Side effects of anabolic androgenic steroids abuse.

Long-term side effects of high doses of anabolic androgenic steroids self-administration were evaluated in this study. Twenty male bodybuilders, voluntarily starting steroid self-administration, were followed every 6 months over 2 years. Physical examination, haematological, metabolic and endocrine variables, semen analysis, hepatic and prostate ultrasound and echocardiographic evaluations were performed. LH values (baseline 3.43 +/- 1.75) were suppressed at 18 (1.98 +/- 1.99) (p = 0.026) and 24 (2.43 +/- 2.17) (p = 0.026), and FSH (3.95 +/- 2.01) at 6 (3.01 +/- 2.16) (p = 0.031), 12 (2.45 +/- 2.54) (p = 0.029), 18 (2.02 +/- 2.29) (p = 0.032) and 24 (3.42 +/- 2.64) (p = 0.032) months and SHBG (34.11 +/- 10.88) values significantly lowered at 12 (24.81 +/- 12.49) (p < 0.05), 18 (21.28 +/- 11.15) (p < 0.01), 24 months (25.42 +/- 11.16) (p < 0.01). A significant decrease in spermatozoa count (p < 0.01), and fertility index (p = 0.01) occurred. HDL-cholesterol (baseline 56.94 +/- 13.54) was reduced at 18 (41.86 +/- 14.17) (p < 0.01) and 24 (43.82 +/- 18.67) (p < 0.05) months and Apo A-1 at 12 (p < 0.001), 18 (p = 0.05) and 24 (p = 0.05) months. The most important long-term adverse effects were lower fertility and the impairment of lipid profile associated with an increased cardiovascular risk.

Energy homeostasis and body weight in obesity: new physiopathological and therapeutic considerations.

This paper reviews recent developments and findings regarding the role of the hypothalamus as the main site in the central nervous system (CNS) for regulating appetite. It contains a specific neural network consisting of the main central monoaminergic neurotransmitters (adrenaline, noradrenaline, dopamine, serotonin) and many neuropeptides with orexigenic and anorexigenic functions. The crucial relationship between CNS and obesity and the complex interconnections of CNS and peripheral peptides are becoming clearer. The mechanisms by which these hormones affect energy homeostasis through long and short-term anabolic and catabolic pathways are described. New anti-obesity therapeutic strategies based on drugs or molecules with new mechanisms of action, some not yet available in Italy but will soon be on the market, are considered.

Isolated and preclinical impairment of left ventricular filling in insulin-dependent and non-insulin-dependent diabetic patients.

BACKGROUND: Diabetes mellitus can induce a pattern of myocardial pathology known as specific diabetic cardiomyopathy, even if this is not clearly specified. HYPOTHESIS: The aim of our study was to evaluate the presence of preclinical myocardial damage in insulin- and non-insulin-dependent diabetic patients and controls by assessment with Doppler echocardiography. METHODS: Twenty insulin-dependent diabetic (IDDM) patients, 10 non-insulin-dependent diabetic (NIDDM) patients, and 12 healthy individuals (C) as controls, matched for age, gender, and without overt cardiovascular disease, were assessed in this study. RESULTS: Systolic function parameters presented normal values in the three groups, with the exception of a slight reduction in ventricular volume indices in the NIDDM group. Diastolic function was clearly impaired in both groups of patients versus that in healthy controls. In particular, ventricular filling was impaired in the NIDDM compared with the IDDM patients, especially the peak early filling rate E (p < 0.001). Moreover, in the IDDM group, the duration of diabetes (p < 0.01) and glycosilated hemoglobin value (HbA1C, p < 0.02) were higher than in the NIDDM group. Multiple regression analysis showed a significant inverse correlation between HbA1C and peak late filling rate A (R2 = 0.28) in both groups of patients and a direct correlation between velocity time integral E and age, duration of diabetes, and HbA1C (R2 = 0.46). The two groups presented a small, homogeneous number of cases with initial microangiopathy and borderline autonomic neuropathy, associated with microalbuminuria. Doppler echocardiography showed an early impairment of left ventricular filling, as well as an early preclinical alteration of myocardial function in diabetic patients, especially in the NIDDM group. CONCLUSION: These early signs of cardiomyopathy could constitute a predisposing condition toward the high cardiac morbidity and mortality rate in diabetic patients.

Left ventricular function in insulin-dependent and in non-insulin-dependent diabetic patients: radionuclide assessment.

The aim of this study was to compare, by gated radionuclide angiography, systolic and diastolic ventricular function in insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients without overt cardiovascular disease. The study population consisted of 20 IDDM patients (15 male, 5 female; 40.7 +/- 10.3 years), 14 NIDDM patients (9 male, 5 female; 47.0 +/- 7.5 years) and 12 healthy subjects (7 male, 5 female; 41.5 +/- 6.3 years) as a control (C) group. The duration of diabetes (DD) and glycosylated hemoglobin (HbA1C) levels were significantly higher in the IDDM patients. The ventricular ejection fraction and peak ejection rate (PER) were assessed by gated radionuclide left ventriculography and were similar in three groups, while the peak filling rate (PFR) was lower in the NIDDM patients compared to the IDDM patients (p < 0.05) and controlled healthy subjects (p < 0.01, IDDM = 3.39 +/- 1.14; NIDDM = 2.65 +/- 0.83; C = 3.55 +/- 0.73), the time to PFR was significantly more prolonged in the NIDDM group than in the IDDM (p < 0.05) and C groups (p < 0.05, NIDDM = 162 +/- 26; IDDM = 140 +/- 28; C = 142 +/- 23). The PFR/PER ratio was near the normal value (approximately equal to 1) in the IDDM patients and controlled subjects, while in the NIDDM patients it was reduced (approximately equal to 0.84 +/- 0.18). Seven IDDM and 4 NIDDM patients had borderline signs of cardiovascular autonomic neuropathy, unrelated to DD, HbA1C and scintigraphic parameters. Left ventricular systolic performance was substantially normal and similar in both the IDDM and NIDDM patients. Ventricular diastolic filling was impaired in the NIDDM patients, as shown by the decrease in PFR and in particular in the PFR/PER ratio. Our radionuclide data suggest that the NIDDM patients had a prevalent abnormality of ventricular diastolic performance, with respect to the IDDM patients, although the latter patients had higher DD and HbA1C values.

[Nutritional principles for the pregnant diabetic]. / Principi di nutrizione della gravida diabetica.

After a short account on alimentation in pregnant women, the authors examine in detail the correct alimentation in pregnant women affected by different types of diabetes. As general lines for a correct nutritional approach, a total caloric intake of 2200-2500 kcal daily (9196-10450 Kj) (which enclose 35-40 kcal/pro/kg ideal weight and a caloric surplus for pregnancy) is recommended. In over-weight women the caloric intake will be reduced till 1500 kcal (6270 Kj) checking constantly metabolic situation (increase of weight should be for the first ten weeks of 100 g weekly, than of 300 g weekly). Altogether weight increase should be from 9 to 12 kg. 15-20% of caloric intake should be represented for proteins, very important for pregnancy and good growth of fetus. Carbohydrate intake should be 55-60% of caloric intake represented for 75-80% by complex glucides and for 20-25% simple glucides to support a suitable amount of dietary fibres (25-30%). The lipid intake recommended should be 25-30% of the daily calories with a third of monounsaturated fat acids, a third of polyunsaturated fat acids and a third of saturated fat acids, with a cholesterol amount under 300 mg/die. In additional the nutritional plan should consist of a adequate amount of "non energetic nutrients" (minerals and vitamins), particularly the calcium intake must be 1200 mg/die and 18 mg/die that of iron and folic acid, vitamin A, D and B intake must be increased. Finally, the authors advise against alcoholic beverages and recommend a regular subdivision of the meals.(ABSTRACT TRUNCATED AT 250 WORDS)

[Adherence to dietetic treatment, the nutritional metabolic status and the progression of chronic kidney failure]. / Aderenza al trattamento dietetico, stato metabolico nutrizionale e progressione dell'insufficienza renale cronica.

Effects of two protein restricted diets on dietary compliance, nutritional and metabolic state, and progression of chronic renal failure (CRF) were investigated. Twenty-one patients with CRF were randomly assigned to either a conventional low protein diet (0.6 g of protein/kg b.w./day) or to a very low protein diet, providing 0.4 g of protein/kg b.w./day, supplemented with a mixture of essential amino acids which contained HIS, TYR and a high proportion of branched chain amino acids. Nutrition, assessed by body weight, anthropometry, serum protein levels and nitrogen balance studies, was maintained in all patients. Some metabolic abnormalities of CRF (i.e., secondary hyperparathyroidism, glucose intolerance) improved in both groups. The supplemented diet provided better adherence to protein prescription, corrected the depletion of VAL and LEU in muscle and was more effective than conventional diet in slowing the rate of progression of CFR.

[Comparison of HbA1c, fructosamine and the main metabolic parameters in a non-insulin-dependent diabetic population]. / Confronto tra HbA1c, fruttosamina e principali parametri metabolici in una popolazione di diabetici N.I.D.

Our objective was the checking of clinical data obtainable from the assay of some parameters in NID diabetic individuals. To this end, we studied 133 patients--57 males and 76 females, average age 74.36 +/- 1.01 years, 72.6% of which were above 65 years of age. The control population was subdivided as follows: 50 subjects, 26 F and 24 M; average age 71.25 +/- 1.32 years, with normal glucidic tolerance as assessed by OGTT. Current glycemia, average glycemia, fructosamine, glycosylated hemoglobin, triglycerides, LDL-cholesterol and apolipoprotein B were obviously much higher than normal in the individuals admitted to the study. A statistically significant correlation was found between average glycemia, glycosylated hemoglobin, LDL-cholesterol and blood triglycerides (p less than 0.05). No correlation was found between current glycemia, fructosamine and glycosylated hemoglobin. Similarly, serum fructosamine was unrelated to the parameters studied. In our study, fructosamine, glycosylated hemoglobin and current glycemia offered unrelatable data. Hence, in our opinion it is necessary to assay these three parameters contemporaneously for a reliable assessment of metabolic compensation.

[Etiopathogenetic role of metabolic, circulatory, sex factors and type and duration of diabetes in diabetic retinopathy. Investigation with vitreofluorophotometry]. / Ruolo eziopatogenetico di fattori metabolici, emovascolari, sesso, tipo e durata del diabete nella retinopatia diabetica. Indagine compiuta con la vitreofluorofotometria.

We have studied metabolic, circulatory and vascular parameters in a group of 57 diabetics (37 affected by IDDM, 20 affected by NIDDM; 35 were males, 22 were females). Goals of present study were: 1) quantitative evaluation of the blood retinal barrier; 2) influence of the metabolic state, blood pressure, sex, type and duration of the diabetes on the ocular conditions; 3) relationship between ophthalmoscopic appearance of the retina and vitreous fluorophotometric recordings. We concluded that: a) ocular alterations depend by lipidic metabolism, blood pressure, sex, type and duration of the diabetes; b) vitreous fluorophotometry has proved a good device for early detection of retinal damages in the diabetic retinopathy.

Effectiveness of long-term treatment with pantethine in patients with dyslipidemia.

A one-year clinical trial with pantethine was conducted in 24 patients with established dyslipidemia of Fredrickson's types II A, II B, and IV, alone or associated with diabetes mellitus. The treatment was well tolerated by all patients with no subjective complaints or detectable side effects. Blood lipid assays repeated after 1, 3, 6, 9, and 12 months of treatment revealed consistent and statistically significant reductions of all atherogenic lipid fractions (total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B) with parallel increases of high-density lipoprotein cholesterol and apolipoprotein A. The results were equally good in patients with uncomplicated dyslipidemia and in those with associated diabetes mellitus. The authors conclude that pantethine (a drug entity related to the natural compound, pantetheine) represents a valid therapeutic support for patients with dyslipidemia not amenable to satisfactory correction of blood lipids by diet alone.

[The dietary problem in cholelithiasis and patients at risk]. / Il problema alimentare nei colelitiasici e nei pazienti a rischio.

Gallstone disease has been recognized to be linked to others metabolic disorders such as obesity, atherosclerosis, hyperlipidemia and diabetes. Previous studies demonstrated a close relationship between abnormal eating habits and gallstone disease. The total caloric intake should be calculated on each individual energy requirement and should be restricted in over-weight patients. The diet should contain approximately 15-20% of the daily calories from proteins, 30-35% from fat (mainly vegetable fat for the higher content in polyunsaturated fat) and 40-55% from carbohydrate (especially complex carbohydrate). In addition the nutritional plan should consist of adequate amount of minerals and vitamins and the fiber consumption should be increased to 30-40 g/day. Finally, at last the Authors recommends (6279-8372 Kj- a regular subdivision of the meals (small and frequent) dressed in the very natural wag.

[Clinical study of a new preparation from plantago seeds and senna pods]. / Studio clinico su un nuovo preparato di semi di piantaggine e frutti di senna.

The lack of fiber in the western diet may contribute to the development of several diseases including gastrointestinal disorders; the clinical effects of a new substance (AGIOLAX) made from plantago seeds and senna pods were studied. 100 patients of both sexes, aged from 40 to 60 years (30 with diabetes mellitus, 40 with obesity and 30 with hyperlipidemia) were treated; everyone complained a slowness, of different degree, of normal intestinal transit time or chronic constipation. The experiment was carried out without the use of a control group. Aim of the present study was to investigate the efficacy and tolerability of the product. In addition to the clinical evaluation of the symptoms, laboratory tests were performed. The patients were treated for 3 months with a daily dose of 2 teaspoons every evening. In the majority of the subjects a good clinical response was obtained; 88% of the patients presented a normalization of the gastrointestinal transit time; only 12% of them did not respond satisfactorily to the substance. Further the drug was well tolerated by 86% of the patients. In conclusion the authors report a good efficacy and tolerability of the product; thus they recommend its use in those disorders characterized by slow intestinal transit time and/or constipation.

[Serial determination of HbA1 or the oral glucose test in the adequate evaluation of fetal growth?]. / Dosaggi seriati di HbA1 o test orale di tolleranza glucidica per una adeguata valutazione della crescita fetale?

The authors compared sequential HbA1 levels with the results obtained by oral glucose tolerance test (O.G.T.T.) with the purpose of detecting the confidence limit of each test regarding the glucose control in pregnant women. HbA1 detection showed more sensitivity than O.G.T.T. in detecting maternal impaired glucose control and in distinguishing between a metabolic or a genetic feto-neonatal macrosomia.

[Dietary fiber and OGTT: blood sugar variations after administration of a new purified glucomannane]. / Fibre dietetiche ed OGTT: variazioni glicemiche dopo somministrazione di un nuovo glucomannano purificato.

After having stressed the importance of fibres in the nutritional field, pointing out the inverse relationship between vegetal fibres consumption in various populations and diffusion of many diseases of the so-called "industrialized" societies (such as obesity, diabetes, dyslipidemias, atherosclerosis, cholelithiasis, cancer of the colon, etc.), the Authors report their experiment on a new experimental product based on glucomannane purified (PRL). The present study was carried out on 24 obese subjects (5 males and 19 females). The patients, normoglycemics in their basic condition, were submitted to OGTT with 75 g of glucose in the morning before eating and were subdivided into two groups, the first (Group A) characterized by the sequence OGTT + placebo; after a few days, by another OGTT + experimental product; the second characterized by the inverse sequence. Four tablets (glucomannane purified 5,2 g) and four tablets of placebo was the posology employed. The evaluation of the possible action of the product in reducing or slowing down the intestinal absorption of glucose was the aim of the research. The results obtained show that the administration of the product under study has led to a sharp decrease of the average glycemic values with variations per cent ranging from 13% to 16% in Group A, from 10% to 11% in Group B and from 7% to 12% in the two groups considered on the whole. In conclusion, the Authors wish an increased diffusion of dietary fibres and particularly of the glucomannanes in all those dysmetabolic forms having at their bases an unbalanced, hypercaloric alimentation, rich in refined aliments and poor in fibres.

[Hyperlipidemia, diabetes and atherosclerosis: efficacy of treatment with pantethine]. / Iperlipidemia, diabete ed aterosclerosi: efficacia del trattamento con pantetina.

The hypolipidemizing effects of Pantethine were investigated by the Authors in 37 hypercholesterolemic and/or hypertriglyceridemic patients. Of these, 21 were also diabetic, in a satisfying glucidic compensation, in order to verify the action of this drug also in this metabolic condition. The study was carried out for three months and during this period the patients were given Pantethine at the dose of 600 mg/die orally. At the 30th, the 60th, the 90th day of treatment the following parameters were controlled: cholesterolemia, HDL cholesterol, apolipoproteins A and B, triglyceridemia, systolic and diastolic arterial pressure, uricemia, body weight. Thirty days after suspending the treatment, the parameters were controlled again to detect a possible "rebound" effect. The results were analyzed on the whole case-record, subdividing the patients in dislipidemic and diabetic-dislipidemic, and on the basis of the Fredrickson's classification. Pantethine induced in all groups a quick and progressive decrease of cholesterolemia, triglyceridemia, LDL cholesterol and Apolipoproteins B with increased HDL cholesterol and Apolipoproteins A. After suspending the treatment, there is a clear inversion of the state of these parameters. The Authors conclude that the present work shows that Pantethine, a natural and atoxic substance, an important component of Coenzyme A, is efficacious in determining a clear tendency towards normalization of the lipidic values.

[Clinical study of the use of a deproteinized guar flour in the treatment of obesity]. / Ricerca clinica sull'impiego di una farina deproteinizzata di guar nel trattamento dell'obesità.

The Authors have studied an experimental product (L. G. 140/S), based on GUAR GUM, to establish its effectiveness and tolerability as a dietetic support in the treatment of obesity. The clinical research work has been conducted on 21 obese subjects (18 females and 3 males) aged 17 to 58 and treated with a hypocaloric and hypoglycemic diet. This preparation has proved useful in helping the patients to conform to the dietary restrictions and/or in normalizing their intestinal transit. No objective or subjective symptoms certainly referable to this preparation have been observed. The administration of the product has been interrupted for precautionary reasons in some cases, since it was not indispensable. Considering the good results they have obtained in terms of tolerability and agreeableness of this product, the Authors conclude that it can be considered a useful support to the restrictive dietary regimen, which is still considered - together with physical activity - the only sound and effective remedy in the treatment of obesity.