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A previous short time span study related to the effectiveness of a teaching pack (TP) in improving the adherence to the Mediterranean Diet (MD) showed positive results. The present study was aimed at investigating and confirming those results, with a follow up data collection, in the same sample, a year after the baseline intervention. Pre- and post-intervention assessments were conducted. Weight and height were measured. Eating patterns/lifestyle were assessed by the KIDMED test and questionnaires. Thirteen schools in three areas with low, medium and high prevalence of overweight/obesity (North, Center and South respectively) were involved, with a representative baseline cluster sample of 494 fourth class children (8-10 years old) in 2015. An intervention group and a control group were recruited in each school; the intervention group (n = 395) got the intervention, the control group (n = 99) did not. The children's KIDMED score changes were the main outcome measures. Differences in percentages of adherence and in yes/no answers on the KIDMED test, at baseline and after one year, for both the intervention and the control groups, were assessed through contingency tables and statistical tests. Improvements in the high and low adherence rates to MD were observed (high adherence: 24.4% to 43.3%; low adherence: 15.0% to 3.9%, p < 0.0001). The percentages of subjects with optimal adherence improved in both sexes (females: 25.5% to 49.5%, p < 0.0001; males: 23.1% to 36.6%, p < 0.0001) in all the geographical areas and ponderal status classes. Accompanying free distribution of fruit and vegetables with a nutritional intervention led by trained teachers with a cross-curricular approach can be successful in promoting healthy eating in children.

Background: The aim of this cross-sectional study was to explore the personal values system of an Italian adolescent sample and examine the interrelations of their values with some variables characterizing their lifestyles., Methods: A representative sample of 365 adolescents (56.2% females), 15-16 years old from the randomly selected second classes of public/private upper secondary schools of an Italian model region was investigated. The lifestyle of adolescents was explored through a 37-items structured, self-administered questionnaire. Ponderal status was evaluated from measured weight and height. The adherence to the Mediterranean Diet of the sample was determined by the KIDMED Test. The adolescents completed the 21-item Portrait Values Questionnaire, which assesses respondents' endorsement of the ten basic human values., Results: The results suggest that variables related to their eating habits may be associated with their basic values. Some not healthy eating habits, such as eating while "watching TV"/using PC"/ "studying," were negatively related to tradition, conformity, and security values. The adolescents with both moderate and strong alcohol use, and with smoking habits also showed the highest percentage of low adherence to the Mediterranean Diet., Conclusions: Our findings might provide some useful information to support the development of more effective and targeted health promotion interventions approaches tailored for this age group.

Background: Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the role of BP and its trend as possible determinants of in-hospital mortality (primary outcome), discharge disabilities and hospitalization length (secondary outcomes) in ischemic stroke patients presented with Hypertensive Emergencies (HE)., Methods: We retrospectively evaluated patients presented to Niguarda Hospital, Emergency Department (ED), from 2015 to 2017 with a neurological ischemic HE. BP at ED presentation (T0), its management in ED (T1) and its values at the stroke unit admission (T2) were evaluated., Results: 267 patients were included (0.13 % of all ED accesses and 17.9 % of all ischemic strokes). In the whole population, BP values were not associated with in-hospital mortality while T0 and T2 SBP result were associated to discharge disability and hospitalization length. In pre-specified subgroup analysis these associations were confirmed only in untreated subjects (not anti-hypertensive nor thrombolysis). In fact, no significant relationship can be found between BP values and any secondary outcome in thrombolysis and anti-hypertensive treated patients., Conclusions: BP values and its management can not be related to in-hospital mortality in stroke patients, presented with HE, while they are associated to discharge disability and hospitalization length. In subgroup analysis, results were confirmed only in untreated (not anti-hypertensive therapies nor thrombolytic)., Competing Interests: Declaration of competing interest The authors declare they have no conflict of interest., (Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person's lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents' socio-economic conditions on children's consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance "OKkio alla Salute" (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, "less healthy" behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours.

In March 2020 Italy went into lockdown due to COVID-19 pandemic and children changed rapidly their lifestyles with possible negative effects on their health status. An online survey collected data on eating habits, physical activity, perception/behaviour of 1027 Italian 2-11 years children during lockdown. The chi-square test was applied to test differences in proportions. Results showed a tendency of eating behaviour to worsen as children age and by areas. Only 32.3% of the children had high adherence to Mediterranean Diet, with better scores in 2-5 years children. 78.1% of the children stopped their habitual physical activity, with higher percentage among 6-11 and in Northern children; only 51.8% maintained some activities at home, playing mainly movement games/sports. Children spent more time on devices, missed school and friends, being more bored and less creative. This framework highlights the growing need for strategies to preserve children's health in this and future pandemics.

The eating patterns in a population can be estimated through dietary surveys in which open-ended assessment methods, such as diaries and interviews, or semi-quantitative food frequency questionnaires are administered. A harmonized dietary survey methodology, together with a standardized operational procedure, in conducting the study is crucial to ensure the comparability of the results and the accuracy of information, thus reducing uncertainty and increasing the reliability of the results. Dietary patterns (i) include several target variables (foods, energy and nutrients, other food components), (ii) require several explanatory variables (age, gender, anthropometric measurements, socio-cultural and economic characteristics, lifestyle, preferences, attitudes, beliefs, organization of food-related activities, etc.), and (iii) have impacts in several domains: imbalance diets; acute and chronic exposures affect health, specifically non-communicable diseases; and then sanitary expenditure. On the other hand, food demand has impacts on the food system: production, distribution, and food services system; food wastes and other wastes generated by food-related activities of the households (e.g., packaging disposal) have consequences on the "health of the planet" which in turn can have effects on human health. Harmonization and standardization of measurement methods and procedures in such a complex context require an ad hoc structured information system made by databases (food nomenclatures, portion sizes, food atlas, recipes) and methodological tools (quantification methods, food coding systems, assessment of nutritional status, data processing to extrapolate what we consider validated dietary data). Establishing a community of professionals specialized in dietary data management could lead to build a surveillance system for monitoring eating habits in the short term, thus reducing costs, and to arrange a training re-training system. Creating and maintaining the dietary data managers community is challenging but possible. In this context, the cooperation between the CREA Research Centre for Food and Nutrition and the Italian National Health Institute (ISS) promoted and supported by the Italian Ministry of Health may represent a model of best practice that can ensure a continuous training for the professional community carrying out a nutritional study., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Turrini, Catasta, Censi, Comendador Azcarraga, D'Addezio, Ferrari, Le Donne, Martone, Mistura, Pettinelli, Piccinelli, Saba, Sette, Barbina, Guerrera, Carbone and Mazzaccara.)

The Adolescents Surveillance System for Obesity prevention (ASSO) Project aimed at developing standardized and web-based tools for collecting data on adolescents' obesity and its potential determinants. This has been implemented and piloted in the local area of Palermo city, Italy. The aim of the present study is to provide an overview of the Project's design, implementation, and evaluation, highlighting all the aspects for a potential scale-up of the surveillance system on the whole national territory and abroad, as a sustainable and effective source of data.The overall structure and management, the ASSO-toolkit, the ASSO-NutFit software, and all developed and used procedures for recruiting, training, and data collecting/analyzing are addressed. An interim evaluation has been performed through a feasibility study; a final Project evaluation has been performed reporting the Strengths, Weaknesses, Opportunities, and Threats (SWOT) and the attributes that a surveillance system should have.This article provides a detailed overview of the Project and highlights that ASSO can be considered a valid, logical, coherent, efficient, and sustainable surveillance system that is consistent with countries' needs and priorities.The system developed by the ASSO Project provides high-quality data and complies with several characteristics typical of a suitable surveillance system. It has a potential of being adopted within the National Health Service and other countries' Health Services for monitoring adolescents' obesity and its determinants, such as food intakes, behaviors, physical activity, and fitness profiles., Competing Interests: The authors report no conflicts of interest.

Background: A new food frequency questionnaire (FFQ) has been recently developed within the Italian Adolescents and Surveillance System for the Obesity prevention (ASSO) Project; it was found to be appropriate for ranking adolescents in food and nutrient levels of intake. The aim of this study was to assess the relative and absolute reproducibility of the ASSO-FFQ for 24 food groups, energy and 52 nutrients., Methods: A test-retest study was performed on two ASSO-FFQs administered one month apart of each other to 185 adolescents, aged 14-17 and attending secondary schools in Palermo (Italy). Wilcoxon test assessed differences in median daily intakes between the two FFQs. Agreement was evaluated by quintiles comparison and weighted kappa. Intraclass Correlation Coefficients (ICC) and Bland-Altman method assessed the relative and absolute reliability respectively., Results: Significant difference (p < 0.05) in median intakes was found only for bread substitutes, savoury food, water, soft drinks, carbohydrates and sugar. The subjects classified into the same or adjacent quintiles for food groups ranged from 62% (white bread) to 91% (soft drinks); for energy and nutrients from 64% (polyunsaturated fatty acids) to 90% (ethanol). Mean values of weighted kappa were 0.47 and 0.48, respectively for food groups and nutrients. Fair to good ICC values (>0.40) were assessed for thirteen food groups, energy and forty-three nutrients. Limits of Agreement were narrow for almost all food groups and all nutrients., Conclusions: The ASSO-FFQ is a reliable instrument for estimating food groups, energy and nutrients intake in adolescents.

The objective of this study is to obtain reliable data from recent surveys carried out in Italy on the prevalence of overweight (OW) and obesity (OB) in children. We searched in MEDLINE/PubMed, Google and Google Scholar and we included the surveys that fulfilled the following criteria: English or Italian language, time period January 2000-April 2008, target of 6-11 years; BMI evaluated according to IOFT cut-offpoints. Search terms included overweight, obesity, children, Italy, associated with AND/OR. 41 studies have been selected; the percentage of OW varied between 14.7% and 31.3% and OB between 4.3% and 27.3%. In girls, OW values ranged from 11.5% to 34.7% and in boys from 12.6% to 30.1%; in girls, the percentage of OB varied between 4.7% and 29.2%, in boys between 4.4% and 25.8%. There were some variations in the prevalence of OW and OB among diferent regions. The highest values were in Central and Southern Italy, except for Sardinia, where the values were similar to that of Northern Italy. Beyond BMI, the most frequently collected variables were dietary pattern, physical activity, and lifestyle. School is the main site of investigation; third grades (8-9 years) is the most studied age group. The urgency to develop actions to contrast obesity in childhood is confirmed by the prevalence values observed in the Italian regions.

Aim: The aim of this study was to investigate the prevalence of overweight/obese and hypertensive roman adolescents belonging to a medium-low social environment. The purpose of this research was also to find out the correlations between high blood pressure and obesity, dietary habits and physical activity., Methods: Nutritional status of 474 subjects (age 12.7+/-0.9 years) of a low-medium social class public school was assessed by measuring height, weight and waist circumference according to international indications. Over-weight and obesity were defined by body mass index (BMI) according to International Obesity Task Force (IOTF). Blood pressure (BP) was measured in duplicate and hypertension was defined by international percentiles. Food habits and lifestyle were investigated by a questionnaire. Multivariate logistic regression was used to relate variables., Results: The prevalence of overweight and obese adolescents was respectively 31.7% and 10.3% with a slight higher presence of males in both cases. The whole sample showed a prevalence of hypertension of 10.1%. Systolic and diastolic BP showed a direct association with BMI and waist circumference (P<0.01). BMI and systolic and diastolic BP were lower in active students (>7 h a week of physical activity). Food habits were not associated with hypertension., Conclusions: The high prevalence of hypertensive adolescents could be explained with the consistent number of overweight/obese subjects, their social medium-low context and their being sedentary. As reported in literature, all these factors may contribute to the ''metabolic syndrome'' aetiology.

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.