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During chronic kidney disease (CKD), typical alterations in the gut microbiota are observed. The kidney no longer plays the role of the main excretory organ as this function is performed by the intestine. In CKD patients, an alteration of intestinal permeability and a degradation of the protective mucous layer are observed. These changes in the intestinal barrier allow the passage of bacterial material from the intestine to the bloodstream through the intestinal wall. This phenomenon contributes to the induction of the chronic inflammatory state, typical of CKD. In nephropathic patients, there is an increase in circulation of p-cresyl sulfate (p-CS), indoxyl sulphate (IS), indole-3 acetic acid (IAA) and trimethylamine-N-oxide (TMAO), all gut-derived uremic toxins. The changes in gut microbiota composition are related to CKD stage and this phenomenon is exacerbated in hemodialysis (HD) adult and pediatric patients. Interestingly, it is observed a positive shift in gut microbiota composition after renal transplantation and at the same time a reduction of circulating gut-derived uremic toxins. Either gut dysbiosis or uremic toxins accumulation contribute to the CKD onset and progression.

Cohort studies, clinical audits of patients with COVID-19 in hospital and routine primary care records provided evidence-based insights on the relationship between excess weigh, obesity and COVID-19. The purpose of this umbrella review is to highlight the relationship between nutritional quality and social inequalities related to CDNCD, obesity and SARS-CoV-2 infection.Only articles published from 2008 to the present were included in the search to show an updated picture of the topic. The search for published studies was conducted in February 2021 in the scientific databases PubMed (MEDLINE). The terms used for the search were "COVID-19", "Obesity", "Disparities", "Nutritional inequalities", "Chronic degenerative non-communicable diseases" and "review" OR "systematic review" OR "meta-analysis" separated by the Boolean operator AND.1874 reviews were found, but only 99 met the objective. Obese or dysmetabolic patients are those who had a worse course of disease following COVID-19. This data was observed not only for Chinese and Caucasians, but also and above all among Africans, African Americans, Latinos and indigenous people. Plausible mechanisms to explain the association between obesity and COVID-19 outcomes, included the role of excess adipose tissue on respiratory function, metabolic dysfunction, the cardiovascular system, enhanced inflammatory response and impaired response to infection.Today, chronic non-communicable degenerative diseases (CDNCDs) are responsible for 70% of public health expenditure, affecting 30% of the population (one or more chronic diseases). Unfortunately, given the health emergency due to SARS-CoV-2, infectious diseases are currently more at the center of attention. However, the spread of infectious communicable diseases and CDNCDs is facilitated in situations of social disparity. In fact, in the poorest countries there are the highest rates of malnutrition and there is a greater risk of contracting viral infections, as well as, paradoxically, a risk of comorbidity, due to access to cheaper food and qualitatively poor, with high caloric density.

The aim of the present study was to evaluate the anthropometric parameters and the body composition through bioelectrical impedance analysis on paediatric subjects with dental agenesis.The study was conducted on 144 subjects (58.3% females and 41.7% males), aged 7-14 years (average age 10.22±2.53 years). Each patient underwent a dental check-up at the Paediatric Dentistry Unit, University of Rome Tor Vergata (Italy) and a nutritional evaluation, aimed at analysing the anthropometric characteristics and evaluating the indices of body composition through bioelectrical impedance analysis (BIA) at the Human Nutrition Unit, University of Rome Tor Vergata. The sample was divided into three groups: a group with single agenesis (Group 1), a group with multiple agenesis (Group 2) and a control group (Group A). Using the predictive equations, the following values were evaluated: resistance (R), reactance (Xc), phase angle (PHA), body cell mass index (BCMI), body cell mass (BCM), total body water (TBW), intracellular water (ICW), extracellular water (ECW), fat mass (FM), fat free mass (FFM).The Excel environment and the SAS System, version 9.3, were used for statistical analysis, providing a descriptive and parametric analysis of the sample. The values of the anthropometric parameters were expressed as mean ± standard deviation. For the statistical analysis of anthropometric parameters and body composition, analysis of variance (1-way ANOVA) was used, which allowed us to find differences and the Student's t-test to compare Groups 1, 2, and A.There is a significant difference in the resistance R value between the case group with single agenesis (Group 1) and the control group (Group A) (R, 710.28±72.46 vs 667.4±104.16, p=0.028), and the phase angle PHA between the case group with multiple agenesis (Group 2) and the control group (Group A) (PHA, 5.18±0.48 vs 5.85±1.05, p=0.028). The BCM% value shows a significant difference between both Group 1 and Group A (BCM%, 50.53 ± 3.29 vs 52.68 ± 4.74, p=0.016) and between Group 2 and Group A (BCM%, 49.25± 2.86 vs 52.68 ± 4.74, p=0.035). The TBW, ICW, ECW, FM, FFM values showed no significant differences between the various groups analysed.Body composition in subjects with dental agenesis presents a higher R, a consequently lower PHA and a lower BCM% compared to the control group. For the first time, the results highlighted the possible relationship between dental agenesis and body composition, measured through BIA.

Background. Probiotic oral intake, via modulation of the microbiota-gut-brain axis, can impact brain activity, mood, and behavior; therefore, it may be beneficial against psychological distress and anxiety disorders. Inflammatory cytokines can influence the onset and progression of several neurodegenerative mood disorders, and the IL-1βrs16944 SNP is related to high cytokine levels and potentially affects mood disorders. The aim of this study was to examine the combined effect of IL-1βpolymorphism and probiotic administration in mood disorder phenotypes in the Italian population.Methods. 150 subjects were randomized into two different groups, probiotic oral suspension group (POSG) and placebo control group (PCG), and received the relative treatment for 12 weeks. Psychological profile assessment by Hamilton Anxiety Rating Scale (HAM-A), Body Uneasiness Test (BUT), and Symptom Checklist 90-Revised (SCL90R) was administered to all volunteers. Genotyping was performed on DNA extracted from salivary samples.Results. After 12 weeks of intervention, a significant reduction of HAM-A total score was detected in the POSG (p<0.01), compared to the PCG. Furthermore, IL-1βcarriers have moderate risk to develop anxiety (OR=5.90), and in POSG IL-1βcarriers, we observed a reduction of HAM-A score (p=0.02).Conclusions. Consumption of probiotics mitigates anxiety symptoms, especially in healthy adults with the minor A allele of rs16944 as a risk factor. Our results encourage the use of probiotics in anxiety disorders and suggest genetic association studies for psychobiotic-personalized therapy.

Lipedema is a disorder of adipose tissue characterized by abnormal subcutaneous fat deposition, leading to swelling and enlargement of the lower limbs and trunk. The aim of this study was to evaluate the lipedema phenotype by investigating the role of polymorphisms related to IL-6 (rs1800795) gene in people with diagnosis of lipedema. The second aim was to identify indicators of body composition, useful for a differential analysis between subjects with lipedema and the control group.Two groups are involved in the study, 45 women with lipedema (LIPPY) and 50 women randomly chosen from the population as Control (CTRL). Clinical and demographical variables recorded include weight, height, body mass index (BMI) and circumference measurements. Body composition (Fat mass, FM; lean mass, LM) was assessed by Dual-energy X-ray Absorptiometry (DXA). The genetic tests for IL-6 (rs18oo795) gene were performed for both groups, using a saliva sample.The study of the relationship between the IL-6 (rs1800795) gene polymorphism, the anthropometric values and the body composition indices has provided the following significant results: subjects with diagnosis of lipedema present statistically significant increased values with regard to weight, BMI, waist, abdomen and hip circumferences, arms, legs and whole FM (% and kg), gynoid FM (kg), legs LM (kg) and ASMMI. Moreover, the value of the waist hip ratio was found to be decreased.For the first time, we suggested that IL-6 gene polymorphism could characterize subjects with lipedema respect to Normal Weight Obese and obese subjects. The intra-group comparisons (LIPPY carriers vs. LIPPY non-carriers and CTRL carriers vs. CTRL non-carriers) showed no statistically significant values. In contrast, the inter-group comparisons (LIPPY non-carriers vs. CTRL non-carriers and LIPPY carriers vs. CTRL carriers) resulted statistically significant. We have identified other indices, such as leg index, trunk index, abdominal index, total index, that could be promising clinical tools for diagnosis of the lipedema phenotype and for predicting the evolution of the disease.

Among the genes involved in obesity, the Fat mass and obesity-associated gene (FTO) is certainly one of the most known and the relation between FTO rs9939609 and BMI is highly discussed; nevertheless, data about its influence on body composition are limited.We carried out a study on a sample of 1066 Italian subjects, whose body composition and FTO rs9939609 were analyzed.We found significant relations between FTO with arm (p=0.01), abdomen (p=0.00), and trunk circumferences (p=0.00), BMI (p=0.01), FM% (p=0.00), and android FM% (p=0.01), whereas no relations were found between FTO and both gynoid fat and lean mass.To conclude, the relation between FTO and BMI is confirmed and is related specifically with android FM%. These results indicated that FTO rs9939609 may be a genetic etiological factor for obesity. Indeed, the specificity for the android FM% would indicate FTO as an etiological factor in the development of cardiovascular diseases.

The human intestine contains over a thousand species of diners microrganisms, collectively known as “intestinal microbiota”, essential to the integrity of the mucosal barrier function. Alterations such as quantitative of microbiota (composed mainly of bacteria, viruses and fungi), which are able to alter this delicate balance, are involved in neurological and systemic diseases (among others, Ulcerative Colitis and Crohn’sdisease, irritable bowel syndrome, stomach and colon cancers, allergies and intolerances, diabetes, atherosclerosis, etc.). Laboratory and human studies also showed an interesting relationship between gut microbiota and obesity [1,2]. Obesity is a medical condition which affects a growing number of people, especially in Western countries. In the United States more than 50% of the population is overweight and about 1/3 is frankly obese. It is also a predisposing condition for a number of diseases that can seriously compromise the health of the individual. No doubt a high-calorie diet and lack of physical activity are the leading causes of obesity, but certainly fascinating is the study of the complex mechanisms involved in the regulation of energy balance and their alterations. In this regard, recent studies suggest that the gut microbiota can play an important role in the pathogenesis of obesity and metabolic syndrome as able to influence nutrient absorption and distribution of energy. Mice bred in sterile conditions (the so-called “germ free”, scilicet without microbiota) need a significantly higher amount of calories compared to the counter part grown under conventional conditions to maintain the same body weight and, in equal diet, have a considerably lower amount of fat mass. Very interesting is that the subsequent colonization of germ-free mice with a normal colonic microbiota determines a rapid and significant increase in body weight and body fat of these animals. Underlying these evidences there are a variety of mechanisms. Bacteria of the microbiota, in fact, appear likely to reduce intestinal expression of a factor, the fastinginduced adipose factor (Fiaf), which is itself an inhibitor of lipoproteinlipase. It follows an abnormal activation of this enzyme, which favor the release of fatty acids from circulating lipoproteins VLDL and chylomicrons with subsequent accumulation of triglycerides in the adipose tissue. Intestinal bacteria are also able to reduce expression, whether in the liver that muscular, of an enzyme, AMPK (adenosine monophosphate-activated protein kinase), which is critical in stimulating β-oxidation of fatty acids. Another recently described mechanism involves rather short-chain fattyacids produced by bacterial fermentation of carbohydrates, which are able to regulate the expression of intestinal hormones, such as Peptide YY, which regulate the production and digestive enzyme release. Finally, monosaccharides produced by fermenting bacteria action of the microbiota, once absorbed and transported to the liver by the portal circle, are able to bind and activate a cytoplasmic factor ( the carbohydrate responsive element binding –ChREBP), which, migrating from the cytoplasm to the nucleus, activates enzymes involved in lipogenesis. Finally, another highlight on the possible role of intestinal flora in obesity comes from the evaluation of the role of lipopolysaccharide (LPS) of the wall of gram negative bacteria in chronic systemic inflammation and therefore insulin resistance and obesity. High-fat diets in particular alter composition of the microbiota (increase Gram negative bacteria/Gram positive) leading to increased levels of circulating LPS; this, in turn, is able to induce the production of pro-inflammatory cytokines (TNF-α, IL1, IL-6, plasminogen activator inhibitor) [3,4] which in turn regulate the glucose tolerance, encouraging the development of insulin resistance [5]. It follows then a possible role of LPS in chronic inflammation associated with diets [6,7] high in fat, with a predisposition to the development of insulin resistance and thus of diabetes. Is easy to understand, therefore, that both experimental animals and humans there are significant differences in the composition of the microbiota [8-15] between qualitative and quantitative obese and lean. In particular, recent studies have clearly demonstrated a significant reduction of bacteria belonging to the family of Bacteroidetes and a proportional increase of bacteria belonging to the familyof Firmicutes and Archea. This results in an increase in the intestinal lumen, of non-digestible polysaccharides capable of breaking down hydrolases, including the β-fructosidases and increased transport proteins needed in absorption of products of fermentation, including the Phospho transferases. Always in obese, the preponderance of methane-producing bacteria, which use hydrogen to produce methane, maintains a constant low hydrogen partial pressure, thus optimizing the processes of bacterial fermentation [16-18]. Ultimately, these quantitative and qualitative changes in metabolic way of bacterial flora guarantee guests to extract maximum energy value from the diet, taking calories also in even potentially low foods, like fibers. The surprising is that these alterations of gut microbiota are absolutely reversible: a low-calorie diet, in fact, is able to balance Bacteroidetes/Firmicutes, reformulate the metabolic structure of the intestinal flora and induce a weight loss that goes along with the balance of the intestinal ecosystem. At present, antibiotics, probiotics, prebiotics and synbiotics are tools used to modulate the bacterial flora in terms of quality and quantity [19-21]. It is clear that an ever deeper knowledge in this field and new data on bacteria able to influence the metabolism, such as Akkermansiamuciniphila, or inflammation, such as Fecalibacteriumprausnitzii may in the future to suggest therapeuticactions on complex microbial intestinal balance which is the basis of obesity and its complications.

AIM: To develop and cross-validate a predictive equation for estimating lean body mass (LBM) in children, based on bioelectrical impedance analysis (BIA) and anthropometric parameters, and to compare our equation with other predictive methods. METHODS: We evaluated body composition of 155 children (age 5-14 years) by BIA and dual energy X-ray absorptiometry (DXA). Children were divided in two groups: developing set and cross-validation set. Statistical analysis as multiple regression and Bland-Altman methods were performed. RESULTS: From developing set (105 children) a predictive LBM (kg) equation was created. From the cross-validated set (35 children), our equation was seen to agree with LBM (kg) by DXA. On the contrary, LBM predicted by Schaefer's equation and BIA did not agree with the criterion measure. CONCLUSIONS: This cross-validated equation can be useful in epidemiological studies and also in clinical practice, permitting a better definition and follow up of children's body composition.

OBJECTIVE: To verify safety respect to weight loss, cardiometabolic diseases of short-term Very low-calorie ketogenic diets (VLCKDs

Postprandial oxidative stress is characterized by an increased susceptibility of the organism towards oxidative damage after consumption of a meal rich in lipids and/or carbohydrates. Micronutrients modulate the immune system and exert a protective action by reducing low-density lipoproteins oxidation (ox-LDL) via induction of antioxidant enzymes.The clinical study was a randomized and cross-over trial, conducted through the CONSORT flowchart. We evaluated the gene expression of 103 genes related to oxidative stress (HOSp) and human inflammasome pathways (HIp), and ox-LDL level at fasting and after 40 g raw "Tonda Gentile delle Langhe" hazelnut consumption, in association with a McDonald's® Meal (McDM) in 22 healthy human volunteers.Ox-LDL levels significantly increased comparing no dietary treatment (NDT) vs. McDM, and decreased comparing McDM vs. McDM + H (p0.05). Percentage of significant genes expressed after each dietary treatment were the follows: (A) NDT vs. McDM: 3.88% HIp and 17.48% HOSp; (B) NDT vs. McDM + H: 17.48% HIp and 23.30% HOSp; (C) McDM vs. McDM + H: 17.48% HIp and 33.98% HOSp.Hazelnut consumption reduced post prandial risk factors of atherosclerosis, such as ox-LDL, and the expression of inflammation and oxidative stress related genes. Chronic studies on larger population are necessary before definitive conclusions.

To verify safety respect to weight loss, cardiometabolic diseases of short-term Very low-calorie ketogenic diets (VLCKDs,800 kcal day-1).Randomized cross-over trial with placebo. The study had no. 2 dietary treatment (DT), conducted in two arms: (1) VLCKD1 in which 50% of protein intake is replaced with synthetic amino acids; (2) VLCKD2 with placebo. The VLCKDs (800 kcal day-1) were different in term of protein content and quality each arm lasted three weeks (wks). Between the two arms a 3-wks washout period was performed to avoid additive effects on DT to follow. At the baseline, at start and end of each arm, all the subjects were evaluated for their health and nutritional status, by anthropometric analysis, body composition (Dual X-ray Absorptiometry (DXA), Bioimpedentiometry, biochemical evaluation, and Peroxisome Proliferator-Activated Receptor γ (PPAR) γ expression by transcriptomic analysis.After VLCKD1 were reduced: Body Mass Index (BMI) (Δ%=-11.1%, p=0.00), Total Body Water (TBW) (p0.05); Android Fat Percentage (AFP) (Δ%=-1.8%, p=0.02); Android Fat Mass (AFM) (Δ%=-12.7%, p=0.00); Gynoid Fat Mass (GFM) (Δ%=-6.3%, p=0.01); Intermuscular Adipose Tissue (IMAT) (Δ%= -11.1%, p=0.00); Homeostasis Model Assessment of Insulin Re-sistance (HOMA-IR) (Δ%=-62.1%, p=0.01). After VLCKD1 a significant increase of uricemia, cre-atinine and aspartate aminotransferase (AST) (respectively Δ%=35%, p=0.01; Δ%=5.9%, p=0.02; Δ%=25.5%, p=0.03). After VLCKD2 were reduced: BMI (Δ%=-11.2%, p=0.00); AFM (Δ%=-14.3%, p=0.00); GFM (Δ%=-6.3%, p=0.00); Appendicular Skeletal Muscle Mass Index (ASMMI) (Δ%=-17.5%, p=0.00); HOMA-IR (Δ%=-59,4%, p=0.02). After VLCKD2, uricemia (Δ%=63.1%, p=0.03), and Vitamin D levels (Δ%=25.7%, p=0.02) were increased. No significant changes of car-diovascular disease (CVD) indexes were observed after DTs. No significant changes of PPARγ lev-el in any DTs.21-days VLCKDs not impair nutritional state; not cause negative changes in global measurements of nutritional state including sarcopenia, bone mineral content, hepatic, renal and lipid profile.

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.