Nutrition and Dietetics Service

Pavia, Italy

Nutrition and Dietetics Service

Pavia, Italy

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Cereda E.,Nutrition and Dietetics Service | Barichella M.,Parkinson Institute | Cassani E.,Parkinson Institute | Caccialanza R.,Nutrition and Dietetics Service | Pezzoli G.,Parkinson Institute
Parkinsonism and Related Disorders | Year: 2013

Background: Literature suggests that sex steroid hormones may modify the risk for Parkinson's disease (PD). We investigated the potential effect of reproductive factors on the clinical features of idiopathic PD (IPD) patients. Methods: All IPD female patients admitted to and evaluated at our Institute over a 12-month period were included in the present cross-sectional study. We investigated the effect of the following parameters by multivariate linear regression analysis: age at menarche, age at menopause, length of fertile life, duration of exposure to endogenous estrogens and cumulative length of pregnancies, use of contraceptives and hormonal replacement therapy. Results: In total, 579 patients were evaluated and 497 reported menopause before PD onset. In this population, age at PD onset was positively associated with age at menarche and at menopause, length of fertile life and duration of estrogen exposure. Moreover, UPDRS motor score was inversely associated with age at menopause, length of fertile life and duration of estrogen exposure. Increasing age at menarche was also associated with predominant resting tremor at PD onset. In models refitted on patients with early PD (disease duration <5 years; N=226) all the associations found were confirmed. The relationship between surrogates of estrogen exposure and UPDRS motor score actually became more significant. Conclusions: Our observations support the concept that hormonal exposure of the nigro-striatal network during life may influence its susceptibility to degenerative stimuli in later life, but the association does not seem to be unique? unidirectional. In particular, increased severity of PD signs correlates with shorter duration of estrogen exposure. The underlying mechanisms need to be clarified. © 2013 Elsevier Ltd.


Cereda E.,Nutrition and Dietetics Service | Cereda E.,Parkinson Institute | Cassani E.,Parkinson Institute | Barichella M.,Parkinson Institute | And 2 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2013

Background & aims: To investigate the association between anthropometric indices of body fat distribution and cardiometabolic risk factors in a population of Parkinson's disease (PD) patients. Methods & results: One hundred and fifty-seven PD patients (57.3% males) were studied measuring: waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (WtHR), body fat percentage (BF%) by impedance, fasting glucose, serum lipids. Information was collected also on diabetes, hypertension and metabolic syndrome (MetS). Increased cardiometabolic risk was defined by ≥2 MetS component traits other than abdominal adiposity. In the whole population, prevalence of overweight and obesity were 35.0% and 19.2%, respectively. However, prevalence of MetS and elevated cardiometabolic risk were 14.6% and 18.5%, respectively. Prevalence was similar between genders, with one exception: adverse fat distribution according to WC and WHR was more common in females (P < 0.001). Using a multivariable model (adjustments: age, smoking status and disease duration), indices were highly correlated with BF% in both genders. WC and WtHR were associated with the number of MetS criteria and elevated risk. The only cardiometabolic parameters associated with anthropometric indices were HDL in men and triglycerides in women. After adjusting also for BMI all the associations found with anthropometric indices disappeared. Conclusions: Despite their correlation with BF%, anthropometric indices of body fat distribution appear to poorly account for the reduced cardiometabolic risk of the PD patient. This finding suggests a low metabolic activity within the adipose tissue. The implications of fat distribution on the cardiometabolic risk of PD patients clearly deserves further investigation. © 2011 Elsevier B.V.


Dakanalis A.,University of Pavia | Carra G.,University College London | Calogero R.,University of Kent | Zanetti M.A.,University of Pavia | And 5 more authors.
European Archives of Psychiatry and Clinical Neuroscience | Year: 2015

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses. © 2014, Springer-Verlag Berlin Heidelberg.


Cereda E.,Nutrition and Dietetics Service | Cereda E.,Parkinson Institute Istituti Clinici Of Perfezionamento | Barichella M.,Parkinson Institute Istituti Clinici Of Perfezionamento | Pedrolli C.,Trento Hospital | And 4 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - Diabetes has been associated with chronic neurodegeneration.We performed a systematic review and meta-analysis to assess the relationship between pre-existing diabetes and Parkinson's disease (PD). RESEARCH DESIGNANDMETHODS - Original articles in English published up to 10 May 2011 were searched for in electronic databases (PubMed, Embase, and Scopus) and by reviewing references of eligible articles. Prospective cohort and case-control studies providing risk and precision estimates relating to pre-existing diabetes and PD were considered eligible. RESULTS - Nine studies/1,947 citations (cohort, N = 4; case-control, N = 5) fulfilled inclusion criteria for meta-analysis. In prospective studies, the onset of diabetes before onset of PD was found to be a risk factor for future PD (relative risk [RR] = 1.37 [95%CI 1.21-1.55]; P<0.0001). This association was confirmed by secondary analyses based on estimates derived after the exclusion of participants who had vascular disease at baseline and/or who developed vascular disease during follow-up (RR = 1.34 [1.14-1.58]; P<0.001) and by sensitivity analyses addressing the association with diabetes at baseline or during follow-up. However, the association found for case-control studies was not significant (odds ratio [OR] 0.75 [95%CI 0.50-1.11]; P = 0.835). Sensitivity analysis based on estimates adjusted for BMI confirmed the lack of a relationship between PD and diabetes (OR 0.56 [0.28-1.15]; P = 0.089). CONCLUSIONS - Although data from cohort studies suggest that diabetes is a risk factor for PD, there is no conclusive evidence on this association. Further prospective studies focused on putative pathogenic pathways and taking a broad range of confounders into account is required to clarify this relationship. © 2011 by the American Diabetes Association.


Dakanalis A.,University of Pavia | Timko C.A.,University of the Sciences in Philadelphia | Carra G.,University College London | Clerici M.,University of Milan Bicocca | And 4 more authors.
Appetite | Year: 2014

Stice's (1994, 2001) dual pathway model proposed a mediational sequence that links body dissatisfaction to lack of control over eating through dieting and negative affect. Van Strien et al. (2005) extended the negative affect pathway of the original dual pathway model by adding two additional intervening variables: interoceptive deficits and emotional eating. The purpose of this study was to test and compare the original and extended model using prospective data. Both types of loss of control over eating (i.e., subjective and objective binge eating) were evaluated. Data collected from 361 adolescent girls, who were interviewed and completed self-report measures annually over a 2-year period, were analysed using structural equation modeling. Although both models provided a good fit to the data, the extended model fit the adolescent girls' sample data better and accounted for a greater proportion of variance in binge eating than the original model. All proposed mediational pathways of both models were supported and all indirect effects examined through bootstrap procedure were significant. Although our results confirmed the validity of both models and extended previous findings to an early- to middle adolescent group, the bi-directional relationship between dietary restriction and negative affect suggests that the association between these key risk factors for binge eating are more complex than outlined in both the original and extended dual-pathway models. © 2014 Elsevier Ltd.


Cereda E.,Nutrition and Dietetics Service | Pedrolli C.,Unita Operativa di Dietetica e Nutrizione Clinica | Zagami A.,Fondazione Bellaria Onlus | Vanotti A.,Servizio di Dietetica e Nutrizione Clinica | And 4 more authors.
British Journal of Nutrition | Year: 2013

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI <Â 92) and low (GNRI 92-98) nutritional risk were 36·1 and 30·6Â %, respectively. At multivariable linear regression, functional status was independently associated with age (P=Â 0·045), arm muscle area (P=Â 0·048), the number of co-morbidities (P=Â 0·027) and mainly with the GNRI (P<Â 0·001). During a median follow-up of 4·7 years (25th-75th percentile 3·7-6·2), 230 (66·5Â %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95Â % CI 1·32, 2·63; P<Â 0·001) and low nutritional risk (HR 1·52, 95Â % CI 1·08, 2·14; P=Â 0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI <Â 92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95Â % CI 1·28, 2·91; P<Â 0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly. Copyright © The Authors 2013.


Cereda E.,Nutrition and Dietetics Service | Malavazos A.E.,U.O. di Diabetologia e Malattie Metaboliche | Caccialanza R.,Nutrition and Dietetics Service | Rondanelli M.,University of Pavia | And 2 more authors.
Clinical Nutrition | Year: 2011

Background & aims: To investigate the association between history of multiple weight loss diets followed by weight regain, namely weight cycling (WCy), and both body weight excess and abdominal fat accumulation. Methods: A one-day cross-sectional survey (" Obesity-Day" ) including 914 participants (605F:309M). Anthropometric variables (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WtHR]), covariates and WCy (≥5 intentional weight loss episodes of ≥5 kg followed by rapid return to pre-diet or higher body weight) were assessed by a self-administered questionnaire, interview and physical examination. Results: Data on central fat accumulation (by WC and WtHR) were available in a representative sub-group (n = 600). WCy was reported by 119 participants (13.0%) of total population and by 79 (13.2%) of those with available data on central fat accumulation. At multivariable linear regressions WCy was independently associated with higher BMI (P = .004), WC (P = .011) and WtHR (P = .008). Sensitivity analyses, performed after excluding those being on a diet at the time of assessment, confirmed these findings. Conclusions: A history of WCy appears related to body weight excess and abdominal fat accumulation. These findings support the importance of designing adequate weight loss programs to achieve long-term weight maintenance and to prevent undesirable and unhealthy weight accumulation. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Cereda E.,Nutrition and Dietetics Service | Barichella M.,Parkinson Institute Istituti Clinici Of Perfezionamento | Cassani E.,Parkinson Institute Istituti Clinici Of Perfezionamento | Caccialanza R.,Nutrition and Dietetics Service | Pezzoli G.,Parkinson Institute Istituti Clinici Of Perfezionamento
Neurology | Year: 2012

Objective: Recent literature suggests that diabetes is a risk factor for Parkinson disease (PD). We investigated the clinical features of patients with idiopathic PD (IPD) in whom the onset of diabetes came first. Methods: We designed a case-control study. From the cohort of all new patients with IPD free of vascular disease (n = 783) admitted and evaluated at our institute over a 3-year period (2007- 2010), we included all the patients with a diagnosis of diabetes prior to PD onset (n = 89) and a control group (n = 89) matched (1:1) for gender, body mass index (±1 kg/m2), and duration of PD (±1 year). The Unified Parkinson's Disease Rating Scale (UPDRS) motor score was the primary endpoint. Results: At study entry, patients with diabetes were similar to controls in terms of most demographic, lifestyle, and general medical features with exception of statins (18% vs 3.4%; p = 0.003). However, diabetes was associated with higher UPDRS motor (22.3 ± 9.0 vs 19.3 ± 7.9; p = 0.019) and activities of daily living (9.7 ± 5.1 vs 8.3 ± 4.3; p = 0.049) scores, more severe Hoehn & Yahr staging (p = 0.009), and higher treatment doses of levodopa (mg/day, 448 ± 265 vs 300 ± 213; p < 0.0001; mg/kg/day, 5.8 ± 4.0 vs 3.8 ± 2.9; p < 0.0001). Conclusions: Onset of diabetes before the onset of PD appears to be a risk factor for more severe PD symptoms. These findings support the hypothesis that diabetes has a role in the etiopathogenesis of PD. Neurologists should be aware of the potential impact of diabetes on overall PD management. Copyright © 2012 by AAN Enterprises, Inc.


Cereda E.,Nutrition and Dietetics Service
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2012

Purpose of review To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). Recent findings Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the costeffectiveness of interventions based on its scoring deserves investigation. © 2011 Wolters Kluwer Health.


Palladini G.,University of Pavia | Milani P.,University of Pavia | Foli A.,University of Pavia | Obici L.,University of Pavia | And 5 more authors.
Haematologica | Year: 2014

The combination of oral melphalan and dexamethasone is considered standard therapy for patients with light-chain amyloidosis ineligible for autologous stem cell transplantation. However, previous trials reported different rates of response and survival, mainly because of the different proportions of high-risk patients. In the present study, including a total of 259 subjects, we treated 119 patients with full-dose melphalan and dexamethasone (dexamethasone 40 mg days 1-4), and 140 patients with advanced cardiac disease with an attenuated dexamethasone schedule (20 mg). Hematologic response rates were 76% in the full-dose group and 51% in the patients receiving the attenuated schedule The corresponding complete response rates were 31% and 12%, respectively. The median survival was 7.4 years in the full-dose group and 20 months in the attenuated-dose group. Use of high-dose dexamethasone, amino-terminal pro-natriuretic peptide type-B >1800 ng/L, a difference between involved and uninvolved free light chains of >180 mg/L, troponin I >0.07 ng/mL, and response to therapy were independent prognostic determinants. In relapsed/refractory subjects bortezomib combinations granted high hematologic response rates (79% and 63%, respectively), proving the most effective rescue treatment after melphalan and dexamethasone. In summary, melphalan plus dexamethasone was highly effective with minimal toxicity, confirming its central role in the treatment of AL amyloidosis. Future randomized trials will clarify whether bortezomib is best used in frontline combination with melphalan and dexamethasone or as rescue treatment. © Ferrata Storti Foundation.

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