The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience.

A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.

A study on the action of vitamin E supplementation on plasminogen activator inhibitor type 1 and platelet nitric oxide production in type 2 diabetic patients.

BACKGROUND AND AIM: Type 2 diabetic (T2DM) patients show decreased fibrinolysis, mainly linked to high plasminogen activator inhibitor type 1 (PAI-1) production, together with a reduced bioavailability of nitric oxide and an impairment in Na(+)/K(+)-ATPase activity possibly involved in increased cardiovascular risk. Vitamin E is the major natural lipid-soluble antioxidant in human plasma. The present work was conducted in order to measure PAI-1, ICAM and VCAM-1 plasma levels, platelet nitric oxide production and membrane Na(+)/K(+)-ATPase activity in type 2 diabetic subjects treated with vitamin E (500 IU/day) for 10 weeks and then followed for other 20 weeks. METHODS AND RESULTS: Thirty-seven T2DM patients (24 males and 13 females) were studied. None of them were affected by any other disease or diabetic complications. Significant differences were detected for PAI-1 antigen (p<0.001), PAI-1 activity (p<0.001), nitric oxide (NO) production (p<0.001), and Na(+)/K(+)-ATPase activity (p<0.001) among the 4 phases of the study. A significant decrease both in ICAM and VCAM-1 plasma levels was also found at the 10th week compared with baseline (respectively p<0.001 and p<0.05). CONCLUSION: Our data suggest that vitamin E counteracts endothelial activation in T2DM patients possibly representing a new tool for endothelial protection.

Platelet nitric oxide production and IR: relation with obesity and hypertriglyceridemia.

BACKGROUND AND AIM: Three NOS isoforms are responsible for nitric oxide production in various tissues. Endothelial constitutive NOS is expressed in vascular endothelium and in platelets, contributing to vascular tone regulation and platelet aggregation. The aim of the present work was to examine eNOS polymorphism, to find a correlation with platelet NO production and degree of insulin resistance (IR) in non-diabetic subjects and in patients affected by type 2 diabetes. METHODS AND RESULTS: Seventy-one non-diabetic subjects and 37 patients affected by Type 2 diabetes were recruited. The subjects were subdivided into 3 groups as cut-off for the definition of an insulin resistant state: IR non-diabetic subjects, insulin sensitive subjects, and insulin-resistant patients affected by Type 2 diabetes. Plasma glyco-metabolic parameters, platelet nitric oxide production, endothelial nitric oxide synthase (eNOS) gene polymorphism were measured in all subjects enrolled. Significant differences between groups were found in BMI, fasting glycaemia, fructosamine and HbA(1c), triglycerides and HDL cholesterol levels. Evaluating all the subjects, platelet NO production was significantly related with BMI, waist circumference, and triglycerides concentrations, thus suggesting an association between increased platelet NO production, obesity and hypertriglyceridemia, independent of the degree of insulin-resistance. CONCLUSION: The modified platelet NO synthesis does not seem to be due to eNOS Glu298Asp polymorphism, while it can be hypothesized that it is caused by an iNOS induction, present in obesity, hypertriglyceridemia and in type 2 diabetes.

Laparoscopic adjustable gastric banding: a 10 year follow-up study.

BACKGROUND: A comprehensive obesity management can only be accomplished by a multidisciplinary team. Despite the numerous efforts made, a winning solution has not been reached yet. When patients do not respond to conventional treatment, LAGB (Laparoscopic Adjustable Gastric Banding) is a generally effective approach with minimal involvement in anatomical modification. STUDY AIM: The aim of this study is to highlight how LAGB can guarantee long-term weight loss and a reduced incidence of complications and reoperations, when it is integrated in a multidisciplinary context and in a long period of close follow-up. METHODS: 50 patients underwent LAGB between 2007 and 2008. From the sixth month after surgery, the LAGB was calibrated every 8-12 weeks, depending on the patient's response to the dietetic program and on his/her clinical and psychological situation. The follow up was planned every two weeks during the first six months after surgery, subsequently once a month during the first year; then every three months up to three years after surgery and every six months thereafter. RESULTS: After 6 months we found a significant weight loss that was progressive up to the second year. From the second year after surgery, the patients maintained their weight up to the tenth year of follow-up, without weight regain. In addition, an improvement of all metabolic parameters was found. CONCLUSIONS: LAGB guarantees good results in terms of weight loss and metabolic control; the careful choice of patients and a close and accurate follow-up are essential for the success of this surgical procedure.

A very low calorie ketogenic diet improves weight loss and quality of life in patients with adjustable gastric banding.

BACKGROUND: Often, in severe obesity, diet and physical activity are not enough to achieve a healthy BMI. Bariatric surgical approach, in particular laparoscopic adjustable gastric banding (LAGB), has encouraging results in terms of weight loss and resolution of obesity-related comorbidities. However, several months after LAGB, some patients are enable to lose weight anymore and don't tolerate a further calibration because of its collateral effects (excessive sense of fullness, heartburn, regurgitation and vomiting). AIM: The aim of this study is to identify the potential role of high protein-low carbohydrate ketogenic diet (KD) in managing weight loss in patients who underwent gastric banding and didn't lose weight anymore. METHODS: 50 patients underwent LAGB between January 2010 and December 2013. In twenty patients (GROUP A) we observed a stop in weight loss so we divided this patients into two groups. One group (group A1: 10 patients) continued to follow a LCD low calorie diet and underwent a further calibration; the other group (group A2: 10 patients) started to follow a KD for the next 8 weeks. RESULTS: Both group resumed a significant weight loss, however group A1 patients reported collateral effects due to calibration and a higher Impact of Weight on Quality of Life - Lite (IWQOL-Lite) that correlates with a lower quality of life than patients following KD. CONCLUSIONS: KD can improve the weight loss and quality of life in patients who underwent LAGB and failed at losing more weight allowing a weight loss comparable to that obtained with a further calibration and it is useful to avoid drastic calibrations and their collateral effects. KEY WORDS: Laparoscopic adjustable gastric binding, Quality of life, Very low calory ketogenic binding.

LAGB: regular follow-up with an interdisciplinary team is the key to success in terms of weight loss and complications.

BACKGROUND: In severe obesity, most patients do not respond to conventional treatment. Bariatric surgery must only be proposed in specific cases. LAGB gives excellent long-term results if patient scrupulously complies the follow-up. STUDY AIM: To evaluate patients who comply with the follow-up procedure over time in terms of weight loss, maintenance of the result, complications and quality of life. METHODS: 209 patients underwent LAGB between October 1999 and December 2007 and followed for 5 years. all patients were offered interdisciplinary counseling to update the therapeutic strategy. RESULTS: Out of 92 patients who after two years had reached the desired weight 58 patients (63%) had a regular follow- up and, when necessary, specific counseling. 34 patients (37%) who did not plan follow-up did not maintain the weight loss, and progressively put on weight between the second and fifth year and had a higher incidence of complications. (SF-36) established in patients regularly followed improvement of the quality of life (QoL), up to the fifth year. Short Form Health Survey patients who did not regularly have follow-up the SF-36 showed a worsening of all the test domains between the second and the fifth year. CONCLUSIONS: After 5 years, patients with severe obesity (BMI> 40) who underwent LAGB, that took part in a interdisciplinary follow-up procedure, obtained a full rehabilitation with a change of lifestyle, and maintained the weight loss obtained after 24 months. The perceived quality of life (QoL) shows a progressive improvement throughout the period of intensive intervention. Long-term efficacy of LAGB depends on a scrupulous followup and interdisciplinary support. KEY WORDS: LAGB, Obesity, Psychotherapy, SF-36.

Interaction between glucose metabolism and endogenous insulin release in hypertension.

The minimal model approach was applied to examine the dynamic interaction between glucose metabolism and endogenous insulin release during an intravenous glucose tolerance test (IVGTT) in a group of hypertensive patients (H group) compared with a group of normotensive subjects (N group). A modified version of the classical minimal model of C-peptide kinetics and secretion was used to evaluate the total amount of insulin secretion per unit of distribution volume (TIS) together with 3 indexes of beta-cell function (the basal, Phi(b), first, Phi1, and second phase, Phi2, beta-cell sensitivity to glucose). These indexes were associated with estimates of glucose effectiveness (S(G)) and insulin sensitivity (S(I)) provided by the classical minimal model of glucose kinetics. No significant differences were found in Phi(b), Phi1, and Phi2 estimates between the H group and the N group. In the H group, the average TIS was 54% higher (P <.05) than in the N group, while S(G) and S(I) estimates showed a 44% decrease (P <.05) and a 51% decrease (P <.05), respectively. These results suggest that hyperglycemia observed in our H group during IVGTT is a compensatory response to insulin resistance (low S(I)) and to the reduced ability of glucose to promote its own metabolism (low S(G)). This hyperglycemic state causes a larger than normal stimulation of beta cell, which explains insulin hypersecretion (higher TIS) even in the presence of normal beta-cell sensitivity values of Phi(b), Phi1, and Phi2.