Effect of the compound L-mimosine in an in vivo model of chronic granuloma formation induced by potassium permanganate (KMNO4).

The plant amino acid L-mimosine has recently been suggested to inhibit cells at a regulatory step in late G1 phase before establishment of active DNA replication forks. In addition, L-mimosine is an extremely effective inhibitor of DNA replication in chromosomes of mammalian nuclei. In this work, the effect of L-mimosine on chronic inflammation induced by dorsal injections of 0.2 ml of a 1:40 saturated crystal solution of potassium permanganate in mice, was studied. Seven days afterwards, all mice developed a subcutaneous granulomatous tissue indicative of chronic inflammatory response at the site of infection. The intraperitoneal administration of L-mimosine (200 microg/dose) to the potassium permanganate treated mice for 5 consecutive days (the first at the same time of inoculation of the KMnO4), produced a significant decrease in size and weight of the granuloma when compared to mice not treated with L-mimosine (controls). In addition, in all mice treated with L-mimosine, there was a strong inhibition of tumor necrosis factor alpha that was revealed in the serum (P<0.05) and in the minced granulomas. Interleukin-6 was not detected in the serum of treated and untreated mice. These findings show for the first time, that L-mimosine may have an anti-inflammatory effect on chronic inflammation and an inhibitory effect on tumor necrosis factor alpha and interleukin-6 generation in supernatant fluids of minced granulomas.

A spectrum of antibody (IgG. IgG1, IgM) response in mice infected with trichinella spiralis treated with L-mimosine.

The purpose of this study was to demonstrate the anti-inflammatory effects of L-mimosine on chronic inflammation, by investigating its effect on the immunological response of BALB/c mice infected with the nematode parasite Trichinella spiralis. Specific anti-parasite immunoglobulins (IgG, IgG1 and IgM) were detected by the ELISA method in the serum of both the treated and the untreated animals at different periods of time for 60 days post infection. Two groups consisting of 18 mice each were used. The mice were 6 weeks of age. Both groups were infected with 220 larvae (L1-T. spiralis) per os: one group was administered an intraperitoneal injection of L-mimosine (200 &mgr;g/100 ml/dose) for 27 days (the first injection started 7 days before infection) and the second group was administered an intraperitoneal injection of saline solution (100 &mgr;l/dose). Parasite specific IgG, IgG1 and IgM levels were determined in the sera of infected, untreated mice. The levels of IgG and IgG1 were increased following infection and remained elevated throughout the experimental period, while IgM was significantly decreased on the 50th day post-infection. These levels were found to be lower in the L-mimosine treated infected mice, compared to the untreated mice. The inhibition started from day 10 and continued until day 60. In healthy animals, the production of immunoglobulins was not measurable. Non-infected animals treated with L-mimosine also showed no detectable anti-parasite specific immunoglobulins.

Large waist circumference and risk of hypertension.

OBJECTIVE: To examine the relationship between 24 h ambulatory blood pressure monitoring and three commonest anthropometric measurements for obesity--body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (W). DESIGN: Cross-sectional survey among outpatients at the Obesity Research Center. SUBJECTS AND METHODS: Four-hundred and sixty-one overweight or obese subjects, non-diabetic, otherwise healthy, aged 20-70 y, of either sex, were consecutively recruited. All subjects underwent 24 h ambulatory blood pressure monitoring. The population study was separated in normotensive and hypertensive males and females and the possible risk factors for hypertension (W, WHR, BMI and age) were subdivided into different classes of values. RESULTS: Logistic regression shows that W is the most important anthropometric factor associated with the hypertensive risk. Among males with W> or =102 cm the odds ratio (OR) for hypertension is three times that of males with W<94 cm using casual BP measure (OR 3.04), nearly four times higher using 24 h BP mean (OR 3.97), and even five times higher using day-time BP mean (OR 5.19). Females with W> or =88 cm have a risk for hypertension twice that of females with W<80 cm, whatever BP measurement was take (casual, 24 h or day-time). Males with WHR> or =0.96 and females with WHR> or =0.86 show significant OR for hypertension only by 24 h BP measurement and by day-time BP measurement. BMI seems to have no significant relationship to hypertensive risk. Age shows a significant relationship to hypertensive risk only considering males aged > or =55 y and females aged > or =50 y. CONCLUSION: The waist circumference seems to have a strong association with the risk of hypertension, principally by the ambulatory BP monitoring, when compared with casual BP measurement.

Clinical nutrition: inadequate teaching in medical schools.

BACKGROUND AND AIM: The teaching of Clinical Nutrition (CN) is frequently neglected in Medical Schools, though many official institutions strongly recommend its incorporation in their curricula. This work aimed to assess CN knowledge among final-year medical students and final-year dietology diploma students. METHODS AND RESULTS: We compared the performances of final-year Medical School students who did and who did not take the CN course and final-year dietology students in a computer-based multiple choice question examination related to core CN competencies that primary-care physicians and dieticians should know and be able to put into practice. The medical students who did not take the CN course correctly answered significantly fewer questions compared with those who did and the dietology students (both p < 0.001). There was also a difference in the percentages of who passed the test: students who did not take the course: those 18%; those who did: 77%; dietology students: 76% (p < 0.001). CONCLUSIONS: There are numerous barriers to the incorporation of nutrition in Medical School curricula. The medical school students may have achieved poorer results because dietology students followed nutrition education programs later in their curriculum. Our Medical School has therefore included CN education as part of its internal medicine course since 1998.

[Professional licensing examination. Innovative experience: the Integrated Multimedia Pilot Project of the Chieti University]. / L'esame di Stato per l'abilitazione professionale. Un'esperienza di rinnovamento: il Progetto pilota multimediale integrato dell'Università di Chieti.

The Medical Licensing Examination (MLE) is governed, in Italy, by a law enacted in 1956. An ideal clinical competence assessment tool should effectively, reliably and objectively measure all the components of clinical competence: basic knowledge and clinical skills as history-taking, performing a physical examination, formulating the most likely diagnosis, establishing a management plan, communication and interpersonal relations. Since 1998 first session of the MLE, Chieti University implemented computer-based case simulations and standardized patients in the Multimedia Integrated Pilot Project (MIPP) administration. At the present time, we have examined 370 subjects during five sessions of MLE. This preliminary work shows results regarding the examinees in the first examination session of 1998 and 1999. The two groups of examinees are relatively homogeneous for number, age, gender, length of curriculum and country of University degree. In both groups the curriculum scores (preclinical, clinical and total) and the MIPP final score are reported for all subjects, first ten and last ten examinees. The MIPP final score is moderately correlated with the preclinical, clinical and total curriculum scores. Recently, the Federation of State Medical Boards and the National Board of Medical Examiners, sponsoring organisations of the United States Medical Licensing Examination (USMLE), have been planning the implementation of computer-based testing for the USMLE. It is important to point out that our MIPP-based MLE is not a mere didactic experiment, but a legal certifying examination valid for licensure.

Effects of 50 Hz sinusoidal electromagnetic fields on MCP-1 and RANTES generated from activated human macrophages.

Extremely low frequency electromagnetic fields (ELF-EMF) induce cellular changes and modulate signal transduction pathways, and may be beneficial in the treatment of inflammatory diseases. In this paper we studied two inflammatory chemokines, MCP-1 and RANTES produced by human cultured isolated monocytes from peripheral blood, with or without PHA and in the absence or presence of 50 Hz magnetic field of 1.0 mT for 24 h. The production of MCP-1 and RANTES was determined by ELISA method. Here, we found that ELF-EMF strongly inhibited the production of these chemokines stimulated by PHA, while the control was not affected. Since MCP-1 and RANTES exert chemoattraction for several populations inflammatory leukocytes, the inhibitory effect of these chemokines could be one of the mechanisms by which ELF-EMF is therapeutic in inflammatory diseases.

Chronic fatigue syndrome: circadian rhythm and hypothalamic-pituitary-adrenal (HPA) axis impairment.

Chronic Fatigue Syndrome (CFS) is a clinical condition characterized by a persistent or relapsing debilitating fatigue at rest, lasting more than 6 months, and made worse by exercise. At the present moment, there are three potential etiopathogenic factors: immunologic, viral and neuroendocrine. The purpose of our study was to evaluate possible alterations of the hypothalamic-pituitary-adrenal (HPA) axis in our CFS patients by studying the circadian rhythms of prolactin (PRL), thyrotropic hormone (TSH), adrenocorticotropic hormone (ACTH), and cortisol (CS). A total of 36 patients were enrolled according to the Centers for Disease Control and Prevention case-definition criteria. Twenty healthy subjects were included as controls. Blood samples were taken every 4 hours during a single 24-hour period. We performed a fluorometric enzyme immunoassay with serum PRL, cortisol and TSH, and an immunoradiometric assay with plasma ACTH. The circadian rhythms of PRL, TSH, ACTH and CS were statistically significant in both CFS and control groups. At 24:00 and 04:00 hrs the CFS patients showed lower ACTH levels than healthy subjects (p < 0.001); the PRL levels were higher at 04.00 h in CFS patients than in healthy subjects.

Non insulin-dependent diabetes mellitus (type 2) secondary failure. Metformin-glibenclamide treatment.

The goal of sulphonylurea (S) treatment in Non-Insulin-Dependent Diabetes Mellitus (NIDDM - type 2 diabetes) subjects should be to obtain a satisfactory glycemic control (fasting glycemic levels < 140 mg%). The loss of an adequate blood glucose control after an initial variable period of S is known as secondary failure (SF). The number of SF are extremely variable among different trials for many reasons, some of which are patient-related: increased food intake, weight gain, non-compliance, poor physical activity, stress, diseases and÷or impaired pancreatic beta cell function, desensitization after S chronic therapy, reduced absorption, concomitant therapies. Many therapeutic strategies have been proposed to achieve an adequate metabolic control in type 2 diabetes patients: switch to intensive insulin therapy and subsequent return to S therapy; association with insulin; association with sulphonylureas plus biguanides. The association biguanides and S, in particular glibenclamide plus metformin, is now widely used by diabetologists in SF since glibenclamide improves insulin secretion while metformin exerts its antidiabetic.

Does holiday hypoglycaemia exist?

BACKGROUND: To determine whether an excessive, prolonged and, above all, unusual physical exertion could be associated with episodes of mild hypoglycaemia in non-insulin-dependent diabetes mellitus (NIDDM) patients treated with glibenclamide. EXPERIMENTAL DESIGN: 11 months of observation with retrospective analysis of patient personal diaries to determine the hypoglycaemic risk. SETTING: Diabetic Unit-Department of Medicine and Aging-Chieti University School of Medicine. PATIENTS: We enrolled 340 NIDDM outpatients adjusted for sex, age, body mass index, alcohol intake and oral treatment regimen with glibenclamide. PATIENTS were tested monthly for circadian blood glucose profiles and glycosylated hemoglobin. Mild hypoglycaemia was defined on the basis of blood glucose values < 2.8 mmol/l associated with mild autonomic symptoms, without requiring external assistance. Each diabetic patient filled personal diary indicating the therapy regimen and the characteristics of eventual hypoglycaemic episodes occurring during the observation period. RESULTS: 21.8% of NIDDM patients experienced one or two episodes of mild hypoglycaemia during the observation period. The analysis of the patients' diaries showed that 60% of the hypoglycaemic episodes was associated with excessive, prolonged and unexpected physical exertions. Within this group, about 70% of the episodes occurred during a holiday ("holiday hypoglycaemia"). After analyzing the socio-demographic and clinical characteristics of the diabetic patients reporting hypoglycaemic events, we found a higher risk for "holiday hypoglycaemia" in patients with a lower educational level, with a sedentary occupation or among the ex-farmers. CONCLUSIONS: As resulted in the present study, unexpected physical exertions may represent a relevant cause of mild hypoglycaemia in diabetic patients receiving oral antidiabetic therapy. However, this hypoglycaemic cause may have been underestimated in the literature. Educational programs conducted by general practitioners or diabetologists could be useful for the patients in reducing the number of mild hypoglycaemic episodes.

Risk factors for hypertension in obese women. The role of weight cycling.

OBJECTIVE: To study significant factors associated with the risk of hypertension among obese women, with and without a history of weight cycling (WC). DESIGN: Case-control study. SETTING: Obesity Clinic of Chieti University, Italy. SUBJECTS: A group of 258 obese women aged 25-64 y (103 cases with hypertension and 155 controls) were recruited. All obese subjects had the same clinical characteristics, were without a family history for hypertension, were non-smokers, had normal lipidemic profiles and normal glucose tolerance, were not taking any medication and were otherwise healthy. INTERVENTION: In the weight cycling women, the history of WC was established on the basis of at least five weight losses in the previous 5 y due to dieting, with a weight loss of at least 4.5 kg per cycle. A logistic regression model adjusted for confounding variables such as waist-to-hip ratio (WHR) and weight cycling history parameters was used and the odds ratio (OR) with 95% confidence intervals was calculated. RESULTS: The risk of hypertension increases in subjects with larger WHR (OR 7.8; 95% CI 3.4-17.9) and with a positive history for WC (OR 4.1; 95% CI 2.4-6.9). Further, in obese patients with WC, the weight cycling index and the sum of the weight regained are also important risk factors for hypertension. CONCLUSIONS: These findings could support the hypothesis that it is the combined exposure of central-type obesity and WC that strongly raises the risk of hypertension. SPONSORSHIP: This work has been financially supported by a grant of Ministero dell'Università e della Ricerca Scientifica e Tecnologica.

Impact of different scoring methods on the clinical skills assessment of internal medicine students.

The aim of this study was to determine how different scoring methods could influence the results achieved in clinical competence assessment examinations at the end of the medical school curriculum. Fifty-six final-year medical school students were examined using a programme of multimedia computer-based simulated cases (Procuste programme). For generating results, the following scoring methods were applied: (1) the method used for the Internal Medicine official certification examination which includes both weighted and unweighted items; (2) a method with only unweighted items;(3) a method which includes single-item analysis. Each time an absolute pass/fail cut-off standard ( S 60/100) and a relative pass/fail cut-off (mean minus 1 standard deviation) were applied.Taking as a reference the first method, the effect of using different scoring methods on the percentage of student failure was evaluated. Furthermore, correlation studies between the results obtained with these scoring methods and the grades reported by the examinees during the medical school curriculum were performed. It was found that the first method generated a more realistic pass/fail rate compared with the two other methods. Furthermore this method, which has been used for the last 10 years for administering internal medicine examinations, showed better correlation coefficients with the curriculum scores.

Weight fluctuations could increase blood pressure in android obese women.

Recent studies have documented a relationship between increased morbidity and mortality from cardiovascular diseases and a history of weight cycling (WC) in obese subjects. We performed a cross-sectional analysis in 96 weight-cycling android obese women, matched with 96 non-weight-cycling android obese women by age, body mass index (BMI) and waist-to-hip ratio (WHR), to evaluate any increase in blood pressure (BP) levels in association with WC. The patients were all between 20 and 45 years old, were non-menopausal, did not smoke, did not take any medication, had normal glucose tolerance and were otherwise healthy. A history of WC was established on the basis of at least five weight losses in the previous 5 years due to dieting, with a weight loss of at least 4.5 kg per cycle. We documented higher levels of casual BP in the weight-cycling obese compared with the non-weight-cycling subjects: 147+/-12/90+/-8 mmHg versus 125+/-14/79+/-8 mmHg (P<0.001). The women with WC showed a statistically significant positive correlation between BP and age, weight, BMI, waist circumference, WHR, total weight regained and weight cycling index (WCI). However, in a multiple regression model only the WHR and WCI contributed significantly to the BP variability. These findings could support the hypothesis that it is the combined exposure of central-type obesity and WC that strongly raises the prediction of hypertension.

[Assessment of clinical competence of medical school graduates in Italy with standardized patients. The opinion of the examinees]. / Sperimentazione in Italia del metodo del paziente standardizzato per la valutazione della competenza clinica. L'opinione dei neolaureati.

An international collaborative project for the evaluation of clinical competence at the end of the Medical School curriculum using the ECFMG-CSA (Educational Commission for Foreign Medical Graduates--Clinical Skills Assessment) prototype was started in Italy in April 1996. Faculty representatives from Italian Medical Schools and experts from the ECFMG in Philadelphia participated in the Project. The CSA consists of integrated clinical encounters with 10 standardized patients during which the examinee is asked to obtain a focused history, perform a relevant physical examination and communicate initial diagnoses and management plan to the Standardized Patient (SP). The SP then completes checklists that are scored by Faculty members. The project was concluded in Spring 1998 and a total of 173 new graduates were examined. The data elaborated by the primary site in Chieti University will be available in the Fall 1998 by the ECFMG in Philadelphia. This preliminary communication reports the opinions of the examinees on the ECFMG-CSA, contained in the questionnaires administered after the test. Most of the examinees considered this new methodology as a valid tool for the assessment of clinical competence, especially history-taking and interpersonal skills and stated that the SP simulations were realistic. The 72% of examinees indicated that the Medical School curriculum does not adequately prepare for the CSA examination. Lastly, 68% was in favour of including the SP in the Medical Licensing Examination.

Many factors can affect the prevalence of hypertension in obese patients: role of cuff size and type of obesity.

OBJECTIVE: To determine to what extent methodological errors, including measurements taken with inappropriate cuffs and/or inaccuracies in patient enrollment, can contribute to overestimating the prevalence of hypertension in overweight or obese women. EXPERIMENTAL DESIGN: Randomized and comparative investigation in overweight or obese outpatient women of the Obesity Clinic, Internal Medicine Institute, Chieti University. PATIENTS: In 1,791 overweight or obese women, randomly selected and stratified by age (41-60 years), blood pressure (BP) was taken with casual measurement in the morning. The entire study group was divided into two subgroups. In the first one, causal BP was measured with a standard-size cuff (RCS), while an appropriate large-size cuff was used for the second one (LCS). Patients of the latter subgroup were also divided by type of obesity (android and gynoid), based on their waist-to-hip ratio. RESULTS: In the LCS subgroup, the hypertension prevalence rate was strikingly lower among overweight and obese women, as well as in the younger and older age groups, when compared with the corresponding RCS subgroups (p < 0.001). The hypertension prevalence rate was higher for all android obese subjects (53%), including younger (34%) and older (64%) groups, when compared with gynoid obese patients (29%, 18% and 42%, respectively). CONCLUSIONS: A comparison of different reports on the prevalence of hypertension in obesity reveals considerable differences, due mainly to age, sex, race and income level. Nevertheless, our data seem to indicate that even after adjusting for the above-mentioned variables, two significant confounding factors, cuff hypertension and the prevalence of android obesity in the obese study population, could be responsible for over-estimating the prevalence of hypertension. It should be noted that for certain groups of overweight and obese women, the prevalence of hypertension becomes similar to the rate found among the general population, as reported in many large epidemiological surveys.

Association between anthropometric and ultrasound measurements of fatness with ambulatory blood pressure monitoring in obese women.

OBJECTIVE: An association between body fat distribution indices and the amount of visceral adipose tissue (AT) with blood pressure (BP) has been documented. However, most studies used casual morning BP values as the dependent variable. The aim of our study was to identify which of the obesity indices (the body mass index (BMI), waist-to-hip ratio (WHR), sagittal diameter or visceral (AT) measured by ultrasonography (US)) better correlated with BP determined by 24 h ambulatory monitoring. DESIGN: Retrospective study on obese women, outpatients at the Obesity Clinic, Internal Medicine Institute, Chieti University, Italy. SUBJECTS AND MEASUREMENTS: In fifty-one obese outpatient women, BP was determined with a single morning measurement (casual BP) and with 24 h ambulatory monitoring (ABPM). The obesity parameters were the BMI, WHR, sagittal diameter and the amount of intra-abdominal and subcutaneous fat determined by US. RESULTS: Except for the BMI, all obesity indices as WHR, sagittal diameter and visceral AT measured by US were strongly correlated with both casual and 24 h ambulatory BP values. When such parameters were evaluated in a multivariate analysis, only the WHR remained significantly related to 24 h ABPM parameters and not to casual values. CONCLUSIONS: These results suggest that a simple measure of fat distribution as the WHR could represent a good predictor of hypertension in obesity, providing that BP is measured in a more reproducible manner, such as by 24 h ambulatory BP monitoring.

Transdermal clonidine therapy and blood pressure nocturnal fall in mild hypertensive male subjects.

UNLABELLED: Treatment of mild hypertension with an antihypertensive drug administered by means of a transdermal therapeutic system (TTS) could produce favorable results, when compared with a traditional oral regimen. PURPOSE: Using 24-h ambulatory blood pressure (BP) monitoring (ABPM) in mild hypertensive male subjects, to analyze three aspects which have not been completely clarified: a) whether a latency in the antihypertensive effect may be present, recording BP already from the first day of application of the patch, b) the eventual hazardous enhancement of circadian nocturnal fall in BP values in treated mild hypertensive patients and, c) the possible overlapping of antihypertensive effect between the administration of two consecutive patches. SUBJECTS AND METHODS: In 12 caucasian male outpatients (yrs 55 +/- 3 SEM) with uncomplicated essential mild hypertension, a patch containing placebo was applied for the first week (T 0 period). At the end of the T 0 period, a 5 mg TTS-2 clonidine patch was applied for one week, and, subsequently, a new patch of 5 mg TTS-2 clonidine was kept for another week. ABPM was performed on the last day of the placebo period (T 0) and on the 1st day (T1), the 7th day (T2) and the 14th day (T3) of transdermal clonidine therapy. RESULTS: Both systolic and diastolic BP (24 h mean, day-night-time) decreased on the 1st, 7th and 14th day, when compared with T0. However, no significant differences were documented between the BP levels on the 1st and the 7th day of treatment. The incidence of nocturnal fall in systolic and diastolic BP was evaluated and no significant differences were found, when compared with night-time reference values. CONCLUSIONS: When compared with the placebo period, TTS-2 clonidine lowers SBP and DBP within the first 24 hours of application. The antihypertensive effect persists at the end of the first week, as well as after 14 days. The lowest values of systolic-diastolic BP documented were not below the levels reported in normotensive men. Therefore, TTS-2 clonidine seems to act as an antihypertensive agent rather than a hypotensive drug since it normalizes BP without lowering it below physiological levels.

The prevalence of hypertension in gynaecoid and android obese women.

Until now the different epidemiological studies performed have yielded widely different results in terms of the prevalence of hypertension in obese patients. This is mainly due to methodological errors in blood pressure (BP) measurements, including such false positives as white-coat or cuff hypertension, and more recently, to the different distribution in the study population of obese subjects at risk of hypertension (android obesity type). In 803 obese outpatient women (body mass index range: 28-45) randomly selected and subdivided into younger and older groups, and into android and gynaecoid, the casual BP was measured in the morning with a large size cuff. In addition, in 82 obese outpatients casual BP was measured simultaneously with the large and a standard size cuff. Another group of 94 patients was submitted to 24-h ambulatory blood pressure monitoring (ABPM). The aim was to observed if the use of inappropriate cuffs, or the incidence of white-coat hypertension and the prevalence of obese subjects at risk of hypertension, may contribute considerably to overestimating the prevalence of hypertension in obesity. The hypertension prevalence rate was 37.6% for the entire study group. The prevalence rate was 26.2% in women with gynaecoid type of obesity and 47.1% in android obese subjects. We could conclude that the use of inappropriate cuffs, office or white-coat hypertension and the prevalence of obese subjects at risk of hypertension, may contribute considerably to overestimating the prevalence of hypertension in obesity. The number of hypertensive subjects in younger obese subjects with gynaecoid fat distribution is similar to non-obese subjects who are age-adjusted, but our data confirm that the prevalence of hypertension in android type of obesity is significantly higher than in non-obese subjects.

[What is the real prevalence of hypertension in obesity?]. / Qual è la reale prevalenza dell'ipertensione nell'obesità?

Many confounding variables (age, sex, race, income level) may contribute to an incorrect estimate of the prevalence of hypertension in the obese population. Furthermore, as far as methodology is concerned, both casual morning BP measurement and, the use, in the obese patient, of inappropriate cuffs both also contribute significantly to the overestimation with the inclusion of false positives even in relevant percentages. Different types of obesity (android or gynoid; visceral or subcutaneous) should be considered when enrolling obese patients in prevalence studies being android or visceral obesity at a higher hypertensive risk. At last and overall, universally recognized cutoff-points for obesity and hypertension should always be used when studying prevalence of hypertension among general population and/or among obese patients. When such conditions are not taken into account, inaccurate and misleading conclusions on the real prevalence of hypertension in obesity may result.

Association of body mass index and regional fat distribution with blood pressure investigated by 24-hour ambulatory blood pressure monitoring in android-type obese.

In 46 female outpatients with android-type obesity, body mass index (BMI) 36.6 +/- 1.0, waist to hip ratio (WHR) > 0.86, and normal glucose tolerance (NGT) who were hypertensive at entry study [blood pressure (BP) > 140/90 mm Hg] and in 10 clinically healthy, nonobese, normotensive women, we evaluated the relationship between BMI, fat mass, WHR, fasting blood glucose, sum of blood glucose levels during oral glucose tolerance test and casual BP levels, 24-h ambulatory BP monitoring (ABP) parameters as the 24-hour mean, day-time mean, night-time mean and, by using a periodic model of cosine regression, MESOR (midline estimating statistic of rhythm), amplitude, acrophase, and baric impact. In android obese women, a negative correlation between ABP levels (day-/night-time, MESOR, and baric impact of systolic BP; night-time and MESOR of diastolic BP) and BMI has been documented. A positive correlation between systolic BP (casual, night-time mean, MESOR, amplitude, and baric impact), diastolic baric impact, and the WHR has been found. No correlation has been demonstrated between ABP monitoring parameters, and BMI, body fat, and WHR in the control group. Our data could suggest that, when enrolling obese subjects, it must be taken into account that obesity is a heterogeneous disorder. There are in fact obese subjects with normal or impaired glucose tolerance, as well as diabetics with moderate to severe obesity and with gynecoid or android-type obesity. In our android obese subjects with NGT, the WHR rather than the BMI was found to be a better predictor of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)