Coffee, caffeine, and the risk of liver cirrhosis.

PURPOSE: To evaluate the effect of the consumption of caffeine-containing beverages on the risk of symptomatic liver cirrhosis (LC). METHODS: From 1994 to 1998, all the consecutive cirrhotic inpatients admitted in 19 collaborative hospitals for signs of liver decompensation in whom the diagnosis of liver cirrhosis was made for the first time (274 cases) and one or two gender, age, and place of residence pair matched individuals (458 controls) were recruited. Data on years of education, lifetime cigarette use, lifetime intake of alcohol- and caffeine-containing beverages, usual consumption of 180 food items, and on markers of hepatitis B and C viral infection were collected. RESULTS: A statistically significant trend toward lowered cirrhosis risk with increasing exposure to coffee was observed. The LC odds ratios decreased from 1.0 (reference category: lifetime abstainers from coffee) to 0.47 (95% confidence interval: 0.20, 1.10), 0.23 (0.10, 0.53), 0.21 (0.06, 0.74), and 0.16 (0.05, 0.50) in 1, 2, 3, and 4 or more cups of coffee drinkers, respectively. There was no convincing evidence that coffee consumption modifies the effects of the known risk factors of liver cirrhosis (alcohol intake and viruses infection). CONCLUSIONS: These findings support the hypothesis that coffee, but not other beverages containing caffeine, may inhibit the onset of alcoholic and nonalcoholic liver cirrhosis.

Alcohol consumption and micronutrient intake as risk factors for liver cirrhosis: a case-control study. The Provincial Group for the study of Chronic Liver Disease.

PURPOSE: The purpose of this study was to assess the relationship of alcohol consumption and intake of 15 selected micronutrients with risk of liver cirrhosis. METHODS: Data from a case-control study performed in 1989-1990 in central Italy involving 115 incident cases and 167 hospital controls were used. RESULTS: Cases and controls did not differ for mean daily intake of calories, carbohydrates, lipids, and proteins. Significant direct dose-response relationships between the intakes of vitamin A and iron and the risk cirrhosis were observed, while significant protective effects were obtained for the intakes of vitamins B2 (riboflavin) and B12. Different patterns of the joint effect of nutrients and alcohol were also observed. The intakes of vitamin A and iron were significantly associated with the risk of cirrhosis in lifetime teetotalers (odds ratios (OR) and 95% coincidence intervals (CI) of 33.6 (1.2-979.9) and 37.9 (1.8-819.4) for higher intake of vitamin A and iron, respectively) and in consumers of < 50 g/day of alcohol (vitamin A: OR 45.0; 95% CI, (2.6-774.6); iron: OR, 73.6; 95% CI, 4.3-999). The OR associated with intakes of vitamins B2 (riboflavin) and B12 were not significant for the first two categories of alcohol use, while a higher intake of these two vitamins reduced the risk of cirrhosis associated with alcohol consumption above 50 g/day; the ORs (95% CI) were 23.0 (2.7-198.9) and 104.4 (7.2-999), respectively, for higher and lower intakes of riboflavin and 12.8 (1.8-88.1) and 138.4 (14.0-999), respectively, for higher and lower intake of vitamin B12. CONCLUSION: These findings might explain at least a portion of the individual susceptibility to alcohol-induced liver damage.

Italian style brewed coffee: effect on serum cholesterol in young men.

BACKGROUND: Increases in blood lipids have been observed in humans when coffee is brewed by the boiling method. The purpose of this study was to evaluate if giving up Italian coffee might reduce blood cholesterol levels. METHODS: Eighty-four normolipidaemic young adult males, after a 3-week baseline (BL), were randomly assigned to three different regimens of coffee consumption: espresso (E), mocha (M), and no coffee, but tea (T). The average coffee consumption during intervention (I) was 3.1 +/- 1.2 and 2.8 +/- 1.1 cups per day for espresso and mocha group respectively (espresso: 25-35 ml/cup; mocha: 40-50 ml/cup). Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were measured eight times during the study. Dietary pattern, alcohol consumption, smoking habits, drug use, and anthropometric data were also recorded. RESULTS: The changes observed in serum cholesterol concentration between baseline and intervention were not statistically different in all groups. The changes were 0.0 mmol/l (T), +0.01 mmol/l (E) and +0.05 mmol/l (M) for total serum cholesterol; 0 mmol/l (T), -0.02 mmol/l (E) and -0. 03 mmol/l (M) for HDL-C; -0.13 mmol/l (T), +0.02 mmol/l (E) and -0. 05 mmol/l (M) for LDL-C. Serum triglycerides showed a significant increase during intervention (P < 0.01 by ANOVA) in all groups with a change of 0.18 mmol/l, 0.18 mmol/l and 0.22 mmol/l, for tea, espresso and mocha group respectively. CONCLUSIONS: The results indicate that coffee brewed in the Italian way does not alter blood levels of total cholesterol, HDL-cholesterol and LDL-cholesterol, since no significant differences were observed in these blood parameters after a 6-week break from coffee consumption.

Food sources of nutrients in the diet of elderly Italians: I. Macronutrients and lipids.

The major sources of macronutrients in the Italian diet were assessed. Elderly Italians, aged > or = 60 recorded their weighed intake for a 7-day period. A total of 945 subjects from 14 centres throughout Italy participated during the period 1983-1987. These data were used to quantify the contribution of individual foods to the total intake of and variability in intake of kilocalories, protein, carbohydrate, total fat, saturated fat, oleic acid, polyunsaturated fatty acids, linoleic acid, and cholesterol. The foods ranked one to five for Italy were compared to the top five foods contributing to these nutrients in the diet of the elderly in the US based on the NHANES II Survey (1976-1980). These data provide information for the design of an Italian data-based quantitative food frequency questionnaire. They are also of interest in their description of an industrialized, well-nourished population with a dietary pattern markedly different from the US--lower in saturated fat, higher in complex carbohydrate and higher in alcohol.

Food sources of nutrients of the diet of elderly Italians: II. Micronutrients.

The foods which contribute most to the intake of selected vitamins and minerals were evaluated for the elderly in Italy and compared to food sources of nutrients in the US. A sample of 945 Italians, aged > or = 60, from 14 centres throughout Italy, each completed weighed 7-day food records during the period 1983-1987. These data were used to quantify the contribution of individual foods to the total intake of and variability in intake of vitamin A, thiamin, riboflavin, vitamin C, calcium, and iron. In addition, those foods contributing most to micronutrient intake for the Italians were compared to those foods contributing most for the elderly in the US as recorded by the NHANES II Survey (1976-1980). Overall, there was a preponderance of vegetable rather than animal sources, and of less processed food sources in Italy. In Italy, wine was an important source of several nutrients, including iron and riboflavin. These data are useful for characterizing diet in a well-nourished population with marked differences in diet from the US. They may also form the basis for a quantitative food frequency questionnaire for epidemiological studies in Italy.

Vitamin nutritional status in Italy.

In almost all countries, the critical point for defining the nutritional status of a population is represented by the poor source of representative data of the whole population or of the main subgroups of the population. Also, in Italy, the sources of data on the nutritional status of biochemically evaluated macro- and micronutrients are scant in relation to specific groups of the population, mainly children and the elderly. In this short review, only the nutritional status for vitamins is considered. The existing limited data, however, indicate that clinical signs of severe deficiency are not observed in Italy and the incidence of vitamin malnutrition is moderate. This is probably due to the large availability and variety of food and to Italian eating habits which reflect the typical Mediterranean diet: rich, for example, in cereals, fresh fruit and vegetables, and olive oil. However, there are particular conditions, linked to lifestyle, in which the risk of a mild or moderate vitamin malnutrition increases. These include a monotonous diet, drug interactions, smoking habits and alcohol consumption.

The antioxidant potential of the Mediterranean diet.

The Mediterranean diet not only produces favourable effects on blood lipids but also protects against oxidative stress. Oxidative damage is thought to represent one of the mechanisms leading to chronic diseases such as atherosclerosis and cancer. Many studies suggest that a link exists between fruit and vegetables in the diet or the amounts of plasma antioxidant vitamins (ascorbic acid, tocopherol and carotenoids) and risk of death from cancer or coronary heart diseases. Although a large emphasis has been given to different components of the diet, attention has recently shifted to the diet as a whole. The Mediterranean diet is able to modulate oxidative stress through complex mechanisms and not just the high antioxidant compound content. The preference for fresh fruit and vegetables in the Mediterranean diet will result in a higher consumption of raw foods, a lower production of cooking-related oxidants and a consequent decreased waste of nutritional and endogenous antioxidants. The high intake of antioxidant and fibre helps to scavenge even the small amount of oxidants or oxidized compounds.

Vitamin requirements: present recommendations and future prospects.

Dietary recommendations evolved from instructions directed at prevention of starvation diseases to the level of intake of essential nutrients that are adequate to meet the known nutrient needs of practically all healthy persons. Vitamin requirements have been modified various times over the years and there are still differences in recommended intakes in different countries. A debate on optimal vitamin intake is ongoing, based on the concepts of deficiency, sufficiency and hypothetical identification of a range within which a further biological advantage can be expected. In establishing appropriate criteria for food and nutrient intakes, additional studies are warranted on the physiological interactions between nutrients and non-nutrients and on many other factors such as genetic determinants and lifestyle which could interfere with disease prevention.

An ecological study of the correlation between diet and tumour mortality rates in Italy.

Cancer is said to be due to nutrition in 35 cases out of 100, ranging from 10 to 70% by sites. Saturated fats show a positive relationship with cancer, while vitamins, vegetables and cereals show a negative relation with it. This work was aimed at studying the relationship between nutrition and cancer in different Italian areas. Cancer mortality rates collected in 94 National Health units over the period 1980-82 have been correlated with the average food consumption of individuals registered in the same units. All the nutrient groups have shown evidence of a correlation between nutrient intake and mortality rates. Fats, animal proteins and saturated fatty acids showed the strongest positive correlations; vegetable proteins, fibre, carbohydrates, oleic acid, vitamins C and B1 gave negative correlations. Thus, it can be concluded that (a) this ecological analysis has confirmed previous hypotheses concerning the role of vegetables in cancer prevention and (b) the relation between nutrition and cancer mortality could be even stronger if applied to the whole population, since a 1-g increase in vegetable protein consumption would result in a reduction of 2.5 cases out of 100, a 1-g increase in fibre would result in a reduction of four cases out of 100 and a 1-g increase in animal fat would result in an increase of one case out of 100.

Food consumption patterns in Italy: the INN-CA Study 1994-1996.

OBJECTIVES: The present study was aimed at surveying the Italian food consumption patterns in the 90s. It represented the second nationwide food intake survey that was carried out by the Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN). DESIGN: Cross-sectional study. SETTING: Free-living households. SUBJECTS: Sampled subjects: 1147 households randomly selected to be representative of the four main geographical areas (North-West, North-East, Centre, South). Analysed subjects: 1978 individuals out of 2734 initially collected in 15 Collaborative Centres strategically scattered through the national territory. METHODS: A mixed 7-day based survey technique was applied in order to survey both individual and household consumption. At individual level, food intake was recorded by a self-compiled diary. At household level food data collection was by compilation of a food inventory by the dietician, a purchased/wasted foods diary and a recipes form both compiled by the person responsible for food related activities (decision of purchase, purchase, preparation of meals) in the household. All recorded data were monitored by the dieticians who visited the households participating in the study, at least three times. Household members were interviewed in order to collect socio-demographic, lifestyle and motivational information. Furthermore, field-workers performed the food coding and the input of data by an ad hoc developed software. The survey design allowed an internal quantitative check of food data. Several check steps were centrally performed RESULTS: The complex methodology caused the 46.8% response rate and afterwards a reduction of the analysed units (72% of the surveyed individuals). However, the analysed sample provided sufficiently reliable data for outlining the most relevant aspects of dietary patterns in Italy. In order to better interpret the results, controversial aspects are also illustrated and discussed in the text. The disparity analysis found that traditional diversities among Italian regions are still alive. In general, males eat more than females. Analysis according to the age class (children: 1-9 years old; adolescents: 10-17; adults: 18-64; elderly: >64) showed differences especially between the group of children vs all the others, but also in the two groups of young individuals vs adults and the elderly, that could represent clues of an incorrect way of eating. CONCLUSIONS: Taking into account the different methodology, the comparison with previous results showed changes in the Italian average diet complying with an increasing attention to healthy aspects by large sectors of the population, but also opposite tendencies that should be carefully monitored. SPONSORSHIP: Minister delle Politiche Agricole e Forestali (Mi.P.A.F.).

[Reduction modality of a dietary questionnaire]. / Modalità di riduzione di un questionario alimentare.

The data relative to the average daily intake of 7 nutrients and total energy obtained through the answers to a dietary questionnaire, consisting of 152 items and administered to 200 patients (admitted for acute pathologies) has been analysed. The aim has been to elaborate a questionnaire consisting of a more limited number of items but maintaining a great part of the informative contents from the original questionnaire. For this aim, a multiple regression model with a selection procedure for independent variables, of the stepwise type, has been used, where the dependent variable is the daily average intake of the nutrient and the independent variables are the consumption of each food included in the complete questionnaire (QC). By combining the results of the model with the 7 nutrients and total energy, 3 reduced questionnaires have been produced (QR): the first two are based on the sole criteria of the inter-individual variance of the intake of the nutrient, explained by the consumption of the foods included in the QR, the third by adding the foods that offer an adequate contribution in order to explain the supply of the nutrient under examination. The application potentials of the 3 QRs have been analysed both by evaluating the inter-class correlation coefficient, deduced by an concordance/discordance matrix relative to the quintilis values of the nutrient deduced by the QC and by each QR, and by simulating their use in a case-control study; for this aim, the attenuation of the odds ratio trend and the increase of the sample dimension has been calculated following the use of a QR instead of a complete one.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional care routines in Italy: results from the PIMAI (Project: Iatrogenic MAlnutrition in Italy) study.

BACKGROUND/OBJECTIVES: Disease-related malnutrition is a common comorbidity at hospital admission. The purpose of the present report was to describe the data on nutritional care routines collected during the Project: Iatrogenic MAlnutrition in Italy (PIMAI) study, as these may be helpful to avoid iatrogenic malnutrition and improve nutritional policies. SUBJECTS/METHODS: Standards of nutritional care were assessed on the basis of (1) adherence to study protocol (completeness of data collected); (2) attitude in assessing the nutritional status; (3) prescription of nutritional therapy (within 3 days) at least in patients presenting with overt malnutrition (body mass index (BMI) <18.5 kg/m(2) or significant weight loss (>or=10% in 3 months and/or >or=5% in the last month)), regardless of its adequacy, and adherence to current guidelines and (4) attitude in monitoring nutritional status during the stay (number of weight measurements performed compared with those expected). RESULTS: In total, 1583 subjects were assessed. A minimum data set for performing the Nutritional Risk Screening 2002 tool was available in 1284 patients (81.1%), but nutritional screening was possible in every patient by alternative analytical criteria related to food intake, anthropometry and biochemistry. However, several missing values were recorded, particularly in biochemical parameters due to lack of prescription by admission wards. According to ward practices, only 38.2% of the patients had the BMI calculated. A nutritional support was prescribed only to 26/191 patients (13.6%) presenting with overt malnutrition. Finally, we recorded that only 21.6% of the patients (207/960 were randomly selected) had their weight monitored on a scheduled basis. This reality was worse in surgical rather than medical departments (17 vs 26%; P<0.001). CONCLUSION: Present results confirm that in Italy, nutritional care routines are still poor and need improvements.

What is the cost of a healthy diet in terms of achieving RDAs?

OBJECTIVE: Assessing how the Italian average food pattern would be affected in terms of consumption structure and expenditure by the adoption of nutritional prescriptions. DESIGN: A linear programming model with nutritional and food habits constraints was employed to generate a pattern following recommended daily allowances (RDAs) and nutritional guidelines provided for the Italian population. SETTING: Food consumption data from ISTAT Household Budget Survey of Italian population. SUBJECTS: Italian families investigated by the Family Budget Survey of the National Institute of Statistics. RESULTS: Compared to actual behaviour, the pattern generated by the model implies an increased consumption of vegetables, pasta, rice and fresh fish, and a decreased consumption of meats, bread, sugars and cakes, and especially fats and oils. At given prices, total expenditure is lower than actual expenditure. CONCLUSIONS: Differences between actual behaviour and the generated pattern are consistent with long-term trends in food consumption. The adoption of RDAs is unlikely to result in an increased food expenditure.

Patterns of food and nutrient intakes in Italy and their application to the development of food-based dietary guidelines.

Patterns of food and nutrient intakes in Italy were estimated starting from a nationwide food survey carried out by the National Institute of Nutrition (NIN) in 1994-6, called INN-CA 1995. The present analysis looks at food and nutrient intakes of the subsample of the adults (18-60-year-old individuals). In particular, the two extreme quartiles of the distribution of total fat intake expressed as percentage of energy were considered in the analysis. The results showed that the subjects included in the fourth quartile (high-fat consumers) consumed fewer vegetables than the subjects in the first quartile (low-fat consumers). Furthermore, high-fat consumers had a tendency to have an unbalanced diet, whereas the low-fat consumers present a better pattern. In synthesis, 50% of the adults reach the goal of at least 400 g of vegetables and fruit daily, and 25% consume less than 30% of energy from total fats. Convincing that part of the population whose diet does not comply with dietary goals to come back to the Mediterranean tradition might be a priority for nutrition education in Italy.