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Chianelli M, Busetto L, Vettor R, Annibale B, Paoletta A, Papini E, Albanese A, Carabotti M, Casarotto D, De Pergola G, Disoteo OE, Grandone I, Medea G, Nisoli E, Raffaelli M, Schiff S, Vignati F, Cinquini M, Gonzalez-Lorenzo M, Fittipaldo VA, Minozzi S, Monteforte M, Tralongo AC, Novizio R, Persichetti A, Samperi I, Scoppola A, Borretta G, Carruba M, Carbonelli MG, De Luca M, Frontoni S, Corradini SG, Muratori F, Attanasio R. Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment. J Endocrinol Invest 2024; 47:1361-1371. [PMID: 38630213 DOI: 10.1007/s40618-024-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/09/2024] [Indexed: 06/02/2024]
Abstract
AIM This guideline (GL) is aimed at providing a clinical practice reference for the management of adult patients with overweight or obesity associated with metabolic complications who are resistant to lifestyle modification. METHODS Surgeons, endocrinologists, gastroenterologists, psychologists, pharmacologists, a general practitioner, a nutritionist, a nurse and a patients' representative acted as multi-disciplinary panel. This GL has been developed following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A systematic review and network meta-analysis was performed by a methodologic group. For each question, the panel identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for clinical practice recommendations. Consensus on the direction (for or against) and strength (strong or conditional) of recommendations was reached through a majority vote. RESULTS The present GL provides recommendations about the role of both pharmacological and surgical treatment for the clinical management of the adult patient population with BMI > 27 kg/m2 and < 40 kg/m2 associated with weight-related metabolic comorbidities, resistant to lifestyle changes. The panel: suggests the timely implementation of therapeutic interventions in addition to diet and physical activity; recommends the use of semaglutide 2.4 mg/week and suggests liraglutide 3 mg/day in patients with obesity or overweight also affected by diabetes or pre-diabetes; recommends semaglutide 2.4 mg/week in patients with obesity or overweight also affected by non-alcoholic fatty liver disease; recommends semaglutide 2.4 mg/week as first-line drug in patients with obesity or overweight that require a larger weight loss to reduce comorbidities; suggests the use of orlistat in patients with obesity or overweight also affected by hypertriglyceridemia that assume high-calorie and high-fat diet; suggests the use of naltrexone/bupropion combination in patients with obesity or overweight, with emotional eating; recommends surgical intervention (sleeve gastrectomy, Roux-en-Y gastric bypass, or metabolic gastric bypass/gastric bypass with single anastomosis/gastric mini bypass in patients with BMI ≥ 35 kg/m2 who are suitable for metabolic surgery; and suggests gastric banding as a possible, though less effective, surgical alternative. CONCLUSION The present GL is directed to all physicians addressing people with obesity-working in hospitals, territorial services or private practice-and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.
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Affiliation(s)
- M Chianelli
- Endocrinology, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - L Busetto
- Department of Medicine, Center for Medical and Surgical Therapy of Obesity, University of Padua, Padua University Hospital, President of the Italian Society for Obesity, Padua, Italy
| | - R Vettor
- Department of Medicine, Medical Clinic 3rd, Endocrine-Metabolic Unit, Padua University Hospital, Center for the Study and Integrated Treatment of Obesity, University of Padua, Padua, Italy
| | - B Annibale
- President of the Italian Society of Gastroenterology and Digestive Endoscopy, Department of Medico-Surgical Sciences and Translational Medicine, Unit of Diseases of the Digestive System and Liver, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - A Paoletta
- Endocrinology, ULSS6 Euganea, Padua, Italy
| | - E Papini
- Endocrinology, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - A Albanese
- Bariatric Surgery Unit, University Hospital of Padua, Padua, Italy
| | - M Carabotti
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | | | - G De Pergola
- Clinical Nutrition Center for Research and Treatment of Obesity and Metabolic Diseases, IRCCS De Bellis, Castellana Grotte, BA, Italy
| | - O E Disoteo
- Diabetology Unit, ASST Grande Ospedale Metropolitano Di Niguarda, Milan, Italy
| | - I Grandone
- Diabetology, Dietology and Clinical Nutrition Unit, Santa Maria Hospital, Terni, Italy
| | - G Medea
- General Practitioner, ATS Brescia, Brescia, Italy
| | - E Nisoli
- Center for the Study and Research on Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - M Raffaelli
- Endocrine and Metabolic Surgery Unit, Agostino Gemelli IRCCS University Polyclinic Foundation, Center for Research in Endocrine Gland and Obesity Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - S Schiff
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - F Vignati
- Endocrine Diseases and Diabetology Unit, Referral Center for the Study, Diagnosis and Treatment of Obesity, Sant'Anna Hospital, ASST Lariana, Como, Italy
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - V A Fittipaldo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - S Minozzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M Monteforte
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A C Tralongo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - R Novizio
- Endocrinology and Metabolism Unit, Catholic University of the Sacred Heart, Rome, Italy.
| | - A Persichetti
- Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - I Samperi
- Endocrinology, ASL Novara, Novara, Italy
| | - A Scoppola
- UOSD Endocrinologia ASL, Roma 1, Rome, Italy
| | - G Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - M Carruba
- Center for the Study and Research on Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - M G Carbonelli
- Dietetics and Nutrition Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - M De Luca
- Department of General Surgery, Rovigo Hospital, Rovigo, Italy
| | - S Frontoni
- Endocrinology Diabetes and Metabolism Unit, Fatebenefratelli Hospital, Rome, Italy
| | - S G Corradini
- Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico Umberto I University Hospital, Rome, Italy
| | - F Muratori
- Endocrine Diseases and Diabetology Unit, Referral Center for the Study, Diagnosis and Treatment of Obesity, Sant'Anna Hospital, ASST Lariana, Como, Italy
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Murro I, Lisco G, Di Noia C, Lampignano L, Zupo R, Giagulli VA, Guastamacchia E, Triggiani V, De Pergola G. Endocrine Disruptors and Obesity: an Overview. Endocr Metab Immune Disord Drug Targets 2022; 22:798-806. [PMID: 35346017 DOI: 10.2174/1871530322666220328122300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 11/22/2022]
Abstract
Obesity is a growing pandemic. Endocrine-disrupting chemicals are widespread in the environment. In this perspective, the authors examine the issue related to the exposure to several chemicals with endocrine-disrupting properties as promoting factors to obesity. Data show that Phthalates, Bisphenol compounds, Persistent Organic Pollutants (POPs), solvents, and personal care products can modify metabolic properties in a dose-response and sex-specific manner. Phthalates and bisphenol compounds increase body mass index, waist circumference, waist to height ratio, and the sum of skinfold thicknesses in women and not in men. Low-dose exposure to Persistent Organic Pollutants is strongly associated with increased body mass index in men and decreased this parameter in women. The mechanism through which these compounds act on anthropometric parameters is not entirely understood. Several studies suggest a possible interference in gonadotropin secretion and the thyroid axis. These inspire a decrease of both total and free testosterone levels in men and FT3 and FT4 levels in women, particularly after a pregnancy. The impact of endocrine disruptor chemicals on adipose tissue inflammation and future cardio-metabolic disorders remains to be elucidated. Therefore, studies involving both healthy and obese individuals are needed to unambiguously confirm results from in vitro and animal models.
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Affiliation(s)
- Isanna Murro
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine - Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. School of Medicine, University of Bari
| | - Carmen Di Noia
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Luisa Lampignano
- Population Health Unit - \'Salus in Apulia Study" National Institute of Gastroenterology \'Saverio de Bellis\', Research Hospital, Castellana Grotte, Bari, Italy
| | - Roberta Zupo
- Population Health Unit - \'Salus in Apulia Study" National Institute of Gastroenterology \'Saverio de Bellis\', Research Hospital, Castellana Grotte, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine - Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. School of Medicine, University of Bari
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine - Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. School of Medicine, University of Bari
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine - Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. School of Medicine, University of Bari
| | - Giovanni De Pergola
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
- Internal Medicine and Geriatrics Unit - National Institute of Gastroenterology \'Saverio de Bellis\', Research Hospital, Castellana Grotte, Bari, Italy
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3
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De Pergola G, Zupo R, Lampignano L, Paradiso S, Murro I, Cecere A, Bartolomeo N, Ciccone MM, Giannelli G, Triggiani V. Effects of a Low Carb Diet and Whey Proteins on Anthropometric, Hematochemical, and Cardiovascular Parameters in Subjects with Obesity. Endocr Metab Immune Disord Drug Targets 2021; 20:1719-1725. [PMID: 32520693 PMCID: PMC8226150 DOI: 10.2174/1871530320666200610143724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 05/04/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The best way to lose body weight, without using drugs and/or suffering hunger and stress, has not yet been defined. The present study tested a low carbohydrate diet, enriched with proteins, in subjects with overweight and obesity. METHODS The study enrolled 22 uncomplicated overweight and obese subjects. Several parameters were examined before and after 6 weeks of a low-carbohydrate diet, enriched with 18 g of whey proteins. Anthropometric (body mass index, waist circumference) variables, fasting hormones (insulin, TSH, FT3, FT4), and metabolic (glucose, prealbumin, and lipid levels) parameters were measured. 25- OH-vitamin D (25 (OH) D), parathyroid hormone (PTH) and osteocalcin, were also quantified. Body composition parameters (fat mass, fat-free mass, body cell mass, total body water) were measured by electrical bioimpedance analysis. As cardiovascular parameters, blood pressure, endothelium flowmediated dilation (FMD), and common carotid artery intima-media thickness were also measured. RESULTS The low-carbohydrate diet integrated with proteins induced a significant decrease in body weight (P < 0.001), waist circumference (P < 0.001), fat mass (P < 0.001), diastolic blood pressure (P < 0.01), triglycerides (P < 0.001), total cholesterol (P < 0.001), pre-albumin (P < 0.001), insulin (P < 0.001), HOMAIR (P < 0.001), FT3 (P < 0.05), and c-IMT (P < 0.001), and a significant increase in FMD (P < 0.001) and 25 (OH) D (P < 0.001) was also observed. CONCLUSION All these results suggest that a short-term non-prescriptive low carbohydrate diet, enriched with whey proteins, may be a good way to start losing fat mass and increase health.
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Affiliation(s)
- Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - Luisa Lampignano
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - Silvia Paradiso
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Isanna Murro
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Annagrazia Cecere
- Section of Cardiovascular Disease, Department of Organ Transplantation, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Bartolomeo
- Medical Statistics, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marco M Ciccone
- Section of Cardiovascular Disease, Department of Organ Transplantation, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Vincenzo Triggiani
- Section of Endocrinology and Metabolic Diseases, Department of Emergency and Organ Transplantation University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Zupo R, Castellana F, Sardone R, Scicchitano P, Lampignano L, Ciccone MM, Triggiani V, Guastamacchia E, Giannelli G, De Pergola G. Impaired fasting plasma glucose is a risk indicator of interventricular septum thickening among non-diabetic subjects with obesity. Diabetes Res Clin Pract 2020; 169:108436. [PMID: 32941960 DOI: 10.1016/j.diabres.2020.108436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate whether progressively higher fasting plasma glucose (FPG) is associated to thickening of the interventricular septum (IVS) among non-diabetic subjects with obesity. METHODOLOGY We studied 227 consecutive non diabetic patients (155 women and 72 men, age range 18-72 years) with overweight or obesity (BMI ≥ 25 Kg/m2), taking no medication or supplement. Hormonal, metabolic and routine laboratory parameters were collected. Echocardiography and ultrasonography echo-color Doppler of intima-media thickness of the common carotid artery (IMT-CCA) were performed to evaluate intima-media thickness of the common carotid artery (IVST) and early signs of atherosclerosis, respectively, in all enrolled subjects. RESULTS Of the 227 subjects, 48.9% had higher IVST values. Age (p 0.04), waist circumference (p 0.01), systolic (p < 0.01) and diastolic blood pressure (p < 0.01), FPG (p < 0.01), insulin (p 0.04), HOMA IR (p = 0.01), uric acid (p < 0.01) serum levels, IMT-CCA (p < 0.01), and left atrial diameter (LAD) (p < 0.01) were significantly higher in subjects with pathological IVST. Logistic regression models demonstrated an independent relation of FPG to IVST, both in semi and fully adjusted models (ORs 1.045 and 1.039, respectively). Moreover, graph presentation of the ORs and 95% CIs by FPG quintiles showed a positive risk trend for pathological IVST. CONCLUSIONS Higher FPG levels represent an independent sensitive predictor of IVS thickening in subjects with obesity, even before overt diabetes. These results emphasize the importance of preventive management of the diabetes risk in obesity.
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Affiliation(s)
- Roberta Zupo
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Fabio Castellana
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Rodolfo Sardone
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Pietro Scicchitano
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy.
| | - Luisa Lampignano
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy.
| | - Vincenzo Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy.
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine. Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy.
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Giovanni De Pergola
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Clinical Nutrition Unit, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy.
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De Pergola G, Zupo R, Lampignano L, Bonfiglio C, Giannelli G, Osella AR, Triggiani V. Higher Body Mass Index, Uric Acid Levels, and Lower Cholesterol Levels are Associated with Greater Weight Loss. Endocr Metab Immune Disord Drug Targets 2020; 20:1268-1281. [DOI: 10.2174/1871530320666200429235830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 01/02/2023]
Abstract
Background:
Identifying predictive factors that contribute to changes in body weight may
well be an interesting approach to the management of obesity.
Objective:
This study was firstly aimed at examining the effect of a one-year lifestyle program based
on improvements in the habitual diet and increased levels of physical activity on weight loss. Secondly,
it was focused on identifying anthropometric, and serum hormonal, metabolic and haematochemical
factors which can be associated with the degree of weight loss in Kg.
Methods:
488 overweight or obese subjects, 383 women and 105 men, aged 18-67 years, were enrolled
in the study. Body mass index, waist circumference, serum blood glucose, lipids, uric acid, creatinine,
insulin, TSH, FT3, FT4, and 24-h urine catecholamines were measured.
Results:
Weight loss was positively associated with BMI (P < 0.01), waist circumference (P < 0.01),
uric acid (P < 0.01), creatinine (P < 0.05), smoking (P < 0.01), and negatively correlated with age (P <
0.01), total cholesterol (P < 0.05), LDL-cholesterol (P < 0.01), HDL cholesterol (P < 0.05). In a multiple
regression model considering weight loss as a dependent variable, and smoking, age, BMI, uric
acid, creatinine, total cholesterol, LDL-cholesterol and HDL cholesterol as independent variables,
weight loss maintained a direct independent relationship with BMI (P < 0.001), uric acid (P < 0.05),
LDL-cholesterol (P < 0.05), and HDL-cholesterol (P < 0.05), and an inverse independent association
with cholesterol (P < 0.01).
Conclusions:
This study suggests that higher BMI and uric acid levels, and lower total cholesterol concentrations
are associated with a greater potential to lose weight.
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Affiliation(s)
- Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinic, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, 70013, Castellana Grotte, Italy
| | - Luisa Lampignano
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, 70013, Castellana Grotte, Italy
| | - Caterina Bonfiglio
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, 70013, Castellana Grotte, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, 70013, Castellana Grotte, Italy
| | - Alberto R. Osella
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, 70013, Castellana Grotte, Italy
| | - Vincenzo Triggiani
- Endocrinology and Metabolic Diseases, Interdisciplinary Department of Medicine, University of Bari “A. Moro” Bari, Italy
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Marcos-Pardo PJ, González-Gálvez N, Espeso-García A, Abelleira-Lamela T, López-Vivancos A, Vaquero-Cristóbal R. Association among Adherence to the Mediterranean Diet, Cardiorespiratory Fitness, Cardiovascular, Obesity, and Anthropometric Variables of Overweight and Obese Middle-Aged and Older Adults. Nutrients 2020; 12:nu12092750. [PMID: 32927609 PMCID: PMC7551167 DOI: 10.3390/nu12092750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to evaluate the independent and combined associations between adherence to the Mediterranean diet (AMedDiet), cardiorespiratory fitness (CRF), and different parameters of overweight and obese middle-aged and older adults. Sixty-two participants were enrolled in this cross-sectional study. Fat mass was measured with Dual energy X-ray absorptiometry. AMedDiet and physical activity (PA) were assessed with the PREDIMED and Global PA Questionnaire (GPAQ). Maximal aerobic power was assessed using the 6-min walk test. Systolic (SBP) and diastolic (DBP) blood pressure (BP) were measured with Omron M6, and double product (DP) and mean BP (MBP) were calculated. Kinanthropometry proportionality variables related to obesity were also calculated. Participants with a low CRF as an independent factor or together with a low AMedDiet obtained significantly higher BP, total and trunk fat mass, and proportionality variables (all p ˂ 0.0001). According to the multiple nonlinear regression analysis, Vo2max, AMedDiet, and sex explained 53.4% of SBP, with this formula: 238.611 − (3.63*Vo2max) + (0.044*Vo2max2) − (13.051*AMedDiet) + (0.68*AMedDiet2) + (12.887*sex). SBP and p rediction SBP with the new formula showed a correlation of 0.731 (p ˂ 0.0001); showing a difference between the values of −0.278 (p = 0.883). In conclusion, CRF as an independent factor and combined with AMedDiet can be associated with BP, body composition, and proportionality in overweight and obese middle-aged and older adults.
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Affiliation(s)
- Pablo J. Marcos-Pardo
- Research Group on Health, Physical Activity, Fitness and Motor Behaviour (GISAFFCOM), Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.J.M.-P.); (A.E.-G.); (T.A.-L.); (A.L.-V.)
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040 Madrid, Spain;
| | - Noelia González-Gálvez
- Research Group on Health, Physical Activity, Fitness and Motor Behaviour (GISAFFCOM), Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.J.M.-P.); (A.E.-G.); (T.A.-L.); (A.L.-V.)
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040 Madrid, Spain;
- Correspondence: ; Tel.: +34-968-278-824
| | - Alejandro Espeso-García
- Research Group on Health, Physical Activity, Fitness and Motor Behaviour (GISAFFCOM), Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.J.M.-P.); (A.E.-G.); (T.A.-L.); (A.L.-V.)
| | - Tomás Abelleira-Lamela
- Research Group on Health, Physical Activity, Fitness and Motor Behaviour (GISAFFCOM), Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.J.M.-P.); (A.E.-G.); (T.A.-L.); (A.L.-V.)
| | - Abraham López-Vivancos
- Research Group on Health, Physical Activity, Fitness and Motor Behaviour (GISAFFCOM), Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.J.M.-P.); (A.E.-G.); (T.A.-L.); (A.L.-V.)
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040 Madrid, Spain;
| | - Raquel Vaquero-Cristóbal
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040 Madrid, Spain;
- Sports Injury Prevention Research Group, Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain
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Relationship of para- and perirenal fat and epicardial fat with metabolic parameters in overweight and obese subjects. Eat Weight Disord 2019; 24:67-72. [PMID: 29956099 DOI: 10.1007/s40519-018-0532-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The accumulation of visceral body fat, has been shown to be associated with higher risk of metabolic and cardiovascular disease. This study was addressed to examine whether para- and perirenal fat thickness and epicardial fat thickness were correlated with anthropometric- and cardiometabolic risk factors. METHODS A cohort of 102 uncomplicated overweight and obese patients was examined. BMI, waist circumference, blood pressure, fasting insulin, glucose, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol serum levels, and insulin resistance (assessed by HOMAIR) were measured. Para- and perirenal fat thickness (PUFT) and epicardial fat thickness (EUFT) were measured by ultrasounds. RESULTS PUFT was positively correlated with BMI (p < 0.001), waist circumference (p < 0.001), insulin (p < 0.001), HOMAIR (p < 0.001), triglycerides (p < 0.05), systolic (p < 0.05) and diastolic (p < 0.05) blood pressure, and negatively correlated with HDL-cholesterol (p < 0.01). EUFT was positively associated with age (p < 0.01), BMI (p < 0.001), waist circumference (p < 0.001), systolic (p < 0.01) and diastolic (p < 0.001) blood pressure, and LDL-cholesterol (p < 0.05). A multivariate analysis by multiple linear regression was performed, and the final model showed a direct association of waist circumference with both PUFT and EUFT, a correlation of PUFT with HOMAIR (positive) and HDL-cholesterol (negative), and a direct association of EUFT (both long axis and short axis) with LDL-cholesterol. All these correlations were independent of other anthropometric, metabolic and hemodynamic parameters. CONCLUSIONS This study shows that accumulation of central fat in apparently healthy overweight and obese subjects is associated to a simultaneous increase of pararenal, perirenal and epicardial fat. Moreover, it shows that only para- and perirenal fat is independently associated to insulin resistance and lower HDL-cholesterol, and only epicardial fat is independently associated to higher LDL cholesterol. Level of evidence Level V, cross-sectional descriptive study.
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De Pergola G, D'Alessandro A. Influence of Mediterranean Diet on Blood Pressure. Nutrients 2018; 10:E1700. [PMID: 30405063 PMCID: PMC6266047 DOI: 10.3390/nu10111700] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
Hypertension is the main risk factor for cardiovascular disease (CVD) and all-cause mortality. Some studies have reported that food typical of the Mediterranean diet (MedDiet), such as whole grains, vegetables, fruits, nuts, and extra virgin olive oil, have a favorable effect on the risk of hypertension, whereas food not typical of this dietary pattern such as red meat, processed meat, and poultry has an unfavorable effect. In this review, we have summarized observational and intervention studies, meta-analyses, and systematic reviews that have evaluated the effects of the MedDiet as a pattern towards blood pressure (BP). However, the number of such studies is small. In general terms, the MedDiet has a favorable effect in reducing BP in hypertensive or healthy people but we do not have enough data to declare how strong this effect is. Many more studies are required to fully understand the BP changes induced by the MedDiet.
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Affiliation(s)
- Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, School of Medicine, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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Body weight-dependent relationships between alcohol consumption and pulse pressure in middle-aged Japanese women. ACTA ACUST UNITED AC 2017; 11:801-810.e2. [PMID: 29102320 DOI: 10.1016/j.jash.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 11/23/2022]
Abstract
High pulse pressure is a risk factor for cardiovascular disease, and excessive alcohol drinking increases the risk of hypertension. The purpose of this study was to elucidate the relationship between alcohol intake and pulse pressure in women and to determine whether body weight influences their relationship. The subjects were 18,791 Japanese middle-aged women, and they were divided into tertile groups for body weight or three different body mass index (BMI, kg/m2) groups (low BMI <22; middle BMI ≥22 and <25; high BMI ≥25). The subjects in each group were further divided into four groups of nondrinkers, occasional drinkers, regular light drinkers, and regular heavy drinkers by habitual alcohol consumption. Pulse pressure levels were compared between nondrinkers and drinkers in each group for body weight or BMI. Pulse pressure was significantly higher in regular heavy drinkers than in nondrinkers in the first tertile group for body weight and in the low BMI group but not in the second and third tertile groups for body weight and in the middle and high BMI groups. In all tertile groups and all BMI groups, pulse pressure was not significantly different in occasional drinkers and regular light drinkers than in nondrinkers. In women with lower body weight, heavy drinking was positively associated with pulse pressure, while this association was not found in women with middle or higher body weight. Thus, body weight potently confounds the relationship between alcohol consumption and pulse pressure.
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De Pergola G, Campobasso N, Nardecchia A, Triggiani V, Caccavo D, Gesualdo L, Silvestris F, Manno C. Para- and perirenal ultrasonographic fat thickness is associated with 24-hours mean diastolic blood pressure levels in overweight and obese subjects. BMC Cardiovasc Disord 2015; 15:108. [PMID: 26419359 PMCID: PMC4588871 DOI: 10.1186/s12872-015-0101-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/21/2015] [Indexed: 12/29/2022] Open
Abstract
Background Renal sinus fat (RSF) has been recognized as a risk factor for arterial hypertension. This study was addressed to examine whether also para- and perirenal fat accumulation is associated to higher 24-h mean systolic (SBP) and/or diastolic blood pressure (DBP) levels in overweight and obese subjects. Methods A cohort of 42 overweight and obese patients, 29 women and 13 men, aged 25–55 years, not treated with any kind of drug, was examined. Body mass index (BMI), waist circumference (WC), fasting insulin and glucose serum levels, insulin resistance (assessed by using the homeostasis model assessment [HOMAIR]), and 24-h aldosterone urine levels were measured. Ambulatory blood pressure monitoring (ABPM) was measured with 15 min intervals from 7.0 a.m. to 11.0 a.m. and with 30 min intervals from 23.0 to 7.0 for consecutive 24 h, starting from 8:30 AM. Measurement of para- and perirenal fat thickness was performed by ultrasounds by a duplex Doppler apparatus. Results Para- and perirenal ultrasonographic fat thickness (PUFT) was significantly and positively correlated with WC (p < 0.01), insulin (p < 0.01), HOMAIR (p < 0.01), and 24-h mean DBP levels (p < 0.05). 24-h mean DBP was also significantly and positively correlated with 24-h aldosterone urine concentrations (p < 0.001). A multivariate analysis by multiple linear regression was performed; the final model showed that the association of 24-h mean DBP as dependent variable with PUFT (multiple R = 0.34; p = 0.026) and daily aldosterone production (multiple R = 0.59; p = 0.001) was independent of other anthropometric, hormone and metabolic parameters. Discussion and Conclusions This study shows a positive independent association between PUFT and mean 24-h diastolic blood pressure levels in overweight and obese subjects, suggesting a possible direct role of PUFT in increasing daily diastolic blood pressure.
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Affiliation(s)
- Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Sciences and Human Oncology, Section of Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy. .,Department of Emergency and Organ Tranplantation (DETO), Section of Nephrology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124, Bari, Italy.
| | - Nicla Campobasso
- Department of Emergency and Organ Tranplantation (DETO), Section of Nephrology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124, Bari, Italy.
| | - Adele Nardecchia
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Sciences and Human Oncology, Section of Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Vincenzo Triggiani
- Department of Emergency and Organ Tranplantation (DETO), Section of Endocrinology and Metabolic Diseases, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124, Bari, Italy.
| | - Domenico Caccavo
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Sciences and Human Oncology, Section of Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Loreto Gesualdo
- Department of Emergency and Organ Tranplantation (DETO), Section of Nephrology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124, Bari, Italy.
| | - Franco Silvestris
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Sciences and Human Oncology, Section of Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy. francesco.silvestris.@uniba.it
| | - Carlo Manno
- Department of Emergency and Organ Tranplantation (DETO), Section of Nephrology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124, Bari, Italy.
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Fedecostante M, Spannella F, Giulietti F, Espinosa E, Dessì-Fulgheri P, Sarzani R. Associations Between Body Mass Index, Ambulatory Blood Pressure Findings, and Changes in Cardiac Structure: Relevance of Pulse and Nighttime Pressures. J Clin Hypertens (Greenwich) 2015; 17:147-53. [DOI: 10.1111/jch.12463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Massimiliano Fedecostante
- Department of Clinical and Molecular Sciences; Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of Hypertension; University “Politecnica delle Marche”; Ancona Italy
- Italian National Research Centre on Aging “U.Sestilli”; IRCCS-INRCA; Ancona Italy
| | - Francesco Spannella
- Department of Clinical and Molecular Sciences; Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of Hypertension; University “Politecnica delle Marche”; Ancona Italy
- Italian National Research Centre on Aging “U.Sestilli”; IRCCS-INRCA; Ancona Italy
| | - Federico Giulietti
- Department of Clinical and Molecular Sciences; Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of Hypertension; University “Politecnica delle Marche”; Ancona Italy
- Italian National Research Centre on Aging “U.Sestilli”; IRCCS-INRCA; Ancona Italy
| | - Emma Espinosa
- Department of Clinical and Molecular Sciences; Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of Hypertension; University “Politecnica delle Marche”; Ancona Italy
- Italian National Research Centre on Aging “U.Sestilli”; IRCCS-INRCA; Ancona Italy
| | - Paolo Dessì-Fulgheri
- Department of Clinical and Molecular Sciences; Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of Hypertension; University “Politecnica delle Marche”; Ancona Italy
- Italian National Research Centre on Aging “U.Sestilli”; IRCCS-INRCA; Ancona Italy
| | - Riccardo Sarzani
- Department of Clinical and Molecular Sciences; Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of Hypertension; University “Politecnica delle Marche”; Ancona Italy
- Italian National Research Centre on Aging “U.Sestilli”; IRCCS-INRCA; Ancona Italy
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Multivariate modeling of body mass index, pulse pressure, systolic and diastolic blood pressure in Chinese twins. Twin Res Hum Genet 2014; 18:73-8. [PMID: 25529467 DOI: 10.1017/thg.2014.83] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Systolic and diastolic blood pressure, pulse pressure (PP), and body mass index (BMI) are heritable traits in human metabolic health but their common genetic and environmental backgrounds are not well investigated. The aim of this article was to explore the phenotypic and genetic associations among PP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. The studied sample contained 615 twin pairs (17-84 years) collected in the Qingdao municipality. Univariate and multivariate structural equation models were fitted for assessing the genetic and environmental contributions. The AE model combining additive genetic (A) and unique environmental (E) factors produced the best fit for each four phenotypes. Heritability estimated in univariate analysis ranged from 0.42 to 0.74 with the highest for BMI (95% CI 0.70-0.78), and the lowest for PP (95% CI 0.34-0.49). The multivariate model estimated (1) high genetic correlations for DBP with SBP (0.87), PP with SBP (0.75); (2) low-moderate genetic correlations between PP and DBP (0.32), each BP component and BMI (0.24-0.37); (3) moderate unique environmental correlation for PP with SBP (0.68) and SBP with DBP (0.63); (4) there was no significant unique environmental correlation between PP and BMI. Overall, our multivariate analyses revealed common genetic and environmental backgrounds for PP, BP, and BMI in Chinese twins.
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De Pergola G, Nardecchia A, Ammirati A, Caccavo D, Bavaro S, Silvestris F. Abdominal obesity is characterized by higher pulse pressure: possible role of free triiodothyronine. J Obes 2012; 2012:656303. [PMID: 23091705 PMCID: PMC3468126 DOI: 10.1155/2012/656303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 08/27/2012] [Indexed: 11/20/2022] Open
Abstract
Objective. This study examined whether obesity is characterized by higher 24 h mean pulse pressure (24 h mean SBP-24 h mean DBP) and whether free thyroid hormones (FT(3) and FT(4)) have a relationship with 24 h mean pulse pressure. Methods. A total of 231 euthyroid overweight and obese patients, 103 women and 128 men, aged 18-68 yrs, normotensive (n = 69) or with recently developed hypertension (n = 162), never treated with antihypertensive drugs, were investigated. Fasting insulin, TSH, FT(3), FT(4), glucose, and lipid serum concentrations were measured. Waist circumference was measured as an indirect parameter of central fat accumulation. Ambulatory blood pressure monitoring (ABPM) was performed. Results. 24 h mean pulse pressure (PP) showed a significant positive correlation with BMI (P < 0.001), waist circumference (P < 0.001), and FT(3) (P < 0.001) and insulin serum levels (P < 0.05). When a multivariate analysis was performed, and 24 h PP was considered as the dependent variable, and waist circumference, FT(3), insulin, male sex, and age as independent parameters, 24 h mean PP maintained a significant association only with waist circumference (P < 0.001) and FT(3) levels (P < 0.05). Conclusion. Our results suggest that FT(3) per se may contribute to higher pulse pressure in obese subjects.
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