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Abstract Background The hypothesis underlying this work is that the social network of a child might have an impact on the alimentary behaviors, in particular for what concerns snack consumption patterns. Methods 1215 Italian children 6-10 ys old were interviewed using a CATI facility in January 2010. 608 "snackers" and 607 "no-snackers" were identified. Information regarding family composition, child and relatives BMI, mother perception of child weight, child, father and mother physical activity, TV watching, social network, leisure time habits and dietary habits of peers, were collected. Association of variables with the status of snacker was investigated using a multivariable logistic regression model. Results Snackers children seem to be part of more numerous social network (1.40 friends vs 1.14, p = 0.042) where the majority of peers are also eating snacks, this percentage being significantly higher (89.5 vs 76.3, p < 0.001) than in the "no-snacker" group. The snacking group is identified by the fact that it tends to practice at least 4 hours per week of physical activity (OR: 1.36, CI: 1.03-1.9). No evidence of an association between snacking consumption and overweight status has been shown by our study. Conclusions The snacking child has more active peer-to-peer social relationships, mostly related with sport activities. However, spending leisure time in sportive activities implies being part of a social environment which is definitely a positive one from the point of view of obesity control, and indeed, no increase of overweight/obesity is seen in relation to snack consumption.

Introduction: There is evidence, although limited, that the Italian population has been no longer following a Mediterranean dietary pattern. The ARIANNA (Adherence to the Mediterranean Diet in Italy) project consists of a survey-based cross-sectional study with the objective of gaining a greater knowledge of adherence to the Mediterranean Diet and its main determinants in different age groups of the Italian population., Methods/analysis: The ARIANNA study will involve males and females aged ≥7 years, born and resident in Italy, and proficient in Italian. The voluntary enrolment will be in the period between March 2023 and May 2023. The data, which will include sociodemographic factors and dietary habits, will be collected through a web-based questionnaire. Adherence to the Mediterranean Diet will be assessed through the use of two validated score systems: the Mediterranean Diet Quality Index in children and adolescents for participants aged ≤16 years and the Mediterranean Diet Serving Score for participants aged ≥17 years. A review of the scientific literature will be carried out to collect historical data on adherence to the Mediterranean dietary pattern in the Italian population, which will be compared with those collected within this project., Ethics and Dissemination: The ARIANNA study has been approved by the Ethics Committee of Istituto Superiore di Sanità. The results will be disseminated through peer-reviewed papers, leaflets and documents for the general public. A report will be presented to the national policy makers, to give them the tools to implement appropriate intervention to improve, in necessary, the adherence to Mediterranean dietary pattern in Italy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The present work aims to present the results of the ' PRESTOinsieme ' (which is ' we will be together soon ' in English). The web-based survey (www.prestoinsieme.com) describes changes in lifestyle habits and symptoms of psychological discomfort in the Italian population during the COVID-19 lockdown., Design: Cross-sectional online survey disseminated by messaging apps (ie, WhatsApp and Telegram) and social networks (ie, Instagram, Facebook and LinkedIn)., Setting: Italy., Participants: Italian population older than 16 years of age., Exposure: COVID-19 lockdown., Main Outcomes and Measures: Survey respondents filled out a set of validated questionnaires aimed at assessing lifestyle habits and psychological health, that is, the General Health Questionnaire (GHQ-12) to screen for psychological distress, the Impact of Event Scale-Revised (IES-R) to screen for post-traumatic stress and the Center for Epidemiologic Studies Depression Scale (CES-D)., Results: Survey respondents totalled 5008. Moderate or severe psychological distress was reported in 25.5% and 22% of survey respondents, respectively. Lower age, female gender, being unemployed (OR 1.57, 95% CI 1.22 to 2.02) or being a student (OR 1.73, 95% CI 1.31 to 2.28) were predictors of more severe depressive symptoms., Conclusions: The present study is one of the largest population-based surveys conducted in Italy during the first COVID-19 lockdown, providing valuable data about the Italian population's psychological health. Further studies should be conducted to understand whether psychological distress persists after the end of the lockdown., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Nutrition is emerging as a key factor in promoting healthy lifestyles in the growing elderly population across Europe. In this study, we examined the non-animal-derived food source consumption among the elderly European population to evaluate the actual contributions of these foods to the diet of the elders. We gathered 21 studies conducted in 17 European countries to evaluate the fruit, vegetable, and legume (along with their derived products) consumption among the elderly (>65 years) population. Foods' nutritional values were calculated and compared to the recommended intakes. A Bayesian multilevel hierarchical analysis was conducted to estimate the caloric intake of food categories and to compare the elderly and general adult populations. Although the lowest consumption was generally associated with the lowest nutrient and fiber intake, the reverse was not always the case. Concerning the general adult population, no differences in the related caloric intake of elders were noticed. Differences were instead evident when foods were divided into subclasses. Elderly populations consume fruit and fruit products, but they drink less fruit and vegetable juices and nectars. In conclusion, elderlies' fruit and vegetable consumption showed a peculiar pattern with respect to the general adult population, whose recognition could be helpful to address tailored policies. Constantly updated studies, including all the lifespan ages, are warranted to design tailored effective public health interventions.

Objectives: Several methodological problems arise when health outcomes and resource utilization are collected at different sites. To avoid misleading conclusions in multi-center economic evaluations the center effect needs to be taken into adequate consideration. The aim of this article is to compare several models, which make use of a different amount of information about the enrolling center., Methods: To model the association of total medical costs with the levels of two sets of covariates, one at patient and one at center level, we considered four statistical models, based on the Gamma model in the class of the Generalized Linear Models with a log link, which use different amount of information on the enrolling centers. Models were applied to Cost of Strategies after Myocardial Infarction data, an international randomized trial on costs of uncomplicated acute myocardial infarction (AMI)., Results: The simple center effect adjustment based on a single random effect results in a more conservative estimation of the parameters as compared with approaches which make use of deeper information on the centers characteristics., Conclusions: This study shows, with reference to a real multicenter trial, that center information cannot be neglected and should be collected and inserted in the analysis, better in combination with one or more random effect, taking into account in this way also the heterogeneity among centers because of unobserved centers characteristics.

Unlabelled: Patients affected by heart failure have a compromised quality of life (QOL) and in the last few years "health related quality of life" has become an important outcome indicator for the evaluation of heart failure treatment., Methods: Translation into Italian of the Left Ventricular Dysfunction Questionnaire (LVD-36), a new, 36-item, disease-specific health status instrument for patients with congestive heart failure, and its subsequent validation by administration to 50 consecutive patients in our heart failure outpatient clinic. The Italian LVD-36 was compared to the "The Minnesota Living with Heart Failure Questionnaire" (MLHF)., Results: The Italian version of the LVD-36 correlates well with MLHF for ejection fraction (EF), NYHA class I and II, etiology and therapy. Since, however, the LVD-36 has only one domain, it may be able to offer more synthetic information than MLHF about patients' status., Conclusions: The Italian version of the LVD-36 appears to be a reliable instrument for assessing patients' QOL and the degree of limitations imposed on them by the disease. It is short, clear and easy to complete. In patients with heart failure the LVD-36 correlates well with the MLHF and may be considered a new disease-specific instrument to estimate changes in health status, and an useful support in optimizing therapeutic options.