Effect of a basic Chinese traditional diet in overweight patients.

Abstract Objective To evaluate the effect of a basic Chinese traditional diet (BTCD) in overweight patients on body mass index (BMI), lean mass, sense of hunger, and eating behaviour. Methods A total of 694 enrolled subjects (218 male and 476 female) were divided into two groups: group A undergoing a 1200-Kcal BTCD, and group B undergoing a 1200-Kcal standard western diet. Results From T0 (before treatment) to T1 (6 weeks after treatment), BMI was lowered in group A from (32.33±5.51) to (31.96±5.56) kg/m2, and in group B from (31.62±6.29) to (31.36±6.47) kg/m2. After treatment, patients in group A lost more weight (0.37±0.52) kg than group B (0.26±0.79) kg (P=0.0044). From T0 to T1, the mean lean mass of group A decreased from (16.48±5.50) to (16.27±5.45) kg. In group B, mean lean mass decreased from (16.93 ±6.49) to (16.44±6.29) kg. The difference was significant (P=0.0078). Conclusion The two diets could lead to lower BMI, improve lean mass as well as eating behaviour and sense of hunger. However, the BTCD was significantly better than the western standard diet

Lower-Limb Joint Coordination Pattern in Obese Subjects

The coordinative pattern is an important feature of locomotion that has been studied in a number of pathologies. It has been observed that adaptive changes in coordination patterns are due to both external and internal constraints. Obesity is characterized by the presence of excess mass at pelvis and lower-limb areas, causing mechanical constraints that central nervous system could manage modifying the physiological interjoint coupling relationships. Since an altered coordination pattern may induce joint diseases and falls risk, the aim of this study was to analyze whether and how coordination during walking is affected by obesity. We evaluated interjoint coordination during walking in 25 obese subjects as well as in a control group. The time-distance parameters and joint kinematics were also measured. When compared with the control group, obese people displayed a substantial similarity in joint kinematic parameters and some differences in the time-distance and in the coupling parameters. Obese subjects revealed higher values in stride-to-stride intrasubjects variability in interjoint coupling parameters, whereas the coordinative mean pattern was unaltered. The increased variability in the coupling parameters is associated with an increased risk of falls and thus should be taken into account when designing treatments aimed at restoring a normal locomotion pattern

Stato di nutrizione della vitamina D e correlazione con misure antropometriche

Premessa Numerosi studi documentano uno stato di carenza di micronutrienti in soggetti obesi; la restrizione calorica può aggravare tale stato di malnutrizione, mentre la lipolisi rende disponibili i composti liposolubili accumulati nel tessuto adiposo. Tale problema è di particolare rilievo nei pazienti sottoposti a chirurgia bariatrica, in cui è descritto un aumento transitorio dei valori sierici di vit.D nel 1° mese post-intervento. Scopo dello studio Valutare lo stato di nutrizione della vit.D e analizzare la correlazione tra concentrazione sierica, BMI, circonferenza vita (CV) e massa adiposa (BF). Materiali e metodi In un campione di 1031 soggetti, reclutati nel periodo 2004-2013 presso il DH di Medicina Interna del DMS, sono stati misurati: statura, peso, BMI, CV, BF (DEXA), livelli sierici di vit.D e PTH. Risultati Il campione è costituito da: M22,2%, età 44,9±14,24 anni; F75,8%, età 46,2±13,5 anni; BMI40kg/m2: M26,5%-F26,3%. È stata analizzata la correlazione tra BMI-vit.D (M: r=-0,235 p=0,05; F: r=-0,207 p=0,000), CV-vit.D (M: r=-0,306 p=0,05; F: r=-0,254 p=0,05), BF%-vit.D (M: r=-0,118; p=0,103 F: r=-0,13; p=0,01); BMI-PTH (M: r=-0,158 p=0,22; F: r=-0,224 p=0,000), CV-PTH (M: r=-0,295 p=0,000; F: r=-0,231; p=0,000), BF%-PTH (M: r=-0,154 p=0,51; F: r=-0,219; p=0,000); vit.D-PTH (M: r=-0,276 p=0,000; F: r=-0,292; p=0,000); vit.D/età (M: r=-0,059 p=0,351; F: r=-0,089; p=0,012). Conclusioni Nelle donne le concentrazioni sieriche di vit.D e PTH risultano correlate con BMI, CV e BF%, mentre negli uomini la vit.D è correlata solo con BMI e CV e il PTH con la CV. Nei soggetti con ipovitaminosi D la frequenza di ipertPTH risulta: M 11,8% - F 14,2%. La correlazione vit.D e PTH con l’età risulta significativa solo nelle donne. Questi risultati: confermano l’alta frequenza di ipovitaminosi D associata a iperPTH nei soggetti obesi; fanno ipotizzare un ruolo determinante dell’assetto ormonale nelle donne e della distribuzione del grasso negli uomini; possono fornire indicazioni per la supplementazione, in particolare durante il rapido decremento ponderale post-chirurgia bariatrica. È auspicabile l’identificazione di biomarkers per la valutazione dello stato di nutrizione della vit.D, che tengano conto dell’accumulo nel tessuto adiposo; tale considerazione potrebbe essere estesa anche alle altre vitamine liposolubili

First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis

Background The aim of this study was to evaluate the possible role of sleeve gastrectomy (SG) per se in the reversibility of diabetes. Methods Insulin secretion and peripheral insulin sensitivity using the intravenous glucose tolerance test (IVGTT) were assessed in 18 obese type 2 diabetic patients and in 10 nondiabetic obese patients before and 3 days after SG, before any food intake and any weight change occurrence. At the same time, ghrelin, GLP-1, and PYY levels were determined. Results In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC) significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC) significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups. Conclusions Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the antidiabetes effect of SG

Abitudini alimentari, infiammazione e stress ossidativo in un campione di soggetti anziani: risultati dello studio Europeo “RISTOMED” - New E-Services for a dietary approach to the elderly (FP 7 - SME - 2007 – 1; Grant 222230)

Premesse: la relazione tra abitudini alimentari, malattie cronico-degenerative e qualità dell’invecchiamento è ampiamente dimostrata, così come il ruolo patogenetico dello stress ossidativo e dell’infiammazione cronica di basso grado. Obiettivi: analizzare in un campione di anziani la relazione tra abitudini alimentari, stress ossidativo e stato infiammatorio, surrogate endopoint che condizionano qualità dell’invecchiamento e insorgenza di malattie cronico-degenerative correlate. Metodi: un totale di 125 soggetti anziani (M 58 e F 67; età 70,4±3,9 aa; BMI 26,7±3,4 kg/m2) è stato reclutato in 3 Paesi europei - Italia, Francia e Germania - nell’ambito del progetto Europeo RISTOMED; sono state rilevate le abitudini alimentari (FFQ) e analizzato stress ossidativo (TAA, SOD, CAT, GSH, Gpx, GR, GST) e stato infiammatorio (PCR, VES, fibrinogeno, WBC, IL6, IL10, TNFα, TGFβ1, IGF1, leptina e adiponectina) in associazione a glicemia, insulinemia, colesterolo totale, trigliceridi, acido folico, vitamina B12, omocisteinemia, HOMA index; è stata eseguita l’analisi dei polimorfismi genetici di APOE (E1, E2, E3, E4), CAT, SOD, GR, Gpx e GST family. Risultati: il campione è risultato omogeneo per i polimorfismi genetici considerati, ad eccezione del polimorfismo GSTT1 e GSTM1; le abitudini alimentari sono risultate significativamente diverse nei 3 Paesi e permettono di identificare 3 distinti pattern alimentari, associati a differenti di stress ossidativo, stato infiammatorio e metabolico. I parametri relativi allo stress ossidativo sono risultati significativamente diversi tra i 3 pattern alimentari(p<0,05), mentre tra i marcatori infiammatori e metabolici sono state osservate differenze significative per VES, TGFβ, IGF-1, Hb, glicemia, ac. folico e omocisteinemia. Conclusioni: sebbene i risultati non permettano di trarre conclusioni inequivocabili, è possibile fare le seguenti considerazioni: il pattern (Germania) caratterizzato dal consumo maggiore di alimenti di origine animale e minore di alimenti di origine vegetale sembrerebbe associato ad un maggiore grado di stress ossidativo e infiammatorio con ridotta sensibilità insulinica; il pattern (Francia) caratterizzato da un’elevata assunzione di ortaggi, frutta, latte e carne sarebbe associato al minore grado di stress ossidativo, ad un elevato stato infiammatorio e a livelli maggiori di colesterolo; il pattern (Italia) caratterizzato da minore assunzione di alimenti di origine animale, più vicino al modello mediterraneo, sembrerebbe collocarsi in una posizione intermedia per stress ossidativo, stato infiammatorio e assetto metabolico

Addition of either pioglitazone or a sulfonylurea in type 2 diabetic patients inadequately controlled with metformin alone: impact on cardiovascular events. A randomized controlled trial.

BACKGROUND AND AIMS: Metformin is the first-line therapy in type 2 diabetes. In patients inadequately controlled with metformin, the addition of a sulfonylurea or pioglitazone are equally plausible options to improve glycemic control. However, these drugs have profound differences in their mechanism of action, side effects, and impact on cardiovascular risk factors. A formal comparison of these two therapies in terms of cardiovascular morbidity and mortality is lacking. The TOSCA.IT study was designed to explore the effects of adding pioglitazone or a sulfonylurea on cardiovascular events in type 2 diabetic patients inadequately controlled with metformin. METHODS: Multicentre, randomized, open label, parallel group trial of 48 month duration. Type 2 diabetic subjects, 50-75 years, BMI 20-45 Kg/m(2), on secondary failure to metformin monotherapy will be randomized to add-on a sulfonylurea or pioglitazone. The primary efficacy outcome is a composite endpoint of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned coronary revascularization. Principal secondary outcome is a composite ischemic endpoint of sudden death, fatal and non-fatal myocardial infarction and stroke, endovascular or surgical intervention on the coronary, leg or carotid arteries, major amputations. Side effects, quality of life and economic costs will also be evaluated. Efficacy, safety, tolerability, and study conduct will be monitored by an independent Data Safety Monitoring Board. End points will be adjudicated by an independent external committee. CONCLUSIONS: TOSCA.IT is the first on-going study investigating the head-to-head comparison of adding a sulfonylurea or pioglitazone to existing metformin treatment in terms of hard cardiovascular outcomes. REGISTRATION

Addition of either pioglitazone or a sulfonylurea in type 2 diabetic patients inadequately controlled with metformin alone: impact on cardiovascular events. A randomized controlled trial.

BACKGROUND AND AIMS: Metformin is the first-line therapy in type 2 diabetes. In patients inadequately controlled with metformin, the addition of a sulfonylurea or pioglitazone are equally plausible options to improve glycemic control. However, these drugs have profound differences in their mechanism of action, side effects, and impact on cardiovascular risk factors. A formal comparison of these two therapies in terms of cardiovascular morbidity and mortality is lacking. The TOSCA.IT study was designed to explore the effects of adding pioglitazone or a sulfonylurea on cardiovascular events in type 2 diabetic patients inadequately controlled with metformin. METHODS: Multicentre, randomized, open label, parallel group trial of 48 month duration. Type 2 diabetic subjects, 50-75 years, BMI 20-45 Kg/m(2), on secondary failure to metformin monotherapy will be randomized to add-on a sulfonylurea or pioglitazone. The primary efficacy outcome is a composite endpoint of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned coronary revascularization. Principal secondary outcome is a composite ischemic endpoint of sudden death, fatal and non-fatal myocardial infarction and stroke, endovascular or surgical intervention on the coronary, leg or carotid arteries, major amputations. Side effects, quality of life and economic costs will also be evaluated. Efficacy, safety, tolerability, and study conduct will be monitored by an independent Data Safety Monitoring Board. End points will be adjudicated by an independent external committee. CONCLUSIONS: TOSCA.IT is the first on-going study investigating the head-to-head comparison of adding a sulfonylurea or pioglitazone to existing metformin treatment in terms of hard cardiovascular outcomes

Addition of either pioglitazone or a sulfonylurea in type 2 diabetic patients inadequately controlled with metformin alone: impact on cardiovascular events. A randomized controlled trial.

BACKGROUND AND AIMS: Metformin is the first-line therapy in type 2 diabetes. In patients inadequately controlled with metformin, the addition of a sulfonylurea or pioglitazone are equally plausible options to improve glycemic control. However, these drugs have profound differences in their mechanism of action, side effects, and impact on cardiovascular risk factors. A formal comparison of these two therapies in terms of cardiovascular morbidity and mortality is lacking. The TOSCA.IT study was designed to explore the effects of adding pioglitazone or a sulfonylurea on cardiovascular events in type 2 diabetic patients inadequately controlled with metformin. METHODS: Multicentre, randomized, open label, parallel group trial of 48 month duration. Type 2 diabetic subjects, 50-75 years, BMI 20-45 Kg/m(2), on secondary failure to metformin monotherapy will be randomized to add-on a sulfonylurea or pioglitazone. The primary efficacy outcome is a composite endpoint of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned coronary revascularization. Principal secondary outcome is a composite ischemic endpoint of sudden death, fatal and non-fatal myocardial infarction and stroke, endovascular or surgical intervention on the coronary, leg or carotid arteries, major amputations. Side effects, quality of life and economic costs will also be evaluated. Efficacy, safety, tolerability, and study conduct will be monitored by an independent Data Safety Monitoring Board. End points will be adjudicated by an independent external committee. CONCLUSIONS: TOSCA.IT is the first on-going study investigating the head-to-head comparison of adding a sulfonylurea or pioglitazone to existing metformin treatment in terms of hard cardiovascular outcomes. Registration: Clinicaltrials.gov ID NCT00700856

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50\ue2\u80\u9375 years with type 2 diabetes inadequately controlled with metformin monotherapy (2\ue2\u80\u933 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15\ue2\u80\u9345 mg) or a sulfonylurea (5\ue2\u80\u9315 mg glibenclamide, 2\ue2\u80\u936 mg glimepiride, or 30\ue2\u80\u93120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57\uc2\ub73 months. The primary outcome occurred in 105 patients (1\uc2\ub75 per 100 person-years) who were given pioglitazone and 108 (1\uc2\ub75 per 100 person-years) who were given sulfonylureas (hazard ratio 0\uc2\ub796, 95% CI 0\uc2\ub774\ue2\u80\u931\uc2\ub726, p=0\uc2\ub779). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p&lt;0\uc2\ub70001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. Interpretation In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora