Does the longevity of the Sardinian population date back to Roman times? A comprehensive review of the available evidence

The discovery early in this century of the exceptional longevity of the Sardinian population has given new impetus to demographic studies of this phenomenon during the classical period. In the 1970s, it was hypothesised that the average mortality rate in Roman Sardinia was lower than in metropolitan Rome itself, postulating an ancient precedent for the remarkable longevity observable nowadays in the island's population. In the present study, the available evidence was examined in order to test this hypothesis. Literary, juridical, epigraphic, papyrological, anthropological and archaeological sources regarding the population of the Roman Empire, including Sardinia, were retrieved by accessing Science Direct, PubMed, Scopus and Google Scholar databases, as well as regional libraries, regardless of time limitation, and were independently reviewed by the authors. For Roman Sardinia, only funerary epitaphs were retrieved, in contrast with the numerous sources available for the whole Roman Empire. Inscriptions revealing the existence of three alleged nonagenarians, two centenarians, two ultracentenarians and one supercentenarian were found, corresponding to 2% in a total of 381 inscriptions. The majority were located in a highly Romanised rural area of central-western Sardinia. However, the ages reported in the epitaphs may be inaccurate because of the influence of confounders such as age rounding, approximations and/or amplifications, and are unrelated to the total number of inhabitants. In conclusion, the funerary evidence, the only available data from Roman Sardinia, is too weak to estimate the life expectancy of the local ancient population and cannot offer valuable arguments to support the hypothesis that exceptional longevity has been a Sardinian trait since Roman times

Effect of age, period and birth-cohort on the frequency of glucose-6-phosphate dehydrogenase deficiency in Sardinian adults.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited disorder common in Sardinia. In this study, the frequency variation of G6PD-deficiency across age groups and birth cohorts was investigated using Age-Period-Cohort analysis.Data were collected from the clinical records of 11,252 patients (6975 women, age range 17-94 years) who underwent endoscopy between 2000 and 2016 at a teaching hospital (University of Sassari), Italy. G6PD status was assessed by enzymatic assay based on G6PD/6GPD ratio. A Poisson log-linear regression model was used to identify age and time trend in G6PD deficiency.Enzyme deficiency was detected in 11.4% of the entire cohort (men: 7.9%; women: 13.6%). Age-Period-Cohort analysis showed no inflection points across age groups, especially after age 80. The effects of time period and birth cohorts on G6PD deficiency were negligible (frequencies before and after 1950 were 11.0% and 11.8%, respectively).These findings indicate that the frequency of G6PD deficiency does not vary significantly in oldest subjects. The lack of evidence for selection across the malaria eradication time may be explained by other factors, including somatic cell selection or misclassification of heterozygotes women as G6PD normal in the older birth cohorts. Additional molecular studies may help clarify these issues. Key message The frequency of glucose-6-phosphate dehydrogenase deficiency is stable across age groups and does not vary in generations born before or after malaria eradication

Health properties of the Italian San Martino® mineral-rich water: A self-controlled pilot study.

Abstract The effect of hyper-mineral waters on human health has long been debated. This pilot study evaluated the influence of San Martino® water (Sardinia, Italy), on clinical and biological parameters, following the treatment of 10 hospitalized patients. Crenotherapy consisted of 1–2 L of the water daily for 10 days. A complete blood count, serum electrolytes, liver and kidney function tests, fasting lipid profile and plasma glucose, and abdominal ultrasound imaging were assessed before and at the end of treatment. In addition, body weight, dyspeptic symptoms, bowel movements, diuresis, uricuria and blood pressure were evaluated daily. According to its physico-chemical properties, the water is hyper-mineral (TDS 2808 mg/L) with a high content of bicarbonate and iron. At the end of the study, diuresis increased by 60% (850 vs 1295 ml/24 h, P = 0.009) and uricuria by 41% (362 vs 490 mg/24 h, P = 0.022) respectively, whereas plasma uric acid level decreased by 7% (4.7 vs 4.3 mg/dL, P = 0.043). Compared to the basal values, serum gamma-glutamyl transferase, alkaline phosphatase and total bilirubin levels, showed a reduction of 65% (31 vs 18 U/L, P = 0.022), 15% (96 vs 90 U/L, P = 0.041), and 11% (0.53 vs 0.45 g/dL, P = 0.041), respectively. Bowel movements improved in 62.5% of patients with constipation, and 80% of dyspeptic patients experienced symptoms relief. Compliance to the treatment reached 100%. Mild differences were observed in body weight and blood pressure, although not in ultrasound imaging during crenotherapy. These findings suggest that the San Martino® hyper-mineral water may have some benefits to human health. Additional studies with a larger-sized cohort and for a longer period are needed to confirm these preliminary results

G6PD deficiency does not enhance susceptibility for acquiring <i>Helicobacter pylori</i> infection in Sardinian patients

Background: Subjects with glucose-6-phosphate dehydrogenase (G6PD) deficiency may be more susceptible to infections due to impaired leukocyte bactericidal activity. The disorder is common in the Mediterranean area. The aim of this study was to investigate whether G6PD deficiency may be a risk factor for acquiring H. pylori infection. Methods: We performed a retrospective study. Data from clinical records of 6565 patients (2278 men and 4287 women, median age 51, range 7‒94) who underwent upper endoscopy between 2002 and 2014 were collected. H. pylori status, assessed by histology plus rapid urease test or 13C-urea breath test, and G6PD status were also reported. A multiple logistic regression model was used to investigate the association between G6PD deficiency and H. pylori infection. Results: Enzyme deficiency was detected in 12% (789/6565) of the entire cohort, and more specifically in 8.3% of men and in 14.0% of women. Overall, the proportion of patients positive for H. pylori was 50.6% and 51.5% among G6PD deficient and non-deficient patients (χ² = 0.271; p = 0.315). Moreover, among G6PD-deficient and normal patients the frequency of previous H. pylori infection was similar. After adjustment for age and gender the risk for acquiring H. pylori infection was similar in G6PD-deficient and normal patients. Only age was a strong statistically significant risk predictor. Conclusions: These results demonstrate for the first time that G6PD deficiency does not enhance patients’ susceptibility to acquire H. pylori infection in Sardinia

Increased seroreactivity to proinsulin and homologous mycobacterial peptides in latent autoimmune diabetes in adults

Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressing form of immune-mediated diabetes that combines phenotypical features of type 2 diabetes (T2D) with the presence of islet cell antigens detected in type 1 diabetes (T1D). Heterogeneous clinical picture have led to the classification of patients based on the levels of antibodies against glutamic acid decarboxylase 65 (GADA) that correlate with clinical phenotypes closer to T1D or T2D when GADA titers are high or low, respectively. To date, LADA etiology remains elusive despite numerous studies investigating on genetic predisposition and environmental risk factors. To our knowledge, this is the first study aimed at evaluation of a putative role played by Mycobacterium avium subsp. paratuberculosis (MAP) as an infective agent in LADA pathogenesis. MAP is known to cause chronic enteritis in ruminants and has been associated with autoimmune disorders in humans. We analyzed seroreactivity of 223 Sardinian LADA subjects and 182 healthy volunteers against MAP-derived peptides and their human homologs of proinsulin and zinc transporter 8 protein. A significantly elevated positivity for MAP/proinsulin was detected among patients, with the highest prevalence in the 32-41-year-old T1D-like LADA subgroup, supporting our hypothesis of a possible MAP contribution in the development of autoimmunity

Phenotypic heterogeneity of latent autoimmune diabetes in adults identified by body composition analysis

Background: In patients with Latent Autoimmune Diabetes in Adults (LADA) a lower body mass index was reported compared with classical type 2 diabetes (T2D), and was found to be associated with a faster progression to insulin-dependence. In this study we determined the body composition in a cohort of LADA patients from Sardinia, Italy, and compared it with age– and gender–matched patients diagnosed as having adult-onset type 1 diabetes (T1D) and non-autoimmune T2D. Methods: In 210 LADA patients, 210 T2D patients and 30 adult-onset T1D patients of Sardinian origin we assessed total and segmental body composition (weight-adjusted percent fat mass and lean mass) by using Dual Energy X-rays Absorptiometry (DXA). Results: In the whole cohort of LADA patients total fat mass was significantly smaller compared with T2D patients (p &lt; 0.0001), while no difference was found between LADA and T1D patients. In LADA men fat depletion involved all body segments, while in LADA women it was observed only in the truncal segment (p &lt; 0.0001), as in the upper and lower regions fat deposits were larger compared to T2D (p &lt; 0.0001). However, LADA women showed a significantly elevated truncal fat compared to T1D women (p &lt; 0.004), whereas no difference was detected in the extremities. Conclusions: Body composition in LADA patients shows substantial difference, in a gender-dependent way, compared to classic T2D. In women fat deposits tend to accumulate in peripheral regions rather than centrally, whereas in men the distribution is more homogeneous. In addition, central fat depletion in LADA women appears to be a significant predictor of faster progression to insulin dependence. Thus, routine assessment of body composition may help the physician identify LADA patients who require early insulin treatment in order to delay beta-cell exhaustion, as well those with increased CV risk due to excess truncal adiposity.</br

Dyspepsia: When and How to Test for Helicobacter pylori

Dyspepsia is defined as symptoms related to the upper gastrointestinal tract. Approximately 25% of western populations complain of dyspeptic symptoms each year. 70% of them do not have an organic cause and symptoms are related to the so-called functional dyspepsia, characterized by epigastric pain, early satiety, and/or fullness during or after a meal occurring at least weekly and for at least 6 months according to ROME III criteria. In order to avoid invasive procedures and adverse effects, to minimize costs, to speed up diagnosis, and to provide the most appropriate treatments, primary care physicians need to recognize functional dyspepsia. Because symptoms do not reliably discriminate between organic and functional forms of the disease, anamnesis, family history of peptic ulcer and/or of gastric cancer, medication history, especially for nonsteroidal anti-inflammatory drugs, age, and physical examination could help the physician in discerning between functional dyspepsia and organic causes. For patients without alarm symptoms, noninvasive testing for H. pylori, with either carbon-13-labeled urea breath testing or stool antigen testing, is recommended as a first-line strategy. In this review, we provide recommendations to guide primary care physicians for appropriate use of diagnostic tests and for H. pylori management in dyspeptic patients

Tissue resonance interaction accurately detects colon lesions: a double-blind pilot study

AIM: To investigated the performance of the tissue resonance interaction method (TRIM) for the non-invasive detection of colon lesions. METHODS: We performed a prospective single-center blinded pilot study of consecutive adults undergoing colonoscopy at the University Hospital in Sassari, Italy. Before patients underwent colonoscopy, they were examined by the TRIMprobe which detects differences in electromagnetic properties between pathological and normal tissues. All patients had completed the polyethylene glycol-containing bowel prep for the colonoscopy procedure before being screened. During the procedure the subjects remained fully dressed. A hand-held probe was moved over the abdomen and variations in electromagnetic signals were recorded for 3 spectral lines (462-465 MHz, 930 MHz, and 1395 MHz). A single investigator, blind to any clinical information, performed the test using the TRIMprob system. Abnormal signals were identified and recorded as malignant or benign (adenoma or hyperplastic polyps). Findings were compared with those from colonoscopy with histologic confirmation. Statistical analysis was performed by χ2 test. RESULTS: A total of 305 consecutive patients fulfilling the inclusion criteria were enrolled over a period of 12 months. The most frequent indication for colonoscopy was abdominal pain (33%). The TRIMprob was well accepted by all patients; none spontaneously complained about the procedure, and no adverse effects were observed. TRIM proved inaccurate for polyp detection in patients with inflammatory bowel disease (IBD) and they were excluded leaving 281 subjects (mean age 59 ± 13 years; 107 males). The TRIM detected and accurately characterized all 12 adenocarcinomas and 135/137 polyps (98.5%) including 64 adenomatous (100%) found. The method identified cancers and polyps with 98.7% sensitivity, 96.2% specificity, and 97.5% diagnostic accuracy, compared to colonoscopy and histology analyses. The positive predictive value was 96.7% and the negative predictive value 98.4%. Among the 281 non-IBD subjects, there were 7 cases with discordant results (2.5%) between TRIMprob and the reference standard including 5 false positive results (1.8%) and 2 false negative (0.7%) results. The main limitation of the TRIMprob system is the need for trained operators. CONCLUSION: The study confirmed that TRIM provides rapid, accurate, convenient and noninvasive means to identify individuals most likely to benefit from colonoscopy

The Association of childhood asthma and <i>Helicobacter pylori</i> infection in Sardinia

Background: It has been suggested that Helicobacter pylori infection might reduce the risk of atopic conditions, such as asthma, in childhood. This risk reduction could relate to the “hygiene hypothesis” which proposes an association between childhood exposure to microbes and risk of atopy. Objectives: To examine the association between Hp infection and childhood acquired asthma in Sardinia. Patients and Methods: Children from Northern Sardinia who were between the ages of 10 months to 6 years and were screened for Hp infection in 1994-1995 using IgG serology, were asked in 2012, whether they had developed asthma and/or allergic disease in pediatric age, using the global initiative on asthma guidelines questionnaire. Results: A total of 64 children participated in the study. The sero-positivity for Hp infection was 14.1%. Eleven (17.2%) children had a confirmed diagnosis of asthma with onset before the age of 5 years, 85.9% were Hp negative and 14.1% Hp positive. Eight children of the 53 without asthma were Hp positive (15%) compare to one children positive for the infection of the 11 patients (0.09%) with asthma (8/53 vs. 1/11; P = 0.6). The majority of children (73%) were from urban areas and 43.8% had a family history of asthma or allergies. Multiple logistic regression analysis was not able to find a studied variable, including Hp infection, significantly associated with pediatric asthma. Conclusions: Our results speak against Hp infection itself playing a role to protect from the risk to develop childhood asthma although household hygiene was not directly assessed

The Association of Childhood Asthma and Helicobacter pylori Infection in Sardinia

Background: It has been suggested that Helicobacter pylori infection might reduce the risk of atopic conditions, such as asthma, in childhood. This risk reduction could relate to the &quot;hygiene hypothesis&quot; which proposes an association between childhood exposure to microbes and risk of atopy. Objectives: To examine the association between Hp infection and childhood acquired asthma in Sardinia. Patients and Methods: Children from Northern Sardinia who were between the ages of 10 months to 6 years and were screened for Hp infection in 1994-1995 using IgG serology, were asked in 2012, whether they had developed asthma and/or allergic disease in pediatric age, using the global initiative on asthma guidelines questionnaire. Results: A total of 64 children participated in the study. The sero-positivity for Hp infection was 14.1%. Eleven (17.2%) children had a confirmed diagnosis of asthma with onset before the age of 5 years, 85.9% were Hp negative and 14.1% Hp positive. Eight children of the 53 without asthma were Hp positive (15%) compare to one children positive for the infection of the 11 patients (0.09%) with asthma (8/53 vs. 1/11; P = 0.6). The majority of children (73%) were from urban areas and 43.8% had a family history of asthma or allergies. Multiple logistic regression analysis was not able to find a studied variable, including Hp infection, significantly associated with pediatric asthma. Conclusions: Our results speak against Hp infection itself playing a role to protect from the risk to develop childhood asthma although household hygiene was not directly assessed