Anna Maria Barile

Background/Objectives: Poor nutritional status is common among hospitalized patients and may adversely affect the response to severe acute illness. We investigated the association between nutritional status at hospital admission and clinical outcomes in patients hospitalized with COVID-19 during the first two pandemic waves in Italy. Methods: This retrospective multicenter study included 1187 patients hospitalized with COVID-19 across nine Italian centers participating in the MODIeCOSe in Italia registry. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), and available anthropometric measures. The primary outcome was a composite of in-hospital death or transfer to an intensive care unit (ICU). Multivariable logistic regression was used to assess the independent association between nutritional status and outcome. Results: Overall, 275 patients (23.2%) experienced the composite adverse outcome. CONUT score was higher in patients with an adverse than in those with a favorable outcome (4.4 ± 2.3 vs. 3.4 ± 1.8; p < 0.001), whereas PNI did not differ significantly. Patients with an adverse outcome also had lower body weight, BMI, waist circumference, and waist-to-height ratio, although anthropometric data were available only in subsets of the cohort. In the main multivariable model adjusted for admission PaO₂/FiO₂ and relevant clinical covariates, higher CONUT remained independently associated with adverse outcome (OR 1.65, 95% CI 1.12–2.45 per 1-SD increase; p = 0.01). The association was similar in a sensitivity analysis excluding PaO₂/FiO₂ (OR 1.79, 95% CI 1.28–2.49; p < 0.001). Conclusions: A higher CONUT score at admission was independently associated with an increased risk of in-hospital death or ICU transfer, supporting its prognostic relevance as an immuno-nutritional index in hospitalized patients with COVID-19.

Background Prediabetes (PD) precedes type 2 diabetes (T2D), it can be easily recognized by fasting plasma glucose concentrations (FPG) or HbA1c or 2 h post glucose load glycemia, thereby enabling prevention strategies. We investigated the progression of PD to T2D in the ABCD study (Alimentazione, Benessere Cardiovascolare e Diabete -ISRCTN15840340) that included a representative cohort of adult people living in the Mediterranean area of Palermo (Italy). Materials and methods The ABCD cohort was enrolled in 2011 and re-evaluated in 2015. The FPG, HbA1c, physical activity level and dietary habits were investigated. In 2011 participants and their family doctors were informed about their health conditions and indications concerning realistic changes for a healthier lifestyle were provided. Results Complete information was obtained on 742 out of 1233 individuals. In 2011, the prevalence of PD was 30.7% of which 12.7% developed T2D and 43.9% reversed to normal glucose tolerance (NGT) at follow-up. In 2015, 106 previously NGT participants developed PD. The progression as to T2D as to PD were associated with age (P < 0.001) and sex (P < 0.001). Body weight, BMI, and waist circumference were higher in people with PD than in those without PD and even higher in PD that developed T2D (P < 0.001). A sedentary lifestyle was observed in the PD and NGT subgroups which developed T2D and PD, respectively. Daily energy intake decreased among people with PD who became NGT (P < 0.001) and increased in those who developed T2D (P < 0.05). The glycemic index of diet decreased in those PD people who became NGT and in those people who maintained NGT at follow-up. The MEDILITE score, that describes the Mediterranean pattern of diet, increased significantly in PD group that became NGT and in NGT group that maintained NGT at final observation. Conclusions This study suggests that improving individual motivation may be an effective strategy to promote healthier lifestyles. A more physically active lifestyle and Mediterranean dietary habits are associated with a reduction of central obesity, and with a favorable evolution of glucose tolerance in PD people. Clinical trial registration ISRCTN15840340

Background: Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. We aimed to investigate if the modality of nutritional treatment as standard oral (ON) or artificial enteral nutrition (AN), assigned by a dedicated nutritional team or not, influences survival in patients with OSCC. Moreover, given the difficulties in obtaining adequate nutritional evaluation in patients with OSCC we preliminary evaluated the magnetic resonance imaging volumetric reconstruction of posterior paraspinal muscles at the level of the third cervical vertebra (MRI-C3) as a tentative new approach to investigate sarcopenia.Methods: This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were retrospectively compared with a control group of 11 patients who were surgically treated for OSCC between January and December 2019 in the same unit of surgery, in the absence of a dedicated nutritional team. Upon discharge, the nutritional treatment consisted of ON or AN. In 2020–2023, industrially produced special medical food formulations were used rather than natural foods as it was in use in 2019; also, adequate protein supplements were assigned in order to reach the recommended protein intake of 1–0-1.2 g/kg ideal body weight. The MRI-C3 volumetric reconstruction was obtained in 16 patients.Findings: As per-protocol, the patients were categorized according to pre-surgery TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 85.7% in the control group (p < 0.001), with higher survival rates at follow-up in the control group (80.5% vs. 27.3%), therefore, the two historical groups were not comparable. Given the limited number of cases, all patients were included in a unique group. Advanced stages of OSCC (log-rank test, p < 0.001) and AN (p < 0.001) were independently associated with a lower survival rates. The 3–12 month post-surgery MRI_C3 volume increased in patients who received ON treatment and decreased in those who received AN treatment (p < 0.001).Conclusion: AN is associated with lower survival probability than ON in patients with OSCC. The MRI-C3 measurement of paravertebral muscles is a promising technique for detecting sarcopenia that needs to be confirmed by further studies including larger groups of patients.

Background: Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. Methods: This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were compared with a historical control group of 11 patients. The nutritional treatment consisted of standard oral (ON) or artificial nutrition (AN). Traditional measurements, including bioimpedance-derived body composition and volumetric reconstruction of the posterior paraspinal muscles at the C3 level based on magnetic resonance imaging (MRI-C3), were obtained in 16 patients to investigate sarcopenia. Results: The patients were categorized according to TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 90.9% in the control group (P

Background: Obesity is the result of energy intake (EI) chronically exceeding energy expenditure. However, the potential metabolic factors, including insulin resistance, remain unclear. This study longitudinally investigated factors associated with changes in body weight. Subjects: A cohort of 707 adults without diabetes were investigated at the 4-year follow-up visit. The habitual intake of energy and macronutrients during the past 12 months was assessed using a validated Food Frequency Questionnaire for the local population. Homeostatic model assessment of β-cell function and insulin resistance (HOMA-IR) was used as a surrogate measure of insulin resistance. Additionally, PNPLA3 was genotyped. Results: Eighty-seven participants were weight gainers (G; cutoff value = 5 kg), and 620 were non-gainers (NG). Initial anthropometric (G vs. NG: age, 44 ± 13 vs 51 ± 13 years, P < 0.001; body mass index, 27.8 ± 6.5 vs 28.1 ± 5.1 kg/m², P = ns; body weight, 76.7 ± 22.1 vs 74.2 ± 14.7 kg, P = ns; final body weight, 86.3 ± 23.7 vs 72.9 ± 14.2 kg, P < 0.001) and diet characteristics, as well as insulin concentrations and HOMA-IR values, were similar in both groups. Four years later, G showed significantly increased EI, insulin concentrations, and HOMA-IR values. G had a higher prevalence of the PNPLA3 CG and GG alleles than NG (P < 0.05). The presence of G was independently associated with age (OR = 1.031), EI change (OR = 2.257), and unfavorable alleles of PNPLA3 gene (OR = 1.700). Final body mass index, waist circumference, and EI were independently associated with final HOMA-IR (P < 0.001). Conclusions: EI is associated with body weight gain, and genetic factors may influence the energy balance. Insulin resistance is a consequence of weight gain, suggesting a possible intracellular protective mechanism against substrate overflow. Clinical trial registration: ISRCTN15840340.

CrossFit is a high-intensity training discipline increasingly practiced in recent years. Specific nutritional approaches are usually recommended to maximize performance and improve body composition in high-intensity training regimens; notwithstanding, to date there are no targeted nutritional recommendations for CrossFit athletes. The Mediterranean Diet (MD) is a diet approach with a well-designed proportion of macronutrients, using only available/seasonal food of the Mediterranean area, whose health benefits are well demonstrated. No studies have evaluated this dietary strategy among CrossFit athletes and practitioners; for this reason, we tested the effects of 8 weeks of MD on CrossFit athletes’ performance and body composition. Participants were assigned to two groups: a diet group (DG) in which participants performed CrossFit training plus MD, and a control group (CG) in which participants partook in the CrossFit training, continuing their habitual diet. Participants were tested before and after the 8 weeks of intervention. At the end of the study, no significant difference was noted in participants’ body composition, whereas improvements in anaerobic power, explosive strength of the lower limbs, and CrossFit-specific performance were observed only in the DG. Our results suggest that adopting a MD in CrossFit athletes/practitioners could be a useful strategy to improve specific strength, endurance, and anaerobic capacity while maintaining overall body composition.

Background: Vitamin D plays a pivotal role in calcium and phosphorus metabolism, also influencing bone tissue. Several studies have reported that vitamin D blood levels were significantly lower in people with obesity, probably due to its uptake by the adipose tissue. Clinical studies that investigated the changes of circulating levels of vitamin D following weight loss reported controversial data. A very low-calorie ketogenic diet is acknowledged as a reliable treatment to achieve a rapid weight loss. Therefore, we investigated the effect of weight loss, consequent to a very low-calorie ketogenic diet, on vitamin D blood concentrations. Methods: A cohort of 31 people with obesity underwent a very low-calorie ketogenic diet for 10–12 weeks. The serum concentrations of vitamin D, parathormone, calcium and phosphorous were measured before and after weight loss; they were compared to a control group of 20 non-obese, non-diabetic, age- and gender-matched persons. Results: Patients with obesity had a higher habitual intake of vitamin D than the control group (p < 0.05). However, the vitamin D blood levels of the obese group were significantly lower than those of the control group (p < 0.005) and they increased after weight loss (p < 0.001). At baseline, vitamin D blood concentrations of the persons with obesity were significantly correlated with both fat mass–kg (r = −0.40; p < 0.05) and body mass index (r = −0.47; p < 0.01). Following very low-calorie ketogenic diet, the change in vitamin D serum concentrations was correlated only with the change in fat mass–kg (r = −0.43; p < 0.01). Conclusion: This study confirmed that patients with obesity have lower vitamin D levels that normalize after significant weight loss, supporting the hypothesis that vitamin D is stored in the adipose tissue and released following weight loss.

Background: Cholesterol has a pivotal role in human physiology, exerting both structural and functional activity. However, higher blood cholesterol levels, especially low-density lipoprotein cholesterol (LDL-C), are a major cardiovascular risk factor. Therefore, special attention has been given to the effect of dietary factors in influencing LDL-C blood levels. In particular, much research has focused on dairy products, since they are a main component of different dietary patterns worldwide. A large body of evidence did not support the hypothesis that dairy products significantly increase circulating LDL-C, but no definitive data are available. Hence, we aimed to assess the relationships among LDL-C, habitual dairy food intake and anthropometric variables in a cohort representative of the general population in a Mediterranean area. Methods: We evaluated 802 healthy adults included in the ABCD_2 (Alimentazione, Benessere Cardiovascolare e Diabete) study (ISRCTN15840340), a longitudinal observational single-center study of a cohort representative of the general population of Palermo, Sicily. The habitual intake of dairy products was assessed with a validated food frequency questionnaire, and LDL-C serum levels and several anthropometric parameters were measured. Results: The group with high LDL-C serum concentrations (≥130 vs. 2 = 0.94) showed that LDL-C blood levels were significantly associated with the habitual intake of milk (p < 0.005) and ricotta cheese (p < 0.001) and with BMI (p < 0.001). Conclusion: Our study reported that total dairy food consumption was not correlated with LDL-C blood levels. However, multivariate analyses showed an inverse association between serum LDL-C and milk intake as well as a positive association between ricotta cheese intake and LDL-C concentrations. More studies are needed to better characterize the relationship between dairy products and circulating LDL-C.