Constipation and pain in Parkinson's disease: a clinical analysis.

Parkinson's Disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms (NMS). Among NMS, constipation and pain are both highly prevalent and debilitating affecting up to 80% of PD patients and impairing their quality of life. Here, we investigated the relationship between constipation and pain in PD patients. This is a retrospective study assessing the relationship between pain and constipation in a PD patient population from a clinical database of patients attending the outpatient clinic of the movement disorders division, Neurology Unit of Policlinico Tor Vergata, in Rome. Subjects were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) part III, Hoehn and Yahr (H&Y) stage, King's Parkinson's Disease Pain Scale (KPPS), Brief Pain Inventory (BPI), Non-Motor Symptoms Scale (NMSS) and Beck Depression Inventory (BDI). Patients were further divided in two groups (Group 1, 32 patients with constipation and Group 2, 35 PD patients without constipation) ANOVA and ANCOVA analysis were used to compare the two groups. PD patients with constipation had significantly higher pain severity and pain interference, as measured by the BPI scale and higher total KPPS score, fluctuation-related pain, nocturnal pain, and radicular pain when compared to PD patients without constipation. This study highlights for the first time a possible interplay between constipation and pain in PD that deserves further investigations.

Motor cortex transcranial direct current stimulation improves non-motor symptoms in early-onset Parkinson's disease: a pilot study.

Early-onset Parkinson's Disease (EOPD) demands tailored treatments. The younger age of patients might account for a higher sensitivity to transcranial direct current stimulation (tDCS) based non-invasive neuromodulation, which may raise as an integrative therapy in the field. Accordingly, here we assessed the safety and efficacy of the primary left motor cortex (M1) anodal tDCS in EOPD. Ten idiopathic EOPD patients received tDCS at 2.0 mA per 20 min for 10 days within a crossover, double-blind, sham-controlled pilot study. The outcome was evaluated by measuring changes in MDS-UPDRS part III, Non-Motor Symptoms Scale (NMSS), PD-cognitive rating scale, and PD Quality of Life Questionnaire-39 scores. We showed that anodal but not sham tDCS significantly reduced the NMSS total and "item 2" (sleep/fatigue) scores. Other parameters were not modified. No adverse events occurred. M1 anodal tDCS might thus evoke plasticity changes in cortical-subcortical circuits involved in non-motor functions, supporting the value as a therapeutic option in EOPD.

Shaping the course of early-onset Parkinson's disease: insights from a longitudinal cohort.

INTRODUCTION: Early -onset Parkinson's disease (EOPD) labels those cases with onset earlier than fifty. Although peculiarities emerged either in clinical or pathological features, EOPD is managed alike typical, late-onset PD. A customized approach would be, instead, better appropriate. Accordingly, a deeper characterization of the clinical course, with an estimation of the disease progression rate, the therapy flow, and the main motor and non-motor complications occurrence, is needed. METHODS: A longitudinal cohort of 193 EOPD patients (selected on a single-centre population of 2000 PD cases) was retrospectively analysed, providing descriptive statics on a series of clinical parameters (genetics, phenotype, comorbidities, therapies, motor and non-motor complications, marital and gender issues) and modelling the trajectories from diagnosis to 10 years later of both Hoehn and Yahr (H&Y) stage and levodopa equivalent daily dose (LEDD). RESULTS: EOPD had a prevalence of 9.7%, including few monogenic cases. It mostly appeared as a motor syndrome, with asymmetric, rigid-akinetic presentation. H&Y linearly progressed with an increment of 0.92 points/10 years; LEDD flow had a non-linear trend, increasing of 526.90 mg/day in 0-5 years, and 166.83 mg/day in 5-10 years. Motor fluctuations started 6.5 ± 3.2 years from onset, affecting up to 80% of the cohort. Neuropsychiatric troubles interested the 50%, sexual complaints the 12%. Gender-specific motor disturbances emerged. CONCLUSION: We shaped EOPD course, modelling a "brain-first" PD subtype, slowly progressive, with non-linear dopaminergic requirement. Major burden mostly resulted from motor fluctuations, neuropsychiatric complications, sexual and marital complaints, with a considerable gender-effect.

The Protective Effect of a Unique Mix of Polyphenols and Micronutrients against Neurodegeneration Induced by an In Vitro Model of Parkinson's Disease.

Parkinson's disease (PD) is second-most common disabling neurological disorder worldwide, and unfortunately, there is not yet a definitive way to prevent it. Polyphenols have been widely shown protective efficacy against various PD symptoms. However, data on their effect on physio-pathological mechanisms underlying this disease are still lacking. In the present work, we evaluated the activity of a mixture of polyphenols and micronutrients, named A5+, in the murine neuroblastoma cell line N1E115 treated with 6-Hydroxydopamine (6-OHDA), an established neurotoxic stimulus used to induce an in vitro PD model. We demonstrate that a pretreatment of these cells with A5+ causes significant reduction of inflammation, resulting in a decrease in pro-inflammatory cytokines (IFN-γ, IL-6, TNF-α, and CXCL1), a reduction in ROS production and activation of extracellular signal-regulated kinases (ERK)1/2, and a decrease in apoptotic mechanisms with the related increase in cell viability. Intriguingly, A5+ treatment promoted cellular differentiation into dopaminergic neurons, as evident by the enhancement in the expression of tyrosine hydroxylase, a well-established dopaminergic neuronal marker. Overall, these results demonstrate the synergic and innovative efficacy of A5+ mixture against PD cellular pathological processes, although further studies are needed to clarify the mechanisms underlying its beneficial effect.

Effects of head trauma and sport participation in young-onset Parkinson's disease.

Head trauma (HT) is emerging as an event anticipating onset of neurodegenerative disorders. However, the potential contribution of HT in young-onset cases (YOPD, age at onset < 50) of Parkinson's disease (PD) has not been examined yet. Here, we systematically assessed HT history in PD patients to estimate the risk associated, especially in terms of age of onset, and define the correlations with the clinical-biochemical profile. The Brain Injury Screening Questionnaire (BISQ) was administered to 94 PD patients (31 with YOPD, known monogenic forms excluded) and 70 controls. HT history was correlated with motor and non-motor scores in all patients, and to CSF biomarkers of neurodegeneration (α-synuclein, amyloid-ß42, total and phosporiled-181 tau, lactate, CSF/serum albumin) into a subgroup. HT increased the risk for both PD and YOPD. In PD patients, but not in those with YOPD, the number of HTs directly correlated with CSF total-tau levels. No other correlations resulted between HT and clinical parameters. Sport-related HT was a specific risk factor for YOPD; conversely, the prolonged sporting life represented a protective factor. HTs can favor PD onset, even as YOPD. Sport-related HT resulted a risk factor for YOPD, although the longer sporting practice delayed PD onset, protecting from YOPD. Tauopathy may underlie the overall association between HT and PD. Additional mechanisms could be instead implicated in HT contribution to YOPD onset.

Wearable Electronics Assess the Effectiveness of Transcranial Direct Current Stimulation on Balance and Gait in Parkinson's Disease Patients.

Currently, clinical evaluation represents the primary outcome measure in Parkinson's disease (PD). However, clinical evaluation may underscore some subtle motor impairments, hidden from the visual inspection of examiners. Technology-based objective measures are more frequently utilized to assess motor performance and objectively measure motor dysfunction. Gait and balance impairments, frequent complications in later disease stages, are poorly responsive to classic dopamine-replacement therapy. Although recent findings suggest that transcranial direct current stimulation (tDCS) can have a role in improving motor skills, there is scarce evidence for this, especially considering the difficulty to objectively assess motor function. Therefore, we used wearable electronics to measure motor abilities, and further evaluated the gait and balance features of 10 PD patients, before and (three days and one month) after the tDCS. To assess patients' abilities, we adopted six motor tasks, obtaining 72 meaningful motor features. According to the obtained results, wearable electronics demonstrated to be a valuable tool to measure the treatment response. Meanwhile the improvements from tDCS on gait and balance abilities of PD patients demonstrated to be generally partial and selective.

Proposed Tandem Effect of Physical Activity and Sirtuin 1 and 3 Activation in Regulating Glucose Homeostasis.

Sirtuins (SIRTs) are seven nicotinamide adenine dinucleotide (NAD+)-dependent protein deacetylases enzymes (SIRT1-7) that play an important role in maintaining cellular homeostasis. Among those, the most studied are SIRT1 and SIRT3, a nuclear SIRT and a mitochondrial SIRT, respectively, which significantly impact with an increase in mammals' lifespan by modulating metabolic cellular processes. Particularly, when activated, both SIRT1 and 3 enhance pancreatic ß-cells' insulin release and reduce inflammation and oxidative stress pancreatic damage, maintaining then glucose homeostasis. Therefore, SIRT1 and 3 activators have been proposed to prevent and counteract metabolic age-related diseases, such as type 2 diabetes mellitus (T2DM). Physical activity (PA) has a well-established beneficial effect on phenotypes of aging like ß-cell dysfunction and diabetes mellitus. Recent experimental and clinical evidence reports that PA increases the expression levels of both SIRT1 and 3, suggesting that PA may exert its healthy contribute even by activating SIRTs. Therefore, in the present article, we discuss the role of SIRT1, SIRT3, and PA on ß-cell function and on diabetes. We also discuss the possible interaction between PA and activation of SIRTs as a possible therapeutic strategy to maintain glucose hemostasis and to prevent T2DM and its complications, especially in the elderly population.

The Effects of High-Intensity Interval Training on Cognitive and Physical Skills in Basketball and Soccer Players.

As athletes pursue excellence, training techniques continue to advance, making structured physical activity an essential tool for enhancing performance. To optimize athletic performance in modern competitive sports, the balance of physical performance and mental clarity is required. This study seeks to examine the effects of High-Intensity Interval Training (HIIT) on cognitive and physical skills in basketball and soccer players. A 3-week HIIT protocol was incorporated based on the Wingate technique. This study included 10 soccer players and 10 basketball players with an average age of 22.79 ± 1.90 years. Participants performed pre- and post-intervention assessments. Physical proficiency was assessed using 20 m sprint, change-of-direction (COD) and dribbling tests, while cognitive skills were assessed using motion object tracking (MOT), working memory, perceptual load (PL), and attention window (AW) tests. The HIIT intervention significantly improved cognitive performance in particular; noteworthy observations were a 15% improvement in motion object tracking test scores and a 16% increase in working memory test scores for basketball players. The attention window test scores showed a 32% increase, and perceptual load test scores were 31% decreased for soccer players post-intervention. There were significant improvements in physical skills; for example, sprint times were decreased by 6%, and change-of-direction and dribbling times were reduced by 8% and 7%, respectively, indicating improved agility, speed, and ball control abilities. In conclusion, both groups performed significantly better on cognitive and physical skill tests post-HIIT intervention.

Exploring the Links between Physical Activity, Emotional Regulation, and Mental Well-Being in Jordanian University Students.

Background: University students face multiple stressors that negatively impact their mental well-being. Effective emotional regulation and physical activity are crucial for mood management and overall health. This study explored the connection between physical activity, emotional regulation, and mental health symptoms (depression, anxiety, and stress) in Jordanian university students. Methods: A cross-sectional online survey involved 416 students (146 male and 270 female) from Jordanian universities. The survey covered demographics, physical activity (International Physical Activity Questionnaire), emotional regulation strategies (Emotion Regulation Questionnaire), and mental health symptoms (Depression Anxiety Stress Scales). Pearson's correlations examined relationships, and ANOVA compared differences in 'low', 'medium', and 'high' physical activity groups. Results: Greater use of expressive suppression was correlated with increased anxiety symptom severity (p = 0.029). Although physical activity levels were not significantly related to emotional regulation, the 'high' physical activity group reported lower depression (p < 0.001) and anxiety symptom severity (p < 0.001) than the 'low' and 'medium' groups. Conclusions: Increased physical activity and emotional expression suppression are independently associated with improved mental well-being in Jordanian university students. This study underscores the importance of integrating physical activity and emotional expression strategies to support student well-being.

Anticoagulation for Left Ventricle Thrombus-Case Series and Literature Review for Use of Direct Oral Anticoagulants.

Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach.

Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status.

Dual antiplatelet therapy (DAPT) has remained the cornerstone for management of acute coronary syndrome (ACS) over the years. Clopidogrel has been the quintessential P2Y12 receptor (platelet receptor for Adenosine 5' diphosphate) inhibitor for the past two decades. With the demonstration of unequivocal superior efficacy of prasugrel/ticagrelor over clopidogrel, guidelines now recommend these agents in priority over clopidogrel in current management of ACS. Cangrelor has revived the interest in injectable antiplatelet therapy too. Albeit the increased efficacy of these newer agents comes at the cost of increased bleeding and this becomes more of a concern when combined with aspirin. Which P2Y12i is superior over another has been intensely debated over last few years after the ISAR-REACT 5 study with inconclusive data. Three novel antiplatelet agents are already in the pipeline for ACS with all of them succeeding in phase II studies. The search for an ideal antiplatelet remains a need of the hour for optimal reduction of ischemic events in ACS.

The Difficulties in Emotional Regulation among a Cohort of Females with Lipedema.

BACKGROUND: Lipedema is a chronic and progressive adipose tissue disorder that causes significant morbidity and negatively influences mental health and quality of life, and increases the risk of depression, anxiety, and eating disorders. One construct of relevance to better understanding psychological disorders is emotion regulation (ER). Therefore, the aim of this study is to investigate the difficulties in ER among lipedema patients compared to healthy people without lipedema. METHODS: This cross-sectional study assessed differences in ER and anxiety between two groups: 26 female patients with lipedema and 26 sex- and age-matched healthy controls. The Difficulties in Emotion Regulation Scale (DERS) assessed emotional regulation across six dimensions: Impulse control, goal-directed behavior, awareness, clarity, non-acceptance, and strategies. Anxiety was assessed by the Hamilton Anxiety Scale (HAM-A). ANOVA assessed differences in measures between lipedema and healthy control groups. RESULTS: Lipedema patients presented with significantly more difficulties in ER and a higher level of anxiety than those without lipedema. Specifically, the lipedema group showed higher and significant differences in total DERS and anxiety scores and all DERS subscales scores compared to those without lipedema. CONCLUSIONS: Lipedema patients showed significant difficulties with ER, and were associated with anxiety symptoms, indicating that ER difficulties may play a role in developing emotional disorders, such as anxiety, for patients with lipedema. The health care provider should pay more attention to ER difficulties and psychological status among lipedema patients.

The Effects of Reduced Physical Activity on the Lipid Profile in Patients with High Cardiovascular Risk during COVID-19 Lockdown.

Background: The COVID-19 pandemic is a serious global health problem. In Italy, to limit the infections, the government ordered lockdown from March 2020. This measure, designed to contain the virus, led to serious limitations on the daily life of the individuals it affected, and in particular in the limitation of physical exercise. The aim of this study was to evaluate the effects of reduced physical activity on the lipid profile in patients with high cardiovascular risk. Methods: We enrolled 38 dyslipidemic patients, 56% male, with an age range of 44-62 years, considered to be at high cardiovascular risk. All patients were prescribed statin drug therapy (atorvastatin 40 mg) and a vigorous physical activity program four times a week, 1 h per session. In addition, a personalized Mediterranean diet was prescribed to all the patients. Total cholesterol, LDL, HDL and triglycerides were measured in patients at T0 before lockdown and at T1 during lockdown. Results: Data showed a significant increase (p < 0.01) in total cholesterol (+6,8%) and LDL (+15,8%). Furthermore, the analysis of the data revealed a reduction in HDL (-3%) and an increase in triglycerides (+3,2%), although both were not significant (p > 0.05). Conclusions: Our study showed that the reduction in physical activity during lockdown led to an increase in LDL levels, and therefore, in the risk of ischemic heart disease in dyslipidemic patients with high cardiovascular risk.

Physical Activity Changes and Correlate Effects in Patients with Parkinson's Disease during COVID-19 Lockdown.

Background: COVID-19 outbreak profoundly affected health systems and people's daily life worldwide. Parkinson's disease (PD) patients lost their normal routine and interrupted regular physical activity, either as physiotherapy or sport, with inevitable consequence on their daily-life and well-being. Objectives: To evaluate the changes in physical activity due to COVID-19 emergency, including self-management strategies or technology-assisted activities, and the subsequent clinical implications in PD patients. Methods: Seventy-four patients from an Italian center have been remotely examined during the lockdown (April-May 2020) by an e-mail structured survey, including self-administered scales. We collected and analyzed data on changes, modalities and amount of physical active practice, on the use of technology-based tools, and on self-perceived clinical condition. Results: Sixty percent of patients reported a significant worsening of their general conditions during the lockdown, the reduction of physical activity being the main risk factor for such change. However, patients found ways to practice physical activity, using satisfactorily technology assistance in 50% of cases (mostly women). Conclusions: The COVID-19 emergency has been an ordeal for PD patients. Nevertheless, patients adapted their habits to continue practicing physical activity that resulted a main determinant of their well-being; as well, they successfully approached technology-based assistance. Education, communication, and networking emerge as critical for a constructive reaction to the emergency's challenges.

Mediterranean Personalized Diet Combined with Physical Activity Therapy for the Prevention of Cardiovascular Diseases in Italian Women.

Cardiovascular diseases (CVDs) and inflammatory risk indexes are used to calculate the exposure to morbidity. Most of them are suggested by the American College of Cardiology/American Heart Association to predict the risk of CVDs diagnosis in primary prevention, instead of treating the ongoing pathology. Prevention starts from habit changes with the prescription of diet and physical activity (PA). The aim of the study is to investigate the effectiveness of a personalized Mediterranean Diet (MD) and a PA intervention, on the risk indexes Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP) and Fatty Liver Index (FLI) in a population of women at risk of CVDs with different pathological conditions. After treatment, patients achieved the best results in body composition (BC) and laboratory tests. The BC analysis showed a significant reduction of total body Fat Mass (FM). CVDs risk indexes significantly decreased, except for Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (PLR). The reduction of the CVDs indexes associated with lipid profile was linked to both weight and FM decrease. AIP and LAP were significantly reduced when losing fat mass and body weight, respectively. A personalized MD therapy plus a PA program led to body weight loss, BC remodelling and risk indexes reduction.

Ischemic injury precipitates neuronal vulnerability in Parkinson's disease: Insights from PINK1 mouse model study and clinical retrospective data.

INTRODUCTION: Increasing evidence demonstrates the relevant association between Parkinson's disease (PD) and vascular diseases/risk factors, as well as a worse clinico-pathological progression in those patients with vascular comorbidity. The mechanisms underlying this relationship have not been clarified yet, although their comprehension is critical in a perspective of disease-modifying treatments development or prevention. METHODS: We performed an experimental protocol of ischemic injury (glucose-oxygen deprivation, OGD) on PTEN-induced kinase 1 knockout (PINK1-/-) mice, a well-established PD model, looking at both electrophysiological and morphological changes in basal ganglia. In addition, 253 PD patients were retrospectively analysed, to estimate the prevalence of vascular risk factors. RESULTS: In PINK1-/- mice, the OGD protocol induced electrophysiological (prolonged depolarization) and morphological alterations (picnotic cells, cellular loss and swelling, thickening of nuclear chromatin) in striatal medium spiny neurons and nigral dopaminergic neurons. Vascular comorbidity occurred in 75% of PD patients. CONCLUSIONS: The ischemic injury precipitates neuronal vulnerability in basal ganglia of PINK1-/- mice, probably through an impairment of mitochondrial metabolism and higher oxidative stress. These experimental data may provide a potential mechanistic explanation for both the association between vascular diseases and PD and their reciprocal interactions in determining the clinico-pathological burden of PD patients.

Amyloid-ß42/Neurogranin Ratio as a Potential Index for Cognitive Impairment in Parkinson's Disease.

BACKGROUND: Synaptopathy is critical in pathophysiology of Parkinson's disease (PD). Cerebrospinal fluid (CSF) levels of neurogranin (NG) and amyloid-ß42 (Aß42) are considered markers of synaptic dysfunction in neurodegenerative diseases. OBJECTIVE: To evaluate the CSF synaptopathy-related biomarkers, especially the novel Aß42/NG ratio, in PD, establishing possible associations with cognitive level and other clinical parameters. METHODS: Levels of NG, Aß42, amyloid-ß40, total and phosphorylated tau, and Aß42/NG ratio were measured in 30 PD patients and 30 controls and correlated with cognitive and motor parameters. The accuracy in distinguishing the cognitive status was determined. RESULTS: NG and Aß42 were significantly reduced in PD, with higher NG levels in patients with worse cognition. The Aß42/NG ratio showed a direct correlation with Mini-Mental State Examination, independently from age and sex, and differentiated cognitively impaired patients with 92% sensitivity and 71.4% specificity, accuracy higher than NG alone. No correlations resulted with motor disturbances or therapy. CONCLUSIONS: The novel Aß42/NG ratio couples either presynaptic or postsynaptic markers of synaptic dysfunction, representing a potential global index of synaptopathy, useful to track cognitive functions in PD.

Tyrosol May Prevent Obesity by Inhibiting Adipogenesis in 3T3-L1 Preadipocytes.

Tyrosol (TR), a major polyphenol found in extra virgin olive oil (EVOO), exerts several antioxidant effects. However, only scarce evidences are present regarding its activity on adipocytes and obesity. This study evaluated the role of TR in adipogenesis. Murine 3T3-L1 preadipocytes were incubated with TR (300 and 500 µM), and TR administration inhibited adipogenesis by downregulation of several adipogenic factors (leptin and aP2) and transcription factors (C/EBPα, PPARγ, SREBP1c, and Glut4) and by modulation of the histone deacetylase sirtuin 1. After complete differentiation, adipocytes treated with 300 and 500 µM TR showed a reduction of 20% and 30% in lipid droplets, respectively. Intracellular triglycerides were significantly reduced after TR treatment (p < 0.05). Mature adipocytes treated with TR at 300 and 500 µM showed a marked decrease in the inflammatory state and oxidative stress as shown by the modulation of specific biomarkers (TNF, IL6, ROS, and SOD2). TR treatment also acted on the early stage of differentiation by reducing cell proliferation (~40%) and inducing cell cycle arrest during Mitotic Expansion Clonal (first 48 h of differentiation), as shown by the increase in both S1 phase and p21 protein expression. We also showed that TR induced lipolysis by activating the AMPK-ATGL-HSL pathway. In conclusion, we provided evidence that TR reduces 3T3-L1 differentiation through downregulation of adipogenic proteins, inflammation, and oxidative stress. Moreover, TR may trigger adipose tissue browning throughout the induction of the AMPK-ATGL-UCP1 pathway and, subsequently, may have promise as a potential therapeutic agent for the treatment and prevention of obesity.

Secular trend of childhood nutritional status in Calabria (Italy) and the United States: the spread of obesity.

The number of children who are overweight has been increasing worldwide, including in Mediterranean countries. Based on this, we hypothesized that the weights of Italian children from Calabria have also increased across the years, approaching even the levels of their North American counterparts. This cross-sectional study, which was conducted at 3 time points (1992, 2004, and 2013/2014) with Calabrian children between the ages of 9 and 10 years, aimed to (1) examine a 20-year trend of growth and weight in Calabrian children and (2) compare these trends to those of children from the United States within a similar period. Data from the National Health and Nutrition Examination Survey were used for comparing Calabrian and American children at similar time points. Height and weight were measured, and body mass index was calculated. Nutritional status was defined by International Obesity Task Force cutoffs. Across 20 years, a positive trend was observed in the height and weight of Calabrian children. Trends of preobesity and obesity increased significantly in Calabria from 10.7% (95% confidence interval [CI] 7.1-15.3) to 30.5% (95% CI 26.4-34.8) and from 2.1% (95% CI 0.7-4.8) to 13.8% (95% CI 10.9-17.2), respectively. Although a cessation was observed between 2004 and 2013/2014, from 2003 to 2004, childhood overweight rates in Calabria were as high as those seen in the United States. There was no significant difference between boys from Calabria and the United States in 2013/2014. Over time, odds to become overweight were significant for most of the children from both populations but higher for those from Calabria. Therefore, inducting a reform in the political, environmental, and societal systems may protect children from becoming overweight by increasing quality of diet and physical activity.

Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents.

OBJECTIVE: The aims of this study were to compare body mass index (BMI) and triponderal mass index (TMI) as predictors of fat mass percentage (FM%) and to develop TMI cutoffs for screening high adiposity. Therefore, TMI- and BMI-based references against FM% criterion for indicating adiposity in Italian children and adolescents were compared. METHODS: This was a cross-sectional study conducted at the University of Rome Tor Vergata, Human Nutrition Unit, from 2008 to 2015. The sample included 485 children and adolescents from 8 to 17 y of age from central-southern Italy. Body weight (kg) and height (m) were assessed to calculate BMI and TMI. FM% was assessed by dual-energy x-ray absorptiometry. The prevalence of high adiposity was based on the 75th percentile of FM%, according to Ogden et al. curves. Statistical tests such as Mann-Whitney, Kruskal-Wallis, polynomial regression, receiver operating characteristics curve, and Cohen's κ, were performed using SPSS version 24 and MedCalc version 18. RESULTS: Prevalence of high adiposity according to FM% was 50.2% (95% confidence interval [CI], 43.2-57.2) in boys and 43.2% (95% CI, 37.3-49.2) in girls. TMI rather than BMI could better predict FM% for both sexes (boys R2 = 0.67 and girls R2 = 0.79 versus boys R2 = 0.44 and girls R2 = 0.74, respectively). TMI was found to present a significantly higher area under the curve than BMI for indicating high adiposity in children and adolescents. TMI sex- and age-specific cutoffs were responsible by better classification of adiposity, followed by the International Obesity Task Force, World Health Organization, and Cacciari reference curves. CONCLUSION: TMI is a useful screening tool in pediatric clinical practice and epidemiologic studies concerning childhood obesity.