Mediterranean Journal of Nutrition and Metabolism

The aim of this study was to verify the clinical efficacy of a diet associated with already commercially available oral amino acid functional cluster (AFC) compared to the administration of a diet associated with a nitrogen protein-based supplement (casein) in antagonizing malnutrition in patients with Chronic renal failure (CRF) undergoing haemodialysis. The secondary aim was to assess the changes in protein levels during the acute phase such as the expression of inflammatory cytokines. Twenty patients in haemodialysis aged between 18 and 85 of both genders (13 m, 7f) were recruited, randomized and divided into two groups and treated for 4 months respectively with: (1) oral AFC supplement (*)8 g/die: group A, and (2) oral supplementation of a protein nitrogenous mixture compared to AFC with a casein protein source) of 6.6 g: group P. During the initial assessment and thereafter on a monthly basis all patients underwent the following: Dietary recall 24 h; Anthropometric: Weight, height, BMI, expected dry weight, actual weight; Biochemical: Albumin, transferrin, Na, K, Cl, Ca, P, Mg, long-interval creatinine (Aminotrofic(®): Errekappa Euroterapici, Milano) pre-albumin, α1 acid glycoprotein, C reactive protein (CRP), protein nitrogen appearance (PNA); Instrumental: Handgrip strength evaluation, Calorimetry by means of Armband, Bio-impedance analysis (BIA), Spitzer Index (quality of life), Subjective Global Assessment Generated by the patient (PG SGA). Considering the nutritional parameters, no significant differences concerning dry weight emerged between the beginning (T0) and the end (T4) (weight A to T0: kg 64.41 ± 6.34; weight A to T4: kg 64.51 ± 7.05: P = NS; weight P to T0: kg 60.17 ± 11.94; weight P to T4: kg 59.86 ± 11.43: P = NS); biochemical parameters, significant differences were observed only for two parameters: pre-albumin (Pre-albumin A to T0 30.12 ± 7.23; Pre-albumin A to T4: 28.91 ± 5.8; Pre-albumin P to T0 22.51 ± 6.04; Pre-albumin P to T4: 26.10 ± 9.82), and Transferrin (Transferrin A to T0 171.77 ± 28.87 mg/dL, Transferrin A to T4: 181.44 ± 38.83 mg/dL: P < 0.005; Transferrin P to T0 160.29 ± 27.46 mg/dL, Transferrin P to T4: 146.57 ± 24.96 mg/dL: P < 0.005), but not in other parameters. From a nutritional perspective, after 4 months of treatment an increase in protein synthesis was noted in group A compared to group P which was proved by the significant increase of transferrin. This pilot study suggests the AFC oral supplementation may represent a valid alternative to intradialytic parenteral treatment and may also allow for an improvement in blood chemical values and nutritional status.

Botanicals are an alternative option to prescription drugs for the alleviation of symptoms due to anxiety disorders and insomnia. Melissa officinalis L. has been shown as an anti-stress and anxiolytic agent. We previously reported moderate stress improvement in mice in which Cyracos(®), a standardized Melissa officinalis L. extract, was administrated. Cyracos(®) contains phytochemicals that inhibit gamma-aminobutyric acid catabolism. This was a prospective, open-label, 15-day study to evaluate the efficacy of Cyracos(®) on stressed volunteers, who have mild-to-moderate anxiety disorders and sleep disturbances. Using clinician rating criteria, primary outcomes showed improvement of symptoms. Cyracos(®) reduced anxiety manifestations by 18% (p < 0.01), ameliorated anxiety-associated symptoms by 15% (p < 0.01) and lowered insomnia by 42% (p < 0.01). As much as 95% of subjects (19/20) responded to treatment, of which 70% (14/20) achieved full remission for anxiety, 85% (17/20) for insomnia, and 70% (14/20) for both. Our study demonstrates, for the first time that chronic administration of Melissa officinalis L. relieves stress-related effects. It is critical that further studies incorporate a placebo and investigate physiological stress markers.

Anecdotal data in the last few years suggest that protein-sparing modified diet (PSMF) delivered by naso-gastric tube enteral (with continuous feeding) could attain an significant weight loss and control of appetite oral feeding, but no phase II studies on safety and efficacy have been done up to now. To verify the safety and efficacy of a protein-sparing modified fast administered by naso-gastric tube (ProMoFasT) for 10 days followed by 20 days of a low-calorie diet, in patients with morbid obesity (appetite control, fat free mass maintenance, pulmonary function tests and metabolic pattern, side effects), 26 patients with a BMI ≥30 kg/m(2) have been selected. The patients had to follow a protein-sparing fast by enteral nutrition (ProMoFasT) for 24 h/day, for 10 days followed by 20 days of low-calorie diet (LCD). The endpoint was represented by body weight, BMI, abdominal circumference, Haber's appetite test, body composition by body impedance assessment (BIA), handgrip strength test, metabolic pattern, pulmonary function test. Safety was assessed by evaluation of complications and side effects of PSMF and/or enteral nutrition. In this report the results on safety and efficacy are described after 10 and 30 days of treatment. After the recruiting phase, a total of 22 patients out of 26 enrolled [14 (63.6 %) females] were evaluated in this study. Globally almost all clinical parameters changed significantly during first 10 days. Total body weight significantly decreased after 10 days (∆-6.1 ± 2; p < 0.001) and this decrease is maintained in the following 20 days of LCD (∆ = -5.88 ± 1.79; p < 0.001). Also the abdominal circumference significantly decreased after 10 days [median (range): -4.5 (-30 to 0); p < 0.001] maintained then in the following 20 days of LCD [median (range) = -7 (-23.5 to -2); p < 0.001]. All BIA parameters significantly changed after 10 and 30 days from baseline. All parameters except BF had a significant change after 10 days of treatment while the difference at 30 days was lower than at 10 days for TBW, FFM and MM with no significant differences from baseline for the last two characteristics. For VAS appetite the difference was significant after 10 days and the decrease in appetite was maintained at 30 days with no significant difference (p = 0.83) between 10 and 30 days. No significant differences in the first 30 days were detected for PA and for both left and right hand grip strength. Particularly, a significant reduction of 1.82 kg in FFM after 10 days was detected, but not after 30 days. In contrast, a decrease of 3.8 kg of BF is observed after 30 days. As far as the respiratory functional tests (RFT) are concerned, a significant difference at 10 days was globally observed for functional residual capacity (p = 0.012) and expiratory reserve volume (p = 0.025). There are no reported major complications and side effects resulting from the enteral nutrition or PSMF. In particular, cardiac arrhythmias have not been reported. From the clinical point of view the PSMF with naso-gastric tube (ProMoFasT) method appears safe, it is associated with a significant weight loss related to decrease of FM and not to loss of FFM and appetite decreases. It is relevant that the RFT are significantly improved after only 10 days suggesting the efficacy of this regime in short period, too. These preliminary data underline the necessity to increase the number of RCT for this method, which could represent a possible alternative to other methodologies, such as the intragastric balloon, in particular when it is recommended to improve RFT before bariatric, gynecological, orthopedic and lymphatic surgery.

The Mediterranean diet is well known for its health-promoting effects. Among its key ingredients, olive oil is the most characteristic. Processing industries have been successfully manufacturing and marketing jarred baby foods with the use of vegetable oils, including olive oil, as well as other sources of visible fat. We aimed to survey manufacturer claims concerning added fat in jarred infant foods supplied to the Polish market. A total of 124 kinds of infant foods from six suppliers were analyzed. Corn, canola, and soybean oil occupied the first three positions, respectively, in rank order of vegetable oils used in jarred baby foods. In our sample, only one type of ready-to-eat jars with vegetables contained olive oil. 11% of products contained cow milk butter or cream. 61% of jarred "dinners" contained poultry or fish, which are typical sources of animal protein in the Mediterranean diet. Given that commercial baby foods currently available in the Polish market contain no olive oil, we advocate considering home preparation of infant foods with the use of visible fat. Medical professionals should encourage food manufacturers to return to the concepts of the Mediterranean diet for young consumers, aimed at long-term health.

Efficacy of a new patented proprietary combination of natural nutraceuticals (PN) containing natural hypolipidemic as red yeast, policosanol and berberine was tested in a large study on dyslipidemic patients in clinical practice. A parallel, controlled, randomized, multicenter study was designed. After 2 weeks on a stable dietary regimen, the patients were randomized to PN 1 tablet/day associated with diet (PN + D) or diet alone (D) for 16 weeks. Entry criteria were: Tot-Chol >200 mg/dL or LDL-Chol >150 mg/dL without a clear indication for statins, or plasma triglycerides >150 mg/dL. Lipid pattern and CV parameters were evaluated at baseline and monthly. 1,751 patients were enrolled in 248 Italian units, 933 patients on PN + D and 818 on D. The baseline lipid values were: Tot-Chol 255.4 versus 243.1 mg/dL, LDL-Chol 170.1 versus 162.2 mg/dL, HDL-Chol 50.0 versus 48.8 mg/dL, and TG 190.5 versus 184.4 mg/dL. PN constantly and significantly improved lipid parameters versus D group: at 16 weeks -19.1 versus -9.4% for Tot-Chol (p < 0.001), -23.5 versus -10.8% for LDL-Chol (p < 0.001), +11.6 versus +4.0% for HDL-Chol (p < 0.001), -17.9 versus -11.3% for TG (p < 0.001). In conclusions, PN plus diet allows an effective improvement of blood lipids with a significant reduction of global CV risk, suggesting a role for PN in CHD prevention.

In patients who cannot, must not or do not want to drink, hydration is a real artificial nutrition intervention. Different clinical situations require a specific approach for fluid administration to reduce the risk of tissue hypoperfusion or oedema. The variations of plasma volume depend not only on the amount of the fluid infused, but also on its distribution, which is determined by the membranes’ properties. Fluids for intravenous therapy are not vehicles but real drugs and the knowledge of their properties should guide the choice: the available data on mortality and major complications do not demonstrate the best efficacy between crystalloids or colloids and between the different types of colloids: saline solution at 0.9% is commonly defined as “physiological”, but has significant differences with plasma; balanced electrolytic solutions seem to give better clinical outcomes compared to saline, which is ultimately overprescribed. 5% glucose solution is equivalent to water because glucose is rapidly metabolised, releasing it. It is necessary to strengthen educational interventions to improve the management of fluid therapy.

Lactose intolerance is found in 70% of the world-wide population. Lactase activity gradually increases till birth and then, after the early months of life, it physiologically begins to lessen. In about 30% of the population it remains active also as an adult due to a mutation: in Europe a substitution of C with T in position 13910 of the lactase gene. Our data show that CC genotype, associated with lactase non-persistence, is found in type 1 diabetes with a high prevalence of 67%. To evaluate the “glycaemic-metabolic control” we investigated the glycosylated haemoglobin (HbA1c) values and we noted that there is no significant difference between CC (non-absorber) and CT/TT (absorber) genotypes of diabetic patients. Glutamic acid decarboxylase antibodies (GADA) are positive in 58% of diabetic patients with CC genotype: this presence could be linked to the intestinal membrane hyperpermeability.

The Czech Republic ranks among the countries with the highest prevalence of dyslipoproteinaemia and cardiovascular diseases (CVD). As a valid tool in the primary prevention of these the authors consider the monitoring of selected components (including metal ions and vitamins) of the antioxidant system in the organism. Oxidative damage of cells and tissues plays an important role in the aetiology of most so-called civilisation diseases. Endogen anti-oxidative protection of the human organism, e.g., in the form of superoxide dismutase, enzymes and selenium (Se), which abolish peroxide hydrogen, or in the form of proteins-binding metals, is insufficient taking into consideration the contemporary way of life in advanced countries. The objective of the present work was to determine total Se in the serum of 386 healthy volunteers from the Rescue Fire Brigades from selected areas of the Czech Republic. The serum Se concentration was determined by the direct electrothermal atomic absorption spectrometry method. The mean serum Se concentration was determined between 0.67 and 0.93 μmol/l. There were no significant differences in values between gender, age and body mass index categories. The low levels of the element in the blood are probably due to its deficiency in the diet.

BackgroundFor an “in the field” estimate of visceral adiposity, simple, inexpensive, non-invasive and highly repetitive methods are needed. The anthropometric measurement most commonly used as an indicator for visceral fat deposits is waist circumference (W). Nevertheless, there are some doubts with regard to the anatomic landmark points where the evaluation needs to be carried out. Sagittal abdominal diameter (SAD) is another anthropometric measurement that has been proposed for the estimation of visceral fat. ObjectiveThe aims of the study are to evaluate intra- and inter-operator variability of the estimation of the SAD compared to W; correlate SAD to other anthropometric parameters and to factors involved in the metabolic syndrome (MS); and identify the values for the estimation of the SAD able to classify different risk levels with respect to the MS. MethodsNinety-five subjects at the Metabolic and Nutritional Rehabilitation Unit “Villa delle Querce” in Nemi were selected. Anthropometric and biochemical parameters were collected. The presence of a MS was detected. Intra- and inter-operator variability in the measurement of W and SAD and the predictive capacity of SAD in the estimation of the risk for MS were calculated. ResultsThe main results achieved were reduced intra- and inter-operator variability in the measurement of SAD compared to W; confirmation of the correlations between SAD and the anthropometric parameters as indicators of a higher fat mass; and good predictive capacity of SAD towards MS (cut-off points: 22.2 cm for men and 19.5 cm for women).

A condition of insulin resistance (IR) frequently occurs in the elderly. This is because of some age-related hormonal and metabolic changes, which are responsible for increased serum levels of fasting blood glucose. IR also induces an increased and prolonged serum value of post-prandial hyperglycaemia, favouring the atherosclerotic process and frequent acute cardiovascular events. This review examines how the post-prandial hyperglycaemic “spikes” play a major role in vascular damage in aged individuals with or without diabetes mellitus. This occurs through oxidative stress, endothelial dysfunction and subclinical inflammation induced by IR, as illustrated by numerous experiments and clinical reports. The evidence opposing all this is from two major trials, the STOP-NIDDM study and the recent HEART2D study. Finally, it is hypothesised that a daily dose of acarbose may prevent or mitigate this damage in aged people without overt diabetes mellitus. KeywordsInsulin resistance–Post-prandial hyperglycaemia–Elderly–Cardiovascular disease–Acarbose

Type 2 diabetes has become the most frequently encountered metabolic disorder in the world and obesity, meaning visceral adiposity, is the core problem. In the abdominal adipose tissue, insulin resistance (IR) reduces the antilipolytic effect of insulin, which in turn leads to reduced glucose uptake and increased release of free fatty acids (FFAs) and glycerol. Chronic exposure of beta cells to elevated FFA levels causes detrimental consequences such as increased insulin secretion at low glucose concentrations, decreased proinsulin biosynthesis, depletion of insulin reserves and reduced response to concentrations of glucose stimulus. Adipose peroxisome proliferator-activated receptors (PPAR)-γ appears to be an essential mediator for the maintenance of whole-body insulin sensitivity that protects non-adipose tissue against lipid overload. Current data suggest that PPAR-γ-activating ligands improve adipose tissue function, and may prevent the progression of IR to diabetes and also endothelial dysfunction to atherosclerosis. Links between environmental influences, the layout of visceral fat, the PPARs, the adiponectin and the adipocytokines still need to be completely clarified.

Essential amino acid supplementation (EAS) may counteract hypercatabolic states, such as chronic heart failure (CHF). This pilot study investigated whether EAS could improve quality of life (QoL), cardiac function and exercise tolerance in patients (pts) with stable CHF on optimal medical treatment (OMT). We enrolled 27 pts (21 males) with ejection fraction (EF) <35% and on OMT with no changes within the previous 6months. EAS, composed of leu (1,250mg), lys (650mg), ile (625mg), val (625mg), thr (350mg), cys (150mg), his (150mg), phe (100mg), met (50mg), t4 (30mg), trp (20mg), B1 (0.15mg) and B6 (0.15mg) vitamins, was given twice a day for 3months. At baseline and after 3months, we evaluated symptoms with NYHA classification, LVD36 questionnaire and QoL scale; cardiac function by echocardiography and exercise tolerance (modified Bruce protocol); pro-BNP, renal function, glucose and troponin. We observed a significant reduction of end-systolic and diastolic volumes (ESV 121.6±63.08 vs. 106.82±50.1mL, p=0.018; EDV 169.1±75.3 vs. 150±67.5mL, p<0.02), an increase of EF (29.8±5.7 vs. 35.4±5.8%, p<0.001) and of cardiac output (5.58±1.57 vs. 6.07±1.66L/min; p=0.015). We assisted a no significant trend toward reduction in mitral regurgitation (p=0.3). EAS improved QoL (NYHA p<0.001; LVD36 14.1±7.2 vs. 12.2±6.9, p=0.015; QoL scale 62.4±12.5 vs. 74±9.7%, p<0.001); exercise tolerance (stage 3.24±1.3 vs. 3.57±1.3, p=0.016; METS 6.6±3.4 vs. 7.1±3.3, p=0.18; Minutes 8.1±4.29 vs. 8.7±3.94, p=0.055). No changes in glucose, creatinine, cholesterol, troponin and a no significant trend toward reduction of pro-BNP was observed (1,077.4±530.3 vs. 851.6±315.1 ng/l, p=0.3). No pts showed adverse effects. After 3months, EAS significantly improves cardiac function, QoL and exercise tolerance in stable CHF pts. KeywordsEssential amino acids supplementation-Chronic heart failure-Hypercatabolism-Cachexia

Glutathione S-transferases (GSTs, EC 2.5.1.18), as the detoxifying enzymes, play an important protective role in embryonic tissues. The GSTs of eleventh-day chick embryonic liver were purified to electrophoretic homogeneity with an overall yield of 31%. The SDS-PAGE analysis of chick embryonic liver GSTs resolved in to three bands, CL1, CL2 and CL3, with relative molecular weights of 27.0, 26.0 and 25.0 kDa respectively. On 72 hours of treatment with acrylamide (AC) (0.1, 0.2 and 0.3 mg) the specific activities of GSTs with CDNB, pNBC, EPNP, BSP, Δ55A and pNPA increased significantly. Total GPx levels were decreased with CHP in liver samples. Immunoblot analysis of AC-treated liver samples showed a dose-dependent increase in the induction of GSTs. CL1 of theta class, CL2 of Mu class and CL3 of alpha class were induced with AC treatment. The theta, mu and alpha classes induced by AC might inhibit the initiation of carcinogenesis. KeywordsGlutathione S-transferases-Acrylamide-Substrate specificities-Chick embryonic liver-Western blot

The relation between oxidative stress and tamoxifen is not completely clear, since some studies attribute a possible antioxidant action, while others describe several pro-oxidative effects. The aim of this study was to evaluate oxidative stress in patients treated with tamoxifen and the effect of administration of green tea catechins on this parameter. Tests aimed at evaluating the derivatives of reactive oxygen metabolites (d-Roms test) and the antioxidant reserve (BAP test) were adopted to estimate oxidative stress. Subjects treated with tamoxifen received Categ [Sofar] (green tea extract with 200 mg of catechins, 2 tablets twice a day for 3 weeks), according to a crossover design. High or very high antioxidant stress levels were found in all the 46 patients treated with tamoxifen, while in a control group of 18 patients treated with aromatase inhibitors or who had no longer been treated with tamoxifen for 1 year or more, high or very high oxidative stress levels were found in 66.7% of cases (p p = n.s.). The levels of oxidative stress and antioxidant reserve did not change significantly in a subgroup where the patients took Categ for 3 weeks followed by 3 weeks washout (group A), while there was a statistical significant reduction in the levels of oxidative stress (p p

The indiscriminate usage of synthetic chemicals and pesticides has led to a widespread contamination of land, water and air with harmful xenobiotics. The exposure to these toxicants results in severe health effects on organisms. Also, some natural foods contain harmless chemical species (nitrate), which however become toxic on certain conditions. Hence it is pertinent to focus attention on commonly consumed plant food materials, which can neutralize the toxicity damage caused by environmental agents. One of the most important sources of antioxidants is green tea. This review focuses on the mechanisms of oxidative damage caused by different xenobiotics and the defensive action of green tea in mitigating the damage. It is concluded that tea polyphenols, catechins and flavonoids scavenge reactive oxygen species and render a protective effect. KeywordsXenobiotics–Antioxidants–Reactive oxygen species–Polyphenols

No study has yet examined how weight loss specifically modifies the impact of the Mediterranean diet (MedDiet) on plasma cell adhesion molecules (CAM) in men with the metabolic syndrome (MetS). Therefore, this study examined the impact of the MedDiet consumed under controlled feeding conditions, with and without weight loss, on plasma CAM concentrations in men with the MetS. The diet of 26 men (age 24–62years) with the MetS was first standardized to a North American control diet for 5weeks followed by a 5-week MedDiet, both under weight-maintaining isocaloric feeding conditions. Participants then underwent a 20-week caloric restriction period that led to a 10.2±2.9% reduction in body weight (p<0.01), followed by the consumption of an isocaloric weight stable MedDiet for 5weeks. All foods including red wine were provided during the isocaloric phases of the study. There was no change in the average concentrations of any of the CAM after the MedDiet without weight loss. The MedDiet combined with weight loss reduced plasma CAM concentrations by 10.9% (p<0.01) compared with the control diet and by 6.8% (p=0.068) compared with the MedDiet without weight loss. These data suggest that weight loss is required for the MedDiet to improve plasma CAM concentrations over a short period of time in men with the MetS. ClinicalTrial.gov registration number: NCT00988650. KeywordsMediterranean diet–Metabolic syndrome–Weight loss–Cell adhesion molecules

The prevalence of diabetes in hospitalised patients is not well identified; in 2000, 12.5% of patients discharged from US hospitals were diagnosed as having diabetes. In Italy data are limited; in Campania, these data show a 6% prevalence of diabetes in discharged patients, while in Emilia Romagna it reaches 21%. These data do not consider stress hyperglycaemia. There are in fact three categories of people who may have hyperglycaemia during hospitalisation: those with known diabetes diagnosed before hospitalisation; those with diabetes diagnosed during hospitalisation; and those with stress hyperglycaemia, i.e., hyperglycaemia occurring during hospitalisation, but decreasing at the time of discharge. Observational studies have clearly shown how hyperglycaemia leads to a worsening of prognosis because of increased morbidity and mortality and of longer hospitalisation in cases of known diabetes and of stress hyperglycaemia. Intervention studies have confirmed that strict glycaemic control brings about significant improvement of prognosis, thus the importance of good glycaemic control is recognised today, also for critically ill patients receiving artificial nutrition (AN). In recent years, the interest in prevention of microangiopathic and macroangiopathic complications has shifted the interest toward hyperglycaemic peaks and glycaemic variability, along with the “glycated haemoglobin” factor. In hospitals most patients do not receive adequate nutritional support for their calorie requirements, either for preventing or curing protein-energy malnutrition (PEM). One of the reasons for inadequate treatment is precisely the fear of worsening hyperglycaemia; from this perspective, hyperglycaemia is considered the major obstacle in practising proper nutritional support. On the other hand, the use of AN without adequate insulin therapy may cause serious metabolic decompensation. The ADI-AMD (Italian Dietetics and Clinic Nutrition Association-Diabetologist Association) Diabetes study group (GS) considered it advisable to review the previous recommendations drawn up in 2005. The scientific proof level at the basis of each recommendation was classified according to that provided for by the National Guidelines Plan. The document reports the objectives considered desirable in handling the majority of the patients with hyperglycaemia while receiving AN; comorbidity and other factors connected with the individual case may justify different choices. KeywordsArtificial nutrition-Insulin-Diabetes-Parenteral nutrition-Enteral nutrition

Background and aimsFamily history of type II diabetes appears to increase the risk of type II diabetes and of coronary heart disease. The aim of this study was to evaluate the effect of a first-degree family history of type II diabetes on fasting plasma concentrations of leptin and adiponectin in an outpatient clinical setting. Methods and resultsThe study included 46 nondiabetic premenopausal overweight and obese women, aged 22–50 years. A total of 22 subjects had no family history of type II diabetes until the third generation (FH−) and 24 subjects had a family history of type II diabetes (FH+), defined as having one or both parents with type II diabetes. Fasting plasma leptin and adiponectin were measured by radioimmunoassay. Leptin concentrations were significantly higher (p < 0.05) in FH+ than in FH− subjects. Moreover, after multiple regression analyses, both leptin (positively, p < 0.01) and adiponectin (negatively, p < 0.05) maintained a significant association with family history of diabetes, independently of age, body mass index, insulin resistance (estimated by homeostasis model assessment, HOMAIR), glucose, lipids, and blood pressure levels. ConclusionsThis study indicated that a genetic predisposition to type II diabetes is associated with higher leptin concentrations and lower adiponectin levels independently of insulin resistance, blood pressure and metabolic parameters, which thus possibly contribute to the higher risk of type II diabetes and cardiovascular disease in subjects with a family history of type II diabetes.

Background and aim Anorexia/cachexia syndrome is frequently correlated with increased oxidative stress (OS). A fermented wheat-germ extract with a standardized benzoquinone content (brand name Avemar) has been shown to exert an intense antioxidant activity with no side effects. The aim of this study was to investigate the effects of Avemar in patients affected by head and neck cancer, correlating the variations with OS with the quality of life as assessed by the Spitzer’s index Patients and methods A cohort of 60 patients affected by head and neck tumours (stage IIIa, IIIb, IV) were enrolled in the study following an open-label protocol. The patients were assigned to two subgroups, A or B. Group A was treated with conventional oncological therapy alone, and group B was treated with Avemar in addition to standard therapy. After 2 months only 55 patients survived and could be evaluated (29 in the control group and 26 in the Avemar group). Each patient was checked for circulating concentrations of hydroperoxides using the FRAS III test Results The levels of OS significantly decreased after 2 months in the group receiving Avemar (group). The value of Spitzer’s index was significantly higher in group B, attesting to an improved quality of life Conclusion Although the specific active substance in Avemar has not yet been identified, the reduction in free oxygen radicals induced by it is correlated with a clinically significant improvement in the quality of life in patients with advanced cancer

This observational study aims to evaluate the eating habits of a population of high school students from Emilia Romagna. 492 students aged between 15 and 19years (265 females and 227 males) were personally interviewed by a dietician regarding their dietary habits, used to assess the macro and micronutrient composition of the diet, the quality of the diet according to the Mediterranean diet quality index (M-DQI) and the total amounts of advanced glycation endproducts (AGEs) ingested daily. The analysis of macronutrients showed a deficit in carbohydrates and an excess in fat, particularly saturated fat, when compared to the recommended daily intake (RDA), particularly evident in males (30.9±7.5 vs. 23.9±6.0, p<0.001; RDA<20g). The analysis of micronutrients depicted a deficit in fibres, particularly in females (15.9±4.0 vs. 18.5±4.5, p<0.001; RDA=20–30g), and in vitamin D (3.04±1.80μg/day; RDA=10–15μg/day). Most of the subjects analysed had M-DQI between medium-poor (280/492, 56.9%) and poor (208/492, 42.3%) while none had a very good score and only three females had a good score. Collectively, males had a worse M-DQI with respect to females. Finally, the total amount of AGEs ingested daily correlated significantly and positively with M-DQI (r=0.283, p<0.001) and, accordingly, it was significantly higher in males with respect to females. The evaluation of the M-DQI in this population of high school students indicates a loss of food traditions typical to Mediterranean countries, with a consequent imbalance in macro and micronutrients with respect to the guidelines for healthy nutrition. Consequently, there is an increase in the intake of AGEs that could be one of the causes of the increased incidence of cardiovascular and metabolic complications in Mediterranean countries. KeywordsStudents-Mediterranean diet quality index-Advanced glycation endproducts-Quality of diet

The aim of this study was to comparatively evaluate the long-term effects of psyllium husk and guar gum supplementation on metabolic syndrome (MS) components. We randomised 141 MS patients to soluble psyllium husk powder or guar gum 3.5 g t.i.d. to be taken 20 min before the main 2 meals, or to a standard diet for a cumulative period of 6 months. Both fibres significantly improved body mass index (−7.2% vs. −6.5%), fasting plasma glucose (−27.9% vs. −11.1%) and insulin (−20.4% vs. −10.8%), HOMA Index (−39.2% vs. −16.7%), glycated haemoglobin (−10.4% vs. −10.3%), low-density lipoprotein cholesterol (−7.9% vs. −8.5%) and apolipoprotein B (−10.5% vs. −5.6%), after 6 months of treatment. Only the psyllium supplementation exerted a significant improvement on plasma triglyceride concentration (−13.3%) and systolic (−3.9%) and diastolic blood pressure (−2.6%). No significant difference was observed regarding the standard diet group in comparison to the baseline. On the basis of our data, psyllium could be more strongly indicated for patients that have to reduce a large number of cardiovascular risk factors, while guar gum could be more rapidly efficacious in strengthening the effect of diets aimed at reducing body weight. KeywordsMetabolic syndrome-Soluble fibres-Hypertension-Hypercholesterolaemia-Hypertriglyceridaemia-Hyperglycaemia-Cardiovascular risk

Metabolic syndrome and allograft non-alcoholic fatty liver disease (NAFLD) is a common occurrence after orthotopic liver transplantation (OLT). NAFLD and hepatitis C virus (HCV) are frequently associated. The association steatosis/HCV determines important implications for clinical practice: steatosis accelerates the progression of fibrosis and reduces the likelihood of obtaining a sustained virological response (SVR) with antiviral therapy. We have evidenced a strong correlation between body mass index (BMI), cholesterol, triglycerides (TGC) and hepatic percentage of steatosis. In subjects with BMI<25 and TGC<160ng/ml, the chance of SVR was 48 times higher than that of non-response. The chances of SVR for patients with percentage of steatosis <15 were 12 times higher than that with higher percentage of steatosis value. Detection, prevention and management of metabolic disorders and NAFLD should be one of the primary objectives of all transplant teams. KeywordsHepatitis C virus-Metabolic syndrome-Non-alcoholic fatty liver disease-Orthotopic liver transplantation

Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the anti-Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the antihypercholesterolaemic, and antihypertriglyceridaemic properties of aged garlic powder, artichoke leaf extracts, guggul, and fenugreek. Single small clinical trials have also suggested that Korean ginseng, green tea, onion, yarrow, holy basil and arjun have an antihypercholesterolaemic effect.

Intestinal microbiota and gut-associated lymphoreticular tissue are in a dynamic equilibrium, the rupture of which causes a condition of dysbiosis in the host. Among many natural foods, milk, because of its composition, is able to influence the host–microbiota relationship. Donkey’s and goat’s milk represents a good alternative to human milk. Healthy effects of both kinds of milk have been reported in either in vitro or in vivo experiments. When administered to elderly subjects, donkey’s milk increased the release of interleukins 6 and 8, while goat’s milk exerted opposite effects. With special reference to fermented cow’s milk, a symbiotic (Gorbach and Goldin) when administered to another group of elderly people, behaved as donkey’s milk upregulating interleukins 6, 8 and also 1. In conclusion, the ability of milk and fermented milk to modulate the altered immune response in senescence needs to be exploited more for maintaining healthy aging. KeywordsAging–Breastfeeding–Immune system–Microbiota–Milk

The aim of this study is to examine the associated risk factors of hypertension and the relationship between blood pressure and obesity determined by different anthropometric measurements in a population of urban adult women of Morocco. The study was conducted in an agricultural community, El Jadida province of Morocco. Body weight, height, waist (WC) and hip circumferences, blood pressure, fasting capillary blood glucose, triglycerides and cholesterol were measured in a sample of 213 women volunteers (18–55years old). Body mass index (BMI), and waist/hip ratio (WHR) were determined. High blood pressure was detected in 35.8% of women. All hypertensive women were at high risk of hyperglycemia (22.4% were hyperglycemic, among which 17.6% were diabetic), hypertriglyceridemia (10.7%), hypercholesterolemia (14.5%) and metabolic syndrome (18.4%). Only 6.6% of the women practice physical activity and 23.6% had no education level. Bivariate correlation showed a positive association between age and obesity. In the same way blood pressure was also positively associated with obesity, age, WC, WHR, fasting plasma glucose and triacylglycerols. The results show a high prevalence of obesity associated with increased prevalence of hypertension (HT). The study data reinforce the need to increase detection and treatment of hypertension and to approach patients’ global risk profiles. It is also suggested that the simultaneous interpretation of anthropometric measurements could be used as screening tool for the identification of HT. KeywordsHigh blood pressure–Metabolic disorder–Obesity–Moroccan women

HIV-related cryptosporidiosis is an opportunistic parasitic infection that may occur in the advanced phases of the disease in case of severe immunodeficiency. It provokes inflammatory diarrhoea with malabsorption and weight loss. Highly active antiretroviral therapy (HAART) and nutritional support are the only treatments in the absence of any efficient therapy. In a young woman affected with vertically transmitted HIV infection, cryptosporidiosis induced severe metabolic imbalance and malnutrition. The contemporary presence of other opportunistic diseases such as oral and pharyngeal candidiasis and disseminated cytomegalovirus disease worsened the symptoms and nutritional alterations. Using specific therapies for these pathogens and adequate nutritional support, both metabolic and nutritional alterations and clinical symptoms were resolved, allowing the commencement of HAART for the improvement of cryptosporidiosis.

The aim of this study was to examine the fatty acid and tocopherol composition and the antioxidant activity of the lipids fractions of two varieties of sorghum grains grown in Algeria. The results revealed that the total oil contents in the sorghum ranged from 11 to 13%. Gas chromatography analysis of the oils revealed that the dominant fatty acids found are palmitic, oleic and linoleic. The oils contain a significant amount of unsaturated fatty acids (>84%). Oils were also high in tocopherol, with a wide variation (between 174.82 and 325.33mg/kg) but with δ-tocopherol predominating in the two oils. The lipid extracts were subjected to screening for their possible antioxidant activity by using 2,2-diphenyl-1-picrylhydrazyl, phosphomolybdenum complex and FRAP assays. In the first case, IC50 values of the extracts were 15.4 and 22.6mg/mL in the red and in the white sorghum, respectively. In the phosphomolybdenum complex and the FRAP assays the antioxidant capacity of the extracts ranged, respectively, between 0.21–0.13μmol/g vitamin E equivalents and 0.030–0.027mmol/g vitamin C equivalents. In the three systems, the antioxidant capacities of vitamin E and ascorbic acid were also determined in parallel experiments. KeywordsSorghum-Oil-Fatty acids-Tocopherol-Antioxidant activity

The main focus of the present work is the analytical study of the fatty acid, triglyceride (TAG) and tocopherol composition of oil extract from the fruit of Algerian tree Argania spinosa. The four dominant fatty acids (FA) found in the oil are: oleic C18:1 (52.86%), linoleic C18:2 (25.0%), palmitic C16:0 (14.65%) and stearic C18:0 (7.06%). The distribution of FA between the sn-2 and sn-1,3 positions of TAG from the oil was also determined. Unsaturated FA showed a preference for the internal position, as generally found in vegetable oils. The TAG composition was calculated using the lipase hydrolysis. The oil was found to contain trisaturated (0.47%), disaturated (9.3%), monosaturated (43.95%) and triunsaturated (45.20%) FA. Flash chromatography with solvent of increasing polarity yielded 83.42% neutral lipids, 1.56% glycolipids and 2.09% phospholipids. The oil was characterised by a relatively high amount of tocopherols (1027.8 mg/kg). The (γ+β)-tocopherols were the major isomers, with the rest being α- and δ-tocopherols.

Zinc and selenium have been shown to singly act in normalising glycaemia and are also postulated to possess insulin-like functions. Supplementation with their combination in the diets of rats with alloxan-induced diabetes was investigated with the aim of investigating their effects on glucose homeostasis and their antioxidant properties on the liver and kidney of alloxan-induced diabetic rats. Thirty-five rats were randomly assigned to five groups and four groups were made diabetic by the administration of 150 mg/kg body weight of alloxan monohydrate, after which three diabetic groups were fed with diets supplemented with zinc, selenium and a combination of the two. Zinc, selenium and the combination significantly reduced blood glucose concentration, restored hepatic functions, increased the antioxidant status of the diabetic rats and reduced lipid peroxidation in both the hepatic and renal tissues. It was concluded that supplementation with zinc, selenium and the combination facilitated glucose uptake, prevented oxidative stress, reduced lipid peroxidation and preserved hepatic function in diabetes. KeywordsZinc-Selenium-Diabetes-Free radicals-Catalase-Glutathione

The aim of the present study was to test the efficacy and safety of an oral amino acid functional cluster (AFC) supplementation in cachectic cancer patients. From April 2008 to March 2009, we carried out an open non-randomized phase II study on 25 cachectic advanced (all stage IV) cancer patients with tumor at different sites who received an oral AFC supplementation for 8weeks. Efficacy was assessed on the basis of improvement of some nutritional/functional (weight, body mass index, lean body mass and grip strength), quality of life (fatigue) and laboratory (albumin, fibrinogen, C-reactive protein, proinflammatory cytokines, leptin and reactive oxygen species) variables. Safety was evaluated according to the NCI-CTCAE version 3. Patients supplemented with the AFC achieved an increase in grip strength (P<0.0001) and total serum albumin (P=0.0003) and a decrease in ROS levels (P=0.001). Moreover, our study showed a trend toward an increase in body weight and leptin and a decrease in CRP and IL-6. In conclusion, the results of the present study suggest that amino acid supplementation may be a significant rational tool for the treatment of cancer cachexia. Our preliminary data should be confirmed in a larger sample size and by a properly designed randomized clinical trial. According to our longstanding experience, a potential area of further research may be to integrate amino acid supplementation into a multi-dimensional approach based on diet, nutritional support and molecularly targeted drugs for the management of cancer cachexia. KeywordsAmino acid functional cluster supplementation-Cancer cachexia-Reactive oxygen species-Fatigue-Albumin

High-density lipoproteins (HDL) plasma levels are inversely correlated with the risk of atherosclerosis and coronary heart disease. The protective effect of HDL has been related to their role in the cholesterol reverse transport and to their ability to inhibit oxidation of low-density lipoproteins (LDL). Several lines of evidence suggest that the protective effect of HDL is at least partially related to the enzyme paraoxonase (PON1), a calcium-dependent esterase associated with the HDL surface. It has been hypothesised that PON1 may have two independent antiatherogenic roles: (a) by preventing the accumulation of oxidised lipids from oxidised lipoproteins (LDL and HDL) and thereby inhibiting the atherogenic and inflammatory response induced by lipid peroxidation products; (b) by detoxifying homocysteine thiolactone (HTL), a toxic metabolite of homocysteine. Recently, it has been reported that HDL-associated PON1 could also play a regulatory role in HDL binding to cell membranes and in HDL-mediated cholesterol efflux in macrophages. Several papers have reported that HDL are also able to protect and/or repair oxidative damage of cell membranes and we have recently demonstrated that the protective role of HDL is related to PON1 activity.

The aim of this study was to assess Ca digestibility using in vitro and in vivo methodology (rats). The tested foods were: cheese (Grana Padano; Emmentaler), soybean-based products (tofu; burger; milk; yogurt), and legumes (peas; beans). Ca digestibility was found to be high in Emmentaler (84.3%), Grana Padano (83.6%) and tofu (80.3%), with significantly lower values for soya burgers (64.1%) and soya milk (60.6%). The lowest values were detected in peas (49.6%) and beans (31.4%). Poor correlation was found between in vivo and in vitro data. The current RDAs have been established on the basis of 30% Ca digestibility, a value which reduces the risk of calcium deficiency but underestimates the contribution of dairy products. The adoption of specific, instead of general, digestibility values for each food might improve the accuracy of dietary formulations. This will require considerable efforts to develop simple and reliable in vitro methods to assess foods. KeywordsCa digestibility–Legumes–Cheese–Anti-nutritional factors

In the field of biology, free radicals which are derived from the incomplete reduction of oxygen take on great importance; they belong to the so called reactive oxygen species, whose production in the organism is an inevitable consequence of various external or internal factors to which it is exposed. Once free radicals are generated they are often capable of giving rise to chain reactions. A lot of biological molecules are susceptible to the attack by free radicals including lipids, proteins, carbohydrates and nucleic acids. Molecular alterations caused by the radical reactions have been frequently studied and are considered as pathogenetically main passages in the development of many diseases and ageing. In order to face a radical attack, living organisms have developed several biological defensive systems against it: the main ones are represented by anti oxidizing molecules and by enzymatic anti oxidizing systems. Among the various defence systems, glutathione stands out as the principal guarantor of homoeostatic intra-cellular oxidation-reduction. One of glutathione's most important functions is to act as cysteine "tank"; this amino acid is extremely unstable in the extra-cellular environment and it rapidly auto-oxidates. Whey proteins (WP) are particularly rich in cysteine (cys) and in glutamine (glu) and therefore potentially capable of increasing the organism's antioxidant defences. It is thought that the principal mechanism which allows WPs to exert their properties is through the contribution of cys and glu, which is rich in these proteins and is used intra-cellularly for the synthesis of glutathione. A diet based on milk serum proteins which supplies a superior quantity of cys, allows for a greater synthesis of hepatic glutathione in oxidative stress conditions. The use of ultra-filtrated WP could represent a useful tool in the control of oxidative stress in numerous pathological situations.

Cancer-related anorexia/cachexia syndrome (CACS) is a multifactorial syndrome characterised by tissue wasting, particularly lean body mass (LBM), metabolic alterations, fatigue, anorexia and reduced food intake. In April 2005 we started a phase III randomised study to establish the most effective and safest treatment for CACS addressing as primary endpoints: LBM, resting energy expenditure (REE), total daily physical activity, interleukin (IL)-6 and tumour necrosis factor (TNF)-α levels, and fatigue. According to the statistical design the sample size was 475 patients (95 per arm). Eligibility criteria: histologically confirmed tumours of any site; weight loss −5% in the last 3 months and/or abnormal laboratory values; life expectancy >4 months. Patients were treated with either antineoplastic therapy or supportive care. All patients received as basic oral treatment polyphenols plus alpha lipoic acid plus carbocysteine plus vitamins A, C and E. Patients were then randomised to one of the following 5 arms: (1) medroxyprogesterone acetate (MPA)/megestrol acetate (MA); (2) pharmaconutritional support containing eicosapentaenoic acid (EPA); (3) l-carnitine; (4) thalidomide; and (5) a combination of all the above agents. Treatment duration was 4 months. Interim analyses were planned after every 100 randomised patients. In September 2008, 280 patients were randomised and 240 were evaluable: M/F 167/113, mean age 62 years (range 30-84), 96% stage IV. A first interim analysis on 125 patients showed a worsening of LBM, REE and fatigue in arm 2 in comparison to the others and therefore it was withdrawn from the study. A second interim analysis after the enrolment of 204 patients showed that arm 1 was clearly significantly less effective than the others for primary efficacy endpoints, therefore it was withdrawn from the study. Statistical analysis in September 2008 showed a significant improvement of LBM (by dual X-ray energy absorptiometry), REE and fatigue in arm 5, a decrease of IL-6 in arms 3 and 5, and a decrease of TNF-α in arms 3 and 4. As for toxicity, 1 patient discontinued MPA because of deep vein thrombosis and 1 patient discontinued L-carnitine because of severe diarrhoea. In conclusion, the interim results seem to suggest that the most effective treatment for cancer patients with CACS/oxidative stress (OS) should be the combination regimen. The study is in progress.

Body composition and anthropometric assessment provide the sports physician with useful information on the health state of the athlete and with some necessary elements to plan specific training loads in the most appropriate way. In practice, the chemical composition of an athlete’s body (especially those who carry out 1–2 daily workouts) is always in a physiologic condition that we can define as “dynamic” (concentration of electrolytes, hydration state and relationship between intra-and extra-cellular water, stages of growth of muscle mass and/or reduction of fat mass, etc.), with the exception of few times of year, such as the short resting break before resuming training. As a consequence, a real “baseline” (or “stationary”) physiological state, allowing to detect the parameters of body composition under the same conditions several times during the year, is only rarely achieved. In this paper, we wanted to review the most interesting parameters and methods for the evaluation of athletes’ body composition, and underline their potential applications, possible advantages, theoretical and practical limitations. KeywordsBody composition–Anthropometry–Bioelectrical impedance analysis–Body compartments–Athletes

BackgroundCancer chemo- and radiotherapy are constantly associated with unwanted side effects at least partially ascribable to oxidative stress, an imbalance between pro-oxidant and antioxidant factors. However, the possible indication and efficacy of antioxidant supplementations — including glutathione-based formulas — aimed to restore the oxidative balance should be, respectively, evaluated and monitored carefully with reliable analytical tools. AimBecause previous studies on cystic fibrosis and athletes showed that high-cysteine-content, whey-based formulas were able to improve glutathione levels in cystic fibrosis and in healthy exercising people, the aim of this preliminary study was to evaluate the impact on oxidative balance of a new antioxidant supplementation, based on a high-cysteine formula containing a protein mimicking breast milk, on women conventionally treated for breast cancer. Subjects and methodsTwenty women suffering from breast cancer under ambulatory conventional antineo-plastic treatment were supplemented for 12 consecutive months with 10 g u.i.d. of an oral nutraceutical lipid- and lactose-free formula containing a mix of peptides from cow’s milk whey having a high content of cysteine and glutamic acid as the main biochemical precursor of glutathione (Prother®, DMF Limbiate, MI, Italy). During the study period the recruited subjects underwent a periodical (bimonthly) clinical visit, during which they were tested for oxidative balance (BAP test and d-ROMs). Before and at the end of the study the women were invited to complete the Spitzer Questionnaire. ResultsPlasma antioxidant capacity, as detected by the BAP test, showed a marked early trend towards a progressive increase, reaching statistical significance at the end of the treatment (2319.5 ± 288.7 vs. 1894.5 ± 362.5 μmol/l reduced iron, respectively; p = 0.007). Plasma oxidant status, as measured by means of the d-ROMs test, after an irregular time-course, increased significantly at the 12th month, compared to the baseline value (350.29 ± 39.29 vs. 407.00 ± 58.54 CARR U, respectively; p = 0.0017). The treatment was well tolerated. DiscussionThe breast milk-mimicking protein formula intake was associated with a restoration of biological antioxidant potential, maybe by increasing the bioavailability of antioxidant components, and reduced glutathione, with no apparent interference with the intrinsic pharmacological/chemical mechanism (oxidant species generation) of the current treatment (chemo/radiotherapy). ConclusionsThis preliminary study indicates that 12 months of regular oral intake of a high-content cysteine nutraceutic formula is associated with increased plasma antioxidant capacity in women conventionally treated for breast cancer. Moreover, the data from oxidative status assessment suggest that the above supplement did not interfere with oxidant production, the increase of which is related to the cancer and antineoplastic treatment itself. Finally, the d-ROMs and BAP tests were shown to be very reliable tools to monitor ambulatory oxidative balance in this kind of patient.

The aim of this study was to evaluate the antioxidant supplementation effect on antioxidant system in hemodialysis patients. The study group consisted of 38 patients undergoing hemodialysis and 72 healthy subjects. The patients orally received combination of vitamins C (250mg/time) and E (200IU/time) three times per week for 2months. Both, enzymatic antioxidants [superoxide dismutase (SOD) and glutathione peroxidase (GPx)] activities and non-enzymatic (vitamins E and C) levels and malondialdehyde (MDA) concentrations as lipid peroxidation product in patients were measured before and after supplementation compared with control group. The levels of antioxidants (vitamin E, C and SOD) (P<0.0001) and GPx (P<0.05) were significantly enhanced and MDA concentrations declined (P<0.0001) during the supplementation period. The study demonstrates that combined supplementation of vitamins C and E can noticeablyaffect antioxidant status and protect against oxidative stress caused during hemodialysis. KeywordsHemodialysis-Combined supplementation-Vitamin C-Vitamin E-Oxidative stress

Previous studies demonstrated that the damaging action of absolute ethanol could be attributed to the enhancement in the reactive oxygen species, increase in lipid peroxidation and inhibition of antioxidative enzyme activity. In this study we investigated the mechanism of protective effect of olive leaf extract (OLE), a natural antioxidant, on gastric mucosal damage induced by absolute ethanol in rats. OLE (80 mg/kg daily) was applied intragastrically (i.g.) two weeks prior to absolute ethanol administration. Areas of gastric lesions were measured and ulcer index (UI) was calculated. The effects of applied OLE on gastric mucosal lesions, malondialdehyde level and antioxidative enzyme (catalase and superoxide dismutase) activity were compared with effects of i.g. pretreatment of reference drug, ranitidine (50 mg/kg). Absolute ethanol administration caused severe gastric mucosal haemorrhage. Pretreatment with OLE, as well as with ranitidine, significantly (p < 0.001) attenuated the gastric lesions induced. Furthermore, OLE was effective in the prevention of an increase in gastric lipid peroxidation and in the prevention of a decrease in antioxidative enzyme activity. The results obtained indicate that OLE has gastroprotective activity against ethanol-induced gastric lesions in rats, possibly related to its antioxidative properties.

The inclusion of whey protein concentrates (WPC) in the diet can lead to a decrease in food intake. Considering that excessive food intake and weight gain are correlated with increased oxidative stress and other risk factors, the anorectic action of WPC may have important clinical implications. The aims of the current study were to verify the effects of WPC in comparison with those of casein on food intake, weight, and oxidized glutathione (GSSG) and total glutathione (GSH) concentrations in the blood and liver with or without oxidative stress induced by oral carbon tetrachloride intoxication. Male Sprague-Dawley rats were fed a balanced liquid diet for 3 weeks. Half of the rats received WPC (group P), while the control group received casein (group C). Group P rats ate significantly less than group C rats (p < 0.0001), and their weights decreased significantly. After carbon tetrachloride intoxication, there was a significant increase in GSH in rats of group P compared with the levels in rats of group C both in the liver (GSH group P 4,994 ± 652.6, group C 2,196 ± 323.2 nmol/mg, p < 0.01) and in the blood (GSH group P 1,368 ± 69.56, group C 1,088 ± 48.35 nmol/ml, p < 0.05). These findings indicate that WPC is effective in reducing food intake and preventing weight gain, and it may also play a protective role against oxidative stress by increasing glutathione synthesis in the liver.

The literature published in the last decade has variously assessed the possible association between coeliac disease (CD) and other chronic inflammatory autoimmune diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and psoriasis (Ps). This study included a total of 93 patients (15 with RA, 27 with PsA and 51 with Ps). None from the group with RA and PsA were positive to the test, while 3 of the patients belonging to the group with Ps tested positive. All three underwent intestinal biopsy, which confirmed the presence of CD. Our data revealed a higher prevalence of CD in patients with Ps compared to the general population: 3:51 patients (5.88%) vs. 1:184 resident (0.54%). It can be affirmed that screening for CD is not routinely recommended for patients suffering from RA and PsA. KeywordsCoeliac disease-Epidemiology-Prevalence-Psoriasis-Psoriatic arthritis-Rheumatoid arthritis

Globe artichoke (Cynara cardunculus var. scolymus L. Fiori) is a traditional component of the Mediterranean diet. Artichoke edible parts are one of the richest dietary sources of polyphenols with high bioavailability, and contain also high-quality inulin, fibres and minerals. Moreover, pharmaceutical artichoke leaf extracts show hypocholesterolemic and choleretic properties. Several clinical studies have shown that the bioactive properties of globe artichoke are due to the high content of polyphenolic compounds in flower heads and leaves, in particular hydroxycinnamates and flavonoids. The total antioxidant capacity of artichoke flower heads is one of the highest reported for vegetables, and is strictly related to their polyphenolic content. Different agronomic variables, such as mycorrhizal inoculation, may affect plant secondary metabolism, and in particular the production of metabolites with health-promoting activities. Our recent data showed large increases of total phenolic content and antioxidant activity in leaves and flower heads of mycorrhizal artichoke plants. KeywordsArtichoke-Functional foods-Polyphenols-Mycorrhizal symbiosis-Antioxidant activity

Lipids are indispensable in artificial nutrition, not only because of their high energy density that allows a volume reduction as well as a limitation of carbohydrate provision, but also because they reduce osmolarity of the formulas, provide essential fatty acids, enhance the bioavailability of fat-soluble vitamins and because of their pharmacological properties, including effects on inflammation and the immune response. First generation formulas in parenteral nutrition are based on soybean/safflower oils. New generations include olive oil, medium-chain/structured triglycerides and fish oil. Their respective indications are not clearly defined, but are a basis for individualized nutritional support. Recent ESPEN guidelines in enteral and parenteral nutrition provide useful information on their use in specific situations. KeywordsLipid–Enteral nutrition–Parenteral nutrition–Omega-3–Omega-6–Fish oil–Olive oil–Medium-chain triglycerides

Lipids and glucides, the energetic compounds in artificial nutrition solutions, are not only “fuel” but possess other biologic functions which may influence disease evolution. Energy-yielding solutions should cover the patient’s metabolic needs but should also limit any inflammatory and oxidative stress or impairment of the immune system. This paper provides a concise overview of the clinical and metabolic properties of the most common energetic substrates employed both in enteral and parenteral nutrition. KeywordsLipids-Glucides-Parenteral and enteral nutrition-Clinical effects

New roles have been discovered for the adipose mass/tissue of obese subjects linked to the production of different cytokines, leptin and oxidative stress, all together playing a crucial role in developing obesity, insulin resistance, metabolic syndrome, and the pathogenesis of various diseases. Inflammatory status and plasma oxidative stress have been reported as also characterizing a new metabolic condition known as normal-weight obese (NWO) syndrome observed in women with normal index but fat mass (FM) >30%. The aim of the present study was to investigate in NWO women, compared with preobese-obese (OB) and control normal weight (NW) subjects, the occurrence of DNA damage, particularly oxidative DNA damage, by using different Comet assay versions. Our goal was to find out some possible new early hallmarks of obesity. We observed above all increase in DNA damage both in OB and NWO women, compared with NW subjects, underlining DNA to be involved in oxidative stress related to metabolic abnormalities occurring in obesity. In addition, the use of either pH >13 versus pH 12.1 alkaline Comet assay versions or pH 12.1 in presence of Fpg enzyme versus pH 12.1 alone, allow us to draw attention to two possible new early differentiated hallmarks: first, alkali labile sites higher in OB compared to NWO; second, 8-oxo-dG level slightly higher in NWO than in OB women. These preliminary results encourage planning broad cohort studies in order to verify and validate these hypothesized predictive/prognostic new hallmarks. KeywordsDNA damage–Oxidative stress–Normal weight obese syndrome–Comet assay–8-OHdG

Background and aim Studies to measure motivation for behavioural change were developed in Italy 15 years ago, following the validation of MAC and MAC2, Italian self-administered questionnaires created for heroin users, tobacco smokers and those with alcohol problems. This article presents the validation study of two sets of instruments created to assess motivation for change toward healthy nutrition and regular physical activity in Italian adult subjects who require or are referred for assessment or treatment to nutrition services. Methods and results The two sets of questionnaires (created within the Nutrition Counselling Project connected to the Piano Triennale Sicurezza Alimentare 2005–2007 (Food and Nutrition Security Plan 2005–2007) of the Region of Veneto) were administered to 431 patients to assess motivation for change toward healthy nutrition and 450 patients to assess motivation for change toward regular physical activity. The instruments showed good internal consistency. Exploratory and Confirmatory Factor Analysis confirms the consistency with the theoretical assumptions. Reliability and concurrent validity yielded strong correlations with the corresponding variables. Conclusions The study confirms the validity of the sets of instruments and their consistency with the model. These sets of instruments are the first psychometric tools integrating three factors (Discrepancy, Self-Efficacy, Readiness to Change) into a three-dimensional model of motivation for change.

Tomatoes are a very important part of the Mediterranean diet. The possibility of a much healthier tomato option represents a great opportunity for the population to enhance their daily diet. Folate is an important bioactive compound for human health and increasing folate content in tomatoes can contribute to reduce some of the problems associated with this deficiency. In this review, the new option of a biofortified tomato produced by the use of DNA recombinant technology will be discussed in terms of food safety of the new genetically modified product. The possibility to increase folate content has been recently demonstrated through two modifications: the first was based on the development of a synthetic form of engineered GTP cyclohydrolase I (GCHI) (based on mammalian synthesis), which was introduced in the plants to prevent the retroinhibition of the GCHI (folate precursor) in plants; the second was based on the pteridine-overproduction trait expressing the aminodeoxychorismate synthase (AtADCS) from Arabidopsis thaliana. Genetically modified tomatoes, able to accumulate an average of 25-fold more folate than controls, were produced. These fruits could provide the complete adult daily requirement in less than one standard serving. The modification also resulted in a 20 times higher accumulation of pteridines and PABA as compared with the wild-type control. The possible risks and benefits derived from the GM modification of the tomato, and the safety of the final product for consumers will be discussed. KeywordsTransgenic food-Tomato-Folate fortification-Food safety-Risk assessment

The aim of our work was to assess the level of fruit and vegetable consumption in the meal provided by the school canteen, also assessing the degree of appreciation for the different fruit and vegetable types. Our focus was on school children in grades 1 (6 year olds) and 5 (10 year olds) so as to cover a broad age range and to assess how tastes and fruit and vegetable intake vary as a function of age. The children’s liking of fruit was not homogeneous; oranges were the most appreciated fruits among 6 year olds while apples and kiwis were the least appreciated. The 10-year-old school children showed no statistically significant differences in their liking of certain fruit types. Fruit intake during the school meals was enough to meet a considerable amount of the vitamin C requirements, above all when oranges, kiwis and strawberries were eaten. Eating apples makes it possible to cover more than 10% of the fibre requirements. This is of great importance given its fundamental role. Although to a lower extent than vitamin C, fruit intake also allows a considerable percentage of the K nutritional requirements to be met, covering up to 28% in the case of bananas. As far as vegetables are concerned, tomatoes are the most popular among 10 year olds; given their high vitamin C content they make it possible to significantly cover the vitamin C requirements (24.5–34.1%). An important role is also played by the intake of carrots in relation to covering the retinol requirements (43.45% in grade 1 and 66.58% in grade 5).