Comparison between dual-energy X-ray absorptiometry and skinfold thickness in assessing body fat in overweigh/obese adult patients with type-2 diabetes

Percentage of body fat (%BF) is estimated in clinical practice using anthropometric equations, but little is known about their reliability in overweight/obese patients with type-2 diabetes. The aim of this study was to compare, in overweight/obese adults with type-2 diabetes, %BF estimated with several commonly used anthropometric equations and %BF measured with dual-energy X-ray absorptiometry (DXA, Hologic). The %BF was measured with DXA in 40 patients aged 40-68 years with type-2 diabetes (mean HbA1c, 7.3\u2009\ub1\u20090.9%). Body density was estimated in the same patients by means of four anthropometric equations and converted to %BF using the Siri and Brozek equations. Paired-sample t-test and the mean signed difference procedure were used to compare anthropometric equation-derived %BF and DXA measurements. The coefficient of determination was computed. Bland-Altman analysis was used to test the agreement between methods. Among the four anthropometric equations, the Durnin-Womersley equation only showed close agreement with DXA in both female and male patients; the other equations significantly underestimated or overestimated %BF. Two new predictive equations were developed using DXA as the reference to predict total body and trunk %BF. Further comparative studies are required to confirm and refine the accuracy of practical, non-invasive methods for monitoring %BF in this population

Association of free-living physical activity measures with metabolic phenotypes in type 2 diabetes at the time of diagnosis. The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS)

Objective: Lifestyle is considered a major determinant of risk of type 2 diabetes (T2D). We investigated whether daily physical activity (DPA) is associated with beta-cell function (BF) and/or insulin sensitivity (IS) in patients with T2D at the time of diagnosis. Methods: In 41 subjects enrolled in the Verona Newly-Diagnosed Type 2 Diabetes Study we assessed: (1) IS, by euglycaemic insulin clamp; (2) BF, estimated by prolonged-OGTT minimal modeling and expressed as derivative and proportional control; (3) DPA and energy expenditure (EE), assessed over 48-hours monitoring by a validated wearable armband system. Results: Study participants (median[IQR]; age: 62 [53-67] years, BMI: 30.8 [26.5-34.3] Kg c5m-2, HbA1c: 6.7 [6.3-7.3]%; 49.7 [45.4-56.3] mmol/mol) were moderately active (footsteps/day: 7,773 [5,748-10,927]; DPA 653MET: 70 [38-125] min/day), but none of them exercised above 6 metabolic equivalents (MET). EE, expressed as EETOT (total daily-EE) and EE 653MET (EE due to DPA 653MET) were 2,398 [2,226-2,801] and 364 [238-617] Kcal/day, respectively. IS (M-clamp 630 [371-878] \u3bcmol/min/m2) was positively associated with DPA and EE, independent of age, sex and BMI (p<0.05). Among the DPA and EE parameters assessed, DPA 653MET and EETOT were independent predictors of IS in multivariable regression analyses, adjusted for age, sex, BMI (R2=16%, R2=19%, respectively; p<0.01). None of model-derived components of BF was significantly associated with DPA or accompanying EE. Conclusions Our study highlighted moderate levels of DPA and total EE as potential determinants of IS, but not BF, in T2D at the time of diagnosis. Intervention studies are needed to conclusively elucidate the effect of DPA on these features

Group b streptococcus late-onset disease: 2003-2010

BACKGROUND: There is insufficient population-based data on group B streptococcus (GBS) late-onset disease (LOD). Risk factors and routes of GBS transmission are poorly understood. METHODS: A prospective, cohort study was conducted to collect incidence data on LOD and evaluate GBS infections over an 8-year period (2003-2010). Starting from January 2007, maternal rectovaginal and breast milk cultures were routinely collected on confirmation of the LOD diagnosis to assess maternal GBS culture status. RESULTS: The incidence rate of LOD was 0.32 per 1000 live births (1.4 and 0.24 per 1000 live births for preterm and term newborns, respectively). The registered cases of LOD (n = 100) were classified as sepsis (n = 57), meningitis (n = 36), or focal infection (n = 7). Thirty neonates were preterm (2 had recurrent infection); 68 were term. Four infants died (3 early preterm, 1 term). At the time the LOD diagnosis was confirmed, 3 (6%) of 53 mothers had GBS mastitis, and 30 (64%) of 47 carried GBS at the rectovaginal site. Early (7-30 days) LOD presentation was associated with neonatal brain lesions or death (odds ratio: 0.96 [95% confidence interval: 0.93-0.99]). Intrapartum antibiotic exposure was significantly associated with mild (12 of 22) rather than severe (11 of 45; P = .03) LOD. CONCLUSIONS: Preterm neonates had the highest rates of LOD and mortality. Most mothers carried GBS at the time of the LOD diagnosis, whereas 6% had mastitis. Intrapartum antibiotics were associated both with delayed presentation of symptoms and milder LOD. Pediatrics 2013;131:e361-e368Early neonatal mortality has remained high and unchanged for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic interventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths. METHODS: Master trainers from the 3 major referral hospitals, 4 associated regional hospitals, and 1 district hospital were trained in the HBB program to serve as trainers for national dissemination. A before (n = 8124) and after (n = 78 500) design was used for implementation. The primary outcomes were a reduction in early neonatal deaths within 24 hours and rates of fresh stillbirths (FSB). RESULTS: Implementation was associated with a significant reduction in neonatal deaths (relative risk [RR] with training 0.53; 95% confidence interval [CI] 0.43-0.65; P ≤.0001) and rates of FSB (RR with training 0.76; 95% CI 0.64-0.90; P = .001). The use of stimulation increased from 47% to 88% (RR 1.87; 95% CI 1.82-1.90; P ≤.0001) and suctioning from 15% to 22% (RR 1.40; 95% CI 1.33-1.46; P ≤.0001) whereas face mask ventilation decreased from 8.2% to 5.2% (RR 0.65; 95% CI 0.60- 0.72; P ≤ .0001). Copyright © 2013 by the American Academy of Pediatrics

Exploring muscle activation during nordic walking: a comparison between conventional and uphill walking

Nordic Walking (NW) owes much of its popularity to the benefits of greater energy expenditure and upper body engagement than found in conventional walking (W). Muscle activation during NW is still understudied, however. The aim of the present study was to assess differences in muscle activation and physiological responses between NW and W in level and uphill walking conditions. Nine expert Nordic Walkers (mean age 36.8\ub111.9 years; BMI 24.2\ub11.8 kg/m2) performed 5-minute treadmill trials of W and NW at 4 km/h on inclines of 0% and 15%. The electromyographic activity of seven upper body and five leg muscles and oxygen consumption (VO2) were recorded and pole force during NW was measured. VO2 during NW was 22.3% higher at 0% and only 6.9% higher at 15% than during W, while upper body muscle activation was 2- to 15-fold higher under both conditions. Lower body muscle activation was similarly increased during NW and W in the uphill condition, whereas the increase in erector spinae muscle activity was lower during NW than W. The lack of a significant increase in pole force during uphill walking may explain the lower extra energy expenditure of NW, indicating less upper body muscle activation to lift the body against gravity. NW seemed to reduce lower back muscle contraction in the uphill condition, suggesting that walking with poles may reduce effort to control trunk oscillations and could contribute to work production during NW. Although the difference in extra energy expenditure between NW and W was smaller in the uphill walking condition, the increased upper body muscle involvement during exercising with NW may confer additional benefit compared to conventional walking also on uphill terrains. Furthermore, people with low back pain may gain benefit from pole use when walking uphill

Comparison of effects of aerobic and resistance trainingin subjects with type 2 diabetes

Progetto 1. Confronto degli effetti del training aerobico e di quello di resistenza muscolare nei soggetti con diabete tipo 2. Numero di registro ClinicalTrials.gov: NCT01182948 Background. L\u2019esercizio \ue8 considerato un importante strumento nel management del diabete tipo 2. Le pi\uf9 recenti linee guida raccomandano a questi pazienti, come strategia per migliorare il controllo glicemico, attivit\ue0 combinata aerobica e di forza. Tuttavia, rimane da definire quali differenze ci siano nei meccanismi con cui queste tipologie di esercizio contribuiscono al miglioramento metabolico nei soggetti diabetici. Questo ha un grande interesse speculativo e pu\uf2 essere di ausilio nel definire le combinazioni pi\uf9 appropriate fra tali tipologie di esercizio. Il nostro studio \ue8 stato disegnato per analizzare tali aspetti. Soggetti e metodi. 40 soggetti con diabete tipo 2, 12 femmine e 28 maschi (et\ue0 56\ub17 anni, BMI 29.4\ub14.6 kg/m2, HbA1c 7.3\ub10.7%) sono stati randomizzati ad un gruppo di esercizio aerobico (AER, n=20) e ad uno di forza muscolare (RES, n=20). Entrambi i gruppi si sono allenati 3 volte/settimana per 4 mesi. Il gruppo AER si \ue8 allenato per 60 minuti per sessione con una intensit\ue0 del 60-65% della frequenza cardiaca di riserva. Il gruppo RES ha svolto 3 serie di 8-10 ripetizioni, eseguendo 8 differenti esercizi mediante macchine isotoniche per sessione. Prima e dopo intervento sono stati valutati: HbA1c e altri parametri metabolici, peso, circonferenza addominale, introito calorico e dispendio energetico (questionari), consumo di ossigeno al picco durante esercizio incrementale (VO2picco), test 1RM arti inferiori e superiori (leg extension e chest press), massa grassa e magra (DEXA Total Body), sensibilit\ue0 insulinica (clamp euglicemico iperinsulinemico), funzione \u3b2-cellulare (OGTT con modello matematico), flessibilit\ue0 metabolica (calorimetria indiretta), grasso addominale sottocutaneo (SAT) e viscerale (VAT) e contenuto di grasso epatico e muscolare (Risonanza Magnetica). Inoltre, \ue8 stata valutata la glicemia durante 48 ore di monitoraggio continuo mediante Holter glicemico. Sono stati anche registrati i cambiamenti della terapia antidiabetica e gli eventi avversi. Nel corso dello studio sono state effettuate altre indagini (espressione genica e misura del DNA mitocondriale in agoaspirati del muscolo vasto laterale, estrazione tissutale di ossigeno durante test da sforzo, funzione barorecettoriale, risposta venoarteriolare, analisi spettrale della funzione autonomica, misura dello stress ossidativo). Tuttavia i risultati di queste valutazioni non sono ancora disponibili e pertanto non saranno oggetto di trattazione. Risultati. I due gruppi avevano simili caratteristiche basali. Dopo 4 mesi di intervento le variazioni di VO2picco e forza muscolare mostravano differenze significative fra i due gruppi (VO2picco 15\ub110 vs 8\ub110%, p=0.04; performance alla leg extension 4\ub111 vs 19\ub110%, p<0.0001, rispettivamente). I livelli di HbA1c erano ridotti in misura simile nei due gruppi (da 7.23\ub10.64 a 6.83\ub10.38; e da 7.34\ub10.69 a 6.99\ub10.64%, rispettivamente nel gruppo AER e nel gruppo RES). BMI, circonferenza vita, massa grassa totale e tronculare, massa magra degli arti, SAT e VAT erano ridotti in entrambi i gruppi, senza differenze significative tra le due tipologie di training. La sensibilit\ue0 insulinica era aumentata in entrambi i gruppi (30% e 15%, rispettivamente), mentre la funzione \u3b2-cellulare e la flessibilit\ue0 metabolica non erano modificate. Sia il gruppo AER che quello RES mostravano una riduzione simile nel grasso epatico e muscolare. Durante la sessione di training la concentrazione di glucosio, misurata mediante Holter glicemico, mostrava una riduzione in entrambi i gruppi. Tuttavia, la riduzione era maggiore in AER rispetto a RES (p<0.001). Differenze tra i due gruppi si osservavano inoltre nelle concentrazioni di glucosio durante la notte successiva alla sessione di training. Dopo i 4 mesi di intervento non vi erano significative modificazioni nella terapia antidiabetica. Non sono stati registrati rilevanti eventi avversi. La riduzione di HbA1c era significativamente associata a cambiamento di massa grassa totale e tronculare, VO2picco, potenza al picco e performance alla leg extension. L\u2019aumento della sensibilit\ue0 insulinica era significativamente associato a cambiamento di VAT, rapporto VAT/SAT e VO2picco. All\u2019analisi multivariata il cambiamento di HbA1c era predetto in modo indipendente dai livelli basali di HbA1c e dalle variazioni di VO2picco, performance alla leg extension e massa grassa tronculare (varianza spiegata 65%). L\u2019aumento della sensibilit\ue0 insulinica era predetto dal cambiamento di VAT e VO2picco mentre i cambiamenti della performance alla leg extension e della massa muscolare degli arti mostravano un\u2019associazione con significativit\ue0 borderline (varianza spiegata 66%). Conclusioni. Questi dati mostrano che l\u2019allenamento aerobico e quello di forza possono esercitare effetti benefici simili sul controllo metabolico nei soggetti con diabete tipo 2, malgrado effetti differenti sulle capacit\ue0 funzionali. La riduzione acuta post-esercizio della glicemia \ue8 maggiore dopo attivit\ue0 aerobica che dopo attivit\ue0 di forza, suggerendo che l\u2019aumentato rischio di ipoglicemia dopo esercizio va considerato soprattutto dopo attivit\ue0 aerobica. Gli effetti positivi dell\u2019esercizio sull\u2019insulinoresistenza appaiono associati in modo indipendente all\u2019aumento nella fitness cardiorespiratoria e alla riduzione del grasso viscerale. Progetto 2. Il modello dei gruppi di cammino supervisionati per implementare la pratica dell\u2019attivit\ue0 fisica nei soggetti con diabete tipo 2. Numero di registro ClinicalTrials.gov: NCT01115205 Background e scopo. L\u2019esercizio fisico ha documentato un potenziale ruolo di primo piano nel management del diabete tipo 2, ma resta da chiarire come questa evidenza possa essere trasferita nella pratica clinica. Numerosi studi hanno documentato l\u2019inefficacia, nell\u2019ottenere cambiamenti metabolici in questi soggetti, di programmi di esercizio non supervisionato. Scopo di questo studio \ue8 stato quello di valutare l\u2019impatto che l\u2019attivit\ue0 di gruppi di cammino supervisionati pu\uf2 avere in questi pazienti. Soggetti e Metodi. 59 soggetti con diabete tipo 2 sono stati randomizzati, con rapporto 1:2, ad un gruppo di controllo o ad un gruppo di intervento. Il gruppo di controllo ha ricevuto raccomandazioni standard, nell\u2019ambito della routine ambulatoriale, per aumentare l\u2019attivit\ue0 fisica spontanea, mentre il gruppo di intervento \ue8 stato organizzato in gruppi di cammino e sottoposto a sedute di counseling. L\u2019intervento ha avuto una durata di 4 mesi per una frequenza di 3 volte/settimana. All\u2019inizio e al termine dell\u2019intervento sono stati misurati HbA1c (outcome primario), glicemia, profilo lipidico, peso e pressione arteriosa. Inoltre, all\u2019inizio e al termine dell\u2019intervento, \ue8 stata misurata la distanza percorsa in 6 minuti di cammino veloce (6 minute walk test) e sono stati quantificati l\u2019attivit\ue0 fisica complessiva svolta e i farmaci antidiabetici prescritti. Risultati. I due gruppi presentavano simili caratteristiche basali. Al termine dello studio le variazioni nella distanza percorsa nel test dei 6 minuti e nel volume di attivit\ue0 fisica complessiva erano maggiori nel gruppo di intervento, mentre i cambiamenti nei parametri metabolici non erano significativamente diversi. Tuttavia, nei soggetti del gruppo di intervento che avevano frequentato almeno il 50% delle sessioni di cammino guidato la riduzione di HbA1c e glicemia era significativamente maggiore del gruppo di controllo. Al termine dei 4 mesi, una riduzione o sospensione dei farmaci antidiabetici era stata prescritta nel 33% dei soggetti del gruppo di intervento e nel 5% dei controlli (p<0.05). Conclusioni. Praticare attivit\ue0 fisica mediante gruppi di cammino guidato pu\uf2 determinare significativi benefici metabolici nei soggetti con diabete tipo 2, purch\ue9 vi sia una adeguata compliance.Project 1. Effects of Aerobic training and Resistance training in type 2 Diabetes. ClinicalTrials.gov Identifier Number: NCT01182948 Background. Exercise is considered a fundamental issue in the management of subjects with type 2 diabetes (T2DM). The most recent guidelines recommend both aerobic and strength exercise in these subjects, as this strategy may have greater beneficial effects on glucose control. However, it still remains unclear which differences and similarities exist between the effects of these two training protocols on the different factors contributing to metabolic control in subjects with T2DM. This is of great speculative interest and could help in programming a more appropriate combination of different exercise modalities. Our study aimed at exploring this crucial issue. Subjects and Methods. 40 T2DM subjects, 12 females and 28 males (mean\ub1SD: age 56\ub17 years, BMI 29.4\ub14.6 kg/m2, HbA1c 7.3\ub10.7%) were randomized to aerobic (AER, n=20) or resistance (RES, n=20) training. In both groups exercise was performed 3 times weekly, for 4 months. The AER group exercised for 60 minutes at 60-65% heart rate reserve. The RES group performed 3 series of 8-10 repetitions of 8 different exercises on weight machines each session, at 70-80% 1RM. Before and after the intervention the following were assessed: HbA1c and other metabolic features, weight, waist circumference, caloric intake and overall physical activity (through questionnaires), peak oxygen uptake (VO2peak), leg and arm muscle 1RM tests (leg extension and chest press), fat mass and fat free mass (DEXA Total Body), insulin sensitivity (euglycemic hyperinsulinemic clamp), \u3b2-cell function (OGTT and mathematical models), metabolic flexibility (calorimetry), subcutaneous (SAT) and visceral abdominal adipose tissue (VAT), and hepatic and skeletal muscle fat content (Magnetic Resonance Imaging). In addition, continuous plasma glucose monitoring for 48 h was carried out and changes in antidiabetic therapy and adverse events were recorded. Some additional investigations were also carried out (expression of relevant genes and measurement of mitochondrial DNA in fine needle aspirates of vastus lateralis muscle; tissue oxygen extraction during exercise test; baroreceptor function; venoarteriolar response; spectral analysis of autonomic system function; oxidative stress measurement). However, these data are not yet available and therefore these aspects have not been included in the thesis. Results. The two groups had similar baseline characteristics. After 4 months of training, changes in VO2peak and strength showed significant differences between the AER and RES groups (VO2peak 15\ub110 vs 8\ub110%, p=0.04; Leg extension performance 4\ub111 vs 19\ub110%, p<0.0001, respectively). HbA1c was similarly reduced in the two groups (from 7.23\ub10.64 to 6.83\ub10.38; and from 7.34\ub10.69 to 6.99\ub10.64%, respectively in the AER and RES groups). BMI, waist, fat mass, truncal fat, limbs lean mass, SAT and VAT were also significantly reduced in both groups, with no statistically significant differences between the two groups. Insulin sensitivity was significantly increased in both groups (by 30% and 15%, respectively), while \u3b2-cell function and metabolic flexibility did not change in the two groups. AER and RES groups showed similar reductions in hepatic and skeletal muscle fat. During the 60 min of supervised training, blood glucose, measured by a continuous glucose monitoring system, showed a reduction in both groups. However, reduction was significantly greater in the AER than in the RES group (p<0.001). Differences between groups were also found in the comparison of blood glucose values recorded during the night following the training session. After 4 months of training there was no significant change in antidiabetic medications and no relevant adverse events were reported. In the entire cohort of subjects, reduction after training of HbA1c was significantly associated with changes in total body fat, truncal fat, VO2peak, maximal workload and leg extension performance. Changes in insulin sensitivity, as measured by the glucose clamp, were significantly associated with changes in VAT and VAT/SAT ratio, as well as with changes in VO2peak. In multiple regression analyses, change after intervention in HbA1c was independently predicted by HbA1c at baseline and changes in VO2peak, leg extension performance and truncal fat (overall variance explained 65%). Change after intervention in insulin sensitivity was independently predicted by changes in VAT and VO2peak, whereas changes of leg extension performance and limb lean mass were of borderline significance (variance explained 66%). Conclusions. These data show that aerobic and resistance training can exert similar beneficial effects on glucose control in type 2 diabetes subjects, despite their different effects on functional capacity. Post-exercise acute blood glucose reduction is greater after aerobic training than after resistance training, suggesting an increased risk of post-exercise hypoglycemia after an aerobic exercise session. Exercise-induced improvement of insulin sensitivity is independently predicted by the increase in cardiorespiratory fitness and reduction in visceral fat. Project 2. Supervised walking groups to increase physical activity in type 2 diabetes patients. ClinicalTrials.gov Identifier Number: NCT01115205 Background. Previous studies reported that self-paced walking is inadequate to obtain metabolic improvement in patients with type 2 diabetes (T2DM). The aims of this study were to evaluate the compliance of T2DM patients with an exercise programme organized into supervised walking groups; and to assess the impact of this model on metabolic control and overall physical activity. Subjects and Methods. 59 T2DM subjects were randomized, with a 1:2 ratio, to a control group or an intervention group. The control group received standard recommendations to increase physical activity. Intervention was based on supervised walking groups and counselling. Progressive training sessions were scheduled 3 times weekly for 4 months. Before and at the end of the study, haemoglobin (Hb)A1c (primary outcome), fasting glucose, serum lipids, weight, and blood pressure were measured. Functional capacity was assessed by a 6 minute walk test. Changes in prescription of antidiabetic medications and overall physical activity were also recorded. Results. At baseline, the two groups were similar. At the end of the study, functional capacity and overall physical activity were higher in the intervention group, whereas changes in metabolic parameters did not show significant differences between the groups. However, in subjects of the intervention group who attended at least 50% of scheduled walking, changes in HbA1c and fasting glucose were greater than in controls. Discontinuation or reduction of antidiabetic drugs occurred in 33% of these patients vs 5 % in the control group (p<0.05). Conclusions. Supervised walking may be beneficial in diabetic subjects, but metabolic improvement requires adequate compliance

La natura morta di Federico Zeri

Il testo esamina in ordine cronologico i numerosi studi di Federico Zeri dedicati alla pittura di Natura morta, prendendo inoltre in considerazione il lavoro da lui svolto nella raccolta dell'imponente nucleo di fotografie di questo tema, oggi a Bologn

La natura morta di Federico Zeri

Il volume raccoglie circa quindici contributi di vari studiosi che esaminano vari temi della pittura di natura morta italiana del Sei e Settecento, pubblicando fra l'altro numerose opere inedite. Il volume scatursice dalla catalogazione delle oltre 13.000 fotografie di opere di natura morta conservate nell'archivio fotografico di Federico Zer

Metabolic Effects of Exercise

Exercise has a powerful action on metabolism, and adaptation of the body to changes induced by exercise is fundamental to be able to provide the energy required for muscle contraction and physiological functions of vital tissues. Depending on the intensity and duration of exercise, different mechanisms are called on to make energy available, and under homeostatic control, this is guaranteed by rapid and coordinated changes in the secretion of several hormones. Molecular mechanisms controlling muscle function and fiber phenotype are related to the specific mode of muscle activation. We can distinguish between two fundamental types of physical activity, endurance exercise and strength exercise, although there is a continuum between these exercise modalities. Besides the acute changes induced by a single exercise session, regular exercise may induce chronic adaptations, improving exercise capacity and affecting energy metabolism. Notably, although acute metabolic effects of exercise are mostly due to insulin-independent effects, exercise training may improve muscle insulin sensitivity and is considered a key tool in the prevention and treatment of metabolic disorders. This chapter focuses on the biochemistry of energy supply to the exercising muscle, on molecular mechanisms involved and on the physiology of energy metabolism during exercise in healthy subjects and patients with insulin resistance and/or diabetes