The Domains of Human Nutrition: The Importance of Nutrition Education in Academia and Medical Schools.

Human nutrition encompasses an extremely broad range of medical, social, commercial, and ethical domains and thus represents a wide, interdisciplinary scientific and cultural discipline. The high prevalence of both disease-related malnutrition and overweight/obesity represents an important risk factor for disease burden and mortality worldwide. It is the opinion of Federation of the Italian Nutrition Societies (FeSIN) that these two sides of the same coin, with their sociocultural background, are related to a low "nutritional culture" secondary, at least in part, to an insufficient academic training for health-care professionals (HCPs). Therefore, FeSIN created a study group, composed of delegates of all the federated societies and representing the different HCPs involved in human nutrition, with the aim of identifying and defining the domains of human nutrition in the attempt to more clearly define the cultural identity of human nutrition in an academically and professionally oriented perspective and to report the conclusions in a position paper. Three main domains of human nutrition, namely, basic nutrition, applied nutrition, and clinical nutrition, were identified. FeSIN has examined the areas of knowledge pertinent to human nutrition. Thirty-two items were identified, attributed to one or more of the three domains and ranked considering their diverse importance for academic training in the different domains of human nutrition. Finally, the study group proposed the attribution of the different areas of knowledge to the degree courses where training in human nutrition is deemed necessary (e.g., schools of medicine, biology, nursing, etc.). It is conceivable that, in the near future, a better integration of the professionals involved in the field of human nutrition will eventually occur based on the progressive consolidation of knowledge, competence, and skills in the different areas and domains of this discipline.

Nutritional status evaluation in patients affected by bethlem myopathy and ullrich congenital muscular dystrophy.

Collagen VI mutations lead to disabling myopathies like Bethlem myopathy (BM) and Ullrich congenital muscular dystrophy (UCMD). We have investigated the nutritional and metabolic status of one UCMD and seven BM patients (five female, three male, mean age 31 ± 9 years) in order to find a potential metabolic target for nutritional intervention. For this study, we used standard anthropometric tools, such as BMI evaluation and body circumference measurements. All results were compared to dual-energy X-ray absorptiometry (DXA), considered the "gold standard" method. Energy intake of each patient was evaluated through longitudinal methods (7-day food diary) while resting energy expenditure (REE) was predicted using specific equations and measured by indirect calorimetry. Clinical evaluation included general and nutritional blood and urine laboratory analyses and quantitative muscle strength measurement by hand-held dynamometry. BM and UCMD patients showed an altered body composition, characterized by low free fat mass (FFM) and high fat mass (FM), allowing us to classify them as sarcopenic, and all but one as sarcopenic-obese. Another main result was the negative correlation between REE/FFM ratio (basal energy expenditure per kilograms of fat-free mass) and the severity of the disease, as defined by the muscle megascore (correlation coefficient -0.955, P-value <0.001). We postulate that the increase of the REE/FFM ratio in relation to the severity of the disease may be due to an altered and pathophysiological loss of energetic efficiency at the expense of skeletal muscle. We show that a specific metabolic disequilibrium is related to the severity of the disease, which may represent a target for a nutritional intervention in these patients.

Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study.

BACKGROUND: Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa (AN), its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge. OBJECTIVES: We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features. DESIGN: Body composition was measured by using dual-energy X-ray absorptiometry in 50 female, adult patients with AN before and after complete weight restoration [body mass index (BMI; in kg/m²) ≥18.5] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants. Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory (BSI-GSI), respectively. RESULTS: After the achievement of complete weight restoration, patients with AN had higher trunk (P < 0.001), android (P < 0.001), and gynoid (P < 0.001) fat masses and lower arm (P < 0.001) and leg (P = 0.001) fat masses with respect to control subjects. No relation was shown between body-composition variables and eating disorder psychopathology in the AN group, and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score. CONCLUSION: The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions, which does not, however, seem to influence either eating disorder psychopathology or psychological distress scores.

Measured physical activity in anorexia nervosa: features and treatment outcome.

OBJECTIVE: To assess the role of measured physical activity (PA) in anorexia nervosa treatment outcome, and to compare the PA of patients with anorexia nervosa with age-matched controls. METHOD: PA was assessed by means of Sense Wear Armband before and after a cognitive-behavioral inpatient treatment in 53 consecutive females with anorexia nervosa, and in 53 healthy age-matched controls. RESULTS: At baseline, patients with anorexia nervosa exhibited a higher duration of moderate-vigorous PA (MVPA≥3 Metabolic Equivalent Tasks (METs)) than controls (t = 2.91; p = .004). Dropouts had higher duration (sec) and expenditure (kcal·day(-1)) of MVPA than completers. At the end of treatment, completers had a higher number of daily steps, MVPA duration, and expenditure than controls. However, PA was not correlated to eating disorder psychopathology either before or after treatment. DISCUSSION: PA is higher in patients with anorexia nervosa than age-matched controls both before and after treatment, and is associated with treatment dropout.

Accuracy of SenseWear Pro2 Armband to predict resting energy expenditure in childhood obesity.

OBJECTIVE: The accuracy of the SenseWear Pro2 Armband (SWA) in estimating resting energy expenditure (REE) in children and adolescents with obesity, using indirect calorimetry (IC) as a reference was evaluated. DESIGN AND METHODS: REE was assessed using both the SWA and IC in 40 obese subjects (26 M/14 F, age 11.5 ± 2.57 years, z-score BMI 3.14 ± 0.53). The agreement between methods was assessed by the Bland-Altman procedure. The relationship between REE assessments and patients' characteristics was also analyzed. RESULTS: SWA- and IC-derived estimates of REE showed a significant correlation (r = 0.614; P < 0.001), but the SWA overestimated mean REE by 13% (P < 0.001). Age and kilogram of fat-free mass (kg-FFM) were significantly correlated with both REE estimation by SWA (r = 0.434 and r = 0.564, respectively) and IC (r = 0.401 and r = 0.518, respectively). Only kg-FFM was demonstrated to be the main predictor factor of REE variability (r(2) 79% SWA; 75% IC). CONCLUSIONS: The SWA overestimated mean REE in childhood obesity, suggesting that the SWA and IC are not yet interchangeable methods. This would require improving the SWA by developing better algorithms for predicting REE and, probably, bias in each individual REE could be reduced by an adjustment for subjects' kg-FFM.

Short-term multidisciplinary non-pharmacological intervention is effective in reducing liver fat content assessed non-invasively in patients with nonalcoholic fatty liver disease (NAFLD).

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to steatohepatitis, and cirrhosis in patients with alcohol intake less than 20 g/day, and is usually associated with insulin resistance (IR). AIM: Given that no drugs are specifically approved for NAFLD, we tested the efficacy of a non-pharmacological multidisciplinary intervention based on a personalized diet, physical activity and behavior therapy. METHODS: In this open non-randomized study, personalized diet, physical exercise and behaviour therapy for 3 months were prescribed in 12 consecutive patients with NAFLD. Lifestyle, including total caloric intake, physical activity and resting energy expenditure was monitored by a SenseWear Armband. Insulin Resistance (IR) was measured by HOMA and oral glucose insulin sensitivity tests (OGIS); fat liver content was estimated by two different semi-quantitative scores and by the Doppler Power Index (DPI). RESULTS: Data show that the multidisciplinary intervention produced a significant reduction of total caloric intake, a 8% reduction in body weight, a modest increase in daily physical activity, a significant (P<0.001) reduction of aminotransferases and a decrease of total hepatic fat content. CONCLUSIONS: A 3-month multidisciplinary intervention inducing at least 8% of weight loss, improves liver tests and decreases liver fat content.

Body Fat Mass Assessment: A Comparison between an Ultrasound-Based Device and a Discovery A Model of DXA.

Objective. To examine measurement of body composition by ultrasound compared with a reference technique:dual energy X-ray absorptiometry (DXA). We evaluated the accuracy of a portable ultrasound-based device in estimating total body fat mass with those assessed by DXA in adult. Methods. Body fat mass has been estimated using a portable ultrasound-based device in comparison with a contemporary reference DXA apparatus: the Hologic Discovery A. Anthropometric data has been assessed in order to maximize the output of the software associated with the ultrasound-based device. A cross-validation between ultrasound technique (US) and DXA was developed in this study. Total body fat mass estimated by ultrasound was compared with this DXA model in a sample of 83 women and 41 men. Results. Ultrasound technique (US) of body fat (BF) was better correlated with DXA in both women (r (2) = 0.97, P < 0.01) and men (r (2) = 0.92, P < 0.01) with standard errors of estimates (SEE) being 2.1 kg and 2.2 kg, respectively. Conclusion. The use of a portable device based on a US produced a very accurate BF estimate in relation to DXA reference technique. As DXA absorptiometry techniques are not interchangeable, the use of our ultrasound-based device needs to be recalibrated on a more contemporary DXA.

Comparison between dual-energy X-ray absorptiometry and skinfolds thickness in assessing body fat in anorexia nervosa before and after weight restoration.

BACKGROUND & AIMS: The aim of the study was to evaluate the correspondence between body fat mass composition (percentage) measured with dual-energy X-ray absorptiometry (DXA) and estimated by means of skinfold thicknesses (ST) measurement in patients with anorexia nervosa (AN), before and after weight gain. METHODS: Percentage body fat (%BF) was measured with DXA and estimated by ST measurements using Siri, Brozek, and Heyward equations in 27 adult patients with AN before and after weight gain (pre- and post-treatment) achieved with inpatient treatment and in 42 healthy age-matched controls. RESULTS: Due to Lohman criteria and Bland Altman plot there is no correspondence between the %BF measured with DXA and the %BF estimated by predictive equations based on ST measurements in patients with AN before and after weight gain, with the exception of Brozek equation which showed a mild agreement in pre-treatment AN. However, a correspondence was observed between the two procedures in healthy controls. CONCLUSIONS: Our data supporting the use of ST measurements do not appear to be an alternative to DXA in estimating body fat percentage, before and after weight gain in patients with AN.

Resting energy expenditure assessment in anorexia nervosa: comparison of indirect calorimetry, a multisensor monitor and the Müller equation.

The aim of this study was to compare the estimations provided by three different means of measuring the resting energy expenditure (REE) in anorexia nervosa (AN) patients. REE was measured, after 24 h of refeeding, using a portable multisensor body monitor [SenseWear Pro2 Armband (SWA)], FitMate™ method and the Müller equation for individuals with body mass index < 18.5, the latter being based on dual-energy X-ray absorptiometry assessment of body composition. The mean differences between REE values estimated by SWA and those provided by the Müller equation and the FitMate™ method were significantly different from zero in both cases. In contrast, the mean differences between FitMate™ method and Müller equation were weakly significantly different from zero, and a significant correlation was noted between these two methods. In conclusion, the SWA does not appear to be an alternative to FitMate™ and Müller equation methods for assessing REE in AN patients.

Influence of lifestyle habits, nutritional status and insulin resistance in NAFLD.

Non alcoholic fatty liver disease (NAFLD) is associated with obesity, diabetes and insulin resistance (IR). The aim of our study was to assess the relationship between IR, anthropometry, lifestyle habits, resting energy expenditure (REE) and degree of fatty liver at ultrasound in 48 overweight patients with NAFLD as compared to 24 controls without fatty liver, matched for age. Nutritional status, alcohol intake and physical activity were assessed by skinfold thickness measurements, a 7-day diary, and SenseWear armband (SWA). REE was assessed by both SWA (REE-SWA) and a Vmax metabolic cart (REE-Vmax). Fatty liver was measured by US and the Doppler Power Index was calculated. IR was assessed using the HOMA index. There was significant correlation between waist circumference, HOMA, Doppler power index and fatty liver grade at US. Multivariate analysis showed that alteration of waist circumference, Doppler power index, and HOMA were the major significant predictors of fatty liver. Our data demonstrated a significant association between NAFLD and central adiposity and IR.

Fluid intake and nutritional risk in non-critically ill patients at hospital referral.

The association between hyporexia/anorexia, reduced food intake and disease-related malnutrition at hospital admission is well established. However, information on fluid intake according to nutritional risk has never been provided. Thus, we assessed the attitude and adequacy of fluid intake among case-mix hospitalised patients according to nutritional risk. A sample of 559 non-critically ill patients randomly taken from medical and surgical wards was evaluated. Nutritional risk was diagnosed by the Nutritional Risk Screening 2002. Usual fluid consumption the week before admission was assessed and categorised as < 5 and > or = 5 cups/d (1 cup = 240 ml), with the acceptable intake being > or = 5 cups/d. Prevalence of nutritional risk was 57.2%, and 46.2% of the patients reported a fluid intake < 5 cups/d. Multiple-adjusted logistic regression revealed that age > or = 65 years (OR: 1.88 (95% CI: 1.03, 3.43); P < 0.04), energy intake (for every 25% increase in food intake compared with estimated requirements, OR: 0.37 (95% CI: 0.25, 0.55); P < 0.001) and the number of drugs taken (every three-drug increase, OR: 0.63 (95 % CI: 0.44, 0.90); P < 0.02) were independently associated with inadequate fluid intake (< 5 cups/d). A significant independent association was also found with nutritional risk (OR: 0.64 (95% CI: 0.43, 0.95); P < 0.03). Nutritional risk appears to be positively associated with greater fluid intake in non-acute hospitalised patients, but both the reasons and the consequences of this relationship, as well as the impact on clinical practice, need to be explored. However, water replacement by oral nutritional support should take advantage of the patients' attitude to assuming a greater fluid intake, limiting at the same time fluid overload during the refeeding phase.

Effect of intense military training on body composition.

Individuals in a structural physical training program can show beneficial changes in body composition, such as body fat reduction and muscle mass increase. This study measured body composition changes by using 3 different techniques-skinfold thickness (SF) measurements, air displacement plethysmography (BOD-POD), and dual-energy x-ray absorptiometry (DXA)-during 9 months of intense training in healthy young men engaged in military training. Twenty-seven young men were recruited from a special faction of the Italian Navy. The program previewed three phases: ground combat, sea combat, and amphibious combat. Body composition was estimated at the beginning, in the middle, and at the end of the training. After the subjects performed the ground combat phase, body composition variables significantly decreased: body weight (P < 0.05), fat-free mass (FFM) (P < 0.001), and fat mass (FM) (P < 0.03). During the amphibious combat phase, body weight increased significantly (P < 0.01), mainly because of an increase in FFM (P < 0.001) and a smaller mean decrease in FM. There was a significant difference (P < 0.05) in circumferences and SF at various sites after starting the training course. Bland-Altman analysis did not show any systematic difference between FM and FFM measured with the 3 different techniques on any occasion. On any visit, FFM and FM correlation measured by BOD-POD (P = 0.90) and DXA was significantly greater than measured by SF. A significant difference was found in body mass index (BMI) measured during the study. BOD-POD and SF, compared with DXA, provide valid and reliable measurement of changes in body composition in healthy young men engaged in military training. In conclusion, the findings suggest that for young men of normal weight, changes in body weight alone and in BMI are not a good measure to assess the effectiveness of intense physical training programs, because lean mass gain can masquerade fat weight loss.

Metabolic syndrome: a child is not a small adult.

Obesity is associated with an increased all-cause mortality rate and even small weight losses can be associated with short-term reduction in risk factors for disease. There is strong evidence that weight loss in obese subjects improves risk factors for diabetes and cardiaovascular diseases. Metabolic syndrome (MS) in adults is defined as a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which includes abdominal obesity, dyslipidemia, glucose intolerance and hypertension. Application of the MS concept in children and adolescents is controversial; in fact no consensus exists on a specific definition for pediatric MS. Lack of consensus is in part due to body evolution associated with childhood and puberty that is related to changes in metabolic and clinical characteristics. The aim of this article is to try to clarify the differences between the MS as a concept and the MS as a diagnostic category, as well as to develop a theory related to its pathophysiology. We comment on the relationship between obesity, regional fat distribution and the MS, and finally we offer some insights into MS methodological approaches for estimating metabolic risk-factor clustering in children and adolescents.

A new device for measuring resting energy expenditure (REE) in healthy subjects.

BACKGROUND AND AIM: Lifestyle change targeted towards increasing daily resting energy expenditure (REE) is one of the cornerstones of obesity treatment. Measurements of energy expenditure and substrate utilization are essential to understanding the metabolic basis of obesity, and the physiological responses to perturbations in habitual food intake. REE is the largest part of human energy expenditure (60-70%) and an increase or decrease in REE would have a large impact on total energy. Accurate and easy-to-use methods for measuring REE are needed, to be applied by clinicians in daily clinical settings to assess the validity of a new instrument to estimate REE in normal weight, healthy adults. METHODS: Ninety-nine subjects (52 females and 47 males) (mean+/-SD, age 38+/-14 years; body mass index (BMI) 23+/-3 kg/m(2)) were tested. REE was assessed using a Sensor Medics Vmax metabolic cart with a ventilated canopy and with the SenseWear armband. Body composition, percentage fat mass (%FM) and percentage fat free mass (%FFM) were assessed by skinfold thickness measurements (SF), bio-electrical impedance analysis (BIA) and air displacement plethysmography (BOD-POD). RESULTS: No significant difference was found among measurements of FFM using the three different techniques. Both SenseWear and Sensor Medics Vmax showed a high correlation, r=0.42 and r=0.40 (p<0.0001) respectively, with BMI. No significant difference was found in mean REE between SenseWear (1540+/-280 kcal/day) and Sensor Medics Vmax (1700+/-330 kcal/day) (p=ns) and the correlation between REE measured by SenseWear and Sensor Medics Vmax was high (r=0.86, p<0.0001). Bland-Altman plot showed no difference in REE determination between SenseWear and Sensor Medics Vmax. %FFM determined by BOD-POD correlated with SenseWear (r=0.42, p<0.0001) as well as Sensor Medics Vmax (r=0.38, p<0.001). CONCLUSION: SF, BIA and BOD-POD provide valid and reliable measurements of FFM. Our results suggest that the SenseWear armband is an acceptable device to accurately measure REE in healthy subjects. Its characteristics have the potential to reduce measurement times and make the SenseWear armband useful for epidemiological studies.

Healthy status and energy balance in pediatrics.

During growth, the human body increases in size and changes proportion of various components due to hormones mediators. Nutritional status is the result of introduction, absorption and utilization of the nutrients and it has a new definition in the relationship between nutritional status and healthy status. In this view energy balance, body function and body composition are three entities correlated each other. This mini-review article examines issues and techniques specifically related to a pediatric population in the field of body composition and energy expenditure. It is broadly divided into two sections. The first section discusses body composition measurements underlying principles, advantages, disadvantages and consensus. The second section reviews energy expenditure and physical activity measurement techniques. In conclusion general clinical suggestions are offered regarding pediatric body composition, healthy status and energy balance.

Low adherence of a clinically healthy Italian population to nutritional recommendations for primary prevention of chronic diseases.

BACKGROUND AND AIM: Several data demonstrated that dietary habits significantly affect the health state of the population. During recent years all the major scientific associations have provided nutritional recommendations for primary prevention of chronic diseases but few data are available about prevalence of adherence to these recommendations in an otherwise healthy population. The aims of this study were to evaluate dietary habits, and to assess the adherence of the general population to the recommendations for correct nutritional behaviour. METHODS AND RESULTS: Dietary habits, anthropometric and biochemical parameters were evaluated in a population of 932 (367 M; 565 F) clinically healthy subjects living in Florence, enrolled in an epidemiologic study conducted between 2002 and 2004. By comparing the dietary pattern with the nutritional guidelines, the study population reported a hyperproteic and hyperlipidic nutritional pattern, with a considerably low contribution from polyunsaturated fats (PUFA). A low fibre intake is shown in both genders. In addition, food consumption pattern showed an increased consumption of some foods such as meat, both fresh and processed, and a low intake of some "healthy" foods like fruit and vegetables. CONCLUSIONS: We found several nutritional flaws in the dietary habits of a clinically healthy Italian population. In particular, we reported a high intake of animal protein and total fats with a very low contribution from PUFA.

Cyanidins: metabolism and biological properties.

Cyanidin and its glycosides belong to the anthocyanins, a widespread class of water-soluble plant compounds that are responsible for the brilliant color (red, orange, blue) of fruits and flowers. They are widely ingested by humans as it has been estimated a daily intake around 180 mg, mainly deriving from fruits and red wines. This paper reviews the literature on the biological activities, absorption and metabolism of cyanidins, with emphasis to the antioxidant, antimutagenic and other protective activities ascribed to these compounds. Their role in contrasting development of cancer and other pathologies is also reviewed. It is concluded that a great deal of work is still necessary to i) definitively clarify the metabolism of cyanidins in human beings; ii) assess the dietary burden and variations within and between populations; iii) evaluate the relationship between cyanidin glycosides-rich food consumption and incidence of given pathologies. The amount of work to be performed is even more significant when considering a possible therapeutic use of cyanidin glycosides-based drugs. With this aim, information on absorption, distribution, metabolism and excretion of cyanidin-glycosides administered by main possible routes are largely insufficient. However, consisting findings allow looking at cyanidins as dietary compounds with a potential beneficial role for human health.

Is elbow breadth a measure of frame size in non-Caucasian populations? A study in low- and high-altitude Central-Asia populations.

UNLABELLED: The concept of frame size has not undergone a thorough evaluation in non-Caucasian populations. Using data from the Central Asia High Altitude Population (CAHAP) study, we tested whether: (1) the relationship between frame size and body composition is different in high-, medium- and low-altitude populations; (2) elbow breadth is a better index of frame size than biacromial and biiliac breadth; and (3) measures of frame size are associated with blood pressure, cholesterol and triglycerides. A number of 334 male subjects aged 33 +/- 10 years (mean +/- standard deviation) were selected from the CAHAP population (n = 384) on the basis of the availability of breadth measurements. The subjects were 85 high-altitude Kirghizs, 105 medium-altitude Kazakhs, 79 low-altitude Kirghizs and 65 low-altitude Uighurs. A detailed anthropometric evaluation and blood pressure, cholesterol and trygliceride measurements were performed on all individuals. Among breadths, elbow had the lowest correlation with arm fat area, thigh fat area, calf fat area and the sum of trunk skinfolds (r < or = 0.196, P < 0.01). Even if elbow breadth did not have the highest correlation with muscularity indexes, its constantly lower association with adiposity indexes shows that it is a better measure of frame size than biacromial breadth and biiliac breadth. The relationship between frame size and body composition did not differ in high-, medium- and low-altitude subjects (P = not significant, analysis of co-variance). Only a weak association was present between breadths, blood pressure, cholesterol and triglycerides (r < or = 0.230, P < 0.01) and it was not influenced by altitude (P = not significant, analysis of co-variance). Elbow breadth was significantly correlated only with diastolic blood pressure (r = 0.121, P < 0.05). IN CONCLUSION: (1) the relationship between frame size and body composition is similar in high- and low-altitude populations; (2) elbow breadth is an index of frame size independent of altitude; and (3) elbow breadth is correlated with diastolic blood pressure, but this correlation is of doubtful biological relevance.