A classification and regression tree analysis for the evaluation of the role of nutritional services on cardiovascular disease risk status of older people living in Greek islands and Cyprus

Abstract

Introduction: The purpose of this study was to evaluate, with classification–regression tree analysis, the structure of the associations between nutritional and health care services and the cumulative prevalence of the classical cardiovascular disease (CVD) risk factors of older individuals living in Greek islands and Cyprus. Methods: During 2005–2009, 744 men and 742 women (>65 years) from nine Greek islands and Cyprus Republic were voluntarily enrolled in the Mediterranean Islands study; various socio-demographic, clinical and lifestyle characteristics were recorded. Moreover, information regarding practising dieticians (n = 88) and nutritional services provided in these islands was also recorded. Results: Both medical and nutrition services act more effectively to elders' cardiovascular health. For example, older individuals living in areas with nutritional services' support for at least five years, with collaboration between dieticians and physicians, reduced the CVD risk factors (CVD RF) burden by 42%. Whereas, in areas with dietetic support less than five years, but more than two, the presence of advanced health care system seemed to control the CVD RF burden to the population average. Conclusions: Despite the fact that the present work shares some limitations mainly because of its cross-sectional design, the classification and regression tree approach has clearly demonstrated the interrelation between nutritional services and the health care system towards achieving benefits among the elders' quality of life.

Keywords::

• cardiovascular risk
• risk modelling
• elderly
• health care
• nutrition
• public health

Acknowledgements

They are particularly grateful to the elders and dieticians from the islands of Cyprus, Lesvos, Samothrace, Crete, Corfu, Limnos, Zakynthos, Cephalonia, Syros and Naxos, who participated in this survey. They also wish to express their gratitude to C. Lazarou, C. Lionis, A. Zeimbekis, F. Anastasiou, P. Stravopodis, A. Skamagathis, E. Gotsis, V. Bountziouka, D. Antoniadis, as well as the Hellenic Dietetic Association, the Hellenic Association of Hospital Dieticians, the Cypriot Dietetic Association and the Hellenic Technological Association of Dieticians – Nutritionists, for their substantial assistance in retrieving information about health care system and nutritional data. The study is under the auspices of the Hellenic Dietetic Association. Stefano Tyrovolas received a scholarship from the Hellenic Atherosclerosis Society and Foundation for Education and European Culture (IPEP) to undertake his Ph.D. thesis, of which this work is part.

Declaration of interest: The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the paper.