Dietary intake and major food sources of polyphenols in people with type 2 diabetes: The TOSCA.IT Study.

PURPOSE: Proper evaluation of polyphenols intake at the population level is a necessary step in order to establish possible associations with health outcomes. Available data are limited, and so far no study has been performed in people with diabetes. The aim of this work was to document the intake of polyphenols and their major food sources in a cohort of people with type 2 diabetes and in socio-demographic subgroups. METHODS: We studied 2573 men and women aged 50-75 years. Among others, anthropometry was measured by standard protocol and dietary habits were investigated by food frequency questionnaire (EPIC). The intake of polyphenols was evaluated using US Department of Agriculture and Phenol-Explorer databases. RESULTS: The mean total polyphenol intake was 683.3 ± 5.8 mg/day. Non-alcoholic beverages represented the main food source of dietary polyphenols and provided 35.5% of total polyphenol intake, followed by fruits (23.0%), alcoholic beverages (14.0%), vegetables (12.4%), cereal products and tubers (4.6%), legumes (3.7%) and oils (2.1%); chocolate, cakes and nuts are negligible sources of polyphenols in this cohort. The two most important polyphenol classes contributing to the total intake were flavonoids (47.5%) and phenolic acids (47.4%). Polyphenol intake increased with age and education level and decreased with BMI; furthermore, in the northern regions of Italy, the polyphenol intake was slightly, but significantly higher than in the central or southern regions. CONCLUSIONS: The study documents for the first time the intake of polyphenols and their main food sources in people with diabetes using validated and complete databases of the polyphenol content of food. Compared with published data, collected in people without diabetes, these results suggest a lower intake and a different pattern of intake in people with diabetes.

Sex differences in food choices, adherence to dietary recommendations and plasma lipid profile in type 2 diabetes - The TOSCA.IT study.

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.

Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low-grade inflammation in patients with type 2 diabetes-The TOSCA.IT Study.

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.

Safety and efficacy of insulin aspart and soluble human insulin in Type 2 diabetes mellitus.

AIM: The UpGrade study evaluated the safety profile and effectiveness of insulin aspart (IAsp, NovoRapid®) and soluble human insulin (SHI) in patients with Type 2 diabetes mellitus, under current clinical practice conditions. METHODS: This 26-week, open-label, non-randomized, observational safety study recruited patients using insulin ± metformin and having received ≥ 2 injections of IAsp or SHI over a period of 3 months to 3 years. Data were collected via patient recall and treatment diaries, at baseline, 13- and 26-week visits. The number of major hypoglycemic episodes was the primary endpoint. Secondary endpoints were minor hypoglycemic episodes, HbA1c, fasting and post-prandial blood glucose. RESULTS: Overall, 4099 patients were included. At study end the incidence of major hypoglycemia was low (mean rate 0.117 ev/pt-y) and rates were lower in subjects using IAsp compared with those using SHI, for both major (0.115 vs. 0.121) and minor (6.648 vs. 9.530) episodes. IAsp correlated with a significantly lower risk of minor hypoglycemic episodes (IRR=0.64, P<0.0001). Overall, HbA1c levels decreased across 26 weeks (7.97% to 7.63%, P<0.0001); IAsp had greater HbA1c reduction than SHI (-0.39% and -0.22%, respectively) and was associated with a marginally significant likelihood (vs. SHI) of achieving HbA1c reduction of ≥ 0.5% (OR=1.22, P=0.059). CONCLUSION: Under current clinical practice conditions, treatment of patients with Type 2 diabetes mellitus using either IAsp or SHI resulted in low rates of major hypoglycemia after 26 weeks. Patients using IAsp had a better clinical safety profile and a greater reduction in HbA1c compared with patients using SHI.

Insulin detemir lowers the risk of hypoglycaemia and provides more consistent plasma glucose levels compared with NPH insulin in Type 1 diabetes.

AIMS: Hypoglycaemia remains a major barrier preventing optimal glycaemic control in Type 1 diabetes due to the limitations of conventional insulin preparations. We investigated whether basal-bolus therapy with insulin detemir (detemir), a new soluble basal insulin analogue, was more effective in reducing the risk of hypoglycaemia compared with NPH insulin (NPH). METHODS: In this multinational, open-label, cross-over trial, 130 individuals with Type 1 diabetes received detemir and NPH twice daily in a randomized order in combination with premeal insulin aspart (IAsp) during two 16-week treatment periods. Risk of hypoglycaemia was based on self-measured plasma glucose (SMPG) and self-reported episodes during the last 10 weeks of each period. RESULTS: Risk of nocturnal and overall hypoglycaemia was, respectively, 50% and 18% lower with detemir than with NPH (P < 0.001). A total of 19 severe hypoglycaemic episodes occurred during treatment with detemir compared with 33 with NPH (NS). HbA(1c) decreased by 0.3% point with both treatments and was comparable at 7.6% (+/- sem 0.06%, 95% confidence interval -0.106, 0.108) after 16 weeks with similar doses of basal insulin. Within-person variation in mean plasma glucose was lower with detemir than with NPH (sd 3.00 vs. 3.33, P < 0.001), as was prebreakfast SMPG (P < 0.0001). CONCLUSIONS: Detemir was associated with a significantly lower risk of hypoglycaemia compared with NPH at similar HbA1c when used in combination with mealtime IAsp. The more consistent plasma glucose levels observed with detemir may allow people to aim for tighter glycaemic control without an increased risk of hypoglycaemia.

Comparison of glycaemic control over 1 year with pioglitazone or gliclazide in patients with Type 2 diabetes.

AIMS: To compare long-term (1 year) efficacy and safety of pioglitazone and gliclazide in patients with Type 2 diabetes. METHODS: This was a double-blind, multicentre, comparative, parallel group trial in 283 patients with Type 2 diabetes, who were randomized to receive 1-year treatment with pioglitazone 30-45 mg/day or gliclazide 80-320 mg/day. Drug dose was titrated on the basis of self-monitored blood glucose (SMBG) measurements and HbA1c values. The 1-year changes in HbA1c, fasting blood glucose (FBG), insulin, HOMA-S (HOmeostatic Model Assessment) and SMBG were compared. In a subgroup of patients (n = 10), systemic glucose production and utilization were determined by a combination of isotopic (deuterated glucose) and clamp techniques. RESULTS: In both groups, there were similar decreases in HbA1c (pioglitazone: -0.79%; gliclazide: -0.79%) and FBG (pioglitazone: -1.0 mmol/l; gliclazide: -0.7 mmol/l), whereas the slope of the reduction of fasting blood glucose was different between groups (P = 0.004). Insulin levels as well as insulin resistance assessed using HOMA-S decreased significantly only after pioglitazone treatment (-11.94 pmol/l and -1.03, respectively, both P = 0.002 vs. baseline). A significantly greater reduction in systemic glucose production was observed in the pioglitazone group (-2.48 micromol/kg/min, P = 0.042) than in the gliclazide group (-1.02 micromol/kg/min). A few, mild adverse events occurred in both groups. CONCLUSIONS: A comparable decrease in HbA1c and FBG was observed with pioglitazone and gliclazide. However, with pioglitazone there was a continuous decrease in FBG over 1 year, whereas gliclazide failed to maintain a similar trend. This favourable effect of pioglitazone was due to its insulin-sensitizing effect and ability to decrease systemic glucose production.

Factors affecting dropout in outpatient eating disorder treatment.

OBJECTIVE: To evaluate the incidence and effects of factors potentially influencing eating disordered patients' dropping out of outpatient cognitive-behavioural therapy (CBT). METHOD: Sixty-seven (64 female, 3 male) patients with eating disorders participated in the study. All patients followed a multidisciplinary team approach for a median period of 9 months. Several factors potentially affecting dropout were retrospectively assessed prior to treatment. RESULTS: The dropout rate was significantly higher in patients with purging anorexia nervosa (AN) compared to those with restrictive AN, bulimia nervosa and eating disorder not otherwise specified (33% vs. 27%, 25% or 21%, respectively, p<0.05). Among several factors influencing dropout, there was a significant association of patient low cooperativeness, purging episodes, restrictive eating, use of several weight control practices and psychiatric co-morbidity in patients who dropped out compared to completers (all p<0.05). CONCLUSIONS: In outpatient eating disorder treatment, non-compliance and premature interruption of therapy are affected primarily by factors which are related to patients' attitude and behaviour. These factors should be carefully addressed in patients with eating disorders to improve outcome.

Insulin aspart improves meal time glycaemic control in patients with Type 2 diabetes: a randomized, stratified, double-blind and cross-over trial.

AIMS: This randomized, multi-centre, double-blind, stratified, two period, cross-over trial was undertaken to assess the pharmacokinetics and pharmacodynamics of insulin aspart injected immediately before compared with regular human insulin injected 30 min before a Mediterranean-style meal in 37 (23 M, 14 F) patients with Type 2 diabetes. METHODS: Insulin aspart or regular human insulin was given subcutaneously (0.15 U/kg) in random sequence, using a double-dummy technique (at one visit: human regular insulin at t=-30 min and placebo at t=0; at the other visit: placebo at t=-30 min and aspart insulin at t=0). Serum glucose and insulin concentrations (15 points) were measured after each meal for 240 min. RESULTS: Post-prandial glycaemic excursions were 20% lower with insulin aspart (IAsp) compared with regular human insulin (HI) treatment [ratio (Iasp/HI)=0.80, CI=(0.66-0.98), P=0.034]. The maximum serum glucose (SG) concentration was similar for the two treatments (P=NS). The (median) time to maximum SG was 25 min shorter for IAsp compared with HI (P=0.048). Maximum serum insulin concentration was higher after IAsp compared with HI (P=0.023) as well as the area under the 4-h serum insulin curve (P=0.006). Furthermore, the time to maximum serum insulin concentration was 27 min shorter after IAsp (P=0.039), even though IAsp was injected 30 min after HI. No adverse events occurred during the trial. CONCLUSIONS: In patients with Type 2 diabetes a more favourable insulin profile and a better glycaemic control were found with IAsp injected immediately before compared with HI injected 30 min before a Mediterranean-style meal.

Validation of the Italian version of the WHO-Well-Being Questionnaire (WHO-WBQ) and the WHO-Diabetes Treatment Satisfaction Questionnaire (WHO-DTSQ).

AIM: To validate the Italian version of the World Health Organization (WHO)-Well-Being Questionnaire (WBQ) and the WHO-Diabetes Treatment Satisfaction Questionnaire (DTSQ) in Type 1 and Type 2 diabetic patients. METHODS: The cultural adaptation of the questionnaires was performed by using standard forward/backward techniques. Internal consistency reliability was estimated by Cronbach's alpha coefficient. Construct validity was evaluated using the Short Form-36 (SF-36) Health Status Questionnaire. Finally, the discriminative properties of the questionnaires were evaluated relative to the patients' characteristics. The questionnaires were administered to a random sample of patients identified in twelve outpatient diabetes clinics. RESULTS: Overall, 412 subjects were recruited, of whom 96 (23%) with Type 1 diabetes. Item-scale correlations were >0.40 for all the items. Cronbach's alpha coefficient was 0.86 for the WHO-DTSQ and ranged between 0.79 and 0.91 for the WHO-WBQ. High correlations were found between WHO-WBQ scales and the mental dimensions of the Short Form-36 (SF-36) questionnaire, but not between WHO-DTSQ and SF-36 scores. Women, obese subjects, those with longer diabetes duration and multiple complications showed a worse quality of life in all of the four areas of the WHO-WBQ. In Type 2 diabetic subjects, SF-36 scores, but not WHO-WBQ scores, were able to discriminate the population according to the treatment modalities. Lower levels of treatment satisfaction were related to female gender, longer diabetes duration, insulin treatment, presence of diabetes complications and HbA1c levels >7.0%. The flexibility of the treatement was perceived as a major problem even among patients treated with oral agents. CONCLUSIONS: The WHO-DTSQ can be considered as a valuable instrument to be used internationally for the description of diabetes treatment satisfaction. The WHO-WBQ also shows adequate psychometric properties, but additional data are needed to clarify whether it is more sensitive than SF-36, the most widely used generic instrument.

Better long-term glycaemic control with the basal insulin glargine as compared with NPH in patients with Type 1 diabetes mellitus given meal-time lispro insulin.

BACKGROUND: Glargine is a long-acting insulin analogue potentially more suitable than NPH insulin in intensive treatment of Type 1 diabetes mellitus (T1 DM), but no study has proven superiority. The aim of this study was to test superiority of glargine on long-term blood glucose (BG) as well as on responses to hypoglycaemia vs. NPH. METHODS: One hundred and twenty-one patients with T1 DM on intensive therapy on four times/day NPH and lispro insulin at each meal, were randomized to either continuation of NPH four times/day (n = 60), or once daily glargine at dinner-time (n = 61) for 1 year. Lispro insulin at meal-time was continued in both groups. In 11 patients from each group, responses to stepped hyperinsulinaemic-hypoglycaemia were measured before and after 1 year's treatment. RESULTS: Mean daily BG was lower with glargine [7.6 +/- 0.11 mmol/l (137 +/- 2 mg/dl)] vs. NPH [8.1 +/- 0.22 mmol/l (146 +/- 4 mg/dl)] (P < 0.05). HbA(1c) at 4 months did not change with NPH, but decreased with glargine (from 7.1 +/- 0.1 to 6.7 +/- 0.1%), and remained lower than NPH at 12 months (6.6 +/- 0.1%, P < 0.05 vs. NPH). Frequency of mild hypoglycaemia [self-assisted episodes, blood glucose < or = 4.0 mmol/l (72 mg/dl)] was lower with glargine vs. NPH (7.2 +/- 0.5 and 13.2 +/- 0.6 episodes/patient-month, P < 0.05). After 1 year, NPH treatment resulted in no change of responses to hypoglycaemia, whereas with glargine plasma glucose, thresholds and maximal responses of plasma adrenaline and symptoms to hypoglycaemia improved (P < 0.05). CONCLUSIONS: The simpler glargine regimen decreases the percentage of HbA(1c) and frequency of hypoglycaemia and improves responses to hypoglycaemia more than NPH. Thus, glargine appears more suitable than NPH as basal insulin for intensive treatment of T1 DM.

Effects of two different glibenclamide dose-strengths in the fixed combination with metformin in patients with poorly controlled T2DM: a double blind, prospective, randomised, cross-over clinical trial.

A double-blind, prospective, randomised, cross-over clinical trial was performed comparing a glibenclamide (G) 5.0 mg/metformin (M) 400 mg combination with a G 2.5 mg/M 400 mg formulation to evaluate whether a higher dose of glibenclamide was able to improve glycaemia in poorly controlled Type 2 diabetic patients. One hundred and ninety-eight patients with poorly controlled Type 2 diabetes mellitus were randomised to receive one of the two trial drugs for a first 3-month period, and were then assigned to the alternative combination for further 3 months. The starting dose (2 tablets/day, 30 min before breakfast and dinner) was to be up-titrated to 3 tablets/day when required. A standard dietary regimen was kept constant for the total trial duration. Fasting plasma glucose, HbA1c, C-peptide, insulin and lactate levels, haematology and blood chemistry were measured at the start/end of each cycle. Patients' self-assessment of the glycaemic profile (at fasting and 2 hr after the main meals) was performed weekly. Patients were constantly monitored for adverse events and episodes of hypoglycaemia, and all events were recorded. Decrease of mean fasting glucose levels measured in the first cycle was more pronounced in the group treated with G 5.0 mg/M 400 (p<0.01) compared to baseline, although the difference was not significant--no changes were observed in the second 3-month period. Results of patients' self-assessment of the glycaemic profile in the overall 6-month period show that the two trial drugs produced similar effects on fasting glucose, but the decrease of post-prandial glycaemic levels was markedly higher with G 5 mg/M 400 mg than with G 2.5 mg/M 400 mg at both main meals. A similar significant decrease (p<0.01) of HbA1c was observed in both sequence groups at the end of the first 3-month treatment period, and mean levels remained unchanged at 6 months. Drug-related adverse events were observed in 2 patients during treatment with G 2.5 mg/M 400 mg and in 5 with G 5 mg/M 400 mg, while 14 and 22 episodes of hypoglycaemia occurred with the two trial drugs, respectively (p=NS between treatments). Metformin-induced increases of lactate levels were similar in the two sequence groups. No differences between groups were found either in the number of up-titrated patients or in all the other laboratory parameters. In conclusion, the new combination containing 5-mg glibenclamide produced a greater improvement in post-prandial glycaemic control compared with the standard fixed doses, and resulted equally safe and well tolerated.

Acute sterile meningitis as a primary manifestation of pituitary apoplexy.

Pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland. In its classical form it is characterized by acute headache, ophthalmoplegia, visual loss and pituitary insufficiency. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and have not been reported as presenting signs. We report a 53-yr-old man who was admitted to hospital following acute headache, fever, neck stiffness and paresis of the left oculomotor and abducent nerves. A lumbar puncture revealed an increased number of polymorphs but with a sterile cerebral spinal fluid. Magnetic resonance imaging (MRI) showed an intrasellar mass with central necrosis in an enlarged sella. Endocrinological evaluation demonstrated insufficient thyroid, adrenocortical, and gonadal function. Necrosis within a chromophobe adenoma was found upon surgical decompression of the sella. After surgery anterior panhypopituitarism did not recover, while ophthalmoplegia subsided. The patient is now in good health under appropriate hormonal replacement therapy.

Acute effects of lyophilised red wine on total antioxidant capacity in healthy volunteers.

This is an open, cross-over study to examine the acute effects of lyophilised red wine (LYOW) on total antioxidant capacity and some metabolic variables in 10 healthy subjects (age 27.7 +/- 3.9 yr) following a light meal. Each subject was studied on two occasions for a 360-min period, after consumption of a 1.22 MJ (291 kcal) meal; on one occasion without and on another occasion with intake of LYOW with high antioxidant activity [15.4 mM trolox equivalent (eq)]. Plasma oxygen radical absorbance capacity (ORAC) values decreased significantly after meal alone from 4.97 +/- 0.499 to 4.39 +/- 0.383 mM trolox eq. (mean +/- SD; p < 0.05) and remained lower until 360 min compared to basal values (p < 0.05). In contrast, ORAC values after meal with LYOW increased significantly from a baseline of 4.79 +/- 0.356 to the highest value of 6.39 +/- 0.570 mM trolox eq at 90 min; then, it decreased to a plateau of 4.99 +/- 0.316 mM trolox eq (p < 0.05), whose values were still higher than baseline ones until 360 min and also significantly different from the values obtained without LYOW from 90 to 360 min (p < 0.05). No correlations were observed between dietary antioxidant vitamin, fruit and vegetable intakes and plasma antioxidant capacity. No differences were found in plasma insulin and glucose values after meal between the two occasions. We conclude that moderate drinking of red wine (350 ml) with high antioxidant capacity increased and sustained for 360 min plasma antioxidant level of 10 healthy subjects after a meal.

Circulating ghrelin levels of visceral obese men are not modified by a short-term treatment with very low doses of GH replacement.

Ghrelin, the endogenous ligand for the GH secretagogue-receptor (GHS-R), in addition to its GH-releasing action, has orexigenic and adipogenic properties. These characteristics make ghrelin a potential hormone involved in the pathogenesis of obesity. Ghrelin levels are decreased in obese humans and it is unknown whether this decrease is responsible for the blunted GH secretion reported in visceral obesity. Since only few data are available on the potential feedback regulation by GH on systemic ghrelin concentrations, it remains to be established whether the correction of circulating GH concentrations in obese individuals affects ghrelin concentrations. To answer this question, we measured plasma ghrelin levels after a week of administration of low doses of recombinant human GH (rhGH) in a randomized, double-blind, placebo (PL)-controlled trial. This study was originally designed to evaluate the effects of GH replacement on lipid kinetics in visceral obese men. Six adult men with abdominal/visceral obesity (age 42+/-3 yr, body weight 107 +/- 10 kg, BMI 33 +/- 1 kg/m2, waist circumference 111 +/- 3 cm, mean +/- SE) were evaluated in the basal state (BS) and after one week of treatment with subcutaneous bedtime injections of either PL, 2.5 (GH2.5) or 3.3 (GH3.3) pg/kg/die of rhGH. In comparison to BS either PL, GH2.5 or GH3.3 did not significantly modify circulating ghrelin concentrations (p = 0.77). In contrast, a significant increase of serum GH (p = 0.0028), IGF-I (p = 0.0033) and whole body rate of lipolysis (p = 0.038, GH2.5; p = 0.009, GH3.3) occurred, in comparison to BS or PL, after GH2.5 and GH3.3, without differences between the two treatments. These data demonstrate that in abdominal/visceral obese men a short-term treatment with very low doses of rhGH replacement, sufficient to augment the rate of lipolysis, do not modify circulating ghrelin levels.

Trace element intake and status of Italian subjects living in the Gubbio area.

Daily intakes of certain trace elements (Pb, Cd, Ni, Hg, and Cr) were assessed using dietary history and weighed record methods and concurrent chemical analysis (CA) of duplicate portions, along with blood levels, in a group (21 M, 23 F) of inhabitants of the Gubbio area (Belvedere, Biscina, Scritto). The evaluation of only intake of trace elements was accomplished in 40 subjects (20 M, 20 F) 1 year later. In both surveys, trace element intakes were generally lower than the potential tolerable weekly intake. However, daily intakes of Pb, Cd, Ni, Hg, and Cr were higher in men compared to women in both surveys (P<0.05). In fact, intakes at the 50th percentile were greater in men by approximately 75% for Pb, 91% for Cd, 20% for Ni, 45% for Hg, and 29% for Cr in the first survey. In the second survey, percentage differences for Pb, Cd, Ni, and Cr were about 12%, 28%, 26%, and 26%, respectively. Blood trace element levels were slightly higher in men in the first survey. Interestingly, no correlation was observed between the intake of trace elements and corresponding blood values. Food basket and total diet, which were computed from the weighed record method for 2 days, showed relevant disagreements with CA of duplicate portion. Moreover, the comparison in content of Pb, Cd, Ni, and Cr obtained by CA of cooked dishes or by calculation using values of raw foods showed significant differences (P<0.05). It was concluded that trace element intake should be assessed by CA of duplicate portion.

Effect of acute and chronic branched-chain amino acids on energy metabolism and muscle performance.

The aim of this study was to report the effects of acute and chronic branched-chain amino acids (BCAA) administration on energy metabolism and muscle performance. In the acute study which was double-blind, cross-over and placebo-controlled, 12 healthy male volunteers were administered orally on two consecutive days either BCAA (14.4 g/day) or isocaloric placebo; this was followed by measurement of oxygen consumption (VO2) and carbon dioxide production (VCO2) for 180 min by indirect calorimetry. In the chronic study, 10 healthy male volunteers were supplemented with BCAA (14.4 g/day) for 30 days. Before (T0) and after (T1) chronic BCAA administration, VO2, arm muscle area (AMA) and maximal voluntary contraction of forearm muscles (grip strength, GS) were evaluated. Acute study: Both meals increased mean respiratory quotient (RQ) from baseline: in the placebo group, this increase was short-term only (between 15 and 60 min), while this effect on RQ lasted for 120 min in the BCAA group. Moreover, between 30 and 90 min, mean RQ was significantly higher in the BCAA group than in the placebo group. Chronic study: GS increased significantly following chronic BCAA administration without significant changes in the AMA. At T0, VO2 increased significantly during the GS test, whereas at T1 no significant increase was observed. In conclusion, no excess thermogenesis could be detected as compared with placebo following acute BCAA administration, indirectly suggesting a relevant contribution of peripheral catabolic (bypassing liver) pathway to BCAA metabolism; furthermore, chronic BCAA supplementation improved the physical fitness of untrained healthy subjects, as demonstrated by the lack of 02 uptake increase during sustained hand grip test.

Diet during pregnancy and total antioxidant capacity in maternal and umbilical cord blood.

OBJECTIVE: To evaluate the longitudinal trend of total antioxidant capacity (ToAC) in a group of pregnant women and the relationship with their food habits and ToAC of their newborns. METHODS: ToAC of 12 pregnant women and of umbilical cord blood was determined by means of the oxygen radical absorbance capacity method; mothers' diet was assessed by the dietary history method. RESULTS: Mothers' oxygen radical absorbance capacity values decreased slightly from the first (5.41 +/- 0.28 mmol/l trolox eq.) to the third (5.23 +/- 0.26 mmol/l trolox eq.) trimester of pregnancy, but significantly at delivery (5.06 +/- 0.17 mmol/l trolox eq., p < 0.05 vs. the first, second and third trimesters). Oxygen radical absorbance capacity values of umbilical cord blood (4.87 +/- 0.24 mmol/l trolox eq.) correlated with mothers' values in the third trimester (r = 0.86; p = 0.004) of pregnancy and at delivery (r = 0.87; p = 0.0002). The mothers' diet was rather poor in fruit and vegetables and did not change throughout pregnancy. CONCLUSIONS: The lowering values of ToAC observed during pregnancy may be a physiological trend or a transient imbalance between higher antioxidant requirements and intake which reflects on newborns' ToAC. Nevertheless, efforts should be made to improve dietary habits in pregnancy in order to optimize the ToAC of mothers and newborns.

Predicting Type 2 diabetes using an electronic nose-based artificial neural network analysis.

Diabetes is a major health problem in both industrial and developing countries, and its incidence is rising. Although detection of diabetes is improving, about half of the patients with Type 2 diabetes are undiagnosed and the delay from disease onset to diagnosis may exceed 10 yr. Thus, earlier detection of Type 2 diabetes and treatment of hyperglycaemia and related metabolic abnormalities is of vital importance. The objectives of the present study were to examine urine samples from Type 2 diabetic patients and healthy volunteers using the electronic nose technology and to evaluate possible application of data classification methods such as self-learning artificial neural networks (ANN) and logistic regression (LR) in comparison with principal components analysis (PCA). Urine samples from Type 2 diabetic patients and healthy controls were processed randomly using a simple 8-sensors electronic nose and individual electronic nose patterns were qualitatively classified using the "Approximation and Classification of Medical Data" (ACMD) network based on 2 output neurons, binary LR analysis and PCA. Distinct classes were found for Type 2 diabetic subjects and controls using PCA, which had a 96.0% successful classification percentage mean while qualitative ANN analysis and LR analysis had successful classification percentages of 92.0% and 88.0%, respectively. Therefore, the ACMD network is suitable for classifying medical and clinical data.

Total antioxidant capacity of colostrum, and transitional and mature human milk.

OBJECTIVE: The relationship between antioxidant (pro-)vitamin content of breast milk and diet of pregnant women has been reported. However, the assessment of a complete and reliable antioxidant index, such as the total antioxidant capacity, has never been performed in human milk. METHODS: In the present study, the total antioxidant capacity of colostrum, and transitional and mature milk was determined by the oxygen radical absorbance capacity (ORAC) assay in 29 lactating women and correlated with their food consumption assessed by dietary history during pregnancy and lactation. In addition, the total antioxidant capacity of 12 infant formulas commonly used in Italy was determined by the same method. RESULTS: Mean ORAC values of mature milk (1.01 +/- 0.37 mmol/l trolox eq.) were slightly lower than those of colostrum and transitional milk (1.17 +/- 0.50 and 1.18 +/- 0.38 mmol/l trolox eq., respectively). Correlations were observed between antioxidant (pro-)vitamin intakes during pregnancy (third trimester) and ORAC values of colostrum and transitional milk (both p < 0.05), but not with ORAC values of mature milk. Correlations were also found between antioxidant (pro-)vitamin intakes during lactation and transitional and mature milk ORAC values (both p < 0.05). Term infant formulas (n = 5) showed a total antioxidant capacity of 1.40 +/- 0.23 mmol/l trolox eq., whereas the antioxidant capacity of other formulas (n = 7) oscillated from 1.27 to 2.52 mmol/l trolox eq. CONCLUSIONS: The total antioxidant capacity of breast milk in lactating women was related to a diet in which the food content of antioxidant compounds was inadequate. Efforts should be made to improve women's dietary habits during pregnancy and lactation, in order to optimize the total antioxidant capacity of breast milk.

Validation of the Italian food composition database of the European institute of oncology.

OBJECTIVE: To compare nutrient intakes obtained by chemical analysis of food composite or duplicate portion of diets with those obtained by weighed record method using the database of the European Institute of Oncology (EIO). SETTING: Nutrition Section, Department of Internal Medicine, University of Perugia, Italy. SUBJECTS: Fifteen subjects aged 40-59 y in 1960 (41 observations in three seasons), twenty-six subjects in 1965, and only nine remaining subjects in 1970 and 1991 were examined in Crevalcore. In Montegiorgio sixteen subjects aged 40-59 y in 1960 (39 observations in three seasons), thirty-two in 1965, twenty in 1970 and nine in 1991 were assessed. Forty-four subjects in Gubbio area (Biscina, Belvedere and Scritto; 21 males, 23 females; age 56.2+/-14.4 y) were evaluated in 1993 and 1994. METHODS: For dietary appraisal the individual weighed record method was used for 7, 3 or 2 days. Equivalent food composites were made up from local foodstuffs and the duplicate portions were chemically analysed for total nitrogen, fat, saturated and polyunsaturated fatty acids, carbohydrates, retinol, beta-carotene, thiamin and riboflavin. RESULTS: In Crevalcore, a significant difference for protein intake was found between analysis and calculation with EIO database in 1965 and 1991 (P<0.05). Fat intake was significant different for EIO database compared to analysis in 1965 survey (P<0.05), but not for other years. In Montegiorgio, there was a significant difference for protein intake between analysis and calculation with EIO database in 1970 and 1991 (both P<0.001). EIO database showed a significant difference in regard to analysis for fat intake in 1960 IV, 1965, 1970 and 1991 (P<0.05). In both areas there was a significant difference between analysis and EIO database for starch and fibre, but not for polyunsaturated fatty acids and soluble carbohydrates (all P<0.05). In Gubbio area, a significant difference was found between analysis and calculation with EIO database for fat, retinol, beta-carotene and riboflavin intakes (all P<0.05). CONCLUSIONS: According to previous and present studies food composition tables and databases, such as the EIO database, cannot be considered a reliable method to determine nutrient intakes, particularly for some vitamins.