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Crigler–Najjar Syndrome (CNS) is a rare genetic disorder caused by mutations in the UGT1A1 gene, leading to impaired bilirubin conjugation and severe unconjugated hyperbilirubinemia. CNS presents in the following forms: CNS type 1 (CNS1), the more severe form with the complete absence of UGT1A1 activity, and CNS type 2 (CNS2), with partial enzyme activity. This narrative review aims to provide a detailed overview of CNS, highlighting its clinical significance and the need for new, more effective treatments. By summarizing current knowledge and discussing future treatments, this article seeks to encourage further research and advancements that can improve outcomes for CNS patients. The literature analysis showed that CNS1 requires aggressive management, including phototherapy and plasmapheresis, but liver transplantation (LT) remains the only definitive cure. The timing of LT is critical, as it must be performed before the onset of irreversible brain damage (kernicterus), making early intervention essential. However, LT poses risks such as graft rejection and lifelong immunosuppression. CNS2 is milder, with patients responding well to phenobarbital and having a lower risk of kernicterus. Recent advancements in gene therapy and autologous hepatocyte transplantation offer promising alternatives to LT. Gene therapy using adeno-associated virus (AAV) vectors has shown potential in preclinical studies, though challenges remain in pediatric applications due to liver growth and pre-existing immunity. Autologous hepatocyte transplantation avoids the risk of rejection but requires further research. These emerging therapies provide hope for more effective and less invasive treatment options, aiming to improve the quality of life for CNS patients and reduce reliance on lifelong interventions. [ABSTRACT FROM AUTHOR]

Background and objective: Low back pain (LBP) is most common pain syndrome in Europe, affecting approximately 50% of European citizens. LBP is a complex condition that negatively affects many aspects of an individual's life such as work productivity, mobility, and mental health. The aim of this study is to assess the impact of pain associated with chronic LBP on patients' quality of life. Methods: Clinical studies reviewed in our search with no time restrictions were identified from PubMed, Web of Science, Scopus, and Cochrane Library databases. Of the initial 1929 studies, only 15 met inclusion criteria. Results: Results of our study indicate that chronic pain has a negative impact on numerous functions and areas in which the individual is involved and that this condition leads to reduced performance. Conclusions: LBP is a debilitating condition for patients, negatively affecting quality of life. Future studies should focus on validating a standardized assessment that examines all aspects affected by LBP through a customized questionnaire. [ABSTRACT FROM AUTHOR]

The high incidence of atrial fibrillation (AFib) following cardiac surgery (postoperative atrial fibrillation, POAF) relies on specific surgical features. However, in the setting of POAF, the role of the microbiome in the modulation of cardiac fibrosis is still not clear. This study aimed to analyze the effect of the microbiome and its main metabolic product (trimethylamine-N-oxide, TMAO) in the fibrosis of myocardial tissue, to investigate its role in POAF. Patients undergoing elective cardiac surgery with cardiopulmonary bypass, central atrio-caval cannulation and no history of AFib, were included. A fragment of the right atrium was analyzed for qualitative and mRNA-quantitative evaluation. A preoperative blood sample was analyzed with enzyme-linked immunosorbent assay (ELISA). A total of 100 patients have been included, with POAF occurring in 38%. Histologically, a higher degree of fibrosis, angiogenesis and inflammation has been observed in POAF. Quantitative evaluation showed increased mRNA expression of collagen-1, collagen-3, fibronectin, and transforming growth factor beta (TGFb) in the POAF group. ELISA analysis showed higher levels of TMAO, lipopolysaccharide and TGFb in POAF, with similar levels of sP-selectin and zonulin. TMAO ≥ 61.8 ng/mL (odds ratio, OR 2.88 [1.35–6.16], p = 0.006), preoperative hemoglobin < 13.1 g/dL (OR 2.37 [1.07–5.24], p = 0.033) and impaired right ventricular function (OR 2.38 [1.17–4.83], p = 0.017) were independent predictors of POAF. Also, TMAO was significantly associated with POAF by means of increased fibrosis. Gut microbiome product TMAO is crucial for myocardial fibrosis, which is a key factor for POAF. Patients in preoperative sinus rhythm who will develop POAF have increased genetic expression of pro-fibrotic genes and enhanced fibrosis in histological staining. Elevated TMAO level (≥61.8 ng/mL) is an independent risk factor for POAF. [ABSTRACT FROM AUTHOR]

According to WHO, "complementary feeding (CF) is the process starting when breast milk alone or infant formula alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast human milk or a breastmilk substitute". CF is one of the most important "critical and sensitive periods" in human life: indeed, timing and approaches to solid foods introduction in an infant's nutrition are of utmost importance as potential epigenetic factors from infancy to adulthood. CF is also deeply influenced by each country and single-family traditions, culture, and beliefs. The aim of our narrative review is to analyze traditional CF practices, including innovative and alternative ones that emerged in the last decades, such as baby-led weaning or plant-based weaning, and to evaluate their effects on the risk of developing non-communicable diseases. Moreover, we will discuss pitfalls and misunderstandings that pediatricians frequently have to face when dealing with complementary feeding. Health care professionals must not have prejudices against parents' wishes or traditions about CF; rather, they should support and educate them in case of any alternative CF choice, always pursuing the infant's adequate growth, neuro- and taste development, and the achievement of correct eating behavior as the primary goal. [ABSTRACT FROM AUTHOR]

Low-grade chronic inflammation linked to obesity can lead to alterations in biomarkers of iron status. The aim of this study was to investigate the primary determinant of serum iron levels among anthropometric measurements, body fat, and serum biomarkers of low-grade chronic inflammation in a group of adult individuals with severe obesity. We enrolled 114 individuals (84 females; 30 males) aged 40.96 ± 12.54 years. Weight and body mass index (BMI) were 121.20 ± 22.33 kg and 44.94 ± 7.29 kg/m2, respectively. Some 30% of individuals had class-II obesity (BMI ≥ 35 ≤ 39.9 kg/m2) and 70% had class-III obesity (BMI ≥ 40 kg/m2). A weak, albeit significant, inverse correlation was found between serum iron levels and c-reactive protein (CRP) (r = −0.259, p = 0.008), fibrinogen (r = −0.261, p = 0.006), BMI (r = −0.186, p = 0.04), waist circumference (WC) (r = −0.265, p = 0.004), and fat mass % (r = −0.285, p = 0.003). With multiple linear regression analysis including CRP, fibrinogen, BMI, WC, and fat mass % as independent variables and serum iron levels as dependent variable, WC was entered in the first step (p = 0.001), which was followed by fat mass % (p = 0.047) and CRP (p = 0.047). Grouping the individuals according to the interquartile range of BMI, WC, and fat mass % (Q1–Q4), the lowest serum iron levels were found in Q4 groups of WC and fat mass % (p = 0.02), while no significant differences were found between groups in BMI quartiles. In conclusion, in our study, population serum iron levels were inversely associated with BMI, visceral obesity, fat mass %, CRP, and fibrinogen, but WC was the major negative predictor of serum iron level. These results supported the fact that visceral distribution of body fat, more than obesity per se, was associated with low serum iron levels in adult individuals with severe obesity. [ABSTRACT FROM AUTHOR]

Oleogels (defined as structured solid-like materials with a high amount of oil entrapped within a three-dimensional network of gelator molecules) represent a healthy alternative to fats that are rich in saturated and trans fatty acids. Given its fatty acids composition (oleic, linoleic, and linolenic acids), olive oil is an excellent candidate for the use of oleogels in the food industry. In this study, a D-optimal mixture design was employed to optimize the replacement of butter with olive oil-based oleogel in a type of sponge cake formulation: the plum cake. In addition, emulsifiers and whey proteins were used as recipe ingredients to extend the product's shelf life by delaying staling phenomena and mold growth. In the experimental design, oleogel, emulsifier, and whey protein variables were set as the ingredients that change in specific ranges, while hardness, porosity, water activity, and moistness were used to characterize the obtained formulations. The experimental data of each response were fitted through polynomial regression models with the aim of identifying the best plum cake formulation. The results revealed that the best mixture was the formulation containing 76.98% olive oil-based oleogel, 7.28% emulsifier E471, and 15.73% whey protein. We stored the optimized plum cake for 3 months at room temperature and then checked for any hardness and moistness changes or mold spoilage. [ABSTRACT FROM AUTHOR]

A fall is an event where a person unintentionally and traumatically finds themselves on the floor or a lower level. Falls are very common, especially in the older adult population. One in four people falls at least once a year after age 65. Because of falls, there can be injuries, whereby there can be an impairment of health status. Fractures, reduced mobility, disability, and the need for institutionalization are potential consequences after falls. In older adult patients, especially frail ones, these types of complications are more common. There are several risk factors for falls. Falls generally result from a combination of factors operating simultaneously. Sarcopenia, cognitive impairment, or poly-pharmacotherapy are just a few examples of risk factors that are common in the older people. Through careful clinical evaluation, it is possible to identify risk factors and conditions predisposing to falls. In some cases, it is possible to correct these factors. Several types of treatment are available to restore the health status before the fall and prevent subsequent falls. Using multi-component interventions, the risk of falls can be effectively reduced. Aware that this review will not be exhaustive of such a broad topic, the purpose of this narrative review is to summarize relevant and recent evidence in the current literature to encapsulate fall-related risk factors, risk identification, fall prevention, and management, including various rehabilitation techniques. This article conforms to the Scale for Assessment of Narrative Review Articles (SANRA) guidelines. [ABSTRACT FROM AUTHOR]

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Growing evidence supports the hypothesis that dietary factors may play a role in systemic low-grade chronic inflammation. Summary evidence from randomized controlled trials has shown substantial effects on biomarkers of inflammation following the adoption of plant-based diets (including, but not limited to, the Mediterranean diet), while consistent findings have been reported for higher intakes of whole grains, fruits, and vegetables and positive trends observed for the consumption of legumes, pulses, nuts, and olive oil. Among animal food groups, dairy products have been shown to have the best benefits on biomarkers of inflammation, while red meat and egg have been shown to have neutral effects. The present review provides an overview of the mechanisms underlying the relation between dietary factors and immune system, with a focus on specific macronutrient and non-nutrient phytochemicals (polyphenols) and low-grade inflammation. Substantial differences within each macronutrient group may explain the conflicting results obtained regarding foods high in saturated fats and carbohydrates, underlying the role of specific subtypes of molecules (i.e., short-chain fatty acids or fiber vs. long chain fatty acids or free added sugars) when exploring the relation between diet and inflammation, as well as the importance of the food matrix and the commixture of foods in the context of whole dietary patterns. Dietary polyphenols and oligopeptides have been hypothesized to exert several functions, including the regulation of the inflammatory response and effects on the immune system. Overall, evidence suggests that dietary factors may affect the immune system regardless of obesity-related inflammation. [ABSTRACT FROM AUTHOR]

Overweight represents a major issue in contemporary orthopaedic practice. A higher body mass index (BMI) is associated with an increase of perioperative complications following several orthopaedic procedures, in particular total hip arthroplasty (THA). However, the influence of overweight on THA surgical time is controversial. In this study, we investigated the association between BMI and surgical time analyzing the role of patients' comorbidities. We conducted a retrospective study on 748 patients undergoing THA at our institutions between 2017 and 2018. Information regarding medical diseases was investigated and the burden of comorbidity was quantified using the Charlson score (CCI). Surgical time and blood loss were also recorded. Median surgical time was 76.5 min. Patients with surgical time above the median had both a higher BMI (28.3 vs. 27.1 kg/m2; p = 0.002); and CCI (1 vs. 0; p = 0.016). According to linear regression, surgical time was associated with BMI in the unadjusted model (p < 0.0001), after adjusting for age and sex (p < 0.0001), and in the multivariable model (p = 0.005). Furthermore, BMI was associated with increased surgical time only in patients with a Charlson score above the median, but not in others. Obesity is associated with increased surgical time during THA, especially in pluricomorbid patients, with a higher risk of perioperative complications. [ABSTRACT FROM AUTHOR]

The impact of obesity on clinical outcomes following joint replacement procedures is resounding. Therefore, multiple strategies to achieve a substantial weight loss before surgery are needed in obese patients. The aim of the study was to test the effect of a fiber-enriched high carbohydrate (FEHC) diet on the reduction in body weight and pain in elderly obese patients undergoing total hip arthroplasty (THA). Sixty-one candidates for THA were included in our study. Prior to the procedure, the participants have been randomly assigned to a 3-month diet intervention (FEHC diet or free diet). Anthropometric measures and food questionnaires were collected at the enrollment and after 3 months. The Oxford Hip Score (OHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario McMaster Universities OA Index (WOMAC) were administered at baseline and before surgery. A statistically significant variation of weight was found in the FEHC diet group (−3.7 kg, −4.4–−2.5) compared to the control group (−0.2 kg; −1.4–1.7; p < 0.0001), as well as significant improvements in the OHS (p < 0.0001), the HOOS (p < 0.0001) and the WOMAC (p < 0.0001) questionnaires. According to the results of the study, the FEHC diet in obese patients undergoing THA might help weight loss and improve related anthropometric parameters as well as hip function and pain. [ABSTRACT FROM AUTHOR]

Phase angle (PhA), a noninvasive bioimpedance marker, is a useful tool for nutritional screening in several diseases. C-reactive protein (CRP), a strong risk factor for metabolic and cardiovascular diseases, is a commonly used biomarker of meta-inflammation. As both PhA and CRP are influenced by age, BMI, and nutritional status, and exhibit a clear sex dimorphism, we examined the association between PhA and CRP levels in 1855 subjects (680 males and 1175 females), aged 18–59 years, with BMIs ranging from 19.5 to 69.4 kg/m2, stratified according to sex. PhA values and CRP levels were significantly lower in females than males (p < 0.001), while the adherence to the Mediterranean diet (MD) was lower in males compared to females (p < 0.001). After adjusting for age, physical activity, BMI, waist circumference, and adherence to the MD, PhA remained negatively associated with CRP levels in both genders (p < 0.001). In the ROC analysis, PhA ≤ 5.5° in males and ≤5.4° in females were the threshold values predicting increased hs-CRP levels. These results suggested that PhA might represent a valid predictor of CRP levels in both sexes regardless of body weight and adherence to the MD, which avoids the collection of blood sampling and expensive biochemical assays. [ABSTRACT FROM AUTHOR]

We aimed at evaluating the effect of the Healthy Eating Plate (HEP) education on migraine frequency and disability. At three evaluation times (T-12 = screening, 12 weeks before the intervention; T0 = time of the educational HEP intervention; and T12 = 12-week follow-up), the enrolled subjects underwent assessment of anthropometric and dietary patterns, monthly migraine days (MMDs), and disability scales (Migraine Disability Assessment score (MIDAS), MIDAS A, MIDAS B). The HEP score estimated adherence to dietary advice. We enrolled 204 out of 240 screened migraineurs, of these, 97 patients completed the follow-up. We defined ADHERENTS as patients presenting an increase in HEP scores from T0 to T12 and RESPONDERS as those with a reduction of at least 30% in MMDs. ADHERENTS presented a significant decrease in MMDs from T0 to T12. In particular, RESPONDERS reduced red, processed meat and carb intake compared to NON-RESPONDERS. Reduction in carb consumption also related to a decrease in perceived disability (MIDAS) and headache pain intensity (MIDAS B). Logistic regression confirmed that the HEP score increase and total carb decrease were related to a reduction in MMDs. This study showed that adherence to the HEP advice, particularly the reduction in carb, red and processed meat consumption, is useful in migraine management, reducing migraine frequency and disability. Trial registration: ISRCTN14092914. [ABSTRACT FROM AUTHOR]

The Mediterranean diet (MD) is a dietary pattern effective in terms of prevention of obesity-related diseases, and represents the gold standard in preventive medicine, due to the synergistic action of many nutrients with antioxidant and anti-inflammatory properties. In addition, excess body weight significantly increases the risk of hypovitaminosis D, a well-recognized common feature of individuals with obesity. It is well-known that there is a clear gender difference in the adherence to the MD. The aim of this study was to investigate the association between adherence to the MD and 25-hydroxyvitamin D (25OHD) levels in adults, according to gender. Study population consisted of 617 participants; 296 were males and 321 were females, matched by age and body mass index (BMI). A validated 14-item questionnaire PREDIMED (Prevención con dieta Mediterránea) was used for the assessment of adherence to the MD. The 25OHD levels were determined by a direct competitive chemiluminescence immunoassay. Females have a higher PREDIMED score than males (7.4 ± 2.8 vs. 6.7 ± 3.1 score, p = 0.001), and according to PREDIMED categories, a greater percentage of males had low adherence to the MD compared to their female counterparts (40.2% vs. 37.1%; χ2 = 8.94, p = 0.003). The 25OHD levels were higher in males than in females (18.3 ± 7.3 vs. 16.8 ± 7.8 ng/mL, p = 0.01), and a higher percentage of males had sufficient 25OHD levels (>30 ng/mL) than their female counterparts (10.5% vs. 3.4%, χ2 = 10.96, p < 0.001). Stratifying the sample population according to 25OHD categories, BMI decreased and PREDIMED score increased significantly along with the increased 25OHD levels, in both males and females, respectively (p < 0.001). Looking at the bivariate correlations, PREDIMED score was positively correlated with 25OHD levels after adjusting for age and BMI, in both males (r = 0.21, p < 0.001) and females (r = 0.30, p < 0.001). At the bivariate proportional odds ratio (OR) model, 25OHD levels presented the highest OR values in the category low adherence vs. high adherence to the MD, in both genders (OR 1.21 and OR 1.31, in males and females, respectively). Receiver operator characteristic (ROC) analysis was performed to determine the cut-off values of PREDIMED scores predictive of 25OHD levels: PREDIMED score >5 in males (p < 0.001) and >7 in females (p < 0.001) could serve as thresholds for 25OHD levels above the median. The results of our study highlighted a novel positive association between adherence to the MD and 25OHD levels in both genders. Although 25OHD levels were higher in males than females, 69.7% were deficient. To the best of our knowledge, this is the first study to show that high adherence to the MD is associated with low BMI and high 25OHD levels in both genders, probably through the anti-inflammatory and anti-oxidant effects that are synergistically exerted by either MD or vitamin D on body weight. [ABSTRACT FROM AUTHOR]

Obesity and unhealthy eating habits have been associated with sleep disturbances (SD). The Mediterranean diet (MD) is a healthy nutritional pattern that has been reported to be associated with better health and sleep quality. Thus, the aim of the study was to investigate whether adherence to the MD is associated with sleep quality in a population of middle-aged Italian adults. This cross-sectional study included 172 middle-aged adults (71.5% females; 51.8 ± 15.7 years) that were consecutively enrolled in a campaign to prevent obesity called the OPERA (Obesity, Programs of Nutrition, Education, Research and Assessment of the best treatment) prevention project that was held in Naples on 11–13 October 2019. Anthropometric parameters, adherence to the MD and sleep quality were studied. Overall, 50.6% of the subjects were good sleepers (the Pittsburgh Sleep Quality Index (PSQI) < 5) while 49.4% were poor sleepers (PSQI ≥ 5). Our results demonstrated that good sleepers, when compared to poor sleepers (p < 0.001) had significantly higher adherence to the MD as assessed by PREDIMED (Prevención con Dieta Mediterránea) score, lower BMI (body mass index) and waist circumference (WC). The higher PSQI, the higher the BMI (p < 0.001) and WC values (p < 0.001), thus suggesting that poor sleep was more common in subjects with obesity. In addition, a negative correlation between PSQI and the PREDIMED score (p < 0.001) was found. to the intake of the cluster of foods enclosed in the MD, rather than the intake of the single food, predicted PSQI. By performing a receiver operator characteristic (ROC) curve analysis, we determined a cut-off value at a PREDIMED score < 9 as the threshold for screening poor sleepers. In conclusion, good sleepers had lower BMI and WC and higher adherence to the MD than poor sleepers. PSQI was positively associated to BMI and WC while it was negatively associated to adherence to the MD. The consumption of the MD dietary pattern rather than the intake of a single nutrient has a beneficial effect on sleep quality. Hence, the assessment of sleep should be taken into account in the management of obesity and promoting adherence to the MD could be a tool to improve SD. [ABSTRACT FROM AUTHOR]

Chronotype is the attitude of a subject in determining individual circadian preference in behavioral and biological rhythm relative to the external light–dark cycle. Obesity and unhealthy eating habits have been associated with evening chronotype. The Mediterranean diet (MD) is a healthy nutritional pattern that has been reported to be associated with better health and quality of sleep. Thus, the aim of the study was to investigate the association of chronotype categories with adherence to the MD in a population of middle-aged Italian adults. This cross-sectional study included 172 middle-aged adults (71.5% females; 51.8 ± 15.7 years) that were consecutively enrolled in a campaign to prevent obesity called the OPERA (obesity, programs of nutrition, education, research and assessment of the best treatment) Prevention Project that was held in Naples on 11–13 October 2019. Anthropometric parameters, adherence to the MD and chronotype were studied. Chronotype was classified as morning in 58.1% of subjects, evening in 12.8% and intermediate in 28.1%. Our results demonstrated that individuals with evening chronotype, when compared to intermediate (p < 0.001) and morning chronotype (p < 0.001), were more prone to follow unhealthy lifestyle, performing less regular activity and being more frequently smokers. In addition, they showed the lowest adherence to the MD compared to morning (p < 0.001) and intermediate chronotypes (p < 0.001). The lower the chronotype score, the higher body mass index (BMI) values in the whole population (r = −0.158; p = 0.038), thus suggesting that evening chronotype was a common finding in subjects with obesity. In addition, positive correlations of chronotype score with age (r = 0.159; p = 0.037) and PREDIMED score (r = 0.656; p < 0.001) were found. The adherence to the MD, more than the intake of the single food items, was found to predict morning and evening chronotypes. In conclusion, evening chronotype was associated with unhealthy lifestyle and low adherence to the MD. Chronotype score was inversely associated to BMI and positively associated to age and adherence to the MD. Thus, the assessment of chronotype should be taken into account in the management of obesity and in the development of nutritional strategies. [ABSTRACT FROM AUTHOR]

Growing evidence reported that vitamin D deficiency is a common finding in obesity. Vitamin D status also seems to be sex-related, although little is known regarding this association. Therefore, the aim of this study was to investigate the sex-related differences of serum 25OH vitamin D (25OHD) concentrations across body mass index (BMI) classes and, if there were any differences, whether they could be explained by sex-related differences in body composition. We enrolled 500 subjects (250 males, age 37.4 ± 11.8 years; 250 females, age 36.6 ± 11.8 years). Body composition was assessed by bioelectrical impedance analysis (BIA) phase-sensitive system. Serum 25OHD concentration was quantified by a direct, competitive chemiluminescence immunoassay. Vitamin D deficiency was defined as a serum 25OHD concentrations < 20 ng/mL (50 nmol/L). Stratifying the sample population according to sex and BMI categories, 25OHD concentrations were significantly higher in males compared to females in all BMI classes and decreased along with the increase of BMI values. Females with vitamin D deficiency had higher fat mass (FM) % compared to males with vitamin D deficiency. The 25OHD concentrations inversely correlated with FM % in both sexes. In a multiple regression analysis model, sex, FM %, and BMI were predictive factors of 25OHD concentration. In conclusion, our study suggests that 25OHD concentrations were lower in females than males across all BMI categories. Given the tight correlation between 25OHD concentrations and FM %, it can be hypothesized that the lower 25OHD concentrations in females than males can be explained by the fact that females have a higher amount of fat than males. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder and is characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. Obesity, low-grade chronic inflammatory status, and insulin-resistance (IR) often coexist in PCOS. The Mediterranean diet (MD) is an anti-inflammatory dietary pattern, which is rich in complex carbohydrates and fiber, and high in monounsaturated fat. There is a close association among obesity, low-grade chronic inflammation, IR, and hormonal derangements in PCOS. The main aim of the present study was to evaluate the adherence to MD, the dietary intake, and the body composition and their association with PCOS clinical severity in a cohort of treatment-naïve women with PCOS when compared with a control group of healthy women matched for age and body mass index (BMI). In this case-controlled, cross-sectional study, we enrolled 112 patients with PCOS and 112 controls. PREvención con DIetaMEDiterránea (PREDIMED) and seven-day food records were used to evaluate the degree of adherence to the MD and dietary pattern, respectively. Body composition was evaluated by bioelectrical impedance analysis (BIA) phase-sensitive system. Testosterone levels and Ferriman-Gallwey score assessed the clinical severity of PCOS. C-reactive protein (CRP) levels were determined with a nephelometric assay with CardioPhase high sensitivity. PCOS women showed higher testosterone levels, Ferriman-Gallwey score, fasting insulin and glucose levels, and Homeostatic Model Assessment (HoMA)-IR when compared with the control group (p < 0.001). In addition, we found that the PCOS women consumed less extra-virgin olive oil, legumes, fish/seafood, and nuts compared with control group. Despite no differences in energy intake between the two groups, the PCOS women consumed a lower quantity of complex carbohydrate, fiber, monounsaturated fatty acids (MUFA), and n-3 polyunsaturated fatty acid (PUFA), and higher quantity of simple carbohydrate, total fat, saturated fatty acid (SFA), PUFA and n-6 PUFA than the control group. The PCOS women have an adverse body composition when compared with controls, with the lowest values of phase angle (PhA) and fat-free mass (p < 0.001). Additionally, after adjusting for BMI and total energy intake, testosterone levels showed significant negative correlations with PREDIMED score (p < 0.001) and consumption of protein (p = 0.005), complex carbohydrate (p < 0.001), fiber (p < 0.001), MUFA (p < 0.001), n-3 PUFA (p = 0.001), and positive associations with CRP levels, simple carbohydrate, SFA, n-6 PUFA (p < 0.001, respectively), and PUFA (p = 0.002). The cut-off for PREDIMED score ≤ 6 (p < 0.001, area under the curve (AUC) 0.848, standard error 0.036, 95% confidence interval (CI) 0.768 to 0.909) could serve as a threshold for significantly increased risk of high value of testosterone levels. In conclusion, a novel direct association between the adherence to MD and the clinical severity of the disease was reported in women with PCOS. This association could support a therapeutic role of foods and nutrients of the Mediterranean dietary pattern in the PCOS pathogenesis likely involving their inflammatory status, IR, and hyperandrogenemia. In addition, we reported a different body composition that is characterized by lower PhA and fat-free mass than controls. These data suggested a role of PhA as a useful marker of the clinical severity of this syndrome and provided strong evidence regarding the strategic relevance of the nutritional assessment in the management of women with PCOS. [ABSTRACT FROM AUTHOR]

Obesity is associated with reduced spontaneous and stimulated growth hormone (GH) secretion and basal insulin-like growth factor I (IGF-1) levels—which in turn is associated with increased prevalence of cardiovascular risk factors. The aim of this study was to investigate: (1) the association of somatotropic axis with cardiometabolic status; (2) the association of somatotropic axis with the Mediterranean diet and nutritional pattern in people with obesity. Cross-sectional observational study was carried out in 200 adult women, aged 36.98 ± 11.10 years with severe obesity (body mass index—BMI of 45.19 ± 6.30 kg/m2). The adherence to the Mediterranean diet and the total calorie intake was assessed. Anthropometric measurements, body composition and biochemical profile were determined along with Growth Hormone (GH)/Insulin like Growth Factor 1 (IGF-1) axis and insulin resistance (homeostatic model assessment for insulin resistance—HoMA-IR). The enrolled subjects were compared after being divided according to GH peak response and according to IGF-1 standard deviation scores (SDS). Derangements of GH peak were detected in 61.5% of studied patients while IGF-1 deficiency was detected in 71% of the population. Both blunted GH peak response and IGF-1 SDS were indicators of derangements of somatotropic axis and were associated with comparable results in terms of cardiometabolic sequelae. Both GH peak and IGF-1 levels were inversely associated with anthropometric and metabolic parameters. The adherence to the Mediterranean diet predicts GH peak response. Fatty liver index (FLI), fat mass (FM) and phase angle (PhA) were predictive factors of GH peak response as well. In conclusion derangements of somatotropic axis is associated with a worse cardiometabolic profile in people with obesity. A high adherence to the Mediterranean diet—and in particular protein intake—was associated with a better GH status. [ABSTRACT FROM AUTHOR]

Obesity is associated to chronic low-grade metabolic inflammation and hypovitaminosis D. Among extra-skeletal effects, an important role in inflammation has been described for vitamin D (25(OH)D). Phase angle (PhA) is a bioelectrical impedance analysis (BIA) parameter that represents an indicator of cellular health in chronic inflammatory states. However, it is still unknown whether a low 25(OH)D levels might correlate with PhA in obesity. Considering the lack of evidence correlating the 25(OH)D levels with PhA in obesity, the aim of this study was to investigate their possible relationship in a group of patients with obesity stratified according to body mass index (BMI) categories. Four hundred and fifty-five adult subjects (219 males and 236 females; 36 ± 11 years) were enrolled. Body composition, including PhA, was assessed using a BIA phase-sensitive system. Serum levels of 25(OH)D was determined by a direct competitive chemiluminescence immunoassay. Most of the participants were affected by grade III obesity (24%) and had 25(OH)D deficiency (67%). Subjects with 25(OH)D deficiency had highest BMI (p < 0.001). Stratifying the sample population according to the BMI classes, 25(OH)D levels decreased significantly along with the increase in BMI (p < 0.001), with the lowest 25(OH)D levels in the class III obesity. In addition, stratifying the sample population according to 25(OH)D categories, BMI and fat mass (FM) decreased, while PhA increased significantly along with the 25(OH)D categories (p < 0.001). The 25(OH)D levels showed significant positive associations with PhA (r = −0.59, p < 0.001), and this association remained significant also after adjusting for BMI and FM (r = 0.60, p < 0.001). The lowest values of PhA were significantly associated with the severity of obesity (OR 0.3, p < 0.001) and of 25(OH)D deficiency (OR 0.2, p < 0.001). To compare the relative predictive power of body composition parameters associated with the 25(OH)D levels, we performed a multiple linear regression analysis. The most sensitive and specific cut-off for 25(OH)D levels to predict the PhA above the median was >14 ng/mL (p < 0.001). In conclusion, we provided preliminary insights into a novel link between 25(OH)D levels and PhA in the setting of obesity. This association uncovered a new potential usefulness of PhA as expression of cell membrane integrity and predictor of inflammation in low 25(OH)D status that might help in identifying high-risk patients with obesity who could benefit from careful 25(OH)D supplementation. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency and obesity are two public health problems extensively exacerbated over the last years. Among the several mechanisms proposed to account for the complex interplay between vitamin D and obesity, one that has gained particular attention is related to the emerging role of obesity-related changes in gut microbiota and gut-derived metabolites, such as Trimethylamine-N-oxide (TMAO). Vitamin D deficiency and high circulating TMAO levels are associated with body weight and the severity of non-alcoholic fatty liver disease (NAFLD). Considering the link of obesity with vitamin D on the one hand and obesity with TMAO on the other hand, and the central role of the liver in both the vitamin D and TMAO metabolism, the aim of this cross-sectional observational study was first, to confirm the possible inverse association between vitamin D and TMAO across different body mass index (BMI) classes and second, to investigate if this association could be influenced by the presence of NAFLD. One hundred and four adult subjects (50 males and 54 females; 35.38 ± 7.49 years) were enrolled. The fatty liver index (FLI) was used as a proxy for the diagnosis of NAFLD. Vitamin D deficiency was found in 65 participants (62.5%), while 33 subjects (31.7%) had insufficient levels, and the remaining subjects had sufficient levels of vitamin D. Subjects with both vitamin D deficiency and FLI-NAFLD had the highest TMAO levels (p < 0.001). By stratifying the sample population according to the BMI classes, vitamin D levels decreased significantly along with the increase of plasma TMAO concentrations, with the lowest vitamin D levels and highest TMAO, respectively, in class III obesity. Vitamin D levels showed significant opposite associations with circulating levels of TMAO (r = −0.588, p < 0.001), but this association was no longer significant after the adjustment for FLI values. The highest values of TMAO were significantly associated with the severity of obesity (OR 7.92; p < 0.001), deficiency of vitamin D (OR 1.62; p < 0.001), and FLI-NAFLD (OR 3.79; p < 0.001). The most sensitive and specific cut-off for vitamin D to predict the circulating levels of TMAO was ≤19.83 ng/mL (p < 0.001). In conclusion, our study suggests that high TMAO levels are associated with vitamin D deficiency and NAFLD. Further studies are required to investigate if there is a causality link or whether all of them are simply the consequence of obesity. [ABSTRACT FROM AUTHOR]

There is a mechanistic link between the gut-derived metabolite trimethylamine-N-oxide (TMAO) and obesity-related diseases, suggesting that the TMAO pathway may also be linked to the pathogenesis of obesity. The Visceral Adiposity Index (VAI), a gender-specific indicator of adipose dysfunction, and the Fatty Liver Index (FLI), a predictor of non-alcoholic fatty liver disease (NAFLD), are early predictors of metabolic syndrome (MetS). In this cross-sectional observational study, we investigated TMAO levels in adults stratified according to Body Mass Index (BMI) and the association of TMAO with VAI and FLI. One hundred and thirty-seven adult subjects (59 males; 21–56 years) were enrolled. TMAO levels were detected using HPLC/MS analysis. Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), VAI and FLI were included as cardio-metabolic indices. TMAO levels increased along with BMI and were positively associated with VAI and FLI, independently, on common potential covariates. The most sensitive and specific cut-offs for circulating levels of TMAO to predict the presence of NAFLD-FLI and MetS were ≥8.02 µM and ≥8.74 µM, respectively. These findings allow us to hypothesize a role of TMAO as an early biomarker of adipose dysfunction and NAFLD-FLI in all borderline conditions in which overt MetS is not present, and suggest that a specific cut-off of TMAO might help in identifying subjects at high risk of NAFLD. [ABSTRACT FROM AUTHOR]

Neuroendocrine tumors (NETs) are rare neoplasms mostly originating from the gastroenteropancreatic tract (GEP-NETs). Data regarding nutritional status in GEP-NET patients are limited. The aim of the study was to investigate the nutritional status and adherence to the Mediterranean Diet (MD) in GEP-NET patients and to correlate them with tumor aggressiveness. A cross-sectional case-control observational study was conducted enrolling 83 patients with well-differentiated G1/G2 GEP-NETs after resection, as well as 83 healthy subjects, age, sex and body mass index-matched. Nutritional status was assessed by evaluating with Bioelectrical Impedance analysis and its phase angle (PhA), adherence to the MD according to PREDIMED score, dietary assessment, anthropometric parameters, and clinico-pathological characteristics. GEP-NET patients consumed less frequently vegetables, fruits, wine, fish/seafood, nuts, and more frequently red/processed meats, butter, cream, margarine, and soda drinks than controls. Patients with more aggressive disease presented a lower adherence to MD according to PREDIMED categories in comparison to G1, localized and free/stable disease status. A smaller PhA value and a lower PREDIMED score were significantly correlated with G2 tumor, metastases, and progressive disease. To the best of our knowledge, this is the first study reporting an association between nutritional status and tumor aggressiveness in a selected group of GEP-NETs. Moreover, higher intakes of food of MD, may represent a potential tool for prevention of tumor aggressiveness. Thus, a skilled nutritionist should be an integral part of the multidisciplinary management of GEP-NET patients. [ABSTRACT FROM AUTHOR]