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Carollo M, Boccardi V, Crisafulli S, Conti V, Gnerre P, Miozzo S, Omodeo Salè E, Pieraccini F, Zamboni M, Marengoni A, Onder G, Trifirò G. Medication review and deprescribing in different healthcare settings: a position statement from an Italian scientific consortium. Aging Clin Exp Res 2024; 36:63. [PMID: 38459218 PMCID: PMC10923734 DOI: 10.1007/s40520-023-02679-2] [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: 11/22/2023] [Accepted: 12/17/2023] [Indexed: 03/10/2024]
Abstract
Recent medical advancements have increased life expectancy, leading to a surge in patients affected by multiple chronic diseases and consequent polypharmacy, especially among older adults. This scenario increases the risk of drug interactions and adverse drug reactions, highlighting the need for medication review and deprescribing to reduce inappropriate medications and optimize therapeutic regimens, with the ultimate goal to improving patients' health and quality of life. This position statement from the Italian Scientific Consortium on medication review and deprescribing aims to describe key elements, strategies, tools, timing, and healthcare professionals to be involved, for the implementation of medication review and deprescribing in different healthcare settings (i.e., primary care, hospital, long-term care facilities, and palliative care). Challenges and potential solutions for the implementation of medication review and deprescribing are also discussed.
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Affiliation(s)
- Massimo Carollo
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Salvatore Crisafulli
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy
| | - Valeria Conti
- Clinical Pharmacology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Simonetta Miozzo
- Italian Society of General Medicine and Primary Care, Florence, Italy
| | - Emanuela Omodeo Salè
- Division of Pharmacy, IEO European Institute of Oncology IRCCS, Milan, Italy
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - Mauro Zamboni
- Department of Medicine-Geriatric Division, University of Verona, Verona, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Graziano Onder
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy.
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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.
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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
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Bortolani A, Fantin F, Giani A, Zivelonghi A, Pernice B, Bortolazzi E, Urbani S, Zoico E, Micciolo R, Zamboni M. Predictors of hospital readmission rate in geriatric patients. Aging Clin Exp Res 2024; 36:22. [PMID: 38321332 PMCID: PMC10847193 DOI: 10.1007/s40520-023-02664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/11/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Hospital readmissions among older adults are associated with progressive functional worsening, increased institutionalization and mortality. AIM Identify the main predictors of readmission in older adults. METHODS We examined readmission predictors in 777 hospitalized subjects (mean age 84.40 ± 6.77 years) assessed with Comprehensive Geriatric Assessment (CGA), clinical, anthropometric and biochemical evaluations. Comorbidity burden was estimated by Charlson Comorbidity Index (CCI). Median follow-up was 365 days. RESULTS 358 patients (46.1%) had a second admission within 365 days of discharge. Estimated probability of having a second admission was 0.119 (95%C.I. 0.095-0.141), 0.158 (95%C.I. 0.131-0.183), and 0.496 (95%C.I. 0.458-0.532) at 21, 30 and 356 days, respectively. Main predictors of readmission at 1 year were length of stay (LOS) > 14 days (p < 0.001), albumin level < 30 g/l (p 0.018), values of glomerular filtration rate (eGFR) < 40 ml/min (p < 0.001), systolic blood pressure < 115 mmHg (p < 0.001), CCI ≥ 6 (p < 0.001), and cardiovascular diagnoses. When the joint effects of selected prognostic variables were accounted for, LOS > 14 days, worse renal function, systolic blood pressure < 115 mmHg, higher comorbidity burden remained independently associated with higher readmission risk. DISCUSSION Selected predictors are associated with higher readmission risk, and the relationship evolves with time. CONCLUSIONS This study highlights the importance of performing an accurate CGA, since defined domains and variables contained in the CGA (i.e., LOS, lower albumin and systolic blood pressure, poor renal function, and greater comorbidity burden), when combined altogether, may offer a valid tool to identify the most fragile patients with clinical and functional impairment enhancing their risk of unplanned early and late readmission.
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Affiliation(s)
- Arianna Bortolani
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy.
| | - Francesco Fantin
- Section of Geriatric Medicine, Centre for Medical Sciences - CISMed, Department of Psychology and Cognitive Science, University of Trento, Rovereto (TN), Italy
| | - Anna Giani
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy
| | - Alessandra Zivelonghi
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy
| | - Bruno Pernice
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy
| | - Elena Bortolazzi
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy
| | - Silvia Urbani
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy
| | - Elena Zoico
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Rocco Micciolo
- Centre for Medical Sciences, Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, 37126, Verona, Italy
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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.
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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
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Martini A, Fantin F, Cavedon M, Zamboni M, Urbani S, Giani A, Brandimarte P, Rossi AP. Evaluation of the impact on hospitalization risk of an electronic pill-box to promote therapeutic adherence in post-acute care setting: a pilot study. Aging Clin Exp Res 2023; 35:2847-2849. [PMID: 37823996 DOI: 10.1007/s40520-023-02562-0] [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: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
Literature review reveals that adherence to prescribed therapy at hospital discharge averages around 50%. The purpose of this study was to evaluate adherence to prescribed therapy assessing the relationship between re-hospitalization rate at 30 days and degree of therapeutic adherence in a sample of elderly patients discharged from an acute geriatric ward using an Electronic Medication Packaging device, MePill. The study population (n = 56) was divided in 3 groups, a counseling group (A), a counseling + MePill device group (B) and a control group (C). Group A had 98.1% adherence to therapy, Group B had 100%, and control group had 90%. Analyzing the rate of hospitalization by type of intervention for Group A and C the hospitalization rate was 21% and 27.7%, respectively, whilst for Group B no patient was hospitalized. Participants in Group A and C had the shorter hospitalization-free survival as compared with subjects in Group B.
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Affiliation(s)
- Angela Martini
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Verona, Ospedale San Lorenzo, Valdagno, Italy
| | - Francesco Fantin
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Verona, Ospedale Cà Foncello, Verona, Italy
| | | | - Mauro Zamboni
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Verona, Ospedale Cà Foncello, Verona, Italy
| | - Silvia Urbani
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Verona, Ospedale Cà Foncello, Verona, Italy
| | - Anna Giani
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Verona, Ospedale Cà Foncello, Verona, Italy
| | - Piero Brandimarte
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Verona, Ospedale Cà Foncello, Verona, Italy
| | - Andrea Petronio Rossi
- Division of Geriatrics, Department of Medicine, Healthy Aging Center Treviso, Ospedale Cà Foncello, 31100, Treviso, Italy.
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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.
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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.)
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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.
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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
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Giani A, Xu H, Eriksdotter M, Fantin F, Zamboni M, Bäck M, Religa D. Natural Course of Aortic Stenosis in Older Subjects: Effects of COVID-19. J Am Med Dir Assoc 2023; 24:1594.e1-1594.e9. [PMID: 37696497 DOI: 10.1016/j.jamda.2023.07.026] [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: 04/04/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE Both aortic stenosis (AS) and COVID-19 affect the morbidity and mortality burden among older adults. The aim of the study was to examine whether aortic stenosis (AS) affects the prognosis after SARS-CoV-2 infection and whether COVID-19 affects AS prognosis, in a cohort of older adults hospitalized with and without COVID-19. DESIGN Observational study. SETTING AND PARTICIPANTS Patients admitted to 9 geriatric clinics in Stockholm from March 2020 to November 2021. METHODS AS and COVID-19 diagnoses were identified by electronic health records; the outcomes were mortality at 30 days and any time during a median follow-up of 630 days. The associations between AS, COVID-19, and mortality were assessed by using Royston-Parmar models adjusting for age, sex, comorbidities, and admission waves. RESULTS Among 28,974 patients, 85 had concomitant AS and COVID-19, 529 had only AS, and 5033 had only COVID-19. Both at 30 days and at any time, as compared to patients without, concomitant AS and COVID-19 subjects had a higher mortality rate (438.4 per 100 py, 95% CI 296.2-648.8, and 72.9, 95% CI 53.7-99.0, respectively) and a higher death risk (adjusted HR 5.5, 95% CI 3.7-8.2; and 2.8, 95% CI 2.1-3.9). AS patients presented increased mortality HR both in the presence and absence of COVID-19 at 30 days (1.6, 95% CI 1.1-2.4; and 1.6, 95% CI 1.2-2.2, respectively) and at any time (1.6, 95% CI 1.1-2.1; 1.4, 95% CI 1.2-1.7, respectively). CONCLUSIONS AND IMPLICATIONS AS was a significant mortality risk factor, independent of concomitant COVID-19. Careful AS management should always be pursued, even in acute and post-acute phases of COVID-19.
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Affiliation(s)
- Anna Giani
- Translational Cardiology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Francesco Fantin
- 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
| | - Magnus Bäck
- Translational Cardiology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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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.
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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
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10
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Gortan Cappellari G, Guillet C, Poggiogalle E, Ballesteros Pomar MD, Batsis JA, Boirie Y, Breton I, Frara S, Genton L, Gepner Y, Gonzalez MC, Heymsfield SB, Kiesswetter E, Laviano A, Prado CM, Santini F, Serlie MJ, Siervo M, Villareal DT, Volkert D, Voortman T, Weijs PJ, Zamboni M, Bischoff SC, Busetto L, Cederholm T, Barazzoni R, Donini LM. Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) - Proceedings from the SOGLI consortium meeting in rome November 2022. Clin Nutr 2023; 42:687-699. [PMID: 36947988 DOI: 10.1016/j.clnu.2023.02.018] [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: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.
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Affiliation(s)
| | - Christelle Guillet
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - John A Batsis
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yves Boirie
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Irene Breton
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stefano Frara
- Università Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | | | | | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | | | | | | | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Trudy Voortman
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Jm Weijs
- Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | | | | | - Tommy Cederholm
- Uppsala University and Karolinska University Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical Sciences, University of Trieste, Trieste, Italy
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11
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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.
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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
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12
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Rossi AP, Donadello K, Schweiger V, Zamboni GA, Dalla Valle Z, Zamboni M, Polati E, Gottin L. Epicardial adipose tissue volume and CT-attenuation as prognostic factors for pulmonary embolism and mortality in critically ill patients affected by COVID-19. Eur J Clin Nutr 2023; 77:105-111. [PMID: 36028776 PMCID: PMC9412799 DOI: 10.1038/s41430-022-01197-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/10/2021] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES The aim of this post-hoc analysis was to evaluate if epicardial adipose tissue (EAT) quantity and quality, as evaluated by computed tomography (CT), have a different role in the risk of mortality and pulmonary embolism in critically ill COVID-19 patients admitted to an intensive care unit (ICU). SUBJECTS/METHODS CT derived EAT volume and density, as well as anthropometric and blood biomarkers, were evaluated in a sample of 138 subjects, 109 men and 29 women, for whom CT images and information on pulmonary embolism were available from a total of 313 subjects who were consecutively admitted to the ICU for COVID-19 from the REINSURE-ARDS prospective registry. RESULTS A total of 28 patients (20.3%) died during the first 28 days after ICU admission. 26 subjects out of 138 had pulmonary embolism (18.8%). Age, weight, BMI, IL-6 levels and pulmonary embolism prevalence were significantly higher across EAT volume tertiles. Subjects who died in the first 28 days from ICU admission were older, had higher EAT volume, D-dimer, LDH and IL-6 level. After adjustment for age and gender, participants in tertile 3 of EAT volume had lower survival at 28 days from ICU admission as compared to subjects in the tertile 1, HR 2.95 (95% C.I. 1.02-8.49), but after adjusting for potential confounders the relation was no longer significant. No relation between EAT density and mortality was observed. From a binary logistic regression, subjects in tertile 3 of EAT volume and in tertile 1 of EAT density showed a 4 times and 3.6 times increased risk of pulmonary embolism, respectively. CONCLUSIONS ICU subjects affected by severe COVID-19 with higher EAT volume and low EAT density should be carefully monitored and managed with a prompt and aggressive approach, to prevent serious and life-threatening consequences and the increase of hospital treatment costs.
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Affiliation(s)
- Andrea P Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, Treviso, Italy.
| | - Katia Donadello
- Department of Surgery, Dentistry, Gynaecology and Pediatric Otorhinolaryngology - Head and Neck Surgery, University of Verona, Anaesthesia and Intensive Care B Unit, University of Verona, AOUI-University Hospital Integrated Trust, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Dentistry, Gynaecology and Pediatric Otorhinolaryngology - Head and Neck Surgery, University of Verona, Anaesthesia and Intensive Care B Unit, University of Verona, AOUI-University Hospital Integrated Trust, Verona, Italy
| | | | - Zeno Dalla Valle
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Enrico Polati
- Department of Surgery, Dentistry, Gynaecology and Pediatric Otorhinolaryngology - Head and Neck Surgery, University of Verona, Anaesthesia and Intensive Care B Unit, University of Verona, AOUI-University Hospital Integrated Trust, Verona, Italy
| | - Leonardo Gottin
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, Cardiothoracic Anesthesia and Intensive Care Unit, AOUI-University Hospital Integrated Trust, Verona, Italy
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13
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Carrara E, Sibani M, Barbato L, Mazzaferri F, Salerno ND, Conti M, Azzini AM, Dalbeni A, Pellizzari L, Fontana G, Di Francesco V, Bissoli L, Del Monte L, Zamboni M, Olivieri O, Minuz P, Maccacaro L, Ghirlanda G, Tacconelli E. How to 'SAVE' antibiotics: effectiveness and sustainability of a new model of antibiotic stewardship intervention in the internal medicine area. Int J Antimicrob Agents 2022; 60:106672. [PMID: 36103917 DOI: 10.1016/j.ijantimicag.2022.106672] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/12/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antibiotic stewardship (AS) is a cornerstone of the fight against antimicrobial resistance; however, evidence on the best practice to improve antibiotic prescription in various hospital settings is still scarce. This study aimed to measure the efficacy of a non-restrictive AS intervention in the internal medicine area of a tertiary-care hospital across a 3-year period. METHODS The intervention comprised a 3-month 'intensive phase' based on education and guidelines provision, followed by 9 months of audits and feedback activities. The primary outcome was the overall antibiotic consumption measured as days of therapy (DOTs) and defined daily doses (DDDs). Secondary outcomes were carbapenem and fluoroquinolone consumption, all-cause in-hospital mortality, length of stay, incidence of Clostridioides difficile and carbapenem-resistant Enterobacterales bloodstream infections (CRE-BSIs). All outcomes were measured in the intervention wards comparing the pre-phase with the post-phase using an interrupted time-series model. RESULTS A total of 145 337 patient days (PDs) and 14 159 admissions were included in the analysis. The intervention was associated with reduced DOTs*1000PDs (-162.2/P = 0.005) and DDDs*1000PDs (-183.6/P ≤ 0.001). A sustained decrease in ward-related antibiotic consumption was also detected during the post-intervention phase and in the carbapenem/fluoroquinolone classes. The intervention was associated with an immediate reduction in length of stay (-1.72 days/P < 0.001) and all-cause mortality (-3.71 deaths*100 admissions/P = 0.002), with a decreasing trend over time. Rates of Clostridioides difficile infections and CRE-BSIs were not significantly impacted by the intervention. CONCLUSIONS The AS intervention was effective and safe in decreasing antibiotic consumption and length of stay in the internal medicine area. Enabling prescribers to judicious use of antimicrobials through active participation in AS initiatives is key to reach sustained results over time.
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Affiliation(s)
- Elena Carrara
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Marcella Sibani
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; Infectious Diseases Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Lorenzo Barbato
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fulvia Mazzaferri
- Infectious Diseases Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Nicola Duccio Salerno
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Michela Conti
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Anna Maria Azzini
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Andrea Dalbeni
- Department of Medicine, General Medicine C Unit & Liver Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Luca Pellizzari
- Geriatric Unit A, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giorgia Fontana
- Geriatric Unit A, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Luisa Bissoli
- Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy
| | - Letizia Del Monte
- Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, University of Verona, Verona, Italy
| | - Oliviero Olivieri
- Medicina Interna ad Indirizzo Immunoematologico ed Emocoagulativo, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Pietro Minuz
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Laura Maccacaro
- Unit of Microbiology and Virology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanna Ghirlanda
- Medical Direction, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy
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14
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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.
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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
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15
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Muollo V, Tatangelo T, Ghiotto L, Cavedon V, Milanese C, Zamboni M, Schena F, Rossi AP. Is handgrip strength a marker of muscle and physical function of the lower limbs? Sex differences in older adults with obesity. Nutr Metab Cardiovasc Dis 2022; 32:2168-2176. [PMID: 35850750 DOI: 10.1016/j.numecd.2022.06.018] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In this cross-sectional study we investigate the association between handgrip strength (HGS) and muscle function of the lower limbs and the predictors of the appendicular lean mass index (ALMI) in older adults with obesity of both sexes. METHODS AND RESULTS Eighty-four older (67 ± 5 years) men (N = 44) and women (N = 40) with obesity (body mass index (BMI) 33 ± 4 kg/m2) performed: the HGS, isokinetic knee extensors (KE) and flexors (KF) muscle strength and power and Short Physical Performance Battery (SPPB). The correlation between HGS and lower limbs muscle function was evaluated, and four multiple hierarchical linear models were built to assess the contribution of each ALMI predictor (i.e., HGS, BMI, SPPB, muscle strength and power). In men, HGS was weakly-to-moderately associated (p < 0.05) with KE, KF muscle function and physical performance. In women, HGS showed a weak association (p < 0.05) with KE muscle function. The significant predictors of ALMI were only the BMI in women, whereas in the group of men BMI, KE maximal strength and power better explain the variance in ALMI than HGS alone. CONCLUSION Our results suggest that HGS should not be used alone as a marker of lower muscle nor physical function. Sex differences exist with the BMI that is a contributor of ALMI both in men and women. However, at least in the group of men, markers related to strength and power of the lower limbs can better describe variations in ALMI compared to HGS in this kind of population. CLINICAL TRIAL REGISTRATION NA.
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Affiliation(s)
| | - Toni Tatangelo
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Laura Ghiotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Valentina Cavedon
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, Healthy Aging Center Verona, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Andrea P Rossi
- Section of Geriatrics, Department of Medicine, Treviso, Italy
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16
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Kirkham FA, Mills C, Fantin F, Tatsuno I, Nagayama D, Giani A, Zamboni M, Shirai K, Cruickshank JK, Rajkumar C. Are you as old as your arteries? Comparing arterial aging in Japanese and European patient groups using cardio-ankle vascular index. J Hypertens 2022; 40:1758-1767. [PMID: 35943103 DOI: 10.1097/hjh.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/26/2022]
Abstract
BACKGROUND Most comparisons of arterial stiffness between ethnic groups focus on pulse wave velocity. This study used the cardio-ankle vascular index (CAVI) in European compared to Japanese individuals to investigate how cardiovascular risk factors affect arterial aging across geographic regions. METHODS Four hundred and ninety-four European and 1044 Japanese individuals underwent measurements of CAVI, blood pressure and information on cardiovascular risk factors. Both datasets included individuals with 0-5 cardiovascular risk factors. RESULTS Average CAVI was higher in the Japanese than the European group in every age category, with significant differences up to 75 years for males and 85 for females. The correlation of CAVI with age, controlled for cardiovascular risk factors, was slightly higher in Japanese females (r = 0.594 vs. Europeans r = 0.542) but much higher in European males (r = 0.710 vs. Japanese r = 0.511). There was a significant correlation between CAVI and total cardiovascular risk factors in the Japanese (r = 0.141, P < 0.001) but not the European group. On linear regression, average CAVI was significantly dependent on age, sex, diabetes, BMI, SBP and geographic region. When divided into 'healthy' vs. 'high risk', the healthy group had a steeper correlation with age for Europeans (r = 0.644 vs. Japanese r = 0.472, Fisher's Z P < 0.001), whereas in the high-risk group, both geographic regions had similar correlations. CONCLUSION Japanese patient groups had higher arterial stiffness than Europeans, as measured by CAVI, controlling for cardiovascular risk factors. Europeans had greater increases in arterial stiffness with age in healthy individuals, particularly for males. However, cardiovascular risk factors had a greater impact on the Japanese group.
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Affiliation(s)
| | | | - Francesco Fantin
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba
- Toho University Medical Center, Sakura Hospital, Sakura
| | - Daiji Nagayama
- Nagayama Clinic, Nagayama
- Toho University Medical Center, Sakura Hospital, Sakura
| | - Anna Giani
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | | | | | - Chakravarthi Rajkumar
- University Hospitals Sussex, NHS Foundation Trust
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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17
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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.
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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
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Giani A, Franconi A, Nicolussi Paolaz S, Zampieri A, Falceri A, Gasparini L, Mattachini E, Santuz B, Zamboni M, Fantin F. P247 ARTERIAL STIFFNESS, SUBENDOCARDIAL PERFUSION AND 30–DAYS READMISSION IN ELDERLY INDIVIDUALS WITH HEART FAILURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Arterial stiffness and subendocardial perfusion impairment significantly affect cardiovascular morbidity and mortality, playing a relevant role in heart failure. The aim of the present study was to describe the trend of hemodynamical parameters, arterial stiffness indexes and subendocardial viability ratio (SEVR) in geriatric patients, hospitalized with hearth failure, and to define the main predictors of 30–days readmission. A cohort of 41 patients, admitted to the Geriatric ward of Verona University Hospital, affected by heart failure, was included in the study. Each subject underwent clinical evaluation, geriatric comprehensive assessment, routine laboratory testing, and cardiac ultrasound. At the time of admission, after achievement of clinical stability (defined as switching from intravenous to oral diuretic therapy) and at the time of discharge, blood pressure measurement and applanation arterial tonometry (with evaluation of carotid–femoral pulse wave velocity –PWVcf– and SEVR) were also performed. SEVR was corrected for hemoglobin concentration and oxygen saturation. Through the three evaluations, a progressive decrease in PWVcf was described (17.79±4.49 m/s, 13.54±4.54 m/s, 9.94±3.73 m/s respectively, p < 0.001); the trend remained significant even after adjustment for age, gender, mean arterial pressure (MAP) variation and left ventricular ejection fraction (LVEF) (p < 0.001). A significant improvement was registered for both SEVR (83.48±24.43, 97.94±26.84, 113.29±38.02 respectively) and corrected SEVR (12.74±4.69, 15.71±5.30, 18.55±6.66 respectively) values (p < 0.001 for both), and it was still significant when adjusted for age, gender, MAP variation and LVEF (p < 0.001). After discharge, 26.8% of patients was readmitted within 30 days. In a multivariate binary logistic regression analysis, considering 30–days readmission as dependent variable, PWVcf at discharge was the only predictor of readmission (OR 2.004, CI 1.154–3.481, p = 0.014) In conclusion, medical therapy seems to improve arterial stiffness and subendocardial perfusion in geriatric patients hospitalized with hearth failure. Furthermore, PWVcf is a valid predictor of 30–days readmission. Its feasibility and reproducibility in clinical practice, may provide an instrument to detect heart failure patients at high risk of rehospitalization.
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Affiliation(s)
- A Giani
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - A Franconi
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - S Nicolussi Paolaz
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - A Zampieri
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - A Falceri
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - L Gasparini
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - E Mattachini
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - B Santuz
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - M Zamboni
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
| | - F Fantin
- AOUI VERONA – GERIATRIA B – SCUOLA DI SPECIALIZZAZIONE IN GERIATRIA – UNIVERSITÀ DI VERONA, VERONA
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Correa-De-Araujo R, Rossi AP, Zamboni M, Addison O, Miljkovic I, Goodpaster B. Editorial: Muscle Quality in Skeletal Muscle Function Deficit: Recent Advances and Potential Clinical and Therapeutic Implications. Front Physiol 2022; 13:847883. [PMID: 35530506 PMCID: PMC9075732 DOI: 10.3389/fphys.2022.847883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosaly Correa-De-Araujo
- National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Andrea P Rossi
- Department of Medicine, Geriatrics Division, Ospedale Cà Foncello, ULSS2, Treviso, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD, United States
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bret Goodpaster
- Advent Health, Translational Research Institute, Orlando, FL, United States
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Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, Boirie Y, Cruz-Jentoft AJ, Dicker D, Frara S, Frühbeck G, Genton L, Gepner Y, Giustina A, Gonzalez MC, Han HS, Heymsfield SB, Higashiguchi T, Laviano A, Lenzi A, Nyulasi I, Parrinello E, Poggiogalle E, Prado CM, Salvador J, Rolland Y, Santini F, Serlie MJ, Shi H, Sieber CC, Siervo M, Vettor R, Villareal DT, Volkert D, Yu J, Zamboni M, Barazzoni R. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr 2022; 41:990-1000. [DOI: 10.1016/j.clnu.2021.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/08/2023]
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21
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Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, Boirie Y, Cruz-Jentoft AJ, Dicker D, Frara S, Frühbeck G, Genton L, Gepner Y, Giustina A, Gonzalez MC, Han HS, Heymsfield SB, Higashiguchi T, Laviano A, Lenzi A, Nyulasi I, Parrinello E, Poggiogalle E, Prado CM, Salvador J, Rolland Y, Santini F, Serlie MJ, Shi H, Sieber CC, Siervo M, Vettor R, Villareal DT, Volkert D, Yu J, Zamboni M, Barazzoni R. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts 2022; 15:321-335. [PMID: 35196654 PMCID: PMC9210010 DOI: 10.1159/000521241] [Citation(s) in RCA: 173] [Impact Index Per Article: 86.5] [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: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. AIMS AND METHODS The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. CONCLUSIONS ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.
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Affiliation(s)
| | | | | | | | | | - John A. Batsis
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Yves Boirie
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Dror Dicker
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Stefano Frara
- San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Gema Frühbeck
- Clínica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | | | | | - Andrea Giustina
- San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | | | - Ho-Seong Han
- Seoul National University Bundang Hospital (SNUBH), Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | - Yves Rolland
- Gerontopole of Toulouse, INSERM 1027, Toulouse University Hospital, Toulouse, France
| | | | | | - Hanping Shi
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Cornel C. Sieber
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Mario Siervo
- University of Nottingham, Nottingham, United Kingdom
| | | | | | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Jianchun Yu
- Peking Union Medical College Hospital, Beijing, China
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- **Rocco Barazzoni,
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Tadiello E, Trento L, Setti M, De Conti G, Onorati F, Faggian G, Zamboni M, Rossi A, Benfari G, Ribichini F. 681 Ventricular fibrosis affects diastolic function and atrial remodelling long-term after aortic valve replacement for aortic valve stenosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Aortic stenosis (AS) is characterized both by progressive valve narrowing and left ventricular remodelling response. Myocardial fibrosis has significant functional consequences and is the key pathological process driving left ventricular decompensation. Furthermore, studies suggest that myocardial fibrosis is irreversible, despite surgical aortic valve replacement (SAVR). The study aims to define the association between myocardial fibrosis and long-term diastolic and atrial function after SAVR, which are both markers of poor clinical outcomes.
Methods
We evaluated patients with isolated AS and no-coronary artery disease referred for SAVR in 2015. All of them received a biological valve and a left ventricular biopsy was performed at the time of surgery. Clinical and echocardiographic evaluation was performed before surgery and after about 6 years, including fully automated 2D speckle tracking analysis software (TomTec). Atrial function was evaluated with PALS, PACS, and LAVi/septal a’ TDI.
Results
Nineteen patients completed the follow-up and formed the study cohort, age 72 ± 6 years, 42% female, ejection fraction 63 ± 6.4%, mean fibrosis 26.4 ± 12.7%. Significant myocardial fibrosis (> 33%) was found in 13/19 patients (68%). Although similar at baseline, after 5.6±0.5 years, PACS was significantly higher in patients with low myocardial fibrosis (13.7±4.2 vs. 8.0±3.8, P=0.01), the same trends were observed for PALS (24.1±7.9 vs. 17.0±6.6, P=0.07) and LAVi/septal a’TDI (5.4±1.3 vs. 7.4±2.8, P=0.06). The diastolic profile at long term follow-up was also significantly worsened in patients with LV fibrosis: E/A 0.9±0.3 vs. 1.3±0.4 P= 0.03 and E/e’ 10.6±3.3 vs. 16.6±4.5 P=0.01).
Conclusions
Myocardial fibrosis at the time of SAVR strongly influences long-term diastolic Doppler profile and atrial function with potentially harmful consequences on clinical status and ventricular performance.
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Affiliation(s)
- Enrico Tadiello
- Unità Operativa Di Cardiologia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Laura Trento
- Unità Operativa Di Cardiologia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Martina Setti
- Unità Operativa Di Cardiologia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Giorgia De Conti
- Unità Operativa Di Geriatria - Azienda Ospedaliera Universitaria Integrata Verona
| | - Francesco Onorati
- Unità Operativa Di Cardiochirurgia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Giuseppe Faggian
- Unità Operativa Di Cardiochirurgia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Mauro Zamboni
- Unità Operativa Di Geriatria - Azienda Ospedaliera Universitaria Integrata Verona
| | - Andrea Rossi
- Unità Operativa Di Cardiologia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Giovanni Benfari
- Unità Operativa Di Cardiologia - Azienda Ospedaliera Universitaria Integrata Verona
| | - Flavio Ribichini
- Unità Operativa Di Cardiologia - Azienda Ospedaliera Universitaria Integrata Verona
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23
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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.
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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
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24
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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.
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Muollo V, Ghiotto L, Milanese C, Zoico E, Zamboni M, Rossi AP, Schena F. Effects Of Strength Training Alone Or With Amino Acids In Sarcopenic Obese Adults. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761984.64631.f6] [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: 11/21/2022]
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26
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Siervo M, Rubele S, Shannon OM, Prado CM, Donini LM, Zamboni M, Homayounfar R, Farjam M, Faghih S, Mazidi M. Prevalence of sarcopenic obesity and association with metabolic syndrome in an adult Iranian cohort: The Fasa PERSIAN cohort study. Clin Obes 2021; 11:e12459. [PMID: 33946126 DOI: 10.1111/cob.12459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/31/2021] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 12/22/2022]
Abstract
Sarcopenic obesity (SO) is characterised by a concomitant high fat mass (FM) and low fat free mass (FFM) leading to an increased cardio-metabolic risk. This analysis aims to estimate the SO prevalence in Iranian adults and evaluate the association of SO with metabolic syndrome (MetS) risk. This cross-sectional analysis included 4296 subjects (age 35-70 years, 55.2% females). Body composition parameters, measured by bioelectrical impedance included: FM, FFM, appendicular lean mass (ALM) and skeletal mass index. SO was classified according to five criteria: (1) FM%-SMI; (2) FM%-ALM/% weight (wt%); (3) FM%-ALM/body mass index (BMI); (4) Residuals of ALM and FM and (5) FM/FFM Ratio. Multivariate logistic regression was applied to explore the association between SO models with MetS risk stratified by gender. Receiving operating characteristic (ROC) curves were used to identify the best FM/FFM ratio cut-off value for detecting MetS cases in males and females. The prevalence of SO varied between 4% and 26% depending upon the classification method. The prevalence of MetS was 12.8% and 31.6% in males and females, respectively. SO models based on ALM/wt% and FM/FFM ratio showed the strongest association with MetS risk in males (OR: 11.5, 95%CI: 7.5-17.7, p < 0.001 and OR: 10.1, 95%CI: 6.9-14.7, p < 0.001, respectively) and females (OR: 4.1, 95%CI: 3.0-5.6, p < 0.001 and OR: 4.6, 95%CI: 3.5-5.9, p < 0.001, respectively). SO is a prevalent condition in an adult Iranian population and the ALM/wt% and the FM/FFM ratio models of SO appeared to be associated with higher MetS risk.
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Affiliation(s)
- Mario Siervo
- School of Life Sciences, Division of Physiology, Pharmacology and Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Sofia Rubele
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Oliver M Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Lorenzo Maria Donini
- Department of Experimental Medicine-Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Rome, Italy
| | - Mauro Zamboni
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Nutritional Sciences, King's College London, London, UK
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27
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Rossi AP, Gottin L, Donadello K, Schweiger V, Brandimarte P, Zamboni GA, Florio A, Boetti R, Pavan G, Zamboni M, Polati E. Intermuscular Adipose Tissue as a Risk Factor for Mortality and Muscle Injury in Critically Ill Patients Affected by COVID-19. Front Physiol 2021; 12:651167. [PMID: 34025446 PMCID: PMC8134543 DOI: 10.3389/fphys.2021.651167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Muscular fatigue and injury are frequently observed in critically ill COVID-19 patients. The aim of this study was to determine whether different muscle adipose tissue depots are associated with mortality and muscle damage in patients affected by COVID-19 admitted to the ICU. METHODS CT images were obtained in 153 ICU patients with COVID-19 (121 males and 32 females). Height, weight, body mass index (BMI), C-reactive protein, Creatine PhosphoKinase (CPK), muscle density, and intermuscular adipose tissue (IMAT) were measured. RESULTS Participants in the highest tertile of IMAT/muscle had the shorter 28-day survival from ICU admission as compared to subjects in the first tertile. Estimates derived from the Cox proportional hazard models, after adjustment for age, sex, and BMI, confirmed the results of the survival analysis (HR 3.94, 95% CI: 1.03-15.09). Participants in the lowest tertile of muscle density had the shorter survival at 28 days from ICU admission as compared to subjects in the highest tertile (HR 3.27, 95% CI: 1.18-4.61), but the relationship was no longer significant when age was included in the model. Subjects in the second muscle density tertile did not show an increased risk.Participants in the highest tertile of IMAT/muscle and those in the lowest tertile of muscle density showed both significantly higher CPK adjusted for weight values as evaluated during the first 8 days of hospitalization. CONCLUSION Our data seem to suggest that higher levels of IMAT/muscle and low muscle density are both associated with higher risk of ICU mortality and muscle injury as evaluated with CPK level.
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Affiliation(s)
- Andrea P. Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Department of Cardio-Thoracic Anaesthesia and Intensive Care, University of Verona, Verona, Italy
| | - Katia Donadello
- Department of Anaesthesia and Intensive Care B, University of Verona, Verona, Italy
| | - Vittorio Schweiger
- Department of Anaesthesia and Intensive Care B, University of Verona, Verona, Italy
| | - Piero Brandimarte
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Giulia A. Zamboni
- Department of Public Health and Diagnostics, Radiology Division, University of Verona, Verona, Italy
| | - Alessandro Florio
- Department of Cardio-Thoracic Anaesthesia and Intensive Care, University of Verona, Verona, Italy
| | - Riccardo Boetti
- Department of Cardio-Thoracic Anaesthesia and Intensive Care, University of Verona, Verona, Italy
| | - Gaia Pavan
- Department of Cardio-Thoracic Anaesthesia and Intensive Care, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Enrico Polati
- Department of Anaesthesia and Intensive Care B, University of Verona, Verona, Italy
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Muollo V, Rossi AP, Milanese C, Zamboni M, Rosa R, Schena F, Pellegrini B. Prolonged unsupervised Nordic walking and walking exercise following six months of supervision in adults with overweight and obesity: A randomised clinical trial. Nutr Metab Cardiovasc Dis 2021; 31:1247-1256. [PMID: 33549445 DOI: 10.1016/j.numecd.2020.12.012] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS This study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults. METHODS AND RESULTS After a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HRmean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HRmean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05). CONCLUSION Despite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03212391 (July 11, 2017).
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Affiliation(s)
- Valentina Muollo
- Department of Medicine, Clinical and Experimental Biomedical Sciences, University of Verona, Verona, Italy.
| | - Andrea P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Raffaela Rosa
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy; CeRiSM, Sport, Mountain and Health Research Center, University of Verona, Rovereto, Italy
| | - Barbara Pellegrini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy; CeRiSM, Sport, Mountain and Health Research Center, University of Verona, Rovereto, Italy
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Rossi AP, Gottin L, Donadello K, Schweiger V, Nocini R, Taiana M, Zamboni M, Polati E. Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid 19. Nutr Metab Cardiovasc Dis 2021; 31:762-768. [PMID: 33549439 PMCID: PMC7677044 DOI: 10.1016/j.numecd.2020.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 09/08/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Recent studies show that obesity is a risk factor for hospital admission and for critical care need in patients with coronavirus disease 2019 (COVID-19). The aim was to determine whether obesity is a risk factor for unfavourable health outcomes in patients affected by COVID-19 admitted to ICU. METHODS AND RESULTS 95 consecutive patients with COVID-19 (78 males and 18 females) were admitted to ICU and included in the study. Height, weight, BMI, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, CRP, CPK, ICU and hospital length of stay and comorbidities were evaluated. Participants with obesity had a lower 28 day survival rate from ICU admission than normal weight subjects. Cox proportional hazard model-derived estimates, adjusted for age, gender and comorbidity, confirmed the results of the survival analysis (HR:5.30,95%C.I.1.26-22.34). Obese subjects showed longer hospital and ICU stay as compared with normal weight counterpart.Subjects with obesity showed significantly higher CRP and CPK levels than normal weight subjects. CONCLUSION In individuals with obesity, careful management and prompt intervention in case of suspected SARS-CoV-2 infection is necessary to prevent the progression of the disease towards severe outcomes and the increase of hospital treatment costs.
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Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy.
| | - Leonardo Gottin
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Katia Donadello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Verona, AOUI-University Hospital Integrated Trust, Verona, Italy
| | - Matteo Taiana
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Enrico Polati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
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Muollo V, Rossi AP, Zignoli A, Teso M, Milanese C, Cavedon V, Zamboni M, Schena F, Capelli C, Pogliaghi S. Full characterisation of knee extensors' function in ageing: effect of sex and obesity. Int J Obes (Lond) 2021; 45:895-905. [PMID: 33526852 DOI: 10.1038/s41366-021-00755-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/21/2020] [Revised: 11/18/2020] [Accepted: 01/12/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND/OBJECTIVES Muscle function is a marker of current and prospective health/independence throughout life. The effects of sex and obesity (OB) on the loss of muscle function in ageing remain unresolved, with important implications for the diagnosis/monitoring of sarcopenia. To characterise in vivo knee extensors' function, we compared muscles torque and power with isometric and isokinetic tests in older men (M) and women (W), with normal range (NW) of body mass index (BMI) and OB. SUBJECTS/METHODS In 70 sedentary older M and W (69 ± 5 years), NW and OB (i.e. BMI < 30 kg m-2 and ≥30 kg m-2, respectively) we tested the right knee's extensor: (i) isometric torque at 30°, 60°, 75° and 90° knee angles, and (ii) isokinetic concentric torque at 60, 90, 150, 180 and 210° s-1 angular speeds. Maximal isometric T-angle, maximal isokinetic knee-extensor torque-velocity, theoretical maximal shortening velocity, maximal power, optimal torque and velocity were determined in absolute units, normalised by body mass (BM) and right leg lean mass (LLMR) and compared over sex, BMI categories and angle or angular speeds by three-way ANOVA. RESULTS In absolute units, relative to BM and LLMR, sex differences were found in favour of M for all parameters of muscle function (main effect for sex, p < 0.05). OB did not affect either absolute or relative to LLMR isometric and isokinetic muscle function (main effect for BMI, p > 0.05); however, muscle function indices, when adjusted for BM, were lower in both M and W with OB compared to NW counterparts (p < 0.05). CONCLUSIONS We confirmed sex differences in absolute, relative to BM and LLMR muscle function in favour of men. While overall muscle function and muscle contractile quality is conserved in individuals with class I OB, muscle function normalised for BM, which defines the ability to perform independently and safely the activities of daily living, is impaired in comparison with physiological ageing.
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Affiliation(s)
| | - Andrea P Rossi
- Department of Medicine, Section of Geriatrics, Healthy Aging Center Verona, Verona, Italy
| | - Andrea Zignoli
- Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Massimo Teso
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Valentina Cavedon
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, Healthy Aging Center Verona, Verona, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.,Sport Mountain and Health Research Center (CeRiSM), University of Verona, Rovereto, Italy
| | - Carlo Capelli
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Silvia Pogliaghi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.
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Aran V, De Marchi P, Zamboni M, Ferreira CG. Dealing with lung cancer in the COVID-19 scenario (A review). Mol Clin Oncol 2020; 14:27. [PMID: 33414908 PMCID: PMC7784234 DOI: 10.3892/mco.2020.2189] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/12/2020] [Indexed: 12/22/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the coronavirus disease 2019 (COVID-19), first appeared in December 2019 in Wuhan (China) and quickly spread worldwide and has since been assigned a pandemic status. This affected the worlds' social interactions, including within medical practices, thus interfering with routine treatments for a variety of diseases including cancer. Different studies have addressed the fact that patients with cancer are often immunocompromised, making them more susceptible to infections. Since COVID-19 frequently causes respiratory distress, patients with lung cancer are considered to be a high-risk group. Genes that have been indicated to mediate viral entry into host cells such as angiotensin-converting enzyme 2 and transmembrane protease serine 2 are expressed in the lung tissue, a fact that could partially explain COVID-19 pathogenesis and lung involvement. Therefore, the current study offers a disease overview including molecular aspects behind the infection and provide a perspective on already published Chinese data plus recommendations for the management of lung cancer patients according to the two main lung cancer types and stages: non-small cell lung cancer and small cell lung cancer. This review aimed to add to the collective effort of selecting the most appropriate guidelines to follow for the treatment of these patients.
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Affiliation(s)
- Veronica Aran
- Instituto Estadual do Cérebro Paulo Niemeyer (IECPN), Rio de Janeiro, RJ 20231-092, Brazil
| | | | - Mauro Zamboni
- Department of Thoracic Surgery, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ 20230-130, Brazil
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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.
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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
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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]
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Zamboni M, Nori N, Brunelli A, Zoico E. How does adipose tissue contribute to inflammageing? Exp Gerontol 2020; 143:111162. [PMID: 33253807 DOI: 10.1016/j.exger.2020.111162] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 08/09/2020] [Revised: 10/09/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
Across aging, white adipose tissue (WAT) undergoes significant changes in quantity and distribution, with an increase in visceral adipose tissue, ectopic fat deposition and a decline in gluteofemoral subcutaneous depot. In particular, WAT becomes dysfunctional with an increase in production of inflammatory peptides and a decline of those with anti-inflammatory activity and infiltration of inflammatory cells. Moreover, dysfunction of WAT is characterized by preadipocyte differentiation decline, increased oxidative stress and mitochondrial dysfunction, reduction in vascularization and hypoxia, increased fibrosis and senescent cell accumulation. WAT changes represent an important hallmark of the aging process and may be responsible for the systemic pro-inflammatory state ("inflammageing") typical of aging itself, leading to age-related metabolic alterations. This review focuses on mechanisms linking age-related WAT changes to inflammageing.
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Affiliation(s)
- Mauro Zamboni
- Division of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric and Gynecology, University of Verona, Verona, Italy.
| | - Nicole Nori
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Anna Brunelli
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Zoico
- Division of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
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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.
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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
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Muollo V, Rossi AP, Milanese C, Masciocchi E, Taylor M, Zamboni M, Rosa R, Schena F, Pellegrini B. The effects of exercise and diet program in overweight people - Nordic walking versus walking. Clin Interv Aging 2019; 14:1555-1565. [PMID: 31695344 PMCID: PMC6717875 DOI: 10.2147/cia.s217570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/31/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose Nordic walking (NW) has been recommended as a form of exercise for clinical populations. Despite intervention programs designed to face a clinical status may last several months, no longitudinal studies have compared the effect of NW to another usual form of exercise, like walking (W). We evaluated the effects of diet combined with a long-supervised NW versus W training on body composition, aerobic capacity and strength in overweight adults. Patients and methods Thirty-eight participants, randomized into a NW (n=19, 66±7 years, body mass index (BMI) 33±5)) and a W (n=19, 66±8 years, BMI 32±5) group, followed a diet and a supervised training routine 3 times/week for 6 months. The variables assessed at baseline, after 3 and 6 months were: anthropometric indexes (ie, BMI and waist circumference (WC)), body composition, aerobic capacity (oxygen consumption (VO2peak), peak power output (PPO), 6-min walking test (6MWT)) and strength (maximal voluntary contraction of biceps brachialis (MVCBB) and quadriceps femoris (MVCQF), chair stand and arm curl (AC)). Results After 6 months both NW and W group decreased significantly BMI (6% and 4%, respectively) and WC (8% and 4%, respectively), but only the NW group reduced (P<0.05) total body fat (8%), android fat (14%) and leg fat (9%). After 6 months, PPO increased (P<0.05) in both groups, but VO2peak improved (P<0.05) only in the NW group (8%). After 6 months, 6MWT increased (P<0.001) in both groups and only the NW group improved (P<0.05) in MVCBB (14%), MVCQF (17%) and AC (35%). Conclusion Our results suggest that NW can give in some relevant health parameters, greater and faster benefits than W. Thus, NW can be a primary tool to counteract the obesity and overweight state in middle-aged adults.
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Affiliation(s)
- Valentina Muollo
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.,CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
| | - Andrea P Rossi
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Masciocchi
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Italy
| | - Miriam Taylor
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, University of Verona Healthy Aging Center, Verona, Italy
| | - Raffaela Rosa
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.,CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
| | - Barbara Pellegrini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.,CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
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Rossi AP, Muollo V, Fantin F, Masciocchi E, Urbani S, Taylor M, Caruso B, Milanese C, Capelli C, Schena F, Zamboni M. Effects of diet combined with Nordic walking or walking programme on weight loss and arterial stiffness in postmenopausal overweight and obese women: The Walking and Aging Verona pilot study. Eur J Prev Cardiol 2019; 27:2208-2211. [PMID: 31581818 DOI: 10.1177/2047487319877712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy
| | - Valentina Muollo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Francesco Fantin
- Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy
| | - Elena Masciocchi
- Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy
| | - Silvia Urbani
- Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy
| | - Miriam Taylor
- Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy
| | - Beatrice Caruso
- Division of Clinical Pathology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Carlo Capelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy
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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.
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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.
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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
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Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48:601. [PMID: 31081853 PMCID: PMC6593317 DOI: 10.1093/ageing/afz046] [Citation(s) in RCA: 984] [Impact Index Per Article: 196.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 12/13/2022] Open
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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.
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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
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Boschi F, Rizzatti V, Zoico E, Montanari T, Zamboni M, Sbarbati A, Colitti M. Relationship between lipid droplets size and integrated optical density. Eur J Histochem 2019; 63. [PMID: 30907383 PMCID: PMC6444373 DOI: 10.4081/ejh.2019.3017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/18/2019] [Accepted: 03/09/2019] [Indexed: 12/19/2022] Open
Abstract
Lipid accumulation is largely investigated due to its role in many human diseases. The attention is mainly focused on the lipid droplets (LDs), spherical cytoplasmic organelles which are devoted to the storage of the lipids. The amount of lipid content is often evaluated by measuring LDs size and/or the integrated optical density (IOD) in cultured cells. Both evaluations are directly associated to the lipid content and therefore they are correlated to each other, but a lack of theoretical relationship between size and IOD was observed in literature. Here we investigated the size-IOD relationship of LDs observed in microscopical images of cultured cells. The experimental data were obtained from immature and differentiated 3T3-L1 murine cells, which have been extensively used in studies on adipogenesis. A simple model based on the spherical shape of the LDs and the Lambert-Beer law, which describes the light absorption by an optical thick material, leads to a mathematical relationship. Despite only light rays’ absorption was considered in the model, neglecting their scattering, a very good agreement between the theoretical curve and the experimental data was found. Moreover, a computational simulation corroborates the model indicating the validity of the mathematically theoretical relationship between size and IOD. The theoretical model could be used to calculate the absorption coefficient in the LDs population and it could be applied to seek for morphologically and functionally LDs subpopulations. The identification of LDs dynamic by measuring size and IOD could be related to different pathophysiological conditions and useful for understand cellular lipid-associated diseases.
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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]
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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).
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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
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Abstract
PURPOSE OF REVIEW Together with age-related body composition changes, the increased prevalence of obesity observed in the past few decades in older individuals has led to a condition called sarcopenic obesity, characterized by a mismatch between muscle mass and fat mass. The operative definition of sarcopenic obesity is still under discussion and creates difficulties in clinical practice. Muscle weakness, rather than low muscle mass, was previously proposed as an alternative criterion and, more recently, the dynapenic abdominal obese phenotype is of increasing interest because of its unfavorable health consequences and usability in clinical practice. RECENT FINDINGS This review focuses on the most recent findings of pathogenic inter-relationships between adipose tissue and muscle. Recent studies on health consequences of sarcopenic obesity and dynapenic abdominal obesity are also examined. Despite the lack of consensus on a definition for sarcopenic obesity, progress has been made in the delineation of the treatment principles for this condition. SUMMARY Further research is needed to compare different definitions of sarcopenic/dynapenic obesity to clarify the relationship between obesity and the most important adverse outcomes in the elderly. The next step will be the definition of best possible therapeutic approaches for this condition.
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Affiliation(s)
- Mauro Zamboni
- Geriatric Division, Department of Medicine, University of Verona
- HealthyAging Center Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Sofia Rubele
- Geriatric Division, Department of Medicine, University of Verona
- HealthyAging Center Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea P Rossi
- Geriatric Division, Department of Medicine, University of Verona
- HealthyAging Center Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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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.
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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
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Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48:16-31. [PMID: 30312372 PMCID: PMC6322506 DOI: 10.1093/ageing/afy169] [Citation(s) in RCA: 5686] [Impact Index Per Article: 1137.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023] Open
Abstract
Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.
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Affiliation(s)
| | - Gülistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Jürgen Bauer
- Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus, Heidelberg, Germany
| | - Yves Boirie
- Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton, UK; and Department of Epidemiology, University of Oxford, OX, UK
| | - Francesco Landi
- Instituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Yves Rolland
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Avan Aihie Sayer
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Stéphane M Schneider
- Department of Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Cornel C Sieber
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine and Ageing, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Maurits Vandewoude
- Department Geriatrics, University of Antwerp, Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam; and the Amsterdam Public Health Research Institute; Amsterdam, The Netherlands
| | - Mauro Zamboni
- Department of Medicine, Geriatric section, University of Verona, Verona, Italy
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Kirkham FA, Bunting E, Fantin F, Zamboni M, Rajkumar C. Independent Association Between Cardio-Ankle Vascular Index and Sarcopenia in Older U.K. Adults. J Am Geriatr Soc 2018; 67:317-322. [PMID: 30460978 DOI: 10.1111/jgs.15648] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/16/2018] [Accepted: 09/13/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the correlation between sarcopenia and arterial stiffness in Caucasians, centering on the relationship between skeletal mass index (SMI) and the cardio-ankle vascular index (CAVI) to assess the use of CAVI in predicting sarcopenia. DESIGN CROSS-SECTIONAL SETTING United Kingdom. PARTICIPANTS UK adults aged 45 years and over (N = 366, n = 177 male, n = 189 female). MEASUREMENTS Bioimpedance analysis was used to derive SMI. CAVI score was calculated using a vascular screening system. Handgrip strength was measured using a standard dynamometer. RESULTS Average CAVI was significantly correlated with SMI (correlation coefficient (r) = -0.285, p < .001), with higher correlation in women (r = -0.416, p < .001) than men (r = -0.214, p = .01). CAVI had the highest correlation with SMI from appendicular muscle (fat-free mass in men, r = -0.253, p = .002; predicted muscle mass in women, r = -0.436, p < .001). There was a significant difference in average CAVI between groups, with participants who were not sarcopenic having lower CAVI (8.98) than those who were sarcopenic (9.80) (p < .001, t-test). Linear regression was performed using SMI as the dependent variable. After adjustment for age, average CAVI was a significant predictor of SMI in women (beta = -0.332, p < .001) but not men. CONCLUSION Indices of sarcopenia are independently associated with a higher CAVI, with greater correlation in women than men. The CAVI can be used to assess overall vascular compliance and may be a useful operator-independent tool that can be used to measure sarcopenia and its cardiovascular implications in older adults. J Am Geriatr Soc 67:317-322, 2019.
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Affiliation(s)
- Frances A Kirkham
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, United Kingdom
| | - Eva Bunting
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, United Kingdom.,University of Sussex, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Francesco Fantin
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Chakravarthi Rajkumar
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, United Kingdom.,University of Sussex, Brighton and Sussex Medical School, Brighton, United Kingdom
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Lucarelli C, Biagio LS, Francica A, Benfari G, Noni M, Abbasciano R, Rossi A, Zamboni M, Onorati F, Ribichini F, Faggian G. RF14 CONSEQUENCES OF PRESSURE OVERLOAD AS DETECTED BY LEFT ATRIAL AND VENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550043.20260.a1] [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: 11/05/2022]
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Lucarelli C, Biagio LS, Francica A, Benfari G, Abbasciano R, Noni M, Rossi A, Zamboni M, Onorati F, Ribichini F, Faggian G. OC04 BASELINE ATRIAL STRAIN RELATES TO POST-SURGICAL FOLLOW UP IN SEVERE AORTIC STENOSIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549885.49380.9b] [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: 11/05/2022]
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