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Lutein is a carotenoid with reported anti-inflammatory properties. A large body of evidence shows that lutein has several beneficial effects, especially on eye health. In particular, lutein is known to improve or even prevent age-related macular disease which is the leading cause of blindness and vision impairment. Furthermore, many studies have reported that lutein may also have positive effects in different clinical conditions, thus ameliorating cognitive function, decreasing the risk of cancer, and improving measures of cardiovascular health. At present, the available data have been obtained from both observational studies investigating lutein intake with food, and a few intervention trials assessing the efficacy of lutein supplementation. In general, sustained lutein consumption, either through diet or supplementation, may contribute to reducing the burden of several chronic diseases. However, there are also conflicting data concerning lutein efficacy in inducing favorable effects on human health and there are no univocal data concerning the most appropriate dosage for daily lutein supplementation. Therefore, based on the most recent findings, this review will focus on lutein properties, dietary sources, usual intake, efficacy in human health, and toxicity.

Several studies link cardiovascular diseases (CVD) with unhealthy lifestyles (unhealthy dietary habits, alcohol consumption, smoking, and low levels of physical activity). Therefore, the strong need for CVD prevention may be pursued through an improved control of CVD risk factors (impaired lipid and glycemic profiles, high blood pressure, and obesity), which is achievable through an overall intervention aimed to favor a healthy lifestyle. Focusing on diet, different recommendations emphasize the need to increase or avoid consumption of entire classes of food, with only partly known and only partly foreseeable consequences on the overall level of health. In recent years, the ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome, and although the beneficial effects on weight loss and glucose metabolism seems to be well established, the effects of a prolonged KD on the ability to perform different types of exercise and the influence of KD on blood pressure (BP) levels, both in normotensives and in hypertensives, are not so well understood. The objective of this review is to analyze, on the basis of current evidence, the relationship between KD, regular physical activity, and BP.

Energy balance and thermodynamic laws regulate body weight. Therefore, obesity must occur over a sufficiently long period of time in which energy intake exceeds energy expenditure. It is clear that a strict application of the law of energy balance cannot fully explain what is observed in real life. One possible hypothesis is that some individuals may have an energy-sparing metabolism, predisposing them to obesity. Furthermore, energy balance can be regulated to maintain body weight within a fixed individual range, a set point, which is influenced by genetic or epigenetic factors. An energy balance regulator, the ponderostat, may be able to increase or decrease both energy expenditure and energy intake, depending on food availability (e.g., periods of famine or low-calorie diet, periods of overeating), to maintain body weight within the set point. The ponderostat is regulated by a complex neuroendocrine system that includes central structures located in the frontal cortex, hypothalamus, and diencephalic region, with peripheral afferents and efferents. Therefore, in many cases, obesity could be considered the consequence of a dysregulated ponderostat. This narrative review proposes a unifying perspective that considers obesity as a biological condition with an abnormal set point and dysregulated energy balance due to abnormalities in ponderostat function. Current and future antiobesity pharmacological treatments may be considered curative for ponderostat dysregulation.

Background: Dietary fats, and especially saturated fatty acid (SFA), have been blamed for being the culprit in the dramatic increase in obesity and its associated diseases. However multiple systematic reviews and recent meta-analyses do not support the association between SFA and cardiovascular diseases. Thus, the objective of this study was to test whether specific types and subtypes of dietary fats are associated with metabolic outcomes in a cohort of Italian adults. Methods: Nutritional and demographic data of 1936 adults living in the south of Italy were examined. Food frequency questionnaires (FFQs) were administered to assess the intake of total dietary fat and each specific class of dietary fat, such as SFA, monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA). The intake of fatty acids was also examined according to the carbon-chain length of each individual class. Cases of hypertension, type-2 diabetes and dyslipidemias were collected from previous doctor-confirmed diagnosis records (or direct measurement of blood pressure). Results: After adjustment for potential confounding factors, individuals reporting higher intakes of total and saturated fats were associated with lower likelihood of having hypertension (odds ratio (OR) = 0.57, 95% CI: 0.35, 0.91 and OR = 0.55, 95% CI: 0.34, 0.89, respectively). Moreover, higher intake of short-chain saturated fatty acids (SCSFAs) and medium-chain saturated fatty acids (MCSFAs) was inversely associated with dyslipidemia and diabetes (OR = 0.43, 95% CI: 0.23, 0.82 and OR = 0.25, 95% CI: 0.09, 0.72, respectively). Among MUFAs, C18:1 was inversely associated with hypertension and diabetes (OR = 0.52, 95% CI: 0.30, 0.92 and OR = 0.21, 95% CI: 0.07, 0.67, respectively), while C14:1 intake was inversely associated only with hypertension (OR = 0.57, 95% CI: 0.37, 0.88). In contrast, C20:1 intake was associated with dyslipidemia (OR = 3.35, 95% CI: 1.33, 8.42). Regarding PUFA, C18:2 and 20:5 were inversely associated with hypertension (OR = 0.33, 95% CI: 0.18, 0.60 and OR = 0.30, 95% CI: 0.10, 0.89, respectively). Conclusions: The consumption of SFA does not seem to be harmful to cardio-metabolic health and, on the contrary, SCSFA may exert beneficial effects. Further studies are needed to clearly validate the results of the present study.

The SELECT trial found semaglutide reduced major adverse cardiovascular events (MACE) in patients with overweight or obesity with cardiovascular disease but without diabetes. We report a prespecified analysis of the SELECT trial on the relationships between baseline adiposity measures, treatment-induced adiposity changes, and subsequent MACE risk. Patients aged at least 45 years, with a BMI of at least 27 kg/m2 were enrolled in 41 countries (804 sites) and randomised 1:1 to once-weekly semaglutide 2·4 mg or placebo. The primary outcome was time to first MACE (composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). Adiposity measures included weight and waist circumference. In this analysis, risk of MACE occurring after 20 weeks was assessed between patients by adiposity changes in the first 20 weeks and, in a separate analysis, all in-trial MACE were assessed between patients by adiposity changes over 104 weeks. This trial is registered with ClinicalTrials.gov, NCT03574597. Semaglutide significantly reduced MACE incidence compared with placebo among 17 604 patients enrolled in SELECT, with consistent benefits across all baseline weight and waist circumference categories. In the semaglutide group, analyses for linear trends showed lower baseline bodyweight and waist circumference were associated with lower incidence of MACE—an average 4% reduction in risk per 5 kg lower bodyweight (hazard ratio [HR] 0·96 [95% CI 0·94–0·99]; p=0·001) and per 5 cm smaller waist circumference (0·96 [0·93–0·99]; p=0·004). In the placebo group, lower baseline waist circumference (0·96 [0·94–0·99]; p=0·007), but not bodyweight (0·99 [0·97–1·01]; p=0·28), was associated with a lower MACE risk and weight loss was paradoxically associated with increased MACE risk. In those receiving semaglutide there was no linear trend linking weight loss at week 20 to subsequent MACE risk, but greater waist circumference reduction at week 20 was associated with lower subsequent MACE risk, and waist circumference reduction by week 104 was associated with lower in-trial risk of MACE. An estimated 33% of the observed benefit on MACE was mediated through waist circumference reduction (HR 0·86 [95% CI 0·77–0·97] after adjustment for time-varying changes in waist circumference). The cardioprotective effects of semaglutide were independent of baseline adiposity and weight loss and had only a small association with waist circumference, suggesting some mechanisms for benefit beyond adiposity reduction. Novo Nordisk.

[...]the study of Yamabe et al. is partly in agreement with some recently published clinical trials that gave different conclusions. [...]applying the Student's t‐test for unpaired data, we observed that patients allocated to the I‐Deg group had significantly (P < 0.01) lower glycated hemoglobin values than those of the I‐G300 group (8.57 vs 8.71%), but also significantly (P < 0.01) lower fasting plasma glucose concentrations (182 vs 191 mg/dL) and self‐monitoring plasma glucose (172 vs 178 mg/dL; P < 0.05). [...]we believe that either head‐to‐head randomized controlled trials or real‐world studies need to be designed including well‐matched groups, paying special attention to potential confounding factors.

Cystic echinococcosis is a zoonosis caused by the ingestion of food or water contaminated by 'Echinococcus' eggs. E. granulosus is the most common causative agent of cystic echinococcosis that still has a relevant incidence in Italy, especially on the islands of Sicily and Sardinia. We report the case of a 64-year-old man with disseminated abdominal cystic echinococcosis (liver, spleen, peritoneum). The patient was asymptomatic and non-eligible for surgical treatment. Treatment with albendazole 400 mg/twice daily was started in 2012 for 15 cycles (each cycle consisted of three 28-day treatments at 14-day intervals) over 10 years for a total of 1260 days of treatment. Serum anti-'Echinococcus' antibody titers and imaging (echography, TC) were evaluated to monitor the evolution of the disease. Imaging techniques documented the regression of all cyst lesions, but it was less evident for the peritoneal localizations that still are in follow-up. In this case, the prolonged treatment with albendazole was effective, safe and free of side effects. Until today, the patient displays a good clinical condition.

Irisin, a novel myokine produced in response to physical activity, promotes white-to-brown fat transdifferentiation. The name irisin referred to the ancient Greek goddess Iris, the messenger who delivered (bad) news from the gods. In mice, it has been demonstrated that irisin plays a key role in metabolic regulation, energy expenditure and glucose homeostasis. New findings from various studies carried out in both animals and humans suggest that irisin might also have other favorable effects, such as increasing bone cortical mass, preventing hepatic lipid accumulation, and improving cognitive functions, thus mediating many exercise-induced health benefits. However, data on the role and function of irisin in humans have prompted controversy, due mostly to the only recent confirmation of the presence of irisin in humans. Another strong limitation to the understanding of irisin mechanisms of action is the lack of knowledge about its receptor, which until now remains unidentified in humans and in animals. This review presents an overall analysis of the history of irisin, its expression, and its involvement in health, especially in humans. Level of Evidence Level V, review.

Background Prediabetes (PD) precedes type 2 diabetes (T2D), it can be easily recognized by fasting plasma glucose concentrations (FPG) or HbA1c or 2 h post glucose load glycemia, thereby enabling prevention strategies. We investigated the progression of PD to T2D in the ABCD study (Alimentazione, Benessere Cardiovascolare e Diabete -ISRCTN15840340) that included a representative cohort of adult people living in the Mediterranean area of Palermo (Italy). Materials and methods The ABCD cohort was enrolled in 2011 and re-evaluated in 2015. The FPG, HbA1c, physical activity level and dietary habits were investigated. In 2011 participants and their family doctors were informed about their health conditions and indications concerning realistic changes for a healthier lifestyle were provided. Results Complete information was obtained on 742 out of 1233 individuals. In 2011, the prevalence of PD was 30.7% of which 12.7% developed T2D and 43.9% reversed to normal glucose tolerance (NGT) at follow-up. In 2015, 106 previously NGT participants developed PD. The progression as to T2D as to PD were associated with age ( P  < 0.001) and sex ( P  < 0.001). Body weight, BMI, and waist circumference were higher in people with PD than in those without PD and even higher in PD that developed T2D ( P  < 0.001). A sedentary lifestyle was observed in the PD and NGT subgroups which developed T2D and PD, respectively. Daily energy intake decreased among people with PD who became NGT ( P  < 0.001) and increased in those who developed T2D ( P  < 0.05). The glycemic index of diet decreased in those PD people who became NGT and in those people who maintained NGT at follow-up. The MEDILITE score, that describes the Mediterranean pattern of diet, increased significantly in PD group that became NGT and in NGT group that maintained NGT at final observation. Conclusions This study suggests that improving individual motivation may be an effective strategy to promote healthier lifestyles. A more physically active lifestyle and Mediterranean dietary habits are associated with a reduction of central obesity, and with a favorable evolution of glucose tolerance in PD people. Clinical trial registration ISRCTN15840340

Purpose Generating real-world evidence on individuals living with severe overweight or obesity in Italy, focusing on their characterization and management from general practitioners (GPs) perspective. Methods This was a non-interventional longitudinal observational cohort study using data from the Italian IQVIA Longitudinal Patient Database (LPD), conducted in collaboration with a working group from the ‘Società Italiana di Obesità’. The study included individuals with body mass index (BMI) ≥ 27 kg/m 2 during ‘January 2018–June 2022’. Data on clinical conditions, GP interventions (including drug prescriptions, and referrals for laboratory tests, instrumental examinations, and specialist visits), and hospitalizations were collected during the year preceding (baseline) and following BMI recording. Data were analyzed according to time (follow-up versus baseline) and BMI thresholds. Results The final cohort consisted of 134,776 individuals: 44.9% with severe overweight, 36.7% with class I, 12.9% with class II, and 5.6% with class III obesity. Overall mean age was 59.9 years and men accounted for 52.9%. Mean age and male proportions decreased across increasing BMI categories. Most frequently recorded conditions during follow-up were hypertension (51.4%), cardiovascular disease (27.5%), and type-2 diabetes (25.1%). Proportions of subjects presenting with clinical conditions and of individuals requiring clinical interventions were higher during follow-up compared to baseline. The likelihood of presenting with most of clinical conditions and interventions increased with BMI. Conclusion Patients living with overweight or obesity experience a significant worsening of their health status which increases healthcare resources utilization. Public health interventions could benefit from supporting GPs with training and resources to enhance obesity management and improve patient outcomes. Level of evidence : Level III: Evidence obtained from well-designed cohort or case–control analytic studies