Mediterranean diet in the management and prevention of obesity

The current pandemic of obesity represents a major global public health problem, mainly due to its association with chronic non-communicable disabling conditions and with increased mortality. Population aging increases the chances of non-communicable chronic diseases allowing a longer exposure to risk factors for these disabling conditions. Obesity is a major risk factor contributing to pathological aging. Numerous epidemiological studies have shown that the risk of death due to cardiovascular disease and cancer increases progressively as overweight and obesity rise. Nutrition research is now focused on the effects of combinations of foods in dietary patterns instead of those of single nutrients or foods. The dietary model with the largest body of evidence of health benefit is that traditionally followed by inhabitants of some Mediterranean countries. There is evidence confirming the inverse association of adhering to Mediterranean diet with overweight and obesity. Four meta-analyses of randomized controlled trials, including up to 16 trials, have shown a greater reduction of body weight and BMI with MedDiet compared to other diets, while a meta-analysis of 7 prospective cohort studies, found a reduced risk of becoming obese and gaining weight over time associated with a higher adherence to MedDiet. This narrative review examines studies reporting inverse associations of a higher adherence to the MedDiet with overweight/obesity and with age-associated chronic diseases related to obesity.

Association between Serum Magnesium and Fractures: A Systematic Review and Meta-Analysis of Observational Studies

Magnesium, an essential cation for numerous cellular processes, is a major component of bone. However, its relationship with the risk of fractures is still uncertain. The present systematic review and meta-analysis aim to investigate the impact of serum Mg on the risk of incident fractures. A systematic search was conducted using several databases including PubMed/Medline and Scopus from inception to 24 May 2022, including observational studies investigating serum Mg and the incidence of fractures considered as outcomes. Abstract and full-text screenings, data extractions, and risk of bias assessments were conducted by two investigators independently. Any inconsistencies were resolved by consensus with a third author. The Newcastle–Ottawa Scale was used to assess the study quality/risk of bias. Among 1332 records initially screened, 16 were retrieved as full-texts; of them, four papers were included in the systematic review with a total of 119,755 participants. We found that lower serum Mg concentrations were associated with a significantly higher risk of incident fractures (RR = 1.579; 95%CI: 1.216–2.051; p = 0.001; I2 = 46.9%). Our systematic review with meta-analysis suggests a strong association of serum Mg concentrations with incident fractures. Further research is needed to confirm our results among other populations and to assess whether serum Mg is potentially relevant in the prevention of fractures, which continue to increase and represent a significant health burden due to the associated disability.

Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity

The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.

Serum ionized magnesium in diabetic older persons

OBJECTIVE

Several alterations of magnesium metabolism have been associated with type 2 diabetes pathophysiology, a condition particularly frequent in older persons. We aimed to evaluate serum total (Mg-tot) and serum ionized magnesium (Mg-ion) in older persons with type 2 diabetes in order to explore clinically applicable methods for the detection of magnesium deficit.

MATERIAL/METHODS

Mg-tot and Mg-ion were measured in 105 fasting subjects with type 2 diabetes (mean age: 71.1±0.8 years; M/F: 45/60) and in 100 age-matched non-diabetic control persons (mean age: 72.2±0.8 years; M/F: 42/58).

RESULTS

Mg-ion concentrations were significantly lower in diabetic persons compared with controls (0.49±0.05 mmol/L vs. 0.55±0.05 mmol/L; p<0.001). Mg-tot was also slightly but significantly lower in diabetic patients (0.82±0.007 mmol/L vs. 0.84±0.006 mmol/L; p<0.05). There was an almost complete overlap in the values of Mg-tot in older diabetic patients and controls; conversely, 44.8% of diabetic patients had Mg-ion values below 0.47 mmol/L, while none of the controls did. After adjustment for age, sex, BMI, and triglycerides, Mg-tot was significantly associated with FBG in all the participants (p<0.05) and Mg-ion was significantly associated with FBG in all the participants (p<0.01) and with HbA1c in diabetic participants (p<0.001).

CONCLUSIONS

Alterations of magnesium serum concentrations are common in type 2 diabetic older adults; Mg-ion evaluation may help to identify subclinical magnesium depletion (i.e. in patients with normal Mg-tot); the close independent associations of Mg-tot and Mg-ion with FBG and with HbA1c reinforce the possible link between magnesium homeostasis and altered glucose metabolism.

Late-onset Sheehan's syndrome presenting with rhabdomyolysis and hyponatremia: a case report

INTRODUCTION

Hyponatremia associated with rhabdomyolysis is a rare event and a correct diagnostic approach is required to rule out this or other diseases as a primary cause and to avoid other complications resulting from a lack of appropriate treatment.

CASE PRESENTATION

A 64-year-old Caucasian woman presented to our facility with worsening fatigue, slurred speech, nausea and vomiting, and high serum levels of creatine kinase and myoglobin together with hyponatremia. Normal arterial blood gas analysis results, normal serum potassium levels, increased urine sodium levels, urine specific gravity of >1003N/m3 and low urine volume suggested an endocrine etiology. Her low cortisol and thyroid hormone serum levels suggested a pituitary disorder. A magnetic resonance imaging study showed atrophy of her pituitary gland. A more detailed study of our patient's obstetric history revealed a post-partum hemorrhage 30 years earlier. She was diagnosed as having late-onset Sheehan's syndrome and treated with hormone replacement therapy, which normalized her clinical picture.

CONCLUSIONS

This case report shows that, in hyponatremia-associated rhabdomyolysis, an endocrinological origin should always be considered. This should include Sheehan's syndrome as it can occur with late onset.

Physiology of the aging bone and mechanisms of action of bisphosphonates

Fragility fractures, a major public health concern, are expected to further increase due to aging of the world populations because age remains a cardinal, independent determinant of fracture risk. With aging the balance between bone formation and resorption during the remodeling process becomes negative, with increased resorption and reduced formation. Bisphosphonates (BPs) are widely prescribed anti-resorptive agents that inhibit osteoclasts attachment to bone matrix and enhance osteoclast apoptosis. BPs can be divided into nitrogen-containing (N-BPs) and non-nitrogen-containing BPs (non-N-BPs). Both classes induce apoptosis but they evoke it differently. Several studies have examined the molecular mechanisms underlying BPs' effects on osteoclasts and bone remodeling. N-BPs (alendronate, risedronate, zoledronate) inhibit the intracellular mevalonate pathway and protein isoprenylation, via the enzyme farnesyl pyrophosphate synthase. N-BPs act by competition, binding to the natural substrate-binding site of the enzyme. The less potent non-N-BPs (etidronate, clodronate), do not inhibit the mevalonate pathway and protein isoprenylation, but are metabolized intracellularly to metabolites, which are cytotoxic analogs of ATP. N-BPs represent the first choice treatment for diseases associated with excessive bone resorption, such as fragility fractures (due to postmenopausal-, male, glucocorticoid- and transplant-induced osteoporosis), Paget's disease of bone, and bone metastasis. Better understanding of BPs' effects on osteoblasts/osteocytes (e.g., preventing apoptosis) and differential distribution may further help explain anti-fracture benefit and bone quality effects. Lower affinity BPs (e.g., risedronate) may allow better access to osteocyte network. Effects of BPs on bone senescence, cancer cells apoptosis and prevention of cardiovascular calcifications may open new avenues for biogerontological research.