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Aims Safety and tolerability of prolonged supplementation with a vitamin D, calcium and leucine-enriched whey protein medical nutrition drink (WP-MND) was evaluated in sarcopenic older adults. Methods A 13-week double-blinded, randomized, isocaloric placebo-controlled trial (PROVIDE study; n = 380) was extended with a voluntary 13-week open-label extension (OLE). OLE participants were randomized to receive daily 1 or 2 servings of WP-MND (21 g protein, 3 g leucine, 10 µg vitD and 500 mg calcium per serving). Gastro-intestinal tolerability, kidney function and serum levels of calcidiol, parathyroid hormone (PTH) and calcium were evaluated at week 0, 13 and 26. Results and discussion In response to the high daily protein intake (median1.5; IQR: 1.3, 1.7 g/kg BW/day), the estimated glomerular filtration rate (eGFR) increased in the test group during the RCT (p = 0.013). The same trend was observed for those participants with moderate chronic kidney disease. During OLE no eGFR change was observed in any of the groups. Serum calcidiol and calcium reached a plateau after 13-week WP-MND supplementation. As expected, PTH significantly changed in the opposite direction, decreasing during RCT in the test group (T vs C: p n = 18; C: n = 2) and 6 developed albumin-corrected calcium levels > 2.55 mmol/L (T: n = 3; C: n = 3), without associated adverse events. Conclusion A 6 months intervention with up to 2 servings of WP-MND did neither result in kidney function deterioration nor symptoms of vitamin D or calcium toxicity. The product was overall well tolerated.

Accumulating evidence suggests a potential role of dietary protein among nutritional factors interfering with the regulation of blood pressure. Dietary protein source (plant versus animal protein), and especially, protein composition in terms of amino acids has been postulated to interfere with mechanisms underlying the development of hypertension. Recently, mounting interest has been directed at amino acids in hypertension focusing on habitual dietary intake and their circulating levels regardless of single amino acid dietary supplementation. The aim of the present review was to summarize epidemiological evidence concerning the connection between amino acids and hypertension. Due to the large variability in methodologies used for assessing amino acid levels and heterogeneity in the results obtained, it was not possible to draw robust conclusions. Indeed, some classes of amino acids or individual amino acids showed non-causative association with blood pressure as well as the incidence of hypertension, but the evidence was far from being conclusive. Further research should be prompted for a thorough understanding of amino acid effects and synergistic actions of different amino acid classes on blood pressure regulation.

Aim:To improve understanding of the determinants of dietary, physical activity (PA), and sedentary behaviours, the European multi-disciplinary consortium on “Determinants of Diet and Physical Activity Knowledge Hub” (DEDIPAC-KH) includes 46 consortia and organisations supported by joint programming grants from 12 countries across Europe (Lakerveld et al., 2014). Six Italian Universities (e.g., Cassino, Chieti-Pescara, Palermo, Roma Foro Italico, Roma Sapienza, and UCSC) participating in the LISTANet consortium supported by MIUR (B84G14000040008) contributed to the Thematic Area2 “Determinants of dietary, PA, and sedentary behaviours across the life course and in vulnerable groups”. In particular, the coordinator of LISTANet Prof Capranica and Prof. MacDonncha from the Irish Physical Activity and Health Consortium act as Work Package (WP) Leaders of PA determinants (WP2.2). Methods: A mix of methods has been used in identifying PA determinants by developing PA taxonomy and a European framework (EU-PAD), seven umbrella systematic literature reviews (e.g., behavioural, biological, economic, physical, policy, psychological, and socio-cultural), and identifying ongoing/recently completed European-funded projects and data sets for secondary data analyses. Results: LISTANet participated in DEDIPAC-KH meetings/seminars/courses/conferences, and organized two workshops dedicated to the EU-PAD framework and umbrella SLRs. Outcomes included internal reports, presentations to international conferences, and scientific papers submitted for publications. Conclusions: The DEDIPAC-KH project represents an excellent start in setting up a complex, cross-country, organisational structure to: 1) guide a European strategic plan for novel and multi-disciplinary research addressing the complexity of determinants of PA behaviours across the life course; and 2) identify key aspects for potential strategies and intervention programmes to implement multi-sectoral European policies in PA. Finally, the cumulated experience of LISTANet could be valuable to fully exploit effective research and actions to increase PA levels of Italian citizens., Italian Journal of Anatomy and Embryology, Vol. 121, No. 1 (Supplement) 2016

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.

In literature, some of the main factors defining the quality of aging are related to the inflammatory status (IS), oxidative stress (OX) and gut microbiota (GM) alterations. These elements may increase prevalence of age-related anorexia associated to a reduction of food intakes and a decrease of physical activity too. RISTOMED held under the EU-7FP, aimed at the evaluation of the effects on IS-OX-GM in the presence of an (e)-diet in an Elderly Population (65-80 yrs).The study was aimed to compare a e-diet elaborated with a new web platform, alone or implemented by 3 different nutraceutic components: Argan oil, probiotic VSL#3 and the AISA 5203-L extract. In order to evaluate the effects of the intervention, the following measurements and questionnaires have been considered within the protocol: Anthropometric data, handgrip, and Short Physical Performance Battery (SPPB), International Physical Activity Questionnaires (IPAQ), SF-36v2(PCS-MCS), Food Frequency Questionnaire (FFQ),among others. All the data and the results of this panel of questionnaires in Bordeaux, Berlin and Rome showed that in all the 4 arms of the 139 men and women enrolled there was an improvement in terms of quality of life. In a cluster of 44 subjects characterized by a low-grade inflammation with higher levels of CRP, ESR, fibrinogen, IL-6 and TNF-a, the e-diet induced a decrease of CRP in the group with the higher inflammation values, whereby AISA 5203-L amplified this protective effect. The e-diet alone decreased the oxidative stress with no further effect of the products. Cholesterol, triglycerides and glucose parameters were also improved by e-diet with a further effect of Argan oil was associated with a progress of these parameters when they were altered at the baseline. VSL#3 decreased homocysteine level, a vascular risk factor. On the basis of the results an improvement of mood was observed in all groups and an improvement of mental component SF36 was observed following the diet and the diet implemented by AISA 5203-L.

The aim of this study is to verify, in a sample of elderly subjects admitted to long-term care, the impact of malnutrition, according to the Mini Nutritional Assessment (MNA), on mortality and on the occurrence of Adverse Clinical Events in a 3-12 months follow-up study.The survey included all patients admitted to a geriatric hospital--"Villa delle Querce", Nemi (Rome, Italy)--between January 1997 and April 2000, whose nutritional status we were able to monitor for over 3 months. The study comprised 167 elderly subjects, of which 125 women (74.9%) aged 83.3 8 years (60-95 years), and 42 men (25.1%) aged 79.6 9 years with an average follow-up period of 7.5 months.Upon admission and at every check we evaluated each subject's cognitive functions, functional status, co-morbidity, frailty, nutritional status (anthropometric and biochemical indices; MNA). During the follow-up we recorded Adverse Clinical Events. We calculated the predictive value of MNA, we correlated variations in MNA scores with variations of nutritional parameters.MNA's predictive ability both upon admission and upon discharge was found to be excellent. The MNA score was found to be correlated-although not to a very high degree-with variations nutritional parameters. Even more than malnutrition, a low MNA score was found to be predictive of a greater incidence of Adverse Clinical Events during hospitalisation and of higher mortality.