Simona Bertoli

Background: Food craving (FC) is an established predictor of obesity. However, its role in weight management is insufficiently addressed in routine clinical practice. Methods: This retrospective study included adults with obesity, stratified by FC status, to compare the effectiveness of semaglutide plus hypocaloric diet (semaglutide group) versus hypocaloric diet alone (control group) in reducing body weight (BW). Assessments were conducted at baseline (T0), 3 months (T3), and 6 months (T6). The primary outcome was the between-group comparison of changes in BW from baseline at T3 and T6, also stratified by FC status. Secondary outcomes included changes in body mass index (BMI) and waist circumference (WC). Results: 120 patients with obesity (mean age ± SD: 51.0 ± 15.9 years; 70% female) were included. Of these, 67 (56%) received semaglutide plus hypocaloric diet and 53 (44%) diet alone. FC was present in 53% of patients and was more frequent in women and younger individuals. BW, BMI, and WC significantly decreased in both semaglutide and control group over time (all p 2 ; p=0.0015), and WC (-2.3 cm; p=0.03) compared with controls. Differences in BW reduction were maintained across patients with FC (-3.1 kg, p=0.03) and without FC (-3.4 kg; p=0.007). Conclusion: Semaglutide plus hypocaloric diet treatment is more effective than hypocaloric diet alone for weight reduction in real-world clinical practice, even in the presence of FC. Assessing FC may support more individualized obesity management strategies.

Background: Relative muscular function has emerged as a clinically relevant marker of muscle quality and health in obesity. However, limited evidence is available regarding age-related associations between relative handgrip strength and body composition outcomes in women with obesity. Methods: This cross-sectional study included 419 female outpatients with obesity (age range 18–80 years). Participants were stratified into age groups according to sample distribution. Body composition was assessed using Body Mass Index (BMI), waist circumference (WC), fat mass percentage (FM%), fat-free mass (FFM%), and waist-to-height ratio (WHtR). Relative handgrip strength (relative HST) was assessed together with balance performance (M-BESS), lower-body functional performance (5STS), and movement quality (FMS CS). Kruskal–Wallis analyses were performed for all functional measures. Age-stratified linear regressions and pooled models including relative HST × age-group interaction terms were used to examine associations with body composition outcomes; whole-sample models were additionally adjusted for age and physical activity level (IPAQ-SF). Results: Significant differences across groups were observed for BMI (p = 0.0006), FM% (p = 0.0308), relative HST (p = 0.0002), M-BESS score (p < 0.0001), and 5STS performance (p < 0.0001). Relative HST was significantly associated with lower FM% and higher FFM% across all age groups. In addition, significant associations with lower WC were observed in middle-aged and older women. However, pooled interaction analyses provided no evidence that the associations between relative HST and FM%, FFM%, WC, or WHtR differed significantly across age groups (p of all interactions > 0.29). Conclusions: Relative HST was associated with body composition outcomes across different age groups of women with obesity, but the strength of these associations did not differ significantly by age group. These findings suggest that relative HST may provide clinically relevant information beyond traditional anthropometric measures. However, prospective studies are needed to determine its potential clinical utility in individualized, person-centered obesity management.

Background: Obesity and Binge Eating Disorder (BED) are common comorbidities in type 2 diabetes mellitus (T2DM), often complicating disease management. Self-efficacy—the belief in one’s ability to manage diabetes—has been shown to influence self-care behaviours and outcomes. This study aimed to assess diabetes management self-efficacy among adults with obesity and T2DM undergoing multidisciplinary rehabilitation, focusing on the impact of BMI, BED, and gender. Methods: A cross-sectional study was conducted with 137 adults (BMI ≥ 30 kg/m²) with T2DM admitted to a residential rehabilitation center. Self-efficacy was measured using the Italian Diabetes Management Self-Efficacy Scale (IT-DMSES), which evaluates confidence in lifestyle and disease management tasks. Data on BMI, BED status, age, and gender were collected. Results: The mean IT-DMSES score was 116.7 ± 23.7, with females scoring slightly higher than males (120.3 ± 24.8 vs. 112.5 ± 22.0, p = 0.057). Higher BMI was significantly associated with lower self-efficacy, particularly in lifestyle (R = 0.282, p = 0.002) and disease management (R = 0.271, p = 0.002) domains. Several individual items, including those related to dietary control and medication adherence, showed strong negative correlations with BMI. BED independently predicted lower self-efficacy on item 13 (emotional eating) (Estimate = −3.18, p = 0.001), even after adjusting for BMI, age, and gender. No significant interactions between gender and BED were observed for overall self-efficacy or domain scores. Conclusions: Although the exploratory nature of the findings requires confirmation, our results underline the independent association of low self-efficacy with BED.

Background: The Ketogenic Diet (KD) has been proposed as an adjunct to standard therapy for gliomas by targeting tumor glycolysis. We systematically reviewed evidence on KD interventions in patients with glioma across multiple outcomes. Methods: Following Cochrane guidelines, we searched MEDLINE, Embase, and Cochrane Library (until 1 February 2025) for studies on humans with glioma treated with any KD versus usual care or other diets. Outcomes included overall survival (OS) and progression-free survival (PFS), quality of life (QoL), biochemical markers (glucose, ketones, glucose–ketone index GKI), anthropometric measures, safety, and tolerability. All study designs were eligible. The quality of the studies was assessed with JBI tools. Data were narratively synthesized due to heterogeneity. The PROSPERO registration is CRD42024547388. Results: Twenty-three studies (306 patients) were included: two RCTs, 11 quasi-experimental studies, six case series, and four case reports. Dietary interventions included classic KD, modified KD, medium-chain triglyceride KD, and Modified Atkins Diet, sometimes combined with fasting. The overall dropout was 20.3%, mainly due to dietary restrictiveness, disease progression, adverse effects, or QoL concerns. Survival results were inconsistent: RCTs showed no significant OS/PFS differences versus controls, although exploratory analyses suggested better outcomes with lower glucose levels. Ketosis was commonly achieved; glucose reductions were variable, and GKI was rarely reported, with target values seldom reached outside fasting periods. Weight/BMI generally decreased modestly or remained stable; adverse events were mostly mild and tolerability was acceptable. Conclusions: Evidence for KDs in glioma patients is heterogeneous and limited. Although ketosis and safety are achievable, survival or QoL benefits remain unproven. Given the methodological challenges, the clinical complexity, and the promising potential of the Ketogenic Diet, further well-designed studies are needed to clarify its clinical utility in glioma treatment.

Background/Objectives: To investigate how β-cell glucose sensitivity, insulin clearance, and insulin sensitivity interact to determine glucose tolerance in a population without overt diabetes. Methods: We analyzed data from 54 individuals without diabetes (age: 44 years, IQR: 27–56; 63% females; BMI: 24.5 kg/m², IQR: 21.9–28.7; HbA1c 33.26 mmol/mol, IQR: 32.13–35.51) undergoing a 3-h OGTT. β-cell glucose sensitivity, insulin clearance, and insulin sensitivity were assessed via modeling of OGTT data. Their relationship with glucose tolerance was evaluated through linear regression models. Results: β-cell glucose sensitivity strongly predicted glucose tolerance during the OGTT (IQR increase effect: −87 mg/dL; 95% CI: −141, −32; p = 0.003) but not fasting glucose (p = 0.4). Patients with lower β-cell glucose sensitivity showed the widest range of glucose tolerance during the OGTT, some approaching diabetic levels whereas others tolerating glucose well; insulin sensitivity was the strongest determinant of this variance (IQR increase effect: −49 mg/dL; 95% CI: −68, −31; p < 0.001) significantly influencing the relationship between β-cell glucose sensitivity and glucose tolerance (interaction term p = 0.035). Conversely, insulin clearance did not show a statistically significant association with mean glucose levels during the OGTT (β: 4.2; 95% CI: −8.0, 16; p = 0.5). However, a non-linear relationship between insulin clearance and β-cell glucose sensitivity was identified, and three distinct metabolic subgroups were defined, highlighting the heterogeneity underlying the development of dysglycemia. Conclusions: β-cell glucose sensitivity is the primary determinant of glucose tolerance during an oral glucose challenge. While high β-cell glucose sensitivity often overcomes low insulin sensitivity, the latter becomes crucial when β-cell glucose sensitivity is low. The identification of distinct metabolic profiles, related to insulin secretion and clearance, highlights the heterogeneity of the transition from glucose tolerance to dysglycemia.

Background: Anemia is a widespread global health issue. Hemoglobin (Hb) concentration measurement remains the most common method for anemia screening and diagnosis. In recent years, there has been growing interest in the development of noninvasive point-of-care technologies that eliminate the need for blood sampling. Objective: This pilot study explores the feasibility of using a noncontact photoplethysmography–based mobile app for Hb monitoring. Methods: Adult volunteers aged 18 years and older, of both sexes, were consecutively recruited. Participants were seated and allowed a 2-minute rest before measurements. During testing, they faced a smartphone running comestai.app , which used the front-facing camera to capture facial videos. Simultaneous readings were collected for Hb over approximately 90 seconds using the app. Ambient lighting was standardized for all remote photoplethysmography recordings. No medical decisions were made based on the app-generated data. A complete blood count, including Hb levels, was used as a reference for comparison with the data collected using comestai.app. Results: A total of 555 (female: n=313, 56.4%; male: n=242, 43.6%) individuals participated in the study. The app achieved a mean absolute error of 1.46, a mean absolute percentage error of 11.26, a mean error of −0.67, and a root mean square error of 1.88. The Bland-Altman plot evaluated the agreement between the app-based and laboratory-based Hb measurements, with the mean difference between the 2 methods being −0.70 g/dL. The method demonstrated an overall accuracy of 75%. The area under the curve was 0.701 (95% CI 0.655-0.745). Conclusions: Comestai.app offers an innovative approach to wellness monitoring by providing noninvasive Hb estimation using the smartphone’s front-facing camera. Continued development, including algorithmic refinement and larger-scale validation in diverse populations, will be key to enhancing accuracy and broadening its utility. By leveraging the ubiquity of smartphones, comestai.app contributes meaningfully to the democratization of health monitoring and the promotion of proactive self-care.

Objective: Since specific bioelectrical reference values for Italian adults are lacking, this study aims to define specific values and test their suitability in pathological cases and athletes. Methods: A sample of 1049 Italian individuals (441 men, 608 women) aged 30–65 years was considered. Competitive athletes (bodybuilding, streetlifting and tennis) were identified within the general sample, and an independent group of individuals with obesity or anorexia nervosa was analyzed for comparison. Anthropometric (weight, kg; stature, mid-upper arm, waist and calf circumferences; cm) and bioelectrical (resistance and reactance, at 50 kHz) variables were taken. Resistivity, (Rsp, Ωcm), reactivity (Xcsp, Ωcm), impedivity (Zsp, Ωcm) and phase angle (PhA, °) were calculated. Two-way ANOVA and Hotelling’s T² test were applied to assess group differences. These data were then pooled with existing datasets to create a comprehensive reference for individuals aged 18 to 100 years. Results: The specific bioelectrical variables were: Rsp = 352.3 ± 55.5, Xcsp = 41.8 ± 9.1, PhA = 6.8 ± 1.0, r (Rsp, Xcsp) = 0.67 (men); Rsp = 384.9 ± 71.2, Xcsp = 40.7 ± 9.4, PhA = 6.1 ± 1.0, r (Rsp, Xcsp) = 0.72 (women). Men showed higher PhA values (p < 0.001), reflecting higher muscle mass and quality, and shorter vectors (p < 0.001), indicative of lower relative fat mass (FM%), than women. Advancing age was associated with lower PhA and longer vectors (p < 0.001). Bioelectrical vectors of individuals with obesity or anorexia nervosa were outside the 95% variability, indicating abnormal values of FM%, whereas those of athletes fell within the lower left quadrant. Conclusions: The specific tolerance ellipses for the Italian adult population fill a gap in the existing literature, providing essential new tools for evaluating body composition in clinical and sports settings, and for comparative analyses.

Background Chronotype reflects an individual’s intrinsic circadian preference for the timing of daily behaviors, including sleep, eating, and physical activity. It influences not only biological rhythms but also lifestyle patterns that may impact metabolic health. In the context of bariatric surgery, numerous factors may affect postoperative outcomes such as weight loss and the risk of weight regain. Given the growing interest in chronobiology and its relevance to obesity management, this study aimed to explore whether chronotype is significantly associated with key weight loss outcomes following bariatric surgery at 6 and 12 months post-intervention. Methods A total of 263 patients underwent bariatric surgery at a single center. Baseline assessments included anthropometric, biochemical, and behavioral evaluations, including chronotype categorization. Postoperative outcomes at 6 and 12 months included absolute weight, BMI, percentage of initial body weight loss (%IBWL), and percentage of excess body weight loss (%EBWL). Results There was no significant difference among the three different chronotypes (evening, intermediate, and morning chronotype) in terms of absolute weight, BMI, %EWL and %IBWL at 6 and 12 months after surgery. Conclusions Our results suggest that chronotype does not seem to play a critical role in weight loss outcomes in bariatric surgery patients, characterized by severe obesity. Further studies are needed to more thoroughly assess the impact of chronotype on bariatric surgery outcomes and a more detailed characterization of chronotype itself in these patients could be decisive.

Objective: This prospective, observational study examined the efficacy of liraglutide in subjects with obesity who did not experience early weight loss during a behavioral intervention in a real‐world setting. Methods: The weight loss intervention lasted for 12 weeks, and at Week 6, we offered liraglutide to subjects who had lost less than 2.5% of their body weight (early unresponder (eUR)). Before and after the intervention, anthropometry, body composition, blood pressure, level of physical activity, nutrition knowledge, quality of life, and daytime sleepiness were assessed. Results: Of 174 participants, 78 subjects were classified as early unresponders: 21 (27%) agreed to start liraglutide therapy (eUR‐LT), and 57 declined (eUR‐NLT), primarily due to the out‐of‐pocket cost. Liraglutide was well tolerated. Four subjects complained of nausea and two of epigastralgia. During the 6–12‐week period, the weight loss was −3.5 ± 1.8 kg (−3.2%) in the eUR‐LT group and −1.3 ± 1.6 kg (−1.4%) in the eUR‐NLT, p < 0.001. Using liraglutide therapy, baseline body mass index, sex, age, and weight change at 6 weeks as independent variables, the multivariate regression analysis found that only liraglutide therapy was significantly associated with weight loss from Week 6 to Week 12 ( p < 0.001). After 12 weeks, total weight loss was −6.0 ± 2.4 kg (−5.3%) in group eUR‐LT, −2.4 ± 1.9 kg (−2.4%) in group eUR‐NLT, and −6.2 ± 2.3 kg (−6.3%) in group eR. In the eUR‐LT group, 66.7% lost ≥ 5% of the initial weight; in group eUR‐NLT, 14%; and in group eR, 72.9%. Conclusion: Liraglutide therapy is beneficial for individuals with obesity who do not respond early to lifestyle intervention. However, the high cost of the drug remains a barrier to its use.