Search

Long-term enteral nutrition (LTEN) can induce gut microbiota (GM) dysbiosis and gastrointestinalrelated symptoms, such as constipation or diarrhoea. To date, the treatment of constipationis based on the use of laxatives and prebiotics. Only recently have probiotics and synbiotics beenconsidered, the latter modulating the GM and regulating intestinal functions. This randomized open-label intervention study evaluated the effects of synbiotic treatment on the GM profile, itsfunctional activity and on intestinal functions in long-term home EN (LTHEN) patients. TwentyLTHEN patients were recruited to take enteral formula plus one sachet/day of synbiotic (interventiongroup, IG) or enteral formula (control group, CG) for four months and evaluated for constipation, stool consistency, and GM and metabolite profiles. In IG patients, statistically significant reduction ofconstipation and increase of stool consistency were observed after four months (T1), compared toCG subjects. GM ecology analyses revealed a decrease in the microbial diversity of both IC and CGgroups. Biodiversity increased at T1 for 5/11 IG patients and Methanobrevibacter was identified asthe biomarker correlated to the richness increase. Moreover, the increase of short chain fatty acidsand the reduction of harmful molecules have been correlated to synbiotic administration. Synbioticsimprove constipation symptoms and influences Methanobrevibacter growth in LTHEN patients.

Background Non-alcoholic fatty liver disease (NAFLD) is a spectrum of pathologies characterized by liver damage without history of excessive alcohol intake. Advanced fibrosis, generally detected by transient elastography (TE), is the most significant predictor of poor prognosis and mortality among these patients. This study aimed at assessing the accuracy of five noninvasive methods, compared to TE, for the evaluation of severity of liver fibrosis in patients with NAFLD. Methods The cohort included 41 patients, in whom the result of TE was compared to AST/ALT ratio, BARD Score (Body Mass Index, AST/ALT ratio, diabetes), AST To Platelet Ratio Index (APRI), Fibrosis-4 Index (FIB-4 Index) and NAFLD Fibrosis Score (NFS). Results The severity of fibrosis, assessed by TE, was the following: F0 (absence of fibrosis): 17%, F1 (mild): 39%, F2 (moderate): 17%, F3 (advanced): 10%, F4 (cirrhosis): 17%. Performances of the diagnostic scores were: 49% for AST/ALT ratio, 68% for BARD Score, 73% for APRI, 59% and 71% for the lower and upper cut-off of FIB-4 Index, 61% and 76% for the lower and upper cut-off of NFS. Conclusions Considering the scores compared to TE, AST/ALT ratio was not enough sensitive, while BARD Score had better diagnostic performance and APRI had a superior accuracy than the formers. However, FIB-4 and NFS were the most useful tests and their performance could be improved through the use of a single cut-off. These findings demonstrated that the most accurate scores, compared to TE, were NFS and FIB-4.

The incidence of type 1 diabetes has increased over the last decades. The pathological pathway is not yet clear, even if genetic and environmental risk factors are known. An early diagnosis can avoid ketoacidosis and its complications. This work aims to discuss the determinants of both ketoacidosis at the onset and access by hospital emergency departments without a suspected diagnosis. An observational bi-centric prospective study was conducted in Northern Italy, on a paediatric population including Italian and migrant patients at the diabetes onset. Seventy-four type 1 diabetes patients, both Italian and migrant, were included in the study. Anthropometric, socio-economic, behavioural, clinical data were collected, and microbiota analyses were performed using stool samples. Regular physical activity is associated with lower ketoacidosis incidence at onset (OR 0.33 95% CI 0.12–0.95 p

Background There are 1.2 million of immigrant children living in Italy. However, data on their nutritional habits are limited. The aim of this study was to assess the nutritional profile in a cohort of both Italian and immigrant children. Methods The study included 86 children aged 5-15 consecutively enrolled from January 2016 to May 2017 within a larger epidemiological study on determinants of diabetes. Immigrant state was defined on the basis of the parent origin. Data on nutritional profile, frequency of food group consumption, and eating habits were collected using the 24-hour dietary recall method and a questionnaire. Anthropometric parameters were measured. Results In the cohort of immigrant children there was a higher prevalence of both overweight (27.3 vs. 14.1%) and obesity (18.2 vs. 3.1%) subjects and a greater total calorie intake compared to Italian children, mainly due to excess simple carbohydrate intake. Immigrant children had a higher consumption of sweets, snacks, and drinks with added sugar. Moreover, unhealthy habits, such as eating alone and eating while watching TV, were more frequent among immigrant children. Conclusions In this cohort, immigrant children had a higher prevalence of overweight/obesity possibly due to less healthy nutritional habits. Culturally-tailored nutritional interventions may help preventing the development of obesity-related diseases in this population.

Background Atherosclerotic Cardiovascular Disease (ASCVD) is the first cause of death in Western Countries. Several risk factors contribute to generate atherosclerosis and the preventive therapeutic approaches, in particular statin therapy, reduce the mortality. However, the residual risk in statin treated patients remains significant, despite reaching the low density lipoproteins cholesterol (LDL-C) goals. Methods we reviewed the literature published in PUB-MED to discuss the role of residual dyslipidemia in particular high density lipoprotein cholesterol (HDL-C), triglycerides (TGs) and lipoprotein(a) [Lp(a)], genetic factors, suboptimal implementation of lifestyle therapy, mood disorders associated to low compliance to application of evidence-based therapies or related to ASCVD. Results we summarized the current knowledge on the topic, evidencing its contradictory aspects. Conclusion HDL-C is an important biomarker for predicting cardiovascular risk, but the classical HDL hypothesis is no longer correct and it is now being replaced by the HDL function hypothesis, thought more studies are needed to validate it. The connection between cardiovascular risk and levels of TGs is not so definite. APOE genotype and Lp(a) levels are two genetics factors associated to CV risk. Healthy lifestyle with particular dietetic factors, connected to psychological aspects, are very important for the optimal control of the global risk.

BACKGROUND Therapy in chronic hepatitis B (chronic hepatitis B) patients aims at improving their survival by preventing disease progression to cirrhosis and its complications. Entecavir (ETV) is currently a first line therapeutic agent recommended for the treatment of CHB. Our aim was to evaluate the long term outcome of a cohort of CHB patients treated with ETV. METHODS Thirty-four patients treated with ETV for at least 6 months were included in this study. The virologic response was determined by the dosage of serum HBV-DNA, HBsAg, HBeAg, anti-HBs and anti-HBe antibodies. Death, acute pancreatitis, lactic acidosis and kidney function impairment were considered as major adverse events. RESULTS The median period of treatment was 55 months (range 15-81). Thirty-three (97%) patients responded to the therapy after a mean time of 14.7 weeks (4-60); of these, 29 (85.3%) maintained the HBV-DNA negativity in serum, while 4 patients (11.8%) had a breakthrough. The remaining patient did not respond. Seroconversion to anti-HBs and anti-HBe was not observed, although 2 patients lost the e and the s antigen, respectively. Baseline alanine aminostransferase (ALT) levels in serum were altered in 18 patients (52.9%), and returned to normal levels during the follow-up, with a reduction of 87.7 IU/L (P