Mediterranean Journal of Nutrition and Metabolism

This review summarizes the main toxic effect of ochratoxin A (OTA) on liver metabolism. This contaminant is a mycotoxin that can be found in raw materials (cereals, coffee, cocoa, spices or grapewine), in processed foods (bread and other bakery products) and, if animals are fed with contaminated feedstuffs, in pork meat. Kidney is a well-known target of OTA, although several findings suggest that liver metabolism can be affected too. OTA intake reduces, in a dose-dependent manner, the synthesis of albumin, while the concomitant increase in transaminases (ALT, ASP) and alkaline phosphatase is in agreement with the hypothesis of liver damage induced by OTA. Feeding animals with OTA-contaminated feeds has significant prooxidative effects that cause a reduction in anti-oxidative defences and an increase in malondialdehyde formation. Experiments on human liver cells support the hypothesis of an inflammatory effect of OTA mediated by TNF-α. An upregulation of apoptosis has also been detected in hepatic cells after OTA treatment, which leads to a higher rate of cell death and to a reduction of liver activity. All these findings suggest that OTA can have a toxic effect on the liver too and for this reason we should pay attention to liver toxicity of OTA in the risk assessment for this mycotoxin.

Primary prevention of cardiovascular disease should begin with a detailed metabolic study of our patients who must follow a nutritional therapy. Recently, new guidelines ESC/EAS 2011 on the treatment of dyslipidemia have been drawn up, according to which it is possible to arrive at desirable values of cholesterol and triglycerides with a synergy between drug treatment and adequate diet therapy. At this time, Mediterranean diet has been undergoing a radical transformation: there is hyperalimentation of the Mediterranean diet in all its components. The effectiveness of the Mediterranean diet on the reduction of lipids has been demonstrated, and the problem is how to implement this diet in the general population and dyslipidemic patients. Certainly, awareness, education of their nutritional status, suitable food and portions can increase adherence to diet.

Thyroid has a key role in energetic metabolism and its activity is influenced by caloric intake: reducing in prolonged fasting and malnutrition. Iodine deficiency may induce severe thyroid diseases; if it occurs during growth, it results in permanent disabling systemic damage. For this reason, local governments and WHO promote programs of iodine supplementation. Goitrogenic foods induce clinical damage only if ingested in great amounts and in case of iodine deficiency. The relationship among diet, foods and thyroid function is complex whether it regards iodine intake or its absorption and utilization favoring inhibiting nutrients. People with thyroid dysfunction should change some dietetic habits, choosing synergic nutrient-rich foods and reducing the antagonist ones; they should reduce fats for slowing their cellular oxidation rate and introduce proteins and carbohydrates at 20 and 55% of total energy intake, respectively.

Morocco like several developing countries is undergoing a nutritional transition characterized by the coexistence of nutritional deficiencies and diseases of overweight within the same household. The aim of this work was to determine the prevalence of anemia and overweight (overweight and obesity) among women of reproductive age in two sentinel centers, one rural and one urban area Kenitra. A sample of 128 women was recruited during their visit to the immunization of their preschool children at the health centers. Anthropometric measures and evaluation of hemoglobin were done under the supervision of the medical team of the health center. Women responded to a questionnaire on their demographic and socioeconomic characteristics. The mean age and standard deviation was 28.37 ± 6.91 with a minimum of 15 and a maximum of 50 years. Body mass index average was 25.83 ± 6.15 kg/m² and the average hemoglobin was 11.43 ± 1.5 g/dl. According to standard threshold of more than 30 kg/m² and less than 12 mg/dl, respectively, for BMI and hemoglobin, the results show rates of overweight or obesity in 56 % of subjects with a strict obesity prevalence of 15.6 %. Anemia reached a high rate of 60 %. The prevalence of anemia is very high compared with the values of national surveys. Obesity is strongly associated with age. Indeed, older women are at increased risk especially if they have a high number of siblings. The nutrition transition looks serious in the study area. Nutrition education and awareness for physical activity are needed. On the other hand, the strategies against iron deficiency and anemia should identify at-risk populations and advocate a more aggressive nutrition communication.

The purpose of the study was to assess the vitamin D status of obese patients with severe mental illness (SMI) treated with olanzapine. Fifteen obese SMI patients treated with olanzapine were pair-matched with healthy obese subjects. Another 52 overweight and obese SMI patients volunteered to participate in the study (total n = 67) and were divided into three subgroups (group A = overweight, group B = obese, group C = severely obese). Anthropometric, body composition, blood glucose, lipids, 25(OH)D, intact parathyroid hormone, and calcium measurements were performed. No differences were found between healthy and SMI subjects in any of the dependent variables (p > 0.05). The obese and severely obese patients demonstrated significantly lower levels of serum 25(OH)D concentration (p < 0.01) compared with overweight. A significant inverse correlation was found between serum 25(OH)D concentration and all anthropometric parameters (p < 0.05). The results indicate that obese SMI patients appear to be vitamin D deficient, similar to healthy obese subjects. The level of obesity seems to play a significant role in their vitamin D status: the greater the body fat of the patients the lower the serum 25(OH)D concentration. Thus, as in healthy individuals, an inverse association exists between the degree of adiposity and the serum 25(OH)D concentration in SMI patients.

In the last few years, increasing evidence about the role played by obesity as cardiovascular risk factor has been shown. However, not all the obese patients are at the same high cardiovascular risk and it is important to have simple and reliable diagnostic tools to detect those patients worthy of a stricter cardiovascular prevention. The purpose of the present pilot study was to test the capability of biomarker dosage in detecting early cardiac dysfunction. Twenty-eight consecutive obese patients, visited at the obese clinic of the San Maurizio Regional Hospital of Bolzano were included in the study. The patients with known cardiovascular disease were excluded. All the patients underwent the dosage of copeptin, mid regional proANP (Mr-proANP), BNP, the standard haematological testing and a complete echocardiography. All the patients had a normal ejection fraction of the left ventricle (61 ± 5.2 %), normal copeptin (median 8.2 pmol/L with and interquartile range of 6.05–12.6) and BNP levels (37.0 ± 27.5 pg/mL). Mr-proANP was 67.5 ± 45.5 pmol/L, resulting above the upper level of normality in 5/28 patients (17.8 %). No significant relation was found between copeptin levels and left ventricular volumes, mass, ejection fraction, atrial dimensions and diastolic function. Mr-proANP showed a significant reverse non-linear relationship with diastolic dysfunction of the left ventricle, measured by E/E′ ratio. BPN, on the contrary, showed a significant non-linear relation with diastolic dysfunction. BNP dosage has been shown to have efficacy in early identification of heart dysfunction, even in the presence of preserved systolic function.

This study compares the effects of oat and barley bread on lipid profiles and blood glucose of type 2 diabetic patients. In a cross-over short-term trial, 36 type 2 diabetic patients having one lipid parameters out of the normal limit were randomly assigned into two bread groups. They were given 250 g oat or barley bread daily for 3 weeks. A total of 5 cc of venous blood was drawn before, after 10 days and at the end of the trial for respective assays. After a washout period of 3 weeks, patients were moved into the other bread group and all steps of the previous phase were accomplished similarly. A 3-day food recall questionnaire was completed on the 1st, 10th and 21st days of both phases of the trial. Findings indicated that all of the metabolic and anthropometric indicators were improved in both groups except waist to hip ratio. The mean differences in fasting serum glucose (FSG) in the barley group and the oat bread groups were 32 ± 2.7 and 6.2 ± 9.2 mg/dl; the mean differences for serum high density lipoprotein-cholesterol (HDL-c) in the barley group and the oat bread groups were 9.2 ± 1.8 and 1.34 ± 0.2 mg/dl, respectively. The trend in the differences in the FSG and the HDL-c were significant between the two groups (P = 0.001). This study showed that both oat and barley bread are effective for improvement of anthropometric and metabolic indicators, and that the beneficial effects of oat bread in reducing blood glucose and HDL was higher than for barley bread.

Type of carbohydrate and glycemic index of traditional foods is still a challenge in nutritional management of diabetics. This study was conducted to determine the GI of pasta (ordinary and infused), made from either nol (common wheat) or semolina (durum wheat) flour, compared to white rice in subjects. Twelve healthy volunteers with body mass index 23.5 ± 1.45 kg/m² and age 36 ± 2.85 years participated in this study. Twelve hours overnight fasting capillary blood samples were collected from subjects at baseline by finger stick using a sterile lancet pen immediately before ingestion of either 50 g of D-glucose anhydrate dissolved in 300 ml distilled water, 192.3 g cooked pasta or 185.2 g of rice (50 g carbohydrate) alongside 300 ml water. Blood samples were collected again at 0, 15, 30, 45, 60, 90 and 120 min. All subjects consumed the test meals at 1-week interval. The standard glucose solution was administered at the first and fourth week of study. Blood samples were analysed using an Accu-Chek Aviva Blood Glucose Monitor. The area under the curve was calculated as the incremental area under the blood glucose response curve for each test in each individual. The GI values were determined according to FAO/WHO standard methods. This study indicated that the GI of ordinary pasta made from semolina {47} is significantly lower than nol flour pasta {68} or cooked rice {73}. There was a reverse, but non-significant, difference between the GI of semolina-infused pasta {63} versus nol-infused pasta {60}. Glycemic index for pasta (semolina and non-infused) was significantly less than that of nol wheat pasta, cooked rice and white bread. This study underscores the importance of consuming ordinary pasta made from semolina as part of a low GI diet for controlling blood glucose levels.

The aim of this study was to verify the clinical efficacy of a diet associated with already commercially available oral amino acid functional cluster (AFC) compared to the administration of a diet associated with a nitrogen protein-based supplement (casein) in antagonizing malnutrition in patients with Chronic renal failure (CRF) undergoing haemodialysis. The secondary aim was to assess the changes in protein levels during the acute phase such as the expression of inflammatory cytokines. Twenty patients in haemodialysis aged between 18 and 85 of both genders (13 m, 7f) were recruited, randomized and divided into two groups and treated for 4 months respectively with: (1) oral AFC supplement (*)8 g/die: group A, and (2) oral supplementation of a protein nitrogenous mixture compared to AFC with a casein protein source) of 6.6 g: group P. During the initial assessment and thereafter on a monthly basis all patients underwent the following: Dietary recall 24 h; Anthropometric:Weight, height, BMI, expected dry weight, actual weight; Biochemical: Albumin, transferrin, Na, K, Cl, Ca, P, Mg, long-interval creatinine (Aminotrofic^®: Errekappa Euroterapici, Milano) pre-albumin, α1 acid glycoprotein, C reactive protein (CRP), protein nitrogen appearance (PNA); Instrumental: Handgrip strength evaluation, Calorimetry by means of Armband, Bio-impedance analysis (BIA), Spitzer Index (quality of life), Subjective Global Assessment Generated by the patient (PG SGA). Considering the nutritional parameters, no significant differences concerning dry weight emerged between the beginning (T0) and the end (T4) (weight A to T0: kg 64.41 ± 6.34; weight A to T4: kg 64.51 ± 7.05: P = NS; weight P to T0: kg 60.17 ± 11.94; weight P to T4: kg 59.86 ± 11.43: P = NS); biochemical parameters, significant differences were observed only for two parameters: pre-albumin (Pre-albumin A to T0 30.12 ± 7.23; Pre-albumin A to T4: 28.91 ± 5.8; Pre-albumin P to T0 22.51 ± 6.04; Pre-albumin P to T4: 26.10 ± 9.82), and Transferrin (Transferrin A to T0 171.77 ± 28.87 mg/dL, Transferrin A to T4: 181.44 ± 38.83 mg/dL: P < 0.005; Transferrin P to T0 160.29 ± 27.46 mg/dL, Transferrin P to T4: 146.57 ± 24.96 mg/dL: P < 0.005), but not in other parameters. From a nutritional perspective, after 4 months of treatment an increase in protein synthesis was noted in group A compared to group P which was proved by the significant increase of transferrin. This pilot study suggests the AFC oral supplementation may represent a valid alternative to intradialytic parenteral treatment and may also allow for an improvement in blood chemical values and nutritional status.