Cristina Fatone

A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules

This randomized controlled study was designed to test the efficacy and safety of percutaneous ultrasound (US)-guided laser photocoagulation (PLP) for treatment of subjects with compressive symptoms due to benign thyroid nodules and/or at high surgical risk. Twenty six subjects were randomized to the intervention (no. 13, age 68±3 yr, mean±SEM) or observation (no. 13, age 71±2 yr) groups. In the control group, the volume of nodules did not significantly change over the 30 week period of observation. In the intervention group, median nodule volume at baseline was 8.2 ml (range 2.8–26.9) and was not significantly different from that of the control group. Nodules decreased significantly (p<0.0001) by 22% after 2 weeks (6.5ml; range 2.4–16.7) and by 44% after 30 weeks (4.6 ml; range 0.69–14.2). Energy given was correlated (p<0.05) with the reduction of thyroid nodule volume. All patients tolerated the treatment well and reported relief from compressive and cosmetic complaints (p<0.05). At the time of enrolment 7/13 (54%) and 6/13 (46%) of patients in the intervention and control groups, respectively, had sub clinical hyperthyroidism. PLP normalized thyroid function at 6 and 30 weeks after treatment. In conclusion, PLP is a promising safe and effective procedure for treatment of benign thyroid nodules in patients at high surgical risk.

Meal intake similarly reduces circulating concentrations of octanoyl and total ghrelin in humans

Several data show that meal intake and nutritional status regulate circulating ghrelin concentrations in humans. Ghrelin mainly circulates in two different forms: octanoyl and des-octanoyl ghrelin. Most circulating ghrelin is des-octanoyl ghrelin which is considered inactive because it lacks endocrine activity. However, recent evidence suggests that des-octanoyl ghrelin exerts biological activity such as stimulation of adipogenesis, cardiovascular effects and control of cell growth. In healthy humans, although the total ghrelin concentration is known to peak before meals and to be reduced by food intake, no data are available about the octanoyl ghrelin response in the absorptive state. Therefore, after an overnight fast, we compared the effects of a mixed meal ingestion (meal study) or of additional 240 min fasting (control study) on plasma concentrations of octanoyl and total ghrelin in 6 healthy subjects (body mass index: 23±0.7). At baseline, octanoyl-ghrelin accounted for 3.15±0.2% of total circulating ghrelin without differences between the two sessions. A similar ratio was maintained in the absorptive state with no differences between the studies and basal values. Compared with control, meal intake significantly suppressed (nadir at 90 min) octanoyl and total ghrelin by 38±3 and 40±3% of basal values, respectively. In the meal study, multivariate analysis of variance showed that serum insulin best predicted plasma octanoyl-ghrelin concentrations accounting for 97% of its variation (r2=−0.97, p=0.0016). In conclusion: in healthy humans, octanoyl-ghrelin represents about 3–4% of total circula-ting ghrelin and this ratio is closely maintained in post-absorptive and absorptive states.

Two weekly sessions of combined aerobic and resistance exercise are sufficient to provide beneficial effects in subjects with Type 2 diabetes mellitus and metabolic syndrome

This study was performed to establish whether only 2 sessions per week of combined aerobic and resistance exercise are enough to reduce glycated hemoglobin (HbA1c) and to induce changes in skeletal muscle gene expression in Type 2 diabetes mellitus (DM2) subjects with metabolic syndrome. Eight DM2 subjects underwent a 1-yr exercise program consisting of 2 weekly sessions of 140 min that combined aerobic [at 55–70% of maximal oxygen uptake (VO2max)] and resistance circuit training [at 60–80% of 1 repetition maximum (RM)]. The training significantly improved VO2max) (from 33.5±3.8 ml/kg/min to 38.2±3.5 ml/kg/min, p=0.0085) and muscle strength (p<0.05). Changes over baseline were significant for HbA1c, reduced by 0.45% (p=0.0084), fasting blood glucose (from 8.8±1.5 to 6.9±2.2 mmol/l, p=0.0132), waist circumference (from 98.9±4.8 to 95.9±4.6 cm, p=0.0054), body weight (from 87.5±10.7 to 85.7±10.1 kg, p=0.0375), systolic blood pressure (from 137±15 to 126±8 mmHg, p=0.0455), total cholesterol (from 220±24 to 184±13 mg/dl, p=0.0057), and LDL-cholesterol (from 150±16 to 105±15 mg/dl, p=0.0004). Mitochondrial DNA/nuclear DNA ratio at 6 and 12 months did not change. There was a significant increase of mRNA of peroxisome proliferator-activated receptor (PPAR)-γ after 6 months of training(p=0.024); PPARα mRNA levels were significantly increased at 6 (p=0.035) and 12 months (p=0.044). The mRNA quantification of other genes measured [mitochondrially encoded cytochrome c oxidase subunit II (MTCO2), cytochrome c oxidase subunit Vb (COX5b), PPARγ coactivator 1α (PGC-1α), glucose transporter 4 (GLUT 4), forkhead transcription factor BOX O1 (FOXO-1), carnitine palmitoyltransferase 1 (CPT-1), lipoprotein lipase (LPL), and insulin receptor substrate 1 (IRS-1)] did not show significant changes at 6 and 12 months. This study suggests that a twice-per-week frequency of exercise is sufficient to improve glucose control and the expression of skeletal muscle PPARγ and PPARα in DM2 subjects with metabolic syndrome.

Mutual Interactions between Depression/Quality of Life and Adherence to a Multidisciplinary Lifestyle Intervention in Obesity

CONTEXT There is scarce knowledge of the interaction between depression/health-related quality of life (HRQOL) and lifestyle intervention in obesity. OBJECTIVE The aim of the study was to establish whether baseline mood status or HRQOL affects attendance to educational or exercise sessions and whether attendance to these two components of the intervention affects mood and/or HRQOL in obesity. DESIGN A total of 282 overweight/obese subjects (body mass index, 33.4 ± 5.9 kg/m(2); 103 males, 179 females; age, 53.8 ± 13.0 yr, mean ± sd) were consecutively enrolled in a multidisciplinary lifestyle intervention program. During the intensive phase of the intervention (3 months) patients were invited to attend eight educational sessions and 26 exercise group sessions. RESULTS Poor adherence to exercise sessions is predicted by baseline depressive mood (P =0.006) and by low levels of HRQOL (domains of Vitality, Physical Role Functioning, Social Functioning, Mental Composite, Physical Composite Scores) (P < 0.05). Attendance to the educational sessions is associated with beneficial effects of the lifestyle intervention on depressive symptoms (P < 0.013) and on several mental domains of HRQOL (P < 0.041); attendance to the exercise sessions predicted the beneficial effects on perceived general health (P < 0.021) and body mass index (P < 0.011). Attendance to both educational and exercise components is associated (P < 0.05) with the reductions in waist circumference, fat mass, and blood pressure observed after the intensive phase of the intervention. CONCLUSIONS Measurement of depressive mood and HRQOL before lifestyle intervention allows identification of patients at increased risk of attrition with exercise and educational sessions. Both the exercise and the educational sessions are essential for gaining the full spectrum of psychological and clinical benefits from multidisciplinary lifestyle intervention in obesity.

An innovative model for changing the lifestyles of persons with obesity and/or Type 2 diabetes mellitus

Aim: To describe the multidisciplinary lifestyle intervention model used in an experimental CURIAMO (Centro Universitario Ricerca Interdipartimentale Attività Motoria) project designed to validate the short- and long-term efficacy of the model in obesity and Type 2 diabetes. Research design and methods: Over a 3-yr period, about 1000 adults (70% diabetes-free and overweight or obese; 30% with Type 2 diabetes and overweight or obese). Inclusion criteria: Age range 18–80 yr, body mass index >27 kg/m2 with or without Type 2 diabetes mellitus; participants will be divided into three age groups (18–45, 45–65, 65–80 yr). The study duration will be from 5 to 6 yr: 1 yr of intervention followed by a mean follow-up period of 4 yr. In the first years, after a 4-month intensive lifestyle intervention, subjects will follow a maintenance programme. The intervention, which includes seven steps, involves the following experts: endocrinologists, sport medicine doctors or cardiologists, psychologists, dietitians, educators, nurses, exercise physiologists, and promoters of outdoor activities. Results: The main endpoint of the study is to measure the efficacy of the lifestyle improvement intervention, defined as a loss of at least 7% of body weight combined with an increase of at least 10 MET/h−1 week−1 of energy expenditure by physical activity, after 1 yr and during the follow-up. A cost/utility analysis of the model will be made in participants with diabetes. Conclusions: We expect that the CURIAMO model will be highly effective, and that the aim of the intervention will be achieved in more than 70% of cases.

Description of the EUROBIS Program: A Combination of an Epode Community-Based and a Clinical Care Intervention to Improve the Lifestyles of Children and Adolescents with Overweight or Obesity

The present paper describes the Epode Umbria Region Obesity Prevention Study (EUROBIS) and aims to implement the C.U.R.I.A.MO. model through the EPODE methodology. The main goal of the EUROBIS is to change the pendency of slope of the actual trend towards the increase in the yearly rates of childhood overweight and obesity in Umbria and to improve healthy lifestyles of children and their parents. The project is the first EPODE program to be performed in Italy. The aims of the Italian EUROBIS study are: (1) a community-based intervention program (CBP) carrying out activities in all primary schools of the Umbria Region and family settings as first step, to reverse the current obesity trend on a long-term basis, and (2) a clinical care program for childhood and adolescent by C.U.R.I.A.MO. model. C.U.R.I.A.MO. model is a multidisciplinary approach to improve three key aspects of healthy lifestyles: nutrition, exercise, and psychological aspects with the strategy of a family-based approach. The community-based intervention and clinical trial provide an innovative valuable model to address the childhood obesity prevention and treatment in Italy.

Physical Inactivity is the Main Cause of the Metabolic Syndrome

The metabolic syndrome is characterized by the coexistence of visceral adiposity, impaired fasting glucose or overt diabetes mellitus, reduced HDL cholesterol, and increased blood pressure and triglycerides. In Western and developing countries the prevalence of the metabolic syndrome is rising because the explosion of the twin epidemics: obesity and diabetes [1 5]. Visceral adiposity plays a key role in the subsequent manifestation of diabetes and of the full metabolic syndrome. The present article sustains the hypothesis that obesity, diabetes, and the metabolic syndrome are increasing mainly because people no longer need to be physically active in their daily lives [1 5].

Alternative indicators of metabolic control

Abstract This brief review will focus on indicators of metabolic control alternative to glucose, ketone body and lactate measurements, specifically reviewed in other articles of this issue. The effects of insulin on protein metabolism are summarized and, the potential clinical relevance of monitoring energy expenditure in diabetic subjects is discussed. Many studies have shown that maintaining a regular physical activity regimen improves quality of life, reduces the risk of mortality from all causes, prevents type 2 diabetes mellitus in subjects with impaired glucose tolerance, and enhances glucose control in subjects affected by type 2 diabetes mellitus. Monitoring energy expenditure is a novel approach to implement the non-pharmacological treatment of subjects with diabetes mellitus.

L’esercizio fisico e la funzione ipofisaria

RiassuntoLa pratica di attività motoria costituisce per l’organismo umano e animale uno dei più importanti stressor a cui l’organismo reagisce con una risposta biologica fisiologica e adattativa che coinvolge principalmente il sistema neuro-endocrino.

L’esercizio fisico come terapia del diabete di tipo 2

RiassuntoL’incremento esponenziale dell’obesità nel mondo ha determinato una diffusione epidemica del diabete mellito di tipo 2. La triade terapeutica “dieta, esercizio fisico e farmaci” è alla base di un’ottimale ed efficace gestione di questa patologia. La modifica dello stile di vita costituisce oggi l’unico strumento terapeutico efficace a lungo termine ed economicamente vantaggioso.