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Background: An adequate vitamin intake is essential for a good nutritional status, especially in older women, who are more sensitive to nutritional deficiencies. The American, European and Italian Recommended Dietary Allowances (RDAs) derive mainly from studies on adults, and it is not clear whether they also apply to elderly people. Comparing the RDAs with the actual vitamin intake of a group of healthy older women could help to clarify the real needs of elderly people., Objective: Our aim was to compare the American, European, and Italian RDAs with the actual vitamin intake of a group of healthy older women., Design: This was a cross-sectional study., Participants: The study included 286 healthy women aged older than 65 years., Main Outcome Measures: For each micronutrient, the 50th percentile of the distribution of its intake was considered as the average requirement, and the corresponding calculated RDA for our sample was the average requirement×1.2, as recommended by the US Food and Nutrition Board. This calculated RDA was then compared with the American, European, and Italian RDAs., Statistical Analyses Performed: Student's t test or the Mann-Whitney test (after checking the normal distribution of the micronutrient) for continuous variables; the χ(2) test for categorical variables., Results: The calculated RDA were 2,230 μg retinol equivalents for vitamin A, 2.8 μg for vitamin B-12, 0.9 mg for thiamin, 1.4 mg for riboflavin, 3.6 mg for pantothenic acid, 1.4 mg for vitamin B-6, 320 μg for folic acid, and 115 mg for vitamin C., Conclusions: Our findings suggest that the current RDAs are adequate for older women's intake of riboflavin, vitamin B-6, and folic acid, but should be raised for vitamin B-12 and for vitamin C., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Aim: Aim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs)., Data Synthesis: The disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The localization of lipomatous masses suggests that MSL lipomas could originate from brown adipose tissue (BAT). Moreover, studies on cultured pre-adipocytes demonstrate that these cells synthetize the mitochondrial inner membrane protein UCP-1, the selective marker of BAT. Surgical removal of lipomatous tissue is to date the only validated therapeutic approach., Conclusions: MSL is supposed to be the result of a disorder of the proliferation and differentiation of human BAT cells., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: To identify the mean values and percentiles for ASMM (appendicular skeletal muscle mass) and the prevalence of sarcopenia, in terms of muscle mass reduction, using different cutoffs in a European population., Design: A retrospective analysis on the dataset from a multicenter study on apparently healthy Italian adults conducted between 1999 and 2002. A significant muscle mass loss, necessary to diagnose sarcopenia, was defined in 3 different ways: (1) by subtracting 2 SDs from the mean ASMM index (ASMMI) of a young adult population (20-39 year-olds), as in the Rosetta study and the NHANES survey; (2) by calculating the 15th percentile of the distribution of our young population, corresponding to about 1 SD below the mean ASMMI; (3) by calculating the 20th percentile of the distribution of the ASMMI (as in the Health ABC study) of an elderly population., Setting: Five centers for the diagnosis and treatment of osteoporosis in various parts of the country (Padova, Verona, Parma, Roma, Napoli)., Participants: Participants were 1535 volunteers (1208 women and 327 men) aged 20 to 80 years, drawn from among staff members, university students, lay people contacted by word of mouth, and patients presenting spontaneously for osteoporosis screening., Measurements: Body weight and height were measured for all participants. Body composition was assessed by DEXA, and the ASMMI was calculated as the ASMM divided by body height in meters squared., Results: Both men's and women's lean mass in the arms and ASMM were highest in the young group and became lower in older age. In men, the ASMMI dropped gradually from age 20 to 29 to age 60 to 69, then remained stable in the oldest group. In women, the ASMMI gradually increased from age 20 to 29 to age 60 to 69, then dropped among the 70- to 80-year-olds. Based on the 15th percentile of the ASMMI for our young adult reference population, the cutoffs for sarcopenia were 7.59 kg/m(2) in men and 5.47 kg/m(2) in women; if the 20th percentile of the ASMMI in our elderly subjects (>65 years) was considered, the cutoffs were 7.64 kg/m(2) in men and 5.78 kg/m(2) in women. Applying the different diagnostic criteria to the those older than 65, the prevalence of sarcopenia ranged from 0% to about 20% in both genders., Conclusion: The 15th percentile (or 1 SD below the mean) of the ASMMI of our young adults, and the 20th percentile of this index for an elderly reference population proved more effective in identifying cases of sarcopenia than subtracting 2 SD from the mean ASMMI of a young adult population., (Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Background & Aims: To establish reference values for limb composition, fat-free mass (FFM) and fat mass (FM) in Italian adults for gender-specific age brackets 20-80 years old and to assess age-related regional changes in body composition., Methods: A multicenter, retrospective study was conducted on 1571 healthy subjects, 1240 women and 331 men. Regional FFM and FM were measured by dual-energy X-ray absorptiometry. FM was expressed as % of limb weight., Results: FFM in men diminished with age in both arms and legs, with reference ranges (25th -75th percentile) of 3.8-4.6 kg and 10.4-12.2 kg, respectively for 20-29 year-olds, and 3.1-3.9 kg and 8.2-10.4 kg for 70-79 year-olds. Women's arm FFM remained stable with aging (reference values 1.7-2.2 kg), decreasing in their legs (6.2-7.2 kg for 20-29 year-olds, 5.5-6.5 kg for 70-79 year-olds). Limb FM% increased with age in both genders: the reference values were 9-15% (arms) and 12-21% (legs) for 20-29 year-old men, and 19-26% and 19-29%, respectively, for 70-79 year-olds; for women's arms, they were 25-36% for 20-29 year-olds and 36-48% for 70-79 year-olds, while their leg FM remained the same with aging, i.e. 32-40%., Conclusions: These data complete the published reference values for whole body composition, enabling physiological or pathological changes in limb composition to be identified in Caucasian populations living in the Mediterranean area., (Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Maximal VO2 (VO2max) and metabolic equivalents (METs) decline with aging due to body composition and cardiovascular modifications. However, a detailed evaluation of these variables for this population has not been done. The aim of this study was to evaluate VO2max and METs in healthy elderly women, and to establish whether the calculated resting VO2 (3.5 ml/min/kg) underestimates the true METs., Methods: 81 females over 65 years old attending a twice-weekly mild fitness program were studied. Body composition was measured by DEXA. VO2max and resting VO2 (VO(2rest-meas)) were measured by indirect calorimetry. METs were measured (METs-meas) using the VO2max/VO(2rest-meas) ratio, and calculated (METs-cal) from the ratio between measured VO2max and calculated resting VO2 (3.5 ml/min/kg of body weight)., Results: The VO(2rest-meas) and VO2max measured by indirect calorimetry were 2.9+/-0.4 ml/min/kg and 17.5+/-2.8 ml/min/kg, respectively. The METs-meas were higher than the METs-cal (6.1+/-1.2 vs 5.0+/-0.8; p<0.001). The 25th-75th percentile range of measured METs was 5.2-6.8., Conclusions: Our study confirmed that, in elderly women, METs values ranging between 5 and 7 are compatible with an acceptable physical activity. The estimated resting VO2 (3.5 ml/min/kg) does not appear to be applicable to elderly women, because it underestimates the real METs in this population., (Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: To establish reference values for fat-free mass (FFM), the FFM index (FFMI), fat mass (FM) and the FM index (FMI) in an Italian adult population, developing percentile distribution curves for age brackets between 20 and 80 years., Methods: A multicenter, retrospective study was conducted on a sample of 1866 healthy Italian adults, 1435 females and 431 males. FFM and FM were measured by dual-energy X-ray absorptiometry. FFMI and FMI were calculated as the ratio of FFM and FM to height squared., Results: The reference range for the FFMI (25-75th percentile) was similar in all age groups, i.e. 18.7-21 kg/m(2) in men and 14.9-17.2 kg/m(2) in women. In both genders, FM, the FMI and FM as a percentage of body weight (FM%) increased with age. The reference values for FM% in the two age brackets 20-29 and 60-69 were, respectively, 13-20% and 22.5-29.3% for men and 26.1-34.9%, 32.5-39.6% for women., Conclusions: These body composition ranges can be used by clinicians and nutritionists as reference values for a Caucasian population in the Mediterranean area when evaluating body composition variations occurring in aging, malnutrition and chronic diseases.

Study Objective: Our study investigates nutritional status, resting energy expenditure (REE) and physical performance in elderly patients with stable COPD to identify any early conditions of hypermetabolism, malnutrition and sarcopenia., Methods: Eighty-six males (40 stable COPD and 46 healthy subjects) over 65 years old were studied. All subjects underwent spirometry, blood gas analysis and a 6-min walking test (6MWT). Fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM) were measured by dual energy X-ray absorptiometry (DEXA). REE was measured by indirect calorimetry., Results: COPD patients had a lower FFM both expressed in kilograms and after correction for height squared. The prevalence of sarcopenia was higher for COPD subjects (38% vs 31%). REE, both in absolute values and adjusted for FFM was significantly higher in COPD patients. Hypermetabolism was found in 60% of COPD cases and 13.7% (P<0.01) of healthy subjects. No relationship was found in COPD patients between the measured/predicted REE ratio (REE(m)/REE(p)) and FEV1. In the hypermetabolic COPD subgroup, the REE(m)/REE(p) ratio correlated with 6MWT., Conclusions: Elderly patients with stable COPD develop an increased REE. This hypermetabolism seems to be independent of the severity of the pulmonary obstruction and to influence the patient's physical performance.

Study Objectives: In obese patients, obstructive sleep apnea syndrome (OSAS) is attributed to a reduction in pharyngeal cross-sectional area due to peripharyngeal fat deposition. The effect of weight loss on the size of the upper airways of obese subjects is still unknown. We analyzed the pharyngeal cross-sectional area before and after weight loss in morbidly obese patients with OSAS., Design, Setting, and Subjects: A group of 17 middle-aged, morbidly obese men was evaluated by anthropometry and cardiorespiratory sleep studies before and after weight loss obtained by insertion of an intragastric balloon. The pharyngeal cross-sectional area was measured by acoustic pharyngometry., Results: The mean (+/- SD) body mass index was 55.8 +/- 9.9 kg/m2 at baseline and 48.6 +/- 11.2 kg/m2 at the time of balloon removal (6 months after insertion) [p < 0.001]. At baseline, patients had visceral obesity, large necks, and severe OSAS. Weight loss was associated with a significant mean reduction of waist circumference (156.4 +/- 17.6 vs 136.7 +/- 18.4 cm, respectively; p < 0.001), sagittal abdominal diameter (37.8 +/- 3.0 vs 32.3 +/- 4.0 cm, respectively; p < 0.001), and neck circumference (51.1 +/- 3.7 vs 47.9 +/- 4.3 cm, respectively; p < 0.001). Moreover, weight loss induced a nearly complete resolution of OSAS (apnea-hypopnea index, 52.1 +/- 14.9 vs 14.0 +/- 12.4 events/h, respectively; p < 0.001). At baseline, obese patients had significantly lower pharyngeal cross-sectional areas compared to a group of 20 nonobese male control subjects, both in the upright and supine position, at different levels of the pharynx. In obese patients, the weight loss induced by the positioning of the intragastric balloon was associated with an increase in the size of the upper airway passage. After weight loss, both the mean pharyngeal cross-sectional area and the area at glottis level were still lower in obese subjects than in nonobese subjects; however, the pharyngeal cross-sectional area at the oropharyngeal junction was similar in the two groups., Conclusions: Morbidly obese men with OSAS have a reduced pharyngeal cross-sectional area. A weight reduction of about 15% of baseline body weight may substantially increase the pharyngeal cross-sectional area and substantially improve the severity of OSAS in morbidly obese subjects with sleep apnea.

Aims: The aim of the present study was to investigate possible alterations in body composition and resting energy expenditure (REE) in type 1 multiple symmetric lipomatosis (MSL)., Subjects and Methods: Thirteen men aged from 40 to 78 years affected by type I MSL were compared with 13 healthy control subjects. Fat mass (FM) and fat-free mass (FFM) were determined by DEXA using both standard analysis and specifically for the lipomatous region. REE was measured by indirect calorimetry., Results: FM was higher in MSL subjects at proximal arm level, but significantly lower at distal leg level than in controls (left 1.63+/-0.55 vs. 2.26+/-0.49 kg, P<0.05; right 1.63+/-0.53 vs. 2.40+/-0.54 kg, P<0.01). Arm FFM was similar in the two groups, while distal leg FFM was significantly lower in MSL cases (left: 7.8+/-1.3 vs. 8.7+/-0.8 kg, P<0.05; right: 8.0+/-1.5 vs. 9.2+/-0.9 kg, P<0.05). FFM strongly correlated with REE (r:0.86;P<0.001). REE, expressed as an absolute value and adjusted for FFM (1830+/-215 vs. 1675+/-120 kcal, P<0.05) was higher in MSL patients., Conclusion: In conclusion, MSL patients had a marked FFM and FM atrophy in the lower segments of the legs and an altered energy expenditure (hypermetabolism).

Background and Aims: In underweight elderly subjects it is important to estimate body composition and particularly fat-free mass (FFM). Bioelectrical impedance analysis (BIA) is a non-invasive method in determining FFM, but its usefulness in these frail subjects should be verified. The aim of this study is to verify in underweight elderly people the reliability of previously published BIA formulas in detecting FFM., Methods: Fifty-seven hospitalized elderly subjects (27 males and 30 females) with body mass index <20 kg/m(2) were selected. In all subjects, FFM was detected by dual energy X-ray absorptiometry. Moreover, BIA measurements were performed at standard frequency (50 kHz and 800 microA) and FFM was derived using the main previous published BIA equations., Results: In men, Kyle and Rising equations gave acceptable estimates of FFM with a mean error, respectively, of 1+/-1.9 and 1.4+/-1.7 kg. Also RJL formula could be used after adjusting for a correction factor. In women, no equation seemed sufficiently reliable to estimate FFM., Conclusions: BIA method seems useful to evaluate body composition in underweight elderly men but it seems to have intrinsic limits in women. Nevertheless, the variability in behavior of the different equations suggests to be careful in adopting BIA equations.

Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and disability. Many studies have investigated factors influencing quality of life (QoL) in middle-aged COPD sufferers, but little attention has been given to elderly COPD. The aim of the present study was to investigate the impact of COPD on QoL and functional status in the elderly. Sixty COPD patients and 58 healthy controls over 65 years old were administered Pulmonary Function Tests, 6 min Walking Test (6MWD) for exercise tolerance, the Barthel Index and Mini Mental State Examination (MMSE) for functional status, the Geriatric Depression Scale (GDS) for mood, and the Saint George Respiratory Questionnaire (SGRQ) for QoL. FEV1 and PaO2 were reduced in COPD patients. Also the distance walked during 6MWD was significantly shorter for patients than controls (282.5 +/- 89.5 vs. 332.9 +/- 95.2 m; P < 0.01). Moreover, COPD patients had significantly worse outcomes for the Barthel Index, GDS and SGRQ. The logistic regression model demonstrated that a decrease in FEV1 is the factor most strictly related to the deterioration of QoL in COPD patients. Mood was also an independent factor influencing QoL. In conclusion, elderly COPD patients show a substantial impairment in QoL depending on the severity of airway obstruction; symptoms related to the disease may be exaggerated by mood deflection.

Body fat mass (BFM), skinfold thickness (ST), and fat cell weight (FCW) have been studied in 86 newborn infants with different maturity and different intrauterine growth, and in parabiotic twins. Preterm infants (35.5 +/- 0.4 wk) with body weight appropriate for gestational age had lower values of BFM and sum of ST as compared to the control group, without differences in FCW (0.23 +/- 0.03 versus 0.22 +/- 0.02 micrograms). In infants born between 30 and 41 wk of gestation with body weights at birth appropriate for gestational age, ST and BFM progressively increase with gestational age, while the FCW remains constant. These observations suggest that fat mass growth in the last 2 months of fetal life, essentially depends on fat cell replication. In full-term large-for-date babies, bFM resulted significantly greater than in controls both in absolute values (p less than 0.001) and in percentage values of total body weight (p less than 0.001). The FCW in large for date newborns resulted significantly greater than in controls (0.50 +/- 0.06 versus 0.22 +/- 0.2 micrograms, p less than 0.001). In full-term small-for-date newborns BFM, ST, and FCW resulted significantly lower than in controls (p less than 0.001). In full-term newborns with different body weight at birth, fat cell weight was correlated to BFM (r = 0.67; p less than 0.01), to BFM as percentage of body weight (r = 0.67; p less than 0.001) and to ST (r = 0.73; p less than 0.001). In three couples of identical parabiotic twins, the larger baby of every pair showed even greater values of BFM, ST, and FCW and fat cell weight than the respective sibling. These observations suggest that in newborns with different intrauterine growth, a different triglyceride content in single adipocytes largely explains the variations in fat mass development.