Publications by authors named "Maurizio Marra"

62 Publications

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

Nutrition 2021 Feb 13;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
February 2021

Nutritional indicators and metabolic alterations in outpatients with anorexia nervosa: a retrospective study.

Eat Weight Disord 2021 Feb 19. Epub 2021 Feb 19.

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

Purpose: In patients living with Anorexia Nervosa (AN), dehydration and haemoconcentration, may prevent a correct interpretation of laboratory nutritional parameters. Our study aims to evaluate if some indicators of disease severity, as body mass index (BMI), Phase Angle (PhA) and months of amenorrhea may be predictors of metabolic alterations (serum albumin, liver enzymes).

Methods: In 154 outpatients with AN, case history was collected, and anthropometric and laboratory parameters measured. Patients were divided according to the following tertiles (T) of BMI, duration of amenorrhea and PhA: (1) BMI (T1 < 15.6; T2 15.6-16.8; T3 > 16.8 kg/m); (2) Amenorrhea duration (T1 < 7; T2 7-14; T3 > 14 months); (3) PhA value (T1 < 4.64; T2 4.64-5.35; T3: > 5.35°). ROC curves were used to determine which of these three indicators (BMI, PhA and amenorrhea duration) might better identify patients belonging to Group A or B (less than 3 or more metabolic abnormalities).

Results: The most frequent registered metabolic alterations were for alkaline phosphatase (ALP), alanine aminotransferase, cholesterol and hemoglobin. Aspartate aminotransferase, ALP and gamma glutamyl transferase abnormalities were frequent in the first tertiles of all the three indicators. Albumin was low in the T1 of BMI and PhA. No differences in nutritional alterations emerged according to amenorrhea duration. PhA had the best performance (AUCs: 0.721) in identifying patients with 3 or more abnormalities, with the optimal cut-off value of 4.5°.

Conclusions: Our data confirmed PhA as the more reliable predictor of metabolic alterations, followed by BMI and amenorrhea duration, especially in the first tertile.

Evidence-based Medicine: Level 2.
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http://dx.doi.org/10.1007/s40519-021-01121-8DOI Listing
February 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 2020 Nov 26. 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
November 2020

Bilio-pancreatic diversion: report of a case involving bone metabolism complications.

J Int Med Res 2020 Nov;48(11):300060520974229

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

Prolonged vitamin D deficiency may result in lower calcium absorption and osteoporosis, leading to pathologic fractures. We report the case of a young woman with severe, complicated osteoporosis, which developed several years after biliopancreatic diversion that was performed to treat morbid obesity. Chronic low vitamin D levels provided a continuous stimulus for parathormone secretion, which resulted in parathyroid hyperplasia/adenoma and autonomous production of the hormone.
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http://dx.doi.org/10.1177/0300060520974229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708713PMC
November 2020

Bioimpedance phase angle in elite male athletes: a segmental approach.

Physiol Meas 2021 01 1;41(12):125007. Epub 2021 Jan 1.

Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, Naples 80138, Italy.

Objective: Phase angle (PA), a bioelectrical impedance analysis (BIA) parameter, has proven to be a proxy of body cell mass in athletes, but very few data are available on its segmental evaluation (upper and lower limbs). Therefore, we aimed to assess whether whole-body and segmental PA varied among elite male athletes of different sports and compared these to control groups. Additionally, we investigated its relationship with anthropometric and body composition parameters.

Approach: Elite athletes practicing cycling, water polo and ballet dance aged 18-40 years underwent anthropometric and BIA measurements. PA (whole-body and upper and lower limbs) was considered as raw BIA variable. Data were also compared with healthy subjects with similar characteristics who served as control groups.

Main Results: Participants included three groups of male athletes: 18 cyclists (age 28.6 ± 3.4 years; weight 70.6 ± 5.4 kg; BMI 21.5 ± 1.4 kg m), 20 water polo players (age 23.9 ± 4 years; weight 89.0 ± 5.2 kg; BMI 25.9 ± 1.9 kg m) and 18 ballet dancers (age 19.2 ± 1.3 years; weight 63.3 ± 5.8 kg; BMI 20.8 ± 1.0 kg m) and three groups of healthy control subjects each of which similar for general characteristics (one to one) to the previous ones. Both whole-body and limb PAs were significantly higher in athletes compared to their respective controls, whereas no differences were found among sport groups. PA was positively correlated with BMI and fat-free mass (FFM) more in athletes than in controls and FFM was the main determinant.

Significance: PA may represent a useful proxy parameter of soft tissue mass quality, directly related to physical activity level. Furthermore, the direct evaluation of segmental PA among athletes practicing different sports may be useful for assessing and monitoring the differences among athletes and changes due to training.
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http://dx.doi.org/10.1088/1361-6579/abcb5cDOI Listing
January 2021

Bioelectrical impedance analysis (BIA) -derived phase angle in sarcopenia: A systematic review.

Clin Nutr 2020 Nov 1. Epub 2020 Nov 1.

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

Background & Aims: Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status because it is thought to be a proxy of water distribution and body cell mass; it is also associated to muscle strength and is an effective predictor of different clinical outcomes. Since an association may be expected between PhA and sarcopenia (defined by low skeletal muscle mass and impaired muscle function), the aim of this systematic review was to evaluate: a) changes in PhA due to sarcopenia; b) prevalence of sarcopenia according to PhA values; c) derivation of phase angle cut-offs for detecting sarcopenia; d) sarcopenia and PhA as predictors of clinical outcomes.

Methods: A systematic research on electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to January 31st, 2020 was performed according to PRISMA checklist. Using PICOS strategy, "P" corresponded to participants of any age, gender or ethnicity, "I" designated diagnosis of sarcopenia, "C" indicated subjects without sarcopenia, "O" corresponded to PhA, and "S" selected all study types. Methodological quality was assessed using the National Institute of Health (NIH) quality assessment tool.

Results: Through the initial literature search and after removing duplicates and excluding papers by screening titles and abstracts, 79 potentially relevant studies were examined. Thirteen studies (7668 subjects) met the inclusion criteria. The overall risk of bias was low. Sarcopenia was associated with a significant lower PhA in seven studies out of eight, while five studies out of six reported a high prevalence of sarcopenia was in patients with low PhA. Different cut-off point values from 4.05 to 5.05° have been derived for the identification of sarcopenia. PhA and sarcopenia were independent predictors of survival in cancer patients and geriatric hospitalized patients.

Conclusions: Data from the selected papers demonstrate that PhA is decreased in sarcopenic subjects and the prevalence of sarcopenia is higher in subjects with low PhA. Further studies are needed to determine to what extent PhA may be valuable in detecting low muscle quality and/or identifying sarcopenia.
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http://dx.doi.org/10.1016/j.clnu.2020.10.048DOI Listing
November 2020

Long-Term Outcomes from a 10-Year Follow-Up of Women Living with a Restrictive Eating Disorder: A Brief Report.

Nutrients 2020 Aug 4;12(8). Epub 2020 Aug 4.

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

Background: This study aimed to evaluate several socio-demographic and long-term clinical outcomes in a cohort of women living with a restrictive eating disorder.

Methods: Patients were asked to fill in a general data collection form aiming to investigate their current conditions and to attend the outpatient unit for a 10-year follow-up clinical and laboratory evaluation.

Results: Forty-four patients completed the follow-up general data collection form and 20 agreed to attend the outpatient unit for the 10 year-follow-up evaluation. In total, 52% of patients were single, 55% had achieved a university degree, and 55% had steady employment. After 10 years, there was a clear improvement in biochemical markers, but cholesterol levels were still slightly high. The prevalence of osteopenia in the whole sample was 70% when measured on the lumbar column and 20% on the total body, while osteoporosis was found in 10% of patients and only on the lumbar column.

Conclusion: According to the collected data, women with a history of restrictive eating disorders appear to re-adapt well to social life by obtaining the level of their unaffected peers in terms of education and employment.
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http://dx.doi.org/10.3390/nu12082331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468732PMC
August 2020

Adapted recreational football small-sided games improve cardiac capacity, body composition and muscular fitness in patients with type 2 diabetes.

J Sports Med Phys Fitness 2020 Sep 12;60(9):1261-1268. Epub 2020 Jun 12.

Department of Human Movement Sciences and Wellbeing, Parthenope University, Naples, Italy -

Background: The usefulness of adapted small-sided games (SSGs) in improving cardiac function in subjects with T2DM is still debated. Here we evaluated the effects of 18 weeks indoor muscular activation training (6 weeks; IMA) followed by adapted SSGs football training (12 weeks) on cardiac function, muscular fitness, body composition and adiponectin expression in sedentary T2DM volunteers.

Methods: Six T2DM patients underwent IMA protocol of 6 weeks, twice a week followed by 12 weeks SSGs (5-a-side, once a week) training. Glucose, lipid profile and serum homocysteine concentration, body composition (BC), bone mineral density (DEXA), were determined at baseline and after 18 weeks (IMA+SSGs). VO2max and muscular fitness were recorded at baseline and after IMA (6 weeks) and SSGs (12 weeks), respectively.

Results: No significant differences were found for VO2max and muscular fitness after 6weeks of IMA. After 18 weeks (6 weeks IMA + 12 weeks SSGs) of training, significant improvements were found in the following parameters: work capacity, VO2peak, Ventilation (VEpeak), breathing reserve consumption and oxygen uptake efficiency slope (P<0.05); leg fitness (P<0.05), BC (P<0.05), vertebral column T-score (P<0.01) and adiponectin (total and high-molecular-weight; P<0.05). Compared to baseline, a reduction in serum homocysteine occurred after 18 weeks of training (P<0.05).

Conclusions: We evidenced that weekly adapted SSGs friendly football matches for 12 weeks improve cardiorespiratory capacity and the expression of independent markers associated with cardiovascular risk in T2DM patients, suggesting an overall reduced CVD-risk in these patients. These preliminary data encourage us to test the efficacy of this type of exercise in a larger population.
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http://dx.doi.org/10.23736/S0022-4707.20.10498-5DOI Listing
September 2020

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

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

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

Bioelectrical impedance phase angle in sport: a systematic review.

J Int Soc Sports Nutr 2019 Nov 6;16(1):49. Epub 2019 Nov 6.

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

Background: Phase angle (PhA) is a raw BIA variable that has been gaining attention in recent years because it is supposed to be an index of the ratio between extracellular and intracellular water, body cell mass, and cellular integrity. The aim of this systematic review was to evaluate the variability of PhA between different sports and its relationships with sport performance. Additionally, we investigated whether PhA depends on gender or age, and analyzed the differences between athletes and controls.

Methods: A systematic research using PubMed, Scopus and Web of Science up to June 2019 was performed. Selection criteria included studies on subjects who practice sports in planned and continuous modality at competitive or elite level.

Results: Thirty-five papers met the inclusion criteria (twenty-one cross-sectional data, fourteen longitudinal data). A few but convincing studies have shown that mean PhA is higher in athletes vs. controls. PhA increases with age and is likely to be higher in male than female athletes. A large variability in PhA is observed for the same sport, while it is still uncertain to what extent PhA differs between various sports. There are no clear relationships of PhA with sport performance or training/untraining.

Conclusion: It is still to be defined to what extent PhA varies between different sports and changes with training/untraining. It can be argued that for a given sport much more data should be collected in a systematic way and for a period of time appropriate in order to determine changes and trends. This is even more crucial in the case of intervention studies.
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http://dx.doi.org/10.1186/s12970-019-0319-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6833254PMC
November 2019

Cardiac Changes in Patients on Long-Term Parenteral Nutrition.

Nutrients 2019 Jul 13;11(7). Epub 2019 Jul 13.

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

Patients with short bowel syndrome (SBS) on long-term home parenteral nutrition (HPN) chronically receive high fluid volumes directly into the right atrium (RA) through the superior vena cava. We retrospectively evaluated cardiac function measured by routine transthoracic echocardiography (TTE) in a population of 26 SBS patients on long-term HPN and compared their data on echocardiograph-derived right heart structure and function, with those of a control group of 26 patients also bearing a central venous catheter (CVC) for other reasons. Results showed that body weight and BMI were significantly higher in the control group. The echocardiographic estimate of RA pressure was higher in HPN patients than in controls ( = 0.01). An increased estimate of RA pressure indicates the need to consider TTE in the follow-up of long-term HPN patients to detect functional impairment early.
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http://dx.doi.org/10.3390/nu11071587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682873PMC
July 2019

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

Assessment of Body Composition in Health and Disease Using Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA): A Critical Overview.

Contrast Media Mol Imaging 2019 29;2019:3548284. Epub 2019 May 29.

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

The measurement of body composition (BC) represents a valuable tool to assess nutritional status in health and disease. The most used methods to evaluate BC in the clinical practice are based on bicompartment models and measure, directly or indirectly, fat mass (FM) and fat-free mass (FFM). Bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA) (nowadays considered as the reference technique in clinical practice) are extensively used in epidemiological (mainly BIA) and clinical (mainly DXA) settings to evaluate BC. DXA is primarily used for the measurements of bone mineral content (BMC) and density to assess bone health and diagnose osteoporosis in defined anatomical regions (femur and spine). However, total body DXA scans are used to derive a three-compartment BC model, including BMC, FM, and FFM. Both these methods feature some limitations: the accuracy of BIA measurements is reduced when specific predictive equations and standardized measurement protocols are not utilized whereas the limitations of DXA are the safety of repeated measurements (no more than two body scans per year are currently advised), cost, and technical expertise. This review aims to provide useful insights mostly into the use of BC methods in prevention and clinical practice (ambulatory or bedridden patients). We believe that it will stimulate a discussion on the topic and reinvigorate the crucial role of BC evaluation in diagnostic and clinical investigation protocols.
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http://dx.doi.org/10.1155/2019/3548284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560329PMC
July 2020

Resting Energy Expenditure, Body Composition and Phase Angle in Anorectic, Ballet Dancers and Constitutionally Lean Males.

Nutrients 2019 Feb 27;11(3). Epub 2019 Feb 27.

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

Background: The prevalence of anorexia nervosa among males is increasing but few data are available in the literature. This cross sectional study aims to evaluate resting energy expenditure (REE) and phase angle as a marker of qualitative changes of fat free mass (FFM) in three leanness groups as compared with control subjects.

Methods: 17 anorectic (AN) males, 15 constitutionally lean (CL) individuals, 12 ballet dancers (DC), and 18 control (CTR) subjects were evaluated. REE was measured by indirect calorimetry (V max29- Sensormedics), and body composition was evaluated by bioimpedance analysis (BIA) at 50 kHz (DS Medica). Phase angle (a bioimpedance variable related to nutritional status) was used to evaluate differences in FFM characteristics between these three types of leanness.

Results: REE, adjusted for FFM and fat mass (FM), were significantly higher in CL and lower in AN individuals (1783 ± 47 vs. 1291 ± 58 kcal, < 0.05) compared to the other groups. Body composition was similar in AN and CL whereas dancers had the highest FFM (58.9 ± 4.8 kg, < 0.05); anorectic males showed the lowest phase angle (5.8 ± 1.2 degrees vs. other groups, < 0.05) and dancers the highest phase angle (7.9 ± 0.7 degree vs. other group, < 0.05).

Conclusions: Our findings confirm that phase angle could be a useful marker of qualitative changes, above all in the field of sport activities. On the other hand, there is the need to further evaluate the relationship between resting energy expenditure, body composition and endocrine status in different conditions of physical activity and dietary intake.
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http://dx.doi.org/10.3390/nu11030502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471802PMC
February 2019

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

Essential Amino Acid Profile in Parenteral Nutrition Mixtures: Does It Meet Needs?

Nutrients 2018 Dec 6;10(12). Epub 2018 Dec 6.

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

Background And Aims: The study compares the essential amino acid (EAA) composition of different parenteral nutrition (PN) mixtures with whey protein EAA profile and the theoretical daily EAA requirements (set by WHO/FAO/UNU or IAAO method). According to the individual EAA profile, the potential effect of several PN mixtures was evaluated on the skeletal muscle mass (SMM) of patients on home PN.

Methods: Eight AA solutions and fifteen complete PN mixtures were considered. Twenty-nine clinically stable patients with short bowel syndrome on home total PN were retrospectively evaluated. SMM was estimated by bioelectrical impedance analysis.

Results: The prescribed doses of EAA that showed a significant increase in home PN patients muscle mass were considerably greater than the theoretical ones, showing an EAA profile similar to whey protein. At the daily dose of 1 g of total AA s/kg body weight (BW), the considered PN mixtures mostly failed to improve SMM. Only prescribed doses which included more than 0.25 g/kg BW of total BCAA with at least 0.10 g/kg BW leucine, 0.08 g/kg BW isoleucine, and 0.06 g/kg BW methionine showed a significant increase in SMM.

Conclusions: The theoretical daily requirement for each EAA was met by all considered PN solutions when the prescribed daily dose of total AAs was set at 1 g/kg BW. Nevertheless, our data suggest that only an increase in total BCAA, also richer in single AA leucine, isoleucine, and methionine, is associated with the maintenance and/or increase of SMM. According to these preliminary observations, we support the prescription of an EAA composition of PN mixtures close to that of whey protein for the preservation of SMM in patients on long-term total PN.
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http://dx.doi.org/10.3390/nu10121937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316548PMC
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

Prediction of body composition in anorexia nervosa: Results from a retrospective study.

Clin Nutr 2018 10 27;37(5):1670-1674. Epub 2017 Jul 27.

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

Background & Aims: The assessment of body composition is crucial in evaluating nutritional status in female subjects with anorexia nervosa (AN) and improving their clinical management. The aim of this retrospective study was to assess the accuracy of selected BIA (bioimpedance analysis) equations for fat-free mass (FFM) in female AN subjects and to formulate a specific equation for these subjects.

Methods: Eighty-two restrictive female AN subjects (age 20.5 ± 3.7 yrs, BMI 15.7 ± 1.7 kg/m) were studied. Body composition was determined with dual-energy X-ray absorptiometry (DXA) and estimated by BIA using five different equations. Linear correlation analysis was carried out to evaluate the association of FFM with selected variables. Multiple regression analysis was used to formulate specific equations to predict FFM in AN.

Results: All predictive equations underestimated FFM at the population level with a bias from -5.6 to -11.7%, while the percentage of accurate predictions varied from 12.2% to 35.4%. More interestingly, multiple regression analysis clearly indicates that, in addition to weight, ZI or RI also emerged as independent predictors of DXA-derived FFM, increasing the prediction power of the equation well above that observed with anthropometric characteristics only.

Conclusions: This study shows that the selected predictive BIA equations considered exhibit an insufficient accuracy at the population and the individual level. Predictive formulas based on body weight plus BIA parameters such as RI and ZI offer a rather accurate prediction of FFM (with high R squared).
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http://dx.doi.org/10.1016/j.clnu.2017.07.016DOI Listing
October 2018

Evaluation of Hypocaloric Diet With Protein Supplementation in Middle-Aged Sarcopenic Obese Women: A Pilot Study.

Obes Facts 2017 20;10(3):160-167. Epub 2017 May 20.

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

Objective: The aim of this study was to evaluate the efficacy of a nutritional program, which is characterized by a different modulation of proteins, in adult patients with sarcopenic obesity.

Methods: We studied 18 obese women aged 41-74 years. Obesity was diagnosed as fat mass > 34.8% and sarcopenia was defined when lean body mass was <90% of the subject's ideal fat free mass. All subjects were randomly assigned to different nutritional interventions: Hypocaloric diet plus placebo (A) and hypocaloric high-protein diet (1.2-1.4 g / kg body weight reference / day) (B). Anthropometric measurements, body composition, resting energy expenditure, handgrip test, Short Physical Performance Battery (SPPB), and SF-36 questionnaire were evaluated at baseline and after 4 months.

Results: Weight significantly decreased in both groups. Women with high-protein diet preserved lean body mass compared to low-calorie diet and improved significantly muscle strength; SPPB score did not change in both groups. SF-36 test showed a significant change for general health after 4 months in group B.

Conclusions: In our study, sarcopenic obese patients with high-protein diet showed an improvement in muscle strength. Furthermore, dietary protein enrichment may represent a protection from the risk of sarcopenia following a hypocaloric diet.
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http://dx.doi.org/10.1159/000468153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644943PMC
January 2018

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

Segmental bioimpedance analysis in professional cyclists during a three week stage race.

Physiol Meas 2016 07 31;37(7):1035-40. Epub 2016 May 31.

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

Bioelectrical impedance analysis has been widely used in the clinical and sport areas because it is a safe, non-invasive, rapid and inexpensive technique that evaluates some electrical properties of the body, such as resistance (R), reactance (X c ) and phase angle (PhA). The aim of this study is to evaluate body composition changes in professional cyclists, participating at the Giro D'Italia 2012, a three week stage race, and in particular PhA modifications as an expression of fat free mass nutritional status. Data were collected at the beginning, in the middle and at the end of the competition. Body weight, circumferences, skinfold thickness and BIA variables (total and segmental body) were measured. Body composition, measured by skinfold thickness, changed during the competition: fat free mass increased, but not significantly, in the middle and at the end of the competition, whereas fat mass significantly decreased versus the baseline in the middle and at the end of the competition. The total PhA did not significantly change in the middle of the competition but was significantly reduced at the end. The arm PhA did not change significantly at both times of the competition, whereas a significant reduction was reported for leg PhA in the middle and at the end of the competition. These results suggest the use of bioimpedance analysis, in particular PhA measurement, to monitor athletes' fat free mass characteristics during medium- and long-term competitions.
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http://dx.doi.org/10.1088/0967-3334/37/7/1035DOI Listing
July 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

Serum levels of adipocytokines in psoriasis patients receiving tumor necrosis factor-α inhibitors: results of a retrospective analysis.

Int J Dermatol 2015 Jul 15;54(7):839-45. Epub 2015 Apr 15.

Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy.

Background: Adipocytokines are bioactive molecules that are deeply involved in the occurrence of atherosclerosis, obesity, and autoimmune inflammatory diseases.

Objectives: This study was conducted to evaluate the effects of tumor necrosis factor-α (TNF-α) inhibitors on serum levels of adipocytokines in patients with chronic plaque psoriasis.

Methods: Serum levels of adiponectin, resistin, visfatin, leptin, TNF-α, and interleukin-6 (IL-6) were evaluated in sera obtained from 47 patients with psoriasis, both at baseline and after they had received TNF-α inhibitors for 24 weeks. Equivalent data were obtained for 39 control subjects matched by age, sex, body mass index, waist : hip ratio, geographical origin, Mediterranean dietary habits, and smoking habits.

Results: At baseline, mean serum levels of TNF-α, IL-6, leptin, resistin, and visfatin were higher in the psoriasis group than in healthy controls; these differences were statistically significant (P < 0.05). Conversely, mean serum levels of adiponectin were significantly lower in patients with psoriasis than in controls (P < 0.0001). Serum levels of adipocytokines did not linearly correlate with anthropometric indices in psoriasis patients (P > 0.05), except in the case of leptin, for which serum levels were related to waist : hip ratio in both men and women (P < 0.05). After 24 weeks of treatment, although serum levels of proinflammatory adipocytokines were decreased, only that of leptin showed a statistically significant reduction (P = 0.0003). Serum levels of adiponectin, an anti-inflammatory adipocytokine, were only mildly increased and persisted at a significantly lower level than in healthy controls (P > 0.005).

Conclusions: Patients with psoriasis show an imbalance between pro- and anti-inflammatory adipocytokines, which is reduced but not normalized after administration of TNF-α inhibitors for 24 weeks. This partial rebalancing seems to be mainly related to a reduction in proinflammatory adipocytokines, rather than an increase in anti-inflammatory adipocytokines.
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http://dx.doi.org/10.1111/ijd.12706DOI Listing
July 2015

Accuracy of predictive equations for estimating resting energy expenditure in obese adolescents.

J Pediatr 2015 Jun 11;166(6):1390-6.e1. Epub 2015 Apr 11.

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

Objective: To compare resting energy expenditure (REE) measured by indirect calorimetry with REE predicted using different equations in obese adolescents.

Study Design: We recruited 264 obese patients (body mass index ranging from 30.0-70.0 kg/m(2)) between 14 and 18 years of age. Data were obtained comparing measured and predicted REE derived from published equations for normal weight and obese adolescents. The average differences between measured and predicted REE, as well as the accuracy at ± 10% level, were evaluated.

Results: Evaluating the mean REE in 109 males (1938 ± 271 kcal/d) and 155 females (2569 ± 459 kcal/d), we found that the Lazzer equation in males had the smallest difference between measured and predicted REE; in females the Henry-1, Food and Agriculture Organization/World Health Organization/United Nations University, Schmelze, and Lazzer equations were the most accurate. The prediction accuracy was considered adequate within ± 10%.

Conclusions: REE predictive equations developed in obese patients and for specific age groups are more suitable than those for the general population. Inaccuracy of predicted REE could affect dietary prescription appropriateness and, consequently, dietary compliance in this age group.
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http://dx.doi.org/10.1016/j.jpeds.2015.03.013DOI Listing
June 2015

Preliminary evaluation of the prevalence of sarcopenia in obese patients from Southern Italy.

Nutrition 2015 Jan 10;31(1):79-83. Epub 2014 May 10.

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

Objectives: Sarcopenic obesity has not yet been widely defined. The aim of this study was to evaluate the prevalence of sarcopenia in a group of severely obese adults from southern Italy by using two different indexes: percentage of skeletal muscle mass (SMP) and skeletal muscle mass normalized for height (SMI); and to determine SMP and SMI cutoff points in a southern Italy reference population.

Methods: Skeletal muscle mass of 131 consecutive obese adult outpatients (51 men and 80 women; ages 45-67 y; body mass index 44.6 ± 7.7 kg/m(2)), was assessed by bioimpedance analysis. SMP and SMI cutoff points to identify moderate and severe sarcopenia were calculated in a reference group of 500 young southern Italy adults (100 men and 400 women; ages 18-40 y; body mass index 25.2 ± 5.6 kg/m(2)) and applied to assess the prevalence of sarcopenia in the study population.

Results: SMP cutoff points to identify moderate and severe sarcopenia were, 28.8% to 35.6% and ≤ 28.7% in men and 23.1% to 28.4% and ≤ 23% in women, respectively. The corresponding values for SMI were 8.44 to 9.53 kg/m(2) and ≤ 8.43 kg/m(2) in men, 6.49 to 7.32 kg/m(2) and ≤ 6.48 kg/m(2) in women. According to SMP, 23 of 51 (45.1%) men and 19 of 80 (23.8%) women were moderately sarcopenic; 28 of 51 (54.9%) men and 61 of 80 (76.3%) women met the definition of severe sarcopenia. Based on SMI, only 2 of 51 (3.9%) men were moderately sarcopenic.

Conclusions: This study confirms that sarcopenia rates vary widely in obese patients depending on the criteria used. SMP as a screening tool to identify a sarcopenia at-risk population.
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http://dx.doi.org/10.1016/j.nut.2014.04.025DOI Listing
January 2015