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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.)

Objectives: Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status., Design and Setting: Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto)., Participants: 526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile")., Measurements: Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication., Results: The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet composition analyses of anorexic older adults revealed a lower intake of all food groups and a general tendency to a monotonous diet., Conclusion: Anorexia is a frequent condition in older Italians, particularly those hospitalized, with important consequences in the nutritional and functional status. The analysis of dietary components and its quality along with the frequency of intake of single food groups may be useful to plan intervention strategies aiming to improve the nutritional and health status of older adults with anorexia. An early detection of anorexia followed by an adequate intervention in older hospitalized patients to avoid further worsening of clinical and functional status is warranted.

Objective: To explore the trends of vitamin intake over a 10-year follow-up in a group of successfully aging elderly people., Design: Longitudinal study., Setting: City of Padua, Italy., Participants: 78 (34M/44F) free-living and still well-functioning survivors among the Italian participants in the SENECA multicenter project, aged 70-75 y at the baseline., Measurements: data were collected by means of a modified validated dietary history, both at baseline and then 10 y later. The dietary intake of vitamins B1, B2, A and C were considered, calculating the percentages of individuals with an intake below the lowest European Recommended Dietary Intake (RDI)., Results: mean energy and macronutrient intake were consistent with dietary guidelines at both time points. There was no decline in total energy intake after a decade. At baseline, the intake of all vitamins exceeded the Lowest European RDI, with the exception of vitamin B1, for which 44% of the men and 60% of the women were already deficient. After a decade, the prevalence of vitamin B2 and vitamin A deficiencies rose to 50% of the sample. Vitamin C deficiencies rose in a decade from 3% to 6% in men and from 2.3% to 4.5% in women and it was the least prevalent., Conclusion: despite an adequate nutritional/functional status and a total energy intake that could be expected to cover the recommendations for micronutrients too, a considerable proportion of our successfully aging elderly were already deficient in, or at high risk of becoming deficient in several essential vitamins. Multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly.

Background and Aims: A protective effect of moderate alcohol consumption on the cardiovascular system has consistently been reported, but limited evidence has been produced on the association of alcohol with metabolic factors in the elderly. The aim of this study was to investigate the association between different levels of current alcohol consumption and cardiovascular risk factors in a representative sample of elderly Italian men, mainly wine drinkers., Methods and Results: This is a cross-sectional multi-centre study on a population-based sample of Italian men aged 65-84 years, drawn from the Italian Longitudinal Study on Aging (ILSA) cohort. The analyses included 1896 men. Almost all the drinkers (98%) drank wine as a lifelong habit. Adjusted ORs for risk levels for cardiovascular factors (BMI, waist circumference, fibrinogen, α2 protein, white blood cells, HDL cholesterol, Apo A-I, total cholesterol, Apo B-I, triglycerides, LDL, glycated hemoglobin, insulin, fasting plasma glucose, HOMA IR, systolic and diastolic blood pressure) were estimated, comparing drinkers with teetotalers using multivariate logistic regression models. We found alcohol consumption in older age associated with healthier hematological values of fibrinogen, HDL cholesterol, Apo A-I lipoprotein and insulin, but it was also associated with a worse hematological picture of total, LDL cholesterol levels, and systolic pressure., Conclusion: Our results indicated in elderly moderate wine drinkers a noticeably safe metabolic, inflammatory and glycemic profile that might balance higher blood pressure, leading to a net benefit. These findings however need to be placed in relation to the known adverse social and health effects of heavy drinking., (Copyright © 2009 Elsevier B.V. All rights reserved.)

Background and Aims: The prevalence of the preclinical phase of dementia varies greatly, according to the diagnostic criteria and assessment procedures applied. The purpose of this study was to estimate the prevalence of cognitive impairment according to the Aging-Associated Cognitive Decline (AACD) diagnostic criteria in an Italian elderly population., Methods: In a multicenter community-based prospective study, 4785 Italian subjects aged 65-84 years, randomly selected from the registries of 12 Italian municipalities, were assessed by personal and informant interviews, physical and neurological examinations and an extensive neuropsychological battery., Results: Of these older subjects, 274 (9.2%) fulfilled all the AACD criteria, whereas 561 (18.8%) fulfilled only 3 of them (AACD-3). When the two groups diagnosed according to AACD criteria (AACD and AACD- 3) were merged, the prevalence was 28.0% (28.3% for men, 27.6% for women). Two other groups of subjects were also identified: a) Subjects with Objective evidence of Cognitive Decline without cognitive complaints (OCD), 508 (17.0%), i.e., subjects with documented neuropsychological deficits, although neither subjects nor informants reported cognitive complaints; and b) Subjects with Cognitive Complaints without objective demonstrable cognitive deficits (CC), 44 (1.5%), i.e., subjects and/or informants reported cognitive complaints without evidence of neuropsychological deficits. Thus, taking into account the additional OCD group, a total of 1343 persons with cognitive impairment without dementia (45.0%) was identified., Conclusions: On the basis of our results, we estimate that 45% of our population-based Italian sample aged 65-84 years had some kind of cognitive deficits without dementia.

Background: Increasing numbers of pregnancies are seen in obese women treated surgically with laparoscopic adjustable gastric banding (LAGB). We compared their maternal and fetal outcomes with obese women without LAGB and normal-weight controls., Methods: Sixty-nine obese women with LAGB (83 pregnancies) were compared with 120 obese women without LAGB and 858 controls., Results: By comparison with normal controls, post-LAGB pregnancies had higher rates of gestational hypertension (9.6% vs 2.4%, p < 0.05), preeclampsia/eclampsia (12.0% vs 2.3%, p < 0.001), abortion (10.8% vs 0.3%, p < 0.001), cesarean section (45.9% vs 28.2%, p < 0.01), preterm delivery (17.6% vs 3.6%, p < 0.001), and babies needing neonatal intensive care (20.3% vs 9.0%, p < 0.01). Compared with the no-LAGB obese group, the post-LAGB pregnancies had lower rates of gestational hypertension (9.6% vs 23.5%, p < 0.05), preeclampsia/eclampsia (12.0% vs 20.8%, p < 0.05), and cesarean section (45.9% vs 65.8%, p < 0.01). The post-LAGB obese women gained less weight during the pregnancy (6.6 +/- 7.9 vs 14.8 +/- 10.1 kg, p < 0.001) and experienced less gestational hypertension (14.8% vs 33%), preeclampsia/eclampsia (7.4% vs 14.8%), and macrosomia (4.2% vs 16%) than in pregnancies before LAGB. No significant differences in maternal and fetal outcomes emerged between post-LAGB pregnant women who lost versus those who gained weight during pregnancy. Compared with those no longer morbidly obese, women still morbidly obese after LAGB had a lower weight gain (2.8 +/- 11.8 vs 8.6 +/- 9.5 kg, p < 0.05) and a higher gestational hypertension rate (29.4% vs 8.9%, p < 0.05)., Conclusion: The risks of negative maternal and fetal outcomes for obese women can be reduced by LAGB if the women are closely followed up.

Background: several studies have shown that religiosity has beneficial effects on health, mortality and pathological conditions; little is known about religiosity in Alzheimer's disease and the progression of its cognitive, behavioral and functional symptoms. Our aim was to identify any relationship between religiosity and the progression of cognitive impairment and behavioral disorders in mild-moderate Alzheimer's disease, and any relationship between the patient's religiosity and the stress in caregivers., Materials and Methods: 64 patients with Alzheimer's disease were analyzed at baseline and 12 months later using the Mini-Mental State Examination (MMSE), the Behavioral Religiosity Scale (BRS) and the Francis Short Scale (FSS). Caregivers were also questioned on the patient's functional abilities (ADL, IADL), the behavioral disturbances (NPI), and on their stress (NPI-D, CBI). Patients were divided into 2 groups according to BRS: a score of <24 meant no or low religiosity (LR), while a score of > or =24 meant moderate or high religiosity (HR)., Findings: LR patients had worsened more markedly after 12 months in their total cognitive and behavioral test scores. Stress was also significantly higher in the caregivers of the LR group. Global BRS and FSS scores correlated significantly with variations after 1 year in the MMSE (r: 0.50), NPI (r:-0.51), NPI-D (r:-0.55) and CBI (r:-0.62). A low religiosity coincided with a higher risk of cognitive impairment, considered as a 3-point decrease in MMSE score (OR 6.7, CI: 1.8-24.7)., Interpretation: higher levels of religiosity in Alzheimer's dementia seem to correlate with a slower cognitive and behavioral decline, with a corresponding significant reduction of the caregiver's burden.

Objective: The aim of this study was to investigate the relationships between nutritional indices (Body mass index (BMI), serum albumin), sarcopenia, bone mineral density (BMD) and the severity of their pulmonary obstruction in elderly patients with chronic obstructive pulmonary disease (COPD)., Methods: The method involved was a prospective transversal study; 82 males >65 years old, 41 stable patients with COPD and 41 healthy elderly individuals (controls). All subjects underwent spirometry, biochemical analyses and dual energy X-ray absorptiometry. The significance of the differences between mean values and prevalence rates was tested. The relationships between BMD and independent predictors were analysed by multiple linear regressions. Logistic regression models were applied on dichotomised variables., Results: In patients with COPD, the prevalence of osteoporosis was higher in subjects with sarcopenia (46% vs. 0%; p < 0.05) and with BMI < 25.1 kg/m(2) (58% vs. 15%; p < 0.02). Multiple regression analysis indicated that BMI, appendicular skeletal muscle mass (ASMM), albumin, and forced expiration volume after 1 s (FEV1) explained the 70% of BMD variability at the hip and 56% at the spine. Logistic regression showed that a BMI < 25.1 kg/m(2) was independently associated with osteoporosis risk (OR = 10.0; 95%CI 1.3-76); no independent effect emerged for FEV1% (

Objective: To explore the trends of food preferences and nutrient intake over a 10-year follow-up in a group of successfully aging elderly., Design: Longitudinal study., Setting: City of Padua, Italy., Participants: Randomly stratified sample of 97 men and 94 women born between 1913 and 1918., Measurements: The study involved a dietary assessment conducted in 1988/89 and repeated in 1999. Data were collected by means of a modified validated dietary history., Results: Nutrient and energy intake remained fairly stable over a decade, despite changes in eating habits, with a higher intake of sweets and a lower consumption of soft drinks in both genders. All individuals significantly increased their daily intake of water., Conclusion: Despite changes in eating habits, no significant decline in total energy and macronutrient intake was recorded in a decade in our elderly. The increased daily consumption of water and decreased use of soft drinks would suggest that these people were still receptive to nutritional advice even in very old age, while the increase in their sweet-eating might be because aging itself increases a person's sweet tooth, and this could be regarded as an age-related effect on dietary habits.

Background: Interest in bariatric surgery is growing as an effective method for long-term metabolic control in morbidly obese patients with type 2 diabetes. We analyzed the weight loss and changes in use of diabetic medication in obese patients with type 2 diabetes treated with laparoscopic adjustable gastric banding (LAGB)., Methods: From 1993 to 2005, 1791 morbid obese patients underwent LAGB at our institution. Of the 1791 patients, 394 (22%) had type 2 diabetes mellitus at baseline. Of the 394 patients with diabetes, 52 were receiving diabetic medication. The median follow-up period for the drug-treated diabetic patients was 3 years (range .25-9)., Results: The drug-treated diabetic patients were older (age 47.6 +/- 7.5 versus 37.5 +/- 10.7 years, P <.001), weighed more (body mass index 49.1 +/- 9.5 versus 45.6 +/- 7.5 kg/m(2), P 0.001), and were more frequently affected by co-morbidities than the nondiabetic patients at surgery. The percentage of excess weight loss 1 year after surgery was less (32.4% +/- 14.1% versus 41.1% +/- 19.9%, P <.01) for the drug-treated diabetic patients than for the nondiabetic patients. This difference was maintained for 5 years of follow-up. A significant decline occurred in the use of both oral diabetic medication and insulin after surgery. Of the 52 patients treated with oral antidiabetic medication at baseline, 33 required oral antidiabetic medication at the end of follow-up. Of the 6 patients who also required insulin at baseline, 2 did so at the end of follow-up. The use of diabetic medication had increased in 4 patients (7.7%), was unchanged in 12 (23.1%), had decreased in 17 (32.7%), and was suspended in 19 (36.5%) of 52 patients., Conclusion: The amount of weight loss after LAGB was less in drug-treated diabetic patients than in nondiabetic patients. However, LAGB was associated with a sustained reduction in the use of diabetic medication., (Copyright 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Although there is plenty of evidence of the association between metabolic syndrome (MS) and cardiovascular disease, the relationship between alcohol consumption and MS is still questioned. The few publications with respect to the elderly seem to indicate that alcohol consumption is unassociated with MS. The aim of this study was to assess the association between alcohol consumption and the prevalence and incidence of MS, as well as its components in a large sample of Italian elderly people., Subjects/methods: This is a multicenter study on a population-based sample of Italian people aged 65-84 years. The Italian Longitudinal Study on Aging (ILSA) included a prevalence phase in 1992 and an incidence phase from 1995 to 1996. The median length of follow-up was 3.5 years. In the present study, the analysis included 1321 men grouped into five alcohol consumption classes: abstainers, and those consuming or=48 g of alcohol in a day. Among the 1122 women considered, the last two of the above five categories were pooled together (>24 g/day). MS was defined according to ATP III criteria. All statistical analyses were stratified by gender., Results: Adjusted odds ratios showed that categorized alcohol consumption was not significantly associated with the prevalence and incidence of MS when compared with abstainers in either gender. For the MS incidence survey, three of five components (systolic pressure, glycemia and waist circumference) proved to be significantly and harmfully affected by alcohol consumption in males, whereas no such significant association emerged in females., Conclusions: These results suggest that alcohol can modify an individual's metabolic condition and that, even among the elderly, men might be more sensitive to the effects of alcohol than women.

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.)

Objectives: To analyze the association between weight loss and weight gain after middle age and the prevalence of late disability., Design: Secondary analysis of baseline data from a longitudinal population study., Setting: Progetto Veneto Anziani Study., Participants: Two thousand nine hundred ten (1,187 male, 1,723 female) Italians aged 65 and older., Measurements: Disability status (impairment in at least one activity of daily living) was analyzed according to current body mass index (BMI), BMI at age 50, and intercurrent weight changes (weight gain >10%, weight gain 5-10%, weight stable, weight loss 5-10%, weight loss >10%)., Results: In subjects with normal weight at aged 50, weight gain of more than 10%, weight gain of 5% to 10%, and weight loss of more than 10% were significantly associated with disability (reference stable weight). Adjustment for major chronic diseases did not affect the relationship between weight gain and disability but attenuated the association between weight loss and disability. In participants with obesity at aged 50, weight gain of more than 10% and weight gain of 5% to 10% were associated with the presence of disability; adjustment for chronic diseases did not affect these associations. In these participants, no associations were found between weight loss and disability status., Conclusion: Weight gain after middle age was associated with late disability, particularly in participants who were already obese. Weight loss after middle age was associated with disability only in normal-weight participants, and this association was attenuated after adjustment for chronic diseases.

Objective: Obesity is increasing in the elderly and it is associated with an increased risk of medical complications, decline in physical function and disability. Very few studies specifically evaluated the outcome of obesity treatment in the aging patients. Aim of this work is therefore the evaluation of the efficacy of medical therapy in a group of obese patients >or=65 years old., Methods: The study has been performed on the clinical records of obese outpatients treated at the medical branch of the Unit for Medical and Surgical Therapy of Obesity at the University of Padova. Patients were recruited from January 1st, 2001 to June 30th, 2006 in order to have patients with at least one year of potential follow-up. In particular two groups were enrolled: 100 patients >or=65 years old and 200 patients <65 years old. The baseline characteristics, the prescriptions and the treatment outcome were compared., Results: Mean age of the elderly patients was 69.1+/-3.7 years (range 65-80 years). We did not find any significant difference between elderly and adult patients in the sex distribution (female patients 76% in the elderly group and 72% in the adult group; p=0.276) and in the severity of overweight (body mass index: 37.8+/-6.0 kg/m2 in the elderly; 37.2+/-6.3 kg/m2 in adults; p=0.425). The elderly group was characterized by a higher incidence of comorbidities and a lower incidence of eating behavior disorders at baseline. No significant differences in the dietary prescription were found, whereas physical activity was prescribed in 27/100 elderly patients (27%) and in 97/200 (48%) adults patients (p<0.000). Weight loss was evaluated by analyzing the percentage of patients reaching at least a 10% weight loss from baseline after 12 months of treatment. In elderly patients still in active treatment after 12 months, only 5/28 (18%) patients reached the specified goal, whereas in adult patients still in treatment, 18/47 (38%) patients reached the goal (p<0.05). Lower age at baseline, female sex, and lower body mass index were found to be the only significant predictors of 10% weight loss in logistic regression. In our experience, drop-out rate after 12 months was similar in adults (77%) and in older patients (72%). In a multivariate Cox regression model, the risk of drop-out was reduced by married or widowed status, the prescription of physical activity at baseline, and the presence of type 2 diabetes. The risk of drop-out was increased by the presence of osteoarthritis. Even after adjustments for these confounding variables, age did not play any significant role as drop-out predictor., Conclusion: Advanced age seems to be a predictor of poor response to treatment in obese outpatients treated by conventional medical therapy. Drop-out rate was not significantly influenced by age.

The aim of this study is to analyze the relationships between obesity, fat distribution and pharyngeal transversal area in women. Cross-sectional areas of the pharynx at the oro-pharyngeal junction and at the glottis and mean pharyngeal area were measured by acoustic pharyngometry in 145 women (age 42.9 +/- 15.1 years; range 14-82 years). Body weight, waist, hip and neck circumferences, and sagittal abdominal diameter (SAD) were determined. Pharyngeal area at the oro-pharyngeal junction, measured both in orthostatic and in lying position, was negatively related to BMI, waist, hip and SAD. Mean pharyngeal area was negatively related to BMI and to SAD only in orthostatic position. No significant correlations were found between pharyngeal areas at the glottis and any anthropometric measurements. In multiple regression analysis, only SAD retained independent relationship with pharyngeal area at the level of the oro-pharyngeal junction in both the positions and with mean pharyngeal area in the orthostatic position. We demonstrated an inverse association between upper airways size and both adiposity and visceral fat distribution in women.

Background: To investigate the impact on bone and muscle of pathological conditions involving only one of the upper limbs, it is important to know the physiological differences due to the dominance effect., Aim: To evaluate any physiological differences between dominant and non-dominant upper limbs in terms of bone mineral density (BMD), muscle mass, and muscle density at different levels., Subjects and Methods: The study considered 60 right-handed healthy adults, 30 men and 30 women. Cortical BMD, muscle area, and muscle density were investigated by pQCT-XCT-3000 Stratec at the proximal radius, trabecular and total BMD at the distal radius, and trabecular and cortical BMD at the second phalanx of the third finger. Hand grip strength was also measured., Results: No significant differences in BMD were found between the dominant and non-dominant upper limbs at any of the sites considered, in men or women. Muscle density was also similar on the two sides, whereas muscle area at the proximal radius was significantly lower on the non-dominant side in both men [4177.5+/-475.1 vs 4009.3+/-552.7 mm2; Delta%: 4.1%; 95% confidence interval (CI) 1.7%-6.5%] and women (2903.9+/-470.9 vs 2720.3+/-411.7 mm2; Delta%: 6.1%; 95%CI 4.3%-7.9%). Hand grip strength proved greater on the right side in both men (48.5+/-8.8 vs 45.2+/-8.7 kg; Delta% 7.1; p<0.001) and women (29.1+/-4.3 vs 27.0+/-5.1 kg; Delta% 7.1; p<0.001)., Conclusion: The dominance effect does not seem to influence trabecular or cortical BMD at any of the sites in the upper limb. Muscle density is not modified by dominance, while muscle area is reduced on the non-dominant side and this should be borne in mind when the effect of pathological conditions on the body composition of a single forearm is investigated.

Blood pressure (BP) measurement in clinical assessment by means of a mercury sphygmomanometer (MS) has numerous drawbacks. It has been proposed that non-invasive, 24-hr ambulatory blood pressure monitoring (NIABPM) should provide more appropriate BP values for both the diagnosis of hypertension and for its subsequent monitoring during treatment. The aim of the present study was to investigate, in 100 ambulatory and 250 hospitalized elderly subjects, the prevalence of white coat hypertension (WCH) and masked hypertension (MH) in a cohort of older subjects, by using both clinical readings (MS) and NIABPM. The results of our analyses indicate that a higher prevalence of old-old subjects regarded as normotensive at anamnesis or with normal BP values at MS are true hypertensive (50% of ambulatory patients and 17.1% of hospitalized patients) or masked hypertensive (10.3% of ambulatory patients and 28.6% of hospitalized patients), and consequently at higher risk of cardiovascular morbidity and mortality.

Here we report an investigation on the serial position effect (SPE) in elderly patients with early dementia due to different etiologies. The Rey's 15 words test has been used to evaluate whether different types of dementia show different patterns of immediate and delayed recall and of learning process. Ninety-four patients were recruited from the Geriatric Clinic of Padua. We evaluated the primacy effect (PE), the recency effect (RE) and the learning process within the sample. Our results indicate that different etiologies have different patterns of anterograde memory impairment.

Aim: We report an unusual case of "failed suicide" in an oldest old woman who was apparently "aging successfully"., Method: This case was analysed in the light of a careful literature review., Results: This was an unusual case of failed suicide, attempted by a 94-year-old woman who had planned the suicide several days earlier., Conclusions: The unusual features of this case relate to: 1) the person's female gender and very advanced age; 2) her apparently "successful aging" condition; 3) the violent method and unusual means she used; 4) the suicide note written several days beforehand.

Objectives: The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds., Subjects and Methods: Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.5+/-5.3 years and 136 men aged 73.9+/-5.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry., Results: The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI <22 (OR=12) and a protein intake <65.7 g/day (OR=3.7). Women carried some risk already in the BMI 25-30 class (OR=5), and a much greater risk in the BMI <22 class (OR=26). Albumin <40 g/l also emerged as an independent risk factor (OR=2.6)., Conclusions: BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values <22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Age-related sarcopenia does not seem to be involved in bone mass loss.

Aims and Objectives: To compare different body temperature assessment methods in older people and to assess the role of cognitive and functional characteristics in temperature recordings., Background: Axillary gallium-in-glass thermometers are commonly used. Their accuracy depends on the proper placement of the device and their permanence in place for eight minutes. With adequate instruction, well-functioning patients can measure their axillary temperature by themselves, while in cognitively and functionally impaired older people, inadequate understanding of instructions and misplacement of the thermometer might determine significant recording errors. Electronic ear and axillary temperature measurements are faster, but their accuracy has not been demonstrated convincingly with older people., Methods: Patients (n = 107; aged 65-104 years) were recruited. Barthel Index and Short Portable Mental Status Questionnaire (SPMSQ) scores were obtained for each patient. Temperature readings were obtained using: the axillary gallium-in-glass thermometer, with (T(nurse)) and without (T(self)) the nurse's assistance; the electronic axillary thermometer (T(el)) and the infrared tympanic thermometer (T(tymp)). The T(nurse) was considered as the reference method., Results: Mean difference and standard deviation (mean +/- SD) in temperature recordings between the different techniques and T(nurse) differed significantly from zero for T(self) (-0.40 SD 0.42) and T(tymp) (+0.19 SD 0.48). No significant differences in temperature recordings emerged between T(nurse) and T(el). In simple linear regression models, the difference between T(self) and T(nurse) significantly correlated with age, gender, SPMSQ score and Barthel Index. Multiple linear regression analysis showed an underestimation of body temperature in older patients with cognitive impairments., Conclusion: Unassisted gallium-in-glass axillary temperature assessment is inadequate, in older patients. The differences between T(self) and T(nurse) are significantly influenced by age and mental decline. T(el) provides adequate accuracy. Relevance to clinical practice. In geriatric settings, the electronic axillary thermometer is a safe and accurate alternative to the more traditional gallium-in-glass thermometer, with the advantage of saving time (five seconds in recording vs. eight minutes).

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.

Objective: To analyze the effects of the surgical removal of subcutaneous adipose tissue by ultrasound-assisted megalipoplasty (UAM) on energy expenditure and adipocytokine concentrations in obese women., Methods: Fifteen premenopausal obese women with BMI 37.5+/-6.3 kg/m(2) (range: 30.7-53.6 kg/m(2)) underwent UAM. Body composition (by DEXA), resting metabolic rate (REE) by indirect calorimetry, insulin resistance (by the HOMA method), leptin, C-reactive protein, interleukin-6, resistin and adiponectin were measured before and 1, 3, 28 and 180 days after the procedure., Results: UAM significantly reduced fat mass at day 3, without further changes in the following days. REE increased at day 3 after UAM, returned to baseline levels at day 28 and significantly declined at day 180. Leptin levels transiently increased after UAM and then declined according to fat mass reduction. C-reactive protein, interleukin-6 and resistin levels acutely increased after UAM and then returned to the baseline levels. Adiponectin levels acutely declined after the procedure and then stabilized to a plasma level slightly lower than at baseline. Insulin resistance deteriorated in the acute post-operative phase and then improved., Conclusion: The surgical removal of subcutaneous fat was associated to an acute inflammatory reaction with high REE and insulin-resistance. Later on, the metabolic effects of fat mass removal appeared, with a reduction of leptin levels and REE and an improvement of insulin resistance.

Background: Transitions from Mediterranean to Western eating habits has been observed, particularly in young people. Thus little information is available on food patterns consumption in overweight/obese Italian elderly., Objectives: To describe dietary patterns in a sample of obese/overweight adults, providing differences between older and younger outpatients., Methods: Dietary patterns, anthropometric measurements, obesity onset, history of weight and demographic data were obtained in a retrospective survey, according to age groups (< 35 y, 35-64 y, >or= 65 y) and gender in 395 outpatients., Results: Main differences in dietary patterns have been observed across age groups. Older outpatients reported higher frequency of consumption of fresh fruit and vegetables, and lower daily consumption of sweet high-fat foods. All the participants reported eating cereals. The frequency of consumption of white meat and fish was higher in the oldest age group. The consumption of moderate amount of red wine at mealtime was common in older male patients only; the frequency of consumption of cheese did not differ across age groups, but compared to normal-weight Italian population was higher in older-aged female., Conclusion: Our study provides evidence of two different dietary patterns: a western diet which may have influenced weight gain in the younger patients and an Italian Mediterranean diet in the older ones. Despite its healthy effect, Mediterranean diet style did not prevent older obese patients from additional weight gain. Information on dietary habits may be useful to improve weight management and obesity prevention even in older subjects.

Objectives: To test the association between body mass index (BMI) and lower extremity motor performance in elderly people., Design: Multicenter, cross-sectional, observational study., Setting: A sample of individuals aged 65 and older recruited for the baseline survey of the Italian Longitudinal Study on Aging., Participants: Two thousand six hundred seventy-two individuals (1,436 men, 1,236 women) independent with transfers and toileting and independent or requiring assistance for bathing or dressing., Measurements: Motor function was assessed using a Motor Performance Test (MPT), with a set of six tasks exploring lower extremity performance (LEP): rising once from a chair, turning in a half circle, tandem walking, standing on one leg, stair climbing, and walking 5 m., Results: The highest prevalence rates of difficulty in performing the tasks occurred in men and women, respectively, in tandem walking (14%, 28%), stair climbing (17.0%, 43%) and walking 5 m (15%, 30%). In both sexes, moderate (men: odds ratio (OR)=1.99, 95% confidence interval (CI)=1.16-3.43; women OR=2.07, 95% CI=1.18-3.65) and severe obesity (men: OR=3.45, 95% CI=1.21-9.89; women: OR=3.16, 95% CI=1.43-6.95) were each independently associated with overall motor performance impairment after adjusting for age, smoking, and comorbidity. Best performance was generally observed in the normal-weight and overweight groups., Conclusion: The results confirm that, in both sexes, overweight is not related to motor impairment. Only in women, low BMI is associated with higher probability of overall motor performance impairment. These data suggest that moderate obesity should be distinguished from severe obesity when assessing the relationship between BMI and LEP.

Indwelling catheters are commonly used in elderly patients with urinary retention, incontinence, pressure ulcers, and cancer, ostensibly for the patient's comfort but sometimes to ease the burden of health care workers. Indwelling catheterization is overused; catheters should be inserted only for specific, well-documented indications. The best way to avoid catheter-associated infections and other complications is to avoid long-term catheter use whenever possible. Given the risks involved, catheterization is indicated only as a last resort, after other options have failed.

Background: To compare the mortality rate of obese patients treated by laparoscopic gastric banding (LAGB) with the mortality rate of matched obese patients observed at medical centers. The net effect of bariatric surgery on total mortality is still controversial. Gastric bypass has been shown to reduce the relative risk of death, but similar data with LABG are still lacking., Methods: The surgical series was composed of 821 patients with a body mass index (BMI) >40 kg/m(2) consecutively treated with LAGB at Padova University, Italy. The reference group was composed of 821 gender-, age-, and BMI-matched patients selected from a sample of 4681 adults with a BMI >40 kg/m(2) observed at 6 Italian medical centers not using surgical therapy., Results: The mean follow-up was 5.6 +/- 1.9 and 7.2 +/- 1.2 years in the surgical and reference group, respectively. The vital status was known in 97.6% of the surgical group (8 deaths) and in 97.4% of the reference group (36 deaths). In the surgical group, the percentage of excess weight loss was 39.8% +/- 17.9% 1 year after LAGB and 37.2% +/- 23.8% 5 years after LAGB. The rate of late revisional surgery was 12.2%. Survival was estimated using the Kaplan-Meier method, and the differences between the 2 groups were evaluated using the log-rank test. The survival rate was significantly greater in the surgical group (P = 0.0004). On multivariate Cox analysis, the 5-year relative risk of death in the surgical group, adjusted for gender, age, and baseline BMI, was 0.36 (95% confidence interval 0.16-0.80)., Conclusion: LAGB was associated with a 0% operative mortality rate and 40% stable excess weight loss. LAGB patients had a 5-year 60% lower risk of death than comparable morbidly obese patients.

Background and Aims: Great efforts have been made in developed societies to extend human life expectancy as much as possible. Continuing investments into extending the life-span into the "fourth age" actually reduce the opportunities of people to age successfully and die in dignity. Consequently, in recent years, the concept of "Successful Aging" (SA) has gained increased attention: investigators recognize the importance of separating pathologic changes from those which may be attributed to aging in itself, in order to interpret correctly the differences between Pathologic Aging, Normal Aging, and Successful Aging. Hence, according to recent literature on aging, our aim was to question here the validity of recommendations made in the literature for policy making in the treatment of aging and suggest new alternatives., Methods: We have tried to understand and develop a method of analysis to the following question: what do we actually mean by SA? Successful Aging may be seen as an arbitrary, subjective term, so we studied which indicators characterize elderly persons as successful aged., Results: The results of this study show that older people's views of SA appear to be multidimensional and more complex than the apparent viewpoint of many of early studies, which tended to focus on a single dimension of health - psychological or mental., Conclusions: We argue the proper use of various health indicators and health enhancers, as proposed in the current international literature, in the definition of SA.

Background: Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size., Methods: The study involved 52 institutionalized bedridden elderly women (aged 83.7 +/- 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured., Results: The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 +/- 236.7 vs 1085.5 +/- 161.3 kcal/d; p <.05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 +/- 6.7 vs 21.1 +/- 4.0 kcal/d/kg; p <.01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (DeltaREE) correlated with PS volume (r = 0.58; p <.01), but not with area., Conclusion: Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.

Background: This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common., Methods: Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 +/- 24 kg, mean BMI 46.2 +/- 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, short- and long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy., Results: Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5). Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7 %), and other 1 (0.05 %). Port-related complications occurred in 200 patients (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation ("bandinaro") in 24 (1.3%). Weight in kg was 103.7 +/- 21.6, 102.5 +/- 22.5, 105.0 +/- 23.6, 106.8 +/- 24.3, 103.3 +/- 26.2 and 101.4 +/- 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals was 37.7 +/- 7.1, 37.2 +/- 7.2, 38.1 +/- 7.6, 38.5 +/- 7.9, 37.5 +/- 8.5 and 37.7 +/- 9.1. The case/control study found a statistically significant difference in survival in favor of the surgically-treated group., Conclusions: LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount.

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.

Background: We analyzed the role of high plasma ghrelin concentrations at surgery as a negative predictor of weight loss in morbidly obese patients treated with laparoscopic gastric banding (LAGB)., Methods: Fasting plasma ghrelin concentrations were measured in 113 women before LAGB, and 16 of them were identified as having ghrelin concentrations clearly higher than expected according to the BMI levels. The 2-year postoperative outcome of these 16 patients was compared to the outcome of the remaining subjects., Results: Mean fasting plasma ghrelin concentration in the group with hyperghrelinemia was 82.3+/-23.1 pg/ml and in women with normal ghrelin was 27.1+/-11.3 pg/ml (P<0.001). No differences in age, age at onset of obesity or degree of obesity were observed between the two groups. Women with hyperghrelinemia had a weight gain during the waiting time similar to women with normal ghrelin. The prevalence of comorbidities and eating behavior disturbances was similar in the two groups, but depression was 2.5 fold more prevalent in the hyperghrelinemic women than in the women with normal ghrelin. The %EWL after LAGB surgery was similar in women with high and normal ghrelin concentrations, with no differences in levels of postoperative band filling. No differences in band-related complications or revisional surgery rate were observed between the two groups., Conclusion: A high fasting ghrelin concentration at baseline did not significantly affect the outcome after LAGB in morbidly obese women, in terms of weight loss and complications rate.

The aim of the present study was to analyze the influence of various factors on the prognosis for elderly patients with gastric carcinoma. Forty-eight patients aged > or =65 years admitted to Padova General Hospital were divided into two groups by age (<75 or >75 years). They all had a histologically confirmed diagnosis of gastric adenocarcinoma. Information on their clinicopathological characteristics was collected from the Padova Hospital medical records. On univariate analysis, significant prognostic factors in the two age groups were gender, stage, histotype (Lauren's intestinal type), Charlson index, and type of surgery (curative resection, palliative resection, and no surgery). On multivariate analysis, independent prognostic factors were the Charlson index, tumor stage, and age group. The 52-month survival rate was 72.7% for females and 12.5% for males for patients > or =75 years (P = 0.01), while for the whole series of patients it was 67.5% for females and 29.9% for males (P = 0.003). The 17-month survival rate was 55.6% for surgically treated patients and 0% for the untreated cases in stage 4 (P = 0.03). Gastric cancer should be treated with conventional surgery even in the very elderly, since the survival rate for this age group does not differ significantly from the figures for younger patients.

Objective: In the clinical practice, visceral proteins are used as indirect markers of protein energy malnutrition (PEM), but their reliability could be reduced with advancing age. The aim of this work is to investigate the reliability of albumin, prealbumin, retinol-binding protein (RBP) and transferrin in evaluating nutritional status in old patients and their relationship with fat-free mass (FFM)., Design: Cross-sectional study., Setting: Padua, Italy., Subjects: In 44 underweight (body mass index < 20 kg/m(2)) (66-97 years) and 69 normal weight or overweight elderly subjects (62-98 years), albumin, prealbumin, transferrin and RBP were determined in the plasma. Body composition and particularly FFM was obtained by dual X-ray absorptiometry. FFM was also expressed as FFM index (FFMI) calculated as FFM divided by height squared. Subjects affected by acute illnesses and inflammatory states were excluded., Results: Albumin, prealbumin and RBP mean values were significantly lower in underweight subjects. No differences between two groups were found for transferrin. Albumin prealbumin and RBP resulted under the normal range in 55, 25 and 54% of underweight subjects, respectively. Transferrin's values were low in about 40% of underweight and normal weight subjects, respectively. In all subjects, FFMI shows a significant correlation with albumin (r: 0.52), prealbumin (r: 0.64) and RBP (r: 0.57). No correlation between FFMI and transferrin was found., Conclusions: Visceral proteins, except for transferrin, seem to be useful indexes in detecting malnutrition in the elderly; low values still in the normal range should also be carefully evaluated because they could suggest a poor nutritional status.

Objective: To investigate the reliability of bioelectrical impedance analysis (BIA) in estimating total body water (TBW) and extracellular water (ECW) in elderly patients suffering from congestive heart failure (CHF)., Material and Methods: In 72 elderly subjects, 34 with CHF (aged 83.9+/-6.9 years) and 38 healthy controls (78.7+/-7.5 years), TBW and ECW values were assessed using dilution methods, and bioelectrical variables were measured using single frequency BIA (SF-BIA) at 1 and 50 kHz, and bioelectrical spectroscopy (BIS)., Results: In CHF patients, Ht(2)/R(1) correlated weakly with TBW (r = 0.56) and ECW (0.47). In both healthy controls and CHF patients, TBW correlated strongly with Ht(2)/R(50), Ht(2)/R(0), Ht(2)/R(8) and Ht(2)/Zc. Using multiple regression analysis and the Bland-Altmann approach, SF-BIA at 50 kHz and BIS proved similar in predicting TBW for both the explained variance (R(2)~0.89) and the limits of agreement. In all subjects, ECW was estimated best by including height, weight and Ht(2)/R(0 )(R(2) 0.75) or Ht(2)/Zc (R(2) 0.77) in multivariate models, while SF-BIA at 50 kHz did not explain more than 71 % of ECW variability. The SEE % was nonetheless about twice the SEE % for estimating TBW., Conclusions: SF-BIA at 1 kHz is unreliable in predicting body fluids in elderly people with CHF. SF-BIA at 50 kHz and BIS are useful for estimating TBW in healthy elderly people and in cases of water imbalance, but both methods are less reliable in estimating ECW, particularly in conditions of fluid overload.

Case Report: A 75-year-old man presented in May 2003 with suspected drop attack (atonic seizure). He reported falling over and losing consciousness. He was a retired, single ex-smoker, who lived alone in an apartment that was in a poor state of repair with precarious hygienic conditions. Over the course of 2 years he had unintentionally lost more than 10 kg (22 lbs) in weight. He had been diagnosed with diabetes approximately 10 years prior, and was receiving treatment with oral hypoglycemic therapy (fenformin/ glibenclamide, 25/2.5 mg, bid). He had been hospitalized for pneumonia in 2000. In recent months, he had gone to the emergency department several times (about once every 2 weeks) due to his weight loss and asthenia, without obtaining a definite diagnosis. On physical examination, his cognitive status was normal, but his nutritional status was deteriorated. Other clinical findings were negative. Blood chemistry tests revealed hypoalbuminemia (26.00 g/L). His personal hygiene was precarious and the apartment was completely neglected despite assistance by social support networks. In conversation with the social support worker, it was revealed that the patient was homosexual; with the patient's informed consent, he was tested and found positive for HIV. He was consequently transferred to the Infectious Diseases Department where further biochemical tests revealed: HIV-RNA Quantitative > 100.000 copies/ML COBAS Amplicor, antibodies anti-HIV 1-2 reactive sample (Enzygnost HIV Integral and Axsym HIV 1/2 GO [Abbott] EIA method, antibodies anti-HIV 1 positive (Western Blot). The patient's serum also tested positive for syphilis (TPHA positive 1:320). The patient refused any specific treatment, left the hospital, and was lost to follow-up.

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.

Objective: Helicobacter pylori infection has not been studied thoroughly in elderly patients. The aim of this study was to evaluate the reliability of stool antigen assay (HpSA) in the assessment of H. pylori infection in hospitalized, frail, elderly patients., Materials and Methods: The study population consisted of 85 consecutively recruited elderly patients (> or =65 years old) hospitalized between May 1999 and December 2001 with diagnostic indications for upper gastrointestinal endoscopy. Twenty-nine subjects had been receiving treatment with proton-pump inhibitors (PPIs), such as omeprazole (10-20 mg/day) for 2-15 days, and 56 were not receiving treatment. HpSA was evaluated versus UBT (urea breath test), serology and histology: patients with at least two positive results out of the latter three tests were considered positive for H. pylori infection, while patients with at least two negative tests out of three were considered negative., Results: The sensitivity and specificity of HpSA in the 56 untreated patients were, respectively, 76% (true positives TP = 22; false negatives FN = 7) and 93% (true negatives TN = 25; false positives FP = 2). The sensitivity and specificity of HpSA in the 29 patients on PPI treatment were, respectively, 82% (TP = 9; FN = 2) and 83% (TN = 15; FP = 3)., Conclusions: HpSA is an accurate, non-invasive and easy method for diagnosing H. pylori infection in elderly patients.

Background: The present study aims at defining a body mass index (BMI) threshold for risk of being underweight in elderly persons on the basis of the BMI distribution in a large Italian population-based sample and on its ability to predict short-term mortality., Methods: At baseline (1992), BMI was obtained for 3110 (1663 males and 1447 females) persons aged 65-84 participating in the Italian Longitudinal Study on Aging (ILSA). BMI and risk factors (age, sex, education, smoking status, disability, and disease status) have been considered for their potential association with 4-year all-cause mortality. Information on vital status at 1995 was obtained for 2551 participants., Results: The fifth centile of BMI was well approximated by a value of 20 for both sexes. Also in both sexes, at a BMI value of 24 the a posteriori probability of death started to increase, doubling at a value of 22 for men and 20 for women. Crude mortality was 14.6% for men and 9.8% for women. The hazard ratios and confidence intervals (CIs) comparing mortality for each BMI two-unit class to the 26-28 class, after adjusting for confounding variables, showed significantly higher rates only for BMI values below 20 (2.9; 95% CI, 1.2-7.0), although a consistent increase in hazard ratio (1.6; 95% CI, 0.9-3.0) already appeared for the 20-22 BMI group., Conclusions: Our study confirms that low BMI is an independent predictive factor of short-term mortality in elderly persons. A BMI value of 20 kg/m2 seems to be a reliable threshold for defining underweight elderly persons at high risk. Nevertheless, more careful clinical and nutritional management should also be applied to elderly persons with higher BMI values.

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: The authors investigated the outcome of morbidly obese patients with binge eating disorder (BED) treated surgically with laparoscopic adjustable gastric banding., Methods: The 5-year outcomes of 130 patients with BED and 249 patients without BED are described. The diagnosis of BED was made preoperatively and all patients with BED were supported with psychological therapy., Results: Patients with and without BED had similar BMI levels before surgery. More patients with than without BED had depressive symptoms and associated minor disturbances of eating behavior (night eating and grazing). Percent excess weight loss (%EWL) in the first 5 years after surgery was similar in patients with and without BED. The percentage of BED patients showing %EWL >50% at the 5-year evaluation was 23.1, and 25.7% in non-BED patients. The percentage of patients showing weight regain in the last 4 years of follow-up was similar in binge eaters (20.8%) and in non-binge eaters (22.5%). The 5-year frequency of gastric pouch and esophageal dilatation was significantly higher in binge eaters than in non-binge eaters (25.4 vs 17.7 %, P<0.05 and 10.0 vs 4.8%, P<0.05, respectively). Binge eaters underwent a higher number of postoperative band adjustments than non-binge eaters (3.0+/-2.1 vs 2.6+/-1.9, P<0.05) and the maximum band fill after surgery was higher in the BED patients than in non-BED patients (3.2+/-1.2 vs 2.8+/-1.3 ml, P<0.01)., Conclusion: Morbidly obese patients with BED supported by adequate psychological treatment can have good outcomes after gastric banding.

Objective: To investigate the impact on drop-out rates of several baseline clinical characteristics of a sample of overweight and obese outpatients., Design: Retrospective clinical trial., Subjects: The charts of 383 patients aged 15-82 y attending an outpatient clinic for the treatment of obesity were examined from the first clinical evaluation until 1 y of diet ambulatory treatment., Measurements: We characterised the participants at baseline on the basis of their somatic characteristics, socioeconomic status, obesity-related diseases and dietary habits. The most significant factors resulting in univariate statistical analysis (waist, body mass index (BMI), full-time job, depressive syndrome, number of obesity-related diseases, daily frequency of fruit consumption) were then examined as independent variables in direct multiple logistic regression with the dependent variable drop-out., Results: The 1-y drop-out rate was 77.3%. A total of 87 patients completed the follow-up study. The noncompleter patients had slightly lower BMI and waist circumference mean values, and they were further regularly employed in full-time jobs, while the completer patients were principally pensioners and housewives. Drop-outs had a lower number of obesity-related diseases and as a result were less depressed. By the logistic regression, full-time job is the best predictor of premature withdrawal (odds ratio=2.40). Age, gender, anthropometric measurements, lifestyle and dietary habits did not result as significant predictors of drop-out., Conclusion: The overweight and obese outpatients at higher risk of ambulatory treatment drop-out are more likely to work full hours, have less obesity-related complications and be less depressed. In our study, the full-time job condition seems to be the strongest predictor of premature withdrawal.

Background: We examined associations between cardiovascular diseases and risk factors with pathological levels of and significant changes in serum creatinine (SCr) in a large prevalence phase and longitudinal phase community-based sample of an elderly Italian population (ILSA Study) showing no clinical evidence of renal impairment., Methods: The prevalence phase was performed on 2981 subjects, aged 65-84 years, who were negative for renal diseases, had available SCr values and had complete clinical information on their cardiovascular risk factors. Of these, 371 were considered 'healthy' since they were not affected by cardiovascular diseases or diabetes, whereas 2610 tested positive for cardiovascular diseases and were considered 'diseased'. The sex-specific 95th percentiles for SCr (cut-off points) were calculated in the healthy reference sample to define the upper limit for normal SCr values. The distribution and prevalence of diseased subjects having values over the cut-off point values were then estimated. Associations between values over the cut-off point levels and pathological or clinical conditions were analysed from the diseased sample. The longitudinal phase was carried out on 1906 subjects who had SCr values and sufficient clinical information for our investigation. The incidence of an increase of >26.5 micromol/l of SCr was evaluated in the longitudinal cohort., Results: In healthy subjects, the 95th SCr percentiles (cut-off points) were 123.8 micromol/l in men and 97.2 micromol/l in women. In diseased subjects, the prevalence of SCr values over the cut-off point was 4.6% in men and 9.3% in women. In logistic regression analysis, independent variables that correlated with over the cut-off point SCr values were: age >75 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.5-3.4], atherosclerosis of the lower limbs (OR = 2.0; 95% CI = 1.2-3.3), cerebrovascular disease (OR = 1.9; 95% CI = 1.2-3.3), angiotensin-converting enzyme (ACE) inhibitor medication (OR = 1.8; 95% CI = 1.2-2.8), fibrinogen values >3.5 g/l (OR = 1.2; 95% CI = 1.2-2.7) and diuretic treatment (OR = 1.6; 95% CI = 1.1-2.4). After a mean 3.6 years follow-up, multiple logistic regression analysis showed that risk factors for pathological loss of renal function (rise of SCr >26.5 micromol/l) were: current smokers >20 cigarettes/day (OR = 2.3; 95% CI = 1.0-5.3), fibrinogen values >3.5 g/l (OR = 2.2; 95% CI = 1.6-3.3), diabetes (OR = 1.8; 95% CI = 1.1-2.8), age >75 years (OR = 1.7; 95% CI = 1.2-2.4) and isolated systolic hypertension (OR = 1.6; 95% CI = 1.0-2.6). The loss of renal function examined during the longitudinal phase appeared to be independent of baseline SCr levels., Conclusion: The present prevalence and longitudinal studies show that age-associated decline in renal function in elderly subjects is associated with co-existing cardiovascular diseases and risk factors. These observations should be incorporated into clinical practice since some of the factors detrimental to kidney function, such as smoking, altered fibrinogen levels and elevated systolic blood pressure, can be prevented and/or modified when appropriate measures are taken.