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Background/objectives: Anemia, leukopenia and, although less frequently, thrombocytopenia are possible hematological complications of anorexia nervosa considered strictly secondary to chronic malnutrition. This is a retrospective study on the prevalence of these disorders in a large cohort of 318 female patients with AN (20.4±5.6 years, body mass index (BMI) 15.9±1.6 kg/m2), recruited in the Outpatient Unit for Malnutrition secondary to Eating Disorders at the Department of Clinical Medicine and Surgery, Federico II University Hospital, since February 1991 to December 2012.Subjects/methods: Patients were studied on an outpatient basis after obtaining medical history, clinical examination, routine hematobiochemical and endocrine tests, electrocardiography, psychiatric interview and bioelectrical impedance analysis and, in particular, phase angle determination. All patients with other comorbidities, in particular with mean corpuscular volume <80 fl, were excluded for suspected genetic alteration in the synthesis of hemoglobin.Results: Hematologic data showed that 16.7% of patients had anemia, 7.9% neutropenia and 8.9% thrombocytopenia. These abnormalities were strictly related to the duration of illness (P=0.028), and to protein energy malnutrition, in particular, BMI and phase angle (P<0.001).Conclusions: Our study offers description of the incidence of hematologic defects in a selected and large sample of AN female patients, suggesting that its incidence is related to the degree and duration of protein energy malnutrition. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the prevalence of β3-adrenergic receptor (ADRB3) Trp64Arg polymorphism and its relationship with the metabolic syndrome in severe obesity.Design:Cross-sectional outpatients study.Patients and methods:In 265 (100 men) severely obese non-diabetic subjects and 78 (25 men) healthy volunteers, genomic DNA was isolated from peripheral leukocytes. In obese patients, plasma concentrations of leptin, lipids, glucose and insulin, the homeostasis model assessment index and blood pressure have been measured. The Trp64Arg mutation was identified with the real-time TaqMan method.Results:Neither genotype distribution nor allele frequency differed between the two groups. The metabolic syndrome prevalence was 59% in obese subjects, and was higher in men than in women (65 vs 55%: P=0.03). The body mass index (BMI) was related to age tertiles (β=0.08; P<0.001; multiple linear regression) in Trp64Arg-positive obese subjects.Conclusion:We confirm the high prevalence of the metabolic syndrome among severely obese subjects. ADRB3 polymorphism was significantly related to insulin resistance only in obese male subjects. Moreover, increased BMI was related to age in obese subjects with the ADRB3 polymorphism.Sponsorship:MIUR, COFIN 2004.European Journal of Clinical Nutrition (2007) 61, 1213–1219; doi:10.1038/sj.ejcn.1602640; published online 14 February 2007 [ABSTRACT FROM AUTHOR]

Objective:To evaluate long-term mortality rate of anorexia nervosa (AN) patients in a southern Italy population compared to the most recent literature.Design:Retrospective and review setting.Patients and interventions:One hundred and forty-seven female AN patients, consecutively admitted from 1994 to 1997 to the Outpatient Unit, were re-examined between June and November 2003. Our data are compared with 10 other studies published since 1988.Results:One hundred and twenty-three deaths in 2240 patients, amounting to a total mortality rate of 5.25% were reported in the literature. Deaths due to suicide, AN-related and AN-unrelated diseases were 1.20, 3.07 and 0.98%, respectively. After correcting for unrelated deaths, mortality rate was 4.27%. In our 8-year follow-up, we found a mortality rate of 2.72% (1.82% after correcting for unrelated deaths). Standardized mortality ratio was 9.7.Conclusion:We interpret our favourable findings as a consequence of an integrated, clinical–nutritional and psychiatric approach. Finally, considering AN demographic characteristics, that is young female subjects in Westernized societies, mortality rate is confirmed to be dramatically high.Sponsorship:‘Federico II’ University of Naples.European Journal of Clinical Nutrition (2007) 61, 119–122. doi:10.1038/sj.ejcn.1602491; published online 2 August 2006 [ABSTRACT FROM AUTHOR]

Aim:To evaluate the current use of Home Parenteral Nutrition (HPN) in a Southern European region.Subjects and methods:A total of 159 (86 m, 73 f) HPN patients, mean age 60.1±14.2 years, BMI 18.8±3.3 kg/m2, consecutively referred to the Artificial Nutrition outpatient Unit of the Federico II University Hospital in Naples (Italy), from January 2000 to December 2002 and treated for at least 4 weeks. Retrospective evaluation of baseline disease, indications and duration of HPN treatment, type of venous access, complications.Results:In all, 140 (88%) were cancer and 19 (12%) noncancer patients. Main indications were carcinosis in 68 for total, and hypophagia/dysphagia in 62 patients for partial/integrative (to oral-enteral nutrition) HPN; mean duration of HPN was 81.45±110.86 days of treatment and infection rate 2.89‰ in the whole population and 2.66‰ in the 36 patients treated for more than 3 months. No other major complications have been observed.Conclusion:HPN is confirmed to be a safe and effective treatment when prescribed and administered by a trained team.European Journal of Clinical Nutrition (2006) 60, 58–61. doi:10.1038/sj.ejcn.1602267; published online 31 August 2005 [ABSTRACT FROM AUTHOR]

Purpose: Inadequate oral intake may play an important role in the onset of malnutrition in patients with Crohn's disease (CD). The aims of this cross-sectional study were: (1) to compare dietary intake in clinically active and quiescent CD patients, and (2) to assess patients' nutritional adequacy relative to the dietary reference values (DRVs) for the Italian population using LARN (Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana)., Methods: Patients aged between 18 and 65 years with a diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record. Disease activity was clinically defined using the Crohn's disease activity index (CDAI)., Results: Overall, 117 patients, 71 males and 46 females, with a mean age of 39.6 ± 13.8 years and a mean body weight of 65.4 ± 11.8 kg, were ultimately included. Our findings showed that the amount of nutrients was similar between patients with active and quiescent disease. The mean intake of macronutrients was adequate, except for fiber, while dietary micronutrients were insufficient. Median intakes of sodium, phosphorus, and fluorine met LARN recommendations in both sexes, and the DRVs were accomplished by many patients (53/117; 104/117 and 98/117, respectively). Interestingly, dietary amounts of iron and zinc were barely acceptable in males but not in females. However, a few of the patients (< 15) met the LARN for potassium, calcium, and magnesium, regardless of sex and CDAI. With respect to vitamins, no relevant difference was found between the active and quiescent groups, and none of them met recommended values in both sexes., Conclusions: This study showed that the assessment of dietary intake can be crucial for optimizing dietary intervention with focused nutrition counseling, to improve nutritional status in CD patients.

The use of hypnosis can generate hallucinatory phenomena, which ranged from vivid/auditory imagery to fully developed "hallucinations" in selected people. The aim of this pilot trial was investigating the acute effects of a hypnosis-induced hallucinated breakfast (HB) compared to those of a real breakfast (RB) on subjective appetite and appetite-regulating hormones in highly hypnotizable individuals. Eight healthy post-menopausal women were recruited to consume two meals: the HB and the RB in a randomized crossover design. Participants underwent appetite sensations measurements (before meal and each 30-min until 270-min) and blood sample collection (at 0, 20, 60, 90, 180-min). A 3-day food-record was filled after each meal. The adjusted repeated measures ANCOVA did not show any meal×time interactions on subjective appetite postprandially. As expected, significantly higher glucose (p < 0.001), insulin (p < 0.001), and lower free fatty acid (p < 0.001) concentrations were found after the RB, but not following HB. Furthermore, RB significantly increased postprandial levels of glucagon-like-peptide-1 and peptide-YY at 20, 60, 90 and 180-min, whereas acylated-ghrelin and leptin levels did not differ. Postprandial neuropeptide-Y and orexin-A values significantly increased at different time-points after RB, but not following HB, while α-melanocyte-stimulating hormone levels enhanced after HB only. Energy intakes were significantly lower after HB on the test-day only (HB = 1146.6 ± 343.8 vs RB = 1634.7 ± 274.2 kcal/d; p = 0.003). Appetite sensation might be modulated by fully developed meal "hallucination" induced by hypnosis, likely affecting brain-peptides implicated in the appetite regulation. However, further studies are needed to verify these results obtained in a highly selected group of individuals. NCT03934580.

Objectives: The negative effects of malnutrition on the prognosis of hospitalized patients are well documented; however, less known is the awareness and knowledge of health care professionals about this complication. The aim of this study was to evaluate the trend of the requests for nutritional consultation in years and the prescription of artificial nutrition (AN), for adult patients at a university hospital in southern Italy in the years 2004, 2008, 2012, and 2016 to assess the progress of medical teams concerning awareness of hospital malnutrition., Methods: This was a retrospective study that evaluated the time trend of nutritional consultation requests and related prescription of AN, for adult patients at a university hospital in southern Italy in the years 2004, 2008, 2012, and 2016. Of 112 233 inpatients, 2505 received a nutritional consultation with the prescription of AN., Results: The number of patients on AN increased from 507 of 33 240 (1.52%) in 2004 to 730 of 29 195 (2.5%) in 2008 (P < 0.001), remaining almost stable in 2012 and 2016. The request for AN was quite equally distributed between surgical (51.5%) and medical wards (48.5%), with a prevalence among patients with oncologic diseases (806 patients [65.6%]). As for nononcologic diseases, 20.4% involved the gastrointestinal tract and 6.3% the nervous system. Throughout the 12 y of observation, parenteral nutrition was the main prescribed support (59.8%) followed by oral nutritional supplements (26.1%) and enteral nutrition (9.3%). Mean nutritional intervention duration was 11 d (±10.8 d)., Conclusions: The request of AN for hospitalized patients increased over time, probably owing to improved medical consciousness of the potential risks for malnutrition and the availability of a specialized clinical nutrition team., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background/objectives: The aim of this study was to compare resting energy expenditure (REE) measured (MREE) by indirect calorimetry (IC) and REE predicted (PREE) from established predictive equations in a large sample of obese Caucasian adults., Subjects/methods: We evaluated 1851 obese patients (body mass index (BMI)>30 kg m - 2 ) aged between 18a and 65 years. Data were obtained by comparing MREE with PREE, derived from different equations, within and between normal weight and obese groups. The mean differences between PREE and MREE as well as the accuracy prediction within ±10% level were investigated in the whole sample and in three subgroups, classified by BMI (Group 1=30-39.9 kg m - 2 ; Group 2=40-49.9 kg m - 2 ; Group 3>50 kg m - 2 )., Results: We observed that FAO, Henry and Muller3 (body composition (BC)) equations provided good mean PREE-MREE (bias -0.7, -0.3 and 0.9%; root mean standard error (RMSE) 273, 263 and 269 kcal per day, respectively); HB and Henry equations were more accurate individually (57 and 56.9%). Only the Muller1 (BC) equation gave the lowest PREE-MREE difference (bias -1.7%; RMSE 228 kcal per day) in females, while Johnstone and De Lorenzo equations were the most accurate (55.1 and 54.8%). When the sample was split into three subgroups according to BMI, no differences were found in males; however, the majority of the equations included in this study failed to estimate REE in severely obese females (BMI>40 kg m - 2 ). Overall, prediction accuracy was low (~55%) for all predictive equations, regardless of BMI., Conclusions: Different established equations can be used for estimating REE at the population level in both sexes. However, the accuracy was very low for all predictive equations used, particularly among females and when BMI was high, limiting their use in clinical practice. Our findings suggest that the validation of new predictive equations would improve the accuracy of REE prediction, especially for severely obese subjects (BMI>40 kg m - 2 ).

Objectives: Sarcopenic obesity has not yet been widely defined. The aim of this study was to evaluate the prevalence of sarcopenia in a group of severely obese adults from southern Italy by using two different indexes: percentage of skeletal muscle mass (SMP) and skeletal muscle mass normalized for height (SMI); and to determine SMP and SMI cutoff points in a southern Italy reference population., Methods: Skeletal muscle mass of 131 consecutive obese adult outpatients (51 men and 80 women; ages 45-67 y; body mass index 44.6 ± 7.7 kg/m(2)), was assessed by bioimpedance analysis. SMP and SMI cutoff points to identify moderate and severe sarcopenia were calculated in a reference group of 500 young southern Italy adults (100 men and 400 women; ages 18-40 y; body mass index 25.2 ± 5.6 kg/m(2)) and applied to assess the prevalence of sarcopenia in the study population., Results: SMP cutoff points to identify moderate and severe sarcopenia were, 28.8% to 35.6% and ≤ 28.7% in men and 23.1% to 28.4% and ≤ 23% in women, respectively. The corresponding values for SMI were 8.44 to 9.53 kg/m(2) and ≤ 8.43 kg/m(2) in men, 6.49 to 7.32 kg/m(2) and ≤ 6.48 kg/m(2) in women. According to SMP, 23 of 51 (45.1%) men and 19 of 80 (23.8%) women were moderately sarcopenic; 28 of 51 (54.9%) men and 61 of 80 (76.3%) women met the definition of severe sarcopenia. Based on SMI, only 2 of 51 (3.9%) men were moderately sarcopenic., Conclusions: This study confirms that sarcopenia rates vary widely in obese patients depending on the criteria used. SMP as a screening tool to identify a sarcopenia at-risk population., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background & Aims: Home Artificial Nutrition (HAN) is a well established extra-hospital therapy, contributing to decreased health care costs, by reducing the number and length of hospitalizations. The knowledge of the epidemiology of HAN helps plan health-care funding and in analyze the factors that can improve HAN service., Subjects and Methods: An update on the prevalence of Home Artificial Nutrition (HAN) in the Campania region (Southern Italy) and patients clinical characteristics has been regularly carried out in the past seven years after a specific regional regulation issued in 2005., Results: Total number of patients on HAN has increased from 355 in April 2005 to 1165 in April 2012 (+228.2%); in particular, patients on Home Parenteral Nutrition (HPN) increased from 156 in April 2005 to 306 in April 2012 (+96.2%) and patients on Home Enteral Nutrition (HEN) from 199 to 838 (+321.1%) respectively. HEN/HPN ratio in adults has changed from 1.3/1 in April 2005 to 2.7/1 in April 2012, gradually nearing the expected national mean ratio of 5/1 as observed in the 2005 national survey., Conclusions: The specific regional regulation in Campania has contributed to increase the prescription of HAN and to ameliorate its indications; in particular, through the years, HEN is gradually nearing national standards., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Mitochondrial DNA (mtDNA) haplogroups have been associated with the expression of mitochondrial-related diseases and with metabolic alterations, but their role has not yet been investigated in morbid obese Caucasian subjects. Therefore, we investigated the association between mitochondrial haplogroups and morbid obesity in patients from southern Italy. The mtDNA D-loop of morbid obese patients (n = 500; BMI > 40 kg/m(2)) and controls (n = 216; BMI < 25 kg/m(2)) was sequenced to determine the mtDNA haplogroups. The T and J haplogroup frequencies were higher and lower, respectively, in obese subjects than in controls. Women bearing haplogroup T or J had twice or half the risk of obesity. Binomial logistic regression analysis showed that haplogroup T and systolic blood pressure are risk factors for a high degree of morbid obesity, namely, BMI > 45 kg/m(2) and in fact together account for 8% of the BMI. In conclusion, our finding that haplogroup T increases the risk of obesity by about two-fold, suggests that, besides nuclear genome variations and environmental factors, the T haplogroup plays a role in morbid obesity in our study population from southern Italy.

The melanocortin-4 receptor (MC4R) is involved in regulating energy homeostasis; mutations in this gene have been associated with 1-5% of early-onset human obesity. The aim of this study was to functionally characterize MC4R mutations identified in morbidly obese subjects living in Southern Italy. We studied their ligand binding, signaling pathway and subcellular localization. As expected, mutants Q43X and S19fsX51, which produce truncated forms of receptor, were devoid of activity. The activity of mutants W174C and A175T were very different even though the mutations are adjacent and are in the same transmembrane helix (TMH). In fact, the production and expression of mutant A175T on the plasma-membrane (PM) was similar to that of the wild-type (wt) receptor and the mutant retained 70% of wt receptor activity; on the contrary, the production of W174C mutant in the cytoplasm was similar to that of the wt receptor and mutant A175T but was only barely detectable on the PM and was devoid of activity. Confocal microscopy showed that W174C remained entrapped in the endoplasmic reticulum (ER) of the cells. Structural analysis showed that substitution of Trp174, located in the middle of TMH4 and 100% conserved in all known MC4Rs, with Cys could impair the relative orientation of TMH2 and TMH4 thereby affecting the overall protein architecture. Furthermore, co-expression studies showed that mutant A175T but not W174C had a dominant negative effect on the wt receptor activity., (Copyright 2010 Elsevier B.V. All rights reserved.)

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Aim: To determine the prevalence (cases per million inhabitants) of home artificial nutrition (HAN), enteral (HEN) and parenteral (HPN), in Italy, grouped according to administrative regions, patient age and primary disease, and to analyze the impact both of the presence of an HAN regional regulation and of demographic characteristics., Methods: In April 2005, the Regional Coordinators of the Italian Society for Parenteral and Enteral Nutrition (SINPE) recorded all the ongoing cases of HAN using a structured questionnaire and were asked to estimate the representativeness of the collected sample with respect to the total expected HAN., Results: A total of 6955 cases of HAN (93.5% adults, 6.5% pediatric patients < or = 18 years) were recorded in 16 of the 20 Italian regions (80% of the Italian population; sample representativeness 78%). HAN prevalence 152.6 (83.9% HEN, 16.1% HPN); the HAN range among the regions was: prevalence 28.1-519.8; oncological disease 13.8-75.7%, neurological disease 15.5-79.9%, intestinal failure 1.3-14.0%. An HAN regulation was present in 11 regions. A positive association (P=0.012) was found between the number of years since the regulation was issued and the HAN prevalence, and also between the % neurological patients and the population density (P=0.130) and the % inhabitants > or = 75 years (P=0.040)., Conclusions: The need for HAN regards a great number of patients throughout the country; there are substantial differences between the regions with respect to both the prevalence and the use of HAN in various disease categories. A specific regulation may favor the development of HAN.

Background and Aim: A large number of mitochondrial DNA (mtDNA) mutations have been implicated in degenerative diseases and aging. The aim of this study was to evaluate whether the 15497 G/A mtDNA polymorphism (G251S) in the cytochrome b subunit of respiratory complex III, which has been associated with obesity-related variables and lipid metabolism in a Japanese population, is associated with severe obesity also in adult Caucasians from southern Italy., Methods and Results: Unrelated severely obese patients (n = 317; BMI > 40kg/m2) and controls (n = 217; BMI < 25kg/m2) from Southern Italy were genotyped by allelic discrimination TaqMan assay for the 15497 G/A mtDNA polymorphism. In obese patients fasting serum total cholesterol, triglycerides, HDL-cholesterol and glucose were measured enzymatically and sitting blood pressure and heart rate were also collected. Mean levels of total cholesterol, triglycerides and glucose were below the upper reference limit for healthy subjects. Female obese subjects showed lower levels of blood pressure and heart rate and higher levels of HDL cholesterol than male obese patients (P < 0.001). All the control subjects and 315/317 severely obese patients were homozygous for the G allele (wild type), whereas only 2/317, were females homozygous for the A allele., Conclusions: The mtDNA 15497 G/A polymorphism in cytochrome b was present in 0.6% obese subjects, two females whose lipid parameters and BMI were similar to those of the overall group. Therefore, this mutation may appear to contribute in rare instances to severe obesity but does not explain the majority of cases in our population. A more extensive genetic haplogroup characterization is required to identify associations to obesity in Caucasians.

Background and Aim: Sedentary lifestyle contributes to increased body weight in western societies. We evaluated physical activity (PA) and its association with some clinical and biochemical parameters in overweight and obese outpatients., Methods and Results: Two hundred and seventy-eight overweight obese outpatients, aged 18-65 years, were recruited in this cross-sectional study. Patients were interviewed about their usual PA, using a standardized questionnaire. A total metabolic index (TMI) was derived estimating weekly energy expenditure. In Class III obese patients, fasting serum HDL-cholesterol (HDL-Chol) and resting heart rate (HR) were also measured. BMI was inversely related to TMI in the whole group (r = -0.123, p = 0.041). Dividing the patients into groups 1 and 2 according to median BMI (30.3 kg/m(2)), group 1 had a significantly higher TMI than group 2 (p = 0.003), mainly due to the difference in weekly walking time (p < 0.001). Among Class III obese patients, despite similar BMI, the group with longer walking time had both significantly higher HDL-cholesterol (p = 0.046) and lower HR (p < 0.001)., Conclusion: In overweight and obese individuals BMI is inversely related to PA energy expenditure. This relationship can be, at least in part, ascribed to the reduction of weekly walking time with increasing BMI. In Class III obese patients, even a low level of PA can positively affect both HDL-Chol and resting HR. It appears useful to focus on obese patients in also in general practice in order to recognize sedentary life styles and encourage PA through individualized programs.

Background: The genetic characterization of obese individuals could clarify the molecular mechanisms underlying body weight regulation and lead to targeted therapy. Here we report variants of the proopiomelanocortin (POMC) and melanocortin receptor 4 (MC4R) genes detected in severely obese adults living in southern Italy., Methods: A total of 196 unrelated nondiabetic severely obese individuals [111 females and 85 males; mean (SD) age, 32.2 (11.5) years; mean body mass index, 48.8 (8.1) kg/m(2)] and 100 normal-weight healthy volunteers (34 males and 66 females) entered the study. POMC and MC4R were genotyped by sequencing analysis. Leptin, insulin, glucose, and the lipid profile were measured in fasting serum samples. We used the protein truncation test to verify the stop-codon mutation. Anthropometric measurements, sitting blood pressure, and heart rate were also recorded., Results: Of the obese participants, 1.5% had mutations in POMC exon 3 (new mutations, P231L and E244X; known, R236G) and 2.5% had MC4R mutations (new mutations, W174C, Q43X, S19fsX51, and I317V; known, A175T). These mutations were not present in the controls. Gene polymorphisms were identified in similar percentages of severely obese and nonobese individuals, i.e., respectively, 52.5% and 51% (POMC) and 1% and 2% (MC4R)., Conclusions: We detected 2 new POMC mutations and 4 new MC4R mutations in a large number of severely obese adults living in southern Italy. These mutations, not present in normal-weight individuals, are further evidence that defects in the melanocortin pathway are related to severe obesity.

The aim of this study was to compare how different diagnostic criteria can influence the estimation of obesity in children. Five hundred and eighty-seven children from Southern Italy were evaluated for the presence of obesity according to six different methods: two using Ideal Body Weight, according to Tanner and the National Center for Health Statistics, and four using Body Mass Index, according to Rolland-Cachera, Must, Cole (International Obesity Task Force) and the Centers for Disease Control and Prevention. Large discrepancies were found between old and new methods in identifying childhood obesity with respect to absolute prevalence, differences between the sexes, and age-related trends. The use of different weight-height indices, the employment of different cut-off points, the large differences between the reference populations, and the different time periods of data collection explain differences between methods. This should be always taken into consideration when data from different epidemiological or clinical studies are compared.

Background & Aims: The epidemiology of bone disease in home parenteral nutrition (HPN) is unknown. The aim of this paper is to evaluate the prevalence and severity of reduced bone mineral density (BMD) in long-term HPN., Design: Cross-sectional, multicentre study including patients who within the last 12 months had their BMD assessed by dual-energy-X-ray absorptiometry after at least 6 months of HPN. Data on bone pain and fractures, the primary gastrointestinal diseases, nutritional and rehabilitation status and HPN regimen were reviewed. Both the T-score (no. of SD below mean BMD of young subjects) and the Z-score (no. of SD from normal BMD values corrected for sex and age) were analysed., Results: A T -score <-1 at any site of assessment was observed in 84% of the 165 patients enrolled (

Background and Aims: This study was to review albumin prescriptions and indications in 4122 patients hospitalized in internal medicine wards in the years 1996, 1998 and 1999, before and after the ad hoc regulations issued in 1997 by the Italian Ministry of Health., Methods: In 1996 (n=63), 1998 (n=59) and 1999 (n=55) 177 of these patients (4.3%) were given i.v. albumin., Results: 161 (91%) of them had serum albumin values of <3.5 g/dl, while in only 36% were these values <2.5 g/dl., Conclusion: In the majority of cases albumin was erroneously prescribed, often to enhance diuretic efficacy or in protein energy malnutrition. Its prescription has not been influenced by the new recommendations., (Copyright 2001 Harcourt Publishers Ltd.)

Objectives: To evaluate the effectiveness of an integrated medical-psychiatric treatment of major eating disorders., Design: Historical cohort study., Setting: Outpatient Unit for Protein Energy Malnutrition of the Department of Clinical and Experimental Medicine, "Federico II" University of Naples, time of study: January 1994 to December 1997 PARTICIPANTS: 147 female patients with restrictive or bulimic anorexia nervosa (mean age 19.8 +/- 13.7, BMI 14.7 +/- 2.1 Kg/m2) consecutively attending the outpatient unit between January 1994 and December 1997., Main Outcome Measures: Hospitalization and mortality rates were evaluated up to Jan 1999 with a minimum follow-up of 18 months., Results: There were 23 admissions to the Clinical Nutrition ward for 19 patients (i.e. 12.9%) mostly due to severe protein energy malnutrition, and 2 deaths, only 1 strictly related to anorexia (mortality rate 0.7%)., Conclusions: Integrated outpatient medical-psychiatric treatment for major eating disorders is an effective and inexpensive procedure that reduces mortality and admissions due to medical complications in the medium term.

Objective: This study is aimed at investigating the influence of body size, body fat and sexual maturation on blood pressure (BP) in adolescents., Design: A cross-sectional study., Setting: A suburban student population of Southern Italy., Subjects: One hundred ninety students attending the first and second year of a secondary school. Five were excluded because they were affected by major diseases. The remaining were 98 M and 87 F (mean age for either group = 12.0+/-0.8 y)., Methods: Blood pressure was measured by a mercury sphygmomanometer, body weight by a platform beamscale, other measurements included height, biceps, triceps, subscapular and suprailiac skinfolds by a caliper; sexual maturation was evaluated according to Tanner., Results: Body size was greater than in Tanner's population: in particular body weight (but not height) in our sample markedly exceeded that of the children of the same age in Tanner's population. Boys had higher systolic blood pressure (SBP) than girls (BP = 109/64+/-12/10 vs. 103/63+/-11/8 mm Hg, P<0.02 for SBP), while heart rate and waist/hip ratio were lower. During puberty evaluated on the basis of pubic hair growth BP in girls was higher than in the prepubertal phase (107/66+/-9/7 vs. 99/61+/-10/7, P<0.01). Pubertal boys showed a reduced percent of body fat (calculated from four skinfold measurements) in comparison to prepubertal ones (21.0%+/-4.5 vs. 24.5%+/-7.1, P<0.01). In linear correlation analysis, height, BW, BMI and lean body mass were found to be significantly associated with SBP in both sexes and to diastolic blood pressure (DBP) in girls. Percent body fat was correlated with SBP in boys, while sexual maturation was associated to SBP and DBP in girls only. Multiple regression analysis indicated a significant contribution of body size to BP variability, particularly in the girls. Sexual maturation was excluded from the final regression equations when height, BW or lean body mass were present., Conclusions: These data indicate that body weight in these adolescents is greater that in Tanner's population of the same age and sex. Body size appears to be a major determinant of BP, whereas sexual maturation seems to influence BP levels mainly through body growth. The influence of percent body fat on BP setting seems to be of limited importance.

Objective: The present study estimates the prevalence of obesity among ten-year old children living in Southern Italy and compares it with the prevalence of obesity among children living in other western countries., Methods: 110 children attending the 4th grade of a randomly selected primary school in Naples were studies in the 1992. Eighty-eight per cent of the total school population was examined: 52 girls, 58 boys: mean age = 9.6 years (SEM = +/- 0.10). Each child underwent medical examination and anthropometric assessment. The percentile values for Body Mass Index (BMI = weight/height 2) and triceps skinfolds thickness (mm) were calculated and compared to that of children of the same age and sex living in other countries, chosen from comparable studies available in the literature., Results: Percentile values for triceps skinfolds thickness in Neapolitan children are similar to those reported in the other populations considered for comparison, however BMI values were different. Children in Naples have the highest BMI values at the 50th, 75th, 90th and 95th percentile. The prevalence of obesity among Neapolitan children was estimated using as a cut-off, the BMI value at the 90th percentile of each population considered for the comparison and calculating the rate ratio with 95% confidence interval (95% CI). The prevalence of obesity in Naples among girls, was 5.2 times (3.8-6.6 95% CI) as high as in France, 3.3 times (2.2-4.4) as high as in Holland, 1.7 times (0.9-2.5) as high as in USA, 2.5 times (1.7-3.4) as high as in Milan (Northern Italy); among boys it was 4.3 times (3.0-5.6) as high as in France, 4.0 times (2.7-5.2) as high as in Holland, 2.1 times (1.2-3.0) as high as in the USA, 2.5 times (1.7-3.4) as high as in Milan.

The aim of this paper was to evaluate the factors affecting body fat excess and distribution in prepubertal age. A cross-sectional survey was carried out on children attending the 4th grade of a primary school in Naples. Eighty-eight per cent of the total sample was examined: 52 girls, 58 boys; mean age = 9.6 yrs (s.e. +/- 0.10). Each child underwent a medical examination, anthropometric measurements and bio-impedance analysis of body composition. The parents were asked to fill in a questionnaire that included demographic data, family history, parent's weight and height, child's perinatal history and his or her involvement in sports activities. Data were analyzed by multiple linear regression. The results showed a direct correlation between parental BMI and children's anthropometric measurements: the children's BMI correlated with the fathers' (P = 0.02) and mothers' BMI (P = 0.027); the children's waist/hip ratio correlated with the fathers' BMI (P = 0.07); the children's subscapular skinfolds correlated with the father's (P = 0.07) and mothers' BMI (P = 0.02); the children's triceps skinfolds correlated with the fathers' BMI (P = 0.004). Among congenital factors, sex was shown to be correlated with the children's waist/hip ratio (P = 0.05) with a lower ratio in the female, indicating a sex influence on body fat distribution even in prepubertal age. The children's BMI correlated with their waist/hip ratio (P = 0.001). Children's systolic blood pressure showed a positive correlation with triceps (P = 0.04) and subscapular (P = 0.05) skinfolds thickness % FAT-PLI (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Up until now, conflicting results have been reported on the association between serum cholesterol and risk of breast cancer in women. In this study, the serum concentrations of cholesterol, HDL-cholesterol, triglycerides and total lipids in women with breast cancer (BC) have been compared to those of women with benign breast disease (BBD). BC women had higher serum concentration of HDL-cholesterol both in pre- and in post-menopausal age. No difference was observed in the serum concentration of total cholesterol, triglycerides and total lipids. These findings could be explained by an increased estrogen activity which is believed to be involved in the development of breast cancer, and in the modulation of lipid metabolism (lowering LDL-cholesterol and increasing HDL-cholesterol). High serum HDL-cholesterol could be a biochemical index of increased risk of having breast cancer.

On 5 and 6 April 1991, at the National Research Council (CNR) in Rome, a Consensus Conference on the relationship between overweight, obesity and health was held. The conference was sponsored by FATMA (Applied Project on Disease Factors of the CNR) and UICO (Italian Society for the Study of Obesity) with the purpose of establishing guidelines for health employees. The development of the conference followed the methodology set down by OMAR to obtain a rational and significant consensus on the answers to six basic questions prepared by the planning committee. The questions were the pivotal point of the conference and were brought to the attention of all the attendees and widely diffused among the medical community; they were proposed with the aim of giving an exhaustive definition of obesity, to investigate its relationship with mortality and morbidity, to highlight its social characterization, to indicate methods of evaluation and recommendations for weight loss, to select groups at risk, and to focus general guidelines for research. After the presentation of the state of the art on 18 topics by experts in the field, the 22 members of the consensus panel, impartial experts from a vast area of the scientific community, discussed a draft document representing the answers to the questions, which was subsequently submitted to the 307 attendees, discussed and then approved. This paper is the definitive document of the Consensus Conference. The introduction explains the reasons which led to the decision to promote the conference six years after the one held in the United States. The methodology is then set out. The questions are answered in the form of recommendations and backed up by data and scientific evidence from the literature.

On April 5th and 6th 1991, at the National Research Council (CNR) in Rome, a Consensus Conference on the relationship between Overweight, Obesity and Health was held. The Conference was sponsored by FATMA (Applied Project on Disease Factors of the CNR) and UICO (Italian Society for the Study of Obesity) with the purpose of establishing guidelines for health employees. The development of the Conference followed the methodology set down by OMAR to obtain a rational and significant consensus on the answers to 6 basic questions prepared by the Planning Committee. The questions were the pivotal point of the Conference and were brought to the attention of all the attendees and widely diffused among the medical community; they were proposed with the aim of giving an exhaustive definition of obesity, to investigate its relationship with mortality and morbidity, to highlight its social characterization, to indicate methods of evaluation and recommendations for weight loss, to select groups at risk, and to focus general guidelines for research. After the presentation of the state of the art on 18 topics by experts in the field, the 22 members of the Consensus Panel, impartial experts from a vast area of the scientific community, discussed a draft document representing the answers to the questions, which was subsequently illustrated to the 307 attendees, discussed and then approved. This paper is the definitive document of the Consensus Conference. The introduction explains the reasons which led to the decision to promote the Conference six years after the one held in the United States. The methodology is then set out. The questions are answered in the form of recommendations and backed up by data and scientific demonstrations from the literature.

We studied fat distribution and metabolic risk factors in 434 38-year old women selected from population registrars in 5 cities in different parts of Europe. In the present study we focussed on the geographical variation in serum concentrations of free testosterone and its relation to measures of obesity, fat distribution and indicators of cardiovascular risk (serum lipids, insulin, and blood pressure). There were significant differences in free testosterone levels (F = 5.4, p less than 0.001) with lowest levels in Polish women (mean +/- SEM: 1.56 +/- 0.08 pg/ml) and highest in women from Italy (2.07 +/- 0.12 pg/ml). In the pooled data, free testosterone levels were correlated with several anthropometric variables (strongest with subscapular/triceps ratio r = 0.27, with subscapular skinfold and waist/thigh circumference ratio r = 0.25 p-values less than 0.001). In addition, free testosterone was positively correlated with serum total cholesterol (r = 0.11), HDL/total cholesterol fraction (r = 0.12), serum insulin (r = 0.20) and diastolic blood pressure (r = 0.15). These associations remained significant after adjustment for body mass index and waist/thigh ratio (not for diastolic blood pressure) but were no longer significant after further adjustment for insulin levels. There were considerable differences in strength of the associations mentioned between the 5 centers. We conclude that degree of obesity, fat distribution and serum levels of free testosterone all, to a limited degree, contribute to the metabolic profile of randomly selected 38-year old women but that adjustment for such variables increases the differences in metabolic profiles between women from different centers of Europe.

This study includes anthropometric measurements (Body Mass Index, triceps and subscapular skinfolds, % Body Fat and Mid Arm Muscle circumference) of a cross-sectional sample of 1247 elderly representative of the Italian population between 65-95 yr (522 males and 725 females). BMI at the 50th percentile is 26 for males and 27.7 for females, at the 90th it is 31.1 and 34.7 for males and females, respectively. Compared with the data of Master et al. (1960), 13% (males) and 28% (females) of the elderly Italian subjects were overweight in 1985.

Skinfold thickness, % body fat content, body mass index, systolic and diastolic blood pressure, plasma glucose, serum cholesterol and triglycerides have been measured in 132 middle-aged men (mean age 39.8 +/- 9.9, range 20-59 yr) and in 114 middle-aged women (mean age 39.1 +/- 9.3, range 20-59 yr). Anthropometric data were related to blood pressure and biochemical parameters by using a straight-line regression analysis. Body mass index, % body fat content, subscapular and suprailiac skinfold thickness, consideral as indicative of splanchnic fat distribution, were positively correlated to blood pressure, plasma glucose, cholesterol and triglycerides. Triceps skinfold thickness, an index of peripheral fat distribution, showed weaker or no correlation with these parameters. These preliminary observations in the Neapolitan area support the hypothesis that, in addition to body mass index and % body fat content, preferential splanchnic fat distribution is associated with cardiovascular risk factors.

The above study was carried out in a population sample of 1250 elderly subjects living at home, from five Italian regions (Budrio in Emilia-Romagna, Ponte S. Nicolò in Veneto, Bernareggio in Lombardy, Sezze in Latiumm, Melito in Campania). The results obtained lead to the following conclusions: 1. The condition of loneliness appears to have a detrimental influence on health in both sexes. Among other consequences, loneliness leads to progressive spontaneous reduction of daily milieu and social requirements, as well as to an impression of dependence that cannot be easily overcome. 2. The study of the relationship between the presence or absence of chronic pathologies and legal title of domicile has shown that if the home is their own by legal property or usufruct this has a favorable influence, especially in males. Property also satisfies emotional needs, through the profound ties between personal history and certain places. 3. Positive changes in life style may have beneficial effects on the interaction between socio-economic variables and the onset of chronic pathologies, especially in old age.