Search

SommarioDescritte per la prima volta negli anni’20 del Novecento, le diete chetogeniche sono passate da dietoterapia “di nicchia” per epilessie farmaco-resistenti o secondarie a rare malattie metaboliche (es. deficit di GLUT-1), a trattamento diffuso di patologie associate a malnutrizione per eccesso (diabete mellito di tipo 2, obesità). Attualmente non esiste una definizione univoca, ma si possono individuare tre classificazioni che combinano elementi differenti (composizione in macronutrienti, bilancio energetico, rapporto chetogenico) e risultano, pertanto, tra loro complementari. L’eterogeneità nella nomenclatura ha contribuito a generare false convinzioni sulla dieta chetogena, talvolta accostata a protocolli “low-carb” o “iperproteici”. Fare chiarezza non rappresenta quindi un mero esercizio accademico, ma un imperativo sia della ricerca sia della pratica clinica.

The extent to which inflammation impacts food intake remains unclear, serving as a key risk factor for malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). To address this, we analyzed a large, merged dataset of geriatric hospitalized patients across Europe. The study included 1650 consecutive patients aged ≥65 year from Germany, Italy, Finland, Denmark, and Poland. Nutritional intake was assessed using the first item of the Mini Nutritional Assessment Short Form; C-reactive protein (CRP) levels were measured using standard procedures. In total (age 79.6 ± 7.4 year, 1047 females), 23% exhibited moderate to severe inflammation, and 12% showed severe inflammation; 35% showed moderate reductions in food intake, and 28% were considered malnourished. Median CRP levels differed significantly between patients with severe, moderate, and no decrease in food intake. Among patients with a CRP level of 3.0–4.99 mg/dL, 19% experienced a severe decrease in food intake, while 66% experienced moderate to severe decreases. Regression analysis revealed that inflammation was the most prominent risk factor for low food intake and malnutrition, surpassing other factors such as age, gender, infection, and comorbidity. A CRP level of ≥3.0 mg/dL is associated with reduced food intake during last 3 months in two thirds of hospitalized geriatric patients and therefore indicative for a high risk of malnutrition.

Purpose Anorexia nervosa (AN) is a serious and complex mental disorder affecting mainly young adult women. AN patients are characterized by low body weight in combination with self-induced starvation, intense fear of gaining weight, and distortion of body image. AN is a multifactorial disease, linked by recent evidence to a dysregulation of the immune system. Methods In this pilot study, 22 blood serums from AN patients were tested for the presence of autoantibodies against primate hypothalamic periventricular neurons by immunofluorescence and by a home-made ELISA assay. Cellular fluorescence suggests the presence of autoantibodies which are able to recognize these neurons (both to body cell and fiber levels). By means of ELISA, these autoantibodies are quantitatively evaluated. In addition, orexigenic and anorexigenic molecules were measured by ELISA. As control, 18 blood serums from healthy age matched woman were analysed. Results All AN patients showed a reactivity against hypothalamic neurons both by immunofluorescence and ELISA. In addition, ghrelin, pro-opiomelanocortin (POMC), and agouti-related peptide (AGRP) were significantly higher than in control serums (p p Conclusions Immunoreaction and ELISA assays on AN blood serum suggest the presence of autoantibodies AN related. However, it is not easy to determine the action of these antibodies in vivo: they could interact with specific ligands expressed by hypothalamic cells preventing their physiological role, however, it is also possible that they could induce an aspecific stimulation in the target cells leading to an increased secretion of anorexigenic molecules. Further studies are needed to fully understand the involvement of the immune system in AN pathogenesis. Level of evidence V, descriptive study.

SommarioLa prima osservazione che la malnutrizione e la perdita di peso contribuiscano alla morte dei malati di cancro in maniera significativa e indipendentemente dagli effetti del tumore stesso risale a più di 70 anni fa. Da allora l’intervento nutrizionale, inteso sia come screening sia come trattamento medico orientato alla ricerca e alla cura della malnutrizione, ha assunto sempre più significato nella gestione della patologia tumorale. Ciò sia al suo esordio sia durante la naturale evoluzione della malattia, anche quando accompagnata dai trattamenti medici convenzionali (radioterapia, chemioterapia, chirurgia e cure palliative). La nutrizione artificiale nelle sue diverse declinazioni (supplementi nutrizionali orali, nutrizione enterale e parenterale), la farmacoterapia, il protocollo enhanced recovery after surgery (ERAS) e l’immunonutrizione sono ad oggi gli strumenti a nostra disposizione per invertire o almeno arrestare il processo prima che sopraggiunga la cachessia. Questa breve rassegna nasce con l’intento di descrivere a che punto siamo nel trattamento nutrizionale del paziente oncologico e quali sono ad oggi le evidenze di efficacia dei vari interventi nei diversi momenti di malattia.

SommarioNegli ultimi anni il digiuno intermittente è emerso quale approccio innovativo per promuovere il calo ponderale e migliorare lo stato di salute metabolica in contrapposizione agli interventi più convenzionali incentrati sulla restrizione calorica. Il digiuno intermittente (Intermittent Fasting) e il Time-Restricted Feeding (TRF) negli animali (anche noto come Time-Restricted Eating, TRE nell’uomo) hanno raggiunto una crescente popolarità parallelamente al consistente aumento delle evidenze scientifiche nell’ambito della cronobiologia, con la recente attribuzione del premio Nobel per la Medicina nel 2017 a Jeffrey C. Hall, Michael Rosbash e Michael W. Young quale riconoscimento per il contributo alle scoperte dei meccanismi molecolari che sottendono il ritmo circadiano. Il sistema circadiano regola il metabolismo in un ciclo di circa ventiquattro ore, determinando una ritmicità circadiana endogena nel dispendio energetico, nell’appetito, nella sensibilità insulinica e in altri processi metabolici. Molti di tali processi, tra cui la sensibilità insulinica e la termogenesi indotta dalla dieta, presentano un picco nella prima parte della giornata. Numerose evidenze sia nell’animale sia nell’uomo sottolineano che alimentarsi in momenti della giornata che siano asincroni rispetto ai ritmi delle suddette funzioni metaboliche promuova l’eccesso ponderale e le alterazioni metaboliche ad esso associate.

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.

OBJECTIVES Eating disorders (EDs) are severe psychiatric conditions characterized by malnutrition, dysfunctional behaviors, and hypovitaminosis D. In various psychiatric conditions, including EDs, preliminary evidence has correlated impulsivity to a low level of 25-hydroxyvitamin D [25(OH)D]. This study aims to reinforce this evidence by examining different facets, both behavioral and psychological, of the impulsivity construct in patients with ED. METHODS A sample of 119 women was evaluated with a validated questionnaire and computerized neuropsychological tasks: the UPPS-P impulsive behavior scale, a go/no-go task, and the Balloon Analogue Risk Task (BART). A clinical evaluation for EDs and blood sample collection were also performed to assess specific psychopathology and determine the serum level of 25(OH)D. RESULTS Significant correlations were found between serum levels of 25(OH)D and BART scores (p = 0.012) and lack of perseverance (p = 0.034). Moreover, regression analyses showed that higher BART scores may be explained by hypovitaminosis D and higher levels of lack of perseverance in patients with EDs. CONCLUSIONS The specific aspect of impulsivity linked to goal strategy and behaviors may be explained in patients with EDs by hypovitaminosis D. A possible connection to the brain inflammatory system is also discussed, along with possible directions for future research.

Malnutrition, whether characterized by not enough or too much nutrient intake, is detrimental to the liver. We herein provide a narrative literature revision relative to hepatic disease occurrence in over or undernourished subjects, to shed light on the paradox where both sides of malnutrition lead to similar liver dysfunction and fat accumulation. Medline, EMBASE, and Cochrane Library were searched for publications up to July 2020. Articles discussing the association between both chronic and acute liver pathology and malnutrition were evaluated together with studies reporting the dietary intake in subjects affected by malnutrition. The association between overnutrition and non-alcoholic fatty liver disease (NAFLD) is well recognized, as the beneficial effects of calorie restriction and very low carbohydrate diets. Conversely, the link between undernutrition and liver injury is more complex and less understood. In developing countries, early exposure to nutrient deficiency leads to marasmus and kwashiorkor, accompanied by fatty liver, whereas in developed countries anorexia nervosa is a more common form of undernutrition, associated with liver injury. Weight gain in undernutrition is associated with liver function improvement, whereas no study on the impact of macronutrient distribution is available. We hypothesized a role for very low carbohydrate diets in the management of undernutrition derived liver pathology, in addition to the established one in overnutrition-related NAFLD. Further studies are warranted to update the knowledge regarding undernutrition-related liver disease, and a specific interest should be paid to macronutrient distribution both in the context of refeeding and relative to its role in the development of hepatic complications of anorexia nervosa. Narrative review, Level V.

SommarioL’obesità sarcopenica è una sindrome più frequentemente presente nella popolazione anziana, associata ad aumentato rischio di disabilità, morbilità e mortalità. Questo articolo discute l’evoluzione e le controversie legate alla definizione di tale patologia, i fattori di rischio, i meccanismi fisiopatologici, le conseguenze clinico-funzionali, le modalità di valutazione della composizione corporea e i criteri diagnostici presenti. Vengono descritte, inoltre, le possibili strategie di trattamento.

SommarioAlla base dell’attuale epidemia di obesità (globesity) la sedentarietà occupa un posto di primo ordine: non solo perché mantiene l’eccesso di tessuto adiposo, ma perché predispone il soggetto obeso all’erosione della massa muscolare scheletrica (sarcopenia) e del patrimonio minerale osseo (osteopenia/osteoporosi). In questo scenario si inserisce la DXA che, a fronte di un costo biologico e tempi di esecuzione minimi, nella versione total-body fornisce una fotografia attendibile e dettagliata della composizione corporea (si pensi alla massa magra appendicolare o al tessuto adiposo viscerale). Dettagli che però sono essenziali proprio per le diagnosi di sarcopenia e obesità.

Exposure to artificial light at night (ALAN) has been associated with disruption of the circadian system, which has been pointed out to have detrimental effects on health. Exposure to outdoor ALAN is very frequent in industrialised countries due to nocturnal light pollution and the relevant involvement of the total workforce in shift work and night work. Ecological and epidemiologic studies highlight the association between exposure to ALAN and several diseases, mainly obesity and cancer. More recently, also indoor ALAN exposure has been investigated. Among several multifactorial mechanisms linking ALAN exposure and health risks, suppression of melatonin secretion plays a pivotal role leading to alterations in circadian rhythm patterns, that are detrimental in terms of appetite regulation, and dysfunctions in metabolic signalling and cell growth in cancer. In addition, gut dysbiosis, inflammation, hypovitaminosis D, imbalance in cytokine secretion and levels are responsible for the multiple relationship linking circadian dysregulation due to ALAN exposure and obesity, and cancer. Therefore, the current manuscript summarises human and basic studies pointing out the impact of ALAN exposure on health, mostly focusing on obesity and cancer. Based on extant evidence, prevention strategies for obesity and cancer should be prompted, targeting exposure to ALAN. (C) 2022 Published by Elsevier Ltd.

Purpose The present study aimed to validate the ORTO-15 questionnaire for orthorexia nervosa (ON), translated by our group into the Greek language, and replicate the findings of the recently proposed 6-item ORTO-R. Methods The tool was translated into the Greek language (ORTO-15-GR) using the forward–backward–forward method. A total of 848 adults participated in the validation study by filling in the questionnaires and providing general characteristics (age, gender, educational level, body weight, and height). The internal consistency of the tool was assessed by the omega (ω) coefficient, and confirmatory factor analyses (CFA) examined its factorial structure. Using the original six items of the ORTO-15 tool, a separate CFA model examined the factorial structure of the proposed ORTO-R tool. Furthermore, regression models tested the association of ORTO-R with study variables. Results For ORTO-15-GR, the omega coefficient was 0.70 and for the ORTO-R 0.65. For the latter, the CFA revealed acceptable goodness-of-fit (standardized factor loadings from 0.36 to 0.64); however, all ORTO-15 models were characterized by a poor fit. In addition, there was a negative association between ORTO-R score and female gender, body mass index (BMI), and having a nutrition-related health problem. Conclusion The replication of ORTO-R indicates that it is a reliable tool in the field of ON. Therefore, the use of a 6-item questionnaire for ON assessment appears promising in research and clinical settings. Supplementary Information The online version contains supplementary material available at 10.1007/s42000-022-00351-4.

Background Within the literature, there is a variety of different measurement methods for orthorexic behaviours. The ORTO-15 is the one that attracted most research attention. Many scholars criticized the ORTO-15 for its unstable factor structure and over-estimation of the prevalence of orthorexia nervosa. For this purpose, Rogoza and Donini (Eat Weight Disord 26:887–895, 2020) re-assessed the original data and created a new tool, ORTO-R. The development of the ORTO-R theoretically solved many ambiguities associated with its parent measure. However, to date, no study, including the original one, tested the validity of the ORTO-R, leaving its utility somewhat speculative. Methods We gathered data from 363 Lebanese individuals, who answered the ORTO-R questions and a set of measures used to determine the validity of the scale (eating attitudes, perfectionism, body dissatisfaction, self-esteem, anxiety, and depression). Within this study, we analysed the internal consistency of the scale and different aspects of its validity (factorial, convergent, and divergent). Results Results supported all expectations; we successfully confirmed a one-factor measurement model of the ORTO-R, which appeared to be internally consistent. The ORTO-R score correlated positively to other orthorexic behaviours as well as to disordered eating attitudes, perfectionism, anxiety, and depression. It was also negatively related to self-esteem, but was unrelated to body dissatisfaction. Conclusion The ORTO-R may be deemed as a valid instrument for the assessment of orthorexic behaviours. Level of evidence V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Front-of-pack labels (FOPLs) aim at communicating to consumers the health value of food items in support of public health policies. Two main types can be discerned: directive and semidirective FOPLs using color schemes (e.g., Nutri-Score) and informative FOPLs (e.g., Nutrinform Battery). Directive approaches tend to show a "wear-out effect" and, additionally, they tend to have various underlying conceptual problems. Usually, their nutritional scores are calculated using changing, arbitrary algorithms and involve a reductionist set of parameters of debatable validity. Thus, they overstate the effects of selected nutritional factors, such as saturated fat and energy, while overlooking the food matrix and the more holistic aspects of nourishment. Moreover, they do not reflect the portion that is consumed, ignore the preparation steps at home, and fail to serve as a useful basis for composing a healthy diet. Also, so long as the nutritional formulations match the algorithmic standards, they tend to allow ultra-processed products. Thus, this might confuse and mislead consumers. Overconfidence in green-colored labels could even result in unbalanced dietary choices, whereas avoidance of red products may eliminate certain foods from the diet that are rich in essential nutrients (e.g., cheese), leading to opposite results than aimed for. The latter is particularly relevant to vulnerable populations, such as the young, pregnant women, and older adults, or for individuals with specific needs. Taken together, directive FOPLs such as Nutri-Score contradict the declared intent of the European Commission to empower consumers to undertake healthy and balanced diets based on easily accessible and robust information. Although informative systems usually also keep the focus on a few selected nutritional parameters, they have are less paternalizing and obviate the need to classify foods as healthy or unhealthy. They also focus attention on the individual portions that are consumed (even if the definition of portion size remains contentious). Given the importance of dietary patterns, rather than individual foods or nutrients, directiveFOPLs of the Nutri-Score type represent a regretful case of nutritionism. Finally, attempts to associate the adoption of a FOPL with an improvement in the health status are few and mainly applied in virtual settings; none of which are longitudinal, nor have they been able to identify a causal link.

To the best of our knowledge, no scientific publications on orthorexia nervosa have been based on a French population. The goal of our study was to confirm the factor structure of the French version of the ORTO-15 questionnaire. An online survey (N = 768) was conducted asking participants (84.77% were women) to answer several questions about their dietary habits and to assess orthorexia nervosa using the ORTO-15 scale. Confirmatory factor analysis (CFA) was used for the validation. Given our results, we deemed it necessary to adapt the French version of the ORTO-15 questionnaire by omitting three items. The CFA supported the ORTO-12-FR (composed of 12 items and addressing three domains: rational, emotional, and behavioral) as the better-fitting model, with an internal consistency of 0.73. The Comparative Fit Index value was 0.93, the Tucker–Lewis Index was 0.90, and the Root Mean-Square Error of Approximation was 0.05. Our results provide evidence for the reliability of ORTO-12-FR with a French population. V, descriptive cross-sectional study.

La frequente associazione tra PCOS e insulino-resistenza offre l’opportunita di intervenire sulle abitudini alimentari delle pazienti per migliorare i sintomi della patologia e prevenire cosi l’insorgenza delle patologie cronico-degenerative ad essa associate. La gestione nutrizionale dovrebbe essere incentrata sulla perdita di peso, con particolare attenzione a favorire il consumo di alimenti ricchi in fibra, cereali a basso indice glicemico, acidi grassi mono- e polinsaturi e ridurre il consumo di alimenti ricchi in acidi grassi saturi e trans-idrogenati.

Il carico di glicogeno e la supercompensazione sono pratiche dietetiche finalizzate a massimizzare la prestazione atletica e a ridurre l’acqua nel compartimento extracellulare al fine di migliorare rapidamente e visibilmente la definizione muscolare. La Rassegna tratta sinteticamente il ruolo che ricoprono gli ormoni e l’esercizio fisico nel condizionare le fisiologiche riserve di glicogeno muscolare e le strategie dietetiche per incrementarle. Analizza, inoltre, il bilancio idro-elettrolitico degli atleti durante la preparazione di una gara di bodybuilding.

International audience; Objectives: Knowledge of factors determining dietary intake is important to develop targeted strategies to prevent malnutrition and age-related diseases. The aim of the present systematic review was to analyze the state of the art regarding the role of social status, cultural aspects, and psychological distress on dietary intake in community-dwelling older adults. Methods: A systematic search was performed per the Preferred Reporting Items for Systematic Reviews and Meta- Analyses procedure. Titles, abstracts, and full textswere screened for predefined inclusion and exclusion criteria. Results: Thirty-nine studies were included. Seven different groups of psychosocial and cultural determinants were associated with dietary intake. Family structure and living situation (e.g., loneliness, marital status), educational level, and income were the most important determinants associated with dietary choices and eating behavior. Less frequently, social assets, demographic parameters, psychosocial status, and awareness of current dietary recommendations were associated with the quality of the eating pattern. Conclusions: The results of our review indicate heterogeneity of the studies in the field of social and psychological determinants of dietary patterns in older adults, but some important conclusions can be drawn. Further research harmonizing and integrating approaches and methodologies are required to better understand the determinants of dietary intake and the complexity of their interactions.

The hospital catering service plays a decisive role in responding to clinical and nutritional needs and in providing food that is acceptable to patients. Unfortunately, at the moment, most hospital catering services provide a service deemed insufficient by users and are burdened by a high proportion of food waste that may negatively affect the nutritional and clinical status of patients. The aim of this study was to verify the efficacy of the NI-Nutritional Intelligence project in improving the nutritional and sensorial quality of hospital meals.The study was conducted in the Cristo Re Hospital of Rome (Italy), where two different cooking techniques were compared: traditional procedures and the low-aggression gastronomic procedures of the Niko Romito Food Processing Technique. Data were collected on both objective (food waste) and subjective (customer satisfaction) evaluations of the food service.The proportion of participants wasting at least 50% of dishes served dropped from 25.9% to 20% for the first course, from 32.8% to 20% for the main course, and from 29.3% to 20.4% for the side (P0.05 in all cases). Regarding customer satisfaction, the percentage of participants who gave a positive opinion on the variety of the menus gradually increased from 74.1% to 95% (P0.05). The same happened for opinions concerning the presentation of the dishes (smell, color, flavor): positive judgments went from 51.7% to 76% (P0.05). The overall scoring of the food service (0-10) went from 6.38 ± 2.3 to 7.6 ± 2.1 (P0.05).The hospital catering service must be able to provide patients with meals with an adequate supply of energy and nutrients to allow them to recover their health and reduce hospital stays. The Nutritional Intelligence project, based on the gastronomic method proposed in the Niko Romito Food Processing Technique, significantly reduces food waste and improves customer satisfaction without imposing service costs related to catering staff and foodstuffs.

Purpose Orthorexia Nervosa (ON) is described as an extreme level of preoccupation around healthy eating, accompanied by restrictive eating behaviors. During the years, different assessment instruments have been developed. The aim of the study is to adapt into Italian the Düsseldorf Orthorexia Scale (I-DOS) and to test its psychometric properties. Method A total sample of 422 volunteer university students (mean age = 20.70 ± 3.44, women 71.8%) completed a group of self-report questionnaires in large group sessions during their lecture time. The scales assessed ON (the I-DOS and the Orhto-15), disordered eating (Disordered Eating Questionnaire, DEQ), depressive symptoms (Beck Depression Inventory-II, BDI-II), obsessive and compulsive symptoms (Obsessive Compulsive Inventory-Revised, OCI-R), and self-reported height and weight. Results The fit of the unidimensional structure and reliability of the I-DOS was tested trough Confirmatory Factor Analysis (CFA) as well as its criterion validity computing correlation coefficients among Ortho-15, DEQ, BDI-II, OCI-R, BMI. Analyses confirmed the unidimensional structure of the I-DOS with acceptable or great fit indices (CFI = 0.984; TLI = 0.978; SRMR = 0.043; RMSEA = 0.076) and the strong internal consistency (α = 0.888). The correlations path supported the criterion validity of the scale. The estimated total prevalence of both ON and ON risk was 8.1%. Conclusions This 10-item scale appears to be a valid and reliable measure to assess orthorexic behaviors and attitudes. Level of evidence Level V, descriptive cross-sectional study.

Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting.

Sarcopenic obesity (SO) is characterised by a concomitant high fat mass (FM) and low fat free mass (FFM) leading to an increased cardio-metabolic risk. This analysis aims to estimate the SO prevalence in Iranian adults and evaluate the association of SO with metabolic syndrome (MetS) risk. This cross-sectional analysis included 4296 subjects (age 35-70 years, 55.2% females). Body composition parameters, measured by bioelectrical impedance included: FM, FFM, appendicular lean mass (ALM) and skeletal mass index. SO was classified according to five criteria: (1) FM%-SMI; (2) FM%-ALM/% weight (wt%); (3) FM%-ALM/body mass index (BMI); (4) Residuals of ALM and FM and (5) FM/FFM Ratio. Multivariate logistic regression was applied to explore the association between SO models with MetS risk stratified by gender. Receiving operating characteristic (ROC) curves were used to identify the best FM/FFM ratio cut-off value for detecting MetS cases in males and females. The prevalence of SO varied between 4% and 26% depending upon the classification method. The prevalence of MetS was 12.8% and 31.6% in males and females, respectively. SO models based on ALM/wt% and FM/FFM ratio showed the strongest association with MetS risk in males (OR: 11.5, 95%CI: 7.5-17.7, p < 0.001 and OR: 10.1, 95%CI: 6.9-14.7, p < 0.001, respectively) and females (OR: 4.1, 95%CI: 3.0-5.6, p < 0.001 and OR: 4.6, 95%CI: 3.5-5.9, p < 0.001, respectively). SO is a prevalent condition in an adult Iranian population and the ALM/wt% and the FM/FFM ratio models of SO appeared to be associated with higher MetS risk.

Purpose of review Tough plenty of literature investigated therapeutic options for body composition changes targeting elderly people, evidence concerning potential treatments of sarcopenic obesity as a unique condition is scarce. The aim of the present review was to summarize recent evidence regarding treatment of sarcopenic obesity in adult and older individuals. Recent findings Exercise-based interventions were effective in ameliorating lean mass or sarcopenia-related indices and reducing total adiposity. Importantly, in one study, modifications of body composition were obtained in the absence of significant changes in body mass index. The majority of studies relied on resistance training, and all provided with beneficial effects in body composition. Conversely, effects in terms of muscle strength and functional ability were heterogeneous. Electrical acupuncture and whole-body electromyostimulation associated with nutritional supplementation resulted to be novel effective strategies in inducing body composition changes. Nonetheless, findings from nutritional supplementations are not conclusive, leading to conflicting results on strength and functional outcomes. Summary Specific interventions could improve sarcopenic obesity, but overall significance is limited by scarcity of data and lack of uniformity in the definition of sarcopenic obesity itself. Further research should clarify optimal treatment options for sarcopenic obesity in age classes other than the geriatric population.

Background: Some patients affected by COVID-19 present a life-threatening hyperinflammatory state known as cytokine storm syndrome (CSS) associated with a high mortality rate. Our hypothesis is that a eucaloric ketogenic diet (EKD) may be a safe and efficacious treatment option to reduce CSS and consequently to reduce the need for CPAP, ICU admission and COVID-19 mortality.Aim of the study: The primary objective is to explore the effect of an EKD on mortality, admission to the ICU and the need for NIV in hospitalized patients with COVID-19 in comparison to a eucaloric standard diet (ESD). The secondary objectives are to collect data about the safety and feasibility of an EKD during hospitalization and to evaluate the effect of the diet on biological and inflammatory parameters, particularly interleukin-6 (IL-6).Patients and methods: The study is a retrospective explorative analysis of 34 patients fed with an EKD during hospitalization for COVID-19 in comparison to 68 patients fed an ESD selected and matched using propensity score one-to-two to avoid the confounding effect of interfering variables.Results: A trend of reduced 30-day mortality (HR 0.416, 95% CI 0.122 – 1.413, P = 0.160) and a trend regarding the need for ICU admission (HR 0.357, 95% CI 0.045 – 2.847, P = 0.331) were observed in subjects treated with the EKD compared to patients fed with the standard diet. No significantly different risks in the need for CPAP (HR 0.968, CI 0.289 – 3.242, P = 0.958 for EKD) or the composite endpoint (HR 0.674, CI 0.233 – 1.949, P = 0.446 for EKD) were detectable between the two groups of dietary patterns.Furthermore, IL-6 concentrations between t 0 and t 7 (seven days after the beginning of the diet) in the ketogenic nutrition group showed a median difference of -26.0 ȵg/mL and a mean difference of -164 ȵg/mL (data from 23 of the 34 pairs) compared to controls, with a trend toward significance (P = 0.062). EKD was safe and no adverse events were observed in patients fed an EKD.Discussion and conclusions: These preliminary data on the clinical results for mortality, need for ICU admission and the effect on the IL-6 concentration during EKD feeding, collected in a retrospective way during the most aggressive period of the COVID-19 pandemic, suggest a favorable role of this dietary treatment in COVID-19 clinical management. The EKD was safe and well accepted by patients during hospitalization and seems to be an interesting tool in controlling COVID-19 CSS. The results of the prospective controlled randomized trial, currently underway with a large number of subjects, are necessary to confirm these preliminary data.

Background: Some patients affected by Covid 19 present a life threatening hyperinflammatory state known as a cytokine storm syndrome (CSS) associated with a high mortality rate. Our hypothesis is that eucaloric ketogenic diet (EKD) may be a safe and efficacious treatment option to reduce CSS and consequently to reduce need of CPAP, ICU admission and mortality COVID-19 related.Aim of the study: Primary objective is to explore the effect of EKD on mortality, access to ICU and the need of NIV in COVID-19 hospitalized patients in comparison to a eucaloric standard dietstandard diet (ESDESD). Secondary objectives are to collect data about safety and feasibility of EKD during hospitalization and to evaluate the effect of the diet on biological and inflammatory parameters and particularly on interleukin -6 (IL-6).Patients and Methods: The study is a retrospective explorative analysis of 34 patients fed with EKD during hospitalization for COVID-19 in comparison to 68 patients in ESDESD selected and matched using propensity score one-to-two to avoid the confounding effect of interfering variables.Results: A trend of reduction of 30-day mortality (HR 0.416, 95% CI 0.122 – 1.413, P = 0.160) and a trend in need for ICU admission (HR 0.357, 95% CI 0.045 – 2.847, P = 0.331) were observed in subjects treated with EKD respect to patients fed with standard one. No significant different risks in need for CPAP (HR 0.968, CI 0.289 – 3.242, P = 0.958 for EKD) and composite endpoint (HR 0.674, CI 0.233 – 1.949, P = 0.446 for EKD) were detectable between the two groups of dietary patterns.Furthermore, IL-6 concentrations, between t 0 and t 7 (seven days after the beginning of the diet), collected in the ketogenic nutrition group, show a median IL-6 difference of -26.0 ȵg/mL or a mean IL-6 difference of -164 ȵg/mL (data from 23 of the 34 pairs) compared to controls, with a trend to (P = 0.062).Discussion and conclusions: These preliminar data, collected in a retrospective way during the most aggressive period of Covid-19 pandemia, on clinical results on mortality, need for ICU and effect on IL-6 concentration during EKD suggest a favorable role of this dietary treatment in COVID-19 clinical management. EKD resulted well accepted by patients during hospitalization and seems to be an interesting tool in controlling Covid-19-CSS. The results of the prospective controlled randomized trial, actually ongoing, in a largest number of subjects are necessary to confirm these preliminary data.