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Papers by Maria Maraki

Journal of Immigrant and Minority Health, Apr 7, 2016

Previous studies have shown that the diets of migrant populations are of poor quality; however, s... more Previous studies have shown that the diets of migrant populations are of poor quality; however, studies on populations remaining in one geographical region as a minority after an acute population movement are scarce. Therefore, the aim of the present study was to assess dietary intake and growth of Greek minority adolescents in Turkey. Anthropometric measurements and dietary assessment were performed in 103 Greek Orthodox students (aged 10-19 years old) of three minority schools in Istanbul. Prevalence of overweight and obesity according to the WHO growth charts was 39.8 %. Accordingly, 40 % of the sample exhibited excess body fat. Dietary intakes of protein, carbohydrate, fiber, vitamins E and D, folic acid and calcium were inadequate, while energy, total fat and iron intakes were considered adequate. Our results indicate that Greek minority adolescents living in Turkey have similar weight status compared to their counterparts in Greece, but greater body fat than Turkish coevals, while being at risk of several nutrient inadequacies.

International Health, Jul 25, 2018

Background: The health of asylum seekers is of cardinal importance for the future health of Europ... more Background: The health of asylum seekers is of cardinal importance for the future health of Europe. The aim of the present cross-sectional study was to assess malnutrition prevalence among refugee children living in reception areas in northern Greece. Methods: A total of 192 refugee children (1-18 y old), inhabitants of the refugee reception centres in Drama and Kavala, were evaluated for acute and chronic malnutrition according to the WHO growth standards and charts. Results: In the total sample, 13.0% of the participants had at least one form of malnutrition, the prevalence of underweight was 7.8% and stunting affected 7.3% of the children. Moreover, a greater proportion of adolescent girls from the Drama centre (38.5%) demonstrated at least one form of malnutrition compared with the children in Kavala (p=0.046). Girls demonstrated an increased prevalence of malnutrition compared with boys, while children <5 y of age appeared more vulnerable. Conclusions: The present data underscore the necessity for malnutrition screening among refugees in order to have an early assessment of their nutritional status and address the direct and root causes of this substantial problem.

Mediterranean Journal of Rheumatology, 2023

Immunonutrition is the maintenance and induction of immune homeostasis with the use of nutritiona... more Immunonutrition is the maintenance and induction of immune homeostasis with the use of nutritional factors, the so called, immunonutrients. Immunonutrition focuses on four "Is" representing an equal number of systemic responses with regards to: a) Immunity, b) Infection, c) Inflammation and d) Injury. Although at the early stages of the development of immunonutrition, its application was focused on malnourished patients, with a latter extension in the intensive care unit setting, today we acknowledge the great importance of immunonutrients in rheumatology. In rheumatic diseases (RDs), all the "Is" representing the four aims and targets of immunonutrition are fulfilled. Impaired Immunity is the hallmark of RDs, with both innate and adaptive immunity contributing to the development and course of each disease entity, representing distinct immunoregulation abnormalities, often paired with micronutrient deficiencies. Infections are both drivers and a frequent epiphenomenon of systemic RDs. Subclinical inflammation is propagated long before the first signs or symptoms of RDs and musculoskeletal conditions (injury) are apparent in all patients with RDs, accompanied by pain, underlying connective tissue disease and the consequent reduction in the function of musculoskeletal. Herein, the role of probiotics, curcumin, vitamins, Selenium, Zinc and n-3 fatty acids as immunonutrients is discussed.

Clinical Nutrition Supplements, 2011

The aim of this study is to assess the insulin response to different types of enteral nutrition f... more The aim of this study is to assess the insulin response to different types of enteral nutrition formulas by measuring fractional urinary C-peptide (UCP) in diabetic (DM) and non-DM patients. Methods: UCP was determined by radioimmuno assay (Byk-Sangtec Diagnostica, Germany) in 11 stable patients with tube feeding for dysphagia (5 DM and 6 non-DM). Urine was collected from 9 to 21 h (day) and from 21 to 9 am the next day (night). It was administered 5 bolus of 300 cc of specific enteral nutrition rich in monounsaturated fatty acids from 9 to 21 h and an standard high-carbohydrate formula in other day in the same way. Statistical analysis: Mann-Whitney test, and Wilcoxon test. Informed consent was obtained. Results: 1-In DM the levels of UCP were lower than nondiabetics (p < 0.0001). Without day/night variation, both with specific high fat diet (7.7±9 2 vs 2.6±2 7) or standard formula (15±1 vs 15±12 ng) (p > 0.05). 2-In non-DM, UCP levels were 6 times higher during the day than during the night, both with specific (24±29 vs 4.5±2 8 ng) as with standard formula (55±46 vs 17±19 ng) (p < 0.0001). 3-UCP levels with a specific formula were almost half that with the standard formula in both DM and non-DM. Conclusion: 1-UCP levels indicate fractional insulin secretion at different times. 2-In DM the levels were lower than non-DM and without response to nutrient supply. 3-The amount of carbohydrates in the formula determines the timing and amount of UCP in non-DM patients.

Journal of Physical Activity and Health, Feb 1, 2020

Background: Although plenty of evidence indicates that weight loss maintainers are highly physica... more Background: Although plenty of evidence indicates that weight loss maintainers are highly physically active, studies focusing on the sex-specific differences in activity levels between maintainers and regainers are scarce. The authors aimed to investigate sex-specific differences in activity patterns in a cohort of Mediterranean maintainers and regainers. Methods: Sample includes 756 participants of the MedWeight registry (60.5% women), aged 18-65 years, who lost ≥10% of their initial weight, and either maintained their loss for ≥12 months or regained it. Participants completed a series of questionnaires, including demographics and weight history. Activity levels were evaluated with the International Physical Activity Questionnaire-short version. Results: Maintainers of both sexes were, in total, more active than their same-sex regainers. When specific activities were considered, women maintainers spent more time walking than regainers (P adjusted = .02), whereas men maintainers spent more time in vigorous activities (P adjusted = .001) and walking than regainers (P adjusted = .001). Modest increments in activity of sex-relevant intensity were associated with increased odds for maintenance. Conclusions: Maintainers attained a more active lifestyle than their same-sex regainers, involving more walking for both sexes and more vigorous activities for men. The detected differences, according to activity intensity, support that activity patterns associated with successful weight loss are distinguishable between sexes.

Current Opinion in Clinical Nutrition and Metabolic Care, Nov 1, 2010

International Journal of Environmental Research and Public Health, Nov 20, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

American Journal of Physiology-endocrinology and Metabolism, Sep 1, 2015

This review updates the effect of lifestyle on plasma triacylglycerols (TAG) in the postprandial ... more This review updates the effect of lifestyle on plasma triacylglycerols (TAG) in the postprandial state, commonly reported as postprandial lipemia (PPL), an independent risk factor for cardiovascular diseases (CVD). Numerous studies have shown that Mediterranean diet may reduce PPL. However, most of these studies were focused on the type of fat (i.e., monounsaturated fat from olive oil), and the other components of the Mediterranean lifestyle were neglected. Physical activity, an integral part of this lifestyle, is widely investigated on its own and shown to reduce PPL. In addition, preliminary results of studies examining other Mediterranean "ingredients", such as legumes, fish, and herbs, showed additional benefits; however, data on the long-term effects are limited. More studies are needed to confirm short-term results and investigate the effects of the whole Mediterranean lifestyle on PPL and whether these effects mediate its protective role on CVD. Moreover, investigation of the effects in nonhealthy populations and the underlying mechanisms would be clinically helpful in individualizing the appropriate intervention. triglycerides; olive; physical activity; diet; lipid metabolism FREE-LIVING HUMANS spend most of their time in a nonfasting, postprandial state; however, routine health screening is performed in the fasting state. Regarding lipids [mainly triacylglycerols (TAG) and their carriers, TAG-rich lipoproteins (TRL)], the most profound changes are taking place in the postprandial state, i.e., the hours after the consumption of dietary fat. TAG and TRL metabolism in the postprandial state are schematically shown in Fig. 1. Recent evidence suggests that elevated levels of plasma TAG in the postprandial state, commonly reported as postprandial lipemia (PPL) or nonfasting TAG, is associated with increased risk for atherosclerosis, independently of other known cardiovascular disease (CVD) risk factors (32, 61). In addition, TAG-TRL remnants [i.e., chylomicrons and VLDL with reduced amount or depleted of TAG after the action of lipoprotein lipase (LPL)] may penetrate the arterial wall and may be taken up by monocytes, forming foam cells. Several epidemiological studies have shown that CVD patients have increased levels of postprandial TRL (62), while VLDL remnants have also be found in atheromatique plaques. In addition, reduced TRL catabolism is associated with changes in the size of other lipoproteins (e.g., formation of HDL 3 and LDL 3 ; Fig. 2) that are thought to be atherogenic (66, 74), as well as oxidative stress,

Clinical Nutrition Supplements, 2010

Clinical Nutrition, Dec 1, 2011

Background & aims: Postprandial lipemia is assessed using the oral fat tolerance test (OFTT), a s... more Background & aims: Postprandial lipemia is assessed using the oral fat tolerance test (OFTT), a six-hour procedure requiring hourly blood sampling. In order to simplify the test, we investigated whether a) a single postprandial triacylglycerol concentration, b) an OFTT lasting less than six hours or c) an OFTT requiring fewer blood samples, may accurately assess postprandial lipemia under various conditions. Methods: Seventy-two subjects underwent a conventional OFTT. Predictability of single-point concentrations and time-shortened tests was assessed using linear regression and re-sampling analysis. Validity of reduced-sampling tests was assessed using Pearson's correlation coefficients and Bland-Altman analysis. Results: a) A single-point triacylglycerol concentration (3 or 4 h postprandially) did not present significant correlation with postprandial lipemia in the hypetriacylglycerolemic, exercise and energy restriction groups (P > 0.05), b) Time-shortened OFTT (4 h) was able to predict postprandial lipemia in every group studied (R 2 ¼ 0.707e0.970, P < 0.01), except the hypertriacylglycerolemics (P ¼ 0.338), c) Reducedsampling OFTT (3 or 4 samples) was able to assess postprandial lipemia in every group as well as in the overall sample (r ¼ 0.874-0.997, P < 0.05). Conclusions: A more convenient, reduced-sampling OFTT may be used alternatively to the conventional OFTT, whereas a time-shortened OFTT may be appropriate only for healthy people.

European Journal of Neurology

Background and purposeLifestyle factors have been implicated in the long‐lasting neurodegenerativ... more Background and purposeLifestyle factors have been implicated in the long‐lasting neurodegenerative process in prodromal Parkinson's disease (pPD). The aim was to investigate the associations between adherence to a Mediterranean diet (MeDi) and longitudinal changes of pPD probability and the development of Parkinson's disease (PD) or pPD in a Mediterranean older population.MethodsData from the Hellenic Longitudinal Investigation of Aging and Diet cohort (community‐dwelling individuals, aged ≥ 65 years) were used. A detailed food frequency questionnaire was used to evaluate dietary intake and calculate MeDi adherence score, ranging from 0 to 55, with higher scores indicating higher adherence. The probability of pPD was calculated according to the updated Movement Disorder Society research criteria.ResultsIn all, 1047 non‐PD/dementia with Lewy bodies (DLB) participants were followed for 3 ± 1 years. MeDi adherence was associated with lower increase in pPD probability over time ...

Hippokratia, 2015

BACKGROUND We sought to establish cross-sectional curves for body weight, height, body mass index... more BACKGROUND We sought to establish cross-sectional curves for body weight, height, body mass index (BMI), and waist circumference for 4- to 18-year-old Greek boys and girls, using the empirical distribution and the Lambda Mu and Sigma (LMS) statistical method. METHODS From March 2014 to May 2014, a total of 473,837 boys and girls aged 4 to 18 years who attended school in Greece were enrolled. The studied sample was representative, in terms of age-sex distribution and geographical region. Anthropometric indices measurements (i.e., height, weight and waist circumference) were performed and BMI was calculated and used to calculate normative values, using the percentiles of the empirical distributions and the LMS method. RESULTS Updated growth references for 4- to 18-year-old Greek children tabulated as critical percentiles and LMS values from 3 to 97 (P3, P10, P25, P50, P75, P90, P97) and smoothed curves are presented. Positive secular trends of height, weight and waist circumference we...

Movement Disorders, 2020

ABSTRACTObjectiveThe objective of this study was to validate the recently updated research criter... more ABSTRACTObjectiveThe objective of this study was to validate the recently updated research criteria for prodromal Parkinson's disease (pPD) proposed by the International Parkinson's Disease and Movement Disorders Society.MethodsA total of 16 of 21 markers of pPD were ascertained in the Hellenic Longitudinal Investigation of Aging and Diet cohort composed of community‐dwelling individuals aged ≥65 years. The probability of pPD was calculated for 961 individuals without Parkinson's disease (PD) or dementia with Lewy bodies at baseline who were followed‐up for a median of 3 years. The ability of the criteria to predict conversion to PD/dementia with Lewy bodies was assessed by estimating their sensitivity and specificity, plotting receiver operating characteristics curves, and using logistic regression. These analyses were repeated using the original criteria.ResultsNo incident PD/dementia with Lewy bodies case had probable pPD at baseline (ie, ≥80% pPD probability). At cut...

Parkinsonism & Related Disorders, 2021

INTRODUCTION Some case series have suggested that psychotic features could occur even before the ... more INTRODUCTION Some case series have suggested that psychotic features could occur even before the onset of motor symptoms of Parkinson's Disease (PD). Our aim was to investigate a possible association between psychotic symptoms and prodromal Parkinson's disease in a population-based cohort, the Hellenic Longitudinal Investigation of Aging and Diet study. METHODS This cross-sectional study included participants aged ≥65 years without dementia or PD. We defined psychotic symptoms as the presence of at least one new hallucinatory or delusional feature, assessed with the Neuropsychiatric Inventory scale and the Columbia University Scale for Psychopathology in Alzheimer's Disease, exhibited only at follow-up and not present at baseline visit. We calculated the probability of prodromal PD (pPD) for every participant, according to the 2019 International Parkinson and Movement Disorders Society research criteria for prodromal PD. RESULTS Participants who developed psychotic manifestations over a three-year follow up (20 of 914) had 1.3 times higher probability of pPD score (β [95%CI]: 1.3 [0.9-1.5], p=0.006) compared to non-psychotic subjects. This association was driven mostly by depressive symptoms, constipation and subthreshold parkinsonism (p<0.05). CONCLUSION Our data indicate that emerging psychotic features evolve in parallel with the probability of pPD. This is the first study that provides evidence for the presence of psychotic experiences in pPD. The association detected needs to be confirmed in longitudinal studies.

Movement Disorders, 2019

BackgroundIdentification and characterization of Parkinson's disease (PD) in its prodromal st... more BackgroundIdentification and characterization of Parkinson's disease (PD) in its prodromal stage is crucial.ObjectiveThe objective of this study was to investigate the association between motor function and the probability of prodromal PD in a community‐dwelling older population.MethodsWe used data from a population‐based cohort of older adults (HELIAD study). Subjective motor function was evaluated with a 12‐item motor symptoms questionnaire and objective motor function indirectly with a physical activity questionnaire and two gait speed tests. The probability of prodromal PD was calculated according to the Movement Disorder Society research criteria for n = 1731 without PD. Regression multiadjusted models were used to investigate the associations between each motor measure and prodromal PD probability.ResultsFor each unit increase in motor symptoms score and for each kcal/kg/day lower energy expenditure (corresponding to 20 minutes of light walking/day for a 75‐kg man) there w...

Neurology, 2019

ObjectiveGiven the limited information on cognitive function before Parkinson disease (PD) clinic... more ObjectiveGiven the limited information on cognitive function before Parkinson disease (PD) clinical onset in the general population, we sought to assess prodromal PD (pPD) probability and relate it to detailed cognitive performance in a community cohort.MethodsIn a population-based cohort of 1,629 dementia-free and PD-free participants ≥65 years of age in Greece, we assessed probability of pPD according to the International Parkinson and Movement Disorder Society's criteria. Clinical cognitive diagnoses (cognitively unimpaired, mild cognitive impairment [MCI], dementia) considering neuropsychological testing and functional status were assigned in consensus conferences. Cognitive performance in 5 cognitive domains was assessed by a detailed neuropsychological battery and summarized in the form of z scores. We investigated associations between pPD probability (and its individual constituents) and cognitive outcomes.ResultsThe median probability of pPD was 1.81% (0.2%–96.7%). Parti...

Obesity Medicine, 2017

Objectives: Retirement from professional sports engagement is associated with reduced physical ac... more Objectives: Retirement from professional sports engagement is associated with reduced physical activity, physical pain, depression, obesity and ischemic heart disease; however, whether in particular, soccer players experience metabolic abnormalities after retirement is currently unknown. Therefore, the aim of this pilot cross-sectional study was to investigate the prevalence of metabolic syndrome (MetS) and its associates in retired professional soccer players (RSP), compared to controls. Methods: Twelve retired elite soccer players and 12 non-athletes, matched for age and body mass index, participated in a case-control study. Anthropometric and blood pressure measures and fasting blood samples were taken and analyzed. Dietary intake was assessed using food records, while other data on health status and lifestyle were also obtained. Results: Prevalence of MetS was indifferent between groups. Among RSPs, those with MetS had gained significantly more weight since retirement, and exhibited greater body fatness (% of body weight), Fat Mass Index (FMI) and energy intake. RSPs who gained more than 12 kg after retirement from soccer (80.0% of RSPs) were in a greater risk for developing MetS, whereas none of those who gained less than 12 kg (n ¼ 7) was diagnosed with MetS. Among RSPs, those with MetS had approximately triple chances of skipping breakfast daily and smoking, and eightfold more chances of eating right before their night sleep. Overall, a greater proportion of RSPs with MetS had familial overweight (P ¼ 0.03) and experienced problems during sleeping (P ¼ 0.028). Each increase per 1 kg/m 2 in the FMI almost doubled the chances of having MetS (OR: 1.9, 95% CI: 1.1e3.4, P ¼ 0.025). Conclusions: RSPs should focus on attaining a healthy body weight after retirement (via moderate exercise and neutral energy balance), in order to minimize the chances of developing MetS.

Frontiers in Molecular Neuroscience, 2021

Several studies have investigated the association of the Parkinson’s disease (PD) polygenic risk ... more Several studies have investigated the association of the Parkinson’s disease (PD) polygenic risk score (PRS) with several aspects of well-established PD. We sought to evaluate the association of PRS with the prodromal stage of PD. We calculated PRS in a longitudinal sample (n = 1120) of community dwelling individuals ≥ 65 years from the HELIAD (The Hellenic Longitudinal Investigation of Aging and Diet) study in order to evaluate the association of this score with the probability of prodromal PD or any of the established risk and prodromal markers in MDS research criteria, using regression multi-adjusted models. Increases in PRS estimated from GWAS summary statistics’ ninety top SNPS with p < 5 × 10–8 was associated with increased odds of having probable/possible prodromal PD (i.e., ≥ 30% probability, OR = 1.033, 95%CI: 1.009–1.057 p = 0.006). From the prodromal PD risk markers, significant association was found between PRS and global cognitive deficit exclusively (p = 0.003). To ...