Molecular Typing and Resistance Profile of Acinetobacter baumannii Isolates during the COVID-19 Pandemic: Findings from the "EPIRADIOCLINF" Project.

Due to the COVID-19 pandemic, there has been a shift in focus towards controlling the spread of SARS-CoV-2, which has resulted in the neglect of traditional programs aimed at preventing healthcare-associated infections and combating antimicrobial resistance. The present work aims to characterize the colonization or infection with Acinetobacter baumannii of COVID-19 patients and to identify any clonality between different isolates. Specifically, data and resistance profiles of A. baumannii isolates were prospectively collected from patients recruited by the EPIRADIOCLINF project. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used for molecular typing. Overall, we analyzed 64 isolates of A. baumannii from 48 COVID-19 patients. According to our analysis, we have identified the spread of a clonally related isolate, referred to as B. The PFGE pattern B includes four subtypes: B1 (consisting of 37 strains), B2 (11), B3 (5), and B4 (2). Furthermore, in the isolates that were examined using MLST, the most observed sequence type was ST/281. In terms of resistance profiles, 59 out of the total isolates (92.2%) were found to be resistant to gentamicin, carbapenems, ciprofloxacin, and tobramycin. The isolation and identification of A. baumannii from COVID-19 patients, along with the high levels of transmission observed within the hospital setting, highlight the urgent need for the implementation of effective prevention and containment strategies.

Updates on developing and applying biosensors for the detection of microorganisms, antimicrobial resistance genes and antibiotics: a scoping review.

Background: The inappropriate use of antibiotics in clinical and non-clinical settings contributes to the increasing prevalence of multidrug-resistant microorganisms. Contemporary endeavours are focused on exploring novel technological methodologies, striving to create cost-effective and valuable alternatives for detecting microorganisms, antimicrobial resistance genes (ARGs), and/or antibiotics across diverse matrices. Within this context, there exists an increasingly pressing demand to consolidate insights into potential biosensors and their implications for public health in the battle against antimicrobial resistance (AMR). Methods: A scoping review was carried out to map the research conducted on biosensors for the detection of microorganisms, ARGs and/or antibiotics in clinical and environmental samples. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used. Articles published from 1999 to November 2022 and indexed in the following databases were included: MEDLINE, EMBASE, Web of Science, BIOSIS Citation index, Derwent Innovations index, and KCI-Korean Journal. Results: The 48 studies included in the scoping review described the development and/or validation of biosensors for the detection of microorganisms, ARGs and/or antibiotics. At its current stage, the detection of microorganisms and/or ARGs has focused primarily on the development and validation of biosensors in clinical and bacterial samples. By contrast, the detection of antibiotics has focused primarily on the development and validation of biosensors in environmental samples. Asides from target and samples, the intrinsic characteristics of biosensors described in the scoping review were heterogenous. Nonetheless, the number of studies assessing the efficacy and validation of the aforementioned biosensor remained limited, and there was also a lack of comparative analyses against conventional molecular techniques. Conclusion: Promoting high-quality research is essential to facilitate the integration of biosensors as innovative technologies within the realm of public health challenges, such as antimicrobial resistance AMR. Adopting a One-Health approach, it becomes imperative to delve deeper into these promising and feasible technologies, exploring their potential across diverse sample sets and matrices.

The Effect of Maternal Dietary Patterns on Birth Weight for Gestational Age: Findings from the MAMI-MED Cohort.

Limited evidence exists on the effects of maternal dietary patterns on birth weight, and most studies conducted so far did not adjust their findings for gestational age and sex, leading to potentially biased conclusions. In the present study, we applied a novel method, namely the clustering on principal components, to derive dietary patterns among 667 pregnant women from Catania (Italy) and to evaluate the associations with birth weight for gestational age. We identified two clusters reflecting distinct dietary patterns: the first one was mainly characterized by plant-based foods (e.g., potatoes, cooked and raw vegetables, legumes, soup, fruits, nuts, rice, wholemeal bread), fish and white meat, eggs, butter and margarine, coffee and tea; the second one consisted mainly of junk foods (sweets, dips, salty snacks, and fries), pasta, white bread, milk, vegetable and olive oils. Regarding small gestational age births, the main predictors were employment status and primiparity, but not the adherence to dietary patterns. By contrast, women belonging to cluster 2 had higher odds of large for gestational age (LGA) births than those belonging to cluster 1 (OR = 2.213; 95%CI = 1.047-4.679; p = 0.038). Moreover, the odds of LGA increased by nearly 11% for each one-unit increase in pregestational BMI (OR = 1.107; 95%CI = 1.053-1.163; p < 0.001). To our knowledge, the present study is the first to highlight a relationship between adherence to an unhealthy dietary pattern and the likelihood of giving birth to a LGA newborn. This evidence adds to the current knowledge about the effects of diet on birth weight, which, however, remains limited and controversial.

Impact of Eating Context on Dietary Choices of College Students: Evidence from the HEALTHY-UNICT Project.

While personal characteristics have been evaluated as determinants of dietary choices over the years, only recently studies have looked at the impact of eating context. Examining eating context, however, can be challenging. Here, we propose the use of a web-app for the Ecological Momentary Assessment of dietary habits among 138 college students from Catania (Italy) and therefore for examining the impact of eating context on dietary choices. Eating away from home was associated with lower odds of consuming vegetables, fruits, and legumes and higher odds of consuming processed meat, salty snacks, and alcoholic drinks compared with eating at home. Eating in the company of other people was associated with higher odds of consuming vegetables, red meat, fish, legumes, milk, and sugar-sweetened beverages and lower odds of consuming nuts than eating alone. This study proposed a new way to capture and assess how eating environment might affect dietary habits. Based on our results, meal location and social context have significant effects on the dietary choices of college students, pointing to the need to incorporate these aspects into further epidemiological studies.

The Impact of the COVID-19 Pandemic on Dietary Patterns of Pregnant Women: A Comparison between Two Mother-Child Cohorts in Sicily, Italy.

A maternal diet, before and during pregnancy, plays a key role in ensuring maternal and newborn health. The COVID-19 pandemic, however, may have compromised dietary habits in the general population and in specific subgroups of individuals. Here, we evaluated the impact of COVID-19 on the diet of pregnant women, using data from two mother-child cohorts in Sicily (Italy). Dietary data were collected using a food frequency questionnaire and analyzed through the Mediterranean diet (MD) score and principal component analysis (PCA). The comparison of maternal dietary consumption before and during the COVID-19 pandemic showed differences in terms of vegetables (p < 0.001), fruit (p < 0.001), dairy products (p < 0.001), fish (p < 0.001), and legumes (p = 0.001). Accordingly, after adjusting for covariates, mothers enrolled during the pandemic were more likely to report low adherence to MD than those enrolled before (OR = 1.65; 95%CI = 1.12−2.42; p = 0.011). A similar result was obtained by analyzing the adherence to a prudent dietary pattern, derived through PCA and characterized by high intake of cooked and row vegetables, legumes, fruit, fish, and soup. Overall, these findings suggested that the COVID-19 pandemic may have influenced maternal diet during pregnancy. However, further efforts are needed to investigate the main causes and consequences of this change.

Nutrient intakes and telomere length of cell-free circulating DNA from amniotic fluid: findings from the Mamma & Bambino cohort.

Pregnancy represents a crucial period in which several exposures-and especially maternal diet-might shape children's health. Thus, identifying how maternal dietary intakes early affect biological aging in children represents a public health mission. We aimed to assess the relationship between maternal intake of nutrients in early pregnancy and telomere length of cell-free circulating DNA (cfDNA) from amniotic fluid. We used data and samples from the ongoing prospective "Mamma & Bambino" study, which recruits mother-child pairs from Catania at the first prenatal visit. Maternal nutrient intakes were assessed using a Food Frequency Questionnaire, while relative telomere length of cfDNA was assessed by real-time polymerase chain reaction. Our analysis included 174 mother-child pairs. The intakes of iron, vitamin B1, and magnesium were positively correlated with relative telomere length (p-values < 0.05). However, only the intake of magnesium was positively associated with relative telomere length, after applying a linear regression model (ß = 0.002; SE = 0.001; p = 0.024). Magnesium deficiency was negatively associated with relative telomere length after adjusting for the same covariates (ß = -0.467; SE = 0.176; p = 0.009). To our knowledge, this is the first evidence of a positive relationship between maternal nutrient intake and telomere length of cfDNA. Further efforts are needed for deeply investigating the effect of maternal dietary intakes on telomere length, in order to develop effective public health strategies.

Evaluating Dietary Patterns in Women from Southern Italy and Western Mexico.

Traditional diets are known to be beneficial; however, both Italian and Mexican populations are gradually moving away from the Mediterranean and traditional Mexican diets. Since women play a key role in safeguarding dietary traditions and may reflect population dietary changes, we aimed to identify Italian and Mexican women's current dietary patterns (DPs) and characterize their nutrient content. Cross-sectional analyses were separately conducted on two convenience samples of 811 women from Southern Italy and 215 women from Western Mexico. Food frequency questionnaires, 24 h recalls, and a principal component analysis (PCA) approach were used to derive a posteriori DPs. In Italian women, the first DP was characterized by the consumption of legumes, vegetables, and fish (8.8% of the total variance), while the second DP was characterized by snack foods, processed meats, and non-olive oils. In Mexican women, the first DP was characterized by the consumption of meats and processed foods (12.6% of the total variance), while the second DP by fruits, vegetables, and whole grains. In both populations, adhering to the DPs rich in healthy foods (i.e., fruits, vegetables, legumes, and fish) was associated with a higher quality of diet in terms on nutrient content. However, adherence to the Western-type DPs was more common among women of younger age (p < 0.035). Thus, more extraordinary efforts are needed in promoting each country's traditional healthy diet, especially among the new generations.

The Application of Clustering on Principal Components for Nutritional Epidemiology: A Workflow to Derive Dietary Patterns.

In the last decades, different multivariate techniques have been applied to multidimensional dietary datasets to identify meaningful patterns reflecting the dietary habits of populations. Among them, principal component analysis (PCA) and cluster analysis represent the two most used techniques, either applied separately or in parallel. Here, we propose a workflow to combine PCA, hierarchical clustering, and a K-means algorithm in a novel approach for dietary pattern derivation. Since the workflow presents certain subjective decisions that might affect the final clustering solution, we also provide some alternatives in relation to different dietary data used. For example, we used the dietary data of 855 women from Catania, Italy. Our approach-defined as clustering on principal components-could be useful to leverage the strengths of each method and to obtain a better cluster solution. In fact, it seemed to disentangle dietary data better than simple clustering algorithms. However, before choosing between the alternatives proposed, it is suggested to consider the nature of dietary data and the main questions raised by the research.

The Relationship between Body Mass Index, Obesity, and LINE-1 Methylation: A Cross-Sectional Study on Women from Southern Italy.

Uncovering the relationship between body mass index (BMI) and DNA methylation could be useful to understand molecular mechanisms underpinning the effects of obesity. Here, we presented a cross-sectional study, aiming to evaluate the association of BMI and obesity with long interspersed nuclear elements (LINE-1) methylation, among 488 women from Catania, Italy. LINE-1 methylation was assessed in leukocyte DNA by pyrosequencing. We found a negative association between BMI and LINE-1 methylation level in both the unadjusted and adjusted linear regression models. Accordingly, obese women exhibited lower LINE-1 methylation level than their normal weight counterpart. This association was confirmed after adjusting for the effect of age, educational level, employment status, marital status, parity, menopause, and smoking status. Our findings were in line with previous evidence and encouraged further research to investigate the potential role of DNA methylation markers in the management of obesity.

Burden of Healthcare-Associated Infections in Sicily, Italy: Estimates from the Regional Point Prevalence Surveys 2016-2018.

An assessment of the burden of healthcare-associated infections (HAIs) in terms of disability-adjusted life years (DALYs) is useful for comparing and ranking HAIs and to support infection prevention and control strategies. We estimated the burden of healthcare-associated pneumoniae (HAP), bloodstream infection (HA BSI), urinary tract infection (HA UTI), and surgical site infection (SSI) in Sicily, Italy. We used data from 15,642 patients aged 45 years and above, identified during three repeated point prevalence surveys (PPSs) conducted from 2016 to 2018 according to the European Centre for Disease Prevention and Control protocol. The methodology of the Burden of Communicable Diseases in Europe project was employed. The selected HAIs accounted for 8424 DALYs (95% uncertainty interval (UI): 7394-9605) annually in Sicily, corresponding to 344 DALYs per 100,000 inhabitants aged 45 years and above (95% UI: 302-392). Notably, more than 60% of the burden was attributable to HAP, followed by HA BSI, SSI, and HA UTI. The latter had the lowest burden despite a relatively high incidence, whereas HA BSI generated a high burden even through a relatively low incidence. Differences between our estimates and those of European and Italian PPSs encourage the estimation of the burden of HAIs region by region.

The Effect of Alcohol on Telomere Length: A Systematic Review of Epidemiological Evidence and a Pilot Study during Pregnancy.

Several studies-albeit with still inconclusive and limited findings-began to focus on the effect of drinking alcohol on telomere length (TL). Here, we present results from a systematic review of these epidemiological studies to investigate the potential association between alcohol consumption, alcohol-related disorders, and TL. The analysis of fourteen studies-selected from PubMed, Medline, and Web of Science databases-showed that people with alcohol-related disorders exhibited shorter TL, but also that alcohol consumption per se did not appear to affect TL in the absence of alcohol abuse or dependence. Our work also revealed a lack of studies in the periconceptional period, raising the need for evaluating this potential relationship during pregnancy. To fill this gap, we conducted a pilot study using data and samples form the Mamma & Bambino cohort. We compared five non-smoking but drinking women with ten non-smoking and non-drinking women, matched for maternal age, gestational age at recruitment, pregestational body mass index, and fetal sex. Interestingly, we detected a significant difference when analyzing relative TL of leukocyte DNA of cord blood samples from newborns. In particular, newborns from drinking women exhibited shorter relative TL than those born from non-drinking women (p = 0.024). Although these findings appeared promising, further research should be encouraged to test any dose-response relationship, to adjust for the effect of other exposures, and to understand the molecular mechanisms involved.

Vaccination Status of Mothers and Children from the 'Mamma & Bambino' Cohort.

According to the evidence demonstrating vaccines' safety and effectiveness in anticipation of and during pregnancy, several countries have established immunization programs during the periconceptional period. Here, we evaluated vaccination status among 220 mother-child pairs, using data from the 'Mamma & Bambino' cohort. The self-reported data were evaluated at delivery, and with planned follow-ups at 1-2 years after delivery. In general, we noted that the vaccination status among the women was heterogeneous, ranging from 8.3% (vaccine against Human Papillomavirus, HPV) to 65.6% (vaccine against Diphtheria Tetanus and Pertussis, DTaP). Excluding the women who contracted the diseases in the past, the main ground for refusal was the lack of information. We also demonstrated that increasing age was associated with higher odds of not being vaccinated against Measles-Mumps-Rubella (MMR; OR = 1.12; 95% CI = 1.04-1.21; p = 0.004), HPV (OR = 1.20; 95% CI = 1.08-1.33; p = 0.001) and DTaP (OR =1.09; 95% CI = 1.01-1.18; p = 0.040). As expected, we showed that the proportion of newborns vaccinated with the Hexavalent and Pneumococcal vaccines was high (99.5% and 98.6%, respectively), while the vaccination coverage against MMRV did not reach the auspicated threshold (84.1%). Overall, these results underlined the need for the improvement of women's knowledge about the recommendations for vaccination, especially during pregnancy.

The Impact of Socio-Demographic Factors on Breastfeeding: Findings from the "Mamma & Bambino" Cohort.

Background and objectives: The World Health Organization (WHO) recommends women (1) to initiate breastfeeding within one hour of birth; (2) to exclusively breastfeed for the first six months; and (3) to continue breastfeeding until two years of age. However, women do not always adhere to these recommendations, threatening the health of their children. The present study aims to evaluate breastfeeding status and the main maternal factors associated with exclusive breastfeeding for six months among women from the "Mamma & Bambino" study, a prospective cohort settled in Catania, Italy. Materials and Methods: We used data from 220 women (median age = 37 years) enrolled in the "Mamma & Bambino" cohort during prenatal obstetric counselling. Self-reported breastfeeding status was collected during the follow-up interviews at 1 and 2 years, referring to breastfeeding status (i.e., yes or no) and type of breastfeeding (i.e., exclusive or predominant). We also collected data about duration of breastfeeding to classify women into those who adhered to the WHO recommendation and those who did not. Results: In the general population, we noted that the proportion of women who have breastfed increased with increasing educational level. Accordingly, logistic regression analysis demonstrated that medium (OR = 3.171; 95% CI = 1.285-7.822; p = 0.012) and high educational levels (OR = 4.549; 95% CI = 1.525-13.570; p = 0.007) were positively associated with breastfeeding if compared to low educational level. Among women who have breastfed, instead, the proportion of adherents to the WHO recommendation was higher among those with medium-high educational level and those who were employed. In line with this, we demonstrated that full-time employment (OR = 2.158; 95% CI = 1.033-4.508; p = 0.041) and medium educational level (OR = 4.632; 95% CI = 1.227-17.484; p = 0.024) were positively associated with exclusive breastfeeding for the first six months. Conclusions: Socio-demographic factors should be taken into account through public health strategies for improving maternal knowledge about health benefits of exclusive breastfeeding.

The Relationship between Telomere Length and Gestational Weight Gain: Findings from the Mamma & Bambino Cohort.

Inadequate gestational weight gain (GWG) affects a growing number of pregnancies, influencing intrauterine environment and long-term health. Uncovering molecular mechanisms associated with GWG could be helpful to develop public health strategies for tackling this issue. Here, our study aimed to understand the relationship of DNA telomere length with weigh gain during pregnancy, using data and samples from the ongoing prospective "Mamma & Bambino" study (Catania, Italy). GWG was calculated according to the Institute of Medicine (IOM) guidelines. Relative telomere length was assessed by real-time quantitative polymerase chain reaction in 252 samples of maternal leucocyte DNA (mlDNA) and 150 samples of cell-free DNA (cfDNA) from amniotic fluid. We observed that relative telomere length of mlDNA seemed to weakly increase with GWG. In contrast, telomere length of cfDNA exhibited a U-shaped relationship with GWG. Women with adequate GWG showed longer telomere length than those who gained weight inadequately. Accordingly, the logistic regression model confirmed the association between telomere length of cfDNA and adequate GWG, after adjusting for potential confounders. Our findings suggest an early effect of GWG on telomere length of cfDNA, which could represent a molecular mechanism underpinning the effects of maternal behaviours on foetal well-being.

Three-Year Trends of Healthcare-Associated Infections and Antibiotic Use in Acute Care Hospitals: Findings from 2016-2018 Point Prevalence Surveys in Sicily, Italy.

Repeated point prevalence surveys (PPSs) of healthcare-associated infections (HAIs) and antibiotic use are crucial to monitor trends over years at regional level, especially in countries with decentralized healthcare systems. Here, we reported the results of three PPSs conducted in Sicilian acute care hospitals (Italy) from 2016 to 2018, according to the European Centre for Disease Prevention and Control protocol. Overall, prevalence of patients with at least one HAI was 5.1% in 2016, 4.7% in 2017, and 5.1% in 2018, without a significant trend over years (p = 0.434). At the patient level, the most important factor associated with HAIs was antibiotic use, since patients receiving at least one antimicrobial were more likely to be infected than those who did not receive antimicrobials (OR = 18.87; 95%CI = 13.08-27.22). The analysis of the prevalence of antibiotic use indicated a significant trend across years of the PPSs: 50.5% of patients received at least one antimicrobial agent in 2016, 55.2% in 2017, and 53.7% in 2018 (p < 0.001). The most common indication for antimicrobial prescription was medical prophylaxis, while third-generation cephalosporins represented the most frequently used class of antimicrobial agents, followed by fluoroquinolones and combinations of penicillins. Our study confirms that HAIs still remain a major public health issue, which could be intensified by antibiotic abuse. This raises the need for infection prevention and control and antibiotic stewardship programs aimed to improve knowledge about appropriate antibiotic prescription and to reduce the use of broad-spectrum antimicrobials.

Adherence to the Mediterranean diet partially mediates socioeconomic differences in leukocyte LINE-1 methylation: evidence from a cross-sectional study in Italian women.

Although previous research demonstrated that socioeconomic status (SES) might affect DNA methylation, social inequalities alone do not completely explain this relationship. We conducted a cross-sectional study on 349 women (Catania, Italy) to investigate whether behaviors might mediate the association between SES and long interspersed nuclear elements (LINE-1) methylation, a surrogate marker of global DNA methylation. Educational level, used as an indicator of SES, and data on behaviors (i.e. diet, smoking habits, physical activity, and weight status) were collected using structured questionnaires. Adherence to Mediterranean diet (MD) was assessed by the Mediterranean Diet Score (MDS). Leukocyte LINE-1 methylation was assessed by pyrosequencing. Mediation analysis was conducted using the procedure described by Preacher and Hayes. Women with high educational level exhibited higher MDS (ß = 0.669; 95%CI 0.173-1.165; p < 0.01) and LINE-1 methylation level (ß = 0.033; 95%CI 0.022-0.043; p < 0.001) than their less educated counterpart. In line with this, mediation analysis demonstrated a significant indirect effect of high educational level on LINE-1 methylation through the adherence to MD (ß = 0.003; 95%CI 0.001-0.006). Specifically, the mediator could account for 9.5% of the total effect. To our knowledge, this is the first study demonstrating the mediating effect of diet in the relationship between SES and DNA methylation. Although these findings should be confirmed by prospective research, they add value to the promotion of healthy dietary habits in social disadvantaged people.

Dietary Folate Intake and Folic Acid Supplements among Pregnant Women from Southern Italy: Evidence from the "Mamma & Bambino" Cohort.

Folate requirement among women who plan to become pregnant should be raised to 600 µg/day during the periconceptional period. To meet this need, several countries began to promote the use of folic acid supplements before and during pregnancy. Here, we investigated prevalence and determinants of dietary folate intake and folic acid supplement use among 397 pregnant women (aged 15-50 years old, median = 37 years old). We also investigated their effects on neonatal outcomes in a subgroup of women who completed pregnancy. For doing that, we used data from the "Mamma & Bambino" project, an ongoing mother-child cohort settled in Catania (Italy). Inadequate folate intake was evaluated using a Food Frequency Questionnaire and defined as an intake < 600 µg/day. Women were also classified as non-users (i.e., women who did not use folic acid supplements), insufficient users (i.e., women who did not take folic acid supplements as recommended), and recommended users of folic acid supplements. Neonatal outcomes of interest were preterm birth (PTB) and small for gestational age (SGA). Nearly 65% of women (n = 257) reported inadequate folate intake, while 74.8% and 22.4% were respectively classified as insufficient or recommended users of supplements. We demonstrated higher odds of inadequate folate intake among smoking women (OR = 1.457; 95%CI = 1.046-2.030; p = 0.026), those who followed dietary restrictions (OR = 2.180; 95%CI = 1.085-4.378; p = 0.029), and those with low adherence to the Mediterranean Diet (OR = 3.194; 95%CI = 1.958-5.210; p < 0.001). In a subsample of 282 women who completed pregnancy, we also noted a higher percentage of SGA among those with inadequate folate intake (p < 0.001). Among 257 women with inadequate folate intake, those with low educational level were more likely to not take folic acid supplements than their more educated counterpart (OR = 5.574; 95%CI = 1.487-21.435; p = 0.012). In a subsample of 184 women with inadequate folate intake and complete pregnancy, we observed a higher proportion of SGA newborns among women who did not take supplement before pregnancy and those who did not take at all (p = 0.009). We also noted that the proportion of PTB was higher among non-users and insufficient users of folic acid supplements, but difference was not statistically significant. Our study underlined the need for improving the adherence of pregnant women with recommendations for dietary folate intake and supplement use. Although we proposed a protective effect of folic acid supplement use on risk of SGA, further research is encouraged to corroborate our findings and to investigate other factors involved.

Determinants of Adherence to the Mediterranean Diet: Findings from a Cross-Sectional Study in Women from Southern Italy.

The Mediterranean diet (MD)-the dietary pattern usually consumed by Mediterranean populations-can help promote a favorable health status and better quality of life. Uncovering the main factors associated with the adherence to MD may be useful in understanding and counteracting the global shift toward a Western diet, which has been documented also in the Mediterranean region. Here, we evaluated the adherence to MD and its major social and behavioral determinants in women from Catania, Southern Italy. This cross-sectional study included 841 women, aged 25-64 years, with no history of severe diseases. Adherence to MD was assessed by the Food Frequency Questionnaire and Mediterranean Diet Score (MDS). Associations between variables were tested by multivariable logistic regression analysis and expressed as an odds ratio (OR) with a 95% confidence interval (CI). Among social factors, medium and high educational levels were associated with an ideal intake of alcohol (OR = 4.059; 95%CI = 1.311-12.570; p = 0.015; OR = 4.258 95%CI = 1.068-16.976; p = 0.040; respectively), living in a couple with ideal intake of cereals (OR = 2.801 95%CI = 1.188-6.602; p = 0.018), and having children with an ideal intake of fruits (OR = 3.149; 95%CI = 1.245-7.762; p = 0.015). With respect to behaviors, current smoking was negatively associated with an ideal intake of meat (OR = 0.449; 95%CI = 0.0220-0.917; p = 0.028), while more engagement in physical activity was associated with an ideal intake of vegetables (OR = 6.148; 95%CI = 1.506-25.104; p = 0.011) and legumes (OR = 5.832; 95%CI = 1.414-24.063; p = 0.015). In line with these findings, moderately or highly physically active women were more likely to show medium or high adherence to MD than those who performed less physical activity (OR = 6.024; 95%CI = 1.192-30.440; p = 0.040; OR = 9.965 95%CI = 1.683-58.993; p = 0.011; respectively). Our results confirm an urgent need for public health strategies, which should take into account determinants of diet quality. Particularly, our study indicates that more engagement in physical activity is a major positive determinant of the adherence to MD.

Dietary Patterns are Associated with Leukocyte LINE-1 Methylation in Women: A Cross-Sectional Study in Southern Italy.

Bioactive food compounds have different effects on global DNA methylation, an epigenetic mechanism associated with chromosomal stability and genome function. Since the diet is characterized by a mixture of foods, we aimed to identify dietary patterns in women, and to evaluate their association with long interspersed nuclear elements (LINE-1) methylation, a surrogate marker of global DNA methylation. We conducted an observational cross-sectional study of 349 women from Southern Italy, with no history of severe diseases. Dietary patterns were derived by food frequency questionnaire and principal component analysis. LINE-1 methylation of leukocyte DNA was assessed by pyrosequencing. We observed that intake of wholemeal bread, cereals, fish, fruit, raw and cooked vegetables, legumes, soup, potatoes, fries, rice, and pizza positively correlated with LINE-1 methylation levels. By contrast, vegetable oil negatively correlated with LINE-1 methylation levels. Next, we demonstrated that adherence to a prudent dietary pattern-characterized by high intake of potatoes, cooked and raw vegetables, legumes, soup and fish-was positively associated with LINE-1 methylation. In particular, women in the 3rd tertile exhibited higher LINE-1 methylation level than those in the 1st tertile (median = 66.7 %5mC; IQR = 4.67 %5mC vs. median = 63.1 %5mC; IQR = 12.3 %5mC; p < 0.001). Linear regression confirmed that women in the 3rd tertile had higher LINE-1 methylation than those in the 1st tertile (ß = 0.022; SE = 0.003; p < 0.001), after adjusting for age, educational level, employment status, smoking status, use of folic acid supplement, total energy intake and body mass index. By contrast, no differences in LINE-1 methylation across tertiles of adherence to the Western dietary pattern were evident. Interestingly, women who exclusively adhered to the prudent dietary pattern had a higher average LINE-1 methylation level than those who exclusively or preferably adhered to the Western dietary pattern (ß = 0.030; SE = 0.004; p < 0.001; ß = 0.023; SE = 0.004; p < 0.001; respectively), or those with no preference for a specific dietary pattern (ß = 0.013; SE = 0.004; p = 0.002). Our study suggested a remarkable link between diet and DNA methylation; however, further mechanistic studies should be encouraged to understand the causal relationship between dietary intake and DNA methylation.

Maternal Dietary Patterns Are Associated with Pre-Pregnancy Body Mass Index and Gestational Weight Gain: Results from the "Mamma & Bambino" Cohort.

The present study investigated the association of maternal dietary patterns with pre-pregnancy body mass index (BMI) and total gestational weight gain (GWG), using data of 232 women from the "Mamma & Bambino" cohort. Dietary patterns were derived by a food frequency questionnaire and principal component analysis. Self-reported pre-pregnancy BMI and GWG were calculated according to the World Health Organization and Institute of Medicine guidelines, respectively. The adherence to the "Western" dietary pattern-characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks-was associated with increased GWG (ß = 1.217; standard error [SE] = 0.487; p = 0.013), especially among obese women (ß = 7.363; SE = 1.808; p = 0.005). In contrast, the adherence to the "prudent" dietary pattern-characterized by high intake of boiled potatoes, cooked vegetables, legumes, pizza and soup-was associated with reduced pre-pregnancy BMI (ß = -0.631; SE = 0.318; p-trend = 0.038). Interestingly, the adherence to this pattern was positively associated with GWG among underweight (ß = 4.127; SE = 1.722; p = 0.048), and negatively among overweight and obese individuals (ß = -4.209; SE = 1.635; p = 0.016 and ß = -7.356; SE = 2.304; p = 0.031, respectively). Our findings point out that the promotion of a healthy diet might represent a potential preventive strategy against inadequate weight gain, even during the periconceptional period.