The hesitancy in the nutritional prevention.

Abstract: Our letter discusses the concept of 'Nutritional Prevention Hesitancy', comparing it to the well-studied phenomenon of 'Vaccine Hesitancy'. Both hesitancies can be fueled by 'infodemics', the rapid spread of accurate and inaccurate information that can lead to public confusion and mistrust in authoritative sources. Drawing parallels between the two, the text highlights that nutritional prevention hesitancy can result in individuals not adopting evidence-based nutritional strategies, potentially leading to poorer health outcomes. The text emphasizes the critical role of diet in preventing diseases such as heart disease, diabetes, and certain types of cancer, and underscores the need for multifaceted strategies to combat misinformation and promote healthier dietary habits.

The "Nutritional Prevention" within Italy's National Prevention Plan 2020-25.

Abstract: Italy's National Prevention Plan 2020-25 is the first to address nutritional prevention, highlighting its importance in combating chronic diseases. This letter discusses the relationship between food safety, nutritional security, and the need for nutritional prevention in the plan. Chronic diseases, such as cardiovascular disease, cancer, and diabetes, are significant public health concerns in Italy, with poor nutrition being a critical risk factor. Incorporating nutritional prevention can promote healthy eating habits, food security and sustainability, reduce healthcare costs, and promote social cohesion and equality. Successful implementation will require cooperation among the government, the private sector, and the civil society to ensure healthier food choices and prevent chronic diseases in Italy.

Diet and primary prevention of stroke: Systematic review and dietary recommendations by the ad hoc Working Group of the Italian Society of Human Nutrition.

BACKGROUND AND AIMS: To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and haemorrhagic strokes. The present review was conducted in the framework of the work carried out through 2015 and 2016 for the preparation of the Italian Guidelines for the Prevention and Treatment of Stroke, 8th Edition, by ISO-SPREAD (Italian Stroke Organization and the Stroke Prevention and Educational Awareness Diffusion). METHODS AND RESULTS: Systematic review of articles focused on primary prevention of stroke published between January 2013 to May 2016 through an extensive search of the literature using MEDLINE/PUBMED, EMBASE and the Cochrane Library. Articles were ranked according to the SIGN methodology while the GRADE system was used to establish the strength of recommendations. As a result of our literature search, we examined 87 meta-analyses overall (mainly of prospective studies), a few isolated more recent prospective studies not included in the meta-analyses, and a smaller number of available randomized controlled trials and case-control studies. Based on the analysis of the above articles, 36 Syntheses of the available evidence and 36 Recommendations were eventually prepared. The present document was developed by organizing the available evidence into three individual areas (nutrients, food groups and dietary patterns) to provide a systematic and user-friendly overview of the available evidence on the relationship between nutrition and primary prevention of stroke. Yet analysis of foods and food patterns allowed translating the information about nutrients in a tool more amenable to use in daily life also in the light of the argument that people eat foods rather than nutrients. CONCLUSIONS: The present literature review and dietary recommendations provide healthcare professionals and all interested readers with a useful overview for the reduction of the risk of total, ischemic and haemorrhagic stroke through dietary modifications.

Population based strategy for dietary salt intake reduction: Italian initiatives in the European framework.

Excess dietary sodium chloride (salt) intake is etiologically related to hypertension and cardiovascular disease (CVD). Moderate reduction of salt intake reduces blood pressure (BP) and is expected to contribute to reduce the risk of CVD. Previous community-based trials to reduce BP by means of salt reduction were very successful. The initial positive results of national strategies of dietary salt intake reduction in several European countries, driven by the initiative of the World Health Organisation (WHO) and non-governmental organisations such as the World Action of Salt and Health (WASH), have paved the way for action in other European Union (EU) member states. In Italy, several initiatives aiming at reduction of salt intake at the population level have been recently undertaken. These initiatives include i) the evaluation of current dietary habits promoted by the Working Group for Dietary Salt Reduction in Italy (GIRCSI); ii) the chemical analysis of the bread salt content, a major source of sodium intake in Italy, and the agreement between the bakers' associations and the Ministry of Health for a gradual reduction of the bread salt content; iii) the implementation of educational campaigns to increase population awareness, iv) the involvement of the food catering system. In the immediate future, food reformulation must be extended to other food categories in collaboration with industry, foods' salt targets ought to be defined, the food labelling system must be improved and population salt awareness must be further increased through educational campaigns. The GIRCSI Working Group is committed to pursue these objectives.

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Is antioxidant and n-3 supplementation able to improve functional status in poststroke patients? Results from the Nutristroke Trial.

BACKGROUND: To test whether supplementary antioxidants and n-3 fatty acids, alone or in combination, could improve functional status in stroke survivors. METHODS: We performed a randomized, double-blind, placebo-controlled clinical trial in 72 stroke patients (47 males; age 65.3 +/- 12.9 years) admitted to a rehabilitation hospital for sequelae of first-ever ischemic stroke, and divided them into 4 subgroups. Group 1 patients received daily oral antioxidants, group 2 received n-3 polyunsaturated fatty acids, group 3 both supplements, and group 4 placebo, all for 12 months. No difference at baseline was observed among groups in neurological severity or in disability. All measures were repeated after 6 and 12 months of treatment. All major clinical events were recorded. RESULTS: At baseline, 25% of the patients had a low plasma vitamin status, and 48.5% was at risk of undernutrition. At the 1-year follow-up, we observed a trend for lower mortality (p = 0.060) in subgroups treated with n-3 fatty acids, but without significant differences in rehabilitation result status among groups. CONCLUSIONS: Malnutrition is widely observed in patients admitted to a rehabilitative hospital for stroke rehabilitation, and dietary supplementation, even if not able to improve rehabilitation results, is likely to reduce mortality at the 1-year follow-up.

[The plan for prevention of obesity of ASL RMB, Italy]. / Prevenzione dell'Obesità: l'esperienza del piano attuativo aziendale per la prevenzione dell'obesità in una ASL romana.

Lazio District, by pointing out the guidelines of the "Obesity and Overweight for Lazio District Plan" (DGR no1166, 23/12/05), enacts the "National Prevention Plan 2005-2007". The Public Health Service for Food and Nutrition has been the main player of the Plan; the District and Department of Health of the District had a technical and organizational support role. Within the development of the Plan for prevention of obesity of ASL RMB, a technical multidisciplinary group was constituted and three more programs were developed, all of them were dedicated to promotion and support of breast-feeding, prevention of obesity and overweight in childhood and adulthood. The educational activity concerning promotion and support of breast-feed ing actively involved operators from consultory rooms and hospital staff from ASL. The reports about nutritional surveillance allowed a careful analysis of the service conditions and priorities. Special criticality facets have been pointed out such as the high prevalence of overweight (31%) and obesity (7%), the habit of skipping breakfast, a low fruit and vegetables consumption, a generally sedentary lifestyle and, during the intervention, the parents' low involvement. In geriatric age cases, a high malnutrition risk both for overnutrition and undernutrition was found in the elderly groups that were checked; the diets' nutritional density as well as the physical activity aspect recover an important role in the intervention planning. Moreover the discussions with catering companies were an important aspect in order to make several target groups aware. The globally considered experience highlighted positive elements of mobilization, consensus, reorientation of activities and resources, giving proof of the significance of integration concerning specifical aims of different company services. Nevertheless, the carrying on of such activities needs resource investments in the specifical area and enlargement of activities especially for the multisector-based efforts.

[Overweight and obesity in Italian children aged 6-11 years]. / Prevalenza di sovrappeso ed obesità in Italia nella fascia di età 6-11 anni.

The objective of this study is to obtain reliable data from recent surveys carried out in Italy on the prevalence of overweight (OW) and obesity (OB) in children. We searched in MEDLINE/PubMed, Google and Google Scholar and we included the surveys that fulfilled the following criteria: English or Italian language, time period January 2000-April 2008, target of 6-11 years; BMI evaluated according to IOFT cut-offpoints. Search terms included overweight, obesity, children, Italy, associated with AND/OR. 41 studies have been selected; the percentage of OW varied between 14.7% and 31.3% and OB between 4.3% and 27.3%. In girls, OW values ranged from 11.5% to 34.7% and in boys from 12.6% to 30.1%; in girls, the percentage of OB varied between 4.7% and 29.2%, in boys between 4.4% and 25.8%. There were some variations in the prevalence of OW and OB among diferent regions. The highest values were in Central and Southern Italy, except for Sardinia, where the values were similar to that of Northern Italy. Beyond BMI, the most frequently collected variables were dietary pattern, physical activity, and lifestyle. School is the main site of investigation; third grades (8-9 years) is the most studied age group. The urgency to develop actions to contrast obesity in childhood is confirmed by the prevalence values observed in the Italian regions.

[Testing a nutritional and taste education intervention approach to increase vegetables and fruit consumption among children]. / Intervento di Educazione Alimentare e del Gusto per in- crementare l'assunzione di ortaggi, legumi e frutta nei bambini.

The purpose of the study was to test a nutrition education intervention to promote a higher consumption of vegetables, pulse and fruit among children. The study involved 274 children of primary school (third and fourth grade). The sample was divided in three groups: A (exposed to intervention without taste education activities), B (exposed to intervention with taste education activities), C (control group not exposed to any intervention). Before starting the intervention on pupils, all teachers were properly trained and parents participated to informative/formative meetings. The teachers were also provided with didactic units to implement on children. The efficacy of intervention was evaluated by measuring food target not eaten at school lunch, before and after the implementation of intervention; it showed less plate waste for vegetables (side dishes) for both groups A and B (53.2% vs 44%) and (23.3% vs 8.1%) respectively, while for fruit only group A reduced to half its reject. The differences were however not significant. No increasing consumption was observed for soups or pasta prepared with vegetables or legumes. According to these preliminary results, we observed for some vegetable food items a better dietary behaviour trend among children of both groups who received the intervention compared with controls.

[Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity]. / Valori elevati di pressione arteriosa: ruolo di fattori nutrizionali e stili di vita.

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.

[Smoking cessation and weight gain]. / Trattamento per la disassuefazione dal fumo ed incremento ponderale.

Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits, but weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The aim of the study was to analyse predictors of weight gain after smoking cessation. The sample included 1067 residents, aged 18-70 years, in a health district of Rome who answered to an anonymous postal questionnaire. Among them 482 were former smokers; 398 provided lifetime histories of both body weight and smoking and were considered in the analysis. 52.5% (49.3% M; 60.5% F) reported weight gain after smoking cessation; among these 25.4% reported a weight gain > or =5 kg. The multivariate logistic regression analysis showed a direct association between female gender (OR 1.9, CI 95% 1.1-3.2), age - 45 years (45-65 years: OR 2.5, CI 95% 1.4-4.4; > 64 years OR 2.1, CI 95% 1.0-4.0), number of cigarettes per day >20/day (OR 3.8, CI 95% 1.3-11.5) and weight gain after smoking cessation. The relevance of weight gain following smoking cessation suggests that health benefits associated with smoking cessation may to some extent be negated by the detrimental effects on health of associated weight gain. Smoking cessation programmes should therefore consider incorporating follow-up support to prevent weight gain; regular measurements of body weight together with dietary indications and increase of physical activity are basic factors to implement in the intervention of smoking cessation.

[Increase of hypertension among adolescents in Rome]. / Notevole aumento di soggetti ipertesi tra gli adolescenti romani.

AIM: The aim of this study was to investigate the prevalence of overweight/obese and hypertensive roman adolescents belonging to a medium-low social environment. The purpose of this research was also to find out the correlations between high blood pressure and obesity, dietary habits and physical activity. METHODS: Nutritional status of 474 subjects (age 12.7+/-0.9 years) of a low-medium social class public school was assessed by measuring height, weight and waist circumference according to international indications. Over-weight and obesity were defined by body mass index (BMI) according to International Obesity Task Force (IOTF). Blood pressure (BP) was measured in duplicate and hypertension was defined by international percentiles. Food habits and lifestyle were investigated by a questionnaire. Multivariate logistic regression was used to relate variables. RESULTS: The prevalence of overweight and obese adolescents was respectively 31.7% and 10.3% with a slight higher presence of males in both cases. The whole sample showed a prevalence of hypertension of 10.1%. Systolic and diastolic BP showed a direct association with BMI and waist circumference (P<0.01). BMI and systolic and diastolic BP were lower in active students (>7 h a week of physical activity). Food habits were not associated with hypertension. CONCLUSIONS: The high prevalence of hypertensive adolescents could be explained with the consistent number of overweight/obese subjects, their social medium-low context and their being sedentary. As reported in literature, all these factors may contribute to the ''metabolic syndrome'' aetiology.

[Mini Nutritional Assessment (MNA) and nutritional risk in elderly. A proposal of nutritional surveillance system for the Department of Public Health]. / Il Mini Nutritional Assessment (MNA) e la valutazione del rischio nutrizionale in età geriatrica. Proposta di un modello operativo di sorveglianza nutrizionale all'interno del Dipartimento di Prevenzione.

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.

Nutrition and prevention of ischemic stroke: present knowledge, limitations and future perspectives.

Stroke, particularly ischemic stroke, has a major impact on public health due to its high incidence, prevalence and rate of subsequent disability in Italy as in most industrialised countries. Apart from age, many modifiable factors, such as hypertension, smoking, diabetes, dyslipidemia, obesity, physical inactivity, alcohol abuse and hyperhomocysteinemia, have been recognised as playing a role in the pathogenesis of this disease. While appropriate pharmacological therapy has proven effective in the prevention of stroke in particular categories of patients, most of the above mentioned predisposing conditions are amenable to be affected by nutrition. Unequivocal demonstration of a protective or adverse role of single foods and nutrients against the risk of stroke has been however difficult to achieve due to confounding by biological variability, methodological inadequacies in the assessment of individual nutritional habits and difficulty to carry out long-term randomised controlled trials in the nutritional area. Notwithstanding, in several cases, causal relationships could be inferred from case-control and cohort studies in the presence of plausible and reproducible associations, evidence of dose-dependent effects and consistency in the results of different studies. The aim of this paper was to review present knowledge and highlight limitations and future perspectives about the role of nutrition in the prevention of ischemic stroke.

Nutritional variables related to gingival health in adolescent girls.

In order to study the nutritional variables associated with gingival health, a case-control study was designed to control strong variables whose effect on gingival status may obscure the potential effect of weaker ones, such as nutrition. Two groups of 27 gingivitis-affected and -unaffected female adolescents were selected. All were aged 17-19 years, with mean age of the two groups statistically not different. All were non-smokers, all reported daily toothbrushing frequency of twice/day or more, and none had clinical signs of hyponutrition. Mean DMFT of the two groups was statistically not different. The effect of nutritional variables, obtained by a three-day food record and by assessing the nutritional status of the girls, on presence/absence of gingivitis was evaluated by a variety of stepwise logistic regression analyses. Age (positive correlation), riboflavin, calcium and frequency of fibre intake (negative correlations) significantly explained the risk for gingivitis. Strong intercorrelation between riboflavin and calcium was also found, due to the high quantity of milk consumed by the girls, since this food provided the main source of riboflavin and calcium. The data suggest that some dietary measures may be useful for the maintenance of healthy gingival status.

Rampant early childhood dental decay: an example from Italy.

OBJECTIVES: This study sought to estimate the prevalence and related prediction factors for dental caries in 3- to 5-year-old children in Rome, Italy. METHODS: From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis. Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD). Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis. RESULTS: The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD. Among all children, mean dft and dt scores per person were 1.1 (SD = 2.4) and 0.9 (SD = 2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD = 4.2) and 6.7 (SD = 4.3), respectively. Children with RECDD had 56 percent of all the decayed teeth in the sample. Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition. CONCLUSIONS: The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health. Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk.