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1. Eating Disorders and bariatric surgery

Author

1. Ballardini D., Pozzi L., Dapporto E., Tomba E, Manzato, E., Cuzzolaro M., Donini L, and 1. Ballardini D., Pozzi L., Dapporto E., Tomba E

Subjects
digestive, oral, and skin physiology, eating disorders, bariatric surgery, obesity
Abstract

Many studies have shown that patients with severe obesity who are candidates for bariatric surgery are frequently affected by eating disorders which can persist even after surgery. Furthermore, bariatric patients can develop EDs and dysfunctional eating behaviours in the post-bariatric phase: EDs (BED, AN, BN, NES), LOC, grazing, picking, emotional eating, craving and sweet eating. The presence of eating disorders and dysfunctional eating behaviours may influence the outcomes in terms of weight loss and metabolic parameters. After the description of an illustrative clinical case of a patient with pre-surgical BED and post-surgical BN, the need for a multidisciplinary and structured diagnostic-therapeutic programme for the bariatric patient is discussed in order to prevent or treat feeding and eating disorders. The importance of a multidisciplinary team (physician, dietician, psychotherapist, psychiatrist) is also highlighted in the management and treatment of these patients.

Published
2021

5. Cow’s Milk Consumption and Health: A Health Professional’s Guide

Author

Marangoni, F., Pellegrino, L., Verduci, E., Ghiselli, A., Bernabei, Roberto, Calvani, Riccardo, Cetin, I., Giampietro, M., Perticone, F., Piretta, L., Giacco, R., La Vecchia, C., Brandi, M. L., Ballardini, D., Banderali, G., Bellentani, S., Canzone, G., Cricelli, C., Faggiano, P., Ferrara, N., Flachi, E., Gonnelli, S., Macca, C., Magni, P., Marelli, G., Marrocco, W., Miniello, V. L., Origo, C., Pietrantonio, Filomena, Silvestri, P., Stella, R., Strazzullo, P., Troiano, E., Poli, A., Bernabei R. (ORCID:0000-0002-9197-004X), Calvani R. (ORCID:0000-0001-5472-2365), Pietrantonio F., Marangoni, F., Pellegrino, L., Verduci, E., Ghiselli, A., Bernabei, Roberto, Calvani, Riccardo, Cetin, I., Giampietro, M., Perticone, F., Piretta, L., Giacco, R., La Vecchia, C., Brandi, M. L., Ballardini, D., Banderali, G., Bellentani, S., Canzone, G., Cricelli, C., Faggiano, P., Ferrara, N., Flachi, E., Gonnelli, S., Macca, C., Magni, P., Marelli, G., Marrocco, W., Miniello, V. L., Origo, C., Pietrantonio, Filomena, Silvestri, P., Stella, R., Strazzullo, P., Troiano, E., Poli, A., Bernabei R. (ORCID:0000-0002-9197-004X), Calvani R. (ORCID:0000-0001-5472-2365), and Pietrantonio F.

Abstract

The most recent scientific evidence supports the consumption of cow’s milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow’s milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor–patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products’ nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardio

Published
2019

7. Manifesto delle criticità in Nutrizione clinica e preventiva: Le prime dieci sfide Italiane (2015-2018)

Author

Lucchin, L., Fusco, M. A., Caretto, A., Alessandrini, L., Facchin, N., Grossi, E., Dalle Grave, R., Banderali, G., Banderali, A., Rovera, G. M., Ballardini, D., Bertoni, G., Gramezi, A., Ronchi, B., Baldi, A., Carruba, M., Lacirignola, M., Capone, R., Agostoni, C., Fargion, S., Mosca, F., Roggero, P., Giannì, M. L., De Cosmi, V., Donegani, G., Leonardi, F., Mattivi, F., Viola, R., Ferreiro, M. S., Giannini, M., Poli, A., Marangoni, F., Fatati, G., Grandone, I., Di Lorenzo, N., Carbonelli, M. G., Foschi, D., Riccardi, G., Giacco, R., Trimarchi, F., Aroso, M., Corazza, G. R., Biolo, G., Brighenti, F., Casini, A., Giovannini, M., Riva, E., Verduci, E., Sirtori, C., Cicero, A., Racca, A., Sarpa, B., Nisoli, E., Sbraccia, P., Busetto, L., Muratori, F., Migliaccio, P., Piretta, L., Melchionda, N., Donini, L. M., Guberti, E., Alonzo, E., Giorgino, F., Laviola, L., Banni, S., Agodi, A., Frittitta, L., Rotella, C. M., Dicembrini, I., Barbaro, V., Morelli, L., Contaldo, F., Gnessi, L., Laviano, A., Muscaritoli, M., Pinto, A., Vania, A., De Lorenzo, A., Di Renzo, L., Vettor, R., D'Andrea, F., Battino, M., Melissano, M., Scaffidi, C., Archero, E., Vezzali, V., Buzzavo, G., Lucchin, L., Fusco, M. A., Caretto, A., Alessandrini, L., Facchin, N., Grossi, E., Dalle Grave, R., Banderali, G., Banderali, A., Rovera, G. M., Ballardini, D., Bertoni, G., Gramezi, A., Ronchi, B., Baldi, A., Carruba, M., Lacirignola, M., Capone, R., Agostoni, C., Fargion, S., Mosca, F., Roggero, P., Giannì, M. L., De Cosmi, V., Donegani, G., Leonardi, F., Mattivi, F., Viola, R., Ferreiro, M. S., Giannini, M., Poli, A., Marangoni, F., Fatati, G., Grandone, I., Di Lorenzo, N., Carbonelli, M. G., Foschi, D., Riccardi, G., Giacco, R., Trimarchi, F., Aroso, M., Corazza, G. R., Biolo, G., Brighenti, F., Casini, A., Giovannini, M., Riva, E., Verduci, E., Sirtori, C., Cicero, A., Racca, A., Sarpa, B., Nisoli, E., Sbraccia, P., Busetto, L., Muratori, F., Migliaccio, P., Piretta, L., Melchionda, N., Donini, L. M., Guberti, E., Alonzo, E., Giorgino, F., Laviola, L., Banni, S., Agodi, A., Frittitta, L., Rotella, C. M., Dicembrini, I., Barbaro, V., Morelli, L., Contaldo, F., Gnessi, L., Laviano, A., Muscaritoli, M., Pinto, A., Vania, A., De Lorenzo, A., Di Renzo, L., Vettor, R., D'Andrea, F., Battino, M., Melissano, M., Scaffidi, C., Archero, E., Vezzali, V., and Buzzavo, G.

Subjects
Medicine (all)
Abstract

Razionale EXPO 2015 affronta un bisogno primario per l’essere umano: “nutrire il pianeta; energia per la vita”. Per le ripercussioni globali a breve-medio termine è una importante occasione di confronto nazionale e internazionale. La problematica dovrebbe essere affrontata in modo razionale, chiaro e, soprattutto, ampiamente compartecipato dall’opinione pubblica. Dato per scontato che il primo nutrimento è l’ossigeno, l’assunto è che la composizione e non solo la qualità del cibo ingerito siano indispensabili per stabilire la porzione e la frequenza di consumo. Il primo aspetto da fare emergere dovrebbe pertanto riguardare le caratteristiche della corretta nutrizione e le modalità per ottenerla, considerando che il comportamento alimentare è la risultante di una complessa interazione tra fattori biologici, psicologici e l’ambiente in cui si vive. Cibo in quantità suf#ciente, sicuro e in grado di fornire il giusto apporto nutrizionale sono le condizioni per mantenere la salute e avere una vita attiva (World Food Summit del 1996). Mentre la Commissione Europea propone un aggiornamento dei Regolamenti a garanzia della sicurezza alimentare con una rinnovata attenzione alla prevenzione e alle ricadute ecologiche dell’alimentazione, le Agenzie Internazionali (OMS, FAO, UE) sottolineano la necessità di porre la giusta attenzione agli aspetti nutrizionali dell’alimentazione e alle sue conseguenze in termini di salute. Sulla scelta al consumo le tre priorità emergenti sono: 1. ricerca del benessere e salute. L’equazione “mangiare bene-stare bene”, sempre più percepita dalla popolazione, necessita di chiarimenti sui rapporti tra sano e naturale, sano e industriale, sano e biologico (più di 700 milioni di euro in Italia nel 2014 per prodotti bio), sano ed eco-friendly; 2. attenzione all’ambiente e alla sostenibilità; 3. criteri etici nella scelta dei prodotti. La visione globale della problematica risulta estremamente complessa, richiedendo una pianificazione a 360° che va oltre il mero ambito sanitario. Imprescindibile alla sua realizzazione, specie a livello nazionale, l’esistenza di un “Sistema Paese” di fatto coeso. Se nutrire l’individuo è lo scopo principale del cibo, dovrebbero risultare de#nite le priorità/emergenze nutrizionali da affrontare su scala nazionale e internazionale per poter rendere efficaci i modelli d’intervento sia di tipo preventivo sia terapeutico e di piani#cazione agro-alimentare per le popolazioni. Purtroppo, le politiche d’intervento attivate nei vari Paesi dimostrano ancora impostazioni fortemente settoriali e in parte condizionate da interessi economico-finanziari. Una constatazione risulta evidente: l’incomprensibile inadeguato investimento strategico in nutrizione clinica e preventiva nell’ambito della politica sanitaria nazionale. E a maggior ragione, alla luce dei grandi cambiamenti demografici avvenuti in tutti i Paesi del mondo: invecchiamento della popolazione, aumento degli adolescenti, specie nei Paesi in via di sviluppo, migrazioni. Ciò ha modificato prevalenza e incidenza delle patologie cronico degenerative, che richiedono un numero crescente d’interventi riabilitativi, specie in relazione alla malnutrizione per eccesso e difetto (calorico-proteica e/o in micronutrienti). Una evidenziazione delle criticità condivisa dai tecnici del settore, nel rispetto della necessaria multidisciplinarietà, risulta pertanto quanto mai necessaria per un serio raffronto, anche a livello internazionale, su problematiche comuni. La “pesatura” delle stesse, sulla base di criteri quantitativi assoluti, rende oggettiva e trasparente all’opinione pubblica e ai policy maker la possibile e ottimale allocazione delle risorse necessarie per contrastarle. Il manifesto delle criticità in nutrizione clinica e preventiva: • faciliterà la riflessione dei cittadini italiani, sottoposti a una eccessiva e costante pressione mediatica – prevalentemente a fini commerciali – su tali argomenti, fonte di crescente confusione e insicurezza circa i comportamenti da seguire. Non bisognerebbe lasciarsi sfuggire l’opportunità di un’ampia ri*essione di carattere scientifico, che possa portare all’attenzione di un pubblico globale temi che sono centrali per l’intera Comunità Internazionale non solo per la durata di Expo 2015; • potrà fungere da strumento operativo d’indirizzo istituzionale per un intervallo temporale di almeno quattro anni, necessario per una ef#cace pianificazione degli interventi. Il documento non è una linea-guida o un decalogo di nobili propositi, ma una analisi oggettiva corredata di azioni strategiche fattibili e auspichiamo vincolanti. Deve aumentare il convincimento che le problematiche nutrizionali (per lo più connesse alla patologia cronica), non sono risolvibili con soli interventi sanitari, ma richiede un cambio di orientamento culturale a livello produttivo, distributivo e di consumo. In questa operazione risulta evidente la centralità del Ministero della Salute e in particolare della Direzione Generale della Igiene e Sicurezza degli Alimenti e della Nutrizione, per un’eventuale revisione delle politiche in materia (tramite strumenti quali linee-guida, LEA, PSN, ecc.) e ricadute in ambito nazionale (politiche regionali in materia sanitaria dedicate alla nutrizione) e internazionale.

Published
2015

8. Manifesto delle criticità in nutrizione clinica e preventiva (2015-2018)

Author

Fusco, Ma, Lucchin, L, Dalle Grave, R, Banderali, G, Rovera, Gm, Ballardini, D, Bertoni, G, Gramezi, A, Ronchi, B, Baldi, A, Carruba, M, Lacirignola, M, Agostoni, C, Fargion, S, Donegani, G, Leonardi, F, Mattivi, F, Viola, R, Ferreiro, Ms, Giannini, M, Fatati, G, Grandone, I, Di Lorenzo, N, Carbonelli, Mg, Riccardi, G, Giacco, R, Trimarchi, F, Aroso, M, Corazza, G, Brighenti, F, Casini, A, Giovannini, M, Riva, E, Sirtori, C, Cicero, A, Nisoli, E, Sbraccia, P, Migliaccio, P, Piretta, L, Melchionda, N, Donini, Lorenzo Maria, Guberti, E, Alonzo, E, Giorgino, F, Laviola, L, Agodi, A, Frittitta, L, Rotella, Cm, Dicembrini, I, Morelli, L, Contaldo, F, Gnessi, Lucio, Laviano, Alessandro, Muscaritoli, Maurizio, Pinto, Alessandro, Vania, Andrea, De Lorenzo, A, Di Renzo, L, Vettor, R, D’Andrea, F, Battino, M, and Biolo, G.

Subjects
nutrizione clinica
Published
2015

14. Relationships between growth factors (somatomedin-C and growth hormone) and body development, metabolic control, and retinal changes in children and adolescents with IDDM.

Author

Salardi, Silvana, Cacciari, Emanuele, Ballardini, Donatella, Righetti, Francesca, Capelli, Maurizio, Cicognani, Alessandro, Zucchini, Stefano, Natali, Gabriele, Tassinari, Davide, Salardi, S, Cacciari, E, Ballardini, D, Righetti, F, Capelli, M, Cicognani, A, Zucchini, S, Natali, G, and Tassinari, D

Published
1986
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15. Manifesto of the critical issues in preventive and clinical nutrition: The first ten Italian challenges (2015-2018),Manifesto delle criticità in Nutrizione clinica e preventiva: Le prime dieci sfide Italiane (2015-2018)

Author

Lucchin, L., Fusco, M. A., Caretto, A., Alessandrini, L., Facchin, N., Grossi, E., Dalle Grave, R., Banderali, G., Banderali, A., Rovera, G. M., Ballardini, D., Bertoni, G., Gramezi, A., Ronchi, B., Baldi, A., Carruba, M., Lacirignola, M., Capone, R., Agostoni, C., Fargion, S., Mosca, F., Roggero, P., Giannì, M. L., Cosmi, V., Donegani, G., Leonardi, F., Mattivi, F., Viola, R., Ferreiro, M. S., Giannini, M., Poli, A., Marangoni, F., Fatati, G., Grandone, I., Di Lorenzo, N., Carbonelli, M. G., Foschi, D., Riccardi, G., Giacco, R., Trimarchi, F., Aroso, M., Corazza, G. R., Biolo, G., Brighenti, F., Casini, A., Giovannini, M., Riva, E., Elvira Verduci, Sirtori, C., Cicero, A., Racca, A., Sarpa, B., Nisoli, E., Sbraccia, P., Busetto, L., Muratori, F., Migliaccio, P., Piretta, L., Melchionda, N., Donini, L. M., Guberti, E., Alonzo, E., Giorgino, F., Laviola, L., Banni, S., Agodi, A., Frittitta, L., Rotella, C. M., Dicembrini, I., Barbaro, V., Morelli, L., Contaldo, F., Gnessi, L., Laviano, A., Muscaritoli, M., Pinto, A., Vania, A., Lorenzo, A., Di Renzo, L., Vettor, R., D Andrea, F., Battino, M., Melissano, M., Scaffidi, C., Archero, E., Vezzali, V., and Buzzavo, G.

20. 86

Author

SALARDI, S., BALLARDINI, D., RIGHETTI, F., BALSAMO, A., ZAPPULLA, F., PIRAZZOLI, P., TASSINARI, D., and CACCIARI, E.

Published
1984

22. The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement

Author

Lucia Tecuta, Romana Schumann, Donatella Ballardini, Elena Tomba, Tecuta L., Schumann R., Ballardini D., and Tomba E.

Subjects
eating disorder, metacognitive beliefs, General Medicine, metacognitions, eating disorders, cognitive behavioral therapy, metacognition
Abstract

The metacognition of needing to control thoughts has been implicated in eating disorders (EDs)—specifically, in association with the drive for thinness and over-control. To date, it has yet to be investigated longitudinally in ED outpatients undergoing CBT-based treatment. The current study aims to examine whether endorsing a need to control thoughts undergoes modifications during CBT-based treatment for EDs and whether its modification correlates with treatment response in terms of reduced ED symptomatology. Seventy female ED outpatients (34 with AN, 29 with BN, 7 with OSFED) were assessed at baseline and at the end of treatment with the Metacognitions Questionnaire (MCQ), the Eating Attitudes Test (EAT-40), and the General Health Questionnaire (GHQ). Post-treatment, significant reductions were observed in MCQ-need to control thoughts. Using hierarchical linear regression analyses such decreases significantly explained the variance in observed reductions in EAT-oral control and to a lesser extent, reductions in EAT-bulimia and food preoccupation and EAT-dieting. These results underscore the importance of metacognitive change in EDs and the potential utility of CBT-based treatment in its modification. Improving ED outcomes may warrant broadening the therapeutic target of over-control and a sense of loss of control beyond dysfunctional eating behaviors to include maladaptive metacognitions that concern the need to control thoughts.

Published
2022
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23. Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders

Author

Valentina Gardini, Romana Schumann, Donatella Ballardini, Elena Tomba, Lucia Tecuta, Tecuta L., Gardini V., Schumann R., Ballardini D., and Tomba E.

Subjects
cognitive–behavioral therapy, cognitive reappraisal, medicine.medical_treatment, eating disorders, Anorexia nervosa, Article, maladaptive cognitions, Cognitive reappraisal, Multivariate analysis of variance, mental disorders, Medicine, business.industry, Bulimia nervosa, Eating disorder, General Medicine, medicine.disease, Cognitive behavioral therapy, Eating disorders, Irrational belief, General Health Questionnaire, irrational beliefs, business, Body mass index, Clinical psychology
Abstract

Background: Research on which specific maladaptive cognitions characterize eating disorders (ED) is lacking. This study explores irrational beliefs (IBs) in ED patients and controls and the association between IBs and ED-specific and non-specific ED symptomatology and cognitive reappraisal. Methods: 79 ED outpatients with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorders and 95 controls completed the Attitudes and Beliefs Scale-2 (ABS-2) for IBs. ED outpatients also completed the Eating Disorder Inventory-3 (EDI-3) for ED-specific (EDI-3-ED Risk) and non-specific (EDI-3-General Psychological Maladjustment) symptomatology; General Health Questionnaire (GHQ) for general psychopathology; Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal. Results: Multivariate analysis of variance with post hoc comparisons showed that ED outpatients exhibit greater ABS-2-Awfulizing, ABS-2-Negative Global Evaluations, and ABS-2-Low Frustration Tolerance than controls. No differences emerged between ED diagnoses. According to stepwise linear regression analyses, body mass index (BMI) and ABS-2-Awfulizing predicted greater EDI-3-ED Risk, while ABS-2-Negative Global Evaluations and GHQ predicted greater EDI-3-General Psychological Maladjustment and lower ERQ-Cognitive Reappraisal. Conclusion: Awfulizing and negative global evaluation contribute to better explaining ED-specific and non-specific ED symptoms and cognitive reappraisal. Therefore, including them, together with BMI and general psychopathology, when assessing ED patients and planning cognitive–behavioral treatment is warranted.

Published
2021

24. State and trait anger and its expression in cluster headache compared with migraine: a cross-sectional study

Author

Giulia Giannini, Giulia Pierangeli, Marialuisa Rausa, Pietro Cortelli, Sabina Cevoli, Corrado Zenesini, Sara Anastasia Contin, Donatella Ballardini, Valentina Favoni, Rausa M., Cevoli S., Giannini G., Favoni V., Contin S.A., Zenesini C., Ballardini D., Cortelli P., and Pierangeli G.

Subjects
Adult, Male, medicine.medical_specialty, Neurology, Cross-sectional study, media_common.quotation_subject, Migraine Disorders, Pain, Subgroup analysis, Cluster Headache, Dermatology, Anger, behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, Chronic Migraine, mental disorders, medicine, Humans, 030212 general & internal medicine, media_common, business.industry, Cluster headache, STAXI-2, General Medicine, Middle Aged, medicine.disease, Psychiatry and Mental health, Cross-Sectional Studies, Feeling, Migraine, behavior and behavior mechanisms, Chronic headache, Female, Neurology (clinical), business, Emotional regulation, 030217 neurology & neurosurgery, psychological phenomena and processes, Clinical psychology, Personality
Abstract

Background: Anger is involved in the emotional experience of pain. Individuals with migraine are more likely to hold their anger-in than controls. However, only one study evaluated anger in cluster headache (CH). The objective is to compare anger between migraine and CH patients. Methods: One hundred thirty-five migraine and 108 CH patients completed the State Trait Anger Expression Inventory (STAXI-2), composed of 7 subscales. State Anger measures the intensity of the individual’s angry feelings at the time of testing. Trait Anger evaluates general predisposition to become angry. Anger Expression Out and Anger Expression In measure the extent to which anger could be overtly expressed or suppressed. Anger Control Out and Anger Control In evaluate how individual try to control the outward or inward expression of anger. Anger Expression Index is a general index. Results: CH patients have higher median scores than migraine patients in State Anger (46 vs 44, p = 0.012). CH patients have lower scores in Anger Control Out (44 vs 50, p = 0.016). In subgroup analysis, CH patients during the cluster period have higher scores than chronic migraine patients in State Anger (47 vs 44, p = 0.035), while CH patients in headache-free period did not differ from migraine patients. Conclusions: Migraine and CH patients differ in state anger, indicating that CH patients experienced higher intensity of anger during the time of testing. These data add new information about emotional regulation in headache patients and could support the hypothesis of different emotional and behavioral responses to pain in migraine and CH patients.

Published
2019

25. Morningness–eveningness preference and eating disorders

Author

Donatella Ballardini, Chiara Mencarelli, Valentina Magelli, Vincenzo Natale, Romana Schumann, Natale V., Ballardini D., Schumann R., Mencarelli C., and Magelli V.

Subjects
medicine.medical_specialty, MORNINGNESS-EVENINGNESS, HUMAN CIRCADIAN RHYTHMS, BULIMIA, medicine.disease, Eating Disorder Inventory, Preference, EATING DISORDERS, Eating disorders, CIRCADIAN TYPOLOGY, medicine, Morningness eveningness, In patient, Big Five personality traits, Psychology, Psychiatry, Prospective cohort study, Clinical treatment, General Psychology
Abstract

The aim of this work was to attempt to clarify the relationship between eveningness preferences and eating behaviour. In a survey a sample of 270 females (146 recruited in a treatment centre for eating disorders and 124 control) was administered the reduced version of the morningness–eveningness questionnaire (MEQr) and the eating disorder inventory 2 (EDI-2). A significant higher percentage of evening-type in patient versus control group was observed. About 46 patients who participated in the survey were enrolled in a further prospective study. A significant regression of symptomatology as scored by EDI-2 corresponded to a significant increase in MEQr scores (i.e. shift towards morningness). We concluded that altered eating behaviours could modulate circadian preference. The results are discussed in relation to possible applications for clinical treatment.

Published
2008

26. Psychological well-being in out-patients with eating disorders: a controlled study

Author

Elena, Tomba, Emanuela, Offidani, Lucia, Tecuta, Romana, Schumann, Donatella, Ballardini, Tomba E, Offidani E, Tecuta L, Schumann R, and Ballardini D.

Subjects
Adult, Male, Anorexia Nervosa, Psychometrics, Health Status, Feeding Behavior, Patient Acceptance of Health Care, PSYCHOLOGICAL WELL-BEING, eating attitude, Diagnostic and Statistical Manual of Mental Disorders, Young Adult, Mental Health, Italy, Socioeconomic Factors, Case-Control Studies, eating disorder, Outpatients, Humans, Female, Bulimia Nervosa, Attitude to Health, Binge-Eating Disorder
Abstract

OBJECTIVE: Positive functioning is widely neglected in research on eating disorders (EDs). The aim of this exploratory study was to assess psychological well-being (PWB) in out-patients with ED and in controls. METHOD: The authors assessed PWB in 245 out-patients with EDs [105 with bulimia nervosa (BN), 57 with anorexia nervosa (AN), and 83 with binge eating disorder (BED) who met DSM-IV-TR] and 60 controls. They tested whether PWB was associated with eating attitude test (EAT) scores and if such associations differed among ED groups while taking into account confounding variables. RESULTS: Significant differences between groups in all PWB scales were found. While individuals with BN reported significantly lower scores in all PWB dimensions than healthy controls, patients with BED scored significantly lower than controls in PWB autonomy, environmental mastery, and self-acceptance scales. Patients with AN showed similar scores to controls in all PWB dimensions, except for positive relationships and self-acceptance. In all ED groups, most PWB dimensions resulted significantly and negatively associated with EAT scales, except for AN where oral control was found to positively correlate with a high sense of purpose in life. All results were maintained even after adjusting for possible confounding variables. DISCUSSION: Patients with EDs reported an impairment in PWB. The paucity of PWB was not necessarily dependent on the presence of high levels of psychological distress and on the severity of the disorder. Such assessments may therefore yield a more comprehensive evaluation in this clinical population.

Published
2014

27. Strumenti psicometrici per la valutazione dei DCA nel setting di cura interdisciplinare

Author

TOMBA, ELENA, BALLARDINI D., SCHUMANN R., and Tomba E.

Subjects
APPROCCIO INTERDISCIPLINARE, DISTURBI DEL COMPORTAMENTO ALIMENTARE, STRUMENTI DI VALUTAZIONE
Abstract

Un processo di valutazione accurato è fondamentale per la progettualità di un intervento di cura che voglia definirsi efficace e basato “su evidenze scientifiche”. La natura multifattoriale che lega i fattori biologici, psicologici esociali all’esordio e al mantenimento dei DCA, l’ampia gamma di quadri sub-sindromici attraverso i quali, dalla patologia più conclamata, si sfuma fino alle variegate espressioni della “normalità” del comportamento alimentare, l’elevatissimo grado di comorbilità con altri disturbi psichiatrici del DSM-IV-TR (Diagnostic and Statistical Criteria for Mental Disorder, Four Edition,Text Revised (APA, 1994) (in particolare dell’area ansiosa e dell’umore) e con altre patologie più squisitamente mediche rendono complessa la delimitazione e descrizione degli ambiti di valutazione di maggiore rilevanza clinica per il trattamento di questa popolazione. In questo capitolo sono descritti i più importanti strumenti psicometrici per la rilevazione precoce e la formulazione diagnostica dei DCA e del loro trattamento in un setting di cura interdisciplinare psico-nutrizionale.

Published
2011

28. SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery.

Author

De Luca M, Zese M, Bandini G, Zappa MA, Bardi U, Carbonelli MG, Carrano FM, Casella G, Chianelli M, Chiappetta S, Iossa A, Martinino A, Micanti F, Navarra G, Piatto G, Raffaelli M, Romano E, Rugolotto S, Serra R, Soricelli E, Vitiello A, Schiavo L, Zani ICM, Ragghianti B, Lorenzoni V, Medea G, Antognozzi V, Bellini R, Berardi G, Campanile FC, Facchiano E, Foletto M, Gentileschi P, Olmi S, Petrelli M, Pilone V, Sarro G, Ballardini D, Bettini D, Costanzi A, Frattini F, Lezoche G, Neri B, Porri D, Rizzi A, Rossini R, Sessa L, D'Alessio R, Di Mauro G, Tolone S, Bernante P, Docimo L, Foschi D, Angrisani L, Basso N, Busetto L, Di Lorenzo N, Disoteo O, Forestieri P, Musella M, Paolini B, Silecchia G, and Monami M

Abstract

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complications or high degrees of BMI (> 40 Kg/m 2 ), metabolic bariatric surgery can be a valid therapeutic option. Many different types of surgical procedures have been developed in last decades, mainly performed via laparoscopic approaches. However, clinical indications for metabolic and bariatric surgery (MBS) and the choice of the most appropriate type of procedure have not been clarified so far.The Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to design and develop the updated version of the Italian guidelines aimed at assisting healthcare professionals in the choice of the surgical option for the treatment of obesity and related conditions. Between June and October 2022, a panel of 24 experts and an evidence review team (ERT, 10 members), participated in the definition of clinical questions, outcomes, and recommendations and collected and analyzed all the available evidence on the basis of pre-specified search strategies. GRADE methodology and PICO (Patient, Intervention, Comparison, Outcome) conceptual framework have been adopted for the development of the present guidelines. Aim of the present guideline is to verify indications to surgery with respect to the presence of comorbid conditions, evaluate the different types of surgical approaches and endoscopic bariatric procedure and revise indication to revision surgery and postoperative procedures., (© 2024. Italian Society of Surgery (SIC).)

Published
2024
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29. Mapping the Path to Cognitive Balance: Applying the States of Mind Model and Network Analysis to Eating Disorder Patients.

Author

Tecuta L, Tomei G, DiGiuseppe R, Schumann R, Ballardini D, and Tomba E

Abstract

Background : In eating disorders (EDs), cognitive-behavioral therapy (CBT) represents one of the first-line treatment options albeit with sub-optimal results. The assessment of cognitive balance through an index measuring increased adaptive thinking and reduced maladaptive thinking, the desired outcomes, and the ultimate goal of CBT treatments warrants attention. The states of mind model (SOM) provides a framework through which a cognitive balance index can be defined. The current cross-sectional controlled study tested the clinical utility of the SOM model in a sample of ED outpatients. Methods : ED outpatients (n = 199) were assessed at baseline with the attitudes and beliefs scale-2 (ABS-2) for rational beliefs (RBs) and irrational beliefs (IBs), from which a SOM ratio score index (RBs/(RBs + IBs)) was calculated, the eating disorder inventory-3 (EDI-3) for ED symptoms and ED-related psychopathological features, the psychological well-being scales (PWB) for positive psychological functioning. A matched control sample (n = 95) was also assessed with the ABS-2. Results : ED patients exhibited significantly lower SOM and RB scores compared to controls. Network analysis results highlighted the centrality of the SOM-cognitive balance index, PWB-self-acceptance, and EDI-3-general psychological maladjustment, as well as the importance of the influence that cognitive balance and general psychological maladjustment exert on each other. Conclusions : The findings support the clinical utility of the SOM ratio applied to cognitions in EDs. This demonstrates its ability to differentiate such patients from controls and in capturing worse ED-related general psychopathology as well as compromised aspects of psychological well-being, in particular self-acceptance and environmental mastery. It thus might be considered in CBT treatment of EDs a potential cognitive clinimetric and clinical index of ED severity indicating key difficulties in counteracting maladaptive thinking with adaptive thinking.

Published
2023
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30. The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement.

Author

Tecuta L, Schumann R, Ballardini D, and Tomba E

Abstract

The metacognition of needing to control thoughts has been implicated in eating disorders (EDs)-specifically, in association with the drive for thinness and over-control. To date, it has yet to be investigated longitudinally in ED outpatients undergoing CBT-based treatment. The current study aims to examine whether endorsing a need to control thoughts undergoes modifications during CBT-based treatment for EDs and whether its modification correlates with treatment response in terms of reduced ED symptomatology. Seventy female ED outpatients (34 with AN, 29 with BN, 7 with OSFED) were assessed at baseline and at the end of treatment with the Metacognitions Questionnaire (MCQ), the Eating Attitudes Test (EAT-40), and the General Health Questionnaire (GHQ). Post-treatment, significant reductions were observed in MCQ-need to control thoughts. Using hierarchical linear regression analyses such decreases significantly explained the variance in observed reductions in EAT-oral control and to a lesser extent, reductions in EAT-bulimia and food preoccupation and EAT-dieting. These results underscore the importance of metacognitive change in EDs and the potential utility of CBT-based treatment in its modification. Improving ED outcomes may warrant broadening the therapeutic target of over-control and a sense of loss of control beyond dysfunctional eating behaviors to include maladaptive metacognitions that concern the need to control thoughts.

Published
2022
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31. Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders.

Author

Tecuta L, Gardini V, Schumann R, Ballardini D, and Tomba E

Abstract

Background: Research on which specific maladaptive cognitions characterize eating disorders (ED) is lacking. This study explores irrational beliefs (IBs) in ED patients and controls and the association between IBs and ED-specific and non-specific ED symptomatology and cognitive reappraisal., Methods: 79 ED outpatients with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorders and 95 controls completed the Attitudes and Beliefs Scale-2 (ABS-2) for IBs. ED outpatients also completed the Eating Disorder Inventory-3 (EDI-3) for ED-specific (EDI-3-ED Risk) and non-specific (EDI-3-General Psychological Maladjustment) symptomatology; General Health Questionnaire (GHQ) for general psychopathology; Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal., Results: Multivariate analysis of variance with post hoc comparisons showed that ED outpatients exhibit greater ABS-2-Awfulizing, ABS-2-Negative Global Evaluations, and ABS-2-Low Frustration Tolerance than controls. No differences emerged between ED diagnoses. According to stepwise linear regression analyses, body mass index (BMI) and ABS-2-Awfulizing predicted greater EDI-3-ED Risk, while ABS-2-Negative Global Evaluations and GHQ predicted greater EDI-3-General Psychological Maladjustment and lower ERQ-Cognitive Reappraisal., Conclusion: Awfulizing and negative global evaluation contribute to better explaining ED-specific and non-specific ED symptoms and cognitive reappraisal. Therefore, including them, together with BMI and general psychopathology, when assessing ED patients and planning cognitive-behavioral treatment is warranted.

Published
2021
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32. Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis.

Author

Calcaterra V, Mazzoni C, Ballardini D, Tomba E, Zuccotti GV, Mameli C, De Giuseppe R, and Cena H

Abstract

Background: Disordered eating behaviors (DEBs), including diagnosable eating disorders, are quite common and can interfere with optimal type 1 diabetes (T1DM) management. We explored DEBs prevalence in youth with T1DM, proposing news diagnostic subscales, to represent the clinical dimensions associated with feeding and eating disorders (ED); Methods: additionally to SCOFF questionnaire and Diabetes Eating Problem Survey-Revised (DEPS-R), four subscales combined from the original DEPS-R questionnaire were administered to 40 youths with T1DM (15.0 ± 2.6); Results: females showed higher scores than males in DEPS-R original factor 2 ("preoccupations with thinness/weight", p = 0.024) and in DEPS-R proposed "restriction" factor ( p = 0.009). SCOFF scores was correlated with original DEPS-R factors 1 ("maladaptive eating habits") and 2 ( p < 0.001) and with the newly proposed DEPS-R factors: restriction, disinhibition, compensatory behaviors, diabetes management (all p < 0.02). Diabetes management was the only factor related to glycated hemoglobin level ( p = 0.006). Patients with high DEPS-R score (≥20) scored higher than patients with low (<20) DEPS-R score in DEPS-R original factors 1 ( p < 0.001) and 2 ( p = 0.002) as well as in the proposed factors including restriction, disinhibition, diabetes management (all p < 0.02); Conclusions: the complicated nature of DEBs calls for the development target specific questionnaires to be used as screening tools to detect cases of DEBs and exclude non cases. Early recognition of DEBs in adolescents with T1DM is essential for effective prevention and successful treatment.

Published
2020
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33. State and trait anger and its expression in cluster headache compared with migraine: a cross-sectional study.

Author

Rausa M, Cevoli S, Giannini G, Favoni V, Contin SA, Zenesini C, Ballardini D, Cortelli P, and Pierangeli G

Subjects
Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Anger physiology, Cluster Headache physiopathology, Emotional Regulation, Migraine Disorders physiopathology, Personality physiology
Abstract

Background: Anger is involved in the emotional experience of pain. Individuals with migraine are more likely to hold their anger-in than controls. However, only one study evaluated anger in cluster headache (CH). The objective is to compare anger between migraine and CH patients., Methods: One hundred thirty-five migraine and 108 CH patients completed the State Trait Anger Expression Inventory (STAXI-2), composed of 7 subscales. State Anger measures the intensity of the individual's angry feelings at the time of testing. Trait Anger evaluates general predisposition to become angry. Anger Expression Out and Anger Expression In measure the extent to which anger could be overtly expressed or suppressed. Anger Control Out and Anger Control In evaluate how individual try to control the outward or inward expression of anger. Anger Expression Index is a general index., Results: CH patients have higher median scores than migraine patients in State Anger (46 vs 44, p = 0.012). CH patients have lower scores in Anger Control Out (44 vs 50, p = 0.016). In subgroup analysis, CH patients during the cluster period have higher scores than chronic migraine patients in State Anger (47 vs 44, p = 0.035), while CH patients in headache-free period did not differ from migraine patients., Conclusions: Migraine and CH patients differ in state anger, indicating that CH patients experienced higher intensity of anger during the time of testing. These data add new information about emotional regulation in headache patients and could support the hypothesis of different emotional and behavioral responses to pain in migraine and CH patients.

Published
2019
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34. Cow's Milk Consumption and Health: A Health Professional's Guide.

Author

Marangoni F, Pellegrino L, Verduci E, Ghiselli A, Bernabei R, Calvani R, Cetin I, Giampietro M, Perticone F, Piretta L, Giacco R, La Vecchia C, Brandi ML, Ballardini D, Banderali G, Bellentani S, Canzone G, Cricelli C, Faggiano P, Ferrara N, Flachi E, Gonnelli S, Macca C, Magni P, Marelli G, Marrocco W, Miniello VL, Origo C, Pietrantonio F, Silvestri P, Stella R, Strazzullo P, Troiano E, and Poli A

Subjects
Animals, Cattle, Food Hypersensitivity, Humans, Diet, Milk, Nutritive Value
Abstract

The most recent scientific evidence supports the consumption of cow's milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow's milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor-patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products' nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardiovascular disease No clear data are available about the association between milk intake and cancer. Current scientific literature suggests that an appropriate consumption of milk and its derivatives may be beneficial at all ages, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy.

Published
2019
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35. Palm oil and human health. Meeting report of NFI: Nutrition Foundation of Italy symposium.

Author

Marangoni F, Galli C, Ghiselli A, Lercker G, La Vecchia C, Maffeis C, Agostoni C, Ballardini D, Brignoli O, Faggiano P, Giacco R, Macca C, Magni P, Marelli G, Marrocco W, Miniello VL, Mureddu GF, Pellegrini N, Stella R, Troiano E, Verduci E, Volpe R, and Poli A

Subjects
Cardiovascular Diseases epidemiology, Congresses as Topic, Fatty Acids administration & dosage, Fatty Acids adverse effects, Humans, Italy, Meta-Analysis as Topic, Neoplasms epidemiology, Nutrition Policy, Nutritional Status, Randomized Controlled Trials as Topic, Risk Factors, Societies, Scientific, Triglycerides administration & dosage, Triglycerides adverse effects, Palm Oil administration & dosage, Palm Oil adverse effects
Abstract

The use of palm oil by the food industry is increasingly criticized, especially in Italy, for its purported negative effects on human health and environment. This paper summarizes the conclusions of a Symposium on this topic, gathered by the Nutrition Foundation of Italy, among experts representing a number of Italian Medical and Nutritional Scientific Societies. Toxicological and environmental issues were not considered. Participants agreed that: no evidence does exist on the specific health effects of palm oil consumption as compared to other saturated fatty acids-rich fats; the stereospecific distribution of saturated fatty acids in the triacylglycerol molecule of palm oil limits their absorption rate and metabolic effects; in agreement with International guidelines, saturated fatty acids intake should be kept <10% of total energy, within a balanced diet; within these limits, no effect of palm oil consumption on human health (and specifically on CVD or cancer risk) can be foreseen.

Published
2017
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36. Does psychological well-being change following treatment? An exploratory study on outpatients with eating disorders.

Author

Tomba E, Tecuta L, Schumann R, and Ballardini D

Subjects
Adult, Case-Control Studies, Cognitive Behavioral Therapy, Feeding and Eating Disorders therapy, Female, Humans, Outpatients psychology, Remission Induction, Treatment Outcome, Young Adult, Feeding and Eating Disorders psychology, Personal Satisfaction
Abstract

Psychological well-being changes following cognitive-behavioral therapy-based treatment were investigated in outpatients with eating disorders (ED). While it is known that CBT reduces symptomatology in EDs, less is known about how changes in positive functioning may ensue. One-hundred and eighty five ED outpatients were analyzed for pre-treatment and post-treatment changes in psychological well-being (PWB) by last observation carried forward - Wilcoxon signed rank tests. Significant gains in all PWB dimensions were found, with moderate effect size correlations in environmental mastery (r=-.418), personal growth (r=-.351) and self-acceptance (r=-.341). A subsample of patients in remission (n=51) was selected and compared to healthy controls in PWB post-treatment scores through Mann-Whitney U tests. Remitted patients showed significantly lower psychological well-being in two dimensions compared to controls: PWB-positive relations (r=-.360) and PWB-self-acceptance (r=-.288). However, more than 50% of ED outpatients in remission had PWB scores that fell below the 50th percentile of healthy controls in all psychological well-being dimensions, despite significant treatment response. Several mechanisms of psychological well-being change following CBT-based treatment are discussed. The assessment of treatment outcome in EDs may benefit from considering changes in positive functioning such as psychological well-being, in addition to the standard measurement of BMI, symptomatology and behavioral parameters. CBT-based treatment outcomes may be strengthened by promoting the development of optimal domains particularly in the interpersonal realm, such as building of quality and warm relationships and focusing on enhancing self-acceptance., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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37. Psychological well-being in out-patients with eating disorders: a controlled study.

Author

Tomba E, Offidani E, Tecuta L, Schumann R, and Ballardini D

Subjects
Adult, Anorexia Nervosa diagnosis, Anorexia Nervosa therapy, Attitude to Health, Binge-Eating Disorder diagnosis, Binge-Eating Disorder therapy, Bulimia Nervosa diagnosis, Bulimia Nervosa therapy, Case-Control Studies, Diagnostic and Statistical Manual of Mental Disorders, Feeding Behavior psychology, Female, Humans, Italy, Male, Mental Health, Outpatients statistics & numerical data, Patient Acceptance of Health Care psychology, Psychometrics, Socioeconomic Factors, Young Adult, Anorexia Nervosa psychology, Binge-Eating Disorder psychology, Bulimia Nervosa psychology, Health Status, Outpatients psychology
Abstract

Objective: Positive functioning is widely neglected in research on eating disorders (EDs). The aim of this exploratory study was to assess psychological well-being (PWB) in out-patients with ED and in controls., Method: The authors assessed PWB in 245 out-patients with EDs [105 with bulimia nervosa (BN), 57 with anorexia nervosa (AN), and 83 with binge eating disorder (BED) who met DSM-IV-TR] and 60 controls. They tested whether PWB was associated with eating attitude test (EAT) scores and if such associations differed among ED groups while taking into account confounding variables., Results: Significant differences between groups in all PWB scales were found. While individuals with BN reported significantly lower scores in all PWB dimensions than healthy controls, patients with BED scored significantly lower than controls in PWB autonomy, environmental mastery, and self-acceptance scales. Patients with AN showed similar scores to controls in all PWB dimensions, except for positive relationships and self-acceptance. In all ED groups, most PWB dimensions resulted significantly and negatively associated with EAT scales, except for AN where oral control was found to positively correlate with a high sense of purpose in life. All results were maintained even after adjusting for possible confounding variables., Discussion: Patients with EDs reported an impairment in PWB. The paucity of PWB was not necessarily dependent on the presence of high levels of psychological distress and on the severity of the disorder. Such assessments may therefore yield a more comprehensive evaluation in this clinical population., (Copyright © 2013 Wiley Periodicals, Inc.)

Published
2014
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