Objective: To analyse the relationships between eating pattern, vomiting frequency, weight loss a... more Objective: To analyse the relationships between eating pattern, vomiting frequency, weight loss and the rate of band related complications in morbidly obese patients undergoing Adjustable Silicone Gastric Banding (ASGB). Subjects: 80 morbidly obese patients (57 females and 23 males) consecutively operated by ASGB were evaluated both before and 3, 6 and 12 months after ASGB. Ten patients (12.5%) had binge eating disorder and were analysed separately. Measurements: (1) weight loss expressed as percentage of overweight, (2) total daily energy intake, (3) percentage of energy as lipids, carbohydrates and proteins, (4) percent as liquid, soft or solid foods and (5) vomiting frequency. Results: ASGB induced a highly significant reduction of total daily energy intake and percent as solid foods, without significant changes in macronutrient distribution. There was an inverse relationship between vomiting frequency and the intake of solid foods. Non-binge eaters with more vomiting ate less solid food and lost more weight than patients without vomiting. The frequency of neostoma stenosis was higher in patients with high vomiting frequency than in patients with no vomiting. Patients with binge eating disorder had a significantly higher vomiting frequency and a five-fold higher frequency of neostoma stenosis than patients without binge eating disorder. However, the percentage of overweight lost did not differ between patients with and without binge eating. Conclusions: Vomiting is a major determinant of global outcome after ASGB. The vomiting frequency in the first months after ASGB was associated with eating pattern, the frequency of neostoma stenosis and possibly the rate of weight loss during the first year of follow-up.
Background. Our study investigated nutritional status, body composition, and resting energy expen... more Background. Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size. Methods. The study involved 52 institutionalized bedridden elderly women (aged 83.7 6 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured. Results. The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 6 236.7 vs 1085.5 6 161.3 kcal/d; p , .05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 6 6.7 vs 21.1 6 4.0 kcal/d/kg; p , .01). Hypermetabolism, i.e., a measured REE. 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (ÁREE) correlated with PS volume (r ¼ 0.58; p , .01), but not with area. Conclusion. Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.
The accuracy of waist to hip girth ratio (WHR) in assessing visceral/subcutaneous abdominal fat d... more The accuracy of waist to hip girth ratio (WHR) in assessing visceral/subcutaneous abdominal fat distribution has not yet been clearly established in the obese population. The purpose of the present study was to evaluate the relationship between WHR and visceral/subcutaneous fat distribution, both assessed by computerized tomography (CT), in a group of 28 obese patients (15 male, 13 female). Furthermore, 33 normal weight or slightly overweight subjects (23 male, 10 female) were studied as a control group. Obese subjects of both sexes were found to have higher values of WHR than non-obese; conversely visceral:subcutaneous fat area ratio (VSR) values did not differ significantly. Significant correlation between WHR and BMI was present both in males (r = 0.41, P < 0.01) and in females (r = 0.54, P < 0.01). In normal weight males significant correlations between WHR and visceral fat area or VSR were found. In obese males these correlations were much weaker. In normal weight females a significant correlation was found between waist circumference and visceral fat area, whereas in obese females no positive correlations were found between anthropometric measurements and CT indices of visceral fat distribution. In conclusion, WHR cannot be considered as a reliable index of visceral/subcutaneous fat distribution in obese patients, particularly if they are females.
To evaluate the association between BMI levels, muscular strength, muscle composition and physica... more To evaluate the association between BMI levels, muscular strength, muscle composition and physical performance in the elderly. Italians subjects from the Progetto Veneto Anziani (ProVA) study were analyzed. The ProVa was a population study focused on chronic diseases and functional limitations in Italian subjects aged ≥65 years living in two Northeast Italian cities. The ProVa study included 3099 subjects. ProVa participants with unknown information on BMI or disability status were excluded. The final sample was thus represented by 1.188 men, and 1.723 women. Physical performance was measured with the Short Physical Performance Battery (SPPB) and leg muscular strength with dynamometry. Fat distribution and skeletal muscle composition were measured in an abdominal single-scan magnetic resonance (MRI) in a randomly selected sample of 348 subjects. Study population was stratified by BMI classes. An association between BMI levels and SPPB was observed. Normal weight subjects showed the best SPPB scores (8.29±0.03), with significant differences compared to underweight (7.50±0.15; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), overweight (8.12±0.02; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), class I (7.72±0.04; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), class II (6.67±0.09; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and class III obesity (5.88±0.24; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). This pattern was not modified by adjustment for possible confounders. Compared to normal weight subjects (22.9±0.1 kg), leg muscular strength was higher in overweight (23.8±0.1; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and in class I obesity (24.5±0.1; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), but it was reduced in class II (21.4±0.3; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and class III (19.8±0.9; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The association between BMI and impaired physical performance was not affected by adjustment for muscular strength. An inverse association between SPPB scores and fat infiltration in skeletal muscle was observed in patients with abdominal MRI. A poor physical performance was observed in overweight and obese elderly subjects. Leg strength was reduced only in subjects with severe obesity. Physical performance was negatively influenced by the degree of fat infiltration in skeletal muscle.
Excerpt Several different types of lipomatosis have been described: 1) multiple symmetric lipomat... more Excerpt Several different types of lipomatosis have been described: 1) multiple symmetric lipomatosis, characterized by a symmetric formation of fatty tumors (1, 2), associated with signs of a medi...
The aim of the study was to assess the relation between the waist to hips ratio (WHR) and the dis... more The aim of the study was to assess the relation between the waist to hips ratio (WHR) and the distribution of adipose tissue in visceral or subcutaneous site through the use of CAT. Results are expressed as the ratio of visceral to subcutaneous adipose tissue area (VSR). A total of 61 patients were randomly selected for inclusion in the study. Contrary to normal weight subjects, obese patients did not reveal significant correlations between the two ratios. Following multi-variant analysis in normal weight subjects, WHR appeared to be influenced by sex, BMI and VSR. In patients with prevalently visceral adiposity WHR was determined by sex and VSR, whereas in patients with prevalently subcutaneous adiposity it was influenced by BMI alone. In conclusion, the significant correlations between WHR and tomographic indices of adipose tissue distribution reported in the literature are not present in all types of patient, and in particular are not found in obese patients and normal weight subjects with prevalently subcutaneous adiposity.
Study objective: Our study investigates nutritional status, resting energy expenditure (REE) and ... more Study objective: Our study investigates nutritional status, resting energy expenditure (REE) and physical performance in elderly patients with stable COPD to identify any early conditions of hypermetabolism, malnutrition and sarcopenia. Methods: Eighty-six males (40 stable COPD and 46 healthy subjects) over 65 years old were studied. All subjects underwent spirometry, blood gas analysis and a 6-min walking test (6MWT). Fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM) were measured by dual energy X-ray absorptiometry (DEXA). REE was measured by indirect calorimetry. Results: COPD patients had a lower FFM both expressed in kilograms and after correction for height squared. The prevalence of sarcopenia was higher for COPD subjects (38% vs 31%). REE, both in absolute values and adjusted for FFM was significantly higher in COPD patients. Hypermetabolism was found in 60% of COPD cases and 13.7% (Po0.01) of healthy subjects. No relationship was found in COPD patients between the measured/predicted REE ratio (REE m /REE p) and FEV 1. In the hypermetabolic COPD subgroup, the REE m /REE p ratio correlated with 6MWT. Conclusions: Elderly patients with stable COPD develop an increased REE. This hypermetabolism seems to be independent of the severity of the pulmonary obstruction and to influence the patient's physical performance.
Purpose of Review Bariatric surgery is today the most effective therapy for weight loss and reduc... more Purpose of Review Bariatric surgery is today the most effective therapy for weight loss and reduction of comorbidity burden in patients with severe obesity. However, bariatric surgery does not benefit equally all the patients. A consistent variability in outcomes has been observed. Predicting responses to bariatric surgery could be an important tool in clinical practice, by improving patients' selection or by identifying patients in which more aggressive follow-up and post-operative intervention should be applied. Predictive factors for weight loss, weight regain, diabetes remission and recurrence are briefly reviewed in this paper. Recent Findings Many pre-operative factors have been proposed as negative or positive predictors of body weight reduction after surgery. However, none of these factors has been consistently demonstrated to have a sufficiently strong predictive power to influence eligibility to bariatric surgery itself. Weight regain can occur after bariatric surgery and its probability seems to be more influenced by post-operative behavioral factors than by pre-operative predictors. Several effective scores have been developed to predict diabetes remission after surgery, however long-term maintenance and diabetes recurrence after surgery seem again more influenced by post-operative behaviors and weight loss maintenance. Summary In general, more attention and active interventions to pre-operative and post-operative eating behaviors and lifestyle modifications are probably more important at the clinical level than the search of pre-operative predictors of long-term outcomes.
Nutrition, metabolism, and cardiovascular diseases : NMCD, 2015
Aim of this study is an updated review of our case series (72 patients) as well as available lite... more Aim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs). The disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The locali...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1995
To analyze the relationship between visceral fat accumulation and resting energy expenditure in o... more To analyze the relationship between visceral fat accumulation and resting energy expenditure in obese women and to evaluate the effects of a severe weight loss both on energy expenditure and on fat distribution. Twelve premenopausal women, aged 19-50 years, undergoing adjustable silicone gastric banding (ASGB) for morbid obesity participated at the study. The patients were evaluated twice. The baseline evaluation was performed immediately before surgery. After surgery, a diet specifically developed for patients submitted to gastric restriction (2.5 MJ/day) was given to the patients. The second evaluation was performed 6 months after surgery. Resting metabolic rate (RMR) was determined by indirect calorimetry. Total fat area (TFA), visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by abdominal computed tomography. Fat mass (FM) and fat free mass (FFM) were derived by bioelectrical impedance analysis. At baseline, RMR was positively related to VFA (r = 0.60, P <...
The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battlegro... more The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors – within health systems and at a national level – along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address ...
Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a g... more Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of ...
In physiological conditions, the adipose organ resides in well-defined areas, where it acts provi... more In physiological conditions, the adipose organ resides in well-defined areas, where it acts providing an energy supply and as an endocrine organ involved in the control of whole-body energy metabolism. Adipose tissue adipokines connect the body’s nutritional status to the regulation of energy balance. When it surrounds organs, it provides also for mechanical protection. Adipose tissue has a complex and heterogenous cellular composition that includes adipocytes, adipose tissue-derived stromal and stem cells (ASCs) which are mesenchymal stromal cells, and endothelial and immune cells, which signal to each other and to other tissues to maintain homeostasis. In obesity and in other nutrition related diseases, as well as in age-related diseases, biological and functional changes of adipose tissue give rise to several complications. Obesity triggers alterations of ASCs, impairing adipose tissue remodeling and adipose tissue function, which induces low-grade systemic inflammation, progress...
Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by overgrowing lipomatous t... more Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by overgrowing lipomatous tissue (LT) in the subcutaneous adipose tissue (SAT). What LT is and how it expands are not completely understood; previous data suggested that it could derive from brown AT precursors. In six MSL type I patients, we compared LT morphology by histological and immunohistochemistry (IHC) analysis, gene expression, by qPCR, kinase activity, by Western Blot and in vitro assay to paired-control SAT using AT from patients with pheochromocytoma as a human browning reference. In the stromal vascular fraction (SVF), we quantified adipose stem cells (ASCs) by flow cytometry, the proliferation rate, white and beige adipogenic potential and clonogenicity and adipogenicity by a limiting dilution assay. LT displayed white AT morphology and expression pattern and did not show increased levels of the brown-specific marker UCP1. In LT, we evidenced AKT, CK2 and ERK1/2 hyperactivation. LT-SVF contained inc...
Resting energy expenditure (REE) declines more than what is expected according to body compositio... more Resting energy expenditure (REE) declines more than what is expected according to body composition changes after caloric restriction. This metabolic adaptation is considered one of the factors favoring weight regain. The aim of this study is to evaluate the changes of REE and calculate the degree of metabolic adaptation occurring after laparoscopic sleeve gastrectomy (LSG). REE (by indirect calorimetry) and body composition (fat-free mass or FFM, fat mass or FM by bioelectrical impedance analysis) were determined before and after 12 months in 154 patients with obesity treated with laparoscopic sleeve gastrectomy (LSG). Weight loss was 29.8 ± 10.6%, with corresponding relative reductions in FM (44.5 ± 22.8%), FFM (13.7 ± 9.9%), and REE (27.3 ± 12.9%). A predictive equation for REE was computed by using the baseline FFM and FM values to account for body composition changes. A predicted post-weight loss REE was calculated by using this equation and entering post-weight loss body compos...
Objective: To analyse the relationships between eating pattern, vomiting frequency, weight loss a... more Objective: To analyse the relationships between eating pattern, vomiting frequency, weight loss and the rate of band related complications in morbidly obese patients undergoing Adjustable Silicone Gastric Banding (ASGB). Subjects: 80 morbidly obese patients (57 females and 23 males) consecutively operated by ASGB were evaluated both before and 3, 6 and 12 months after ASGB. Ten patients (12.5%) had binge eating disorder and were analysed separately. Measurements: (1) weight loss expressed as percentage of overweight, (2) total daily energy intake, (3) percentage of energy as lipids, carbohydrates and proteins, (4) percent as liquid, soft or solid foods and (5) vomiting frequency. Results: ASGB induced a highly significant reduction of total daily energy intake and percent as solid foods, without significant changes in macronutrient distribution. There was an inverse relationship between vomiting frequency and the intake of solid foods. Non-binge eaters with more vomiting ate less solid food and lost more weight than patients without vomiting. The frequency of neostoma stenosis was higher in patients with high vomiting frequency than in patients with no vomiting. Patients with binge eating disorder had a significantly higher vomiting frequency and a five-fold higher frequency of neostoma stenosis than patients without binge eating disorder. However, the percentage of overweight lost did not differ between patients with and without binge eating. Conclusions: Vomiting is a major determinant of global outcome after ASGB. The vomiting frequency in the first months after ASGB was associated with eating pattern, the frequency of neostoma stenosis and possibly the rate of weight loss during the first year of follow-up.
Background. Our study investigated nutritional status, body composition, and resting energy expen... more Background. Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size. Methods. The study involved 52 institutionalized bedridden elderly women (aged 83.7 6 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured. Results. The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 6 236.7 vs 1085.5 6 161.3 kcal/d; p , .05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 6 6.7 vs 21.1 6 4.0 kcal/d/kg; p , .01). Hypermetabolism, i.e., a measured REE. 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (ÁREE) correlated with PS volume (r ¼ 0.58; p , .01), but not with area. Conclusion. Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.
The accuracy of waist to hip girth ratio (WHR) in assessing visceral/subcutaneous abdominal fat d... more The accuracy of waist to hip girth ratio (WHR) in assessing visceral/subcutaneous abdominal fat distribution has not yet been clearly established in the obese population. The purpose of the present study was to evaluate the relationship between WHR and visceral/subcutaneous fat distribution, both assessed by computerized tomography (CT), in a group of 28 obese patients (15 male, 13 female). Furthermore, 33 normal weight or slightly overweight subjects (23 male, 10 female) were studied as a control group. Obese subjects of both sexes were found to have higher values of WHR than non-obese; conversely visceral:subcutaneous fat area ratio (VSR) values did not differ significantly. Significant correlation between WHR and BMI was present both in males (r = 0.41, P < 0.01) and in females (r = 0.54, P < 0.01). In normal weight males significant correlations between WHR and visceral fat area or VSR were found. In obese males these correlations were much weaker. In normal weight females a significant correlation was found between waist circumference and visceral fat area, whereas in obese females no positive correlations were found between anthropometric measurements and CT indices of visceral fat distribution. In conclusion, WHR cannot be considered as a reliable index of visceral/subcutaneous fat distribution in obese patients, particularly if they are females.
To evaluate the association between BMI levels, muscular strength, muscle composition and physica... more To evaluate the association between BMI levels, muscular strength, muscle composition and physical performance in the elderly. Italians subjects from the Progetto Veneto Anziani (ProVA) study were analyzed. The ProVa was a population study focused on chronic diseases and functional limitations in Italian subjects aged ≥65 years living in two Northeast Italian cities. The ProVa study included 3099 subjects. ProVa participants with unknown information on BMI or disability status were excluded. The final sample was thus represented by 1.188 men, and 1.723 women. Physical performance was measured with the Short Physical Performance Battery (SPPB) and leg muscular strength with dynamometry. Fat distribution and skeletal muscle composition were measured in an abdominal single-scan magnetic resonance (MRI) in a randomly selected sample of 348 subjects. Study population was stratified by BMI classes. An association between BMI levels and SPPB was observed. Normal weight subjects showed the best SPPB scores (8.29±0.03), with significant differences compared to underweight (7.50±0.15; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), overweight (8.12±0.02; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), class I (7.72±0.04; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), class II (6.67±0.09; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and class III obesity (5.88±0.24; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). This pattern was not modified by adjustment for possible confounders. Compared to normal weight subjects (22.9±0.1 kg), leg muscular strength was higher in overweight (23.8±0.1; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and in class I obesity (24.5±0.1; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), but it was reduced in class II (21.4±0.3; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and class III (19.8±0.9; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The association between BMI and impaired physical performance was not affected by adjustment for muscular strength. An inverse association between SPPB scores and fat infiltration in skeletal muscle was observed in patients with abdominal MRI. A poor physical performance was observed in overweight and obese elderly subjects. Leg strength was reduced only in subjects with severe obesity. Physical performance was negatively influenced by the degree of fat infiltration in skeletal muscle.
Excerpt Several different types of lipomatosis have been described: 1) multiple symmetric lipomat... more Excerpt Several different types of lipomatosis have been described: 1) multiple symmetric lipomatosis, characterized by a symmetric formation of fatty tumors (1, 2), associated with signs of a medi...
The aim of the study was to assess the relation between the waist to hips ratio (WHR) and the dis... more The aim of the study was to assess the relation between the waist to hips ratio (WHR) and the distribution of adipose tissue in visceral or subcutaneous site through the use of CAT. Results are expressed as the ratio of visceral to subcutaneous adipose tissue area (VSR). A total of 61 patients were randomly selected for inclusion in the study. Contrary to normal weight subjects, obese patients did not reveal significant correlations between the two ratios. Following multi-variant analysis in normal weight subjects, WHR appeared to be influenced by sex, BMI and VSR. In patients with prevalently visceral adiposity WHR was determined by sex and VSR, whereas in patients with prevalently subcutaneous adiposity it was influenced by BMI alone. In conclusion, the significant correlations between WHR and tomographic indices of adipose tissue distribution reported in the literature are not present in all types of patient, and in particular are not found in obese patients and normal weight subjects with prevalently subcutaneous adiposity.
Study objective: Our study investigates nutritional status, resting energy expenditure (REE) and ... more Study objective: Our study investigates nutritional status, resting energy expenditure (REE) and physical performance in elderly patients with stable COPD to identify any early conditions of hypermetabolism, malnutrition and sarcopenia. Methods: Eighty-six males (40 stable COPD and 46 healthy subjects) over 65 years old were studied. All subjects underwent spirometry, blood gas analysis and a 6-min walking test (6MWT). Fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM) were measured by dual energy X-ray absorptiometry (DEXA). REE was measured by indirect calorimetry. Results: COPD patients had a lower FFM both expressed in kilograms and after correction for height squared. The prevalence of sarcopenia was higher for COPD subjects (38% vs 31%). REE, both in absolute values and adjusted for FFM was significantly higher in COPD patients. Hypermetabolism was found in 60% of COPD cases and 13.7% (Po0.01) of healthy subjects. No relationship was found in COPD patients between the measured/predicted REE ratio (REE m /REE p) and FEV 1. In the hypermetabolic COPD subgroup, the REE m /REE p ratio correlated with 6MWT. Conclusions: Elderly patients with stable COPD develop an increased REE. This hypermetabolism seems to be independent of the severity of the pulmonary obstruction and to influence the patient's physical performance.
Purpose of Review Bariatric surgery is today the most effective therapy for weight loss and reduc... more Purpose of Review Bariatric surgery is today the most effective therapy for weight loss and reduction of comorbidity burden in patients with severe obesity. However, bariatric surgery does not benefit equally all the patients. A consistent variability in outcomes has been observed. Predicting responses to bariatric surgery could be an important tool in clinical practice, by improving patients' selection or by identifying patients in which more aggressive follow-up and post-operative intervention should be applied. Predictive factors for weight loss, weight regain, diabetes remission and recurrence are briefly reviewed in this paper. Recent Findings Many pre-operative factors have been proposed as negative or positive predictors of body weight reduction after surgery. However, none of these factors has been consistently demonstrated to have a sufficiently strong predictive power to influence eligibility to bariatric surgery itself. Weight regain can occur after bariatric surgery and its probability seems to be more influenced by post-operative behavioral factors than by pre-operative predictors. Several effective scores have been developed to predict diabetes remission after surgery, however long-term maintenance and diabetes recurrence after surgery seem again more influenced by post-operative behaviors and weight loss maintenance. Summary In general, more attention and active interventions to pre-operative and post-operative eating behaviors and lifestyle modifications are probably more important at the clinical level than the search of pre-operative predictors of long-term outcomes.
Nutrition, metabolism, and cardiovascular diseases : NMCD, 2015
Aim of this study is an updated review of our case series (72 patients) as well as available lite... more Aim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs). The disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The locali...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1995
To analyze the relationship between visceral fat accumulation and resting energy expenditure in o... more To analyze the relationship between visceral fat accumulation and resting energy expenditure in obese women and to evaluate the effects of a severe weight loss both on energy expenditure and on fat distribution. Twelve premenopausal women, aged 19-50 years, undergoing adjustable silicone gastric banding (ASGB) for morbid obesity participated at the study. The patients were evaluated twice. The baseline evaluation was performed immediately before surgery. After surgery, a diet specifically developed for patients submitted to gastric restriction (2.5 MJ/day) was given to the patients. The second evaluation was performed 6 months after surgery. Resting metabolic rate (RMR) was determined by indirect calorimetry. Total fat area (TFA), visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by abdominal computed tomography. Fat mass (FM) and fat free mass (FFM) were derived by bioelectrical impedance analysis. At baseline, RMR was positively related to VFA (r = 0.60, P <...
The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battlegro... more The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors – within health systems and at a national level – along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address ...
Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a g... more Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of ...
In physiological conditions, the adipose organ resides in well-defined areas, where it acts provi... more In physiological conditions, the adipose organ resides in well-defined areas, where it acts providing an energy supply and as an endocrine organ involved in the control of whole-body energy metabolism. Adipose tissue adipokines connect the body’s nutritional status to the regulation of energy balance. When it surrounds organs, it provides also for mechanical protection. Adipose tissue has a complex and heterogenous cellular composition that includes adipocytes, adipose tissue-derived stromal and stem cells (ASCs) which are mesenchymal stromal cells, and endothelial and immune cells, which signal to each other and to other tissues to maintain homeostasis. In obesity and in other nutrition related diseases, as well as in age-related diseases, biological and functional changes of adipose tissue give rise to several complications. Obesity triggers alterations of ASCs, impairing adipose tissue remodeling and adipose tissue function, which induces low-grade systemic inflammation, progress...
Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by overgrowing lipomatous t... more Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by overgrowing lipomatous tissue (LT) in the subcutaneous adipose tissue (SAT). What LT is and how it expands are not completely understood; previous data suggested that it could derive from brown AT precursors. In six MSL type I patients, we compared LT morphology by histological and immunohistochemistry (IHC) analysis, gene expression, by qPCR, kinase activity, by Western Blot and in vitro assay to paired-control SAT using AT from patients with pheochromocytoma as a human browning reference. In the stromal vascular fraction (SVF), we quantified adipose stem cells (ASCs) by flow cytometry, the proliferation rate, white and beige adipogenic potential and clonogenicity and adipogenicity by a limiting dilution assay. LT displayed white AT morphology and expression pattern and did not show increased levels of the brown-specific marker UCP1. In LT, we evidenced AKT, CK2 and ERK1/2 hyperactivation. LT-SVF contained inc...
Resting energy expenditure (REE) declines more than what is expected according to body compositio... more Resting energy expenditure (REE) declines more than what is expected according to body composition changes after caloric restriction. This metabolic adaptation is considered one of the factors favoring weight regain. The aim of this study is to evaluate the changes of REE and calculate the degree of metabolic adaptation occurring after laparoscopic sleeve gastrectomy (LSG). REE (by indirect calorimetry) and body composition (fat-free mass or FFM, fat mass or FM by bioelectrical impedance analysis) were determined before and after 12 months in 154 patients with obesity treated with laparoscopic sleeve gastrectomy (LSG). Weight loss was 29.8 ± 10.6%, with corresponding relative reductions in FM (44.5 ± 22.8%), FFM (13.7 ± 9.9%), and REE (27.3 ± 12.9%). A predictive equation for REE was computed by using the baseline FFM and FM values to account for body composition changes. A predicted post-weight loss REE was calculated by using this equation and entering post-weight loss body compos...
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Papers by Luca Busetto