Explore the vast range of titles available.

Although higher dietary intakes of magnesium (Mg) seem to correspond to lower diabetes incidence, research concerning Mg supplementation in people with or at risk of diabetes is limited. Thus, we aimed to investigate the effect of oral Mg supplementation on glucose and insulin-sensitivity parameters in participants with diabetes or at high risk of diabetes compared with placebo. A literature search in PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Clinicaltrials.gov without language restriction, was undertaken. Eligible studies were randomized controlled trials (RCTs) investigating the effect of oral Mg supplementation vs placebo in patients with diabetes or at high risk of diabetes. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used for summarizing outcomes with at least two studies; other outcomes were summarized descriptively. Eighteen RCTs (12 in people with diabetes and 6 in people at high risk of diabetes) were included. Compared with placebo ( n =334), Mg treatment ( n =336) reduced fasting plasma glucose (studies=9; SMD=−0.40; 95% CI: −0.80 to −0.00; I 2 =77%) in people with diabetes. In conditions in people at high risk of diabetes (Mg: 226; placebo=227 participants), Mg supplementation significantly improved plasma glucose levels after a 2 h oral glucose tolerance test (three studies; SMD=−0.35; 95% CI: −0.62 to −0.07; I 2 =0%) and demonstrated trend level reductions in HOMA-IR (homeostatic model assessment-insulin resistance; five studies; SMD=−0.57; 95% CI: −1.17 to 0.03; I 2 =88%). Mg supplementation appears to have a beneficial role and improves glucose parameters in people with diabetes and also improves insulin-sensitivity parameters in those at high risk of diabetes.

Summary Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures. Introduction People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs). Methods Two investigators searched major databases for articles reporting BMD (expressed as g/cm 2 or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated. Results From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD = −0.69; 95 % CI = −0.86 to −0.52; I 2  = 0 %), total hip (seven studies; SMD = −0.82; 95 % CI = −1.11 to −0.52; I 2  = 72 %), and femoral neck (six studies; SMD = −0.67; 95 % CI = −−1.00 to −0.34; I 2  = 69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR = 1.15, 95 % CI = 1.12–1.17, p  < 0.0001, studies = 4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR = 1.31, 95 % CI = 0.95–1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR = 4.12, p  < 0.0001). Conclusions Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.

A long history of diabetes mellitus and increasing age are associated with the onset of diabetic neuropathy, a painful and highly disabling complication with a prevalence peaking at 50% among elderly diabetic patients. Acetyl- l -carnitine (ALC) is a molecule derived from the acetylation of carnitine in the mitochondria that has an essential role in energy production. It has recently been proposed as a therapy to improve the symptoms of diabetic neuropathy. ALC is widely distributed in mammalian tissues, including the brain, blood–brain barrier, brain neurons, and astrocytes. Aside from its metabolic activity, ALC has demonstrated cytoprotective, antioxidant, and antiapoptotic effects in the nervous system. It exerts an analgesic action by reducing the concentration of glutamate in the synapses. It facilitates nerve regeneration and damage repair after primary trauma: its positive effects on metabolism promote the synthesis, fluidity, and functionality of neuronal membranes, increase protein synthesis, and improve the axonal transport of neurofilament proteins and tubulin. It also amplifies nerve growth factor responsiveness, an effect that is believed to enhance overall neurite growth. ALC has been proposed for the treatment of various neurological and psychiatric diseases, such as mood disorders and depression, dementias, Alzheimer’s disease, and Parkinson’s disease, because synaptic energy states and mitochondrial dysfunction are core factors in their pathogenesis.

Androgen Insensitivity Syndrome represents a disorder due to partial (PAIS), mild (MAIS) or complete (CAIS) resistance to androgens caused by X-linked mutations of androgen receptor gene. CAIS is characterized by a female phenotype and XY karyotype. Cases of patients with CAIS and associated obesity have been reported, while to date, there are no reports about the onset of an Eating Disorder (ED) in the carriers of this condition. We describe the case of a patient affected by CAIS and Anorexia Nervosa (AN) restricting type later shifted to Bulimia Nervosa (BN). A previous overweight was present since childhood, contributing to severe Body Dissatisfaction (BD) and consequent restrictive behaviour in adolescence. Beyond its peculiarity, this case highlights also the importance of diagnosing and monitoring the overweight and BD in CAIS patients to avoid the onset of an ED. Level of Evidence : V, descriptive study.

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<0.001), overweight (8.12±0.02; p<0.001), class I (7.72±0.04; p<0.001), class II (6.67±0.09; p<0.001) and class III obesity (5.88±0.24; p<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<0.001) and in class I obesity (24.5±0.1; p<0.001), but it was reduced in class II (21.4±0.3; p<0.001) and class III (19.8±0.9; p<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.

Loss of the sense of taste is common among older people. Morbidities and polypharmacy may contribute to the age-related decline in gustatory function. The aims of the present study were to investigate taste perception in elderly hospitalized patients by comparing their taste recognition thresholds with those of healthy, free-living elderly individuals and to identify potential determinants of taste loss. The participants in this observational study were 55 elderly patients hospitalized in the acute geriatric section of the Department of Medical and Surgical Sciences at Padova University and 41 free-living individuals aged older than 65 years, randomly recruited from elderly people attending mild fitness programs at public gymnasiums in Padova. Data were collected on nutrition, health, cognitive, and functional status for all participants. Gustatory capabilities were assessed using aqueous solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride (representing sweet, salty, sour, and bitter stimuli, respectively), and taste recognition thresholds were measured in both groups. In comparison with the free-living elderly subjects, those in hospital were significantly less able to recognize the taste of citric acid (P < 0.05). Low citric acid sensitivity was independently associated with advanced age (≥75 years; odds ratio [OR] 3.01, 95% confidence interval [CI] 1.01-9.82), polypharmacy (number of prescribed drugs ≥ 4; OR 2.74, 95% CI 1.01-7.72), and poor nutritional status (as assessed by Mini Nutritional Assessment score < 23.5; OR 5.08, 95% CI 1.76-14.6). Because gustatory impairment may reduce a person's appetite and lead to inadequate dietary intake, compensatory nutritional measures, such as the use of flavor-enhanced foods, should be strongly encouraged, particularly in the hospital setting.

Purpose The purpose of the study is to evaluate whether donepezil (D) plasma concentrations and activity of CYP2D6 and CYP3A4 are associated with the therapeutic response of patients with mild to moderate Alzheimer’s disease (AD). Methods This study comprised 54 patients affected by probable AD in therapy with D 10 mg/daily for at least 3 months. Plasma concentrations of D and its three main metabolites (6DD, 5DD, DNox) were assayed with a novel high performance liquid chromatography (HPLC) technique. Cognitive progression was assessed at baseline and at 9 months of follow-up with the mini mental state examination (MMSE). The activities of the two cytochromes involved in D metabolism—CYP2D6 and CYP3A4—were evaluated according to their metabolic ratios in plasma or urine, after test doses of probe drugs (dextromethorphan and omeprazole). Results A significant correlation was found between plasma levels of D and variations in MMSE scores after 9 months of therapy ( r 2  = 0.14; p  = 0.006). Neither the concentrations of D metabolites nor the metabolic ratios of CYP2D6 and CYP3A4 showed any correlations with cognitive variations. Low CYP2D6 activity and advanced age were associated with high D concentrations. Patients who were treated with CYP2D6 and P-glycoprotein (P-gp) inhibitors also had higher D plasma levels (mean difference = 19.6 ng/mL; p  = 0.01) than those who were not. Conclusions D plasma concentrations, but not cytochrome phenotyping, are associated with cognitive outcomes in AD patients.

This study aimed to ascertain the efficacy of bioelectrical impedance vector analysis (BIVA) in assessing body composition in the elderly by comparing findings with the results of dual-energy X-ray absorptiometry (DXA), and to test an analytical variant of the method (specific BIVA). Cross-sectional study. The sample comprised 207 free-living elderly individuals (75 men and 132 women) aged 65 to 93 years. Anthropometric and bioelectrical measurements were taken according to standard criteria. BIVA was applied using the ‘classic' procedure and correcting bioelectrical values for body geometry to obtain an estimate of the whole-body impedivity. DXA was used as a reference body composition assessment method. BIVA (classic and specific values) and DXA findings were compared using Student's t and Hotelling's T2 tests, and Pearson's correlation coefficient. In both sexes, BIVA distinguished between individuals with different amounts of fat and fat-free mass (lean mass including bone mineral content), according to DXA, but not between those with different proportions of fat mass (FM%). Specific bioelectrical values detected changes in body composition. BIVA should be used with caution for evaluating body composition in the elderly. Specific bioelectrical values proved effective, showing promise as a methodological variant of BIVA, suitable for identifying age-related changes in body fatness.

Background/Objectives: The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI). Subjects/Methods: A longitudinal study was conducted on 161 NH residents aged ⩾70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾25 and weight stable/gain, BMI ⩾25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss). Results: People with a BMI ⩾25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P =0.005; in association with weight stable/gain: HR=2.45, P =0.01), and the mortality risk was also increased in people with a BMI ⩾25 and weight loss (HR=1.74, P =0.03). Conclusions: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese.

Upfront lenalidomide in newly diagnosed multiple myeloma has become the gold standard. Nonetheless, proper management of lenalidomide-refractory patients is challenging. Daratumumab–bortezomib–dexamethasone (DaraVd) has been approved after ≥ 1 prior therapy, but data on upfront lenalidomide refractoriness are scarce. We run a retrospective study to assess the outcomes of 85 lenalidomide-refractory patients treated at first relapse with DaraVd in 10 Italian centers. Baseline characteristics were representative of a general population, despite inferior median age (57 years). Sixteen (27%) at diagnosis and 7 (29%) at relapse had high-risk cytogenetics (t(4;14) and/or t(14;16) and/or del17). Furthermore, one had del1p, one gain1q (3 copies) and one amp1q (≥ 4 copies) at diagnosis; one gain1q and one amp1q at relapse. Overall response rate was 86% (61% ≥ VGPR). Median PFS and OS were 15 and 47 months, respectively (25-months median follow-up). Previous dose/duration of lenalidomide did not influence PFS, favorably affected by the absence of amp1q ( p  = 0.04), bone marrow plasma cells < 60% ( p  = 0.003), absence of extramedullary-disease ( p  = 0.009), and ≥ VGPR ( p  < 0.001) or ≥ CR ( p  = 0.012). In a multivariate model, response ≥ VGPR was confirmed to be independently associated to PFS (median: 26 vs. 7 months). At least one grade ≥ 2 adverse event (AE) occurred in 67 (85%) patients. Most common AEs were hematological (72%), infections (30%, 8% grade-3, 1% grade-5), pneumonia (14%), and asthenia (38%). Peripheral neuropathy rate was 58% (8% grade-3). Toxicity-related bortezomib dose reduction occurred in 39 (49.4%) patients; 27 (44%) delayed Dara (1 median dose), mostly for infections. Three patients discontinued for toxicity. Collectively, second-line DaraVd remains an alternative in lenalidomide-refractory patients, especially for those ineligible for pomalidomide/carfilzomib-based regimens, T-cell-redirecting therapies or other experimental drugs. Highlights Proper management of multiple myeloma (MM) patients relapsing on upfront lenalidomide is challenging. Daratumumab-bortezomib-dexamethasone (DaraVd) is approved after ≥1 prior therapy in MM. Data on second-line DaraVd in lenalidomide-refractory MM patients are scarce. A retrospective study on 85 patients confirmed DaraVd as a viable option in this setting.