TAS1R3 and TAS2R38 Polymorphisms Affect Sweet Taste Perception: An Observational Study on Healthy and Obese Subjects.

Background: The inter-individual differences in taste perception find a possible rationale in genetic variations. We verified whether the presence of four different single nucleotide polymorphisms (SNPs) in genes encoding for bitter (TAS2R38; 145G > C; 785T > C) and sweet (TAS1R3; −1572C > T; −1266C > T) taste receptors influenced the recognition of the basic tastes. Furthermore, we tested if the allelic distribution of such SNPs varied according to BMI and whether the associations between SNPs and taste recognition were influenced by the presence of overweight/obesity. Methods: DNA of 85 overweight/obese patients and 57 normal weight volunteers was used to investigate the SNPs. For the taste test, filter paper strips were applied. Each of the basic tastes (sweet, sour, salty, bitter) plus pure rapeseed oil, and water were tested. Results: Individuals carrying the AV/AV diplotype of the TAS2R38 gene (A49P G/G and V262 T/T) were less sensitive to sweet taste recognition. These alterations remained significant after adjustment for gender and BMI. Moreover, a significant decrease in overall taste recognition associated with BMI and age was found. There was no significant difference in allelic distribution for the investigated polymorphisms between normal and overweight/obese patients. Conclusions: Our findings suggest that overall taste recognition depends on age and BMI. In the total population, the inter-individual ability to identify the sweet taste at different concentrations was related to the presence of at least one genetic variant for the bitter receptor gene but not to the BMI.

The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience.

A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.

Laparoscopic adjustable gastric banding: a 10 year follow-up study.

BACKGROUND: A comprehensive obesity management can only be accomplished by a multidisciplinary team. Despite the numerous efforts made, a winning solution has not been reached yet. When patients do not respond to conventional treatment, LAGB (Laparoscopic Adjustable Gastric Banding) is a generally effective approach with minimal involvement in anatomical modification. STUDY AIM: The aim of this study is to highlight how LAGB can guarantee long-term weight loss and a reduced incidence of complications and reoperations, when it is integrated in a multidisciplinary context and in a long period of close follow-up. METHODS: 50 patients underwent LAGB between 2007 and 2008. From the sixth month after surgery, the LAGB was calibrated every 8-12 weeks, depending on the patient's response to the dietetic program and on his/her clinical and psychological situation. The follow up was planned every two weeks during the first six months after surgery, subsequently once a month during the first year; then every three months up to three years after surgery and every six months thereafter. RESULTS: After 6 months we found a significant weight loss that was progressive up to the second year. From the second year after surgery, the patients maintained their weight up to the tenth year of follow-up, without weight regain. In addition, an improvement of all metabolic parameters was found. CONCLUSIONS: LAGB guarantees good results in terms of weight loss and metabolic control; the careful choice of patients and a close and accurate follow-up are essential for the success of this surgical procedure.

A very low calorie ketogenic diet improves weight loss and quality of life in patients with adjustable gastric banding.

BACKGROUND: Often, in severe obesity, diet and physical activity are not enough to achieve a healthy BMI. Bariatric surgical approach, in particular laparoscopic adjustable gastric banding (LAGB), has encouraging results in terms of weight loss and resolution of obesity-related comorbidities. However, several months after LAGB, some patients are enable to lose weight anymore and don't tolerate a further calibration because of its collateral effects (excessive sense of fullness, heartburn, regurgitation and vomiting). AIM: The aim of this study is to identify the potential role of high protein-low carbohydrate ketogenic diet (KD) in managing weight loss in patients who underwent gastric banding and didn't lose weight anymore. METHODS: 50 patients underwent LAGB between January 2010 and December 2013. In twenty patients (GROUP A) we observed a stop in weight loss so we divided this patients into two groups. One group (group A1: 10 patients) continued to follow a LCD low calorie diet and underwent a further calibration; the other group (group A2: 10 patients) started to follow a KD for the next 8 weeks. RESULTS: Both group resumed a significant weight loss, however group A1 patients reported collateral effects due to calibration and a higher Impact of Weight on Quality of Life - Lite (IWQOL-Lite) that correlates with a lower quality of life than patients following KD. CONCLUSIONS: KD can improve the weight loss and quality of life in patients who underwent LAGB and failed at losing more weight allowing a weight loss comparable to that obtained with a further calibration and it is useful to avoid drastic calibrations and their collateral effects. KEY WORDS: Laparoscopic adjustable gastric binding, Quality of life, Very low calory ketogenic binding.

LAGB: regular follow-up with an interdisciplinary team is the key to success in terms of weight loss and complications.

BACKGROUND: In severe obesity, most patients do not respond to conventional treatment. Bariatric surgery must only be proposed in specific cases. LAGB gives excellent long-term results if patient scrupulously complies the follow-up. STUDY AIM: To evaluate patients who comply with the follow-up procedure over time in terms of weight loss, maintenance of the result, complications and quality of life. METHODS: 209 patients underwent LAGB between October 1999 and December 2007 and followed for 5 years. all patients were offered interdisciplinary counseling to update the therapeutic strategy. RESULTS: Out of 92 patients who after two years had reached the desired weight 58 patients (63%) had a regular follow- up and, when necessary, specific counseling. 34 patients (37%) who did not plan follow-up did not maintain the weight loss, and progressively put on weight between the second and fifth year and had a higher incidence of complications. (SF-36) established in patients regularly followed improvement of the quality of life (QoL), up to the fifth year. Short Form Health Survey patients who did not regularly have follow-up the SF-36 showed a worsening of all the test domains between the second and the fifth year. CONCLUSIONS: After 5 years, patients with severe obesity (BMI> 40) who underwent LAGB, that took part in a interdisciplinary follow-up procedure, obtained a full rehabilitation with a change of lifestyle, and maintained the weight loss obtained after 24 months. The perceived quality of life (QoL) shows a progressive improvement throughout the period of intensive intervention. Long-term efficacy of LAGB depends on a scrupulous followup and interdisciplinary support. KEY WORDS: LAGB, Obesity, Psychotherapy, SF-36.

Mineral water administration may increase kidney elimination of urea, creatinine and folic acid in a concentration-dependent fashion.

BACKGROUND: In a previous experimental study we showed that the administration of a large water load in a short time increases the urinary flow and the transport capacity in the excretory tract of the rabbit ureter. In human subjects drinking a water load of 25 ml/kg(BW) in 30 minutes, diuresis, creatinine and urea clearance increase more than in those drinking the same load in 24 hours. PURPOSE: The aim of the present study was to investigate possible correlations between percent reduction and baseline values of serum urea, creatinine, folic acid, and magnesium in humans. METHODS AND RESULTS: 20 volunteers were divided in two groups. Subjects in group 1 received a water load of 25 ml/kg(BW) in 24 hours followed by the same load in 30 minutes. Subjects in group 2 received the same water load but in inverse order. Before and after each water administration, the following variables were measured and compared: diuresis, serum urea, creatinine, folic acid and magnesium concentration, and urea and creatinine clearance. RESULTS: Serum urea and folic acid concentration decreased up to 40% after administration of the water load in 24 hours. Serum creatinine concentration decreased up to 20% after administration of the water load in 30 minutes. The concentration drop of these metabolites increased with increasing baseline metabolite concentrations.

The role of color Doppler in acute kidney injury.

In recent years, echographic studies of the kidney have improved radically due to new technologies which have recently become available. Among these, perhaps the most useful one is the ultrasonographic (US) procedure for the simultaneous laboratory and clinical workup of patients affected with acute nephropathic syndromes. However, traditional B-mode ultrasonography lack of sensibility and specificity in identifying and evaluating Acute Kidney Injury (AKI) is well known. Although the most objective measure in the study of different nephropathies remains by far the biopsy, several studies have indicated the usefulness of combining the B-mode ultrasound (US) with echo-color Doppler as a tool in determining intrarenal parenchymal arteries in the for differential diagnosis and predicion of clinical outcomes. In fact, the resistivity index (RI), determined by the formula: IR = (peak systolic velocity)--(end-diastolic or telediastolic velocity)/(peak systolic velocity) can be, after proper technical correction, easily measured at the level of the arcuate arteries or at the interlobar arteries. The final value is the average of 3-5 peaks, consecutively determined for each kidney at the upper pole, in the mesorenal area and also at the lower pole. The variation in normal IR values is < or = 0.70 with the difference diminishing progressively from segmental to interlobar vessels. Acute Kidney Injury (AKI) is perhaps one of the most important areas for the application of the Resistivity Index (RI). The differential diagnosis between prerenal AKI (which is functional and reversible if the cause of hypoperfusion is corrected) and renal AKI (which is organic and mainly caused by tubular necrosis (ATN) or acute interstitial nephritis) is facilitated by measurements of the RI, in addition to the normal clinical laboratory and clinical data. In fact, most pre-renal AKI patients show normal parenchymal vascular flow, with RI < 0.70, whereas those with AKI due to NTA have a reduced parenchymal perfusion, accompanied by elevated RI values, prior to any evidence of abnormal values of creatinine or of oligoanuria. Follow-up of patients with both renal and prerenal AKI by serial monitoring of RI during medical treatment of AKI shows a progressive reduction and ultimately the normalization of RI values of renal parenchymal vessels and often precedes the return to normal kidney function. In post-renal obstructive AKI patients, absolute values of RI > 0.70 on the obstructed kidney and a RI difference (deltaRI) between the two kidneys of > 0.06-0.08 are considered diagnostic of an obstruction. Elevated values of RI are also considered useful in the diagnosis of hemolytic-uremic syndrome (HUS) and are a significant predictor of prognosis: the normalization of IR precedes the return of normal renal functionality. Similarly, measurement of RI in patients with liver disease and normal renal function may help in early detection of latent hepato-renal syndrome. Although the IR is not, strictly speaking, a measure of renal function it may nevertheless be correlated with it especially if elevated arterial resistivity is accompanied by a reduction in renal function itself. Thus, IR may be considered a useful predictive index in specific clinical settings.

PTH 1-84 and PTH "7-84" in the noninvasive diagnosis of renal bone disease.

BACKGROUND: The intact parathyroid hormone (PTH) assay evaluates levels of serum 1-84 PTH and other N-terminally truncated PTH fragments, mainly PTH "7-84." This PTH molecule has been found experimentally to interfere with biological activity of PTH 1-84, perhaps through its binding to the PTH receptor complex. Therefore, assuming that high levels of PTH 7-84 are a cause of bone resistance to PTH, it has been hypothesized that a decreased 1-84 to 7-84 PTH ratio caused by a relative increase in PTH 7-84 level might help in the noninvasive diagnosis of low-turnover osteodystrophy (LTO). METHODS: This study was performed in 35 patients with chronic renal failure on hemodialysis therapy who underwent bone biopsy for a histological, histomorphometric, and histodynamic study. In addition, blood samples were obtained for intact PTH, 1-84 PTH, and total PTH assays. PTH 7-84 level was obtained from the difference between total and 1-84 PTH assay results. RESULTS: Nine patients had LTO (8 patients, adynamic bone disease; 1 patient, osteomalacia), 12 patients had hyperparathyroidism (HP), and 14 patients had mixed osteodystrophy (MO). On average, 1-84 PTH levels were approximately 60% of mean values for intact PTH. The two assays were strictly correlated. Average 1-84 to 7-84 PTH ratios were 1.57 +/- 0.85, 1.73 +/- 1.31, and 1.95 +/- 2.1 in the three histological groups (LTO, HP, and MO, respectively), with no significant difference. CONCLUSION: Contrary to previous expectations, results do not favor the hypothesis of a role of 7-84 PTH in bone resistance in renal osteodystrophy. The 1-84 to 7-84 PTH ratio is not a marker of LTO and is of no use in noninvasive histological diagnosis.

Renal osteodystrophy in predialysis and hemodialysis patients: comparison of histologic patterns and diagnostic predictivity of intact PTH.

BACKGROUND: Comparison of renal osteodystrophy in predialysis and hemodialysis has been rarely reported. Distinct patterns of renal osteodystrophy could be found in these conditions. In addition the use of parathyroid hormone (PTH) and other markers for noninvasive diagnosis may result in different predictive values in predialysis and hemodialysis patients. METHODS: 79 consecutive patients with conservative chronic renal failure and 107 patients on hemodialysis were studied. All patients were subjected to bone biopsy for histological and histomorphometric evaluation. The patients had no exposure to aluminium before dialysis and relatively low exposure while on hemodialysis. RESULTS: In the predialysis patients, bone biopsies showed 9 cases of adynamic bone disease (ABD) and 8 cases of osteomalacia (OM), 50 patients with mixed osteodystrophy and 2 cases of hyperparathyroidism. Among the hemodialysis patients 12 cases had ABD, 3 cases OM, 30 mixed osteodystrophy, and 61 patients hyperparathyroidism. In the predialysis patients with chronic renal failure, bone aluminium was on average 4.5 mg/kg dry weight, while in dialysis patients the average value was 35.4 mg/kg dry weight. Discriminant analysis of low turnover osteodystrophy (ABD and OM) by intact PTH showed higher accuracy in dialysis than in predialysis patients. Correlation studies of intact PTH versus bone formation rate, osteoblast surface/bone surface and osteoclast surface/bone surface showed significantly steeper slopes in dialysis than in predialysis patients, which indicates that bone resistance to PTH is more marked in predialysis patients. CONCLUSIONS: The prevalence of ABD and OM in the geographic area investigated is lower than in other reports. Aluminium exposure does not seem to be the cause of low turnover osteodystrophy in the present population. The predictive value of intact PTH in the noninvasive diagnosis of renal bone disease is higher in hemodialysis patients than in predialysis patients. Predialysis chronic renal failure, when compared to the dialysis stage, seems to be characterized by resistance of bone tissue to PTH.