Is the association between precarious employment and mental health mediated by economic difficulties in males? Results from two Italian studies.

BACKGROUND: Flexible employment is increasing across Europe and recent studies show an association with poor mental health. The goal of the current study is to examine this association in the Italian population to assess the possible mediating role of financial strain. METHODS: Data were obtained by two Italian cross-sectional studies (PASSI and HIS) aimed at monitoring the general population health status, health behaviours and determinants. Mental health status was assessed using alternatively two validated questionnaires (the PHQ-2 and the MCS-12 score) and Poisson regression models were performed to assess if precarious work was associated with poor mental health. A formal mediation analysis was conducted to evaluate if the association between precarious work and mental health was mediated by financial strain. RESULTS: The analyses were performed on 31,948 subjects in PASSI and on 21,894 subjects in HIS. A nearly two-fold risk of depression and poor mental health was found among precarious workers, compared to workers with a permanent contract, which was strongly mediated by financial strain. CONCLUSIONS: Even with the limitations of a cross-sectional design, this research supports that precarious employment contributes through financial strain to reduce the mental health related quality of life and to increase mental disorders such as symptoms of depression or dysthymia. This suggests that when stability in work cannot be guaranteed, it would be appropriate to intervene on the wages of precarious jobs and to provide social safety nets for ensuring adequate income.

Energy Balance-Related Behaviors, Perinatal, Sociodemographic, and Parental Risk Factors Associated with Obesity in Italian Preschoolers.

OBJECTIVE: The obesity epidemic stems from the complex interplay between genetics and environmental factors. Identifying age-specific risk factors in preschoolers may allow implementing more effective intervention strategies. The aim of the present investigation was to examine the association of overweight/obesity with several perinatal, parental, socioeconomic status (SES), and lifestyle-related risk factors in a large sample of Italian preschoolers. METHODS: One thousand eleven children (age 2.0 to 5.7 years) were included in the study. Family pediatricians measured weight and height and collected information on obesity risk factors by means of questionnaires. Perinatal risk factors were recalled from electronic medical records. Weight status was defined according to cutoffs of the International Obesity Task Force (IOTF). RESULTS: Seven hundred sixty-four children (75.6%) were normal weight, and 247 (24.4%) were overweight/obese. Multivariate analysis showed that skipping breakfast (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.32-10.51), daily drinking of sugar-sweetened beverages (OR = 2.0; 95% CI, 1.02-4.03), meat consumption <5 times/week (OR = 2.2; 95% CI, 1.11-4.57), and formula feeding (OR = 2.1; 95% CI, 0.8-4.5) were significantly (p < 0.05) associated with increased risk of obesity. CONCLUSIONS: Though exclusive formula or mixed feeding represents an age-specific risk factor for overweight/obesity, lifestyle factors associated with increased risk in Italian preschoolers include habits that are common to school-age children, such as skipping breakfast and consumption of sugar-sweetened beverages. The reduced consumption of meat emerged as a risk factor for overweight/obesity, but future research is required to better understand this relationship. Our data suggest, on the whole, that prevention of such unhealthy behaviors must be pursued in preschoolers by means of age-specific interventions.

Local control in metastatic neuroblastoma in children over 1 year of age.

BACKGROUND: Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to evaluate the impact of radical surgery on survival in children over 1 year of age. METHODS: Fifty-eight patients older than 1 year of age with metastatic NBL were treated with conventional plus high-dose chemotherapy with or without addition of local radiotherapy (RT, 21Gy). Surgery was classified as radical surgery (complete resection and gross total resection) or non-radical surgery. The Kaplan-Meier method and the Cox proportional hazard model were used to calculate the probability of progression free and overall survival (PFS and OS) and for multivariate analysis. RESULTS: The 5-year PFS and OS for patients with radical surgery were 26% (95% CI 14-40%) and 38% (95% CI 23-53%) respectively, while the PFS and OS for patients without radical surgery were 33% (95% CI 10-59%) and 31% (95% CI 10-55%) (respectively, P 0.85 and P 0.42). The 5-year PFS and OS for patients who received RT were 36% (95% CI 19-53%) and 46% (95% CI 26-64%) respectively, while the 5-year PFS and OS for patients who did not receive RT were 22% (95% CI 9-38%) and 27% (95% CI 13-42%) respectively (P 0.02 for PFS). Multivariate analysis confirmed the role of well-known prognostic factors, such as the presence of MYCN amplification, age and response before high-dose chemotherapy. CONCLUSIONS: Our data suggest that the degree of resection does not influence survival in metastatic NBL patients treated with high-dose chemotherapy; local RT contributes to local disease control.

Allogeneic hematopoietic stem cell transplantation in thalassemia major: results of a reduced-toxicity conditioning regimen based on the use of treosulfan.

Sixty thalassemia patients (median age, 7 years; range, 1-37) underwent allogeneic hematopoietic stem cell transplantation (HSCT) after a preparation combining thiotepa, treosulfan, and fludarabine. Before HSCT, 27 children were assigned to risk class 1 of the Pesaro classification, 17 to class 2, and 4 to class 3; 12 patients were adults. Twenty patients were transplanted from an HLA-identical sibling and 40 from an unrelated donor. The cumulative incidence of graft failure and transplantation-related mortality was 9% and 7%, respectively. Eight patients experienced grade II-IV acute GVHD, the cumulative incidence being 14%. Among 56 patients at risk, 1 developed limited chronic GVHD. With a median follow-up of 36 months (range, 4-72), the 5-year probability of survival and thalassemia-free survival are 93% and 84%, respectively. Neither the class of risk nor the donor used influenced outcome. This treosulfan-based preparation proved to be safe and effective for thalassemia patients given allogeneic HSCT.

Exploring COVID-19 Vaccination Willingness in Italy: A Focus on Resident Foreigners and Italians Using Data from PASSI and PASSI d'Argento Surveillance Systems.

(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d'Argento, in the period of August 2020-December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.

Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019).

CONTEXT: In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking. OBJECTIVE: The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program. METHODS: From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism. RESULTS: The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 µg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%. CONCLUSION: Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.

Multiple infusions of mesenchymal stromal cells induce sustained remission in children with steroid-refractory, grade III-IV acute graft-versus-host disease.

Mesenchymal stromal cell (MSC) infusions have been reported to be effective in patients with steroid-refractory, acute graft-versus-host disease (aGvHD) but comprehensive data on paediatric patients are limited. We retrospectively analysed a cohort of 37 children (aged 3 months-17 years) treated with MSCs for steroid-refractory grade III-IV aGvHD. All patients but three received multiple MSC infusions. Complete response (CR) was observed in 24 children (65%), while 13 children had either partial (n = 8) or no response (n = 5). Cumulative incidence of transplantation-related mortality (TRM) in patients who did or did not achieve CR was 17% and 69%, respectively (P = 0.001). After a median follow-up of 2.9 years, overall survival (OS) was 37%; it was 65% vs. 0% in patients who did or did not achieve CR, respectively (P = 0.001). The median time from starting steroids for GvHD treatment to first MSC infusion was 13 d (range 5-85). Children treated between 5 and 12 d after steroid initiation showed a trend for better OS (56%) and lower TRM (17%) as compared with patients receiving MSCs 13-85 d after steroids (25% and 53%, respectively; P = 0.22 and 0.06, respectively). Multiple MSC infusions are safe and effective for children with steroid-refractory aGvHD, especially when employed early in the disease course.

Influenza Vaccination Uptake and Prognostic Factors among Health Professionals in Italy: Results from the Nationwide Surveillance PASSI 2015-2018.

(1) Influenza causes a significant health and socio-economic burden every year, and health personnel (HP) are at higher risk of exposure to respiratory pathogens than the general population. (2) The study's purpose was to describe and compare influenza vaccine uptake and its prognostic factors among Medical Doctors (MDs) and Non-Medical Health Personnel (NMHP) vs. Non-HP (NHP). We analyzed 2014-2018 data (n = 105,608) from the Italian Behavioral Risk Factor Surveillance System PASSI that, since 2008, has been collecting health-related information continuously in sampled adults. (3) MDs and NMHP represented, respectively, 1.1% and 4.6% of the sample. Among HP, 22.8% (CI 19.8-26.1%) of MDs and 8.5% (CI 7.5-9.5%) of NMHP reported to have been vaccinated vs. 6.3% (CI 6.1-6.5%) in NHP. This difference is confirmed in the three categories (MDs, NMHP, NHP), even more across age groups: in 18-34 yy, respectively, 9.9%, 4.4%, 3.4% vs. 28.4%, 13.9%, 10.6% in 50-64 yy. PASSI surveillance shows an increasing influenza vaccination uptake over time, especially among MDs (22.2% in 2014 vs. 30.5% in 2018). (4) Despite such an increase, especially among younger HP, influenza vaccination uptake is low. Even more under pandemic scenarios, these figures represent key information to address effective strategies for disease prevention and health promotion.

Depressive symptoms among adults in 2018-2019 and during the 2020 COVID-19 pandemic in Italy.

BACKGROUND: Restrictions due to Coronavirus disease 2019 (COVID-19) has produced a large number of effects on mental health, which are expected to endure over time. In this study, we assessed depressive symptom levels before the COVID-19 pandemic, from January 2018 to December 2019, and during the pandemic in Italy in 2020. METHODS: We used the Patient Health Questionnaire-2 (PHQ-2), which is a screening instrument devised to detect probable depression and which has been annually administered in the framework of the Italian Behavioural Risk Factor Surveillance System since 2008. Depressive symptoms were assessed in a sample of 41,362 18-64-year-old adults surveyed in 2018-2019 and in a sample of 14,612 adults surveyed in 2020. RESULTS: The prevalence of depressive symptoms increased from 6.1% (95% CI 5.8%-6.4%) in 2018-2019 to 7.1% (95% CI 5.6%-8.6%) in March-April 2020. It then declined in May-June to 4.4% (95% CI 3.2%-5.5%) but in July-August it once again increased to 8.2% (95% CI 6.0%-10.4%) and, finally, gradually returned above the pre-lockdown level by November-December 2020 (5.9%; 95% CI 4.7%-7.1%). Compared to before the health crisis, during the pandemic, women and individuals with financial difficulties were found to have a significantly higher risk of depressive symptoms while younger, individuals with a higher education and those living in South Italy became increasingly vulnerable. CONCLUSIONS: While the average response to the pandemic was one of resilience over time, women and younger individuals were found to be particularly prone to the risk of depressive symptoms, as a result of the pandemic. In future investigations, the risk of individuals living in the South of Italy should also be taken into consideration.

Data from the PASSI d'Argento Surveillance System on Difficulties Met by Older Adults in Accessing Health Services in Italy as Major Risk Factor to Health Outcomes.

(1) Age-friendly health systems ensure access to quality healthcare services to all people, especially older adults. (2) We used data on elderly population collected from 2016 to 2019 by the Italian ongoing surveillance system PASSI d'Argento to analyze the prevalence and associations between accessing health services and modifiable risk factors included in the 25 × 25 strategy for the burden of noncommunicable diseases with health outcomes. (3) Chronic diseases and hospitalization as descriptors of health status showed that the elderly perceived as having poor access to care and prevention incurred a higher risk of hospitalization. The association between difficulties in accessing health services and hospitalization was always the highest in terms of the adjusted prevalence ratio (aPR), regardless of the other behavioral risk factors considered, controlling each model with sociodemographic conditions. Elderly hospitalized at least once for two days or more in the last 12 months had greater risk to have problems in accessing health services, whereas the model included health conditions such as obesity (aPR = 1.95 95% CI 1.75-2.17), smoking (aPR = 1.95 95% CI 1.76-2.16), alcohol use (aPR = 1.93 95% CI 1.73-2.14), hypertension (aPR = 1.92 95% CI 1.73-2.13) and diabetes (aPR = 1.91 95% CI 1.73-2.12). (4) Health policies should encompass socio-economic and living environment barriers which prevent access to care among older adults.

Monitoring cardiovascular diseases and associated risk factors in the adult population to better orient prevention strategies in Italy.

INTRODUCTION: Cardiovascular disease (CVD) is the first cause of death in Europe and over the world. This study analyses health-related behaviours in adults referring doctor-diagnosed CVDs. MATERIALS AND METHODS: We used data from the Italian cross-sectional Behavioural Risk Factor Surveillance System PASSI gathered in 2015-2018. Complex survey design analyses included the Taylor series method for variance estimation and Poisson regression for associations between socio-demographic characteristics and CVD. RESULTS: Among 132,598 respondents, the prevalence of doctor-diagnosed CVD was 5%. Higher percentages are observed among: men, older individuals, socioeconomically disadvantaged people. Compared to the general population, people with CVD have greater risk and aggravating factors, and a worse health status overall. All protective behaviors and lifestyles shall be improved. DISCUSSION AND CONCLUSIONS: In Italy, adults with CVD are more likely to be exposed to aggravating modifiable risk factors: it represents a valuable information for increased preventive interventions, even more in the light of the COVID-19 pandemic scenario.

Modifiable Risk Factors, Health Profile and Well-Being of the Elderly Diagnosed with Cancer in Italy: Passi d'Argento Surveillance System 2016-2019 Results.

(1) Cases of cancer are expected to increase in the next years and the risk of cancer increases with age. Data 2016-2019 from the Italian population-based surveillance PASSI d'Argento (PdA) allow the description of the physical and psychosocial well-being of people aged ≥65 years diagnosed with cancer (Ca), and the comparison with elderly suffering from other chronic conditions (Ch) and healthy older individuals (H). (2) Data are collected by Local Health Units' professionals using a standardized questionnaire during telephone interviews. (3) A total of 8051 out of the 56,352 interviewees reported a previous diagnosis of cancer: an annual average cancer prevalence of 12.8% (95% CI 12.4-13.3%) corresponding to 1.725 million elderly residing in Italy. In comparison to the H, Ca were more likely to refer bad health (aPR = 4.21; 95% CI: 3.70-4.79), suffer from depressive symptoms (aPR = 2.65; 95% CI: 2.35-2.99), disability (aPR = 2.50; 95% CI: 2.22-2.81) or sensory problems (aPR = 1.51; 95% CI: 1.40-1.63), be frail (aPR = 1.45; 95% CI: 1.30-1.61). Ca are often current smokers (aPR = 1.26; 95% CI: 1.11-1.45) and sedentary (aPR = 1.10; 95% CI: 1.03-1.18). (4) PdA provides valuable information to researchers and policy-makers by showing the difficulties for older people with cancer in contributing socially and accessing basic social and health services, which amplifies the risk of cognitive decline, isolation, and psychological deterioration.

What Is the Willingness to Receive Vaccination Against COVID-19 Among the Elderly in Italy? Data From the PASSI d'Argento Surveillance System.

Introduction: Italy was one of the earliest countries to experience a severe COVID-19 epidemic and vaccinating the elderly, who constitute 23% of the population and have experienced the highest mortality rates, is a top priority. Estimating prevalences and understanding risk factors for COVID-19 vaccine hesitancy or refusal are important for development of targeted interventions. Methods: We used data from a specially developed COVID-19 module of PASSI D'Argento, an ongoing surveillance system of residents 65+ years of age to measure the prevalence and identify risk factors for hesitancy and refusal to receive the COVID-19 vaccine. We calculated multinomial regression relative risk ratios to examine the association between demographic characteristics, health status, COVID-19 attitudes and experiences and likely vaccine hesitancy and refusal. Results: Of the 1876 respondents, 55% reported they would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, we identified several risk factors in common between the hesitancy group and the refusal group, including not having received vaccination against influenza during the previous flu season (hesitancy: RRR = 2.0; 95% CI 1.4-2.9; refusal: RRR = 12.1; 95%CI 7.6-19.4) and lower risk of having had a death from COVID-19 among family or friends (hesitancy: RRR = 4.8; 95%CI 2.0-11.4; refusal: RRR = 15.4; 95%CI 3.7-64.5). The hesitancy group was significantly more likely being worried and they did not know if consequences of the disease would be serious for them. Conclusion: Our findings show the importance of establishing and maintaining active contact between the preventive services, primary care providers and the population because trust is difficult to establish during an emergency like the COVID-19 pandemic. Italian public health is based on a capillary network of general practitioners and having them reach out to their patients who have not previously received influenza vaccine may be a useful strategy for targeting efforts to further encourage uptake of COVID-19 vaccination.

Smoking prevalence among healthcare workers in Italy, PASSI surveillance system data, 2014-2018.

INTRODUCTION: Data on smoking among Italian Health Personnel (HP) from PASSI surveillance system from 2014-2018 were analysed. MATERIALS AND METHODS: Among 169,678 working-age respondents, smoking prevalence was estimated among 1,253 Medical Doctors (MDs), 4,840 Non-Medical HP (NMHP), 87,749 Non-HP (NHP) and multivariate analysis was conducted. RESULTS: Current smokers were 23.0% among HP. Smoking prevalence in MDs (16.0%) was significantly lower than those observed in NMHP (25.3%) and NHP (28.6%). A declining trend was detected in all three groups and was more evident among MDs: from 20.8% in 2014 to 11.5% in 2018. Amongst MDs, smoking was significantly associated with male gender (Adjusted Odds Ratio, AdjOR=1.61), younger age (AdjOR=2.00), residing in South (AdjOR=1.71). Among NMHP, smoking prevalence was associated with low economic condition (AdjOR=1.54) and non-university education. DISCUSSION AND CONCLUSIONS: To further reduce smoking in HP, it is necessary to develop specific training courses in educational curricula.

The two behavioural risk factor surveillances on the adult and elderly populations as information systems for leveraging data on health-related sustainable development goals in Italy.

INTRODUCTION: Current lengthening of average life and constant increase of population ageing associated to forces that include rapid unplanned urbanisation and globalisation of unhealthy behaviours have determined the huge relevance of noncommunicable diseases (NCDs). Monitoring key modifiable behavioural risk factors has resulted to be crucial both in spatial terms and as per temporal trends in order to allow comparisons between different geographic areas or levels and over time. MATERIALS AND METHODS: In Italy, PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) and Passi d'Argento are the ongoing Behavioural Risk Factor Surveillance Systems (BRFSSs), respectively, on adults (people aged 18-69) and elderly (65 and older). RESULTS: The two Italian surveillances are information systems providing data not only on the third Sustainable Development Goal (SDG) that explicitly addresses ensuring healthy lives and promoting well-being for all, but on a total of nine health-related SDGs (HRSDGs) and 19 HRSDG targets/indicators. We describe these pairs more in detail specifying where in case of BRFSS core indicators (N = 14 HRSDG targets/indicators) concerning six HRSDGs or, on the other hand, as per BRFSS further in-depth analysis (N = five HRSDG targets/indicators) in regard of four different HRSDGs. About the HRSDG 3, HRSDG target 3.4, HRSDG indicator 3.4.1, from the PASSI and Passi d'Argento data it is possible not only to detect the prevalence of NCDs in adults and elderly living in Italy, but also to evaluate the social determinants of health, such as gender, age group, educational level, economic difficulties, as well as the associations with modifiable lifestyle risk factors. CONCLUSIONS: The two Italian BRFSSs generate accurate data, which are highly relevant to design, implement, monitor, and evaluate programs and policies at different levels (local, regional, national) for NCD prevention and health promotion. They provide numbers which can also serve as propaedeutic or, in some cases, complementary ground to address a robust measurement of several HRSDG patterns.

Roll-your-own cigarette use in Italy: sales and consumer profile-data from PASSI surveillance, 2015-2016.

OBJECTIVES: The use of roll-your-own (RYO) cigarette has substantially increased in most high-income countries recently. This work aims to update Italian trends on loose tobacco sales and to describe the consumer profile of predominant RYO users. METHODS: Data from the Italian Agency of Customs and State Monopolies and from PASSI (Italian behavioral risk factor surveillance system) were used. Information on 16,858 interviews to current smokers aged 18-69 was analyzed. RESULTS: Sales of loose tobacco increased more than sevenfold between 2004 and 2017. In 2015-2016, 11.6% of smokers reported smoking predominantly RYO cigarettes, with higher percentages among the youngest where a significant association between use of RYO and education was observed, unlike what happened in older adults. The association between economic difficulties and use of RYO was observed only in older adults. CONCLUSIONS: A growing trend in RYO cigarette sales was registered between 2004 and 2017. In young smokers, the greater use of RYO was observed among the most educated regardless of financial strain, while in older ones among those with economic difficulties.

PASSI d'Argento (Silver Steps): the main features of the new nationwide surveillance system for the ageing Italian population, Italy 2013-2014.

BACKGROUND: Italy is particularly concerned by population ageing. The costs for society are substantial. In this context a national, representative surveillance system, Passi D'Argento (PDA), was implemented in 2009 to monitor "active aging" and health status in people aged over 64 and to develop preventive health programs to reduce frailty. METHODS/DESIGN: PDA recruited a representative sample of 24 129 individuals (March 2012-January 2013) aged over 64 who were interviewed by trained staff using a standardized questionnaire. The PDA collects information about participation in society and employment, independent living, health conditions, safety and living environment. Indicator values are used to obtain population health profiles and to compare different LHUs' profiles within the same region or between different regions. DISCUSSION: The PDA surveillance system proved to be feasible and to be a powerful and innovative local and national tool for monitoring health status, frailty in Italy's elderly population and the essential levels of care currently provided to the elderly.

Reference ranges of HOMA-IR in normal-weight and obese young Caucasians.

AIMS: Insulin resistance (IR) may develop very early in life being associated with occurrence of cardiometabolic risk factors (CMRFs). Aim of the present study was to identify in young Caucasians normative values of IR as estimated by the homeostasis model assessment (HOMA-IR) and cutoffs diagnostic of CMRFs. METHODS: Anthropometrics and biochemical parameters were assessed in 2753 Caucasians (age 2-17.8 years; 1204 F). Reference ranges of HOMA-IR were defined for the whole population and for samples of normal-weight and overweight/obese individuals. The receiver operator characteristic analysis was used to find cutoffs of HOMA-IR accurately identifying individuals with any CMRF among total cholesterol and/or triglycerides higher than the 95th percentile and/or HDL cholesterol lower than the 5th for age and sex, impaired glucose tolerance, and alanine aminotransferase levels ≥40 U/l. RESULTS: Overweight/obese individuals had higher HOMA-IR levels compared with normal-weight peers (p < 0.0001) at any age. HOMA-IR index rose progressively with age, plateaued between age 13 and 15 years and started decreasing afterward. HOMA-IR peaked at age 13 years in girls and at 15 years in boys. The 75th percentile of HOMA-IR in the whole population (3.02; AUROC = 0.73, 95 % CI = 0.70-0.75), in normal-weight (1.68; AUROC = 0.76, 95 % CI = 0.74-0.79), and obese (3.42; AUROC = 0.71, 95 % CI = 0.69-0.72) individuals identified the cutoffs best classifying individuals with any CMRF. CONCLUSIONS: Percentiles of HOMA-IR varied significantly in young Caucasians depending on sex, age, and BMI category. The 75th percentile may represent an accurate cutoff point to suspect the occurrence of one or more CMRFs among high total cholesterol and triglycerides, low HDL cholesterol, and ALT ≥ 40 UI/l.