[Lighthouse keeper syndrome: update.] / Sindrome del guardiano del faro: attualizzazione.

A few years ago, with the expression "lighthouse keeper syndrome", we identified those who showed exceptional attention to the control of eating and body weight. Recently the same term was used to describe, at the end of the lockdown, the feeling of living with fear the encounter with external reality, which for many weeks remained confined outside our homes. We are of the opinion that the lighthouse keeper syndrome includes all those behaviors characterized by voluntary, even if often unconscious, social isolation and by the exasperated search for absolute dominion over a single aspect of our being. There are two types of social isolation, the static one typical of those who spend their time closed at home (hikikomori) and the dynamic one characteristic of those who go out, walk but do not interact with other individuals. The radicalization of some food trends can lead to convivial group social isolation. The changes in the characteristic clinical manifestations of lighthouse keeper syndrome demonstrate the impact of society and culture on the individual psychopathology.

[Evidence in obesity research: translating them in clinical practice and public health strategies.] / Le evidenze della ricerca sull'obesità: tradurle nella clinica e in strategie di sanità pubblica.

Obesity is a complex disease due to the interaction between genetic, psychological, and environmental determinants. Sadly, implementing into practice research results is frequently difficult. Many are the obstacles: medical habits, the peculiar organization of the National health service centred on acute diseases treatment, the prevalent narrative of obesity as an aesthetic issue rather than a medical one. Obesity should be considered a chronic diseases, and should be taken into account in the National plan for Chronic Care. Than, specific implementation programmes would be planned, aimed to disseminate knwoledge and skills among the health professionals, fostering multidisciplinarity through continuing medical education of specialized teams.

[Active and green city project: a program of urban health.] / Active and green city project: l'urban health in pratica.

Urbanization is one of the leading global trends of the 21st century that has a significant impact on health. Non-communicable diseases (NCDs), are the result of a combination of genetic, physiological, environmental and behavioural factors. These diseases are related to rapid unplanned urbanization, unhealthy diets and a lack of physical activity. This report presents a project (Active and green city project) that wants to rethink the city in terms of health and sustainable quality of life. The first objective is the implementation of physical activity and sustainable nutrition to improve the health of citizens by strengthening the cultural identity of the city. The project aims to be a practical response to the various call to actions of the scientific societies.

Front-of-pack (FOP) labelling systems to improve the quality of nutrition information to prevent obesity: NutrInform Battery vs Nutri-Score.

Many systems for classifying food products to adequately predict lower all-cause morbidity and mortality have been proposed as front-of-pack (FOP) nutritional labels. Although the efforts and advances that these systems represent for public health must be appreciated, as scientists involved in nutrition research and belonging to diverse Italian nutrition scientific societies, we would like to draw stakeholders' attention to the fact that some FOP labels risk being not correctly informative to consumers' awareness of nutritional food quality. The European Commission has explicitly called for such a nutrition information system to be part of the European "strategy on nutrition, overweight and obesity-related issues" to "facilitate consumer understanding of the contribution or importance of the food to the energy and nutrient content of a diet". Some European countries have adopted the popular French proposal Nutri-Score. However, many critical limits and inadequacies have been identified in this system. As an alternative, we endorse a new enriched informative label-the NutrInform Battery-promoted by the Italian Ministry of Health and deeply studied by the Center for Study and Research on Obesity, Milan University. Therefore, the present position paper limits comparing these two FOP nutritional labels, focusing on the evidence suggesting that the NutrInform Battery can help consumers better than the Nutri-Score system to understand nutritional information, potentially improving dietary choices. LEVEL OF EVIDENCE: II. Evidence was obtained from well-designed controlled trials without randomization.

Diabetes mellitus and Parkinson's disease: dangerous liaisons between insulin and dopamine.

The relationship between diabetes mellitus and Parkinson's disease has been described in several epidemiological studies over the 1960s to date. Molecular studies have shown the possible functional link between insulin and dopamine, as there is strong evidence demonstrating the action of dopamine in pancreatic islets, as well as the insulin effects on feeding and cognition through central nervous system mechanism, largely independent of glucose utilization. Therapies used for the treatment of type 2 diabetes mellitus appear to be promising candidates for symptomatic and/or disease-modifying action in neurodegenerative diseases including Parkinson's disease, while an old dopamine agonist, bromocriptine, has been repositioned for the type 2 diabetes mellitus treatment. This review will aim at reappraising the different studies that have highlighted the dangerous liaisons between diabetes mellitus and Parkinson's disease.

The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity.

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors - within health systems and at a national level - along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity - not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers.

[Online conversations to understand the disease and promote the doctor-patient relationship.] / Conversazioni online per comprendere la malattia e favorire il rapporto medico-paziente.

An anthropologist's approach to patient engagement is different from that of other professionals. An anthropologist is used to asking himself apparently trivial questions that help deconstruct cultural constructs. In his work, narrative medicine has a fundamental importance: it is a clinical-assistance intervention methodology that allows you «to acquire, understand, integrate the different points of view of those involved in the disease and in the treatment process¼ (Italian Health Institute). Digital technologies help integrate psychosocial components with biological and clinical ones, allowing a matching between the patient and the doctor free from the tight spaces and times of the clinic.

[VLCD and VLCKD in the treatment of obese people with non-insulin-dependent diabetes or prediabetes: clinical evidence and reflections.] / VLCD E VLCKD nel trattamento di obesi affetti da diabete non insulinodipendente o prediabete: evidenze e riflessioni cliniche.

The dramatic rise in the prevalence of obesity and diabetes has become a major global public health issue. "Prediabetes" is the term used for individuals whose glucose levels do not meet the criteria for diabetes but are too high to be considered normal. Prediabetes is associated with obesity, especially visceral obesity, is a high risk state for diabetes. Obesity management can delay the progression from prediabetes to type 2 diabetes and is beneficial in the treatment of type 2 diabetes. In the strategy of weight loss there are several dietary approaches available, divided between low calories diet and very low-calorie diets (VLCDs). VLCDs include the very-low-carbohydrate diet (VLCKD) can lead to a state of ketosis. Type 2 diabetes (T2D) has long been identified as an incurable chronic disease; on the contrary, there is evidence that the reversibility of type 2 diabetes is achievable using very low calorie diets or carbohydrate restriction diets. This report provides an update on the scientific evidence relating to highly low-calorie diets and the opinion of the President of the Italian Obesity Network.

Effects of polyphenols on cardio-metabolic risk factors and risk of type 2 diabetes. A joint position statement of the Diabetes and Nutrition Study Group of the Italian Society of Diabetology (SID), the Italian Association of Dietetics and Clinical Nutrition (ADI) and the Italian Association of Medical Diabetologists (AMD).

AIM: A large body of evidence supports a role of polyphenols in the prevention of chronic diseases, i.e. type 2 diabetes (DMT2), cardiovascular diseases and some types of cancer. In the present manuscript, the effect of polyphenol/phenolic compounds on the main cardio-metabolic risk factors (body weight, blood pressure, blood glucose concentrations, plasma lipids, inflammation and oxidative stress) in humans will be discussed. DATA SYNTHESIS: Epidemiological evidence supports the beneficial effects of polyphenol-rich diets in the prevention of T2D risk. However, the available evidence from randomized controlled clinical trials did not allow the identification of specific phenolic compounds or polyphenol-rich foods that effectively improve cardio-metabolic risk factors. The most promising results in terms of the management of cardio-metabolic risk factors derive from RCTs based on a long-term intake of polyphenol-rich foods and beverages. Therefore, future studies should focus on a diet containing different classes of polyphenols rather than a specific food or phenolic compound. The hypothesis is that a polyphenol-rich diet may have a pleiotropic effect on cardiometabolic risk factors thanks to the specific action of different polyphenol subclasses. CONCLUSION: The lack of conclusive evidence on the effectiveness of polyphenols in the management of cardio-metabolic risk factors does not allow recommendation of their use as supplements to reduce T2D and CVD risk. However, the daily consumption of naturally polyphenol-rich foods and beverages might be advised according to the current nutritional dietary recommendation.

[Technology and diabetes: lights and shadows.] / Tecnologia e diabete: luci e ombre.

"Diabetes technology" is the expression used to describe the hardware, devices, and software that people with diabetes use to manage blood glucose levels, stave off diabetes complications, reduce the burden of living with diabetes, and improve quality of life. This writing is focus on continuous glucose monitoring (CGM) with the most common devices currently in use. The complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation. The almost continuous availability of glycemic data deriving from CGM could have a negative impact on the quality of life of patients due to data overload and stress for frequent alarms. Narrative medicine can be of help. Narrative medicine has been defined as medicine practiced with narrative skills of recognizing, absorbing, interpreting and being moved by stories of illness. The art of medicine has roots that lie deep in developing the biopsychosocial connection. Understanding a human body (both its physiology and pathology) along with components of emotional and spiritual cores can lead to provision of excellent medical care and better outcomes for people with diabetes.

Impact of Insulin Degludec in Hospitalized Patients With and Without Type 2 Diabetes Requiring Parenteral/Enteral Nutrition: An Observational Study.

INTRODUCTION: Hyperglycemia in inpatients is a major problem, especially when nutritional support is required. This study aims to assess the impact of treatment with insulin degludec (IDeg) on mean blood glucose (BG) and glycemic variability in noncritical hospitalized patients with and without type 2 diabetes (T2DM) receiving enteral and/or parenteral nutrition (EN, PN). METHODS: Mean BG and glycemic variability from admission up to 7 days of hospitalization were evaluated in consecutive cases with and without T2DM. Percentage of coefficient of variation (CV) for glucose was used to express glycemic variability. RESULTS: Overall, 26 patients (13 with and 13 without T2DM) were admitted to the hospital for any cause. Subjects were 65.4% men and they were mainly elderly (mean age 66.3 ± 13.4 years). PN was administered in 88.5% of patients and EN in 19.2%. At admission, mean HbA1c level was 5.9 ± 0.7% in patients without diabetes and 9.1 ± 2.5% in patients with T2DM. During hospitalization, mean daily BG levels changed from 151 ± 47.3 mg/dl (day 1) to 157 ± 66.7 mg/dl (day 7) in patients without diabetes and from 210 ± 66.5 mg/dl to 192 ± 48.6 mg/dl in patients with T2DM. CV decreased from 14% (day 1) to 11% (day 7) in patients without diabetes and from 20% (day 1) to 9% (day 7) in patients with T2DM. No symptomatic or severe hypoglycemia occurred. CONCLUSIONS: Despite the small sample size and the lack of control group, this study represents the first proof-of-concept that IDeg in hospitalized patients with or without T2DM who require nutritional support has the potential to maintain stable levels of BG and reduce glycemic variability. FUNDING: Novo Nordisk S.p.A. grant.

Rationale and design of the Early Sleeve gastrectomy In New Onset Diabetic Obese Patients (ESINODOP) trial.

No randomized clinical trials (RCTs) have yet evaluated the bariatric surgery's efficacy and safety in patients newly diagnosed with type 2 diabetes mellitus (T2DM). The aim of this multicenter RCT is to compare bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), with conventional medical therapy (CMT) in obese patients (body mass index between 30 and 42 kg/m2) newly diagnosed with T2DM and without any diabetes-related complications at any stage. A total of 100 eligible patients will be randomized at a 1:1 ratio to undergo one of the two planned treatments and will be followed for at least 6 years after randomization. The main objective of the ESINODOP trial is to investigate the efficacy of LSG compared with CMT alone in inducing and maintaining a remission of T2DM (defined as HbA1c levels ≤6.0 %, without active pharmacologic therapy after 1 year). The remission of T2DM will also be evaluated with the criteria provided by the American Diabetes Association (ADA), and the additional parameters such as adverse event rates, micro- and macrovascular complications, weight loss, gastrointestinal hormones, and quality of life will be compared. The study started on September 2015 and the planned recruitment period is 3 years. Patient recruitment and follow-up take place in the two diabetology and nutrition centers participating in the study, which are performed on a national basis. The ESINODOP trial is designed with the intent of comparing the efficacy of CMT alone to that of CMT in conjunction with LSG performed at the time of diabetes diagnosis in mildly obese diabetic patients. Currently, patients with these characteristics are not eligible for bariatric/metabolic surgery.

[Sustainable diet: history lessons]. / Alimentazione sostenibile: l'insegnamento del passato.

Global dietary patterns changed dramatically in the past 50 years, presenting both a boom and a threat to the health and well-being of populations everywhere. We need sustainable diets, with low-input, local and seasonal agro-ecological food productions as well as short distance production-consumption nets for fair trade. The development of a global food system able to guarantee everyone a balanced food intake requires health professionals an awareness and a commitment to increasingly complex education. Dietary changes such as the adherence of to the Mediterranean Dietary Pattern can reduce the environmental footprint and thus the use of natural resources. Increased focus on improving the utilization of freshwater fishes and the correct use of the waters of rivers and lakes should also be encouraged. Cultural heritage, food quality and culinary skills are other key aspects determining sustainable dietary patterns and food security. The Mediterranean street food (Mediterraneità), for intrinsic characteristics, can represent valid model to address the main issues concerning the sustainable food system. The issues of sustainability offer a great opportunity to nutritional science and scientists to play a more central role in the political analysis of future food systems. We are confident that preserve the past helps us understand the present and build for the future, the Mediterranean lifestyle is much more than the Mediterranean diet and, finally, the rivers and the lakes may be our future.

[Artificial nutrition: technical, scientific and ethical considerations]. / La nutrizione artificiale: aspetti tecnico-scientifici ed etico-deontologici.

Artificial nutrition (AN) is a relatively new medical treatment which started in the 1960 with parenteral nutrition (PN) and over the last 20 years has come to include enteral nutrition (EN) in hospitals and homes. Enormous clinical progress and continual evolution in techniques aimed at rendering organ funtion substitution more complete and efficient have come to the point where AN can only be suitably performed (indications for therapy, treatment regimen and monitoring) in specialized institutions. However, there has been much discussion about whether artificial nutrition should be considered a medical intervention or an essential intervention of care: in 2004 the Terri Schiavo case became worldwide news and the suspension of AN was decided by the law courts. In Italy, on 5 September 2014, the Council of State gave its opinion on case of Eluana Englaro. In 2007 the Italian Association for Dietetics and Clinical Nutrition (ADI) and the Professional Board of Physicians of the Province of Terni, have shared a paper that takes into account the scientific, technical and ethical considerations of AN in the light of the relative codes. The intent of this position paper was to supply a framework of clinical practices, ethical principles, and professional guidelines that will impart information and can assist decision making regarding AN and hydration. The document is still relevant today.

[Diabetes, psychosocial distress and quality of care]. / Diabete, disagio psicosociale e qualità delle cure.

Diabetes is on the rise world wide; according to the latest report from the International Diabetes Federation, the number of people affected by the disease will increase by 55% from 382 in 2013 to almost 600 million in 2033. Individuals living with type 1 or type 2 diabetes are at increased risk for depression and anxiety. Diabetes impacts on physical, emotional, social and financial aspects of life across cultures and countries, yet gaps in care exist around psychosocial and self-management education and support. The DAWN2 study provides a first multinational, multidisciplinary systematic framework for the comparison of unmet needs of people with diabetes and those who care for them in four continents. it is necessary to develop a system of patient-centered care, in which the empowerment of the person is the main instrument, and at the same time target on which to focus. Transforming study results into actions at the national level will represent one of the main activities of the DAWN2 initiative. In Italy, to do so, it is not enough write new documents but new resources are required.

[Chronic pain in the obese: a quali-quantitative observational study]. / Dolore cronico nell'obesità: studio osservazionale quali-quantitativo.

INTRODUCTION: Obesity (Ob) is one of the major issues for the public health care system with a constantly increasing prevalence. Chronic Pain (CP), on the other hand, is a pathological condition as severe and prevalent as the former. Ob and CP are not only pathological conditions, they also are important factors of risk for the onset of a number of morbid conditions. MATERIALS AND METHODS: In our study we have enrolled 182 patients with Ob, to whom we have asked to fill a brief questionnaire with the purpose of evaluating prevalence and characteristics of CP, therapeutic attitude and its results, as well as the knowledge of the Law n. 38 - 15/03/2010. RESULTS: From the analysis of gathered data, CP is present in the 39% of subjects with Ob (73.2% of females and 23.9% of males) and proportionally increases as BMI increases. The majority of patients (48%) shows pain at articular level, and a "pin" and a "gripping" pain are the two types of pain that are mostly described. Almost all the subjects enrolled (90%) suffer of a pain reported at a moderate to intense level. 15% circa of the patients do not take any therapy, while FANS have resulted to be the most used drugs among them (over 50% of the patients) and the 45% of the subjects have currently reported not to have a good control over the pain. The Law n. 38 has been reported unknown by the 8.2% of the investigated sample. CONCLUSIONS: The study has demonstrated a substantial association between the Ob and CP, particularly in the female gender, the clinical relevance of pain, its BMI-dependent tendency, the inadequacy of the therapy and the widespread lack of awareness and attention to the themes and issues of pain.

[Chronic pain in the diabetic patient: a quali-quantitative observational study]. / Dolore e diabete mellito: studio osservazionale quali-quantitativo.

AIM: The purpose of this study is to evaluate the prevalence and characteristics of pain in subjects affected by Diabetes Mellitus (DM), to assess approach and therapeutically valid outcomes as well as the knowledge of the Law n. 38/15/03/2010 of the Italian Government ("Dispositions to guarantee the access to the Palliative Cares and Pain Therapy"). MATERIALS AND METHODS: We have enrolled 462 patients affected by DM [242 (52.4%) males, 209 (42.5%) females; while in 11 (5.1%) cases the gender has not been specified], with characteristics as follows: 62 patients (13.4%) affected by T1DM (37 males and 25 females) e 400 patients (86.6%) affected by T2DM (224 males e 176 females). The average age was of 65.2 years old (range 20-91). All the patients have been presented with an original questionnaires based on 10 questions. RESULTS: 221 subjects (48%) have claimed to have experienced pain; 60% within the females, 38% within the males (p<0.001). 31% of these are to be included among the patients with T1DM, 50.5% among those with T2DM (p<0.01). The presence of chronic pain has been acknowledged by 162 subjects (35%). As per chronic pain, this has been described as articular pain by 128 patients (80%), while 63 (38%) located the pain through the spine and 29 (18%) throughout the muscles. Chronic pain was described as moderate by 73 subjects (45%), intense by 59 (36%), feeble by 15 (9%), utterly intense by 5 (3%), moderate/intense by 1 (1%). The drugs for treating the chronic pain used by the patients have been enlisted as follows: FANS (41%), paracetamol (30%), glucocorticoids (3%), weak opioids (2%); 27% of subjects have received no therapy. As for the Law 38/2010, only 8% have said they have had news of it. CONCLUSIONS: The data gathered in this study have drawn attention on the fact that the presence of pain is higher in female gender, with a prevalence of 60% compared to the 38% of the male gender. It has been observed no relation with the age range, in particular no proportional increase level of pain has been observed, although the higher peak of prevalence has been experienced in the age range between 70-79, both for pain in general and for chronic pain. Speaking about efficacy of the treatment, almost 50% of the subjects have received no improvement from the therapy.

[Sustainability of food choices: the position of the Italian experts in nutrition]. / Sostenibilità delle scelte alimentari: la posizione degli esperti italiani di nutrizione.

The development of a global food system able to guarantee everyone a balanced food intake requires health professionals an awareness and a commitment to education increasingly complex. FAO strongly recommends the development of a code of conduct for sustainable diets. Sustainable diets are those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. We wanted to examine, through a specific questionnaire, the opinions of scientific italian opinion leaders on this topic. The comments received confirm the variability of the concept of sustainability among those who participated in our survey. In relation to the consumption of certain foods we detect the potential conflict between "healthy" and "sustainable". The nutritional need of increasing the consumption of healthy foods is widely shared, but more than a doubt emerges about the sustainability of these solution. Our survey shows the absolute necessity of shared documents in this regard (recommendations and/or guidelines) and of a thorough implementation of such documents among opinion makers.

Effects of laparoscopic sleeve gastrectomy in patients with morbid obesity and metabolic disorders.

PURPOSES: Obesity and its correlation with other pathological conditions determine the onset of the metabolic syndrome, which exposes the patient to a higher risk of major cardiovascular complications. Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure that appears to influence both the reduction of fat mass and the action of some gastrointestinal hormones. PATIENTS AND METHODS: Between January 2011 and July 2013, 23 patients with morbid obesity underwent LSG and follow-up. In the evaluation of patients, the criteria for metabolic syndrome given by the International Diabetes Federation were followed. A multidisciplinary team of experts evaluated patients before surgery and in subsequent scheduled postoperative visits at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months. Anthropometric and metabolic parameters were analyzed. RESULTS: The mean excess weight loss was 8.57±3.02%, 17.65±6.40%, 25.47±7.90%, 33.76±9.27%, 41.83±10.71%, 46.02±13.90%, 52.60±14.05%, 58.48±16.07%, and 62.59±21.29% at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months, respectively. In the same observational period there was an excellent improvement of metabolic indices. None of the patients previously taking prescribed hypoglycemic drugs restarted therapy. Mean fasting plasma glucose significantly decreased compared with the preoperative values. Blood pressure had a statistically significant improvement. Modification in the lipid profile was more variable. During the period of observation 22 of 23 patients reported in this study did not fit the criteria for metabolic syndrome. CONCLUSIONS: Morbid obesity and related diseases may benefit from a surgical approach in selected patients. Randomized controlled trials are needed to evaluate the role of LSG.

[Italian eating behavior: survey 2011]. / I comportamenti alimentari degli italiani: Osservatorio 2011.

Obesity is one of the most serious public health challenges of the 21st century for the European region. The concept of personal responsibility affected social, legal, and political approaches to obesity. It evokes blame and weakness of the individual, and it is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. It is needed not only to gain a correct understanding of the progress of the epidemic but also to evaluate preventive initiatives that are progressively introduced. As part of the social, health and agri-food production in the country, knowledge of dietary habits and lifestyle of the population in real time is a valuable resource. The data from ADI-Nestlé Observatory confirmed that it is unfair to say that poor diet and sedentary behaviour are individually responsible for obesity-related health burden in Italy, but both factors need to be improved and addressed through structural political and social structural measures.