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Biomedical subjects

Fabrizio Pasanisi

Publications and source records attributed to Fabrizio Pasanisi.

At least 19 recordsLinked to original sources
PubMed2006

Predictive factors of survival in patients with peritoneal carcinomatosis on home parenteral nutrition.

OBJECTIVE: We worked to identify predictors of survival in patients with carcinomatosis on home parenteral nutrition (HPN). METHODS: Survival rate was evaluated in 152 terminal patients (45 men and 107 women) with peritoneal carcinosis on HPN. Selected anthropometric measurements (weight and body mass index), laboratory tests (serum albumin, cholesterol, cholinesterase [CHE], hemoglobin, and lymphocyte count) and clinical variables (ascites, pain, and vomiting) were recorded at baseline. A Karnofsky Performance Status (KPS) was also determined. RESULTS: Sites of primary cancer were the stomach in 31.6%, ovaries in 27.6%, colorectum in 19.7%, and other in 21.1%. At baseline patients had abnormally low values: 55.3% had a body mass index no greater than 20.0 kg/m2, 40.4% had a serum albumin level lower than 3.0 g/dL, 55.7% had a lymphocyte count no higher than 1200/mm3, 54.6% had a cholesterol level lower than 160 mg/dL, and 63.1% had a CHE level lower than 5400 U/L. Pain, ascites, vomiting, and a KPS score no higher than 40 were observed in 44.1%, 55.3%, 76.3%, and 51.3% of patients, respectively. Survival ranged from 6 to 1269 d (median 45 d). Patients with a KPS score no higher than 40 had shorter survival than did patients with a KPS score of at least 50 (median 28.5 versus 81, P = 0.0001). Multivariate analysis (R2 = 0.152 for the entire model) indicated that KPS (P = 0.01) and CHE (P = 0.034) were significant predictors of survival. Moreover, three different combinations of selected clinical and laboratory variables identified patients who survived fewer than 60 d (high specificity). CONCLUSIONS: Time of survival widely varied among terminal cancer patients; identification of predictive factors could help to draw up guidelines to improve indications for HPN. In this study, traditional predictors (KPS, albumin, pain, and vomiting) and CHE level appeared to be a useful survival predictor index in incurable patients with peritoneal carcinosis on HPN.

Adult↗
PubMed2006

Severe acute liver damage in anorexia nervosa: two case reports.

OBJECTIVE: Two female patients (18 and 30 y old, body mass indexes 14.1 and 13.2 kg/m2) with severe, restrictive anorexia nervosa developed sudden severe liver damage. In addition to overt protein-energy malnutrition, they showed marked hypotension, bradycardia, dry skin, acrocyanosis, and hypothermia. Most common causes of liver failure, such as hepatotropic viruses, hepatotoxic drugs, alcohol, cannabis, and cocaine abuse, were excluded. METHODS: Therapeutic intervention consisted of immediate plasma volume support, progressive parenteral or oral nutritional rehabilitation, and parenteral potassium and phosphorus supplements to avoid the refeeding syndrome. RESULTS AND CONCLUSION: Improvement of initial clinical symptoms and rapid recovery of liver enzymes after this type of treatment suggest that severe liver damage in anorexia nervosa may be secondary to acute hypoperfusion.

Adolescent↗
PubMed2005

The mtDNA 15497 G/A polymorphism in cytochrome b in severe obese subjects from Southern Italy.

BACKGROUND AND AIM: A large number of mitochondrial DNA (mtDNA) mutations have been implicated in degenerative diseases and aging. The aim of this study was to evaluate whether the 15497 G/A mtDNA polymorphism (G251S) in the cytochrome b subunit of respiratory complex III, which has been associated with obesity-related variables and lipid metabolism in a Japanese population, is associated with severe obesity also in adult Caucasians from southern Italy. METHODS AND RESULTS: Unrelated severely obese patients (n = 317; BMI > 40kg/m2) and controls (n = 217; BMI < 25kg/m2) from Southern Italy were genotyped by allelic discrimination TaqMan assay for the 15497 G/A mtDNA polymorphism. In obese patients fasting serum total cholesterol, triglycerides, HDL-cholesterol and glucose were measured enzymatically and sitting blood pressure and heart rate were also collected. Mean levels of total cholesterol, triglycerides and glucose were below the upper reference limit for healthy subjects. Female obese subjects showed lower levels of blood pressure and heart rate and higher levels of HDL cholesterol than male obese patients (P < 0.001). All the control subjects and 315/317 severely obese patients were homozygous for the G allele (wild type), whereas only 2/317, were females homozygous for the A allele. CONCLUSIONS: The mtDNA 15497 G/A polymorphism in cytochrome b was present in 0.6% obese subjects, two females whose lipid parameters and BMI were similar to those of the overall group. Therefore, this mutation may appear to contribute in rare instances to severe obesity but does not explain the majority of cases in our population. A more extensive genetic haplogroup characterization is required to identify associations to obesity in Caucasians.

Adult↗
PubMed2005

Assessment of physical activity in an outpatient obesity clinic in southern Italy: results from a standardized questionnaire.

BACKGROUND AND AIM: Sedentary lifestyle contributes to increased body weight in western societies. We evaluated physical activity (PA) and its association with some clinical and biochemical parameters in overweight and obese outpatients. METHODS AND RESULTS: Two hundred and seventy-eight overweight obese outpatients, aged 18-65 years, were recruited in this cross-sectional study. Patients were interviewed about their usual PA, using a standardized questionnaire. A total metabolic index (TMI) was derived estimating weekly energy expenditure. In Class III obese patients, fasting serum HDL-cholesterol (HDL-Chol) and resting heart rate (HR) were also measured. BMI was inversely related to TMI in the whole group (r = -0.123, p = 0.041). Dividing the patients into groups 1 and 2 according to median BMI (30.3 kg/m(2)), group 1 had a significantly higher TMI than group 2 (p = 0.003), mainly due to the difference in weekly walking time (p < 0.001). Among Class III obese patients, despite similar BMI, the group with longer walking time had both significantly higher HDL-cholesterol (p = 0.046) and lower HR (p < 0.001). CONCLUSION: In overweight and obese individuals BMI is inversely related to PA energy expenditure. This relationship can be, at least in part, ascribed to the reduction of weekly walking time with increasing BMI. In Class III obese patients, even a low level of PA can positively affect both HDL-Chol and resting HR. It appears useful to focus on obese patients in also in general practice in order to recognize sedentary life styles and encourage PA through individualized programs.

Adolescent↗
PubMed2005

Six novel mutations in the proopiomelanocortin and melanocortin receptor 4 genes in severely obese adults living in southern Italy.

BACKGROUND: The genetic characterization of obese individuals could clarify the molecular mechanisms underlying body weight regulation and lead to targeted therapy. Here we report variants of the proopiomelanocortin (POMC) and melanocortin receptor 4 (MC4R) genes detected in severely obese adults living in southern Italy. METHODS: A total of 196 unrelated nondiabetic severely obese individuals [111 females and 85 males; mean (SD) age, 32.2 (11.5) years; mean body mass index, 48.8 (8.1) kg/m(2)] and 100 normal-weight healthy volunteers (34 males and 66 females) entered the study. POMC and MC4R were genotyped by sequencing analysis. Leptin, insulin, glucose, and the lipid profile were measured in fasting serum samples. We used the protein truncation test to verify the stop-codon mutation. Anthropometric measurements, sitting blood pressure, and heart rate were also recorded. RESULTS: Of the obese participants, 1.5% had mutations in POMC exon 3 (new mutations, P231L and E244X; known, R236G) and 2.5% had MC4R mutations (new mutations, W174C, Q43X, S19fsX51, and I317V; known, A175T). These mutations were not present in the controls. Gene polymorphisms were identified in similar percentages of severely obese and nonobese individuals, i.e., respectively, 52.5% and 51% (POMC) and 1% and 2% (MC4R). CONCLUSIONS: We detected 2 new POMC mutations and 4 new MC4R mutations in a large number of severely obese adults living in southern Italy. These mutations, not present in normal-weight individuals, are further evidence that defects in the melanocortin pathway are related to severe obesity.

Adolescent↗
PubMed2005

Phase angle is a predictor of basal metabolic rate in female patients with anorexia nervosa.

The aim of the study was to evaluate the relationship between basal metabolic rate (BMR) and bioelectrical impedance analysis (BIA) in undernourished female patients with anorexia nervosa. Participants were 86 female patients with anorexia nervosa (age 20.8+/-4.7 years; weight 39.3+/-5.2 kg; body mass index 15.4+/-1.6 kg m-2). BMR was measured by indirect calorimetry and single-frequency BIA was determined at 50 kHz on the whole body. The BIA variables considered were resistance, reactance, phase angle and the bioimpedance index (height2/resistance). Fat-free mass was calculated from subcutaneous skin fold thickness. In the study group BMR was 3782+/-661 kJ d-1 while bioimpedance index varied between 27.6 and 49.9 cm2 Omega-1 and phase angle between 2.54 degrees and 6.49 degrees. BMR was significantly correlated with weight, height, body mass index and fat-free mass, and, among BIA variables, with reactance and phase angle. Multiple regression analysis indicated that phase angle was a predictor of BMR not only when solely BIA variables were considered, but also in combination with either weight and age or fat-free mass. In conclusion, phase angle emerged as a strong predictor of BMR in female patients with anorexia nervosa. Nevertheless, further studies are necessary to confirm this finding in other forms of protein energy malnutrition and justify the inclusion of BIA variables in the equations used to predict BMR in the clinical setting.

Adult↗
PubMed2005

Obesity epidemics: simple or simplicistic answers?

Among the strategies suggested to face obesity epidemics there is also a mere reduction of only 100-200 kcal day, i.e. less mouthfuls of food and a little more walking every day. Are these proposals "simple and feasible" or, vice versa, "simplicistic and unrealistic" solutions? A possible source of such confusion comes firstly from dietary guidelines: the "food pyramid" may easily lead to misinterpretation as low-fat foods enriched in simple sugars produce similar metabolic abnormalities as saturated fat rich foods. Replacement of fruit derived fructose with other fructose-enriched beverages is not adequately considered. In total, 45-60 min of moderately intense physical activity, instead of "few steps", daily appears a more realistic evaluation of the role of physical activity in energy balance but is still an unrealistic intervention strategy in many obese individuals requiring a long preliminary rehabilitation period. Another complaint is the current poor distinction between "preventive, population oriented" and "therapeutic, clinical" intervention strategies possibly due to the long duration of the latent "preclinical" phase of the disease and the scarcity of safe and effective drugs. Obesity may be considered a "culture-bound" disease and as such it requires a proper cultural, political and educational strategies. The number of obesity clinics worldwide is too limited; educational interventions in the crucial period of the developmental age are lacky. The social science content of medical school curricula, and teaching healthy behaviours, needs to be improved. In conclusion, a deeper reflection from Medical Societies on the relationship between the negative aspects of the "transition diet" and "globalization process" may help to produce really "simple" and more successful strategies against obesity epidemics and its complications.

Diet, Reducing↗
PubMed2005

Effects of sibutramine-induced weight loss on cardiovascular system in obese subjects.

BACKGROUND AND AIM: To assess efficacy of sibutramine in obese subjects, and influence on hemodynamics, valve function and left ventricular (LV) geometry and performance. METHODS AND RESULTS: Three-month double-blind, parallel groups, randomized, placebo-controlled of 15 mg o.i.d. sibutramine administration combined with diet. Twenty-five to 65 year-old males or postmenopausal females, were enrolled if their BMI was between 30 and 40 kg/m(2), without evidence of concomitant diseases. Body weight, BMI, blood pressure (BP), echocardiographic LV mass, cardiac output, and diastolic function were measured. Body weight and BMI were better reduced with sibutramine (weight loss of 5% or more in 9 of 11 patients) than placebo group (weight loss of 5% or more in 5 of 9 patients; all p<0.05). Systolic and diastolic BP decreased similarly in both arms. No difference in mean heart rate was detected between treatments. The two groups had slightly different LV geometry at baseline. LV mass decreased with weight loss, more in the sibutramine group (p<0.05), due to reduction in LV chamber size. Stroke volume tended to be reduced in the sibutramine group, influencing diastolic pattern. E/A ratio tended to decrease in the sibutramine group without changes in isovolumic relaxation time and deceleration time of E velocity. No onset or increased severity of valve regurgitation was detected. CONCLUSIONS: Combined to hypocaloric diet, sibutramine increases weight loss in obese individuals. Weight changes have positive effect on reduction of BP and contribute to reduce LV mass, the hallmark of markers of preclinical cardiovascular disease and most powerful predictor of adverse outcome.

Adult↗
PubMed2004

Fasting respiratory quotient as a predictor of long-term weight changes in non-obese women.

BACKGROUND/AIMS: The identification of metabolic and environmental predictors of excess body fat is still far from being achieved. The aim of this study was to evaluate whether respiratory quotient in non-obese women is a predictor of body weight changes after a 6-year follow-up period. METHODS: Forty-three non-obese healthy women participated in the study. Their baseline general characteristics were: age 40.5 +/- 12.8 years; height 159 +/- 7 cm; weight 61.8 +/- 10.1 kg, and body mass index (BMI) 24.4 +/- 3.8 kg/m2. At baseline basal metabolic rate and respiratory quotient were determined by indirect calorimetry, while weight and BMI were recorded at the first observation and after the 3- and 6-year follow-ups. RESULTS: At the first observation basal metabolic rate was 5,360 +/- 713 kJ/day and respiratory quotient 0.850 +/- 0.052. After 6 years, with weight changes equal to 1.4 +/- 4.5 kg, baseline respiratory quotient was a significant predictor (p < 0.05) of changes in body weight or BMI together with baseline BMI. CONCLUSIONS: This follow-up study confirms that a high respiratory quotient (measured on free diet) predisposes to weight gain, especially in women with the highest baseline respiratory quotient (above the 90th percentile of the distribution for this variable).

Adult↗
PubMed2003

Variants of uncoupling protein-2 gene and obesity: interaction with peroxisome proliferator-activated receptorgamma2.

OBJECTIVE: To analyse the association of the UCP2 gene, alone or in combination with the PPARgamma2 gene, with obesity. DESIGN: Cross-sectional, case-control study. STUDY POPULATION: From a working population of 4500 Italian Caucasian employees of the Italian telephone company participating in a firm-sponsored health screening programme, we selected all those with obesity [n = 122; body mass index (BMI) > or = 30 kg/m2]. For each case, three nonobese age- and sex-matched individuals were selected as controls from the same population (n = 374). Included in the study were also 76 severely obese (BMI > or = 40 kg/m2) patients consecutively admitted to the obesity clinic of the department. Diabetic individuals were excluded. MEASUREMENTS: The -866G/A UCP2 and the Pro12Ala PPARgamma2 polymorphisms were determined on genomic DNA of the studied individuals. Several metabolic and anthropometric measures were also obtained, like plasma glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol and BMI. RESULTS: BMI, plasma glucose, insulin, triglycerides, total and HDL cholesterol were not significantly different in carriers and noncarriers of the -866G/A variant. No significant association was observed between the -866G/A UCP2 gene polymorphism and moderate or severe obesity. This was also observed when the UCP2 polymorphism was analysed in combination with the PPARgamma2 polymorphisms. CONCLUSIONS: The -866G/A variants of the UCP2 gene are not associated with either obesity or other features of the metabolic syndrome in the studied groups of the Italian population. This negative finding is not modified after a combined analysis of the UCP2 polymorphism and the Pro12Ala polymorphism of PPARgamma2.

Blood Glucose↗
PubMed2003

Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa.

BACKGROUND: Anorexia nervosa is associated with lower left ventricular mass (LVM) and systolic dysfunction. Whether these abnormalities reflect chronic protein-energy malnutrition or are primarily related to lower cardiac workload is unclear. OBJECTIVE: The objective of the study was to verify whether low LVM in anorexia nervosa is explained by low hemodynamic load. DESIGN: Ninety-one women with anorexia nervosa [macro x +/- SD age: 20.5 +/- 6.1 y; body mass index (in kg/m(2)): 15.6 +/- 1.9; group 1] and 62 normal-weight female control subjects (age: 22.5 +/- 5.5 y; body mass index: 20.9 +/- 1.2; group 2) underwent Doppler echocardiography. LVM was evaluated as the percentage predicted by body height, sex, and stroke work (systolic blood pressure x stroke volume). RESULTS: The left ventricular chamber dimension was smaller and the chamber walls were thinner in group 1 than in group 2, which resulted in significantly lower LVM and LVM indexes (P < 0.0001). Ejection fraction, heart rate, stroke volume, and cardiac output were significantly (P < 0.007) lower in group 1, but peripheral resistance was substantially higher (P < 0.0001). The deviation of LVM from predicted values was lower and the proportion of subjects with inadequate LVM was significantly higher in group 1 than in group 2 (P < 0.0001). This difference was attenuated after adjustment for body weight and heart rate. There were no relations between LVM and laboratory tests in group 1. CONCLUSIONS: Anorexia nervosa is a condition of low hemodynamic load that leads to low LVM. Even with adjustment for stroke work, however, LVM is lower than would be predicted by height, because of the effect of body weight reduction (ie, wasting of lean body mass).

Adult↗
PubMed2002

Prevention and treatment of implanted central venous catheter (CVC) - related sepsis: a report after six years of home parenteral nutrition (HPN).

Catheter-related sepsis is a serious and common complication in patients receiving home parenteral nutrition (HPN). Prevention measures, prevalence of infections, types of agents and implanted central venous catheters (CVC), effectiveness of antibiotic therapy have been evaluated in 221 patients consecutively followed in our unit from January 1995 to December 2000. The clinical diagnosis of catheter-related infection was made using well-defined criteria. Patients were divided into two groups: A and B, receiving instructions with different modalities: standard (A) and detailed (B), respectively. Sixty CVC-related sepsis occurred in 32 (14%) patients. A multivariate analysis showed that the duration of HPN (P<0.001; OR=0.9), type of catheter (P=0.009; OR=0.12) and type of disease (P=0.033; OR=4.92) significantly influence catheter infection. The type of implanted CVC (159 port-a-cath in 153 patients and 71 tunnelled in 68) seems to affect the infection rate, this being lower in tunnelled (P=0.03). Infection rate was lower in B vs A group (P<0.001) with all types of catheters, suggesting the preventive role of very careful training. In particular, the incidence of CVC-related sepsis was 6/1000 days of HPN (i.e. 6/1000 days of catheterization) in Group A and 3/1000 in Group B. Systemic and antibiotic lock therapy was performed with an 83% successful rate. Gram-positive bacteria were the most frequent CVC infection agents, which are usually eradicated by antibiotic therapy lasting 7 days.

Adult↗