Changing food choices: the option for high-protein foods and the move away from the Mediterranean diet.

PURPOSE:  The growing importance placed on health and physical well-being by consumers continues to influence food industry choices. The food market therefore, pandering to the desires for a lean and athletic body, offers new products deemed more healthy and able to impact body image. It is evidenced, thus, a change in food choices and habits, with more attention to the quality and nutrient content of the products consumed, in which protein is assuming increasing importance. The purpose of the study is to highlight important changes in eating habits and in particular the increase in the consumption of high-protein foods, attributable to the focus on physical fitness and thinness, resulting in a decreasing adherence to the Mediterranean diet and the progressive loss of its positive impact on health. METHODS AND RESULTS: This analysis is based on CIRCANA srl data on food consumption trends (change percentage of quantity and value sales) in recent years. Specifically, between January and September 2022 vs. 2021, there was a 21.6% increase in the sale of high-protein products, significantly higher than all the previous ones. CONCLUSIONS: The past few years have seen the gradual discovery of new products, at first little-known and niche, which are becoming major players on the national food consumption scene. The trend is toward a growing preference for high-protein foods and diets with the gradual abandonment of the Mediterranean and an increased risk of nutritional deficiencies, obesity, and cardiovascular disease. LEVEL OF EVIDENCE: Level IV, evidence obtained from multiple time series with or without the intervention.

Changes in food choice following restrictive measures due to Covid-19.

BACKGROUND AND AIMS: Following the Covid-19 proliferation beyond the borders of China at the beginning of 2020, containment measures have been taken by different countries around the globe. Citizens were forced to stay at home. The aim of this study is twofold. First, we will provide an analysis of food consumption in Italy during the emergency from a social stance. Secondly, we will consider the risks in relation to health of these food product choices. METHODS AND RESULT: This analysis is based on IRi's data on consumption trends (percentage increase in sales in value) during the first period of the spread of coronavirus, from 23rd of February through the 29th of March, 2020. The sample includes 10 769 stores. There was an increase in the consumption of pasta, flour, eggs, long-life milk and frozen foods, in comparison to a reduction of fresh food goods. The sales of snacks have dropped in relation to the production of homemade bread, pizza and cakes. CONCLUSION: The increase in the consumption of some types of food is linked with their symbolic value and its tendency to carry on at home some external socialization habits. But be careful: these habits are not always healthy.

Correction to: Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey­based study.

The article "Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey­based study", written by "Renata Bracale, Concetta M. Vaccaro, Vittoria Coletta, Claudio Cricelli, Francesco Carlo Gamaleri, Fabio Parazzini and Michele Carruba" was originally published electronically on the publisher's internet portal on 8th November 2019 without open access.

Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey-based study.

PURPOSE: Adopting a Mediterranean-like dietary pattern may help in preventing several chronic diseases. We assessed the eating behaviour and compliance with the Mediterranean diet pyramid recommendations in Italy. METHODS: This is a cross-sectional study conducted in subjects aged ≥ 20 years. A 14-question survey based on the updated Mediterranean diet pyramid was launched online from April 2015 to November 2016. At test completion, a personalized pyramid displaying the possible deficiencies and/or excesses was generated, that could be the basis to plan diet and lifestyle modifications. RESULTS: Overall, 27,540 subjects completed the survey: the proportion of females (75.6%), younger subjects (20.7%) and people with a University degree (33.1%) resembled those of the Italian population of Internet users rather than of the general population. 37.8% of participants declared a sedentary lifestyle, including 29.6% of those aged 20-29 years. A lower-than-recommended intake of all food categories included in the Mediterranean diet pyramid, along with excess of sweets, red and processed meats, emerged, that may affect health in the long term. Low adherence to recommendations was observed especially among females and older people. Notably, a discrepancy surfaced between the responders' perceived and actual behaviour toward the regular consumption of fruits and vegetables (81.8% vs 22.7-32.8%, respectively). CONCLUSIONS: The nutritional habits and lifestyle of Italian participants are poorly adherent to the Mediterranean diet recommendations. The personalized pyramid tool may help in raising the awareness of individuals and their families on where to intervene, possibly with the support of healthcare professionals, to improve their behaviour. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Family lifestyle and childhood obesity in an urban city of Northern Italy.

PURPOSE: Over the last decades, the prevalence of overweight and obesity in elementary school children has steadily increased worldwide. This phenomenon is also linked to food habits. The main purpose of our study was to understand the role that environmental factors may play in this context; in particular, we investigated how and to what extent family food habits and children lifestyle are associated with the spread of children obesity. METHODS: One hundred and nine primary schools, with 6-11-year-old children (n = 14,500), were recruited for this cross-sectional study in Milan (Italy). Children anthropometric data were measured and reported by parents; citizenship, fruit and vegetable consumption data of both parents and children were collected. Time spent watching television and doing physical activity was also investigated in children. RESULTS: The study revealed that children's vegetable (not fruit) consumption was positively associated with physical activity, while negatively associated with time watching TV; in particular, fewer hours spent watching television were a stronger protective factor than more hours spent doing physical activity. Moreover, the parental feeding style was associated with children's attitudes toward consumption of fruit and vegetable. Family characteristics (family size and level of parents' education) and children gender were associated to the risk of being overweight/obese. CONCLUSIONS: Our findings support the relevance of environmental factors in childhood food consumption and BMI distribution among children in an urban city. This is the reason why we stress the need to design ad hoc interventions, which should be developed in accordance with the socio-economic peculiarities of a cosmopolitan city suburb.

Childhood obesity, overweight and underweight: a study in primary schools in Milan.

AIMS: The study aims to assess the prevalence of obesity, overweight and underweight in children enrolled in government primary schools (6-11 years of age) in the city of Milan, Italy. METHODS: One hundred and nine schools were randomly selected for the study. A cross-sectional study was conducted between March and June 2008. A survey was conducted using 16,588 questionnaires completed by parents. Anthropometric data (reported) of both parents and children and information on levels of physical activity and time children spent watching television (TV) were obtained. RESULTS: In the total sample, parents are predominantly (75.0 %) of normal weight (M: 55.2 %; F: 79.1 %), 16.8 % are overweight (M: 36.9 %; F: 12.6 %), 4.0 % are obese (M: 6.6 %; F: 3.5 %) and 4.2 % are underweight (M: 1.3 %; F: 4.8 %). Among children, 68.7 % are of normal weight (M: 68.2 %; F: 69.2 %), 14.7 % are overweight (M: 15.3 %; F: 14.2 %), 4 % are obese (M: 4.5 %; F: 3.4 %), 11.8 % are underweight (M: 11.2 %; F: 12.5 %) and 0.8 % are severely thin (M: 0.9 %; F: 0.7 %). Children practice physical activity once or twice/week (48.3 %), three to four times/week (38.9 %) or five to seven times/week (8.9 %), while 3.9 % of children do not do any exercise. Most children (85.3 %) watch TV from 30 min to 2 h/day. CONCLUSION: Contrary to the reported national average, the study shows the presence of only moderate levels of above-average weight and obesity among children. However, it remains important to monitor this phenomenon to raise awareness and to design programs of prevention throughout the country.

Mitochondrial Dysfunction in Peripheral Blood Mononuclear Cells as Novel Diagnostic Tools for Non-Alcoholic Fatty Liver Disease: Visualizing Relationships with Known and Potential Disease Biomarkers.

Non-alcoholic fatty liver disease (NAFLD) is a health emergency worldwide due to its high prevalence and the lack of specific therapies. Noninvasive biomarkers supporting NAFLD diagnosis are urgently needed. Liver mitochondrial dysfunction is a central NAFLD pathomechanism that changes throughout disease progression. Blood-cell bioenergetics reflecting mitochondrial organ dysfunction is emerging for its potential applications in diagnostics. We measured real-time mitochondrial respirometry in peripheral blood mononuclear cells (PBMCs), anthropometric parameters, routine blood analytes, and circulating cytokines from a cohort of NAFLD patients (N = 19) and non-NAFLD control subjects (N = 18). PBMC basal respiration, ATP-linked respiration, maximal respiration, and spare respiratory capacity were significantly reduced in NAFLD compared to non-NAFLD cases. Correlation plots were applied to visualize relationships between known or potential NAFLD-related biomarkers, while non-parametric methods were applied to identify which biomarkers are NAFLD predictors. Basal and ATP-linked mitochondrial respiration were negatively correlated with triglycerides and fasting insulin levels and HOMA index. Maximal and spare respiratory capacity were negatively correlated with IL-6 levels. All the mitochondrial respiratory parameters were positively correlated with HDL-cholesterol level and negatively correlated with fatty liver index. We propose including blood cell respirometry in panels of NAFLD diagnostic biomarkers to monitor disease progression and the response to current and novel therapies, including mitochondrial-targeted ones.

Social networks and eating disorders during the Covid-19 pandemic.

OBJECTIVE: The purpose of this study is to assess the increase both in the use of the Internet and social media and in Google searches regarding eating disorders (ED) in Italy during the Covid-19 pandemic. Our aim is also to verify the possible impact of such an increase on ED, since patients treated for ED by the National Health Service (NHS) have increased in the first 6 months of 2020 as well. METHOD: We used data from Wearesocial surveys on Internet users in the first 6 months of 2020 and the Google searches related to the query of "food disorders" and "body shaming." The first results of a project of the Italian Ministry of Health on ED have been considered too. RESULTS: The social media users in July 2020 increased to 60% of the Italian population; a tendential increase in Google searches on these issues has emerged. Finally, new patients of NHS with ED showed a high increase in the first 6 months of 2020 (+40.9%). CONCLUSION: Considering the contents diffused on the Internet, it is fundamental to watch over net usage in the adolescent population and those with ED, because massive access to social media can be considered almost as a risk factor.

Saving and empowering young lives in Europe (SEYLE): a randomized controlled trial.

BACKGROUND: There have been only a few reports illustrating the moderate effectiveness of suicide-preventive interventions in reducing suicidal behavior, and, in most of those studies, the target populations were primarily adults, whereas few focused on adolescents. Essentially, there have been no randomized controlled studies comparing the efficacy, cost-effectiveness and cultural adaptability of suicide-prevention strategies in schools. There is also a lack of information on whether suicide-preventive interventions can, in addition to preventing suicide, reduce risk behaviors and promote healthier ones as well as improve young people's mental health.The aim of the SEYLE project, which is funded by the European Union under the Seventh Framework Health Program, is to address these issues by collecting baseline and follow-up data on health and well-being among European adolescents and compiling an epidemiological database; testing, in a randomized controlled trial, three different suicide-preventive interventions; evaluating the outcome of each intervention in comparison with a control group from a multidisciplinary perspective; as well as recommending culturally adjusted models for promoting mental health and preventing suicidal behaviors. METHODS AND DESIGN: The study comprises 11,000 adolescents emitted from randomized schools in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the scientific coordinating center. Each country performs three active interventions and one minimal intervention as a control group. The active interventions include gatekeeper training (QPR), awareness training on mental health promotion for adolescents, and screening for at-risk adolescents by health professionals. Structured questionnaires are utilized at baseline, 3- and 12-month follow-ups in order to assess changes. DISCUSSION: Although it has been reported that suicide-preventive interventions can be effective in decreasing suicidal behavior, well-documented and randomized studies are lacking. The effects of such interventions in terms of combating unhealthy lifestyles in young people, which often characterize suicidal individuals, have never been reported. We know that unhealthy and risk-taking behaviors are detrimental to individuals' current and future health. It is, therefore, crucial to test well-designed, longitudinal mental health-promoting and suicide-preventive interventions by evaluating the implications of such activities for reducing unhealthy and risk behaviors while concurrently promoting healthy ones. TRIAL REGISTRATION: The German Clinical Trials Register, DRKS00000214.

TNF-alpha downregulates eNOS expression and mitochondrial biogenesis in fat and muscle of obese rodents.

Obesity is associated with chronic low-grade inflammation. Thus, at metabolically relevant sites, including adipose tissue and muscle, there is abnormal production of proinflammatory cytokines such as TNF-alpha. Here we demonstrate that eNOS expression was reduced, with a concomitant reduction of mitochondrial biogenesis and function, in white and brown adipose tissue and in the soleus muscle of 3 different animal models of obesity. The genetic deletion of TNF receptor 1 in obese mice restored eNOS expression and mitochondrial biogenesis in fat and muscle; this was associated with less body weight gain than in obese wild-type controls. Furthermore, TNF-alpha downregulated eNOS expression and mitochondrial biogenesis in cultured white and brown adipocytes and muscle satellite cells of mice. The NO donors DETA-NO and SNAP prevented the reduction of mitochondrial biogenesis observed with TNF-alpha. Our findings demonstrate that TNF-alpha impairs mitochondrial biogenesis and function in different tissues of obese rodents by downregulating eNOS expression and suggest a novel pathophysiological process that sustains obesity.

Hemodialysis Arteriovenous Access Occlusion Using the Amplatzer Vascular Plug in Patients with Intractable Arm Edema.

OBJECTIVES: Vascular occlusion of hemodialysis arteriovenous access (AVA) using an Amplatzer vascular plug (AVP; St. Jude Medical, St. Paul, MN, USA) is an arising and alternative practice in selected patients; however, few reported cases can be found in the literature. Herein, we report on our experience with endovascular treatment of complicated AVA. MATERIALS AND METHODS: From September 2015 to December 2016, 3 patients at our clinic underwent an occlusion of hemodialysis AVA with 2 different Amplatzer vascular plugs: 2 patients with type II and 1 patient with type IV. Of these, 1 patient was treated for an autologous radiocephalic fistula, the second patient was treated for an autologous brachiocephalic fistula located at the elbow, and the third was, instead, treated for a radiocephalic forearm fistula. The reason for closing the AVA in all patients was due to the presence of dialysis-associated steal syndrome with critical hand ischemia and intractable ipsilateral edema. RESULTS: All AVAs were treated using an AVP. No plug migration, access revascularization, persistent ischemia, nor other complications were observed. CONCLUSION: This report suggests that the use of AVP for embolization of complicated AVA is a safe and reasonable alternative to open surgery in selected patients.

Endovascular treatment of spontaneous isolated abdominal aortic dissection.

Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.

Muscle uncoupling protein 3 expression is unchanged by chronic ephedrine/caffeine treatment: results of a double blind, randomised clinical trial in morbidly obese females.

UNLABELLED: Ephedrine/caffeine combination (EC) has been shown to induce a small-to-moderate weight loss in obese patients. Several mechanisms have been proposed, among which an increased thermogenic capacity of skeletal muscle consequent to the EC-induced up-regulation of uncoupling protein 3 (UCP3) gene expression. We did a parallel group double-blind, placebo-controlled, 4-week trial to investigate this hypothesis. Thirteen morbidly obese women (25-52 years of age, body-mass index 48.0±4.0 kg/m2, range 41.1-57.6) were randomly assigned to EC (200/20 mg, n = 6) or to placebo (n = 7) administered three times a day orally, before undergoing bariatric surgery. All individuals had an energy-deficit diet equal to about 70% of resting metabolic rate (RMR) diet (mean 5769±1105 kJ/day). The RMR analysed by intention to treat and the UCP3 (long and short isoform) mRNA levels in rectus abdominis were the primary outcomes. Body weight, plasma levels of adrenaline, noradrenaline, triglycerides, free fatty acids, glycerol, TSH, fT4, and fT3 were assessed, as well as fasting glucose, insulin and HOMA index, at baseline and at the end of treatments. Body weight loss was evident in both groups when compared to baseline values (overall -5.2±3.2%, p<0.0001) without significant differences between the treated groups. EC treatment increased the RMR (+9.2±6.8%, p = 0.020), differently from placebo which was linked to a reduction of RMR (-7.6±6.5%, p = 0.029). No significant differences were seen in other metabolic parameters. Notably, no changes of either UCP3 short or UCP3 long isoform mRNA levels were evident between EC and placebo group. Our study provides evidence that 4-week EC administration resulted in a pronounced thermogenic effect not related to muscle UCP3 gene expression and weight loss in morbidly obese females under controlled conditions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02048215.

Synergistic effect of L-Carnosine and EGCG in the prevention of physiological brain aging.

The benefits of multi-target action are well established in a variety of pathological models. Many dietary supplements and nutraceuticals may be useful to slow age-related cognitive declines and the risk of developing neurodegenerative disease. L-Carnosine and EGCG are natural compounds that have received particular attention because of their potential role in modulating oxidative stress associated with aging and chronic conditions. The biological activities of these naturally occurring substances have frequently been used to prevent or reduce senile features; however they have never been evaluated as a combined treatment. In the present study we investigated the combined effect of L-Carnosine and EGCG on the activation of two stress-responsive pathways: HO-1 and Hsp72 (the inducible form of Hsp70), which play an important role in cytoprotection against oxidative stress-induced cell damage. We demonstrated that the neuroprotective effects of EGCG and L-Carnosine are achieved through the modulation of HO-1/Hsp72 systems. Furthermore, the combined action of both compounds resulted in a synergistic increase of HO-1 expression which suggests a crosstalk between the HO-1 and the Hsp72-mediated pathways. Our results indicate that the combined administration of EGCG and L-Carnosine would benefit the treatment and prevention of neurodegenerative diseases by reducing the neuronal damage caused by oxidative stress.

Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.

BACKGROUND: To evaluate the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis in comparison with other imaging modalities. METHODS: The authors performed a search of the Medline/ PubMed (National Library of Medicine, Bethesda, Maryland) for original research and review publications examining the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis. The search design utilized a single or combination of the following terms : (1) acute cholecystitis, (2) ultrasonography, (3) computed tomography, (4) magnetic resonance cholangiopancreatography and (5) cholescintigraphy. This review was restricted to human studies and to English-language literature. Four authors reviewed all the titles and subsequent the abstract of 198 articles that appeared appropriate. Other articles were recognized by reviewing the reference lists of significant papers. Finally, the full text of 31 papers was reviewed. RESULTS: Sonography is still used as the initial imaging technique for evaluating patients with suspected acute calculous cholecystitis because of its high sensitivity at the detection of GB stones, its real-time character, and its speed and portability. Cholescintigraphy still has the highest sensitivity and specificity in patients who are suspected of having acute cholecystitis. However, due to a combination of reasons including logistic drawbacks, broad imaging capability and clinician referral pattern the use of cholescintigraphy is limited in clinical practice. CT is particularly useful for evaluating the many complications of acute calculous cholecystitis. The lack of widespread availability of MRI and the relatively high cost prohibits its primary use in patients with acute calculous cholecystitis. CONCLUSIONS: US is currently considered the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis.

Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature.

BACKGROUND: Ultrasound is a widely used technique in the diagnosis of acute appendicitis; nevertheless, its utilization still remains controversial. METHODS: The accuracy of the Ultrasound technique in the diagnosis of acute appendicitis in the adult patient, as shown in the literature, was searched for. RESULTS: The gold standard for the diagnosis of appendicitis still remains pathologic confirmation after appendectomy. In the published literature, graded-compression Ultrasound has shown an extremely variable diagnostic accuracy in the diagnosis of acute appendicitis (sensitivity range from 44% to 100%; specificity range from 47% to 99% ). This is due to many reasons, including lack of operator skill, increased bowel gas content, obesity, anatomic variants, and limitations to explore patients with previuos laparotomies. CONCLUSIONS: Graded-compression Ultrasound still remains our first-line method in patients referred with clinically suspected acute appendicitis: nevertheless, due to variable diagnostic accuracy, individual skill is requested not only to perform a successful exam, but also in order to triage those equivocal cases that, subsequently, will have to undergo assessment by means of Computed Tomography.

Pleiotropic protective effects of phytochemicals in Alzheimer's disease.

Alzheimer's disease (AD) is a severe chronic neurodegenerative disorder of the brain characterised by progressive impairment in memory and cognition. In the past years an intense research has aimed at dissecting the molecular events of AD. However, there is not an exhaustive knowledge about AD pathogenesis and a limited number of therapeutic options are available to treat this neurodegenerative disease. Consequently, considering the heterogeneity of AD, therapeutic agents acting on multiple levels of the pathology are needed. Recent findings suggest that phytochemicals compounds with neuroprotective features may be an important resources in the discovery of drug candidates against AD. In this paper we will describe some polyphenols and we will discuss their potential role as neuroprotective agents. Specifically, curcumin, catechins, and resveratrol beyond their antioxidant activity are also involved in antiamyloidogenic and anti-inflammatory mechanisms. We will focus on specific molecular targets of these selected phytochemical compounds highlighting the correlations between their neuroprotective functions and their potential therapeutic value in AD.

Calorie restriction promotes mitochondrial biogenesis by inducing the expression of eNOS.

Calorie restriction extends life span in organisms ranging from yeast to mammals. Here, we report that calorie restriction for either 3 or 12 months induced endothelial nitric oxide synthase (eNOS) expression and 3',5'-cyclic guanosine monophosphate formation in various tissues of male mice. This was accompanied by mitochondrial biogenesis, with increased oxygen consumption and adenosine triphosphate production, and an enhanced expression of sirtuin 1. These effects were strongly attenuated in eNOS null-mutant mice. Thus, nitric oxide plays a fundamental role in the processes induced by calorie restriction and may be involved in the extension of life span in mammals.

Mitochondrial biogenesis in mammals: the role of endogenous nitric oxide.

Nitric oxide was found to trigger mitochondrial biogenesis in cells as diverse as brown adipocytes and 3T3-L1, U937, and HeLa cells. This effect of nitric oxide was dependent on guanosine 3',5'-monophosphate (cGMP) and was mediated by the induction of peroxisome proliferator-activated receptor gamma coactivator 1alpha, a master regulator of mitochondrial biogenesis. Moreover, the mitochondrial biogenesis induced by exposure to cold was markedly reduced in brown adipose tissue of endothelial nitric oxide synthase null-mutant (eNOS-/-) mice, which had a reduced metabolic rate and accelerated weight gain as compared to wild-type mice. Thus, a nitric oxide-cGMP-dependent pathway controls mitochondrial biogenesis and body energy balance.