Is adherence to the Mediterranean diet associated with good sleep duration in primary-school children?

Objective: The Mediterranean diet (MD) contributes to preventing numerous chronic diseases and has benefits on cognitive development. Adherence to the MD is associated with sleep quality and duration in adults and adolescents, but this association seems to have been little investigated in primary-school children. The aim of this cross-sectional study was to verify whether good sleep duration was associated with adherence to the MD. Design: The study enrolled a sample of Italian primary school children. Their mothers were asked to answer an anonymous, self-administered questionnaire investigating the children's adherence to the MD (using the KidMed score) and variables related to their lifestyles, behavioral traits and socio-economic factors. Logistic regression models were developed to analyze the association between adherence to the MD, entered as the dependent variable, and adequacy of sleep duration. Setting: Primary schools in Padova, Italy. Subjects: 267 Italian 6-year-olds in their first year of primary school. Results: The multivariate analysis showed an association between adherence to the MD and hours of sleep: for children with a good sleep duration, the odds ratio of a poor-to-moderate adherence to the MD was 0.282 (95% CI, 0.109-0.681, p < 0.05). Conclusion: Ensuring an adequate sleep duration may be an important strategy for enhancing adherence to the MD. Sleep and dietary education should be included in future health promotion programs.

Is emotional eating associated with behavioral traits and Mediterranean diet in children? A cross-sectional study.

BACKGROUND: Stress and negative emotions may impact on appetite, inducing some individuals to eat less and others to eat more. This behavior has been implicated in the onset of bodyweight problems and eating disorders in childhood. The aim of our study is to evaluate factors potentially associated with emotional eating in children. METHODS: The present cross-sectional study derives from a survey conducted in 2021 on 8-9 years old children attending 11 primary schools. A questionnaire was administered that contained multiple-choice items relating to the children and their mothers, and touching on all the factors thought to be associated with emotional eating as behavioral traits or adherence to Mediterranean diet. A multivariable logistic regression was performed to test the association. RESULTS: Emotional undereating was positively associated with emotional symptoms (OR 1.72; 95% CI 1.11-2.67); emotional overeating was positively associated with both emotional symptoms (OR 2.01; 95% CI 1.29-3.13) and hyperactivity (OR 2.80; 95% CI 1.59-4.92), and inversely associated with peer problems (OR 0.50; 95% CI 0.25-0.99). Emotional undereating was also positively associated with the number of siblings (OR 1.50; 95% CI 1.03-2.18), and inversely associated with a good adherence to the Mediterranean diet (OR 0.25; 95% CI 0.08-0.84). CONCLUSIONS: The study found children's emotional eating associated with both dietary patterns and behavioral traits (in particular emotional symptoms, hyperactivity and peer problems). It could be useful to improve parents' awareness so that they can anticipate and pay more attention to this issue. Adherence to the Mediterranean diet should also be reinforced, by means of health promotion interventions at school, for example.

Primary school children and nutrition: lifestyles and behavioral traits associated with a poor-to-moderate adherence to the Mediterranean diet. A cross-sectional study.

The Mediterranean diet has consistently shown a beneficial influence on health and longevity. The aim of this cross-sectional study was to identify all the various factors-such as socio-demographics, lifestyles, and behavioral traits-associated with the risk of a poor adherence to the Mediterranean diet in a sample of Italian primary school children. The study sample included 267 children in their first year of primary school. Their mothers were asked to answer an anonymous, self-administered questionnaire that investigated their children's adherence to the Mediterranean diet (using the KidMed score) and variables related to their lifestyles, behavioral traits, and socio-economic factors. A multivariate logistic regression was performed to test the association between adherence to the Mediterranean diet and the other variables investigated. Most of the children involved in this study (73.9%) were classifiable as having a poor-to-moderate adherence to the Mediterranean diet. Higher odds of a poor adherence to the Mediterranean diet were associated with videogame playing for more than 1 h a day and lower levels of mothers' health consciousness. On the other hand, the odds were lower in association with more time spent practicing sport, higher levels of prosocial behavior, and with mothers having a high school education as opposed to fewer years of schooling.Conclusions: These results point to the need to consider the role of mothers' health consciousness and formal education in influencing their children's diets. Health promotion interventions should focus on the importance of a healthy overall lifestyle, which includes not only appropriate nutrition but also time spent on physical activity and leisure activities (such as playing videogames).What is Known:• Most of the children were classified as having a poor or moderate adherence to the Mediterranean diet. This result reflects a trend common to numerous countries of the Mediterranean area in recent years.• A mother's level of formal education influences her child's diet.What is New:• Higher levels of prosocial traits coincided with lower odds of a poor adherence to the Mediterranean diet.

Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty. METHODS: Since April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 +/- 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 +/- 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started. RESULTS: A total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90-180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 +/- 10.8 kg/m(2) and had decreased to 39 +/- 8.5 kg/m(2) after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% +/- 24.4%. Two patients required a duodenal switch for insufficient weight loss. CONCLUSION: LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.

Case of sensory ataxic ganglionopathy-myelopathy in copper deficiency.

Spinal cord involvement associated with severe copper deficiency has been reported in the last 8 years. Copper deficiency may produce an ataxic myelopathy. Clinical and neuroimaging findings are similar to the subacute combined degeneration seen in patients with vitamin B12 deficiency. Macrocytic, normocytic and microcytic anemia, leukopenia and, in severe cases, pancytopenia are well known hematologic manifestations. The most patients with copper deficiency myelopathy had unrecognized carency. Some authors suggested that early recognition and copper supplementation may prevent neurologic deterioration but clinical findings do not improve. We present a patient with copper deficiency, dorsal root ganglions and cervical dorsal columns involvement. Clinical status and neuroimaging improved after copper replacement therapy. Sensory neurons of dorsal root ganglia may be the most sensitive nervous pathway. In this case the early copper treatment allowed to improve neurologic lesions and to prevent further involvements.

Wernicke's syndrome during parenteral feeding: not an unusual complication.

OBJECTIVE: Wernicke's encephalopathy (WE) is an acute disorder due to thiamine deficiency, characterized by ophthalmoplegia, ataxia, and mental confusion, similar to that classically observed in alcoholism. Some cases of WE were reported to coincide with other conditions such as hyperemesis gravidarum, bariatric surgery, and total parenteral nutrition. In this study the objective was to retrospectively evaluate the prevalence of WE among intravenously fed patients in our hospital during the previous 2 y. METHODS: Among all cases of WE diagnosed by cranial magnetic resonance scan during a 2-y period in the Azienda Ospedaliera of Padua, we identified patients who exhibited WE during parenteral feeding. Albumin plasma levels, measured at the onset of WE symptoms, were used to estimate nutritional status. RESULTS: We found seven cases of WE that coincided with intravenous feeding. WE occurred, on average, 13 d after the start of glucose infusion. The five subjects with albumin plasma levels lower than 35 g/L at the onset of WE received glucose infusion for fewer days. In six cases the clinical signs disappeared the day after thiamine infusion. In one case mental function did not normalize and the patient developed Korsakoff's syndrome despite prolonged thiamine treatment. CONCLUSION: During a 2-y period we observed a high prevalence of WE in intravenously fed patients due to lack of thiamine supplementation. A prophylactic treatment must be performed in at-risk patients and multivitamin infusion containing thiamine must be administered daily during the course of intravenous feeding.

Irreversible subacute sclerotic combined degeneration of the spinal cord in a vegan subject.

OBJECTIVE: We describe a case of irreversible subacute sclerotic combined degeneration of the spinal cord in a Western vegan subject. METHODS: A 57-y-old man, member of a vegan cult for 13 y, developed weakness, paraplegia, hyper-reflexia, distal symmetric muscular hypotrophy, impairment of superficial sensation in the hands and feet, loss of deep sensation in the lower limbs, and neurogenic bladder and bowel. Magnetic resonance imaging of the cervical and dorsal spine disclosed abnormally increased signal intensity on T(2)-weighted sections in the posterior and lateral columns. Subacute sclerotic combined degeneration of the spinal cord was diagnosed and treatment with cobalamin was started. RESULTS: Despite rehabilitative treatment, the patient developed spastic hypertonia with mild improvement of paresthesias. Six months later, vitamin B12 plasma levels and hematological analysis were normal. One year later, spastic paraplegia was still present and the patient was unable to walk despite improvement on magnetic resonance imaging. CONCLUSION: Irreversible subacute sclerotic combined degeneration of the spinal cord is a rare but possible effect of a strict vegetarian diet.

Knowledges about herbal products among subjects on warfarin therapy and patient-physician relationship: a pilot study.

PURPOSE: The purpose of our study was to analyse behaviours and patient-physician relationship about phytotherapy among a sample of Italian patients on warfarin therapy for atrial fibrillation. METHODS: During a 4-month study period, interviews of patients on warfarin therapy, followed regularly in the medical laboratories to monitor INR values, were conducted on the basis of a pre-structured 25-item questionnaire. RESULTS: Among a study population of 294 patients, 69 subjects reported to have been taking one or more phytotherapic products in the last year in combination with warfarin. Users were mostly in the age group >50 years and had a low level of education. Five out of 69 patients reported side effects, while 16/69 referred an unstable INR value. The majority of our subjects considered phytotherapy useful and without risks. CONCLUSIONS: The present survey highlights the potential risk of confidence with the 'natural world', the lack of discussion on this argument among health care providers and patients on warfarin therapy and the need to monitor strictly the INR value.

Wernicke's encephalopathy during parenteral nutrition.

BACKGROUND: Thiamine deficiency in humans affects the cardiovascular, muscular, nervous, and gastrointestinal systems. Wernicke's encephalopathy is described in alcoholism, in hyperemesis gravidarum, and in prolonged IV feeding without vitamin supplementation. METHODS: We report a case of a 66-year-old man undergoing surgery for acute necrotic-hemorrhagic pancreatitis, who presented a Wernicke's syndrome during parenteral nutrition (PN). After surgery, he was treated with infusion of industrial 3-compartment bags, without vitamin supplementation. On the seventh postoperative day, nausea and vomiting began, and 5 days later the patient showed diplopia, ataxia, general muscular stiffness, reduction of osteotendinous reflexes, confusional state, and thrombocytopenia. The magnetic resonance scan evidenced pathologic changes in the medial thalamus, in the third and fourth ventricular floor, in the cerebellar vermis, and in the periaqueductal gray substance. RESULTS: All neurologic signs and platelet blood count gradually normalized after IV supplementation of thiamine, 100 mg daily. The magnetic resonance scan repeated 40 days after the first one was normal. CONCLUSIONS: Our report points out the risk of incorrect procedures in management of industrial 3-compartment bags. Moreover, we suggest that thrombocytopenia may be related to thiamine deficiency.