A follow-up study was conducted to identify the heart disease risk-factor status and dietary changes of surviving elderly subjects in Crete who took part in the Seven Countries Study in 1960. In 1991, data were obtained from 245 of the 686 original male participants (169 of the original 40-49-y age group and 76 men 50-59 y age group). In 1991, the men were 70-79 and 80-89 y old. There was a significant (11.5%) increase in serum total cholesterol concentrations between 1960 and 1991. Body mass index and systolic and diastolic blood pressures also increased significantly, and all age groups were characterized by central obesity. A representative subsample of 21 men took part in a 3-d weighed food record study. Dietary data indicated increases in the intake of saturated fat and decreases in monounsaturated fat over the 30-y period. Comparison with a 1962 representative Cretan sample indicated a significantly increased concentration of adipose palmitic acid (16:0) in our surviving sample. The observed changes occurred during a period when many developed countries were observing a decline in most heart disease risk factors.

Background: No study to date has focused on the impact of Greek Orthodox Christian fasting on serum lipoproteins and obesity yet.

OBJECTIVE: To report on the body mass index (BMI), waist-to-hip ratio (WHR) and sum of skinfolds in a cohort of Cretan children and identify the factors associated with these indices. DESIGN: The present study was a follow-up study. Children were measured prospectively at ages 6, 9 and 12. SUBJECTS: Pupils came from 40 schools randomly selected from the 541 primary schools in three different provinces of Crete. 1046 pupils were examined at age 6. At age 9, a representative sample from the original cohort (n 579) was randomly selected for re-evaluation. At the age of 12, a sample of 831 pupils was re-examined, following similar procedures. MEASUREMENTS: Both during baseline and each subsequent follow-up, data were obtained on pupils' anthropometry, serum lipids, dietary intake, physical ®tness and physical activity as well as their dietary and their health knowledge. Data on parents' anthropometry, age, occupation, educational level, and issues relating to health habits, attitudes and knowledge were also collected. RESULTS: Half of the obese children at age 6 were also obese at age 12. Cretan children had higher mean BMI than similar American cohorts. Compared to their American counterparts, Cretans had higher proportions of overweight in both genders across all ages tested. The endurance run test (ERT), an index of physical ®tness, was positively associated with obesity indices. Sum of skinfolds related positively to serum LDL-C. Children from urban areas had higher skinfold sums than children from rural areas. Parental health-related hedonism related positively to children's BMI. CONCLUSION: It appears that these ®ndings offer some support to the reported increasing prevalence of obesity among Greek children. Higher ERT, presumably re¯ecting higher physical activity, is associated with lower obesity. The relationship between degree of fatness and LDL-C appears to be evidenced at an early age in life. This relationship may relate to the reported VLDL and cholesteryl ester transfer protein elevations in obesity. The parental attitude of health-related hedonism appears to be linked with children's adiposity.

A health education intervention was carried out for three consecutive years on primary school Cretan children. Baseline measures were obtained from 962 pupils (509 boys and 453 girls) registered in first grade in 1992. The health education intervention programme was directed at both the children of the intervention group and their parents, and has a projected duration of 6 years. After the completion of the 3 years of intervention and while pupils were in fourth grade, measures were obtained for evaluation purposes on a random subsample of 393 pupils of the original cohort. Statistically greater improvements in the intervention, as opposed to the control group, were observed for both children's and parents' health knowledge, and children's standing broad jump, sit-ups (SUP), sit-and-reach, handgrip and endurance run test (ERT). Furthermore, time spent on moderate to vigorous physical activities out of school significantly increased for intervention group children compared to the control group. Statistically smaller increases in the intervention as opposed to the control group were observed in suprailiac skinfold and body mass index. The degree of improvement in both SUP and ERT related positively to parent's baseline physical activity score. Finally, the parental attitude of health-related hedonism related negatively to SUP improvement.

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