Circadian rhythm of some parameters of body composition in the elderly investigated by means of bioelectrical impedance analysis.

We studied the within-day determinations of some body composition (BC) parameters in clinically healthy elderly subjects with the aim of investigating their circadian rhythms (CR), which are known to vary in a circadian manner in clinically healthy young adults. The study involved six non-smoking, clinically healthy elderly males (mean age: 75 +/- 4 years; mean weight: 71.07 +/- 10.26 kg; mean height: 170 +/- 5 cm, mean BMI: 24 +/- 1 kg/m2). The BC parameters were determined by means of bioelectrical impedance analysis (BIA) at 2-hour intervals during the day and night, with the subjects lying horizontally in bed. The time-qualified BC estimates were analysed using the Cosinor method. The analysis revealed that the healthy elderly subjects had lost the CR of a number of the BC parameters, including fat body mass, cell body mass, extracellular body mass, total body water, extracellular body water, intracellular body water, and the Na and K exchangeable pools. However, they still retained the CR of body weight and lean body mass, with the expected nocturnal phase of oscillation. The abolition of the CR of the majority of BC parameters in the elderly suggests that human senescence is characterised by consistent changes in the daily rhythmic patterns of fat, water and electrolyte metabolism.

[Treatment of euthyroid goiter in the elderly]. / Terapia del gozzo eutiroideo degli anziani.

PURPOSE: A study was conducted to evaluate the effectiveness of the medical therapy with synthetic hormone levothyroxine (L-T4) in the elderly subjects with multinodular euthyroid goiter. PATIENTS AND METHODS: 187 elderly subjects (34 males and 153 females) ranging between 63 and 85 years of age with multinodular euthyroide goiter were examined. For each subject has been calculated the index of body mass (BMI) which has consented the identify two groups of subjects: the elderly patients with normal weight and the obese subjects. RESULTS: In the mostly of the patients (82%), both normal weight and obese, the L-T4 therapy has not determined significant changes either of the dimensions or the number of the nodules. In the obese subjects the L-T4 therapy has not caused decrease of weight at least to the 20% of the initial body weight. CONCLUSIONS: The results of the research have proved the limited effectiveness of the suppressive therapy with levothyroxine in the reduction of the volume and/or of the number of the nodules, without however denying the usefulness in the preventing the worsening of the nodular disease of thyroid. The study also has revealed that the therapy with levothyroxine is ineffective for the body weight reduction in the obese subjects.

[Prevalence of obesity in adolescence]. / Prevalenza dell' obesità nell'adolescenza.

PURPOSE: A clinical epidemiological research was conducted in Sardinia on a sample of hig school students to survey the preminence of obesity and overweight during adolescence. PATIENTS AND METHODS: 304 normal subjects were examined, 161 males and 143 females ranging between 16 and 18 years of age. For each subject the index of body mass was considered then compared to the standard values of population using Hamil schedules. RESULTS: The survey revealed a normal weight in mostly of the teen-agers. Obesity was observed however in 23.6% of males and in 5.6% of females on what was seen the percentage of overweight or excessively fat subjects is below the percentage of underweight teen-agers (21% of males and 43% of females). CONCLUSIONS: This difference could be considered the proof of a particular adolescential attitude that seen as a positive aim and is identified with social acceptance and sexual attraction especially among girls. This is confirmed by the fact that when questioned a great number of teen-agers admitted they were or they had been on a diet to lo lose weight.

Monolateral idiopathic cyst of the vitreous.

PURPOSE: The authors describe the case of a 58-year-old female patient that came to their observation for recurrent episode of transient blurred vision due to an idiopathic monolateral vitreal cyst localised in the posterior vitreous in the left eye. METHODS: Patient evaluation included: best corrected visual acuity, slit-lamp examination, vitreo-retinal biomicroscopy, ultrasound examination, ultrabiomicroscopy, fluorescein angiography. CONCLUSIONS: The authors review the literature including the most recent reports regarding this rare condition.

Anxiety, depression, hunger and body composition: III. Their relationships in obese patients.

The present paper explores the relationships between anxiety, depression, hunger sensation and body composition in obese patients (OP). The aim is to detect whether or not there are abnormalities in these relationships in OP as compared to clinically healthy subjects (CHS). The study was performed on 22 CHS (2 M, 20 W; mean age = 24 +/- 2 years; mean body mass index = 21 +/- 2 kg/m2) and 48 OP (4 M, 44 W; mean age = 40 +/- 17 years; mean body mass index = 32 +/- 7 kg/m2). Anxiety and depression were found to be correlated, negatively, with the relative lean body mass, and, positively, with the fat body mass in OP but not in CHS. These findings corroborate the idea that anxiety and depression can reach an abnormal expression when obesity shows its worst loss in lean body mass and its highest expansion in adipocyte mass. As hunger sensation was found not to correlate with either anxiety or depression in OP, the opinion is expressed that the impairment of anxio-depressive integrity is a corollary of obesity rather than a primary affective disorder leading to obesity via an enhanced food intake.

Daily hunger sensation and body compartments: II. Their relationships in obese patients.

Hunger sensation (HS) is a signal whose levels change during the 24-h day. The daily mean level of HS was correlated with the human body compartments, as investigated by bioelectrical impedance analysis, to detect the relationship between the orectic perception and both the free fat mass (FFM) and the fat body mass (FBM) in 22 clinically healthy subjects (CHS) (2 M, 20 W, BMI: 18.5-24.0 kg/m2) and 48 obese patients (OP) (4 M, 44 W, BMI: 25.2-54.7 kg/m2). In CHS, the daily mean level of HS correlated positively with the FFM and negatively with the FBM. These correlations were not present in OP. This lack of relationships between HS and the body compartments where energy is maximally consumed (i.e., the FFM) and maximally stored (i.e., the FBM) indicates that the orectic response to energy expenditure and the orectic inhibition to fat accumulation are feedback mechanisms which are impaired in obesity.

[The long-term results of low-calorie diet therapy in the obese]. / Risultati a lungo termine della terapia dietetica ipocalorica negli obesi.

PURPOSE: To evaluate long-term results of hypocaloric dietetic treatment in patients with essential obesity. PATIENTS AND METHODS: The study was carried out in 1,479 woman and 320 men. Body weight was evaluated at 3 months and at 1, 2 and 3 years. RESULTS: The best results in short term reduction of weight excess were found in obesity due to sedentariness or arisen after operation or emotional stress. It has been also observed that the percentage of subjects loosing weight decreased after the first year of treatment, while the percentage of subjects gaining body weight. CONCLUSIONS: Long term hypocaloric dietetic treatment in subjects with low or moderate essential obesity should primarily be aimed preventing further gain in body weight.

[Thyroid tumors in obesity]. / Tumori della tiroide nell'obesità.

BACKGROUND: The presence of nodules in the thyroid gland is the most frequent cause of endocrinopathy. The prevalence of thyroid nodules in the United States is estimated to be between 3-10%, whereas the prevalence of thyroid nodules in European adult population is estimated to be between 4-10%. At our Clinic of Obesity, the presence of nodules in the thyroid gland of obese patients is often found, incidentally, for this reason, we decide to investigate the prevalence of this pathology in obese patients and to quatify the number of times in which the presence of nodules had not been previously diagnosed. METHODS: 3248 obese patients were examined during in the last six years (1991-1996); of these patients 747 were affected by obesity and thyropathy; of these 747 we took into consideration only those with a cold single nodule and correlated the presence of the nodule with BMI, sex and age. RESULTS AND CONCLUSIONS: The prevalence of a cold single nodule in the obese patients was 31%, of which 83% has not been previously diagnosed. Of cold nodules 8% was represented by carcinoma. The carcinoma appeared more often in females than in males (3:1). The incidence of cold nodules was more frequent in adults and in mild-medium obesity.

[Latent thyroid diseases in obesity]. / Tireopatie latenti nell'obesità.

We have investigated 2672 obese subjects (2324 females and 348 males); of these, the following two groups were considered: obese subjects with or without thyroid disease. Subjects were stratified according to age, sex, and BMI. The prevalence of thyroid disease was correlated to age, sex and BMI increased body weight. Our data showed that 22% of patients affected by essential obesity and not resident in area of iodine deficiency is affected by thyroid diseases which are not diagnosed (18%). In the obese subjects, presence of goiter is more frequent than in the normal weight subjects and affects mainly adult males. Chronic thyroiditis is typical of females (9:1 female:male ratio) with no difference between normo and overweight subjects. Prevalence of single nodule in the obese is similar to the normal weight subjects, it is more frequent in adults and in subjects with medium size obesity. However, occurrence of carcinoma (8%) in single nodules appears higher in the overweight (5-6%) as compared to the normal weight subjects.

[Benign thyroid nodules in the elderly. Medical treatment]. / I noduli tiroidei benigni nell'anziano. Trattamento medico.

BACKGROUND AND AIM: Benign thyroid nodules are a frequent pathology in the general population and in particular in the aged, but their treatment is still controversial. The percentage by which volume and/or the number of nodules is reduced using L-thyroxine treatment reported in the literature varies widely: from 9 to 68%. The aim of this study was to study the therapeutic efficacy of thyroxine treatment in the aged. METHODS: A retrospective study was performed in 105 elderly out-patients (mean age 68 +/- 6 years) suffering from thyroid nodules forming part of a population of 7452 thyroid patients from central Italy attending the 2nd Medical Clinic at "La Sapienza" University of Rome from 1986 to 1994. Other diseases which might influence treatment were excluded in all subjects. Thyroid hormones, TSH and antithyroid antibodies were assayed using RIA techniques; patients also underwent ultrasonography of the gland, 131I thyroid captation with scintigraphy and cytological analysis using fine needle aspiration. Patients were treated with L-thyroxine (75-150 micrograms/day) and controlled after 6, 12 and 24 months. No collateral effects were reported. RESULTS: The majority of patients (some 85%) remained stationary; just under 10% improved and only a few showed a deterioration of symptoms. CONCLUSIONS: Medical therapy continues, in the authors' opinion, to be the first choice in the treatment of benign thyroid nodules also in elderly patients owing to its easy management, low cost and scarce collateral effects.

Hunger sensation: a chronobiometric approach to its within-day and intra-day recursivity in anorexia nervosa restricting type.

Hunger sensation (HS) is a perception with a daily (circadian) and within-day (ultradian) recursive pattern. In human beings, circadian repeatability was investigated by means of the Single Cosinor method, while the ultradian recursivity was investigated by means of the spectral analysis, both applied to the 24-h HS profile (orexigram). Orexigrams were provided by each subject investigated, who self-rated her subjective orectic stimulus (OS) (from 1 to 10 hunger units) every half hour. The study was performed in 19 female patients aged 13-52 newly diagnosed as in the first episode of Anorexia Nervosa Restricting Type, with a BMI below 18.7. The control group consisted of 10 clinically healthy women aged 21 to 52 years with a BMI from 23 to 25. Two types of orexigrams were found. The first was characterized by a low profile with negligible ultradian variability, in which the HS circadian rhythm (CR) was still detectable, but the power spectrum (PS) was composed of unusual ultradian components associated with a very diminished amplitude for the circadian harmonics. The second was characterized by an almost regular profile, in which the ultradian variability was clearly detectable, the CR regularly fluctuated, and the PS was almost regularly composed. These findings indicate that anorectic patients (AP) can be recognized by their orexigram as "hyporectic", or "eurectic". Therefore, the term "anorexia" seems to be appropriate for AP who exhibit the first type of orexigram (anorectic aphagia nervosa), whereas the second identifying those who could be defined as suffering from "eurectic aphagia nervosa".

Daily hunger sensation and body composition: I. Their relationships in clinically healthy subjects.

The human hunger sensation (HS) is a perceptive signal characterized by day-night variability (DNV). This pattern was investigated with respect to its relations with the body compartments in 22 clinically healthy subjects (CHS, 11 males and 11 females, mean age: 24 +/- 2.5 years, mean BMI: 21 +/- 1.7). The DNV was investigated by means of conventional descriptive statistics and the single cosinor method (SCM). Both procedures were applied to the orexigram, i.e., the 24-h profile of the orectic stimulus (OS) provided by each subject, who self-rated his/her HS (from 1 to 10 hunger units) every half hour. Body composition was investigated by Bioelectrical Impedance Analysis (BIA) on the day when the orexigrams were compiled. It was found that the daily HS level correlates positively with the Free Fat Body Mass (FFBM) and negatively with the Fat Body Mass (FBM). These opposite relations indicate that HS is stimulated by the needs of the FFBM, and inhibited by expansion of the FBM, and provide further evidence of the existence of an "adipostat" anorectic mechanism.

[Comparison of results of short- and long-term therapy of obesity]. / Confronto dei risultati a breve e a lungo termine nel trattamento dell'obesità.

A study concerning long term results of dietetic treatment of obesity has been conducted on 1479 obese women, aged 16 to 76 years, who attended the ambulatory during the period 1992-1995. Best results in short term reduction of weight excess were found in obesity due to sedentariness or arisen after operations or emotional stress. Also, it has been noticed that percentage of subjects who went on to loose weight decreased after first year of treatment instead, percentage of subjects who grew fat increased. So, authors believe that long term therapy main object in obese people isn't loss of weight but to avoid further weight increases.

Work-related accidents of ophthalmologic interest in Italy during 1986-1991.

The authors analysed accidents of ophthalmological interest obtaining information from the database of the INAIL (National Insurance Institute for Professional Casualties) concerning the period of 1986-1991. The INAIL registers all casualties that cause work disabilities exceeding 3 days. The investigation included all job types grouped into two major categories: agriculture (16% of all insured labour) and industry/craftsmanship (84%). Over 78% of the cases examined were in the industry/craftsmanship category. Approximately 22% of the cases were in the agriculture category. Every year in Italy, about 6% of regularly employed workers suffer casualties. The incidence of casualties of ocular interest has been a stable 0.37% in the years examined; 2.88% of these casualties produce permanent consequences (1/10,000 workers per year). The risk in 3 times higher in agriculture.

[The role and chronobiometric study of ambulatory arterial pressure monitoring in hypertensive patients with a recent cerebral ischemia episode]. / Ruolo e studio cronobiometrico del monitoraggio ambulatoriale della pressione arteriosa in pazienti ipertesi con recente episodio ischemico cerebrale.

Essential hypertensive patients with a history of recent TIA syndrome were investigated by ambulatory blood pressure monitoring (ABPM). The aim of this trial was to verify the presence of false normotensive patients in order to optimize the secondary prevention of hypertensive cerebrovascular damage (ischemic or hemorrhagic stroke). This study was carried out on 51 patients (26 M and 25 F, mean age = 58 +/- 14 yrs) and 225 clinically healthy control subjects (113 M and 112 F, mean age = 55 +/- 12 yrs), who underwent an ABPM. The BP time series were analyzed by chronobiometric procedures. The comparison of the individual BP within-day values to the reference limit revealed a highly significant proportion of these patients (90%) whose hypertension was not well controlled. Their BP series showed supranormal values ranging from 39% to 56% of all the readings, with a pressure excess ranging from 8.35 h to 11.34 h. The high incidence of not adequately treated patients with a history of recent TIA syndrome confirms that their hypertension should be controlled by means of the ABPM. These results suggest that the chronomodulation of the antihypertensive treatment might be the better management of BP regimen in these patients for the secondary prevention of cerebrovascular damage.

Circadian rhythms in human body composition.

The study investigates how the human body composition (BC) changes as a function of the day-night cycle. The BC was investigated using bioelectrical impedance analysis (BIA) of 10 clinically healthy subjects (CHS), monitored in supine position (readings at 2-h intervals), avoiding mealtimes, dietary abuses, and bladder and intestinal retention. Time series data were analyzed for their temporal characteristics and circadian rhythm (CR). All the variables of BC (lean body mass, fat body mass, body cell mass, total body water, intracellular and extracellular body water, sodium and potassium exchangeable pool) showed a within-day variability with nighttime crests. Such an oscillatory synchronism corroborates the hypothesis that the rest time plays a fundamental role, via its anabolic effects, in conferring the nocturnal phase to the CR of the human BC.

[Prevalence of obesity in school age: preliminary study on students from 2 Roman schools]. / Studio sulla prevalenza dell'obesità nell'età scolare: indagine preliminare sugli alunni di due scuole romane.

The present study, aimed at the prevention of infantile obesity was carried out in two schools of Roma and regarded also the alimentary education. 295 students 101 males and 194 females was considered; the result pointed out that 114 (38.6%) were found obese, 57 (19.3%) overweight and 124 (42.0%) normal weight. The alimentary behaviour was the same of other students: usually three meals and often snacks use during the day, a lot of the student use to eat watching the television and the physical activity is done not so much. The results of these paper are related to the literature data.

[Prevalence of Toxoplasma gondii infections in groups of individuals in Rome and its environment]. / Prevalenza delle infezioni da Toxoplasma gondii in gruppi di individui di Roma e provincia.

This study was aimed out to point out the prevalence of Toxoplasma gondii infections in Roma and in the province. The results pointed out that the percentage of antibodies positivity has been 45% this prevalence was the same of the prevalence reported by other authors in Italy. The presence of a lot of women without anti-Toxoplasma gondii antibodies shows that is necessary to continue the control of the young women especially at the beginning of the pregnancy.