Assessment of psychological predictors of weight loss: How and what for?

Obesity is a multifactorial disease and the prominent factors playing a role in its pathogenesis are biological, environmental and psychological. There is a growing interest in understanding psychological functioning of obese subjects and the influence of psychological factors on treatment outcome. The aim of the present narrative review is to critically analyze the current literature, in order to point out the most common psychological constructs studied in obesity and to give an overview of the main existing tools investigating psychological features which have been considered significant for the prediction of success in weight loss and maintenance programs in obese patients. In this framework, the most common psychological constructs studied are: self-motivation, self-efficacy, locus of control, health related quality of life, self-esteem, self-control, concerns about body image, outcome expectations, and personality traits. These features have been explored through a wide variety of psychometric instruments. However, as an overall, studies evaluating the association between psychological features and treatment outcome failed to give consistent results. A possible explanation may consist on the fact that many tools widely used to explore psychological features were not specifically designed for obese patients and none of them was comprehensive of all possible psychological features involved. The identification of well-defined sub-groups of patients and the validation of more reliable and comprehensive tools, specifically designed for obese subjects, should be forecasted in order to reach a better knowledge of psychological functioning of obese individuals and to improve the outcome of weight loss programs

Measurement of body composition as a surrogate evaluation of energy balance in obese patients.

In clinical practice obesity is primarily diagnosed through the body mass index. In order to characterize patients affected by obesity the use of traditional anthropometric measures appears misleading. Beyond the body mass index, there are overwhelming evidences towards the relevance of a more detailed description of the individual phenotype by characterizing the main body components as free-fat mass, muscle mass, and fat mass. Among the numerous techniques actually available, bioelectrical impedance analysis seems to be the most suitable in a clinical setting because it is simple, inexpensive, noninvasive, and highly reproducible. To date, there is no consensus concerning the use of one preferred equation for the resting energy expenditure in overweight and/or obese population. Energy restriction alone is an effective strategy to achieve an early and significant weight loss, however it results in a reduction of both fat and lean mass therefore promoting or aggravating an unfavourable body composition (as sarcobesity) in terms of mortality and comorbidities. Therefore the implementation of daily levels of physical activity should be simultaneously promoted. The major role of muscle mass in the energy balance has been recently established by the rising prevalence of the combination of two condition as sarcopenia and obesity. Physical exercise stimulates energy expenditure, thereby directly improving energy balance, and also promotes adaptations such as fiber type, mitochondrial biogenesis, improvement of insulin resistance, and release of myokines, which may influence different tissues, including muscle

The role of DPP4 activity in cardiovascular districts: in vivo and in vitro evidence.

The introduction of incretin hormone-based therapies represents a novel therapeutic strategy, since these drugs not only improve glycemia with minimal risk of hypoglycemia, but also have other extraglycemic beneficial effects. These agents, which are effective in improving glucose control, could also have positive effects on the incidence of cardiovascular events. The aim of this review is to summarize the present literature about the role of dipeptidyl peptidase 4 (DPP4) in cardiovascular districts, not only strictly correlated to its effect on glucagon-like peptide-1 (GLP-1) circulating levels, but also to what is known about possible cardiovascular actions. Actually, DPP4 is known to be present in many cells and tissues and its effects go beyond purely metabolic aspects. Almost always the inhibition of DPP4 activity is associated with improved cardiovascular profile, but it has shown to possess antithrombotic properties and these different effects could be connected with a site and/or species specificity of DPP4. Certainly, DPP4 seems to exert many functions, both directly and indirectly, on cardiovascular districts, opening new possibilities of prevention and treatment of complications at this level, not only in patients affected by diabetes mellitus

From Theory to Clinical Practice in the Use of GLP-1 Receptor Agonists and DPP-4 Inhibitors Therapy

Promoting long-term adherence to lifestyle modification and choice of antidiabetic agent with low hypoglycemia risk profile and positive weight profile could be the most effective strategy in achieving sustained glycemic control and in reducing comorbidities. From this perspective, vast interest has been generated by glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 inhibitors (DPP-4i). In this review our ten-year clinical and laboratory experience by in vitro and in vivo studies is reported. Herein, we reviewed available data on the efficacy and safety profile of GLP-1 receptor agonists and DPP-4i. The introduction of incretin hormone-based therapies represents a novel therapeutic strategy, because these drugs not only improve glycemia with minimal risk of hypoglycemia but also have other extraglycemic beneficial effects. In clinical studies, both GLP-1 receptor agonists and DPP-4i, improve β cell function indexes. All these agents showed trophic effects on beta-cell mass in animal studies. The use of these drugs is associated with positive or neucral effect on body weight and improvements in blood pressure, diabetic dyslipidemia, hepatic steazosis markets, and myocardial function. These effects have the potential to reduce the burden of cardiovascular disease, which is a major cause of mortality in patients with diabetes

LA SINDROME METABOLICA

As the word itself says, a syndrome is not a disease in its own right, but a set of various diseases that coexist in the same individual. Metabolic Syndrome (MS) was first described many years ago, but it came back to the fore again in 1998 by Alberti and Zimmet who tried to give it a more modern definition. It was then in 2001 that Grundy defined simpler and easily determinable criteria in an outpatient setting. When compared with other diagnostic criteria, such as those of the International Diabetes Federation, it was seen that the 2001 criteria had a higher specificity, even if a lower sensitivity, and therefore were those to be preferred in identifying the truly affected patients by SM. The MS criteria actually represent the most important modifiable cardiovascular risk factors, as they are related to Visceral Obesity and Insulin Resistance (IR), which proceed in parallel in individuals. Visceral adipose tissue is a true endocrine organ that produces many hormone-acting substances called Adipokines. These are the main responsible for the establishment and maintenance of the IR, as well as for hypertension, hypertriglyceridemia and blood coagulation alterations. In fact, in patients with MS, excess adipose tissue is almost always accompanied by a decrease in muscle tissue, i.e. a state of sarcopenia. Muscle tissue also produces cytokines and hormonal substances with protective function against the cardiovascular risk factors present in the MS criteria, the lack of muscle mass reduces the production of these molecules and therefore the presence of sarcopenia further worsens the entity of the cardiovascular risk. There are other additional factors, other than those present in the classifications, which can play an important role in MS. Current scientific evidence shows a correlation between vitamin D and risk, incidence, number and severity of the components of the Metabolic Syndrome and its complications (DM2 and cardiovascular diseases). About 90% of obese and diabetic patients have a more or less serious deficiency of vitamin D, and this condition has been directly correlated with the dysfunctional adiposity index (LAP index). The other condition that is frequently observed in MS patients is hyperuricemia and this seems mainly due to the high consumption of fructose in the diet. The consequences of fructose metabolism can lead to a decrease in intracellular ATP, an increase in uric acid production, oxidative stress, inflammation, and an increase in lipid synthesis, which are associated with endothelial dysfunction. The latter represents an early manifestation of vascular disease and a stimulus for the development of Metabolic Cardiorenal Syndrome

Terapia medica del dolore neuropatico del soggetto diabetico

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Functionalized additively manufactured parts for the manufacturing of the future

Abstract Innovation technology is giving the opportunity to fabricate products and parts in alternative ways and with special characteristics, which do not strictly depend on the primary manufacturing process. In particular, smart manufacturing seeks for flexible systems and customizable products, recognizing additive manufacturing (AM) processes as a key element. To successfully integrate AM into the production chain it is necessary to overcome its limitations in terms of final product quality and reliability, wisely choosing post-processing operations. This work outlines how it is possible to significantly improve AM product performance using an environment friendly process, such as burnishing, coupled with a numerical simulation model encouraging customer integration and developing a flexible manufacturing process capable to conform with the main idea behind Industry 4.0

Burnishing of AM materials to obtain high performance part surfaces

Purpose: This paper aims to provide a flexible solution to include additive manufacturing into a process chain complying with Industry 4.0 pillars, overcoming major drawbacks in terms of reliability and experimental effort. Design/methodology/approach: The study is based on the combination of real experimental activities and simulated ones. Findings: The main findings of this work consist into validation of the proposed process chain, which proves to be effective in terms of process flexibility (additive manufacturing, burnishing and process simulation acting synergistically), cost and time reduction and final output quality, encouraging customer involvement towards customization. Originality/value: This paper contributes to current research on the application of burnishing process, an easy to implement and environmentally friendly post-processing method to improve the performance of AM products, by providing a unique perspective integrating a reliable simulation model. Other researchers can employ these outcomes towards manufacturing of the future. A reduced version of this work has been previously published in Procedia Computer Science (Sanguedolce, Rotella, Saffioti & Filice, 2021)Peer Reviewe

Binge and Emotional Eating in obese subjects seeking weight loss treatment

Objective: Binge Eating Disorder (BED) is highly prevalent among individuals seeking weight loss treatment. Considering the possible trigger factors for BED, different studies focused on the role of emotional eating. The present study compared threshold, subthreshold BED, and subjects without BED in a population of overweight/obese individuals seeking weight loss treatment, considering the anamnesis, the eating disorder specific and general psychopathology, the organic and psychiatric comorbidity, the emotional eating as a trigger factor for binge eating, and the quality of life. Design: cross-sectional survey.Subjects: Four hundred thirty eight overweight subjects seeking weight loss treatment have been enrolled in the study. Measurements: Subjects have been evaluated by means of a clinical interview (SCID I) and different self-reported questionnaires (Eating Disorder Examination Questionnaire, Binge Eating Scale, Beck Depression Inventory, Spielberg's State-Trait Anxiety Inventory, Symptom Checklist 90, Emotional Eating Scale, and Obesity Related Well-Being questionnaire). Results: One hundred and five subjects (24% of the sample) fulfilled the DSM-IV criteria of lifetime BED, 146 (33.3%) fulfilled the criteria of lifetime subthreshold BED, and 187 (42.7%) subjects were diagnosed overweight non-BED. No correlations between the binges frequencies and the overweight levels were found. All the three groups showed high psychiatric comorbidities, and the three groups significantly differed in terms of emotional eating, which was positively correlated to the binge eating frequencies. Conclusions: Threshold and subthreshold BED deserve a careful psychopathological investigation and emotional eating seems to play a key role as trigger factor for binge eating. Obesity is associated with a high psychiatric comorbidity and a low quality of life, independently from the specific and general eating disorder psychopathology