Dietary cadmium exposure and risk of melanoma: an Italian population-based case-control study

Background and aim. The heavy metal cadmium could be highly toxic to humans, and its environmental exposure has been linked to many adverse health effects, such as atherosclerosis, diabetes, and cancer, including melanoma. Although the underlying mechanisms need yet to be clearly identified, recent findings suggested that cadmium can specifically promote the malignant transformation of melanoma cells through the aberrant DNA methylation inducing dysregulation of specific gene expression. Since in the non-occupationally exposed population, in addition to smoking, food intake is the major source of cadmium exposure, we aimed at assessing the risk of cutaneous melanoma in relation to dietary cadmium intake. Methods. Using a population-based study design, we recruited 380 incident cases of newly-diagnosed melanoma and 719 sex- and age-matched controls in the Emilia-Romagna Region, Northern Italy. We evaluated their dietary habits through a semi-quantitative food frequency questionnaire and we computed the odds ratio (OR) and its 95% confidence interval (CI) for melanoma according to quintile distribution of cadmium intake, using a conditional logistic regression model, matching by sex, age and province of residence, and adjusting also for phototype, non-alcoholic energy intake, body mass index, and Italian Mediterranean Diet Index. Results: Median intake of cadmium was 5.81 µg/day (interquartile range 4.46-7.59) in cases, and 5.63 µg/day (4.46-7.34) in controls. OR of melanoma associated with 1-unit increase in cadmium intake was 1.11 (95% CI 1.00-1.24). Melanoma risk increased with increasing quintile of cadmium exposure, with ORs of 1.55 (95% CI 0.99-2.42), 1.54 (95% CI 0.99-2-40), 1.75 (95% CI 1.12-2.75), and 1.65 (95% CI 1.05-2.61) in the second to the highest quintile compared to the lowest quintile. Sex-stratified analysis showed substantially comparable results and a generally higher risk in female population, with continuous ORs of 1.10 (95% CI 0.93-1-29), and 1.15 (95% CI 0.99-1.33) in men and women, respectively. Conclusions: Our results suggest a positive association between cadmium exposure through diet and risk of cutaneous melanoma in a Northern Italy population. Such association started to occur at a level of exposure lower than the tolerable intake established by the World Health Organization, and considered to be safe for humans

Dietary cadmium intake and risk of cutaneous melanoma: a population-based case-control study in Northern Italy

BACKGROUND AND AIM. Cadmium is a toxic heavy metal for humans, and its environmental exposure has been linked to many adverse health effects, including cancer, atherosclerosis and diabetes. In particular, recent findings suggest that cadmium may increase risk of cutaneous melanoma, possibly through the promotion of the malignant transformation of melanoma cells through aberrant DNA methylation and by inducing gene expression dysregulation. Since in non-occupational exposed and non-smoking subjects dietary exposure is the major source of cadmium exposure, we aimed to assess melanoma risk in relation to dietary cadmium intake. METHODS. We recruited 380 newly-diagnosed incident cases of cutaneous melanoma and 719 sex- and age-matched population controls in four North Italian provinces (Parma, Reggio Emilia, Modena, and Bologna) of Emilia-Romagna Region. We estimated their dietary habits using a semi-quantitative food frequency questionnaire and we evaluated melanoma risk by computing the odds ratio (OR) and its 95% confidence interval (CI) according to quintile distribution of cadmium intake. We used a conditional logistic regression model to compute ORs, matching by sex, age and province of residence, and adjusting also for phototype, non-alcoholic energy intake, body mass index, and Italian Mediterranean Diet Index. Also a spline regression model was used in order to evaluated possible dose-response relation. RESULTS: Median cadmium intake was 5.81 µg/day (interquartile range 4.46-7.59) in cases, and 5.63 µg/day (4.46-7.34) in controls. OR of melanoma associated with 1-unit increase in cadmium intake was 1.11 (95% CI 1.00-1.24). Melanoma risk increased with increasing quintile of cadmium exposure, with ORs of 1.55 (95% CI 0.99-2.42), 1.54 (95% CI 0.99-2-40), 1.75 (95% CI 1.12-2.75), and 1.65 (95% CI 1.05-2.61) from second to highest quintile compared to lowest quintile. Sex-stratified analysis showed substantially comparable results and a generally higher risk in women, with continuous ORs of 1.10 (95% CI 0.93-1-29), and 1.15 (95% CI 0.99-1.33) in men and women, respectively. Spline regression analysis showed a non-linear risk increase, with possible plateau at 5-6 µg/day of cadmium intake. Slightly higher risk estimates in women and older subjects were detected. CONCLUSIONS: Our results seem to point out a positive association between dietary cadmium exposure and melanoma risk in the study population. Such association started to occur at a level of exposure lower than the tolerable intake established for food safety by international authorities

Healthy status and energy balance in pediatrics

During growth, the human body increases in size and changes proportion of various components due to hormones mediators. Nutritional status is the result of introduction, absorption and utilization of the nutrients and it has a new definition in the relationship between nutritional status and healthy status. In this view energy balance, body function and body composition are three entities correlated each other. This mini-review article examines issues and techniques specifically related to a pediatric population in the field of body composition and energy expenditure. It is broadly divided into two sections. The first section discusses body composition measurements underlying principles, advantages, disadvantages and consensus. The second section reviews energy expenditure and physical activity measurement techniques. In conclusion general clinical suggestions are offered regarding pediatric body composition, healthy status and energy balance

Dietary exposure estimates to fifteen trace elements in an adult population of Emilia Romagna region, Northern Italy

The health effects and the exposure levels of trace elements in humans are important public health topics. Assessing their dietary intake is fundamental to evaluate the long-term risks for public health and for food safety assessment. Since a priority of food safety regulatory agencies is to ensure the protection of consumers and to assess the health risks for the general population, to estimate the actual dietary intake of trace elements for comparison with the upper and lower tolerable levels is very important. In this study, we aimed to evaluate the dietary intake of several trace elements in an Italian community, namely of antimony, barium, beryllium, boron, cobalt, lithium, molybdenum, nickel, silver, strontium, tellurium, thallium, titanium, uranium, and vanadium. To do that, in 2016-2017 we collected a total of 908 food samples available in Italian markets and groceries from two Northern Italy provinces (Modena and Reggio Emilia), and we measured their trace element content through inductively-coupled plasma mass spectrometry. We also administered a validated semi-quantitative food frequency questionnaire to 708 residents (300 men and 48 women) in the Emilia-Romagna Region, to assess their dietary habits and eventually to estimate their dietary intake of the aforementioned trace elements. Overall, study results showed that in our population the dietary exposure levels to selected trace elements could be considered similar to that observed in other European and non-European populations. Though we cannot rule out the possibility that the dietary exposure estimates in the present study may not be representative of the population as a whole, our results provide a good and updated assessment of trace elements far frequently evaluated in a sample of Italian adult consumers from the Emilia Romagna region. Our findings finally suggest that our population should not be at risk of adverse health effects in relation to excess or deficiency of the investigated trace elements since the estimated dietary intake generally point out exposure levels within the safe range as far as indicated by recommendations of international agencies

Dietary intake of calcium, phosphorus and magnesium in a Northern Italian community.

Minerals are essential micronutrients for growth, development, and maintenance of healthy tissues, the long term insufficient intake of minerals may lead to bone demineralization and often requires the use of food supplements. The ratios of certain minerals intake like calcium and phosphorus are also proved to can affect the bioavailability of calcium and even lead to adverse health consequence. This study was designed to explore the dietary sources of calcium (Ca), phosphorus (P), and magnesium (Mg) and the ratios between different minerals (Ca/P). We measured the content of these elements in foods composing typical Italian diet using inductively coupled plasma-mass spectrometry and we estimated their daily dietary intakes assessing through a semi-quantitative food frequency questionnaire specifically developed within the European Prospective Investigation into Cancer and Nutrition (EPIC) study in a Northern Italian Community. In 890 analyzed food samples the main contributors to calcium are milk and dietary products, dry fruits, legumes and sweet products. Important sources of phosphorus are represented by dry fruits, legumes, milk and dairy products and meat. While dry fruits, legumes, cereals and fish symbolized the most important sources for magnesium. In our Italian population sample, the estimated median (interquartile range) dietary daily intakes are 786.3 (592.2-1062.7) μg/day for calcium; 1291.7 (1017.2-1591.4) mg/day for phosphorus and 323.2 (260.3-396.6) mg/day for magnesium. The calcium-phosphorus (Ca/P) ratio in this study was 0.63 (0.52-0.73). These values are in agreement with those suggested by European and International recommended intake for adult population, with the exception of calcium which is slightly lower than recommended values and suggest that this population does not present nutritional deficiencies requiring any supplementation

A new device for measuring resting energy expenditure (REE) in healthy subjects.

Lifestyle change targeted towards increasing daily resting energy expenditure (REE) is one of the cornerstones of obesity treatment. Measurements of energy expenditure and substrate utilization are essential to understanding the metabolic basis of obesity, and the physiological responses to perturbations in habitual food intake. REE is the largest part of human energy expenditure (60-70%) and an increase or decrease in REE would have a large impact on total energy. Accurate and easy-to-use methods for measuring REE are needed, to be applied by clinicians in daily clinical settings to assess the validity of a new instrument to estimate REE in normal weight, healthy adults. METHODS: Ninety-nine subjects (52 females and 47 males) (mean+/-SD, age 38+/-14 years; body mass index (BMI) 23+/-3 kg/m(2)) were tested. REE was assessed using a Sensor Medics Vmax metabolic cart with a ventilated canopy and with the SenseWear armband. Body composition, percentage fat mass (%FM) and percentage fat free mass (%FFM) were assessed by skinfold thickness measurements (SF), bio-electrical impedance analysis (BIA) and air displacement plethysmography (BOD-POD). RESULTS: No significant difference was found among measurements of FFM using the three different techniques. Both SenseWear and Sensor Medics Vmax showed a high correlation, r=0.42 and r=0.40 (p<0.0001) respectively, with BMI. No significant difference was found in mean REE between SenseWear (1540+/-280 kcal/day) and Sensor Medics Vmax (1700+/-330 kcal/day) (p=ns) and the correlation between REE measured by SenseWear and Sensor Medics Vmax was high (r=0.86, p<0.0001). Bland-Altman plot showed no difference in REE determination between SenseWear and Sensor Medics Vmax. %FFM determined by BOD-POD correlated with SenseWear (r=0.42, p<0.0001) as well as Sensor Medics Vmax (r=0.38, p<0.001). CONCLUSION: SF, BIA and BOD-POD provide valid and reliable measurements of FFM. Our results suggest that the SenseWear armband is an acceptable device to accurately measure REE in healthy subjects. Its characteristics have the potential to reduce measurement times and make the SenseWear armband useful for epidemiological studies

Assessment of food contamination and dietary intake of lead and thallium in a Northern Italy population.

Lead and thallium are heavy metals released in the environment after natural and anthropogenic activities. Food and water intake are the major sources of human exposure to these elements. In this study, we aimed at characterizing lead and thallium content in foods consumed in Northern Italy population, in order to estimate the dietary intake of these metals. To do that we bought food samples in markets and groceries collected during the period from October 2016 to February 2017 in the Emilia Romagna region, and we measured their element content using inductively coupled plasma-mass spectrometry. Finally, after assessing dietary habits of an Emilia-Romagna community by using a validated food frequency questionnaire, we eventually estimated dietary intake of these metals in that community. In the 890 analyzed food samples, the highest lead contamination levels were found in seafood, vegetables, sweets and beverages. The estimated dietary intake of lead was 5.758 (interquartile range-IQR: 4.547-7.427) µg/day, corresponding to 0.089 (IQR: 0.069-0.113) µg/kg of body weight per day, with cereals, beverages and vegetables as major contributors. About thallium, one third of specimens showed very low levels below the limit of detection, with the highest contamination levels in vegetables, dry fruits and sweets. The dietary intake of thallium was 0.236 (IQR: 0.183-0.312) µg/day, mainly from vegetables, beverages, cereals and sweets. In conclusion, our study provides an estimation of lead and thallium intake in a Northern Italian community and shows a generally low exposure levels from dietary sources

Sensitivity and specificity of body mass index and skinfold thicknesses in detecting excess adiposity in children aged 8-12 years

Primary objective: The study aimed to evaluate the sensitivity (SN) and specificity (SP) of body mass index (BMI) and skinfold thicknesses in detecting excess adiposity in children. Research design: Cross-sectional. Materials and methods: 986 children (500 females and 486 males) aged 10 +/- 1 years (mean +/- SD; range: 8-12 years) were studied. All underwent anthropometric measurements and bioelectrical impedance analysis (BIA). Dual-energy X-ray absorptiometry (DXA) was performed in 52 children to develop a population-specific algorithm for the assessment of fat-free mass (FFM) from BIA. The algorithm was applied to the remaining 934 children to estimate their FFM. Fat mass (FM) was obtained by subtracting FFM from weight (Wt). Values of FM:Wt were transformed in Z-scores and converted into 19 percentile categories (from 5 to 95 in steps of 5). The same procedure was performed with BMI and the log-transformed sum of four skinfold thicknesses (triceps, biceps, subscapular and suprailiac; lt-4SF). Excess adiposity was defined as a level of FM:Wt greater than the internally derived 85th percentile. SN and SP of each internally derived percentile of BMI and lt-4SF in detecting excess adiposity were calculated. Results: In the pooled sample (n = 934), SN and SP were 0.39 and 0.99 for the 95th percentile of BMI, 0.65 and 0.95 for the 85th percentile of BMI, and 0.75 and 0.94 for the 85th percentile of lt-4SF. Conclusions: BMI percentiles employed in the present study have a high SP but a low SN in detecting excess adiposity in 8-12-year-old children. The use of the sum of four skinfolds has the potential to increase the SN of a screening programme for excess adiposity in children of this age