Psychological Distress in Morbid Obesity in Relation to Weight History

Background: Very few data are available on psychological distress in morbidly obese subjects in relation to the history of their weight. In subjects with childhood obesity, psychological distress might be better than in adult-onset obesity, because of progressive adaptation to the social stigma. Methods: Psychological distress was tested in relation to BMI at age 20 years (BMI-20), weight history and somatic co-morbidities in 632 treatment-seeking, morbidly obese participants from the QUOVADIS cohort (130 men, 502 women; mean age 45.5 years). The number of dieting attempts/year, BMI increase and cumulative BMI loss since age 20 were calculated as weight cycling parameters.The Symptom Check List-90 (SCL-90), the Psychological General Well- Being (PGWB), the Binge-Eating Scale, and the ORWELL-97 questionnaire were used to score psychometry and health-related quality of life (HRQL). Complications were quantitatively assessed by a modified Charlson\u2019s score. Results: BMI-20 was normal in 35% of cases and >35 kg/m2 in only 14%. Psychometric scores were not different in relation to BMI-20, when corrected for age, with the exception of the General Health scale of PGWB, showing a greater distress in subjects with normal BMI-20. In most cases, the prevalence of pathological results of questionnaires showed a Jshaped curve, with participants with normal BMI-20 or those with Class II-III obesity in early adulthood having the highest prevalence of psychological/psychiatric distress and poor HRQL.Weight cycling was a risk factor for binge-eating, depression and interpersonal sensitivity in SCL-90, whereas somatic co-morbidities adversely affected most SCL-90 and all PGWB scales. Conclusion: Weight cycling and somatic co-morbidities, but not age of onset of obesity, are the main factors negatively influencing psychological health in treatment-seeking, morbidly obese subjects

MRONJ in breast cancer patients under bone modifying agents for cancer treatment-induced bone loss (CTIBL): a multi-hospital-based case series

BackgroundCancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ.MethodsThis multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients' data were retrospectively collected from the clinical charts of seven recruiting Italian centres.ResultsMRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandible (73.3%). The mean duration of BMAs therapy at MRONJ presentation was 34.9 months. The more frequent BMAs was denosumab (53.3%). Ten patients (66.7%) showed the following local risk factors associated to MRONJ development: periodontal disease (PD) in three cases (20%) and the remaining six (40%) have undergone PD-related tooth extractions. One patient presented an implant presence-triggered MRONJ (6.7%). In five patients (33.3%) no local risk factors were observed.ConclusionsThis is the first case series that investigated BC patients under BMAs for CTIBL prevention suffering from MRONJ. These patients seem to have similar probabilities of developing MRONJ as osteo-metabolic ones. Breast cancer patients under BMAs for CTIBL prevention need a regular prevention program for MRONJ, since they may develop bone metastases and be treated with higher doses of BMAs, potentially leading to a high-risk of MRONJ

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

I paesaggi terrazzati della Campania, Italia

Terraced landscapes in Italy represent a resource of sustainable development and environmental protection. Terraced agrarian landscapes have multiple functions: ecological, social, cultural, economic. The abandonment of traditional agricultural activities and the fragmentation due to urban development threaten the conservation of these unique landscapes. A detailed mapping of terraced landscapes at national level has been undertaken with the Mapter project, with the aim of identifying terraced landscapes in the Italian peninsula. This paper offers an overview of historic terraced landscapes in the Campania region, Italy, identifying the structural factors in different territories. A frst mapping has been realized using the institutional geospatial databases of the Campania Region authority and the Corine Land Cover 2012, validated through comparison with satellite images. The maps have been realized in GIS environment. The results identify agrarian terraced landscapes in the provinces of Naples, Salerno and Caserta, including the islands of Ischia and Capri and sites of Outstanding Universal Value (OUV) among which the UNESCO World Heritage Site of Amalf Coast and the terraced area of San Martino hill in the historic centre of Naples. Terraces are thus an important landscape and environmental resource in the Campania region. The Regional Landscape Plan, forthcoming, can represent a useful regulation tool for the safeguard and valorisation of terraced landscapes in Campania. Cultural landscape

An Italian investigation on nutritional risk at hospital admission: The PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

Background & aims: Nutritional risk on admission to hospital, which turns out to be high in most countries, was investigated. However, when consulting the "malnutrition-mapping" in Europe, the lack of Italian data raises attention. Accordingly, we designed a multidisciplinary, cross-sectional survey: the PIMAI study (Project: Iatrogenic MAlnutrition in Italy). Methods: Patients were enrolled from 13 large (>400 beds) multidisciplinary hospitals. Randomly selected adult (>18-year-old) patients were included according to a 4-strata model by gender and age (<65 and ≥65 years). Nutritional risk was assessed by the Nutritional Risk Screening 2002 tool. Results: A total of 1284 patients were evaluated. Overall prevalence of nutritional risk was 28.6% with similar distribution between sexes and higher rates in medical rather than in surgical departments (33.6% vs 22.8%; p < 0.0001). Risk prevalence was markedly heterogeneous among specialties, ranging between 4.8% (ophthalmology) and 62.5% (oncology units). Moreover, in adults aged 18-65 years the prevalence of "risk of malnutrition" was significantly lower than in those ≥65 years (18.3% vs 41.9%; p < 0.0001). Conclusions: The prevalence of nutritional risk on admission to hospital is high also in Italy. However, in patients aged 18-65 years nutritional risk appears a less prevalent comorbidity, thus supporting the role of age as an important determinant. © 2009 European Society for Clinical Nutrition and Metabolism

A nationally representative survey of hospital malnutrition: The Italian PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

Hospital malnutrition is high in every country it was investigated, but no nationally representative prevalence study, considering potential geographical interfering factors, has yet been performed. We designed a multidisciplinary, cross-sectional, nation-wide survey: the PIMAI study (Project: Iatrogenic MAlnutrition in Italy). Adult (>18 years old) patient inclusion was managed on a four-strata randomisation model according to sex and age (<65 and ≥65 years). Malnutrition was defined by analytical criteria related to recent food intake and both physical (body mass index, weight loss, midupper arm anthropometry) and biochemical (albumin, prealbumin and lymphocyte count) malnutrition correlates. Thirteen hospitals (n = 1583) completed the study. The survey is likely to represent the country of Italy. Overall prevalence of malnutrition was 30.7%, with higher rates in the northern macroarea (36.7%) than in central (28.0%), southern (26.9%) and island (16.7%) ones (p < 0.0001). This discrepancy appeared to be mainly related to the prevalence of overweight/obesity. By a multivariate model, malnutrition was significantly lower in males (p < 0.05) and surgical wards (p < 0.002), associated with geography (p < 0.05) and consistently higher in patients aged ≥65 years (p < 0.01), presenting with malignancies (p < 0.005) and having multidrug therapy (p < 0.05). The prevalence of hospital malnutrition is high also in Italy. It presents with different geographical distribution also according to overweight prevalence. This evidence should be considered when designing national nutritional policies. © 2009 Springer-Verlag Italia