Smoking trends in Italy from 1950 to 2000.

STUDY OBJECTIVE: To assess how the prevalence of smokers in Italy from 1950 to 2000 has changed, in parallel with law development and the growing attention towards smoking prevention. DESIGN, SETTING, AND PARTICIPANTS: Historical data on smoking trends have been obtained using data collected in 2000 by the National Institute of Statistics. A correction coefficient is proposed to overcome the bias of differential mortality reported in other papers. The sample is made up of 102 261 people aged 15-69 years. MAIN RESULTS: A general downward trend is seen; there is a more pronounced decrease starting from 1975 to 1980. In both sexes the peak prevalence tends to decrease according to the birth cohort because of the earlier age in which they gave up. A partial exception to the decline of tobacco use in recent years may be made for the 15-19 year-old age group, which has remained stable since 1990. CONCLUSIONS: Although a comprehensive community programme against tobacco was not developed, the different prevention actions implemented in Italy have contributed to a change in attitude and behaviour. The effect of tobacco control strategies implemented in Italy until now is more evident in relation to the breaking of the smoking habit, which happens at an increasingly younger age, although it is not clear how much it is able to prevent people from starting smoking.

Body composition in coeliac disease adolescents on a gluten-free diet: a longitudinal study.

Our aim was to evaluate body composition in a group of coeliac disease adolescents on a gluten-free diet and to re-examine them at the end of the adolescence spurt. We studied 48 patients (group 1A), 30 age-matched healthy controls (group 2A), 11 group 1A patients after 4 years (group 1B) and 11 adolescents who were age- and sex-matched with group 1B (group 2B). Weight, height, bone mineral content, fat mass, fat-free mass (FFM) and bone mineral density were evaluated using dual-energy X-ray absorptiometry. All parameters were lower in group 1A than in group 2A subjects ( p<0.001). After 4 years, the body compartments of group 1B coeliac disease patients normalised, except for weight and FFM which remained lower than in group 2B subjects ( p<0.005). In conclusion, our study demonstrates that adolescence is a period where some parameters of body composition can still be recovered.

[Nutritional status, obesity and metabolic control in children with type 1 diabetes mellitus]. / Stato nutrizionale, obesità ed equilibrio metabolico in soggetti in età evolutiva affetti da diabete mellito di tipo 1.

BACKGROUND AND AIMS: The aim of this study was to evaluate the nutritional status of children with type 1 diabetes and to search for possible influences of changes in body composition on aspects of diabetes. METHODS: A group of 96 diabetic subjects (41 males and 55 females) were studied, aged between 3 and 19 years old. The following parameters were examined: weight, stature, 5 skin folds, 7 circumferences, bioelectric impedance, arterial pressure, cholesterolemia, triglyceridemia, insulin dose, HbA1c and duration of disease. RESULTS: Obesity and overweight were present in 34.5% of the sample, but obesity was only observed in females (25.5%). There was also a high percentage of underweight subjects (11.5% of the entire sample). The mean values of weight BMI, 5 skin folds, 4 circumferences, FM (calculated using fold measurement and BIA) and AFA were higher in females, whereas mean values of waist/hip ratio and waist/thigh ratio and FFM (in % of body weight) were higher in males. A close correlation was also found between the 4 weight classes (underweight, normal weight, overweight, obese) and the majority of marker parameters for adiposity (5 folds, 4 circumferences, BIA, FM calculated using BIA, fold measurement and AFA). Of the other parameters examined (mean duration of disease, HbA1c assay, daily insulin dose, total cholesterolemia, triglycerididemia, arterial pressure), only the daily insulin dose showed higher values in females in 3 weight classes (underweight, normal weight and obese). Following a comparison with the control population (2469 subjects), higher mean values were found in the latter compared to diabetic subjects, but only in relation to 3 skin folds (tricipital, subscapular and suprailiac) and one circumference (forearm). CONCLUSIONS: The study shows a high frequency of overweight and obesity in children with type 1 diabetes, comparable to that in the healthy population. The finding of a higher frequency of obesity in diabetic females might be explained by their advanced puberal status, given that almost all the obese diabetic females were aged between 10 and 19 years old. The study confirms the validity of a number of anthropometric measurements (BMI, folds, circumference) and BIA in the evaluation of nutritional status in terms of body composition.

[Nutritional status, obesity, and metabolic balance in pediatric patients with type I diabetes mellitus]. / Stato nutrizionale, obesità ed equilibrio metabolico in soggetti in età evolutiva affetti da diabete mellito di tipo 1.

BACKGROUND AND AIMS: The aim of this study was to evaluate the nutritional status of children with type 1 diabetes and to search for possible influences of changes in body composition on aspects of diabetes. METHODS: A group of 96 diabetic subjects (41 males and 55 females) were studied, aged between 3 and 19 years old. The following parameters were examined: weight, stature, 5 skin folds, 7 circumferences, bioelectric impedance, arterial pressure, cholesterolemia, triglyceridemia, insulin dose, HbA1c and duration of disease. RESULTS: Obesity and overweight were present in 34.5% of the sample, but obesity was only observed in females (25.5%). There was also a high percentage of underweight subjects (11.5% of the entire sample). The mean values of weight BMI, 5 skin folds, 4 circumferences, FM (calculated using fold measurement and BIA) and AFA were higher in females, whereas mean values of waist/hip ratio and waist/thigh ratio and FFM (in % of body weight) were higher in males. A close correlation was also found between the 4 weight classes (underweight, normal weight, overweight, obese) and the majority of marker parameters for adiposity (5 folds, 4 circumferences, BIA, FM calculated using BIA, fold measurement and AFA). Of the other parameters examined (mean duration of disease, HbA1c assay, daily insulin dose, total cholesterolemia, triglycerididemia, arterial pressure), only the daily insulin dose showed higher values in females in 3 weight classes (underweight, normal weight and obese). Following a comparison with the control population (2469 subjects), higher mean values were found in the latter compared to diabetic subjects, but only in relation to 3 skin folds (tricipital, subscapular and suprailiac) and one circumference (forearm). CONCLUSIONS: The study shows a high frequency of overweight and obesity in children with type 1 diabetes, comparable to that in the healthy population. The finding of a higher frequency of obesity in diabetic females might be explained by their advanced puberal status, given that almost all the obese diabetic females were aged between 10 and 19 years old. The study confirms the validity of a number of anthropometric measurements (BMI, folds, circumference) and BIA in the evaluation of nutritional status in terms of body composition.

Antituberculosis drug-resistance surveillance as a tool for tuberculosis control programmes: a retrospective study.

The aim of this study was to verify the suitability of antituberculosis (antiTB) drug-resistance surveillance as a tool for tuberculosis (TB) control programmes at local level. A retrospective study reviewing laboratory records and medical records of TB patients referred to Udine Hospital between 1981 and 1995 was analysed. The initial susceptibility pattern for each Mycobacterium tuberculosis isolate was recorded. It was found that between 1981 and 1995, 899 M. tuberculosis strains underwent susceptibility testing for four first-line drugs. Over a period of 15 yrs the annual number of M. tuberculosis strains initially decreased and then stabilized. Overall, 15.3% of the 899 strains showed initial resistance to at least one first-line drug, and 2.8% to two or more first-line drugs. Streptomycin-resistant strains were the most commonly observed (10.8%), with resistance to isoniazid, rifampicin and ethambutal shown to be 6.4, 1.0 and 0.4%, respectively. Multidrug resistant (MDR)-TB was observed in only five cases. An additional four cases eventually developed secondary MDR-TB during the follow-up. The proportion of resistant strains did not vary significantly over time. Recurrent TB disease was significantly associated with resistant strains (odds ratio = 3.59, p < 0.01). Only one patient had a documented human immunodeficiency virus (HIV)-positive serology. All six patients who developed MDR-TB during or after treatment, were suffering either from chronic alcoholism or from a psychotic disorder. In the study it was shown that recurrent tuberculosis cases, tuberculosis patients with behavioural problems (i.e. alcoholism, psychiatric disorder) and patients presenting with primary resistant Mycobacterium tuberculosis strains are at risk of multidrug-resistant tuberculosis and may thus benefit from the directly observed treatment approach, which has been proposed as a mainstay in tuberculosis control programme strategy.

[Lactitol in chronic idiopathic constipation in children]. / Il lattitolo nella stipsi cronica idiopatica del bambino.

Fifty-one children affected by chronic idiopathic constipation (23 males, 28 females), ranging in age from 8 months to 16 years were enrolled in the study; 42 completed the trial. The patients were divided into two groups: Group A: 19 children treated with lactitol (250-400 mg/kg/day); Group B:23 patients treated with lactulose (500-750 mg/kg/day). Parents filled a questionnaire concerning clinical response to therapy for a period of 30 days. In 17 Group A children and in 17 Group B children orocecal transit time using H2 Breath Test with lactulose was performed. A statistically significant increase of week stool frequency was found after treatment both with lactitol or lactulose (p < 0.001). Nevertheless Group B patients complained abdominal pain (p < 0.005) and flatus (p < 0.001) more frequently. Other adverse reactions, such as vomiting and meteorism, were more frequent in Group B patients (n.s.). In addition patients treated with lactitol found that sugar as more palatable and had a better compliance to the therapy. Orocecal transit time did not show statistically significant differences after the therapy with both these sugars, indicating that the activity of lactulose and lactitol occurs in the colon and that small bowel functions are not affected by a previous therapy with these sugars. In conclusion, our study demonstrate that lactitol, because of the less number of side effects compared to lactulose, should be considered as an useful agent in the treatment of chronic idiopathic constipation in childhood.

Nutritional epidemiology during school age.

Nutritional research covers different fields, two of which are of particular interest: evaluation of the nutritional status, and epidemiology of food consumption. For many years, studies in these fields have been promoted by our research group, which bases its methodology on anthropometric measurements, bioelectrical impedance measurements, and check of nutritional habits. Our studies involve more than 2500 subjects from pre-school age to adolescence. This work represents the basis for an educational approach with the ultimate aim of improving life styles. One of our first studies on school meals during nursery period and composition and application of "dietary tables" showed inadequacies of energy intakes and macronutrients distribution. In another study, aimed to evaluate the intake of soluble sugars, more than 2/3 of participating school children were found to consume more than 70 g of soluble sugars per day, while 10% of them exceeded 150 g/day. Results of the following study, in which special attention was given to salted and sweet snacks, showed that snacks can account for 34% of the total daily energy intake; although its adequacy, the energy distribution per macronutrients showed a clear imbalance. As for adolescence, a very critical age, the evaluation of weight self-perception revealed that only 62% of them had a correct perception of their weight. This research also devoted special attention to home prepared breakfast, which is consumed by the vast majority of enrolled subjects, although only rarely it is nutritionally adequate. A double age-related trend could thus be drawn: on one side, there is the tendency of the "overweight status" to decrease (from a starting-point of about 20%); on the other side, this tendency is unfortunately compensated by the increasing trend of "obesity" (which almost reaches 30%).

[Retrospective study on weaning in Rome and its province. Results and critical considerations]. / Indagine retrospettiva sul divezzamento a Roma e provincia. Risultati e considerazioni critiche.

The authors report and comment on the results of an epidemiological retrospective study on weaning. The study was performed in Rome and its province through the administration of a structured interview to the parents of 851 children, aged between 6 months and 3 years. Data show that most children are correctly weaned, in terms of both timing and quality of foods. In some cases, however, incorrect dietary habits were found, such as: too early (usually together with too early administration of gluten-containing foods) or too late weaning, and use of cow's milk instead of follow-up formulae during the second semester of life. Data presented here show that the early weaning significantly correlates with a maternal low degree of education and short period of breast-feeding. On the basis of their data and according to the international literature, the authors present some new weaning suggestions: these could help decrease the present gap between recommended dietary allowances and real consumption in this age group.

[Prevalence of lactose malabsorption in Roman school children. A H2 breath test study using a cow's milk]. / Prevalenza del malàssorbimento del lattosio in una popolazione scolastica romana. Un'indagine mediante H2 breath test con latte vaccino.

The aim of this study was to evaluate the prevalence of lactose malabsorption in a population of 75 (43 males, 32 females) apparently healthy school-children using the H2 breath test with cow's milk. The children, ranging in age from 8 years and 6 months to 15 years and 2 months (mean: 11 years, 7 months) were divided into 2 age groups: Group I (no. = 26): age < 11 years and Group II (no. = 49): age > 11 years. After on overnight fasting, lasting at least 8 hours, samples of expired air were collected at 0 time and at 30-min intervals following the administration of 250 ml cow's milk for a total time of 3 hours. The H2 breath concentration was then measured by gas chromatography (Micro-Lyzer Quintron Instruments Company mod. 12). A net rise of more than 20 ppm H2 was considered as lactose malabsorption. Subjects with symptoms such as excessive flatulence, abdominal pain, or diarrhoea, were considered as lactose intolerant. Two-hundred and 50 ml of cow's milk (12 g of lactose) was considered a more physiological vehicle than the traditional lactose aqueous solution. The examined children, all on free diet, showed a fasting alveolar from 0 to 43 ppm (mean +/- SD = 7.9 +/- 7.6). Sixty-six children out of 70 (93.3%), who completed the test had a total absorption of lactose. Two out of 4 children with lactose malabsorption originated from areas (East Africa and Central America), where a high incidence of this metabolic disorder is a characteristic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

[The evaluation of body composition in children by anthropometry and impedance measurement]. / Valutazione della composizione corporea nel bambino mediante antropometria ed impedenziometria.

Several anthropometric parameters (weight, height, thickness skinfolds, and body circumferences) together with the bioelectric impedance (BIA) were measured in a group of 407 healthy prepuberal children (205 males, mean age +/- SD: 6.8 +/- 1.6 years; 202 females, mean age +/- SD: 6.6 +/- 1.6 years) who did not practice any competitive sport. The group was divided into six weight classes (underweight to obese 3). The average values of the anthropometric data, BIA, FM (which is derived from the thickness skinfolds and BIA), TBW (derived from BIA), AFA and AMA (both derived from the forearm circumference and triceps skinfold) were all evaluated in relation to sex and weight classes. The average values of all the measured thickness skinfolds, FM and AFA were higher in the females. When considering the body circumferences, only the wrist circumference showed a statistically significant difference between sexes, being higher in males. In contrast both the rates waist/hips circumferences and waist/thigh circumferences were higher in males. As far as the BIA and FM average values is concerned, these were higher in females. The average value of FM derived from measuring the thickness skinfolds (males = 17.65 +/- 4.89%: females = 23.81 +/- 4.72% of body weight) proved higher than that one derived from BIA (males = 17 +/- 9.02%; females = 19.27 +/- 9.18%). The analysis of anthropometric and BIA data in relation to the weight classes showed significant variations of the mean values, except the rates waist/hips circumferences and waist/thigh circumferences. Therefore our data seem to exclude the presence of any difference of the fat distribution between sexes in paediatric age.(ABSTRACT TRUNCATED AT 250 WORDS)

Beta 2-microglobulin levels in celiac disease.

The serum levels of beta 2-microglobulins (beta 2-m) were studied in 65 celiac children. Significant statistical differences (p less than 0.05) were found between the values of patients on a gluten-containing diet (mean +/- SD, 1.92 +/- 0.64 mg/L) and those on a gluten-free diet for less than (mean +/- SD, 2.38 +/- 0.76 mg/L) or greater than (mean +/- SD, 1.46 +/- 0.77 mg/L) 8 months. A significant difference was also found between the first group and the 15-subject control group, who underwent intestinal biopsy for low stature or chronic diarrhea but had normal intestinal mucosa (mean +/- SD, 1.56 +/- 0.42 mg/L). Serum beta 2-m levels were above normal values (less than 2 mg/L) in 10 of 26 (38.5%) celiac patients on a gluten-containing diet and in two of 15 (13.3%) subjects of the control group. The beta 2-m values of patients on a gluten-free diet for less than or equal to 8 months were significantly different (p less than 0.001) from those of patients on a gluten-free diet for greater than 8 months, as well from those of the control group. No significant differences were found between patients on a gluten-free diet for greater than 8 months and the control group. A significant correlation between the antigliadin antibody (AGA) IgA and beta 2-m in the patients on a gluten-free diet for greater than 8 months and control-group patients was found.(ABSTRACT TRUNCATED AT 250 WORDS)

[Nutrition and behavior in pediatrics]. / Alimentazione e comportamento in pediatria.

The influence of diet on human behaviour was first postulated several centuries ago, albeit in terms of a magical interpretation of life. Due to our improved knowledge of the basic science, we are now able to provide experimental proof to support this concept. Some opinions, which were once believed to be true, have now been disproved, whereas others have been reconfirmed in physiological terms. This paper aims to evaluate the state of the art in particular with regard to pediatrics. It is now certain that some amino-acids in the diet can influence brain activity by enhancing or reducing the metabolic rates of different neurotransmitters. A modulating effect on the brain has even been suggested with regard to some vitamins and minerals, but data on this aspect are still under evaluation. On the other hand, no data have yet been reported to support the hypothesis of a specific etiological role played by any nutrient in the development of behavioural disturbances.

Radiological changes of the ileum in children with coeliac disease: is "intestinal adaptation" a specific radiographic sign?

We retrospectively reviewed the radiographic findings of 86 children with chronic diarrhoea and/or short stature. Radiographic small intestine examination showed morphologic changes characteristic for the malabsorption syndrome in 58 children with coeliac disease on a gluten-containing diet. In addition, 32 (55%) of these children showed "intestinal adaptation" or "jejunalization" (increase in the number and thickness of the folds). In the control group (28 children, cross-matched) 11 (39%) presented non specific radiological changes while the others presented a normal mucosal pattern. No features of "intestinal adaptation" were noted. No significant differences between CD patients with and without "intestinal adaptation" were found in the evaluation of the nutritional status, including serum levels of albumin, iron, transferrin, ferritin and zinc, and in the results of the one-hr xylose test and 72-hr faecal fat absorption test, and anti-gliadin antibody levels (IgA and IgG). No significant correlation was noted between the duration of gluten-containing diet and the presence of "intestinal adaptation". It appears that "intestinal adaptation" lends specificity to the radiographic small intestine examination, also in paediatric practice.

[Cutis laxa syndrome. Clinical, histologic and ultrastructural study of a new variant]. / Sindrome della cutis laxa. Studio clinico, istologico ed ultrastrutturale di una nuova variante.

Cutis laxa (generalized elastolysis) is a rare systemic disorder of connective tissue, whose elastic fibers appear fragmented and disorganized. The present study reports an undescribed form of cutis laxa in an infant male with loose and inelastic skin, osteoporosis, pulmonary emphysema and dislocation of the hip. The clinical features and the inheritance patterns of the various forms of cutis laxa are also discussed.

Iron deficiency in children with celiac disease.

To evaluate the incidence of either evident anemia or a subclinical status of iron deficiency in celiac disease (CD), we studied 80 celiac children aged 6 months to 18 years. They were subdivided into various groups according to morphology of gut mucosa and diet. Only eight of 47 celiac children had an evident anemia at the time of the first peroral bowel biopsy. In addition, 51% of the patients with atrophic mucosa and 56% of the children on a gluten-containing diet had serum iron levels less than 50 micrograms/dl; 35% of patients of both groups had serum ferritin levels less than 12 micrograms/L. On the contrary, only a small number of children with normal mucosa on a gluten-free diet showed a laboratory, subclinical picture of iron deficiency. The results of our study can therefore be summarized in three major items: (a) Low levels of both serum iron and ferritin can frequently be found during active CD. (b) Regular determination of serum iron levels appears to be useful in controlling the state of iron stores in such patients, as well as in deciding whether and when to recommend temporary iron supplementation. (c) Serum ferritin tests did not offer more information than the easier and cheaper serum iron determinations.