Silvia Savastano - Academia.edu (original) (raw)
Papers by Silvia Savastano
Journal of Clinical Medicine, 2021
In the past three decades, several recent studies have analyzed the alarming increase of obesity ... more In the past three decades, several recent studies have analyzed the alarming increase of obesity worldwide, and it has been well established that the risk of many types of malignancies is increased in obese individuals; in the same period, thyroid cancer has become the fastest growing cancer of all malignancies. We investigated the current literature to underline the presence of a connection between excess body weight or Body Mass Index (BMI) and risk of thyroid cancer. Previous studies stated that the contraposition between adipocytes and adipose-resident immune cells enhances immune cell production of multiple pro-inflammatory factors with subsequent induction of hyperlipidemia and vascular injury; these factors are all associated with oxidative stress and cancer development and/or progression. Moreover, recent studies made clear the mitogenic and tumorigenic action of insulin, carried out through the stimulation of mitogen-activated protein kinase (MAPK) and phosphoinositide-3 ki...
Nutrients, 2020
Prader–Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia with progressive, ... more Prader–Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia with progressive, severe obesity, and an increased risk of obesity-related comorbidities in adult life. Although low dietary vitamin D intake and low 25-hydroxy vitamin D (25OHD) levels are commonly reported in PWS in the context of bone metabolism, the association of low 25OHD levels with fat mass has not been extensively evaluated in PWS adults. The aims of this study were to investigate the following in PWS adults: (1) 25OHD levels and the dietary vitamin D intake; (2) associations among 25OHD levels with anthropometric measurements and fat mass; (3) specific cut-off values for body mass index (BMI) and fat mass predictive of the 25OHD levels. In this cross-sectional, single-center study we enrolled 30 participants, 15 PWS adults (age 19–41 years and 40% males) and 15 control subjects matched by age, sex, and BMI from the same geographical area (latitude 40° 49’ N; elevation 17 m). Fat mass was assesse...
Nutrients, 2020
Chronotype is the attitude of a subject in determining individual circadian preference in behavio... more Chronotype is the attitude of a subject in determining individual circadian preference in behavioral and biological rhythm relative to the external light–dark cycle. Obesity and unhealthy eating habits have been associated with evening chronotype. The Mediterranean diet (MD) is a healthy nutritional pattern that has been reported to be associated with better health and quality of sleep. Thus, the aim of the study was to investigate the association of chronotype categories with adherence to the MD in a population of middle-aged Italian adults. This cross-sectional study included 172 middle-aged adults (71.5% females; 51.8 ± 15.7 years) that were consecutively enrolled in a campaign to prevent obesity called the OPERA (obesity, programs of nutrition, education, research and assessment of the best treatment) Prevention Project that was held in Naples on 11–13 October 2019. Anthropometric parameters, adherence to the MD and chronotype were studied. Chronotype was classified as morning i...
Nutrients, 2019
Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder and is characterize... more Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder and is characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. Obesity, low-grade chronic inflammatory status, and insulin-resistance (IR) often coexist in PCOS. The Mediterranean diet (MD) is an anti-inflammatory dietary pattern, which is rich in complex carbohydrates and fiber, and high in monounsaturated fat. There is a close association among obesity, low-grade chronic inflammation, IR, and hormonal derangements in PCOS. The main aim of the present study was to evaluate the adherence to MD, the dietary intake, and the body composition and their association with PCOS clinical severity in a cohort of treatment-naïve women with PCOS when compared with a control group of healthy women matched for age and body mass index (BMI). In this case-controlled, cross-sectional study, we enrolled 112 patients with PCOS and 112 controls. PREvención con DIetaMEDiterránea (PREDIMED) and seven-day...
Nutrients, 2019
Obesity is associated with reduced spontaneous and stimulated growth hormone (GH) secretion and b... more Obesity is associated with reduced spontaneous and stimulated growth hormone (GH) secretion and basal insulin-like growth factor I (IGF-1) levels—which in turn is associated with increased prevalence of cardiovascular risk factors. The aim of this study was to investigate: (1) the association of somatotropic axis with cardiometabolic status; (2) the association of somatotropic axis with the Mediterranean diet and nutritional pattern in people with obesity. Cross-sectional observational study was carried out in 200 adult women, aged 36.98 ± 11.10 years with severe obesity (body mass index—BMI of 45.19 ± 6.30 kg/m2). The adherence to the Mediterranean diet and the total calorie intake was assessed. Anthropometric measurements, body composition and biochemical profile were determined along with Growth Hormone (GH)/Insulin like Growth Factor 1 (IGF-1) axis and insulin resistance (homeostatic model assessment for insulin resistance—HoMA-IR). The enrolled subjects were compared after bein...
Best practice & research. Clinical endocrinology & metabolism, 2017
There is a growing body of evidence indicating that patients with adult GH deficiency (GHD) are c... more There is a growing body of evidence indicating that patients with adult GH deficiency (GHD) are characterized by a cluster of traditional and emerging cardiovascular risk factors and markers, which can significantly increase their cardiovascular morbidity and mortality possibly linked to aberrations in GH status. Patients with adult GHD present multiple different cardiovascular abnormalities. In addition, cardiovascular risk in adult GHD is increased due to altered body composition, abnormal lipid profile, insulin resistance and impaired glucose metabolism. Cardiovascular risk factors can be reversed, at least partially, after GH replacement. However, evidence on the effects of GH replacement on cardiovascular events and mortality is too limited in adult GHD patients. Aim of this review is to provide an at-a-glance overview of the role of the GH/IGF-I on the cardiovascular system and the state of art of the effects of GH replacement on cardiovascular system.
Reviews in Endocrine and Metabolic Disorders, 2017
Low vitamin D status and obesity have concomitantly reached epidemic levels worldwide. Up to now ... more Low vitamin D status and obesity have concomitantly reached epidemic levels worldwide. Up to now the direction of the association between low vitamin D status and obesity, the exact mechanisms responsible for this association and the clinical usefulness to increase vitamin D status for reducing adiposity still warrant further evaluation. The aim of the present review was to examine the current evidence linking low vitamin D status and obesity in relation to the role of the nutritionist. On the one side, considering obesity as a causal factor, low sun exposure in obese individuals due to their sedentary lifestyle and less outdoor activity, vitamin D sequestration in adipose tissue, and volumetric dilution of ingested or cutaneously synthesized vitamin D 3 in the large fat mass of obese patients, might represent some of the factors playing a major role in the pathogenesis of the low vitamin D status. On the other side, the expression of both vitamin D 3 receptors and enzymes responsible for vitamin D 3 metabolism in adipocytes depicted a role for the low vitamin D status per se in the development of obesity by modulating adipocyte differentiation and lipid metabolism. Nutritionists need to accurately address the aspects influencing the low vitamin D status in obesity and the vitamin D supplementation in obese individuals.
International Journal of Environmental Research and Public Health, 2016
Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activ... more Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activation, where both environmental and genetic factors contribute to its pathogenesis. Among the risk factors for psoriasis, evidence is accumulating that nutrition plays a major role, per se, in psoriasis pathogenesis. In particular, body weight, nutrition, and diet may exacerbate the clinical manifestations, or even trigger the disease. Understanding the epidemiological relationship between obesity and psoriasis is also important for delineating the risk profile for the obesity-related comorbidities commonly found among psoriatic patients. Moreover, obesity can affect both drug's pharmacokinetics and pharmacodynamics. Additionally, the overall beneficial effects on the obesity-associated comorbidities, clinical recommendations to reduce weight and to adopt a healthy lifestyle could improve the psoriasis severity, particularly in those patients with moderate to severe disease, thus exerting additional therapeutic effects in the conventional treatment in obese patients with psoriasis. Education regarding modifiable environmental factors is essential in the treatment of this disease and represents one of the primary interventions that can affect the prognosis of patients with psoriasis. The goal is to make psoriatic patients and health care providers aware of beneficial dietary interventions. The aim of this review is to assess the relevance of the environmental factors as modifiable risk factors in psoriasis pathogenesis, with particular regard to the involvement of obesity and nutrition in the management of psoriasis, providing also specific nutrition recommendations.
Journal of Translational Medicine, 2016
Background: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental fa... more Background: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental factors, show multiple bidirectional associations, with important metabolic implications in psoriatic patients. Besides body mass index (BMI) as a measure of obesity, data on phase angle (PhA), a direct measure by bioelectrical impedance analysis (BIA), used as a marker of cellular health and a predictor of morbidity and mortality in various diseases, are still lacking in psoriasis. In this case-control, cross-sectional study, we investigated the PhA in 180 pairs of adult psoriatic patients and healthy controls, evaluating also the potential use of the PhA as marker of the clinical severity, the quality of life, and the presence of the MetS in psoriatic patients. Methods: Anthropometric measures, metabolic profile and bioelectrical variables were evaluated. The clinical severity was assessed by standardized psoriasis area and severity index (PASI) score and c-reactive protein (CRP) levels, and the quality of life was evaluated by dermatology life quality index (DLQI). MetS was diagnosed according to Adult Treatment Panel III. Results: Psoriatic patients presented smaller PhA (p < 0.001) and higher prevalence MetS compared with controls. The PhA was significantly associated with number of parameters of MetS in both groups (p < 0.001). After adjusting for BMI, this association remained significant in psoriatic patients only (p < 0.001). Among psoriatic patients, the PhA was the major index value for the diagnosis of MetS (OR 5.87, 95 % CI 5.07-6.79) and was inversely associated with both PASI score and DLQI, independently of BMI (p < 0.001). At multiple regression analysis, the PhA well predicted the PASI score and DLQI. Based on ROC curves, the most sensitive and specific cutoffs of PhA to predict the highest PASI score and the lowest DQLI were ≤4.8° and ≤4.9°, respectively. Conclusions: We reported that psoriatic patients presented small PhAs, with a novel association between PhA, clinical severity, quality of life in psoriatic patients, and MetS. Further studies are required to validate the PhA's prognostic ability in assessing the clinical severity and MetS in psoriatic patients.
Clinical Nutrition, 2017
Background & aims: Nutrition is the major environmental factor that influences the risk of develo... more Background & aims: Nutrition is the major environmental factor that influences the risk of developing pathologies, such as obesity. Although a number of recent reviews pinpoint a protective effects of milk on body weight and obesity related co-morbidities, an inaccurate estimate of milk might contribute to hamper its beneficial effects on health outcomes. Seven-day food records provide prospective food intake data, reducing recall bias and providing extra details about specific food items. Milk intake stimulates the somatotropic axis at multiple levels by increasing both growth hormone (GH) and insulin-like growth factor-1 (IGF-1) secretion. On the other hand, obesity is associated with reduced spontaneous and stimulated GH secretion and basal IGF-1 levels. Aim of this study was to evaluate the milk consumption by using the 7-days food record in obese individuals and to investigate the association between milk intake and GH secretory status in these subjects. Methods: Cross-sectional observational study carried out on 281 adult individuals (200 women and 81 men, aged 18e74 years) with moderate-severe obesity (BMI 35.2e69.4 kg/m 2). Baseline milk intake data were collected using a 7 day food record. Anthropometric measurements and biochemical profile were determined. The GH/IGF-1 axis was evaluated by peak GH response after GHRH þ ARGININE and IGF-1 standard deviation score (SDS). Results: The majority of individuals (72.2%) reported consuming milk; 250 mL low-fat milk was the most frequently serving of milk consumed, while no subjects reported to consume whole milk. Milk consumers vs no milk consumers presented the better anthropometric measurements and metabolic profile. At the bivariate proportional odds ratio model, after adjusting for BMI, age and gender, milk consumption was associated the better GH status (OR ¼ 0.60; p < 0.001). Among milk consumers, subjects consuming 250 mL reduced-fat milk vs 250 mL low-fat milk presented the better anthropometric measurements and metabolic profile. At the bivariate proportional odds ratio model, after adjusting for BMI, age and gender, the consume of 250 mL reduced-fat milk was associated better GH status (OR ¼ 0.54; p ¼ 0.003). Conclusions: A novel positive association between milk consumption, GH status, and metabolic profile in obese individuals was evidenced. Regardless of the pathogenetic mechanisms, this novel association might be relevant in a context where commonly obese individuals skip breakfast, and suggests the need of a growing cooperation between Nutritionists and Endocrinologists in the management of the obese patients.
Journal of Translational Medicine, 2015
Background: Many studies have evaluated the role of individual nutrients on the development of ps... more Background: Many studies have evaluated the role of individual nutrients on the development of psoriasis. However, only few studies have investigated the effect of a healthy eating pattern, such as the Mediterranean diet. In this study, we aimed to investigate the relationship between adherence to the Mediterranean diet, the body composition and the severity of psoriasis in a group of naïve-treatment patients with psoriasis. Methods: This is a cross-sectional case-control observational study. Sixty-two patients (49 males and 13 females, mean age: 50.2±10.5yrs) affected with mild-to-severe psoriasis were consecutively enrolled. Sixty-two age-, sex-and body mass index (BMI)-matched healthy subjects served as control group. A validated 14-item questionnaire (PREDIMED: PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the Mediterranean diet. The severity of psoriasis was by assessed by standardized Psoriasis Area and Severity Index (PASI) score and C-reactive protein (CRP) levels. Body composition was analyzed with bioelectrical impedance analysis. Results: A higher percentage of psoriatic patients had a lower PREDIMED score compared to the control group (30.6% vs 4.8%). PASI score was significantly associated with the percentage of fat mass (FM%) and CRP levels. PASI score and CRP levels were significantly associated with the dietary components included in the PREDIMED questionnaire or with the PREDIMED score. At multiple regression analysis, the major predictor of PASI score were FM among BIA parameters, (r 2 =0.537, β=0.740, p<0.001), and FM (r 2 =0.537, β=0.603, p<0.001) and PREDIMED score (r 2 =0.599, β=−0.296, p=0.007) among anthropometric measures, FM and PREDIMED score. Finally, among all items of the PREDIMED questionnaire, EVOO (r 2 =0.548, β=−0.741, p<0.001), and fish consumption (r 2 =0.139, β=−0.372, p=0.005) have an independent predictive value for PASI score and CRP levels. Conclusions: This is the first study to evaluate the association between adherence to the Mediterranean diet and the severity of psoriasis. Moreover, our study highlights the usefulness of the assessment of body composition by bioelectrical impedance analysis in the evaluation of the psoriatic patients.
Growth Hormone & IGF Research, 2015
Background: The main components of GH/insulin-like growth factor (IGF)-1 axis and Sirtuin 4 (Sirt... more Background: The main components of GH/insulin-like growth factor (IGF)-1 axis and Sirtuin 4 (Sirt4), highly expressed in liver and skeletal muscle mitochondria, serve as active regulators of mitochondrial oxidative capacity with opposite functions. In obesity both GH/IGF-1 status and serum Sirt4 levels, likely mirroring its reduced mitochondrial expression, might be altered. Objective: To evaluate the association between circulating levels of Sirt4, body composition, metabolic parameters and cardio-metabolic risk profile in obese patients according to their different GH/IGF-1 status. Design: Cross-sectional study with measurement of serum Sirt4, GH after GH releasing hormone (GHRH) + Arginine test, IGF-1 and assessment of body composition, glucose and lipid metabolism in 50 class II-III obese subjects (BMI 35.6 to 62.1 kg/m 2) and 15 normal weight subjects. Low GH secretion and IGF-1 were defined using predetermined cutoff-points. The Homeostatic Metabolic Assessment of insulin resistance index and Visceral adiposity index were also calculated. The association of Sirt4 with peak stimulated GH and IGF-1, body composition, metabolic parameters and cardio-metabolic risk profile was assessed. Results: Serum Sirt4 was inversely related to anthropometric and metabolic parameters and positively related to peak GH and IGF-1. After adjusting for peak GH and IGF-1, the relationships between Sirt4 and BMI became not significant. At multiple regression analysis IGF-1 (p b 0.001) was the independent predictor for Sirt4. Conclusion: There was a close relationship between low IGF-1 and low serum Sirt4. This observation suggested that in obese patients, low GH/IGF-1 status was likely associated with a major compensatory decrease in circulating levels of Sirt4 to oppose to its negative regulator effect on mitochondrial oxidative capacity.
Endocrine, 2014
The aim of the study is to clarify the relationship between adipose tissue dysfunction, metabolic... more The aim of the study is to clarify the relationship between adipose tissue dysfunction, metabolic profile and growth hormone (GH)/insulin-like growth factor (IGF)-I secretion in healthy adult subjects. We investigated the metabolic profile in a cohort of 231 consecutive healthy subjects in relation to GH, IGF-I levels, and visceral adiposity index (VAI). Anthropometric measures, lipid profile, and glucose and insulin levels during oral glucose tolerance test, Homa-IR and ISI Matsuda, IGF-I and GH peak after GHRH plus Arginine test were analyzed. The subjects with high VAI showed lower GH peak (22.8 ± 11.1 vs. 42.2 ± 21.3 lg/L; p = 0.049) and lower IGF-I (presented as IGF-I under normal range, UNR) (0.54 ± 0.14 vs. 0.64 ± 0.12; p = 0.005) than group with normal VAI. ROC curve analysis identified the cutoff , able to detect subjects with high VAI, i.e., 31.8 lg/L for GH peak and 0.63 for IGF-1 UNR. The subjects with GH peak and IGF-I UNR under the cutoff showed significantly higher levels of VAI, systolic and diastolic blood pressure, glucose and insulin levels, Homa-IR, and lower ISI Matsuda, with a concomitant worse lipid profile (all p \ 0.001). A strong relationship between GH axis, VAI and metabolic risk has been demonstrated. A percentage of apparently healthy subjects show a degree of visceral adipose dysfunction associated with GH and IGF-I levels that do not meet the criteria of overt GH deficiency (GHD). Long-term prospective studies could help to clarify and confirm whether a hypothetical condition of subclinical GHD could be taken into account as a new clinical entity. Keywords Growth hormone Á Visceral adiposity Á Metabolic risk Á GH deficiency Carolina Di Somma and Alessandro Ciresi have equal contributions.
World Journal of Gastroenterology, 2010
Non-alcoholic fatty liver disease (NAFLD), a further expression of metabolic syndrome, strictly l... more Non-alcoholic fatty liver disease (NAFLD), a further expression of metabolic syndrome, strictly linked to obesity and diabetes mellitus, is characterized by insulin resistance (IR), elevated serum levels of free fatty acids and fatty infiltration of the liver, which is known as hepatic steatosis. Hepatocyte apoptosis is a key feature of this disease and correlates with its severity. Free-fatty-acidinduced toxicity represents one of mechanisms for the pathogenesis of NAFLD and hormones, growth factors and adipokines influence also play a key role. This review highlights the various pathways that contribute to the development of hepatic steatosis. Circulating concentrations of inflammatory cytokines are reckoned to be the most important factor in causing and maintaining IR. Low-grade chronic inflammation is fundamental in the progression of NAFLD toward higher risk cirrhotic states.
Obesity Surgery, 2011
Background Sleeve gastrectomy (SG) was pioneered as a twostage intervention for super and super-s... more Background Sleeve gastrectomy (SG) was pioneered as a twostage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied. Methods Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8±10.9 (15.0-64.0), and body mass index (BMI, kg/m 2) 48.7±9.3 (33.7-74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss. Results Mean operative time was 105 min (95-180), and mean hospitalization was 5.6 days (1-14). There was no mortality. There were 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n=55) to 37.5±9.3 (22.2-58.1); %EWL was 48.1 ±19.3 (15.5-98.9). Twelve-month BMI (n=41) was 38.4± 10.5 (19.3-62.3); %EWL was 51.7±25.0 (8.9-123.3). Fortyeight-month BMI (n=13) was 35.6±6.8 (24.9-47.5); %EWL was 61.1±12.2 (43.9-82.1) (p<0.001). Preoperative BMI was predictive of >70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n=23) were off medication (mean HbA 1C , 5.9± 0.5%; glycemia, 90.0±19.9 mg/dL (p<0.01) at 3 months). Conclusions Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications.
The Journal of Clinical Endocrinology & Metabolism, 2008
Background: Severe GH deficiency (GHD) is associated with, increased cardiovascular risk and inti... more Background: Severe GH deficiency (GHD) is associated with, increased cardiovascular risk and intima-media thickness (IMT) at major arteries.Objective: The objective of the study was to investigate the 5-yr effects of GH replacement on common carotid IMT and insulin resistance syndrome (IRS) (at least two of the following: triglycerides levels ≥ 1.7 mmol/liter, high-density lipoprotein-cholesterol levels ≤ 1.0 mmol/liter, blood pressure above 130/85 mm Hg, fasting glucose 6.1–7 or 2 hr after glucose 7.7–11.1 mmol/liter).Design: This was an interventional, open, prospective, controlled study.Patients: Patients included 35 men with severe GHD and 35 age-matched healthy men as controls.Intervention: All patients received standard replacement therapy; GH replacement was added in 22 patients (group A) and refused by 13 others (group B).Measurements: Five-year changes in IMT and IRS prevalence were measured.Results: At baseline, IMT was higher in the patients with (P < 0.001) and withou...
The Journal of Clinical Endocrinology & Metabolism, 2009
The objective of the study was to reevaluate the diagnostic accuracy of GH peak after GHRH plus a... more The objective of the study was to reevaluate the diagnostic accuracy of GH peak after GHRH plus arginine test (GHRHϩARG) according to patients' age, body mass index (BMI), and waist circumference to diagnose GH deficiency (GHD). Outcome Measures: GH peak after GHRHϩARG and IGF-I levels reported as SD score. Subjects: Subjects included 408 controls (218 women, 190 men, aged 15-80 yr) and 374 patients with hypopituitarism (167 women, 207 men, aged 16-83 yr). Results: In the (elderly) healthy subjects 15-25 yr old (young), 26-65 yr old (adults) and older than 65 yr, GH cutoffs were 15.6, 11.7, and 8.5 g/liter, 11.8, 8.1, and 5.5 g/liter, and 9.2, 6.1, and 4.0 g/liter, respectively, in the lean, overweight, and obese subjects. Waist circumference was the best predictor of GH peak (t ϭ Ϫ7.6, P Ͻ 0.0001) followed by BMI (t ϭ Ϫ6.7, P Ͻ 0.0001) and age (t ϭ Ϫ5.7, P Ͻ 0.0001). Based on the old (Ͻ9.1 g/liter) and new GH cutoff, 286 (76.5%) and 276 (73.8%) of 374 hypopituitary patients had severe GHD. The receiving-operator characteristic analysis showed GH cutoffs in line with the third percentile or slightly higher results so that the prevalence of GHD increased to 90.1%. Conclusions: The results of the current study show that waist circumference and BMI are the strongest predictors of GH peak after GHRHϩARG followed by age. However, the old cutoff value of 9.0 g/liter was in line with the new cutoffs in 95% of patients. (J Clin Endocrinol Metab 94: 4414-4422, 2009) G H Deficiency (GHD) in the adult population causes a syndrome characterized by altered body composition, reduced bone mineralization, unfavorable lipid profile, reduced cardiac performance, early atherosclerosis, and impaired quality of life (1, 2). Even if not completely proven, it is suggested that these abnormalities are associated with reduced life expectancy (3-8). Currently several pharmacological stimuli of GH secretion, such as insulin-induced hypoglycemia (ITT), glucagon, GHRH plus arginine (GHRHϩARG), and GHRH plus GH releasing peptide-6, are used to diagnose GHD (9, 10). With currently available GH assay methods, severe GHD in adults is reportedly diagnosed by a GH peak less than 3.0 g/liter to ITT or glucagon and less than 9.1 g/liter to GHRHϩARG. In childhood, diagnosis of GHD is based on a peak GH response of less than 5-7 g/liter to ITT, a cutoff that was validated against height velocity (11). Similarly, the validity of cutoff GH after GHRHϩARG proposed by Aimaretti et al. (12) has been supported by a correlation with impairment of lipid pro
The Journal of Clinical Endocrinology & Metabolism, 2009
The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired... more The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired GH secretion is frequent in obese patients. Objective: Our objective was to investigate if GH treatment prevents LBM loss in the early postoperative period. Design: This was an open, prospective, randomized, and controlled study. Patients: A total of 24 women (body mass index: 44.4 Ϯ 7.6 kg/m 2 , aged 36.8 Ϯ 11.7 yr) undergoing laparoscopic-adjustable silicone gastric banding (LASGB) and with GH deficiency after LASGB was included in the study. Treatment Protocol: Group A (n ϭ 12) included a standardized diet regimen and exercise program plus recombinant human GH (0.5 Ϯ 0.13 mg every day), and group B (n ϭ 12) included a standardized diet regimen and exercise program. The follow-up duration was 6 months. Results: The excess of body weight loss did not differ between groups A and B after 3 and 6 months. At 3 months, LBM loss was lower (P Ͻ 0.0001) and fat mass (FM) loss was higher (P ϭ 0.02) in group A than group B. At 3 and 6 months, appendicular skeletal muscle mass loss was lower (P ϭ 0.000) in group A than group B. At 3 (P ϭ 0.0003 and 0.0005, respectively) and 6 months (P Ͻ 0.0001 and 0.0002, respectively), the percent changes of FM and lean body mass were significantly higher in group A than group B. In both groups fasting and postglucose area under the plasma concentrationtime curve insulin significantly reduced. The homeostasis model assessment of insulin and insulin sensitivity indexes and total to high-density lipoprotein cholesterol ratio improved only in group A. Conclusions: GH treatment for 6 months after LASGB reduces loss in LBM and appendicular skeletal muscle mass during a standardized program of low-calorie diet and physical exercise program, with improvement of lipid profile and without a deterioration of glucose tolerance. (J Clin Endocrinol Metab 94: 817-826, 2009) O besity should be considered an onerous worldwide problem because of the impressive number of associated complications (1). The subgroup of individuals with class III or morbid obesity, defined as body mass index (BMI) more than 40 kg/m 2 , is a particular concern due to both health risk concerns and resistance to medical therapy (2). In the United States, it is
The Journal of Clinical Endocrinology & Metabolism, 2004
JCEM is published monthly by The Endocrine Society (http://www. endo-society.org), the foremost p... more JCEM is published monthly by The Endocrine Society (http://www. endo-society.org), the foremost professional society serving the endocrine community.
The Journal of Clinical Endocrinology & Metabolism, 2006
Background: Partial GH deficiency (GHD) in adults is poorly studied. Objective: The objective of ... more Background: Partial GH deficiency (GHD) in adults is poorly studied. Objective: The objective of the study was to investigate the natural history and clinical implications of partial GHD.
Journal of Clinical Medicine, 2021
In the past three decades, several recent studies have analyzed the alarming increase of obesity ... more In the past three decades, several recent studies have analyzed the alarming increase of obesity worldwide, and it has been well established that the risk of many types of malignancies is increased in obese individuals; in the same period, thyroid cancer has become the fastest growing cancer of all malignancies. We investigated the current literature to underline the presence of a connection between excess body weight or Body Mass Index (BMI) and risk of thyroid cancer. Previous studies stated that the contraposition between adipocytes and adipose-resident immune cells enhances immune cell production of multiple pro-inflammatory factors with subsequent induction of hyperlipidemia and vascular injury; these factors are all associated with oxidative stress and cancer development and/or progression. Moreover, recent studies made clear the mitogenic and tumorigenic action of insulin, carried out through the stimulation of mitogen-activated protein kinase (MAPK) and phosphoinositide-3 ki...
Nutrients, 2020
Prader–Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia with progressive, ... more Prader–Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia with progressive, severe obesity, and an increased risk of obesity-related comorbidities in adult life. Although low dietary vitamin D intake and low 25-hydroxy vitamin D (25OHD) levels are commonly reported in PWS in the context of bone metabolism, the association of low 25OHD levels with fat mass has not been extensively evaluated in PWS adults. The aims of this study were to investigate the following in PWS adults: (1) 25OHD levels and the dietary vitamin D intake; (2) associations among 25OHD levels with anthropometric measurements and fat mass; (3) specific cut-off values for body mass index (BMI) and fat mass predictive of the 25OHD levels. In this cross-sectional, single-center study we enrolled 30 participants, 15 PWS adults (age 19–41 years and 40% males) and 15 control subjects matched by age, sex, and BMI from the same geographical area (latitude 40° 49’ N; elevation 17 m). Fat mass was assesse...
Nutrients, 2020
Chronotype is the attitude of a subject in determining individual circadian preference in behavio... more Chronotype is the attitude of a subject in determining individual circadian preference in behavioral and biological rhythm relative to the external light–dark cycle. Obesity and unhealthy eating habits have been associated with evening chronotype. The Mediterranean diet (MD) is a healthy nutritional pattern that has been reported to be associated with better health and quality of sleep. Thus, the aim of the study was to investigate the association of chronotype categories with adherence to the MD in a population of middle-aged Italian adults. This cross-sectional study included 172 middle-aged adults (71.5% females; 51.8 ± 15.7 years) that were consecutively enrolled in a campaign to prevent obesity called the OPERA (obesity, programs of nutrition, education, research and assessment of the best treatment) Prevention Project that was held in Naples on 11–13 October 2019. Anthropometric parameters, adherence to the MD and chronotype were studied. Chronotype was classified as morning i...
Nutrients, 2019
Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder and is characterize... more Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder and is characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. Obesity, low-grade chronic inflammatory status, and insulin-resistance (IR) often coexist in PCOS. The Mediterranean diet (MD) is an anti-inflammatory dietary pattern, which is rich in complex carbohydrates and fiber, and high in monounsaturated fat. There is a close association among obesity, low-grade chronic inflammation, IR, and hormonal derangements in PCOS. The main aim of the present study was to evaluate the adherence to MD, the dietary intake, and the body composition and their association with PCOS clinical severity in a cohort of treatment-naïve women with PCOS when compared with a control group of healthy women matched for age and body mass index (BMI). In this case-controlled, cross-sectional study, we enrolled 112 patients with PCOS and 112 controls. PREvención con DIetaMEDiterránea (PREDIMED) and seven-day...
Nutrients, 2019
Obesity is associated with reduced spontaneous and stimulated growth hormone (GH) secretion and b... more Obesity is associated with reduced spontaneous and stimulated growth hormone (GH) secretion and basal insulin-like growth factor I (IGF-1) levels—which in turn is associated with increased prevalence of cardiovascular risk factors. The aim of this study was to investigate: (1) the association of somatotropic axis with cardiometabolic status; (2) the association of somatotropic axis with the Mediterranean diet and nutritional pattern in people with obesity. Cross-sectional observational study was carried out in 200 adult women, aged 36.98 ± 11.10 years with severe obesity (body mass index—BMI of 45.19 ± 6.30 kg/m2). The adherence to the Mediterranean diet and the total calorie intake was assessed. Anthropometric measurements, body composition and biochemical profile were determined along with Growth Hormone (GH)/Insulin like Growth Factor 1 (IGF-1) axis and insulin resistance (homeostatic model assessment for insulin resistance—HoMA-IR). The enrolled subjects were compared after bein...
Best practice & research. Clinical endocrinology & metabolism, 2017
There is a growing body of evidence indicating that patients with adult GH deficiency (GHD) are c... more There is a growing body of evidence indicating that patients with adult GH deficiency (GHD) are characterized by a cluster of traditional and emerging cardiovascular risk factors and markers, which can significantly increase their cardiovascular morbidity and mortality possibly linked to aberrations in GH status. Patients with adult GHD present multiple different cardiovascular abnormalities. In addition, cardiovascular risk in adult GHD is increased due to altered body composition, abnormal lipid profile, insulin resistance and impaired glucose metabolism. Cardiovascular risk factors can be reversed, at least partially, after GH replacement. However, evidence on the effects of GH replacement on cardiovascular events and mortality is too limited in adult GHD patients. Aim of this review is to provide an at-a-glance overview of the role of the GH/IGF-I on the cardiovascular system and the state of art of the effects of GH replacement on cardiovascular system.
Reviews in Endocrine and Metabolic Disorders, 2017
Low vitamin D status and obesity have concomitantly reached epidemic levels worldwide. Up to now ... more Low vitamin D status and obesity have concomitantly reached epidemic levels worldwide. Up to now the direction of the association between low vitamin D status and obesity, the exact mechanisms responsible for this association and the clinical usefulness to increase vitamin D status for reducing adiposity still warrant further evaluation. The aim of the present review was to examine the current evidence linking low vitamin D status and obesity in relation to the role of the nutritionist. On the one side, considering obesity as a causal factor, low sun exposure in obese individuals due to their sedentary lifestyle and less outdoor activity, vitamin D sequestration in adipose tissue, and volumetric dilution of ingested or cutaneously synthesized vitamin D 3 in the large fat mass of obese patients, might represent some of the factors playing a major role in the pathogenesis of the low vitamin D status. On the other side, the expression of both vitamin D 3 receptors and enzymes responsible for vitamin D 3 metabolism in adipocytes depicted a role for the low vitamin D status per se in the development of obesity by modulating adipocyte differentiation and lipid metabolism. Nutritionists need to accurately address the aspects influencing the low vitamin D status in obesity and the vitamin D supplementation in obese individuals.
International Journal of Environmental Research and Public Health, 2016
Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activ... more Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activation, where both environmental and genetic factors contribute to its pathogenesis. Among the risk factors for psoriasis, evidence is accumulating that nutrition plays a major role, per se, in psoriasis pathogenesis. In particular, body weight, nutrition, and diet may exacerbate the clinical manifestations, or even trigger the disease. Understanding the epidemiological relationship between obesity and psoriasis is also important for delineating the risk profile for the obesity-related comorbidities commonly found among psoriatic patients. Moreover, obesity can affect both drug's pharmacokinetics and pharmacodynamics. Additionally, the overall beneficial effects on the obesity-associated comorbidities, clinical recommendations to reduce weight and to adopt a healthy lifestyle could improve the psoriasis severity, particularly in those patients with moderate to severe disease, thus exerting additional therapeutic effects in the conventional treatment in obese patients with psoriasis. Education regarding modifiable environmental factors is essential in the treatment of this disease and represents one of the primary interventions that can affect the prognosis of patients with psoriasis. The goal is to make psoriatic patients and health care providers aware of beneficial dietary interventions. The aim of this review is to assess the relevance of the environmental factors as modifiable risk factors in psoriasis pathogenesis, with particular regard to the involvement of obesity and nutrition in the management of psoriasis, providing also specific nutrition recommendations.
Journal of Translational Medicine, 2016
Background: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental fa... more Background: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental factors, show multiple bidirectional associations, with important metabolic implications in psoriatic patients. Besides body mass index (BMI) as a measure of obesity, data on phase angle (PhA), a direct measure by bioelectrical impedance analysis (BIA), used as a marker of cellular health and a predictor of morbidity and mortality in various diseases, are still lacking in psoriasis. In this case-control, cross-sectional study, we investigated the PhA in 180 pairs of adult psoriatic patients and healthy controls, evaluating also the potential use of the PhA as marker of the clinical severity, the quality of life, and the presence of the MetS in psoriatic patients. Methods: Anthropometric measures, metabolic profile and bioelectrical variables were evaluated. The clinical severity was assessed by standardized psoriasis area and severity index (PASI) score and c-reactive protein (CRP) levels, and the quality of life was evaluated by dermatology life quality index (DLQI). MetS was diagnosed according to Adult Treatment Panel III. Results: Psoriatic patients presented smaller PhA (p < 0.001) and higher prevalence MetS compared with controls. The PhA was significantly associated with number of parameters of MetS in both groups (p < 0.001). After adjusting for BMI, this association remained significant in psoriatic patients only (p < 0.001). Among psoriatic patients, the PhA was the major index value for the diagnosis of MetS (OR 5.87, 95 % CI 5.07-6.79) and was inversely associated with both PASI score and DLQI, independently of BMI (p < 0.001). At multiple regression analysis, the PhA well predicted the PASI score and DLQI. Based on ROC curves, the most sensitive and specific cutoffs of PhA to predict the highest PASI score and the lowest DQLI were ≤4.8° and ≤4.9°, respectively. Conclusions: We reported that psoriatic patients presented small PhAs, with a novel association between PhA, clinical severity, quality of life in psoriatic patients, and MetS. Further studies are required to validate the PhA's prognostic ability in assessing the clinical severity and MetS in psoriatic patients.
Clinical Nutrition, 2017
Background & aims: Nutrition is the major environmental factor that influences the risk of develo... more Background & aims: Nutrition is the major environmental factor that influences the risk of developing pathologies, such as obesity. Although a number of recent reviews pinpoint a protective effects of milk on body weight and obesity related co-morbidities, an inaccurate estimate of milk might contribute to hamper its beneficial effects on health outcomes. Seven-day food records provide prospective food intake data, reducing recall bias and providing extra details about specific food items. Milk intake stimulates the somatotropic axis at multiple levels by increasing both growth hormone (GH) and insulin-like growth factor-1 (IGF-1) secretion. On the other hand, obesity is associated with reduced spontaneous and stimulated GH secretion and basal IGF-1 levels. Aim of this study was to evaluate the milk consumption by using the 7-days food record in obese individuals and to investigate the association between milk intake and GH secretory status in these subjects. Methods: Cross-sectional observational study carried out on 281 adult individuals (200 women and 81 men, aged 18e74 years) with moderate-severe obesity (BMI 35.2e69.4 kg/m 2). Baseline milk intake data were collected using a 7 day food record. Anthropometric measurements and biochemical profile were determined. The GH/IGF-1 axis was evaluated by peak GH response after GHRH þ ARGININE and IGF-1 standard deviation score (SDS). Results: The majority of individuals (72.2%) reported consuming milk; 250 mL low-fat milk was the most frequently serving of milk consumed, while no subjects reported to consume whole milk. Milk consumers vs no milk consumers presented the better anthropometric measurements and metabolic profile. At the bivariate proportional odds ratio model, after adjusting for BMI, age and gender, milk consumption was associated the better GH status (OR ¼ 0.60; p < 0.001). Among milk consumers, subjects consuming 250 mL reduced-fat milk vs 250 mL low-fat milk presented the better anthropometric measurements and metabolic profile. At the bivariate proportional odds ratio model, after adjusting for BMI, age and gender, the consume of 250 mL reduced-fat milk was associated better GH status (OR ¼ 0.54; p ¼ 0.003). Conclusions: A novel positive association between milk consumption, GH status, and metabolic profile in obese individuals was evidenced. Regardless of the pathogenetic mechanisms, this novel association might be relevant in a context where commonly obese individuals skip breakfast, and suggests the need of a growing cooperation between Nutritionists and Endocrinologists in the management of the obese patients.
Journal of Translational Medicine, 2015
Background: Many studies have evaluated the role of individual nutrients on the development of ps... more Background: Many studies have evaluated the role of individual nutrients on the development of psoriasis. However, only few studies have investigated the effect of a healthy eating pattern, such as the Mediterranean diet. In this study, we aimed to investigate the relationship between adherence to the Mediterranean diet, the body composition and the severity of psoriasis in a group of naïve-treatment patients with psoriasis. Methods: This is a cross-sectional case-control observational study. Sixty-two patients (49 males and 13 females, mean age: 50.2±10.5yrs) affected with mild-to-severe psoriasis were consecutively enrolled. Sixty-two age-, sex-and body mass index (BMI)-matched healthy subjects served as control group. A validated 14-item questionnaire (PREDIMED: PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the Mediterranean diet. The severity of psoriasis was by assessed by standardized Psoriasis Area and Severity Index (PASI) score and C-reactive protein (CRP) levels. Body composition was analyzed with bioelectrical impedance analysis. Results: A higher percentage of psoriatic patients had a lower PREDIMED score compared to the control group (30.6% vs 4.8%). PASI score was significantly associated with the percentage of fat mass (FM%) and CRP levels. PASI score and CRP levels were significantly associated with the dietary components included in the PREDIMED questionnaire or with the PREDIMED score. At multiple regression analysis, the major predictor of PASI score were FM among BIA parameters, (r 2 =0.537, β=0.740, p<0.001), and FM (r 2 =0.537, β=0.603, p<0.001) and PREDIMED score (r 2 =0.599, β=−0.296, p=0.007) among anthropometric measures, FM and PREDIMED score. Finally, among all items of the PREDIMED questionnaire, EVOO (r 2 =0.548, β=−0.741, p<0.001), and fish consumption (r 2 =0.139, β=−0.372, p=0.005) have an independent predictive value for PASI score and CRP levels. Conclusions: This is the first study to evaluate the association between adherence to the Mediterranean diet and the severity of psoriasis. Moreover, our study highlights the usefulness of the assessment of body composition by bioelectrical impedance analysis in the evaluation of the psoriatic patients.
Growth Hormone & IGF Research, 2015
Background: The main components of GH/insulin-like growth factor (IGF)-1 axis and Sirtuin 4 (Sirt... more Background: The main components of GH/insulin-like growth factor (IGF)-1 axis and Sirtuin 4 (Sirt4), highly expressed in liver and skeletal muscle mitochondria, serve as active regulators of mitochondrial oxidative capacity with opposite functions. In obesity both GH/IGF-1 status and serum Sirt4 levels, likely mirroring its reduced mitochondrial expression, might be altered. Objective: To evaluate the association between circulating levels of Sirt4, body composition, metabolic parameters and cardio-metabolic risk profile in obese patients according to their different GH/IGF-1 status. Design: Cross-sectional study with measurement of serum Sirt4, GH after GH releasing hormone (GHRH) + Arginine test, IGF-1 and assessment of body composition, glucose and lipid metabolism in 50 class II-III obese subjects (BMI 35.6 to 62.1 kg/m 2) and 15 normal weight subjects. Low GH secretion and IGF-1 were defined using predetermined cutoff-points. The Homeostatic Metabolic Assessment of insulin resistance index and Visceral adiposity index were also calculated. The association of Sirt4 with peak stimulated GH and IGF-1, body composition, metabolic parameters and cardio-metabolic risk profile was assessed. Results: Serum Sirt4 was inversely related to anthropometric and metabolic parameters and positively related to peak GH and IGF-1. After adjusting for peak GH and IGF-1, the relationships between Sirt4 and BMI became not significant. At multiple regression analysis IGF-1 (p b 0.001) was the independent predictor for Sirt4. Conclusion: There was a close relationship between low IGF-1 and low serum Sirt4. This observation suggested that in obese patients, low GH/IGF-1 status was likely associated with a major compensatory decrease in circulating levels of Sirt4 to oppose to its negative regulator effect on mitochondrial oxidative capacity.
Endocrine, 2014
The aim of the study is to clarify the relationship between adipose tissue dysfunction, metabolic... more The aim of the study is to clarify the relationship between adipose tissue dysfunction, metabolic profile and growth hormone (GH)/insulin-like growth factor (IGF)-I secretion in healthy adult subjects. We investigated the metabolic profile in a cohort of 231 consecutive healthy subjects in relation to GH, IGF-I levels, and visceral adiposity index (VAI). Anthropometric measures, lipid profile, and glucose and insulin levels during oral glucose tolerance test, Homa-IR and ISI Matsuda, IGF-I and GH peak after GHRH plus Arginine test were analyzed. The subjects with high VAI showed lower GH peak (22.8 ± 11.1 vs. 42.2 ± 21.3 lg/L; p = 0.049) and lower IGF-I (presented as IGF-I under normal range, UNR) (0.54 ± 0.14 vs. 0.64 ± 0.12; p = 0.005) than group with normal VAI. ROC curve analysis identified the cutoff , able to detect subjects with high VAI, i.e., 31.8 lg/L for GH peak and 0.63 for IGF-1 UNR. The subjects with GH peak and IGF-I UNR under the cutoff showed significantly higher levels of VAI, systolic and diastolic blood pressure, glucose and insulin levels, Homa-IR, and lower ISI Matsuda, with a concomitant worse lipid profile (all p \ 0.001). A strong relationship between GH axis, VAI and metabolic risk has been demonstrated. A percentage of apparently healthy subjects show a degree of visceral adipose dysfunction associated with GH and IGF-I levels that do not meet the criteria of overt GH deficiency (GHD). Long-term prospective studies could help to clarify and confirm whether a hypothetical condition of subclinical GHD could be taken into account as a new clinical entity. Keywords Growth hormone Á Visceral adiposity Á Metabolic risk Á GH deficiency Carolina Di Somma and Alessandro Ciresi have equal contributions.
World Journal of Gastroenterology, 2010
Non-alcoholic fatty liver disease (NAFLD), a further expression of metabolic syndrome, strictly l... more Non-alcoholic fatty liver disease (NAFLD), a further expression of metabolic syndrome, strictly linked to obesity and diabetes mellitus, is characterized by insulin resistance (IR), elevated serum levels of free fatty acids and fatty infiltration of the liver, which is known as hepatic steatosis. Hepatocyte apoptosis is a key feature of this disease and correlates with its severity. Free-fatty-acidinduced toxicity represents one of mechanisms for the pathogenesis of NAFLD and hormones, growth factors and adipokines influence also play a key role. This review highlights the various pathways that contribute to the development of hepatic steatosis. Circulating concentrations of inflammatory cytokines are reckoned to be the most important factor in causing and maintaining IR. Low-grade chronic inflammation is fundamental in the progression of NAFLD toward higher risk cirrhotic states.
Obesity Surgery, 2011
Background Sleeve gastrectomy (SG) was pioneered as a twostage intervention for super and super-s... more Background Sleeve gastrectomy (SG) was pioneered as a twostage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied. Methods Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8±10.9 (15.0-64.0), and body mass index (BMI, kg/m 2) 48.7±9.3 (33.7-74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss. Results Mean operative time was 105 min (95-180), and mean hospitalization was 5.6 days (1-14). There was no mortality. There were 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n=55) to 37.5±9.3 (22.2-58.1); %EWL was 48.1 ±19.3 (15.5-98.9). Twelve-month BMI (n=41) was 38.4± 10.5 (19.3-62.3); %EWL was 51.7±25.0 (8.9-123.3). Fortyeight-month BMI (n=13) was 35.6±6.8 (24.9-47.5); %EWL was 61.1±12.2 (43.9-82.1) (p<0.001). Preoperative BMI was predictive of >70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n=23) were off medication (mean HbA 1C , 5.9± 0.5%; glycemia, 90.0±19.9 mg/dL (p<0.01) at 3 months). Conclusions Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications.
The Journal of Clinical Endocrinology & Metabolism, 2008
Background: Severe GH deficiency (GHD) is associated with, increased cardiovascular risk and inti... more Background: Severe GH deficiency (GHD) is associated with, increased cardiovascular risk and intima-media thickness (IMT) at major arteries.Objective: The objective of the study was to investigate the 5-yr effects of GH replacement on common carotid IMT and insulin resistance syndrome (IRS) (at least two of the following: triglycerides levels ≥ 1.7 mmol/liter, high-density lipoprotein-cholesterol levels ≤ 1.0 mmol/liter, blood pressure above 130/85 mm Hg, fasting glucose 6.1–7 or 2 hr after glucose 7.7–11.1 mmol/liter).Design: This was an interventional, open, prospective, controlled study.Patients: Patients included 35 men with severe GHD and 35 age-matched healthy men as controls.Intervention: All patients received standard replacement therapy; GH replacement was added in 22 patients (group A) and refused by 13 others (group B).Measurements: Five-year changes in IMT and IRS prevalence were measured.Results: At baseline, IMT was higher in the patients with (P < 0.001) and withou...
The Journal of Clinical Endocrinology & Metabolism, 2009
The objective of the study was to reevaluate the diagnostic accuracy of GH peak after GHRH plus a... more The objective of the study was to reevaluate the diagnostic accuracy of GH peak after GHRH plus arginine test (GHRHϩARG) according to patients' age, body mass index (BMI), and waist circumference to diagnose GH deficiency (GHD). Outcome Measures: GH peak after GHRHϩARG and IGF-I levels reported as SD score. Subjects: Subjects included 408 controls (218 women, 190 men, aged 15-80 yr) and 374 patients with hypopituitarism (167 women, 207 men, aged 16-83 yr). Results: In the (elderly) healthy subjects 15-25 yr old (young), 26-65 yr old (adults) and older than 65 yr, GH cutoffs were 15.6, 11.7, and 8.5 g/liter, 11.8, 8.1, and 5.5 g/liter, and 9.2, 6.1, and 4.0 g/liter, respectively, in the lean, overweight, and obese subjects. Waist circumference was the best predictor of GH peak (t ϭ Ϫ7.6, P Ͻ 0.0001) followed by BMI (t ϭ Ϫ6.7, P Ͻ 0.0001) and age (t ϭ Ϫ5.7, P Ͻ 0.0001). Based on the old (Ͻ9.1 g/liter) and new GH cutoff, 286 (76.5%) and 276 (73.8%) of 374 hypopituitary patients had severe GHD. The receiving-operator characteristic analysis showed GH cutoffs in line with the third percentile or slightly higher results so that the prevalence of GHD increased to 90.1%. Conclusions: The results of the current study show that waist circumference and BMI are the strongest predictors of GH peak after GHRHϩARG followed by age. However, the old cutoff value of 9.0 g/liter was in line with the new cutoffs in 95% of patients. (J Clin Endocrinol Metab 94: 4414-4422, 2009) G H Deficiency (GHD) in the adult population causes a syndrome characterized by altered body composition, reduced bone mineralization, unfavorable lipid profile, reduced cardiac performance, early atherosclerosis, and impaired quality of life (1, 2). Even if not completely proven, it is suggested that these abnormalities are associated with reduced life expectancy (3-8). Currently several pharmacological stimuli of GH secretion, such as insulin-induced hypoglycemia (ITT), glucagon, GHRH plus arginine (GHRHϩARG), and GHRH plus GH releasing peptide-6, are used to diagnose GHD (9, 10). With currently available GH assay methods, severe GHD in adults is reportedly diagnosed by a GH peak less than 3.0 g/liter to ITT or glucagon and less than 9.1 g/liter to GHRHϩARG. In childhood, diagnosis of GHD is based on a peak GH response of less than 5-7 g/liter to ITT, a cutoff that was validated against height velocity (11). Similarly, the validity of cutoff GH after GHRHϩARG proposed by Aimaretti et al. (12) has been supported by a correlation with impairment of lipid pro
The Journal of Clinical Endocrinology & Metabolism, 2009
The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired... more The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired GH secretion is frequent in obese patients. Objective: Our objective was to investigate if GH treatment prevents LBM loss in the early postoperative period. Design: This was an open, prospective, randomized, and controlled study. Patients: A total of 24 women (body mass index: 44.4 Ϯ 7.6 kg/m 2 , aged 36.8 Ϯ 11.7 yr) undergoing laparoscopic-adjustable silicone gastric banding (LASGB) and with GH deficiency after LASGB was included in the study. Treatment Protocol: Group A (n ϭ 12) included a standardized diet regimen and exercise program plus recombinant human GH (0.5 Ϯ 0.13 mg every day), and group B (n ϭ 12) included a standardized diet regimen and exercise program. The follow-up duration was 6 months. Results: The excess of body weight loss did not differ between groups A and B after 3 and 6 months. At 3 months, LBM loss was lower (P Ͻ 0.0001) and fat mass (FM) loss was higher (P ϭ 0.02) in group A than group B. At 3 and 6 months, appendicular skeletal muscle mass loss was lower (P ϭ 0.000) in group A than group B. At 3 (P ϭ 0.0003 and 0.0005, respectively) and 6 months (P Ͻ 0.0001 and 0.0002, respectively), the percent changes of FM and lean body mass were significantly higher in group A than group B. In both groups fasting and postglucose area under the plasma concentrationtime curve insulin significantly reduced. The homeostasis model assessment of insulin and insulin sensitivity indexes and total to high-density lipoprotein cholesterol ratio improved only in group A. Conclusions: GH treatment for 6 months after LASGB reduces loss in LBM and appendicular skeletal muscle mass during a standardized program of low-calorie diet and physical exercise program, with improvement of lipid profile and without a deterioration of glucose tolerance. (J Clin Endocrinol Metab 94: 817-826, 2009) O besity should be considered an onerous worldwide problem because of the impressive number of associated complications (1). The subgroup of individuals with class III or morbid obesity, defined as body mass index (BMI) more than 40 kg/m 2 , is a particular concern due to both health risk concerns and resistance to medical therapy (2). In the United States, it is
The Journal of Clinical Endocrinology & Metabolism, 2004
JCEM is published monthly by The Endocrine Society (http://www. endo-society.org), the foremost p... more JCEM is published monthly by The Endocrine Society (http://www. endo-society.org), the foremost professional society serving the endocrine community.
The Journal of Clinical Endocrinology & Metabolism, 2006
Background: Partial GH deficiency (GHD) in adults is poorly studied. Objective: The objective of ... more Background: Partial GH deficiency (GHD) in adults is poorly studied. Objective: The objective of the study was to investigate the natural history and clinical implications of partial GHD.