Marigliano B

Mediterranean Dietary Pattern Adherence: Associations with Prediabetes, Metabolic Syndrome, and Related Microinflammation

BACKGROUND The adherence to the Mediterranean Diet (Med Diet) seems to reduce the incidence of metabolic syndrome. The present study aimed to explore whether the adherence to the overall Med Diet pattern and to specific Med Diet items is associated with the presence of metabolic syndrome, impaired fasting glucose (IFG), insulin resistance (IR), and microinflammation in subjects free of diabetes and cardiovascular diseases. MEASUREMENTS Each patient underwent clinical assessment. Adherence to the Med Diet was measured by a previously validated 14-item questionnaire. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria; IR was defined by homeostasis model assessment of insulin resistance (HOMA-IR); inflammation was assessed through a high-sensitivity C-reactive protein (hsCRP) assay. RESULTS A total of 120 subjects (64.2% women, mean age 59.8±10.2 years) were enrolled at this study. Subjects with lower Med Diet pattern adherence exhibited higher occurrence of metabolic syndrome and all its components and higher HOMA-IR and hsCRP values (P for all <0.0001). Subjects with metabolic syndrome were less likely to consume olive oil (P=0.002) and vegetables (P=0.023). By multivariable analyses, the overall Med Diet score was found to be strongly and inversely associated with the presence of metabolic syndrome [B=-0.066; 95% confidence interval (CI) -0.105 to -0.028; P=0.001], IFG (B=-0.076; 95% CI -0.114 to -0.038; p<0.0001), high HOMA-IR (B=-0.071; 95% CI -0.108 to -0.034; P<0.0001) and high hsCRP (B=-0.082; 95% CI -0.125 to -0.045; P<0.0001). None of specific Med Diet items independently predicted metabolic syndrome, IFG, and high HOMA-IR. Instead, the consumption of white meat over red meat (B=-0.324; 95% CI -0.467 to -0.178; P<0.0001) was found to be inversely associated with increased hsCRP. CONCLUSIONS The inverse associations between adherence to Med Diet and the prevalence of metabolic syndrome and prediabetes may be due more to the effects of the entire dietary pattern rather than to individual food components. Metabolic syndrome-related microinflammation may further be linked to specific Med Diet components.

Depressive symptoms in older people with metabolic syndrome: is there a relationship with inflammation?

To investigate if there is a higher prevalence of depressive symptoms in older people with metabolic syndrome (MetS) compared with those without and whether dedpressive symptoms are independently associated to MetS and its single components and to the inflammatory markers.

Role of cardiovascular risk factors (CRF) in the patients with mild cognitive impairment (MCI)

Few therapeutic options are available nowadays to improve the prognosis of patients with Alzheimers disease (AD). There are rather several evidences in literature that controlling vascular risk factors may be an effective intervention for modifying the course of this disease. The aim of our study was to investigate the role of CRF in 50 patients with MCI according to Petersenss criteria, and to evaluate their influence on cognitive and behavioral features of the disease and on the development of dementia. Statistical analysis of the data showed that the 60% of the patients with MCI and CRF developed dementia, while 40% maintained the same cognitive conditions at the end of the study. Only 32% of the subjects without cardiovascular comorbidities developed dementia. The results of the study suggest that CRF play a key role in cognitive decline of patients with MCI. Patients with MCI and CRF showed not only worse cognitive performances, but also behavioral disorders, depression and functional disability. Patients with CRF had higher conversion rate to AD than the other group, with a mean disease-free period 3 months shorter than the control group.

Vitamin D: drug of the future. A new therapeutic approach

Besides increasing calcium absorption in the bowel and promoting the normal formation and mineralization of bone, vitamin D exerts relevant pleiotropic effects in different tissues. Serum levels of vitamin D show correlation with the risk of infections, cardiovascular diseases, cancer and autoimmune disorders. The possible therapeutic role of vitamin D in different kind of diseases: inflammatory, immunologic, infectious and neoplastic ones, explains the growing interest in this vitamin due to its pleiotropic effects, and makes it a candidate to become a potential drug in the next future.

Olfactory Deficit and Hippocampal Volume Loss for Early Diagnosis of Alzheimer Disease A Pilot Study

Background:The aim of this pilot study was to verify the role of olfactory test and volumetric magnetic resonance imaging measure of hippocampus to predict conversion from mild cognitive impairment to Alzheimer disease (AD). Materials and Methods:Eighteen patients with amnesic mild cognitive impairment, broadly defined, were followed at 12 months. Hypothesized baseline predictors for follow-up conversion to AD were olfactory deficit and hippocampal volumes loss. Results:In the 1-year follow-up, 5 patients converted to AD. The 2 clinical predictors olfactory test and hippocampal volume loss showed the same sensitivity of 92.3% but the olfactory test showed a higher specificity than the hippocampal volume loss (75% vs. 60%). Conclusions:Our findings suggest the potential utility of olfactory test and hippocampal volume loss for early detection of AD.

Atrial fibrillation (AF) and cognitive impairment in the elderly: A case–control study

AF is able not only to increase the risk of cognitive decline due to acute cerebrovascular events, but also to reduce cardiac output, with the consequence of impaired cerebral perfusion. The aim of this study was to evaluate the association between AF, dementia and depression in patients with negative anamnesis for past strokes. Our sample included 26 patients with a diagnosis of AF (paroxystic, persistent, permanent) and 31 patients with sinus rhythm, enrolled as controls. All selected patients underwent a Multidimensional Geriatric Assessment in order to investigate cognitive and behavioral functions. Statistical analysis of results showed a greater frequency of latent cognitive impairment in patients with AF, even in the absence of memory disorders. As a matter of facts, AF patients showed Mini Mental State Examination (MMSE) scores significantly lower than those with sinus rhythm (p<0.05) and Geriatric Depression Scale (GDS) scores higher than those without AF, evidencing a greater risk of depression too (p<0.02). Results showed a statistically significant association between AF, depression and cognitive impairment in early stage. In conclusion, AF is not only associated with the risk of developing cognitive impairment, but it can also be considered as a risk factor for dementia and depression, even in the absence of medical history of past stroke.

Empirical antibiotic therapy (ABT) of lower respiratory tract infections (LRTI) in the elderly: Application of artificial neural network (ANN). Preliminary results

LRTI are among the most common diseases in developed countries, including chronic obstructive pulmonary disease (COPD), one of the most frequent conditions. Their treatment in general practice is often unsuccessful and this increases hospital admissions. We know, bacterial infections in the elderly show a higher morbidity and mortality, either for more severe symptoms, than in younger adults, or because the causing agent often remains unknown. The need for a quick initiation of ABT often requires to chose on empirical grounds. To date there are no official guidelines for empirical ABT of COPD exacerbations, but only heterogeneous and often conflicting recommendations exist. The aim of our study was to identify a tool to guide the choice of the most effective empirical ABT when symptoms are acute and bacteriological tests cannot be performed. We used an ANN to study 117 patients aged between 55 and 97 years (mean 81.5 ± 8.7 years) (± S.D.), admitted with a diagnosis of pneumonia, COPD exacerbation or pneumonia with respiratory failure. We registered symptoms at onset and some individual variables such as age, sex, risk factors, comorbidity, current drug therapies. Then the ANN was applied to choose ABT in 20 patients versus 20 subjects whose therapy was chosen by the physicians, comparing these groups for therapys efficacy, mean durations of therapy and hospitalization (H). In the learning phase, the ANN could predict the resolution index 99.05% of the time (i.e., 104 times) with a ± S.D. = 0.23. After the training, during the test phase, the network predicted the resolution index 91.67% of the time (i.e., 11 times) with a ± S.D. = 0.54, thus proving the validity of the relations identified during the learning phase. Preliminary results of the application of our tool, show the ANN allowed us to greatly reduce the duration of the ABT and subsequently of the H. Based on preliminary results, we assume that the use of ANN can make a valuable contribution in the choice of empirical ABT in the course of acute lung diseases in elderly.

[Predictors of liver fibrosis in patients with non-alcoholic fatty liver disease. The role of metabolic syndrome, insulin-resistance and inflammation].

INTRODUCTION NAFLD (non-alcoholic fatty liver disease) reaches an high prevalence in the general population, and it is closely related to metabolic syndrome (MetS). The entity of metabolic abnormalities and the chronic inflammation seem to play a main role in the development of liver fibrosis. The aim of our study is to determine whether subjects with NAFLD and MetS have higher liver fibrosis degree when compared with NAFLD subjects without MetS, and to investigate the relations between fibrosis, MetS and its single components and inflammation. MATERIALS AND METHODS We considered 24 patients with NAFLD. Those who had viral- and alcohol- related liver disease were excluded. MetS was diagnosed according to NCEP ATP III criteria; inflammatory status was determined through C-reactive protein (PCR) assay. The peripheral insulin-resistance was assessed by calculating HOMA ir. Liver fibrosis was measured by transient elastography (Fibroscan®). RESULTS Subjects with MetS had higher HOMA ir, PCR and Fibroscan® score (log value: 0.92±0.24 KPa vs 0.73±0.2 KPa; p=0.047). The linear correlation analysis showed that Fibroscan® score was related to MetS, number of MetS components, waist circumference, HOMA ir and PCR. However the multivariate regression analysis showed that only HOMA ir (B=0.077; 95%CI: -0.002- 0.157; p=0.05) and PCR (B=0.152; 95% CI: 0.006 - 0.299; p=0.006) were independent predictors of higher Fibroscan® score. CONCLUSION MetS is associated to higher liver fibrosis degree in subjects with NAFLD. The insulin-resistance and inflammation seem to be the main determinants.

Vascular depression in the elderly. Does inflammation play a role

Vascular depression in the elderly. Does inflammation play a role?Depression is the most common comorbidity in the elderly, and it is a major determinant of disability. The late-onset depression in highly associated to cardiovascular disease. Depressive symptoms may follow vascular brain damage, especially when mood regulating areas are affected. However depression is strongly associated to vascular disease even when there is no manifest brain damage. Recently great attention has been given to chronic inflammation, both related to depression and vascular disease. Both experimental and clinical evidence shows that a rise in the concentrations of proinflammatory cytokines and glucocorticoids in depressed patients is associated with defect in serotonergic function. Chronic inflammation may underlie many forms of depression associated with vascular disease and metabolic syndrome. The importance of the inflammation hypothesis of depression lies is that psychotropic drugs may have central anti-inflammatory action, and that new generation of central anti-inflammatory drugs may be useful in depression treatment.

[Well-being and physical activity in the frail elderly].

Physical inactivity damage the elderly patients. The Authors stressed the concept about the very important role of daily, moderate, physical activity on self-sufficiency and mental health and the importance of the house-care for the efficiency and well-being of elderly patients.