A Blood Test for the Diagnosis of Multiple Sclerosis.

Multiple sclerosis (MS) is an autoimmune chronic disease characterized by inflammation and demyelination of the central nervous system (CNS). Despite numerous studies conducted, valid biomarkers enabling a definitive diagnosis of MS are not yet available. The aim of our study was to identify a marker from a blood sample to ease the diagnosis of MS. In this study, since there is evidence connecting the serotonin pathway to MS, we used an ELISA (Enzyme-Linked Immunosorbent Assay) to detect serum MS-specific auto-antibodies (auto-Ab) against the extracellular loop 1 (ECL-1) of the 5-hydroxytryptamine (5-HT) receptor subtype 2A (5-HT2A). We utilized an ELISA format employing poly-D-lysine as a pre-coating agent. The binding of 208 serum samples from controls, both healthy and pathological, and of 104 serum samples from relapsing-remitting MS (RRMS) patients was tested. We observed that the serum-binding activity in control cohort sera, including those with autoimmune and neurological diseases, was ten times lower compared to the RRMS patient cohort (p = 1.2 × 10-47), with a sensitivity and a specificity of 98% and 100%, respectively. These results show that in the serum of patients with MS there are auto-Ab against the serotonin receptor type 2A which can be successfully used in the diagnosis of MS due to their high sensitivity and specificity.

Serum Interleukin 6, Controlling Nutritional Status (CONUT) Score and Phase Angle in Patients with Crohn's Disease.

Crohn's disease (CD) is a chronic inflammatory disorder that may occur in any segment of the gastrointestinal tract. Asymptomatic or untreated inflammation along with malnutrition can often coexist in patients with CD, impairing clinical outcomes, therefore the aim of this study was to assess the relationship between inflammation, malnutrition risk and nutritional status in CD patients. Consecutive adult CD outpatients aged 18-65 years were recruited. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI), whilst anthropometry and phase angle (PhA) were measured. The Controlling Nutritional Status (CONUT) score was retrospectively calculated for screening malnutrition risk and blood samples were taken. A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and an average weight of 64.9 ± 12.0 kg were included. Serum interleukin (IL)-6 concentration was increased in active-CD patients, unrelated to medical treatment, which was associated with CDAI and PhA. Based on the CONUT score, the prevalence of patients with moderate/severe malnutrition risk (score ≥ 5) was 10%, showing lower age, body mass index and fat mass, but higher IL-6 and IL-1ß levels than subjects classified as not at risk (score 0-1). Finally, increased IL-6 levels and reduced PhA values were identified as independent predictors of moderate/severe malnutrition risk (p < 0.05). In conclusion, IL-6 increased in active-CD patients, which was inversely correlated with PhA. Although the CONUT score might be helpful for identifying CD patients at moderate/severe risk of malnutrition, larger studies are needed to verify these results in different settings.

Comparison of bioelectrical impedance analysis-derived phase angle in individuals with different weight status.

OBJECTIVE: Obesity is characterized not only by an increase of fat mass but also by alterations in skeletal muscle. Bioimpedance analysis (BIA)-derived phase angle (PhA) may provide specific information on the inherent characteristics of fat-free mass, and is widely used as an index of poor nutritional status. The aim of this study was to describe whether and to what extent PhA varies depending on age, sex, and body mass index (BMI) in individuals with different weight status. METHODS: We selected 1877 participants for this retrospective study (two weight status groups): 983 individuals with obesity (age 40 ± 13.9 y; BMI 39.5 ± 7.2 kg/m²) and 894 controls (age 40 ± 13.3 y; BMI 24.6 ± 2.7 kg/m²). Anthropometry and PhA at 50 kHz for the whole body were performed in all participants. RESULTS: PhA was greater in men than in women, although a decline of PhA was observed with age, which was linear in women and occurred in men after 40 y of age. On the other hand, no significant differences were observed with increasing BMI in either sex; lower values might be observed when BMI >50 kg/m². CONCLUSIONS: A more detailed appraisal of BIA-derived PhA in obesity is reported in the present study, providing basic data that might be taken into consideration in prevention and clinical nutrition. Further studies are needed to explore differences of PhA in individuals with different weight status.

Evaluation of the Nutritional Status of Gaucher Disease Type I Patients under Enzyme Replacement Treatment.

(1) Background: Gaucher disease (GD) is a rare lysosomal storage disease. The few studies analyzing Resting Energy Expenditure (REE) in GD involved mainly untreated patients and supported a hypermetabolic condition possibly due to the associated inflammatory state. Definitive conclusions could not be drawn also because of the heterogeneity and the small size of the samples investigated. In order to expand current knowledge concerning, in particular the condition of patients under Enzyme Replacement Therapy (ERT), we evaluated the nutritional status of a relatively large sample of GD patients followed at Federico II University Hospital in Naples, Italy. (2) Methods: The study, having a cross-sectional design and involving 26 patients on ERT, included routine biochemical analyses, bioelectrical impedance analysis, indirect calorimetry, and administration of food frequency and physical activity questionnaires. The results in GD patients were compared with those from an appropriate control group. (3) Results: GD patients had normal biochemical parameters in 80% of cases, except for HDL-cholesterol, consumed a hyper-lipidic diet, and had a 60% prevalence of overweight/obesity. Body composition did not differ between patients and controls; however, measured REE was significantly lower than predicted and was reduced in comparison with the healthy controls. (4) Conclusions: This study provided novel elements to the present knowledge about REE and the nutritional status of GD patients under ERT. Its results warrant confirmation in even larger GD population samples and a more in-depth investigation of the long-term effects of treatment superimposed on the basic pathophysiological disease condition.

Prevalence of Sarcopenia in Women with Breast Cancer.

Sarcopenia is a common finding in patients with cancer and potentially influences the patient's outcome. The aim of this study was to evaluate the prevalence of sarcopenia, according to the European Working Group on Sarcopenia in Older People, in a sample of women with breast cancer (BC) and a BMI lower than 30 kg/m2. This cross-sectional study was conducted in patients with BC, stage 0-III, and receiving therapy for BC; the women were recruited at the Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. A control group with similar age and BMI was selected from the internal database. Anthropometry, bioimpedance analysis (BIA) and hand grip strength (HGS) were measured to detect sarcopenia. A total of 122 patients (mean age 49.3 ± 11.0 years, BMI 24.6 ± 3.0 kg/m2) and 80 healthy controls were analyzed. Sarcopenia was found in 13.9% patients with BC, while none of the subjects in the control group was sarcopenic. By comparing BC patients with and without sarcopenia and the control group, the fat-free mass of sarcopenic BC patients were significantly lower than those of both non-sarcopenic BC patients and the control (p < 0.05). The phase angle was also significantly lower in sarcopenic patients (−0.5 degrees, p = 0.048) than in the control group. Considering the prevalence of sarcopenia in patients with BC, our findings suggest the usefulness of body composition and HGS evaluation for early screening of sarcopenia to reduce the risk of associated complications.

Bioelectrical Phase Angle in Patients with Breast Cancer: A Systematic Review.

Breast cancer (BC) is the most common cancer diagnosed among women worldwide. Phase angle (PhA), a proxy measure of membrane integrity and function, has gained relevance in clinical practice and it has been suggested to be a prognostic and nutritional indicator. This systematic review aimed to explore PhA and its relationship with nutritional status and survival in BC patients. Four databases (PubMed, EMBASE, Web of Science, and CINAHL) were systematically searched until September 2021 for studies evaluating PhA in BC patients. A total of 16 studies met the inclusion criteria, where 11 were observational studies and 5 were interventional studies. Baseline PhA-value varied from 4.9 to 6.30 degrees, showing a great variability and heterogeneity across the selected studies. Available data suggested that PhA decreased by 5-15% after completing chemotherapy, and those effects might persist in the long term. However, the use of tailored nutritional and/or exercise programs during and after therapy could prevent PhA reduction and body derangement. High PhA values were found in women displaying a better nutritional status, while inconsistent data were found on survival. Therefore, further studies are needed to focus on the clinical relevance of PhA in BC patients, evaluating its association with disease outcomes and survival.

Nutritional Screening and Anthropometry in Patients Admitted From the Emergency Department.

BACKGROUND: Due to the high prevalence of malnutrition among hospitalized patients, screening and assessment of nutritional status should be routinely performed upon hospital admission. The main objective of this observational study was to evaluate the prevalence of and the risk for malnutrition, as identified by using three nutritional screening tests, and to observe whether some anthropometric and functional parameters used for nutritional evaluation were related to these test scores. METHODS: This single-center observational study included 207 patients admitted from the emergency department for hospitalization in either the internal medicine or surgery units of our institution from September 2017 to December 2018. The prevalence of malnutrition among this patient sample was evaluated by using the Nutritional Risk Screening (NRS-2002), the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body mass index (BMI), bioimpedance analysis (BIA), handgrip strength (HGS) and calf circumference (CC) assessments were also performed. RESULTS: According to the NRS-2002, 93% of the patients were at no risk or at low nutritional risk (NRS score < 3), and 7% were at a high nutritional risk (NRS score ≥ 3). On the other hand, according to the SGA, 46.3% of the patients were well-nourished (SGA-a), 49.8% were moderately malnourished (SGA-b), and 3.9% were severely malnourished (SGA-c). Finally, according to the GLIM criteria, 18% patients were malnourished. Body weight, body mass index (BMI), phase angle (PhA), CC and HGS were significantly lower in the patients with NRS scores ≥ 3, SGA-c and in patients with stage 1 and stage 2 malnutrition, according to the GLIM criteria. CONCLUSION: The NRS-2002, the SGA and the GLIM criteria appear to be valuable tools for the screening and assessment of nutritional status. In particular, the lowest NRS-2002, SGA and GLIM scores were associated with the lowest PhA and CC. Nevertheless, a weekly re-evaluation of patients with better screening and assessment scores is recommended to facilitate early detection of changes in nutritional status.

Body Composition and Bioelectrical-Impedance-Analysis-Derived Raw Variables in Pole Dancers.

Few data are available on the body composition of pole dancers. Bioelectrical impedance analysis (BIA) is a method that is used to estimate fat-free mass (FFM) and fat mass (FM), while raw BIA variables, such as the impedance ratio (IR) and phase angle (PhA), are markers of body cell mass and the ratio between extracellular and total body water. The aim of this study was to evaluate the body composition of pole dancers compared to controls, in particular, those raw BIA variables that are considered as markers of muscle composition. Forty female pole dancers and 59 controls participated in the study. BIA was performed on the whole body and upper and lower limbs, separately, at 5, 50, 100 and 250 kHz. The FFM, FFM index, FM and body fat percentage (BF%) were predicted. The bioelectrical impedance indexes IR and PhA were also considered. Pole dancers exhibited higher FFMI and BI indexes and lower BF%. PhA was greater and IRs were smaller in pole dancers than in controls for the whole body and upper limbs. Considering the training level, FFM, whole-body IR and PhA were higher in the professionals than non-professionals. Raw BIA variables significantly differed between the pole dancers and controls, suggesting a higher BCM; furthermore, practicing pole dancing was associated with a greater FFM and lower FM.

Resting energy expenditure in elite athletes: development of new predictive equations based on anthropometric variables and bioelectrical impedance analysis derived phase angle.

BACKGROUND: An accurate estimation of athletes' energy needs is crucial in diet planning to improve sport performance and to maintain an appropriate body composition. This study aimed to develop and validate in elite athletes new equations for estimating resting energy expenditure (REE) based on anthropometric parameters as well as bioimpedance analysis (BIA)-derived raw variables and to validate the accuracy of selected predictive equations. METHODS: Adult elite athletes aged 18-40 yrs were studied. Anthropometry, indirect calorimetry and BIA were performed in all subjects. The new predictive equations were generated using different regression models. The accuracy of the new equations was assessed at the group level (bias) and at the individual level (precision accuracy), and then compared with the one of five equations used in the general population or three athletes-specific formulas. RESULTS: One-hundred and twenty-six male athletes (age 26.9 ± 9.1 yrs; weight 71.3 ± 10.9 kg; BMI 22.8 ± 2.7 kg/m2) from different sport specialties were randomly assigned to the calibration (n = 75) or validation group (n = 51). REE was directly correlated with individual characteristics, except for age, and raw BIA variables. Most of the equations from the literature were reasonably accurate at the population level (bias within ±5%). The new equations showed a mean bias -0.3% (Eq. A based on anthropometric parameters) and -0.6% (Eq. B based on BIA-derived raw variables). Precision accuracy (individual predicted-measured differences within ±5%) was ~75% in six out of eight of the selected equations and even higher for Eq. A (82.4%) and Eq. B (92.2%). CONCLUSION: In elite athletes, BIA-derived phase angle is a significant predictor of REE. The new equations have a very good prediction accuracy at both group and individual levels. The use of phase angle as predictor of REE requires further research with respect to different sport specialties, training programs and training level.

Bioelectrical impedance (BIA)-derived phase angle in adults with obesity: A systematic review.

BACKGROUND & AIMS: Bioimpedance analysis-derived phase angle (PhA), as marker of body cell mass and cell integrity, might be altered in obesity, a condition which is characterized by alterations in muscle structure and function. The aim of this systematic review was to evaluate whether and to which extent PhA varies in individuals/patients with excess body weight focusing on: a) changes in PhA due to obesity; b) changes in PhA after bariatric interventions or training programs. METHODS: According to PRISMA criteria, a systematic literature search until February 2021 using PubMed, Embase, Scopus, and Web of Science was performed. Selection criteria included studies on patients with obesity without comorbidities other than metabolic diseases. RESULTS: A total of 278 articles were first identified. After removing duplicates and excluding studies that did not fulfil the inclusion criteria, the full text of the remaining 80 potentially relevant studies was examined to finally retrieve 11 cross-sectional and 10 longitudinal studies. Few studies have shown that PhA is lower in individuals/patients with obesity than in controls. The only study on the matter showed a decrease with age after the fourth decade of life. Four out of five studies reported consistently greater mean values in men than in women. In two studies PhA was lower in patients with severe obesity; in addition, Patients with low PhA had higher BMI and PhA was inversely correlated with fat mass. Longitudinal studies showed that PhA markedly decreased after bariatric surgery and slightly increased after training programs. CONCLUSIONS: Thus, a relatively low number of studies have evaluated PhA in individuals/patients with obesity with sometimes contradictory and preliminary results. PhA might be useful to evaluate muscle quality in individuals/patients with obesity but further studies are needed to more accurately associate this variable with changes in muscle structure and strength, as well as in metabolic functions.

A proposal for reference values of hand grip strength in women with different body mass indexes.

OBJECTIVE: Hand grip strength (HGS) is frequently used in clinical practice, resulting in a potential marker of nutritional status. This study aimed to develop reference values of HGS in Italian women with different categories of body mass index (BMI). Additionally, the main predictors of HGS were identified. METHODS: A cross-sectional study was conducted in Italian women between ages 16 and 55 y with different categories of BMI at the Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples Italy. The whole sample was divided into tertiles according to BMI: 15 to 17.29 kg/m2 (T1), 17.3 to 19.9 kg/m2 (T2), and 20 to 25 kg/m2 (T3). Anthropometry, bioimpedance analysis, and muscle strength by an HGS test were evaluated. The cut-off values for HGS were developed for all participants and stratified by age group. Finally, a multivariate linear regression analysis was performed to assess the main predictors of HGS. RESULTS: A total of 529 women with a mean age of 23.2 ± 7.0 y and an average BMI of 18.9 ± 2.5 kg/m2 were analyzed. HGS was higher for the dominant hand than for the non-dominant hand in all BMI tertiles. On both sides, according to age groups, HGS increased with increasing age in T1 and T3, whereas it increased in the women between ages 20 and 30 y in T2 only. Multivariate linear regression analysis showed that predictors of HGS varied according to tertiles. Specifically, we found that body weight (R2 = 0.252) was the main predictor in T1, whereas phase angle (PhA) was the main determinant in both T2 (R2 = 0.240) and T3 (R2 = 0.216). CONCLUSION: This study defined the normal reference values of HGS in Italian women with different BMI ranges, stratifying the sample group by age. Additionally, the main predictors of HGS were assessed for each BMI tertile. In primary malnutrition (T1), the main predictor of HGS was body weight, whereas in the other two tertiles (T2, T3), the PhA was the main predictor of HGS.

Nutritional indicators and metabolic alterations in outpatients with anorexia nervosa: a retrospective study.

PURPOSE: In patients living with Anorexia Nervosa (AN), dehydration and haemoconcentration, may prevent a correct interpretation of laboratory nutritional parameters. Our study aims to evaluate if some indicators of disease severity, as body mass index (BMI), Phase Angle (PhA) and months of amenorrhea may be predictors of metabolic alterations (serum albumin, liver enzymes). METHODS: In 154 outpatients with AN, case history was collected, and anthropometric and laboratory parameters measured. Patients were divided according to the following tertiles (T) of BMI, duration of amenorrhea and PhA: (1) BMI (T1 < 15.6; T2 15.6-16.8; T3 > 16.8 kg/m2); (2) Amenorrhea duration (T1 < 7; T2 7-14; T3 > 14 months); (3) PhA value (T1 < 4.64; T2 4.64-5.35; T3: > 5.35°). ROC curves were used to determine which of these three indicators (BMI, PhA and amenorrhea duration) might better identify patients belonging to Group A or B (less than 3 or more metabolic abnormalities). RESULTS: The most frequent registered metabolic alterations were for alkaline phosphatase (ALP), alanine aminotransferase, cholesterol and hemoglobin. Aspartate aminotransferase, ALP and gamma glutamyl transferase abnormalities were frequent in the first tertiles of all the three indicators. Albumin was low in the T1 of BMI and PhA. No differences in nutritional alterations emerged according to amenorrhea duration. PhA had the best performance (AUCs: 0.721) in identifying patients with 3 or more abnormalities, with the optimal cut-off value of 4.5°. CONCLUSIONS: Our data confirmed PhA as the more reliable predictor of metabolic alterations, followed by BMI and amenorrhea duration, especially in the first tertile. EVIDENCE-BASED MEDICINE: Level 2.

New predictive equations for estimating resting energy expenditure in subjects with normal weight and overweight.

OBJECTIVE: The aim of this study was to develop and validate new predictive equations for estimating resting energy expenditure (REE) in subjects with normal weight and overweight, considering anthropometric parameters as well as raw variables from bioimpedance analysis (BIA). METHODS: Adult participants with normal weight and overweight were recruited and randomly split into calibration and validation groups. Indirect calorimetry (IC) and BIA were performed in all subjects. New predictive equations were developed using the following models: model 1 with age, weight, stature, and body mass index (BMI) as predictors; and model 2: model 1 + raw BIA variables (bioimpedance index and phase angle). The accuracy of the new equations at both the group (bias) and individual (within ±10%) levels was tested in the validation group. Three published predictive equations were also compared, with the REE values measured by IC. RESULTS: A total of 2483 adults were included for developing and validating the new equations. All selected formulas, including the new ones, showed a bias of <5% in estimating REE at the group level. Accuracy at the individual level was slightly higher for the new equations, especially for the equation based on raw BIA variables (men = 70.3%; women = 72.3%). CONCLUSIONS: Compared to the equations in the literature, the new equations showed good accuracy at both the group and individual levels, with a slight improvement in individual accuracy for the formula including raw BIA variables. However, future research is required to verify the role of the raw BIA variables in predicting REE in subjects with normal weight and overweight.

Prediction of resting energy expenditure in healthy older adults: A systematic review.

BACKGROUND & AIMS: Estimates of energy requirements, based on measured or predicted resting energy expenditure (REE), are needed to avoid undernutrition or overnutrition (and their clinical consequences) in elderly subjects. The aims of this systematic review were to evaluate the prediction accuracy of REE in healthy elderly subjects and to ascertain which equation is more reliable at group level and/or individual level. METHODS: Studies assessing prediction of REE in general elderly population were systematically searched using PubMed, EMBASE, Web of Science and CINAHL until March 2020. Prediction accuracy of REE was assessed at both group (bias) and individual (precision) level for each equation. RESULTS: Fourteen studies met the inclusion criteria of this systematic review. Bias was reported in 8 papers and calculated in another 5 from absolute values. There was a prevalent tendency towards an overestimation of REE across the studies. The least bias was observed for the Mifflin (-0.3%) and Harris-Benedict (+2.6%) equations, with values above 5% for the FAO/WHO/UNU, Fredrix and Muller equations. Precision widely varied between studies for the same equation. The higher precision was observed using the Harris-Benedict equation (~70%), while the Henry and Mifflin equations provided estimates within 10% of measured values in 65% and 61% of elderly individuals, respectively. CONCLUSIONS: None of the prediction equations considered provides accurate and precise REE estimates in healthy older adults. However, the best prediction is given by the Mifflin equation at group level and by the Harris-Benedict equation at individual level. Further studies with strong quality design are needed to evaluate the variability and accuracy of REE in the elderly general population.

Bioimpedance phase angle in elite male athletes: a segmental approach.

OBJECTIVE: Phase angle (PA), a bioelectrical impedance analysis (BIA) parameter, has proven to be a proxy of body cell mass in athletes, but very few data are available on its segmental evaluation (upper and lower limbs). Therefore, we aimed to assess whether whole-body and segmental PA varied among elite male athletes of different sports and compared these to control groups. Additionally, we investigated its relationship with anthropometric and body composition parameters. APPROACH: Elite athletes practicing cycling, water polo and ballet dance aged 18-40 years underwent anthropometric and BIA measurements. PA (whole-body and upper and lower limbs) was considered as raw BIA variable. Data were also compared with healthy subjects with similar characteristics who served as control groups. MAIN RESULTS: Participants included three groups of male athletes: 18 cyclists (age 28.6 ± 3.4 years; weight 70.6 ± 5.4 kg; BMI 21.5 ± 1.4 kg m2), 20 water polo players (age 23.9 ± 4 years; weight 89.0 ± 5.2 kg; BMI 25.9 ± 1.9 kg m2) and 18 ballet dancers (age 19.2 ± 1.3 years; weight 63.3 ± 5.8 kg; BMI 20.8 ± 1.0 kg m2) and three groups of healthy control subjects each of which similar for general characteristics (one to one) to the previous ones. Both whole-body and limb PAs were significantly higher in athletes compared to their respective controls, whereas no differences were found among sport groups. PA was positively correlated with BMI and fat-free mass (FFM) more in athletes than in controls and FFM was the main determinant. SIGNIFICANCE: PA may represent a useful proxy parameter of soft tissue mass quality, directly related to physical activity level. Furthermore, the direct evaluation of segmental PA among athletes practicing different sports may be useful for assessing and monitoring the differences among athletes and changes due to training.

Bioelectrical impedance analysis (BIA) -derived phase angle in sarcopenia: A systematic review.

BACKGROUND & AIMS: Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status because it is thought to be a proxy of water distribution and body cell mass; it is also associated to muscle strength and is an effective predictor of different clinical outcomes. Since an association may be expected between PhA and sarcopenia (defined by low skeletal muscle mass and impaired muscle function), the aim of this systematic review was to evaluate: a) changes in PhA due to sarcopenia; b) prevalence of sarcopenia according to PhA values; c) derivation of phase angle cut-offs for detecting sarcopenia; d) sarcopenia and PhA as predictors of clinical outcomes. METHODS: A systematic research on electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to January 31st, 2020 was performed according to PRISMA checklist. Using PICOS strategy, "P" corresponded to participants of any age, gender or ethnicity, "I" designated diagnosis of sarcopenia, "C" indicated subjects without sarcopenia, "O" corresponded to PhA, and "S" selected all study types. Methodological quality was assessed using the National Institute of Health (NIH) quality assessment tool. RESULTS: Through the initial literature search and after removing duplicates and excluding papers by screening titles and abstracts, 79 potentially relevant studies were examined. Thirteen studies (7668 subjects) met the inclusion criteria. The overall risk of bias was low. Sarcopenia was associated with a significant lower PhA in seven studies out of eight, while five studies out of six reported a high prevalence of sarcopenia was in patients with low PhA. Different cut-off point values from 4.05 to 5.05° have been derived for the identification of sarcopenia. PhA and sarcopenia were independent predictors of survival in cancer patients and geriatric hospitalized patients. CONCLUSIONS: Data from the selected papers demonstrate that PhA is decreased in sarcopenic subjects and the prevalence of sarcopenia is higher in subjects with low PhA. Further studies are needed to determine to what extent PhA may be valuable in detecting low muscle quality and/or identifying sarcopenia.

Bilio-pancreatic diversion: report of a case involving bone metabolism complications.

Prolonged vitamin D deficiency may result in lower calcium absorption and osteoporosis, leading to pathologic fractures. We report the case of a young woman with severe, complicated osteoporosis, which developed several years after biliopancreatic diversion that was performed to treat morbid obesity. Chronic low vitamin D levels provided a continuous stimulus for parathormone secretion, which resulted in parathyroid hyperplasia/adenoma and autonomous production of the hormone.

Long-Term Outcomes from a 10-Year Follow-Up of Women Living with a Restrictive Eating Disorder: A Brief Report.

BACKGROUND: This study aimed to evaluate several socio-demographic and long-term clinical outcomes in a cohort of women living with a restrictive eating disorder. METHODS: Patients were asked to fill in a general data collection form aiming to investigate their current conditions and to attend the outpatient unit for a 10-year follow-up clinical and laboratory evaluation. RESULTS: Forty-four patients completed the follow-up general data collection form and 20 agreed to attend the outpatient unit for the 10 year-follow-up evaluation. In total, 52% of patients were single, 55% had achieved a university degree, and 55% had steady employment. After 10 years, there was a clear improvement in biochemical markers, but cholesterol levels were still slightly high. The prevalence of osteopenia in the whole sample was 70% when measured on the lumbar column and 20% on the total body, while osteoporosis was found in 10% of patients and only on the lumbar column. CONCLUSION: According to the collected data, women with a history of restrictive eating disorders appear to re-adapt well to social life by obtaining the level of their unaffected peers in terms of education and employment.

Adapted recreational football small-sided games improve cardiac capacity, body composition and muscular fitness in patients with type 2 diabetes.

BACKGROUND: The usefulness of adapted small-sided games (SSGs) in improving cardiac function in subjects with T2DM is still debated. Here we evaluated the effects of 18 weeks indoor muscular activation training (6 weeks; IMA) followed by adapted SSGs football training (12 weeks) on cardiac function, muscular fitness, body composition and adiponectin expression in sedentary T2DM volunteers. METHODS: Six T2DM patients underwent IMA protocol of 6 weeks, twice a week followed by 12 weeks SSGs (5-a-side, once a week) training. Glucose, lipid profile and serum homocysteine concentration, body composition (BC), bone mineral density (DEXA), were determined at baseline and after 18 weeks (IMA+SSGs). VO2max and muscular fitness were recorded at baseline and after IMA (6 weeks) and SSGs (12 weeks), respectively. RESULTS: No significant differences were found for VO2max and muscular fitness after 6weeks of IMA. After 18 weeks (6 weeks IMA + 12 weeks SSGs) of training, significant improvements were found in the following parameters: work capacity, VO2peak, Ventilation (VEpeak), breathing reserve consumption and oxygen uptake efficiency slope (P<0.05); leg fitness (P<0.05), BC (P<0.05), vertebral column T-score (P<0.01) and adiponectin (total and high-molecular-weight; P<0.05). Compared to baseline, a reduction in serum homocysteine occurred after 18 weeks of training (P<0.05). CONCLUSIONS: We evidenced that weekly adapted SSGs friendly football matches for 12 weeks improve cardiorespiratory capacity and the expression of independent markers associated with cardiovascular risk in T2DM patients, suggesting an overall reduced CVD-risk in these patients. These preliminary data encourage us to test the efficacy of this type of exercise in a larger population.