La Salute della donna in post-menopausa: dalla fisiologia alla terapia

La menopausa è quel periodo della vita delle donna che è caratterizzato da notevoli cambiamenti in vari distretti corporei che spesso si associano ad un aumentato rischio di insorgenza di patologie. E’ noto, ad esempio, che con la menopausa aumenta il rischio cardiovascolare, come pure aumenta il rischio di fratture da osteoporosi e disturbi dell’apparato genitale. Alla base dei suddetti cambiamenti vi è la cessazione della funzione ovarica con il conseguente calo degli estrogeni circolanti e la perdita degli effetti protettivi esercitati da essi durante il periodo fertile. Attualmente, a conclusione di 2 importanti studi di prevenzione primaria e secondaria sembra siano state abbandonate tutte le speranze circa il successo della terapia sostitutiva estro-progestinica. Lo studio del fisiologico profilo ormonale della donna nel periodo fertile e delle azioni espletate dai vari ormoni sessuali, inclusi gli androgeni, nei vari distretti corporei, fornisce la base per credere nella giustezza della terapia ormonale sostituiva; nel contempo, dalla fisiologia comprendiamo che qualche meccanismo è stato finora trascurato e potrebbe spiegare il fallimento della terapia ormonale, finora sperimentata. Sono, infatti, aumentate le evidenze scientifiche circa gli effetti positivi di una terapia ormonale che includa testosterone. Studi di popolazione hanno evidenziato che le donne in menopausa con maggiori concentrazioni di testosterone totale o libero hanno il minor rischio di aterosclerosi carotidea. Studi di laboratorio hanno dimostrato che il testosterone è in grado di inibire la formazione della placca aterosclerotica mentre quelli sulla somministrazione degli androgeni nelle donne hanno rivelato un profilo globale di sicurezza, senza alcuna comparsa di eventi avversi. L’opinione che il testosterone abbia effetti pro-aterogeni nel sesso femminile può e deve essere considerata un pregiudizio, non sostenuto attualmente da prove scientifiche, che se portato ulteriormente avanti, continuerà a frenare l’avanzare della ricerca nel campo della salute delle donna in postmenopausa e a privare le donne di una opzione terapeutica pratica e vicina alla sua condizione fisiologica.Estrogen and/or progestin replacement therapy was viewed as the perfect solution for many healthy problems in postmenopausal women and was worldwide approved for relief of menopausal symptoms, prevention of osteoporosis and long-term use has been in vogue to prevent a range of chronic conditions, especially heart disease. However, recent evidence from primary and secondary prevention trials and observational studies showed increased risk of coronary heart disease and created doubt about the role of hormones replacement therapy in the prevention of cardiovascular disease. However, there is increasing interest in the use of Testosterone as part of replacement therapy, in particular to improve reported impaired sexual function. In this work, we want to provide a useful review of the current knowledge regarding sexual hormones actions and their effects in the body districts. Now is the time to take a look at role of androgens on women’s health. Observational studies showed in the postmeopausal women with higher total testosterone, the lower risk of carotid atherosclerosis, and the inhibition of atherosclerotic plaque development in culture studies with testosterone. The studies in humans with exogenous androgens showed that testosterone administration is well tolerated, with few side effects. The women physiology can help the physicians to provide the best therapy for prevention of cardiovascular diseas

Hypokalemia during the early phase of refeeding in patients with cancer

OBJECTIVE: Refeeding syndrome occurs in patients with severe malnutrition when refeeding begins after a long period of starvation. This syndrome increases the risk of clinical complications and mortality. Hypophosphatemia is considered the primary characteristic of the syndrome. The aim of our study was to investigate the presence of other electrolyte alterations in patients with cancer during the early stage of refeeding. METHODS: In this observational study, we enrolled 34 patients with cancer of the upper aerodigestive tract receiving upfront radiotherapy who were also enrolled in a nutrition program. A caloric intake assessment, anthropometric measurements and biochemical laboratory tests were performed. RESULTS: Significant weight loss (∼20%) was found in these patients. In the patients receiving artificial nutrition, we found lower levels of potassium and total protein compared with those who were fed orally (p = 0.03 for potassium and 0.02 for protein, respectively). Patients on enteral tube feeding had a higher caloric intake compared with those who were fed orally (25±5 kcal/kg/day vs. 10±2 kcal/kg/day). CONCLUSION: Hypokalemia, like hypophosphatemia, could be a complication associated with refeeding in patients with cancer. Hypokalemia was present in the early stages of high-calorie refeeding

The impact of endometriosis on dietary choices and activities of everyday life: a cross-sectional study

IntroductionEndometriosis is characterized by ectopic endometrial tissue and severe pain; frequently, women afflicted by this condition resort to non-medical interventions, such as dietary modifications. The aim of this study is to assess the impact of endometriosis on dietary patterns and quality of life.MethodsAn online survey was conducted among Italian women with endometriosis to gather self-reported demographic, clinical, dietary habit, and daily life data post-diagnosis.ResultsA total of 4,078 participants were included. Following an endometriosis diagnosis, 66% reported changes in eating habits, and 92% experienced a decline in daily life. Respondents chose dietary interventions: gluten-free (15%), anti-inflammatory (8%), Mediterranean (7.1%), or ketogenic (4%) diets, to improve health and reduce symptoms. The study revealed a shift in eating habits, with increased consumption of vegetables, fruits (10%), cereals, legumes (6.6%), and fish (4.5%), while reducing dairy products (18.4%), soy-containing foods (6.7%), and high saturated fats (8%). Eating habit changes correlated with endometriosis stages and worsened daily life. Educational level, endometriosis stages, years of symptoms, and eating habit changes linked to changes in daily life.ConclusionOur findings emphasize the importance of monitoring eating behaviors to prevent unhealthy habits and malnutrition in women with endometriosis. Further studies are needed to evaluate how different diets impact symptoms and enhance daily life for these individuals

Sarcopenia and Appendicular Muscle Mass as Predictors of Impaired Fasting Glucose/Type 2 Diabetes in Elderly Women

Elderly women exhibit a high risk of type 2 diabetes (T2D), but no definitive data exist about the possible role of postmenopausal increases in visceral adiposity, the loss of lean body mass, or decreases in the sum of the lean mass of arms and legs (appendicular skeletal muscle mass (ASMM)). This retrospective, longitudinal study investigated whether body composition (bioelectrical impedance analysis) predicted the development of impaired fasting glucose (IFG) or T2D in a cohort of 159 elderly women (age: 71 5 years, follow-up: 94 months) from southern Italy (Clinical Nutrition and Geriatric Units of the “Mater Domini” University Hospital in Catanzaro, Calabria region, and the “P. Giaccone ”University Hospital in Palermo, Sicily region). Sarcopenia was defined in a subgroup of 128 women according to the EWGSOP criteria as the presence of low muscle strength (handgrip strength <16 kg) plus low muscle mass (reported as appendicular skeletal muscle mass <15 kg). Participants with a low ASMM had a higher IFG/T2D incidence than those with a normal ASMM (17% vs. 6%, p-adjusted = 0.044); this finding was independent of BMI, fat mass, waist circumference, and habitual fat intake (OR = 3.81, p = 0.034). A higher incidence of IFG/T2D was observed in the subgroup with sarcopenia than those without sarcopenia (33% vs. 7%, p-adjusted = 0.005) independent of BMI and fat mass (OR = 6.75, p = 0.007). In conclusion, this study demonstrates that elderly women with low ASMM had a higher probability of developing IFG/T2D. Further studies are needed to confirm these results in men and in other age groups

Exploring the impact of lipid droplets on the evolution and progress of hepatocarcinoma

Over the past 10 years, the biological role of lipid droplets (LDs) has gained significant attention in the context of both physiological and pathological conditions. Considerable progress has been made in elucidating key aspects of these organelles, yet much remains to be accomplished to fully comprehend the myriad functions they serve in the progression of hepatic tumors. Our current perception is that LDs are complex and active structures managed by a distinct set of cellular processes. This understanding represents a significant paradigm shift from earlier perspectives. In this review, we aim to recapitulate the function of LDs within the liver, highlighting their pivotal role in the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) (Hsu and Loomba, 2024) and their contribution to the progression towards more advanced pathological stages up to hepatocellular carcinoma (HC) (Farese and Walther, 2009). We are aware of the molecular complexity and changes occurring in the neoplastic evolution of the liver. Our attempt, however, is to summarize the most important and recent roles of LDs across both healthy and all pathological liver states, up to hepatocarcinoma. For more detailed insights, we direct readers to some of the many excellent reviews already available in the literature (Gluchowski et al., 2017; Hu et al., 2020; Seebacher et al., 2020; Paul et al., 2022)

Lipid Oxidation Assessed by Indirect Calorimetry Predicts Metabolic Syndrome and Type 2 Diabetes

Purpose: Diabetes has been linked to an impaired ability to oxidize fatty acids. Fat oxidation can be assessed clinically by a respiratory quotient measurement during fasting. We hypothesized that a respiratory quotient might predict metabolic syndrome and type 2 diabetes onset.Methods: In this longitudinal study we used an existing database of 233 individuals who had complete nutritional and biochemical data at baseline and after 12-month follow-up. All participants underwent an indirect calorimetry to measure the respiratory quotient. We excluded participants with diabetes, metabolic syndrome, chronic diseases, and those who had changed food habits in the previous 3 months. Only 88 subjects met the inclusion criteria.Results: Two individuals developed type 2 diabetes and 10 metabolic syndrome after 1 year. Participants in the high respiratory quotient group (>0.91) had a higher incidence of metabolic syndrome/diabetes than those in the low quotient group (25 vs. 8% p = 0.04). In this group, mean basal respiratory quotient was 0.97 ± 0.04. In the high respiratory quotient group, Kaplan-Meier curves showed a greater probability of having metabolic syndrome/diabetes than those in the low respiratoryquotient group (log Rank χ2-test = 8.44; p = 0.004). A multivariable Cox proportional hazards model demonstrated that energy expenditure and weight increase did not predict metabolic syndrome/diabetes [HR (95% CI) = 1 (0.996–1.005), p = 0.86 and 3.9 (0.407–38.061), p = 0.23, respectively).Conclusions: A greater probability of metabolic syndrome/diabetes was found in individuals with a basal respiratory quotient of >0.91 than in those with a respiratoryquotient of ≤ 0.91 after 1 year. In the short-term anthropometric measurements and their variation overtime were not correlated with metabolic syndrome/diabetes