M. Fadda

Consuming more of daily caloric intake at dinner predisposes to obesity. A 6-year population-based prospective cohort study

Background/Objectives It has been hypothesized that assuming most of the caloric intake later in the day leads to metabolic disadvantages, but few studies are available on this topic. Aim of our study was to prospectively examine whether eating more of the daily caloric intake at dinner leads to an increased risk of obesity, hyperglycemia, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD). Subjects/Methods 1245 non-obese, non-diabetic middle-aged adults from a population-based cohort underwent a 3-day food record questionnaire at enrollment. Anthropometric values, blood pressure, blood metabolic variables, and estimated liver fat were measured at baseline and at 6-year follow-up. Design Prospective cohort study. Results Subjects were divided according to tertiles of percent daily caloric intake at dinner. A significant increase in the incidence rate of obesity (from 4.7 to 11.4%), metabolic syndrome (from 11.1 to 16.1%), and estimated NAFLD (from 16.5 to 23.8%) was observed from the lower to higher tertile. In a multiple logistic regression model adjusted for multiple covariates, subjects in the highest tertile showed an increased risk of developing obesity (OR = 2.33; 95% CI 1.17–4.65; p = 0.02), metabolic syndrome (OR = 1.52; 95% CI 1.01–2.30; p = 0.04), and NAFLD (OR = 1.56; 95% CI 1.10–2.22; p = 0.01). Conclusions Consuming more of the daily energy intake at dinner is associated with an increased risk of obesity, metabolic syndrome, and NAFLD.

Is the timing of caloric intake associated with variation in diet-induced thermogenesis and in the metabolic pattern? A randomized cross-over study

Background/Objectives:Food-induced thermogenesis is generally reported to be higher in the morning, although contrasting results exist because of differences in experimental settings related to the preceding fasting, exercise, sleeping and dieting. To definitively answer to this issue, we compared the calorimetric and metabolic responses to identical meals consumed at 0800 hours and at 2000 hours by healthy volunteers, after standardized diet, physical activity, duration of fast and resting.Subjects/Methods:Twenty subjects (age range 20–35 years, body mass index=19–26 kg m−2) were enrolled to a randomized cross-over trial. They randomly received the same standard meal in the morning and, 7 days after, in the evening, or vice versa. A 30-min basal calorimetry was performed; a further 60-min calorimetry was done 120-min after the beginning of the meal. Blood samples were drawn every 30-min for 180-min. General linear models, adjusted for period and carry-over, were used to evaluate the ‘morning effect’, that is, the difference of morning delta (after-meal minus fasting values) minus evening delta (after-meal minus fasting values) of the variables.Results:Fasting resting metabolic rate (RMR) did not change from morning to evening; after-meal RMR values were significantly higher after the morning meal (1916; 95% confidence interval (CI)=1792, 2041 vs 1756; 1648, 1863 kcal; P<0.001). RMR was significantly increased after the morning meal (90.5; 95% CI=40.4, 140.6 kcal; P<0.001), whereas differences in areas-under-the-curve for glucose (−1800; −2564,−1036 mg dl−1 × h, P<0.001), log-insulin (−0.19; −0.30,−0.07 μU ml−1 × h; P=0.001) and fatty free acid concentrations (−16.1;−30.0,−2.09 mmol l−1 × h; P=0.024) were significantly lower. Delayed and larger increases in glucose and insulin concentrations were found after the evening meals.Conclusions:The same meal consumed in the evening determined a lower RMR, and increased glycemic/insulinemic responses, suggesting circadian variations in the energy expenditure and metabolic pattern of healthy individuals. The timing of meals should probably be considered when nutritional recommendations are given.

The Italian need for intestinal transplantation

Abstract The introduction of total parenteral nutrition in 1968 by Dudrik for the cure of patients with intestinal failure opened a new horizon of life support for patients once considered to have an end-stage prognosis. Small bowel transplantation (SBT) is currently restricted to patients with end-stage intestinal failure on life-saving long-term parenteral nutrition. Until now SBT has been an alternative to long-term home parenteral nutrition (HPN) only for patients with irreversible intestinal failure and for those with intolerance to HPN or for whom HPN was impossible. The Italian HPN Register enrolls adult patients on HPN, who could be considered potential candidates for SBT under criteria accepted in the literature (no malignant diseases or human immunodeficiency virus infection, age less than 60 years, irreversible end-stage intestinal failure, duration of HPN, loss of vascular access) (Fig 1). Nevertheless, the Italian HPN Register reveals the following issues. The centers and patients are not homogeneously spread throughout Italy; HPN is not regulated by national law or subsidized by the national health service (possibility of missing patients); and the anatomic, clinical, psychological, and environmental conditions of every patient are not sufficiently documented. For these reasons, the number of candidates for SBT could be under- or overestimated and not representative of the population. To avoid this misunderstanding, we considered our series in the Piemonte Region where our unit is the reference point for the HPN patients of our region; HPN has been regulated and subsidized by regional law since 1985; and the territory and inhabitants are known. Therefore, our center could be a representative model of the Italian HPN population. We can assume from the Piemonte HPN Register an estimate of the number of SBT adult candidates in the Italian population. The aim of our retrospective study was to evaluate the historical collection of adult patients on HPN from our Piemonte HPN Register and establish which of these patients might be suitable candidates for transplantation.