Nutritional Quality of Wholegrain Cereal-Based Products Sold on the Italian Market: Data from the FLIP Study

The consumption of wholegrains (WG) is encouraged worldwide, but the lack of a common legal definition of such products leads to an unclear classification and identification on the grocery store shelf. In Italy, several products are generally sold as WG, but it cannot be determined if they are made entirely with all WG cereal(s) or if they are partially produced with WG ingredients (PWG). The aims of this study were to (a) survey the number of cereal-based food items formulated with WG, PWG, or refined (RG) present on the Italian market; and (b) analyse the nutritional quality, intended as nutrition facts, of WG products in comparison to PWG and RG. Nutritional information and declarations were retrieved from packs of 3040 products belonging to five different categories: breakfast cereals, biscuits, sweet snacks, bread, and bread substitutes. A descriptive analysis of the products and comparison of energy, macronutrients, fibre and salt among RG, PWG and WG products within each category was performed. In all categories, a major portion of the products did not contain WG ingredients. Results showed that the nutritional quality of RG, PWG, and WG products varied in relation to the product category and that WG inclusion cannot be always considered a marker of the overall nutritional quality of foods. Instead, it is necessary to evaluate the global product characteristics, and it is important to pay attention to differences between WG and PWG products that can be perceived by consumers as equivalent

Effect of the Pasta Making Process on Slowly Digestible Starch Content

The rate at which starch is digested in the human intestine elicits different glycemic responses and reflects the glycemic index (GI) of foods. In vitro measurement of starch digestibility can reflect the GI of food. Differences in starch digestibility among four durum wheat pasta samples, couscous, and bread were evaluated to better describe the role of the pasta making process in affecting starch digestibility. Statistical differences in RDS (rapidly digestible starch), SDS (slowly digestible starch), and RS (resistant starch) of products were found (p < 0.05). As expected, pasta samples showed the highest value of SDS/av starch compared to couscous and bread. Fusilli and cavatelli samples presented the highest SDS/av starch ratio (55.80 +/- 3.06% and 53.91 +/- 3.50%, respectively), then came spaghetti 49.39 +/- 2.83% and penne 45.93 +/- 1.19%, while couscous presented the lowest value of SDS/av starch (2.64 +/- 0.50%), followed by bread (11.78 +/- 2.63%). Our study confirmed that the pasta making process efficiently mediates an increase in SDS/Av starch content, which has been specifically quantified above 40%, therefore strongly related to a lowered glycemic response in vivo. Our results strengthened the concept that pasta is a good source of SDS, which makes it useful for glycemic control

Evolutionary Wheat Populations in High-Quality Breadmaking as a Tool to Preserve Agri-Food Biodiversity

Plant biodiversity preservation is one of the most important priorities of today’s agriculture. Wheat (Triticum spp. L.) is widely cultivated worldwide, mostly under a conventional and monovarietal farming method, leading to progressive biodiversity erosion. On the contrary, the evolutionary population (EP) cultivation technique is characterized by mixing and sowing together as many wheat genotypes as possible to allow the crop to genetically adapt over the years in relation to specific pedoclimatic conditions. The objective of this study was to assess the nutritional, chemical and sensory qualities of three different breads obtained using different organic EP flours, produced following a traditional sourdough process and compared to a commercial wheat cultivar bread. Technological parameters, B-complex vitamins, microelements, dietary fibre and phenolic acids were determined in raw materials and final products. Flours obtained by EPs showed similar characteristics to the commercial wheat cultivar flour. However, significant differences on grain technological quality were found. The breads were comparable with respect to chemical and nutritional qualities. Overall, the sensory panellists rated the tasted breads positively assigning the highest score to those produced with EPs flours (6.75–7.02) as compared to commercial wheat cultivar-produced bread (cv. Bologna, 6.36)

Le infezioni da streptococco B in Emilia-Romagna: un problema sempre più pediatrico

Introduction: Group B streptococcus (GBS) is still a leading cause of neonatal sepsis and meningitis. It can result in death or long-term disabilities, including mental retardation and hearing or vision loss. Even if the adoption of preventive strategies significantly decreased the rate of early-onset infections, cases of GBS infection continue to occur. Methods: We determined incidence and clinical features of disease in Emilia-Romagna, a Northern region of Italy where GBS preventive strategies have been implemented. Results: The total number of live births was 12,933. Early-onset infections (EOD) were 30 (2 infants died), whereas late-onset diseases (LOD) were 26 (4 infants died), with the latter accounting for most meningitis and deaths. Risk factors were found in 12 and 7 infants with EOD and LOD respectively. 2 women. Twenty-one term mothers had antenatal screening: four were GBS colonized but 17 were culture negative. Conclusion: The incidence of EOD found in Emilia-Romagna is one of the lowest in Europe. Several early infections were still observed because of negative screening results. LODs accounted for most meningitis cases and deaths

Pasta Structure Affects Mastication, Bolus Properties, and Postprandial Glucose and Insulin Metabolism in Healthy Adults

Background: Structure and protein-starch interactions in pasta products may be responsible for lower postprandial glycemic responses compared with other cereal foods. Objective: We tested the effect on postprandial glucose metabolism induced by two pasta products, couscous and bread, through their structural changes during mastication and simulated gastric digestion. Methods: Two randomized controlled trials (n = 30/trial) in healthy normal weight adults (23.9 and 23.0 kg/m2) evaluated postprandial glucose metabolism modulation to 50g of available carbohydrate portions of durum wheat semolina spaghetti, penne, couscous, and bread. A mastication trial involving 26 normal weight adults was conducted to investigate mastication processes and changes in particle size distribution and microstructure (light microscopy) of boluses after mastication and in vitro gastric digestion. Results: Both pasta products resulted in lower areas under the 2h-curve for blood glucose (-40% for spaghetti and -22% for penne vs couscous; -41% for spaghetti and -30% for penne vs bread), compared with the other grain products (P < 0.05). Pasta products required more chews (spaghetti: 34 \ub1 18; penne: 38 \ub1 20; bread: 27 \ub1 13; couscous: 24 \ub1 17) and longer oral processing (spaghetti: 21 \ub1 13 s; penne: 23 \ub1 14 s; bread: 18 \ub1 9 s; couscous: 14 \ub1 10 s) than bread or couscous (P < 0.01). Pastas contained more large particles (46-67% of total particle area) compared to bread (0-30%) and couscous (1%) after mastication and in vitro gastric digestion. After in vitro gastric digestion, pasta samples still contained large areas of non-hydrolyzed starch embedded within the protein network, protein in bread and couscous was almost entirely digested, and starch was hydrolyzed. Conclusions: Preservation of the pasta structure during mastication and gastric digestion explains slower starch hydrolysis and, consequently, lower postprandial glycemia compared to bread or couscous prepared from the same durum wheat semolina flour in healthy adults. Postprandial in vivo trials were registered at clinicaltrials.gov as NCT03098017 & NCT03104686.Clinical Trial Registry: NCT03098017 & NCT03104686 www.clinicaltrials.gov

Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study

Purpose: Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcus (GBS) early-onset disease (EOD). No European study evaluates the relative impact of risk factors (RFs) for EOD after a screening-based strategy and widespread IAP use We aimed to evaluate the risks of EOD in an Italian region where a screening-based strategy for preventing EOD was implemented. Materials and methods: Cases of EOD born at or above 35 weeks' gestation were reviewed and matched with controls. Results: There were 109 cases of EOD among 532,154 live births. Most cases had negative GBS prenatal screening (56/91, 61.5%) and were unexposed to IAP (86/109, 78.9%). At multivariate analysis, GBS bacteriuria (OR\u2009=\u20096.99), positive prenatal screening (OR\u2009=\u200913.7) and maternal intrapartum fever (OR\u2009=\u2009188.3) were associated with an increased risk of EOD, whereas intrapartum beta-lactam antibiotics were associated with a decreased risk of EOD ( 654\u2009h: OR\u2009=\u20090.008; <4\u2009h: OR\u2009=\u20090.04). Neonates born to nonfebrile, GBS positive pregnant women, receiving beta-lactam antibiotics had very low probability of EOD, particularly if IAP was adequate. Conclusions: GBS positive prenatal screening, GBS bacteriuria and intrapartum fever are associated with EOD. Intrapartum beta-lactam antibiotics reduce the probability of EOD in neonates born to nonfebrile mothers

Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers

OBJECTIVES: The involvement of the gut microbiota in the pathogenesis of calcium nephrolithiasis has been hypothesised since the discovery of the oxalate-degrading activity of Oxalobacter formigenes, but never comprehensively studied with metagenomics. The aim of this case-control study was to compare the faecal microbiota composition and functionality between recurrent idiopathic calcium stone formers (SFs) and controls. DESIGN: Faecal samples were collected from 52 SFs and 48 controls (mean age 48±11). The microbiota composition was analysed through 16S rRNA microbial profiling approach. Ten samples (five SFs, five controls) were also analysed with deep shotgun metagenomics sequencing, with focus on oxalate-degrading microbial metabolic pathways. Dietary habits, assessed through a food-frequency questionnaire, and 24-hour urinary excretion of prolithogenic and antilithogenic factors, including calcium and oxalate, were compared between SFs and controls, and considered as covariates in the comparison of microbiota profiles. RESULTS: SFs exhibited lower faecal microbial diversity than controls (Chao1 index 1460±363vs 1658±297, fully adjusted p=0.02 with stepwise backward regression analysis). At multivariate analyses, three taxa (Faecalibacterium, Enterobacter, Dorea) were significantly less represented in faecal samples of SFs. The Oxalobacter abundance was not different between groups. Faecal samples from SFs exhibited a significantly lower bacterial representation of genes involved in oxalate degradation, with inverse correlation with 24-hour oxalate excretion (r=-0.87, p=0.002). The oxalate-degrading genes were represented in several bacterial species, whose cumulative abundance was inversely correlated with oxaluria (r=-0.85, p=0.02). CONCLUSIONS: Idiopathic calcium SFs exhibited altered gut microbiota composition and functionality that could contribute to nephrolithiasis physiopathology

Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Background: The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). Conclusions: This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography

Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Background: The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and >= 40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions: This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers