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da Mota Santana J, Pereira M, Carvalho GQ, dos Santos DB, Oliveira AM. Long-Chain Polyunsaturated Fatty Acid Concentrations and Association with Weight Gain in Pregnancy. Nutrients 2021; 14:nu14010128. [PMID: 35011002 PMCID: PMC8746780 DOI: 10.3390/nu14010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 12/02/2022] Open
Abstract
Lower concentrations of omega-3 (ω-3) and higher concentrations of omega-6 (ω-6) have been associated with excess weight in adults; however, the information on this relationship in pregnancy remains in its infancy. This study aimed to investigate the association between plasma levels of ω-3 and ω-6 long-chain polyunsaturated fatty acids (PUFAs) and weight gain during the gestational period. This is a prospective cohort study involving 185 pregnant women registered with the prenatal services of a municipality in the northeast of Brazil. The dosage of the serum concentration of fatty acids and the anthropometric measurements were carried out at the baseline, and the women’s weight information in the first, second, and third trimesters was collected from their pregnancy cards. Serum fatty acids were determined with the help of gas chromatography. The response variable of this study is the latent variable weight gain in pregnancy, derived from three variables: gestational weight in the first, second, and third trimesters. The main exposure was the plasma concentrations of PUFAs. Structural equation modeling was used for the data analysis. The mean age of the pregnant women was 26.74 years old (SD: 5.96 years). Most of the women had not completed high school (84%) and had a low income (70.86%). It was observed that the ω-3 PUFAs, represented by ALA plasm (alpha-linolenic acid), DHA (docosahexaenoic acid), and the EPA/ALA ratio (eicosapentaenoic acid to alpha-linolenic acid ratio), were negatively associated with the weight gain during pregnancy construct (−0.20, −0.12, and −0.14, respectively). Meanwhile, the PUFAs represented by the ratio between the ω-6 category acids ARA and LA (arachidonic acid and linoleic acid) had a direct and positive association (0.22) with that construct. Excess maternal weight gain was associated with ω-3 and ω-6 plasma levels. The women with the greatest gestational weight gain were the ones that presented the highest ARA/LA ratio (ω-6) and the lowest plasma concentrations of ALA, DHA, and EPA/ALA ratio (ω-3).
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Affiliation(s)
- Jerusa da Mota Santana
- Center of Health Sciences, Universidade Federal do Recôncavo da Bahia, Avenida Carlos Amaral, R. do Cajueiro, 1015, Santo Antonio de Jesus 44574-490, Brazil;
- Collective Health Institute, Universidade Federal da Bahia, Rua Basílio da Gama, s/n—Canela, Salvador 40110-040, Brazil;
- Correspondence: ; Tel.: +55-(75)-988537636
| | - Marcos Pereira
- Collective Health Institute, Universidade Federal da Bahia, Rua Basílio da Gama, s/n—Canela, Salvador 40110-040, Brazil;
| | - Gisele Queiroz Carvalho
- Campus Avançado de Governador Valadares, Universidade Federal de Juiz de Fora, Governador Valadares 35010-17, Brazil;
| | - Djanilson Barbosa dos Santos
- Center of Health Sciences, Universidade Federal do Recôncavo da Bahia, Avenida Carlos Amaral, R. do Cajueiro, 1015, Santo Antonio de Jesus 44574-490, Brazil;
| | - Ana Marlucia Oliveira
- Collective Health Institute, Universidade Federal da Bahia, Rua Basílio da Gama, s/n—Canela, Salvador 40110-040, Brazil;
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West AL, Miles EA, Lillycrop KA, Napier JA, Calder PC, Burdge GC. Genetically modified plants are an alternative to oily fish for providing n-3 polyunsaturated fatty acids in the human diet: A summary of the findings of a Biotechnology and Biological Sciences Research Council funded project. NUTR BULL 2021; 46:60-68. [PMID: 33776584 PMCID: PMC7986926 DOI: 10.1111/nbu.12478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The n-3 polyunsaturated fatty acids (PUFA) present primarily in oily fish, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are important components of cell membranes and that are needed for normal development and cell function. Humans have very limited capacity for EPA and DHA synthesis from α-linolenic acid and so they must be obtained pre-formed from the diet. However, perceived unpalatability of oily fish and fish oil concerns about contamination with environmental pollutants, dietary choices that exclude fish and animal products, and price limit the effectiveness of recommendations for EPA and DHA intakes. Moreover, marine sources of EPA and DHA are diminishing in the face of increasing demands. Therefore, an alternative source of EPA and DHA is needed that is broadly acceptable, can be upscaled and is sustainable. This review discusses these challenges and, using findings from recent nutritional trials, explains how they may be overcome by seed oils from transgenic plants engineered to produce EPA and DHA. Trials in healthy men and women assessed the acute uptake and appearance in blood over 8 hours of EPA and DHA from transgenic Camelina sativa compared to fish oil, and the incorporation of these PUFA into blood lipids after dietary supplementation. The findings showed that postprandial EPA and DHA incorporation into blood lipids and accumulation in plasma lipids after dietary supplementation was as good as that achieved with fish oil. The oil derived from this transgenic plant was well tolerated. This review also discusses the implications for human nutrition, marine ecology and agriculture.
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Affiliation(s)
- A. L. West
- Faculty of MedicineSchool of Human Development and HealthUniversity of SouthamptonSouthamptonUK
| | - E. A. Miles
- Faculty of MedicineSchool of Human Development and HealthUniversity of SouthamptonSouthamptonUK
| | - K. A. Lillycrop
- Faculty of Natural and Environmental SciencesCentre for Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - J. A. Napier
- Department of Plant SciencesRothamsted ResearchHarpendenUK
| | - P. C. Calder
- Faculty of MedicineSchool of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustUniversity of SouthamptonSouthamptonUK
| | - G. C. Burdge
- Faculty of MedicineSchool of Human Development and HealthUniversity of SouthamptonSouthamptonUK
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Wade AT, Tregoweth E, Greaves D, Olds TS, Buckley JD, Keage HAD, Coates AM, Smith AE. Long-Chain Omega-3 Fatty Acid Intake Is Associated with Age but not Cognitive Performance in an Older Australian Sample. J Nutr Health Aging 2020; 24:857-864. [PMID: 33009536 DOI: 10.1007/s12603-020-1405-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFA) are essential nutrients and may be capable of delaying age-related cognitive decline. However, previous studies indicate that Australians are not meeting recommendations for LCn-3 PUFA intake. The current study therefore examined LCn-3 PUFA intake in an older Australia sample, as well as associations between LCn-3 PUFA intake and cognitive function. METHODS Cross-sectional data were collected from 90 adults aged 50 to 80 years. LCn-3 PUFA intake was assessed using a food frequency questionnaire and red blood cell fatty acid profiles were used to calculate the Omega-3 Index (RBC n-3 index). Cognitive function was measured using Addenbrooke's Cognitive Examination-III. RESULTS Positive associations were observed between age and RBC n-3 index (b=0.06, 95% CI: 0.01 - 0.10, P=0.01), and age and LCn-3 PUFA intake from fish oil capsules (b=17.5, 95% CI: 2.4 - 32.5 mg/day, P=0.02). When adjusting for LCn-3 PUFA from fish oil capsules, the association between age and RBC n-3 index was no longer significant. No associations were observed between LCn-3 PUFA intake and cognitive function. CONCLUSION LCn-3 PUFA and fish oil consumption increased with age in this sample of older Australians, particularly due to supplement intake. However, LCn-3 PUFA intake was not associated with cognitive function.
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Affiliation(s)
- A T Wade
- Ashleigh E. Smith, Alliance for Research in Exercise Nutrition and Activity, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001. Tel: +618 8302 1735.
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Le HV, Nguyen QV, Nguyen DV, Otto JR, Malau-Aduli BS, Nichols PD, Malau-Aduli AEO. Enhanced Omega-3 Polyunsaturated Fatty Acid Contents in Muscle and Edible Organs of Australian Prime Lambs Grazing Lucerne and Cocksfoot Pastures. Nutrients 2018; 10:E1985. [PMID: 30558276 PMCID: PMC6316222 DOI: 10.3390/nu10121985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 02/07/2023] Open
Abstract
The enhancement of health-beneficial omega-3 long⁻chain (≥C20) polyunsaturated fatty acid (n-3 LC-PUFA) contents in the muscle, liver, heart, and kidney of Australian prime lambs through pasture grazing and supplementation with oil infused pellets was investigated. Forty-eight first-cross prime lambs were randomly assigned into a split-plot design with pasture type as the main plot effect and pellet supplementation as a sub-plot effect in a feeding trial that lasted for nine weeks. The n-3 LC-PUFA content in Longissimus dorsi muscle of all lambs was well above the 30 mg threshold for "omega-3 source" nutrition claim under the Australian Food Standards and Guidelines. Pasture type impacted the fatty acid contents in muscle, heart, and kidney of prime lambs. Lambs grazing cocksfoot grass only had high 18:3n-3 (ALA) and n-3 LC-PUFA contents (67.1 mg/100 g and 55.2 mg/100 g, respectively) in the Longissimus dorsi muscle, which was not significantly different (p > 0.8990) from the contents of lambs grazing only lucerne. Supplementation of pellets with or without oil infusion to grazing lambs generally decreased the ALA and n-3 LC-PUFA contents and increased the n-6/n-3 ratio in the Longissimus dorsi muscle. The fatty acid content in the internal organs of grazing lambs was also affected by pellet supplementation. The liver and kidney of grazing lambs were both "good sources" (60 mg/100 g) of omega-3. The cocksfoot grass showed considerable potential for producing healthy, premium quality meat with high contents of n-3 and n-3 LC-PUFA, which may consequently enhance the omega-3 intake of Australian lamb consumers.
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Affiliation(s)
- Hung V Le
- Animal Genetics and Nutrition, Veterinary Sciences Discipline, College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
- National Institute of Animal Science, Thuy Phuong, Bac Tu Liem, Hanoi 129909, Vietnam.
| | - Quang V Nguyen
- Animal Genetics and Nutrition, Veterinary Sciences Discipline, College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
- College of Economics and Techniques, Thai Nguyen University, Thai Nguyen 252166, Vietnam.
| | - Don V Nguyen
- Animal Genetics and Nutrition, Veterinary Sciences Discipline, College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
- National Institute of Animal Science, Thuy Phuong, Bac Tu Liem, Hanoi 129909, Vietnam.
| | - John R Otto
- Animal Genetics and Nutrition, Veterinary Sciences Discipline, College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
| | - Bunmi S Malau-Aduli
- Asia Pacific Nutrigenomics and Nutrigenetics Organisation (APNNO), CSIRO Food & Nutrition, Adelaide, SA 5000, Australia.
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
| | - Peter D Nichols
- Animal Genetics and Nutrition, Veterinary Sciences Discipline, College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
- CSIRO Oceans & Atmosphere, PO Box 1538, Hobart, TAS 7001, Australia.
- Nutrition Society of Australia (NSA), Level 3, 33-35 Atchison Street, St Leonards, NSW 2065, Australia.
- Australasian Section, American Oil Chemists Society (AAOCS), 2710 S. Boulder, Urbana, IL 61802-6996, USA.
| | - Aduli E O Malau-Aduli
- Animal Genetics and Nutrition, Veterinary Sciences Discipline, College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
- Asia Pacific Nutrigenomics and Nutrigenetics Organisation (APNNO), CSIRO Food & Nutrition, Adelaide, SA 5000, Australia.
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Xue Z, Wan F, Yu W, Liu J, Zhang Z, Kou X. Edible Oil Production From Microalgae: A Review. EUR J LIPID SCI TECH 2018. [DOI: 10.1002/ejlt.201700428] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zhaohui Xue
- School of Chemical Engineering and Technology; Tianjin University; 300072 Tianjin China
| | - Fang Wan
- School of Chemical Engineering and Technology; Tianjin University; 300072 Tianjin China
| | - Wancong Yu
- Tianjin Academy of Agricultural Sciences; 300381 Tianjin China
| | - Jing Liu
- School of Chemistry and Chemical Engineering; Qinghai Nationalities University; 810007 Qinghai China
| | - Zhijun Zhang
- Tianjin Academy of Agricultural Sciences; 300381 Tianjin China
| | - Xiaohong Kou
- School of Chemical Engineering and Technology; Tianjin University; 300072 Tianjin China
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Zhang YY, Liu W, Zhao TY, Tian HM. Efficacy of Omega-3 Polyunsaturated Fatty Acids Supplementation in Managing Overweight and Obesity: A Meta-Analysis of Randomized Clinical Trials. J Nutr Health Aging 2017; 21:187-192. [PMID: 28112774 DOI: 10.1007/s12603-016-0755-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Studies in rodents and humans have indicated that omega-3 polyunsaturated fatty acids (n-3 PUFA) may reduce weight. The aim of this meta-analysis was to evaluate evidence for the efficacy of n-3 PUFA in managing overweight and obesity. METHODS We performed a systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials until May 2015. Two reviewers independently determined the eligibility of studies and assessed the reporting quality of included randomized controlled trials (RCTs). RESULTS A total of 11 RCTs involving 617 participants were included in this meta-analysis. Based on the meta-analysis of nine studies, a statistically nonsignificant difference was revealed in weight loss between n-3 PUFA and placebo (p=0.99; weighted mean difference [WMD]: 0.00; 95% confidence interval [CI] -0.42 to 0.43), whereas n-3 PUFA was superior to placebo in reducing serum triglyceride levels (p=0.0007; standard median difference [Std MD]: -0.59; 95% CI -0.93 to -0.25). Based on meta-analysis of seven studies, the analysis of aggregated data showed a significant reduction in waist circumference (p=0.005; WMD: -0.53; 95% CI -0.90 to -0.16). There were no significant differences in body mass index, total serum levels of cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and fasting glucose levels. CONCLUSIONS The evidence from RCTs showed that n-3 PUFA might effectively reduce waist circumference and triglyceride levels in overweight and obese adults, but n-3 PUFA may not effectively reduce body weight. Given the small number and poor quality of RCTs included in the meta-analysis, these results are inconclusive. A large-scale, well-designed RCT is needed to further address this issue.
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Affiliation(s)
- Y Y Zhang
- H.M. Tian, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, GuoXue Lane 37, Chengdu, Sichuan, 610041, P.R.China, Tel./fax: +86 028 85422982, E-mail addresses:
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Bostock EL, Morse CI, Winwood K, McEwan IM, Onambélé GL. Omega-3 Fatty Acids and Vitamin D in Immobilisation: Part A- Modulation of Appendicular Mass Content, Composition and Structure. J Nutr Health Aging 2017; 21:51-58. [PMID: 27999850 PMCID: PMC5306237 DOI: 10.1007/s12603-016-0710-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/25/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Muscle size decreases in response to short-term limb immobilisation. This study set out to determine whether two potential protein-sparing modulators (eicosapentaenoic acid and vitamin D) would attenuate immobilisation-induced changes in muscle characteristics. DESIGN The study used a randomised, double-blind, placebo-controlled design. SETTING The study took part in a laboratory setting. PARTICIPANTS Twenty-four male and female healthy participants, aged 23.0±5.8 years. INTERVENTION The non-dominant arm was immobilised in a sling for a period of nine waking hours a day over two continuous weeks. Participants were randomly assigned to one of three groups: placebo (n=8, Lecithin, 2400 mg daily), omega-3 (ω-3) fatty acids (n=8, eicosapentaenoic acid (EPA); 1770 mg, and docosahexaenoic acid (DHA); 390 mg, daily) or vitamin D (n=8, 1,000 IU daily). MEASUREMENTS Muscle and sub-cutaneous adipose thickness (B-mode ultrasonography), body composition (DXA) and arm girth (anthropometry) were measured before immobilisation, immediately on removal of the sling and two weeks after re-mobilisation. RESULTS Muscle thickness (-5.4±4.3%), upper and lower arm girth (-1.3±0.4 and -0.8±0.8%, respectively), lean mass (-3.6±3.7%) and bone mineral content (BMC) (-2.3±1.5%) decreased significantly with limb immobilisation in the placebo group (P<0.05). Despite no significant effect of group, ω-3 and vitamin D supplementation showed trends (p>0.05) towards attenuating the decreases in muscle thickness, upper/lower arm girths and BMC observed in the placebo group. The ω-3 supplementation group demonstrated a non-significant attenuation of the decrease in DXA quantified lean mass observed in the placebo group. Sub-cutaneous adipose thickness increased in the placebo group (P<0.05). ω-3 and vitamin D both blunted this response, with ω-3 having a greater effect (P<0.05). All parameters had returned to baseline values at the re-mobilisation phase of the study. CONCLUSION Overall, at the current doses, ω-3 and vitamin D supplementation only attenuated one of the changes associated with non-injurious limb immobilisation. These findings would necessitate further research into either a) supplementation linked to injury-induced immobilisation, or b) larger doses of these supplements to confirm/refute the physiological reserve potential of the two supplements.
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Affiliation(s)
- E L Bostock
- Gladys Onambele-Pearson, Health, Exercise and Active Living Research Centre, Department of Exercise and Sport Science, Manchester Metropolitan University, Crewe Green Road, Crewe, CW1 5DU, United Kingdom. Tel: +44 (0) 161 247 5594;
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Efficacy of omega-3 polyunsaturated fatty acids supplementation in managing overweight and obesity: A meta-analysis of randomized clinical trials. J Nutr Health Aging 2016. [DOI: 10.1007/s12603-016-0750-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ticinesi A, Meschi T, Lauretani F, Felis G, Franchi F, Pedrolli C, Barichella M, Benati G, Di Nuzzo S, Ceda GP, Maggio M. Nutrition and Inflammation in Older Individuals: Focus on Vitamin D, n-3 Polyunsaturated Fatty Acids and Whey Proteins. Nutrients 2016; 8:186. [PMID: 27043616 PMCID: PMC4848655 DOI: 10.3390/nu8040186] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022] Open
Abstract
Chronic activation of the inflammatory response, defined as inflammaging, is the key physio-pathological substrate for anabolic resistance, sarcopenia and frailty in older individuals. Nutrients can theoretically modulate this phenomenon. The underlying molecular mechanisms reducing the synthesis of pro-inflammatory mediators have been elucidated, particularly for vitamin D, n-3 polyunsaturated fatty acids (PUFA) and whey proteins. In this paper, we review the current evidence emerging from observational and intervention studies, performed in older individuals, either community-dwelling or hospitalized with acute disease, and evaluating the effects of intake of vitamin D, n-3 PUFA and whey proteins on inflammatory markers, such as C-Reactive Protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α). After the analysis, we conclude that there is sufficient evidence for an anti-inflammatory effect in aging only for n-3 PUFA intake, while the few existing intervention studies do not support a similar activity for vitamin D and whey supplements. There is need in the future of large, high-quality studies testing the effects of combined dietary interventions including the above mentioned nutrients on inflammation and health-related outcomes.
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Affiliation(s)
- Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
- Department of Clinical and Experimental Medicine, University of Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
- Department of Clinical and Experimental Medicine, University of Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
| | - Fulvio Lauretani
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
| | - Giovanna Felis
- Department of Biotechnology, University of Verona, Strada Le Grazie 15, Verona 37134, Italy.
| | - Fabrizio Franchi
- Geriatric Unit, "Guglielmo da Saliceto" Hospital, AUSL Piacenza, Via Taverna 49, Piacenza 29121, Italy.
| | - Carlo Pedrolli
- Dietetics and Clinical Nutrition Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Provincia Autonoma di Trento, Largo Medaglie d'Oro 9, Trento 38122, Italy.
| | - Michela Barichella
- Parkinson Institute, Azienda Socio-Sanitaria Territoriale "Gaetano Pini"-C.T.O., Via Bignami 1, Milan 20126, Italy.
| | - Giuseppe Benati
- Geriatric Unit, Ospedale G.B. Morgagni-L. Pierantoni, Via Carlo Forlanini 34, Forlì 47121, Italy.
| | - Sergio Di Nuzzo
- Department of Clinical and Experimental Medicine, University of Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
| | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, University of Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
- Clinical Geriatrics Unit, Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
| | - Marcello Maggio
- Department of Clinical and Experimental Medicine, University of Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
- Clinical Geriatrics Unit, Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, Parma 43126, Italy.
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