Search

Antonio Maria Borzì,1,2,* Carola Buscemi,3,4,* Davide Corleo,3,4 Cristiana Randazzo,3,4 Giuseppe Rosafio,3,4 Gianni Pantuso,5 Silvio Buscemi3,4 1Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy; 2Specialization School in Geriatrics, Catania, Italy; 3Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy; 4Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy; 5Dipartimento di Discipline Chirurgiche e Odontostomatologiche (DICHIRONS), Unit of Chirurgia Oncologica, Policlinico University Hospital, Palermo, Italy *These authors contributed equally to this workCorrespondence: Silvio BuscemiUnit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Piazza delle cliniche 2, Palermo 90127, ItalyEmail silvio.buscemi@unipa.itPurpose: Bariatric surgery (BS) is becoming an increasingly frequent treatment option especially in people with morbid obesity, demonstrating that it is able to reduce total mortality and cardiovascular (CV) risk. Despite endothelial dysfunction is an essential requisite contributing to atherosclerosis and predicting CV events, only some studies have investigated the effects of BS on endothelial function with controversial results. In this study, the effects of weight loss on endothelial function were investigated in obese patients after BS and compared with patients after medical nutrition treatment (MNT).Patients and Methods: Seventeen obese patients who underwent BS procedures (9 adjustable gastric bands, 3 gastric by-passes and 5 biliopancreatic diversions) were included in the study and compared with 18 obese individuals who underwent MNT. Endothelial function was investigated by flow-mediated dilation (FMD) of the brachial artery. Also, carotid intima-media thickness (c-IMT) was measured as a marker of subclinical atherosclerosis.Results: At the end of follow-up, the mean weight loss was 18.8% in the BS group and 7.0% in the MNT group. After treatment, FMD significantly decreased in the BS group (mean ± SD before: 9.0 ± 4.7; after: 6.1 ± 2.9%; P= 0.04); however, no significant change was observed in the MNT group (before: 9.4 ± 5.8; after: 8.3 ± 5.3; P= 0.41). The modification of endothelial function was negatively correlated with c-IMT change in the BS group (r= − 0.63; P < 0.007).Conclusion: A significant endothelial dysfunction occurred following BS but not after MNT. Furthermore, the decline of endothelial function observed in the BS group might have contributed to atherosclerosis.Keywords: obesity, endothelial function, bariatric surgery, medical nutrition therapy

Introduction: The recent global pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has involved more than 7 million people worldwide and been associated with more than 400,000 deaths. No clear information is known about all the potential risk factors for COVID-19 or what factors adversely influence its clinical course and mortality. Therefore, we analyzed the role of obesity, type 2 diabetes, and hypertension as risk factors for COVID-19. Methods: We identified articles for inclusion by searching PubMed and Google Scholar (last accessed 15 June 2020). Retrospective review of literature. Analysis of epidemiological data concerning obesity prevalence and COVID-19 incidence, particularly in Italy and the USA. Results: Data from several retrospective studies of prevalence showed that patients with hypertension, type 2 diabetes, and obesity may have more severe COVID-19, intensive care unit admission, and higher mortality rates, but it is not definitively clear if this is an independent association. In general, the prevalence of obesity in patients with COVID-19 seems to bethe same as that of the general population throughout the world; however, obesity seems to be associated with more severe disease and mortality in younger (< 60 years) patients. Similar effects seem to occur in patients with diabetes and/or hypertension but at older ages (> 60 years). In strict connection, it has been proposed that the use of drugs inhibiting angiotensin-converting enzyme 2 (ACE-2) or dipeptidyl dipeptidase 4 (DPP-4) might influence viral activity and disease severity since ACE-2 and DPP-4 receptors mediate SARS-CoV- 2 entry into the host cells; however, no evidence exists to date that shows that this may be the case. Conclusion: Overall, diabetes, hypertension, and obesity seem to negatively affect the clinical course and disease outcome in patients with COVID-19. However, these data need further confirmation by studies with more accurate data registration.

Background: Vitamin D plays a pivotal role in calcium and phosphorus metabolism, also influencing bone tissue. Several studies have reported that vitamin D blood levels were significantly lower in people with obesity, probably due to its uptake by the adipose tissue. Clinical studies that investigated the changes of circulating levels of vitamin D following weight loss reported controversial data. A very low-calorie ketogenic diet is acknowledged as a reliable treatment to achieve a rapid weight loss. Therefore, we investigated the effect of weight loss, consequent to a very low-calorie ketogenic diet, on vitamin D blood concentrations. Methods: A cohort of 31 people with obesity underwent a very low-calorie ketogenic diet for 10–12 weeks. The serum concentrations of vitamin D, parathormone, calcium and phosphorous were measured before and after weight loss, they were compared to a control group of 20 non-obese, non-diabetic, age- and gender-matched persons. Results: Patients with obesity had a higher habitual intake of vitamin D than the control group (p &lt, 0.05). However, the vitamin D blood levels of the obese group were significantly lower than those of the control group (p &lt, 0.005) and they increased after weight loss (p &lt, 0.001). At baseline, vitamin D blood concentrations of the persons with obesity were significantly correlated with both fat mass–kg (r = −0.40, p &lt, 0.05) and body mass index (r = −0.47, 0.01). Following very low-calorie ketogenic diet, the change in vitamin D serum concentrations was correlated only with the change in fat mass–kg (r = −0.43, 0.01). Conclusion: This study confirmed that patients with obesity have lower vitamin D levels that normalize after significant weight loss, supporting the hypothesis that vitamin D is stored in the adipose tissue and released following weight loss.

Irisin is a recently discovered exercise-induced myokine that has been attributed the role of favoring white-to-brown adipose tissue trans-differentiation. We confirmed in a population-based cohort that irisin serum concentrations are independently correlated with the habitual level of physical activity, but we also observed an independent correlation with serum concentrations of high-sensitivity C-reactive protein (hs-CRP), thus suggesting that inflammation may influence irisin production. In order to investigate the association between irisin and inflammation, we measured serum irisin concentrations in a group of inflamed inpatients. We hypothesized that if an association between irisin and inflammation exists, severely inflamed patients, even though physically inactive, might also exhibit high serum irisin levels. We recruited 40 consecutive markedly inflamed inpatients on the basis of serum CRP levels. Their irisin serum concentrations (Phoenix Europe, Germany) were compared with those obtained in the population-based cohort of the ABCD_2 study (Alimentazione, Benessere Cardiovascolare e Diabete) (ISRCTN15840340). The inflamed patients exhibited higher serum irisin concentrations (median: 6.77 ng/ml; 95% CI for the median: 5.97–7.23) than those observed in the ABCD cohort (median: 5.21 ng/ml; 95% CI for the median: 5.08–5.30; p

A prolonged positive energy balance may contribute to fat accumulation and obesity development. It was observed several years ago that population resident in southern Italy consumed a particular diet and was less obese and lived significantly longer, and it was referred as the Mediterranean diet. The Mediterranean diet is a dietary plan based on fruits, vegetables, olive oil, and low intake of saturated fatty acids. A large body of literature suggested that the Mediterranean diet is effective in preventing obesity. Both observational and intervention studies clearly demonstrated that a higher adherence to Mediterranean diet is associated with a reduced risk of being obese and that obese individuals who underwent hypocaloric Mediterranean diet significantly reduced their body weight. Surveys indicate that adherence to the Mediterranean diet in Italy has decreased over the past 50 years. At the same time the prevalence of obesity in Italian population significantly increased, especially in southern Italy, reaching alarming proportions. National initiatives were promoted to recover the nutritional habits inspired to Mediterranean diet, and recent data show a slight decrease in the prevalence of obesity over the last 15 years, particularly among children and adolescents. Although obesity is still a matter of concern in Italy, the effectiveness of nutrition programs based on the Mediterranean diet suggests that preserving the traditional Mediterranean dietary habits may contribute to prevent obesity with beneficial effects on health.

Lutein is a carotenoid with reported anti-inflammatory properties. A large body of evidence shows that lutein has several beneficial effects, especially on eye health. In particular, lutein is known to improve or even prevent age-related macular disease which is the leading cause of blindness and vision impairment. Furthermore, many studies have reported that lutein may also have positive effects in different clinical conditions, thus ameliorating cognitive function, decreasing the risk of cancer, and improving measures of cardiovascular health. At present, the available data have been obtained from both observational studies investigating lutein intake with food, and a few intervention trials assessing the efficacy of lutein supplementation. In general, sustained lutein consumption, either through diet or supplementation, may contribute to reducing the burden of several chronic diseases. However, there are also conflicting data concerning lutein efficacy in inducing favorable effects on human health and there are no univocal data concerning the most appropriate dosage for daily lutein supplementation. Therefore, based on the most recent findings, this review will focus on lutein properties, dietary sources, usual intake, efficacy in human health, and toxicity.

Purpose: The aim of the present study was to evaluate the association between the Mediterranean diet and obesity in a Mediterranean cohort. Methods: The study population of MEAL (Mediterranean Healthy Eating, Ageing, and Lifestyle) study comprised 1814 men and women (18 + years) recruited in the city of Catania, southern Italy. Food intake was evaluated through a validated food frequency questionnaire and the Mediterranean diet adherence was assessed through the MEDI-LITE score. Results: Individuals highly adherent to the Mediterranean diet (highest quartile of the score) were less likely to be obese (OR 0.53, 95% CI 0.32, 0.89) despite there was no significant associations when considering men and women separately. The dietary profile of obese and non-obese individuals did not significantly differ, except for vitamin E, processed meat, and alcohol more consumed among non-obese ones. Among the food groups characterizing this dietary pattern, only satisfaction of the criterion for dairy products (< 1 serving/day) was significantly associated with lower odds of being obese. Among other covariates, current smoking was associated with obesity, while high physical activity and regular alcohol drinking were inversely associated. Some differences between men and women in the highest category of occupational status occurred, as the former were less likely, while the latter were more likely to be obese. Conclusions: Higher adherence to the Mediterranean diet as a whole dietary pattern, rather than its individual components, is associated with less likelihood of being obese. Level of evidence: Level V, cross-sectional descriptive study.

There is actually no consensus about the possibility that in some instances, obesity may be a benign metabolically healthy (MH) condition as opposed to a normal-weight but metabolically unhealthy (MUH) state. The aim of this study was to characterize MH condition and to investigate possible associations with metabolic and cardiovascular complications. One thousand nineteen people (range of age 18–90 years) of the cohort of the ABCD_2 study were investigated. Participants were classified as normal weight (BMI 2) or overweight-obese (BMI ≥25 kg/m2); they were also classified as MH in the presence of 0-1 among the following conditions: (a) prediabetes/type 2 diabetes, (b) hypertension, (c) hypertriglyceridemia or low HDL cholesterolemia, and (d) hypercholesterolemia. MUH condition was diagnosed if ≥2 of the conditions listed were found. The prevalence of overweight/obese people was 71.1%, of whom 27.4% were found to be MH. In addition, 36.7% of the normal-weight participants were MUH. HOMA-IR, high sensitivity C-reactive protein, and the carotid intima-media thickness were significantly different in the 4 subgroups (P<0.001), with higher values observed in the MUH normal-weight and obese groups. In conclusion, this study highlights the importance of identifying a MH condition in normal-weight and in obese people in order to offer better treatment.

Aim: There are conflicting data concerning the possibility that obesity and diabetes raise the risk of thyroid nodules. The incidence of thyroid nodules is increasing, as is that of obesity and diabetes; therefore, understanding whether these metabolic and nutritional disorders influence nodular thyroid disease is important for organizing prevention strategies. This study investigated the association between thyroid nodules, obesity, diabetes, and dietary habits. Materials and methods: A cohort of randomly selected adults (455 males, 746 females; age: 18–90 years) living in Palermo (Italy), a mild iodine deficiency area, was cross-sectionally investigated. Participants underwent high-resolution ultrasonographic evaluation of the thyroid, and answered a food frequency questionnaire. Laboratory blood measurements were obtained in 587 participants. Results and discussion: Thyroid nodules were detected in 475 (39.5%) participants. The number of thyroid nodules was correlated with age (r = 0.19; P < 0.001), gender (r = 0.08; P = 0.005), and body mass index (r = 0.07; P = 0.02). No significant correlation was observed between the number of nodules and glycated hemoglobin, serum insulin concentrations, and homeostasis model assessment of insulin resistance. Age-adjusted and gender-adjusted prevalence of both overweight/obesity and type 2 diabetes of each group of participants divided according to the number of nodules significantly increased with the number of nodules (P < 0.05 in both cases). The group of participants with nodules exhibited a significantly lower age-adjusted and gender-adjusted habitual intake of milk (P = 0.02). Multivariate regression analysis showed that age, gender, body mass index, diabetes, and habitual consumption of milk were independently correlated with presence of thyroid nodules. Conclusion: This study seems to indicate that an association exists between obesity, diabetes, and thyroid nodules.