EVALUATION OF DIFFERENT TYPES OF PASTA DI GRAGNANO ON APPETITE REGULATION AND METABOLIC PROFILE

Among cereal products, pasta is widely consumed in Italy, particularly in the south, where it represents the main source of resistant starch. Pasta has a low glycemic index (GI), in particular whole grain pasta (WGP) is a good source of dietary fiber and bioactive compounds. This thesis, investigated the effect of different types of pasta meal, including a mixed meal with pulses, on appetite regulation and glucose response, with special attention on the effect of WGP on satiation, satiety and food intake. Two research projects, in Italy and Denmark, were performed, by which we tested different types of pasta made in Gragnano and classified as Protect Geographical Indication (PGI). First, we observed that WGP increased feeling of satiety and decreased hunger sensation compared to other types of pasta analyzed in the thesis. In addition, WGP influenced meal-induced thermogenesis (MIT) and fullness, suggesting a relation between appetite and MIT. However, the post-prandial metabolic profile was not influenced as well as gut hormones. Second, we compared WGP with refined grain pasta (RGP) and we found that WGP resulted in an early increase in breath hydrogen excretion, suggesting that colonic fermentation might be a possible link between satiety and WGP intake. Overall, WGP did not affect food intake both within and at the subsequent meal, however, interesting sex-based difference was found. In conclusion, the results strongly showed the beneficial effect of WGP on appetite, nevertheless, further investigation are needed in order to better define the mechanism of actions

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

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 (n = 1680) and validation (n = 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

Prediction and evaluation of resting energy expenditure in a large group of obese outpatients

The aim of this study was to compare resting energy expenditure (REE) measured (MREE) by indirect calorimetry (IC) and REE predicted (PREE) from established predictive equations in a large sample of obese Caucasian adults

Comparison of bioelectrical impedance analysis-derived phase angle in individuals with different weight status

Objective: Obesity is characterized not only by an increase of fat mass but also by alterations in skeletal muscle. Bioimpedance analysis (BIA)-derived phase angle (PhA) may provide specific information on the inherent characteristics of fat-free mass, and is widely used as an index of poor nutritional status. The aim of this study was to describe whether and to what extent PhA varies depending on age, sex, and body mass index (BMI) in individuals with different weight status. Methods: We selected 1877 participants for this retrospective study (two weight status groups): 983 individuals with obesity (age 40 ± 13.9 y; BMI 39.5 ± 7.2 kg/m²) and 894 controls (age 40 ± 13.3 y; BMI 24.6 ± 2.7 kg/m²). Anthropometry and PhA at 50 kHz for the whole body were performed in all participants. Results: PhA was greater in men than in women, although a decline of PhA was observed with age, which was linear in women and occurred in men after 40 y of age. On the other hand, no significant differences were observed with increasing BMI in either sex; lower values might be observed when BMI >50 kg/m². Conclusions: A more detailed appraisal of BIA-derived PhA in obesity is reported in the present study, providing basic data that might be taken into consideration in prevention and clinical nutrition. Further studies are needed to explore differences of PhA in individuals with different weight status

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

SummaryBackground & aimsCrohn'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.Methods36 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.ResultsThe 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).ConclusionsOur 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

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

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Paralytic ileus, a new rare toxicity of capecitabine: Two case reports

Paralytic ileus (or adynamic ileus) refers to a lack of passage of intestinal contents due to disturbances of normal intestinal motility, in absense of mechanical obstruction. The most common causes are intra-abdominal surgery, severe metabolic problems, drugs. We present two clinical cases related to patients with breast cancer and admitted with paralytic ileus following treatment with capacitabine in local Lanciano Hospital. Naranjo, Jones algoritms suggest a direct causal relationship. Our two cases, to our knowledge, represent the first published report of this particular intestinal toxicity of capecitabine. Pathophisiological explanation is difficult because no data are known about fluoropyrimidines effects on enteric motor functions (motor system, neural influences, hormonal factors): Tegafur (UFT) also, another oral fluoropyrimidine, induces paralytic ileus. We hypothesize that some 5-flourouracil metabolites (5-fluorocitrate; fluoro-beta-alanine), seldom responsible for central and peripherical neurotoxicity from fluoropyrimidines, can sometimes cause a neuropathy, and so a paralytic ileus. Paralytic ileus is probably a rare complication of capecitabine, but the oncologist should take it into careful consideration, because of his possible seriousness and because a suitable management of early signs of abdominal distension (with nasogastric suction and/or rectal tube, i.v. infusion of fluids and electrolytes, etc.) can avoid a unnecessary operative treatment

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

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

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation