Publications by authors named "Giorgio Bedogni"

129 Publications

External Validation of Surrogate Indices of Fatty Liver in the General Population: the Bagnacavallo Study.

J Clin Med 2021 Feb 1;10(3). Epub 2021 Feb 1.

Italian Liver Foundation, 34012 Basovizza, Italy.

We externally validated the fatty liver index (FLI), the lipid accumulation product (LAP), the hepatic steatosis index (HSI), and the Zhejiang University index (ZJU) for the diagnosis of fatty liver (FL) and non-alcoholic fatty liver disease (NAFLD) in the general population. The validation was performed on 2159 citizens of the town of Bagnacavallo (Ravenna, Italy). Calibration was evaluated by calculating the calibration slope and intercept and by inspecting calibration plots; discrimination was evaluated using the c-statistic. The average calibration slope was 1 and the average intercept was 0 for all combinations of outcomes and indices. For the diagnosis of FL, the c-statistic was 0.85 for FLI, 0.83 for ZJU, 0.82 for HSI, and 0.80 for LAP; for the diagnosis of NAFLD, the c-statistic was 0.77 for FLI, 0.76 for ZJU, 0.75 for HSI, and 0.74 for LAP. All indices were strongly correlated with each other. In conclusion, FLI, LAP, HSI, and ZJU perform similarly well to diagnose FL and NAFLD in the Bagnacavallo population, even if FLI has a small advantage as discrimination is concerned.
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http://dx.doi.org/10.3390/jcm10030520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867182PMC
February 2021

The Impact of Formula Choice for the Management of Pediatric Cow's Milk Allergy on the Occurrence of other Allergic Manifestations: The Atopic March Cohort Study.

J Pediatr 2021 Jan 29. Epub 2021 Jan 29.

Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy; European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy; Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy.

Objectives: To compare the impact of different formulas on the occurrence of other atopic manifestations and the time of immune tolerance acquisition.

Study Design: In a 36-month prospective cohort study the occurrence of other AMs (eczema, urticaria, asthma, and rhinoconjunctivitis) and the time of immune tolerance acquisition were comparatively evaluated in immunoglobulin E-mediated CMA children treated with: extensively hydrolyzed casein formula containing the probiotic L. rhamnosus GG(EHCF+LGG), rice hydrolyzed formula(RHF), soy formula(SF), extensively hydrolyzed whey formula(EHWF), or amino-acid based formula(AAF).

Results: 365 subjects were enrolled into the study, 73 per formula cohort. The incidence of AMs was: 0.22 (Bonferroni corrected 95% confidence interval(CI) 0.09 to 0.34) in the EHCF+LGG cohort; 0.52 (0.37 to 0.67) in the RHF cohort; 0.58 (0.43 to 0.72) in the SF cohort; 0.51 (0.36 to 0.66) in the EHWF cohort; and 0.77 (0.64 to 0.89) in the AAF cohort. The incidence of AMs in the RHF, SF, EHWF and AAF cohorts vs. the EHCF+LGG cohort was always higher than the pre-specified absolute difference of 0.25 at an alpha-level of 0.0125, with corresponding risk ratios of 2.37 (1.46 to 3.86, p <0.001) for RHF vs. EHCF+LGG; 2.62 (1.63 to 4.22, p<0.001) for SF vs. EHCF+LGG; 2.31(1.42 to 3.77, P < .001) for EHWF vs. EHCF+LGG; and 3.50(2.23 to 5.49, p<0.001) for AAF vs. EHCF+LGG. The 36-month immune tolerance acquisition rate was higher in the EHCF+LGG cohort.

Conclusion: The use of EHCF+LGG for CMA treatment is associated with lower incidence of AMs and higher rate of immune tolerance acquisition.
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http://dx.doi.org/10.1016/j.jpeds.2021.01.059DOI Listing
January 2021

Changes of Body Weight and Body Composition in Obese Patients with Prader-Willi Syndrome at 3 and 6 Years of Follow-Up: A Retrospective Cohort Study.

J Clin Med 2020 Nov 8;9(11). Epub 2020 Nov 8.

Division of Auxology, Istituto Auxologico Italiano, IRCCS, 28824 Verbania, Italy.

Few short-term studies of weight loss have been performed in adult patients with Prader-Willi syndrome (PWS) undergoing metabolic rehabilitation. We performed a retrospective cohort study of 45 adult obese PWS patients undergoing a long-term multidisciplinary metabolic rehabilitation program based on diet and physical activity. Body composition was evaluated by dual-energy X-ray absorptiometry in 36 (80%) patients. The mean (95% CI) weight change was -3.6 (-7.6 to 0.4, = 0.08) kg at 3 years and -4.6 (-8.5 to -0.8, = 0.02) kg at 6 years, and that of BMI was -1.7 (-3.4 to 0.1, = 0.06) kg/m at 3 years and -2.1 (-3.8 to -0.4, = 0.02) kg/m at 6 years. A decrease of about 2% in fat mass per unit of body mass was observed, which is in line with the expectations for moderate weight loss. A possibly clinically relevant decrease in total and low-density lipoprotein cholesterol was also observed. These long-term results are important for patients with PWS, which is characterized by severe hyperphagia, behavioral disturbances, and cognitive impairment and is generally considered "resistant" to classical weight loss interventions.
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http://dx.doi.org/10.3390/jcm9113596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695203PMC
November 2020

Safety of boneless reconstruction of the mandible with a CAD/CAM designed titanium device: The replica cohort study.

Oral Oncol 2021 Jan 5;112:105073. Epub 2020 Nov 5.

Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy. Electronic address:

Objective: We evaluated the safety of REPLICA, a CAD/CAM-designed patient-specific titanium mandible, in patients with mandibular defects not suitable for reconstruction with traditional techniques.

Patients And Methods: We performed a cohort study with a composite primary outcome assigned at the end of a 1-year follow-up. The outcome was assigned in the presence of all the following: 1) absence of intraoral or skin extrusion of REPLICA; 2) decrease or cessation of oral pain; 3) stability or increase in mouth opening; 4) resumption of oral feeding without the need of nasogastric tube; 5) absence of fracture at multidetector computer tomography (MDCT); 6) absence of displacement (MDCT); 7) absence of screw loosening (MDCT). The secondary outcome was the patient-reported QOL at 6 months of follow-up as detected by the EORTC QLQ-C30 and QLQ-H&N35 questionnaires.

Results: Between March 2012 and June 2017, 18 consecutive patients, with a median (IQR) age of 67 (65;74) underwent reconstruction of mandibular defects with REPLICA at our Unit. The primary outcome was reached by 14 of the 18 patients. QOL data were available for 15 patients at the 6-month follow-up, showing a good profile of general and disease-specific QOL.

Conclusion: REPLICA offered a safe solution at 1-year for the treatment of mandibular defects not suitable for reconstruction with traditional techniques, and was associated with subjective well-being and satisfaction. Further studies are needed to assess the full range of indications of REPLICA.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105073DOI Listing
January 2021

Rice flour fermented with Lactobacillus paracasei CBA L74 in the treatment of atopic dermatitis in infants: A randomized, double- blind, placebo- controlled trial.

Pharmacol Res 2021 Jan 4;163:105284. Epub 2020 Nov 4.

Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.

To assess the effect of a fermented rice-flour obtained from Lactobacillus paracasei CBA L74 in managing infants with moderate to severe atopic dermatitis. Infants with moderate to severe atopic dermatitis, aged 6-36 months, were randomly assigned to receive once-daily consumption of rice flour containing heat-killed probiotic Lactobacillus paracasei CBA L74 or placebo for 12 weeks as supplementary approach to topical treatment. Primary outcome was SCORAD index change from baseline to 12 weeks; secondary outcomes were gut microbiota composition, as evaluated by the analysis of fecal samples, and serum cytokines at baseline and at the end of the intervention period in both groups, and steroid usage over the treatment period and one month after stopping it. V3-V4 region of the 16S ribosomal RNA gene was sequenced to evaluate changes in the gut microbiota. SCORAD index decreased over the treatment period in both groups. The difference in the SCORAD change was -2.1 (-5.5 to 1.3; p = 0.223) for the experimental vs. the placebo group, not reaching the minimal clinical difference of 8.7 units. The use of topical steroids, measured as finger tips units, decreased from 4 to 16 weeks, in both groups; the reduction was significantly higher in experimental than in placebo group (p value from Wilcoxon rank sum test = 0.031). No significant differences were observed for cytokines levels between groups. The composition of gut microbiota at the phylum and class taxonomic levels resulted very similar, at baseline and after intervention, in both groups. Similarly, no significant differences were observed in the relative abundance of bacterial genera between groups. In conclusion, though the heat-killed Lactobacillus paracaseiwas not proved to be effective in reducing the severity of atopic dermatitis, it showed a steroid sparing effect the value of which needs to be further investigated.
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http://dx.doi.org/10.1016/j.phrs.2020.105284DOI Listing
January 2021

Reply to "Efficacy and safety of hydrolyzed formulas for cow's milk allergy management: A systematic review of randomized controlled trials".

Clin Exp Allergy 2021 Jan 25;51(1):155-157. Epub 2020 Oct 25.

Department of Translational Medical Science, University Federico II of Naples, Naples, Italy.

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http://dx.doi.org/10.1111/cea.13758DOI Listing
January 2021

Spleen stiffness can be employed to assess the efficacy of spontaneous portosystemic shunts in relieving portal hypertension.

Ann Hepatol 2020 Nov - Dec;19(6):691-693. Epub 2020 Aug 20.

Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Italian Liver Foundation, Basovizza (Trieste), Italy; Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, Trieste, Italy.

Introduction: Spleen stiffness (SS) has been found to mirror dynamic changes in portal pressure after transjugular intrahepatic portosystemic shunt (TIPS) placement. However, there is no data available regarding SS in patients with spontaneous portosystemic shunting (SPSS), especially in regards to prediction of hepatic decompensation.

Methods: We retrospectively selected patients with confirmed SPSS and esophageal varices (EVs) at endoscopic examination, and recorded any decompensating event (i.e., variceal hemorrhage, overt hepatic encephalopathy, refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome) in the first twelve months following liver and spleen elastography.

Results: The patients who presented decompensating events showed lower platelet count (94.5 vs. 121.5 g/L, p < 0.001), higher SS (44 vs. 30 kPa, p < 0.001), higher probability of EVs according to SS (77 vs. 2 %, p < 0.001), and higher spleen diameter (14 vs. 12 cm, p = 0.043). They also showed a higher prevalence of splenorenal shunts (66.7 vs. 31.2%), and a significantly wider SPSS major diameter (14.5 vs. 8 mm, p < 0.001).

Conclusion: SS could predict SPSS efficacy in relieving portal pressure, and could predict decompensating events in patients with SPSS.
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http://dx.doi.org/10.1016/j.aohep.2020.07.004DOI Listing
August 2020

Modeling the time-related fluctuations of AFP and PIVKA-II serum levels in patients with cirrhosis undergoing surveillance for hepatocellular carcinoma.

Cancer Biomark 2020 ;29(2):189-196

Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy.

Background: The time-related variability of HCC biomarkers has not been investigated so far.

Objective: To assess the changes of alpha-fetoprotein (AFP) and protein induced by vitamin-K absence/antagonist-II (PIVKA-II) in patients with HCC (HCC+) as compared to patients without HCC (HCC-).

Methods: AFP and PIVKA-II were measured by a single laboratory using an automated chemiluminescent-enzyme-immunoassay (Fujirebio Inc., Tokyo, Japan) in 1163 sera of 418 cirrhotics (31.1% HBV, 58.6% HCV, 10.3% non-viral etiology) undergoing ultrasound HCC surveillance. The mean (range) number of effective time-points available for analysis was 2.8 (2.0 to 3.0); 124 patients with HCC were matched with 294 who remained HCC free for at least 12 months after the last specimen. AFP and PIVKA-II changes were estimated over time by means of a random-effect generalized least squares (RE-GLS) regression model under the missingness at random assumption.

Results: Patients with and without HCC had comparable chronic liver disease etiology and staging. AFP/PIVKA-II median (25th; 75th percentile) values at the latest time-point were 4.2 (2.6; 8.6) ng/mL/32 (25; 42) mAU/mL in HCC- and 8.4 (4.4; 32.1) ng/mL/66 (32; 192) mAU/mL in HCC+ (p< 0.001). Log10AFP and log10PIVKA-II time-changes differed in HCC+ and HCC- patients. In HCC+ patients, both log10AFP and log10PIVKA-II showed an increasing trend over time. In HCC- patients, log10PIVKA-II variations were minimal as compared to log10AFP variations. The percent increase of log10AFP at 6 months vs. baseline was 11% (95%CI 5 to 17%) and 5% (95%CI 1 to 8%) for log10PIVKA-II in HCC+vs. HCC- patients.

Conclusions: The present retrospective study of the biological variability of AFP and PIVKA-II suggests that their time-related changes may serve as potential predictors of HCC. This topic needs to be addressed by longitudinal studies.
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http://dx.doi.org/10.3233/CBM-190118DOI Listing
January 2020

Is there an association between commonly employed biomarkers of liver fibrosis and liver stiffness in the general population?

Ann Hepatol 2020 Jul - Aug;19(4):380-387. Epub 2020 May 12.

Italian Liver Foundation, Basovizza, Trieste, Italy. Electronic address:

Introduction And Objectives: Surrogate biomarkers of liver fibrosis developed in tertiary care are increasingly used in general populations. We evaluated the association between liver stiffness (LS) and five continuous (AST/ALT, APRI, Forns Index, FIB-4, GGT) and two discrete biomarkers (BARD, BAAT) in a general population.

Patients And Methods: 636 (29%) of the 2159 citizens of the Bagnacavallo Study had LS measured by transient elastography. Using linear regression with univariate multiple imputation, we evaluated the association of LS with the above biomarkers in the total sample of 2159 citizens.

Results: The mean change of LS between the 5 and 9 internal percentile of any continuous biomarker was ≤1kPa. The mean change of LS between scores 0 and 3 of BARD and scores 0 and ≥3 of BAAT was >1kPa but of doubtful clinical relevance.

Conclusion: We found a modest association between LS and seven biomarkers of liver fibrosis in a general population.
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http://dx.doi.org/10.1016/j.aohep.2020.04.003DOI Listing
May 2020

External Validation of Equations to Estimate Resting Energy Expenditure in 2037 Children and Adolescents with and 389 without Obesity: A Cross-Sectional Study.

Nutrients 2020 May 14;12(5). Epub 2020 May 14.

Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 20145 Milan and 28921 Verbania, Italy.

We performed an external cross-validation study of 10 equations to estimate resting energy expenditure (REE) in 2037 children with and 389 without obesity. Inclusion criteria were Caucasian ethnicity, age ≤ 18 years, and availability of REE. REE was measured using indirect calorimetry. The correct classification fraction (CCF) of an equation was defined as the fraction of subjects whose estimated REE was within 10% of measured REE. The Molnár equation was the most accurate REE prediction equation with CCFs of 0.70 (95% CI 0.65 to 0.76) in girls without obesity, 0.64 (95% CI 0.61 to 0.66) in girls with obesity, 0.76 (95% CI 0.67 to 0.83) in boys without obesity, and 0.66 (95% CI 0.63 to 0.69) in boys with obesity. The Mifflin equation was the second most accurate equation with CCFs of 0.67 (95% CI 0.61 to 0.73) in girls without obesity, 0.61 (95% CI 0.58 to 0.64) in girls with obesity, 0.75 (95% CI 0.66 to 0.82) in boys without obesity, and 0.66 (95% CI 0.63 to 0.69) in boys with obesity.
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http://dx.doi.org/10.3390/nu12051421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285137PMC
May 2020

Could Inflammatory Indices and Metabolic Syndrome Predict the Risk of Cancer Development? Analysis from the Bagnacavallo Population Study.

J Clin Med 2020 Apr 20;9(4). Epub 2020 Apr 20.

Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy.

Background: Despite the robust data available on inflammatory indices (neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)) and clinical outcome in oncological patients, their utility as a predictor of cancer incidence in the general population has not been reported in literature.

Methods: The Bagnacavallo study was performed between October 2005 and March 2009. All citizens of Bagnacavallo (Ravenna, Emilia-Romagna, Italy) aged 30-60 years as of January 2005 were eligible and were invited by written letter to participate to the study. All participants underwent a detailed clinical history and physical examination following the model of the Dionysos Study. All blood values included in the analysis were obtained the day of physical examination. Cancer incidence data were obtained from the population-based Romagna Cancer Registry, which operates according to standard methods. The aim of this analysis was to examine the association between metabolic syndrome and baseline SII, NLR, and PLR levels, and the diagnosis of an invasive cancer in the Bagnacavallo study cohort.

Results: At univariate analysis, metabolic syndrome was not associated with an increase of cancer incidence (HR 1.30; = 0.155). High glucose (HR 1.49; = 0.0.16), NLR HR 1.54, = 0.002), PLR (HR 1.58, = 0.001), and SII (HR 1.47, = 0.006) were associated with an increase of cancer incidence. After adjusting for clinical covariates (smoking, physical activity, education, age, and gender) SII, PLR, and NLR remained independent prognostic factors for the prediction of cancer incidence.

Conclusions: Inflammatory indices are promising, easy to perform, and inexpensive tools for identifying patients with higher risk of cancer in cancer-free population.
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http://dx.doi.org/10.3390/jcm9041177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231063PMC
April 2020

Predictive energy equations for spinal muscular atrophy type I children.

Am J Clin Nutr 2020 05;111(5):983-996

International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy.

Background: Knowledge on resting energy expenditure (REE) in spinal muscular atrophy type I (SMAI) is still limited. The lack of a population-specific REE equation has led to poor nutritional support and impairment of nutritional status.

Objective: To identify the best predictors of measured REE (mREE) among simple bedside parameters, to include these predictors in population-specific equations, and to compare such models with the common predictive equations.

Methods: Demographic, clinical, anthropometric, and treatment variables were examined as potential predictors of mREE by indirect calorimetry (IC) in 122 SMAI children consecutively enrolled in an ongoing longitudinal observational study. Parameters predicting REE were identified, and prespecified linear regression models adjusted for nusinersen treatment (discrete: 0 = no; 1 = yes) were used to develop predictive equations, separately in spontaneously breathing and mechanically ventilated patients.

Results: In naïve patients, the median (25th, 75th percentile) mREE was 480 (412, 575) compared with 394 (281, 554) kcal/d in spontaneously breathing and mechanically ventilated patients, respectively (P = 0.009).In nusinersen-treated patients, the median (25th, 75th percentile) mREE was 609 (592, 702) compared with 639 (479, 723) kcal/d in spontaneously breathing and mechanically ventilated patients, respectively (P = 0.949).Both in spontaneously breathing and mechanically ventilated patients, the best prediction of REE was obtained from 3 models, all using as predictors: 1 body size related measurement and nusinersen treatment status. Nusinersen treatment was correlated with higher REE both in spontaneously breathing and mechanically ventilated patients. The population-specific equations showed a lower interindividual variability of the bias than the other equation tested, however, they showed a high root mean squared error.

Conclusions: We demonstrated that ventilatory status, nusinersen treatment, demographic, and anthropometric characteristics determine energy requirements in SMAI. Our SMAI-specific equations include variables available in clinical practice and were generally more accurate than previously published equations. At the individual level, however, IC is strongly recommended for assessing energy requirements. Further research is needed to externally validate these predictive equations.
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http://dx.doi.org/10.1093/ajcn/nqaa009DOI Listing
May 2020

Associations Among Taste Perception, Food Neophobia and Preferences in Type 1 Diabetes Children and Adolescents: A Cross-Sectional Study.

Nutrients 2019 Dec 13;11(12). Epub 2019 Dec 13.

Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy.

Type 1 diabetes (T1D) is one of the most common systemic diseases in childhood which predisposes the patient to serious short-term and long-term complications, affecting all body systems. Taste and olfactory impairments were first described a long time ago in adult patients affected by diabetes (both type 1 and type 2 diabetes). However, studies evaluating taste perception, behavioral attitudes (e.g., food neophobia), and preferences toward foods in children and adolescents affected by T1D are globally lacking. Therefore, the purpose of this study was to assess taste sensitivity, food neophobia, and preferences among children and adolescents affected by T1D and healthy controls in a cross-sectional study. T1D patients presented a significantly lower ability in general to correctly identify taste qualities, especially bitter and sour tastes. Moreover, they were characterized by fewer fungiform papillae compared to controls, as well as a lower responsiveness to the bitter compound 6-n-propylthiouracil (PROP). There were no significant differences in food neophobia scores between the two groups, but differences were observed in the mean hedonic ratings for some product categories investigated. Diabetic patients showed a greater liking for certain type of foods generally characterized by sourness and bitterness, an observation probably linked to their impaired ability to perceive taste stimuli, e.g., sourness and bitterness. These results may help to enhance the understanding of these relationships in populations with elevated diet-related health risks.
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http://dx.doi.org/10.3390/nu11123052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950790PMC
December 2019

Sex- and Age-Related Differences in the Contribution of Ultrasound-Measured Visceral and Subcutaneous Abdominal Fat to Fatty Liver Index in Overweight and Obese Caucasian Adults.

Nutrients 2019 12 9;11(12). Epub 2019 Dec 9.

International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy.

Differences in body fat distribution may be a reason for the sex-, age-, and ethnicity-related differences in the prevalence of fatty liver disease (FL). This study aimed to evaluate the sex- and age-related differences in the contribution of visceral (VAT) and subcutaneous (SAT) abdominal fat, measured by ultrasound, to fatty liver index (FLI) in a large sample of overweight and obese Caucasian adults, and to identify the VAT and SAT cut-off values predictive of high FL risk. A cross-sectional study on 8103 subjects was conducted. Anthropometrical measurements were taken and biochemical parameters measured. VAT and SAT were measured by ultrasonography. FLI was higher in men and increased with increasing age, VAT, and SAT. The sex*VAT, age*VAT, sex*SAT, and age*SAT interactions negatively contributed to FLI, indicating a lower VAT and SAT contribution to FLI in men and in the elderly for every 1 cm of increment. Because of this, sex- and age-specific cut-off values for VAT and SAT were estimated. In conclusion, abdominal adipose tissue depots are associated with FLI, but their contribution is sex- and age-dependent. Sex- and age-specific cut-off values of ultrasound-measured VAT and SAT are suggested, but they need to be validated in external populations.
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http://dx.doi.org/10.3390/nu11123008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950624PMC
December 2019

Fatty liver, cardiometabolic disease and mortality.

Curr Opin Lipidol 2020 02;31(1):27-31

Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Faenza, Italy.

Purpose Of Review: We discuss the findings of the most recent metanalyses on the association between nonalcoholic fatty liver disease (NAFLD), cardiometabolic disease and mortality.

Recent Findings: Recent metanalyses have shown that NAFLD is associated with incident type 2 diabetes mellitus (T2DM) and incident cardiovascular disease (CVD). Nonalcoholic steatohepatitis, which can be diagnosed by liver biopsy only in tertiary care centers, is often associated with liver fibrosis, which has been shown by metanalyses to increase both cardiovascular and liver-related mortality. Hyperlipidemia, lipotoxicity and impaired insulin secretion are among the possible mechanisms underlying the association of NAFLD with T2DM and CVD. Metanalyses of the association between NAFLD and mortality in the general population, where risk stratification cannot be performed on the basis of liver biopsy, have given contradictory results.

Summary: To establish conclusively whether NAFLD adds to known prognostic factors of death in the general population will require a shared operational definition of NAFLD, purposefully designed cohort studies, and the use of clinically relevant measures of effect size.
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http://dx.doi.org/10.1097/MOL.0000000000000652DOI Listing
February 2020

Spleen Stiffness Probability Index (SSPI): A simple and accurate method to detect esophageal varices in patients with compensated liver cirrhosis.

Ann Hepatol 2020 Jan - Feb;19(1):53-61. Epub 2019 Oct 23.

Dipartimento Universitario Clinico Di Scienze Mediche Chirurgiche e Della Salute, Università Degli Studi Di Trieste, Italy; Clinica Patologie Fegato, Azienda Sanitaria Universitaria Integrata Di Trieste, Italy; Fondazione Italiana Fegato, Italy.

Introduction And Objectives: Recent findings pointed out that even low-risk esophageal varices (EVs) are markers of severe prognosis. Accordingly, we analyzed spleen stiffness (SS) as a non-invasive method to predict EVs of any grade in a cohort of patients with compensated liver cirrhosis.

Method: We measured SS and liver stiffness (LS) using point-Shear-Wave Elastography (pSWE) with Philips Affiniti 70 system in 210 cirrhotic patients who had undergone endoscopic screening for EVs. We compared SS and LS predictive capability for EVs of any grade.

Results: SS was higher in cirrhotic patients with EVs if compared to patients without EVs (p<0.001). The cut-off analysis detected 31kPa (100% sensitivity and negative predictive value) as the value to rule-out EVs and 69kPa (100% specificity and positive predictive value) to rule-in EVs. Besides, we developed the Spleen Stiffness Probability Index (SSPI), that can provide a probability of presence/absence of EVs. SSPI was the best model according to all discriminative and calibration metrics (AIC=120, BIC=127, AUROC=0.95, Pseudo-R2=0.74). SS demonstrated higher correlation with spleen bipolar diameter and spleen surface (r=0.52/0.55) if compared to LS (r=0.30/0.25) - and with platelet count as well (r=0.67 vs r=0.4).

Conclusion: SS showed significantly higher performance than other parameters, proving to be the best non-invasive test in the screening of EVs: by directly applying SS cut-off of 31kPa, our department could have safely avoided endoscopy in 36% of patients. Despite cut-off analyses, it was possible to create a probability model that could further stratify low-risk from high-risk patients (for any grade of EVs).
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http://dx.doi.org/10.1016/j.aohep.2019.09.004DOI Listing
January 2021

Serum miRNA Are Promising Biomarkers for the Detection of Early Hepatocellular Carcinoma after Treatment with Direct-Acting Antivirals.

Cancers (Basel) 2019 Nov 11;11(11). Epub 2019 Nov 11.

Department of Internal Medicine-DIMED, University-Hospital of Padova, 35128 Padova, Italy.

Direct antiviral agents (DAAs) have excellent efficacy against chronic hepatitis C virus (HCV) infection. Despite this strength, recent studies raised concerns about an unexpected hepatocellular carcinoma (HCC) occurrence rate after DAA therapy. In this exploratory case-control study, we evaluated the potential use of miRNAs as serum biomarkers for the detection of early HCC in DAA-treated patients. In the discovery phase, the circulating miRNome was assessed in 10 matched patients with (HCC+) or without HCC (HCC-) occurrence. Microarray analysis was performed before (T0) and after one month of the DAA therapy (T1). MiRNAs discriminating HCC+ and HCC- patients were validated in 60 samples by means of RT-qPCR. We estimated the time-averaged difference of a given miRNA between HCC+ and HCC- patients using a bootstrapped random-effect generalized least square regression model (RE-GLS). At T0, miR-1207-5p, miR-1275, miR-3197, miR-4443, miR-3178, miR-483-5p, miR-4706, miR-4793-3p and miR-1246 discriminated HCC+ from HCC- patients ( < 0.05). At T1, only miR-1180-3p, miR-1228-3p, miR-4329 and miR-4484 ( < 0.05) discriminated HCC+ from HCC- patients. The subsequent validation phase identified miR-3197 as changing with both disease and time. Our results suggest that patients might be already committed to HCC occurrence before DAA therapy. MiR-3197 shows some potential for the identification of patients at risk of HCC during DAA treatments.
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http://dx.doi.org/10.3390/cancers11111773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895878PMC
November 2019

Association of serum lipids with β-cell function in obese children and adolescents.

Endocr Connect 2019 Oct;8(10):1318-1323

Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo (VB), Italy.

Few data are available on the association between serum lipids and insulin secretion (ISEC) in children. We evaluated the association of triglycerides (TG), HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) with ISEC in 1150 non-diabetic obese children and adolescents using multivariable robust median regression. The following models were employed: (1) IGI or incAUCR as the ISEC response variable; (2) QUICKI, OGIS, the Stumvoll index or the Matsuda insulin sensitivity index as the insulin sensitivity (ISEN) predictor; (3) TG, HDL-C and LDL-C as the predictors of interest; (4) 120-min glucose, age, sex and body mass index as confounders. LDL-C and TG were not associated with ISEC in any model. In three out of four IGI models, an increase of 1 interquartile range (IQR) of HDL-C was associated with a decrease of median incAUCR ranging from -9 (robust 95% CI -17 to -2) to -8 (-14 to -1) pmol/mmol. In two out of four incAUCR models, an increase of 1 IQR of HDL-C was associated with a decrease of median IGI ranging from -8 (-15 to -1) to -7 (-11 to -2) pmol/mmol. TG and LDL-C are not associated and HDL-C is inversely associated with ISEC in obese children and adolescents.
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http://dx.doi.org/10.1530/EC-19-0333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790900PMC
October 2019

Nutrient intake in aging infants and toddlers: 3-year follow-up of the Nutrintake study.

Int J Food Sci Nutr 2020 Jun 12;71(4):464-472. Epub 2019 Sep 12.

Clinical Epidemiology Unit, Liver Research Center, Trieste, Italy.

We performed a 3-year follow-up of the children enrolled into the Nutrintake Study to evaluate the changes of anthropometry and nutrient intake in aging infants and toddlers. Nutrient intake was assessed using a 7-day weighted food-diary. Of the 390 Nutrintake children, 164 (42%) participated in the present study. Their median (IQR) age was 54 (48; 66) months and their anthropometrical status, expressed as standard deviation scores, remained stable during the follow-up. During the same period, there was no biologically relevant change in the intake of macronutrients expressed as percentage of energy while median increases of 757 mg/day, 0.7 mg/day and 3.1 g/1000 kcal per day were detected for sodium, iron and fibre, respectively. As compared to the Italian reference standards, the Nutrintake children continued to show at the 3-year follow-up an excessive intake of simple carbohydrates, proteins, sodium, and a low intake of iron and fibre.
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http://dx.doi.org/10.1080/09637486.2019.1663798DOI Listing
June 2020

Taste perception and oral microbiota are associated with obesity in children and adolescents.

PLoS One 2019 11;14(9):e0221656. Epub 2019 Sep 11.

Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy.

Obesity in childhood and adolescence is considered the most prevalent nutritional disorder, in which eating behaviours represent one important factors of influence. Many aspects influence eating behaviours, but taste is considered the main predictor. However, data concerning correlations of obesity, taste sensitivity and behavioural attitudes, such as food neophobia, in children and adolescents are inconsistent. Moreover, it has been suggested that oral bacteria could have a possible role in obesity development and, also, in taste perception. In this context, the present study focused on host related factors with a proposed link to weight gain. To this purpose, taste sensitivity, salivary microbiota composition and food neophobia were compared between children and adolescents with and without obesity in a cross-sectional study. Results showed that children with obesity presented a significantly lower ability in correctly identifying taste qualities and were characterized by a lesser number of Fungiform Papillae (reported as FP/cm2) compared to normal-weight subjects. Differences in the ecological indexes of microbial alpha-diversity was found between subjects with obesity and normal-weight ones. Moreover, independently from nutritional status, some bacterial genera seemed to differ between subjects with different sensitivity. The potentiality of this multidisciplinary approach could help to better understand and deepen the sensory-driven and microbiological factors related to weight gain.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221656PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738620PMC
March 2020

Dietary Treatment with Extensively Hydrolyzed Casein Formula Containing the Probiotic Lactobacillus rhamnosus GG Prevents the Occurrence of Functional Gastrointestinal Disorders in Children with Cow's Milk Allergy.

J Pediatr 2019 10 18;213:137-142.e2. Epub 2019 Jul 18.

Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy; European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy; Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy.

Objective: To investigate whether the addition of the probiotic Lactobacillus rhamnosus GG (LGG) to the extensively hydrolyzed casein formula (EHCF) for cow's milk allergy (CMA) treatment could reduce the occurrence of functional gastrointestinal disorders (FGIDs).

Study Design: This cohort study included children with a positive history for CMA in the first year of life who were treated with EHCF alone or in combination with LGG and had evidence of immune tolerance acquisition to cow's milk for at least 12 months. FGID was diagnosed according to the Rome III diagnostic criteria by investigators unaware of previous treatment. A cohort of consecutive healthy children was also evaluated as a control population.

Results: A total of 330 subjects were included, 110 per cohort (EHCF, EHCF+LGG, and healthy controls). The rate of subjects with ≥1 FGID was significantly lower in the EHCF+LGG cohort compared with the EHCF cohort (40% vs 16.4%; P < .05). In the EHCF+LGG cohort, a lower incidence was observed for all components of the main study outcome. The prevalence of FGIDs in the healthy cohort was lower than that in the EHCF cohort and similar to that in the EHCF+LGG cohort. The incidence rate ratio of FGIDs for the EHCF+LGG cohort vs the EHCF cohort (0.40; 95% CI, 0.25-0.65; P < .001) was unmodified after correction for age at CMA diagnosis, breastfeeding, weaning time, and presence of a first-degree relative with an FGID.

Conclusions: These results confirm the increased risk for developing FGIDs in children with CMA and suggest that EHCF+LGG could reduce this risk.
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http://dx.doi.org/10.1016/j.jpeds.2019.06.004DOI Listing
October 2019

Publisher Correction: Randomized controlled trial on the influence of dietary intervention on epigenetic mechanisms in children with cow's milk allergy: the EPICMA study.

Sci Rep 2019 Jun 26;9(1):9504. Epub 2019 Jun 26.

Department of Translational Medical Science, University Federico II, Naples, Italy.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.
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http://dx.doi.org/10.1038/s41598-019-45226-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593099PMC
June 2019

Analysis of Retinal Perfusion in Children, Adolescents, and Young Adults with Type 1 Diabetes Using Optical Coherence Tomography Angiography.

J Diabetes Res 2019 8;2019:5410672. Epub 2019 May 8.

Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy.

We performed a cross-sectional study to analyze the retinal vasculature in children, adolescent, and young adults with type 1 diabetes using optical coherence tomography angiography (OCTA). Patients underwent funduscopic examination for diabetic retinopathy (DR) screening during an annual visit for the screening of diabetes-related complications which included the evaluation of glycated hemoglobin (HbA1c), microalbuminuria, lipid profile, arterial pressure, and neurological assessment. In addition, OCTA of the retinal vasculature was performed. Quantitative analysis of the OCTA images evaluated the vessel density at the superficial (SCP) and deep (DCP) capillary plexus of the retina. Structural vascular alterations were evaluated qualitatively. Results were compared to those obtained in a group of healthy age-, sex-, and pubertal stage-matched controls. The effect of age, disease duration, age at the disease onset, mean HbA1c since the onset, and lipid profile on vascular density was tested. Fifty-three patients (median age 15.5, IQR 12.4-19.4 years; 57% females) with type 1 diabetes and 48 controls were enrolled. The median (IQR) HbA1c was 7.6% (60 mmol/mol) (6.9-8.1%, 52-65 mmol/mol), and the median (IQR) duration of disease was 6.0 (3.3-10.3) years. Mean vessel density measured with OCTA was lower in patients compared to controls with the temporal sector showing the highest difference both in the SCP (0.55 vs. 0.57, < 0.001) and the DCP (0.63 vs. 0.65, < 0.001). None of the predictors was associated with the superficial and deep vascular densities. Only 2 patients had clinically detectable DR. Microvascular structural changes were found on OCTA in both of these patients and in one without funduscopic alterations. In conclusion, patients with type 1 diabetes without clinically detectable DR had decreased capillary density compared to controls on OCTA images. These findings may provide useful information for the screening and the management of patients with type 1 diabetes. Further studies are needed to confirm our results and their clinical relevance.
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http://dx.doi.org/10.1155/2019/5410672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530197PMC
January 2020

Diagnostic Performance Analysis of the Point-of-Care Bilistick System in Identifying Severe Neonatal Hyperbilirubinemia by a Multi-Country Approach.

EClinicalMedicine 2018 Jul 17;1:14-20. Epub 2018 Jul 17.

Bilimetrix s.r.l., Area Science Park, 34149 Trieste, Italy.

Importance: The real prevalence and clinical burden of severe neonatal jaundice are undefined due to difficulties in measuring total serum bilirubin (TSB) outside secondary and tertiary clinical centers.

Objective: To assess the diagnostic performance of the point-of care Bilistick System (BS) in identifying neonatal jaundice patients requiring treatment.

Design: Between April 2015 and November 2016, 1911 neonates, were recruited to participate in the study. Blood samples were simultaneously collected for the TSB determination by BS and by hospital laboratory (Lab). Data were collected and sent to the Bilimetrix headquarter in Trieste where statistical analysis was performed. Newborns with neonatal jaundice were treated with phototherapy according to each center's guidelines.

Setting: 17 hospitals from Nigeria, Egypt, Indonesia, and Viet Nam.

Participants: 1911 newborns were included, of which 1458 (76·3%) fulfilled the inclusion criteria.

Results: TSB level measured by BS agreed (p < .0001) with the lab result in all four countries. The diagnostic performance of BS showed a positive predictive value (PPV) of 92·5% and a negative predictive value (NPV) of 92·8%.

Conclusions And Relevance: BS is a reliable system to detect neonatal jaundice over a wide range of bilirubin levels. Since Bilistick is a point-of-care test, its use may provide appropriate and timely identification of jaundiced newborns requiring treatment.
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http://dx.doi.org/10.1016/j.eclinm.2018.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537563PMC
July 2018

Is vitamin D deficiency a risk factor for osteonecrosis of the jaw in patients with cancer? A matched case-control study.

J Craniomaxillofac Surg 2019 Aug 13;47(8):1203-1208. Epub 2019 Mar 13.

Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.

Purpose: A previous case-control histomorphometric study showed higher odds of osteomalacia in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Vitamin D deficiency causes osteomalacia and may therefore be involved in the pathogenesis of BRONJ. The present case-control study aimed at testing such hypothesis.

Materials And Methods: BRONJ+ and BRONJ- patients treated with bisphosphonates were matched by sex (same) and age (within 5 years). Serum 25-hydroxy-vitamin D (25-OH-D), parathyroid hormone, bone alkaline phosphatase, total procollagen type 1 amino-terminal propeptide, carboxy-terminal collagen crosslinks, Dickkopf WNT signaling pathway inhibitor 1 and sclerostin were measured.

Results: The main outcome was vitamin D deficiency defined as 25-OH-D < 50 nmol/l. A total of 51 BRONJ+ and 73 BRONJ- patients were studied. The frequency (95% CI) of vitamin D deficiency was 59% (45%-72%) in BRONJ+ and 62% (48%-75%) in BRONJ- patients. This amounts to a difference of -3% (-22%-16%, p = 0.77) for BRONJ+ patients. Serum 25-hydroxy-vitamin D and parathyroid hormone were similar in BRONJ+ and BRONJ- patients. Among the bone metabolism markers, only sclerostin differed between the two groups, being higher in BRONJ+ patients.

Conclusion: The present matched case-control study suggests that vitamin D deficiency is not a risk factor for BRONJ.
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http://dx.doi.org/10.1016/j.jcms.2019.03.007DOI Listing
August 2019

Randomized controlled trial on the influence of dietary intervention on epigenetic mechanisms in children with cow's milk allergy: the EPICMA study.

Sci Rep 2019 02 26;9(1):2828. Epub 2019 Feb 26.

Department of Translational Medical Science, University Federico II, Naples, Italy.

Epigenetic mechanisms could drive the disease course of cow's milk allergy (CMA) and formula choice could modulate these pathways. We compared the effect of two different dietary approaches on epigenetic mechanisms in CMA children. Randomized controlled trial on IgE-mediated CMA children receiving a 12-month treatment with extensively hydrolyzed casein formula containing the probiotic L.rhamnosus GG (EHCF + LGG) or with soy formula (SF). At the baseline, after 6 and 12 months of treatment FoxP3 methylation rate and its expression in CD4 T cells were assessed. At same study points IL-4, IL-5, IL-10, and IFN-γ methylation rate, expression and serum concentration, miRNAs expression were also investigated. 20 children (10/group) were evaluated. Baseline demographic, clinical and epigenetic features were similar in the two study groups. At 6 and 12 months, EHCF + LGG group showed a significant increase in FoxP3 demethylation rate compared to SF group. At the same study points, EHCF + LGG group presented a higher increase in IL-4 and IL-5 and a higher reduction in IL-10 and IFN-γ DNA methylation rate compared to SF group. A different modulation of miR-155, -146a, -128 and -193a expression was observed in EHCF + LGG vs. SF. Dietary intervention could exert a different epigenetic modulation on the immune system in CMA children.
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http://dx.doi.org/10.1038/s41598-019-38738-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391485PMC
February 2019

Assessment of fat-free mass from bioelectrical impedance analysis in men and women with Prader-Willi syndrome: cross-sectional study.

Int J Food Sci Nutr 2019 Aug 4;70(5):645-649. Epub 2019 Feb 4.

c Istituto Auxologico Italiano, IRCCS, Division of Auxology and Metabolic Diseases, Piancavallo (VB) , Italy.

We have recently shown that population-specific formulae are required to estimate fat-free mass (FFM) from bioelectrical impedance analysis (BIA) in obese women with Prader-Willi syndrome (PWS) matched by age and percent fat mass (FM) to non-PWS women. The present cross-sectional study was aimed at developing generalised BIA equations that could be used in PWS subjects independently of sex and FM. We used dual-energy X-ray absorptiometry to measure FFM and BIA to measure whole-body impedance at 50 kHz (Z) in 34 women and 21 men with PWS. The impedance index, that is, height (cm)/Z (Ω), explained 77% (BCa-bootstrapped 95% CI 65 to 85%) of the variance of FFM with a root mean squared error of the estimate of 3.7 kg (BCa-bootstrapped 95% CI 3.2 to 4.5 kg). BIA can be used to estimate FFM in obese and non-obese PWS men and women by means of population-specific equations.
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http://dx.doi.org/10.1080/09637486.2018.1554623DOI Listing
August 2019

Growth Pattern, Resting Energy Expenditure, and Nutrient Intake of Children with Food Allergies.

Nutrients 2019 Jan 22;11(2). Epub 2019 Jan 22.

Pediatric Department, Vittore Buzzi Children's Hospital, Università degli Studi di Milano, via Castelvetro 32, 20154 Milan, Italy.

Growth impairment has been reported in children with food allergies (FA). However, the available data on the dietary intake of FA children are controversial, and no data are available on their resting energy expenditure (REE). The aim of this study was to test whether REE differs between FA and healthy children. In this study, 30 FA children were matched by sex and age, with 31 healthy controls using coarsened exact matching (CEM). Their REE was measured by indirect calorimetry (IC). Energy and macronutrient intake were evaluated using a three-day dietary record. Between-group comparisons were performed by robust median regression using CEM-related weights. The association of REE with allergies was also evaluated using robust median regression models. Anthropometric measurements, REE, and nutrient intake were similar in FA children and matched controls. Taking into account the association of REE with gender and age, a statistically significant but biologically negligible association was detected between median REE and allergy status (+9% in FA children). In conclusion, we did not find any biologically relevant difference in REE, anthropometry, and dietary intake in children with FA compared to healthy children.
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http://dx.doi.org/10.3390/nu11020212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412797PMC
January 2019

Association of Bright Liver With the PNPLA3 I148M Gene Variant in 1-Year-Old Toddlers.

J Clin Endocrinol Metab 2019 06;104(6):2163-2170

Research Area for Multifactorial Disease, Children's Hospital Bambino Gesù, Rome, Italy.

Context: Nonalcoholic fatty liver disease (NAFLD) is being increasingly diagnosed at younger ages, pointing toward an early-life origin.

Objective: To evaluate the frequency and risk factors for bright liver (BL) in 1-year-old toddlers.

Design: Secondary analysis of the 1-year follow-up of the Feeding Study. Exposures were child PNPLA3 and TM6SF2 gene variants; child anthropometry at birth and at 1 year of follow-up; child subcutaneous, visceral, and epicardial adipose tissue at 1 year of follow-up; maternal anthropometry at the start and at the end of pregnancy; and maternal red blood cell fatty-acid composition at the third trimester of pregnancy.

Setting: General population.

Participants: Among 505 mother-toddler pairs, 391 children (77%) underwent liver and abdominal ultrasonography at the 1-year follow-up.

Main Outcome: BL as diagnosed by ultrasonography.

Results: Seventeen (4%) of 391 toddlers had BL. Compared with the toddlers with the PNPLA 3 CC genotype, the odds (95% CI) of BL were 3.01 (1.05 to 8.64, P < 0.05) times higher in those with the PNAPLA3 CG genotype and 5.37 (1.12 to 25.77, P < 0.05) higher in those with the PNPLA3 CC genotype. We found no association between BL status and TM6SF2. Body weight, body mass index, and maternal weight gain during pregnancy were higher in BL+ than in BL- children. Visceral adipose tissue was higher but subcutaneous adipose tissue and epicardial adipose tissue were similar in BL+ and BL- children.

Conclusions: Four percent of the Feeding Study children had BL at 1 year of age. In line with expectations, PNAPLA3 was already a predictor of BL at this early age.
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http://dx.doi.org/10.1210/jc.2018-01998DOI Listing
June 2019

Prevalence of and risk factors for fatty liver in the general population of Northern Italy: the Bagnacavallo Study.

BMC Gastroenterol 2018 Nov 28;18(1):177. Epub 2018 Nov 28.

Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Faenza, Italy.

Background: The estimation of the burden of disease attributable to fatty liver requires studies performed in the general population.

Methods: The Bagnacavallo Study was performed between October 2005 and March 2009. All the citizens of Bagnacavallo (Ravenna, Italy) aged 30 to 60 years as of January 2005 were eligible. Altered liver enzymes were defined as alanine transaminase > 40 U/l and/or aspartate transaminase > 37 U/l.

Results: Four thousand and thirty-three (58%) out of 6920 eligible citizens agreed to participate and 3933 (98%) had complete data. 393 (10%) of the latter had altered liver enzymes and 3540 had not. After exclusion of subjects with HBV or HCV infection, liver ultrasonography was available for 93% of subjects with altered liber enzymes and 52% of those with normal liver enzymes. The prevalence of fatty liver, non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) was 0.74 (95%CI 0.70 to 0.79) vs. 0.35 (0.33 to 0.37), 0.46 (0.41 to 0.51) vs. 0.22 (0.21 to 0.24) and 0.28 (0.24 to 0.33) vs. 0.13 (0.11 to 0.14) in citizens with than in those without altered liver enzymes. Ethanol intake was not associated and all the components of the metabolic syndrome (MS) were associated with fatty liver. All potential risk factors were associated with a lower odds of normal liver vs. NAFLD while they were unable to discriminate AFLD from NAFLD.

Conclusions: Fatty liver as a whole was highly prevalent in Bagnacavallo in 2005/9 and was more common among citizens with altered liver enzymes.
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http://dx.doi.org/10.1186/s12876-018-0906-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262973PMC
November 2018