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Santarpia L, Orefice R, Alfonsi L, Marra M, Contaldo F, Pasanisi F. The Anxiety Burden in Patients with Chronic Intestinal Failure on Long-Term Parenteral Nutrition and in Their Caregivers. Nutrients 2024; 16:1168. [PMID: 38674859 PMCID: PMC11054644 DOI: 10.3390/nu16081168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background and aims: Home parenteral nutrition (HPN) is a life-saving treatment for patients affected by chronic intestinal failure (CIF). Both this clinical condition and its therapy require radical lifestyle modifications, affecting life quality and psychological balance in patients as well as family members. Patient psychological burden has rarely been taken into consideration, not to mention that of caregivers. This study aims to evaluate the levels of anxiety in CIF patients on HPN, and their caregivers, consequently determining their impact on the psychological and physical aspects. Methods: After a brief introductory interview, adult patients on HPN for CIF and their caregivers were asked to fill in the HAMA-A questionnaire. Results: Fifty patients and their respective caregivers were enrolled. Mean HAMA-A scores were similar in patients and caregivers and testified the presence of a mild to severe impact of CIF and HPN in both groups, with a significantly higher impact on female patients and caregivers. After adjusting age, education level, duration of CIF and HPN dependence, and degree of kinship, no differences were revealed in the scores. Conclusions: The study confirms that CIF patients on HPN and their caregivers have a significant anxiety burden independently from the duration of the disease, therefore needing appropriate support.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (R.O.); (L.A.); (M.M.); (F.P.)
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Nardone OM, Calabrese G, La Mantia A, Testa A, Rispo A, Alfonsi L, Pasanisi F, Castiglione F. Effectiveness of Partial Enteral Nutrition as Add-On to Biologics in Patients With Refractory and Difficult-to-Treat Crohn's Disease: A Pilot Study. Crohns Colitis 360 2024; 6:otae011. [PMID: 38464346 PMCID: PMC10923207 DOI: 10.1093/crocol/otae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Indexed: 03/12/2024] Open
Abstract
Background Partial enteral nutrition (PEN) is a well-established treatment for children with Crohn's disease (CD). However, its efficacy in adults with CD remains uncertain. We aimed to assess the effectiveness of PEN as an add-on to escalated biological therapy in adults with CD who have lost response to biologics. Methods We conducted a retrospective observational study including patients who had lost response to biologics and received PEN in combination with escalated treatment, compared to those treated only with escalated therapy. The primary endpoint was steroid-free clinical remission (CR) at 24 weeks. Secondary endpoints included transmural healing (TH) and response (TR) rates along with selected clinical outcomes. Results Forty-two patients were screened; 12 (28.6%) were excluded for complicated disease and 30 (71.4%) were included in the final analysis. Fourteen (46.7%) patients completed PEN treatment at 8 weeks, while 16 patients (53.3%) discontinued treatment due to intolerance and continued with escalation of biologic (BT group). At 24 weeks, 9 patients (64.3%) in the PEN group achieved CR, compared to 4 patients (25%) in the BT group (P = .03). The TR rate was 64.9% in the PEN group and 25% in the BT group (P = .03). Patients receiving PEN exhibited an increase in albumin levels compared to those in the BT group (Δ = 0.5; P = .02). A higher rate of therapy changes (68.7%) was observed in the BT group compared to 14.2% in the PEN group (P = .004). Prior failure to 2 lines of biological therapy was associated with adherence to PEN (OR = 1.583; CI = 1.06-2.36; P = .01). Conclusions In patients who had lost response to biologics, PEN in combination with escalated biologics was associated with CR and TR and improved nutritional status. Hence, the addition of PEN should be considered for patients with difficult-to-treat CD.
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Affiliation(s)
- Olga Maria Nardone
- Gastroenterology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Calabrese
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessia La Mantia
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Cioffi I, Di Vincenzo O, Morlino D, Santarpia L, Pagano C, Alfonsi L, Imperatore N, Castiglione F, Pasanisi F. Prevalence of Vitamin D deficiency and its association with disease activity in adult patients with Crohn’s disease. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marra M, Cioffi I, Morlino D, Vincenzo OD, Pagano MC, Imperatore N, Alfonsi L, Santarpia L, Castiglione F, Scalfi L, Pasanisi F. New Predictive Equations for Estimating Resting Energy Expenditure in Adults With Crohn's Disease. JPEN J Parenter Enteral Nutr 2020; 44:1021-1028. [PMID: 32010994 PMCID: PMC7496798 DOI: 10.1002/jpen.1790] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increased resting energy expenditure (REE) has been hypothesized to be a potential cause of weight loss in individuals with Crohn's disease (CD). This study aimed to develop and validate new predictive equations for estimating REE in adults with CD. METHODS Adults, ages 18-65 years, with CD were recruited. Anthropometry, indirect calorimetry, and bioimpedance analysis were performed in all patients. Disease activity was assessed by Crohn's Disease Activity Index. The new predictive equations were generated using different regression models. Prediction accuracy of the new equations was assessed and compared with the most commonly used equations. RESULTS A total of 270 CD patients (159 males, 111 females) were included and randomly assigned to the calibration (n = 180) and validation groups (n = 90). REE was directly correlated with weight and bioimpedance index, whereas the relation with both age and disease activity was inverse. The new equations were suitable for estimating REE at population level (bias: -0.2 and -0.3, respectively). Individual accuracy was good in both models (≥80%, respectively), especially in females; and similar results were shown by some of the selected equations. But, when accuracy was set within ±5%, the new equations gave the highest prediction. CONCLUSION The new, disease-specific, equations for predicting REE in individuals with CD give a good prediction accuracy as far as those proposed in the literature for the general population. However, the new ones performed better at the individual level. Further studies are needed to verify the reliability and usefulness of these new equations.
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Affiliation(s)
- Maurizio Marra
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Delia Morlino
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Olivia Di Vincenzo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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De Santis A, Marchetti D, Pavón-Carrasco FJ, Cianchini G, Perrone L, Abbattista C, Alfonsi L, Amoruso L, Campuzano SA, Carbone M, Cesaroni C, De Franceschi G, De Santis A, Di Giovambattista R, Ippolito A, Piscini A, Sabbagh D, Soldani M, Santoro F, Spogli L, Haagmans R. Precursory worldwide signatures of earthquake occurrences on Swarm satellite data. Sci Rep 2019; 9:20287. [PMID: 31889060 PMCID: PMC6937265 DOI: 10.1038/s41598-019-56599-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
The study of the preparation phase of large earthquakes is essential to understand the physical processes involved, and potentially useful also to develop a future reliable short-term warning system. Here we analyse electron density and magnetic field data measured by Swarm three-satellite constellation for 4.7 years, to look for possible in-situ ionospheric precursors of large earthquakes to study the interactions between the lithosphere and the above atmosphere and ionosphere, in what is called the Lithosphere-Atmosphere-Ionosphere Coupling (LAIC). We define these anomalies statistically in the whole space-time interval of interest and use a Worldwide Statistical Correlation (WSC) analysis through a superposed epoch approach to study the possible relation with the earthquakes. We find some clear concentrations of electron density and magnetic anomalies from more than two months to some days before the earthquake occurrences. Such anomaly clustering is, in general, statistically significant with respect to homogeneous random simulations, supporting a LAIC during the preparation phase of earthquakes. By investigating different earthquake magnitude ranges, not only do we confirm the well-known Rikitake empirical law between ionospheric anomaly precursor time and earthquake magnitude, but we also give more reliability to the seismic source origin for many of the identified anomalies.
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Affiliation(s)
- A De Santis
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy.
| | - D Marchetti
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
- Now at School of Remote Sensing and Geomatics Engineering NUIST, Nanjing University of Information Science and Technology, Nanjing, China
| | - F J Pavón-Carrasco
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
- Now at Univ. Complutense de Madrid, Facultad CC. Físicas, Avd. Complutense, s/n - Madrid 28040, Spain & Geoscience Institute IGEO (CSIC - UCM), Madrid, 28040, Spain
| | - G Cianchini
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - L Perrone
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - C Abbattista
- Planetek Italia srl, via Massaua 12, Bari, 70132, Italy
| | - L Alfonsi
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - L Amoruso
- Planetek Italia srl, via Massaua 12, Bari, 70132, Italy
| | - S A Campuzano
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - M Carbone
- Planetek Italia srl, via Massaua 12, Bari, 70132, Italy
| | - C Cesaroni
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - G De Franceschi
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - Anna De Santis
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - R Di Giovambattista
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - A Ippolito
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
- Now at ASI, Via del Politecnico snc, Roma, 00133, Italy
| | - A Piscini
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - D Sabbagh
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - M Soldani
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
| | - F Santoro
- Planetek Italia srl, via Massaua 12, Bari, 70132, Italy
| | - L Spogli
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, Roma, 00143, Italy
- SpacEarth Technology, Via di Vigna Murata 605, Roma, 00143, Italy
| | - R Haagmans
- European Space Agency, ESTEC, Keplerlaan 1, NL-2201 AZ, Noordwijk, The Netherlands
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Santarpia L, Alfonsi L, Castiglione F, Pagano MC, Cioffi I, Rispo A, Sodo M, Contaldo F, Pasanisi F. Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn's Disease. Nutrients 2019; 11:nu11122947. [PMID: 31817074 PMCID: PMC6950059 DOI: 10.3390/nu11122947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory bowel disease frequently associated with malabsorption and secondary protein-energy malnutrition (PEM). METHODS Biochemical and clinical data of 63 (34 females, 29 males) patients with PEM due to CD sent to our outpatient unit for nutritional evaluation were retrospectively analyzed. Patients were divided into two groups, according to disease activity. Thirty-eight patients (group A) had the active disease, and 25 patients (group B) suffered from malabsorption resulting from past intestinal resections due to CD. After a physical and hemato-biochemical evaluation at the first visit, all patients received disease-specific personalized dietetic indications. When indicated, oral nutritional supplements, oral/parenteral vitamins, micronutrients, and electrolytes, up to parenteral nutrition, were prescribed. RESULTS After 1, 3, and 6 months of nutritional therapy, body weight, body mass index (BMI), and serum butyryl-cholinesterase significantly improved in both groups. In 8 out of 13 (61.5%) patients with a cutaneous stoma, intestinal continuity was restored. CONCLUSIONS This study confirms the effectiveness of nutritional rehabilitation and provides information on the time required for nutritional treatment in patients with CD, both during the acute phase and after malabsorption due to intestinal resection.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
- Correspondence: ; Tel./Fax: +39-081-746-2333
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (F.C.); (A.R.)
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (F.C.); (A.R.)
| | - Maurizio Sodo
- General and Transplantation Surgery, Department of Public Health, Federico II University Hospital, 80131 Naples, Italy;
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
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Santarpia L, Viceconte G, Foggia M, Alfonsi L, Tosone G, Camera L, Pagano MC, De Simone G, Contaldo F, Pasanisi F. Home Parenteral Nutrition in Patients with Intestinal Failure: Possible Undetected Complications. Nutrients 2019; 11:nu11030581. [PMID: 30857281 PMCID: PMC6471421 DOI: 10.3390/nu11030581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). Materials and Methods: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. Results: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. Conclusion: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Giulio Viceconte
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Foggia
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Grazia Tosone
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Luigi Camera
- Radiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Giuseppe De Simone
- Anesthesiology and Intensive Care Unit, Department of Neurosciences, Federico II University, 80131 Naples, Italy.
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
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Iacone R, Scanzano C, Santarpia L, Alfonsi L, Marra M, Pagano MC, D'Isanto A, Frangipane I, Vitalone A, D'Angeli M, Contaldo F, Pasanisi F. Essential Amino Acid Profile in Parenteral Nutrition Mixtures: Does It Meet Needs? Nutrients 2018; 10:nu10121937. [PMID: 30563270 PMCID: PMC6316548 DOI: 10.3390/nu10121937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIMS The study compares the essential amino acid (EAA) composition of different parenteral nutrition (PN) mixtures with whey protein EAA profile and the theoretical daily EAA requirements (set by WHO/FAO/UNU or IAAO method). According to the individual EAA profile, the potential effect of several PN mixtures was evaluated on the skeletal muscle mass (SMM) of patients on home PN. METHODS Eight AA solutions and fifteen complete PN mixtures were considered. Twenty-nine clinically stable patients with short bowel syndrome on home total PN were retrospectively evaluated. SMM was estimated by bioelectrical impedance analysis. RESULTS The prescribed doses of EAA that showed a significant increase in home PN patients muscle mass were considerably greater than the theoretical ones, showing an EAA profile similar to whey protein. At the daily dose of 1 g of total AA s/kg body weight (BW), the considered PN mixtures mostly failed to improve SMM. Only prescribed doses which included more than 0.25 g/kg BW of total BCAA with at least 0.10 g/kg BW leucine, 0.08 g/kg BW isoleucine, and 0.06 g/kg BW methionine showed a significant increase in SMM. CONCLUSIONS The theoretical daily requirement for each EAA was met by all considered PN solutions when the prescribed daily dose of total AAs was set at 1 g/kg BW. Nevertheless, our data suggest that only an increase in total BCAA, also richer in single AA leucine, isoleucine, and methionine, is associated with the maintenance and/or increase of SMM. According to these preliminary observations, we support the prescription of an EAA composition of PN mixtures close to that of whey protein for the preservation of SMM in patients on long-term total PN.
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Affiliation(s)
- Roberto Iacone
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Clelia Scanzano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Maurizio Marra
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Anna D'Isanto
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Ignazio Frangipane
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Andrea Vitalone
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Mariana D'Angeli
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
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Cioffi I, Imperatore N, Pagano M, Di Vincenzo O, Alfonsi L, Testa A, Marra M, Castiglione F, Contaldo F, Pasanisi F. Nutritional assessment in patients with crohn’s disease: A cross-sectional study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Santarpia L, Pagano MC, Cioffi I, Alfonsi L, Cuomo R, Labruna G, Sacchetti L, Contaldo F, Pasanisi F. Impaired Enterohormone Response Following a Liquid Test Meal in Gastrectomized Patients. Ann Nutr Metab 2017; 71:211-216. [PMID: 29136633 DOI: 10.1159/000481919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Total gastrectomy (TG) is responsible for symptoms or disturbance of alimentary status (changes in body weight, food intake per meal and frequency of meal per day) which, in turn are responsible for weight loss and malnutrition. The study evaluates the gut hormone responses in totally gastrectomized (TG) patients after a liquid meal test. METHODS Twenty total gastrectomized cancer-free patients (12 M, 8 F, 56.4 ± 10.2 years, BMI 21.4 ± 2.2 kg/m2) and 10 healthy volunteers (4 M, 6 F, 48.0 ± 12.7 years, BMI 26.7 ± 3.0 kg/m2 ) drank a liquid meal (1.25 kcal/mL) at the rate of 50 mL/5' min for a maximum of 30 min. Satiety score was assessed and blood sample was taken at different time points. RESULTS The time response course, particularly for insulin, glucose-like pepetide-1, and cholecystokinin, significantly differed between TG patients and controls. CONCLUSIONS Our results may help to better understand hormone responses triggered by the faster arrival of nutrients in the small bowel and to explain some post-TG symptoms.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Naples, Italy
| | | | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Naples, Italy
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Naples, Italy
| | - Rosario Cuomo
- Gastrenterology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Labruna
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | | | - Franco Contaldo
- Internal Medicine and Clinical Nutrition Unit, Naples, Italy.,Interuniversity Center for Obesity and Eating Disorders (CISRODCA), Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Naples, Italy.,Interuniversity Center for Obesity and Eating Disorders (CISRODCA), Naples, Italy
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Alfonsi L, Ambroglini F, Ambrosi G, Ammendola R, Assante D, Badoni D, Belyaev V, Burger W, Cafagna A, Cipollone P, Consolini G, Conti L, Contin A, Angelis E, Donato C, Franceschi G, Santis A, Santis C, Diego P, Durante M, Fornaro C, Guandalini C, Laurenti G, Laurenza M, Lazzizzera I, Lolli M, Manea C, Marcelli L, Marcucci F, Masciantonio G, Osteria G, Palma F, Palmonari F, Panico B, Patrizii L, Picozza P, Pozzato M, Rashevskaya I, Ricci M, Rovituso M, Scotti V, Sotgiu A, Sparvoli R, Spataro B, Spogli L, Tommasino F, Ubertini P, Vannaroni G, Xuhui S, Zoffoli S. The HEPD particle detector and the EFD electric field detector for the CSES satellite. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2016.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Santarpia L, Buonomo A, Pagano MC, Alfonsi L, Foggia M, Mottola M, Marinosci GZ, Contaldo F, Pasanisi F. Central venous catheter related bloodstream infections in adult patients on home parenteral nutrition: Prevalence, predictive factors, therapeutic outcome. Clin Nutr 2016; 35:1394-1398. [DOI: 10.1016/j.clnu.2016.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
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13
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Sammarco R, Marra M, Pagano MC, Alfonsi L, Santarpia L, Cioffi I, Contaldo F, Pasanisi F. Resting energy expenditure in adult patients with Crohn's disease. Clin Nutr 2016; 36:467-470. [PMID: 26869381 DOI: 10.1016/j.clnu.2016.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/07/2015] [Accepted: 01/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND & AIMS Crohn's disease (CD) is a chronic intestinal disorder of unknown etiology involving any section of the gastrointestinal tract often associated with protein-energy malnutrition (PEM). Increased resting energy expenditure (REE) unmatched by adequate dietary intake is amongst the pathogenetic mechanisms proposed for PEM. Aim of this study was to evaluate REE in CD patients receiving or not immuno-suppressive therapy as compared to controls. METHODS 36 CD patients (22 M and 14 F, age range 18-55 years) clinically stable and without complications since at least 6 month were studied. REE was evaluated by indirect calorimetry and body composition by BIA. Full biochemistry was performed. Patients were divided into two groups: Group 1 (G1 = 12 patients) without and Group 2 (G2 = 24 patients) with immuno-suppressive therapy. RESULTS The two groups were similar for age, height and BMI whereas significantly differed for weight (G1 vs G2: 56.9 ± 7.44 vs 62.3 ± 8.34 kg), fat free mass (FFM: 40.4 ± 5.73 vs 48.2 ± 7.06 kg), fat mass (FM: 17.0 ± 3.55 vs 13.9 ± 5.54 kg) and phase angle (PA: 5.6 ± 1.4 vs 6.5 ± 1.0°). Serum inflammation parameters were significantly higher in G1 than in G2: hs-PCR: 7.76 ± 14.2 vs 7.16 ± 13.4 mg/dl; alfa 2-protein: 11.7 ± 3.69 vs 9.74 ± 2.08 mg/dl; fibrinogen: 424 ± 174 vs 334 ± 118 mg/dl (p < 0.05). REE was higher in G2 vs G1: 1383 ± 267 vs 1582 ± 253kcal/die (p < 0.05) both in men: 1579 ± 314 vs 1640 ± 203 and women: 1267 ± 140 vs 1380 ± 132. Nevertheless, when corrected for FFM, REE resulted higher in G1 than G2 (34.8 ± 4.89 vs 33.0 ± 4.35 kcal/kg, p < 0.05) group, also higher compared to our, age and sex matched, control population (REE/FFM: 30.9 ± 4.5 kcal/kg). CONCLUSIONS Our preliminary results show that REE when adjusted for FFM is increased in clinically stable CD patients and mildly reduced by immunosuppressive therapy possibly through a direct action on inflammation and on body composition characteristics.
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Affiliation(s)
| | | | | | | | | | | | - Franco Contaldo
- Department of Clinical Medicine and Surgery, Italy; Interuniversity Centre for Obesity and Eating Disorders (CISRODCA), Federico II University of Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Italy; Interuniversity Centre for Obesity and Eating Disorders (CISRODCA), Federico II University of Naples, Italy
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14
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Santarpia L, Grandone I, Alfonsi L, Sodo M, Contaldo F, Pasanisi F. Long-term medical complications after malabsorptive procedures: effects of a late clinical nutritional intervention. Nutrition 2014; 30:1301-5. [PMID: 24986553 DOI: 10.1016/j.nut.2014.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/30/2013] [Accepted: 03/16/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The growing prevalence of severe obesity, combined with the failure of conservative treatments, has led to a significant spread of bariatric surgical procedures. The aim of this study was to emphasize the need of adequate presurgery patient selection and close follow-up after malabsorptive procedures for bariatric surgery. METHODS The study retrospectively evaluated 25 (20 F, 5 M; mean age 43 ± 13 y) obese patients (mean weight before intervention 134 ± 30.7 kg, body mass index 50.7 ± 10.1 kg/m(2)) attending our outpatient clinical nutrition unit for severe malabsorption and secondary malnutrition after surgical intervention that had been performed outside the regional area. RESULTS All patients received personalized dietetic indications; in 12 of 25 (48%) cases integrated by oral protein supplements and in 5 of 25 (20%) by medium chain triglycerides. According to screening exams, patients were prescribed oral/parenteral iron, vitamins A, B group, D, and folate supplementation. In 14 of 25 (56%) patients, parenteral hydration and in 4 of 25 (16%), long-term parenteral nutrition was required. Five patients required hospitalization for severely complicated protein-energy malnutrition. CONCLUSION Nutritional deficiencies are common after malabsorptive procedures for bariatric surgery; these can be present or latent before surgery, frequently going unrecognized and/or inadequately treated particularly when patients are not strictly followed up by the operating center. Despite the adequate-even intensive-intervention, clinical nutritional status moderately improved in all patients.
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Affiliation(s)
- Lidia Santarpia
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
| | - Ilenia Grandone
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
| | - Lucia Alfonsi
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, Pre and Post Transplant Surgery, Federico II University Hospital, Naples, Italy
| | - Franco Contaldo
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
| | - Fabrizio Pasanisi
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
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15
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Iacone R, Scanzano C, Alfonsi L, Sgambati D, Fierro F, Negro G, Pastore E, D'Isanto A, Contaldo F, Pasanisi F, Santarpia L. Daily macro and micronutrient supply for patients on total enteral nutrition: are they in keeping with new dietary reference intakes for the Italian population? Nutr Metab Cardiovasc Dis 2014; 24:e15-e17. [PMID: 24462048 DOI: 10.1016/j.numecd.2013.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/05/2013] [Accepted: 10/04/2013] [Indexed: 11/23/2022]
Affiliation(s)
- R Iacone
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy.
| | - C Scanzano
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy.
| | - L Alfonsi
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - D Sgambati
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - F Fierro
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - G Negro
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - E Pastore
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - A D'Isanto
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - F Contaldo
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - F Pasanisi
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
| | - L Santarpia
- Home Artificial Nutrition Unit, Internal Medicine and Clinical Nutrition Section, Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Via S. Pansini 5, Naples 80131, Italy
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16
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Iacone R, Santarpia L, Scanzano C, Alfonsi L, Pastore E, D'Isanto A, Sgambati D, De Caprio C, Contaldo F. PP205-MON COMPARISON BETWEEN COMPOUNDED AND INDUSTRIAL NUTRITIONAL MIXTURES FOR PATIENTS RECEIVING HOME PARENTERAL NUTRITION. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60515-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Santarpia L, Pagano MC, Cuomo R, Alfonsi L, Contaldo F, Pasanisi F. Iron absorption following a single oral dose of ferrous sulfate or ferric gluconate in patients with gastrectomy. Ann Nutr Metab 2013; 63:55-9. [PMID: 23899667 DOI: 10.1159/000351447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/13/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Iron deficiency anemia frequently occurs in gastrectomized patients. METHODS Serum iron levels following the ingestion of a single oral dose of 105 mg elemental iron, taken as ferrous sulfate (FeS) or ferric gluconate (FeG), have been evaluated in 20 gastrectomized patients (and 20 controls). All subjects participated on 2 different test days, 1 month apart: they took a single dose of 105 mg elemental iron as FeS or FeG after a night of fasting. Serum iron concentrations at baseline, 30, 60, 120 and 180 min after the oral dose administration were measured. RESULTS In patients and controls receiving FeG, serum iron levels did not significantly change. After oral ingestion of FeS, patients' serum iron levels gradually increased. The increase in serum iron levels was 148 and 168% at 120 and 180 min in patients (p < 0.0001 for both evaluations), whilst in controls, it was 216% at 120 min and 234% at 180 min, i.e. significantly higher than in gastrectomized patients (p < 0.001 for both evaluations). CONCLUSIONS In gastrectomized patients, a single oral dose of FeS shows a significant increase in iron serum concentration, albeit lower than in controls. Further studies on a larger sample of patients will be necessary to confirm these results.
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Affiliation(s)
- L Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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18
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Santarpia L, Cuomo R, Camera L, Alfonsi L, Contaldo F, Pasanisi F. A patient with oeosinophilic gastroenteritis and severe malnutrition improved with home parenteral nutrition. BMJ Case Rep 2010; 2010:2010/nov11_1/bcr0420102928. [PMID: 22798439 DOI: 10.1136/bcr.04.2010.2928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Oeosinophilic gastroenteritis is a chronic and rare disorder characterised by massive oeosinophilic tissue infiltration involving one or more segments of the digestive tract. The management of patients with oeosinophilic gastroenteritis is complex and the therapeutic response often poor. Here we discuss the clinical case and management of a 23-year-old man with oeosinophilic gastroenteritis since the first year of life and the decision to prescribe lifelong total parenteral nutrition.
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Affiliation(s)
- Lidia Santarpia
- Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy.
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19
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Santarpia L, Alfonsi L, Tiseo D, Creti R, Baldassarri L, Pasanisi F, Contaldo F. Central venous catheter infections and antibiotic therapy during long-term home parenteral nutrition: an 11-year follow-up study. JPEN J Parenter Enteral Nutr 2010; 34:254-62. [PMID: 20467007 DOI: 10.1177/0148607110362900] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catheter-related bloodstream infections are a serious and common complication in patients receiving home parenteral nutrition (HPN). METHODS Prevalence of infections, type of agents, and effectiveness of antibiotic therapy were evaluated in 296 patients (133 males, 163 females; mean age 58.2 +/- 13.5 years) receiving HPN for at least 3 months, from January 1995 to December 2006. Patients underwent 99,969 (331 +/- 552; minimum 91, maximum 4353) days of catheterization, corresponding to 93,236 (311 +/- 489; minimum 52, maximum 4353) days of HPN. RESULTS Fifty-two patients (24 males and 28 females; 35 oncological and 17 nononcological) were diagnosed with 169 infections. The overall corresponding infection rate was 2.0 per 1000 days of catheterization, with a progressive, regular decrease with time. In 30 cases, immediate central venous catheter removal was necessary. Infections were eradicated in 103 of 139 (74%) cases. As to the most common causative agent, 86 (51%) infections were due to Staphylococcus epidermidis. Of these, 64 were treated from 1995 to 2004, 57 of them (89%) successfully; 22 were treated from 2005 onward, only 7 of them (32%) successfully. CONCLUSIONS Although the global infection rate has progressively decreased over the years, S epidermidis has shown an alarming increase in resistance to antibiotic treatment in the last 2 years, suggesting the need for strategies to prevent central venous catheter infection.
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Affiliation(s)
- Lidia Santarpia
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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20
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Del Genio F, Del Genio G, De Sio I, Marra M, Alfonsi L, Finelli C, Contaldo F, Pasanisi F. Noninvasive evaluation of abdominal fat and liver changes following progressive weight loss in severely obese patients treated with laparoscopic gastric bypass. Obes Surg 2009; 19:1664-71. [PMID: 19526270 DOI: 10.1007/s11695-009-9891-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 05/28/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a chronic complex disease, consequence of an unbalance between energy intake and expenditure and of the interaction between predisposing genotype and facilitating environmental factors. The aim of the study was to evaluate body composition, abdominal fat, and metabolic changes in a group of severely obese patients before and after laparoscopic gastric bypass (LGBP) at standardized (10% and 25%) total weight loss. METHODS Twenty-eight patients (14 M, 14 F; age 41.71 +/- 6.9 years; body mass index (BMI) 49.76 +/- 5.8 kg/m(2)) were treated with laparoscopic gastric bypass. All evaluations before surgery and after achieving ~10% and ~25% weight loss (WL). Body composition was assessed by bioimpedance analysis; resting metabolic rate (RMR) was measured by indirect calorimetry. RESULTS Body weight, BMI, and waist circumference significantly decreased at 10% and 25% WL. We observed a significant reduction of both RMR (2,492 +/- 388 at entry vs. 2,098 +/- 346.6 at 10% WL vs. 2,035 +/- 312 kcal per 24 h at 25% WL, p = 0.001 vs. baseline) as well as of RMR corrected for fat-free mass (FFM; 35.7 +/- 6.7 vs. 34.9 +/- 9.0 at 10% WL vs. 33.5 +/- 5.4 at 25% WL kilocalorie per kilogram FFM x 24 h, p = 0.041 vs. baseline). Body composition analysis showed a relative increase in FFM and a reduction of fat mass at 25% WL. A significant reduction in blood glucose, insulin, homeostasis model assessment index was observed. Ultrasonography showed a marked decrease in the signs of hepatic steatosis. CONCLUSION In conclusion, our study confirms that LGBP is a safe procedure in well-selected severely obese patients and has early favorable effects on both metabolic parameters and body composition. Longer-term observations are required for in-depth evaluation of body composition changes.
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Affiliation(s)
- Federica Del Genio
- Department of Clinical and Experimental Medicine, Interuniversity Center for Obesity and Eating Disorder (CISRO), Federico II School of Medicine, Via Pansini 5, 80131, Naples, Italy.
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21
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Santarpia L, Marra M, Montagnese C, Alfonsi L, Pasanisi F, Contaldo F. Prognostic significance of bioelectrical impedance phase angle in advanced cancer: Preliminary observations. Nutrition 2009; 25:930-1. [DOI: 10.1016/j.nut.2009.01.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 12/24/2008] [Accepted: 01/29/2009] [Indexed: 10/20/2022]
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22
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Santarpia L, Catanzano F, Ruoppolo M, Alfonsi L, Vitale DF, Pecce R, Pasanisi F, Contaldo F, Salvatore F. Citrulline blood levels as indicators of residual intestinal absorption in patients with short bowel syndrome. Ann Nutr Metab 2008; 53:137-142. [PMID: 18997462 DOI: 10.1159/000170888] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 07/03/2008] [Indexed: 05/27/2023]
Abstract
Plasma citrulline is known to be a marker of absorptive enterocyte mass in humans. We evaluated whether citrulline and other blood amino acids are indicators of residual small intestinal length and therefore potential predictors of dependence on parenteral nutrition in the long term. We studied 25 patients with short bowel syndrome (SBS) after at least 18 months since last digestive circuit modification; 24 of them were again evaluated 1 year later. Ten patients were weaned off parenteral nutrition and 15 were dependent on parenteral nutrition. Fifty-four healthy volunteers (28 women and 26 men) served as controls. Amino acid levels were determined on serum with high-performance liquid chromatography (HPLC) as well as on blood and serum with tandem mass spectrometry analysis. Five amino acids (citrulline, leucine, isoleucine, valine and tyrosine) were significantly lower in all SBS patients than in controls, whereas glutamine, measured only by HPLC, was significantly higher. Nevertheless, only serum citrulline measured with HPLC was significantly related to small bowel length. We conclude that HPLC remains the reference methodology to evaluate blood or serum amino acid levels in adult population with SBS.
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Affiliation(s)
- Lidia Santarpia
- Dipartimento di Medicina Clinica e Sperimentale, Università di Napoli Federico II, Napoli, Italy.
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23
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del Genio F, Alfonsi L, Marra M, Finelli C, del Genio G, Rossetti G, del Genio A, Contaldo F, Pasanisi F. Metabolic and nutritional status changes after 10% weight loss in severely obese patients treated with laparoscopic surgery vs integrated medical treatment. Obes Surg 2007; 17:1592-8. [PMID: 18000718 DOI: 10.1007/s11695-007-9286-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 07/17/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bariatric surgery is considered the most effective treatment for reducing excess body weight and maintaining weight loss (WL) in severely obese patients. There are limited data evaluating metabolic and body composition changes after different treatments in type III obese (body mass index [BMI] > 40 kg/m(2)). METHODS Twenty patients (9 males, 11 females; 37.6 +/- 8 years; BMI = 50.1 +/- 8 kg/m(2)) treated with dietary therapy and lifestyle correction (group 1) have been compared with 20 matched patients (41.8 +/- 6 years; BMI = 50.4 +/- 6 kg/m(2)) treated with laparoscopic gastric bypass (LGBP; group 2). Patients have been evaluated before treatment and after >10% WL obtained on average 6 weeks after LGBP and 30 weeks after integrated medical treatment. Metabolic syndrome (MS) was evaluated using the Adult Treatment Panel III/America Heart Association (ATP III/AHA) criteria. Resting metabolic rate (RMR) and respiratory quotient (RQ) was assessed with indirect calorimetry; body composition with bioimpedance analysis. RESULTS At entry, RMR/fat-free mass (FFM) was 34.2 +/- 7 kcal/24 h.kg in group 1 and 35.1 +/- 8 kcal/24 h.kg in group 2 and did not decrease in both groups after 10% WL (31.8 +/- 6 vs 34.0 +/- 6). Percent FFM and fat mass (FM) was 50.7 +/- 7% and 49.3 +/- 7% in group 1 and 52.1 +/- 6% and 47.9 +/- 6% in group 2, respectively (p = n.s.). After WL, body composition significantly changed only in group 1 (% FFM increased to 55.9 +/- 6 and % FM decreased to 44.1 +/- 6; p = 0.002). CONCLUSION After >10% WL, MS prevalence decreases precociously in surgically treated patients; some improvements in body composition are observed in nonsurgically treated patients only. Further investigations are needed to evaluate long-term effects of bariatric surgery on body composition and RMR after stable WL.
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Affiliation(s)
- Federica del Genio
- Interuniversity Center for Obesity and Eating Disorder (CISRO), Department of Clinical and Experimental Medicine, Federico II School of Medicine, Via Pansini 5, 80131 Naples, Italy
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24
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Bonifacio R, Alfonsi L, Santarpia L, Orban A, Celona A, Negro G, Pasanisi F, Contaldo F. Clinical outcome of long-term home parenteral nutrition in non-oncological patients: a report from two specialised centres. Intern Emerg Med 2007; 2:188-95. [PMID: 17914647 DOI: 10.1007/s11739-007-0056-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 11/28/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND METHODS Forty-one (20 m, 21 f) non-oncological home parenteral nutrition (HPN) patients (52.0+/-16.6 years, BMI 20.2+/-4.0 kg/m(2)), enrolled from 1995 to 2005, underwent a clinical and biochemical follow-up at 3 months, 1 and 3 years. RESULTS At admittance the Karnofsky Index ranged between 40 and 50 in 13 (31.7%) and 60 and 80 in 28 (68.3%) patients; the most frequent underlying disease was mesenteric infarction (11 patients, 27%). All had a central venous access. Mean catheterization days were 864+/-992, while mean HPN days were 630+/-668. At the 3-month follow-up, all patients were on HPN, at 1 year 24 (58.5%) and at 3 years 11 (27%). At 3 months, 1 and 3 years there was a significant increase in BMI (p=0.001), body weight (p=0.001) and Karnofsky Index (p=0.001), as well as an improvement of several biochemical parameters. Survival rate of HPN patients was 90.2% at 1 year, 87.8% at 3 years and 82.9% at 5 years. As to HPN-related complications, there was a central venous catheter (CVC) obstruction in 8 patients (19.5%) and 47 CVC infections in 24 (58.5%) patients. The infection rate was 1.32/(00) days of catheterization (1.8/(00) from 1995 to 1998 and 1.0/(00) from 1999 to 2005). Hospitalisation was necessary in over 50% of patients, and death occurred in 8, always as a consequence of the primary disease. CONCLUSIONS The experience of the nutritional team and careful patient and caregiver training reduce CVC infection rate and the overall risk of complications possibly due to HPN.
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Affiliation(s)
- R Bonifacio
- Internal Medicine and Clinical Nutrition, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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25
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Violante G, Alfonsi L, Santarpia L, Cillis MC, Negro G, De Caprio C, Russo N, Contaldo F, Pasanisi F. Adult home parenteral nutrition: a clinical evaluation after a 3-year experience in a Southern European centre. Eur J Clin Nutr 2006; 60:58-61. [PMID: 16132056 DOI: 10.1038/sj.ejcn.1602267] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM To evaluate the current use of Home Parenteral Nutrition (HPN) in a Southern European region. SUBJECTS AND METHODS A total of 159 (86 m, 73 f) HPN patients, mean age 60.1 +/- 14.2 years, BMI 18.8 +/- 3.3kg/m2, consecutively referred to the Artificial Nutrition outpatient Unit of the Federico II University Hospital in Naples (Italy), from January 2000 to December 2002 and treated for at least 4 weeks. Retrospective evaluation of baseline disease, indications and duration of HPN treatment, type of venous access, complications. RESULTS In all, 140 (88%) were cancer and 19 (12%) noncancer patients. Main indications were carcinosis in 68 for total, and hypophagia/dysphagia in 62 patients for partial/integrative (to oral-enteral nutrition) HPN; mean duration of HPN was 81.45 +/- 110.86 days of treatment and infection rate 2.89% in the whole population and 2.66% in the 36 patients treated for more than 3 months. No other major complications have been observed. CONCLUSION HPN is confirmed to be a safe and effective treatment when prescribed and administered by a trained team.
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Affiliation(s)
- G Violante
- Internal Medicine and Clinical Nutrition, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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Santarpia L, Alfonsi L, Pasanisi F, De Caprio C, Scalfi L, Contaldo F. Predictive factors of survival in patients with peritoneal carcinomatosis on home parenteral nutrition. Nutrition 2006; 22:355-60. [PMID: 16413750 DOI: 10.1016/j.nut.2005.06.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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Contaldo F, Alfonsi L, Santarpia L, Pasanisi F. Artificial nutrition at the bioethic cross-road between treatment and basic health care. Clin Nutr 2005; 25:171-2. [PMID: 16314003 DOI: 10.1016/j.clnu.2005.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 10/12/2005] [Indexed: 12/01/2022]
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Alfano V, Bellini O, De Filippo E, Alfonsi L, Pasanisi F, Contaldo F. Integrated medical-psychiatric treatment of the "crisis phase" in severe protein-energy malnutrition secondary to major eating disorders. Eat Weight Disord 2004; 9:158-62. [PMID: 15330085 DOI: 10.1007/bf03325061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
C.A., a 23-year old male was admitted in the clinical nutrition medical ward for severe, complicated protein-energy malnutrition (PEM) [body mass index (BMI) 11.08 kg/m2; body weight kg 35.81 due to major eating disorders. C.A.'s personality was narcissistic, with a rigid psychic structure. During hospitalitation (lasted 72 days) two acute episodes (a possibly self-inflicted damage and a persecution feeling) occurred that we consider as part of the "crisis phase", the period in which the patient's restrictive behaviour is no longer able to keep his personality equilibrium stable. The patient was treated by an integrated medical and psychiatric approach, including periods of never forced parenteral nutrition, nutritional and intensive psychoterapeutic interventions. For a short period the patient received also a pharmacological support (aloperidol orally). Treatment was successful and the patient was discharged completely autonomous and followed up on an outpatient basis. After about one year follow-up he is still in good clinical condition and in sufficient psychological equilibrium.
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Affiliation(s)
- V Alfano
- CSIRO, Clinical Nutrition, Department of Clinical and Experimental Medicine, University "Federico II", Napoli, Italy
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Peroni DG, Piacentini GL, Alfonsi L, Zerman L, Di Blasi P, Visona' G, Nottegar F, Boner AL. Rhinitis in pre-school children: prevalence, association with allergic diseases and risk factors. Clin Exp Allergy 2003; 33:1349-54. [PMID: 14519139 DOI: 10.1046/j.1365-2222.2003.01766.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of our study was to assess the prevalence of rhinitis, sneezing, runny or blocked nose apart from colds in a pre-school children population and to evaluate the risk factors and relationship with allergic diseases and sensitization. METHODS Eighteen nursery schools were randomly selected. The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire (WQ) was distributed and filled by parents of pre-school children (3-5 years). The allergic sensitization to common aeroallergens and foods was evaluated by skin prick test (SPT). chi2 tests were used to compare proportions between rhinitic and non-rhinitic children. RESULTS One thousand four hundred and two (92%) valuable questionnaires were returned. Prevalence of rhinitis in the last 12 months was 16.8%. Rhinitic children compared to non-rhinitic children presented a significant increase of diagnosed asthma (20.8% vs. 6.2%, P<0.001), lifetime wheezing (43.2% vs. 21.6%, P<0.001), wheezing in the last 12 months (25.0% vs. 9.4%, P<0.001), atopic dermatitis (22.9% vs. 13.9%, P<0.001) and allergic sensitization (29.9% vs. 13.7%, P<0.001). Sensitization to grass pollen and house dust mites were significant risk factors for rhinitis (P<0.01). A family history of atopy, having pets at home, male gender and greater age were significant risk factors for rhinitis, but not smoking exposure, sharing a bedroom or breastfeeding. CONCLUSIONS In pre-school children rhinitis has a strong association with wheezing symptoms, asthma and atopic dermatitis. Allergic sensitization is a risk factor for rhinitis and should be evaluated even in pre-school children.
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Affiliation(s)
- D G Peroni
- Department of Paediatrics, University of Verona, Verona, Italy.
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Santarpia L, Alfonsi L, Genua M, D'Armiento F, Contaldo F, Pasanisi F. Stable reversal of primitive intestinal lymphangiectasia. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Violante G, Alfonsi L, Santarpia L, Cillis C, Russo N, Negro G, Contaldo F, Pasanisi F. Indications to home parenteral nutrition in an outpatient clinical nutrition unit. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Violante G, Alfonsi L, Santarpia L, Cillis C, Russo N, Negro G, Contaldo F, Pasanisi F. Home parenteral nutrition: New patients from 2000 to 2002 in an outpatient clinical nutrition unit in Southern Italy. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bonifacio R, Alfonsi L, Santarpia L, Genua M, Contaldo F, Pasanisi F. Admission rate in patients with non neoplastic diseases on long term home artificial nutrition. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- D G Peroni
- Clinica Pediatrica Universita' di Verona, Policlinico GB Rossi, Piazzale Scuro, 37134 Verona, Italy.
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Santarpia L, Pasanisi F, Alfonsi L, Violante G, Tiseo D, De Simone G, Contaldo F. Prevention and treatment of implanted central venous catheter (CVC) - related sepsis: a report after six years of home parenteral nutrition (HPN). Clin Nutr 2002; 21:207-11. [PMID: 12127928 DOI: 10.1054/clnu.2002.0541] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Lidia Santarpia
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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Pasanisi F, Orban A, Scalfi L, Alfonsi L, Santarpia L, Zurlo E, Celona A, Potenza A, Contaldo F. Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. Nutrition 2001; 17:581-4. [PMID: 11448576 DOI: 10.1016/s0899-9007(01)00579-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical, anthropometric, hematologic, and biochemical variables, evaluated immediately before starting nutritional treatment, were related to survival in 76 terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. At baseline, abnormally low values were observed in the following percentages of patients: 40.8% for body mass index, 59.2% for serum albumin, 84.2% for hemoglobin, 48.7% for lymphocyte count, and 60% for serum cholesterol. Survival on home parenteral nutrition ranged between 6 and 301 d, with a median of 74 d. Hemoglobin, serum albumin and serum cholesterol were lower in patients with a survival of less than 3 mo. With regard to Karnofsky performance status, median survival times were 63 d for a score below or equal to 50 and 128 d for a score between 60 and 70. Albumin and a Karnofsky score above 50 (but not age, weight, body mass index, lymphocyte count, or cholesterol) emerged (with a positive sign) as predictors of survival. In conclusion, terminal-cancer patients with irreversible bowel obstruction are often malnourished, showing a high prevalence of anemia and hypoalbuminemia. Survival differs widely and can be predicted only to a limited extent from initial values of serum albumin and Karnofsky performance status.
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Affiliation(s)
- F Pasanisi
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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Finelli C, Alfano V, Pasanisi F, Marra M, Violante G, Alfonsi L, Scalfi L, Contaldo F. Use and abuse of albumin: a survey of clinical records from an internal medicine ward. Clin Nutr 2001; 20:183-5. [PMID: 11327749 DOI: 10.1054/clnu.2000.0390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS This study was to review albumin prescriptions and indications in 4122 patients hospitalized in internal medicine wards in the years 1996, 1998 and 1999, before and after the ad hoc regulations issued in 1997 by the Italian Ministry of Health. METHODS In 1996 (n=63), 1998 (n=59) and 1999 (n=55) 177 of these patients (4.3%) were given i.v. albumin. RESULTS 161 (91%) of them had serum albumin values of <3.5 g/dl, while in only 36% were these values <2.5 g/dl. CONCLUSION In the majority of cases albumin was erroneously prescribed, often to enhance diuretic efficacy or in protein energy malnutrition. Its prescription has not been influenced by the new recommendations.
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Affiliation(s)
- C Finelli
- Dipartimento di Medicina Clinica e Sperimentale, Università Federico II di Napoli, Italy
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Alfonsi L, Gammaitoni L, Santucci S, Bulsara AR. Intrawell stochastic resonance versus interwell stochastic resonance in underdamped bistable systems. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 62:299-302. [PMID: 11088463 DOI: 10.1103/physreve.62.299] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2000] [Indexed: 05/23/2023]
Abstract
We show that, for periodically driven noisy underdamped bistable systems, an intrawell stochastic resonance can exist, together with the conventional interwell stochastic resonance, resulting in a double maximum in the power spectral amplitude at the forcing frequency as a function of the noise intensity. The locations of the maxima correspond to matchings of deterministic and stochastic time scales in the system. In this paper we present experimental evidence of these phenomena and a phemonological nonadiabatic description in terms of a noise-controlled nonlinear dynamic resonance.
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Affiliation(s)
- L Alfonsi
- Dipartimento di Fisica, Universita di Perugia, I-06100 Perugia, Italy
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Alfano V, Tritto G, Alfonsi L, Cella A, Pasanisi F, Contaldo F. Stable reversal of pathologic signs of primitive intestinal lymphangiectasia with a hypolipidic, MCT-enriched diet. Nutrition 2000; 16:303-4. [PMID: 10758368 DOI: 10.1016/s0899-9007(00)00223-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report on a patient with protein-losing enteropathy due to primitive intestinal lymphangiectasia with an early reversal of clinical and biochemical signs and a stable late reversal of pathologic signs after treatment with a hypolipidic diet enriched with medium-chain triacylglycerols.
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Affiliation(s)
- V Alfano
- Department of Clinical and Experimental Medicine, Clinical Nutrition, Federico II University, Naples, Italy
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40
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Pinelli L, Mormile R, Alfonsi L, Gonfiantini E, Piccoli R, Chiarelli F. The role of nutrition in prevention of complications in insulin-dependent diabetes mellitus. Acta Paediatr Suppl 1999; 88:39-42. [PMID: 10195853 DOI: 10.1111/j.1651-2227.1999.tb14339.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nutrition management is an integral part of overall diabetic treatment that includes insulin, physical activity, emotional support and guidance. The aim of the present study was to evaluate a dietary approach in line with the recommended dietary allowances in terms of protein, total and saturated fat, carbohydrates as well as fibre and polyunsaturated fatty acid. A correct dietary approach may help to prevent and to reduce to a minimum any risk of hyperglycaemia, hypoglycaemia and important long-term complications such as obesity, hyperlipidaemia and hypertension, and at the same time normal growth development.
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Affiliation(s)
- L Pinelli
- Department of Pediatrics, Verona University Hospital, Italy
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Abstract
OBJECTIVE Patients with diabetes can develop gastrointestinal motor complications; however, prevalence of gut dysmotility in children with diabetes is poorly understood. We measured gastric emptying time and gastric electrical activity in children with IDDM; presence of dyspeptic symptoms was also assessed. RESEARCH DESIGN AND METHODS Gastric emptying time and gastric electrical activity were measured by ultrasonography and electrogastrography (EGG), respectively, in 40 consecutive IDDM children (median age: 9 years [6-14]) without autonomic neuropathy; 15 healthy children (median age: 7 years [4-15]) served as control subjects. The EGG variables studied were percent of electrical dysrhythmias (bradygastria or 0.5-2.0 cpm, tachygastria or 4.0-9.0 cpm; normal rhythm is 2.0-4.0 cpm) and fed-to-fasting ratio of the dominant EGG power. Blood glucose level in the fasting state and 180 min after feeding and HbA1C concentration were also measured. Data are given as median (ranges) and means +/- SD. Statistical analysis was performed using the parametric t test and the nonparametric signed-rank tests, with P < 0.05 considered significant. RESULTS Gastric emptying time was delayed in 26 patients (group A), whereas in 14 patients (group B), it was in the same range as control values; group A patients significantly differed from group B for increased prevalence of gastric electrical dysrhythmias (P < 0.01) and for a lower fed-to-fasting ratio of the dominant EGG power (P < 0.01). Group B patients did not differ from control subjects for the EGG variables measured. Diabetic children with gastroparesis had significantly higher levels of both HbA1C and blood glucose measured 180 min after feeding than those with normal gastric emptying time (P < 0.05); there was a significant correlation between levels of HbA1C and degree of gastric emptying delay, whereas a significant inverse correlation between gastric emptying time and fed-to-fasting ratio of the dominant EGG power was found both in patients and control subjects. CONCLUSIONS Delay of gastric emptying time and gastric electrical abnormalities are found in a high proportion of children with diabetes and can contribute to poor glycemic control, most likely by causing a mismatch between the onset of insulin action and the delivery of nutrients into the small intestine. Diabetic children with unexplained poor glycemic control should be investigated for abnormalities in gastric motility.
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Affiliation(s)
- S Cucchiara
- Gastrointestinal Endoscopy and Motility Unit, University of Naples, Italy.
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Franzese A, Valerio G, Argenziano A, Esposito-Del Puente A, Iannucci MP, Caputo G, Alfonsi L, Contaldo F, Rubino A. Onset of obesity in children through the recall of parents: relationship to parental obesity and life events. J Pediatr Endocrinol Metab 1998; 11:63-7. [PMID: 9642631 DOI: 10.1515/jpem.1998.11.1.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is a multifactorial disease due to the influence of both genetic and environmental factors. Parents of 886 obese patients (427 boys and 459 girls, aged 1-18 years) were investigated by means of a questionnaire in order to study the factors associated with the onset of obesity in children and the relationship to genetic background. At presentation obese patients had a very high mean ideal body weight percent (IBW%) (154 +/- 19%, median 152%, range 120-246). A significantly higher mean IBW% was found in children of obese parents (one obese parent: 158 +/- 21%, median 156%, range 120-246; two obese parents 160 +/- 18%, median 158%, range 123-226) in comparison to children of normal weight parents (150 +/- 18%; median 147%, range 120-235; p = 0.0001 for children of one or two obese parents versus children of normal weight parents). Parents of 414 subjects (46.7%) (Group A) answered that obesity had always been present. The remaining 472 parents (53.3%) (Group B) stated that obesity had had a beginning at a mean age of 5.3 +/- 2.6 years (median 5.0 years, range 1.0-17.0). No difference was found in age at presentation, sex distribution, birth weight and number of obese parents between the two groups. Parents in Group B recalled an event associated with obesity onset in 197 cases (health event: 119 answers, psycho-social event: 78 answers). Genetic background did not influence this pattern of feedback. In conclusion, parents of obese subjects seek medical advice when obesity is severe. Pediatricians should exert strict surveillance on weight from a very young age. The recall in 22% patients of health or psychosocial events at the onset of obesity emphasizes that medical counselling is important when the occurrence of particular events in life may cause erroneous eating habits.
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Affiliation(s)
- A Franzese
- Department of Pediatrics, University Federico II, Naples, Italy
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Franzese A, Valerio G, Argenziano A, De Filippo G, Iannucci MP, Buono P, Alfonsi L, Pisacane A. Social deprivation influences illness onset in diabetic children. Diabetologia 1997; 40:988-9. [PMID: 9267999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Franzese A, Valerio G, Ciccarelli NP, De Filippo G, Iannucci MP, Alfonsi L, Buono P, Farina V. Severe hypertrophic cardiomyopathy in an infant of a diabetic mother. Diabetes Care 1997; 20:676-7. [PMID: 9097004 DOI: 10.2337/diacare.20.4.676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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