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BACKGROUND: In healthy elderly people, reduced appetite and the consequent decrease in food intake has been defined as the "anorexia of aging"; this condition may lead to malnutrition. The aim of this study was to investigate how different compositions of macronutrients affect satiety and hunger signals as well as subjective sensations after meals in healthy elderly subjects. METHODS: Experimental controlled study. Ambulatory healthy community-dwelling subjects evaluation in a single center on 12 elderly subjects, (75.2+/-2 years old) and 12 younger controls (28.2+/-2 years old). Using a visual analogical scale, hunger was evaluated under fasting conditions and at 30-minute intervals for up to 4 hours after two 800-kcal meals, where 20% and 40% of the calories were derived from fat. Serum samples were collected at -30, 60, 120, and 240 minutes to determine the concentrations of GLP-1, acylated and desacylated ghrelin, triglycerides, glucose, and insulin. RESULTS:Serum concentrations of GLP-1 were higher after the 40% fat meal than after the 20% fat meal (P < .01) in the elderly but not in the younger subjects. Acylated to desacylated ratio was lower after the 40% fat meal (P < .05) in the elderly. Only in the older group were triglycerides higher (P < .05), whereas hunger was significantly lower (P < .05) after the 40% fat meal. CONCLUSION: In healthy elderly people relatively large amounts of fat increase the satiety signal from GLP-1 and lower the acylated to desacylated ratio of ghrelin, consequently decreasing hunger. This condition may lead to a reduction in calorie intake.

BACKGROUND Oxidative stress may be the cause or effect of several pathogenetic processes such as neurodegenerative diseases. The aim of this paper was to evaluate the diagnostic efficacy in Parkinson's disease (PKD) of a panel of oxidative stress markers selected from the many proposed by the most recent literature. METHODS 23 molecules including both plasma and urinary oxidative markers such total radical oxygen species, homocysteine, biological antioxidant potential, glutathione, superoxide dismutase, uric acid, total bilirubin, iron, ferritin, coenzyme Q10, 3-nitrotyrosine, total lipoperoxides, 4-hydroxy-nonenal, and 8-hydroxy-deoxy-guanosine were determined both in PKD and aged control subjects. For each analyte and group, the respective reference intervals were determined. Statistical analysis was used to assess the existence of significant differences between intervals in order to indicate which markers can better characterize PKD and distinguish it from the control population. RESULTS Some parameters were different in both groups when compared to those observed in younger subjects, supporting the hypothesis that aging is associated with an increase of oxidative stress. A peculiar increase of oxidative damage on nucleic acids was found in PKD, as well as a less efficient turnover of the DNA and an increase of protein peroxidation. CONCLUSIONS Our results demonstrate that in PKD there is an increase of oxidative attack on nucleic acids and that the protein nitration is a characteristic phenomenon. These observations are in good agreement with the hypothesis that in PKD oxidative damage occurs that counter-regulatory systems attempt to balance, but inefficiently.

Background The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. Methods We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). Results The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. Conclusions Subjects with preexisting cardiovascular conditions who were receiving long-term sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.)

Bone turnover markers (BTMs) are widely used for the management of osteoporosis, and the premenopausal reference range is the target value for the treatment of postmenopausal osteoporosis with antiresorbing agents. Three serum BTMs (serum C-telopeptide of type I collagen [CTX], osteocalcin [OC], and N-terminal propeptide of type I procollagen [P1NP]), serum calcium, creatinine, phosphate, magnesium, and follicle-stimulating hormone (FSH) were measured in 638 healthy premenopausal women aged 20-50 years. In 83 women on the contraceptive pill (CP), the levels of the three BTMs adjusted for all confounding factors were 14-26% lower (P0.005) than in non-CP users. In 18 women considered perimenopausal for serum FSH levels30 IU/mL despite having regular menses, BTM levels were significantly higher than in age-matched women. This group of subjects and the women on the CP were excluded from further analysis. The three BTMs significantly decreased with advancing age and were negatively and independently correlated with body mass index (P0.001) and serum phosphate. In conclusion, we confirm that CP use is associated with significantly lower BTM values. An increase in BTM concentrations can be observed in perimenopausal women, i.e., women with normal menses but FSH levels30 IU/mL. BTMs decrease substantially with advancing age, and this appears to be associated with changes in body weight and serum phosphate. New normative ranges for serum OC, CTX, and P1NP were identified; and our findings in general impose a redefinition of the criteria for establishing the normal ranges for BTMs.

Objectives: The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy. Design: The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study. Setting: Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. Measurements: The patient’s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results: The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented. Conclusions: Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.

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

OBJECT: To study the relationship between hydration of lean body mass and adipose tissue location. DESIGN: Cross-sectional, clinical study of visceral adipose tissue area and total body water as a percentage of lean body mass. PATIENTS: Seventy-two adult, overweight, women, 52 pre- and 20 post-menopausal (age: 18-72 years, body mass index: 26-52). MEASUREMENTS: Total body water was obtained by electrical impedance measurement; visceral adipose tissue and lean body mass were obtained by computed tomography measurement of visceral adipose tissue area at the level of the 4th-5th lumbar vertebra. RESULTS: Visceral adipose tissue was found, by multiple regression analysis, to be the only predictor of the hydration of the lean body mass. The other independent variables: age, menopausal status, body mass index, glucose and insulin both fasting and after glucose load were not able to significantly improve the predictive power. CONCLUSION: Results of this study confirm the existence of a relationship between visceral adipose tissue content and hydration of the lean body mass.

To assess the relationship between circulating leptin levels, bone mineral content and density in the elderly.A cross-sectional study.A cohort of 92 men and 171 women, with ages ranging from 68 to 75 years, selected as a healthy and normal functioning group, in the city centre of Verona.Plasma leptin levels were determined in each participant. Body composition was evaluated with dual energy X-ray absorptiometry (DXA). Bone mineral content (BMC) and bone mineral density (BMD) were measured at whole-body, hip and femoral neck level in all subjects.In both men and women a significant relationship between fat mass and whole-body BMC or BMD was found. The strength of this association was consistently reduced after adjustment for plasma leptin. A significant association between circulating leptin levels, whole-body, total hip and femoral neck BMC and BMD was found in both sexes. This association retained the statistical significance after adjustment for fat mass percentage, especially in women. In stepwise multiple linear regression analyses, leptin was shown to be a significant predictor of whole-body, total hip and femoral neck BMC and BMD, independently of age and the percentage of body fat in both sexes. The circulating levels of leptin accounted for a variance in whole-body BMC of 8.9% in men and 18.2% in women, and in whole-body BMD of 10.6% in women.Our data show a significant relationship between leptin, bone mineral mass and density in healthy elderly men and women.

Obesity increases the risk of developing type II diabetes. However, the link between the two remains unclear, although insulin resistance and visceral adiposity are dominant risk factors. A study with CT scanning confirmed that the degree of visceral adiposity had a significant positive correlation with insulinaemia, and was negatively associated with insulin sensitivity. A 48 month retrospective study in patients with type II diabetes, who had received dietary therapy, identified a 'responder' group in whom metabolic improvements accompanied weight loss. Preferential loss of visceral fat may be an important factor in these 'responders'. Patients losing6.9 kg (or at least 10% mean baseline body weight) have demonstrated significant improvements in their glucose, HbA1 and lipid profiles. Modest weight loss by patients with type II diabetes therefore improves glycaemic control, insulin sensitivity and cardiovascular risk factors; and the risk of developing long-term diabetes-related complications may also be reduced by such metabolic improvements.

The aim of this study was the verification of the clinical utility of predictive equations for total and intra-abdominal adipose tissue areas. Formulas were calculated using computed tomography (CT) as the gold standard. Ninety-three females were randomly divided into two groups. The predictive equation group was used to calculate the predictive equations for computed tomography adipose tissue areas at the L4-L5 level. These equations were then used to predict total and intra-abdominal adipose tissue area in the validation group. Correlations were made between metabolic parameters and both measured and calculated areas and single predictors. The following measurements were carried out: age, weight/height ratio, body mass index, waist, hip, waist/hip ratio, ultrasound measurement of intra-abdominal distance between abdominal muscle and aorta, sagittal abdominal diameter by CT, adipose tissue intra-abdominal area by CT, total abdominal adipose tissue area by CT. Blood glucose and insulin both fasting and after glucose load. Fasting cholesterol and triglycerides. The best predictors of total and visceral adipose tissue areas were, respectively: weight/height ratio and ultrasound intra-abdominal measurement. Correlations between metabolic parameters and adipose tissue areas both as measured and as calculated by predictive equations were quite similar. Correlations between metabolic parameters and single best predictors of measured adipose tissue areas also gave the same results. Some simple and safe anthropometric measurements can be used, instead of total and visceral adipose tissue area as assessed by CT, when studying associations between adipose tissue and metabolic parameters on sufficiently large groups of patients.

Computerized tomography, a method of proven reliability for direct measurement of both total and visceral body fat, is not widely usable and alternative means of assessing body fat are required. Several anthropometric parameters, including ultrasound measurements of intra-abdominal and subcutaneous fat, were considered in 119 females (age 15-72 years, body mass index 24-51 kg/m2). Computerized tomography was also performed for total and visceral fat areas at the L4-L5 level. Reliability of each of these measurements in predicting total fat was assessed. Tertiles for visceral fat area were calculated (114, 114-170,170 cm2). Only ultrasound intra-abdominal fat measurements were able to distinguish between all three VAT groups (16 +/- 10, 32 +/- 13, 50 +/- 22 mm); neither sagittal diameter nor waist/hip girth ratio were able to distinguish between the two114 cm2 groups. Predictive equations for total adipose tissue area confirmed weight/height ratio as the best predictor of total fat. Ultrasound intra-abdominal thickness was the 1 degree variable to enter the stepwise regression in predictive equations for visceral adipose tissue area. The 2 degrees was age, the 3 degrees sagittal diameter, the 4 degrees waist/hip girth ratio and the 5 degrees ultrasound subcutaneous abdominal thickness (adjusted r2 = 0.784; P0.001).

The study was performed on 601 patients (294 males and 307 females) of a general practitioner. Alcohol intake and smoking habits were compared with other anthropometric measurements including waist-to-hip girth ratio. Patients were divided into non-smokers and smokers (subdivided into three groups according to the number of cigarettes smoked per day) and into non-drinkers and drinkers (subdivided into three groups with different alcohol intakes). Ex-smokers were excluded from the study. Analysis of covariance using age, body mass index, physical activity and menopausal status as covariates, showed that: (1) cigarette smoking is not accompanied by a specific pattern for body fat distribution; (2) waist-to-hip ratio was significantly different for the four classes of alcohol intake for women (non-drinkers: 0.809,11 g: 0.805, 11-20 g: 0.809,20 g: 0.826; F = 2.8, P0.05) but not for men (non-drinkers: 0.944,20 g: 0.934, 21-40 g: 0.940,40 g: 0.943; F = 0.9); (3) increased alcohol intake corresponds to an increased lipid and energy supply.