Publications by authors named "Iolanda Cioffi"

27 Publications

  • Page 1 of 1

The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature.

Clin Nutr 2021 06 22;40(6):3688-3701. Epub 2021 Apr 22.

Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy.

Background & Aims: The refeeding syndrome (RFS) has been recognized as a potentially life-threatening metabolic complication of re-nutrition, but the definition widely varies and, its incidence is unknown. The aim of this systematic review and meta-analyses was to estimate the incidence of RFS in adults by considering the definition used by the authors as well as the recent criteria proposed by the American Society of Parenteral and Enteral Nutrition (ASPEN) consensus. Furthermore, the incidence of refeeding hypophosphatemia (RH) was also assessed.

Methods: Four databases were systematically searched until September 2020 for retrieving trials and observational studies. The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI).

Results: Thirty-five observational studies were included in the analysis. The risk of bias was serious in 16 studies and moderate in the remaining 19. The incidence of RFS varied from 0% to 62% across the studies. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. Similarly, the incidence of RH ranged between 7% and 62%. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20 kcal/kg/day seemed to have a higher incidence of both RFS (pooled incidence = 44%; 95% CI 36%-52%) and RH (pooled incidence = 27%; 95% CI 21%-34%). However, due to the high heterogeneity of data, summary incidence measures are meaningless.

Conclusion: The incidence rate of both RFS and RH greatly varied according to the definition used and the population analyzed, being higher in ICU inpatients and in those with increased initial caloric supply. Therefore, a universally accepted definition for RFS, taking different clinical contexts and groups of patients into account, is still needed to better characterize the syndrome and its approach.
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http://dx.doi.org/10.1016/j.clnu.2021.04.023DOI Listing
June 2021

Impact of Refeeding Syndrome on Short- and Medium-Term All-Cause Mortality: A Systematic Review and Meta-Analysis.

Am J Med 2021 08 15;134(8):1009-1018.e1. Epub 2021 Apr 15.

Department of Medical Sciences, University of Turin, Turin, Italy.

Background: The refeeding syndrome has been described as a potentially life-threatening complication of renutrition. However, moving from single reports to larger population studies, the real impact of refeeding syndrome on all-cause mortality is still unknown.

Methods: PubMed/Medline, EMBASE, Cochrane library, and CINAHL databases were systematically searched until September 2020 for studies reporting mortality rates in patients who developed the syndrome at renutrition compared with those who did not develop it. Effect sizes were pooled through a random-effect model.

Results: Thirteen studies were finally considered in the meta-analysis, for a total of 3846 patients (mean age 64.5 years; 58% males). Pooled data showed a nonsignificant trend toward an increased short-term (≤1 month) mortality in patients developing the refeeding syndrome (odds ratio = 1.27, 95% confidence interval 0.93-1.72), mostly driven by studies in which renutrition was not prescribed and supervised by a nutritional support team (P = .01 at subgroup analysis) and by studies published in previous years (P = .04 at meta-regression). When examining medium-term (≤6 month) mortality, an overall statistical significance toward higher risk was observed (odds ratio = 1.54, 95% confidence interval 1.04-2.28).

Conclusion: This was the first meta-analysis that specifically assessed the impact of refeeding syndrome on mortality. Our results suggested a nonsignificant trend toward increased mortality in the short term but a significantly increased mortality in the medium term. The supervision/management of the refeeding process by a nutrition specialist might be a key factor for the limitation of this mortality excess.
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http://dx.doi.org/10.1016/j.amjmed.2021.03.010DOI Listing
August 2021

A proposal for reference values of hand grip strength in women with different body mass indexes.

Nutrition 2021 Jul-Aug;87-88:111199. Epub 2021 Feb 13.

Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.

Objective: Hand grip strength (HGS) is frequently used in clinical practice, resulting in a potential marker of nutritional status. This study aimed to develop reference values of HGS in Italian women with different categories of body mass index (BMI). Additionally, the main predictors of HGS were identified.

Methods: A cross-sectional study was conducted in Italian women between ages 16 and 55 y with different categories of BMI at the Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples Italy. The whole sample was divided into tertiles according to BMI: 15 to 17.29 kg/m (T1), 17.3 to 19.9 kg/m (T2), and 20 to 25 kg/m (T3). Anthropometry, bioimpedance analysis, and muscle strength by an HGS test were evaluated. The cut-off values for HGS were developed for all participants and stratified by age group. Finally, a multivariate linear regression analysis was performed to assess the main predictors of HGS.

Results: A total of 529 women with a mean age of 23.2 ± 7.0 y and an average BMI of 18.9 ± 2.5 kg/m were analyzed. HGS was higher for the dominant hand than for the non-dominant hand in all BMI tertiles. On both sides, according to age groups, HGS increased with increasing age in T1 and T3, whereas it increased in the women between ages 20 and 30 y in T2 only. Multivariate linear regression analysis showed that predictors of HGS varied according to tertiles. Specifically, we found that body weight (R = 0.252) was the main predictor in T1, whereas phase angle (PhA) was the main determinant in both T2 (R = 0.240) and T3 (R = 0.216).

Conclusion: This study defined the normal reference values of HGS in Italian women with different BMI ranges, stratifying the sample group by age. Additionally, the main predictors of HGS were assessed for each BMI tertile. In primary malnutrition (T1), the main predictor of HGS was body weight, whereas in the other two tertiles (T2, T3), the PhA was the main predictor of HGS.
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http://dx.doi.org/10.1016/j.nut.2021.111199DOI Listing
June 2021

New predictive equations for estimating resting energy expenditure in subjects with normal weight and overweight.

Nutrition 2021 04 10;84:111105. Epub 2020 Dec 10.

Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.

Objective: The aim of this study was to develop and validate new predictive equations for estimating resting energy expenditure (REE) in subjects with normal weight and overweight, considering anthropometric parameters as well as raw variables from bioimpedance analysis (BIA).

Methods: Adult participants with normal weight and overweight were recruited and randomly split into calibration and validation groups. Indirect calorimetry (IC) and BIA were performed in all subjects. New predictive equations were developed using the following models: model 1 with age, weight, stature, and body mass index (BMI) as predictors; and model 2: model 1 + raw BIA variables (bioimpedance index and phase angle). The accuracy of the new equations at both the group (bias) and individual (within ±10%) levels was tested in the validation group. Three published predictive equations were also compared, with the REE values measured by IC.

Results: A total of 2483 adults were included for developing and validating the new equations. All selected formulas, including the new ones, showed a bias of <5% in estimating REE at the group level. Accuracy at the individual level was slightly higher for the new equations, especially for the equation based on raw BIA variables (men = 70.3%; women = 72.3%).

Conclusions: Compared to the equations in the literature, the new equations showed good accuracy at both the group and individual levels, with a slight improvement in individual accuracy for the formula including raw BIA variables. However, future research is required to verify the role of the raw BIA variables in predicting REE in subjects with normal weight and overweight.
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http://dx.doi.org/10.1016/j.nut.2020.111105DOI Listing
April 2021

Prediction of resting energy expenditure in healthy older adults: A systematic review.

Clin Nutr 2021 05 26;40(5):3094-3103. Epub 2020 Nov 26.

Department of Public Health, Federico II University Hospital, Naples, Pansini 5, 80131 Italy.

Background & Aims: Estimates of energy requirements, based on measured or predicted resting energy expenditure (REE), are needed to avoid undernutrition or overnutrition (and their clinical consequences) in elderly subjects. The aims of this systematic review were to evaluate the prediction accuracy of REE in healthy elderly subjects and to ascertain which equation is more reliable at group level and/or individual level.

Methods: Studies assessing prediction of REE in general elderly population were systematically searched using PubMed, EMBASE, Web of Science and CINAHL until March 2020. Prediction accuracy of REE was assessed at both group (bias) and individual (precision) level for each equation.

Results: Fourteen studies met the inclusion criteria of this systematic review. Bias was reported in 8 papers and calculated in another 5 from absolute values. There was a prevalent tendency towards an overestimation of REE across the studies. The least bias was observed for the Mifflin (-0.3%) and Harris-Benedict (+2.6%) equations, with values above 5% for the FAO/WHO/UNU, Fredrix and Muller equations. Precision widely varied between studies for the same equation. The higher precision was observed using the Harris-Benedict equation (~70%), while the Henry and Mifflin equations provided estimates within 10% of measured values in 65% and 61% of elderly individuals, respectively.

Conclusions: None of the prediction equations considered provides accurate and precise REE estimates in healthy older adults. However, the best prediction is given by the Mifflin equation at group level and by the Harris-Benedict equation at individual level. Further studies with strong quality design are needed to evaluate the variability and accuracy of REE in the elderly general population.
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http://dx.doi.org/10.1016/j.clnu.2020.11.027DOI Listing
May 2021

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review.

Intern Emerg Med 2021 01 19;16(1):49-60. Epub 2020 Oct 19.

Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Turin, Italy.

The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2-5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.
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http://dx.doi.org/10.1007/s11739-020-02525-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843537PMC
January 2021

Body composition, segmental bioimpedance phase angle and muscular strength in professional volleyball players compared to a control group.

J Sports Med Phys Fitness 2020 Jun;60(6):870-874

Department of Public Health, Federico II University of Naples, Naples, Italy.

Background: The assessment of body composition is central in evaluating athletes' nutritional status and the effects of training. The aim of this study was to evaluate body composition and the relation between bioimpedance phase angle (PhA) and muscular strength in elite female volleyball players.

Methods: Twelve volleyball players (age 23.8±3.6 years; weight 63.0±5.1 kg; height 170±4 cm; BMI 21.9±1.3 kg/m2) and 22 non-athletic females, who served as a control group (age 23.6±2.0 years; weight 60.7±4.8 kg; height 167±5 cm; BMI 21.9±1.3 kg/m2), participating in the study. Skinfold thickness measures were used and segmental bioelectrical impedance analysis (BIA) was performed. Additionally, hand grip strength was used to evaluate muscular strength.

Results: Volleyball players had lower FM and higher FFM than controls (FM(kg)=15.7±2.7 vs. 18.0±3.0, P=0.036; FM(%)=24.8±3.0 vs. 29.5±3.8, P=0.001; FFM(kg)=47.4±3.5 vs. 42.8±3.6, P=0.001). Both whole-body and segmental PhA were higher in volleyball players (P<0.05) than in controls, whereas no differences were observed for hand grip strength. A positive relation was found between hand grip strength and whole-body and upper limbs PhA in all subjects, resulting stronger in volleyball players (r=0.696, P=0.012 and r=0.821, P=0.001, respectively).

Conclusions: The data confirmed that body composition differed between volleyball players and non-athletic subjects. In addition, a strong correlation between PhA and hand grip strength in both volleyball players and in controls was found. However, further evaluations are needed to investigate the use of hand grip strength in sport performance.
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http://dx.doi.org/10.23736/S0022-4707.20.10548-6DOI Listing
June 2020

Acute assessment of subjective appetite and implicated hormones after a hypnosis-induced hallucinated meal: a randomized cross-over pilot trial.

Rev Endocr Metab Disord 2020 Sep;21(3):411-420

Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.

The use of hypnosis can generate hallucinatory phenomena, which ranged from vivid/auditory imagery to fully developed "hallucinations" in selected people. The aim of this pilot trial was investigating the acute effects of a hypnosis-induced hallucinated breakfast (HB) compared to those of a real breakfast (RB) on subjective appetite and appetite-regulating hormones in highly hypnotizable individuals. Eight healthy post-menopausal women were recruited to consume two meals: the HB and the RB in a randomized crossover design. Participants underwent appetite sensations measurements (before meal and each 30-min until 270-min) and blood sample collection (at 0, 20, 60, 90, 180-min). A 3-day food-record was filled after each meal. The adjusted repeated measures ANCOVA did not show any meal×time interactions on subjective appetite postprandially. As expected, significantly higher glucose (p < 0.001), insulin (p < 0.001), and lower free fatty acid (p < 0.001) concentrations were found after the RB, but not following HB. Furthermore, RB significantly increased postprandial levels of glucagon-like-peptide-1 and peptide-YY at 20, 60, 90 and 180-min, whereas acylated-ghrelin and leptin levels did not differ. Postprandial neuropeptide-Y and orexin-A values significantly increased at different time-points after RB, but not following HB, while α-melanocyte-stimulating hormone levels enhanced after HB only. Energy intakes were significantly lower after HB on the test-day only (HB = 1146.6 ± 343.8 vs RB = 1634.7 ± 274.2 kcal/d; p = 0.003). Appetite sensation might be modulated by fully developed meal "hallucination" induced by hypnosis, likely affecting brain-peptides implicated in the appetite regulation. However, further studies are needed to verify these results obtained in a highly selected group of individuals. NCT03934580.
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http://dx.doi.org/10.1007/s11154-020-09559-4DOI Listing
September 2020

Nutrition Transition and Cancer.

Nutrients 2020 Mar 18;12(3). Epub 2020 Mar 18.

Clinical Nutrition and Internal Medicine, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples Via Pansini, 580131 Naples, Italy.

Urbanization, population aging, and climatic changes have mostly contributed to nutrition transition and, consequently, to effects of food habits on the epidemic of chronic non-communicable diseases (NCDs), especially cancer. Climatic changes are negatively affecting crop production, particularly biodiversity, leading to reduced food choices and, consequently, nutritional value and the protection conferred from consumption of a variety of nutrients essential in a healthy diet. This brief review analyzes the possible link between rapid demographic changes, climatic and environmental crises, and the current food system as possible factors contributing to the role of nutrition transition in the onset of cancer.
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http://dx.doi.org/10.3390/nu12030795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146228PMC
March 2020

Macronutrients in Parenteral Nutrition: Amino Acids.

Nutrients 2020 Mar 14;12(3). Epub 2020 Mar 14.

Clinical Nutrition Unit, Department of Clinical Medicine and Surgery Federico II University Hospital, 80131 Naples, Italy.

The right amount and quality of amino acids (AAs) supplied to patients on parenteral nutrition (PN) reduces muscle mass loss, may preserve or even increase it, with significant clinical benefits. Several industrial PN mixtures are available so that nutrition specialists can choose the product closest to the patient's needs. In selected cases, there is the possibility of personalizing compounded mixtures in a hospital pharmacy that completely meets the individual nutritional needs of PN patients. This narrative review deals with the AA solutions used in PN mixtures. The physiology, the methods to calculate the AA needs, and the AA and energy requirements suggested by scientific guidelines for each patient type are also reported.
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http://dx.doi.org/10.3390/nu12030772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146427PMC
March 2020

Association between Health-Related Quality of Life and Nutritional Status in Adult Patients with Crohn's Disease.

Nutrients 2020 Mar 11;12(3). Epub 2020 Mar 11.

Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy.

This study aimed to assess health related quality of life (HRQoL) in adult patients with Crohn's disease (CD), considering disease severity and gender differences, and also its relationship with nutritional status. Consecutive adult patients aged 18-65 years with CD were recruited. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in active and quiescent phases. HRQoL was evaluated using the validated short form (SF)-36 questionnaire for the Italian population. Additionally, anthropometry, bioimpedance analysis, and handgrip-strength (HGS) were performed. Findings showed that 135 patients (79 men and 56 women) were included, having a mean age of 38.8 ± 14 years and a BMI of 23.2 ± 3.7 kg/m. Overall, active CD patients had a lower perception of their QoL compared to those clinically quiescent, while gender differences emerged mostly in the quiescent group. Interestingly, HRQoL was significantly associated with many nutritional variables, and muscle strength was the main predictor Therefore, HRQoL is perceived lower in active compared to quiescent patients, but women experienced poorer QoL than men, especially in the quiescent phase. Finally, higher QoL scores were found in subjects being in clinical remission phase with a preserved muscle function. However, further studies are still required to verify these findings
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http://dx.doi.org/10.3390/nu12030746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146465PMC
March 2020

Correction to: Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.

Rev Endocr Metab Disord 2020 Mar;21(1):35

Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.

The article "Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis" written by Pellegrini Marianna, Cioffi Iolanda, Evangelista Andrea, Ponzo Valentina, Goitre Ilaria, Ciccone Giovannino, Ghigo Ezio, Bo Simona" was originally published with the surname and then first name of all authors.
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http://dx.doi.org/10.1007/s11154-020-09542-zDOI Listing
March 2020

Evaluation of nutritional adequacy in adult patients with Crohn's disease: a cross-sectional study.

Eur J Nutr 2020 Dec 18;59(8):3647-3658. Epub 2020 Feb 18.

Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy.

Purpose: Inadequate oral intake may play an important role in the onset of malnutrition in patients with Crohn's disease (CD). The aims of this cross-sectional study were: (1) to compare dietary intake in clinically active and quiescent CD patients, and (2) to assess patients' nutritional adequacy relative to the dietary reference values (DRVs) for the Italian population using LARN (Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana).

Methods: Patients aged between 18 and 65 years with a diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record. Disease activity was clinically defined using the Crohn's disease activity index (CDAI).

Results: Overall, 117 patients, 71 males and 46 females, with a mean age of 39.6 ± 13.8 years and a mean body weight of 65.4 ± 11.8 kg, were ultimately included. Our findings showed that the amount of nutrients was similar between patients with active and quiescent disease. The mean intake of macronutrients was adequate, except for fiber, while dietary micronutrients were insufficient. Median intakes of sodium, phosphorus, and fluorine met LARN recommendations in both sexes, and the DRVs were accomplished by many patients (53/117; 104/117 and 98/117, respectively). Interestingly, dietary amounts of iron and zinc were barely acceptable in males but not in females. However, a few of the patients (< 15) met the LARN for potassium, calcium, and magnesium, regardless of sex and CDAI. With respect to vitamins, no relevant difference was found between the active and quiescent groups, and none of them met recommended values in both sexes.

Conclusions: This study showed that the assessment of dietary intake can be crucial for optimizing dietary intervention with focused nutrition counseling, to improve nutritional status in CD patients.
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http://dx.doi.org/10.1007/s00394-020-02198-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669764PMC
December 2020

New Predictive Equations for Estimating Resting Energy Expenditure in Adults With Crohn's Disease.

JPEN J Parenter Enteral Nutr 2020 08 3;44(6):1021-1028. Epub 2020 Feb 3.

Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.

Background: Increased resting energy expenditure (REE) has been hypothesized to be a potential cause of weight loss in individuals with Crohn's disease (CD). This study aimed to develop and validate new predictive equations for estimating REE in adults with CD.

Methods: Adults, ages 18-65 years, with CD were recruited. Anthropometry, indirect calorimetry, and bioimpedance analysis were performed in all patients. Disease activity was assessed by Crohn's Disease Activity Index. The new predictive equations were generated using different regression models. Prediction accuracy of the new equations was assessed and compared with the most commonly used equations.

Results: A total of 270 CD patients (159 males, 111 females) were included and randomly assigned to the calibration (n = 180) and validation groups (n = 90). REE was directly correlated with weight and bioimpedance index, whereas the relation with both age and disease activity was inverse. The new equations were suitable for estimating REE at population level (bias: -0.2 and -0.3, respectively). Individual accuracy was good in both models (≥80%, respectively), especially in females; and similar results were shown by some of the selected equations. But, when accuracy was set within ±5%, the new equations gave the highest prediction.

Conclusion: The new, disease-specific, equations for predicting REE in individuals with CD give a good prediction accuracy as far as those proposed in the literature for the general population. However, the new ones performed better at the individual level. Further studies are needed to verify the reliability and usefulness of these new equations.
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http://dx.doi.org/10.1002/jpen.1790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496798PMC
August 2020

Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn's Disease.

Nutrients 2019 Dec 4;11(12). Epub 2019 Dec 4.

Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy.

Background: Crohn's disease (CD) is a chronic inflammatory bowel disease frequently associated with malabsorption and secondary protein-energy malnutrition (PEM).

Methods: Biochemical and clinical data of 63 (34 females, 29 males) patients with PEM due to CD sent to our outpatient unit for nutritional evaluation were retrospectively analyzed. Patients were divided into two groups, according to disease activity. Thirty-eight patients (group A) had the active disease, and 25 patients (group B) suffered from malabsorption resulting from past intestinal resections due to CD. After a physical and hemato-biochemical evaluation at the first visit, all patients received disease-specific personalized dietetic indications. When indicated, oral nutritional supplements, oral/parenteral vitamins, micronutrients, and electrolytes, up to parenteral nutrition, were prescribed.

Results: After 1, 3, and 6 months of nutritional therapy, body weight, body mass index (BMI), and serum butyryl-cholinesterase significantly improved in both groups. In 8 out of 13 (61.5%) patients with a cutaneous stoma, intestinal continuity was restored.

Conclusions: This study confirms the effectiveness of nutritional rehabilitation and provides information on the time required for nutritional treatment in patients with CD, both during the acute phase and after malabsorption due to intestinal resection.
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http://dx.doi.org/10.3390/nu11122947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950059PMC
December 2019

Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.

Rev Endocr Metab Disord 2020 03;21(1):17-33

Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.

Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens. Studies involving TRF regimen were systematically searched up to January 2019. Effect size was expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). A total of 11 studies, 5 randomized controlled trials and 6 observational, were included. All selected studies had a control group without time restriction; hours of fasting ranged from 12-h until 20-h and study duration from 4 to 8-weeks. Most studies involved the Ramadan fasting. TRF determined a greater weight-loss than control regimens (11 studies, n = 485 subjects) (WMD: -1.07 kg, 95%CI: -1.74 to -0.40; p = 0.002; I = 56.2%), unrelated to study design. The subgroup analysis showed an inverse association between TRF and fat free mass in observational studies (WMD: -1.33 kg, 95%CI: -2.55 to -0.11; p = 0.03; I = 0%). An overall significant reduction in fasting glucose concentrations was observed with TRF regimens (7 studies, n = 363 subjects) (WMD: -1.71 mg/dL, 95%CI: -3.20 to -0.21; p = 0.03; I = 0%), above all in trials (WMD:-2.45 mg/dL, 95%CI: -4.72 to -0.17; p = 0.03; I = 0%). No between-group differences in the other variables were found. TRF regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. However, long-term and well-designed trials are needed to draw definitive conclusions.
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http://dx.doi.org/10.1007/s11154-019-09524-wDOI Listing
March 2020

Assessment of bioelectrical phase angle as a predictor of nutritional status in patients with Crohn's disease: A cross sectional study.

Clin Nutr 2020 05 4;39(5):1564-1571. Epub 2019 Jul 4.

Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131, Naples, Italy.

Background & Aims: The assessment of body composition (BC) can be used to identify malnutrition in patients with Crohn's disease (CD). The aim of this study was to evaluate the nutritional status of CD patients by assessing BC, phase angle (PhA) and muscle strength. Differences in disease duration and medications were also considered.

Methods: Consecutive adult CD patients aged 18-65 years were enrolled in this cross-sectional study. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in the active and quiescent phases. All participants underwent anthropometry, BC and handgrip-strength (HGS) measurements; additionally, blood samples were taken. Data from CD patients were also compared with age-, sex- and BMI-matched healthy people.

Results: A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and a mean body weight of 64.9 ± 12 kg were recruited and compared to controls. The findings showed that all nutritional parameters, especially PhA and HGS, were lower in CD patients than in controls, and these parameters were substantially impaired as disease activity increased. Active CD patients had a lower body weight and fat mass than both the quiescent and control groups. PhA was negatively correlated with age (r = -0.362; p = 0.000) and CDAI (r = -0.135; p = 0.001) but was positively associated with fat free mass (FFM) (r = 0.443; p = 0.000) and HGS (r = 0.539; p = 0.000). Similarly, serum protein markers were lower in the active CD group than in the quiescent group (p < 0.05). Disease duration and medications did not significantly affect nutritional status.

Conclusions: BIA-derived PhA is a valid indicator of nutritional status in CD patients, and its values decreased with increasing disease activity. Additionally, small alterations in BC, such as low FFM, and reduced HGS values can be considered markers of nutritional deficiency. Therefore, the assessment of BC should be recommended in clinical practice for screening and monitoring the nutritional status of CD patients.
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http://dx.doi.org/10.1016/j.clnu.2019.06.023DOI Listing
May 2020

Are Raw BIA Variables Useful for Predicting Resting Energy Expenditure in Adults with Obesity?

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

Interuniversity Centre for Obesity and Eating Disorders, Federico II University Hospital, Pansini 5, 80131 Naples, Italy.

This study aimed to develop and validate new predictive equations for resting energy expenditure (REE) in a large sample of subjects with obesity also considering raw variables from bioimpedance-analysis (BIA). A total of 2225 consecutive obese outpatients were recruited and randomly assigned to calibration ( = 1680) and validation ( = 545) groups. Subjects were also split into three subgroups according to their body mass index (BMI). The new predictive equations were generated using two models: Model 1 with age, weight, height, and BMI as predictors, and Model 2 in which raw BIA variables (bioimpedance-index and phase angle) were added. Our results showed that REE was directly correlated with all anthropometric and raw-BIA variables, while the correlation with age was inverse. All the new predictive equations were effective in estimating REE in both sexes and in the different BMI subgroups. Accuracy at the individual level was high for specific group-equation especially in subjects with BMI > 50 kg/m². Therefore, new equations based on raw-BIA variables were as accurate as those based on anthropometry. Equations developed for BMI categories did not substantially improve REE prediction, except for subjects with a BMI > 50 kg/m². Further studies are required to verify the application of those formulas and the role of raw-BIA variables for predicting REE.
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http://dx.doi.org/10.3390/nu11020216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413163PMC
January 2019

Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials.

J Transl Med 2018 12 24;16(1):371. Epub 2018 Dec 24.

Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.

Background: This systematic review and meta-analysis summarized the most recent evidence on the efficacy of intermittent energy restriction (IER) versus continuous energy restriction on weight-loss, body composition, blood pressure and other cardiometabolic risk factors.

Methods: Randomized controlled trials were systematically searched from MEDLINE, Cochrane Library, TRIP databases, EMBASE and CINAHL until May 2018. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI).

Results: Eleven trials were included (duration range 8-24 weeks). All selected intermittent regimens provided ≤ 25% of daily energy needs on "fast" days but differed for type of regimen (5:2 or other regimens) and/or dietary instructions given on the "feed" days (ad libitum energy versus balanced energy consumption). The intermittent approach determined a comparable weight-loss (WMD: - 0.61 kg; 95% CI - 1.70 to 0.47; p = 0.87) or percent weight loss (WMD: - 0.38%, - 1.16 to 0.40; p = 0.34) when compared to the continuous approach. A slight reduction in fasting insulin concentrations was evident with IER regimens (WMD = - 0.89 µU/mL; - 1.56 to - 0.22; p = 0.009), but the clinical relevance of this result is uncertain. No between-arms differences in the other variables were found.

Conclusions: Both intermittent and continuous energy restriction achieved a comparable effect in promoting weight-loss and metabolic improvements. Long-term trials are needed to draw definitive conclusions.
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http://dx.doi.org/10.1186/s12967-018-1748-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304782PMC
December 2018

Fecal Short Chain Fatty Acids and Dietary Intake in Italian Women With Restrictive Anorexia Nervosa: A Pilot Study.

Front Nutr 2018 29;5:119. Epub 2018 Nov 29.

Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.

Nutritional disorders such as Anorexia Nervosa (AN) can shape the composition of gut microbiota and its metabolites such as short chain fatty acid (SCFA). This study aims to compare fecal SCFA along with dietary intake of women with restrictive AN (r-AN = 10) and those of sex-matched lean controls (C = 8). The main fecal short chain fatty acids (SCFA) were assessed by gas chromatography equipped with a flame ionization detector. All participants completed 7-day food record and underwent indirect calorimetry for measuring resting energy expenditure (REE). Butyrate and propionate fecal concentrations were significantly reduced in r-AN patients compared to controls. The intake of carbohydrate and fat was significantly lower in r-AN patients than controls as well as energy intake and REE; whereas the amount of protein and fiber did not differ between groups. These preliminary results showed that r-AN patients had a reduced excretion of fecal SCFA, likely as a mechanism to compensate for the lower energy and carbohydrate intake observed between groups. Therefore, further studies need to be performed in patients with AN to explore the link between nutritional disorders, gut microbiota and its metabolites.
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http://dx.doi.org/10.3389/fnut.2018.00119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281687PMC
November 2018

Effects of resveratrol on bone health in type 2 diabetic patients. A double-blind randomized-controlled trial.

Nutr Diabetes 2018 09 20;8(1):51. Epub 2018 Sep 20.

Department of Medical Sciences, University of Turin, Turin, Italy.

Objectives: Patients with type 2 diabetes (T2DM) are at increased fracture risk. Resveratrol has shown beneficial effects on bone health in few studies. The aim of this trial was to investigate the effects of resveratrol on bone mineral density (BMD) and on calcium metabolism biomarkers in T2DM patients.

Methods: In this double-blind randomized placebo-controlled trial 192 T2DM outpatients were randomized to receive resveratrol 500 mg/day (Resv500 arm), resveratrol 40 mg/day (Resv40 arm) or placebo for 6 months. BMD, bone mineral content (BMC), serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D were measured at baseline and after 6 months.

Results: At follow-up, calcium concentrations increased in all patients, while within-group variations in alkaline phosphatase were higher in both resveratrol arms, and 25-hydroxy vitamin D increased in the Resv500 arm only, without between-group differences. Whole-body BMD significantly decreased in the placebo group, while whole-body BMC decreased in both the placebo and Resv40 arms. No significant changes in BMD and BMC values occurred in the Resv500 arm. The adjusted mean differences of change from baseline were significantly different in the Resv500 arm vs placebo for whole-body BMD (0.01 vs -0.03 g/cm, p = 0.001), whole-body BMC (4.04 vs -58.8 g, p < 0.001), whole-body T-score (0.15 vs -0.26), and serum phosphorus (0.07 vs -0.01 µmol/L, p = 0.002). In subgroup analyses, in Resv500 treated-patients BMD values increased to higher levels in those with lower calcium and 25-hydroxy vitamin D values, and in alcohol drinkers.

Conclusions: Supplementation with 500 mg resveratrol prevented bone density loss in patients with T2DM, in particular, in those with unfavorable conditions at baseline.
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http://dx.doi.org/10.1038/s41387-018-0059-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147949PMC
September 2018

Impaired Enterohormone Response Following a Liquid Test Meal in Gastrectomized Patients.

Ann Nutr Metab 2017 14;71(3-4):211-216. Epub 2017 Nov 14.

Internal Medicine and Clinical Nutrition Unit, Naples, Italy.

Background: Total gastrectomy (TG) is responsible for symptoms or disturbance of alimentary status (changes in body weight, food intake per meal and frequency of meal per day) which, in turn are responsible for weight loss and malnutrition. The study evaluates the gut hormone responses in totally gastrectomized (TG) patients after a liquid meal test.

Methods: Twenty total gastrectomized cancer-free patients (12 M, 8 F, 56.4 ± 10.2 years, BMI 21.4 ± 2.2 kg/m2) and 10 healthy volunteers (4 M, 6 F, 48.0 ± 12.7 years, BMI 26.7 ± 3.0 kg/m2 ) drank a liquid meal (1.25 kcal/mL) at the rate of 50 mL/5' min for a maximum of 30 min. Satiety score was assessed and blood sample was taken at different time points.

Results: The time response course, particularly for insulin, glucose-like pepetide-1, and cholecystokinin, significantly differed between TG patients and controls.

Conclusions: Our results may help to better understand hormone responses triggered by the faster arrival of nutrients in the small bowel and to explain some post-TG symptoms.
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http://dx.doi.org/10.1159/000481919DOI Listing
June 2019

Adequacy of nutrient intake in women with restrictive anorexia nervosa.

Nutrition 2017 Jun 24;38:80-84. Epub 2017 Feb 24.

Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy; Interuniversity Centre for Obesity and Eating Disorders (CISRO), Federico II University Hospital, Naples, Italy.

Objective: The aim of the present study was to assess energy and nutrient intake in a group of women with restrictive AN (r-AN) compared with a control group.

Methods: Thirteen r-AN patients and 13 healthy female controls completed 7-d food records. Intake of macro- and micronutrients was compared between the two groups as well as to the Dietary Reference Intake for the Italian Population (LARN) for specific ages. Additionally, the r-AN patients underwent indirect calorimetry for measuring resting energy expenditure (REE).

Results: Total energy intake was significantly lower in the r-AN group than in controls (906 ± 224 vs 1660 ± 139, respectively; P < 0.01). Nutrient composition significantly differed, as well. Mean intake of sodium, phosphorus, and zinc was higher in controls than in the women with r-AN (P < 0.01), but neither group of women met LARN recommendations for potassium, calcium, or iron intake. With respect to vitamins, no significant differences were found for riboflavin or vitamins A, B, or C between groups, whereas levels of other vitamins differed (P < 0.01). Both groups failed to meet the LARN recommendation for vitamin D intake; moreover, none of the r-AN patients met recommended intake levels of vitamin E, thiamine, niacin, and folate.

Conclusions: Intakes reported by r-AN patients did not meet requirements for most micronutrients evaluated in this study and, as expected, both energy needs and specific dietary patterns differed between groups. Therefore, a careful evaluation of food consumption should be recommended to reduce nutritional gaps in these patients. According to these preliminary observations, nutritional counseling, mainly focused on calcium and vitamin D intake, should be suggested for healthy women, as well.
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http://dx.doi.org/10.1016/j.nut.2017.02.004DOI Listing
June 2017

Effects on satiation, satiety and food intake of wholegrain and refined grain pasta.

Appetite 2016 12 2;107:152-158. Epub 2016 Aug 2.

Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark. Electronic address:

Wholegrains have received much attention in recent years due to their role in prevention of obesity and its comorbidities. Many studies about energy regulation are focused on the effect between meals (satiety), but the effect within meal (satiation) for wholegrain foods has not been extensively studied. The objective was to investigate the effect of WG pasta (WGP) compared to refined grain pasta (RGP), on ad libitum energy intake (EI) within and at the subsequent meal as well as appetite. Two different ad libitum lunch meals (study A) and two different iso-caloric lunch meals (study B) were administered in sixteen overweight/obese subjects in a crossover design. The test meals consisted of RGP and WGP served with tomato sauce. Study A: the ad libitum lunch meal was consumed then EI registered. Study B: the iso-caloric lunch meal was served, then subjective appetite sensation and breath hydrogen excretion were assessed for 240 min followed by an ad libitum meal where EI was calculated. Overall, WGP did not significantly differ in the effect on ad libitum EI within meal (p = 0.23) in study A. In study B, WGP resulted in an increased sensation of satiety (p < 0.001) and lower ratings of hunger (p < 0.001) without increased in breath hydrogen excretion (p = 0.11). Again, no overall effect on EI at the subsequent meal was seen (p = 0.12). In conclusion, WGP increased satiety, diminished hunger without modifying energy intake at the subsequent meals.
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http://dx.doi.org/10.1016/j.appet.2016.08.002DOI Listing
December 2016

Quality of meal and appetite sensation.

Curr Opin Clin Nutr Metab Care 2016 Sep;19(5):366-370

Department of Clinical Medicine and Surgery, Internal Medicine and Clinical Nutrition Unit, Federico II University, Naples, Italy.

Purpose Of Review: The scope of this review is to summarize recent studies assessing the role of meal composition on appetite sensation.

Recent Findings: Currently, data confirm a positive effect on appetite sensations following protein-rich meals, suggesting that at least 25-30-g protein/meal provide potential improvements on appetite, but further long-term studies are required to confirm the results. A greater interest has been showed in the interaction between short-chain fatty acids produced by gut microbiota, following dietary fiber consumption, and appetite sensation, but research is ongoing. Finally, as reflected in the recent literature, new systematic reviews should be carried out to assess the effect of dietary fibers on appetite sensation.

Summary: Meal composition, in terms of nutrients, widely differs in the ability to affect appetite sensation. This mostly depends on the content of protein and dietary fibers in a meal. The effect of higher protein intake on appetite sensation has been well documented with positive results, whereas dietary fibers, although the majority of evidence suggests positive results, still show inconsistent data because of various methodological approaches. Generally, more research both in the short and long term is required to investigate the underlying mechanism associated with appetite sensation.
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http://dx.doi.org/10.1097/MCO.0000000000000302DOI Listing
September 2016

Resting energy expenditure in adult patients with Crohn's disease.

Clin Nutr 2017 04 22;36(2):467-470. Epub 2016 Jan 22.

Department of Clinical Medicine and Surgery, Italy; Interuniversity Centre for Obesity and Eating Disorders (CISRODCA), Federico II University of Naples, Italy.

Background & Aims: Crohn's disease (CD) is a chronic intestinal disorder of unknown etiology involving any section of the gastrointestinal tract often associated with protein-energy malnutrition (PEM). Increased resting energy expenditure (REE) unmatched by adequate dietary intake is amongst the pathogenetic mechanisms proposed for PEM. Aim of this study was to evaluate REE in CD patients receiving or not immuno-suppressive therapy as compared to controls.

Methods: 36 CD patients (22 M and 14 F, age range 18-55 years) clinically stable and without complications since at least 6 month were studied. REE was evaluated by indirect calorimetry and body composition by BIA. Full biochemistry was performed. Patients were divided into two groups: Group 1 (G1 = 12 patients) without and Group 2 (G2 = 24 patients) with immuno-suppressive therapy.

Results: The two groups were similar for age, height and BMI whereas significantly differed for weight (G1 vs G2: 56.9 ± 7.44 vs 62.3 ± 8.34 kg), fat free mass (FFM: 40.4 ± 5.73 vs 48.2 ± 7.06 kg), fat mass (FM: 17.0 ± 3.55 vs 13.9 ± 5.54 kg) and phase angle (PA: 5.6 ± 1.4 vs 6.5 ± 1.0°). Serum inflammation parameters were significantly higher in G1 than in G2: hs-PCR: 7.76 ± 14.2 vs 7.16 ± 13.4 mg/dl; alfa 2-protein: 11.7 ± 3.69 vs 9.74 ± 2.08 mg/dl; fibrinogen: 424 ± 174 vs 334 ± 118 mg/dl (p < 0.05). REE was higher in G2 vs G1: 1383 ± 267 vs 1582 ± 253kcal/die (p < 0.05) both in men: 1579 ± 314 vs 1640 ± 203 and women: 1267 ± 140 vs 1380 ± 132. Nevertheless, when corrected for FFM, REE resulted higher in G1 than G2 (34.8 ± 4.89 vs 33.0 ± 4.35 kcal/kg, p < 0.05) group, also higher compared to our, age and sex matched, control population (REE/FFM: 30.9 ± 4.5 kcal/kg).

Conclusions: Our preliminary results show that REE when adjusted for FFM is increased in clinically stable CD patients and mildly reduced by immunosuppressive therapy possibly through a direct action on inflammation and on body composition characteristics.
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http://dx.doi.org/10.1016/j.clnu.2016.01.005DOI Listing
April 2017

Whole-grain pasta reduces appetite and meal-induced thermogenesis acutely: a pilot study.

Appl Physiol Nutr Metab 2016 Mar 16;41(3):277-83. Epub 2015 Nov 16.

a Internal Medicine and Clinical Nutrition Unit, Federico II University Hospital, 80131 Naples, Italy.

In epidemiological studies, the intake of foods rich in dietary fiber is associated with a reduced risk of developing overweight and type 2 diabetes. This work aims to identify acute strategies to regulate appetite and improve glucose control by using different pasta meals. Hence, 4 different isocaloric lunch meals, consisting of (i) refined-grain pasta (RG+T), (ii) whole-grain pasta (WG+T), (iii) lemon juice-supplemented refined-grain pasta (LRG+T), and (iv) refined-grain pasta with legumes (RG+L), were administered to 8 healthy participants in a crossover design. On the test days, participants underwent baseline measurements, including appetite sensation, blood sample, and resting energy expenditure (EE), after which the test lunch was served. Subjective appetite was assessed and a blood sample was taken each hour for 240 min, and postprandial EE was measured for 3 h. In repeated-measures analysis of covariance (ANCOVA), postprandial fullness (p = 0.001) increased and hunger (p = 0.038) decreased. WG+T had a lower EE than did both LGR+T (p = 0.02) and RG+L (p < 0.001). Likewise, meal-induced thermogenesis was lower for WG+T compared with RG+L (58 ± 81 kJ vs 248 ± 188 kJ; p < 0.05). Plasma glucose (p = 0.001) was lower for RG+T, and triacylglycerols (p = 0.02) increased for LRG+T; however, insulin, C-peptide, and ghrelin were comparable in all other meals. In conclusion, our study indicates that acute consumption of whole-grain pasta may promote fullness and reduce hunger, lowering postprandial thermogenesis, and adding lemon juice to the pasta or legumes does not appear to affect appetite. However, none of pasta meal alterations improved the postprandial metabolic profile.
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http://dx.doi.org/10.1139/apnm-2015-0446DOI Listing
March 2016
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