(3), March 2007, 393–401
2) E. Kross et al: A comparison of predictive equations of energy expenditure and measured energy expenditure
in critically ill patients. J Crit.Care, Volume 27, Issue 3, June 2012, Pages 321.e5–321.e12
3) Hegazi RA et al: Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven
formula. Critical Care 2011 15:234
4) Daren K et al: Canadian Clinical Practice Guidelines for Nutrition Support in Mechanically Ventilated, Critically
Ill Adult Patients. J. of parenteral and Enteral Nutrition 27, No. 5 (2003)
5) Mc Clave S et al: Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult
Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral
Nutrition (A.S.P.E.N.). JPEN J Parenter. Enter. Nutr. (2009) 33(3):277-316.
6) L. Araújo-Junqueira and Daurea A. De-Souza: Enteral nutrition therapy for critically ill adult patients; critical
review and algorithm creation. Nutr Hosp. 2012;27(4):999-1008
Name: Dr. Kyprianou Theodoros
Degrees/Credentials: Consultant in Pulmonary Medicine and Intensive Care, Honorary Senior Lecturer/
Lead of Clinical Skills, St Georges Univ. of London Medical School
Position Title: Head, Multidisciplinary Intensive Care Unit, Nicosia General Hospital
Employer Address: Ministry of Health
Contact Address: Nicosia General Hospital - Dept. of Intensive Care, 214 Palaios dromos Lemesou, Latsia
Phone/Email: +357 2203809 (08.00 - 16.00), [email protected]
Kyriakidou Stella
Psychologist, Member of Cyprus Parliament
Abstract Title
Myths and realities about cancer –the psychology’s aspect
(Part of panel: Cancer: Myths and realities)
Objectives
1. Identity the rule of psychologist for the treatment of cancer
2. Define the myths and realities for cancer
3. Determine the contribution of the emotional status of the cancer patients to their clinical outcome
38.
Name: Dr Stella Kyriakidou
Degrees/Credentials: Psychologist, Member of Cyprus Partiament
Kyriakidou Evi, BSc, MSc
Nutrition Support Dietitian, Barts Health NHS Trust
Abstract Title
Nutrition and Trauma (presentation of case studies)
Objectives
1. Describe the metabolic response to trauma and injury
2. Describe the effects on substrate utilisation
3. Discuss the dietetic implications of these responses
This session explains the metabolic response to sepsis, trauma and injury and outlines the effects of these
responses on substrate utilisation. It aims to enhance the attendees’ knowledge on stress response as well
as the dietetic implications of trauma and injury. The relevance to dietetic practice will be explored through a
case study presentation.
Attendees will be able to discuss the relevance of the metabolic responses to dietetic practise through the
presentation of a case study.
Abstract
The metabolic responses to injury differ significantly to those of starvation. Severe trauma triggers the release
of various neuroendocrine and immunological mediators which induce marked metabolic changes in an attempt
to restore the body to its pre-injury condition.
Metabolic changes after trauma are occurring in two different phases, the “ebb” phase and the “flow” phase.
The “ebb” phase is initiated within minutes after trauma and persists for several hours after the initial insult. It
is characterized by a decline in body temperature and oxygen consumption, aimed at reducing post-traumatic
energy depletion (Hasenboehler et al, 2006) . The “flow” phase, is described in two parts a) the catabolic and
b) the anabolic phase. The initial catabolic phase can last several days or weeks depending on the severity of
the insult and is associated with a hypermetabolic state and a significantly increased consumption of energy
and oxygen (Trager, DeBacker & Radermacher, 2003; Rixen & Siegel, 2000).
During the stress response there is an increased secretion of pituitary hormones as well as activation of the
sympathetic nervous system and immune system as characterized by the release of pro-inflammatory cytokines
(Schlag & Redl, 1996; Ertel et al, 1998).
This results in fat mobilisation, hyperglyceamia, sodium and water retention and net protein breakdown. The
overall metabolic effect of the hormonal changes is increased catabolism which mobilizes substrates to provide
energy sources, and a mechanism to retain salt and water and maintain fluid volume and cardiovascular
homeostasis.
Nutrition support in severely injured patients cannot prevent catabolism and negative nitrogen balance and
thus the aim of nutrition support is to minimise nitrogen losses. However, it is of key importance not to “overfeed”
critically injured patients, since this may contribute to adverse outcomes (Plank & Hill, 2003; Biffl, Moore &
Haenel, 2002; Reid, 2006). Early overfeeding of severely injured patients leads to an increase in overall oxygen
consumption, carbon dioxide production, hepatic lipogenesis, and hyperglycemia (Reid, 2006).
International clinical guidelines for nutrition support in critically ill patients have been published by various
societies including the American Society of Parenteral and Enteral Nutrition (ASPEN), the European Society
of Parenteral and Enteral Nutrition (ESPEN),and the Intensive Care Society (ASPEN, 2009; ESPEN, 2006;
ICS, 2004)
The ESPEN guidelines suggest providing no more than 20-25kcal/kg per day during the acute and initial
phase of critical illness. This can be increased to 25-30kcal/kg per day during the anabolic recovery phase.
The ASPEN guidelines suggest the use of predictive equations or providing 25-30kcal/kg per day and the
Intensive Care Society recommends the use of 25kcal/kg per day in critically ill patients.
39.
With regards to protein there is no advantage of providing more than 0.2g/kg of nitrogen in severely injured
patients as positive nitrogen balance will never be achieved and higher protein intakes are associated with the
risks of overfeeding (Elia, 2005)
Once catabolism declines and the patient enters the anabolic phase nutrition support aims to increase protein
synthesis and restore muscle mass. Sufficient energy and protein provision is important during this phase in
order to replenish losses.
The timing of nutrition support is also critical in the severely injured patient. Although early enteral nutrition
has been associated with a decreased posttraumatic infection rate, a shorter duration of hospital stay, and
an improved overall outcome (Moore et al, 1994; Spain, 2002), this should be started after the patient is fully
resuscitated with a stable cardiovascular system.
References:
1) Biffl WL, Moore EE, Haenel JB (2002). Nutrition support of the trauma patient. Nutrition, 18:960-965.
2) Elia M. (2005). Principles of clinical nutrition: contrasting the practice of nutrition in health and disease. In:
Clinical Nutrition, Blackwell Publishing, Oxford, pp1-14.
3) Ertel W, Keel M, Marty D, Hoop R, Safret A, Stocker R, Trentz O (1998). Significance of systemic inflammation
in 1,278 trauma patients. Unfallchirurg, 101:520-526.
4) Hasenboehler et al. (2006). Metabolic changes after polytrauma: an imperative for early nutritional support.
World Journal of Emergency Surgery, 1:29
5) Intensive Care Society (2004). Standards and Publications. Available at www.ics.ac.uk
6) Kreyman KG et al. (2006). ESPEN guidelines on Enteral Nutrition: Intensive Care. Clinical Nutrition, 25:210-23
7) McClave SA et al (2009). Guidelines for the provision and assessment of nutrition support therapy in the
adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and
Enteral Nutrition (ASPEN).J Parenter Enteral Nutr 33: 277-316
8) Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A (1994). Clinical
benefits of an immune-enhancing diet for early postinjury enteral feeding. J Trauma 37:607-615.
9) Plank LD, Hill GL (2003). Energy balance in critical illness. Proc Nutr Soc, 62(2):545-552.
10) Reid C (2006). Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and
possible consequences. J Hum Nutr Diet, 19:13-22.
11) Rixen D, Siegel JH (2000). Metabolic correlates of oxygen debt predict posttrauma early acute respiratory
distress syndrome and the related cytokine response. J Trauma, 49:392-403.
12) Schlag G, Redl H (1996). Mediators of injury and inflammation. World J Surg, 20:406-410.
13) Spain DA (2002). When is the seriously ill patient ready to be fed? J Parenter Enteral Nutr, 26(6
Suppl):S62-5; discussion S65-8.
14) Träger K, DeBacker D, Radermacher P (2003). Metabolic alterations in sepsis and vasoactive drug-related
metabolic effects. Curr Opin Crit Care, 9(4):271-278
Name: Kyriakidou Evi
Degrees/Credentials: BSc Nutrition, MSc Dietetics
Position Title: Nutrition Support Dietitian, Barts Health NHS Trust
Employer Address: Barts Health NHS Trust, Royal London Hospital, Outpatient Therapies 2nd Floor, Central
Tower, London F1 1BB
Contact Address: 81 Oakdale Road, Manor House, London N4 1NU
Phone/Fax/Email: 0044 20 3594 1156 / 0044 20 3594 3215 / [email protected]
40.
Lappa Fotini BSc (Hons), MSc
Dietitian – Sports Nutritionist
Lecturer in Nutrition (Intercollege and the University of Nicosia)
Yiakoumi Ioannis, BSc, MSc
Lecturer in Culinary Art, Intercollege
Abstract Title
Culinary demonstration: Fiber: small changes, big difference
Objectives
1. Provide the most recent information on fiber and its positive effects on human health.
2. Obtain sufficient knowledge on the various nutritional ways of cooking dietary fiber.
3. Obtaining insight into various means of increasing dietary fiber in meals whilst still maintaining the great
taste factor and palatable content of such
The goal is to impart ideas and knowledge as to the various cooking practices available for increasing dietary
fiber content in meals, in order to provide palatable, appealing and nutritionally balanced food. The additional
aim is to provide the attendees with further information as to the nutritional and health benefits involved in
adopting such practices
• Health and nutritional advantages of using dietary fiber in cooking/meals.
• Ability of increasing dietary fiber content in meals whilst still maintaing quality in taste.
Abstract
Dietary fiber is deemed to be a key component in healthy eating. It contains a unique blend of bioactive
components including resistant starches, vitamins, minerals, phytochemicals and antioxidants. So, the health
benefits of dietary fiber, as a kind of phytochemical is no longer an issue. Epidemiological and clinical studies
demonstrate that a generous intake of dietary fiber reduces risk for developing the following diseases:
cardiovascular disease (CVD)1,2, hypertension3, type two diabetes4,5 , obesity5,6 ,cancer7,8,9, certain
gastrointestinal disorders10,11, constipation and hemorrhoids12. Furthermore, increased consumption of dietary
fiber improves serum lipid concentrations13, lowers blood pressure14 and aids in weight loss and long term
weight management15.
Defining dietary fiber is a complex process and depends on both nutritional and analytical concepts. Generally
speaking dietary fiber is a non-starch polysaccharide in (mostly) plant food that is resistant to digestion and
absorption in the small intestine. Simplistically, fibers have been categorized into soluble, such as viscous or
fermentable fibers (e.g. pectin) that are fermented in the colon, and insoluble fibers (e.g. wheat bran) that have
bulking action but may only be fermented to a limited extent in the colon5.
Dietary fiber can be separated into many different fractions. These fractions include arabinoxylan, inulin, pectin,
bran, cellulose, β-glucan and resistant starch. The study of these components may give us a better understanding
of how and why dietary fiber may decrease the risk of certain diseases as mentioned above. Although the
mechanisms behind the reported effects of dietary fiber on human health are not well established, it is believed
that the synergistic effect of phytochemicals, increased nutrient content and digestive properties are key elements
in the treatment and prevention of obesity and diabetes 16,4, reduced CVD17 and decreased incidence of
certain types of cancer18,19.
Fruit, vegetables, whole grains, pulses, cereals and seaweeds are the major sources of dietary components
for fiber. Current recommendations for dietary fiber intake (by USDA) are related to age, gender, and energy
intake, and the general recommendation for adequate intake is 14 g/1000 kcal. Using the energy guideline of
2000 kcal/day for women and 2600 kcal/day for men, the recommended daily dietary fiber intake is 28 g/day
for adult women and 36 g/day for adult men20.
Unfortunately, most persons today consume less than half of the recommended levels of dietary fiber daily.
The goal of this demonstration is therefore to impart ideas on easy to make recipes for increasing dietary fiber
in meals, in order to provide palatable, appealing and nutritionally balanced food with all the health benefits
that stem from a higher dietary fiber intake.
References
1) Streppel M.T, Ocke M.C, Boshuizen H.C, Kok F.J, Kromhout D. “Dietary fiber intake in relation to coronary
heart disease and all cause mortality over 40 y: The Zutphen Study”. Am. J. Clin. Nutr. 2008, 88, 1119-1125.
2) Badimon L., Vilahur G., Padro T. “Nutraceuticals and atherosclerosis: Human trials”. Cardiovasc. Ther.
2010;28:202–215.
41.
3) Whelton SP.; Hyre AD.; Pedersen B.; Yi Y.; Whelton PK.; He J. “Effect of dietary fiber intake on blood pressure:
a metaanalysis of randomized, controlled clinical trials”. J Hypertens 2005;23:475–481
4) Weickert M.O; Pfeiffer A.F. “ Metabolic effects of dietary fiber consumption and prevention of diabetes” J.
Nutr. 2008, 138, 439-442.
5) James W Anderson.; Pat Baird.; Richard H Davis Jr.; Stefanie Ferreri.; Mary Knudtson.; Ashraf Koraym.;
Valerie Waters.; and Christine L Williams. “ Health benefits of dietary fiber” Nutrition Reviews Vol. 67(4):188–
205
6) Tucker L.A.; Thomas K.S. “Increasing total fiber intake reduces risk of weight and fat gains in women “J.
Nutr. 2009, 139, 576-581.
7) Li Q.; Holford TR.; Zhang Y.; Boyle P.; Mayne ST.; Dai M.; Zheng T. “Dietary fiber intake and risk of breast
cancer by menopausal and estrogen receptor status”. Eur J Nutr. 2012, Feb 16. Epub ahead of print
8) Park Y.; Brinton L.A.; Subar A.F.; Hollenbeck A.; Schatzkin A. “Dietary fiber intake and risk of breast cancer
in postmenopausal women: The National Institutes of Health-AARP Diet and Health Study”. Am. J. Clin. Nutr.
2009, 90, 664-671.
9) Schatzkin A.; Park Y.; Leitzmann M.F.; Hollenbeck A.R; Cross A.J. “Prospective study of dietary fiber, whole
grain foods, and small intestinal cancer” Gastroenterology 2008, 135, 1163-1167.
10) El-Serag HB.; Satia JA.; Rabeneck L. “Dietary intake and the risk of gastro-oesophageal reflux disease: a
cross sectional study in volunteers”. Gut 2005;54:11–17.
11) Tsai CJ.; Leitzmann MF.; Willett WC.; Giovannucci EL. “Long term intake of dietary fiber and decreased
risk of cholecystectomy in women”. Am J Gastroenterol 2004;99:1364–1370.
12) Cummings JH. “The effect of dietary fiber on fecal weight and composition”. In: Spiller G, ed. Dietary Fiber
in Human Nutrition. Boca Raton, FL: CRC Press; 2001:183–252.
13) Champagne CM.; Broyles ST.; Moran LD.; Cash KC.; Levy EJ.; Lin PH.; Batch BC.; Lien LF.; Funk KL.;
Dalcin A.; Loria C.; Myers VH. “Dietary intakes associated with successful weight loss and maintenance during
the Weight Loss Maintenance trial”. J Am Diet Assoc. 2011 Dec;111(12):1826-35.
14) Bantle J.P.; Wylie-Rosett J.; Albright A.L.; Apovian C.M.; Clark N.G.; Franz M.J.; Hoogwerf B.J.; Lichtenstein
A.H.; Mayer-Davis E., et al. “Nutrition recommendations and interventions for diabetes: A position statement
of the American Diabetes Association”. Diabetes Care 2008;31:S61–78.
15) Michael R. Lyon and Veronica Kacinik. “Is There a Place for Dietary Fiber Supplements in Weight
Management”? Curr Obes Rep 2012 June; 1(2): 59–67.
16) Graziano Riccioni.; Valeriana Sblendorio.; Eugenio Gemello.; Barbara Di Bello.; Luca Scotti.; Salvatore
Cusenza.; and Nicolantonio D’Orazio. “Dietary Fibers and Cardiometabolic Diseases” Int J Mol Sci 2012;
13(2): 1524–1540
17) Liu S.; Stampfer M.J.; Hu F.B.; Giovannucci E., Rimm E.; et al.” Whole grain consumption and risk of coronary
heart diseae: Results from the Nurses’ Health Study” Am. J. Clin. Nutr. 1999, 70, 412-419
18) Ferguson L.R.; Chavan R.R.; HArris P.J. “Changing concepts of dietary fiber: Implications for carcinogenesis”
Nutr. Cancer 2001, 39, 155-169.
19) Terry P.; Giovannucci E.; Michels K.B.; Bergkvist L.; Hansen H.; et al. “ Fruit, vegetables, diatary fiber, and
risk of colorectal cancer” J. Natl. Cancer Inst. 2001, 93, 525-533.
20. US Department of Agriculture (USDA), US Department of Health and Human Services. Dietary Guidelines
for Americans. Washington, DC: USDA; 2005
Name: Lappa Fotini
Degrees/Credentials: BSc (Hons), MSc
Position Title: Dietitian – Nutritionist with specialization in Sports Nutrition, Lecturer in Nutrition (Intercollege and
the University of Nicosia)
Employer Address: Intercollege and The University of Nicosia, Culinary Arts Department, 46 Makedonitissas
Ave. P.O.Box 24005, 1700 Nicosia
Contact Address: 53 Stavrou St., 2035 – Strovolos, Nicosia - Cyprus
Phone/ Email: (00357) 22 492148 / [email protected]
42.
Name: Yiakoumi Ioannis
Degrees/Credentials: BSc/ MSc
Position Title: Lecturer, Intercollege, Nicosia
Employer Address: 46 Makedonitissas Ave. P.O.Box 24005, 1700 Nicosia
Contact Address: 46 Makedonitissas Ave. P.O.Box 24005, 1700 Nicosia
Phone/ Email: (00357) 99-183297 / (00357)22-357778 / [email protected]
Loizou Despo, BSc (Hons), SRD
Clinical Dietitian, Nutritionist, Home Economics Counselor and Teacher
Abstract Title
Food – A-Pedia (Part of panel: Professional development and education)
Objectives
1. Recognize the importance of promoting health education from the early stages of life
2. Have an overview of how health and nutrition education is applied and promoted in schools
3. Identify the role of the dietitian as health educator
Promoting health by fostering healthy eating practices and regular physical activity is believed to have a great
impact on health and wellbeing during childhood and later stages in life. Schools are considered as one of the
best settings for educating a large segment of the population, including young people, school staff, parents,
families and community members. The sub-thematic nutrition education area focuses not only on nutrition
education but also on developing skills and behaviours related to good nutritional practices.
Participants will be able to incorporate the information and knowledge acquired during the presentation when
promoting health and nutrition education goals among children and adolescents (5-14 years).
Abstract
Healthy eating practices and regular physical activity have been the focus of many scientific articles, as they
are believed to have a great impact on health and wellbeing during childhood and later stages in life.
A number of factors indicate the need to promote health through school-based nutrition education. Such factors
include, the on growing epidemic of childhood and adulthood overweight and obesity, as well as the effects
this has on the development of other public health problems.
Schools are considered as one of the best settings for educating a large segment of the population, including
young people, school staff, parents, families and community members. Thus, when designing and implementing
nutrition education activities, a health promoting school approach should take into consideration the needs
and interests of the above mentioned groups. Furthermore, such activities should aim in promoting interactions
between students, family members, teachers and their social environment.
A number of school-based initiatives have been implemented with the aim of promoting health all around the
world. The World Health Organisation has introduced the European Network of Health Promoting Schools
project that has led to the development of a school-based nutrition education curriculum, along with a Planning
and Evaluation Guide. Furthermore, The Schools for Health in Europe Network (SHE network) is the European
platform for school health promotion. The SHE network aims at supporting organisations and professionals to
further develop and sustain school health promotion in each member state.
Specifically, at the Netherlands a health promoting school approach was implemented based on eight components,
namely; health education, physical activity, food policy, a healthy and safe school environment, participation of
parents and community, psychological and social-emotional guidance and counseling, provision of care and
workplace health promotion. Additionally, in the United Kingdom, the Food Standard Agency (FSA) launched
a set of food competences across the UK, to help young people choose, cook and eat safe healthy food. The
competences were set out as a framework of core skills and knowledge for children and young people aged
5-16+ years.
Moreover, in the USA, in 1997 the Centre for Disease Control and Prevention (CDC) issued guidelines for
school and community health programmes to promote physical activity and healthy eating among young people,
while in 2000, the School Health Index for physical activity and healthy eating was published as a school
self-assessment and planning guide to implement health promotion projects in Elementary, Middle and High
schools.
43.
Finally, in Cyprus as part of the educational reform of the school curriculum, health education has been introduced
mainly through the Home Economics and the Biology subjects, both in primary and secondary school level
(5-14 years) taking into consideration the transition from “health education to health promotion”. As such, the
new curriculum was designed with emphasis on changing children’s attitudes and behaviors towards health,
to strengthen their ability to contribute to the creation of a healthy community, by taking into account their physical,
social and cultural environment. It is worth noting that the sub-thematic nutrition education area focuses
not only on nutrition information but also on developing skills and behaviours related to areas, such as food
preparation and cooking, food production, preservation and storage, social and cultural aspects of food and
eating as well as on good consumer practices. Furthermore, it enhances self-esteem and promotes a positive
body image.
In conclusion, teaching methods should not only be interactive but should also vary depending on the learning
objectives of the curriculum. This could include role playing activities and drama, classroom discussions and
small projects designed and implemented by the students. Furthermore, the use of specifically designed
computer programs for nutrition education and worksheets could be used, together with cooking activities,
keeping food records charts, shopping activities, designing meals and menus and taste-testing. In addition,
extra-curricular activities could also be endorsed, such as cooking sessions with parents and members of the
community, school gardening, organizing exhibitions, organizing and participating in workshop activities, as
well as other activities promoting physical wellbeing such as biking or walking to school.
References
1) Aldinger, C.E., Jones J.T. (1998) Healthy Nutrition: An essential element of a Health-Promoting School.
WHO Information Series on School Health. Document four. Geneva.
2) Ballam, R. (2010). Food and Nutrition teaching throughout the UK. Nutrition Bulletin, British Nutrition Foundation, 35, 34-36.
3) Boonen, A., Vries, N., Ruiter, S., Bowker, S., Buijs, G. (2009). HEPS Guidelines. Netherlands Institute for
Health Promotion (NIGZ). Woerden.
4) Buijs, G. (2009). SHE strategic plan 2008-2012. Netherlands Institute for Health Promotion (NIGZ). Woerden
5) Centers for Disease Control and Prevention (CDC) (1996). Guidelines for School Health Programs to Promote
Lifelong Healthy Eating. MMWR, 45, 1–33.
6) Centers for Disease Control and Prevention (CDC) (1997). Guidelines for School Health Programs to Promote
Lifelong Healthy Eating. Journal of School Health, 67, 9-26.
7) Dixey, R., Heindl, I, Loureiro, I., Pérez –Rodrigo, C., Snel, J., Warnking, P. (1999). Healthy eating for
young people in Europe. Nutrition education in Health Promoting Schools. Copenhagen: European Network
of Health Promoting Schools.
8) International Union of Health Promotion Education (2008). Achieving Health Promoting Schools:Guidelines
for Promoting Health in Schools. IUHPE, Saint-Denis.
9) International Union of Health Promotion Education (2009). Promoting Health in Schools: From Evidence to
Action. IUHPE, Saint-Denis.
10) Ioannou, S., Kouta, C., Charalambous, N. (2011). Moving from health education to health promotion. Developing
the health education curriculum in Cyprus. Health Education, 112(2), 153-169.
11) Jensen, B.B., Simowska, V. (2002). Models of health promoting schools in Europe. International Planning
Committee. Copenhagen.
12) Kazela A., Loucaidou V., Loizou, D., Lambi K. (2012). Home Economics-Health Education. A’ Gymnasium.
Teacher’s Guide Book. Nicosia, Cyprus: Curriculum Development Unit, Pedagogical Institute, Ministry of Education
and Culture.
13) Pérez-Rodrigo C., Aranceta J. (2001). School-based nutrition education: lessons learned and new perspectives.
Public Health Nutrition, 4(1A), 131-139.
14) Pérez-Rodrigo C., Aranceta J. (2003). Nutrition education in schools: experiences and challenges.
European Journal of Clinical Nutrition, (Suppl 1), S82-S85.
15) Roe, L., Hunt, P., Bradshaw, H., Rayner, M. (1997). Health promotion interventions to promote healthy
eating in the general population: a review. London: HEA.
16) Simovska, V., Bruun Jensen B., Carlsson, M., Albeck, C. (2006). Shape Up Europe. Barcelona, Spain:
P.A.U. Education. www.shapeupeurope.net.
44.
17) Simovska, V. (2007). The changing meanings of participation in school based health education and health
promotion: the participants’ voices. Health Education Research, 22 (6), 864-878.
18) Story, M., Neumark-Sztainer, D., French, S. (2002). Individual and environmental influences on adolescent eating behaviors. Journal of the American Dietetic Association, 102 (Suppl), S40–S51.
19) US Department of Health and Human Services. Centers for Disease Control and Prevention, CDC. (2000)
SHI. School Health Index for physical activity and healthy eating. A self-assessment and planning guide.
Elementary school. Atlanta.
20) US Department of Health and Human Services. Centers for Disease Control and Prevention, CDC. (2000).
SHI. School Health Index for physical activity and healthy eating. A self-assessment and planning guide. Middle
school/High school. Atlanta. WHO (1993). European Network of Health Promoting Schools. A joint
WHO-CE-CEC Project. Copenhagen: WHO-Euro.
Name: Despo Loizou
Degrees/Credentials: BSc (Hons) Nutrition and Dietetics , SRD
Position Title: Clinical Dietitian, Nutritionist, Home Economics Counselor and Teacher
Employer Address: Ministry of Education and Culture, Kimonos and Thoukididou Corner, 1434, Nicosia,
Cyprus
Contact Address: 8 Kikeronos Str. 2028, Dasoupoli, Strovolos, Nicosia, Cyprus
Phone/Fax/Email: +35722446440 / +35722446441 / [email protected]
Dr. Madden Angela, PhD, RD
Professional Lead for Dietetics, University of Hertfordshire
A. Abstract Title
Nutritional screening using MUST -workshop / Interactive Presentation
(Part of panel: Weight management and metabolic diseases)
Objectives
1. Outline the purpose and value of using nutritional screening.
2. Explain the role of validated tools in nutritional screening and support this with evidence.
3. Describe the challenges and implications associated with nutritional screening and how these can be addressed in practice.
This session will review the evidence for screening nutritional status of people in different situations. The
process of validating screening tools will be considered with a focus on the Malnutrition Universal Screening
Tool (MUST). The challenges and implications associated with using nutritional screening in practice will be
considered.
Delegates who wish to assess their learning should write an evidence-based paragraph addressing each of
the objectives relating these to their own practice, i.e. clinical, primary care, public health etc.
Abstract
Purpose and value of nutrition screening
Medical screening is defined as the process of identifying apparently healthy people who may be at increased
risk of a disease or condition (UK National Screening Committee, 2012). Those identified as being at risk
can then be offered further tests and treatment if necessary to improve health. Similarly, nutrition screening
aims to identify people who are at increased risk of the consequences of nutritional impairment, including
under-nutrition and obesity, and to offer appropriate action to address this. There is considerable evidence to
indicate that nutritional impairment is common in people living in the community and in hospitalised patients
and, in both these groups, is associated with worse health outcomes. Therefore, using resources to screen
for nutritional impairment appears logical. However, nutrition screening will only yield potential benefits if it is
undertaken using an appropriate tool and if the findings from the screen are used to determine further nutritional intervention.
The role of validated screening tools
Many different nutrition screening tools are currently in use in different settings and with general and specific
populations (Green & Watson, 2005; Phillips et al., 2010). For a tool to be useful, it needs to be systematically
developed and evaluated (Jones, 2002). This includes examination in a relevant setting of (1) its reliability
45.
when used by different observers, (2) the contribution made by component variables, e.g. body mass index
or weight loss, (3) the appropriateness of the cut-off points used and (4) the ability of the tool to yield results
which predict healthcare outcomes. Two commonly used tools which have been widely evaluated include the
Malnutrition Universal Screening Tool, MUST, (Elia, 2003) and the Mini Nutritional Assessment, MNA, (Guigoz
et al., 1996).
Challenges associated with nutrition screening
Whilst establishing the validity of a nutrition screening tool should be an essential pre-requisite for its use, other issues associated with using the tool also need to be considered. These can raise challenges which can be
broadly described in two related groups. Firstly, the practicality and logistics of undertaking the measurements, how
these are interpreted, the training required, the overall acceptability to those being screened and the costs of
implementing the whole process (Elia & Stratton, 2011; Elia & Stratton, 2012). Secondly, as there is little evidence
to indicate that nutrition screening alone is associated with beneficial changes in clinical outcome (Weekes et
al., 2009; Vincent et al., 2012), the process of screening must fit within a wider nutritional programme that
includes suitable intervention for individuals identified as being at nutritional risk. These challenges need to be
addressed in clinical and public health practice in order to optimise potential benefits from nutritional screening
and intervention.
References:
1) Elia, M. (2003) The ‘MUST’ Report. Nutritional Screening of Adults: A Multidisciplinary Responsibility.
Development and Use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. Malnutrition Advisory
Group (MAG), a Standing Committee of the British Association of Parenteral and Enteral Nutrition (BAPEN).
Redditch: BAPEN.
2) Elia, M., Stratton, R.J. (2011) Considerations for screening tool selection and role of predictive and concurrent
validity. Current Opinion in Clinical Nutrition and Metabolic Care 14, 425-433.
3) Elia, M., Stratton, R.J. (2012) An analytic appraisal of nutrition screening tools supported by original data
with particular reference to age. Nutrition, 28, 477-494.
4) Green, S.M. & Watson, R. (2005) Nutritional screening and assessment tools for use by nurses: Literature
review. Journal of Advanced Nursing 50, 69-83.
5) Guigoz, Y., Vellas, B. & Garry, P.J. (1996) Assessing the nutritional status of the elderly: The Mini Nutritional
Assessment as part of the geriatric evaluation. Nutrition Reviews 54, S59-S65.
6) Jones, J.M. (2002) The methodology of nutritional screening and assessment tools. Journal of Human Nutrition and Dietetics 15, 59-71.
7) Phillips, M.B., Foley, A.L., Barnard, R., Isenring, E.A. & Miller, M.D. (2010). Nutritional screening in community-dwelling older adults: A systematic literature review. Asia Pacific Journal of Clinical Nutrition 19, 440-449.
8) UK National Screening Committee (2012). What is screening ? Accessed from http://www.screening.nhs.
uk/screening 8 September 2012.
9) Vincent, R.P., Omar, S., Elnenaei, M.O., Goo, C.H., Salota, R., Wu, P.F., Delaney, H.J. & le Roux, C.W.
(2012). Adherence to the national institute of clinical excellence guidance on parenteral nutrition screening is
not enough to improve outcomes. Clinical Nutrition doi:10.1016/j.clnu.2012.05.015.
10) Weekes, C.E., Spiro, A., Baldwin, C., Whelan, K., Thomas, J.E., Parkin, D. & Emery, P.W. (2009). A review of the evidence for the impact of improving nutritional care on nutritional and clinical outcomes and cost.
Journal of Human Nutrition and Dietetics 22, 324-335.
B. Abstract Title
Non-alcoholic fatty liver disease / NASH (Part of panel: Novelties in Nutrition)
Objectives
1. Describe the prevalence, prognosis and putative pathogenesis of non-alcoholic fatty liver disease (NAFLD)
and non-alcoholic steatohepatitis (NASH).
2. Evaluate the evidence to support nutritional interventions in the treatment of NAFLD and NASH.
This session will provide an overview of the hepatic complications associated with overweight and obesity.
The current evidence to support nutritional intervention in this condition will be presented.
Delegates who wish to assess their learning should write an evidence-based paragraph addressing each of
the objectives and identify what they consider are the major gaps in the evidence and where future research
priorities should lie.
46.
Abstract
Introduction
Non-alcoholic fatty liver disease (NAFLD) is a term used to describe the early stages of a progressive spectrum of
liver conditions that are associated with over-nutrition. In some individuals, this may develop into non-alcoholic
steatohepatitis (NASH) and then, sequentially, to fibrosis, cirrhosis and hepatocellular carcinoma although
progression is not inevitable. NAFLD is diagnosed when lipid accumulated in the hepatocytes accounts for
>5% of the liver weight in people who abstain from alcohol or drink very little (men<21 and women <14 drinks/
week) (Basaranoglu et al., 2010). Most people with NAFLD are also at risk from other metabolic disorders
including obesity, diabetes and dyslipidaemia.
Prevalence
Prevalence varies with population and diagnostic criteria but an estimated 20% of the general adult population
has NAFLD and 3-5% has NASH (Chalasani et al., 2012). Approximately 90% of adults undergoing bariatric
surgery for severe obesity have NAFLD with ~5% being diagnosed incidentally with cirrhosis. Age, gender and
ethnicity influence prevalence with risk of NAFLD increased in older people, men and Hispanic individuals.
Children, especially if obese, may also be affected (Schwimmer et al., 2006)
Prognosis
Individuals with NAFLD have an increased risk of mortality compared to matched healthy populations and
cardiovascular disease is the most common cause of death. Those with NASH have an increased risk of
liver-related death.
Putative pathogenesis
A ‘two-hit’ mechanism has been proposed to explain the development of NAFLD and progression to NASH
based on increased insulin resistance secondary to obesity. This causes (1) peripheral lipolysis and reduced
hepatic lipid oxidation leading to accumulation of hepatocyte lipid and then (2) hepatic lipid peroxidation resulting
in anti-oxidant stress and cellular damage (Zivkovic et al., 2007). This does not explain NAFLD in non-obese
individuals.
Evidence to support dietary management
Lifestyle modification leading to weight loss in adults is most likely to be beneficial with loss of 3-5% of body
weight associated with reduction in lipid accumulation in NAFLD whilst a 10% loss is associated with reduced
inflammation in NASH. This can be achieved by dietary restriction of energy intake and / or increased energy
expenditure through exercise (Chalasani et al., 2012; Thoma et al., 2012). There is some evidence that rapid
weight loss (>1.6 kg/week) is not advisable (Andersen et al., 1991) and that a Mediterranean diet and lower
intake of fructose / simple sugars may be beneficial (Zivkovic et al., 2007; Yki-Järvinen, 2010). High alcohol
intake, defined as men >14 and women >7 drinks/week, is not recommended; the reported potential benefits
of consuming <1 drink/day have not been confirmed. The antioxidant effects of vitamin E in pharmacological
doses have been examined with varying results and supplements are not currently recommended in NAFLD
but 800 IU / day is advised for non-diabetic adults with NASH (Chalasani et al., 2012). No good quality dietary
studies have been undertaken in children with NAFLD or NASH but appropriate lifestyle modification in those
who are overweight is considered likely to be of benefit.
References
1) Andersen, T., Gluud, C., Franzmann, M.B. & Christoffersen, P. (1991) Hepatic effects of dietary weight loss
in morbidly obese subjects. Journal of Hepatology 12, 224-229.
2) Basaranoglu, M., Kayacetin, S., Yilmaz, N., Kayacetin, E., Tarcin, O. & Sonsuz, A. (2010). Understanding
mechanisms of the pathogenesis of nonalcoholic fatty liver disease. World Review of Gastroenterology 16,
2223-2226.
3) Chalasani, N., Younossi, Z., Lavine, J.E., Diehl, A.M., Brunt, E.M., Cusi, K., Charlton, M. & Sanyal, A.J.
(2012) The diagnosis and management of non-alcoholic fatty liver disease: Practice guidelines. Gastroenterology
142,1592-1609.
4) Schwimmer, J.B., Deutsch, R., Kahen, T., Lavine, J.E., Stanley, C. & Behling, C. (2006) Prevalence of fatty
liver in children and adolescents. Pediatrics 118, 1388-1393.
5) Thoma, C., Day, C.P. & Trenall, M.I. (2012) Lifestyle interventions for the treatment of non-alcoholic fatty
liver disease in adults: a systematic review. Journal of Hepatology 56, 255-266.
6) Yki-Järvinen, H. (2010) Nutritional modulation of nonalcoholic fatty liver disease and insulin resistance: human
data. Current Opinion in Clinical Nutrition and Metabolic Care 13, 709-714.
7) Zivkovic, A.M., German, J.B. & Sanyal, A. (2007) Comparative review of diets for the metabolic syndrome:
Implications for nonalcoholic fatty liver disease. American Journal of Clinical Nutrition 86, 285–300.
47.
Name: Dr. Madden Angela
Degrees/Credentials: PhD RD
Position Title: Professional Lead for Dietetics
Employer Address: University of Hertfordshire, Hatfield, Hertfordshire, AL 109AB, UK
Contact Address: Department of Human and Environmental Science, University of Hertfordshire, Hatfield,
AL109AB
Phone/Fax/Email: +441707 281385, +44 1707 285230, [email protected]
Mc Clinchy Jane, MSc,RD,FHEA
Principal Lecturer and Programme tutor, University of Hertsforshire
A. Abstract Title
The Role of the Multidisciplinary team in giving nutritional advice
(Part of a panel: Professional development and education)
Objectives
1. Discuss the research evidence supporting the need for health care professionals to deliver nutritional advice
2. Discuss the research evidence exploring the potential role for health care professionals in the delivery of
nutritional advice
3. Contribute to the discussion regarding how dietitians can support the role of health care professionals in the
delivery of nutritional advice
Long term health conditions either wholly or partly diet related, continue to increase in the United Kingdom and
internationally; however there are insufficient dietitians to provide nutritional advice. This paper pulls together
research projects undertaken by the presenter as well as published research to explore the role of the
multidisciplinary team in delivering nutritional advice.
The objectives will be assessed through the discussion after the presentation
Abstract
Long term health conditions either wholly or partly diet related, continue to increase in the United Kingdom
and internationally. Registered dietitians are the only qualified health professionals that assess diagnose and
treat individual nutritional problems at an individual and wider public health level, however there are insufficient
dietitians to provide nutritional advice. A wide range of health professionals including GPs, practice nurses,
midwives and pharmacists deliver nutritional advice (McClinchy et al. 2011, AfN 2012). In addition the AHPF
(2008) identified allied health professionals as being key in supporting the self-management of long term conditions.
In the last twenty years the NHS has shifted from a doctor led organisation to a profession led organisation
with a large number of professionals each with their own specialism. This has brought with it concerns about
communication between the different professions (Colyer 2004). This paper pulls together research projects
undertaken by the presenter as well as published research to explore the role of the multidisciplinary team in
delivering nutritional advice.
Across Europe including the UK, dietitians receive referrals from doctors who may need to give first line dietary
advice. In the UK the Royal College of Physicians expects doctors to be aware of nutritional problems and how
to manage them (Kopelman and Lennard-Jones 2002) and the NHS now gives financial reward to primary
care doctors for the improved management of their patients who have long term health conditions including
those which are either wholly or partly diet related such as diabetes, hypertension or obesity (NHS Employers
2006). GPs do give nutritional advice (McClinchy et al. 2011) however this may be limited by negative attitudes,
lack of knowledge and confidence and time. Nurses are spending more time in managing long term conditions
(Truswell et al. 2003) and may have more time to give on-going support to their patients (Laurent et al. 2007),
however although they see their role in delivering nutritional advice as important their effectiveness may be
limited by lack of training and confidence.
Community pharmacists in the UK now undertake public health work as part of their contract (PSNC 2012) and
research has found that their involvement can be effective (Botomino et al. 2008). In France however there is
some evidence that their ability to undertake this role may be limited by lack of knowledge (Ragot et al. 2005)
and research suggests that their role could be further enhanced by additional training and access to evidence
based materials.
There is some evidence that AHPs have a role in delivering nutritional advice for example in referring onto
dietitians however they may not feel well equipped to do so (McClinchy et al. 2010). At the same time dietitians
may not feel that this is an appropriate role for AHPs because of their lack of training. Both AHPs and dietitians
48.
appear to be uncertain of each other’s role suggesting that the concerns regarding communication between
specialist professions raised by Colyer (2004) may limit the effectiveness of nutritional interventions.
With the increase in long term conditions there is a need for dietitians to enlist the support of other healthcare
professionals to deliver nutritional interventions at the level of first line advice and to ensure they are aware of
who to refer to when specialist advice is required.
References
1) AfN, (2012), Workforce Competence Model in Nutrition. London, Association for Nutrition.
2) AHPF (2008) Our NHS our future: NHS Next Stage Review. AHPs as Integrators of care Report of the key
findings from the Allied health Professions Federation event . London, Chartered Society of Physiotherapy.
3) Botomino, A., Bruppacher, R., Krähenbühl, S., & Hersberger, K. E. (2008). Change of body weight and
lifestyle of persons at risk for diabetes after screening and counselling in pharmacies. Pharmacy World and
Science, 30(3), 222-226. doi: 10.1007/s11096-007-9174-3
4) Colyer, H. M. (2004). The construction and development of health professions: where will it end? J Adv
Nurs., 48(4), 406-412.
5) Kopelman, P. & Lennard-Jones, J. (2002) Nutrition and patients -A doctor’s responsibility. Report of a working party of the Royal College of Physicians London: Royal College of Physicians.
6) Laurant, M., Reeves, D., Hermens, R., J., B., Grol, R. & Sibbald, B. (2005) Substitution of doctors by nurses in primary care (Review). Cochrane database of systematic reviews, Issue 4. Art. No.: CD001271. DOI:
10.1002/14651858.CD001271.pub2.
7) McClinchy, J., Gordon, L., Williams, G., Fairey, G., Cairns, M., (2010) An exploration of the nutritional advice
given to patients by Allied Health Professionals. J. Hum Nutr Diet, 23, pp437-464
8) McClinchy, J., Dickinson, A., Barron, D., & Thomas, H. (2011). Practitioner and lay perspectives of the service
provision of nutrition information leaflets in primary care. Journal of human nutrition and dietetics: the official
journal of the British Dietetic Association, 24(6), 552-559.
9) NHS Employers (2006). Revisions to the GMS contract 2006/07: Delivering Investment in General Practice.
Retrieved 27th January, 2012, from http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/QOF-changes-200607.aspx http://www.nhsemployers.org/primary/primary-886.cfm
10) Ragot, S., Sosner, P., Bouche, G., Guillemain, J. & Herpin, D. (2005) Appraisal of the knowledge of hypertensive patients and assessment of the role of the pharmacists in the management of hypertension: results of a
regional survey. Journal of Human Hypertension, 19, 577-584.
11) Truswell, A. S., Hiddink, G. J. & Blom, J. (2003) Nutrition guidance by family doctors in a changing world:
problems, opportunities, and future possibilities. American Journal of Clinical Nutrition, 77(suppl), 1089S1092S.
12) PSNC (2012) The Pharmacy Contract London, PSNC accessed on the 29th July 2012 at http://www.psnc.
org.uk/pages/introduction.html
B. Abstract Title
Workshop: Nutrition Care Process
Objectives
1. Define the NCP and apply this to their own practice
2. Define the IDNT and be able to apply this to their own practice
3. Understand the value of the process and the IDNT to dietetic practice
This session aims to support delegates in the application to their own practice, exploring the differences in the
processes in use and the use of the IDNT. The session will be an interactive workshop involving group work
and the use of case studies.
The objectives will be assessed through the delegates involvement in group work
49.
Abstract
The BDA has recently re-launched the Nutrition and Dietetic Process (N&DP) (BDA, 2012a). The process is
considered to be a problem-solving model designed to facilitate communication. The UK process is based on
the American Dietetic Association now the Academy of Nutrition and Dietetics (AND). It was included in the
dietetic pre-registration education and training guidelines (CPSM, 2000), was first introduced to the association
to the UK in 2006, updated in 2009 (BDA, 2009) and included in the BDA curriculum guidelines (BDA, 2008).
Following this, universities started to teach the process to their students for them to use whilst on placement;
however evidence from student feedback suggests that the use of the process is limited. In addition early
results of research suggest that some departments are using the process whilst others in the UK remain uncertain of its effectiveness and concern that it may restrict dietitians’ autonomy. In addition dietitians in the UK
use a range of processes for example; SOAP (subjective, objective, assessment, plan); RAT (referral, assessment,
treatment); Clinical Reasoning (see Pender 2008). However the use of these may not be standard within any
one department.
The International Dietetic and Nutrition Terminology (IDNT) provides a standardised set of terms to describe
the results of each step of the model and enables consistency of practice (ADA, 2008)). At the same time as
the re-launch of the N&DP the BDA have also produced a record standards briefing (BDA, 2012b) which refers
to the use of the IDNT and the need to develop its use. This is already a key part of the USA process and it is
the intention of the European dietitians to also use the IDNT.
The evidence from the USA and early UK research suggests that on-going training in the implementation of
the process is needed. (Lacey & Pritchett, 2003). The BDA is aware of the need to develop the process and
terminology as well as tools to facilitate its use within UK and the importance of learning from international
experiences (BDA 2012b).
This session aims to support delegates in the application to their own practice, exploring the differences in the
processes in use and the use of the IDNT. The session will be an interactive workshop involving group work
and the use of case studies.
References
1) ADA, (2008) Nutrition Care Process Part II: Using the International Dietetic and Nutrition Terminology to
Document the Nutrition Care Process. Journal of the American Dietetic Association, 108(8):1287-93.
2) BDA (2008) Curriculum Framework for the Pre-Registration Education and Training of Dietitians. Birmingham,
BDA
3) BDA (2009) The Nutrition and Dietetic Care Process Birmingham, BDA
4) BDA (2012a) Model and Process for Nutrition, Birmingham, BDA
5) BDA (2012b) Briefing: Record Standards, Birmingham, BDA
6) CPSM, (2000) Dietitians Board: Pre-registration Education and Training, London, CPSM
7) Lacey, K & Pritchett, E. (2003) Nutrition Care Process and Model: ADA adopts road map to quality care and
outcomes management. Journal of the American Dietetic Association, 103 pp1061-1071.
Name: McClinchy Jane
Degrees/Credentials: MSc by Research, Registered Dietitian, Fellow of the Higher Education Academy
Position Title: Principal Lecturer and Programme Tutor BSc (Hons) Dietetics
Employer Address: University of Hertfordshire College Lane Campus, College Lane, Hatfield, Herts AL109AB
Contact Address: University of Hertfordshire College Lane Campus, College Lane, Hatfield, Herts AL109AB
Phone/Fax/Email: 00441707 285102 / 0044 1707 284977 / [email protected]
Dr Papamichael Demetres, MB, BS, FRCP
Director, Dept., of Medical Oncology
Abstract Title
Bowel cancer and treatment
(Part of panel: The state of the science: evidence to support diet and physical activity recommendations for cancer prevention)
Objectives
1. Get a broad overview of current options for systemic chemotherapy for colon cancer
50.
Abstract
More therapeutic options are now available than ever before for patients with metastatic colorectal cancer
(mCRC) and as such, treatment decisions have become more complex. A multidisciplinary approach is now
more than ever before, required to effectively manage these patients.
In the past few years, many trials have reported on the value of combining biological agents, such as those
targeting vascular endothelial growth factor and epidermal growth factor receptors, with chemotherapy. However,
despite the plethora of information now available, the optimal treatment strategy for patients with mCRC
remains unclear. Indeed, the propensity of investigators to conduct clinical trials utilising a variety of
chemotherapy backbones combined with the increased complexity of retrospectively incorporating analyses
of genetic mutation status (eg KRAS and BRAF) have led to conflicting results for seemingly similar endpoints,
especially overall survival. As a result, guidelines that have been developed, while having some similarities,
are quite often different in terms of suggested therapeutic algorithms.
The aim of this presentation is to review and distil the currently available data reported from phase III trials of
chemotherapy plus biologics in the mCRC setting.
References:
1. Fortunato Ciardiello, Sabine Tejpar, Demetris Papamichael. Implications of k-ras mutation status for the
treatment of metastatic colorectal cancer. Target Oncol. 2009 Dec;4(4):311-22
2. Daniel J. Hicklin and Lee M. Ellis Role of the Vascular Endothelial Growth Factor Pathway in Tumor Growth
and Angiogenesis J Clin Oncol 2005 vol. 23 (5) 1011-1027
Name: Papamichael Demetres
Degrees/Credentials: MB BS FRCP
Position Title: Director, Dept., of Medical Oncology
Employer Address: Bank of Cyprus Oncology Centre, 32 Acropoleos Ave., Strovolos 2006, Nicosia
Contact Address: Bank of Cyprus Oncology Centre, 32 Acropoleos Ave., Strovolos 2006, Nicosia
Phone/Fax/Email: +35722 841306 / +357 22511870 / [email protected]
Dr Papandreou Dimitris, PhD, M.S., M.Ed., R.D
Assistant Professor of Nutrition, Department of Life and Health Sciences, University of Nicosia
Abstract Title
New directions in lactose intolerance: moving from science to solutions
(Part of Satellite Symposium: Gastrointestinal Disorders and Nutrition)
Objectives
1. Identify lactose intolerance and how this differs by age, ethnicity and race.
2. Identify strategies that are effective in managing individuals with lactose intolerance.
There are race and age differences in Lactose Intolerance. Evidence regarding the effect of dairy exclusion
diets on long-term gastrointestinal and bone health outcomes is relatively sparse in quantity and low in quality.
The majority of symptomatic individuals diagnosed with lactose intolerance can likely tolerate up to 12 grams
(equivalent of 1 cup of milk) at a given setting with minimal to no symptoms, especially if consumed with other
foods.
1. By presenting the definition criteria of lactose intolerance as well as the prevalence in different countries.
2. By describing all possible strategies (lactose reduced milk, hydrolyzed milk, probiotics, e.t.c.) that would
benefit individuals with lactose intolerance.
Abstract
Milk and milk products contain high concentrations of the disaccharide lactose (galactose and glucose linked
by a beta-galactoside bond). Intestinal absorption of lactose requires that the disaccharide be hydrolyzed to
its component monosaccharides, both of which are rapidly transported across the small bowel mucosa. We
defined lactose intolerance to be present when ingestion of 50 grams of lactose (or less) as a single dose by
a lactose malabsorbing subject induces gastrointestinal symptoms. The problem may become more serious
when self-diagnosed lactose intolerant parents place their children on lactose restricted diets (even in the absence
of symptoms) or use enzymatic replacement in the belief that the condition is hereditary. Children and adults
with lactose Intolerance may avoid dietary milk intake to reduce symptoms of intolerance. Since the avoidance
51.
of milk and milk containing products can result in a dietary calcium intake that is below recommended levels of
1,000 milligrams (mg) per day for men and women and 1,300 mg for adolescents,osteoporosis and associated
fractures secondary to inadequate dietary calcium is the perceived major potential health problem associated
with real or assumed lactose intolerance. Current dietary recommendations suggest consuming 3 cups/day
of fat-free or low-fat milk or equivalent milk products. This amount is equivalent to about 50 grams of lactose,
which we defined to be the threshold of minimum tolerance. Probiotics seem to have promise in the prevention or treatment of several diseases, including lactose intolerance. Data from numerous studies have shown
that the appropriate strains of lactic acid bacteria in fermented milk products can relieve symptoms of lactose
intolerance by secretion of bacterial lactase into the intestine and stomach. Lactose Intolerance is well recognized by the medical and lay community and is often blamed for being the cause of diarrhea, abdominal
pain, bloating, and flatulence. Patients self diagnose the condition and drastically reduce or stop their intake
of lactose or use supplements to help digest lactose. This has the variable effect of reducing or alleviating
symptoms. However, given the subjective nature of symptoms and the large placebo effect of any dietary
manipulation, it is unclear if the response is a <<placebo effect>> or due to use of supplements. The literature
on efficacy of hydrolyzed milk, probiotics, and supplements to help digest lactose is not so clear with this
problem. Rigorous double blinded placebo controlled studies are required to demonstrate efficacy, and larger
long-term studies demonstrating effectiveness are needed.
References:
1) U.S. Department of Health and Human Services. Lactose Intolerance and Health. Agency for Healthcare
Research and Quality. 2010; No 10-E004
2) Kanis JA, Johansson H, Oden A, et al. A meta-analysis of milk intake and fracture risk: low utility for case
finding. Osteoporos Int. 2005; 16(7):799-804.
3) Kull M, Kallikorm R, Lember M. Impact of molecularly defined hypolactasia, self-perceived milk intolerance
and milk consumption on bone mineral density in a population sample in Northern Europe. Scand J Gastroenterol.
2009; 44(4):415-421.
4) Jarvinen RM, Loukaskorpi M, Uusitupa MI. Tolerance of symptomatic lactose malabsorbers to lactose in
milk chocolate. Eur J Clin Nutr. 2003; 57(5):701-705.
5) Hertzler SR, Huynh BC, Savaiano DA. How much lactose is low lactose? J Am Diet Assoc. 1996; 96(3):243-246.
6) Soghra K, Hamideh M. H, Mohammad T, Mohammad R. N and Abbas A. I. Probiotics as an Alternative
Strategy for Prevention and Treatment of Human Diseases: A Review. Inflammation & Allergy - Drug Targets.
2012; 11: 79-89
Name: Papandreou Dimitris
Degrees/Credentials: PhD, M.S., M.Ed., R.D.
Position Title: Assistant Professor of Nutrition, Department of Life and Health Sciences.
Employer Address: University of Nicosia, 46 Makedonitissas Ave, 1700, Nicosia, Cyprus
Contact Address: University of Nicosia, 46 Makedonitissas Ave, 1700, Nicosia, Cyprus
Phones/Email: +306937001606, +35797784892, [email protected]
Papadopoulou Nicoleta, MS, RD, CDN
Clinical Dietitian
Abstract Title
Role of nutrition and exercise in the treatment of metabolic syndrome
(Part of panel: Eat well, love better, move more: treatment of cardiometabolic syndrome)
Objectives
1. Define metabolic syndrome and be able to identify its risk factors
2. Understand the role of dietary interventions/ modifications. Exercise and lifestyle changes in the treatment
of metabolic syndrome
3. Identify dietary and lifestyle practices that help with the treatment of metabolic syndrome.
It is now known that when certain chronic disease risk factors co-occur (dyslipidemia, hypertension, impaired
glucose tolerance, hyperinsulinemia and abdominal obesity), there is an increased risk for cardiovascular
disease and diabetes. The metabolic syndrome is a defined collection of three or more these chronic disease
risk factors. The treatment of metabolic syndrome aims to treat both the underlying cause of the syndrome,
and also to treat the associated cardiovascular risk factors. Since many people with metabolic syndrome are
52.
overweight and lead a sedentary lifestyle, weight reduction, dietary intervention and implementing exercise
programmes should be a primary focus on the treatment of metabolic syndrome.
The above objectives are assessed by (1) Defining the metabolic syndrome and its risk factors (2) review the
important role of weight reduction, diet, and exercise in improving the metabolic syndrome and its risk factors
(3) Review literature on dietary and lifestyle practices that help with the treatment of metabolic syndrome.
Abstract
Metabolic syndrome has received much attention in the last years due to its rising prevalence levels worldwide.
There has been much debate regarding the definition of metabolic syndrome, however there is a general
agreement that it is mainly characterized by a collection of metabolic disorders, such as dyslipidemia, hypertension,
impaired glucose tolerance, hyperinsulinemia and abdominal obesity (1,2). Each of the associated conditions
has an independent consequence but collectively, they have a synergistic effect, making the risk of developing
both type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD) even greater (1). Metabolic syndrome is
a complex illness that is largely influenced by lifestyle factors. Thus, the major emphasis in the management
of metabolic syndrome is to lessen the changeable, underlying risk factors such as obesity, physical inactivity,
and atherogenic diet (one that is high in saturated fat and cholesterol).
The NCEP ATPIII has recommended therapeutic lifestyle changes (TLC) in order to decrease the incidence of
metabolic syndrome (3). Moreover, results from several studies suggest that people with metabolic syndrome
may benefit from aggressive lifestyle modifications including dietary alterations and adopting a more
physical and active lifestyle (1,2,3,4). Therefore, weight reduction, dietary intervention and implementing exercise
programs should be a primary focus and the initial therapies recommended for the treatment of metabolic
syndrome. If lifestyle interventions are not enough, then drug treatment for abnormalities in the individual risk
factors may be indicated.
Since many people with metabolic syndrome are overweight, weight loss is of primary importance, especially
for those individuals with metabolic syndrome who present with abdominal obesity (1,4,). Weight loss and
maintenance of a lower weight are best attained by a combination of reduced caloric intake, exercise, and
changes in an individual’s eating and lifestyle behaviors. In certain instances, weight loss drugs, even though
of limited use, may be prescribed. In addition, bariatric surgery is another option being used increasingly in the
United States for severe obesity. Nevertheless, diet and exercise are the choices of preference.
Beyond weight management and reduction of total calories, substantial evidence indicates that there are
protective health benefits from dietary patterns which are high in fruits, vegetables, legumes and whole grains
and which include fish, nuts, and low-fat dairy products (2,3,5,6,7,8,9). Moreover, the diet for the treatment of
the metabolic syndrome should be limited in the intake of saturated fat. Moderate amounts of monounsaturated
fat may be allowed as they do not induce harmful metabolic effects. The traditional Mediterranean diet is one
such dietary pattern that has received much attention and has been researched extensively. Indeed, Mediterranean
style dietary patterns seem to be effective and particularly promising in reducing the incidence of metabolic
syndrome and its associated risk factors.
Lastly, increasing physical activity not only assists in weight loss but also has favorable outcomes on metabolic
risk factors (1,3). More importantly, it mitigates overall atherosclerotic cardiovascular disease risk. Current
recommended guidelines suggest ≥ 30 minutes of moderate-intensity exercise, such as brisk walking, on
most, and preferably all, days of the week. Even greater amounts of physical activity have a greater benefit.
Hence, going beyond current recommendations will be particularly beneficial. Nevertheless, for high-risk patients,
such as those with recent acute coronary syndromes or recent revascularization, exercise programs should
be carried out under medical supervision.
In conclusion, lifestyle interventions should be the first therapies suggested for the treatment of metabolic
syndrome. A large body of evidence seems to indicate the significant beneficial effects of diet and exercise
in reducing the risks associated with metabolic syndrome and, consequently, any associated co-morbidities.
References:
1) Scott M. Grundy, James I. Cleeman, Stephen R. DanielsKaren A. Donato, Robert H. Eckel, Barry A. Franklin,
David J. Gordon, Ronald M. Krauss,Peter J. Savage, Sidney C. Smith Jr, John A. Spertus, Fernando Costa:
Diagnosis and Management of the Metabolic Syndrome
An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation.
2005;112:2735-2752
2) Demosthenes B Panagiotakos, Evangelos Polychronopoulos: The role of Mediterranean diet the epidemiology
of metabolic syndrome; converting epidemiology to clinical practice. Lipids Health Dis. 2005; 4: 7
3) Christos Pitsavos, Demosthenes Panagiotakos, Michael Weinem, and Christodoulos Stefanadis. Diet, Exercise
and the Metabolic Syndrome. Rev Diabet Stud. 2006 Fall; 3(3): 118–126.
4) Riccardi G, Rivellese AA. Dietary treatment of the metabolic syndrome--the optimal diet. Br J Nutr. 2000
Suppl 1:S143-8.
53.
5) Giugliano D, Ceriello A, Esposito K.. The effects of diet on inflammation: emphasis on the metabolic syndrome.
J Am Coll Cardiol. 2006;48(4):677-85.
6) Babio N, Bulló M, Salas-Salvadó J. Mediterranean diet and metabolic syndrome: the evidence. Public
Health Nutr. 2009 Sep;12(9A):1607-17.
7) Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano
D. Effect of a Mediterranean style diet on endothelial dysfunction and markers of vascular inflammation in the
metabolic syndrome: a randomized trial. JAMA. 2004 Sep 22;292(12):1440-6.
8) Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean
diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am
Coll Cardiol. 2011;57(11):1299-313.
9) Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a
Greek population. N Engl J Med 2003; 348: 2599-608.
Name: Nicoleta Papadopoulou
Degrees/Credentials: MS, RD, CDN
Position Title: Clinical Dietitian
Employer Address: 6 George Davaris str, suite 101, Strovolos 2024
Contact Address: 6 George Davaris str, suite 101, Strovolos 2024
Phone/Fax/Email: 99458617, 22496577, [email protected]
Dr. Pavlidou Sofia, MD
Scientific Collaborator, Atherosclerosis Outpatient Clinic, Second Department of Cardiology, Medical
School, Aristotle University of Thessaloniki, “Hippokration” Hospital, Thessaloniki, Greece
Secretary of Atherosclerosis Society of Northern Greece
Abstract Title
Μύθοι και αλήθειες σχετικά με τη διατροφή. Τι πραγματικά ωφελεί την καρδιά μας;
(‘‘Myths and truths about nutrition. What really is good for our heart?’’)
Objectives
1. Improve their health by following a healthy diet
Abstract
Food is essential to the growth of all living organisms as well as their sustenance to life. Besides, the pharmaceutical
and by extension healing properties of certain types of food have been known since the era of Hippocrates,
who claimed that «food must be our medicine and medicine must be our food».
In Mediterranean cuisine there is a wide range of foods which are supposed to contribute to the good function
of the body, more specifically of the cardiovascular system. However, there are controversial opinions and, as
a result there is confusion regarding what really benefits and protects us from cardiovascular diseases.
Garlic and onion are two kind of food which are believed to have a positive influence on the reduction of arterial
blood pressure and cholesterol. In fact to possibly achieve hypotension and hypolipidemic action, an excessive
amount needs to be consumed, that is 15-20 gloves of garlic and 4-5 onions daily.
Red wine contains plenty of substances with beneficial effects on the cardiovascular system. The primary
ones are polyphenols e.g resveratrol, glycerol and tanins. These substances act as antioxidants and their action
is stronger than that vitamins C and E. They also reduce oxidization of LDL lipoprotein and the agglutination of
thrombocytes. Besides, they reduce homocysteine, an aminoacid whose high concentration has a negative
effect on the cardiovascular system.
Salt is used not only for making food more savory but also for preserving it. The influence of salt on arterial
blood pressure has been indisputable and scientifically established for several decades. Today, it is a given
fact excluding salt from our diet is not sufficient but what is also necessary is to maintain ideal bodily weight
and reduce consumption of all foods containing large amounts of salt, e.g bread, cheese, sausages, nuts.
Dark chocolate contains polyphenols and flavonoid substances. These substances contribute to the reduction
of systolic arterial blood pressure, to the improvement of glucose metabolism and to the increase in tissue
sensitivity to insulin. Besides they make endothelium more functional and reduce blood coagulability. Consequently
daily consumption of dark chocolate in small quantities has beneficial effects on our cardiovascular system.
54.
Eggs are an extremely popular and nutritious type of food, with is rich in vitamins and minerals, high quality
proteins, cholesterol, unsaturated fats and antioxidant compounds. Dyslipidemics often mistakenly exclude
this type of food from their diet as consumption of eggs in moderation (up to 3 per week) is allowed as part of
a balance diet.Green tea contains polyphenols, which are antioxidant substances that reduce LDL cholesterol,
prevent its oxidization while reducing blood coagulability.
Cinnamon is a spice obtained from the inner bark of several trees from genus Cinnamomum and that is used
on both sweet and savoury foods. Studies have shown that cinnamon has a lot of benefits to the cardiovascular
system. They suggest that just ½ teaspoon of cinnamon per day can reduce the risk of heart and cardiovascular
disease, because it can lower LDL cholesterol. Also, several studies have shown that Cinnamon may help
treat Type 2 Diabetes by lowering blood sugar levels and increasing the amount of insulin production in the
body.
Finally, regarding coffee, today the view that coffee increases arterial blood pressure is widespread and strong
it has been proved that the influence of caffeine on arterial blood pressure is temporary after coffee consumption
and has no long-term effects. On the other hand, coffee contains antioxidant substances and magnesium,
which positively affect endothelium function.
References:
1) Apostolos Efthimiadis, Atherosclerosis, Cardiometabolic Risk Factors. Publ. Siokis, Thessaloniki, 2008
2) M. J. Gibney, Nutrition & Metabolism, Blackwell Publishing, 2003
3) Egg consumption in relation to cardiovascular disease and mortality: the Physiciansʼ Health Study, American
Journal of Clinical Nutrition 2008; 87;964-9, Απρίλιος 2008.
4) Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet on the Pressure-Natriuresis Relationship,
Hypertension 07/2003, 42: 8 – 13
5) Caffeine Affects Cardiovascular & Neuroendocrine Activation at Work & Home, Psychosomatic Medicine
08/2002, 64: 595-603
6) Das S, Das DK. Resveratrol: a therapeutic promise for cardiovascular diseases. Recent Patents Cardiovasc Drug Discov. 2007 Jun;2(2):133-8.
7) Palumbo G, Bacchi S, Palumbo P, Primavera LG, Sponta AM., Grapefruit juice: potential drug interaction,
Clin Ter. 2005 May-Jun;156(3):97-103.
8) Τhe effect of grapefruit juice consumption on the metabolism of statins in patients with familial hyperlipi
demia H. Paschalidou, A. Efthimiadis, I. Efthimiadis, D. Psirropoulos, M. Raptopoulou – Gigi. Ανακοίνωση στο
12ο Παγκόσμιο Συνέδριο Αθηροσκλήρωσης, Ρώμη, 18-22 Ιουνίου 2006, Atherosclerosis, 2006, suppl. Vol 7
Iss 3 pp 576, Νο ThP16377
Name: Pavlidou Sofia
Degrees/Credentials: Degree of Medicine, Medical School, Aristotle University of Thessaloniki, Student of
Dietology, Technological University of Thessaloniki
Position Title: 1. Scientific Collaborator, Atherosclerosis Outpatient Clinic, Second Department of Cardiology,
Medical School, Aristotle University of Thessaloniki, “Hippokration” Hospital, Thessaloniki, Greece, 2. Secretary
of Atherosclerosis Society of Northern Greece
Contact Address: Str. Kalidopoulou 12, 54642, Thessaloniki, Greece
Phone/Fax/Email: +306948947793, +302310-256839, [email protected]
Dr. Philippou Christiana, RD, DProf
Clinical Dietitian and sports nutritionist
Vice President of CyDNA
Abstract Title
Myths and realities about cancer –the nutrition aspect
(Part of panel: Cancer: Myths and realities)
Objectives
1. Explain the nature of controversy regarding dietary fat, diet fiber, red meat, alcohol. overweight and obesity
and the risk of cancer
2. Discuss the role of antioxidant vitamins and minerals in cancer prevention.
3. Discuss current dietary guidelines and rational related to the cancer risk of naturally occurring carcinogens,
food additives and contaminants
55.
4. Describe the role of phytochemicals as anticarcinogenic agents.
5. Identify the types of quackery associated with cancer prevention.
The relationship between diet and cancer is complex. The current dietary recommendations will be explored
and examine the scientific evidence which provide the underlying rationale for those guidelines.
The objectives will be assessed through the discussion after the presentation
Abstract
The causes of cancer can be genetic, environmental, viral, or related to life style. While strides have been
made in the treatment of the disease and survival rates have improved, a cure for cancer remains elusive. Although
the relationship between cancer and diet is not as clear as that between smoking and cancer, Wynder and
Gori (1977) have estimated that 40 percent of cancer incidence in men and approximately 60 percent in
women is associated with diet. The most often quoted figures about diet and cancer come from Doll and Peto
(1981) study which estimated that 35 percent of all cancer deaths (range 10 percent to 70 percent) are related
to diet. Research suggests that the majority of cancer incidence is due to life-style and environmental factors,
supporting the conclusion that most cancers are preventable (NCI, 2009). In fact, experts have indicated that
eliminating modifiable risk factors such as smoking and poor nutrition is the most effective way to reduce the
burden of cancer (Curry, et al, 2003). About one-third of cancer deaths may be attributable to nutrition and
physical activity factors, including excess weight (ACS, 2009).
Some dietary components such as fat and alcohol, as well as obesity seem to promote the cancer process,
while others including fiber, vitamin A, and phytochemicals found in fruits and vegetables may be protective
or inhibit the cancer process. Dietary substances can be considered carcinogenic or co-carcinogenic and,
therefore, associated with increased cancer risk. These include alcohol, salt-cured or smokes meats, foods
containing nitrates and nitrites, and a high caloric dietary intake. Food substances may also be proactive or
protective, thus reducing cancer risk. Examples of dietary substances from this category include cruciferous
vegetables, and possibly vitamin C and D (Kushi, 2006).
Hundreds of studies, both experimental and epidemiological have been done to uncover the importance of
dietary fat in the cancer puzzle. In 1982, the National Research Council’s (NRC) Committee on Diet, Nutrition
and Cancer concluded that of all the dietary components studied up to that time, the scientific evidence was
most suggestive of an association between fat intakes and the occurrence of cancer of certain sites, particularly
the breast and colon (NRC, 1982). Most experts feel that a low fat diet is still the most prudent course to follow,
especially in light of the other diseases in which a high fat diet is implicated.
High fat diets have been weakly associated with an increased risk of colorectal, prostate and postmenopausa
breast cancers. Research is ongoing as to whether these associations are due to total amount of fat, specific
type of fat, calories contribute by fat, or some other factor related to high fat foods. Although the knowledge is
incomplete the advice (AICR 2006, Kushi et al 2006) is to consume fat in moderation emphasizing healthier
fats while limiting consumption of unhealthy or saturates fats and in particular to limit consumption of red
meats Scientific evidence does not suggest that protein in and of itself modifies the risk of cancer at any site.
However, all of the major cancer-relates agencies do caution about the amount of red meat that should be
consumed to reduce cancer risk (550-600gr/week) (WCRF/AICR 2007).
In regards to overweight and obesity the recommendations are unanimous to achieve and maintain a healthy
weight throughout life.
Despite the uncertainties associated with fiber research, dietary fiber guidelines are fairly consistent among
the major health organizations. They all emphasise the importance of variety when selecting fiber-rich foods.
All the major cancer and health agencies offer the same advice to increase the consumption of a variety of
fruits and vegetables for vitamins and minerals. The NRC advice is to avoid taking supplements in excess
of the RDA in any one day. The WCRF/AICR, 2007 recommends not using supplements to protect against
cancer and to aim to meet nutritional needs through diet alone.
The role of nitrites and nitrates in an increased risk of cancer, evidence is also available that salt cures or
pickled foods may increase the risk of stomach and oesophageal cancer (WSG, 1991).
WHO/FAO 2003 and WCRF/AICR 2007, do not recommend consumption of alcohol. But if consumed alcohol
should limited.
Steinmetz and Potter, 1991 suggested that the potential for cancer chemoprevention by non-nutrients components of
fruits, vegetables and plant can be overshadowed by the recognition that some of the compounds have shown
carcinogenic effects, including certain flavonoids, indoles and phenolic compounds To be sure, other adverse
effects of vegetable and fruit consumption must be acknowledged i.e. the presence of nitrates, aflatoxin, and
pesticides and herbicides. Furthermore, evidence from many studies now suggests that a diet rich in fruits
and vegetables provides protection against cancers of the colon, rectum, stomach, lung, mouth, pharynx and
oesophagus and probably reduces the risk of cancers of the breast, bladder, pancreas and larynx. WHO/FAO,
2003, Kushi, 2006, all support the inclusion of generous amount of fruits and vegetables in our diets.
References:
1) American Cancer Society, 2009, www.cancer.org
56.
2) American Institute for Cancer Research; Recommendations for Cancer prevention.
Available at www.aicr.org, 2009.
3) Curry SJ, Byers T, Hewitt M, eds. Fulfilling the Potential of Cancer Prevention and Early detection, National
cancer Policy Board: Institute of Medicine, Washington, DC National Academy Press, 2003.
4) Doll R, Peto R: The causes of cancer: Quantitative estimates of available risks of cancer in the United
States today: J Natl cancer Inst 66: 1191 – 1308, 1981.
5) Kushi I, Byers T, Doyle C, et al: American Cancer Society guidelines on nutrition and physical activity for
cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J
Clin 56: 254-281, 2006
6) Steinmetz KA, Potter JD: Vegetables, fruit and cancer.II. Mechanisms Cancers Causes Control 2: 427-442,
1991.
7) The Work Study on Diet, Nutrition and Cancer: American Cancer Society Guidelines on Diet, Nutrition and
Cancer, CA 41: 334-338, 1991.
8) US Department of Health and Human Services, National Institute of Health, National Cancer Institute: Division of
Cancer Prevention and Control. Annual Report 1987, Washington DC: US Government Printing Office; 2009.
9) WHO/FAO Joint Expert Committee on Diet Nutrition and Prevention of Chronic Diseases (2002 Geneva
Switzerland). Diet, Nutrition and the Prevention of Chronic Diseases. WHO technical Report Series 916. Geneva
Switzerland, WHO, 2004.
10) World Cancer Research Fund/ American Institute for Cancer Research. Food, Nutrition and Physical Activity,
and the Prevention for Cancer. A Global Perspective, Washington DC: AJCR, 2007.
11) Wynder EL, Gori GB: Contributors of the environment to cancer incidence. An epidemiologic exercise. J of
Natl Cancer Inst 58: 825 – 832, 1977.
Name: Christiana Philippou Charidemou
Degrees/Credentials: RD, DProf
Position Title: Clinical Dietitian and Sport nutritiunist Vice President of CyDNA
Employer Address: Ministry of Education and European University
Contact Address: Methonis 3 Strovolos 2057 Nicosia / Cyprus
Phone/Fax/Email: 99 497959, [email protected]
Philpot Ursula, BSc (hons) , MSc, PGCHE, RD
Chair of the British Dietetic Association’s Mental Health Group
Advanced Practice Dietitian and Senior Lecturer- Eating disorders
Abstract Title
Eating disorders workshop: Anorexia & Bulimia
Objectives
1. Select suitable treatment options for each condition and assess when to signpost to other treatment providers
if needed
2. Deliver a range of dietetic interventions to enable behaviour change in clients suffering from Anorexia Nervosa
or Bulimia Nervosa
The workshop will focus on assessing and guiding clients to appropriate treatment for their eating disorder.
The workshop will aim to up- skill dietitians working in this area to deliver a range of dietetic interventions to
support behaviour change in clients suffering from either anorexia Nervosa or Bulimia Nervosa. This will be
delivered through a series of knowledge updates and practical exercises, and via discussion of case studies.
The interventions will be discussed and participants will look at the practical application of dietetic interventions
to real life case studies.
To assess knowledge and application of knowledge, the participants will discuss a range of case studies, and
will consider which treatment options may be most appropriate, which dietetic interventions they could use,
and the rationale for these.
57.
After this presentation, the attendee will be able to:
1. Carry out a dietetic assessment
2. Select suitable dietetic treatment options for each condition
3. Deliver a range of dietetic interventions that enable behaviour change in clients suffering from Anorexia
Nervosa or Bulimia Nervosa
Abstract
Working with patients with eating disorders requires a comprehensive level of knowledge and skill mix to meet
the complex needs and challenges of this client group. The dietitian should be able to draw on a range of
dietetic interventions that can be applied to individual circumstances and that fit with a psychologiocal approach
to recovery.
Eating disordered behaviours arise from psychological difficulties and are a way of coping with and communicating
distress. A collaborative team of professionals is required to best manage individuals with an eating disorder
(Mehler and Anderson 1999), each contributing their own unique skills and expertise. The specialist dietitian
is an important member of the multi-disciplinary team (MDT); with the expert skills needed to address these
complex disorders involving food, weight and appetite.
As highlighted by the National Institute for Health and Clinical Excellence (NICE) in 2004, dietary counselling
should not be provided as the sole treatment for anorexia nervosa. Managing medical risk is not the sole
responsibility of the dietitian, although the nutritional assessment is a key aspect of the medical risk assessment,
especially during the process of refeeding and in the management of refeeding syndrome (MARSIPAN, 2010;
QIS 2006). Nutritional counselling is required to guide an individual back to normalised eating patterns and
behaviours, but it is not a substitute for psychotherapy (Beumont, Russell and Touyz 1993).
The specialist eating disorders dietitian (skills and knowledge described below) has a role in assessment,
treatment, monitoring, support and education. The role in assessment is to determine nutritional status, eating
patterns and behaviour, knowledge, food rules and beliefs, meal planning, shopping and cooking skills, motivation to
change, and how underlying psychopathology impacts on eating behaviours and behaviour change. Dietitians
are able to accurately assess habitual dietary intakes in people with an eating disorder (Hadigan, Anderson
and Miller 2000). The dietitian develops the nutrition section of the treatment plan in consultation with the
patient, and then supports the patient and the rest of the MDT throughout implementation. This includes intensive
one to one work, but also group work. The development of a good therapeutic relationship is essential (Dresser
1984), as well as enhanced communication skills to support nutritional rehabilitation.
Individuals with an eating disorder are believed to have a good comprehension of nutrition. However, Beaumont
et al. (1981) show that individuals with an eating disorder have sound knowledge of the calorie content of
foods, but a poor understanding of the basics of healthy eating, and how to meet their nutritional requirements.
In addition, there is a tendency for clients with an eating disorder to have faulty ideas and beliefs towards food
(Cockfield and Philpot, 2009). It is the responsibility of the dietitian to educate individuals in areas related to
nutrition. A broader role in education extends to offering support and education to other health professionals,
families, carers, non-specialist dietitians involved with patients with eating disorders, and the general public,
through various mediums such as group work, presentations, the media etc. Thus, the specialist dietitian must
have excellent communication skills and be a good negotiator, as well as have an up-to-date knowledge of the
evidence base to support their advice.
Specialist Dietitians should have a sound knowledge of the development and maintenance of eating disorders in
addition to an understanding of the physiological, psychological and medical aspects of a range of eating disorders.
This needs to be underpinned by a broad understanding of mental health and psychological interventions and
their application e.g. Motivational Enhancement Therapy, Cognitive Behavioural Therapy, Cognitive Analytical
Therapy, Dialectical Behaviour Therapy, Interpersonal Therapy, and Psychodynamic/Psychoanalytic Psychotherapy.
Enhanced communication, counselling and motivational interviewing skills are vital, especially since not all
individuals with an eating disorder are motivated to change their behaviours, and ambivalence is a core condition
in Anorexia Nervosa. Where it exists evidenced based nutrition practice should be followed (Wakefield & Williams,
2009; ADA guidelines 2006)
References:
1) American Dietetic Association (2006) ‘Position of the American Dietetic Association: Nutrition intervention
in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders’ Journal of the American Dietetic
Association 106, (12) 2073-2082
2) Beaumont, P. J. V., Chambers, T. L., Rouse, L., and Abraham, S. F. (1981) ‘The Diet Composition and Nutritional
Knowledge of Patients with Eating Disorders’ Journal of Human Nutrition 35, (4) 265-273
3) Beumont, P. J. V., Russell, J. D., and Touyz, S. W. (1993) ‘Treatment of Anorexia
4) Nervosa’ The Lancet 341, 1635-1640
5) Cockfield, A., and Philpot, U. (2009) ‘Feeding Size 0: The challenges of anorexia nervosa. Managing anorexia
from a dietitian’s perspective’ The Proceedings on the Nutrition Society 68, (3) 281-288
6) Cockfield Annette, Philpot Ursula for the British Dietetic Association’s Mental Health Group. Re-feeding Protocol
for Seriously Ill Patients with Anorexia Nervosa (April 2011)
58.
7) Dresser, R. (1984) ‘Feeding the Hunger Artists: Legal issues in treating anorexia nervosa’ Wisconsin Law
Review 294-374
8) Hadigan, C. M., Anderson, E. J., and Miller, K. K. (2000) ‘Assessment of Macronutrient and Micronutrient
Intake in Women with Anorexia Nervosa’ International Journal of Eating Disorders 28, 284-292
9) Mehler, P. S., and Anderson, A. E. (1999) Eating Disorders: A guide to medical care and complications London:
The John Hopkins University Press
10) National Institute for Health and Clinical Excellence (2004) Eating Disorders: Core interventions in the treatment
and management of anoxia nervosa, bulimia nervosa and related eating disorders London
11) Quality Improvement Scotland: Eating disorders Scotland Recommendations for Management and Treatment.
(2006) which has an appendix on the role of the dietitian www.nhshealthquality.org/nhsqis/files/EATDISORDER_REP_NOV06
12) Royal College of Psychiatrists (2004) Guidelines for the Nutritional Management of Anorexia Nervosa London:
Royal College of Physicians London
13) Royal College of Psychiatrists (2010). Report: CR162. Management of Really Sick Patients with Anorexia
Nervosa (MARSIPAN). Royal College of Physicians London
14) Wakefield A, Williams H (2009). Practice Recommendations for the Nutritional Management of Anorexia
Nervosa in Adults. Dietitians Association of Australia
Name: Philpot Ursula
Degrees/Credentials: BSc (hons), MSc Nutrition and Dietetics, PGCHE, RD
Chair of the British Dietetic Association’s Mental Health Group www.bda.uk.com
Position Title: Advanced Practice Dietitian and Senior Lecturer- Eating disorders
Employer Address: Leeds Metropolitan University, Faculty of Health and Social Sciences, School of Wellbeing, Calverly Street, Leeds, LS1 3HE
Contact Address: Leeds Metropolitan University, Faculty of Health and Social Sciences, School of Wellbeing,
Calverly Street, Leeds, LS1 3HE
Phone/Fax/Email: 01138124996, [email protected]
Dr Risvas Gregoris, PhD
Dietician – Public Health Nutritionist
Abstract Title
Intervention programs for the prevention of childhood obesity at the community level
(Part of Satellite Symposium by Lanitis)
Objectives
1. Realize the value of education in the prevention of childhood obesity
2. Comprehend how a successful intervention is planned and implemented according to scientific literature
3. Understand what are the future research needs in the field
Childhood obesity is a major public health crisis nationally and internationally. The prevalence of childhood
obesity has increased over few years. It is caused by imbalance between calorie intake and calories utilized.
One or more factors (genetic, behavioral, and environmental) cause obesity in children. Hence, effective intervention
strategies are being used to prevent and control obesity in children. The purpose of this presentation is to
address various factors influencing childhood obesity, a variety of interventions and governmental actions addressing
obesity and the challenges ahead for managing this epidemic.
Childhood obesity can be tackled at the population level by education, prevention and sustainable interventions
related to healthy nutrition practices and physical activity promotion.
Abstract
Childhood obesity is due to the imbalance between caloric intake of the child and the calories utilized. Factors
causing childhood obesity are genetic, behavioral, and environmental. Firstly, there are certain genetic factors
59.
which may lead to obesity in children. Genetic factors may influence the metabolism, by changing the body
fat content and energy intake and energy expenditure. Heritability of obesity from parents also influences
obesity in children. Secondly, there are some behavioral factors which can cause obesity. Children may eat
large portions of food, foods high in sugar, and energy-rich foods. Hence, energy intake is higher than energy
expenditure. Lack of physical activity also plays an important role in obesity. It is seen that children and teens
nowadays lack the required amount of physical activity. Children snack more in front of television and spent
most of their time sitting without any physical activity. All these behavioral factors are in a vicious circle with
one leading to another. Finally, environmental factors are those that surround the children and influence their
food intake and physical activity.
Hence, there is need to address this problem at every possible step through effective interventions and motivation
strategies. Parents and siblings are the people around the child who can influence child behavior and lifestyle.
Hence, effective interventions in a family setting can be beneficial to change child’s behavior of overeating and
unhealthy choice of food. Physical activity can be improved by small strategies like parking cars away from
stores so that kids can walk and to take stairs instead of elevators or escalators. It is essential that parents are
aware of the potential risk the child is facing due to obesity and take actions to control the problem.
Children spend most of their time in schools. Hence, school plays an important role in the life of the child.
There are many school-based intervention strategies. Some interventions focus on nutrition-based or physicalbased aspect of weight-control independently, while others jointly focus on both aspects of nutrition and physical activity to achieve the aim of weight control in children. Schools can encourage kids to make a healthy
food choice and also involve kids in physical activity by strategies like lengthening the time of physical activity;
involving them in moderate to vigorous physical activity for short durations, encouraging them to walk or active
commuting, and taking stairs instead of elevators. Kids should be encouraged to participate in various physical
activities like games and dance groups with more emphasis on non-competitiveness. Classroom-based health
education can make older children and teens aware of eating nutritious diet and engaging in regular physical
activity.
Community also plays a crucial role in healthy lifestyle of children. The term ‘community’ includes the environment
around children along with other factors like geographic location, race, ethnicity, and socioeconomic status.
This resource can be effectively used to promote healthy nutrition and healthy behavior. Thus, community can
help children to get affordable and accessible healthy food options and encourage healthy nutrition. Community
organizations along with parents can promote nutrition and physical activity-based programs for children, eg.,
walk to school. Community can make the neighborhood safe and accessible to children and motivate them to
increase physical activity. Other programs like providing play groups with safe play grounds and bike paths for
kids to play outside will reduce their time spent in front of television sets. Community can provide children with
easy accessible facilities like gymnasiums and supervised physical education with strategies such as music
for physical activities. Community can influence media or local entertainment to promote healthy educational
programs for parents and children.
There may be some potential barriers to these interventions, which may make the task of promoting healthy
behavior and improving physical activity in children challenging. Financial investment in these interventions
is very crucial. All the intervention-based programs need monitoring of progress and sustainability over many
years, which may be costly. In today’s world of economic problems funding for such programs is limited. In
addition, obese children are mostly discriminated due to their body image. Stigmatization of these children by
their peers and by others acts as a mental barrier leading to negative body image and fear of food.
Conclusively, childhood obesity problem can be reduced by educating children and parents about healthy
nutrition and encouraging them to be physically active. There are effective interventions and government policies
for prevention and control of childhood obesity. Sustainability of these interventions is a key factor, so that
children can adopt these healthy behaviors as a lifelong practice and have a healthy life.
References
1) Ben-Sefer E, Ben-Natan M, Ehrenfeld M. Childhood obesity: Current literature, policy and implications for
practice. Int Nurs Rev. 2009;56:166–73.
2) Carraro R, García Cebrián M. Role of prevention in the contention of the obesity epidemic. Eur J Clin Nutr.
2003;57(Suppl 1):S94–6.
3) Doak CM, Visscher TLS, Renders CM, Seidell JC. The prevention of overweight and obesity in children and
adolescents: A review of interventions and programmes. Obes Rev. 2006;7:111–36.
4) Economos CD, Irish-Hauser S. Community interventions: A brief overview and their application to the obesity
epidemic. J Law Med Ethics. 2007;35:131–7.
5) Fussenegger D, Pietrobelli A, Widhalm K. Childhood obesity: Political developments in Europe and related
perspectives for future action on prevention. Obes Rev. 2008;9:76–82.
6) Hutchinson G. Tackling obesity through school-based interventions. Br J Sch Nurs. 2010;5:335–7.
7) Kanekar A, Sharma M. Meta-analysis of school-based childhood obesity interventions in the U.K. and U.S.
Int Q Community Health Educ. 2009;29:241–56.
8) Pott W, Albayrak O, Hebebrand J, Pauli-Pott U. Treating childhood obesity: Family background variables
and the child’s success in a weight-control intervention. Int J Eat Disord. 2009;42:284–9.
60.
9) Rahman T, Cushing RA, Jackson RJ. Contributions of built environment to childhood obesity. Mt Sinai J
Med. 2011;78:49–57.
10) Tucker P, Irwin JD, Bouck LM, He M, Pollett G. Preventing paediatric obesity; recommendations from a
community-based qualitative investigation. Obes Rev. 2006;7:251–60.
11) Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell
CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue
12.
Name: Dr. Risvas Gregoris
Degrees/Credentials: PhD, Dietician – Public Health Nutritionist
Position Title: Post- doctoral fellos, Unit of Human Nutrition
Employer Address: Agricultural University of Athens, Iera Odos 75, Athens, Greece
Contact Address: Nutrimed Ltd, Nezer 1, 11743 Athens, Greece
Phone/Fax/Email: +302109239836, [email protected]
Prof Sanders Tom, BSC, PhD, DSc, RPHNutr
Professor of Nutrition & Dietetics
A. Abstract Title
Integrated dietary intervention to reduce risk of cardiovascular disease (Keynote speaker)
Objectives
1.Understand the key dietary parameters that modify cardiovascular risk
2. Summarise the find key findings from randomized controlled trials that have used an integrated dietary approach
to cardiovascular disease prevention
3.Have a realistic expectation as to what can be achieved by modification of diet in terms of cardiovascular
disease prevention
Most dietary interventions have focused on modifying single components of diet, whereas in practice individuals
have different dietary patterns. This session focuses on the modification of the overall dietary pattern to
reduce risk of cardiovascular disease.
To be able to describe the key components of a cardioprotective diet.
Abstract
Most research on the relationship between diet and cardiovascular disease has focused on modifying individual elements of the diet on at a time. In practice people have different dietary patterns and certain dietary patterns are
associated with a lower risk of cardiovascular disease notably the Mediterranean diet and western vegetarian
diets. For the past few decades, dietary advice for the prevention of cardiovascular disease has focused on
avoiding obesity, decreasing the intake of saturated fatty acids and reducing the intake of salt. Many dietary guidelines also focus on reducing the intake of added sugar. Recent meta-analyses have questioned the effectiveness of the current approach which focuses on saturated fat, salt and sugar.This simplistic approach ignores
the contribution of certain nutrient dense foods to the diet particularly in the case of oily fish, nuts and dairy
foods. Following the observation that people who reported consuming high intakes of fruit and vegetables
had a lower risk of cardiovascular disease, it was hypothesised that protection was provided by anti-oxidant
vitamins that prevented the oxidation of low density lipoprotein, a step in the atherogenic process. Subsequently,
antioxidants vitamins (carotene, tocopherol and vitamin C) and those involved in homocysteine metabolism
(folate, vitamin B12, vitamin B6) were suggested to be cardioprotective. However, their efficacy in versus placebo has been put to test in randomized controlled trials and meta-analyses of the results do not support their
use in cardiovascular disease prevention. Prospective cohort studies have analysed dietary patterns indicate
that the consumption of certain foods such as fruit and vegetables, nuts, oily fish, wholegrain cereals and dairy
products are associated with a lower risk of cardiovascular disease whereas intake of red and processed meat
and trans fatty acids are associated with a higher risk. The Lyon Heart study first indicated that a Mediterranean style diet compared to the typical modified fat diet was more effective in secondary prevention of cardiovascular disease. Primary prevention trials of diet modification are unlikely to ever be conducted because of
the huge number of subjects needed to be studied and the difficulty in determining compliance to treatment.
Elevated blood pressure and serum cholesterol (or better still the ratio of total cholesterol:HDL cholesterol)
and body weight are the most robust surrogate risk markers for risk of cardiovascular disease according to the
Prospective Triallists Collaboration studies. Most dietary intervention trials have focused on modifying one or
61.
two dietary components on surrogate risk markers. The DASH studies showed that modifying the overall
dietary pattern had a more marked effect on lowering blood pressure than that obtained by salt reduction or
increased intake of fruit and vegetables. The Portfolio diet demonstrated using rather extreme diets that large
reductions in blood cholesterol could be obtained by multiple interventions but the diet is unlikely to be acceptable
to many. The CRESSIDA trial was designed to test whether an integrated dietary intervention involving modification
of several factors (salt restriction, replacement of saturated fatty acids with monounsaturated fatty acids, increased oily fish, fruit, vegetable and wholegrain intakes and restricted use of added sugar) compared with
a balanced traditional British diet in older men and women. The main
results of this trial, which will be presented at meeting, and included modest weight loss, reduced LDL cholesterol
and lower blood pressure. The intervention diet was found to be very acceptable to the participants and we
were able to demonstrate compliance to the diet using a series of biomarkers. The session will conclude with
suggestions how this dietary advice can be put into practice.
References:
1) Astrup, A., Dyerberg, J., Elwood, P., Hermansen, K., Hu, F. B., Jakobsen, M. U., Kok, F. J., Krauss, R. M.,
Lecerf, J. M., Legrand, P., Nestel, P., Risérus, U., Sanders, T., Sinclair, A., Stender, S., Tholstrup, T. & Willett,
W. C. 2011. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: Where
does the evidence stand in 2010? American Journal of Clinical Nutrition, 93, 684-688.
2) Mozaffarian, D., Appel, L. J. & Van Horn, L. 2011. Components of a cardioprotective diet: new insights. Circulation, 123, 2870-91.
3) Siri-Tarino, P. W., Sun, Q., Hu, F. B. & Krauss, R. M. 2010. Meta-analysis of prospective cohort studies
evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition,
91, 535-546.
B. Abstract Title
Impact of the amount & composition of dietary fat and carbohydrate on metabolic syndrome &
cardiovascular disease risk
Objectives
1.To be familiar with the current definition of metabolic syndrome and its practical value
2.To have an update on the status of randomized controlled trials of diet that have compared manipulation of
macronutrient intake on the physiological paramaters of insulin resistance
3.To understand how high carbohydrate diets may exacerbate cardiovascular risk in the overweight
There has been much controversity regarding the relative proportions of fat and carbohydrate in the diet in
relation to metabolic syndrome and cardiovascular risk. This session will summarise recent trials on indices
of risk.
To understand the complexities of the effects of dietary fat and carbohydrate intake on features of metabolic
syndrome.
Abstract
The term metabolic syndrome was first coined by Reavan in his Banting lecture. It described a constellation
of risk factors: hypertension, dyslipidaemia, microalbuminuria,elevated fasting glucose and gout that were associated
with increased risk of cardiovascular disease and type 2 diabetes mellitus. Later definitions are more pragmatic and
designed to identify individuals at risk of metabolic syndrome with simple measurements and include measures of central obesity (waist measurement >94 cm for men >80 cm for women) and the presence of 2 out of
three other factors (blood pressure >130/85 mm Hg), low HDL (<1.03 for en and <1.29 mmol/L for women)
or raised triglycerides (>1.7 mmol/L), or elevated fasting glucose (>5.6 mmol/L). It currently is a moot point
whether type 2 diabetes mellitus is a disorder of glucose metabolism or lipid metabolism. It is clear that many
of the features develop many years before their is impaired glucose tolerance. What is uncontroversial is that
risk of metabolic syndrome increases with central obesity and that regular physical activity reduces the risk of
developing it. The role of fat and carbohydrate in modifying the features of metabolic syndrome is less clear. In
animal models, fructose or high fat feeding (over 50% energy from fat) is used to produce insulin resistance.
However, the relevance of these models to human health is questionable. Human diets consist of a mixture of
starches and sugars providing 45-60% of the energy intake whereas fat provides 25-40% energy in economically developed countrie. The proportion of energy from fat has fallen close to 35% energy in most European
countries. The KANWU study suggested that saturated fatty acid increased insulin resistance whereas
monounsaturated fatty acids had a neutral effect. However, this was a finding or borderline statistical significance.
Two large randomized controlled trial (RISCK and LIPGENE) have recently tested the hypothesis that replacing
saturated fatty acid with monounsaturated fatty acids would improve insulin sensitivity in participants at risk of
metabolic syndrome. Neither of the studies was able to demonstrate an adverse effect saturated fatty acid on
insulin resistance. The RISCK study also compared low fat/high carbohydrate diets with low or high glycemic
62.
indices and found some evidence to suggest an improvement in insulin sensitivity with the low glycemic index
diet. However, both low and high glycemic index high carbohydrate diets lowered HDL cholesterol compared
to diets with higher fat intakes and also increased urinary microalbumin excretion. In terms of lipid metabolism,
the most favourable effects were noted with a high monounsaturated fat diet with carbohydrates of low glycemic
index. The available evidence suggest that the focus on the prevention of metabolic syndromes should be on
energy restriction to produce moderate weight loss and the avoidance of physical inactivity. High carbohydrate
diets may exacerbate metabolic syndrome particularly if the carbohydrate is derived from high glycemic index
foods. Energy restricted diets with a higher proportion of energy from fat (35-40% energy), mainly derived from
monounsaturated fatty acids, with a lower proportion of carbohydrate may be preferable to the current dietary
advice which recommends diets containing (25-30% energy from fat)
References:
1) Jebb, S. A., Lovegrove, J. A., Griffin, B. A., Frost, G. S., Moore, C. S., Chatfield, M. D., Bluck, L. J., Williams,
C. M. & Sanders, T. A. B. 2010. Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity
and cardiovascular risk: The RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial. American Journal
of Clinical Nutrition, 92, 748-758.
2) Tierney, A. C., Mcmonagle, J., Shaw, D. I., Gulseth, H. L., Helal, O., Saris, W. H. M., Paniagua, J. A.,GobekLeszczỸska, I., Defoort, C., Williams, C. M., Karsltröm, B., Vessby, B., Dembinska-Kiec, A., López-Miranda,
J., Blaak, E. E., Drevon, C. A., Gibney, M. J., Lovegrove, J. A. & Roche, H. M. 2011. Effects of dietary fat
modification on insulin sensitivity and on other risk factors of the metabolic syndrome-LIPGENE: A European
randomized dietary intervention study. International Journal of Obesity, 35, 800-809.
Name: Prof. Tom Sanders
Degrees/Credentials: BSC, PhD, DSc, RPHNutr
Position Title: Professor of Nutrition & Dietetics
Employer Address: King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH
Contact Address: Franklin Wikins Building, 150 Stamford Street, London SE1 9NH
Dr Wakil Elie
Diplome D’etat Francais De Docteur En Pharmacie / “Human Relations” Specialist
Abstract Title
Open discussion: Importance and value of being assertive
Objectives
1. Understand why people are different
2. Evaluate the impact of assertiveness
3. Identify key disclosure skills
Being trained in assertive communication actually increases the appropriate use of this sort of behaviour.
It enables us to swap old behaviour patterns for a more positive approach to life:
• If we react defensively we are being PASSIVE
• If we attack we are being AGGRESSIVE
• A third, more satisfactory alternative, is to be ASSERTIVE
• Market your self effectively as a professional clinical dietician
• Develop a credible image that inspires confidence
• Reinforce your self-confidence
Abstract
Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest
and direct way. It recognises our rights whilst still respecting the rights of others. It allows us to take responsibility
for ourselves and our actions without judging or blaming other people. And it allows us to constructively confront
and find a mutually satisfying solution where conflict exists.
Passive behaviour is when we:
• Fail to stand up for our rights or do so in such a way that others can easily disregard them
• Express our thoughts, feelings and beliefs in apologetic cautious or self-effacing ways
• Fail to express our views of feelings altogether
63.
Passivity is based on the belief that our own needs and wants will be seen by others to be less important that
their own.
Agressive behaviour is when we:
• Stand up for our own rights in such a way that we violate the rights of another person
• Express thoughts, feelings and beliefs in inappropriate ways, even if we believe those views to be right.
Aggression enhances us at the expense of others and can serve to put another person down. It is based on
the belief that our opinions are more important than other people’s.
Assertive behaviour is when we:
• Stand up for our own rights in a way that does not violate another person’s rights
It leads to an honest, open and direct expression of our point of view which, at the same time, shows that we
understand the other person’s position.
How to be assertive
a) The acton → when ...
b) The response → I feel ...
c) The reasons/effect → Because ...
d) The preferred outcome → and what I would like ... /
What would make it better
Advantages of Assertiveness
- Close working relationships
- Greater confidence in yourself
- Greater confidence in others
- Increased self responsibility
- Increased self-control
- Savings in time and energy
- An increased chance of everyone winning
Name: Wakil Elie
Degrees/Credentials: Diplome D’etat Francais De Docteur En Pharmacie / “Human Relations” Specialist
Position Title: Director
Employer Address: E.W. Human Development Ltd, 27, A. Araouzos Street, 1076-Nicosia
Contact Address: P. O. Box 27291, 1643-Nicosia
Phone/Fax/Email: 22769048/22769003/[email protected]
Dr Yamasaki – Patrikiou Edna, MD, MSc, PhD
Head, Department of Life and Health Sciences, University of Nicosia
Associate Professor, University of Nicosia
Abstract Title
Caffeine and Cognitive Function
(Part of panel: Novelties in Nutrition)
Objectives
1. Discuss potential benefits, side effects of acute and chronic use of caffeine
2. Characterize caffeine effects on cognition
3. Discuss caffeine and the prevention of cognitive disorders
After this presentation, the attendee will be able to:
1. Cite the general effects of acute and chronic caffeine ingestion in the body and in cognitive function
2. Understand and discuss the potential use of caffeine in the prevention of cognitive disorders
3. Apply to their clinical practice the knowledge of the potential beneficial effects of caffeine in cognitive function
This presentation will provide an overall view of acute and chronic caffeine effects in the body and in cognitive
function, and the most recent research supporting its use in the prevention of cognitive loss in aging and
diseases.
Through discussion of the material presented, and application of its knowledge in clinical practice.
64.
Abstract
Caffeine is probably the most widely consumed and accepted psychoactive substance, producing complex
pharmacological actions.
A normal person consumes approximately 70-350mg/day or 5 to 8 mg/kg/day (equivalent to 3 cups of coffee),
which induces a peak plasma concentration of 0.25 to 2mg/L (or approximately 10uM), and produces overall
psychostimulant effects, reducing fatigue and enhancing performance, and also affecting mood and cognitive
performance.
Higher doses (above 400-500mg/day) may lead to undesired effects (anxiety, increased blood pressure, headache,
confusion) among individuals. Repeated exposure to caffeine results in rapid tolerance, and chronic exposure
produces effects opposite to that of acute caffeine.
The complex actions of caffeine are in part due to its multiple molecular effects, raging from GABAA receptor
inhibition, PDE inhibition, and antagonism of adenosine receptors.
Differences in the affinity of caffeine for these multiple potential targets may contribute to the biphasic motor
and cardiovascular, cognitive responses to increasing doses of caffeine in rodents, and to the anxiety, sleeplessness,
and increases in blood pressure and heart rate associated with high doses of caffeine in human.
This complexity may also underlie the association of caffeine consumption with a variety of common disorders
detected by epidemiological studies, including Dementia, Parkinson’s and Alzheimer’s Diseases.
References:
1) Eskelinen MH et al (2009). Midlife Coffee and Tea drinking and the risk of late-life dementia: a population-based
CAIDE study. J Alzheimer’s Disease;16:85-91.
2) Arendash GW and Chuanhai Cao (2010). Caffeine and Coffee as therapeutics against Alzheimer’s disease.
J Alzheimer’s Disease; 20:S117-126
3) Chen JF et al., (2010). What knock-out animals tell us about the effects of caffeine. J Alzheimer’s Disease;
20:S17-S24.
4) Santos C et al., (2010). Caffeine intake and dementia: systematic review and meta-analysis. J Alzheimer’s
Disease; 20:S187-S204
5) Smit HJ and Rogers, PJ (2000). Effects of low doses of caffeine on cognitive performance, mood and thirst
in low and high caffeine consumers. Psychopharmacology;152:167-173.
Name: Yamasaki – Patrikiou Edna
Degrees/Credentials: MD, MSc, PhD
Position Title: Head, Department of Life and Health Sciences, University of Nicosia / Associate Professor,
University of Nicosia
Employer Address: Department of Life and Health Sciences, University of Nicosia, PO Box 24005, 1700 Nicosia
Phone/Email: 22841743, [email protected]
Prof Zampelas Antonis, BSc, MSc, PhD
Professor of Human Nutrition, Agricultural University of Athens
A. Abstract Title
The latest on ω-3 fatty acids: from cardiovascular diseases to mood disorders
(Part of panel: Mediterranean diet and cardiovascular disease)
Objectives
1. Have a general knowledge about the n-3 fatty acids and some aspects of their metabolism
2. Know the effects of n-3 fatty acids on cardiovascular diseases risk
3. Be familiar with other beneficial properties of n-3 fatty acids on disease states
Abstract
Dietary n-3 fatty acids, and especially n-3 fatty acids from fish oils (EPA and DHA), and their effects on health
and disease has attracted interest for clinical research and public health since the mid ‘50s.
The most abundant research on n-3 fatty acids concerns their effects in the prevention of cardiovascular
diseases. The use of n-3 fatty acids has been recommended to reduce cardiovascular risk by multiple mechanisms,
including a decrease in plasma triglycerides, thrombotic factors, inflammatory markres, and they are effective
in preventing cardiovascular events, cardiac death and coronary events, especially in persons with high
cardiovascular risk [1]. One of their side effects was considered to be a small increase in plasma glucose levels
but overall pooled findings do not support either major harms or benefits of fish/seafood or EPA and DHA on
65.
the development of diabetes [2].
A very recent review, looked at studies which investigated effects of n-3 fatty acid supplementation in pregnant
and lactating women and infants during postnatal life, on the visual acuity, psychomotor development, mental
performance and growth of infants and children [3]. The results were not consistent. In particular, some studies
showed beneficial effects of DHA supplementation during pregnancy and/or lactation especially on visual acuity outcomes and some on long-term neurodevelopment; a few, showed positive effects on growth. Some others claimed a beneficial effect of such supplementation on visual, neural, or developmental outcomes and no
effects on growth. However, evidence from randomized controlled trials (RCTs) does not seem to demonstrate
a clear and consistent benefit of n-3 fatty acids supplementation during pregnancy and/or lactation on term
infants growth, neurodevelopment and visual acuity.
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of the joints and bones and arachidonic
acid is the precursor of inflammatory eicosanoids which are involved in RA. Some therapies used in RA target
arachidonic acid metabolism. Fish oils have been shown to slow the development of arthritis in animal models
and to reduce disease severity [4]. A number of RCTs of fish ois have been performed in patients with RA and
there is evidence for a fairly consistent, but modest, benefit of marine n-3 fatty acids on joint swelling and pain,
duration of morning stiffness, global assessments of pain and disease activity.
n-3 fatty acids has also been proposed to be protective against dementia and age related cognitive impairment.
From a Cochrane review on the benefits of n-3 fatty acids supplementation on cognitive function among cognitively
healthy older people, which included also trials conducted with individuals with prevalent poor cognitive function
or dementia, there was no evidence to support the routine use of n-3 fatty acid supplements for the prevention,
or amelioration, of cognitive decline in later life. [5].
Finally, there is some evidence that n-3fatty acids may influence neuronal function and mood. It is difficult
though to summarize the effects because of considerable heterogeneity in the literature [6]. However, the
evidence available provides some support of a benefit of n-3 fatty acids in individuals with but no evidence of
any benefit in individuals without a diagnosis of depressive illness.
References:
1) Delgado-Lista J, Perez-Martinez P, Lopez-Miranda J and Francisco Perez-Jimenez. Long chain omega-3
fatty acids and cardiovascular disease: a systematic review. Br J Nutr 2012;107: S201–S213.
2) Wu JHY, Micha R, Imamura F, Pan A, Biggs ML, Ajaz O, Djousse L, Hu FB and Mozaffarian D. Omega-3 fatty
acids and incident type 2 diabetes: a systematic review and meta-analysis. Br J Nutr 2012;107: S214–S227.
3) Campoy C, Escolano-Margarit V, Anjos T, Szajewska H, Uauy R. Omega 3 fatty acids on child growth, visual
acuity and neurodevelopment. Br J Nutr 2012;107:S85–S106.
4) Miles EA, Calder PC. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. Br J Nutr 2012;107:S171–S184.
5) Dangour AD, Andreeva VA, Sydenham E, Uauy R. Omega 3 fatty acids and cognitive health in older people.
Br J Nutr 2012;107:152-8.
6) Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 longchain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr 2010;91:757–70.
B. Abstract Title
Νutritional Policies for the Prevention and Treatment of Obesity
(Part of Lanitis Satellite Synposium)
Objectives
1. Understand the significance of the problem of obesity in epidemiological and financial terms
2. Be familiar with the methods used to prevent obesity in a population levels
3. Know the effectiveness of the major measures under public policy initiatives to improve dietary habits of the
populations especially in European Union.
Abstract
The prevalence of chronic diseases which are associated with dietary habits has been gradually reaching
epidemic dimensions in Europe. It is noteworthy that in Greece, the problem of overweight-obesity concerns
40% of children aged 11-12 years of age [1], while it has also been calculated that 5-7% of the budget of the
National Health Services in the European Union countries is dedicated for the treatment of obesity. Moreover,
in 2002, obesity-related indirect costs, such as the reduction in productivity, reached 33 million euros which
corresponds to 0.5% of the gross domestic product of the whole European Union [2]. Therefore, due to this
alarming financial cost, along with the deterioration of the quality of life, obesity is now a major problem of
public health and several countries have developed policies to improve the dietary habits of their populations.
66.
Measures which have been designed and implemented in the European Union as well as in the United States,
in order to promote healthy eating, include advertising controls, public information campaigns, nutrition education,
nutritional labeling, nutrition information on menus, fiscal measures: taxes/subsidies on foods, regulation of
meals: school and workplace meals [3]. The largest number of measures adopted in the European Union are
those intended to promote informed choice, predominantly through public information campaigns and nutrition
education in schools. Measures to change the market environment are rare, with the exception of policies
aiming to improve the provision of healthy foods in schools. From all these actions taken, and although the
assessment of their effectiveness is particularly difficult, it seems that positive results in the behavior change
seem to have the nutritional labeling and the monitoring of advertisements which target children. Campaigns
which aim the increase in nutritional information seem to improve the willingness towards a change but they
do not improve dietary behavior per se. Regarding fiscal measures, there is not enough information of the
effectiveness of tax increases in the dietary behavior change and the prevention of obesity in the European
Union level. What it seems to be the case is that a small increase in taxes does not lead to beneficial results
towards a change in the nutritional behavior but it increases significantly the income of the State. On the other
hand, a significant increase in taxes could have some results, but is unknown how these type of increases
would influence the whole food chain, from the primary production up to the end product. Therefore, potentially
significantly negative impact in the National Economy from for example a decrease in income and/or an increase
in unemployment cannot be predicted.
Finally, the role of the Food Industry should not be ignored or underestimated. The re-design of food products
aiming at lower energy density, fat, saturated fat, trans fat, sodium and added sugars content could significantly
contribute not only in the prevention of obesity but also in the improvement of several risk factors associated
with cardiovascular diseases, hypertension, diabetes and cancer.
References:
1) Farajian P, Risvas G, Karasouli K, Pounis GD, Kastorini CM, Panagiotakos DB, Zampelas A. Very high childhood
obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: the GRECO study.
Atherosclerosis 2011;217:525-30.
2) Fry J, Finley W. The prevalence and costs of obesity in the EU. Proc Nutr Soc 2005;64:359–62.
3) Capacci S, Mazzocchi M, Shankar B, Macias JB, Verbeke W, Perez-Cueto FJA, Kozioł-Kozakowska A, et
al. Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness Nutrition
Reviews 2012; 70:188–200.
Name: Zampelas Antonis
Degrees/Credentials: BSc, MSc, PhD
Position Title: Professor of Human Nutrition
Employer Address: Agricultural University of Athens, Unit of human Nutrition, Department of Food Science
and Technology,Agricultural University of Athens, Iera Odos 75, Athens 11855, Greece
Contact Address: Agricultural University of Athens, Unit of human Nutrition, Department of Food Science and
Technology,Agricultural University of Athens, Iera Odos 75, Athens 11855, Greece
Phone/Fax/Email: +30 210 5294701, [email protected]
67.
Posters/Oral Presentations
68.
Oral Presentation
OP01
FTO GENE AND BODY MASS INDEX IN YOUNG EUROPEAN CHILDREN:
DO PHYSICAL ACTIVITY LEVELS INFLUENCE THE EFFECT OF THE RISK GENOTYPE?
Anna Christina Koni1, Guan Wang1, Mark Bailey1, Robert Scott2, Licia Iacoviello3, Alfonso Siani4, Paola Russo4,
Fabio Lauria4, Michael Tornaritis5, Charalambos Hadjigeorgiou5, Toomas Veidebaum6, Kenn Konstabel6,
Staffan Marild7, Gabriele Eiben7, Luis Moreno8, Jose Casajus8, Wolfgang Ahrens9, Karin Bammann9, Eva
Kovacs10, Denes Molnar10, Stefaan De Henauw11, Krishna Vyncke11, Yannis Pitsiladis, FACSM1; on behalf of
the IDEFICS Consortium.
1University
of Glasgow, Glasgow, United Kingdom. 2University of Cambridge, Cambridge, United Kingdom.
University, Campobasso, Italy. 4Institute of Food Sciences-CNR, Avellino, Italy. 5Research and Education
Foundation of Child Health, Strovolos, Cyprus. 6National Institute for Health Development, Tallinn, Estonia.
7Göteborg University, Göteborg, Sweden. 8University of Zaragoza, Zaragoza, Spain. 9University of Bremen,
Bremen, Germany. 10University of Pecs, Pecs, Hungary. 11University of Ghent, Ghent, Belgium.
3Catholic
Childhood obesity is considered to be one of the most serious public health problems of the 21st century. The
worldwide prevalence of obesity has increased dramatically over the past three decades and is continuing to
rise rapidly, along with increasing levels of childhood obesity. Although the human genome has not changed
over the years, obesity levels and the mortality rates have dramatically increased, thus it becomes more
evident that environmental factors such as physical activity or sedentary lifestyle may have a key role in this
increase of obesity prevalence.Modifiable lifestyle factors such as levels of physical activity have been shown
to be associated with body mass index (BMI). The IDEFICS study with a cohort size of 16,223 young children
is one of the largest single studies in the pre-adult life stages to undertake saliva/DNA collection in conjunction
with extensive phenotypic assessment and is therefore well-suited for studying the interaction between genes,
physical activity and adiposity.
Purpose: To investigate environmental and genetic associations on BMI in European children.
Methods: Anthropometric measurements (including adiposity) and objectively measured physical activity using
accelerometry were assessed in a subgroup of children (n=4678) aged 2-10 years from the IDEFICS study.
DNA from saliva samples was generated for genotyping. Here we report associations between BMI, selected
physical activity measures and the FTO gene (rs9939609) as assessed using GLM and regression models.
Results: Clear effects on BMI were observed with time spent in sedentary behaviors (P < 0.0001), MVPA (P
< 0.0001) and Overall Physical Activity (count.min-1)* (P < 0.0001). Gender differences were examined for all
these activity measures. FTO (SNP rs9939609) was found to influence age- and gender-adjusted BMI (0.119
unit, p<0.0001), genotype explaining 0.4% of the BMI variance. However, the strength of this association was
marginal after further adjustment for main effects of physical activity. No interaction was observed between
physical activity patters and FTO, however the effect size of each copy of the risk allele (A) on obesity-related
phenotypes increased with increasing time spent in sedentary behaviors. Although no interactions were found
between FTO genotype and time spent in MVPA, the relationship between each copy of the risk allele and
increasing MVPA became significant for those who spent less time in MVPA (lower tertile).
Conclusion: These preliminary results confirm previous associations between the FTO gene and adiposity
in a cohort of European children aged between 2 and 10 years, but they also highlight the need to adjust for
levels of physical activity when estimating the genotype effects on obesity risk. Although there was no evidence
of a significant PA*FTO interaction, increasing total physical activity or reducing time spent in sedentary behaviour
could be beneficial on reducing the genetic effect of FTO on obesity related traits. This observation has important
public health value, as it emphasizes that being physically active may overcome, at least in part, the genetic
predisposition to obesity traits induced by variations in the FTO gene.
Oral Presentation
OP02
IMPACT OF BREAKFAST CONSUMPTION ON DIET QUALITY AND HEALTH
OUTCOMES IN CYPRIOT CHILDREN
Papoutsou S1, Briassoulis G2, Chadgigeorgiou Ch1, Savva SC1, Solea T1, Hebestreit A3, Pala V4, Sieri S4,
Kourides Y1, Kafatos A5 & Tornaritis M1
1 Research
and Education Institute of Child Health, Strovolos, Cyprus
Intensive Care Unit, University of Crete, Heraklion, Crete, Greece.
3 BIPS - Institute for Epidemiology and Prevention Research, Department: Epidemiological Methods and Etiologic
Research Head of Unit ‘Lifestyle Related Disorders’ Bremen, Germany
4 Department of Preventive & Predictive Medicine, Nutritional Epidemiology Unit. Fondazione IRCCS Istituto
Nazionale dei Tumori, Milan, Italy
5 Preventive Medicine and Nutrition Clinic, Department of Social Medicine, Faculty of Medicine, School of
Health Sciences, University of Crete, Heraklion, Greece.
2 Pediatric
Background: In Cyprus, where childhood obesity is rising rapidly, breakfast habits of children and their effect
on health outcomes, were never thoroughly studied.
Objective: To examine diet quality, nutrients intake and health outcomes of children in relation to their breakfast
habits.
69.
Design: Cross-sectional subsample data of the IDEFICS study. Breakfast frequency, breakfast quality, Youth
Healthy Eating Index (YHEI) and daily nutrients intake were assessed through a parental questionnaire and
a 24-h dietary recall. Breakfast frequency was assessed as daily or non daily consumption. Breakfast quality
pattern was divided in five breakfast categories: “Ready To Eat cereals consumers”, “milk consumers”, “pastry
consumers”, “other breakfast consumers” and “breakfast skippers”. BMI, BMI z-scores, waist circumference,
Conicity Index, blood lipid profile and blood pressure were examined in relation to breakfast patterns.
Participants: Cypriot children aged 4 to 8 years from two urban areas in Cyprus: Strovolos and Pafos areas
(n=2151). The study was conducted in 2007-2008 in public and private kindergartens and primary schools.
Statistical analyses: Mann–Whitney–U test was used to determine associations between breakfast frequency
and health outcomes as well as breakfast quality pattern and nutrient intakes. Logistic regression models were
fitted to evaluate associations between breakfast type consumption and insufficient micronutrient intakes (intake
lower than the two thirds of RDA/AI) adjusting for sex, area, mother’s age and BMI z-score.
Results: Regarding breakfast frequency consumption, as parents reported, 62.8% of boys and 64.1% of girls
eat breakfast daily and around three out of ten children eat breakfast only during weekends. Girls who had
breakfast on a daily basis had lower mean BMI, waist circumference, BMI z-score, tendency to lower mean
serum total cholesterol and LDL cholesterol, lower mean serum triglycerides, atheromatic index and diastolic
blood pressure, than non daily consumers. Both boys and girls that do not eat breakfast daily scored lower
in YHEI. The Mean Intake Ratio as calculated for 10 micronutrients (calcium, iron, magnesium, phosphorus,
potassium, vitamin A, vitamin C, thiamin, riboflavin and vitamin B6) was higher in Ready To Eat (RTE) cereals
consumers than all the other breakfast consumers and breakfast skippers; in addition RTE cereals consumers
were more likely to ensure sufficient micronutrients intake, higher carbohydrate intake and lower fat intake
when expressed as a percentage of total energy intake. Fiber intake was low for all breakfast type consumers;
preference in RTE cereals rich in fibers was extremely low.
Conclusion: Daily breakfast consumption might have a positive effect in controlling children’s diet quality
and health indicators including obesity indexes, serum lipid profile and blood pressure. Health professionals in
Cyprus must educate parents for the importance of daily breakfast consumption by the whole family, especially
when combined with the optimal breakfast choices.
Oral Presentation
OP03
A NATIONAL STUDY OF THE DIETARY INTAKE OF CYPRIOT CHILDREN AND ADOLESCENTS
AGED 6-18 YEARS AMD THE EFFECT OF MOTHER’S EDUCATIONAL STATUS AND CHILDREN’S
WEIGHT STATUS ON ADHERENCE TO NUTRITIONAL RECOMMENDATIONS
E Philippou1, MJ Tornaritis1,2, C Hadjigeorgiou1, YA Kourides1, A Panayi1 and SC Savva1
1 Research and Education Institute of Child Health, Nicosia, Cyprus
2 Pedagogical Institute of Cyprus, Nicosia, Cyprus
Aim: To assess the dietary intake of Cypriot children and the influence of their mother’s education and their
own weight status on adherence to dietary recommendations.
Methods: The intake of a random sample of 1414 Cypriot children aged 6-18y was assessed using a 3-day
food diary. Children were grouped based on their age (6.0-8.9, 9.0-13.8 and 14.0-18.9y) and gender. Adherence to recommendations was estimated and the influence of their mother’s education and their own weight
status on adherence were explored.
Results: A large percentage of children exceeded the recommended intakes of total fat (42.4-83.8% in different age groups), saturated fatty acids (90.4-97.1%) and protein (65.2-82.7%), while almost all (94.7-100%)
failed to meet the recommended fibre intake. Additionally, a large proportion of children (27.0-59.0%) consumed
>300mg/day cholesterol and exceeded the upper limit of sodium (47.5-78.5%). In children aged 9.0-13.9y,
there was a high prevalence of inadequacy for magnesium, and in girls aged 14.0-18.9y, of Vitamin B6 (21.0%)
and iron (25.3%). Children whose mother was more educated were more likely to consume >15%en from protein
(Odds Ratio: 1.81 (95% CI:1.13-2.94) and >300 mg/day cholesterol (2.25 (1.37-3.69) and 1.96 (1.17-3.28) for
mothers with secondary and tertiary education respectively). Overweight/obese children were less likely than
normal weight children to consume <6% PUFA (0.55 (0.38-0.78) and more likely to consume >15%en protein
(1.90 (1.30-2.76) and have a <Adequate Intake of calcium (1.76 (1.12-2.77).
Conclusions: Cypriot children consume a low quality diet. Their mother’s education and their own weight
status influence their adherence to dietary recommendations. Public health initiatives need to be developed
aiming to improve Cypriot children’s dietary intake.
70.
Oral Presentation
OP04
A PIONEER NUTRACEUTICAL FORMULA (PLP10) FOR THE TREATMENT OF RELAPSING
REMITING MULTIBLE SCLEROSIS: A RANDOMIZED, DOUBLE BLIND PLECEBO-CONTROLLED
PROOF-OF-CONCEPT CLINICAL TRIAL
Ioannis S. Patrikios1,3,4*, George N. Loukaides1,3,4, Evangelia E. Ntzani2 & Marios C. Pantzaris1,3*
1 Neurology Clinic C, The Cyprus Institute of Neurology and Genetics (CING), Nicosia, Cyprus. 2 Clinical and
Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of
Medicine (UISM), Ioannina, Greece. 3 PALUPA Medical Ltd., CING, Nicosia, Cyprus. 4 European University
Cyprus, Department of Health and Science, Nicosia, Cyprus. *Correspondence should be addresses to
e-mail: [email protected] or [email protected]
Background: For many years, the role of polyunsaturated fatty acids (PUFA) in the pathophysiology and development
of neurodegenerative diseases and specifically multiple sclerosis has been a subject of considerable discussion
and research but without proof of efficacy. We aimed to assess whether our novel intervention, formulated
based on systems medicine concept, comprising specific fatty acids and vitamins within a specific ratio, quantity,
quality, and structural form reduce disease activity in patients with relapsing remitting multiple sclerosis who
were either treated with disease modifying treatment (DMT-interferon or glatiramer acetate) or untreated.
Methods: We contacted a 30-month randomized, double-blind, placebo-controlled, parallel design, phaseII
proof of concept clinical study at the Cyprus Institute of Neurology and Genetics (CING). An experienced
neurologist, a registered clinical dietitian and a medical biochemist with specialties on lipidology and immunology,
were the investigators involved in the trial. Of a total of 80 patients, 20 were randomly assigned to receive
intervention A (docosahexaenoic acid (DHA)/eicosapentaenoic acid (EPA) (3:1 wt/wt) omega-3, linoleic acid
(LA)/gamma (γ)-linolenic acid (GLA) (2:1 wt/wt) omega-6 fatty acids, omega-3/omega-6 (1:1 wt/wt), other specific
PUFA, monounsaturated fatty acids (MUFA), minor quantity of specific saturated fatty acids (SFA), vitamin A
and vitamin E), 20 to receive γ-tocopherol, intervention C, 20 to receive the combination of interventions A and
C, intervention B (PLP10) and 20 to receive placebo, as an oral solution, once daily. The first six months were
used as normalization period and considered as pre-entry period. The primary end point was the annualized
relapse rate (ARR) and the key secondary end point was the time to disability progression. This study is registered
as an International Standard Randomized Controlled Trial, number ISRCTN87818535.
Findings: PLP10 reduced the annual relapse rate (ARR) by 70% (p=0·003), in relation to the baseline ARR
and the placebo increased by 46% (p=0·354). During study, for the primary end point, PLP10 reduced the
ARR by 58% (95% confidence interval 0·10 to 0·79, p=0·016) and for the secondary end point, significantly
reduced the risk of sustained progression of disability by 86% over the two-year period (hazard ratio, 0·11;
95% confidence interval 0·01-0·97, p=0·047) versus placebo. The cumulative probability of progression on
basis of survival analysis was 10% in the PLP10 group, and 70% in the placebo group. Proportionately more
patients in the PLP10 group (72%) versus placebo group (20%) were free from new or enlarging T2-weighted
lesions on brain magnetic resonance image (MRI) scans over the two-year study. No adverse events were
reported. Interventions A and C showed no significant efficacy.
Interpretation: PLP10 treatment significantly reduced the ARR, and the risk of sustained disability progression
without any adverse or significant side effects. This is the first clinical study of systems medicine approach
medical nutrient formula that holds strong promise as an effective treatment for relapsing remitting multiple
sclerosis.
Oral Presentation
OP05
EFFECTS OF AN INTERVENTION AND MAINTENANCE WEIGHT LOSS DIET WITH AND
WITHOUT EXERCISE ON ANTHROPOMETRIC INDICES IN OVERWEIGHT AND OBESE
HEALTHY WOMEN.
Andreou E, Philippou C, Papandreou D.
Department of Life and Health Science, Intercollege, University of Nicosia, Nicosia, Cyprus.
Background αnd Aims:
There is growing evidence that excess body weight and body fat levels may lead to various diseases. A low-calorie
diet has been found to reduce body weight and fat; however, 95% of patients regain the weight within a short
period of time. The aim of this study was to investigate the effects of a reduced-calorie diet with and without
exercise on body composition profile as well as to evaluate maintenance of weight loss 18 weeks after the
intervention had concluded.
Methods:
Two hundred and six overweight and/or obese women were randomized by a computer to either diet only
(DO) or diet and exercise (DE) for an 18-week intervention period and 18 weeks of maintenance. Statistical
significance was set at p < 0.05.
Results:
Body mass index (BMI) was reduced by 5.1 in the DE group compared to 3.2 in the DO group 18 weeks after
the intervention period had ended; waist circumference (WC) was 14.2 cm lower in the exercise group and 8
cm lower in the diet alone group, and body fat was reduced by 15.5% in the DE group, while no changes were
observed in the DO group.
Conclusion:
A combination of a reduced-calorie diet with exercise may successfully reduce weight, BMI, WC and body fat
levels.
71.
Oral Presentation
OP06
EXPANSION OF CYPRUS FOOD COMPOSITION TABLES
S.Yiannopoulos, Μ. Christodoulidou K.Kontoghorghe, E. Kakouri and P. Kanari
Laboratory of Food Composition Quality and Nutritional value, State general Laboratory, 44 Kimonos,1451, Nicosia
Food composition tables are an important tool in the hands of researchers, dietitians, doctors and even consumers.
The knowledge of food composition and dietary habits can prevent certain diseases as over-consumption of
animal fat might be responsible for cardiac diseases while the absence of dietary fiber from the diet is correlated
with colon cancer. The knowledge of food composition helps in the identification of quality and its specific
characteristics, beneficial or not. The composition tables can also be used for the nutritional analysis making
achievable the calculation of the amount of energy and nutrients consumption and the establishment of a daily
diet. They can also be used for educational/informational purposes.
The necessity for the creation of a national database for the composition of foodstuffs consumed in Cyprus
initiated in 1992 aiming to the proper evaluation of the relation between food and the health of Cypriot consumers.
The first edition of Food Composition Table was published in 1994 and the second in 1999. The change of
eating habits together with the high consumption of ready to eat meals, imposed the additional investigation of
traditional and complex cooked fast-foods, resulting in the current 3rd edition in 2012.
The innovation of the Cyprus Food Composition Tables (CFCT) compared to others is that they are completely
based on laboratory chemical analyses and not data from bibliography, and all the samples are analyzed
individually. or the first 2editions of the CFCT, 400 samples were analyzed. For the present expanded 3rd
edition, 324 more samples (of 74 different types of foodstuffs) were examined including a) ready to eat traditional
food - like kolokasi, pastitsio, meatballs, koupepia, zalatina etc, b)fast-foods such as hamburger, kebab, pizza
etc. and c) traditional sweets. Additionally, due to the nutrition claim of high content in ω-3 fatty acids, fish from
both fish-farms ( sea and fresh water) and sea were analyzed. The analysis included the determination of
macro- and micronutrients (ie fat, carbohydrates, proteins, moisture, ash, dietary fibers, metals, fatty acids,
etc). Emphasis was given in parameters directly related to health, such as cholesterol, saturated and unsaturated
lipids, salt, etc. All the analyses were carried out in the laboratory of Food Composition, Quality and Nutritional
Value of the State General Laboratory, which is accredited since 2002 by the Hellenic Accreditation Body,
ESYD. The analytical methods used are either accredited or sufficiently validated and officially accepted according
the Quality Control System and the EN/ISO 17025:2005 standard.
For the statistical analysis, the Laboratory Information System (LIMS) was used.
The presentation will refer to the selection of the representative food samples (according to the dietary habits
of Cypriot consumer) and the results of the chemical analysis. Examples of frequently consumed foodstuffs
will be presented.
Keywords: Cyprus’ traditional foodstuffs, fast-foods, laboratory chemical analyses
Bibliography
1. H.Greenfield, D.A.T. Southgate, Food Composition Date, Production, Management and Use, ISBN 9251049491
F.A.O. Rome 2003
2. Kafatos A, Chasapidou M., Food Composition Tables of Greek foodstuffs YPET/EPET II (http://www.nutrition.
med.uoc.gov)
3. Pearson’s Composition and Analysis of Foods, 9th edition 1991, ISBN:0-470-21693-x
4. McCance R.A. & Widdowson E.M. The Composition of Foods Sixth summary Edition Cambridge Royal Society
of Chemistry 2002.
Poster Presentation
PP1
COMPARISON OF THE ASSOCIATION BETWEEN DIFFERENT OBESITY MEASURES AND
TYPE 2 DIABETES IN A CYPRIOT POPULATION
Nikoleta Andreou, Dr Alexandros Heraclides, Dr Eleni Andreou
University of Nicosia, Cyprus / University of Hertfordshire
Background: Obesity and type 2 diabetes (T2D) have become an epidemic. Obesity is one of the well recognized
risk factors for the development of T2D. Fat estimation through central and overall obesity measurements is
associated with diabetes and can be used to detect patients at high risk.
Aim of the study: The purpose was to compare central and overall obesity measures in predicting prevalent
T2D.
Methods: A case-control epidemiological study of 115 participants residing in Cyprus was conducted. The
following obesity measures were used: BMI, %body fat, waist circumference (WC), and waist-to-height-ratio
(WHtR). Diabetes status was self-reported and confirmed by a physician. Data of demographics, lifestyle factors,
dietary habits and medical history were used as potential confounders. Logistic regression was used to determine the association of each obesity measure (categorized into tertiles) and prevalent T2D.
Results: There was a positive association between central and overall obesity with T2D. The odds ratio (95%
confidence interval) for having diabetes comparing the highest tertile of BMI, %FAT, WC and WHtR ratio with
lowest tertile was: 6.22 (95% CI 2.38;16.25), 3.84 (95% CI 1.45;10.20), 5.51 (95% CI 2.12;14.33) and 3.97
(95% CI 1.13;13.85), respectively, after adjusting for age and gender. The odds ratios were slightly reduced
after multivariate adjustment, but the odds of diabetes were still linearly and strongly associated with BMI and
waist circumference. A weaker linear association was observed for %FAT, while WHtR did not show a linear
association.
72.
Poster Presentation
PP2
EMOTIONAL EATING AS A COMMON BARRIER DURING WEIGHT LOSS AND WEIGHT LOSS
MAINTENANCE: FOCUS GROUPS RESULTS
Y. Koutras, K. Mouliou, E. Karfopoulou, M. Yannakoulia
Department of Nutrition and Dietetics, Harokopio University Athens, Greece
Introduction: The behaviors contributing to successful long-term weight loss maintenance are not fully understood.
Identification and corrections regarding potential barriers arising during the process of weight loss regulation,
may arouse a person’s ability to act toward a sustain weight loss goal.
Aim: To identify common barriers during weight loss and maintenance, as experienced by weight loss maintainers,
as well as regainers.
Methods: 44 volunteers were recruited (41% males), and formed 4 focus groups of maintainers and 4 of regainers.
Participants had intentionally lost at least 10% of their starting weight and kept it off for at least one year
(maintainers) or had regained most of the weight initially lost (regainers).
Results: Maintainers compared to regainers were younger (27±7 vs 42±16 yrs, p=0.002) and had a lower current
Body Mass Index (24.1±2.8 vs. 31.2±4.3Kg/m2, p<0.001). During weight loss, maintainers reported hunger,
external triggers to eat, frustration over slow weight loss rates and emotional eating as the main barriers.
Similarly, regainers reported emotional eating, hunger, external triggers to eat and unsatisfactory weight loss
rates as barriers during weight loss but they also perceived cravings, time and effort required for cooking and
social pressure to lose weight as additional barriers. Furthermore, maintainers reported that common barriers
during maintenance were external cues to eat and emotional eating, with few participants stating no barriers.
Both maintainers and regainers consider emotional eating to be one of the leading causes of regaining weight,
and emotional well-being as an essential factor for long-term weight loss maintenance. However, maintainers
reported compensating for emotional eating the following day, by eating less and/or exercising more, whereas
regainers did not identify any counterbalancing strategies.
Conclusions: Emotional eating seems to be a commonly-cited barrier for people who have lost weight and
maintained it, as well as for those who regained it. Even though both groups are susceptible to emotional
eating and neither has a strategy to avoid it, maintainers, but not regainers take corrective action. Further
research should reveal potential differences of the perceived barriers and coping strategies.
73.
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75.
Index
Page
Agathangelou Petros …………………………………………………………………………. 11,14
Agrotou Androula ………………………………………………….………………………….. 5, 15
Andreou Eleni ……………………………………………………………………………........ 4, 11, 14, 15, 18, 21
Antoniou Pavlos ……………………………………………………....…………………….… 11, 15, 24
Avraamides Panayiotis ………………………………………………………………….....… 11, 14, 26,
De Looy Anne …………………………………………………………………………........… 11,15,17, 27
Efthimiadis Apostolos ………………………………………………………………………... 11,14,15, 29
Escott- Stump Sylvia ……………………………………………………………………......... 11,15, 30
Hadjilouca Phroso ………………………………………………………….....……………… 15
Hassapidou Maria …………………………………………………………………………….. 11, 14, 31
Heraclides Alexandros ……………………………………………………………………….. 11,15, 32
Ioannou Elina ………………………………………………………………………………….. 11, 17, 34
Kakouri – Ioannou Eleni ….………………………………………………………………….. 11, 17, 35
Kountouri Stalo ……………………………………………………………………....……….. 11, 17, 36
Kyprianou Theodoros ………………………………………………………………………… 11, 17, 37
Kyriakidou Stella ……………………………………………………………………………… 11, 18, 38
Kyriakidou Evi …………………………………………………………………………………. 11,17,39
Lappa Fotini …………………………………………………………………………………… 11,15,41
Loizou Despo ………………………………………………………………………………….. 11, 17, 43
Madden Angela ……………………………………………………………………………….. 11, 17, 45
McClinchy Jane ……………………………………………………………………………….. 11,17, 18, 48
Papandreou Dimitris ………………………………………………………………………….. 11, 15, 51
Papamichael Demetris ……………………………………………………………………….. 11, 17, 50
Papadopoulou Katerina ………………………………………………………………………. 12, 14
Papadopoulou Nicoleta …………………………………………………………………….... 12,14, 52
Pavlidou Sofia ……………………………………………………………………………...…. 12, 14, 54
Philippou Charidemou Christiana ………………………………………............………….. 12,14,17, 18, 55
Philpot Ursula …………………………………………………...............……………………. 12, 16, 57
Risvas Grigoris …………………………………………………………..............…………... 12,16, 59
Sanders Tom ………………………………………………..............………………………... 12,15, 61
Wakil Elie ………………………………………………………………................…………... 12, 17, 63
Yamasaki – Patrikiou Edna ……………………………….........………………………........ 12, 17, 64
Yiakoumi Ioannis ………………………………………………………..............……………. 12, 15,41
Zampelas Antonis …….…………………………………………………..............………….. 12, 14, 16, 65
76.
Notes
77.
78.
The conference is addressed to Dietitians,
Food Scientists, Food Technologists,
Health Professionals, Medical Specialists.
CyDNA
Tel.: +357 22 452258, Fax: +357 22 452292
P.O.Box 28823, 2083 Nicosia, Cyprus
www.cydadiet.org
Conference Secretariat
Tel.: +357 22713780 - Fax: +357 22869744
E-mail: [email protected]
2 Leonidou & Acropoleos Ave., 2007 Strovolos
Nicosia - Cyprus
First published 2012
ISBN 978 - 9963 - 9876 - 2 - 7

Page 71 - Palupa Medical LTD

Transcription

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