The impact of overweight on lipid phenotype in different forms of dyslipidemia: a retrospective cohort study.

PURPOSE: Dyslipidemia plays a pivotal role in increasing cardiovascular risk. In clinical practice the misleading association between altered lipid profile and obesity is common, therefore genetically inherited dyslipidemias may not completely be addressed among patients with overweight. Thus, we aim to investigate the influence of overweight and obesity on the lipid phenotype in a cohort of patients with different forms of dyslipidemia. METHODS: A retrospective analysis was conducted on patients with dyslipidemia from 2015 to 2022. Patients were stratified in familial hypercholesterolemia (FH), familial combined hyperlipidemia (FCHL), non-familial hyperlipidemia or polygenic hypercholesterolemia (PH). Clinical characteristics and lipid profile were evaluated. RESULTS: Of the total of 798 patients, 361 were affected by non-familial hyperlipidemia (45.2%), while FCHL, FH and PH was described in 19.9%, 14.0% and 20.9% of patients, respectively. Overweight prevalence was higher in FCHL and non-familial hyperlipidemia patients than FH and PH patients. Subjects with overweight and obesity were independently associated with lower levels of high-density lipoprotein cholesterol (HDL-C) compared to patients with normal weight (52.4 and 46.0 vs 58.1, respectively; p < 0.0001); levels of triglycerides (TG) and non-HDL-C were higher in patients with overweight and obesity than patients with normal weight (257.3 and 290.9 vs 194.8, and 221.5 and 219.6 vs 210.1, p < 0.0001 and p = 0.01, respectively), while no differences were observed between patients with overweight and obesity. CONCLUSION: While dyslipidemias can be influenced by various factors, an important determinant may lie in genetics, frequently acting as an underlying cause of altered lipid profiles, even in cases of overweight conditions.

Whey proteins inhibit food intake and tend to improve oxidative balance in obese zucker rats.

BACKGROUND/AIMS: Whey proteins (WP), obtained from milk after casein precipitation, represent a heterogeneous group of proteins. WP are reported to inhibit food intake in diet-induced experimental obesity; WP have been proposed as adjuvant therapy in oxidative stress-correlated pathologies. This work evaluates the effects of WP in comparison with casein, as a source of alimentary proteins, on food intake, weight growth and some indexes of oxidative equilibrium in Zucker Rats, genetically prone to obesity. METHODS: We monitored food intake and weight of Zucker Rats during the experiment, and some markers of oxidative equilibrium. RESULTS: WP induced significant decrease of food intake in comparison to casein (WP 80.41 ± 1.069 ml/day; CAS: 88.95 ± 1.084 ml/day; p < 0.0005). Body weight growth was slightly reduced, and the difference was just significant (WP 128.2 ± 6.56 g/day; CAS 145.2 ± 3.29 g/day; p = 0.049), while plasma HNE level was significantly lower in WP than in CAS (WP 41.2 ± 6.3 vs CAS 69.61 ± 4.69 pmol/ml, p = 0.007). Mild amelioration of oxidative equilibrium was indicated by a slight increase of total glutathione both in the liver and in the blood and a significant decrease of plasma 4-hydroxynonenal in the group receiving WP. CONCLUSIONS: The effect of WP on food intake and weight growth in Zucker Rats is particularly noteworthy since the nature of their predisposition to obesity is genetic; the possible parallel amelioration of the oxidative balance may constitute a further advantage of WP since oxidative stress is believed to be interwoven to obesity, metabolic syndrome and their complications.

Anorexia nervosa and heart disease: a systematic review.

Anorexia nervosa (AN) is an eating disorder that most frequently afflicts females in adolescence. In these subjects, cardiovascular complications are the main cause of morbidity and mortality. Aim of this review is to analyze the hemodynamic, pro-arrhythmic and structural changes occurring during all phases of this illness, including re-feeding. A systematic literature search was performed on studies in the MEDLINE database, from its inception until September 2017, with PUBMED interface focusing on AN and cardiovascular disease. This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital. In addition, reduced cardiac mass, with smaller volumes and decreased cardiac output, may be found. Furthermore, mitral prolapse and a mild pericardial effusion may occur, the latter due to protein deficiency and low levels of thyroid hormone. In anorectic patients, some cases of hypercholesterolemia may be present; however, conclusive evidence that AN is an atherogenic condition is still lacking, although a few cases of myocardial infarction have been reported. Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications.

Feasibility of protein-sparing modified fast by tube (ProMoFasT) in obesity treatment: a phase II pilot trial on clinical safety and efficacy (appetite control, body composition, muscular strength, metabolic pattern, pulmonary function test).

Anecdotal data in the last few years suggest that protein-sparing modified diet (PSMF) delivered by naso-gastric tube enteral (with continuous feeding) could attain an significant weight loss and control of appetite oral feeding, but no phase II studies on safety and efficacy have been done up to now. To verify the safety and efficacy of a protein-sparing modified fast administered by naso-gastric tube (ProMoFasT) for 10 days followed by 20 days of a low-calorie diet, in patients with morbid obesity (appetite control, fat free mass maintenance, pulmonary function tests and metabolic pattern, side effects), 26 patients with a BMI ≥30 kg/m2 have been selected. The patients had to follow a protein-sparing fast by enteral nutrition (ProMoFasT) for 24 h/day, for 10 days followed by 20 days of low-calorie diet (LCD). The endpoint was represented by body weight, BMI, abdominal circumference, Haber's appetite test, body composition by body impedance assessment (BIA), handgrip strength test, metabolic pattern, pulmonary function test. Safety was assessed by evaluation of complications and side effects of PSMF and/or enteral nutrition. In this report the results on safety and efficacy are described after 10 and 30 days of treatment. After the recruiting phase, a total of 22 patients out of 26 enrolled [14 (63.6 %) females] were evaluated in this study. Globally almost all clinical parameters changed significantly during first 10 days. Total body weight significantly decreased after 10 days (∆-6.1 ± 2; p < 0.001) and this decrease is maintained in the following 20 days of LCD (∆ = -5.88 ± 1.79; p < 0.001). Also the abdominal circumference significantly decreased after 10 days [median (range): -4.5 (-30 to 0); p < 0.001] maintained then in the following 20 days of LCD [median (range) = -7 (-23.5 to -2); p < 0.001]. All BIA parameters significantly changed after 10 and 30 days from baseline. All parameters except BF had a significant change after 10 days of treatment while the difference at 30 days was lower than at 10 days for TBW, FFM and MM with no significant differences from baseline for the last two characteristics. For VAS appetite the difference was significant after 10 days and the decrease in appetite was maintained at 30 days with no significant difference (p = 0.83) between 10 and 30 days. No significant differences in the first 30 days were detected for PA and for both left and right hand grip strength. Particularly, a significant reduction of 1.82 kg in FFM after 10 days was detected, but not after 30 days. In contrast, a decrease of 3.8 kg of BF is observed after 30 days. As far as the respiratory functional tests (RFT) are concerned, a significant difference at 10 days was globally observed for functional residual capacity (p = 0.012) and expiratory reserve volume (p = 0.025). There are no reported major complications and side effects resulting from the enteral nutrition or PSMF. In particular, cardiac arrhythmias have not been reported. From the clinical point of view the PSMF with naso-gastric tube (ProMoFasT) method appears safe, it is associated with a significant weight loss related to decrease of FM and not to loss of FFM and appetite decreases. It is relevant that the RFT are significantly improved after only 10 days suggesting the efficacy of this regime in short period, too. These preliminary data underline the necessity to increase the number of RCT for this method, which could represent a possible alternative to other methodologies, such as the intragastric balloon, in particular when it is recommended to improve RFT before bariatric, gynecological, orthopedic and lymphatic surgery.

Effects of a new mixture of essential amino acids (Aminotrofic(®)) in malnourished haemodialysis patients.

The aim of this study was to verify the clinical efficacy of a diet associated with already commercially available oral amino acid functional cluster (AFC) compared to the administration of a diet associated with a nitrogen protein-based supplement (casein) in antagonizing malnutrition in patients with Chronic renal failure (CRF) undergoing haemodialysis. The secondary aim was to assess the changes in protein levels during the acute phase such as the expression of inflammatory cytokines. Twenty patients in haemodialysis aged between 18 and 85 of both genders (13 m, 7f) were recruited, randomized and divided into two groups and treated for 4 months respectively with: (1) oral AFC supplement (*)8 g/die: group A, and (2) oral supplementation of a protein nitrogenous mixture compared to AFC with a casein protein source) of 6.6 g: group P. During the initial assessment and thereafter on a monthly basis all patients underwent the following: Dietary recall 24 h; Anthropometric: Weight, height, BMI, expected dry weight, actual weight; Biochemical: Albumin, transferrin, Na, K, Cl, Ca, P, Mg, long-interval creatinine (Aminotrofic(®): Errekappa Euroterapici, Milano) pre-albumin, α1 acid glycoprotein, C reactive protein (CRP), protein nitrogen appearance (PNA); Instrumental: Handgrip strength evaluation, Calorimetry by means of Armband, Bio-impedance analysis (BIA), Spitzer Index (quality of life), Subjective Global Assessment Generated by the patient (PG SGA). Considering the nutritional parameters, no significant differences concerning dry weight emerged between the beginning (T0) and the end (T4) (weight A to T0: kg 64.41 ± 6.34; weight A to T4: kg 64.51 ± 7.05: P = NS; weight P to T0: kg 60.17 ± 11.94; weight P to T4: kg 59.86 ± 11.43: P = NS); biochemical parameters, significant differences were observed only for two parameters: pre-albumin (Pre-albumin A to T0 30.12 ± 7.23; Pre-albumin A to T4: 28.91 ± 5.8; Pre-albumin P to T0 22.51 ± 6.04; Pre-albumin P to T4: 26.10 ± 9.82), and Transferrin (Transferrin A to T0 171.77 ± 28.87 mg/dL, Transferrin A to T4: 181.44 ± 38.83 mg/dL: P < 0.005; Transferrin P to T0 160.29 ± 27.46 mg/dL, Transferrin P to T4: 146.57 ± 24.96 mg/dL: P < 0.005), but not in other parameters. From a nutritional perspective, after 4 months of treatment an increase in protein synthesis was noted in group A compared to group P which was proved by the significant increase of transferrin. This pilot study suggests the AFC oral supplementation may represent a valid alternative to intradialytic parenteral treatment and may also allow for an improvement in blood chemical values and nutritional status.

Whey proteins influence hepatic glutathione after CCl4 intoxication.

Whey proteins (WP) are known to contain more cysteine than casein (CAS), so it is suggested that they should ameliorate the oxidative equilibrium in the organisms. To evaluate the influence of a WP-based diet on liver glutathione (GSH) content, male Sprague-Dawley rats were fed for 3 weeks a balanced liquid diet containing either WP or CAS as main source of protein. Liver GSH content was evaluated at the end of the treatment by high performance liquid chromatography (HPLC), both in basal conditions and after oxidative stress induced by CCl4 acute intoxication. In basal conditions, WP diet significantly increased hepatic GSH in comparison to CAS diet. After CCl4 intoxication, hepatic GSH was negligibly increased in CAS group, while its increase was much more marked in WP group, so that the difference between the two diets was significant; this suggests that WP provided rats with better ability to increase their GSH synthesis in case of need.

Management and treatment of eating disorders in an Italian region.

OBJECTIVE: Eating disorders (ED) are an outstanding health problem in western countries, and bear significant mortality, e.g. anorexia nervosa (AN), and morbidity. The Liguria Region Health Department set up a study with the support of a number of specialists to investigate the number and characteristics of patients referred to institutions, how patients were managed, and the healthcare facilities and personnel involved. METHODS: The retrospective study required that all regional institutions, except two, involved in the treatment of ED during the year 2001 filled out a special questionnaire. RESULTS: Twenty-one institutions (n=19 public, n=2 private) followed 1,220 patients with ED in the mentioned year. The prevalence of such disorders was 6 fold higher in females (1,054 F, 166 M; age range 12-32 years). Bulimia nervosa (BN) proved to be the disorder category most frequently observed (prevalence 59%) followed by AN (26%, p<0.0001) and ED not otherwise specified (EDNOS) (15%, p<0.0001). Most (approximately 90%) of these patients were managed in outpatient settings, and a multidisciplinary team approach was used in fewer than 20% of cases. Hospitalization (complete or partial) was required in 10.5% of patients: 7.1% for mental disturbances and 3.4% for severe malnutrition/electrolyte abnormalities. Fewer than one fourth of patients was admitted to two specialty units (one public and one private) for inpatients in our region with ED. Treatment provided in these centers included a specific nutritional rehabilitation program and psychologic/psychiatric care. Patients more severely underweight underwent nasogastric or parenteral feeding whenever deemed clinically appropriate. The grade of knowledge of ED by general practitioners/pediatricians and their links with trained centers were poor. CONCLUSIONS: Although our data were obtained from a selected population, thus preventing epidemiological conclusions, they show that ED are a significant health concern in our region, with BN representing the most common disorder diagnosed in the different settings (general or specialized medical practices). Overall, the prevalence of such disorders was assessed as six fold higher in females than in males. The emerging issues to be improved are: i) poor level of communication among different specialists and subsequent scanty use of a multidisciplinary team approach in the management of ED ii) insufficient use of guidelines for the management of such disorders iii) paucity of specialty institutions for inpatients with ED iv) inadequate knowledge of the problem by primary care physicians and the community, and poor links with the healthcare institutions that might help.

Interrelationships between body composition and energy expenditure in cancer malnutrition. The role of bioimpedance assessment.

AIM: The aim of the experience was a case-control evaluation of the role of biological impedance assessment (BIA) for estimating resting energy expenditure (REE) instead of indirect calorimetry (IC) in cancer patients. METHODS: Thirteen patients with gastric cancer (GK) were studied vs 18 control (C) patients. GK patients were depleted in fat free mass (FFM) (33+/-3 vs 44+/-5 kg; p<0.0001) and in body cell mass (BCM), (19+/-1 vs 26+/-3 kg; p<0.0001). RESULTS: The REE, calculated with the Harris-Benedict formula (REE-HB) was higher in C than in GK (1,443+/-149 vs 1,196+/-109 Kcal/day; p<0.0001) despite that, when evaluated by means of Indirect Calorimetry (REE-IC), it showed similar values in both groups (1,456+/-157 vs 1,353+/-210 Kcal/day; p=NS; C vs GK), a remarkable decrease of BCM in GK notwithstanding. The REE-IC/actual weight ratio was 21+/-2 Kcal/kg/day in C and 25+/-3 Kcal/kg/day in GK (p<0.005) and the REE-IC/BCM ratio was 55+/-4 Kcal/kg/day in C, and 68+/-8 Kcal/kg/day, in GK (p<0.0001), with a significant correlation between BCM and REE-IC in controls vs GK. CONCLUSIONS: The group of gastric malnourished cancer patients showed an increase in REE-IC in comparison with REE-HB; the increase in REE-IC was not related to the size of the remaining BCM; it is impossible to get a satisfying linear regression function expressing REE in terms of body composition measures obtained by means of BIA instead of indirect calorimetry; the IC is more appropriate to evaluate REE in cancer malnourished patients because in the present experience the Harris-Benedict formula underestimates this parameter by more than 10% (11.06%).

Food intake and body composition in cancer cachexia.

As a complex syndrome, cachexia has different clinical manifestations; anorexia appears to be one of the most frequent findings, together with weight loss. Anorexia is the cause and partly the consequence of metabolic changes and of progressive undernourishment. In cancer cachexia, weight loss is associated with a marked decrease of food intake and severe alteration of body composition. Malnourished cancer patients show a marked loss of adipose tissue and protein mass with BIA evidence of decreased body cell mass and expansion of extracellular water. The mechanisms of anorexia and cachexia are still a matter of debate, but the possible involvement of cytokines in the pathogenesis of this syndrome has opened up new possibilities for its understanding and treatment. As a result of the multifactorial etiology of cancer cachexia/anorexia, therapies that stimulate appetite and promote greater food intake, coupled with factors that influence metabolism and cytokine production may be an optimal therapeutic strategy. Of particular interest appears to be the possible role played by fish oil in antagonizing the negative effects of cytokines. Future research in this field will help clinicians develop new methods to treat patients who have disease-induced starvation and wasting.

Dyspepsia among young conscripts: correlations with psychoemotional state and eating habits.

The prevalence of dyspepsia was evaluated in 83 young conscripted soldiers: 38 of them were normally resident in the town where the barracks was sited (Genoa) while 45 came from different districts. Dyspepsia was observed in 49.4% of total cases, and there were significant differences in the incidence between the two groups. In 40 out of 41 cases, dyspepsia was of the functional type. Psychoneurotic reactions were found in 69.8% of total cases and these reactions were closely correlated with the occurrence of dyspepsia both in soldiers who were local residents and those who were not. Dyspepsia could not however be correlated with eating habits, or with the consumption of alcohol, coffee or tobacco.