Mediterranean Journal of Nutrition and Metabolism

The elderly are an important part of the population. They are more frail, more often sick and it takes them longer to get better; therefore they consume a larger proportion of health services. Nutrition is adjuvant to medical treatment. Swallowing disorders are common in elderly patients. These may be manifestations of different neurological disorders, but the most common swallowing disorder is deconditioning during acute illness. Enteral nutrition bypasses the swallowing system, using nasogastric tubes or percutaneous gastric and enteric tubes. These feeding technologies can supply the needs of the elderly patient. Nevertheless, rehabilitation of the swallowing system, giving the elderly patient optimal functionality, is our main task. In addition to the medical treatment, logotherapists also have a crucial role in swallowing rehabilitation. Enteral nutrition (EN) is an essential part of geriatric medicine.

The clinical course of inflammatory bowel disease (IBD) is characterised by periods of quiescent disease interspersed with episodes of active inflammation; consequently, malabsorption and malnutrition are the most important problems in IBD patients. It has been widely demonstrated that nutritional support allows more tolerability both to drugs and surgery therapy increases the duration of remission. Among enteral formula enriched in specific nutraceuticals like glutamine or transforming growth factor β2 used in IBD, we tested those enriched with omega 3, soluble fibre and arginine. We observed a high compliance and a statistically significant improvement of symptoms, nutritional status, inflammatory index and Crohn's disease activity index. A specific nutritional intervention, in particular specific enteral nutrition formula, is essential in the prevention and treatment of malnutrition caused by IBD.

Pulses represent one of the most important food categories that have been extensively used as staple foods to cover basic protein and energy needs throughout the history of humanity. In addition to their low lipid and high dietary fibre content, emerging evidence stresses the importance of pulses as carriers of several constituents of potential biological importance, including enzyme inhibitors, lectins, phytates, oxalates, polyphenols, saponins and phytosterols. Investigations in humans suggest that pulses may contribute to human health and well-being, mostly through prevention of coronary heart disease and possibly diabetes. The mechanisms responsible for this apparently protective role may include a favourable influence on blood lipids and glucose. The nutritional value of pulses, which are a key component of the traditional Mediterranean diet, is not generally recognised and is frequently under-appreciated.

The induction of enteral nutrition in diabetic subjects is problematic because of the difficulty in controlling glycaemia. The use of a sliding scale is discouraged, while scheduled insulin therapy is optimal. We compiled a protocol for patients' insulinisation during induction of enteral nutrition that takes into account basal and nutritional requirements. This allows the fulfilment of patients' actual insulin requirements and optimisation of insulin therapy.

A purified fraction of water-soluble polysaccharides was isolated from Glycyrrhiza uralensis Fisch using ion exchange and size exclusion chromatography. The present study was undertaken to discuss the preliminary immunoregulation mechanism of glycyrrhiza polysaccharide (GP) by cytochemistry and quantitative analyses, and intracellular enzyme measurement of macrophages. Acid phosphatase (ACPase), adenosine triphosphatase (ATPase), acid α-naphthyl acetate esterase (ANAE) and succinate dehydrogenase (SDH) in macrophages were stained with different methods. The results indicate that GP increased the production of ACPase, ATPase, ANAE and SDH; the activities of lysozyme (LSZ) and superoxide dismutase (SOD) of macrophages were also induced by GP. Our data suggest that the beneficial therapeutic effects of GP may be attributed partly to its ability to modulate macrophage immune functions.

Aim and methods: Nutrition, unhealthy lifestyles and cancer appear to be strictly related, but few authors have analysed the interest in dietary information of cancer patients and their families. This survey was conducted in the Veneto area (Italy) to investigate the concern of cancer patients and their family members about diet as a health tool before and after diagnosis of cancer. Results: Seven hundred and four questionnaires were collected: 380 from cancer patients and 324 from family members of cancer subjects. Breast cancer (BC) was the most frequent disease for patients (61.8%) as well as families (26.5%). Generally, the importance of having precise diet information after diagnosis is recognised by 40.3% of patients, with significant differences between the various types of cancer: gastric and colon/rectum cancer (GCC) patients were more concerned than BC women about precise information concerning a diet to follow immediately after diagnosis (p = 0.000, ODs = 3.10, CI 1.68–5.71) or during treatments (p = 0.001, ODs = 2.67, CI 1.46–4.89). The nutritional information is supplied to patients in 34% of cases and to relatives in 30.3%, often from non-medical sources. In total healthcare workers (family doctor, oncologist, surgeon, dietician) represented the exclusive source of dietary information for 24.9% of patients and 22.9% of family members. Diet after diagnosis changes in 69.1% of GCC patients and in 39.2% of BC women. Relatives, particularly women, report difficulties preparing patients' meals in 30.7% of cases, changes in the eating habits of the entire family in 29.9% and discontent connected with patients diet in 13.9%. The concern about proper nutrition after diagnosis increases more in GCC subjects (p < 0.025) when compared to BC subjects and in patients with more recent diagnosis (p < 0.041) when compared with patients with diagnosis >5 years ago, while in family members the interest in diet after diagnosis increases more in women than in men (p < 0.030) without other differences regarding the degree of relationship, type of cancer or diagnosis time. Relatives (92.7%) have more interest in nutritional education than patients (74.9%). Cancer patients <65 years were more interested in educational initiatives concerning nutrition (p = 0.000, ODs = 4.46, CI 2.6–7.4) than older patients (>65 years) and female subjects were more concerned than male patients (p = 0.008, ODs = 2.11, CI 1.2–3.6). Conclusions: The interest in the dietary knowledge and in educational initiatives concerning nutrition is high in cancer patients and their relatives, although it decreases with the age. The poor attention paid to nutrition of cancer patients by various healthcare workers deserves consideration, since the psychophysical wellbeing and perhaps also survival of cancer patients can be improved by correct dietary management, as well as, naturally, by the principal treatments themselves.

Lactose intolerance is found in 70% of the world-wide population. Lactase activity gradually increases till birth and then, after the early months of life, it physiologically begins to lessen. In about 30% of the population it remains active also as an adult due to a mutation: in Europe a substitution of C with T in position 13910 of the lactase gene. Our data show that CC genotype, associated with lactase non-persistence, is found in type 1 diabetes with a high prevalence of 67%. To evaluate the “glycaemic-metabolic control” we investigated the glycosylated haemoglobin (HbA1c) values and we noted that there is no significant difference between CC (non-absorber) and CT/TT (absorber) genotypes of diabetic patients. Glutamic acid decarboxylase antibodies (GADA) are positive in 58% of diabetic patients with CC genotype: this presence could be linked to the intestinal membrane hyperpermeability.

The aim of our study was to directly compare the metabolic effect of monounsaturated fatty acid rich oils and polyunsaturated fatty acid rich oils on the plasma lipid pattern of moderately hypercholesterolaemic subjects under controlled isocaloric condition. After a 30-day run-in diet, 44 healthy Caucasian subjects with moderate hypercholesterolaemia were randomly assigned to one of four different isocaloric diets, differing only regarding the oil used (corn oil, corn oil supplemented with vitamin E, extra-virgin olive oil or different self-selected oils), for 45 days. At the end of the study, when compared to the baseline value, low-density lipoprotein (LDL)-cholesterolaemia was significantly lower only in patients taking corn oil (−13.9%; 95%CI −5.9 to −20.1; p = 0.02) or corn oil with added vitamin E (−19.1%; 95%CI −6.9 to −24.1; p = 0.03). Differences in plasma high-density lipoprotein (HDL)-cholesterol and triglyceride levels from baseline levels and between the four diets did not reach statistical significance.

HIV-related cryptosporidiosis is an opportunistic parasitic infection that may occur in the advanced phases of the disease in case of severe immunodeficiency. It provokes inflammatory diarrhoea with malabsorption and weight loss. Highly active antiretroviral therapy (HAART) and nutritional support are the only treatments in the absence of any efficient therapy. In a young woman affected with vertically transmitted HIV infection, cryptosporidiosis induced severe metabolic imbalance and malnutrition. The contemporary presence of other opportunistic diseases such as oral and pharyngeal candidiasis and disseminated cytomegalovirus disease worsened the symptoms and nutritional alterations. Using specific therapies for these pathogens and adequate nutritional support, both metabolic and nutritional alterations and clinical symptoms were resolved, allowing the commencement of HAART for the improvement of cryptosporidiosis.

The importance of following a correct diet is well known and unquestioned, and is one of the underpinning principles of the nutritional treatment of diabetes mellitus. However, we are all fully aware of how difficult and challenging it may be to achieve significant results, as we need to motivate the patients, and in some cases also motivate ourselves. Moreover, over time the various schools of thought have given differing interpretations on how to set up a nutritional treatment plan. Eventually, pressure from the Ministry of Health on the Scientific Associations – through the National Healthcare Plan – with regard to the need to change people's lifestyles by recommending correct dietary habits led the Italian Dietetics and Clinical Nutrition Association (Associazione Italiana di Dietetica e Nutrizione Clinica) and the Diabetologists' Association (Associazione Medici Diabetologi) to combine their efforts through the creation of a joint Diabetes and Nutrition study group. The study group's objectives are to provide tools to help physicians optimise their work in the nutritional area, and to identify consistent, rational operating guidelines. This publication addresses the key topic, i.e., the need to set forth recommendations for the nutritional medical treatment of diabetes mellitus. While taking into account the latest national and international studies, our approach sought to adjust those studies to the lifestyles and habits prevalent in this country. Needless to say, these recommendations are constantly evolving and subject to improvement, and the study group's task will be to focus their efforts on providing physicians with the most advanced tools, and to identify patients' as well as physicians' needs. As a whole, these objectives will represent a valuable service available in everyday clinical practice in the area of nutritional treatment of diabetes mellitus.