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De Amicis R, Bertoli S, Bruno A, De Carlo G, Battezzati A, Foppiani A, Leone A, Lo Mauro A. Short-term effects of Mediterranean diet on nutritional status in adults affected by Osteogenesis Imperfecta: a pilot study. Orphanet J Rare Dis 2024; 19:94. [PMID: 38429777 PMCID: PMC10905835 DOI: 10.1186/s13023-024-03100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Osteogenesis Imperfecta (OI) is a heterogeneous group of connective tissue disorders, characterized by varying degrees of skeletal fragility. Patients experience a range of comorbidities, such as obesity, cardiovascular, and gastrointestinal complications, especially in adulthood. All aspects that could benefit from dietary intervention. The aim of this study was to evaluate the effects of a 6-months restricted Mediterranean Diet (rMD) on nutritional status in adult patients affected by OI. We carried out a 6-months longitudinal pilot study. 14 adults (median age: 35 years; 7 women; 7 OI type III) where recruited in 2019 among the members of As.It.O.I., the Italian Association of Osteogenesis Imperfecta. As.It.O.I. All the evaluations were performed at the University of Milan, Italy. The rMD provided a reduction of 30% from daily total energy expenditure. 45% of calories derived from carbohydrates, 35% from fat and 0.7-1.0 g/kg of body weight from proteins. Comparisons of continuous variables after 6 months of intervention were performed by the paired t-test. All P-values were two-tailed, and p < 0.05 was considered significant. RESULTS Patients showed significant improvement in anthropometric measurements (BMI = 30.5 vs 28.1 kg/cm2, p < 0.001; Body Fat % = 32.9 vs 29.9, p = 0.006; Waist circumferences = 83.6 vs 79.6 cm; p < 0.001; Arm Fat Area = 29.8 vs 23.07 cm2; p < 0.011) and energy expenditure (REE/kg = 27.2 vs 29.2 kcal/kg, p < 0.001). Glucose and lipid profiles improved (Δglycemia = - 8.6 ± 7.3 mg/dL, p = 0.003; ΔTC = - 14.6 ± 20.1 mg/dL, p = 0.036; ΔLDL = - 12.0 ± 12.1 mg/dL, p = 0.009). Adherence to the MD significantly increased, moving from a moderate to a strong adherence and reporting an increased consumption of white meat, legumes, fish, nuts, fruits and vegetables. CONCLUSION A rMD was effective in improving nutritional status and dietary quality in adults with OI. These results underscores the need to raise awareness of nutrition as part of the multidisciplinary treatment of this disease.
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Affiliation(s)
- Ramona De Amicis
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy.
- IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145, Milan, Italy.
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy.
- IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145, Milan, Italy.
| | - Amalia Bruno
- IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145, Milan, Italy
| | - Giulia De Carlo
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Medicine, 20100, Milan, Italy
| | - Andrea Foppiani
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy
| | - Antonella Lo Mauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza, Leonardo Da Vinci, 20133, Milan, Italy
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Lo Mauro A, Tringali G, Codecasa F, Abbruzzese L, Sartorio A, Aliverti A. Pulmonary and chest wall function in obese adults. Sci Rep 2023; 13:17753. [PMID: 37852999 PMCID: PMC10585005 DOI: 10.1038/s41598-023-44222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
Obesity is frequently associated with breathing disorders. To investigate if and how the highest levels of obesity impact respiratory function, 17 subjects with obesity (median age: 49 years; BMI: 39.7 kg/m2, 8 females) and 10 normal-weighted subjects (49 years; 23.9 kg/m2, 5 females) were studied. The abdominal volume occupied 41% in the obese group, being higher (p < 0.001) than the normal-weighted group (31%), indicating accumulation of abdominal fat. Restrictive lung defect was present in 17% of subjects with obesity. At rest in the supine position, subjects with obesity breathed with higher minute ventilation (11.9 L/min) and lower ribcage contribution (5.7%) than normal weighted subjects (7.5 L/min, p = 0.001 and 31.1%, p = 0.003, respectively), thus indicating thoracic restriction. Otherwise healthy obesity might not be characterized by a systematic restrictive lung pattern. Despite this, another sign of restriction could be poor thoracic expansion at rest in the supine position, resulting in increased ventilation. Class 3 obesity made respiratory rate further increased. Opto-electronic plethysmography and its thoraco-abdominal analysis of awake breathing add viable and interesting information in subjects with obesity that were complementary to pulmonary function tests. In addition, OEP is able to localize the restrictive effect of obesity.
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Affiliation(s)
- Antonella Lo Mauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza L. Da Vinci, 20133, Milan, Italy.
| | - Gabriella Tringali
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Piancavallo-Verbania, Italy
| | - Franco Codecasa
- Division of Pneumological Rehabilitation, Istituto Auxologico Italiano, IRCCS, Piancavallo-Verbania, Italy
| | - Laura Abbruzzese
- Division of Eating and Nutrition Disorders, Istituto Auxologico Italiano, IRCCS, Piancavallo-Verbania, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Piancavallo-Verbania, Italy
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza L. Da Vinci, 20133, Milan, Italy
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Abstract
Muscular dystrophy is a group of inherited myopathies characterised by progressive skeletal muscle wasting, including of the respiratory muscles. Respiratory failure, i.e. when the respiratory system fails in its gas exchange functions, is a common feature in muscular dystrophy, being the main cause of death, and it is a consequence of lung failure, pump failure or a combination of the two. The former is due to recurrent aspiration, the latter to progressive weakness of respiratory muscles and an increase in the load against which they must contract. In fact, both the resistive and elastic components of the work of breathing increase due to airway obstruction and chest wall and lung stiffening, respectively. The respiratory disturbances in muscular dystrophy are restrictive pulmonary function, hypoventilation, altered thoracoabdominal pattern, hypercapnia, dyspnoea, impaired regulation of breathing, inefficient cough and sleep disordered breathing. They can be present at different rates according to the type of muscular dystrophy and its progression, leading to different onset of each symptom, prognosis and degree of respiratory involvement. KEY POINTS A common feature of muscular dystrophy is respiratory failure, i.e. the inability of the respiratory system to provide proper oxygenation and carbon dioxide elimination.In the lung, respiratory failure is caused by recurrent aspiration, and leads to hypoxaemia and hypercarbia.Ventilatory failure in muscular dystrophy is caused by increased respiratory load and respiratory muscles weakness.Respiratory load increases in muscular dystrophy because scoliosis makes chest wall compliance decrease, atelectasis and fibrosis make lung compliance decrease, and airway obstruction makes airway resistance increase.The consequences of respiratory pump failure are restrictive pulmonary function, hypoventilation, altered thoracoabdominal pattern, hypercapnia, dyspnoea, impaired regulation of breathing, inefficient cough and sleep disordered breathing. EDUCATIONAL AIMS To understand the mechanisms leading to respiratory disturbances in patients with muscular dystrophy.To understand the impact of respiratory disturbances in patients with muscular dystrophy.To provide a brief description of the main forms of muscular dystrophy with their respiratory implications.
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Affiliation(s)
- Antonella Lo Mauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Dellaca RL, Aliverti A, Lo Mauro A, Lutchen KR, Pedotti A, Suki B. Correlated variability in the breathing pattern and end-expiratory lung volumes in conscious humans. PLoS One 2015; 10:e0116317. [PMID: 25803710 PMCID: PMC4372358 DOI: 10.1371/journal.pone.0116317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
In order to characterize the variability and correlation properties of spontaneous breathing in humans, the breathing pattern of 16 seated healthy subjects was studied during 40 min of quiet breathing using opto-electronic plethysmography, a contactless technology that measures total and compartmental chest wall volumes without interfering with the subjects breathing. From these signals, tidal volume (VT), respiratory time (TTOT) and the other breathing pattern parameters were computed breath-by-breath together with the end-expiratory total and compartmental (pulmonary rib cage and abdomen) chest wall volume changes. The correlation properties of these variables were quantified by detrended fluctuation analysis, computing the scaling exponentα. VT, TTOT and the other breathing pattern variables showed α values between 0.60 (for minute ventilation) to 0.71 (for respiratory rate), all significantly lower than the ones obtained for end-expiratory volumes, that ranged between 1.05 (for rib cage) and 1.13 (for abdomen) with no significant differences between compartments. The much stronger long-range correlations of the end expiratory volumes were interpreted by a neuromechanical network model consisting of five neuron groups in the brain respiratory center coupled with the mechanical properties of the respiratory system modeled as a simple Kelvin body. The model-based α for VT is 0.57, similar to the experimental data. While the α for TTOT was slightly lower than the experimental values, the model correctly predicted α for end-expiratory lung volumes (1.045). In conclusion, we propose that the correlations in the timing and amplitude of the physiological variables originate from the brain with the exception of end-expiratory lung volume, which shows the strongest correlations largely due to the contribution of the viscoelastic properties of the tissues. This cycle-by-cycle variability may have a significant impact on the functioning of adherent cells in the respiratory system.
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Affiliation(s)
- Raffaele L. Dellaca
- Dipartimento di Elettronica, Informatica e Bioingegneria—DEIB, Politecnico di Milano University, Milano, Italy
- * E-mail:
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informatica e Bioingegneria—DEIB, Politecnico di Milano University, Milano, Italy
| | - Antonella Lo Mauro
- Dipartimento di Elettronica, Informatica e Bioingegneria—DEIB, Politecnico di Milano University, Milano, Italy
| | - Kenneth R. Lutchen
- Biomedical Engineering Department, Boston University, Boston, Massachusetts, United States of America
| | - Antonio Pedotti
- Dipartimento di Elettronica, Informatica e Bioingegneria—DEIB, Politecnico di Milano University, Milano, Italy
| | - Bela Suki
- Biomedical Engineering Department, Boston University, Boston, Massachusetts, United States of America
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Aliverti A, Uva B, Laviola M, Bovio D, Mauro AL, Tarperi C, Colombo E, Loomas B, Pedotti A, Similowski T, Macklem PT. Concomitant ventilatory and circulatory functions of the diaphragm and abdominal muscles. J Appl Physiol (1985) 2010; 109:1432-40. [DOI: 10.1152/japplphysiol.00576.2010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Expulsive maneuvers (EMs) caused by simultaneous contraction of diaphragm and abdominal muscles shift substantial quantities of blood from the splanchnic circulation to the extremities. This suggests that the diaphragm assisted by abdominal muscles might accomplish ventilation and circulation simultaneously by repeated EMs. We tested this hypothesis in normal subjects by measuring changes (Δ) in body volume (Vb) by whole body plethysmography simultaneously with changes in trunk volume (Vtr) by optoelectronic plethysmography, which measures the same parameters as whole body plethysmography plus the volume of blood shifts (Vbs) between trunk and extremities: Vbs = ΔVtr − ΔVb. We also measured abdominal pressure, pleural pressure, the arterial pressure wave, and cardiac output (Q̇c). EMs with abdominal pressure ∼100 cmH2O for 1 s, followed by 2-s relaxations, repeated over 90 s, produced a “stroke volume” from the splanchnic bed of 0.35 ± 0.07 (SD) liter, an output of 6.84 ± 0.75 l/min compared with a resting Q̇c of 5.59 ± 1.14 l/min. Refilling during relaxation was complete, and the splanchnic bed did not progressively empty. Diastolic pressure increased by 25 mmHg during each EM. Between EMs, Q̇c increased to 7.09 ± 1.14 l/min due to increased stroke volume and heart rate. The circulatory function of the diaphragm assisted by simultaneous contractions of abdominal muscles with appropriate pressure and duration at 20 min−1can produce a circulatory output as great as resting Q̇c, as well as ventilation. These combined functions of the diaphragm have potential for cardiopulmonary resuscitation. The abdominal circulatory pump can act as an auxiliary heart.
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Affiliation(s)
- Andrea Aliverti
- TBM Lab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano
| | - Barbara Uva
- TBM Lab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano
| | - Marianna Laviola
- TBM Lab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano
| | - Dario Bovio
- TBM Lab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano
| | | | - Cantor Tarperi
- Department of Neurological and Vision Sciences, University of Verona, Verona; and
| | - Edoardo Colombo
- Dipartimento di Medicina Clinica, Università degli Studi dell'Insubria, Varese, Italy
| | | | - Antonio Pedotti
- TBM Lab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano
| | | | - Peter T. Macklem
- Meakins-Christie Laboratories, Royal Victoria Hospital, McGill University Health Centre Research Institute, Montreal, Qubec, Canada
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Abstract
A combination epidural technique using local anesthetics intraoperatively and morphine postoperatively is shown to offer many advantages. These benefits include inhibition of the surgical stress response, decreased cardiorespiratory depression, decreased blood loss, decreased intubation and pulmonary infection, decreased thromboembolism, decreased hyperglycemic and hypertensive response, nitrogen sparing, a stable resting metabolic rate, prevention of immunosuppression, simplification of cerebral status monitoring, and earlier ambulation and hospital discharge. The main disadvantage in patients undergoing vascular procedures is the risk of epidural hematoma. A review of the literature confirms the extreme rarity of this risk and, in view of the emerging benefits, argues for reconsideration of epidural technique in vascular patients. The addition of epidural morphine to this combined technique affords a postoperative pain-free continuum unmatched by any other method. This significantly decreased pain stress in cardiac patients increases safety and comfort. In conclusion, epidural anesthesia and postoperative epidural narcotics provide a safe and reliable method of management for patients undergoing vascular procedures.
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Mauro AL, Shapiro M. A double-blind study to assess the efficacy of oral tilidine hydrochloride (W5759A)among a group of post-operative orthopedic and trauma patients. Curr Ther Res Clin Exp 1974; 16:725-33. [PMID: 4210462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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DeJesus RY, Oliverio RM, Mojdehi E, Fellini A, Mauro AL. Use of positive end-expiratory pressure to improve oxygenation. N Y State J Med 1974; 74:1024-8. [PMID: 4601369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Mojdehi E, Mauro AL, Labartino L, Reynolds B. Clinical evaluation of hydroxyzine hydrochloride in pediatric anesthesia and its effect on arousal time. Anesth Analg 1968; 47:685-8. [PMID: 5749330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Labartino L, Mojdehi E, Mauro AL. Management of hypotension following spinal anesthesia for cesarean section. Anesth Analg 1966; 45:179-82. [PMID: 5949075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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