Relationship between measures of adiposity, blood pressure and arterial stiffness in adolescents. The MACISTE study.

OBJECTIVE: Children and adolescents with adiposity excess are at increased risk of future cardiovascular (CV) disease. Fat accumulation promotes the development of elevated blood pressure (BP) and arterial stiffness, two main determinants of CV risk which are strongly inter-related. We aimed at investigating whether the association between overweight and arterial stiffness, taken at different arterial segments, is mediated by increased BP or is BP-independent. METHODS: Three hundred and twenty-two Italian healthy adolescents (mean age 16.9±1.4 years, 12% with overweight) attending the "G. Donatelli" High School in Terni, Italy, underwent measurement of arterial stiffness by arterial tonometry (aortic stiffness) and semiautomatical detection of pressure-volume ratio of the common carotid (carotid stiffness). The mediator effect of BP was tested for each anthropometric or biochemical measure of fat excess related to arterial stiffness. RESULTS: Both carotid and aortic stiffness showed positive correlations with body mass index, waist, hip, and neck circumferences (NC). Only carotid stiffness, but not aortic stiffness, was associated with serum markers of fat accumulation and metabolic impairment such as insulin, homeostatic model of insulin resistance (HOMA-IR), serum gamma-glutamyl transferase (sGGT) and uric acid. The association with NC was stronger for carotid than for aortic stiffness (Fisher z -to- R 2.07, P  = 0.04), and independent from BP. CONCLUSIONS: In healthy adolescents, fat accumulation is associated with arterial stiffness. The degree of this association differs by arterial segments, since carotid stiffness is more strongly associated to adipose tissue excess than aortic stiffness and shows a BP-independent association with NC whereas aortic stiffness does not.

Association between Ideal Cardiovascular Health and aortic stiffness in Italian adolescents. The MACISTE study.

BACKGROUND AND AIMS: Ideal Cardiovascular Health (ICH), defined as optimal levels of cardiovascular (CV) health factors and behaviors, has been reported to be very low in adults and children, with consequent several negative health outcomes and higher CV risk. The present study investigated the burden of ICH among Italian adolescents and its association with carotid-femoral pulse wave velocity (cf-PWV). METHODS AND RESULTS: 387 healthy adolescents (mean age 17.1 ± 1.4 years) attending the "G. Donatelli" High School in Terni, Italy, were evaluated. ICH was assessed through clinical evaluation, laboratory measures and interviewer-administered questionnaires. Cf-PWV was measured by arterial tonometry (SphygmoCor). For each ICH metric, a score of 2 was assigned for ideal levels, 1 for intermediate, and 0 for poor. All subjects showed at least one ICH metric, whereas none showed all ICH 7 metrics. The average number of ICH metrics was 4.3 ± 1.1. The highest rates were observed for fasting blood glucose (98%), whereas an ideal healthy diet was achieved only by 8% of subjects. The Cf-PWV was inversely and linearly associated with the sum of ICH metrics (p = 0.03) and the ICH score (p < 0.01). At the multivariate analysis, the association between ICH score and cf-PWV remained significant after adjustment for age, sex, heart rate, mean arterial pressure and other confounders (p = 0.04). CONCLUSION: ICH is relatively uncommon among Italian adolescents and inversely related to cf-PWV. Our results showed a detrimental association between CV unhealthy factors and behaviors with increased aortic stiffness, which starts developing at an early stage of the lifespan.

[Chronic pain in the obese: a quali-quantitative observational study]. / Dolore cronico nell'obesità: studio osservazionale quali-quantitativo.

INTRODUCTION: Obesity (Ob) is one of the major issues for the public health care system with a constantly increasing prevalence. Chronic Pain (CP), on the other hand, is a pathological condition as severe and prevalent as the former. Ob and CP are not only pathological conditions, they also are important factors of risk for the onset of a number of morbid conditions. MATERIALS AND METHODS: In our study we have enrolled 182 patients with Ob, to whom we have asked to fill a brief questionnaire with the purpose of evaluating prevalence and characteristics of CP, therapeutic attitude and its results, as well as the knowledge of the Law n. 38 - 15/03/2010. RESULTS: From the analysis of gathered data, CP is present in the 39% of subjects with Ob (73.2% of females and 23.9% of males) and proportionally increases as BMI increases. The majority of patients (48%) shows pain at articular level, and a "pin" and a "gripping" pain are the two types of pain that are mostly described. Almost all the subjects enrolled (90%) suffer of a pain reported at a moderate to intense level. 15% circa of the patients do not take any therapy, while FANS have resulted to be the most used drugs among them (over 50% of the patients) and the 45% of the subjects have currently reported not to have a good control over the pain. The Law n. 38 has been reported unknown by the 8.2% of the investigated sample. CONCLUSIONS: The study has demonstrated a substantial association between the Ob and CP, particularly in the female gender, the clinical relevance of pain, its BMI-dependent tendency, the inadequacy of the therapy and the widespread lack of awareness and attention to the themes and issues of pain.

[Chronic pain in the diabetic patient: a quali-quantitative observational study]. / Dolore e diabete mellito: studio osservazionale quali-quantitativo.

AIM: The purpose of this study is to evaluate the prevalence and characteristics of pain in subjects affected by Diabetes Mellitus (DM), to assess approach and therapeutically valid outcomes as well as the knowledge of the Law n. 38/15/03/2010 of the Italian Government ("Dispositions to guarantee the access to the Palliative Cares and Pain Therapy"). MATERIALS AND METHODS: We have enrolled 462 patients affected by DM [242 (52.4%) males, 209 (42.5%) females; while in 11 (5.1%) cases the gender has not been specified], with characteristics as follows: 62 patients (13.4%) affected by T1DM (37 males and 25 females) e 400 patients (86.6%) affected by T2DM (224 males e 176 females). The average age was of 65.2 years old (range 20-91). All the patients have been presented with an original questionnaires based on 10 questions. RESULTS: 221 subjects (48%) have claimed to have experienced pain; 60% within the females, 38% within the males (p<0.001). 31% of these are to be included among the patients with T1DM, 50.5% among those with T2DM (p<0.01). The presence of chronic pain has been acknowledged by 162 subjects (35%). As per chronic pain, this has been described as articular pain by 128 patients (80%), while 63 (38%) located the pain through the spine and 29 (18%) throughout the muscles. Chronic pain was described as moderate by 73 subjects (45%), intense by 59 (36%), feeble by 15 (9%), utterly intense by 5 (3%), moderate/intense by 1 (1%). The drugs for treating the chronic pain used by the patients have been enlisted as follows: FANS (41%), paracetamol (30%), glucocorticoids (3%), weak opioids (2%); 27% of subjects have received no therapy. As for the Law 38/2010, only 8% have said they have had news of it. CONCLUSIONS: The data gathered in this study have drawn attention on the fact that the presence of pain is higher in female gender, with a prevalence of 60% compared to the 38% of the male gender. It has been observed no relation with the age range, in particular no proportional increase level of pain has been observed, although the higher peak of prevalence has been experienced in the age range between 70-79, both for pain in general and for chronic pain. Speaking about efficacy of the treatment, almost 50% of the subjects have received no improvement from the therapy.