Tiziana Filardi

Background: This pilot study evaluated changes in eating behavior, appetite, and dietary habits during semaglutide or tirzepatide treatment in adults with obesity. Methods: In this prospective observational study, 38 non-diabetic adults with obesity (mean age 56.1 ± 11.3 years; 73.7% female; BMI 32.7 ± 4.5 kg/m²) initiating semaglutide (n = 21) or tirzepatide (n = 17) were assessed at baseline and after 3 months. Clinical parameters and self-reported eating behaviors were evaluated using standardized measurements and a study-specific questionnaire. Results: Mean body weight decreased by 7.2 ± 4.9 kg (p < 0.001), and systolic blood pressure decreased by 6.1 ± 6.3 mm Hg (p < 0.001). Cravings for sweet and savory foods, difficulty resisting hunger between meals, and daily meal frequency decreased, whereas perceived meal-induced satiety increased (all p ≤ 0.005). A substantial reduction in meal portion size was reported by 84.2% of participants. Reported food-group consumption changed, but improved overall dietary quality was not established. Conclusions: Over 3 months, incretin-based treatment was accompanied by weight loss and changes in self-reported eating behavior. The observational design, absence of a control group, and unvalidated questionnaire limit interpretation. Larger controlled studies using validated measures are warranted.

Background/Objectives: Gestational diabetes mellitus (GDM) is a metabolic disorder associated with an amplified risk of unfavorable pregnancy outcomes. This study aimed to compare clinical characteristics and pregnancy outcomes among GDM patients belonging to different ethnic groups. Patients and Methods: This retrospective analysis included n = 466 women with GDM (n = 167 Asian; n = 299 European). The impact of ethnicity on pregnancy outcomes was evaluated using multivariable logistic regression models, adjusting for confounding factors. Results: Asians were younger than Europeans (p < 0.001) and more frequently multiparous (p = 0.003). Fasting glucose at OGTT was higher in Asians, as well as HbA1c values at the end of pregnancy (p = 0.010 and p = 0.001, respectively). Asian ethnicity was associated with an increased likelihood of insulin therapy (OR = 3.36 [1.72–6.58] 95% CI, p < 0.001), in the adjusted model. The gestational week of delivery was lower in Asians compared to Europeans (p = 0.007). The Asian group had a higher occurrence of cesarean section (p = 0.048) and emergency cesarean section (p = 0.006) compared to the European group. Delivery complications were more frequent in the Asian cohort, adjusting for confounders (OR = 2.19 [1.11–4.32] 95% CI, p = 0.023). Newborns of the Asian group were more frequently small for gestational age (SGA) in adjusted models (OR = 2.36 [1.08–5.15] 95% CI, p = 0.031). Conclusions: Worse GDM outcomes were observed in the Asian cohort compared to the European cohort. Identifying risk factors for GDM-related complications is crucial for developing tailored interventions and reducing the overall disease burden.

Gestational diabetes mellitus (GDM) leads to increased lifelong cardiometabolic risk in both mothers and their offspring. The identification of effective strategies to contain the future risk of type 2 diabetes (T2D) and cardiovascular disease (CVD) is of utmost importance to reduce the burden of the disease. Breastfeeding (BF) is effective in reducing short- and long-term child morbidity. In recent years, BF has emerged as a candidate low-cost intervention to prevent future cardiometabolic complications both in mothers and infants exposed to GDM. The aim of this review is to provide an overview of the evidence about the possible metabolic benefits of BF for both mothers with a history of GDM and their offspring. Increasing evidence supports the positive effects of exclusive BF over formula feeding (FF) or mixed feeding on glucose homeostasis and the lipid profile in women with previous GDM in the early postpartum period. Studies with a longer observation suggest clear benefits of intensive and longer BF on the risk of diabetes and prediabetes in mothers after adjustment for confounders. In regards to infants, in most studies, the intensity and duration of BF are positively associated with slower infant growth curves compared with FF, indicating that the positive effect of BF on growth trends might contrast the increased risk of obesity and metabolic diseases observed in infants exposed to GDM. Considering these findings, a global effort should be made to support BF practice to possibly reduce cardiometabolic morbidity after GDM.

Background/Objectives: Growth differentiation factor-15 (GDF-15) is a component of the transforming growth factor beta (TGF-β) family that may act as regulator of inflammation. A possible protective role of GDF-15 against glucose alterations has been hypothesized. The aim of this pilot study was to evaluate the relationship between a circulating concentration of GDF-15 and metabolic/inflammatory parameters, as well as with adverse perinatal outcomes in patients with gestational diabetes mellitus (GDM). Methods: Twenty-four (n = 24) patients with GDM and n = 29 age-matched pregnant women with normal glucose tolerance (NGT) were recruited at the third trimester of gestation. Clinical and biochemical parameters were collected. Serum levels of GDF-15, small dense low density lipoprotein cholesterol (sdLDL), interleukin 6 (IL-6), a Soluble Urokinase Plasminogen Activator Receptor (su-PAR) were measured by an enzyme-linked immunosorbent assay kit. Fetal ultrasound parameters, maternal, delivery, and perinatal outcomes, were assessed. Results: Serum GDF-15 did not differ between GDM and NGT (p = 0.286). However, in linear regression analysis, a significant negative association was observed between GDF-15 and fetal weight percentile at the third trimester, only in patients with GDM (p = 0.013), even after adjustment for age and pre-pregnancy BMI (p = 0.029). GDF-15 positively associated with IL-6, adjusting for pre-pregnancy BMI (p = 0.047). Pregnant women with adverse perinatal outcomes had higher levels of GDF-15 (p = 0.043). In the regression model, higher levels of GDF-15 were associated with an increased likelihood of adverse perinatal outcomes after adjustment for age and pre-pregnancy BMI (p = 0.044). Conclusions: Besides its action as regulator of inflammation, GDF-15 might have a possible protective role against hyperglycemia-related excessive fetal growth in GDM. GDF-15 circulating levels might also be related to adverse perinatal outcomes.

Background: Gender differences in metabolic response to lifestyle interventions remain poorly explored. This study aimed to evaluate the impact of a six-month Mediterranean diet (MD) intervention combined with regular physical activity on metabolic parameters in overweight adults. Methods: A prospective cohort study was conducted in an obesity clinic in Rome, Italy, involving overweight adults (BMI ≥ 25 kg/m²) motivated to improve their lifestyle. Participants (n = 205; 107 men and 98 women) self-selected into physical activity groups (aerobic, anaerobic, combined or no activity). Gender-specific metabolic changes were assessed, including lipid profiles, liver markers and fasting glucose. Results: Significant gender differences in metabolic results were observed. Men showed greater reductions in total cholesterol (TC) and LDL, as well as significant reductions in alanine aminotransferase (ALT). Women showed a significant increase in HDL cholesterol. Fasting blood glucose decreased significantly in both sexes, with no differences between the sexes. Activity-specific analysis revealed that anaerobic activity significantly improved lipid metabolism in men, while aerobic activity produced the greatest benefits in women, including increased HDL and improved liver marker profiles. Conclusions: Therapeutic strategies combining MD and physical activity must take into account gender-specific physiological differences and the type of sport activity to optimise metabolic benefits. Personalised approaches may improve the management of cardiovascular risk factors in overweight individuals. Study registration: This study is registered on ClinicalTrials.gov (NCT06661330).

Background/Objectives: Obesity is a global health problem with significant chronic disease risks. This study examined gender differences in eating behaviour, body composition, eating frequency and time of hunger in an Italian cohort with obesity (BMI ≥ 30) to inform gender-specific management strategies. Methods: A retrospective analysis of 720 adults (51.5% female, mean age 44.4 ± 13.8 years) assessed body composition and eating behaviour using principal component analysis (PCA) to classify eating profiles (structured, irregular, social and disordered/impulsive eaters). Results: Males showed higher weight, abdominal circumference and fat mass, while females showed higher fat mass percentages (p < 0.001). Gender differences were observed in the frequency of meals (e.g., 54.7% of males and 64.7% of females consumed 4–5 meals per day, p = 0.0018) and the time of hunger (males: before dinner; females: morning hunger, p = 0.005). The PCA profiles revealed that the ‘structured eaters’ had a healthier body composition, whereas the ‘disordered/impulsive eaters’ had a higher fat mass. Irregular eaters were predominantly male (41.0%), while disordered eaters were predominantly female (39.9%) (p = 0.0016). Conclusions: Gender-specific eating patterns influence obesity outcomes. Structured eating was associated with healthier profiles, whereas impulsive or irregular patterns were related to higher fat mass. The retrospective design and non-validated questionnaire for dietary behaviour assessment limit generalisability, warranting further research for tailored interventions. Registration: ClinicalTrials.gov (NCT06654674).

Aims: To evaluate the relationship between SARS-CoV-2 infection and autoimmunity in type 1 diabetes (T1D) and SARS-CoV-2 antibodies frequency at diagnosis of T1D during pandemic. Methods: The presence of T1D-specific autoimmunity was evaluated in a cohort of 99 children and adolescents without diabetes that contracted SARS-CoV-2 infection. Moreover, the frequency of IgM- and IgG-SARS-CoV-2 antibodies was evaluated in 41 newly diagnosed T1D patients not yet vaccinated against SARS-CoV-2 disease, collected during the pandemic, compared to healthy subjects (CTRL). Results: None of the 99 patients that contracted SARS-CoV-2 infection during the pandemic period was found positive for T1D autoantibodies. The frequency of SARS-CoV-2 antibodies was not significantly different in patients newly diagnosed with T1D (12.2%), compared with CTRL (8.4%). Among SARS-CoV-2 antibody positive T1D patients, 80% were target of diabetes autoantibodies and 60% had another concomitant autoimmune disease. Among the CTRL subjects positive for SARS-CoV-2Abs (n = 10), none was found positive for T1D autoantibodies. Conclusions: The results of the present study do not confirm, at least in the short term, a role of COVID-19 as a potential trigger of T1D autoimmunity and do not provide evidence of an increased frequency of SARS-CoV-2 antibodies in newly diagnosed T1D patients in comparison with healthy population.

Type 2 diabetes mellitus (T2DM) is associated with an increased fracture risk. Our study aimed to explore differences in bone alterations between T2DM women and controls and to assess clinical predictors of bone impairment in T2DM. For this observational case control study, we recruited 126 T2DM female patients and 117 non-diabetic, age- and BMI-comparable women, who underwent clinical examination, routine biochemistry and dual-energy X-ray absorptiometry (DXA) scans for bone mineral density (BMD) and trabecular bone score (TBS) assessment-derived indexes. These were correlated to metabolic parameters, such as glycemic control and lipid profile, by bivariate analyses, and significant variables were entered in multivariate adjusted models to detect independent determinants of altered bone status in diabetes. The T2DM patients were less represented in the normal bone category compared with controls (5% vs. 12%; p = 0.04); T2DM was associated with low TBS (OR: 2.47, C.I. 95%: 1.19–5.16, p = 0.016) in a regression model adjusted for age, menopausal status and BMI. In women with T2DM, TBS directly correlated with plasma high-density lipoprotein cholesterol (HDL-c) (p = 0.029) and vitamin D (p = 0.017) levels. An inverse association was observed with menopausal status (p < 0.001), metabolic syndrome (p = 0.014), BMI (p = 0.005), and waist circumference (p < 0.001). In the multivariate regression analysis, lower HDL-c represented the main predictor of altered bone quality in T2DM, regardless of age, menopausal status, BMI, waist circumference, statin treatment, physical activity, and vitamin D (p = 0.029; R² = 0.47), which likely underlies common pathways between metabolic disease and bone health in diabetes.

Purpose Type 2 diabetes (T2D) is a chronic disease which leads to high morbidity, mortality and healthcare costs. Although relevant gains have been made towards evidence-based diabetes care, patients with T2D still experience diabetes complications and excess mortality risk, owing to multiple contributors, including non-clinical factors. The aim of this paper is to provide an overview of the main social determinants of vulnerabilities, which are known to have a relevant impact on T2D outcomes. Results As chronic diseases are under the influence of social inequalities, medicine and sociology are intertwined in the attempt to understand, explain and address them. There is robust evidence about a clear relationship between social determinants of health (SDOH), such as socio-economic status (occupation, education, income), and the likelihood of developing T2D and its complications. Furthermore, the uncontrolled widespread of T2D in urban areas, mainly among suburban communities, suggests that cities might act as amplifiers of SDOH, enhancing inequalities in health care and, therefore, life expectancy. Conclusion In light of the strong association between socio-cultural aspects and T2D outcomes, a global action is needed to raise awareness about disparities in diabetes prevention and treatment to reduce the burden of the disease.

Background and Objectives: The prevalence of gestational diabetes mellitus (GDM) significantly varies across different ethnic groups. In particular, Africans, Latinos, Asians and Pacific Islanders are the ethnic groups with the highest risk of GDM. The aim of this study was to evaluate the impact of ethnicity on pregnancy outcomes in GDM. Patients and Methods: n = 399 patients with GDM were enrolled, n = 76 patients of high-risk ethnicity (HR-GDM), and n = 323 of low-risk ethnicity (LR-GDM). Clinical and biochemical parameters were collected during pregnancy until delivery. Fetal and maternal short-term outcomes were evaluated. Results: HR-GDM had significantly higher values of glycosylated hemoglobin checked at 26–29 weeks of gestation (p < 0.001). Gestational age at delivery was significantly lower in HR-GDM (p = 0.03). The prevalence of impaired fetal growth was significantly higher in HR-GDM than LR-GDM (p = 0.009). In logistic regression analysis, the likelihood of impaired fetal growth was seven times higher in HR-GDM than in LR-GDM, after adjustment for pre-pregnancy BMI and gestational weight gain (OR = 7.1 [2.0–25.7] 95% CI, p = 0.003). Conclusions: HR-GDM had worse pregnancy outcomes compared with LR-GDM. An ethnicity-tailored clinical approach might be effective in reducing adverse outcomes in GDM.