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Purpose: The optimal macronutrient composition of the diet for the management of type 2 diabetes is debated, particularly with regard to the ideal proportion of fat and carbohydrates. The aim of the study was to explore the association of different proportions of fat and carbohydrates of the diet-within the ranges recommended by different guidelines-with metabolic risk factors. Methods: We studied 1785 people with type 2 diabetes, aged 50-75, enrolled in the TOSCA.IT Study. Dietary habits were assessed using a validated food-frequency questionnaire (EPIC). Anthropometry, fasting lipids, HbA1c and C-reactive protein (CRP) were measured. Results: Increasing fat intake from <25 to ≥35 % is associated with a significant increase in LDL-cholesterol, triglycerides, HbA1c and CRP ( p < 0.05). Increasing carbohydrates intake from <45 to ≥60 % is associated with significantly lower triglycerides, HbA1c and CRP ( p < 0.05). A fiber intake ≥15 g/1000 kcal is associated with a better plasma lipids profile and lower HbA1c and CRP than lower fiber consumption. A consumption of added sugars of ≥10 % of the energy intake is associated with a more adverse plasma lipids profile and higher CRP than lower intake. Conclusions: In people with type 2 diabetes, variations in the proportion of fat and carbohydrates of the diet, within the relatively narrow ranges recommended by different nutritional guidelines, significantly impact on the metabolic profile and markers of low-grade inflammation. The data support the potential for reducing the intake of fat and added sugars, preferring complex, slowly absorbable, carbohydrates. [ABSTRACT FROM AUTHOR]

Diabetes and cancer frequently coexist in the same subject, often with relevant clinical effects on the management and prognosis of the comorbid patient. The existing guidelines, however, do not appropriately address many clinical issues in this setting. Although collaboration between diabetologists and oncologists should play an important role in achieving appropriate levels of care, close coordination or agreement between these specialists is seldom offered. There is an urgent need for greater interdisciplinary integration between all specialists involved in this setting, for a shared approach ensuring that organisational silos are overcome. To this end, the Italian Associations of Medical Diabetologists (AMD) and the Italian Association of Medical Oncology (AIOM) recently established a dedicated Working Group on 'Diabetes and Cancer'. The working group outlined a diagnostic and therapeutic clinical pathway dedicated to hospitalised patients with diabetes and cancer. In this article, we describe the Italian proposal including some suggested measures to assess, monitor and improve blood glucose control in the hospital setting, to integrate different specialists from both areas, as well as to ensure discharge planning and continuity of care from the hospital to the territory., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Pasta is a refined carbohydrate with a low glycemic index. Whether pasta shares the metabolic advantages of other low glycemic index foods has not really been investigated. The aim of this study is to document, in people with type-2 diabetes, the consumption of pasta, the connected dietary habits, and the association with glucose control, measures of adiposity, and major cardiovascular risk factors., Methods: We studied 2562 participants. The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. Sex-specific quartiles of pasta consumption were created in order to explore the study aims., Results: A higher pasta consumption was associated with a lower intake of proteins, total and saturated fat, cholesterol, added sugar, and fiber. Glucose control, body mass index, prevalence of obesity, and visceral obesity were not significantly different across the quartiles of pasta intake. No relation was found with LDL cholesterol and triglycerides, but there was an inverse relation with HDL-cholesterol. Systolic blood pressure increased with pasta consumption; but this relation was not confirmed after correction for confounders., Conclusions: In people with type-2 diabetes, the consumption of pasta, within the limits recommended for total carbohydrates intake, is not associated with worsening of glucose control, measures of adiposity, and major cardiovascular risk factors.

Background and Aims: Diabetic women have a more adverse plasma lipid profile than men. Sex differences in dietary habits may play a role, but are little investigated. The study evaluates the quality of diet, adherence to the nutritional recommendations of the Diabetes and Nutrition Study Group and their relation with plasma lipid in men and women with diabetes., Methods and Results: We studied 2573 people, aged 50-75, enrolled in the TOSCA.IT study (clinicaltrials.gov; NCT00700856). Plasma lipids were measured centrally. Diet was assessed with a semi-quantitative food frequency questionnaire. Women had a more adverse plasma lipid profile than men. Women consumed significantly more legumes, vegetables, fruits, eggs, milk, vegetable oils, and added sugar, whereas men consumed more starchy foods, soft drinks and alcoholic beverages. This stands for a higher proportion (%) of energy intake from saturated fat and added sugar (12.0 ± 2.4 vs 11.5 ± 2.5 and 3.4 ± 3.2 vs 2.3 ± 3.2, P < 0.04), and a higher intake of fiber (11.2 ± 2.8 vs 10.4 ± 2.6 g/1000 Kcal/day) in women. Adherence to the recommendations for saturated fat and fiber consumption was associated with significantly lower LDL-cholesterol regardless of sex. Adherence to the recommendations for added sugars was associated with significantly lower triglycerides and higher HDL-cholesterol in men and women., Conclusions: Men and women with diabetes show significant differences in adherence to nutritional recommendations, but sex differences in plasma lipid profile are unlikely to be explained by nutritional factors. Adherence to the nutritional recommendations is associated with a better plasma lipid profile regardless of sex, thus reinforcing the importance of substituting saturated for unsaturated fat sources, increasing fiber and reducing added sugar intake., (Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Atherosclerosis begins in childhood and develops silently for decades before clinical events such as myocardial infarction or stroke occur. Only few studies have evaluated the relationship between CVD risk factors and carotid artery Intimal Media Thickness (IMT) in young asymptomatic people., Aim: The aim of this study is to investigate risk factors for cardiovascular disease associated with higher Carotid Intimal Media Thickness (IMT) in healthy young subjects., Methods: A cohort of 106 healthy young men, mean age 21 ± 2 years (mean ± SD), BMI 24.4 ± 2.8 (kg/m(2)), on military duty, participated in this cross-sectional study. Waist circumference, carotid intima-media thickness (IMT), blood pressure, and plasma concentrations of relevant metabolic parameters were measured at fasting. Smoking and habitual dietary patterns were evaluated by a semiquantitative questionnaire., Results: The population was divided into two groups on the basis of IMT values: the lowest three quartiles versus the highest quartile (cut-off value = 0.7 mm). BMI, waist circumference, systolic (SBP), and diastolic (DBP) blood pressure were significantly higher in the group with higher IMT (p = 0.02). All other variables, including dietary parameters and smoking, were similar in the two groups. Data analysis showed that IMT values correlated positively with SBP (r = 0.22; p = 0.025), DBP (r = 0.27; p = 0.005), waist circumference (r = 0.29; p = 0.002), and fat mass (r = 0.24; p = 0.01), and negatively with kcal/kg of body weight (r = -0.220.22; p = 0.022) - an indirect marker of physical activity. Based on multiple regression analysis, waist circumference and DBP were the only variables independently associated with IMT (p = 0.029)., Conclusions: In a non-selected sample of healthy young adult males, a larger waist circumference and a higher diastolic blood pressure - albeit within normal values - are the only parameters independently associated with higher IMT.

The aims of the present research are to investigate the possible predictors of pancreatic cancer, in particular smoking status, alcohol consumption, hypercholesterolemia, and diabetes mellitus, in patients with histologically confirmed pancreatic carcinoma and to examine the synergism between risk factors. A case-control study (80 patients and 392 controls) was conducted at the Teaching Hospital "Agostino Gemelli" in Rome. A conditional logistic regression was used for the statistical analysis and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). We also investigated the possible interactions between risk factors and calculated the synergism index (SI). The multivariate analysis revealed that hypercholesterolemia and alcohol consumption resulted in important risk factors for pancreatic cancer even after the adjustment for all variables (OR: 5.05, 95% CI: 2.94-8.66; OR: 2.25, 95% CI: 1.30-3.89, resp.). Interestingly, important synergistic interactions between risk factors were found, especially between ever smoking status and alcohol consumptions (SI = 17.61) as well as alcohol consumption and diabetes (SI = 17.77). In conclusion, the study confirms that hypercholesterolemia and alcohol consumption represent significant and independent risk factors for pancreatic cancer. Moreover, there is evidence of synergistic interaction between diabetes and lifestyle factors (drinking alcohol and eating fatty foods).

Background/aims: Papillary carcinoma of the gallbladder is less invasive, less frequently metastasizes and results in a longer survival than other gallbladder tumors. It is frequently associated with Anomalous Pancreatico-biliary junction (APBJ), a malformation that occurs most frequently in Japan. Consequently, most cases of papillary cancer have been reported in the Japanese literature, while the incidence of this neoplasm, and its association with APBJ, is still unknown in Western Countries., Methodology: Seventy cases of gallbladder cancer, observed between January 1992 and December 2000, were retrospectively evaluated. All the histological sections and available cholangiograms were reviewed., Results: Three cases of papillary carcinoma were found (4.2%); APBJ was detected in one of these. All patients underwent resection and are long-term survivors; one patient developed, three years later, a papillary cancer of the common bile duct and was treated by Whipple's procedure., Conclusions: This study provides evidence that papillary carcinoma is more rare in Western countries than in Japan and it is characterized by a longterm survival after surgical resection. Further studies and reports are necessaries to define if this different incidence can justify differences between Western and Japanese results after surgery for gallbladder cancer.

Background: The present study aimed to investigate the knowledge and attitude of family physicians and their patients respectively in prescribing and adopting lifestyle and dietary changes in order to prevent cardiovascular disease which is the main cause of mortality in the industrialized Western countries., Methods: All physicians working in two suburban areas of Naples and in the city of Avellino were invited to participate in the study and 63% accepted (n = 218). A sample of lay people living in the same areas was randomly selected and 59% accepted (n = 267). Two different questionnaires were used to assess the knowledge and attitudes of physicians and lay people about the role of nutrition and lifestyle in the prevention of cardiovascular risk., Results: Physicians showed satisfactory knowledge and a good attitude to non-pharmacological prevention--particularly secondary prevention--of cardiovascular disease. The opinions of the lay people interviewed on the impact of lifestyle changes on cardiovascular disease prevention were similarly satisfactory although some inconsistencies were noted., Conclusions: In spite of the good propensity of both physicians and their patients to the implementation of lifestyle changes, it appears that dietary modifications prescribed by physicians are not accurately followed or even misunderstood by their patients. This suggests the need of implementing further educational programs.

The mercury levels in many diet samples collected in 5 groups of normal Italian adult population were measured and compared to those referred to an area well known for its high environmental mercury content. In the same subjects, the hair and blood concentration of mercury was evaluated and related to the dietary intake. In fact, the somatic and cytogenetic effects due to the mercury contamination are mainly correlated with the blood and hair content of mercury. Significant cytogenetic effects were detected in a group of subjects exposed to elemental mercury vapor, thus showing an average mercury concentration in the blood of about 45 micrograms/ml. On the basis of the mercury content in the diet and in the blood of both the Italian population groups and the population group of the high mercury area, it can be argued that significant somatic and cytogenetic effects are undetectable at those mercury exposures, thus confirming that a daily intake of 10-40 micrograms mercury can be considered as an acceptable level for the normal population as suggested by WHO.

In the Amiata Mountain area of Tuscany, Italy, a survey has examined the concentrations of mercury and selenium in the environment, in the food chain, and in human biological samples of blood, urine, and hair. This area was selected for study because of its large mineral deposits and concentration of elements, e.g., iron, copper, silver, antimony, and particularly mercury. Subjects consisted of a group with high occupational exposure to mercury vapor, a group randomly exposed to mercury dust, and a group nonoccupationally exposed to mercury. The selenium and mercury contents in all samples were determined by nondestructive neutron activation analysis, and results showed that the human metabolism of mercury is different from that of selenium and that the selenium retention in man could be influenced by the mercury intake. Furthermore, a great part of selenium introduced through the diet passes into the blood, where it is mainly associated with blood cells.

A program is underway in Italy to identify construction materials with high radioactivity contents and to evaluate the resulting indoor exposure on a nationwide scale. Building materials surveyed include those of natural origin and those employing particular by-products such as fly ash and phosphogypsum. The survey currently emphasizes natural building materials, which are widely used in many areas having particular geological features. First results show that Italy includes areas of high natural background, i.e. in Lazio and Campania, in which very high levels of indoor exposure occur that can be directly related to specific activities of the building materials. Moreover, 220Rn daughters are sometimes present at such levels that their contribution to the lung exposure is comparable to that from 222Rn daughters.

Existing data on 210Pb in human teeth are reviewed for various countries. The mean value of 210Pb in the teeth of population groups exposed to "normal" levels of radon-daughter exposure is about 2 mBq/g. A detailed analysis of 48 samples from a "normal" Italian population group revealed that smoking habits and age may have some influence on 210Pb content of teeth, while this is not the case for differences in sex. A group of 45 Austrians exposed to elevated levels of radon and radon daughters is compared with the Italian group. After subtraction of background levels of 210Pb as found for the normal Italian population, the incremental 210Pb tooth content due to excessive radon-daughter exposure has been correlated with the individual cumulative exposure corrected for background radon-daughter exposure. A statistical analysis shows the significance of the linear correlation at the alpha = 0.01 level. For the incremental increase of 210Pb in teeth, a value of 1.2 mBq/g has been used for a lifetime exposure to 1 WLM. This result is compared to corresponding data published in the literature, which are predominantly related to the 210Pb content of bone after short-time exposure at high levels, e.g. in uranium mines. The comparison seems to indicate the influence of the exposure rate and the need for a comprehensive model, which takes into account radon-daughter inhalation, radon dissolved in body fluids and 210Pb metabolism.

No data are available on Selenium concentration in the Italian environment in spite of its importance as an essential and toxic element. In order to get some information about the concentration and distribution of this element in the environment and in the food-chain, a survey has been made in the Monte Amiata area (Toscana, Italy). Such an area was selected for this study owing to its large mineralization due to many elements (e.g. Fe, Cu, Ag, Sb and particularly Hg). The selenium content has been determined by thermal neutron activaltion analysis and a large volume high-resolution Ge-Li gamma ray spectrometer connected on line to a DEC PDP 8/L computer. The instrumental method requires neither a chemical separation technique nor a pre-or post-concentration of Selenium. The Selenium concentration for wet weight in foodstuffs ranges between a value of 0.008 ppm in milk and a value of 0.2 ppm in chicken. The average Se intake for the population living in the area under investigation has been also estimated. A critical discussion of the data is reported together with a comparison with the Se concentration values referring to other countries.

For various reasons an increasing importance has been given in recent time in many parts of the world to the evaluation of the trace element pathways from environment to man. In Italy a large program was recently started based on the study in different groups of population of the relationship existing between the trace element dietary intake and the trace element content in the total excretion and in some human tissues (mainly blood). In this paper the complete data concerning the daily dietary intake, the urinary and fecal excretion, and the blood concentration referred to five population groups living in different regions of Italy will be reported. The main trace elements considered are: Ag, Co, Cr, Cs, Eu, Fe, Hg, Ni, Rb, Sb, Sn, Sc, Se and Zn; all the measurements were performed by means of non-destructive neutron activation analysis.

The concentration of some trace elements has been measured in samples of breast milk collected from several subjects over a period of about 1-3 months starting 15 days post-partum. A decrease of Zn concentration during the lactation period was observed in all subjects. The marked relation existing between dietary intake and milk content of trace elements is confirmed by the finding that Cs concentration in diet, fresh waters and human milk samples from Latium were one to two orders of magnitude higher than those measured in a small town in the south of Italy. In most subjects Cs, Zn, Rb, Fe concentrations during the same day, and in the same feed, are fairly constant. Larger variations are observed for concentrations of Co, Sc, and Sb.