OS01.7.A Detection of methylation-based prognostic signatures in liquid biopsy specimens from patients with meningiomas

Background

Detection of distinct epigenetic biomarkers in circulating cell-free DNA (cfDNA) of liquid biopsy (LB) specimens (e.g. blood) fosters opportunity for prognostication of central nervous system (CNS) tumors and has not been thoroughly explored in patients with meningiomas.

Material and Methods

We profiled the cfDNA methylome (EPIC array) in serum specimens from patients with meningiomas (MNG; n= 63) and harnessed internal and external meningioma tissue methylome data with reported follow up (n=48). To predict recurrence risk (RR), we consolidated a tissue cohort with at least 5 years of follow up and divided them into confirmed recurrence (CR; either reported progressive disease in post-surgical imaging, or additional resections following initial surgery) and confirmed no-recurrence (CNR: no confirmed disease progression w/in at least 5-years of follow-up). Then through application of an iterative process consisting of multiple tissue- and serum-based supervised analyses, we identified risk-specific methylation markers with serum specific features which, when inputted into a random forest algorithm allowed for segregation of both tumor tissue and liquid biopsy specimens according to recurrence risk. We estimated immune cell composition using MethylCIBERSORT, where a reference methylome atlas of chosen immune cell types was utilized to deconvolute the MNG samples.

Results

The resulting recurrence risk classifier demonstrated an appreciable predictive power in classifying samples as high or low recurrence risk across the tumor tissue cohort (ACC: 87.5%, CUI+: 85.2%). When compared to another classifier, our model demonstrated statistically significant agreement across primary meningioma samples (κ=0.269, p=0.002), and more accurately predicted samples to recur across an expanded time window (time to recurrence >5yrs). Across resulting liquid biopsy classifications, recurrence risk subgroups were analogous with reported risk factors, including WHO grade, extent of resection, and tumor location. Recurrence risk subgroups (high and low) also demonstrated differential estimated immune cell contributions, with low-risk samples exhibiting a “hot” profile, or enrichment of B-Cells, CD56- and CD4 T-Cells, and natural killer cells. Notably, the estimated neutrophil to lymphocyte ratio, previously purported to be relevant to tumor prognosis, was appreciably higher for those meningioma samples with the highest recurrence risk.

Conclusion

DNA methylation markers identified in the serum are suitable for the development of machine learning-based models which present high predictive power to prognosticate patients with meningioma and estimate a differential immune profile across recurrence risk groups. After validation in an external cohort, this noninvasive approach may improve the presurgical therapeutic management of patients with meningiomas.

Illuminating gravitational waves: A concordant picture of photons from a neutron star merger

Merging neutron stars offer an excellent laboratory for simultaneously studying strong-field gravity and matter in extreme environments. We establish the physical association of an electromagnetic counterpart (EM170817) with gravitational waves (GW170817) detected from merging neutron stars. By synthesizing a panchromatic data set, we demonstrate that merging neutron stars are a long-sought production site forging heavy elements by r-process nucleosynthesis. The weak gamma rays seen in EM170817 are dissimilar to classical short gamma-ray bursts with ultrarelativistic jets. Instead, we suggest that breakout of a wide-angle, mildly relativistic cocoon engulfing the jet explains the low-luminosity gamma rays, the high-luminosity ultraviolet-optical-infrared, and the delayed radio and x-ray emission. We posit that all neutron star mergers may lead to a wide-angle cocoon breakout, sometimes accompanied by a successful jet and sometimes by a choked jet.

Computer tailored nutrition education: Mediterranean diet

Goal of this work is to promote via on-line applications the knowledge of the Italian Weekly Pyramid, which is based on the concept of WI (Well Being Index) as a unit for a correct lifestyle. On the website www.piramideitaliana.it the user can verify his/her weekly lifestyle by participating in a "game" based on the introduction, for seven consecutive days, of food and beverages consumption and time assigned to physical activity. At the end of the seven days it is possible to access the page with an evaluation of dietary habits together with the possible suggestions for a correct lifestyle. On the basis of the data collected through this web game, a statistical analysis has been developed to evaluate the food habits and the level of physical activity. In the period between September 2005-January 2010 16,546 participants have completed the game. The data collected compare actual WI consumption for each food group with the one suggested by the Pyramid. The sample eating pattern appears almost varied; all the food groups were consumed daily, albeit in much lower quantities with regard to the suggested portions. It is pointed out that some differences in the nutritional habits are related to differences in age groups and in the school degree of the sample analyzed. This work highlights the importance of web-based tailored interventions on population food habits: many people can be reached to promote the knowledge of the guidelines leading to a healthy lifestyle.

A systematic review of the literature concerning the relationship between obesity and mortality in the elderly

INTRODUCTION

Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly.

METHODS

In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies.

CONCLUSION

The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.

Senile anorexia in different geriatric settings in Italy

OBJECTIVES

Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status.

DESIGN AND SETTING

Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto).

PARTICIPANTS

526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile").

MEASUREMENTS

Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication.

RESULTS

The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet composition analyses of anorexic older adults revealed a lower intake of all food groups and a general tendency to a monotonous diet.

CONCLUSION

Anorexia is a frequent condition in older Italians, particularly those hospitalized, with important consequences in the nutritional and functional status. The analysis of dietary components and its quality along with the frequency of intake of single food groups may be useful to plan intervention strategies aiming to improve the nutritional and health status of older adults with anorexia. An early detection of anorexia followed by an adequate intervention in older hospitalized patients to avoid further worsening of clinical and functional status is warranted.

Predicting the outcome of long-term care by clinical and functional indices: the role of nutritional status

In elderly subjects, past researches have already underlined the role of nutritional status as a basic factor able to influence the prognosis either in acute wards or in rehabilitation and long-term care settings. Aim of the study is that of retrospectively verify, through a multivariate analysis, the factors able to condition mortality in long-term care, paying particular attention to the nutritional status.

METHODS

The survey included 513 patients aged more than 65 years admitted to a long-term care unit during a three years period. Exitus within the first three months of hospitalization was considered the outcome variable, while baseline functional, cognitive, clinical and nutritional status were considered the independent variables eventually related to mortality.

RESULTS

The univariate analysis found that some variables were significantly correlated with the outcome: comorbidity, ADL, cognitive status, pressure sores, albumin, transferrin, CRP, mucoprotein, cholesterol, cholinesterase, MAMC and MNA. The predictive value of the block model of the logistic regression analysis was 77.9% (specificity = 85.3%, sensitivity = 63.9%). With the forward stepwise analysis only MNA, cholinesterase, CRP and mucoprotein were considered in the final model. In this case the predictive value of the model was 79.3% (specificity = 84.6%, sensitivity = 69.46%).

[Malnutrition in the elderly: clinical features, psychological and social determinants. Preliminary results]

In industrialized Countries malnutrition is a very frequent condition in frail groups of the population, people with low income and elderly subjects above all if institutionalized. The aim of the study is to: analyse the prevalence of malnutrition in a sample of elderly people located in different geographical areas in Italy; identify the psychological, social, economic, environmental, cultural and demographic determinants of malnutrition. The prevalence of malnutrition (estimated through the MNA) is high in both sexes (28% of F and 21.9% of M. Age, institutionalisation, health status, autonomy status, cognitive status and education level are some of the factors that correlate with the presence of malnutrition. Loneliness and poverty seem to have a negative impact on nutritional status but further data are needed to confirm this hypothesis. The data collected confirm the need to activate services dedicated to assess the nutritional status of elderly people, to implement campaigns in particular on food education for the elderly population, to set tools and guide lines for caregivers.

Obesity in the elderly

Obesity is a prevalent health disease among the elderly as it contributes to the early onset of chronic morbidity and functional impairment and is also related to premature mortality. The prevalence of sarcopenic-obesity increases too with age in each sex leading to a significantly higher prevalence of physical impairment and disability, as well as higher prevalence of metabolic syndrome. We observe a natural phenomenon (ageing) and a complex world-wide illness (obesity) that should not be merely treated as the sum of the treatments for the elderly and for the obese. The balance between the potential benefits of treatment interventions, reducing premature morbidity and mortality, and the impact on quality of life in old age may be different from young and adult age in case of obesity and need to be seriously considered.

Validity of self-reported body weight and height among women including patients with eating disorders

The main objective of this study was to evaluate the accuracy of self-reported weight and height among women with eating disorders. The study sample consisted of 271 women aged 18-50 yrs: 73 anorexic patients (AN) with a body mass index (BMI) of <18.50 kg/m2, 54 normal weight bulimic or rehabilitated patients (BU/RE: 18.5<BMI<25), 38 overweight/ obese women (OW/OB: BMI> or =25 kg/m2) and 106 normal weight women without an eating disorder (NW: 18.5<BMI<25). Their self-reported body weight (BW) and height were recorded during an interview, and measured using standard procedures, and their self-reported and measured BMI was calculated (kg/m2). In comparison with the measured data, the AN patients tended to overestimate their body weight by 0.48+/-2.05 kg (p<0.05), whereas the OW/OB and BU/RE patients underestimated it (OW/OB: -1.52+/-3.21 kg, p=0.006; BU/RE: -1.12+/-2.60 kg, p=0.003). All of the groups overestimated height by at least 1 cm, and the OW/OB group overestimated it by 2.31+/-2.94 (p=0.00000). These differences were reflected in the significant underestimate of BMI by all groups except the AN patients. Pearson's correlation coefficients between the self-reported and measured variables ranged from 0.95 to 0.98. The results of a Bland & Altman analysis showed that the underestimates of weight and BMI were related to the magnitude of the values (BW: r=-0.24, p<0.000078; BMI: r=-0.37, p<0.00000), the differences being greater with increasing values of weight and BMI; sensitivity as greater for the AN patients. The self-reported data led to a significant misclassification of body mass categories, especially among the BU/RE and OW/OB subjects. Our results show that the over-reporting of height and under-reporting of body weight led to significant underestimates of BMI. The AN subjects seemed to know their weight quite well, whereas the BU/RE and OW/OB women significantly underestimated it. On the basis of these findings, measured weight and height should always be preferred to self-reported values.

Nutrition, longevity and behavior

Nutrition offers the means to improve health and well-being and among the predictive factors of successful aging, nutrition appears as one of the major determinants. Whereas adequate nutrition plays a major role in a healthy lifestyle that maintains bodily and mental functioning, inadequate nutrition contributes to a loss of function and to the development and progression of disease. At the moment recommended dietary allowance (RDA) is established to cover the needs of populations of the healthy elderly. In the future special recommendations for subgroups of individuals are essential, taking into account individual health status and genetic factors. Nutrient guidelines for elderly are basically the same as for young adults, propagating a balanced varied nutrition that is rich in complex carbohydrate sources, fruits and vegetables providing fiber, antioxidant and functional nutrients, fish providing vitamin D and essential fatty acids, adequate water supply in view of their potentially impaired thirst perception and reduced renal functions. Finally a balanced diet is the best way to avoid deficiencies and maintain health. If in subgroups of the elderly population an adequate nutrition cannot be achieved, low dose dietary supplements and/or fortified foods and beverages can contribute to improve nutrient intake.

Nutrition in the elderly: role of fiber

Dietary fiber can be considered "any dietary component that reaches the colon without being absorbed in a healthy human gut". Thus "fiber", according to the recent literature, is contemplated any substance other than plant cell-wall material. The latter is a new definition expanding the previous one beyond carbohydrates. In fact, there is evidence that compounds other than cell-wall polysaccharides that are able to evoke similar physiological effects of those stimulated by soluble and insoluble polysaccharides. Moreover, this definition does not presume that the physiological effects of any fiber component are manifested only when fiber reaches the colon. Dietary fiber intake is important from a metabolic view point (lipid and glucose metabolism) or acting as prebiotics on microbiota health, in preventing colonic cancer, in treating bowel diseases and symptoms, on mineral absorption. Fiber intake seems to be important in particular in the elderly to the point that all national dietary guidelines and food guide pyramid for elderly people underline the necessity to increase dietary fiber intake, and therefore fruits and vegetables.

Mediterranean lifestyle: nutritional education on-line

Our goal is to spread on-line the Italian Weekly Pyramid, a tool designed to convey both portion size and frequency of food intake. The Pyramid is referring to the "Well-being Index" (WI) as a unit for an adequate lifestyle. The user can verify his weekly lifestyle by participating to a "game" based on food/beverages consumption and time assigned to physical activity. The site has been visited by 15920 individuals, of whom 4033 completed the game. Self-selected sample, not representative of the Italian population. The data collected included WI consumption by gender for each food group compared to WI suggested. Statistical data evaluation has been performed with the SPSS inc.13 program, without applying any statistical significance to the results. The sample showed a varied eating pattern; all the food groups were consumed almost daily, albeit in much lower quantities with regards to the suggested WI. Fruit and vegetable consumption was higher in women, while men showed a higher intake of meat and cut meats. The percentage of the participants consuming more WI with respect to the recommended amounts was very low for fruit, vegetable, pasta and bread, while was much higher as regards energy dense food.

[A survey on diet manuals in Italian hospitals]

Hospital catering is very important to counteract the onset of malnutrition due to either undernutrition or overnutrition and for dietetic treatment. The aim of the study was to evaluate nutritional quality of the hospital dietetic manual used in some Italian hospitals and to analyze the role of the institutional Catering Service and of the Department of Clinical Nutrition. A survey has been carried out, in some Italian hospitals, using a questionnaire to point out the characteristics of hospitals, the typology of catering service, of the diets and of the staff of the Department of Clinical Nutrition. Only 22% of the hospitals has answered; three Italian regions (Umbria, Molise, Basilicata) are completely missing; -each hospital has a specific dietetic manual in most cases completely different from structure and nutritional quality point of view; the staff acting in this field is absolutely insufficient in term of numerousness and of professional typologies. Hospital in-patients are not homogeneous as for age, dietary needs and diseases, so it's necessary to treat them with an ad hoc nutritional intervention not established in advance in a dietetic manual; if from an organisation point of view it is necessary to have such a dietetic manual, it has to be based on nutritional guidelines and recommended dietary allowances.

[Mediterranean diet and prevention of non-communicable diseases: scientific evidences]

Epidemiological studies showed that the Mediterranean Diet represents a healthy food model in the maintenance of the state of health and in the improvement of the quality of life. The aim of this study was to define the relation between the Mediterranean Diet and the state of health, particularly the role in the prevention of the non-communicable diseases. A systematic literature review was made, analyzing clinical trials published on PubMed from January 2005 to September 2008 and using, separately or in combination, the key words: "Mediterranean Diet", "Health", "Prevention", "Diabetes", "Lipoproteins", "Cardiovascular Diseases", "Cancer." A total of 16 articles were selected. The studies included 101 to 25623 caucasian participants, of both genders, age between 18 and 80 years. Results were analyzed for the effects of the Mediterranean Diet on Cancer; Metabolic Syndrome and Cardiovascular Diseases, in terms of primary and secondary prevention. The Mediterranean Diet showed benefits on the incidence of cancer in healthy subjects, on the metabolic syndrome both in primary prevention that secondary, modifying numerous variables and about cardiovascular diseases, the Mediterranean Diet reduced the risk of relapse and the mortality by acute coronary syndromes and other cardiovascular causes in high risk patients. First of all the Mediterranean Diet must strongly be considered a correlated food model to the style of life, therefore it need further experimental research to validate the effects of Mediterranean Diet on the state of health.

Multidisciplinary approach to obesity

Obesity, associated with morbidity and mortality, is a complex disorder, characterised by an increase in fat mass (FM). Most authors agree in considering essential an integrated treatment made up of nutritional intervention, physical reconditioning programme and cognitive-behavioural psychotherapy. However, the feasibility is problematic and data in literature confirming the validity of this approach are poor.

AIM

To verify the efficacy of a multidimensional approach (Nutritional Psycho-Physical Reconditioning - NPPR) in obesity treatment.

METHODS

All patients admitted from June 2002 to June 2004 (464 subjects) ranged from 18 to 65 years old, with a body mass index (BMI) >30 kg/m2 were included in the programme. After the nutritional status evaluation a standard dietetic treatment (group N) or an integrated and multidisciplinary obesity treatment (group NPPR) was proposed.

RESULTS

In group NPPR treatment duration was significantly higher (142.6+/-26 vs 48.6+/-55 days - p=0.000), while the drop-out amount was definitely lower (5.5 vs 54.4%; p=0.000). Weight loss compared to the initial weight and the difference between initial and final FM resulted significantly higher in group NNPR. Subjects in NPPR obtained a higher increase in the distance covered in a 6-minute walk test (59.9+/-19 vs 40.5+/-17 m; p=0.04) and in muscular strength. State and trait anxiety, mood and quality of life scores improved in NPPR subjects while remained substantially stable in group N.

CONCLUSIONS

An integrated approach to obesity is the way to be pursued in order to obtain important and at least short-term results.

Senile anorexia in acute-ward and rehabilitations settings

The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia.

METHODS

four different Units cooperated to this research study. Patients were recruited from geriatric acute and rehabilitation wards in Italy. Each Research Unit, for the estimation of the prevalence of anorexia in elderly subjects evaluated all the patients aged over 65 recruited from April 2006 to June 2007. Nutritional status, depression, social, functional and cognitive status, quality of life, health status, chewing, swallowing, sensorial functions were evaluated in anorexic patients and in a sample of "normal eating" elderly subjects.

RESULTS

96 anorexic subjects were selected in acute and rehabilitation wards (66 women; 81.5 +/- 7 years; 30 men: 81.8 +/- 8 years. The prevalence of anorexia in the sample was 33.3% in women and 26.7% in men. Anorexic subjects were older and more frequently needed help for shopping and cooking. A higher (although not statistically significant) level of comorbidity was present in anorexic subjects. These subjects reported constipation and epigastrium pain more frequently. Nutritional status parameters (MNA, anthropometry, blood parameters) were significantly worst in anorexic subjects whereas CRP was higher. Chewing and swallowing efficiencies were significantly impaired and eating patterns were different for anorexic subjects with a significant reduction of protein rich foods.

CONCLUSIONS

consequences of anorexia can be extremely serious and deeply affect both patient's mobility, mortality and quality of life. Therefore, it is of utmost importance to perform a special evaluation of the nutritional risk, to constantly evaluate the nutritional status and feeding intake of older patients, to identify and treat the underlying disease when possible, to institute environmental and behavioural modifications, to organise staff better in order to produce higher quality feeding assistance during mealtimes, to plan early nutrition rehabilitation and nutritional education programs for caregivers. There is also the necessity to develop diagnostic procedures easy to perform, able to identify the pathogenesis of anorexia and, therefore, treatment strategies exactly fitting the patients' needs.

An analysis of peroxisome proliferator-activated receptor gamma (PPAR-gamma 2) Pro12Ala polymorphism distribution and prevalence of type 2 diabetes mellitus (T2DM) in world populations in relation to dietary habits

BACKGROUND AND AIM

The human peroxisome proliferator-activated receptor gamma (PPAR-gamma) is involved in lipid storage, glucose homeostasis and adipocyte differentiation. The Ala allele of the Pro12Ala polymorphism has been associated with a protective effect against T2DM. Ala allele frequencies are known for many populations, but data are absent for other interesting human groups.

METHODS AND RESULTS

We examined samples from Ethiopia, Benin, Ecuador and Italy. In addition, we performed an analysis of the Pro12Ala polymorphism distribution in world populations, also in relation to T2DM prevalence and the diet lipid content. In the European populations, the Ala allele frequencies are distributed according to a latitudinal trend, with the highest in the northern and central European populations and the lowest in the Mediterranean populations. Considering the world populations, a significant inverse relationship between Ala frequency and T2DM prevalence was observed mainly in populations where energy from lipids exceeded 30% of the total energy intake.

CONCLUSION

Northern Europe's cold climate has been hypothesised to have played a role in contributing to the present pattern. Moreover our analysis appears to confirm, at a population level, the protective effect of Ala allele against T2DM, already observed in case-control studies, but only in populations with a diet rich in lipids.

Systematic review of nutritional status evaluation and screening tools in the elderly

One univocal definition for nutritional status (NS) does not exist. One set of generally accepted standards for assessing the nutritional status does not exist, either. The NS assessment is absolutely necessary because it drives to identify malnutrition which is a potential cause and or an aggravation of morbidity and mortality. Since malnutrition shows a high prevalence in the elderly, literature about the validation of tools exploring single or complex NS parameters in the elderly has been systematically review. 115 papers, published from January 1st 1990 to July 31st 2003, have been identified: among them, just 9 complied with the established quality criteria and were suitable to be systematically reviewed. Parameters and diagnosis protocols to assess NS used in the selected papers were not homogeneous. Two implications arise from this evidence: - as regards clinical practice: an assessment on NS in clinical practice is complex, but not impossible. Hopefully, despite the absence of a sure reference, nutritionists, during their own clinical practice, ought to choose a validated on their own population and complete tool (considering as NS indicators both dietetic, anthropometric and functional parameters) for NS assessment, among all the redundant set of tools proposed until now; - respecting a scientific point of view, there is the necessity for calling a consensus conference in order to establish an initial consensus to diagnose malnutrition in the elderly and to promote, therefore, a validation study.

Nutritional status determinants and cognition in the elderly

It is possible to identify risks or protective factors against dementia. Increased levels of homocysteine (HCY) and vitamin B deficiency, obesity and central adiposity in midlife are independent risk factors for the development of dementia. High dietary intake of antioxidants and omega-3 fatty acids lower the risk of Alzheimer disease (AD). The supplementation with single nutrients, like vitamin B, omega-3-polyunsaturated fatty acids (PUFA) or antioxidants is generally not effective in lowering the risk of dementia or in slowing the progression of the disease. It is probably necessary that these nutrients are part of a healthy diet (with at least five portions of fruit and vegetables per day and one portion of fish per week) during the lite where other factors interact with them as it happens in the Mediterranean diet. Nutritional strategies for modifying the clinical course of cognitive failure should consider the use of nutritional screening tools in the multidimensional geriatric evaluation. Moreover, the diet, oral supplementation, caregiver education could be important factors to prevent or treat weight loss and its consequences in AD while the use of artificial nutrition in demented patients may have questionable benefits.

Nutritional status and evolution of pressure sores in geriatric patients

The prevalence of pressure sores (PS) ranges from 1 to 18% of in-patients and from 3 to 28% of those admitted to long-term settings. The aim of our study was to verify, a posteriori, how nutritional status influenced the evolution of PS in a population of elderly subjects hospitalised in a long-term care setting.

MATERIALS AND METHODS

The charts of 125 patients with ulcerative or necrotic pressure ulcers were evaluated retrospectively. For each subject we took note of: PS characteristics (stage, ulcer surface, evolution), clinical characteristics (comorbidity, adverse clinical events, cognitive, functional and nutritional status).

RESULTS

In 58 patients (46.4%) there was overall healing of the lesions while in 39 patients (31.2%) we had however an "improvement" of PS. The course of PS was not significantly influenced by the patient's physiological characteristics, by cognitive status or by initial characteristics of PS. Instead, we noticed a significant difference in the course of PS as a function of the level of autonomy and clinical status. The course of PS, and in particular the Healing Index, were influenced by the Nutritional Status and, above all, by its course during the treatment period.

CONCLUSIONS

The development of PS is multifactorial. Whereas, it is clear that factors other than nutrition influence the risk of developing PS, an important role for nutrition in the development and resolution of PS is suggested. Our data certainly confirm the "Quality indicators for prevention and management of pressure ulcers in vulnerable elders", especially were they say "if a vulnerable elder is identified as at risk for pressure ulcer development and has malnutrition, then nutritional intervention or dietary consultation should be instituted because poor diet, particularly low dietary protein intake, is an independent predictor of pressure ulcer development".

Orthorexia nervosa: validation of a diagnosis questionnaire

AIM

To validate a questionnaire for the diagnosis of orhorexia oervosa, an eating disorder defined as "maniacal obsession for healthy food".

MATERIALS AND METHODS

525 subjects were enrolled. Then they were randomized into two samples (sample of 404 subjects for the construction of the test for the diagnosis of orthorexia ORTO-15; sample of 121 subjects for the validation of the test). The ORTO-15 questionnaire, validated for the diagnosis of orthorexia, is made-up of 15 multiple-choice items.

RESULTS AND CONCLUSION

The test we proposed for the diagnosis of orthorexia (ORTO 15) showed a good predictive capability at a threshold value of 40 (efficacy 73.8%, sensitivity 55.6% and specificity 75.8%) also on verification with a control sample. However, it has a limit in identifying the obsessive disorder. For this reason we maintain that further investigation is necessary and that new questions useful for the evaluation of the obsessive-compulsive behavior should be added to the ORTO-15 questionnaire.

Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon

AIM

To propose a diagnostic proceeding and to try to verify the prevalence of orthorexia nervosa (ON), an eating disorder defined as "a maniacal obsession for healthy foods".

MATERIALS AND METHODS

404 subjects were enrolled. Diagnosis of ON was based on both the presence of a disorder with obsessive-compulsive personality features and an exaggerated healthy eating behaviour pattern.

RESULTS

Of the 404 subjects examined, 28 were found to suffer from ON (prevalence of 6.9%). The analysis of the physiological characteristics, the social-cultural and the psychological behaviour that characterises subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education. The orthorexic subjects attribute characteristics that show their specific "feelings" towards food ("dangerous" to describe a conserved product, "artificial" for industrially produced products, "healthy" for biological produce) and demonstrate a strong or uncontrollable desire to eat when feeling nervous, excited, happy or guilty.

MNA predictive value in the follow-up of geriatric patients

OBJECTIVE

The aim of this study is to verify, in a sample of elderly subjects admitted to long-term care, the impact of malnutrition, according to the Mini Nutritional Assessment (MNA), on mortality and on the occurrence of Adverse Clinical Events in a 3-12 months follow-up study.

SUBJECTS

The survey included all patients admitted to a geriatric hospital--"Villa delle Querce", Nemi (Rome, Italy)--between January 1997 and April 2000, whose nutritional status we were able to monitor for over 3 months. The study comprised 167 elderly subjects, of which 125 women (74.9%) aged 83.3 8 years (60-95 years), and 42 men (25.1%) aged 79.6 9 years with an average follow-up period of 7.5 months.

METHODS

Upon admission and at every check we evaluated each subject's cognitive functions, functional status, co-morbidity, frailty, nutritional status (anthropometric and biochemical indices; MNA). During the follow-up we recorded Adverse Clinical Events. We calculated the predictive value of MNA, we correlated variations in MNA scores with variations of nutritional parameters.

RESULTS

MNA's predictive ability both upon admission and upon discharge was found to be excellent. The MNA score was found to be correlated-although not to a very high degree-with variations nutritional parameters. Even more than malnutrition, a low MNA score was found to be predictive of a greater incidence of Adverse Clinical Events during hospitalisation and of higher mortality.

[The quality of a restaurant service at a geriatric rehabilitation facility]

The aim of our study was to measure the quality of a restaurant service of a geriatric rehabilitation and long-term setting as it is perceived from patients compared with an objective measure of the quality. We have also verified the weight of the restaurant service on the whole quality of the hospital. Our data showed some problems in the organisation of the service, a substantially negative judgment from patients, the necessity to integrate subjective judgments with objective evaluations. The data confirmed also the importance that patients give to taste and variability of food and to the way in which it is presented. The results we obtained suggested an audit of the organisation of the restaurant service. The outcome of the proposed changes will be followed up and bring, eventually, to further arrangements.

Administering the "AHSP Questionnaire" (appetite, hunger, sensory perception) in a geriatric rehabilitation care

BACKGROUND

Frail elderly people, living in nursing homes, usually show a malnutrition state caused by an increased need of energy or an inadequate food intake. Among the causes leading to reduction of food intake in elderly people and consequently to malnutrition, is the loss of appetite, often marker of depression and alterations of taste and smell perception.

OBJECTIVE

The aim of this research is to verify the application of the AHSP Questionnaire and relate its score to nutritional state of a frail elderly population hospitalized in a geriatric rehabilitation care.

SETTING AND SUBJECTS

All patients of the "3rd Rehabilitation Department" of the Istituto Geriatrico "Villa delle Querce" Nemi (Rome-Italy).

METHODS

Informations, number and type of medical conditions, prescribed drugs, other parameters that can affect taste, smell, hunger and nutritional status, mood, cognitive and nutritional status have been collected from the clinical folders. To assess appetite, hunger smell and taste perception had been submitted the AHSP Questionnaire.

RESULTS

The AHSP Questionnaire had been administered only to 44 of the 103 patients present at the survey because of the high prevalence of cognitive impairment. AHSP score is lower in presence of malnutrition assessed with MNA (Mini Nutritional Assessment). MNA, expressed as proportional score, seems to present a clear correlation with AHSP's (r=0.59; p=0.000).

CONCLUSION

The results achieved show the scarce adaptability of the AHSP Questionnaire to frail elderly people living in geriatric rehabilitation care. MNA is at the moment the most reliable tool to single out dietary deficiency on geriatrics population.

A "proportional and objective score" for the mini nutritional assessment in long-term geriatric care

BACKGROUND

In a previous study we tested the predictive value of the Mini Nutritional Assessment (MNA) in an Italian population of frail elderly in long-term hospital care. The results of our study confirmed the MNA's excellent overall predictive value and sensitivity. Unfortunately we had a large number of false positive judgments, hence our study's low specificity, which we think was caused by two factors: 1. in most cases it was impossible to conduct a reliable subjective assessment of the patients' nutritional and health status. 2. most patients failed to respond to some of the MNA questions, which as a consequence received a "0" score. The result was an artificially low global MNA score even in well-nourished patients.

OBJECTIVE AND DESIGN

We tried to neutralize the effects of the defective answers by modifying the total score and the cut-off points of the test. Thus, we: 1. replaced the subjective assessment of health and nutritional status with an objective evaluation; 2. replaced the total score of MNA with the ratio of this value with the maximum of points that each subject can obtain without including the items for which we could not have a response. Similarly, the cut-off points (17 and 24) were replaced with the ratio of these values with the maximum of points obtainable by a complete MNA (30). Patients are classified as "malnourished" below 0.56, "at risk of malnutrition" between 0.56 and 0.79, and "well-nourished" from 0.8 up.

RESULTS

This way, the overall predictive value of MNA is increased from 80.3 to 85.4% and the specificity from 12.8 to 25%, whereas the sensitivity increase is modest (from 98 to 98.1%).

Eating behavior of ballet dancers

Ballet dancers are frequently regarded as having a higher risk of developing eating disorders (ED). This paper describes the eating habits and prevalence of ED in a group of female students from a dance academy in Rome, Italy. Participants were assessed with an array of measures conventionally employed (usually singly) in epidemiological studies of ED, namely: an anthropometrical-nutritional evaluation, the EAT, EDI, and BUT questionnaires, and the EDE interview. The 160 students who agreed to participate were evaluated anthropometrically, nutritionally and psychometrically and 83 underwent the EDE structured interview. Their calorie intake was insufficient in all age groups in terms of the nutritional standards required by their daily physical activity. EAT, EDI and BUT enhanced concerns about dieting, food intake control and body image. The significance of the correlations between calorie intake and the EAT Dieting and the EDI Perfectionism and Interceptive Awareness scores increased in function of age. Food, weight and body image concerns increased with age and length of time in the ballet environment The reduced calorie intake was not necessarily linked to the presence of psychopathological signs.

Prediction of stature in the Italian elderly

Adequate quantification of weight and stature is essential in order to determine levels of nutritional support and to monitor the effects of nutritional intervention. Traditional anthropometric techniques are difficult to apply in elderly or handicapped patients chair or bed-bound. The purpose of the present study is to elaborate regression equations for the estimation of stature in the italian elderly population from other anthropometric measures that can be more easily determined. We have found a single model valid for both sexes (in which the value of the variable "sex" equals 0 if woman and 1 if man) to predict stature in italian elderly: Stature = 94.87 + 1.58 knee-height - 0.23 age + 4.8 sex. Cross validation on a control sample of 30 males and 54 females yielded pure errors of 3.1 cm for men and 2.74 cm for women.

Body weight estimation in the Italian elderly

We have developed two different equations, for each sex of the elderly italian population to predict weight from selected measures of recumbent anthropometry, using data of 172 females (72.8 +/- 8 years old) and 113 males (73.4 +/- 8 years old). The independent variables for both sexes were knee stature. subscapular skinfold, arm and calf circumferences. Cross validation was conducted on a free-living sample of 54 females and 30 males. The recommended equations have a 95% probability of predicting the weight of an elderly man or woman to be within plus or minus 4.9 or 6.1 Kg respectively.

[Noise and communal dining facilities]

Noise is a sound which is unwanted, either because of its effect on humans, its effect on fatigue or multifunctions of physical equipment, or its interference with the perception or detection of other sounds. It is a part of environmental pollution which can, in certain circumstances, reach worrying levels for the population (130 dB cause pain). Unsuitable exposure to noise for even short periods of time is responsible for symptomology involving the hearing organs (hypoacusis) and other parts of the body such as the cardiovascular, muscular and digestive systems via the connection between the central and the autonomous nervous systems. Noise in communal eating areas can be classed as coming from 3 sources: 1) operation of cooking machinery; 2) banging of pans and equipment; 3) voices of both staff and diners. The intensity of noise on these premises varies generally between 60 and 80 dB (discomfort threshold). The Regulations governing this subject are D.Lgs n.277 of 15/8/1991 regarding the protection of employees, D.P.C.M. of 1/3/1991 which establishes the maximum levels of noise both in the home and outside, and the more recent D.P.C.M. of 21/5/1999 referring to noise in public places, which includes restaurants. To contain the exposure to noise in public eating places, we believe that action should be taken at legal levels with stricter limits than the recently passed level of 105 dB, in the building planning departments and also with technological intervention in order to reduce the effects that noise has on the auditive and extra-auditive organs and thus limit possible sublimal messages which certainly do not benefit the psycho-physical well-being of the diners.

Enzymatic assay for the determination of olive oil polyphenol content: assay conditions and validation of the method

A new spectrophotometric assay for the determination of the polyphenolic content of olive oil is presented. It is a substrate-recycling assay for phenolic compounds that employs tyrosinase in the presence of excess NADH. The reaction of various phenols with the enzyme produces an o-quinone, which is detected by recycling between reactions with the enzyme and NADH. The method offers some advantages over the classical methods employed to determine the polyphenolic content of olive oil, that is, ease and reproducibility of the analysis, highly increased sensitivity, and selectivity toward phenolic compounds. The amount of total polyphenols was determined in virgin olive oils both with the Folin-Ciocalteu reagent and with the proposed enzymatic method. The results suggest a better estimation of the polyphenol content, as compared with the colorimetric method. This has to be attributed to the different reactivities of the two methods toward phenols and catechols. Finally, the enzymatic method demonstrates that there is a linear relationship between the olive oil phenolic content and the antioxidative capacity of oil extracts.

Lifestyle and dietary differences in smokers and non-smokers from an Italian employee population

In a sample of 200 subjects, representative of a population of 1936 civil servants, we tested differences in life style, dietary habits and distribution of risk factors for CHD between smokers and nonsmokers. The two groups (79 smokers) and (121 non-smokers) did not differ significantly by age or sex. The percentage of sedentary subjects, of hypercholesterolaemics and of hypertensives was found to be particularly high among smokers: 67%, 33% and 30% respectively (vs 59%, 27% and 19% in non-smokers). More smokers were obese (11% vs 5%) but mean BMI was the same in smokers/non-smokers but showed a higher fat mass; the association of CHD risk factors indicates only one significant correlation (P < 0.05) between obesity and hypertension. In male smokers, higher values of LDL and triglycerides and lower intake of energy, vitamins C and A are observed and these values are significantly different than those for non-smokers. In women HDL values are higher in non-smokers whereas, in female smokers, the food cholesterol intake is particularly high 271 +/- 295 mg. There are also correlations both for the anthropometric and clinical parameters and for energy and nutrients, indicating that the lifestyle of smokers is less healthy than that of non-smokers. Smokers cat vegetables and fruits less frequently and consume more alcohol than non-smokers, who prefer sweet foods.

Seasonal changes in the activity of rhodanese in frog (Rana temporaria) liver

1. The investigators studied annual changes in rhodanese activity in mitochondria and cytosol of frog liver cells (Rana temporaria) and found that the value of the enzyme-specific activity was higher in mitochondria than in cytosol, showing significant seasonal fluctuations. 2. The character of changes in the rhodanese activity in mitochondria, regardless of the sex of the studied animal, was demonstrated to be dependent upon the seasonal changes in frog thyroid gland function. 3. In the supernatant fraction of R. temporaria liver homogenate, seasonal changes of rhodanese specific activity seemed to be related to changes in hepatic function.

Cloning and sequence analysis of the human liver rhodanese: comparison with the bovine and chicken enzymes

The cDNA for the human rhodanese (thiosulfate: cyanide sulfurtransferase, EC 2.8.1.1), a nuclearly encoded protein of the mitochondrial matrix, was isolated from a human fetal liver cDNA library. Nucleotide sequence revealed an open reading frame coding for a polypeptide of 295 amino acids, which presented a 57% and 58% identity with the bovine and avian rhodanese, respectively. The analysis of the 5'-ends of the coding region gave no evidence for the presence of a cleavable signal sequence as found in other mitochondrial proteins. A comparison with two available amino acid sequences (cow and chicken) showed that sequence similarity is not restricted to the alpha-helices and beta-structures motifs which are remarkably superimposable in the two halves of bovine rhodanese, but extends to adjacent regions.

Chemical modification of rhodanese with sulphite

The essential sulphydryl group of bovine liver rhodanese (thiosulphate: cyanide sulphurtrasferase, E.C. 2.8.1.1.) is modified by sulphite produced during the enzymatic reaction or added to the fully active enzyme. The enzyme treated with labelled reagent incorporates 1 equivalent of SO3(2-) and loses one -SH group with the formation of a S-sulphonate group at the active site. Mercaptoethanol is effective in both restoring enzyme activity and removing bound sulphite from protein. The inactivation process is dependent on the presence of oxygen and is antagonized by chelation of metal ions, that catalyze sulphite autoxidation, or by scavenging free radicals with mannitol or benzoate. Since the presence of superoxide dismutase and/or catalase protects the enzyme only to a small extent, the inactivation process should be attributed to sulphite radicals rather than intermediates of oxygen reduction.

Synthesis of rhodanese in Hep 3B cells

The biosynthesis of rhodanese was studied in human hepatoma cell lines by immunoblotting and pulse-labeling experiments using polyclonal antibodies raised against the bovine liver enzyme. Rhodanese, partially purified from human liver, showed an apparent molecular weight of 33,000 daltons, coincident with that of rhodanese from Hep 3B cells. After pulse labeling of Hep 3B cells both at 37 degrees C and 25 degrees C, rhodanese in the cytosol fraction exhibited the same molecular weight as the enzyme isolated from the particulate fraction containing mitochondria. Moreover, newly synthesized rhodanese from total Hep 3B RNA translation products showed the same electrophoretic mobility as rhodanese from Hep 3B cells. These results suggest that rhodanese, unlike most mitochondrial proteins, is not synthesized as a higher molecular weight precursor.

Active site modifications quench intrinsic fluorescence of rhodanese by different mechanisms

Beef liver rhodanese can be modified covalently at the active site (Cys-247) either reversibly or irreversibly by sulfur, selenium, iodoacetate, and hydrogen peroxide. Each derivative shows an intrinsic fluorescence lower than that of the free enzyme. The reaction of rhodanese with iodoacetate or hydrogen peroxide is time-dependent and accompanied by enzyme inactivation, by the loss of one or two sulfhydryl groups, respectively, by quenching and bathochromic shift of fluorescence, and by an absorbance perturbation in the near UV. The latter findings are indicative for a displacement of some tryptophyl side chains from hydrophobic to hydrophilic environment. The fluorescence decays of the various rhodanese derivatives can be fitted by a double-exponential function with two lifetimes: a shorter one of 1-1.7 ns and a longer one of 2.8-4.6 ns. The S-loaded and Se-loaded rhodanese samples have proportionally shorter lifetimes and lower quantum yields. No such proportionality was observed for the iodoacetate-treated and for the hydrogen peroxide treated enzyme. These findings indicate that two different quenching mechanisms are operating in rhodanese derivatives, a long-range energy transfer from tryptophan to persulfide (or sulfoselenide) group and a static quenching accompanying a conformational change of the protein after modification of the active site.

Continuous spectrophotometric assay of pantetheinase activity

A continuous spectrophotometric assay for pantetheinase determination using S-pantetheine-3-pyruvate as substrate is described. The enzymatic hydrolysis of this new substrate leads to the formation of S-cysteamine-3-pyruvate, which cyclizes in a non-rate-limiting step to give 2H-1,4-thiazin-5,6-dihydro-3-carboxylic acid (aminoethylcysteine ketimine), a compound exhibiting a strong absorption at 296 nm. The assay is optimized with respect to pH, buffer, and substrate concentration. Prereduction of the enzyme and some properties of the reaction are also studied. The assay is simple, rapid, very sensitive, and specific.

Determination of rhodanese activity by tetrazolium reduction

A colorimetric method for the assay of rhodanese activity based on the continuous determination of the sulfite product is described. 5-Ethylphenazinium ethyl sulfate is used as the intermediate electron carrier between sulfite and nitroblue tetrazolium to produce the colored reduced species. The present method is more sensitive than the usual procedure based on the colorimetric determination of thiocyanate. Furthermore, the color developed by nitroblue tetrazolium reduction affords a straightforward means to locate rhodanese activity in polyacrylamide gels.

Interaction of rhodanese with intermediates of oxygen reduction

Cyanide-promoted inactivation of the enzyme rhodanese [thiosulfate sulfurtransferase (EC 2.8.1.1)] in the presence of ketoaldehydes is caused by reduced forms of molecular oxygen generated during autoxidation of the reaction products. The requirement of both catalase and superoxide dismutase to prevent rhodanese inactivation indicates that hydroxyl radical could be the most efficient inactivating agent. Rhodanese, also in the less stable sulfur-free form, shows a different sensitivity towards oxygen activated species. While the enzyme is unaffected by superoxide radical, it is rapidly inactivated by hydrogen peroxide. The extent of inactivation depends on the molar ratio between sulfur-free enzyme and oxidizing agent. Fully inactive enzyme is reactivated by reduction with its substrate thiosulfate.

The influence of disulfide bonds in proteins on the determination of sulfide

Acid-labile sulfide content of proteins can be determined spectrophotometrically by procedures leading to the formation of methylene blue. A method has been proposed (involving addition of sulfide) to take into account absorption of dye by samples, but it has been found that recovery of sulfide is influenced by disulfide bonds, resulting in non-linear responses. A simplified procedure has been used to determine acid-labile sulfide in mitochondria from chicken liver and kidney, and linear responses to the amount of protein have been obtained.