1
|
Fantin F, Giani A, Manzato G, Zampieri A, Comellato G, Urbani S, Zoico E, Mazzali G, Zamboni M. Sarcopenia, sarcopenic obesity, and arterial stiffness among older adults. Front Cardiovasc Med 2024; 11:1272854. [PMID: 38404726 PMCID: PMC10885346 DOI: 10.3389/fcvm.2024.1272854] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
Background Aging is associated with a higher prevalence of sarcopenia, sarcopenic obesity (SO), and increased arterial stiffening, with possible detrimental effects on morbidity and mortality. The aim of this study was to assess the relationships between sarcopenia, SO, and different indexes of arterial stiffness in older adults. Methods A total of 77 hospitalized patients (mean age 78.68 ± 9.65 years) were evaluated, obtaining anthropometric variables, biochemical samples, handgrip test, and body composition assessment. Arterial stiffness was evaluated by measuring both carotid-femoral pulse wave velocity (cfPWV), a proxy for central stiffness, and cardio-ankle vascular index (CAVI), as well as considering peripheral arteries. The population was sorted into four subgroups: obese, sarcopenic, SO, and controls. Results The highest CAVI (11.31 ± 2.58) was found in sarcopenic patients. SO had the highest value of cfPWV (15.18 ± 8.44 m/s), even after adjustment for significant covariates. In multiple regressions, SO diagnosis resulted as a significant predictor of cfPWV (p = 0.03, R2 = 0.20), and sarcopenia diagnosis resulted as a predictor of CAVI (p = 0.042, R2 = 0.12). Conclusions In conclusion, a positive correlation is found between sarcopenia, SO, and arterial stiffness among older subjects. In particular, greater central arterial stiffness is associated with SO, outlining a remarkable effect on the cardiovascular risk profile.
Collapse
Affiliation(s)
- Francesco Fantin
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Anna Giani
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Gisella Manzato
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Annachiara Zampieri
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Gabriele Comellato
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Silvia Urbani
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Elena Zoico
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| |
Collapse
|
2
|
Rossi AP, Babbanini A, Del Monte L, Vantini G, Stabile G, Urbani S, Fantin F, Zoico E, Zamboni M, Mazzali G. The Role of Ultrasound Muscle Parameters for Myosteatosis and Myofibrosis Measurement in Young, Older, and Obese Subjects. J Am Med Dir Assoc 2024; 25:91-97. [PMID: 37330218 DOI: 10.1016/j.jamda.2023.05.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The aim of the study was to compare quantitative and qualitative ultrasound parameters between healthy young adults and post-acute hospitalized older adults with and without physical disability, as well as between normal weight and overweight/obese persons. DESIGN Cross-sectional observational study. SETTING AND PARTICIPANTS A total of 120 individuals were recruited: 24 healthy young adults, 24 normal weight and 24 overweight/obese community-dwelling adults, and 48 post-acute hospitalized older adults with different degrees of functional autonomy. METHODS The rectus femoris cross-sectional area (CSA), subcutaneous adipose tissue (SCAT) thickness, echogenicity, strain elastography, and compressibility were measured with ultrasound echography. RESULTS Post-acute older adults with a good level of autonomy showed higher echogenicity, a higher compressibility index and elastometry strain, and lower rectus femoris thickness and CSA as compared with young persons. Post-acute individuals with physical disability showed lower echogenicity and a greater stiffness compared with their still autonomous counterparts. Normal weight individuals showed lower stiffness as evaluated with elastometry and a lower SCAT thickness, as compared with individuals with age-matched overweight or obesity. From multiple regression analyses, using CSA as an independent variable, an inverse association with female sex and age was observed, explaining 16% and 51% of variance. Echogenicity was directly associated with age (34% of variance) and with the Barthel index (6% of variance). Elastometry showed association with age and body mass index (BMI), 30% and 16% of variance, respectively. Considering compressibility as a dependent variable, a direct association with age and an inverse association with BMI were observed, with 5% and 11% of variance respectively. CONCLUSIONS AND IMPLICATIONS Muscle mass decreases with age and with physical disability. Echogenicity, which increases with age and disability level, seems to be associated with myofibrosis. Conversely, elastometry seems useful in the characterization of muscle quality in overweight or obese individuals and as a reliable indirect measure of myosteatosis.
Collapse
Affiliation(s)
- Andrea P Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, Treviso, Italy.
| | - Alessio Babbanini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Letizia Del Monte
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Gianluca Vantini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Giovanni Stabile
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Silvia Urbani
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Francesco Fantin
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Elena Zoico
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Division of Geriatrics, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Giani A, Micciolo R, Zoico E, Mazzali G, Zamboni M, Fantin F. Cardio-Ankle Vascular Index and Aging: Differences between CAVI and CAVI0. J Clin Med 2023; 12:6726. [PMID: 37959192 PMCID: PMC10647579 DOI: 10.3390/jcm12216726] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cardio-ankle vascular index (CAVI) and CAVI0 (a mathematical expression derived from CAVI, supposed to be less dependent on blood pressure), can describe arterial stiffness, considering a wide proportion of the arterial tree. The aim of this study was to examine the relationship between CAVI, CAVI0 and aging, looking at the differences between the two arterial stiffness indexes. METHODS A total of 191 patients (68 male, mean age 68.3 ± 14.4 years) referred to the Geriatric Ward and Outpatient Clinic at Verona University Hospital were included and underwent a comprehensive clinical evaluation. CAVI and CAVI0 were obtained for each. RESULTS CAVI0 steeply rises in the elderly age strata, widening the gap between CAVI and CAVI0. An inverse relationship is evident between CAVI0 and DBP in older patients, and CAVI0 is shown to be dependent on age, DBP and age-DBP interaction (R2 = 0.508). Age modifies the effect of DBP on CAVI0, but not on CAVI. CONCLUSIONS The real new findings of our study are that the association between CAVI0 and diastolic blood pressure (DBP) is modified by age, whereas the association between CAVI and DBP is not modified by age. From a clinical point of view, these are very important findings, as DBP decreases with aging, affecting in elderly populations the reliability of CAVI0, which strictly depends on DBP in the formula to calculate it. To monitor the effect of CV therapies, progression of CV diseases and to evaluate clinical outcomes in elderly populations, we suggest using CAVI and not CAVI0.
Collapse
Affiliation(s)
- Anna Giani
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37100 Verona, Italy; (A.G.); (M.Z.)
| | - Rocco Micciolo
- Centre for Medical Sciences and Department of Psychology and Cognitive Sciences, University of Trento, 38123 Trento, Italy;
| | - Elena Zoico
- Section of Geriatric Medicine, Department of Medicine, University of Verona, 37100 Verona, Italy; (E.Z.); (G.M.)
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona, 37100 Verona, Italy; (E.Z.); (G.M.)
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37100 Verona, Italy; (A.G.); (M.Z.)
| | - Francesco Fantin
- Section of Geriatric Medicine, Department of Medicine, University of Verona, 37100 Verona, Italy; (E.Z.); (G.M.)
| |
Collapse
|
4
|
Zoico E, Giani A, Saatchi T, Rizzatti V, Mazzali G, Fantin F, Benfari G, Onorati F, Urbani S, Zamboni M. Myocardial Fibrosis and Steatosis in Patients with Aortic Stenosis: Roles of Myostatin and Ceramides. Int J Mol Sci 2023; 24:15508. [PMID: 37958492 PMCID: PMC10648018 DOI: 10.3390/ijms242115508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Aortic stenosis (AS) involves progressive valve obstruction and a remodeling response of the left ventriculum (LV) with systolic and diastolic dysfunction. The roles of interstitial fibrosis and myocardial steatosis in LV dysfunction in AS have not been completely characterized. We enrolled 31 patients (19 women and 12 men) with severe AS undergoing elective aortic valve replacement. The subjects were clinically evaluated, and transthoracic echocardiography was performed pre-surgery. LV septal biopsies were obtained to assess fibrosis and apoptosis and fat deposition in myocytes (perilipin 5 (PLIN5)), or in the form of adipocytes within the heart (perilipin 1 (PLIN1)), the presence of ceramides and myostatin were assessed via immunohistochemistry. After BMI adjustment, we found a positive association between fibrosis and apoptotic cardiomyocytes, as well as fibrosis and the area covered by PLIN5. Apoptosis and PLIN5 were also significantly interrelated. LV fibrosis increased with a higher medium gradient (MG) and peak gradient (PG). Ceramides and myostatin levels were higher in patients within the higher MG and PG tertiles. In the linear regression analysis, increased fibrosis correlated with increased apoptosis and myostatin, independent from confounding factors. After adjustment for age and BMI, we found a positive relationship between PLIN5 and E/A and a negative correlation between septal S', global longitudinal strain (GLS), and fibrosis. Myostatin was inversely correlated with GLS and ejection fraction. Fibrosis and myocardial steatosis altogether contribute to ventricular dysfunction in severe AS. The association of myostatin and fibrosis with systolic dysfunction, as well as between myocardial steatosis and diastolic dysfunction, highlights potential therapeutic targets.
Collapse
Affiliation(s)
- Elena Zoico
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Anna Giani
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Tanaz Saatchi
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Vanni Rizzatti
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Gloria Mazzali
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Francesco Fantin
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126 Verona, Italy
| | - Silvia Urbani
- Division of Geriatric Medicine, Department of Medicine, University of Verona, 37126 Verona, Italy; (A.G.)
| | - Mauro Zamboni
- Division of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126 Verona, Italy
| |
Collapse
|
5
|
Zoico E, Saatchi T, Nori N, Mazzali G, Rizzatti V, Pizzi E, Fantin F, Giani A, Urbani S, Zamboni M. Senescent adipocytes as potential effectors of muscle cells dysfunction: An in vitro model. Exp Gerontol 2023; 179:112233. [PMID: 37321332 DOI: 10.1016/j.exger.2023.112233] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
Recently, there has been a growing body of evidence showing a negative effect of the white adipose tissue (WAT) dysfunction on the skeletal muscle function and quality. However, little is known about the effects of senescent adipocytes on muscle cells. Therefore, to explore potential mechanisms involved in age-related loss of muscle mass and function, we performed an in vitro experiment using conditioned medium obtained from cultures of mature and aged 3 T3-L1 adipocytes, as well as from cultures of dysfunctional adipocytes exposed to oxidative stress or high insulin doses, to treat C2C12 myocytes. The results from morphological measures indicated a significant decrease in diameter and fusion index of myotubes after treatment with medium of aged or stressed adipocytes. Aged and stressed adipocytes presented different morphological characteristics as well as a different gene expression profile of proinflammatory cytokines and ROS production. In myocytes treated with different adipocytes' conditioned media, we demonstrated a significant reduction of gene expression of myogenic differentiation markers as well as a significant increase of genes involved in atrophy. Finally, a significant reduction in protein synthesis as well as a significant increase of myostatin was found in muscle cells treated with medium of aged or stressed adipocytes compared to controls. In conclusion, these preliminary results suggest that aged adipocytes could influence negatively trophism, function and regenerative capacity of myocytes by a paracrine network of signaling.
Collapse
Affiliation(s)
- Elena Zoico
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy
| | - Tanaz Saatchi
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy.
| | - Nicole Nori
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy
| | - Vanni Rizzatti
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Eleonora Pizzi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Francesco Fantin
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy
| | - Anna Giani
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy
| | - Silvia Urbani
- Department of Medicine, Geriatric Section, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Bolzan B, Morani G, Rizzati V, Zamboni M, Mazzali G, Franzese I, Tomasi L, Mugnai G, De Manna D, Benfari G, De Caro A, Cortinovis M, Faggian G, Luciani GB, Ribichini FL. Correlation between epicardial adipose tissue and atrial fibrillation burden in coronary artery bypass graft surgery. J Cardiovasc Med (Hagerstown) 2023; 24:253-260. [PMID: 36952389 DOI: 10.2459/jcm.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
AIMS Recent studies suggest an association between epicardial adipose tissue (EAT) and atrial fibrillation. The aim of the study is to evaluate the quantitative and qualitative characteristics of EAT in relation to atrial fibrillation burden after coronary artery bypass graft (CABG). METHODS This prospective single-centre study included patients undergoing CABG. The patients underwent transthoracic echocardiography and collection of a bioptic sample containing right appendage and EAT during CABG for histological characterization. After surgery, clinical and telemetry data were collected. RESULTS Fifty-six consecutive patients were enrolled. The mean postsurgical hospitalization was 7.9 ± 3.7 days. Twenty-two patients had at least one episode of atrial fibrillation. In the atrial fibrillation group, there was a bigger atrial volume, a higher degree of diastolic disfunction, a thicker layer of EAT and an older median age in comparison with the group that did not develop it. EAT with a cut-off of 4 mm was a predictor of atrial fibrillation with an odds ratio (OR) of 1.49 (confidence interval (CI) 1.09-2.04), 73% of sensibility and 89% of specificity. From the histological analyses, the patients with atrial fibrillation had a significantly higher percentage of fibrosis. At univariate analysis, atrial volume [OR 1.05, CI 1.01-1.09, P = 0.022], E/A rate (OR 0.04, CI 0.02-0.72 P = 0.29), the percentage of fibrosis (OR 1.12, CI 1.00-1.25, P = 0.045) and age (OR 1.17, CI 1.07-1.28, P = 0.001) were predictors of atrial fibrillation. At multivariate analysis, atrial volume (P = 0.027), fibrosis (P = 0.003) and age (P = 0.039) were independent predictors of atrial fibrillation. CONCLUSION Postcardiac surgical atrial fibrillation is frequent. EAT thickness, atrial volume, fibrosis and age are predictors of postcardiac surgical atrial fibrillation.
Collapse
Affiliation(s)
- Bruna Bolzan
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | | | - Vanni Rizzati
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Ilaria Franzese
- Cardiac Surgery Division, Department of Surgery, University of Verona Medical School, Verona, Italy
| | - Luca Tomasi
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Giacomo Mugnai
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Davide De Manna
- Cardiac Surgery Division, Department of Surgery, University of Verona Medical School, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Annamaria De Caro
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Matteo Cortinovis
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Giuseppe Faggian
- Cardiac Surgery Division, Department of Surgery, University of Verona Medical School, Verona, Italy
| | | | | |
Collapse
|
7
|
Zamboni M, Mazzali G, Brunelli A, Saatchi T, Urbani S, Giani A, Rossi AP, Zoico E, Fantin F. The Role of Crosstalk between Adipose Cells and Myocytes in the Pathogenesis of Sarcopenic Obesity in the Elderly. Cells 2022; 11:3361. [PMID: 36359757 PMCID: PMC9655977 DOI: 10.3390/cells11213361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2023] Open
Abstract
As a result of aging, body composition changes, with a decline in muscle mass and an increase in adipose tissue (AT), which reallocates from subcutaneous to visceral depots and stores ectopically in the liver, heart and muscles. Furthermore, with aging, muscle and AT, both of which have recognized endocrine activity, become dysfunctional and contribute, in the case of positive energy balance, to the development of sarcopenic obesity (SO). SO is defined as the co-existence of excess adiposity and low muscle mass and function, and its prevalence increases with age. SO is strongly associated with greater morbidity and mortality. The pathogenesis of SO is complex and multifactorial. This review focuses mainly on the role of crosstalk between age-related dysfunctional adipose and muscle cells as one of the mechanisms leading to SO. A better understanding of this mechanisms may be useful for development of prevention strategies and treatments aimed at reducing the occurrence of SO.
Collapse
Affiliation(s)
- Mauro Zamboni
- Geriatrics Division, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy
| | - Gloria Mazzali
- Geriatrics Division, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Anna Brunelli
- Geriatrics Division, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy
| | - Tanaz Saatchi
- Geriatrics Division, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy
| | - Silvia Urbani
- Geriatrics Division, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy
| | - Anna Giani
- Geriatrics Division, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy
| | - Andrea P. Rossi
- Geriatrics Division, Department of Medicine, AULSS2, Ospedale Ca’Foncello, 31100 Treviso, Italy
| | - Elena Zoico
- Geriatrics Division, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Francesco Fantin
- Geriatrics Division, Department of Medicine, University of Verona, 37126 Verona, Italy
| |
Collapse
|
8
|
Fantin F, Giani A, Franconi A, Zoico E, Urbani S, Rossi AP, Mazzali G, Zamboni M. Arterial Stiffness, Subendocardial Impairment, and 30-Day Readmission in Heart Failure Older Patients. Front Cardiovasc Med 2022; 9:918601. [PMID: 35783827 PMCID: PMC9249084 DOI: 10.3389/fcvm.2022.918601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Arterial stiffness and subendocardial perfusion impairment may play a significant role in heart failure (HF) outcomes. The aim of the study was to examine the main predictors of 30-day readmission in geriatric patients, hospitalized with HF, explore hemodynamical parameters, arterial stiffness indexes, and subendocardial viability ratio (SEVR). In total, 41 hospitalized patients, affected by HF, were included; they underwent clinical evaluation, routine laboratory testing, and echocardiography. At the time of admission, after the achievement of clinical stability (defined as switching from intravenous to oral diuretic therapy), and at discharge, arterial tonometry was performed to evaluate carotid-femoral pulse wave velocity (PWVcf) and SEVR (then corrected for hemoglobin concentration and oxygen saturation). Through the evaluations, a significant progressive decrease in PWVcf was described (17.79 ± 4.49, 13.54 ± 4.54, and 9.94 ± 3.73 m/s), even after adjustment for age, gender, mean arterial pressure (MAP) variation, and left ventricular ejection fraction (LVEF). A significant improvement was registered for both SEVR (83.48 ± 24.43, 97.94 ± 26.84, and 113.29 ± 38.02) and corrected SEVR (12.74 ± 4.69, 15.71 ± 5.30, and 18.55 ± 6.66) values, and it was still significant when adjusted for age, gender, MAP variation, and LVEF. After discharge, 26.8% of patients were readmitted within 30 days. In a multivariate binary logistic regression analysis, PWVcf at discharge was the only predictor of 30-day readmission (odds ratio [OR] 1.957, 95% CI 1.112–3.443). In conclusion, medical therapy seems to improve arterial stiffness and subendocardial perfusion in geriatric patients hospitalized with heart failure. Furthermore, PWVcf is a valid predictor of 30-day readmission. Its feasibility in clinical practice may provide an instrument to detect patients with HF at high risk of rehospitalization.
Collapse
Affiliation(s)
- Francesco Fantin
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Francesco Fantin,
| | - Anna Giani
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Arianna Franconi
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Zoico
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Silvia Urbani
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea P. Rossi
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric, and Gynecology, University of Verona, Verona, Italy
| |
Collapse
|
9
|
Abstract
BACKGROUND Metabolic Syndrome (MS) is associated to vascular damage, increased arterial stiffness, and impaired myocardial perfusion. Subendocardial viability ratio (SEVR) is a noninvasive estimation of myocardial workload, oxygen supply, and perfusion. The aim of the study was to describe the relation between arterial stiffness, SEVR, and cardio-metabolic risk factors. METHODS A cohort of 55 patients, aged 59.9 ± 10.8 years, was studied; 28 subjects (50.9%) had metabolic syndrome. All patients underwent a clinical evaluation and blood venous sampling, to assess glico-lipid profile. Applanation tonometry was performed, to obtain pulse wave analysis and SEVR values. RESULTS In the overall study population, SEVR showed negative associations with mean (r = -0.301; p = 0.026) and systolic (borderline relation, r = -0.257; p = 0.058) arterial pressure. Metabolic syndrome patients presented lower level of SEVR (p = 0.012), even after adjusting for age, sex, and mean arterial pressure (p = 0.040). Subdividing the study population by the number of metabolic syndrome components, SEVR significantly decreased as the number of Metabolic Syndrome components increased (p for trend 0.005). In a logistic backward regression analysis, both metabolic syndrome and mean arterial pressure resulted significant predictors of SEVR, accounting for 18% of variance. CONCLUSION The reduced SEVR in metabolic syndrome patients could be an important pathophysiological determinant of the increased cardiovascular risk.
Collapse
Affiliation(s)
- Francesco Fantin
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
- Francesco Fantin, Department of Medicine, Section of Geriatric Medicine, University of Verona, Piazzale Stefani 1, Verona 37126, Italy.
| | - Anna Giani
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Ludovico Gasparini
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea P Rossi
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Zoico
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| |
Collapse
|
10
|
Rossi AP, Urbani S, Gattazzo S, Nori N, Fantin F, Zoico E, Mazzali G, Muollo V, Ghoch ME, Zamboni M. The Mini Sarcopenia Risk Assessment (MSRA) Questionnaire score as a predictor of skeletal muscle mass loss. Aging Clin Exp Res 2021; 33:2593-2597. [PMID: 33389711 DOI: 10.1007/s40520-020-01763-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous studies showed a strong relationship between reduction of appendicular muscle mass and worsening disability; hence, accuracy in assessing muscle mass is considered a key feature for a sarcopenia screening tool. AIM The aim of the study was to evaluate if the 7 items of Mini Sarcopenia Risk Assessment (MSRA) questionnaire predict muscle mass loss in a population of community-dwelling elderly subjects over a 5.5-y follow-up. METHODS The study included 159 subjects, 92 women and 67 men aged 71.5 ± 2.2 years and with mean body mass index of 26.7 ± 4.0 kg/m2. Appendicular skeletal muscle mass (ASMM) as measured with Dual-Energy X-ray absorptiometry (DXA), was obtained at baseline and after 2 and 5.5 years of follow-up where the skeletal muscle index (SMI) was calculated. RESULTS A significant reduction of ASMM and SMI was observed at two and 5.5 years of follow-up, in both, men and women. Repeated-measures analysis of variance (ANOVA) found a significant time effect on ASMM for both subjects with MSRA > 30 and ≤ 30 (P < 0.01 and P < 0.001). The group × time interaction was significant (P < 0.001), after even considering separately subjects with normal muscle mass and low muscle mass at baseline (P < 0.05 and P = 0.005). Similar results were obtained for SMI. Considering only the subjects with normal SMI at baseline, subjects with MSRA questionnaire ≤ 30 showed 5.7 (95% CI 1.73-19.03) higher risk of exceeding the low muscle mass threshold. CONCLUSION In a population of community-dwelling elderly men and women, MSRA score of 30 is predictive of a steeper decline in ASMM and SMI and of a higher risk of exceeding the low muscle mass EWGSOP threshold.
Collapse
|
11
|
Fantin F, Disegna E, Manzato G, Comellato G, Zoico E, Rossi AP, Mazzali G, Rajkumar C, Zamboni M. Adipokines and Arterial Stiffness in the Elderly. Vasc Health Risk Manag 2020; 16:535-543. [PMID: 33324067 PMCID: PMC7733384 DOI: 10.2147/vhrm.s274861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the relationship between adipokines and arterial stiffness in a group of 85 elderly subjects and the role of leptin and adiponectin on subclinical vascular damage, defined by a PWV>10 m/s. METHODS In each subject, we evaluated anthropometry, body composition by DXA (fat mass, fat mass%, lean mass), metabolic variables, leptin, adiponectin, systolic, diastolic, mean arterial pressure and pulse pressure (SBP, DBP, MAP, PP), carotid-femoral pulse wave velocity (cfPWV) and carotid-radial pulse wave velocity (crPWV). RESULTS In the study population, significant associations were observed between cfPWV and crPWV, age, SBP, MAP, waist circumference, fat body mass and leptin. The study population was subdivided in 2 subgroups according to adipokine patterns: group 1 included patients with high adiponectin and low leptin, and group 2 patients had high leptin and low adiponectin. SBP, PP, cfPWV were significantly higher in subjects with high leptin and low adiponectin (group 2). Even after adjustment for gender, fat mass%, MAP, HDL cholesterol and triglycerides, cfPWV was higher in group 2 than group 1. In a logistic binary regression on the entire population, considering subclinical vascular damage as a dependent variable and age, gender, MAP, fat mass%, triglycerides, HDL cholesterol and category of subjects with high leptin and low adiponectin as independent variables, MAP and category of subjects with high leptin and low adiponectin were significant predictors (OR, respectively, 1.09 and 3.61). CONCLUSION In conclusion, in the elderly, the presence at the same time of high leptin levels and low adiponectin levels seems to have synergic effects on arterial stiffness.
Collapse
Affiliation(s)
- Francesco Fantin
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | - Eleonora Disegna
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | - Gisella Manzato
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | - Gabriele Comellato
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | - Elena Zoico
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | - Andrea P Rossi
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Section of Geriatrics Medicine, University of Verona, Verona, Italy
| | | | - Mauro Zamboni
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Geriatrics, University of Verona, Verona, Italy
| |
Collapse
|
12
|
Rossi A, Caliari C, Fantin F, Zoico E, Urbani S, Zivelonghi A, Bortolani A, Mazzali G, Bissoli L, Zamboni M. Sarcopenia Risk Evaluation In A Sample Of Hospitalized Elderly Men And Women: Comparison Between The Mini Sarcopenia Risk Assessment (MSRA) and the SARC-F. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Brunani A, Sirtori A, Capodaglio P, Donini LM, Buscemi S, Carbonelli MG, Giordano F, Mazzali G, Pasqualinotto L, Zenti MG, Barbieri V, Villa V, Leonardi M, Raggi A. Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire. Eur J Phys Rehabil Med 2020; 57:630-638. [PMID: 33165313 DOI: 10.23736/s1973-9087.20.06512-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF). AIM The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]). DESIGN Process validation of the ICF-OB schedule. SETTING Baseline conditions of out- and in-patients. POPULATION A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care. METHODS A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m2) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals. RESULTS We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes. CONCLUSIONS The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity. CLINICAL REHABILITATION IMPACT The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.
Collapse
Affiliation(s)
- Amelia Brunani
- IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Verbania, Verbania-Cusio-Ossola, Italy -
| | - Anna Sirtori
- IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Verbania, Verbania-Cusio-Ossola, Italy
| | - Paolo Capodaglio
- IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Verbania, Verbania-Cusio-Ossola, Italy
| | - Lorenzo M Donini
- Food Science and Human Nutrition Research Unit, Sapienza University, Rome, Italy
| | - Silvio Buscemi
- Unit of Endocrinology, Metabolic and Nutrition Diseases, University Hospital Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | | | - Francesca Giordano
- Centro per la Cura dell'Obesità Casa di Cura Solatrix, Rovereto, Trento, Italy
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | | | - Maria G Zenti
- Departement of Medicine, Endocrinology Division, University of Verona, Verona, Italy
| | - Valerio Barbieri
- Centro per i Disturbi Alimentari, Policlinico S. Pietro, Bergamo, Italy
| | - Valentina Villa
- IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Verbania, Verbania-Cusio-Ossola, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | |
Collapse
|
14
|
Rossi AP, Urbani S, Fantin F, Nori N, Brandimarte P, Martini A, Zoico E, Mazzali G, Babbanini A, Muollo V, Zamboni M. Worsening Disability and Hospitalization Risk in Sarcopenic Obese and Dynapenic Abdominal Obese: A 5.5 Years Follow-Up Study in Elderly Men and Women. Front Endocrinol (Lausanne) 2020; 11:314. [PMID: 32695067 PMCID: PMC7339917 DOI: 10.3389/fendo.2020.00314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/24/2020] [Indexed: 12/25/2022] Open
Abstract
Background/Objectives: A general lack of studies comparing the effect of both dynapenic abdominal obesity and sarcopenic obesity on worsening disability and hospitalization risk should be recognized. The aim of the current study was to evaluate, with a 5.5-year follow-up, the prognostic value of sarcopenic obesity and dynapenic abdominal obesity definitions on worsening disability and hospitalization risk in a sample of older adults. Subjects/Methods: In 177 women and 97 men aged 68-78 years, the following outcomes were evaluated at baseline: appendicular skeletal muscle mass (ASMM), percent fat mass (FM%), leg isometric strength, body mass index (BMI), lipid profile, vitamin D3, albumin, fibrinogen, glycemia, physical activity level, income, smoking status, and comorbidities. The rate of reported disabilities and hospitalization were also assessed at baseline, 1, 2, 3, and 5.5-years follow-up. The study population was classified into: (i) non-sarcopenic/obese (NS/O), sarcopenic/non-obese (S/NO), sarcopenic/obese (S/O), non-sarcopenic/non-obese (NS/NO, reference category) according to relative ASMM/FM% tertiles; (ii) non-dynapenic/abdominal obese (ND/AO), dynapenic/non-abdominal obese (D/NAO), dynapenic/abdominal obese (D/AO), non-dynapenic/non-abdominal obese (ND/NAO, reference category) according to muscle strength/waist circumference tertiles. Results: The prevalence of D/AO and S/O was 12.0 and 8.0%, respectively. Only 2 subjects were both D/NAO and S/O (0.8%). D/NAO subjects showed a worsening disability risk of 1.69 times (95% CI: 1.11-2.57), ND/AO subjects showed a 2-fold increased risk (95% CI: 1.34-2.98), while being D/AO more than trebled the risk, even after adjustment for confounding factors (HR: 3.39, 95%; CI: 1.91-6.02). By dividing the study population according to the relative ASMM/FM% tertiles, no groups showed an increased risk of worsening disability. The hospitalization risk, even after adjustment for potential confounders, was 1.84 (95% CI: 1.06-3.19) for D/AO. Dividing the study population according to the relative ASMM/FM% tertiles, no groups showed increased risk of hospitalization. Conclusions: Our results showed that dynapenic abdominal obesity and sarcopenic obesity seem to indicate two distinct phenotypes associated with different health risk profiles. The distribution of participants in waist circumference and muscle strength tertiles allowed for a more accurate risk stratification for worsening disability and hospitalization.
Collapse
Affiliation(s)
- Andrea P. Rossi
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Andrea P. Rossi
| | - Silvia Urbani
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Fantin
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Nicole Nori
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Piero Brandimarte
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Angela Martini
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Zoico
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Alessio Babbanini
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| | - Valentina Muollo
- Department of Medicine, Clinical and Experimental Biomedical Sciences, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Division of Geriatric, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
15
|
Benfari G, Noni M, Onorati F, Cerrito L, Pernigo M, Vinco G, Cameli M, Mandoli G, Borio G, Geremia G, Zivelonghi C, Abbasciano R, Mazzali G, Zamboni M, Faggian G, Rossi A, Ribichini F. Effects of Aortic Valve Replacement on Left Ventricular Diastolic Function in Patients With Aortic Valve Stenosis. Am J Cardiol 2019; 124:409-415. [PMID: 31186115 DOI: 10.1016/j.amjcard.2019.04.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
The afterload increase imposed by severe aortic valve stenosis (AS) creates concentric left ventricular (LV) remodeling and diastolic dysfunction (DD), which are both markers of poor clinical outcome. Ideally, a correctly timed surgery for isolated AS can reverse the LV remodeling. However, data on LV DD after aortic valve replacement (AVR) are sparse and contrasting. Aims of the study are to define the markers of a favorable evolution of the DD at follow-up. Patients with severe isolated AS, scheduled for AVR were prospectively enrolled. Transthoracic echocardiography with DD assessment was performed before surgery, and at 12 months after surgery. Global LV longitudinal and circumferential strain, peak atrial longitudinal and contraction strain (PALS, PACS) were obtained at baseline. LV septal biopsy to assess fibrosis was performed at the time of AVR. Sixty-seven patients were enrolled, age 72 ± 8 years, 66% female, ejection fraction 61 ± 8%, E/e' 13 ± 6, PALS 23 ± 7%. Normal estimated left atrial pressure was detected in 19/67 (28%) versus 43/67 (64%) at follow-up (p <0.0001). In the 37 patients with biopsy available, fibrosis was 24 ± 12%. PALS and AS severity were correlated with LV fibrosis (R2 = 0.19; p = 0.006, and R2 = 0.15; p = 0.02, respectively). PALS (odds ratio: 1.19 [1.05 to 1.41], p = 0.02) and PACS (odds ratio: 1.24 [1.06 to 1.50], p = 0.006) were the only baseline noninvasive parameters independently associated with normal left atrial pressure at follow-up. Mean follow-up time was 791 ± 245 days, and 8 (12%) patients had cardiovascular events (death, hospital admission due to heart failure or ischemic disease, and onset of atrial fibrillation). Myocardial fibrosis (p = 0.05), baseline PALS (p = 0.004), and PACS (p = 0.03) were associated with cardiovascular events. In conclusion, LV diastolic function generally improves after AVR for severe AS. Baseline PALS, PACS, and LV fibrosis were related to the DD and clinical outcome at follow-up; these parameters might cue a better diastolic response to the afterload correction.
Collapse
|
16
|
Fantin F, Giani A, Zoico E, Rossi AP, Mazzali G, Zamboni M. Weight Loss and Hypertension in Obese Subjects. Nutrients 2019; 11:E1667. [PMID: 31330870 PMCID: PMC6682923 DOI: 10.3390/nu11071667] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023] Open
Abstract
Arterial hypertension is strongly related to overweight and obesity. In obese subjects, several mechanisms may lead to hypertension such as insulin and leptin resistance, perivascular adipose tissue dysfunction, renal impairment, renin-angiotensin-aldosterone-system activation and sympathetic nervous system activity. Weight loss (WL) seems to have positive effects on blood pressure (BP). The aim of this review was to explain the mechanisms linking obesity and hypertension and to evaluate the main studies assessing the effect of WL on BP. We analysed studies published in the last 10 years (13 studies either interventional or observational) showing the effect of WL on BP. Different WL strategies were taken into account-diet and lifestyle modification, pharmacological intervention and bariatric surgery. Although a positive effect of WL could be identified in each study, the main difference seems to be the magnitude and the durability of BP reduction over time. Nevertheless, further follow-up data are needed: there is still a lack of evidence about long term effects of WL on hypertension. Hence, given the significant results obtained in several recent studies, weight management should always be pursued in obese patients with hypertension.
Collapse
Affiliation(s)
- Francesco Fantin
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Piazzale Stefani 1, 37126 Verona, Italy.
| | - Anna Giani
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Elena Zoico
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Andrea P Rossi
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Piazzale Stefani 1, 37126 Verona, Italy
| |
Collapse
|
17
|
Rossi AP, Rubele S, Calugi S, Caliari C, Pedelini F, Soave F, Chignola E, Vittoria Bazzani P, Mazzali G, Dalle Grave R, Zamboni M. Weight Cycling as a Risk Factor for Low Muscle Mass and Strength in a Population of Males and Females with Obesity. Obesity (Silver Spring) 2019; 27:1068-1075. [PMID: 31231958 DOI: 10.1002/oby.22493] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/28/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to determine whether multiple weight cycles in adulthood are an independent predictor of lower muscle mass and reduced strength, with potential implication for sarcopenia in adults with obesity. METHODS A total of 60 males and 147 females with obesity were included, with a mean BMI of 37.9 ± 6.0 kg/m2 and a mean age of 52.6 ± 12.4 years. Muscle strength was evaluated with handgrip and appendicular skeletal muscle mass was measured with dual-energy x-ray absorptiometry. RESULTS Participants were categorized into the following three groups: non-weight cyclers, mild weight cyclers, and severe weight cyclers. From a binary logistic regression that considered muscle mass categories as a dependent variable and weight cycling categories, age, and sex as independent variables, severe weight cyclers showed a 3.8-times increased risk of low muscle mass (95% CI: 1.42-10.01). Considering handgrip strength categories as a dependent variable and weight cycling categories, age, sex, and BMI as independent variables, severe weight cycling was associated with an increased risk of low muscle mass (about 6.3 times, 95% CI: 1.96-20.59). Severe weight cyclers showed a 5.2-times greater risk of developing sarcopenia. CONCLUSIONS In adults with obesity, weight cycling is associated with lower muscle mass and strength and a greater likelihood of developing sarcopenic obesity.
Collapse
Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Sofia Rubele
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Cesare Caliari
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Francesco Pedelini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Fabio Soave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Elisa Chignola
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | | | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| |
Collapse
|
18
|
Disegna E, De Caro A, Nori N, Taylor M, Fantin F, Mazzali G, Zoico E, Marchiotto S, Zamboni M, Gattazzo S, Rossi AP. Pentoxifylline in prosthetic valve: a case report. Aging Clin Exp Res 2019; 31:431-434. [PMID: 29949027 DOI: 10.1007/s40520-018-0983-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
|
19
|
Rossi AP, Facchinetti R, Ferrari E, Nori N, Sant S, Masciocchi E, Zoico E, Fantin F, Mazzali G, Zamboni M. Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation. J Thromb Thrombolysis 2019; 46:139-144. [PMID: 29761426 DOI: 10.1007/s11239-018-1679-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p = 0.048, CI 1.003-8.286).
Collapse
Affiliation(s)
- Andrea P Rossi
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy. .,Healthy Aging Center Verona, Verona, Italy.
| | | | - Elena Ferrari
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Nicole Nori
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Selena Sant
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Elena Masciocchi
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Elena Zoico
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Francesco Fantin
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Gloria Mazzali
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Mauro Zamboni
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| |
Collapse
|
20
|
Zoico E, Rubele S, De Caro A, Nori N, Mazzali G, Fantin F, Rossi A, Zamboni M. Brown and Beige Adipose Tissue and Aging. Front Endocrinol (Lausanne) 2019; 10:368. [PMID: 31281288 PMCID: PMC6595248 DOI: 10.3389/fendo.2019.00368] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/23/2019] [Indexed: 01/24/2023] Open
Abstract
Across aging, adipose tissue (AT) changes its quantity and distribution: AT becomes dysfunctional with an increase in production of inflammatory peptides, a decline of those with anti-inflammatory activity and infiltration of macrophages. Adipose organ dysfunction may lead to age-related metabolic alterations. Aging is characterized by an increase in adiposity and a decline in brown adipose tissue (BAT) depots and activity, and UCP1 expression. There are many possible links to age-associated involution of BAT, including the loss of mitochondrial function, impairment of the sympathetic nervous system, age-induced alteration of brown adipogenic stem/progenitor cell function and changes in endocrine signals. Aging is also associated with a reduction in beige adipocyte formation. Beige adipocytes are known to differentiate from a sub-population of progenitors resident in white adipose tissue (WAT); a defective ability of progenitor cells to proliferate and differentiate has been hypothesized with aging. The loss of beige adipocytes with age may be caused by changes in trophic factors in the adipose tissue microenvironment, which regulate progenitor cell proliferation and differentiation. This review focuses on possible mechanisms involved in the reduction of BAT and beige activity with aging, along with possible targets for age-related metabolic disease therapy.
Collapse
Affiliation(s)
- Elena Zoico
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Elena Zoico
| | - Sofia Rubele
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Annamaria De Caro
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Nicole Nori
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Fantin
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Rossi
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Division of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| |
Collapse
|
21
|
El Ghoch M, Rossi AP, Calugi S, Rubele S, Soave F, Zamboni M, Chignola E, Mazzali G, Bazzani PV, Dalle Grave R. Physical performance measures in screening for reduced lean body mass in adult females with obesity. Nutr Metab Cardiovasc Dis 2018; 28:917-921. [PMID: 30017438 DOI: 10.1016/j.numecd.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Little is known about the reduction of lean body mass (LBM) in obesity, or how to identify it in standard clinical settings. We therefore aimed to assess the prevalence of low LBM in adult females with obesity, and to identify the reliability of simple tools for its screening in this population. METHODS AND RESULTS Dual-energy X-ray absorptiometry (DXA) body composition assessment was used to categorise 147 female participants with obesity as with or without low LBM, according to the new definition that takes into account both appendicular lean mass (ALM) and body mass index (BMI)-ALM/BMI <0.512. Participants were also administered the six-minute walking test, handgrip-strength test and 4-metre gait-speed test. Of the sample of 147 participants, 93 (63.3%) met the criteria for reduced LBM. Stepwise multivariate logistic regression analysis showed that the six-minute walking test was the only independent test associated with low LBM (OR = 0.992, 95%CI 0.987-0.998). Receiver operating characteristic (ROC) curve analysis found that the discriminating cut-off points of the tests considered were 470 m, 3.30 s (gait speed = 1.2 m/sec) and 23.5 kg respectively; the 4-metre gait-speed test seems to provide the best balance of sensitivity and specificity, and the greatest discriminatory power at 90% sensitivity. CONCLUSIONS Treatment-seeking adult females with obesity display a great prevalence of reduced LBM. The six-minute walking test was the only independent test associated with low LBM, but the 4-metre gait-speed test seems to be the most accurate functional test for screening for this condition in that population.
Collapse
Affiliation(s)
- M El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy.
| | - A P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - S Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - S Rubele
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - F Soave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - M Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - E Chignola
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - G Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - P V Bazzani
- Department of Radiology, Villa Garda Hospital, Via Montebaldo 89, Garda, 37016, Italy
| | - R Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| |
Collapse
|
22
|
Rossi AP, Rubele S, D'Introno A, Zoico E, Bradimarte P, Amadio G, Nori N, Gnerre P, Mazzali G, Fantin F, Zamboni M. An update on methods for sarcopenia diagnosis: from bench to bedside. Ital J Med 2018. [DOI: 10.4081/itjm.2018.995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sarcopenia has been recognized as an age-related syndrome characterized by low muscle mass, low muscle strength, and low physical performance that is associated with increased likelihood of adverse outcomes including falls, fractures, hospitalization, frailty and mortality. Therefore, it is necessary to identify the condition early for applying intervention and prevention of the disastrous consequences of sarcopenia if left untreated. Clinical definition and diagnostic criteria for sarcopenia have been developed in the last years and different tools have been proposed for screening subjects with sarcopenia, evaluating the muscle mass, the muscle strength and the physical performance. In this review we analyzed the diagnostic criteria of sarcopenia and examined the current assessment tools used for the diagnosis and screening of sarcopenia.
Collapse
|
23
|
Rossi AP, Budui S, Zoico E, Caliari C, Mazzali G, Fantin F, D'Urbano M, Paganelli R, Zamboni M. Role of Anti-Inflammatory Cytokines on Muscle Mass and Performance Changes in Elderly Men and Women. J Frailty Aging 2018; 6:65-71. [PMID: 28555705 DOI: 10.14283/jfa.2017.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Investigate the presence of a correlation between systemic inflammatory profile of community-dwelling individuals and the loss of muscular mass and performance in old age over a 4.5y follow-up, focusing on the role of anti-inflammatory cytokines in muscular changes in elderly. DESIGN Longitudinal clinical study. SETTING Subjects were randomly selected from lists of 11 general practitioners in the city of Verona, Italy. PARTICIPANTS The study included 120 subjects, 92 women and 28 men aged 72.27±2.06 years and with BMI of 26.52±4.07 kg/m2 at baseline. MEASUREMENTS Six minutes walking test (6MWT), appendicular and leg fat free mass (FFM) as measured with Dual Energy X-ray absorptiometry, were obtained at baseline and after 4.5 years (4.5y) of mean follow-up. Height, weight, body mass index (BMI), and circulating levels of TNFα, IL-4, IL-10, and IL-13 were evaluated at baseline. RESULTS A significant reduction of appendicular FFM, leg FFM and 6MWT performance (all p<0.001) was observed after 4.5 y follow-up. In a stepwise regression model, considering appendicular FFM decline as dependent variable, lnIL-4, BMI, baseline appendicular FFM, lnTNFα and lnIL-13 were significant predictors of appendicular FFM decline explaining 30.8% of the variance. While building a stepwise multiple regression considering leg FFM as a dependent variable, lnIL-4, BMI and leg FFM were significant predictors of leg FFM decline and explained 27.4% of variance. When considering 6MWT decline as a dependent variable, baseline 6MWT, lnIL-13 and lnTNFα were significant predictors of 6MWT decline to explain 22.9% of variance. CONCLUSIONS Our study suggest that higher serum levels of anti-inflammatory markers, and in particular IL-4 and IL-13, may play a protective role on FFM and performance maintenance in elderly subjects.
Collapse
Affiliation(s)
- A P Rossi
- A.P. Rossi, MD, PhD, Cattedra di Geriatria, Università di Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126 VERONA, Italy, Tel:+39-45-8122537;FAX:+39-45-8122043, E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Zoico E, Darra E, Rizzatti V, Budui S, Franceschetti G, Mazzali G, Rossi AP, Fantin F, Menegazzi M, Cinti S, Zamboni M. Adipocytes WNT5a mediated dedifferentiation: a possible target in pancreatic cancer microenvironment. Oncotarget 2018; 7:20223-35. [PMID: 26958939 PMCID: PMC4991449 DOI: 10.18632/oncotarget.7936] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 02/06/2016] [Indexed: 12/14/2022] Open
Abstract
A significant epidemiological association between obesity and pancreatic ductal adenocarcinoma (PDAC) has previously been described, as well as a correlation between the degree of pancreatic steatosis, PDAC risk and prognosis. The underlying mechanisms are still not completely known. After co-culture of 3T3-L1 adipocytes and MiaPaCa2 with an in vitro transwell system we observed the appearance of fibroblast-like cells, along with a decrease in number and size of remaining adipocytes. RT-PCR analyses of 3T3-L1 adipocytes in co-culture showed a decrease in gene expression of typical markers of mature adipocytes, in parallel with an increased expression of fibroblast-specific and reprogramming genes. We found an increased WNT5a gene and protein expression early in MiaPaCa2 cells in co-culture. Additionally, EMSA of c-Jun and AP1 in 3T3-L1 demonstrated an increased activation in adipocytes after co-culture. Treatment with WNT5a neutralizing antibody completely reverted the activation of c-Jun and AP1 observed in co-cultured adipocytes. Increasing doses of recombinant SFRP-5, a competitive inhibitor for WNT5a receptor, added to the co-culture medium, were able to block the dedifferentiation of adipocytes in co-culture. These data support a WNT5a-mediated dedifferentiation process with adipocytes reprogramming toward fibroblast-like cells that might profoundly influence cancer microenvironment.
Collapse
Affiliation(s)
- Elena Zoico
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Elena Darra
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Vanni Rizzatti
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Simona Budui
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Guido Franceschetti
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Andrea P Rossi
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Francesco Fantin
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - Marta Menegazzi
- Department of Life and Reproduction Sciences, Biochemistry Section, University of Verona, Verona, Italy
| | - Saverio Cinti
- Department of Experimental and Clinical Medicine, Center of Obesity-University of Ancona (Politecnica delle Marche), Ancona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| |
Collapse
|
25
|
Gabriele S, Fantin F, Zivelonghi A, Zoico E, Mazzali G, Rossi AP, Zamboni M. Delirium after thiazide diuretic suspension can unmask diabetes insipidus. Geriatr Gerontol Int 2017; 17:2620-2622. [DOI: 10.1111/ggi.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Sara Gabriele
- Department of Medicine, Section of Geriatrics; University of Verona; Verona Italy
| | - Francesco Fantin
- Department of Medicine, Section of Geriatrics; University of Verona; Verona Italy
| | | | - Elena Zoico
- Department of Medicine, Section of Geriatrics; University of Verona; Verona Italy
| | - Gloria Mazzali
- Department of Medicine, Section of Geriatrics; University of Verona; Verona Italy
| | - Andrea P. Rossi
- Department of Medicine, Section of Geriatrics; University of Verona; Verona Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics; University of Verona; Verona Italy
| |
Collapse
|
26
|
Zoico E, Rizzatti V, Darra E, Budui SL, Franceschetti G, Vinante F, Pedrazzani C, Guglielmi A, De Manzoni G, Mazzali G, Rossi AP, Fantin F, Zamboni M. Morphological and Functional Changes in the Peritumoral Adipose Tissue of Colorectal Cancer Patients. Obesity (Silver Spring) 2017; 25 Suppl 2:S87-S94. [PMID: 29086519 DOI: 10.1002/oby.22008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/06/2017] [Accepted: 08/17/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The role of peritumoral adipose tissue (AT) has not been extensively studied in colorectal cancer (CRC). METHODS This study was conducted in 20 male subjects undergoing elective surgery for CRC. The differences between the peritumoral visceral adipose tissue (P-VAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) of the patients were described via immunohistochemistry and molecular biology analyses. The interactions between adipocytes and a colon cancer cell line were also investigated by using an in vitro coculture system. RESULTS The analyses revealed that adipocytes near the tumor were significantly smaller than the adipocytes from other sites. The P-VAT was preferentially infiltrated by a CD68+/CD163+/IDO- macrophage subset with a prevalent reparative inflammatory response, while the macrophages identified in VAT and SAT mainly presented inflammatory features. Furthermore, the P-VAT presented a higher expression of adiponectin compared with other sites. Morphological analysis in vitro showed that after a few days of coculture, 3T3-L1 adipocytes were reduced in number and size with an increase in lipolysis rate and dedifferentiation phenomena. CONCLUSIONS This study reveals important morphological and functional changes in the AT surrounding the tumor as an increase in lipolysis and in adiponectin-producing adipocytes, preferentially infiltrated by a macrophage subset, with prevalent reparative inflammatory response.
Collapse
Affiliation(s)
- Elena Zoico
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| | - Vanni Rizzatti
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Darra
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| | | | - Guido Franceschetti
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| | - Fabrizio Vinante
- Hematology Section, Department of Medicine, Cancer Research & Cell Biology Laboratory, University of Verona, Verona, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Giovanni De Manzoni
- Division of General and Upper Gastrointestinal Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| | | | - Francesco Fantin
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Geriatric Section, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
27
|
Pernigo M, Benfari G, Geremia G, Noni M, Borio G, Mazzali G, Zamboni M, Onorati F, Faggian G, Vassanelli C, Rossi A. Atrial Function as an Independent Predictor of Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Surgery for Severe Aortic Stenosis. J Am Soc Echocardiogr 2017; 30:956-965.e1. [DOI: 10.1016/j.echo.2017.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 10/18/2022]
|
28
|
Zoico E, Darra E, Rizzatti V, Tebon M, Franceschetti G, Mazzali G, Rossi AP, Fantin F, Zamboni M. Role of adipose tissue in melanoma cancer microenvironment and progression. Int J Obes (Lond) 2017; 42:344-352. [PMID: 28883539 DOI: 10.1038/ijo.2017.218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND An epidemiological association between excess weight and increased risk of cancer has been described in melanoma, for which the physiopathological mechanisms are still unknown. The study of tumor microenvironment and of the role of adipocytes in cancer development, progression and metastasis has recently received great interest. However, the role of peritumoral adipocytes has been characterized only in a few types of cancer, and in melanoma it still remains to be defined. METHODS We investigated the interactions between adipocytes and melanoma cells using an in vitro co-culture system. We studied the morphological and functional properties of 3T3-L1 adipocytes before and after co-culture with A375 melanoma cells, in order to assess the role of adipocytes on melanoma migration. RESULTS Morphological analysis showed that after 6 days of co-culture 3T3-L1 adipocytes were reduced in number and size. Moreover, we observed the appearance of dedifferentiated cells with a fibroblast-like phenotype that were not present in controls and that had lost the expression of some adipocyte-specific genes, and increased the expression of collagen, metalloproteinases and genes typical of dedifferentiation processes. Through the Matrigel Invasion Test, as well the Scratch Test, it was possible to observe that co-culture with adipocytes induced in melanoma cells increased migratory capacity, as compared with controls. In particular, the increase in migration observed in co-culture was suppressed after adding the protein SFRP-5 in the medium, supporting the involvement of the Wnt5a pathway. The activation of this pathway was further characterized by immunofluorescence and western blot analysis, showing in melanocytes in co-culture the activation of β-catenin and LEF-1, two transcription factors involved in migration processes, neo-angiogenesis and metastasis. CONCLUSIONS These data allow us to hypothesize a dedifferentiation process of adipocytes toward fibroblast-like cells, which can promote migration of melanoma cells through activation of Wnt5a and the intracellular pathways of β-catenin and LEF-1.
Collapse
Affiliation(s)
- E Zoico
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - E Darra
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - V Rizzatti
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - M Tebon
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - G Franceschetti
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - G Mazzali
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - A P Rossi
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - F Fantin
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| | - M Zamboni
- Department of Medicine, Geriatrics Section, University of Verona, Verona, Italy
| |
Collapse
|
29
|
Fantin F, Comellato G, Rossi AP, Grison E, Zoico E, Mazzali G, Zamboni M. Relationship between neck circumference, insulin resistance and arterial stiffness in overweight and obese subjects. Eur J Prev Cardiol 2017; 24:1532-1540. [PMID: 28728486 DOI: 10.1177/2047487317721655] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Only a few studies have investigated the relationship between neck circumference and cardiometabolic risk. The aim of this study was to assess the relationships between neck circumference, waist circumference, metabolic variables and arterial stiffness in a group of overweight and obese subjects evaluating a possible independent role of neck circumference in determining arterial stiffness. Methods and results We studied 95 subjects (53 women) with an age range of 20-77 years and body mass index range from 25.69 to 47.04 kg/m2. In each subject we evaluated body mass index, waist, hip and neck circumference, systolic and diastolic blood pressure, insulin, fasting glucose, cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWVcf) and carotid-radial pulse wave velocity (PWVcr). Both PWVcf and PWVcr were higher in subjects with high values of neck circumference compared with subjects with normal values of neck circumference. Subjects with high values of neck circumference and abdominal obesity presented higher values of mean arterial pressure, PWVcr and homeostasis model assessment (HOMA) index and lower values of high-density lipoprotein than subjects with only abdominal obesity. Two models of stepwise multiple regression were performed in order to evaluate the combined effect of independent variables on arterial stiffness. In the first model PWVcf was considered a dependent variable, and age, gender, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, waist circumference, neck circumference, HOMA index and the use of anti-hypertensive medications were considered independent variables. Age, systolic blood pressure, triglycerides and waist circumference were significant predictors of PWVcf, explaining 65% of its variance. In the second model, in which PWVcr was considered a dependent variable, neck circumference and gender were significant predictors of PWVcr, explaining 24% of its variance. Conclusions These findings emphasise the need to measure not only waist but even neck circumference to better stratify and identify individuals at increased cardiometabolic risk, as upper-body subcutaneous fat is a novel, easily measured fat depot.
Collapse
Affiliation(s)
- Francesco Fantin
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| | - Gabriele Comellato
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| | - Andrea P Rossi
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| | - Elisa Grison
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| | - Elena Zoico
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, University of Verona, Italy
| |
Collapse
|
30
|
Rossi AP, Micciolo R, Rubele S, Fantin F, Caliari C, Zoico E, Mazzali G, Ferrari E, Volpato S, Zamboni M. Assessing the Risk of Sarcopenia in the Elderly: The Mini Sarcopenia Risk Assessment (MSRA) Questionnaire. J Nutr Health Aging 2017; 21:743-749. [PMID: 28537342 DOI: 10.1007/s12603-017-0921-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES to validate the MSRA questionnaire proposed as prescreening tool for sarcopenia, in a population of community-dwelling elderly subjects. DESIGN observational study. SETTING community dwelling elderly subjects. PARTICIPANTS 274 community dwelling elderly subjects, 177 women and 97 men, aged 66-78 years. MEASUREMENTS Based on EWGSOP diagnostic criteria subjects were classified as sarcopenic and non-sarcopenic. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, is composed of seven questions and investigates anamnestic and nutritional characteristics related to risk of sarcopenia onset (age, protein and dairy products consumption, number of meals per day, physical activity level, number of hospitalizations and weight loss in the last year). RESULTS 33.5% of the study population, were classified as sarcopenic. With the 7-item MSRA score, subjects with a score of 30 or less, had a 4-fold greater risk of being sarcopenic than subjects with a score higher than 30 (OR:4.20;95% CI:2.26-8.06); area under the ROC curve was 0.786 (95% CI:0.725-0.847). In a logistic regression, considering as dependent variable the probability of being sarcopenic, and as independent variables the 7 items of the questionnaire, two items (number of meals and milk and dairy products consumption) showed non-significant diagnostic power. A 5-item score was then derived and the area under the ROC curve was 0.789 (95% IC:0.728-0.851). Taking into account the cost of false positive and false negative costs and the prevalence of sarcopenia, the "optimal" threshold of the original MSRA score (based on 7 items) is 30, with a sensitivity of 0.804 and a specificity of 0.505, while the "optimal" threshold of the MSRA score based on 5 items, is 45, with a sensitivity of 0.804 and a specificity of 0.604. CONCLUSION this preliminary study shows that the MSRA questionnaire is predictive of sarcopenia and can be suggested as prescreening instrument to detect this condition. The use of a short form of the MSRA questionnaire improves the capacity to identify sarcopenic subjects.
Collapse
Affiliation(s)
- A P Rossi
- Andrea P Rossi, M.D., Ph.D. Department of Medicine, Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126 Verona, Italy, +39-45-8122537, +39-45-8122043 (fax), E-mail :
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Rossi AP, Rubele S, Pelizzari L, Fantin F, Morgante S, Marchi O, Pedelini F, Zoico E, Mazzali G, Zamboni M. Hospitalization Effects on Physical Performance and Muscle Strength in Hospitalized Elderly Subjects. ACTA ACUST UNITED AC 2017. [DOI: 10.4172/2167-7182.1000401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Rossi AP, Fantin F, Caliari C, Zoico E, Mazzali G, Zanardo M, Bertassello P, Zanandrea V, Micciolo R, Zamboni M. Dynapenic abdominal obesity as predictor of mortality and disability worsening in older adults: A 10-year prospective study. Clin Nutr 2016; 35:199-204. [DOI: 10.1016/j.clnu.2015.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 12/25/2022]
|
33
|
Mazzali G, Fantin F, Zoico E, Sepe A, Bambace C, Faccioli S, Pedrotti M, Corzato F, Rizzatti V, Faggian G, Micciolo R, Cinti S, Santini F, Zamboni M. Heart Fat Infiltration In Subjects With and Without Coronary Artery Disease. J Clin Endocrinol Metab 2015; 100:3364-71. [PMID: 26186298 DOI: 10.1210/jc.2015-1787] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Fat may accumulate around the heart in epicardial adipose tissue or inside the heart as lipid droplets (LDs). OBJECTIVE To compare myocardial steatosis between subjects with and without coronary artery disease (CAD and non-CAD) and to identify which cells contain LDs. DESIGN Body mass index, waist circumference, glucose, insulin, homeostasis model assessment index, leptin, adiponectin, and high-sensitivity C-reactive protein were evaluated in CAD and non-CAD subjects. Biopsies were collected from right atrial myocardium. Immunohistochemistry for perilipin (PLIN) 1 and 2 was used to characterize LDs and their localization in adipocytes or myocardial cells, respectively. Cardiomyocytes apoptosis and hypoxia inducible factor 1 alpha were obtained in a subgroup of subjects. SETTING The study took place in a hospital. PATIENTS Male subjects consecutively undergoing elective cardiac surgery either for coronary bypass grafting (CAD, n = 23) or for valve replacement (non-CAD, n = 18). MAIN OUTCOMES AND MEASURES The study was designed to compare myocardial steatosis between subjects with and without coronary artery disease. RESULTS PLIN1 and PLIN2 resulted significantly higher in CAD than in non-CAD subjects, as did apoptosis. PLIN1 was positively associated with circulating leptin, high-sensitivity C-reactive protein, and apoptosis, and negatively with adiponectin. PLIN2 was positively associated with body mass index, waist circumference, and leptin and negatively with adiponectin. After taking into account the absence/presence of hypertension, diabetes, and CAD/non-CAD, adiponectin was negatively associated with PLIN1 (r(2) = 0.532); waist circumference and adiponectin were associated with PLIN2 (r(2) = 0.399). CONCLUSIONS Myocardial steatosis is greater in CAD than non-CAD subjects, depending on both metabolically active adipocytes interspersed among cardiomyocytes and higher fat deposition inside cardiomyocytes; serum adiponectin and waist circumference are independent predictors of myocardial steatosis.
Collapse
Affiliation(s)
- Gloria Mazzali
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Francesco Fantin
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Elena Zoico
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Anna Sepe
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Clara Bambace
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Silvia Faccioli
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Martina Pedrotti
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Francesca Corzato
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Vanni Rizzatti
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Giuseppe Faggian
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Rocco Micciolo
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Saverio Cinti
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Francesco Santini
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| | - Mauro Zamboni
- Department of Medicine (G.M., F.F., E.Z., A.S., C.B., S.F., M.P., F.C., V.R., M.Z.), Geriatric Section, University of Verona, Verona, Italy; Department of Cardiac Surgery (G.F.), University of Verona, Verona, Italy; Department of Psychology and Cognitive Sciences (R.M.), University of Trento, Trento, Italy; Institute of Human Morphology (S.C.), University of Ancona, Ancona, Italy; and Division of Cardiac Surgery (F.S.), University of Genova, Genova, Italy
| |
Collapse
|
34
|
Dalle Grave R, Calugi S, Compare A, El Ghoch M, Petroni ML, Tomasi F, Mazzali G, Marchesini G. Weight Loss Expectations and Attrition in Treatment-Seeking Obese Women. Obes Facts 2015; 8:311-8. [PMID: 26444382 PMCID: PMC5644826 DOI: 10.1159/000441366] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The analysis of the relation between weight loss goals and attrition in the treatment of obesity has produced conflicting results. The aim of the present study was to investigate the role of weight loss goals on attrition in a cohort of obese women seeking treatment at 8 Italian medical centres. METHODS 634 women with obesity, consecutively enrolled in weight loss programmes, were included in the study. Weight loss goals were evaluated with the Goals and Relative Weights Questionnaire (GRWQ), reporting a sequence of unrealistic ('dream' and 'happy') and more realistic ('acceptable' and 'disappointing') weight loss goals. Attrition was assessed at 12 months on the basis of patients' medical records. RESULTS At 12 months, 205/634 patients (32.3%) had interrupted their programme and were lost to follow-up. After adjustment for age, baseline weight, education and employment status, attrition was significantly associated with higher percent acceptable and disappointing weight loss targets, not with dream and happy weight loss. CONCLUSION In 'real world' clinical settings, only realistic expectations might favour attrition whenever too challenging, whereas unrealistic weight loss goals have no effect. Future studies should assess the effect of interventions aimed at coping with too challenging weight goals on attrition.
Collapse
Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy, Bologna, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy, Bologna, Italy
| | - Angelo Compare
- Human and Social Science, University of Bergamo and Human Factors and Technology in Healthcare Research Centre, Bergamo, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy, Bologna, Italy
| | | | - Franco Tomasi
- Unit of Diabetology, Dietetics & Clinical Nutrition, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Gloria Mazzali
- Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases, ‘Alma Mater Studiorum’ University, Bologna, Italy
- *Giulio Marchesini, MD, Unit of Metabolic Diseases, ‘Alma Mater Studiorum’ University, Via Massarenti 9, 40138 Bologna, Italy,
| |
Collapse
|
35
|
Abstract
In the last decade there has been increasing focus on body fat distribution, rather than on the degree of obesity. More recently, great interest has also been dedicated to ectopic fat deposition in overnourished individuals that reflects a failure of the system of intracellular lipid homeostasis, which, in normal conditions, prevents lipotoxicity in the organs, by confining lipid overload to cells specifically designed to store large quantities of surplus calories, the white adipocytes. Consequently, excess body weight leads to fat infiltration of multiple organs including liver, pancreas, skeletal muscle, and heart thus forming "ectopic fat". Although overfeeding is considered the main predictor of ectopic fat deposition, other factors may be also involved. The purpose of this review is to evaluate the current available data on the predictors of ectopic fat deposition in humans.
Collapse
Affiliation(s)
- Mauro Zamboni
- Section of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
| | - Andrea P Rossi
- Section of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
| | - Francesco Fantin
- Section of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
| | - Simona L Budui
- Section of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
| | - Elena Zoico
- Section of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
| | - Giulia A Zamboni
- Institute od Radiology, University Hospital GB Rossi, Verona, Italy.
| | - Gloria Mazzali
- Section of Geriatrics, Department of Medicine, University of Verona, Verona, Italy.
| |
Collapse
|
36
|
Zoico E, Franceschetti G, Chirumbolo S, Rossi AP, Mazzali G, Rizzatti V, Budui S, Zamboni M. Phenotypic shift of adipocytes by cholecalciferol and 1α,25 dihydroxycholecalciferol in relation to inflammatory status and calcium content. Endocrinology 2014; 155:4178-88. [PMID: 25153146 DOI: 10.1210/en.2013-1969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent experimental data seem to suggest a relevant role for 1,25[OH]2cholecalciferol (1,25[OH]2D3) in adipocyte physiology and pathophysiology, with some studies showing adipogenic and pro-inflammatory properties, and others lipolytic and anti-inflammatory functions. Moreover, to our knowledge, the role of cholecalciferol (D3) in adipocytes function is still not known. Therefore, the aim of this study was to investigate in vitro the effects of 1,25[OH]2D3, as well as of D3, in 3T3-L1 adipocytes in basal and inflammatory conditions, testing the effects of different calcium concentrations in adipocytes culture medium. In 3T3-L1 adipocytes, CYP27A1 and CYP27B1 mRNA were detected in basal conditions and induced after D3 treatment. Pre-treatment of 3T3-L1 adipocytes not only with 1,25[OH]2D3, but also with D3 before inflammatory stimulation, significantly prevented the increase in gene expression and protein secretion of IL-6 and TNF-α, and significantly increased IL-10 mRNA and protein production compared with adipocytes treated only with lipopolysaccharide (LPS). Biological effects of D3 were still present after inhibition of P450 activity with ketokonazole. LPS determined a decrease in cell area compared with controls, paralleled by a significant increase in optical density (OD) of lipid droplets, whereas 1,25[OH]2D3 and D3 alone significantly increased adipocytes area and decreased OD. Pretreatment with both forms of vitamin D preserved cells from the reduction in their area observed after LPS treatment. LPS decreased more the area of cells grown in a high calcium medium than of adipocytes grown in a low calcium medium. In the presence of a high calcium medium, 1,25(OH)2D3 treatment preserved cell area, maintaining its anti-inflammatory and adipogenic properties. In conclusion our results show that D3, besides 1,25[OH]2D3, presents anti-inflammatory effects on 3T3-L1, as well as that adipocytes have the enzymatic pathways necessary to locally regulate the production of active forms of vitamin D, capable of influencing adipocyte phenotype and function.
Collapse
Affiliation(s)
- Elena Zoico
- Department of Medicine, Division of Geriatrics, University of Verona, 37126 Verona, Italy
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Fantin F, Comellato G, Rossi A, Puflea A, Mazzali G, Disegna E, Manzato G, Zamboni M. P149: Arterial stiffness and HF subtypes in elderly patients. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
38
|
Zamboni M, Rossi AP, Corzato F, Bambace C, Mazzali G, Fantin F. Sarcopenia, cachexia and congestive heart failure in the elderly. Endocr Metab Immune Disord Drug Targets 2014; 13:58-67. [PMID: 23369138 DOI: 10.2174/1871530311313010008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/22/2022]
Abstract
Skeletal muscle abnormalities and loss are frequently present in patients with mild or moderate cardiac heart failure (CHF) and may contribute to fatigue and dyspnea. These muscle abnormalities may be associated with age related body composition changes, such as sarcopenia. Muscle damage has also been observed in subjects with cardiac cahexia, a serious CHF complication, associated with poor prognosis independently of functional disease severity, age, and measures of exercise capacity and cardiac function. Loss of muscle mass is a feature of cachexia, whereas most sarcopenic subjects are not cachectic. Individuals with no weight loss, no anorexia, and no measurable systemic inflammatory response may be sarcopenic. Patients with severe CHF show multiple marked histological abnormalities of skeletal muscle, such as muscle fiber atrophy. These abnormalities are different in sarcopenia and cachexia. The majority of mechanisms involved in sarcopenia play a role even in the determination of cachexia and they are amplified in cachexia where they may induce both muscle damage as well as other abnormalities, such as fat and weight loss, through activation of lypolisis or anorexia. To distinguish cachexia and sarcopenia in CHF patients, even if not easy, should be clinically relevant, because no specific treatment is available for cachectic patients whereas treatment options are possible for sarcopenia.
Collapse
Affiliation(s)
- Mauro Zamboni
- Department of Medicine, Geriatric Division, University of Verona, Piazzale Stefani 1, 37126 Verona, Italy.
| | | | | | | | | | | |
Collapse
|
39
|
Zamboni M, Rossi AP, Fantin F, Zamboni G, Chirumbolo S, Zoico E, Mazzali G. Adipose tissue, diet and aging. Mech Ageing Dev 2013; 136-137:129-37. [PMID: 24321378 DOI: 10.1016/j.mad.2013.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/14/2013] [Accepted: 11/27/2013] [Indexed: 12/25/2022]
Abstract
Age related increase in body fat mass, visceral adipose tissue (AT), and ectopic fat deposition are strongly related to worse health conditions in the elderly. Moreover, with aging higher inflammation in adipose tissue may be observed and may contribute to inflammaging. Aging may significantly affect AT function by modifying the profile of adipokines produced by adipose cells, reducing preadipocytes number and their function and increasing AT macrophages infiltration. The initiating events of the inflammatory cascade promoting a greater AT inflammatory profile are not completely understood. Nutrients may determine changes in the amount of body fat, in its distribution as well as in AT function with some nutrients showing a pro-inflammatory effect on AT. Evidences are sparse and quite controversial with only a few studies performed in older subjects. Different dietary patterns are the result of the complex interaction of foods and nutrients, thus more studies are needed to evaluate the association between dietary patterns and changes in adipose tissue structure, distribution and function in the elderly.
Collapse
Affiliation(s)
- Mauro Zamboni
- Department of Medicine, Geriatric Medicine, University of Verona, Italy.
| | - Andrea P Rossi
- Department of Medicine, Geriatric Medicine, University of Verona, Italy
| | - Francesco Fantin
- Department of Medicine, Geriatric Medicine, University of Verona, Italy
| | | | | | - Elena Zoico
- Department of Medicine, Geriatric Medicine, University of Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Geriatric Medicine, University of Verona, Italy
| |
Collapse
|
40
|
Rossi A, Mastrandrea V, Bertassello P, Mazzali G, Bissoli L, Zanardo M, Confente S, Fantin F, Zamboni M. Prognostic value of different sarcopenic obesity definitions for worsening disability in elderly men and women. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
41
|
Fantin F, Rossi AP, Cazzadori M, Comellato G, Mazzali G, Gozzoli MP, Grison E, Zamboni M. Central and peripheral fat and subclinical vascular damage in older women. Age Ageing 2013; 42:359-65. [PMID: 23449599 DOI: 10.1093/ageing/aft005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE the aim of this study was to evaluate the relationship between fat distribution and arterial compliance in a group of elderly women, in particular to test a possible independent role of abdominal fat mass and peripheral fat mass on subclinical vascular damage, defined by a pulse wave velocity (PWV) >12 m/s. METHODS in 96 women with age range 60-80 years (68.65 ± 4.98 years) and BMI range from 18.8 to 41.2 kg/m(2) (27.07 ± 4.61 kg/m(2)), we evaluated the body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, cholesterol, LDL and HDL cholesterol, triglycerides and body composition by dual energy X-ray absorptiometry (DXA). Arterial stiffness was assessed by carotid-femoral (PWVcf) and carotid-radial pulse wave velocity (PWVcr). RESULTS significant associations were found between PWVcf, age, waist circumference, BMI and trunk fat assessed by DXA, as well as TG and HDL cholesterol. After adjustment for the total fat mass a negative statistically significant association between PWVcf and leg fat mass was shown. In multiple regression analyses the mean arterial pressure, trunk fat mass and leg fat mass were significant predictors of vascular damage with OR, respectively, of 1.06 (CI: 1.01-1.11), 1.25 (CI: 1.06-1.48) and 0.73 (CI: 0.53-0.99). CONCLUSIONS the results of this study show, in a sample of apparently healthy elderly women, that central and peripheral adiposity are independent predictors, with an opposite effect on subclinical vascular damage, confirming and strengthening the protective role of the gluteal-femoral fat on cardiovascular risk even in elderly.
Collapse
Affiliation(s)
- Francesco Fantin
- Department of Medicine, Section of Geriatrics, University of Verona, Piazzale Stefani 1 Ospedale Civile Maggiore, Osp Geriatrico 6 Piano Lato Mameli, 37100 Verona, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
|
43
|
Rossi AP, Fantin F, Zamboni GA, Mazzali G, Zoico E, Bambace C, Antonioli A, Pozzi Mucelli R, Zamboni M. Effect of moderate weight loss on hepatic, pancreatic and visceral lipids in obese subjects. Nutr Diabetes 2012; 2:e32. [PMID: 23449531 PMCID: PMC3341708 DOI: 10.1038/nutd.2012.5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To compare the effects of weight loss on visceral and subcutaneous abdominal fat, liver and pancreas lipid content and to test the effects of these changes on metabolic improvement observed after weight loss. DESIGN Weight-loss program designed to achieve a loss of 7-10% of the initial weight. SUBJECTS 24 obese subjects (13 males and 11 females) with age ranging from 26 to 69 years and body mass index (BMI) 30.2-50.5 kg m(-2). MEASUREMENTS weight, BMI, waist circumference, body composition as assessed by dual-energy X-ray absorptiometry, metabolic variables, leptin, adiponectin, visceral and subcutaneous abdominal fat, liver and pancreas lipid content as assessed by magnetic resonance were evaluated before and after weight loss achieved by hypocaloric diet. RESULTS After a mean body weight decrease of 8.9%, BMI, waist circumference, fat mass, all metabolic variables, homeostasis model assessment of insulin resistance (HOMA), alanine amino transferase, gamma glutamyl transpeptidase, high-sensitivity C-reactive protein (hs-CRP) and leptin, but not adiponectin and high-density lipoprotein-cholesterol, significantly decreased (all P<0.01). Visceral and subcutaneos abdominal fat, liver and pancreas lipid content significantly decreased (all P<0.01). Percent changes in liver lipid content were greater (84.1±3%) than those in lipid pancreas content (42.3±29%) and visceral abdominal fat (31.9±15.6%). After weight loss, percentage of subjects with liver steatosis decreased from 75 to 12.5%. Insulin resistance improvement was predicted by changes in liver lipid content independently of changes in visceral fat, pancreas lipid content, systemic inflammation, leptin and gender. CONCLUSION Moderate weight loss determines significant decline in visceral abdominal fat, lipid content in liver and pancreas. Reduction of liver lipid content was greater than that of pancreas lipid content and visceral fat loss. Liver lipid content is the strongest predictor of insulin resistance improvement after weight loss.
Collapse
Affiliation(s)
- A P Rossi
- Department of Medicine, Division of Geriatrics, University of Verona, Verona, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Minniti A, Bissoli L, Di Francesco V, Olivieri M, Mandragona R, Mazzali G, Fontana G, Corzato F, Costa A, Bosello O, Zamboni M. Comparison of physical and psychological status in younger and older overweight-obese women. Nutr Metab Cardiovasc Dis 2011; 21:909-914. [PMID: 20674307 DOI: 10.1016/j.numecd.2010.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/25/2010] [Accepted: 02/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM Obesity prevalence is noticeably growing, even in the elderly. Most of the studies concerning the impact of obesity in the elderly evaluated physical co-morbidities, whilst very few data are available on psychological co-morbidities in people ≥ 60 years of age. The present study aimed to compare anthropometrical measures, physical co-morbidities and psychosocial factors correlated with overweight and obesity in younger and elderly people. METHODS AND RESULTS In 456 women in the age range of 18-59 years and 128 women in the age range of 60-80 years with body mass index (BMI) ≥ 25/kg m², body weight, height and waist and hip circumferences were measured. The presence of co-morbidities such as osteoarthritis, hypertension, type 2 diabetes and hypercholesterolaemia was assessed. The Obesity Related Well Being 97 Questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometric variables. BMI was not significantly different between younger overweight-obese subjects and older overweight-obese subjects, whereas waist circumference and waist-to-hip ratio (WHR) were significantly higher in the elderly. Osteoarthritis, hypertension and hypercholesterolaemia were significantly more frequent in the elderly. Older overweight-obese subjects had better scores in most of the psychometric questionnaires. CONCLUSIONS Our results show that older overweight-obese subjects have generally more physical co-morbidities but a better psychological status than younger adults, despite similar BMI. These data may contribute to a better understanding of obesity consequences in the elderly and may help clinicians to differentiate obesity treatments in relation to patients' age.
Collapse
Affiliation(s)
- A Minniti
- Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Rossi AP, Fantin F, Zamboni GA, Mazzali G, Rinaldi CA, Del Giglio M, Di Francesco V, Barillari M, Pozzi Mucelli R, Zamboni M. Predictors of ectopic fat accumulation in liver and pancreas in obese men and women. Obesity (Silver Spring) 2011; 19:1747-54. [PMID: 21593811 DOI: 10.1038/oby.2011.114] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of the present study was to determine the relationship between body fat distribution, adipocytokines, inflammatory markers, fat intake and ectopic fat content of liver and pancreas in obese men and women. A total of 12 lean subjects (mean age 47.25 ± 14.88 years and mean BMI 22.85 ± 2), 38 obese subjects (18 men and 20 women) with mean age 49.1 ± 13.0 years and mean BMI 34.96 ± 4.21 kg/m2 were studied. MEASUREMENTS weight, height, BMI, waist circumference, as well as glucose, insulin, HOMA (homeostasis model assessment of insulin resistance), cholesterol, triglycerides, high-density lipoprotein cholesterol, high sensitivity C-reactive protein, daily energy intake, leptin, and adiponectin. Magnetic resonance was used to evaluate visceral, subcutaneous adipose tissue (SCAT) as well as liver and pancreas lipid content using in-phase and out-of-phase magnetic resonance imaging (MRI) sequence. Obese subjects had significantly higher weight, waist circumference, SCAT, deep SCAT, visceral adipose tissue (VAT), liver and pancreatic lipid content than lean subjects. Obese women had significantly lower VAT, liver and pancreas lipid content regardless of same BMI. In multiple regression analyses, the variance of liver lipid content explained by gender and VAT was 46%. When HOMA was added into a multiple regression, a small increase in the proportion of variance explained was observed. A 59.2% of the variance of pancreas lipid content was explained by gender and VAT. In conclusion, obese men show higher VAT and ectopic fat deposition in liver and pancreas than obese women despite same BMI. Independent of overall adiposity, insulin resistance, adiponectin and fat intake, VAT, measured with MRI, is the main predictor of ectopic fat deposition in both liver and pancreas.
Collapse
Affiliation(s)
- Andrea P Rossi
- Department of Biomedical and Surgical Science, Division of Geriatric Medicine, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Zoico E, Garbin U, Olioso D, Mazzali G, Fratta Pasini AM, Di Francesco V, Sepe A, Cominacini L, Zamboni M. The effects of adiponectin on interleukin-6 and MCP-1 secretion in lipopolysaccharide-treated 3T3-L1 adipocytes: role of the NF-kappaB pathway. Int J Mol Med 2010; 24:847-51. [PMID: 19885628 DOI: 10.3892/ijmm_00000302] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
It was recently suggested that the transcription nuclear factor-kappaB (NF-kappaB) plays an important role in controlling the inflammation and metabolic alterations associated with obesity. In endothelial and monocytic cells, adiponectin acts as a modulator of the inflammatory response, suppressing NF-kappaB activation. The aim of this study was to assess the ability of different forms of adiponectin to modulate the inflammatory response in adipocytes. 3T3-L1 preadipocytes were cultured according to standard conditions. Fully differentiated adipocytes were stimulated with 1 microg/ml lipopolysaccharides (LPS) for 16 h, with or without pre-treatment with 10 microg/ml of globular (AdG) or full-length (AdFl) adiponectin. Both AdG and AdFl significantly suppressed LPS-induced expression of IL-6 mRNA in adipocytes and reduced the concentration of IL-6 in culture media. Adiponectin pre-treatment significantly reduced the increase in MCP-1 mRNA in adipocytes exposed to LPS. In culture media, the increase in MCP-1 detected after LPS stimulation was significantly attenuated after pre-treatment with AdG. In 3T3-L1, AdG and AdFl reduced NF-kappaB activity by 50 and 40%, respectively compared to the NF-kappaB activation induced by LPS alone. Moreover, both forms of adiponectin significantly attenuated IkappaB-alpha as well as IKK gene expression. Pre-treatment of adipocytes with AdG or AdFl significantly increased PPARgamma mRNA levels, taking its expression back to the basal level. Both AdG and AdFl exert anti-inflammatory activity suppressing IL-6 and MCP-1 production from inflamed adipocytes. This anti-inflammatory action may be mediated through inhibition of NF-kappaB activity as well as through increased PPARgamma expression.
Collapse
Affiliation(s)
- Elena Zoico
- Division of Geriatric Medicine, Department of Surgical and Biomedical Sciences, University of Verona, I-37126 Verona, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Zoico E, Di Francesco V, Bissoli L, Mazzali G, Fontana G, Giuliano K, Bosello O, Zamboni M. Interrelationships between leptin resistance, body composition, and aging in elderly women. J Am Geriatr Soc 2009; 56:1768-9. [PMID: 19166455 DOI: 10.1111/j.1532-5415.2008.01811.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 2008; 18:388-395. [PMID: 18395429 DOI: 10.1016/j.numecd.2007.10.002] [Citation(s) in RCA: 549] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 08/17/2007] [Accepted: 10/04/2007] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM In elderly patients, age-related changes in body composition, as well as the increased prevalence of obesity, determine a combination of excess weight and reduced muscle mass or strength, recently defined as sarcopenic obesity (SO). This review examines the main studies regarding sarcopenic obesity in the elderly. DATA SYNTHESIS Definition of SO necessarily combines those of sarcopenia and obesity. The prevalence of sarcopenia and SO increases with age. Muscle and fat mass are strongly interconnected from a pathogenetic point of view. A better understanding of the mechanisms which lead from loss of muscle mass to fat gain or vice versa from fat gain to muscle loss seems to be crucial. Recent data suggest that peptides produced by adipose tissue may play an important role in the pathophysiology of SO, thus more research is needed to better characterize this new area. Obesity and sarcopenia in the elderly may potentiate each other maximizing their effects on disability, morbidity and mortality. Identifying elderly subjects with SO should be mandatory; effective treatment of sarcopenia and SO may attenuate its clinical impact. CONCLUSION The concept of SO may help to clarify the relationship between obesity, morbidity and mortality in the elderly.
Collapse
Affiliation(s)
- Mauro Zamboni
- Geriatric Medicine, Cattedra di Geriatria, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126 Verona, Italy.
| | | | | | | | | |
Collapse
|
49
|
Zoico E, Zamboni M, Di Francesco V, Mazzali G, Fantin F, De Pergola G, Zivelonghi A, Adami S, Bosello O. Relation between adiponectin and bone mineral density in elderly post-menopausal women: role of body composition, leptin, insulin resistance, and dehydroepiandrosterone sulfate. J Endocrinol Invest 2008; 31:297-302. [PMID: 18475046 DOI: 10.1007/bf03346361] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adipocytokines have been proposed as new mediators of the protective effects of fat mass on the skeleton. The aim of this study was to test the relationship between adiponectin, leptin, and bone mineral density (BMD), independently of body composition, insulin resistance, and other factors known to affect bone metabolism. METHODS Thirty-six post-menopausal non-diabetic elderly women, with ages ranging from 66 to 77 yr took part in the study. In all subjects we evaluated body weight, height, body mass index (BMI), waist circumference, adiponectin, leptin, insulin, DHEAS, and homeostasis model assessment of insulin resistance (HOMA), as well as yr since menopause. Total body fat mass (FM) and BMD at whole body and femoral level were measured with Dual energy X-ray Absorptiometry (DXA). Volumetric BMD was defined as the ratio between total body BMD and height. RESULTS Leptin was positively and adiponectin negatively related with whole body and femoral BMD. Positive associations between insulin, HOMA, DHEAS, and BMD measures were also found. After adjusting for FM, only adiponectin maintained a significant relation with whole body and femoral BMD; the strength of this association was reduced after adjustment for insulin resistance, estimated by HOMA. In stepwise multiple linear regression analyses adiponectin explained 11.7% of total BMD variance, 17.4% of femoral neck BMD variance, and 30.7% of volumetric BMD variance, independently of BMI, FM, leptin, HOMA, and DHEAS. CONCLUSIONS The present study may suggest possible involvement of adiponectin in bone metabolism, independently of FM and insulin resistance even in elderly post-menopausal women.
Collapse
Affiliation(s)
- E Zoico
- Department of Geriatric Medicine, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Zoico E, Di Francesco V, Mazzali G, Zivelonghi A, Volpato S, Bortolani A, Dioli A, Coin A, Bosello O, Zamboni M. High baseline values of fat mass, independently of appendicular skeletal mass, predict 2-year onset of disability in elderly subjects at the high end of the functional spectrum. Aging Clin Exp Res 2007; 19:154-9. [PMID: 17446727 DOI: 10.1007/bf03324682] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS To evaluate the relation between baseline body composition and 2- year onset of functional limitation in elderly subjects at the high end of the functional spectrum. METHODS Anthropometric measurements, physical functioning as measured by a modified version of the Activities of Daily Living Scale, and baseline albumin, were evaluated in 145 men and women aged 66-78 years, free of functional limitations, selected from the general population of Verona. In each subject, total body fat mass (FM) and appendicular FFM (ASMM) were measured by dual-energy X-ray absorptiometry; the FM (FMI) and ASMM indexes (ASMMI) were also calculated by dividing each body composition variable by height squared. RESULTS After 2 years of follow-up, 48.2% of women and 40% of men had developed mild levels of disability, with limitations in kneeling, bending and climbing stairs. In women, but not in men, a BMI higher than 25 Kg/m2 or values of FMI higher than the 50th percentile, were significantly associated with a 3 to 5 times increased risk of limitations in climbing stairs and lower body performance. In men, a trend was found between low values of ASMMI and an increased risk of limitations in kneeling and bending. After cross-tabulating categories based on the 50th percentile of ASMMI and FMI, high values of FMI, independently of ASMMI, were significantly related with higher incidence of limitation in climbing stairs in women. In women, the highest 2-year incidence of limitation in climbing stairs was found in the group of obese subjects. CONCLUSIONS High body fat and high BMI values were associated with a greater probability of developing functional limitations 2 years later in a population of elderly subjects at the high end of the functional spectrum. Moreover, in women, high baseline values of fat mass, independently of appendicular fat-free mass, were more likely to predict the future onset of functional limitations.
Collapse
Affiliation(s)
- Elena Zoico
- Division of Geriatric Medicine, University of Verona, Verona, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|