Abstract
Aim
This study aimed to assess time trends in behavioral risk factors (BRFs) for chronic diseases, including smoking, high body weight and physical inactivity among adults.
Subjects and methods
The study sample comprised 8,052 adults aged 18-99 years from various districts of Crete/Greece, who participated in 24 cross-sectional and longitudinal studies during 1985-2015. A steady questionnaire was used to record health habits and anthropometric measurements, and relationships were evaluated through regression analysis.
Results
Overall, 55% of participants were men with a mean age of 45.2 years. Regarding the three BRFs, 32.6% were smokers, 60.8% were overweight/obese and 55.6% presented physical inactivity. Comparing results between the three decades (1985-1994, 1995-2004 & 2005-2015) a decrease in the prevalence of smoking and physical inactivity (p<0.05) and an increase in high body weight (p<0.001) were found. A significant increase of moderate-to-vigorous physical activity (p<0.001) was observed, as physical inactivity was associated with higher odds of high body weight (OR=1.29; p=0.018) in men and, conversely, lower odds in women (OR=0.74; p=0.011). Overall, factors such as increasing age, time frame (1985-1994 vs 2005-2015), occupation and morbidity were associated with higher odds of high body weight, while educational level was associated with lower odds of high body weight (p<0.05).
Conclusions
The decrease observed in the prevalence of smoking and physical inactivity during 1985-2015 in Crete is encouraging. In recent years however, the increase in the prevalence of overweight/obesity is crucial and warrants further investigation to determine the impact of new nutritional patterns over the beneficial Mediterranean diet and inform appropriate public health actions.
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References
Allegrante JP, Wells MT, Peterson JC (2019) Interventions to Support Behavioral Self-Management of Chronic Diseases. Annu Rev Public Health 40:127–146. https://doi.org/10.1146/annurev-publhealth-040218-044008
Al-Rubaye AKQ, Johansson K, Alrubaiy L (2020) The association of health behavioral risk factors with quality of life in northern Sweden-A cross-sectional survey. J Gen Fam Med 21:167–177. https://doi.org/10.1002/jgf2.333
Anastasaki M, Papadakis S, Linardakis M, Anyfantakis D, Symvoulakis EK, Lionis C (2020) Burden of metabolic syndrome among primary care patients in Crete, Greece: A descriptive study. Eur J Gen Pract 26:166–174. https://doi.org/10.1080/13814788.2020.1851676
Anon (2022) Time spent on health-enhancing (non-work-related) aerobic physical activity by sex, age and income quintile. Eurostat. http://data.europa.eu/88u/dataset/l53kzitf4apvuoxqgipq. Accessed July 5 2023
Anyfantakis D, Symvoulakis E, Linardakis M, Shea S, Panagiotakos D, Lionis C (2015) Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project. BMC Psychiat 15:173. https://doi.org/10.1186/s12888-015-0561-3
Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, Katileviciute A, Khoja S, Kodzius R (2020) Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors. Front Public Health 8:574111. https://doi.org/10.3389/fpubh.2020.574111
CDC CfDCaP (2016) Measuring Physical Activity Intensity: Physical Activity http://www.cdc.gov/physicalactivity/basics/measuring/index.html. Accessed Jan 12 2021
Christakis G, Severinghaus EL, Maldonado Z, Kafatos FC, Hashim SA (1965) Crete: a study in the metabolic epidemiology of coronary heart disease. Am J Cardiol 15:320–332. https://doi.org/10.1016/0002-9149(65)90327-9
Curran PJ, Hussong AM (2009) Integrative data analysis: the simultaneous analysis of multiple data sets. Psychol Methods 14:81–100. https://doi.org/10.1037/a0015914
Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B, Dietz W (2012) Obesity and severe obesity forecasts through 2030. Am J Prev Med 42:563–570. https://doi.org/10.1016/j.amepre.2011.10.026
Hatzis C, Bertsias G, Linardakis M, Scott J, Kafatos A (2004) Determination of serum total homocysteine folic acid and vitamin B12 in healthy Cretan adults. Iatriki 85:293–304
Hatzis C, Bertsias G, Linardakis M, Scott J, Kafatos A (2006) Dietary and other lifestyle correlates of serum folate concentrations in a healthy adult population in Crete, Greece: a cross-sectional study. Nutri J 5:5. https://doi.org/10.1186/1475-2891-5-5
Hatzis CM, Papandreou C, Patelarou E, Vardavas CI, Kimioni E, Sifaki-Pistolla D, Vergetaki A, Kafatos AG (2013) A 50-year follow-up of the Seven Countries Study: Prevalence of cardiovascular risk factors, food and nutrient intakes among Cretans. Hormones (Athens) 12:379–385. https://doi.org/10.1007/bf03401303
Janssen I, LeBlanc A (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behavior Nutri Phys Activ 7:40. https://doi.org/10.1186/1479-5868-7-40
Kafatos A, Kouroumalis I, Vlachonikolis I, Theodorou C, Labadarios D (1991a) Coronary-heart-disease risk-factor status of the Cretan urban population in the 1980s. Am J Clin Nutr 54:591–598. https://doi.org/10.1093/ajcn/54.3.591
Kafatos A, Schlienger JL, Deslypere JP, Ferro-Luzzi A, Cruz JA (1991b) Nutritional status: serum lipids. Euronut SENECA investigators. Eur J Clin Nutr 45(Suppl 3):53–61
Kafatos A, Diacatou A, Labadarios D, Kounali D, Apostolaki J, Vlachonikolis J, Mamalakis G, Megremis S (1993) Nutrition status of the elderly in Anogia, Crete, Greece. J Am Coll Nutr 12:685–692. https://doi.org/10.1080/07315724.1993.10718360
Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D, Mamalakis G, Dontas AS (1997) Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study. Am J Clin Nutr 65:1882–1886. https://doi.org/10.1093/ajcn/65.6.1882
Katzmarzyk PT, Lear SA (2012) Physical activity for obese individuals: a systematic review of effects on chronic disease risk factors. Obes Rev 13:95–105. https://doi.org/10.1111/j.1467-789X.2011.00933.x
Klein-Geltink JE, Choi BC, Fry RN (2006) Multiple exposures to smoking, alcohol, physical inactivity and overweight: Prevalences according to the Canadian Community Health Survey Cycle 1.1. Chronic Dis Can 27:25–33
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL (2000) CDC growth charts: United States. Adv Data:1-27
Kunutsor SK, Isiozor NM, Voutilainen A, Laukkanen JA (2022) Handgrip strength and risk of cognitive outcomes: new prospective study and meta-analysis of 16 observational cohort studies. Geroscience 44:2007–2024. https://doi.org/10.1007/s11357-022-00514-6
Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, Casanova A, Swaminathan S, Anjana RM, Kumar R, Rosengren A, Wei L, Yang W, Chuangshi W, Huaxing L, Nair S, Diaz R, Swidon H, Gupta R et al (2017) The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet 390:2643–2654. https://doi.org/10.1016/s0140-6736(17)31634-3
Li Y, Zhang M, Jiang Y, Wu F (2012) Co-variations and clustering of chronic disease behavioral risk factors in China: China Chronic Disease and Risk Factor Surveillance, 2007. PLoS One 7:e33881. https://doi.org/10.1371/journal.pone.0033881
Linardakis M (2005) The Metabolic Syndrome in Children, Adolescents and Adults of Crete in relation to their diet. Master Thesis, Post Graduate Program in Public Health and Health Care Management, School of Medicine, University of Crete, Heraklion, Greece
Linardakis M, Papadaki A, Smpokos E, Micheli K, Vozikaki M, Philalithis A (2015a) Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004-2005. Prev Chronic Dis 12:E149. https://doi.org/10.5888/pcd12.150134
Linardakis M, Papadaki A, Smpokos E, Micheli K, Vozikaki M, Philalithis A (2015b) Relationship of behavioral risk factors for chronic diseases and preventive health services utilization among adults, aged 50+, from eleven European countries. J Public Health 23:257–265. https://doi.org/10.1007/s10389-015-0683-6
Linardakis M, Papadaki A, Smpokos E, Kafatos A, Lionis C (2020) Prevalence of multiple behavioral risk factors for chronic diseases in medical students and associations with their academic performance. J Public Health 28:383–392. https://doi.org/10.1007/s10389-019-01030-2
Loef M, Walach H (2012) The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med 55:163–170. https://doi.org/10.1016/j.ypmed.2012.06.017
Miech RA, Patrick ME, O'Malley PM, Johnston LD (2017) The Influence of College Attendance on Risk for Marijuana Initiation in the United States: 1977 to 2015. Am J Public Health 107:996–1002. https://doi.org/10.2105/ajph.2017.303745
Moschandreas J, Kafatos A (1999) Food and nutrient intakes of Greek (Cretan) adults. Recent data for food-based dietary guidelines in Greece. Br J Nutr 81(Suppl 2):S71–S76. https://doi.org/10.1017/s0007114599000926
Nikitara K, Odani S, Demenagas N, Rachiotis G, Symvoulakis E, Vardavas C (2021) Prevalence and correlates of physical inactivity in adults across 28 European countries. Eur J Public Health 31:840–845. https://doi.org/10.1093/eurpub/ckab067
Papadaki A, Vardavas C, Hatzis C, Kafatos A (2008) Calcium, nutrient and food intake of Greek Orthodox Christian monks during a fasting and non-fasting week. Public Health Nutr 11:1022–1029. https://doi.org/10.1017/s1368980007001498
Patel S, Ram F, Patel SK, Kumar K (2019) Association of behavioral risk factors with self-reported and symptom or measured chronic diseases among adult population (18-69 years) in India: evidence from SAGE study. BMC Public Health 19:560. https://doi.org/10.1186/s12889-019-6953-4
Peytremann-Bridevaux I, Santos-Eggimann B (2007) Healthcare utilization of overweight and obese Europeans aged 50–79 years. J Public Health 15:377–384. https://doi.org/10.1007/s10389-007-0103-7
Sarri KO, Linardakis MK, Bervanaki FN, Tzanakis NE, Kafatos AG (2004) Greek Orthodox fasting rituals: a hidden characteristic of the Mediterranean diet of Crete. Br J Nutr 92:277–284. https://doi.org/10.1079/bjn20041197
Shrivastava U, Misra A, Mohan V, Unnikrishnan R, Bachani D (2017) Obesity, Diabetes and Cardiovascular Diseases in India: Public Health Challenges. Curr Diabetes Rev 13:65–80. https://doi.org/10.2174/1573399812666160805153328
Smpokos E, Linardakis M, Taliouri E, Kafatos A (2019) Reference growth curves for Greek infants and preschool children, aged 0–6.7 years. J Public Health 27:249–261. https://doi.org/10.1007/s10389-018-0934-4
Stefanaki I, Linardakis M, Lionis C (2020) Is cognitive status of the Cretan elderly aged ≥ 75 years associated with known behavioral and vascular risk factors? J Public Health 28. https://doi.org/10.1007/s10389-018-01006-8
Vardavas CI, Linardakis MK, Hatzis CM, Saris WH, Kafatos AG (2009) Prevalence of obesity and physical inactivity among farmers from Crete (Greece), four decades after the Seven Countries Study. Nutr Metab Cardiovasc Dis 19:156–162. https://doi.org/10.1016/j.numecd.2008.10.008
Vardavas CI, Linardakis MK, Hatzis CM, Saris WH, Kafatos AG (2010) Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet. Eur J Cardiovasc Prev Rehabil 17:440–446. https://doi.org/10.1097/HJR.0b013e32833692ea
Vassilaki M, Linardakis M, Polk DM, Philalithis Α (2015) The burden of behavioral risk factors for cardiovascular disease in Europe. A Significant Prevention deficit. Prev Med 81:326–332. https://doi.org/10.1016/j.ypmed.2015.09.024
Vizbaraite D, Jankauskiene R, Griciūte A, Visagurskienė K, Pajaujiene S (2011) Evaluation of Nutrition Habits of Adolescents in the Aspect of Gender and Physical Activity. Baltic J Sport Health Sci 2:52–58. https://doi.org/10.33607/bjshs.v2i81.331
WHO (2010) WHO Guidelines Approved by the Guidelines Review Committee. In: Global Recommendations on Physical Activity for Health. World Health Organization, Copyright © World Health Organization 2010., Geneva
WHO (2011a) Global status report on noncommunicable diseases 2010. World Health Organization, Geneva
WHO (2011b) Noncommunicable diseases country profiles 2011. World Health Organization, Geneva
WHO (2021) WHO Report on the Global Tobacco Epidemic 2021: the MPOWER package. World Health Organization, Geneva
Acknowledgements
The authors would like to thank all the people who participated in this study and truly appreciate their time and effort. The authors also would like to thank Dr. Rosemary Tzanaki for her valuable assistance in editing the manuscript.
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All authors contributed to the study conception and design. The first draft of the manuscript was written by ES & ML, and all authors commented on previous and latest versions of the manuscript. Material preparation, data collection and analysis were performed by ML. All authors read and approved the final manuscript.
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Smpokos, E., Linardakis, M., Chronakis, K. et al. Smoking, high body weight and physical inactivity assessment in samples of Cretan (Greek) adults over a period of 30 years: 1985-2015. J Public Health (Berl.) (2024). https://doi.org/10.1007/s10389-024-02196-0
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DOI: https://doi.org/10.1007/s10389-024-02196-0