Dietary inflammatory index and mortality: a cohort longitudinal study in a Mediterranean area.

BACKGROUND: Higher Dietary Inflammatory Index (DII®) scores are associated with increased morbidity and mortality. However, little is known about the effects of DII on mortality in Mediterranean countries. Therefore, in the present study, we aimed to investigate the potential association between DII scores and overall, cancer and cardiovascular disease (CVD) mortality in people living in a Mediterranean area. METHODS: DII scores were calculated using a validated food-frequency questionnaire. DII scores were then categorised into tertiles. Mortality was ascertained via death certificates. The association between DII scores with overall and cause-specific mortality was assessed via a multivariable Cox's regression analysis and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs). RESULTS: The study included 1565 participants (mean age 65.5 years; females 44.7%). After a median follow-up of 12 years (2005-2017), 366 (23.4%) participants died. After adjusting for 17 potential confounders, people with higher DII scores had an increased risk of death compared to those in the lowest (most anti-inflammatory) tertile (HR = 1.38; 95% CI = 1.04-1.82 for the second tertile; HR = 1.38; 95% CI = 1.03-1.86 for the third tertile). Each 1 SD increase in DII score increased the risk of death by 13%. No association was found between DII scores and cancer or CVD death when considered separately. CONCLUSIONS: Higher DII scores were associated with a significantly higher mortality risk, whereas the association with cause-specific mortality was less clear. These findings highlight the potential importance of diet in modulating inflammation and preventing death.

Potato Consumption Is not Associated with Higher Risk of Mortality: A Longitudinal Study among Southern Italian Older Adults.

OBJECTIVE: The consumption of potatoes is increasing worldwide, but few studies have assessed the association between potato consumption and mortality, particularly in Mediterranean countries. We therefore investigated whether potato consumption is associated with higher risk of death in a large cohort of people living in South Italy. DESIGN: Longitudinal. SETTING: Community-dwelling. MEASUREMENTS: 2,442 participants coming from MICOL and NUTRIHEP studies aged more than 50 years at baseline were followed-up for 11 years. Dietary intake was assessed by means of a Food Frequency Questionnaire. Potato consumption was categorized in quintiles according to their daily consumption (< 3.95, 3.96-8.55, 8.56-15.67, 15.68-22.0, and > 22.0 g/day). Mortality was ascertained through validated cases of death. The association between potato consumption and mortality was assessed through Cox's regression models, adjusted for potential confounders, and reporting the data as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: The 2,442 eligible participants were prevalently males (54.6%) and aged a mean of 64.3±9.3 years. During the 11-year follow-up, 396 (=16.2%) participants died. After adjusting for 12 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not have an increased overall mortality risk (HR=0.75; 95%CI: 0.53-1.07). Modelling the potato consumption as continuous (i.e. as increase in 10 g/day) did not substantially change our findings (fully-adjusted HR=0.93; 95%CI: 0.84-1.02). CONCLUSION: Overall potato consumption was not associated with higher risk of death in older people living in a Mediterranean area. Future studies are warranted to elucidate the role of potato consumption on all-cause and cause-specific mortality.

Effect of a Low Glycemic Index Mediterranean Diet on Non-Alcoholic Fatty Liver Disease. A Randomized Controlled Clinici Trial.

INTRODUCTION: Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common form of liver disease worldwide affecting all ages and ethnic groups and it has become a consistent threat even in young people. Our aim was to estimate the effect of a Low Glycemic Index Mediterranean Diet (LGIMD) on the NAFLD score as measured by a Liver Ultrasonography (LUS). DESIGN: NUTRIzione in EPAtologia (NUTRIEPA) is a population-based Double-Blind RCT. Data were collected in 2011 and analyzed in 2013-14. SETTING/PARTICIPANTS: 98 men and women coming from Putignano (Puglia, Southern Italy) were drawn from a previous randomly sampled population-based study and identified as having moderate or severe NAFLD. INTERVENTION: The intervention strategy was the assignment of a LGIMD or a control diet. OUTCOME MEASURES: The main outcome measure was NAFLD score, defined by LUS. RESULTS: After randomization, 50 subjects were assigned to a LGIMD and 48 to a control diet. The study lasted six months and all participants were subject to monthly controls/checks. Adherence to the LGIMD as measured by Mediterranean Adequacy Index (MAI) showed a median of 10.1. A negative interaction between time and LGIMD on the NAFLD score (-4.14, 95% CI -6.78,-1.49) was observed, and became more evident at the sixth month (-4.43, 95%CI -7.15, -1.71). A positive effect of the interaction among LGIMD, time and age (Third month: 0.07, 95% CI 0.02, 0.12; Sixth month: 0.08, 95% CI 0.03,0.13) was also observed. CONCLUSIONS: LGIMD was found to decrease the NAFLD score in a relatively short time. Encouraging those subjects who do not seek medical attention but still have NAFLD to follow a LGIMD and other life-style interventions, may reduce the degree of severity of the disease. Dietary intervention of this kind, could also form the cornerstone of primary prevention of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease.

Diet and myocardial infarction: a nested case-control study in a cohort of elderly subjects in a Mediterranean area of southern Italy.

BACKGROUND AND AIM: We evaluated the incidence of myocardial infarction (MI) in a population of Southern Italy and the relationship of dietary macronutrients with incident MI. METHODS AND RESULTS: The ONCONUT cohort included 5632 subjects followed-up, over 50 years, recruited in 1992. At baseline, they completed a validated semi-quantitative food frequency questionnaire and gave details of their medical history. After 5years they were traced by their family physician, who found 108 incident MI. Ninety-seven of them and 194 controls, sampled from the noncases at baseline and paired for diabetes to the cases, entered this nested case-control study. MI rate per 1000 person-years was 9.6 in males and 3.7 in females. In non-diabetics, saturated fat were associated with MI directly (odds ratio (OR): tertile 2 vs. 1 = 2.32, tertile 3 vs. 1 = 2.82; chi-square for trend, p = 0.03) and polyunsaturated fats inversely (OR: tertile 2 vs. 1 = 0.80, tertile 3 vs. 1 = 0.37; chi-square for trend, p = 0.05), while in diabetics, starchy carbohydrates (OR: tertile 2 vs. 1 = 1.51, tertile 3 vs. 1 = 6.73; chi-square for trend, p = 0.01) and glycaemic index (OR: tertile 2 vs. 1 = 2.74, tertile 3 vs. 1 = 5.34; chi-square for trend, p = 0.01) were associated directly with MI. CONCLUSIONS: MI incidence in this population was lower than that found in northern countries. In non-diabetics, saturated fats were associated directly and polyunsaturated fat inversely with MI; in diabetics, starchy carbohydrates and high-glycaemic-index foods were associated directly with MI.

Glycated apolipoprotein B and myocardial infarction.

AIMS: To evaluate the association of serum concentrations of glycated apolipoprotein B (ApoBg) with the incidence of myocardial infarction (MI) in subjects with and without diabetes. METHODS: The design is a nested case-control study. The cohort included 5632 subjects over 50 years of age attending the clinical laboratories of a small geographic area in southern Italy. After five years, 4563 subjects were traced and 103 had developed MI. We sampled from the cohort two controls for each incident case of MI, frequency matched for sex and diabetes. ApoBg was measured using a monoclonal antibody. Logistic regression was used for statistical analysis of the data. RESULTS: ApoBg at baseline was higher in subjects who developed myocardial infarction than in controls in both non-diabetic and diabetic subjects (t test, P=0.009 and P=0.05 respectively). MI odds ratio in the third tertile of ApoBg was 2.01 (95% CI 0.93-4.33) in non-diabetic and 2.88 (0.85-9.68) in diabetic subjects (chi-square test for trend; non-diabetics P=0.03, diabetics P=0.06). Serum triglycerides, cholesterol, HDL and LDL cholesterol, glucose and insulin were not associated with MI (P>0.10). CONCLUSION: ApoBg at baseline is directly associated with the development of MI in the following five years in both diabetic and non-diabetic individuals.

Obstructive primary bladder neck disease: evaluation of the efficacy and safety of alpha1-blockers.

OBJECTIVE: The efficacy and safety of using alpha(1)-adrenergic blockers for treating primary bladder neck obstruction in young and middle-aged men was assessed as the first therapeutic step, before surgery, in a symptomatic non-neurogenic selected group of patients. MATERIALS AND METHODS: From January 1995 to December 2001, primary bladder neck obstruction was diagnosed in 41 men whose average age was 43 years. All of them were evaluated by a complete clinical history, American Urological Association (AUA) symptom score index, physical examination, uroflowmetry, transabdominal ultrasound prostatic volume determination, ultrasound post-void residual determination, videourodynamics including pressure-flow analysis and upper urinary tract screening with renal ultrasound or an excretory urogram. A full daily dose of alpha(1)-adrenergic blockers (alfuzosin or tamsulosin) was administered for at least 6 months. Successful treatment was defined as improved symptoms, voiding diary, maximum flow rate and pressure-flow parameters. Patients who did not gain improvement of symptoms with pharmacological treatment were offered surgery. RESULTS: Overall, pharmacological treatment was successful in 29/41 patients (70.7%) whereas bladder neck endoscopic incision was mandatory in 12/41 (29.3%). CONCLUSIONS: alpha(1)-Blockers were effective and safe for treating young and middle-aged men with symptomatic bladder neck obstruction.

The effect of a soy rich diet on the vaginal epithelium in postmenopause: a randomized double blind trial.

BACKGROUND: A traditional asiatic phytoestrogen-rich diet is associated with a lower incidence of estrogen-dependent cancers and clinical consequences of postmenopausal estrogen deficiency. First Wilcox in 1990, showed an increase of the vaginal cell maturation with phytoestrogens on postmenopausal women, but this has not been confirmed in some subsequent studies. METHODS: In this study, we analyzed the effects of a 6-month soy-rich diet on the vaginal epithelium of asymptomatic postmenopausal women in a randomized clinical trial. 187 women were recruited for the study and divided into three groups: a phytoestrogen rich diet group; a hormonal replacement group, and a control group. A vaginal sample for hormonal cytology was taken before and at the end of the study, and sent unnamed to a cytologist. RESULTS: The karyopycnotic index (KI) increased significantly in the diet group and in the HRT group but not in the control group. The maturation value (MV) had an identical trend to the KI. CONCLUSION: We conclude that a soy rich diet is efficacious in increasing the maturation indices of vaginal cells. This effect could be a useful marker of the efficacy of a dietary intervention with phytoestrogen rich foods, and should be considered during preventive interventions against menopausal effects and vaginal atrophy.

Diet and duodenal ulcer.

BACKGROUND: Despite the fact that the main cause of duodenal ulcer incidence and recurrence is the Helicobacter pylori bacterium, more than 80% of Helicobacter pylori-infected people never develop an ulcer. Diet may be one of the most important environmental factors contributing to duodenal ulcer. AIMS: To explore the role of diet in causation, treatment and prevention of duodenal ulcer recurrence. METHODS: All research papers published in English from 1966 to October 1999 present in Medline, involving human subjects, and having duodenal ulcer as outcome, entered the review. RESULTS AND CONCLUSIONS: Soluble fibre from fruit and vegetables seem to be protective against duodenal ulcer and refined sugars a risk factor. The role of fibre in the treatment and prevention of recurrence of duodenal ulcer is uncertain, as is that of essential fatty acids. However, none of the epidemiological studies on the relationship between diet and duodenal ulcer disease controlled for Helicobacter pylori.

Diet, physical activity, and gallstones--a population-based, case-control study in southern Italy.

BACKGROUND: Gallstones are a highly prevalent condition; however, the nutritional and lifestyle risk factors of this disease are not well understood. OBJECTIVE: We evaluated the association between diet, physical activity, and incident cases of gallstones diagnosed by ultrasound in a population-based, case-control study. DESIGN: One hundred patients with newly diagnosed gallstones and 290 randomly selected control subjects without gallstones were enrolled in the study. The presence of gallstones was determined by ultrasonography. Both patients and control subjects completed a questionnaire about their usual diet and physical activity for the 12 mo before the ultrasonography. The association between diet and physical activity and risk of gallstone formation was analyzed by using multiple logistic regression. RESULTS: Body mass index and intake of refined sugars were directly associated with risk of gallstone formation, whereas physical activity, dietary monounsaturated fats, dietary cholesterol, and dietary fibers from cellulose were inversely associated with risk of gallstone formation. Saturated fats were a risk factor for gallstone formation and the association appeared to be stronger for men than for women. CONCLUSION: These findings suggest that a sedentary lifestyle and a diet rich in animal fats and refined sugars and poor in vegetable fats and fibers are significant risk factors for gallstone formation.

Hypolactasia and metabolic changes in post-menopausal women.

OBJECTIVES: The aims of the study were to evaluate the prevalence of hypolactasia in a group of post-menopausal women in Southern Italy, and to relate hypolactasia to possible changes occurring in biochemical indicators of carbohydrate and fat metabolism as well as in biochemical markers of bone metabolism. METHODS: Fifty post-menopausal women entered the study. Lactose malabsorbers were identified by breath hydrogen test. The kinetics of D-xylose was evaluated by a graphic-mathematical analysis after oral administration of a solution of 10 g of D-xylose in water. Serum glucose, insulin, C-peptide, cholesterol and triglycerides were assayed by commercial kits. The evaluation of dietary habits and physical activities was performed by a questionnaire. The assessment of bone turnover was obtained by measuring osteocalcin, serum alkaline phosphatase, calcium, phosphorus, and urinary hydroxyproline and urinary calcium expressed as a ratio or urinary creatinine. RESULTS: Twenty-six of 50 women showed hypolactasia. Significant differences were found in serum levels of insulin, glucose, and triglycerides, which were lower in malabsorbers than lactose absorbers, and in HDL-cholesterol levels which were higher in the first group than in the second. As regards bone turnover, dietary habits or lactose intake, there were no significant differences between the two groups. CONCLUSIONS: The significant differences found in serum levels of glucose, triglycerides, and HDL-cholesterol between lactose absorbers and malabsorbers may be imputable to the low or absent lactase activity which does not allow the whole amount of lactose in the small bowel of malabsorbers to be metabolized. Moreover, changes in lactose absorbing capacity of intestinal mucosa did not modify the intake of milk or its by-products in malabsorbers as demonstrated by the analysis of food.

Attitudes and clinical practice of Italian gynecologists towards prophylactic oophorectomy during hysterectomy for benign conditions.

OBJECTIVES: To evaluate the attitudes of Italian gynecologists towards prophylactic oophorectomy in women who underwent hysterectomy for benign conditions. METHODS: A postal questionnaire was sent to 490 physicians in charge in 42 obstetric and gynecologic centres affiliated to the Association of Italian Obstetrics and Gynecologists. RESULTS: About 80% of gynecologists perform prophylactic oophorectomy for women aged more than 50, but this percentage decreases to 50% for patients aged 45-50. Most gynecologists avoid prophylactic oophorectomy in women aged less than 40. CONCLUSIONS: This study confirms the wide variability in attitudes of gynecologists towards prophylactic oophorectomy in women aged 40-50 who undergo hysterectomy for benign conditions.

Bladder function in the aged rat: a functional and morphological study.

This study was designed to characterize urinary bladder function in the aged rat (27 months of age). For comparative purposes, two different control groups were included into the experimental protocol: normal 6-month old and hyperdiuretic 6-month old rats. Increased threshold volume for micturition and increased bladder mass were found in both aged and hyperdiuretic rats. No difference in the amplitude of micturition contractions was detected between groups. In the aged rat, but not in the hyperdiuretic one, augmented threshold volume and bladder mass were associated with increased intravesical pressure at micturition and structural changes of intramural bladder innervation. When activated, the vesicovesical reflex did not show any change in terms of rate of isovolumetric contractions. In the aged rat, altered sensory information on the state of maximum fullness seems to play an important role in determining abnormal cystometric findings.

[Reconstructive surgery in complex hypospadias: therapeutic indications and technical considerations in 93 cases]. / La cirugía reconstructiva de los hipospadias complejos: indicaciones terapéuticas y consideraciones técnicas en 93 casos.

Perineo-scrotal hypospadias and the severe sequelae of a failed repair procedure are complicated cases. The present study describes our experience in the treatment of complex hypospadias, the new therapeutic possibilities, their indications and results. From 1981 to 1992, 93 children with complex hypospadias underwent surgery (53 underwent surgery for the first time and 40 for severe sequelae of a failed procedure). Excellent cosmetic results were achieved by surgery. For those undergoing hypospadias repair for the first time, we used a pedicled preputial flap following the Duckett (12 cases) or Standoli (41 cases) technique. For those with severe sequelae from a failed procedure, we utilized a pedicled skin flap (18 cases) or free flap of bladder mucosa or penile skin (22 cases). The overall complication rate was 50% (47 patients). Surgical repair of complex hypospadias is a relatively long and complicated procedure with a long learning curve and a high complication rate in the initial phase. Fistula is the most common complication, although closure is very simple due to the abundant, well vascularized, healthy tissue. Overall our results have been satisfactory, considering the severity of these cases.

Video-urodynamic studies of minor voiding dysfunctions in children: an overview of 13 years' experience.

By the definition 'minor voiding dysfunctions' is understood children with a history of frequency, urgency, daytime wetting, squatting, and infrequent voiding, singly or in combination. Urinary tract infections (UTI) are often present but symptoms must also be present when the children are free of infection. The upper urinary tract is generally normal or has minor anomalies. Any evidence of infravesical obstruction, frank or occult neurogenic bladder, or emotional disturbances must be excluded. In this study we report 13 years' experience of video-urodynamic evaluation in children with minor voiding dysfunctions, with special reference to clinical information, morphofunctional correlations, relationship with recurrent UTI, vesico-ureteric reflux and dilatation of the upper urinary tract. According to our experience we estimate that about 60% of the patients evaluated in this study would not require a video-urodynamic evaluation today.

Ambulatory urodynamics: preliminary experience with vesico-urethral holter in children.

Detrusor function was evaluated by vesico-urethral holter (VUH), a computerized recording system (Urodec 500), in 17 children with lower urinary tract dysfunction. Eight had neurogenic bladders, eight had minor voiding dysfunction, and one was incontinent after posterior urethral valve ablation. VUH was technically satisfactory in, and acceptable to, all patients. It was more accurate in evaluating the type of urinary tract dysfunction than conventional urodynamics in 25% of the male patients and in 32.5% of the female patients.

Urological manifestations of acute appendicitis: report of two new cases.

Clinical manifestations of acute appendicitis are variegated and urologic symptoms may be the first manifestation of the disease. In 1985 we reported on 2 cases of acute appendicitis who presented with irritative bladder symptoms. Here we describe 2 new cases come to our observation because of hematuria and irritative bladder symptoms. A brief review of the literature is also carried out.

Page kidney: a curable form of arterial hypertension. Case report and review of the literature.

A case report of arterial hypertension which occurred 5 years after a blunt renal trauma is presented. The physiopathology of this type of hypertension along with the diagnostic features and the therapeutic aspects are extensively discussed. The sudden appearance of hypertension in a young patient following trauma must suggest a Page kidney as one of the diagnostic possibilities.

[Oro-facial-digital syndrome type II: clinical and cephalometric study of a case]. / La sindrome oro-deigito-facciale tipo II: studio clinico e cefalometrico di un caso.

The Authors report a case of Oral-Facial-Digital syndrome type II (Mohr syndrome); three cephalometric tracings and a clinical study were carried out, in order to evaluate the oro-facial abnormalities. A complete cephalometric study has never been performed in this syndrome before.