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Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, are chronic and recurrent inflammatory diseases. Although the typical symptoms are localized in the gastrointestinal tract, there are also extraintestinal manifestations (EIMs) associated with IBD, probably caused by immune reactions secondary to the pathology of origin. Anybody can be affected by EIMs, which can be dermatological, pulmonary, ocular, musculoskeletal, hepatobiliary and neurological, et al. This represents a therapeutic challenge for clinicians, who must first establish a diagnostic and then a multidisciplinary therapeutic path, in order to guarantee an optimal quality of life for the patient.

Background: inflammatory bowel diseases (IBD) are chronic disorders that affect the gastrointestinal tract but which also present extraintestinal manifestations. One of the problems related to IBD is the presence of both female and male infertility. Aim: determine the correlation between IBD and male and female infertility by analyzing the literature. Material and methods: Studies carried out in the last twenty years have been selected through the pubmed search engine. Only studies were selected that in their conclusions showed a real correlation between IBD and infertility. Results: the first cause of infertility in both sexes is related to the surgical interventions that patients have to face during the course of the disease, but there are also psychological causes or causes related to the use of drugs used for therapy. Conclusions: further studies are needed to understand what are the real mechanisms underlying infertility in subjects suffering from IBD.

Authors’ original file for figure 1

Additional file 1: Questionnaire about food safety knowledge, attitudes and practices of nursing staff of two hospitals in Sicily, Italy. It included five sections: a) demographic characteristics, employment status and hospital/ward where the nurse worked; b) knowledge about food hygiene; c) attitudes towards prevention of foodborne diseases; d) measures to be used in prevention of foodborne diseases; e) sources of information about food hygiene. (DOC 33 KB)

Azathioprine is an immunosuppressive medication used in the treatment of inflammatory diseases (MICI). Despite its extensive use in therapy, azathioprine can result in serious side effects such as myelosuppression. The likelihood of developing myelosuppression also depends on genetic factors: one of the enzymes involved in drug metabolism, methyltransferase tiopurine (TPMT), is subject to genomic polymorphism. To date, 40 polymorphisms have been identified, of which three are associated with a reduction in enzymatic activity. These are TPMT*2, TPMT*3A and TPMT*3C polymorphisms. TPMT*1 is the wild-type coding form for an enzyme capable of efficiently metabolizing the drug. The objective of the study was to determine the frequency of the three polymorphisms in a sample undergoing a TPMT genotype assay at the Molecular Laboratory of the “V. Cervello” hospital in Palermo. The test is carried out using DNA extraction procedures, PCRs, agarose gel electrophoresis and enzymatic digestion. From the analysis of 208 patients undergoing the test from 2011 to 2016, it was found that: 95.67% of patients did not have polymorphism; 2.40% had polymorphism *3A, 1.93% had polymorphism *3C. Therefore, 95.67% of patients may be exposed to azathioprine therapy without incurring side effects. Due to a reduced enzymatic activity, the remaining patients are able to be treated with azathioprine, provided that a lower dosage standard is used or is treated with another immunosuppressive drug.

© The Author(s). 2017. Background: Folic acid and its derivates, known as folates, are chemoprotective micronutrients of great interest because of their essential role in the maintenance of health and genomic integrity. The supplementation of folic acid during pregnancy has long been known to reduce the risk of neural tube defects (NTDs) in the foetus. Folate metabolism can be altered by many factors, including adequate intake through diet. Folate deficiency can compromise the synthesis, repair and methylation of DNA, with deleterious consequences on genomic stability and gene expression. These processes are known to be altered in chronic diseases, including cancer and cardiovascular diseases. Main body: This review focuses on the association between folate intake and the risk of childhood leukaemia. Having compiled and analysed studies from the literature, we show the documented effects of folates on the genome and their role in cancer prevention and progression with particular emphasis on DNA methylation modifications. These changes are of crucial importance during pregnancy, as maternal diet has a profound impact on the metabolic and physiological functions of the foetus and the susceptibility to disease in later life. Folate deficiency is capable of modifying the methylation status of certain genes at birth in both animals and humans, with potential pathogenic and tumorigenic effects on the progeny. Pre-existing genetic polymorphisms can modify the metabolic network of folates and influence the risk of cancer, including childhood leukaemias. The protective effects of folic acid might be dose dependent, as excessive folic acid could have the adverse effect of nourishing certain types of tumours. Conclusion: Overall, maternal folic acid supplementation before and during pregnancy seems to confer protection against the risk of childhood leukaemia in the offspring. The optimal folic acid requirements and supplementation doses need to be established, especially in conjunction with other vitamins in order to determine the most successful combinations of nutrients to maintain genomic health and wellbeing. Further research is therefore needed to uncover the role of maternal diet as a whole, as it represents a main factor capable of inducing permanent changes in the foetus.

Cereals are an important source of carbohydrates in the human contributing to a certain extent also to the need of protein. They constitute a rich source of both nonstarch polysaccharides (dietary fiber) and starch, which together comprise 70-77% of kernel. The Guidelines for a Healthy Diet in Italy define the opportunity to take, on a daily basis, at least 60% of energy from carbohydrates, and particularly 45% from complex carbohydrates. In Italy, especially in Sicily, these nutrients are contained in traditional food as pasta and bread made starting from durum wheat as grow material. Recently, especially in the bigger towns, there is also widespread consumption of bread made with soft wheat.2,3 In the last decade, consumer behavior is changing in Italy4 and it is clear a trend of decline in consumption of pasta and bread, instead there is an opposite trend for the consumption of products considered as a substitute for bread (brioches, crackers, biscuits, and other baked goods). It is evident how the nutritional profile of the latter products deviates from the bread due to the fat content, that ranges from 5 to 20%. It is also known as the derivatives of durum wheat, preferably whole grain products, are also characterized by a lower glycemic index than products of soft wheat. So cereals are a key component to set a proper diet. Some studies also report that influence of a regular and correct consumption of cereals may contribute to reach and to maintain normal weight.5 In 2011 was carried out investigations with the aim to understand better the relationship and the presence of cereals in the diet of preteen. Moreover, it is known as in Sicily, as well as other areas of southern Europe, there is a serious problem of childhood obesity,6,7 mainly related to lifestyles considered incorrect and a lower level of education of the population than other European areas that do not registers this phenomenon. The investigation involved a sample of 1335 subjects, aged between 10 and 13 years, identified through the involvement of 62 schools distributed throughout the region. The sample involved in the investigation was extrapolated according to a stratification that has taken into account the size of the population under study, age ,sex, and distribution by province. For each individual was recorded during the first half of December 2011, thanks to personnel appropriately trained to collect information in a standardized way, a 24-h recall questionnaire (noting the foods eaten in the last 24 hours from the individual). In addition to the parents were asked to complete a questionnaire on the frequency to record information on lifestyle, frequency of intake of cereals. For each individual was recorded weight (kg), height (cm) and body mass index (BMI, Body Mass Index), according to the standards proposed by the International Obesity Task Force.8 About frequency of the conditions of the weight of the individuals in the sample, the results have confirmed what was already mentioned by other authors for Sicily.6,7 Results of the study shows as the population sample, in the various daily meals, have not a correct relationship with cereals, considering the models known for the Mediterranean population. In particular, it is clear the high frequency of subjects who have not took any kind of cereals at breakfast (n=699, 52%) or at morning-snack (n=396, 30%). Moreover 17% of individuals (n=228) has neither taken any kind of breakfast cereal nor at morning-snack; these individuals have access to the primary source of complex carbohydrates, needed daily, only with lunch. The individuals who regularly eat pasta are characterized by a lower Body Mass Index than those who do not consume habitually; the same is for those who regularly take breakfast, according as noted by other authors in specific studies conducted in the Mediterranean basin,9 and for individuals who have eaten at least one type of cereal for breakfast. Regarding this survey it can be stated that further studies are needed to define the extent to which an erroneous presence and distribution in diets of cereals can affect overweight and obesity, particularly among younger age groups of the population. It is evident, however, that it is more necessary than ever to support an effective education campaign that fill the gaps on nutritional knowledge on cereals; contribute to implement pathways on enhancement of cereals mainly on nutritional point of view, with the aim to promoting correct lifestyles and diet patterns better oriented to limit the risks of occurrence in the population of chronic degenerative diseases related to obesity.

The purpose of this work is to investigate the link between an altered intestinal mcro-biota or dysbiosis and chronic inflammatory disorders, in particular inflammatory bowel disease (IBD). Along with probiotics, faecal microbiota transplantation (FMT) opts to be a promising therapeutic treatment for restoring the bacterial homeostasis of the hu-man intestine and reducing the risk of colorectal carcinogenesis. Microbiota is the com-plex microbial flora that resides in the gut establishing a mutually beneficial relation-ship. Alteration of the microbiota’s composition, termed as dysbiosis, may lead to pathological conditions. Treatment with probiotics can restore the normal commensal flora in IBD. Intestinal microbiota affects the circadian rhythm which in turn regulates the expression of different genes in GALT (gut associated lymphoid tissue) playing a role in the prevention of inflammation and colorectal cancer (CRC) progression. This article highlights the involvement of different microbial strains in the pathogenesis of dysbiosis and in the creation of a carcinogenic milieu caused by an altered stimulation of the immune system. Therapies targeting the equilibrium of the microbiota to switch off chronic inflammation and prevent the progression to CRC seem to be a promising therapeutic tool for a variety of inflammation-associated diseases.