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Sarcopenia, the key point of frailty syndrome, leads to decreased physical activity, with important consequences upon the quality of life in elderly. The prevalence of sarcopenia is still uncertain because of the lack of homogeneity of the studied populations, and also because of the variety of techniques. The development of biological markers that can be used in a cost effective manner to guide diagnosis and facilitate monitoring patients with sarcopenia, would mark an important step in managing the care of geriatric patients. Nutrition combined with physical activity is the key component of the management of sarcopenia, with a synergistic effect that helps combat malnutrition and improve the quality of life.

Vitamin D (VitD), a lipid-soluble hormone, is able to regulate the transcription of many genes through vitamin D receptor (vitD receptor-VDR). It has been shown that VitD deficiency is associated with obesity, characterized by a low degree inflammatory state, which contribute to the pathogeny of metabolic syndrome and type 2 diabetes mellitus. VitD deficiency is a public health problem, at the same time the global prevalence of obesity and cardiovascular diseases is continuously growing. Evidence from recent studies on animal models suggest that VitD or VDR deficiency promotes cardiomyocyte hypertrophy, which can be one of the mechanisms for increasing cardiovascular risk. The heart is one of the target organs of action for VitD, because VDR is expressed in cardiomyocytes. Also, previous in vitro studies have shown that VitD is able to inhibit the production of monocyte chemotactic factors (MCP-1) and other pro-inflammatory mediators in human preadipocytes and mature adipocytes. Inflammation is an important factor in the pathogenesis of atherosclerosis. In obesity there are not known data about correlations between plasma levels of VitD and VDR expression in the subcutaneous fat tissue, epicardial visceral adipose tissue, and in particular in myocardium. Also, there are still no studies to test VDR expression in myocardial cells and to investigate the results of dietary VitD supplementation on the expression of VDR in the epicardial adipose tissue and myocardium.

Childhood obesity is a global epidemic with long term implications. The main cause of obesity is an increase in calorie intake and a decrease in physical activity, but also there is clear evidence suggesting a link between the duration and quality of sleep and obesity risk. Good sleep habits are involved in increased ability to concentrate at school, improvement of general state, immune system development, increased quality of life. On the other hand, there are several mechanisms by which chronic sleep deprivation induces weight gain: disturbance of hormones that control hunger center, increased time for meals, reduced physical activity, metabolic changes. Recently, nighttime sleep duration has declined, in contrast with the increasing prevalence of obesity. Childhood sleep habits have a long term effect on weight, with repercussions even into adulthood. This is the reason why there is increasing interest to include sleep quality on the list for childhood obesity prevention. Sleep represents an important and independent risk factor of obesity in children and adolescents and it should be taken into consideration in the management of obesity.

Obesity is a medical and social problem with a dramatically increasing prevalence. It is important to take action since childhood to prevent and treat obesity and metabolic syndrome. Infantile obesity affects all body systems starting in childhood and continuing to adulthood. Understanding the impact of stressors on weight status may be especially important for preventing obesity. The relationship between stress, eating behavior and obesity is not fully understood. However, there is evidence that stress causes disorders in hypothalamic-pituitary-adrenal (HPA) axis, system that regulates both stress and feeding responses. Also, the response is different depending on the type of stressors. Chronic stress, especially when people live in a palatable food environment, induces HPA stimulation, excess glucocorticoids, insulin resistance, which lead to inhibition of lipid mobilization, accumulation of triglyceride and retention of abdominal fat.

Unlabelled: We present a 77-year-old woman with no histor of trauma, or associated with low-energy trauma, admitted to our clinic after three weeks of a left femoral fracture threated in Orthopedic Clinic. The patient was in treatment with bisphosphonates over 10 years for osteoporosis., Discussion and Conclusions: The causal re lationship between prolonged bisphosphonate use and the occurrence of atypical femora fractures (AFF) has not yet been established. For the patient at high risk of fracture, it may be beneficial to continue bisphosphonate treatment beyond five years. The absolute risk of atypical femoral fractures is low (about 100 cases per 100,000 person-years among long term users). For most people with osteoporosis, the proven fragility-fracture risk-reduction. benefits of bisphosphonates outweigh the risks of AFF.

Vitamin D is important for good health, growth and strong bones. Vitamin D is mostly made in the skin by exposure to sunlight. Most foods contain very little vitamin D naturally, though some are fortified with added vitamin D. Hypovitaminosis D is associated with cardiovascular disease, the metabolic syndrome, type 2 diabetes mellitus, cancer as well as with increased mortality. Further, Vitamin D deficiency is related to depression and impaired cognitive function. Increasing age and elevated body fat mass contribute to an increased risk of Vitamin D deficiency. A mild lack of vitamin D may not cause symptoms but can cause tiredness and general aches and pains. A more severe lack can cause s rious problems such as rickets (in children) and osteomalacia in adults). During menopause, the decline of estrogens results in increased bone turnover, a decrease in bone mineral density and elevated fracture risk. Treatment is with vitamin D supplements. Some people are more at risk of vitamin D deficiency, and so are recommended to take vitamin D supplements routinely. These include all pregnant and breastfeeding women, all infants (babies) and young children aged 6 months to 5 years, people aged 65 and over, and people who are not exposed to much sun. There are precise recommendations regarding a sufficient Vitamin D intake in order to prevent bone loss in peri- and postmenopausal women. It is also recommend routine supplements for certain people with darker skin, and for people with certain gut, liver or kidney diseases.

A current area of interest is the determination of factors able to promote the transition from muscle to adipose tissue. The current review has highlighted that treatment of myoblasts with fatty acids (especially oleic acid) and thiazolidindiones causes conversion to adipocytes. The molecular mechanisms mediating the adipogenic action of thiazolidinediones and fatty acids in myoblasts could involve peroxisome proliferators-activated receptor-gamma (PPARgamma and CCAAT-enhancer-binding protein C/EBP. The role of 1,25-D3 in adipogenesis is mediated at the molecular level through VDR-dependent inhibition of C/EBP and PPARgamma expression and a decrease in PPARgamma transactivation activity. Vitamin D supplementation increases muscle strength and ultimately reduces the incidence of falls. Additional research is needed to fully clarify the role of nutritional factors in adipogenesis.

There has been a continuous effort to understand possible non-Ca metabolism roles of vitamin D, including its role in the immune system and, in particular, in T cell-medicated immunity. Vitamin D receptor is found in significant concentrations in the T lymphocyte and macrophage populations, when we refer to immune system, and pretty much in any human tissue and cells. Until the eighties, no one had imagined that vitamin D might play a role in the functioning of the immune system. Today we accepted that the normal immune system harbors a regulatory T cell (Treg) population specialized for immune suppression. Currently, the most commonly known regulatory T-cell lineage is called CD4+ CD25high FoxP3+ regulatory T cells. Several autoimmune disorders have been linked to a deficiency in vitamin D3. In some autoimmune diseases, including multiple sclerosis (MS), a compromised Treg function is believed to be critically involved in the disease process. Vitamin D insufficiency has ramifications not only for bone health, but also in other non-skeletal areas of vitamin D function, such as immune cells, muscle cells and, perhaps, adipocytes. As a final conclusion, further researches in the field of vitamin D, Tregs, immunity (inflammatory processes, rejection, autoimmune diseases, etc.), either in vitro on cell cultures or in vivo using lab animals or volunteers are still necessary.

The migration of the medical staff represents an increasingly worring reason for romanian health policy-makers. According to the Ministry of Health, in 2009 year, the human resources indicators pointed out 26.5 physicians/ 10,000 inhabitants (whereas the European Union average was 32.8) and 60.4 nurses and midwives (whereas the European Union average was 108.5). Between 2007-2010, over 9000 physicians requested professional certificates in order to practice abroad and the majority have left the country. This phenomenon is related to the Romania's entrance in European Union and it is supposed to continue in the coming years. The direct consequences of the migration of the medical staff consist of significant differences between the country's regions in the health workforce distribution, the most affected by the critical shortage of health service providers being the North-Eastern region, especially in rural area. In order to limit the migration phenomenon, the Ministry of Health elaborated some strategies and workforce policies on medium and long-term, but the results will be difficult to assess.

Unlabelled: Omega-3 fatty acids are essential for human health, are crucial for the brain, body development and also in prevention of cardiovascular diseases., Material and Method: We used 60 male Wistar fats, weight 180 +/- 20 grams, divided into two study groups: normal control animals (M) and test animals (T) divided in groups I (N3-PUFA), II (ACC) and III (N3-PUFA and ACC). Administration of the substances was made for 36 weeks (nine months), after which the animals were evaluated and subsequently sacrificed for further biochemical analysis. As an evaluation method has been used multiple T maze labyrinth., Results: Group I recorded a time maze percentage decrease from -4.26% to -33.88%. In group II we recorded a decrease time maze percentage from -5.37% to -34.28%. During the experiment, group III recorded a decrease time maze percentage from -5.1% to -32.33% at the end of the experiment. The control group evolution for the maze recorded a decrease in time maze percentage, reaching 17-18% at the end of the experiment., Conclusion: By improving the diet with polyunsaturated fatty acids increased exponentially cognitive performance compared with normal diet, low in these acids.

Unlabelled: Previous results demonstrate that experimental diabetes mellitus is accompanied by increased oxidant stress within glomeruli. Evidence are emerging that dietary flaxseed supplementation can have beneficial effects on oxidative stress., Materials and Methods: Diabetes was induced by intraperitoneal injection of streptozotocin (STZ) in male Golden Syrian hamsters, and both diabetic and control groups were fed either standard diet, or standard diet supplemented with flaxseed (15 g/100 g diet), for 20 weeks. At the end of the study, blood samples and renal homogenates were used for determination of oxidative stress markers., Results: STZ-induced diabetes in hamsters substantially increased malondialdehyde levels along with corresponding decrease in the antioxidants levels. Supplementation of flaxseed resulted in the decrease in serum and renal homogenate malondialdehyde levels. The activities of antioxidant enzymes, total glutathione (tGSH) and superoxiddismutase (SOD) were also concomitantly raised to near normal levels by flaxseed supplementation diabetic hamsters., Conclusion: Dietary flaxseed supplementation in diabetes mellitus may have beneficial effects on diabetic nephropathy evolution by reducing the levels of oxidative stress and increasing the antioxidant defense systems.

Unlabelled: Endothelial dysfunction and atherogenesis involves a general alteration of unicellular layer of the vascular wall structure. Nutritional antioxidants can improve endothelial dysfunction through dietary supplementation with polyunsaturated fatty acids (PUFA N3 and lignans) from flaxseed. The mechanisms by which these nutritional antioxidants have beneficial effects on endothelial function are less known., Aim: The present study examined the effects of the flaxseed supplemented diet, a rich source in PUFA N3 and lignans on the ovariectomy-induced endothelial dysfunction and atherosclerosis., Material and Method: Forty-two ovariectomized and non-ovariectomized (control) female Wistar rats were used, each one divided in 3 subgroups depending on diet: standard, fat rich or flaxseed supplemented fat rich diet, for 36 weeks. The circulating soluble adhesion molecules of endothelial origin and von Willebrand factor (sVCAM-1, vWF), were measured to assess the endothelial dysfunction., Results: Presence of endothelial dysfunction in ovariectomized animals fed with standard diet associated with a rich PUFA N6 and saturated lipid was proven by the increased plasma concentration of sVCAM-1 and vWE Dietary supplementation with PUFA N3 and lignans (flaxseed) in these animals led to modest decreases of these parameters., Conclusion: The results indicate that dietary supplementation with antioxidant activity substances, in presence of estrogen deficiency, especially when it is associated with increased fat intake, may become a mean of prevention and delay of endothelial dysfunction, via anti-inflammatory actions through a reduction of sVCAM-1.

Unlabelled: Dental caries and restorations in proximal tooth surfaces often impinge upon the periodontal biological health.This study examines whether these factors may contribute to risk for alveolar bone loss., Methods: Approximal tooth surfaces of 96 teeth in 40 patients were evaluated on panoramic radiographs for alveolar bone loss, restorations and caries., Results: Higher values of alveolar bone loss were observed in molars and on the right side of patients. Where a caries/restorative event had occurred in the inter-proximal tooth surface bone loss at the corresponding teeth was approximately twice more than in the omologous non-treated tooth. Increased number of furcations was also observed in molars with caries/restorations., Conclusions: Site-specific periodontal bone loss due to dental caries or restorative events occurs in adults.

Aims: The bakery products fortifying is an option for vitamin D daily intake supplementation. Our study has proposed the evaluation of the community-based elderly compliance to the daily administration of vitamin D fortified bread., Material: A group of 33 subjects between 58 to 89 years of age (71 +/- 6.9 years) who were living in a nursing home for elderly people, from Iaşi, Romania. DIET: The patients have received daily 100 g bund enriched with 125 mg (5000 UI) D3 vitamin and with calcium carbonate (320 mg of elemental calcium) during 12 months., Method: We had used 22 items questioner for evaluation of the Vitamin D supplementation compliance to the daily administration of the vitamin D fortified bread at the institutionalized patients., Results: Patients compliance was very good, 75% of these eating daily the fortified buns, 18% one at two days and the rest of the patients two days in a week. 76% of the patients have consumed the entire bun, 9% of the patients 3/4, 12% of the patient half bun and 3 % of the patients a quarter bun. For 79% of the patients the taste of the bread was good and 21% has complained some deficiencies. By the declaration of the 60% of the patients, the general health status was better at the end of the study., Conclusion: Alimentary supplementation through vitamin D and calcium bread fortification is a practical possibility for prevention of the population vitamin D deficit.

Unlabelled: Vascular complications, such as atherosclerosis, represent an important cause of morbidity and mortality in diabetic patients. The aim of this study was to investigate the effects of dietary flaxseed supplementation, a rich source of lignans, a-linolenic acid and soluble fiber mucilage on serum and hepatic lipid concentrations in streptozotocin-induced diabetes in hamsters., Methods: Twenty-four male Golden Syrian hamsters were used in this experiment; diabetes was induced in half of them by intraperitoneal injection of streptozotocin (50 mg/kg body weight), and both diabetic and control groups were divided in 2 subgroups, one fed standard diet, and one fed standard diet supplemented with flaxseed (15%), for 20 weeks. Serum total cholesterol (TC), HDL-cholesterol (HDL-C), triglycerides (TG), cholesterol/HDL-cholesterol ratio and hepatic cholesterol and triglycerides were measured at the end of the experiment., Results: Dietary flaxseed supplementation in diabetic hamsters was associated with significant reductions in serum TC (-24.9%), TC/HDL-C ratio (-60%) and increase in serum HDL-C (+91%) as compared to diabetic group without supplementation. There were no significant differences in serum TG levels between diabetes supplemented with flaxseed and diabetic groups. Also, flaxseed supplementation in diabetes induced significant reductions in hepatic cholesterol (-39.5%) and triglycerides levels (-28.8%)., Conclusions: These results suggest that dietary flaxseed supplementation may reduce the incidence of diabetic macrovascular complications through improvement of lipid profile.

The aim of our study was to assess the platelet aggregation and adhesiveness in diabetic and non-diabetic hamsters receiving or not a diet supplemented with flaxseed (rich in'alpha-linolenic acid) and vitamin E. Forty-eight 6-month old male Golden Syrian hamsters were distributed in either control (non-diabetic) and diabetic group (STZ, 50 mg/kg body weight, i.p.). The control and diabetic groups received one of the following diets 1. control diet (rich in linoleic acid) ; 2. diet supplemented with flaxseed (15% flaxseed); 3. diet supplemented with flaxseed and vitamin E (40 mg/kg body weight); 4. diet supplemented with flaxseed and vitamin E. We measured platelet aggregation and adhesiveness after 20 weeks from the beginning of the experiment. In diabetic hamsters, only the diet supplemented with both flaxseed and vitamin E resulted in significant reduction of platelet aggregation (5.5 +/- 5.2 mOD/min vs. 10.3 +/- 3.8 mOD/min) and adhesiveness (9.7 +/- 3.9% vs. 23.4 +/- 10.6%) as compared to diabetic animals fed with control diet. In non-diabetic animals, flaxseed rich diet alone was efficient in lowering platelet functions as compared to linoleic acid rich diet. Mixed diet containing flaxseed and vitamin E was more effective than flaxseed alone in modulating platelet functions in diabetic hamsters. These observations indicate that vitamin E exerts important effects on determinants of oxidation and platelet functions and potentiates the flaxseed effects in experimental diabetes.

Malnutrition is known to induce a state of immunodeficiency and a predisposition to death from infectious diseases. During fasting or starvation, it appears that oxidative stress is decreased. The goal of our study was to assess the interrelation between nutritional factors, oxidative stress and immune response. The malondialdehyde (MDA)-marker of lipid peroxidation, white blood cell count, differential count and hormonal status (FSH, LH, and cortisol) were followed in eumenorrheic underweight patients. MDA was significantly lower and lymphocyte count was significantly increased in eumenorrheic underweight patients as compared to normal weight patients. Gonadal and adrenal axes were found normal in eumenorrheic underweight patients. Body mass index was positively correlated with MDA and negatively correlated with lymphocyte count. Low levels of lipid peroxidation and non-suppressed immune function in underweight patients may be explained by an increased sensitivity to leptin but further studies are requested.

Unlabelled: The aim of this study was to investigate the effect of daily consumption of dietary flaxseed (as a source of linolenic acid, LNA) on plasma lipid concentrations in mildly hyperlipidemic patients., Methods: 40 hyperlipidemic patients with plasma total cholesterol greater than 240 mg/dL were distributed in 3 groups: 10 patients who received hypo-lipidic diet (diet group), 10 patients who received hypo-lipidic diet plus statins (diet+HL group), 20 patients who received hypo-lipidic diet plus 20 g ground flax-seeds/day (diet+flax group). Body mass index (BMI), serum total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), triglycerides (TG) and cholesterol/HDL-cholesterol ratio were measured at the beginning and after 60 days of treatment., Results: Flaxseed supplementation was associated with significant reductions in TC (-17.2%), LDL-C (-3.9%), TG (-36.3%) and TC/HDL-C ratio (-33.5%). There were no significant differences in absolute change in BMI nor in percentage change in TC, HDL-C, LDL-C, TC/HDL-C ratio between flaxseed and statin groups., Conclusions: Dietary flaxseed significantly improves lipid profile in hyperlipidemic patients and may favorably modify cardiovascular risk factors.

Department of Pathophysiology, University of Medicine and Pharmacy, Iasi, Romania has a long tradition in studying the diabetes mellitus. The series of experimental studies in diabetes was open by Iulius Nitulescu. His work was focused on the carbohydrate metabolism, and the paper entitled "Sur le metabolisme du sucre chez les vieilliards. L'epreuve de l'hyperglycemie alimentaire" was published in 1933. Later, in 1965, Aurel Sneer introduced the experimental model of diabetes mellitus induced by the alloxan. In 1970, it was for the first time in the medical literature when the importance of lysosomal enzyme discharge was revealed in alloxan-induced diabetes. In the early 70s, the factors conditioning the carbohydrate homeostasis were studied. Starting with 1990, the research was directed to investigate the role of microelements, zinc and magnesium, in the pathogenesis of beta cells injury and chronic complications of diabetes mellitus. Since 1993, our studies have been focused on the role of oxidative stress in the pathogenesis of chronic complications of diabetes mellitus. The effects of exogenous antioxidants, probucol and vitamin E, on the carbohydrate and lipid metabolism, on the markers of oxidative stress, and on the platelet activity were investigated in alloxan-induced diabetes. More than 50 scientifical papers on experimental diabetes and four monographs were published in the last 40 years by the researchers of our department.