Nature and Cognitive Perception of 4 Different Breakfast Meals Influence Satiety-Related Sensations and Postprandial Metabolic Responses but Have Little Effect on Food Choices and Intake Later in the Day in a Randomized Crossover Trial in Healthy Men.

Background: Regular breakfast consumption is associated with better health status and healthier food intake throughout the day, but this association is a complex interaction of several factors. Objective: This study aimed to investigate the effect of nutritional and cognitive-perceived characteristics of breakfast on metabolic and behavioral variables related to food intake. Methods: The study was a randomized, crossover, controlled trial, with 4 experimental conditions consisting of 3 iso-energetic breakfasts and 1 energy-free control meal. Breakfasts had similar nutritional profiles but differed for glycemic index (GI), glycemic load (GL), and perceived healthiness, satiety, palatability, or energy content. Fifteen healthy normal-weight men [means ± SDs; age: 24 ± 2 y; body mass index (BMI; kg/m2) 23.4 ± 1.6] underwent each experimental condition in random order during 4 different weeks, separated by ≥1-wk washout. On the third day of each intervention week, postprandial blood variables (with insulin as primary outcome), satiety ratings, and food intake during an ad libitum lunch consumed 4 h after breakfast (secondary outcomes) were measured for each experimental condition. Results: A main effect of time, treatment, and time × treatment was found for postprandial insulin, glucose, and nonesterified fatty acids (P < 0.001 for all) after having the 3 iso-energetic breakfasts or the energy-free control one. Postprandial satiety was similar for the 3 energy-containing breakfasts, but higher when compared with the energy-free control (P < 0.001). No difference in energy intake was observed for the ad libitum lunch, whereas prolonged breakfast skipping was compensated by an increase (around +10%) in the average energy intake during the rest of the day, resulting in no differences in the total daily energy intake among the 4 conditions. Conclusions: Although other advantages might exist for breakfasts based on low-GI/low-GL foods, our findings support the hypothesis that minor differences in nutritional and perceived characteristics of breakfast are of limited importance regarding medium-term energy intake in healthy men. This trial was registered at clinicaltrials.gov as BRNN-014 NCT02516956.

Brief report: successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: an Italian multicenter study.

OBJECTIVE: To assess fetal and maternal outcomes in women with systemic sclerosis (SSc). METHODS: Prospectively collected data on 99 women with SSc from 25 Italian centers were analyzed retrospectively. Women with SSc were observed during 109 pregnancies (from 2000 to 2011), and outcomes were compared to those in the general obstetric population (total of 3,939 deliveries). The maternal age at conception was a mean ± SD 31.8 ± 5.3 years, and the median disease duration at conception was 60 months (range 2-193 months). RESULTS: SSc patients, compared to the general obstetric population, had a significantly increased frequency of preterm deliveries (25% versus 12%) and severe preterm deliveries (<34 weeks of gestation) (10% versus 5%), intrauterine growth restriction (6% versus 1%), and babies with very-low birth weight (5% versus 1%). Results of multivariable analysis showed that corticosteroid use was associated with preterm deliveries (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.12-11.78), whereas the use of folic acid (OR 0.30, 95% CI 0.10-0.91) and presence of anti-Scl-70 antibodies (OR 0.26, 95% CI 0.08-0.85) were protective. The disease remained stable in most SSc patients, but there were 4 cases of progression of disease within 1 year from delivery, all in anti-Scl-70 antibody-positive women, 3 of whom had a disease duration of <3 years. CONCLUSION: Women with SSc can have successful pregnancies, but they have a higher-than-normal risk of preterm delivery, intrauterine growth restriction, and babies with very-low birth weight. Progression of the disease during or after pregnancy is rare, but possible. High-risk multidisciplinary management should be standard for these patients, and pregnancy should be avoided in women with severe organ damage and postponed in women with SSc of recent onset, particularly if the patient is positive for anti-Scl-70 antibodies.

Bioavailability and metabolism of phenolic compounds from wholegrain wheat and aleurone-rich wheat bread.

SCOPE: This work aimed at investigating absorption, metabolism, and bioavailability of phenolic compounds after consumption of wholegrain bread or bread enriched with an aleurone fraction. METHODS AND RESULTS: Two commercially available breads were consumed by 15 participants on three occasions and matched for either the amount of ferulic acid in the bread or the amount of bread consumed. Urine was collected for 48 h from all the volunteers for phenolic metabolite quantification. Blood samples were collected for 24 h following bread consumption in five participants. A total of 12 and 4 phenolic metabolites were quantified in urine and plasma samples, respectively. Metabolites were sulfate and glucuronic acid conjugates of phenolic acids, and high concentrations of ferulic acid-4'-O-sulfate, dihydroferulic acid-4'-O-sulfate, and dihydroferulic acid-O-glucuronide were observed. The bioavailability of ferulic acid was significantly higher from the aleurone-enriched bread when all ferulic acid metabolites were accounted for. CONCLUSIONS: The study shows that low amounts of aleurone-enriched bread resulted in equivalent plasma levels of ferulic acid as wholegrain bread. This could suggest that, if the absorbed phenolic metabolites after wholegrain product intake exert health benefits, equal levels could be reached through the consumption of lower doses of refined products enriched in aleurone fraction.

[Celiac disease in the elderly: a case report]. / Malattia celiaca in età geriatrica: un caso clinico.

Celiac disease is not a negligible cause of malabsorption in the elderly. Diarrhea, loss of weight and abdominal discomfort are often absent so that celiac disease has indeed a subtle, paucisymptomatic, course in the elderly. More than 50% of the patients have extraintestinal symptoms; only 10-40% have typical complaints pointing to small-intestinal biopsy. Elimination of gluten from diet is the cornerstone of the therapy. A 73-year-old woman with hyporexia, loss of weight, depression, bowel abnormalities and progressive deterioration of her abilities in the instrumental activities of daily living was referred to our department. Antigliadin and antiendomysial antibodies were present. A subsequent small-intestinal biopsy of the second and third portion of duodenum showed subtotal villous atrophy, increase of intra-epithelial lymphocytes as well as hyperplastic glands (type III Marsh score). All these pathological findings were compatible with celiac disease diagnosis so that a gluten-free diet was then initiated.

[Angioedema: first manifestation of non-Hodgkin's lymphoma]. / Angioedema: prima manifestazione di linfoma non Hodgkin.

Angioedema can be hereditary or acquired. Hereditary angioedema is a genetic disease transmitted with an autosomal dominant mechanism. Acquired angioedema usually occurs after the second decade of life and is often related to an underlying disease. In a 48-year-old male patient a diagnosis of a non-Hodgkin lymphoma was made after two episodes of angioedema. No previously documented cases of angioedema in his family were reported; physical examination and routine blood samples were normal whereas the serum levels of C1-esterase inhibitor were reduced. Three months later he presented with epigastric pain after meals and weight loss. Abdominal ultrasonography and computed tomography showed two solid splenic masses infiltrating the greater curvature of the stomach and a 2 cm aortic lymph node. Digestive endoscopy confirmed the neoplastic infiltration. A diagnosis of anaplastic large-cells lymphoma CD30+, anaplastic lymphoma kinase negative was made. The disappearance of the neoplastic gastric infiltration and the decrease in size of the aortic lymph node and splenic mass were achieved after chemotherapy. Serum levels of C1-esterase inhibitor returned to normal. An adult onset not associated with a family history of angioedema should lead the physician to suspect the presence of a major disease.

Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages.

OBJECTIVE: To evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. METHOD: Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. RESULTS: Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. CONCLUSION: Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.

Adverse outcomes in older hospitalized patients: the role of multidimensional geriatric assessment.

BACKGROUND AND AIMS: This study was carried out to detect the incidence of adverse outcomes in hospitalized older patients and the role of multidimensional assessment in identifying predictors of adverse outcomes, which include in-hospital mortality and the need for admission to rehabilitation units or nursing homes after hospital discharge. METHODS: 923 patients at least 65 years old (mean age 78.7 +/- 7.2, 49% women) admitted to the acute care geriatric ward of an internal medicine department were included in the study. On admission, each patient underwent a comprehensive medical, functional, neuropsychological, sociodemographic and nutritional assessment. RESULTS: Incidence of mortality and other adverse outcomes was 6 and 16%, respectively. In-hospital mortality was independently predicted by older age (OR per year: 1.07, 95% CI: 1.02-1.12), male gender (OR: 3.97, 1.99-7.95), higher comorbidity (OR: 2.09, 1.01-4.33), higher heart rate (OR: 2.87, 1.30-6.35), lower systolic blood pressure (OR: 2.22, 1.03-4.81), lower serum albumin values (OR: 3.20, 1.63-6.29) and a lower MMSE score at hospital admission (OR: 5.51, 2.34-12.9). Adverse outcomes were independently predicted by older age (OR per year: 1.03, 1.01-1.06), higher comorbidity (OR: 2.00, 1.35-2.94), lower serum albumin values (OR: 2.57, 1.69-3.90) and a lower admission MMSE score (OR: 2.49, 1.68-3.71). CONCLUSIONS: A multidimensional geriatric assessment should be comprised of simple parameters available early, like serum albumin and MMSE score, that are predictive of adverse outcomes in older hospitalized patients, along with other health Indicators (comorbidity, heart rate and blood pressure).