The prevalence of celiac disease and the appropriateness of the diagnosis in family medicine setting could be lower than expected.

OBJECTIVE: To assess the prevalence of celiac disease (CD) and the appropriateness of this diagnosis in the family medicine setting in Italy. PATIENTS AND METHODS: The electronic databases of 16 general practitioners working in Rome (Italy) were analyzed. The prevalence of CD according to the Italian pathology identification code issued by the Italian National Health System was assessed. In addition, patients registered as having celiac disease without being assigned a pathology identification code were interviewed. RESULTS: Overall, a population of 22,064 patients was analyzed. 91 patients had a diagnosis of CD (0.41%), 60 of whom had a pathology identification code (0.27%), and 31 did not (0.14%). 29 of these patients were interviewed, 16 (17.58% of the CD recorded patients) of whom reported being on a gluten-free or gluten restricted diet, with reported improvement in their clinical symptoms. Half of them further stated that they would not agree to resume a restriction free diet in order to make a definitive CD diagnosis, due to the risk of symptom recurrence. CONCLUSIONS: In a family medicine setting, the prevalence of CD seems to be lower than expected, and one third of patients diagnosed with CD do not fulfill all diagnostic criteria. Any effort to improve the diagnostic work-up for CD should also be made in this setting.

Assessment of nutritional status and therapy in emergency Medicine settings.

Hospital malnutrition is becoming a clinical concern. Our aim was to determine the prevalence of hospital malnutrition through Nutritional Risk Screening 2002 (NRS) and to evaluate nutritional risk through a prospective study. Nutritional status was assessed collecting anthropometric parameters together with the data relating to the diseases in the medical records of patients admitted to the Department of Emergency Medicine of the "Sant'Eugenio" Hospital. One hundred and sixty patients were retrospectively enrolled during a 3-month observational period. The risk of malnutrition was detected in 52% of patients (of whom 38% at risk and 62% at serious risk). The NRS score was positively correlated with patient age, days between hospital admission and nutritional assessment, disease severity, length of hospital stay and catabolism (p less than 0.05); Basal Energy Expenditure (BEE) and mean arm circumference (MUAC) were negatively correlated with positive outcome (p less than 0.05). No correlations were found in the NRS score, gender, height, weight, Body Mass Index (BMI) and Total Energetic Expenditure (TEE) (p=n.s). A high prevalence of the risk of malnutrition may be detected in the emergency medicine setting, particularly in the geriatric population. The NRS score is not strictly related to BMI, but rather is an excellent tool for disease prognosis, as well as nutritional screening.

Obesity and dental caries in paediatric patients. A cross-sectional study.

AIM: The aim of the present cross-sectional study was to evaluate the relationship between childhood obesity and dental caries, in paediatric subjects, through the use of two methods of diagnosis of overweight-obesity: Body Mass Index (BMI), and Dual energy X-ray Absorptiometry (DXA). METHODS: A total of 107 healthy patients, aged between 6 and 12 years (53.3% females, 46.7% males) were included in the study. Each patient underwent a nutritional examination and dental check-up. The nutritional examination was performed at the Department of Neuroscience, Human Nutrition Unit, University of Rome Tor Vergata and consisted of anthropometric measurements, BMI calculation, DXA exam, body fat mass (FM) assessment. Dental examinations were performed by a trained dentist of the Paediatric Dentistry Unit of PTV Hospital, University of Rome Tor Vergata. Dental caries was assessed using visual-tactile method and X-rays (bite-wing and panoramic radiography); the dmft/DMFT index was calculated. The subjects were classified as underweight, normal weight, pre-obese, obese, according to different criteria: a) age- and sex-specific BMI according to the Cacciari growth charts and cut-offs, b) body fat mass percentage (FM%) according to the WHO cut-offs, c) body fat mass percentage (FM%) according to the McCarthy growth charts and cut-offs. STATISTICS: The statistical analysis was performed with the SPSS software (version 11.01; SPSS Inc., Chicago, IL, USA). The dmft/DMFT index was checked for normality using the Kolmogorov-Smirnov test. Independence of the dmft/DMFT distribution from sex and age was checked by using the Mann Whitney and Kruskal Wallis tests. Differences in the dmft/DMFT values between groups, according to BMI and FM% classifications, were tested using the Mann Whitney test. The minimal level of significance of the differences was fixed at p- value ≤ 0.05 for all procedures. RESULTS: The comparison between BMI and DXA data shows statistically significant differences between BMI-%FM (WHO cut-offs) classifications (p ≤ 0.001) and BMI-%FM (McCarthy cut-offs) classifications (p ≤ 0.001). According to the BMI classification, there was no significant association between increase of dmft-DMFT and pre-obesity/obesity, but according to the FM% (WHO cut-offs) classification, the pre-obese/obese children had higher caries indexes than normal weight subjects, both in deciduous teeth (p=0.003) and permanent teeth (p=0.000). Furthermore, according to the FM% (McCarthy cut-offs) classification, obese children had higher caries indexes than normal weight and pre-obese subjects, both in deciduous teeth (p=0.030, p=0.02) and permanent teeth (p=0.019, p=0.011), respectively, but they had a dmft-DMFT value comparable with underweight children. CONCLUSION: The BMI misclassified adiposity status of the paediatric population compared to DXA, which provides a reliable screening and a more specific assessment of body composition. The misclassification of childhood obesity, determined by the BMI, could be used to explain the conflicting data in the literature on the association between obesity and dental caries. Our results highlighted for the first time the relationship between dental caries prevalence and body fat percentage measured by DXA.