Epicardial fat thickness: threshold values and lifestyle association in male adolescents.

BACKGROUND: Obese adolescents with high proportion of visceral fat are at higher risk of developing the metabolic syndrome. OBJECTIVES: The study aims to investigate if echocardiographic epicardial fat thickness (EF) could be predictive of visceral obesity (VO) early in life and to provide EF threshold values specific for male adolescents. Further aim was to investigate the association between EF, lifestyle and metabolic disease familiarity. METHODS: Anthropometric data were collected from 102 normal weight and overweight, healthy male adolescents (mean age: 14.91 ± 1.98 years); bioelectrical impedance analysis and transthoracic echocardiogram were performed in the same sample. Each participant fulfilled a validated self-administered lifestyle questionnaire. RESULTS: We found higher EF values in sedentary adolescents (P < 0.05), in those who never eat fruit and vegetables (P < 0.05), and in those with overweight mothers (P < 0.05). The strongest independent predictor of EF was waist circumference (P < 0.0001). Using the waist to height ratio as a marker of VO, logistic regression analysis revealed that 1 mm EF gain is responsible for seven times higher VO risk (P < 0.0001). Receiver Operating Characteristic (ROC) analysis showed that the optimal cut-off for EF thickness associated to youth VO is 3.2 mm. CONCLUSION: Ultrasonography EF measurement might be a second-level assessment tool, useful to detect early cardiometabolic damage stage.

Nutritional status, dietary habits, nutritional knowledge and self-care assessment in a group of older adults attending community centres in Pavia, Northern Italy.

BACKGROUND: The population of industrialised countries is ageing as a consequence of an increase in life expectancy. As a result of the increasing ageing process, the assessment of nutritional status and dietary habits, as well as the assessment of self-care, is needed to plan selected actions aimed at improving the quality of life in the third and fourth life spans. METHODS: A cross-sectional study was carried out on a randomly selected sample of 200 healthy older adults (≥65 years old), attending community centres for older people in Pavia, Northern Italy. Ninety-two percent of the recruited subjects participated in the survey. Anthropometric measurements and the Mini Nutritional Assessment were performed. Dietary habits, nutritional knowledge and self-care were investigated using a questionnaire administered by two dietitians. RESULTS: The majority of subjects were low socio-economic status and overweight [mean (SD) body mass index = 28.4 (4.3) kg/m(2) ], 12% were malnourished according to their Mini Nutritional Assessment score and the majority of the arm muscle circumference measurements were below the 10th percentile, predicting accelerated loss of lean mass, even in the healthy independently living older adults. Only 30% of the sample had adequate dietary habits, whereas the ability to self-care was good for the whole sample. CONCLUSIONS: The unhealthy and unbalanced diet, frequently too rich in sugar and fats and low in protein intake, might explain being overweight and the loss of lean mass in the study subjects.

Effect of dietary glycemic index on food intake, adiposity, and fasting plasma ghrelin levels in animals.

BACKGROUND: An increase in lipid storage as a consequence of feeding animals with high-glycemic index (GI) diets has been observed by many authors. Ghrelin is one of the most important orexigenic hormones, and curiously, its fasting plasma levels are decreased in human obesity. AIM: As ghrelin secretion is affected by insulin concentration, we hypothesized that carbohydrates with different glycemic responses might influence fasting plasma ghrelin levels. MATERIAL AND METHODS: Twenty rats were divided into two groups and fed ad libitum a low-GI or a high-GI diet for 21 days. RESULTS: In rats fed a high- vs low-GI diet we observed: increased food intake (18.9+/-0.6 vs 16.4+/-2.0 g/day; p<0.01), increased weight gain (28.8+/-6.6 vs 16.4+/-6% of initial weight; p<0.01), higher relative weight of epididymal fat pads (1.7+/-0.4 vs 1.4+/-0.3%; p=0.05), but lower total fasting ghrelin levels (41.1+/-10.7 vs 59.5+/-9.8 pg/ml; p=0.05). CONCLUSIONS: Ghrelin appeared to be downregulated in rats fed a high-GI diet; this observation could be related to the higher food intake and fat mass observed in these rats and to the effects of insulin response on ghrelin levels.

Nutritional assessment of elderly people.

Since today's society is characterised by an increase in the number of elderly persons, who are subject more than any other group to an alteration in their state of nutrition, in this review we propose the possible methods that can be used for an accurate nutritional diagnosis in this age group. Considering that malnutrition, sarcopenia and motor disability are factors that are more likely to occur with aging, it is extremely important for certain clinical anamnestic parameters, such as biohumoral and anthropometric indicators, but also specific tables and questionnaires, to become standard routine practice in health care in order to facilitate the diagnosis of these possible events.

Quality of life (QoL) and motivation for treatment: a female issue?

OBJECTIVE: The Quality of Life (QoL) of overweight and obese subjects is a widely discussed topic. From numerous studies, it emerges that obese persons suffer significant damage as result of their overweight in terms of QoL with regard to their physical and psychosocial well-being, with greater incidence associated with the degree of obesity. Our study aims at evaluating the usefulness of specific psychometric tests on the "obese population" that may be effective for the overall evaluation of the patient and in identifying specific subgroups on the basis of psychometric characteristics relating to QoL and of motivation for treatment. METHODS: The study was carried out on a sample of 150 obese subjects who approached the Section of Human Nutrition of the University of Pavia requesting treatment for weight loss. The persons in the selected sample were subjected to a specialized examination during which, as well as collecting all the anamnestic information on each individual patient, they were also asked to fill out the obesity-specific ORWELL 97 (Obesity Related Well- Being) questionnaire and the DBI (Decisional Balance Inventory) questionnaire. RESULTS: An analysis of the results indicates that the female group is strongly characterized by a lower QoL, as well as by a clearly larger number of failed dieting attempts and by a strong motivation to undergo treatment. CONCLUSIONS: The evaluation of QoL and motivation for treatment in overweight and obese individuals appears to be an effective tool for better identification of the subjects and for planning the most appropriate diagnostic approach.

Overweight and blood pressure: results from the examination of a selected group of adolescents in northern Italy.

OBJECTIVE: The aim of the present study was to investigate blood pressure (BP) levels and their relationship with different indices of body fat in a group of adolescents, in order to evaluate the prevalence of hypertension and plan preventive and corrective strategies. DESIGN: Cross-sectional study in primary care. SETTING: All high schools in the Aosta Valley region, northern Italy. SUBJECTS: Five hundred and thirty-two adolescents of both sexes, aged 15.4 (standard deviation 0.7) years. The following parameters were measured: body weight, body height, body mass index (BMI), four skinfold thicknesses, body fat mass, waist and hip circumferences and BP. RESULTS: BMI data indicated a high prevalence of overweight subjects in both sexes, but higher in males, while the prevalence rate of obese adolescents was lower. Of the total, 11.8 % of subjects suffered from systolic hypertension, while 6.9 % suffered from diastolic hypertension. In linear correlation analysis, BMI and all adiposity indices, except waist:hip ratio, were found to be significantly associated (P ranging between 0.05 and 0.001) with both systolic BP and diastolic BP in both sexes, with r ranging between 0.152 and 0.359. Multiple regression analysis with the stepwise method showed BMI and body fat mass to have the strongest association (P < 0.001) with BP, with r ranging between 0.275 and 0.359. CONCLUSION: Unless reversed, these conditions are worrying and predict the possible development of cardiovascular disease in adulthood. There is a pressing need to develop a comprehensive medical and nutrition plan, together with preventive and corrective strategies, in school programmes.

[Hypocaloric diet and normocaloric diet in outpatient treatment in a group of children and adolescents]. / Dieta ipocalorica e dieta normocalorica nel trattamento ambulatoriale dell'obesità infantile.

OBJECTIVE: The epidemic of obesity, mostly in pediatric age, is of increasing concern because of the impact of overweight on health status in adult life. We have evaluated the impact of two regimens (balanced hypocaloric diet or balanced normocaloric diet) in a group of children ad adolescents. MATERIAL AND METHODS: We have studied 260 patients seen at a community pediatric clinic. Of these, 45 overweight, 35 obese and 6 patients with normal weight were selected. The subjects were assigned to a hypocaloric balanced diet plus lifestyle changes or a normocaloric balanced diet plus lifestyle changes. MAIN RESULTS: In the obese patients on a hypocaloric diet, 64% of subjects remained in the "obese" category and 14% decided to shift to the "normocaloric diet". Also, the drop-out rate was 12%. In the obese patients on a normocaloric diet, 38% remained in the obese category, while 46% showed a reduction of their BMI to the "overweight" category. Moreover, the drop-out rate was lower (5%). CONCLUSION: These findings suggest that a more gentle approach to obesity/overweight in pediatric patients, with less restrictive nutritional interventions, could achieve a better compliance of the family, with a consistent reduction of overweight.

Assessment of dietary intake of polychlorinated biphenyls from a total diet study conducted in Pavia, Northern Italy.

The diet is considered to be the main source of body burden of polychlorobiphenyls (PCBs) in the general population. The most cost-effective and reliable way to estimate the dietary intake is based on total diet studies (TDSs). The aim of the present study was to provide a reliable estimate of recent average dietary intakes of PCBs in Northern Italy. Congener-specific analysis of PCBs was undertaken on total diet samples collected at the cafeteria of the University of Pavia. The average daily intake for total PCBs was calculated to be 0.26 microg/person day-1. The major contributor to PCB intake was accounted for by pooled samples of bread, cereals and potatoes, followed by the protein composite, and fruit and vegetables. Although diverse dietary habits and differences in sampling and analytical procedures make comparison between different studies difficult, the daily intake of PCBs in Northern Italy can be located in the lower part of the range for values reported in the literature.

BMI values and other anthropometric and functional measurements as predictors of obesity in a selected group of adolescents.

BACKGROUND: Obesity is well known to be a problem all over the world: WHO data report that one billion subjects are overweight and 300 million are obese. Epidemiological data (IOTF) show that prevalence rates are increasing not only in industrialized countries, but also in developing countries, especially as far as the adolescent population is concerned. AIM OF THE STUDY: To select adolescents at risk of obesity by BMI calculation and by other anthropometric and functional measurements in the Aosta Valley Mountain Region (Northern Italy). METHODS: 532 adolescents were recruited and participated in the study (254 males and 278 females, aged 15.4 +/- 0.7). According to standard methods, the following parameters were measured: weight and height for BMI calculation, four skin folds (mid-triceps,mid-biceps, subscapular and supra-iliac) to compute body fat mass,waist and hip circumferences, systolic (SBP) and diastolic (DBP) blood pressure. Parental weight and height, educational and socio-economic status were requested from the parents using a questionnaire. RESULTS: Percentages of overweight and obese boys were 20.9% and 4.7% respectively, and percentages of overweight and obese girls were 14.7% and 1.1% respectively (using Cole's cut off point reference standard). Mean body fat mass percentages (males = 19.3 +/- 5.6%, females 23.3 +/- 4.4%) showed males at risk of obesity, as indicated by a higher prevalence rate of overweight and obesity in this gender. Positive correlations (p <0.01) were found between BMI and the following parameters: mid-triceps skinfolds, body fat mass percentage,waist and hip circumferences, but no correlation emerged with WHR; body fat mass positively correlates (p <0.01) with waist and hip circumferences; students' BMI positively correlates with blood pressure (p <0.01),with parental BMI and shows a positive trend towards parental low education and socioeconomic levels. CONCLUSIONS: Overweight and obesity prevalence rates are higher in males than in females according to literature data; family influences weight condition. The correlations that emerged show that BMI is a good adiposity index also in adolescents, it acts as an indicator of cardiovascular risk condition and is influenced by parental BMI.

An evaluation of a colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys.

OBJECTIVE: To test the validity of a colour food photography atlas for quantifying portion size eaten compared with weighed foods. DESIGN: The colour food photography atlas was prepared by cooking, weighing and taking digital photographs of three portion sizes of 434 foods and beverages typical of the Italian diet. SUBJECTS AND INTERVENTIONS: In all, 448 male and female volunteers aged 6-60 y from a wide variety of social backgrounds completed 9075 assessments of food portions eaten at lunch and dinner in relation to a set of colour food photographs during 8 weeks of investigation. The amounts of foods eaten by individuals in five different cafeterias in Pavia, Northern Italy, were weighed by trained investigators at the time of serving and, within 5-10 min of the end of the meal, each subject was asked to quantify all foods consumed with reference to one of the three food photographs or in terms of virtual portions among those shown in the photographs. RESULTS: Multiple regression analysis shows that weights of portion sizes chosen from the set of photographs are significantly associated (P<0.05) to weights of eaten portions (beta=0.81; R(2)=0.70) and are independent of age, gender and BMI. The differences between mean weights of the portions chosen by individuals from photographs and mean weights of eaten foods are significant for all food categories (P<0.05), except for bread. However, because of the very large number of observations, the mean differences are very small (range: from +23.2 g (+11.2%) for first courses to -1.3 g (-2.7%) for bread). Bland-Altman plots show that first courses limits of agreement are wide because the dispersion is increasing while weights are rising. CONCLUSIONS: The use of a series of three photographs and virtual portion sizes being associated with relatively small errors, our findings support the validity of using this colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys on different age groups of Italian subjects.

[Nutritional management of patients suffering of chronic renal failure]. / La terapia nutrizionale nel nefropatico non dializzato.

Nutritional support constitutes a fundamental approach to favour the management of chronic renal failure and to postpone the need of kidney dialysis. The specific goals of the nutrition intervention are: control of protein intake, control of phosphate and of calcium intake, control of potassium intake, control of energy intake, control of lipid intake with clear identification of the polyunsaturated vs monounsaturated vs saturated fatty acid rate, control of vitamin intake, prevention of malnutrition and intervention with oral supplements or artificial nutrition (even if for short time) if malnutrition occurs. The proper management of the nutritional problems of patients with chronic renal failure slows the disease progression, prevents or controls symptoms associated with uremia and postpones the beginning of substitutive treatment that is of hemodialysis or of peritoneal dialysis, thus allowing a better quality of life either in the short or long term for patients suffering of chronic renal failure.

Validation of the Dutch Eating Behaviour Questionnaire parent version (DEBQ-P) in the Italian population: a screening tool to detect differences in eating behaviour among obese, overweight and normal-weight preadolescents.

OBJECTIVE: To validate the Dutch Eating Behaviour Questionnaire Parent version (DEBQ-P) in the Italian population and investigate the differences in eating behaviour among Italian normal-weight, overweight and obese preadolescents. DESIGN: A cross-sectional validation study. Participants were measured and the approved translation of the questionnaire was administered to their parents. SETTING: : Three school communities in the province of Bergamo, Northern Italy. SUBJECTS: A total of 312 preadolescents (mean age 12.9 y; s.d. 0.8, both sexes) from three secondary schools of the province of Bergamo, Northern Italy, and their parents were invited to participate to the study. Informed written consent was obtained from each subject and their parents. Students were measured and their parents filled in the approved translation of the DEBQ-P. Recruitment was opportunistic and school based. RESULTS: Factor and internal consistency analysis confirmed the factor structure of the DEBQ-P and the high internal consistency of its three scales. Variance analysis showed that eating behaviour of Italian normal-weight, overweight and obese preadolescents differs significantly only in regards to the 'restrained eating' scale (F 19.29, P < 0.001), with overweight and obese scoring higher. CONCLUSIONS: The DEBQ-P can be used for screening projects regarding eating behaviour in the Italian population. The association between restrained eating and weight status was confirmed for both sexes, but the relationship between external eating and emotional overeating and overweight requires further exploration.

Reliability of a dietary questionnaire on food habits, eating behaviour and nutritional knowledge of adolescents.

OBJECTIVE: To develop a dietary questionnaire on food habits, eating behaviour and nutrition knowledge of adolescents and to examine its reliability. DESIGN: A cross-sectional baseline survey. The questionnaire was self-administered to study participants twice with 7 days between each administration. SETTING: A school community in Pavia, Italy. SUBJECTS: A group of students (n=72, aged 14-17 y, both sexes) studying in a secondary school in the second year of the course were invited to compile a dietary questionnaire during school time. Informed written consent was obtained from each subject and their parents. Subjects were initially recruited for a nutrition intervention; recruitment was opportunistic and school based. STATISTICAL ANALYSES: Reliability was assessed using the Cronbach's alpha and the Pearson correlation coefficients. RESULTS: Cronbach's alpha ranges from a minimum of 0.55 to a maximum of 0.75, indicating that only two sections have a poor internal consistency. The Pearson correlation coefficients range from a minimum of 0.78 to a maximum of 0.88, indicating a very good temporal stability of the questionnaire. All the Pearson correlation coefficients are statistically significant with P<0.01. CONCLUSIONS: The present questionnaire has the potential to measure the effects of nutrition interventions on adolescents because of its stability in making comparisons over time. The instruments is low in cost and easy to administer and analyse; moreover, it could be modified appropriately to fit the needs of other populations as well.

[Survey on environmental contamination in the total diet of an Italian population]. / Indagine sulla contaminazione ambientale nella dieta totale di una popolazione italiana.

This work is a review of the total diet studies carried out in the nineties in the area of Pavia in order to evaluate food exposure to some xenobiotics: heavy metals (cadmium, mercury, lead, nickel), polycyclic aromatic hydrocarbons (PAHs), pesticides and mycotoxins. The review shows that: total diet studies are the best tool to evaluate food exposure to xenobiotics; however, the studies utility depends both on the presence of an actual correlation between xenobiotic food exposure and xenobiotic concentration in human body and depends also on environmental distribution of the xenobiotic. It's the case of the mycotoxins which, characterised by a punctiform contamination, can be studied only with analytical studies on biological samples, e.g. human milk. The results point out that some groups of the population are at risk because of high xenobiotic food ingestions above the acceptable daily intakes. In conclusion, we suggest that total diet studies should be carried out in a more systematic way in order to obtain effective surveillance and preventive programmes, besides we underline that the definition of reference values may be of great utility.

[Reference concentrations of dietary consumption of xenobiotics]. / Concentrazioni di riferimento dell'assunzione alimentare di xenobiotici.

Total diet studies are the best tool to evaluate food exposure to xenobiotics. These studies are based on xenobiotic concentrations measured in foods that are related to food consumption data in order to obtain reliable assessment of xenobiotic food intakes. This work is a review of the main international literature and points out international, European and Italian data of xenobiotic food ingestion. In particular, it focuses on metals, trace elements, polycyclic aromatic hydrocarbons (PAHs) and some mycotoxin intakes in the total diet. Recorded data show that xenobiotic ingestion differs from nation to nation in relation to environmental pollution and contamination, geographical and climatic conditions, food habits and consumption. Therefore, in order to define reference values for xenobiotic food exposure, it is necessary to set up a monitoring and risk surveillance program by collecting data in a permanent and systematic way. Nevertheless, we have hypothesized some xenobiotic reference values for the area of Pavia based on local studies.

[Adolescent Body Mass Index data: what differences result using different reference standard curves?]. / Indice di Massa Corporea e adolescenti: quali le differenze utilizzando diversi standard di riferimento?

Childhood and adolescent obesity prevalence rates have steadily increased both in industrialised and developing countries in the last years. Data from literature show that BMI is an acceptable indicator to assess overweight and obesity also in children and adolescents. Different reference standard curves for BMI exist: the percentiles of Rolland-Chacherà, Luciano, the National Center for Health Statistics, Cole and Cacciari. Nevertheless, different cut off points are used by the authors to identify underweight, overweight and obesity. The aim of the present study was to investigate what differences can emerge when comparing adolescent BMI using different references standard curves. Five hundreds and thirty-five adolescent subjects, aged 15.4 +/- 0.7 years, were recruited in Aosta Valley (Northen Italy). BMI was calculated according to the following equation: BMI = weight/height2 (kg/m2). The data obtained were distributed according to BMI percentiles and than compared with references standard curves. The comparison shows different results especially when underweight, overweight and obesity are identified. In conclusion, it can be asserted that BMI is an useful indicator to assess adiposity (overweight and obesity) in adolescent, but one should be cautious when comparing results based on different references.

[Obesity etiology: role of leptin]. / Eziologia dell'obesità: il ruolo della leptina.

A huge interest in the scientific community has been aroused since leptin's discovery (from greek leptos=thin), due to its important role in the body energetic balance regulation. This protein is synthesized from ob gene and secreted by the adipose tissue when fat mass increases, decreasing hunger and increasing energy expenditure in order to restore energetic balance. In the latest years many human genetic studies have been conducted showing that sometimes obesity may be due to mutations of genes involved in energetic balance mediated by leptin. These findings amplified the knowledge of obesity etiopathogenesis, thus arousing hopes and expectations for new therapeutic horizons in this disease. Latest researches also outlined many other functions of leptin, some of which are presented in this review. In this paper we collected the most significant data about leptin's physiology and its role in body energetic homeostasis, looking also to the effects on hypothalamus-hypophysis-endocrine axes regulation, on body thermoregulation, on the reproductive function and on foetus and child growth. A wide section is thus reserved to the most recent findings about the role of leptin in obesity and about its therapeutic applications in this field.

[Epidemiology of obesity]. / Epidemiologia del fenomeno obesità.

Overweight and obesity are conditions characterized by weight levels higher than the normal limits for age, sex, and height. Because people stratified for sex and age vary in stature and this influences weight, criteria for being overweight must take height into account: this is defined and set out in WHO guidelines on the basis of Body Mass Index (BMI): weight (kg)/height2 (m2). Obese and overweight individuals are at a greater risk of developing chronic metabolic conditions and general ill health, than those whose weights are within the recommended guidelines. Besides these chronic related conditions for which obesity is a major risk factor incur enormous expenditure. The health hazards of obesity are compounded by the influence of central fat distribution. The disease associations of central fat are present even in people who are not overweight. Waist circumference is a simple measure that gives a very reasonable estimate of the amount of central fat. Data collected in the USA and Europe show a common trend: the increase of obesity and overweight among the adult and children population. Obesity appears to be the result of several factors that interact among them such as: genetic, environment, and behaviour. Current strategies, such as reducing food intake, seem to lead to poor long term outcomes. Management has tended to neglect the unavoidable need to consider obese subjects as chronically ill patients, requiring continuous assistance for active steps to maintain weight loss. Treatments should be multidisciplinary aiming at the achievement of radical changes in the individual's lifestyle. The planning and management of preventive programs for young people such as pubertal children have been disregarded up to now. They require not only attention, but also organization, clear goals and standardized methods. Moreover, a correct education is a key-element of these issues. Our unit has designed for this purpose an observational study aimed to reach a better comprehension of the proportion of ''weight problems'' and eating behavioural patterns in a population of adolescents.