The association of the Mediterranean Adequacy Index with fatal coronary events in an Italian middle-aged male population followed for 40 years.

BACKGROUND AND AIMS: The dietary habits defined as the Mediterranean diet have shown to be protective for coronary heart disease (CHD) and other morbid conditions. The present analysis aims to test the Mediterranean Adequacy Index (MAI), a dietary index derived from the Mediterranean habits, versus the occurrence of fatal CHD events in an Italian male population followed for 40 years. METHODS AND RESULTS: In 1965, at the time of the 5-year follow-up examination of the Italian Rural Areas of the Seven Countries Study, the diet was assessed by the dietary-history method in 1139 men aged 45-64 years, free from previous coronary events, in the rural communities of Crevalcore (Northern Italy) and Montegiorgio (Central Italy). MAI has been computed and its natural log (lnMAI) used for the analysis. Mortality data were collected and coded for the subsequent 40 years. The lnMAI was inversely associated with CHD mortality at 20 and 40 years when entered alone in the Cox proportional hazards model and when adjusted for age, cigarette smoking, systolic blood pressure, serum cholesterol, physical activity and body mass index. The hazard ratio for 1 unit of lnMAI (roughly corresponding to 2.7 units of MAI) was associated with a CHD mortality reduction of 26% in 20 years and 21% in 40 years of follow-up, when adjusted for the covariates. CONCLUSIONS: In an Italian middle-aged male population, MAI showed the protective effect of a healthy Mediterranean Diet pattern versus the occurrence of fatal CHD events at 20 and 40 years.

Gingival Myofibroma. A case report.

AIM: The Myofibroma (MF) is a benign mesenchymal tumor frequently observed in the skin and subcutaneous tissue of the head-neck region. It is described mainly in infants with congenital forms and, in early childhood, with acquired forms. Less often, it can be observed in adolescents and adults. The location of a MF in the oral cavity is occasional and differential diagnosis must be established with other benign and malignant neoplasms, high or low grade, of the oral mucosa. The histology of the myofibroma shows a biphasic growth pattern: elongated spindle cells with eosinophilic cytoplasm, in the borders, polygonal cells arranged in a palisading pattern, with hyperchromatic nuclei, in the central portions. The diagnosis of MF, usually made after excision of the neoformation, is obtained by means of immunohistochemistry, in which there is positivity for vimentin and αactine smooth muscle antibodies and negativity for keratin, S-100, EMA (Epithelial Membrane Antigen) antibodies. The treatment is surgical; the prognosis is generally good with low rates of recurrence after excision. CASE REPORT: The authors describe a case of MF in a 16-year-old male subject, that came to their observation for the growth of a considerable mass attached to the gingival mucosa, describing the therapeutic strategy.

Testicular metastasis of signet ring cell tumour of unknown origin: diagnostic features of a tricky case.

We introduce the diagnostic complexity of a testicular metastasis by signet ring cell adenocarcinoma of unknown origin. Testicular metastases are a rare event but, particular after 50 years of age, a testicular mass could represent a metastasis.

An interdisciplinary approach to a survey on dental caries in a group of 3-year-olds in Ascoli Piceno (Italy).

AIM: The purpose of this study was to investigate the dental caries experience in a group of 3-year-old children, through an interdisciplinary protocol, both paediatric and paedodontic, in the district of Ascoli Piceno (Marche, Italy). MATERIALS AND METHODS: A sample of 82 children, 38 males and 44 females, was recruited by four paediatricians during a preliminary study phase, which consisted of the epidemiological survey explanation to the involved children's parents and informed consents collection; the survey was first planned and then performed by one calibrated examiner, (Cohen k test was 0.85) in two days on May 2008. The examinations were performed in the nurseries of the schools attended by the children. The collected data were analysed by descriptive and association statistics: the chi² test was used to investigate the association between caries and gender, assuming as statistical significance level the p < 0.05 value. RESULTS: The study revealed that caries prevalence in the observed population was 38%, while caries free group accounted for 61%; the mean dmft was 1.06, with a standard deviation of 1.64. No statistical significance was observed in the association between caries and gender (chi²=0.65, p > 0.05). discussion: Dental caries prevalence of the surveyed population, according to the WHO 2010 objectives, was judged quite high, focusing the low caries free group (61% instead of 90% or over) and the children's preschool age; nonetheless the sample situation was not considered as critical, because the WHO 2000 goals were achieved (caries free > 50%). CONCLUSION: The interdisciplinary paedodontic paediatric protocol, used in the present study, was a useful and powerful instrument for preparing the epidemiological survey and could be the basis of future preventive programs.

Sleep-disordered breathing in a sample of 495 children in Southern Italy.

AIM: Our objective was to investigate the occurrence of sleep-related breathing disturbances in a large cohort of school-aged children in Southern Italy, and to evaluate the association with anthropometric data and clinical findings of oropharynx and nasal airways. STUDY DESIGN: A two-phase cross-sectional study was conducted with children from schools in Turi, Italy. MATERIALS AND METHODS: A screening phase aimed to identify symptomatic children and clinical data from a cohort of 495 children by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders and clinical analysis of oral status were performed. According to the answers, children were classified into 3 groups: habitual snorers, occasional snorers, and non-snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with oxygen desaturation index (ODI) > 2 were considered for nocturnal polygraphic monitoring (NPM). Children with apnoea/ hypopnea index (AHI) > 3 received a diagnosis of obstructive sleep apnoea syndrome (OSAS). Moreover, a complete oral examination was performed. RESULTS: A total of 436 questionnaires (response rate: 88.08%) were returned and scored (202 M, 234 F; Mean age ± Standard deviation: 6.2 ± 1.8); 18 children (4%) were identified as habitual snorers, 140 children (32%) were identified as occasional snorers, and 278 children (64%) were identified as non-snorers. The percentage of female children who were habitual snorers was higher than the percentage of male children (4.7% vs 3.6%). Habitual snorers had significantly more nighttime symptoms. OSAS was diagnosed in 2 children by NPM. A statistically significant association between snoring, cross-bite, open-bite and increased over-jet was found. CONCLUSION: Habitual snoring and OSAS are significant problems for children and may be associated with diurnal symptoms. The presence of malocclusion increases the likelihood of sleep-related breathing disturbances.

Well-differentiated giant scrotal liposarcoma: case presentation and management.

Scrotal liposarcoma is an uncommon disease, usually found after the fifth decade. We describe the case of a well-differentiated scrotal liposarcoma associated with a considerable inflammatory reaction, treated with surgical ablation.

Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project.

OBJECTIVE: To investigate and compare the associations between dietary patterns and mortality using different European indexes of overall dietary quality. DESIGN, SETTING AND PARTICIPANTS: The HALE (Healthy Ageing: a Longitudinal study in Europe) population includes 2,068 men and 1,049 women, aged between 70 and 90 years of 10 European countries. Subjects were followed for 10 years. This cohort study was conducted between 1988 and 2000. RESULTS: During the follow-up period, 1,382 people died. The Mediterranean Diet Score (MDS) (HR: 0.82 with 95% CI: 0.75-0.91), the Mediterranean Adequacy Index (MDI) (HR: 0.83 with 95% CI: 0.75-0.92) and the Healthy Diet Indicator (HDI)(HR: 0.89 with 95% CI: 0.81-0.98) were inversely associated with all-causes mortality. Adjustments were made for age, gender, alcohol consumption, physical activity, smoking, number of years of education, body mass index, chronic diseases at baseline and study centre. CONCLUSIONS: The MDS, the MDI and the HDI were significantly inversely related with mortality. SPONSORSHIP: This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000-00211) to D Kromhout.

Oral hygiene habits and attitudes in a school population in L'Aquila (Italy).

AIM: This study aims to analyse the results of a questionnaire submitted to students of the elementary schools in L'Aquila in order to understand their awareness of a correct caries prevention method by using fluoride. MATERIALS AND METHODS: 4th and 5th grade students of elementary schools in L'Aquila were submitted to a questionnaire; from a total of 1205 students, age ranging from 8 to 12, 1094 were questioned; 7 children 8 years old, 282 of 9, 555 of 10, 243 of 11, 8 of 12, and only 2 of 13, respectively (the last 2 were registered later at school because non-EU citizens). RESULTS: Among the Italian population with a low incidence of dental decay, a relatively limited group, called 'high risk decay group', revealed a higher incidence of the pathology than the standard one. CONCLUSION: In a multiracial society, as ours, it is important to carry out an effective screening in order to recognize different categories of patients through simple questions inserted in the patient's case history.

Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study.

OBJECTIVE: To determine whether flavonoid intake explains differences in mortality rates from chronic diseases between populations. DESIGN: Cross-cultural correlation study. SETTING/PARTICIPANTS: Sixteen cohorts of the Seven Countries Study in whom flavonoid intake at baseline around 1960 was estimated by flavonoid analysis of equivalent food composites that represented the average diet in the cohorts. MAIN OUTCOME MEASURES: Mortality from coronary heart disease, cancer (various sites), and all causes in the 16 cohorts after 25 years of follow-up. RESULTS: Average intake of antioxidant flavonoids was inversely associated with mortality from coronary heart disease and explained about 25% of the variance in coronary heart disease rates in the 16 cohorts. In multivariate analysis, intake of saturated fat (73%; P = 0.0001), flavonoid intake (8%, P = .01), and percentage of smokers per cohort (9%; P = .03) explained together, independent of intake of alcohol and antioxidant vitamins, 90% of the variance in coronary heart disease rates. Flavonoid intake was not independently associated with mortality from other causes. CONCLUSIONS: Average flavonoid intake may partly contribute to differences in coronary heart disease mortality across populations, but it does not seem to be an important determinant of cancer mortality.

Diet and 20-y mortality in two rural population groups of middle-aged men in Italy.

The relationships between individual diet, measured in 1965 on the two Italian rural cohorts of the Seven Countries Study on Cardiovascular Disease, and subsequent mortality from all and specific causes of death in 20 y are studied. The analysis covers 1536 men aged 45-64 y at entry to the study. By using a cluster analysis technique, individuals are aggregated into four groups so that the elements within a group have a higher degree of similarity in dietary nutrients than between groups. Impressive differences in death rates between groups are found especially at the 10- and 15-y anniversaries. The relative risk between the least and the most favored group in 15-y mortality from coronary heart disease is 4.7; in 10 y the relative risk for cancer mortality is 2.9 and for liver cirrhosis approximately 4.

Food consumption patterns in the 1960s in seven countries.

At the end of the 1950s the Seven Countries Study was designed to investigate the relations between diet and cardiovascular diseases. Sixteen cohorts were selected in Finland, Greece, Italy, Japan, The Netherlands, United States, and Yugoslavia. During the 1960s food consumption data were collected from random samples of these cohorts by use of the record method. In Finland the intake of milk, potatoes, edible fats, and sugar products was very high. A similar but lower intake pattern was observed in The Netherlands. Fruit, meat, and pastry consumption was high in the United States; cereal and alcoholic drink consumption was high in Italy; and bread consumption high in Yugoslavians except for those in Belgrade. In Greece the intake of olive oil and fruit was high and the Japanese cohorts were characterized by a high consumption of fish, rice, and soy products. These differences in food consumption patterns have lessened during the past 25 y.

Plasma vitamin E, apolipoprotein B and HDL-cholesterol in middle-aged men from southern Italy.

Plasma vitamin E, HDL-cholesterol, apolipoprotein B and triglycerides were measured in an apparently healthy, male, random population sample (n = 74) from Southern Italy. Plasma vitamin E concentration was positively correlated to that of serum cholesterol, non-HDL cholesterol, triglycerides and apolipoprotein B (all P less than 0.001). The results of partial correlation analysis showed that apo B, the apolipoprotein constituent of LDL, was related to vitamin E independently of serum triglycerides, a fairly accurate marker of VLDL. On the other hand, triglycerides were related to vitamin E independently of apo B. Both correlations were much weaker if an adjustment was performed for non-HDL-cholesterol. No independent relationship was demonstrated between plasma vitamin E and HDL-cholesterol.

Haemostatic parameters and lifestyle factors in elderly men in Italy and The Netherlands.

The association between plasma fibrinogen, factor VII, factor X, activated partial thromboplastin time, antithrombin III and the lifestyle factors cigarette smoking, alcohol use, fat intake and physical activity was assessed in 802 men aged 70-90 years in Zutphen (The Netherlands), Montegiorgio and Crevalcore (Italy). Smoking was positively associated with fibrinogen, also after adjustment for other lifestyle factors, age, use of anticoagulants and aspirin like drugs, body mass index, and history of myocardial infarction. Alcohol use was associated with increased levels of factor X and decreased levels of antithrombin III. Fat intake was positively associated with antithrombin III. Between cohorts, considerable differences were observed in levels of haemostatic parameters and the lifestyle factors. Compared to the mediterranean cohorts the Zutphen cohort showed the highest levels of fibrinogen and factor VII. Differences in lifestyle factors could, however, not explain differences between cohorts in levels of any of the haemostatic parameters, despite the observed associations between lifestyle factors and haemostatic parameters.

Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study.

The relation of alcohol consumption to mortality is examined using the data of the Italian rural cohorts of the Seven Countries Study, a prospective investigation of factors related to cardiovascular disease (CVD). The present analysis includes 1536 men aged 45-64, whose dietary habits and food consumption, including alcoholic beverages, were measured in 1965. Of them, 463 men died in a follow-up period of 15 years. The analysis shows a J-shaped relationship between alcohol consumption, expressed as percentage of total daily energy intake, and both overall mortality and cardiovascular mortality; this J-shaped relationship is evident even after adjusting for age, cigarette smoking and occupation. The inverse relationship for consumption of small quantities of alcohol, which is represented by the left side of the J-curve, is no longer significant when all men with previous cardiovascular manifestations are excluded from the analysis, yet it is never completely eliminated.

Alcohol and survival in the Italian rural cohorts of the Seven Countries Study.

BACKGROUND: Middle-aged men who regularly drink a moderate amount of alcohol have lower mortality rates from all causes in comparison with abstainers and heavy drinkers. This cohort study looks at the relationship between alcohol consumption and long-term survival, adjusting for smoking habit and physical activity. METHODS: In 1965, a total of 1536 Italian males aged 45-65 years underwent an examination which included: a general questionnaire, anthropometric measurements, an overall physical examination, ECG recording, blood pressure and serum cholesterol measurements and measurement of food consumption including alcohol. The cohort was followed for total mortality from 1965 to 1995. RESULTS: During a period of 30 years 1096 deaths occurred. Age-adjusted life expectancy for men assuming a mean daily quantity of 63 g of alcohol (range 4-7 drinks per day) was 21.6 +/- 0.4 years, roughly 2 years more than men taking a mean quantity of 3.7 g (10 drinks per day. Taking smoking habit into account, the longest survival of 22.4 +/- 0.5 years was observed in non-smokers drinking 4-7 drinks daily; the lowest, 18.5 +/- 0.7 years, in smokers drinking >10 drinks. Stratifying for physical activity, the longest survival (23.4 +/- 0. 7 years) was experienced by men engaged in heavy physical activity at work drinking 1-4 drinks per day. CONCLUSIONS: The relationship between life expectancy and alcohol consumption (97% wine in this Italian cohort and mostly red wine) is confirmed to be non-linear. Men aged 45-64 at entry drinking about 5 drinks per day have a longer life expectancy than occasional and heavy drinkers.

HDL serum cholesterol and 24-year mortality of men in Finland.

Examinations of 'healthy' men in Helsinki and in rural west and east Finland in 1956 included estimation of total cholesterol and that in the HDL and beta fractions separated by electrophoresis. Vital status to the end of 1980 has been ascertained for all but eight of the 526 men aged 35-61 and for all but two of 261 men aged 30-34 at entry. Among the men aged 35-61, in 24 years 155 died, 63 from coronary heart disease; among the men aged 30-34, 36 died, 16 from coronary heart disease. All causes and coronary death rates were highest in east Finland where HDL cholesterol was also highest. Coronary death rates were not related to HDL cholesterol in east or west Finland but 16 men dead from coronary heart disease in Helsinki tended to have low HDL values. Consideration of five other entry characteristics did not change the picture with regard to HDL-mortality relationships. Solution of the multiple logistic equation using all those variables found the probability of 24-year coronary death was not significantly related to HDL but was significantly related, positively, to the non-HDL cholesterol concentration. HDL and total cholesterol mean values for men of the same age in the same area of Finland, with lipoprotein separation by the new recommended methods, agree closely with the means recorded in 1956. These 24-year findings are not necessarily in conflict with reports in the literature on an inverse relationship between coronary heart disease incidence and HDL cholesterol based on much shorter periods of follow-up and few data on mortality.

Adipose tissue fatty acids and blood pressure in middle-aged men from southern Italy.

Adipose tissue (AT) biopsies were performed in a random population sample of 74 clinically healthy middle-aged men (40-49 years) from southern Italy. The percentage of saturated fatty acids (FA) in AT was directly correlated with systolic (SBP) and diastolic (DBP) blood pressure (p less than 0.01). This relationship was independent of smoking habit and body weight. AT of men in the upper DBP quintile (range 90-102 mmHg) was significantly richer in palmitic acid (p less than 0.01) compared to that of men in the lowest DBP quintile. Dietary history demonstrated that the overall intake of saturated fat (% energy) was similar in the two extreme DBP quintiles. There was a relatively higher consumption of fish by those in the lowest DBP quintile (p less than 0.05). The amount of monounsaturated fat consumed (% energy) was also higher (p less than 0.05) in men with low blood pressure. Men in the upper quintile of DBP consumed more eggs (p less than 0.05).

Twenty-year stroke mortality and prediction in twelve cohorts of the Seven Countries Study.

Twelve cohorts of men aged 40-59 for a total of 8287 individuals in six countries (Finland, the Netherlands, Italy, Yugoslavia, Greece and Japan) were examined in the late 1950s or early 1960s for the measurement of some risk factors and then followed up for mortality and causes of death through 20 years. Large differences in 20-year death rates from stroke were recorded among cohorts, with the highest levels in the pool of the Yugoslavia (67 per 1000) and Japanese cohorts (62 per 1000) and the lowest in the Dutch cohort (22 per 1000). The simple linear correlation (among cohorts) of stroke mortality on mean levels at entry of some factors showed inverse significant coefficients for systolic (-0.63) diastolic (-0.51) and mean blood pressure (-0.72), and for serum cholesterol (-0.72), whereas no significant coefficients were found for mean body mass index, mean cigarette consumption and mean physical activity. The Cox model solved for six national pools of cohorts showed that only age and mean blood pressure carry significant positive coefficients, whereas all the other available factors (cigarette consumption, serum cholesterol, body mass index, physical activity) did not approach significant levels except the negative coefficients of smoking habits in Greece.

All cause mortality and its determinants in middle aged men in Finland, The Netherlands, and Italy in a 25 year follow up.

STUDY OBJECTIVE: The aims were (1) to compare all cause mortality in population samples of different cultures; and (2) to cross predict fatal event by risk functions involving risk factors usually measured in cardiovascular epidemiology. DESIGN: The study was a 25 year prospective cohort study. The prediction of all cause mortality was made using the multiple logistic equation as a function of 12 risk factors; the prediction of months lived after entry examination was made by the multiple linear regression using the same factors. POPULATION SAMPLES: There were five cohorts of men aged 40-59 years, from Finland (two cohorts, 1677 men), from The Netherlands (one cohort, 878 men), and from Italy (two cohorts, 1712 men). SETTING: The Finnish cohorts came from geographically defined rural areas, the Dutch cohort from a small town in central Holland, and the Italian cohorts from rural villages in northern and central Italy. MEASUREMENTS AND MAIN RESULTS: All cause mortality was highest in Finland (557 per 1000), and lower in The Netherlands (477) and in Italy (475). The solutions of the multiple logistic function showed the significant and almost universal predictive role of certain factors, with rare exceptions. These were age, blood pressure, cigarette smoking, and arm circumference (the latter with a negative relationship). Similar results were obtained when solving a multiple linear regression equation predicting the number of months lived after entry examination as a function of the same factors. The prediction of fatal events in each country, using the risk functions of the others, produced limited errors, the smallest one being -2% and the largest +11%. When solving the logistic model in the pool of all the cohorts with the addition of dummy variables for the identification of nationality, it also appeared that only a small part of the mortality differences between countries is not explained by 12 available risk factors. CONCLUSIONS: A small set of risk factors seems to explain the intercohort differences of 25 year all cause mortality in population samples of three rather different cultures.

Food and nutrient consumption of two rural population groups of Italy followed for ten years.

Two groups of men, 40 through 59 years old, from two rural areas of Italy (one in the north and one in the centre) were subjects of dietary surveys on three occasions over 10 years, using the individual weighing technique. Over the 10 years, changes in the consumption of some foods were observed; these were most striking in respect to cereals and legumes, which decreased, and to animal protein and fats, which increased. The decrease of energy was much greater than expected (partly explained by the current mechanization in agriculture in Italy). In one area a low intake of riboflavin was observed, but otherwise the diets could be considered to be nutritionally good. There was no correlation between some dietary variables and anthropometric and blood lipid data, as observed previously. This was probably because the population groups examined were practically homogeneous in regard to habits.