Characterization of Metabolically Healthy Obese People and Metabolically Unhealthy Normal-Weight People in a General Population Cohort of the ABCD Study.

There is actually no consensus about the possibility that in some instances, obesity may be a benign metabolically healthy (MH) condition as opposed to a normal-weight but metabolically unhealthy (MUH) state. The aim of this study was to characterize MH condition and to investigate possible associations with metabolic and cardiovascular complications. One thousand nineteen people (range of age 18-90 years) of the cohort of the ABCD_2 study were investigated. Participants were classified as normal weight (BMI < 24.9 kg/m2) or overweight-obese (BMI ≥25 kg/m2); they were also classified as MH in the presence of 0-1 among the following conditions: (a) prediabetes/type 2 diabetes, (b) hypertension, (c) hypertriglyceridemia or low HDL cholesterolemia, and (d) hypercholesterolemia. MUH condition was diagnosed if ≥2 of the conditions listed were found. The prevalence of overweight/obese people was 71.1%, of whom 27.4% were found to be MH. In addition, 36.7% of the normal-weight participants were MUH. HOMA-IR, high sensitivity C-reactive protein, and the carotid intima-media thickness were significantly different in the 4 subgroups (P < 0.001), with higher values observed in the MUH normal-weight and obese groups. In conclusion, this study highlights the importance of identifying a MH condition in normal-weight and in obese people in order to offer better treatment.

Nutritional predictors of mortality after discharge in elderly patients on a medical ward.

BACKGROUND: Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. MATERIALS AND METHODS: This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. RESULTS: Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004). CONCLUSIONS: The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.

Validation of a food frequency questionnaire for use in Italian adults living in Sicily.

The objective of this study was to validate two interviewer-led food frequency questionnaires (FFQs) of very different lengths: a medium-length FFQ (medium-FFQ) of 36 items and a short-length FFQ (short-FFQ) of 18 items, intending to measure levels of intakes in a local population. Both FFQs were validated against intakes derived from a 3-day dietary record (3-day DR). Sixty-five non-diabetic adults with no known cardiovascular, renal or other systemic diseases were included. High correlation coefficients between the FFQ and the 3-day DR (0.45-0.73) were observed for energy intake, carbohydrates and lipid and protein intake. Bland-Altman plots showed good agreement between the methods. Low (0.26-0.37) correlation coefficients of the different nutrient intakes obtained with the short-FFQ and the 3-day DR were observed, with the exception of alcohol intake (rho = 0.49). This study showed promising evidence for the use of a medium-FFQ as a potentially useful tool for investigating the relationship between habitual diet and diseases in clinical and research settings.

Habitual street food intake and subclinical carotid atherosclerosis.

Street food (SF) is defined as out-of-home food consumption, and generally consists of energy-dense meals rich in saturated fats and poor in fibers, vitamins and antioxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with atherosclerosis has not been considered. The association between habitual SF consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, was therefore investigated. One thousand thirty-five randomly selected adult participants without known diabetes and atherosclerotic cardiovascular diseases were cross-sectionally investigated in Palermo, Italy. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 541 participants. A score of SF consumption was obtained by categorizing each of ten SFs consumed more or less than once a month. Participants were divided into three classes based on the tertiles of SF score distribution. Age, gender distribution, body mass index (BMI), prevalence of hypertension and of clinically silent carotid atherosclerosis (I tertile 20.8 %, II tertile 19.7 %, III tertile 19.0 %; P = 0.85) were not significantly different among the three groups. Clinically silent carotid atherosclerosis was independently associated with age, gender and hypertension. The score of SF consumption was significantly correlated with BMI (r = 0.10; P = 0.04), uric acid (r = 0.16; P = 0.002) and high-density lipoproteins-cholesterol (r = -0.13; P = 0.009) blood concentrations. In conclusion, this study suggests that SF consumption is not associated with clinically silent carotid atherosclerosis. However, given the association of SF consumption with other cardiovascular risk factors, caution requires that this category of food should be limited in patients at high cardiovascular risk.

Endothelial function and other biomarkers of cardiovascular risk in frequent consumers of street food.

BACKGROUND & AIMS: Street food (SF) is defined as out-of-home food consumption, and generally consists of energy dense meals rich in saturated fats, and poor in fibers, vitamins and anti-oxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with endothelial function has not been considered. METHODS: Participants were recruited among those who took part in a previous study of ours, done in Palermo, Italy, which investigated the association between consumption of SF and health in 1002 people. In that study, a score of SF consumption was obtained by categorizing each of ten foods consumed less than or more than once a month (0 = never consumed, 1 = once a month or less, 2 = more than once a month; thus, the sum of single scores could range from 0 to 20). Based on the interquartile values of SF score distribution, in the present study we included low SF consumers, defined on the basis of the first interquartile SF score range (range: 0-1), and high SF consumers, who were those in the forth interquartile range of the SF score (range: 7-20). The group of low SF consumers had 12 participants (median value of SF score: 1; range: 0-1), that of high SF consumers had 13 (median value of SF score: 11; range: 10-16). The brachial artery flow-mediated dilatation (FMD), a measure of endothelial function, and other cardiovascular biomarkers were investigated. RESULTS: High SF consumers had higher BMI (P = 0.026), larger waist circumference (P = 0.041), higher levels of cholesterol (P = 0.013) and uric acid serum concentrations (P = 0.002) compared with low SF consumers. The high SF consumers had a significantly lower FMD (5.4 ± 2.1 versus 8.8 ± 2.8%; ANCOVA with BMI and waist circumpherence as covariates: P = 0.025) than the high consumers. Other cardiovascular biomarkers did not significantly differ between the two groups. CONCLUSIONS: This study suggests that high SF consumption in Palermo may be associated with endothelial dysfunction in healthy people, probably indicating that this category of foods should be limited, especially in people at high cardiovascular risk.

Characterization of street food consumption in Palermo: possible effects on health.

BACKGROUND: Street Food (SF) consists of out-of-home food consumption and has old, historical roots with complex social-economic and cultural implications. Despite the emergence of modern fast food, traditional SF persists worldwide, but the relationship of SF consumption with overall health, well-being, and obesity is unknown. METHODS: This is an observational, cross-sectional study. The study was performed in Palermo, the largest town of Sicily, Italy. Two groups were identified: consumers of SF (n = 687) and conventional restaurant food (RES) consumers (n = 315). Study subjects answered a questionnaire concerning their health conditions, nutritional preferences, frequency of consumption of SF and a score relative to SF consumption ranging from 0 to 20 was calculated. RESULTS: Body mass index (BMI, kg/m2) was significantly and independently correlated with the score of street food consumption (r = 0,103; p < 0.002). The prevalence of different diseases, including hypertension and type 2 diabetes, and the use of medications did not differ between the two groups. Milza (a sandwich stuffed with thin slice of bovine spleen and lung) consumers had a significantly higher prevalence of hypertension (12.2% vs 6.2% in non consumers; p < 0.005) and in this subgroup the use of anti-hypertensive drugs was inversely correlated with the frequency of milza consumption (r = 0.11; P = 0.010). CONCLUSIONS: This study suggests that SF consumption in Palermo is associated with a higher BMI and higher prevalence of hypertension in milza consumers. Further studies should evaluate whether frequent SF consumers have unfavourable metabolic and cardiovascular profile.