Introduction
Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common form of liver disease worldwide affecting all ages and ethnic groups and it has become a consistent threat even in ...young people. Our aim was to estimate the effect of a Low Glycemic Index Mediterranean Diet (LGIMD) on the NAFLD score as measured by a Liver Ultrasonography (LUS).
Design
NUTRIzione in EPAtologia (NUTRIEPA) is a population-based Double-Blind RCT. Data were collected in 2011 and analyzed in 2013-14.
Setting/participants
98 men and women coming from Putignano (Puglia, Southern Italy) were drawn from a previous randomly sampled population-based study and identified as having moderate or severe NAFLD.
Intervention
The intervention strategy was the assignment of a LGIMD or a control diet.
Outcome measures
The main outcome measure was NAFLD score, defined by LUS.
Results
After randomization, 50 subjects were assigned to a LGIMD and 48 to a control diet. The study lasted six months and all participants were subject to monthly controls/checks. Adherence to the LGIMD as measured by Mediterranean Adequacy Index (MAI) showed a median of 10.1. A negative interaction between time and LGIMD on the NAFLD score (-4.14, 95% CI -6.78,-1.49) was observed, and became more evident at the sixth month (-4.43, 95%CI -7.15, -1.71). A positive effect of the interaction among LGIMD, time and age (Third month: 0.07, 95% CI 0.02, 0.12; Sixth month: 0.08, 95% CI 0.03,0.13) was also observed.
Conclusions
LGIMD was found to decrease the NAFLD score in a relatively short time. Encouraging those subjects who do not seek medical attention but still have NAFLD to follow a LGIMD and other life-style interventions, may reduce the degree of severity of the disease. Dietary intervention of this kind, could also form the cornerstone of primary prevention of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease.
Background
Higher Dietary Inflammatory Index (DII®) scores are associated with increased morbidity and mortality. However, little is known about the effects of DII on mortality in Mediterranean ...countries. Therefore, in the present study, we aimed to investigate the potential association between DII scores and overall, cancer and cardiovascular disease (CVD) mortality in people living in a Mediterranean area.
Methods
DII scores were calculated using a validated food‐frequency questionnaire. DII scores were then categorised into tertiles. Mortality was ascertained via death certificates. The association between DII scores with overall and cause‐specific mortality was assessed via a multivariable Cox's regression analysis and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs).
Results
The study included 1565 participants (mean age 65.5 years; females 44.7%). After a median follow‐up of 12 years (2005–2017), 366 (23.4%) participants died. After adjusting for 17 potential confounders, people with higher DII scores had an increased risk of death compared to those in the lowest (most anti‐inflammatory) tertile (HR = 1.38; 95% CI = 1.04–1.82 for the second tertile; HR = 1.38; 95% CI = 1.03–1.86 for the third tertile). Each 1 SD increase in DII score increased the risk of death by 13%. No association was found between DII scores and cancer or CVD death when considered separately.
Conclusions
Higher DII scores were associated with a significantly higher mortality risk, whereas the association with cause‐specific mortality was less clear. These findings highlight the potential importance of diet in modulating inflammation and preventing death.
Different lines of evidence suggest that higher intake of fiber may somehow protect against metabolic syndrome. The prebiotic inulin has widely been studied in relation to its putative beneficial ...effects on lipid and glucose metabolism. Therefore, adding inulin to diet may be a suitable strategy to prevent metabolic syndrome. Aim of the present study was to evaluate the effects of the daily consumption of inulin-enriched pasta on lipid and glucose metabolism as well as on gastrointestinal motility in young healthy subjects. Methods. Twenty-two healthy young male volunteers entered a randomized double blind cross-over study consisting of a 2-weeks a run-in period, two 5-weeks study periods (11% inulin-enriched or control pasta), and an 8-weeks wash-out period in between. Serum lipid and glucose concentrations were evaluated by routine biochemical analyses. Gastric emptying time and electrical activity were non-invasively evaluated by ultrasound and electrogastrography. Data were analyzed by Friedman Repeated Measures ANOVA test. Results. Significant differences among baseline and the treatment group were found for HDL-cholesterol (p=0.004), total cholesterol/HDL-cholesterol ratio (p=0.006), triglycerides (p=0.04), fasting glucose level (p=0.044), fructosamine (p=0.0478), HbA1c (p=0.04), and homeostatic model assessment (HOMA-IR) (p=0.045). The gastric emptying, expressed as final emptying time, was found significantly delayed in the group that assumed inulin-enriched pasta (p=0.008). Conclusions. Inulin-enriched pasta improved lipidic and glicidic metabolism as well as the insulin resistance in healthy young subjects. In addition, it delayed the gastric emptying time which may represent the physiological counterpart of its metabolic effects.
Body mass index (BMI), serum cytokines and serum obesity markers were evaluated in 33 obese children before, during and after a hypocaloric diet. The cytometric bead array "human inflammatory kit" ...was used for the evaluation of serum interleukin (IL)-1beta, IL-6, IL-10 and tumor necrosis factor-alpha. On the other hand, the following obesity biomarkers were evaluated by means of a flowcytomix-human obesity 9 plex kit: Soluble Isoform of CD40 Ligand; Soluble Intercellular Adhesion Molecule-1; Leptin; Monocyte Chemoattractant Protein 1; Myeloperoxidase; Osteoprotegerin; Resistin and Soluble TNF-receptors. Actually, throughout the study modifications of BMI were negligible and, therefore, serum cytokines and obesity markers did not show any significant changes in comparison with baseline values. On the other hand, at the different time points considered the majority of obesity markers were higher than normal controls, thus indicating a low grade inflammation in childhood obesity. Therefore, attempts at reducing this inflammatory status in children which predisposes to the metabolic syndrome outcome are discussed.
We examined the relationship between moderate obesity and glucose metabolism, insulin sensitivity and suspected fatty liver in children. We measured body mass index (BMI), z-score BMI, caliper ...skinfold thickness, waist and hip circumference in 94 participants (mean age 9.7 +/-2.2 years). Fasting blood glucose, insulin, HOMA score, lipid profile and transaminases (ALT, AST) were measured. Fatty liver and skinfold thickness were evaluated by means of ultrasound. The z-score BMI was 2.01 +/-0.39 (mean +/- SD), and the duration of obesity was 4.3+/-3.03 years. A positive correlation was found between caliper and US skinfold thickness for tricipital (r= 0.33; p= 0.003) and sovrailiac skinfold (r= 0.34; p=0.003). Fatty liver was diagnosed in 64% of children and it was positively related to anthropometric measurements. The three sub-groups--group 0 (normal US liver and normal transaminases); group 1 (US fatty liver and normal transaminases); group 2 (US fatty liver and elevated transaminases)--showed a difference concerning z-score BMI, insulin and HOMA parameters (Tukey test: z score BMI group 1 vs group 0 and 2 vs group 0; serum insulin: group 2 vs group 1 and group 2 vs group 0; HOMA IR: group 2 vs group 1 and group 2 vs group 0). Moderately obese children with steatosis exhibited a clear increase of insulin and insulin resistance which represents indices of a future metabolic syndrome. In addition, it is important to perform a liver ultrasound since transaminases seems to be not adequate for the diagnosis of fatty liver.
Amtolmetin guacyl (AMG) is a nonsteroidal antiinflammatory drug (NSAID) of high therapeutic activity and free of damaging effects on the gastrointestinal tract. Since acute ulcer and nausea have been ...found to be associated with gastric dysrhythmias, cutaneous electrogastrography and ultrasonographic study of the gastric emptying time were performed simultaneously in 24 healthy volunteers before and for 180 min after a liquid meal with 0.5 g/kg body weight of alcohol in double-blind, placebo-controlled, crossover studies. Before the recording session, each subject had taken placebo, AMG, a standard NSAID, or a gastric protective drug for four days. Alcohol administration increased the tachygastria percentage while diclofenac, AMG, and misoprostol alone did not induce gastrointestinal symptoms and gastric dysrhythmias. As regards alcohol-induced gastric dysrhythmia, placebo and diclofenac showed a clear increase in tachygastria while AMG and misoprostol did not. AMG is able to induce a normalization of gastric dysrhythmia induced by alcohol administration probably due to its peculiar mechanism of action, which involves capsaicin and CGRP pathways.
To investigate gastric emptying of a mixed solid and liquid meal in normal weight and obese children.
114 volunteer children of school age (range 6-11 y) entered the study. Children were considered ...as being underweight, normal weight, obese, severely obese according to their body mass index (BMI), and were examined using a non-invasive ultrasound method in the morning after an overnight fast period. The examination was always performed in an upright position by the same operator. The half-emptying time and fasting antral area were assessed, and antral area measurements were performed every 30 min for 240 min after meal administration.
Five children (4.4%) were underweight, 53 (46.5%) were normal weight, 19 (16.6%) were obese, and 37 (32.5%) were severely obese. The underweight group was not considered for the analysis. No significant difference in t 1/2 was found among the three groups. A positive statistically significant correlation was found between fasting antral area and BMI (r = 0.44; P<0.0001) in all children. The fasting antral area value was 3.5 cm2 (range 1.6-8.1) in normal weight children, 3.6 cm2 (range 1.9-7.7) in obese children, and 3.9 cm2 (range 1.5-10.8) in severely obese children. There was a significant difference between severely obese and normal weight children (P<.05). No significant difference was found in the gastric emptying between severely obese and obese children, and between severely obese and normal weight ones.
The difference in fasting antral area in these groups may be considered as an early disturbance. In fact the increased gastric volume could cause a change in the sense of satiety with a consequent increase in the intake of these subjects.
The aims of this study were to evaluate the gastric electrical activity and gastric emptying in preterm and term newborns and to assess the development of gastric motility by comparing newborns of ...different gestational ages. The cutaneous electrogastrography and the ultrasonographic study of the gastric emptying were performed before and after milk formula in three groups of infants: 12 preterm newborns with a gestational age of 28–32 weeks, 11 preterm newborns with a gestational age of 32–36 weeks, and 10 full‐term newborns with a gestational age of 36–40 weeks. All recording sessions were performed 1 week after infants had reached full enteral feeding. The percentage of normal slow waves was similar in the three groups but it was not predominant compared to tachygastria in the earliest premature infants (59.3% (12.7–92.3) vs. 29.6% (3.7–78.8); P < 0.05). In addition, a progressive increase in the normal slow wave percentage (59.3% (17.4–87.4), 60.9% (38.1–89.7), 77.8% (66.4–84.8); P < 0.05) was observed as gestation advanced. As regards gastric emptying parameters, the antral area was greater and T½ was longer in the preterm newborns of 28–32 weeks than preterm newborns of 32–36 weeks and full‐term newborns (fasting antral area: 0.96 cm2 (0.6–1.5), 0.63 cm2 (0.4–1.2), 0.55 cm2 (0.1–0.9) respectively, P < 0.05; T½: 83.4 min (76.0–108.5), 70 min (57.5–89.5) and 71.8 min (54.9–81.2), respectively P < 0.05). The comparisons of gastric emptying curves made among the three groups showed a reduced antral dilatation in preterm newborns of 28–32 weeks compared to full‐term newborns at 30 and 60 min after a meal. In conclusion, although enteral feeding is important for the development process of gastrointestinal motility, gastric electrical activity and gastric emptying show an intrinsic maturation depending on the gestational age.
Electrogastrography (EGG) is a reliable technique to record gastric electrical activity. However, the normal values of electrical activity in children and the effects of age, gender, and body mass ...index (BMI) are not well defined. To evaluate these items, EGG signal was picked up before and after a meal in 114 healthy children (age range: 6-12 years) by means of a pair of cutaneous electrodes sonographically placed on the abdominal surface. The dominant frequency was prevalently found in the 2.0-4.0 cpm range (P < 0.001). A significant difference was found comparing the pre- and postprandial instability coefficient of dominant frequency (P < 0.05). The EGG power increased postprandially (power ratio = 3.6), and the power ratio was not correlated to the approach of the wall of the gastric antrum to the abdominal surface (Spearman r = 0.0045, NS). In obese children, the postprandial pattern in response to a mixed test meal containing carbohydrate as the major caloric source was similar to that recorded in normal-weight children. EGG parameters were not affected by age and gender apart from a significant difference in the postprandial instability coefficient obtained from the "girls > or = 9 years" group compared to the "girls <9 years" and "boys > or = 9 years" groups (P < 0.05). In conclusion, in children 6-12 years old, EGG parameters are not affected by BMI in response to a mixed test meal. Gastric electrical rhythm and rate, and gastric power are not influenced by age and gender, whereas the instability coefficient seems to be influenced by these factors. The normal values of the EGG parameters evaluated in this study should be introduced in the analysis of gastric electrical activity for an effective interpretation of the EGG signal from children with functional or organic diseases.
