Gastric ghrelin cells in obese patients are hyperactive.

BACKGROUND/OBJECTIVES: Distribution and activity of ghrelin cells in the stomach of obese subjects are controversial. SUBJECTS/METHODS: We examined samples from stomachs removed by sleeve gastrectomy in 49 obese subjects (normoglycemic, hyperglycemic and diabetic) and quantified the density of ghrelin/chromogranin endocrine cells by immunohistochemistry. Data were compared with those from 13 lean subjects evaluated by gastroscopy. In 44 cases (11 controls and 33 obese patients) a gene expression analysis of ghrelin and its activating enzyme ghrelin O-acyl transferase (GOAT) was performed. In 21 cases (4 controls and 17 obese patients) the protein levels of unacylated and acylated-ghrelin were measured by ELISA tests. In 18 cases (4 controls and 14 obese patients) the morphology of ghrelin-producing cells was evaluated by electron microscopy. RESULTS: The obese group, either considered as total population or divided into subgroups, did not show any significant difference in ghrelin cell density when compared with control subjects. Inter-glandular smooth muscle fibres were increased in obese patients. In line with a positive trend of the desacylated form found by ELISA, Ghrelin and GOAT mRNA expression in obese patients was significantly increased. The unique ghrelin cell ultrastructure was maintained in all obese groups. In the hyperglycemic obese patients, the higher ghrelin expression matched with ultrastructural signs of endocrine hyperactivity, including expanded rough endoplasmic reticulum and reduced density, size and electron-density of endocrine granules. A positive correlation between ghrelin gene expression and glycemic values, body mass index and GOAT was also found. All obese patients with type 2 diabetes recovered from diabetes at follow-up after 5 months with a 16.5% of weight loss. CONCLUSIONS: Given the known inhibitory role on insulin secretion of ghrelin, these results suggest a possible role for gastric ghrelin overproduction in the complex architecture that takes part in the pathogenesis of type 2 diabetes.

The Role of Nutrition in Immune-Mediated, Inflammatory Skin Disease: A Narrative Review.

Immune-mediated inflammatory skin diseases are characterized by a complex multifactorial etiology, in which genetic and environmental factors interact both in genesis and development of the disease. Nutrition is a complex and fascinating scenario, whose pivotal role in induction, exacerbation, or amelioration of several human diseases has already been well documented. However, owing to the complexity of immune-mediated skin disease clinical course and breadth and variability of human nutrition, their correlation still remains an open debate in literature. It is therefore important for dermatologists to be aware about the scientific basis linking nutrition to inflammatory skin diseases such as psoriasis, atopic dermatitis, hidradenitis suppurativa, bullous diseases, vitiligo, and alopecia areata, and whether changes in diet can influence the clinical course of these diseases. The purpose of this narrative review is to address the role of nutrition in immune-mediated inflammatory skin diseases, in light of the most recent and validate knowledge on this topic. Moreover, whether specific dietary modifications could provide meaningful implementation in planning a therapeutic strategy for patients is evaluated, in accordance with regenerative medicine precepts, a healing-oriented medicine that considers the whole person, including all aspects of the lifestyle.

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.

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.

Phytosterol Esterification is Markedly Decreased in Preterm Infants Receiving Routine Parenteral Nutrition.

Several studies reported the association between total plasma phytosterol concentrations and the parenteral nutrition-associated cholestasis (PNAC). To date, no data are available on phytosterol esterification in animals and in humans during parenteral nutrition (PN). We measured free and esterified sterols (cholesterol, campesterol, stigmasterol, and sitosterol) plasma concentrations during PN in 16 preterm infants (500-1249 g of birth weight; Preterm-PN), in 11 term infants (Term-PN) and in 12 adults (Adult-PN). Gas chromatography-mass spectrometry was used for measurements. Plasma concentrations of free cholesterol (Free-CHO), free phytosterols (Free-PHY) and esterified phytosterols (Ester-PHY) were not different among the three PN groups. Esterified cholesterol (Ester-CHO) was statistically lower in Preterm-PN than Adult-PN. Preterm-PN had significantly higher Free-CHO/Ester-CHO and Free-PHY/Ester-PHY ratios than Adult-PN (Free-CHO/Ester-CHO: 1.1 ± 0.7 vs. 0.6 ± 0.2; Free-PHY/Ester-PHY: 4.1 ± 2.6 vs. 1.3 ± 0.8; *P < 0.05). Free-CHO/Ester-CHO and Free-PHY/Ester-PHY ratios of Term-PN (Free-CHO/Ester-CHO: 1.1 ± 0.4; Free-PHY/Ester-PHY: 2.9 ± 1.7) were not different from either Preterm-PN or from Adult-PN. Plasma Free-CHO/Ester-CHO and Free-PHY/Ester-PHY were unchanged after 24 h on fat-free PN both in Preterm-PN and in Adult-PN. Free-PHY/Ester-PHY did not correlate with phytosterol intake in Preterm-PN. Free-PHY/Ester-PHY of Preterm-PN was positively correlated with the Free-CHO/Ester-CHO and negatively correlated with gestational age and birth weight. In conclusion, PHY were esterified to a lesser extent than CHO in all study groups; the esterification was markedly decreased in Preterm-PN compared to Adult-PN. The clinical consequences of these findings warrant further investigations.

[Efficacy and limits of the bariatric surgery]. / Efficacia e limiti della chirurgia bariatrica.

Morbid obesity is associated with and increased risk of serious comorbidities, including type 2 diabetes, sleep apnoea, cardiovascular diseases, and orthopedic disabilities. Not operative treatments for superobese patients have not been shown to produce reliable long-term benefits, therefore surgical therapy has became the treatment of choice. The number of surgical procedures increased in the last year confirm these data. However, before recommended a specific surgical procedures to a superobese patients it is necessary to consider some variables, such as: patient, health structure, and multidisciplinary equipe. Since there are not recommended or condemned surgical procedures, in this paper the Authors tried to evaluate the effectiveness and limits of the most performed surgical procedures for the treatment of pathologic obesity: gastric by-pass, biliopancreatic diversion (duodenal switch), vertical gastroplasty, banding gastric. The Authors used some pointer of outcome to measure effectiveness and limits: five year post-operative percentage excess weight loss >/< 50, peri-operative >/< 1%, early and late complications >/< 15%, reoperation >/< 3%, improvement of quality of life. Thanks to new surgical technique, restrictive options are losing ground, while malabsorbitive bariatric procedures are collecting successful.

Laparoscopic adjustable gastric banding: essential role of psychological support.

BACKGROUND: A follow-up study of laparoscopic adjustable gastric banding (LAGB) in morbidly obese patients was conducted, with special emphasis on psychological aspects. MATERIALS AND METHODS: 128 patients (98/30 females/males) underwent LAGB between October 1995 and March 2001. Age was 38 +/- 9 years, body mass index (BMI) 42.72 +/- 4.25 kg/m2 and body weight 124 +/- 25 kg (mean +/- SD). Weight loss, early and late complications, band calibrations and difference between patients with and without psychotherapy were analysed. Psychological status was investigated before and during LAGB treatment using MMPI. Quality of life was investigated using MOS SF36. RESULTS: Median BMI decreased from 42.7 preoperatively to 31.0 kg/m2 after 12 months. Reduction of BMI was already significant (P < 0.01) after 3 months. In the following 12 months, median BMI wavered between 31.0 and 29.5 kg/m2. Best results were achieved in patients who followed psychotherapy. CONCLUSION: LAGB gave therapeutic success (progressive and significant weight loss). Psychotherapy was not only a simple support to diet but also an important part of the multidiscipline treatment. For best results, the team must care for patients individually and not just follow the same fixed protocol.

Rest energy expenditure in Parkinson's disease: role of disease progression and dopaminergic therapy.

BACKGROUND: Weight loss affects more than 50% of subjects suffering from Parkinson's Disease (PD) and is associated with reduced life expectancy. The pathogenesis is multifactorial and the mechanism of PD metabolism control is unresolved. This cross-sectional study aimed to ascertain the relationship between rest energy expenditure (REE), PD duration, Hoehn & Yahr (H&Y) stage, drug therapy and body mass index (BMI), in order to determine possible predictors of weight loss. METHODS: We studied fifty-eight PD subjects, after excluding conditions with a known influence on metabolism and weight (severe tremor, dyskinesias, dementia, fever, on-going infections, thyroid disease, and dysphagia). Subjects underwent REE measurement, through indirect calorimetry, in both the OFF state (12 h fasting and off medications) and in the ON state (60 min after taking dopaminergic drugs). RESULTS: OFF state. In the majority of PD patients REE values did not differ from those expected (based upon age, gender and BMI), being significantly higher in subjects in H&Y stage IV than H&Y stage II (t = 3.5; p = 0.001). Disease duration and rigidity were significantly associated with increased REE (r(2) = 0.31, F = 3.6; p = 0.0045). ON state. REE decreased by approximately 8% in all subjects, irrespective of disease duration or H&Y stage. BMI was inversely related to disease duration and UPDRS motor score in the OFF state and directly related to UPDRS motor score in the ON state (r(2) = 0.333, F = 3.5; p = 0.003). CONCLUSIONS: In PD REE increases as a function of disease duration; its adverse role in the decrease in BMI seems to be compensated for by dopaminergic medication.