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Pozzuoli, Italy

Centis E.,University of Bologna | Trento M.,University of Turin | Dei Cas A.,University of Parma | Pontiroli A.E.,University of Milan | And 12 more authors.
Acta Diabetologica | Year: 2014

Lifestyle changes to healthy diet (HD) and habitual physical activity (HPA) are recommended in type 2 diabetes mellitus (T2DM). Yet, for most people with diabetes, it may be difficult to start changing. We investigated the stage of change toward healthier lifestyles according to Prochaska's model, and the associated psychological factors in T2DM patients, as a prerequisite to improve strategies to implement behavior changes in the population. A total of 1,353 consecutive outpatients with T2DM attending 14 tertiary centers for diabetes treatment completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments to define the stage of change for HD and HPA, respectively. Logistic regression was used to determine the factors associated with stages that may hinder behavioral changes. A stage of change favoring progress to healthier behaviors was more common in the area of HD than in HPA, with higher scores in action and maintenance. Differences were observed in relation to gender, age and duration of disease. After adjustment for confounders, resistance to change toward HD was associated with higher body mass index (BMI) (odds ratio (OR) 1.05; 95 % confidence interval (CI) 1.02-1.08). Resistance to improve HPA also increased with BMI (OR 1.06; 95 % CI 1.03-1.10) and decreased with education level (OR 0.74; 95 % CI 0.64-0.92). Changing lifestyle, particularly in the area of HPA, is not perceived as an essential part of treatment by many subjects with T2DM. This evidence must be considered when planning behavioral programs, and specific interventions are needed to promote adherence to HPA. © 2014 Springer-Verlag. Source

Di Bonito P.,Pozzuoli Hospital | Sanguigno E.,Pozzuoli Hospital | Forziato C.,Pozzuoli Hospital | Saitta F.,Pozzuoli Hospital | And 2 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - To evaluate whether fasting plasma glucose (FPG) within a normoglycemic range is associated with cardiometabolic risk factors (CMRF) among children and adolescents in an outpatient setting. RESEARCH DESIGN AND METHODS - Subjects (780; age 6-16 years) with FPG<100 mg/dL were divided into tertiles of FPG. RESULTS - BMI, waist circumference, homeostasis model assessment-insulin resistance, systolic blood pressure, and white blood cell (WBC) count (P < 0.0001) increased across tertiles of FPG. Subjects with high-normal FPG (89-99 mg/dL) showed a higher risk of insulin resistance, hypertension, and high WBC count compared with subjects with low-normal FPG, independent of BMI z score. CONCLUSIONS - In outpatient children and adolescents, higher FPG within the normal range is associated with several CMRF, independent of obesity. Thus the simple measurement of FPG may help identify subjects who warrant some monitoring in relation to cardiovascular risk. © 2011 by the American Diabetes Association. Source

Di Bonito P.,Pozzuoli Hospital | Forziato C.,Pozzuoli Hospital | Sanguigno E.,Pozzuoli Hospital | Di Fraia T.,Pozzuoli Hospital | And 4 more authors.
Journal of Endocrinological Investigation | Year: 2010

Objective: To analyze the prevalence of the metabolic syndrome (MetS) defined by three sets of Adult Treatment Panel 111 (ATPIII)-derived criteria, and the ability of each definition to identify insulin-resistance (IR) in a wide cohort of outpatient children. Subjects and methods: Seven hundred and twenty-four children consecutively observed in the Outpatient Pediatric Clinic of Pozzuoli Hospital during the period 2004-2009 were included in the study. Diagnosis of the MetS was made using three definitions: Cook, Jolliffe (which adopt age- and gender-specific cut-points) and de Ferranti. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). IR was defined by the 90 th percentile of HOMA-IR in healthy non-obese Italian children grouped by gender and Tanner stage. The ability of each definition to identify IR was evaluated in terms of sensitivity and specificity. Results: The prevalence of the MetS in the overall cohort was 11,12 and 24% using Cook, Jolliffe and de Ferranti criteria, respectively. Sensitivity and specificity in relation to IR were 19 and 94% with Cook criteria, 21 and 92% with Jolliffe criteria, and 39 and 84% with de Ferranti criteria. Conclusions: The prevalence of the MetS in children increases with increasing body weight. Among the three definitions analyzed, de Ferranti identifies a larger number of children with the MetS. The prediction of IR is weak with all definitions; on the contrary, the absence of MetS identifies fairly well children with low degree of IR. ©2010, Editrice Kurtis. Source

Di Bonito P.,Pozzuoli Hospital | Moio N.,S. Maria delle Grazie | Scilla C.,S. Maria delle Grazie | Cavuto L.,S. Maria delle Grazie | And 6 more authors.
Atherosclerosis | Year: 2010

Background: To evaluate whether the pediatric metabolic syndrome (MetS) or its factors are useful to detect subclinical abnormalities of cardiac, liver, and glomerular damage in an outpatient population. Methods: The population study included 799 children (age 10 ± 3 years, mean ± SD), 24% of whom were normalweight, 25% overweight, and 51% obese. Alanine-aminotransferase (ALT) levels, estimated glomerular filtration rate (eGFR) and HOMA-IR were analyzed in all children. Microalbuminuria (MA) and left ventricular (LV) geometry and function were evaluated in 501 and 247 children, respectively. MetS was defined using Cook's criteria. Results: MetS was diagnosed in 131 children (16%). Children with MetS+ and MetS- were similar for age, gender and Tanner stage distribution. Children with MetS+ showed higher ALT levels (31±19 vs 21±11IU/L, p<0.0001), LV mass (39±10 vs 34±10g/h2.7, p<0.001) and relative wall thickness (0.37±0.06 vs 0.35±0.05, p<0.01) than MetS-The two groups were similar for MA and eGFR. At multiple logistic regression analysis, children MetS+ showed a higher risk (OR, 95% Cl) adjusted for confounding factors, of high ALT levels (1.71, 1.12-2.59, p=0.012) and concentric LV hypertrophy (2.17, 1.01-4.66, p=0.047) than children MetS-The risk of preclinical liver and cardiac damage associated with the MetS phenotype was not higher than predicted by its single components. Conclusions: Children with MetS show a 2-fold greater risk of having high ALT levels and concentric LV hypertrophy. However, the risk of subclinical manifestations of liver and cardiac damage can be predicted equally well by the single components of the syndrome. © 2010 Elsevier Ireland Ltd. Source

Capaldo B.,University of Naples Federico II | Di Bonito P.,Pozzuoli Hospital | Iaccarino M.,University of Naples Federico II | Roman M.J.,New York Medical College | And 6 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-To evaluate whether impaired fasting glucose (IFG) or the combination of IFG and impaired glucose tolerance (IGT) is associated with progressive abnormalities of cardiac geometry and function. RESEARCH DESIGN AND METHODS-We studied 562 nondiabetic (311 women), nonhypertensive participants of the second Strong Heart Study exam, without prevalent cardiovascular (CV) disease and with estimated glomerular filtration rate ≥60 mL/min/1.73 m 2 (age 46-65 years, 198 with isolated IFG [35%], and 132 with combined IFG and IGT [23%]). Anthropometric parameters, insulin resistance, fibrinogen, C-reactive protein (CRP), lipid profile, blood pressure (BP), and echocardiographic parameters were compared with 232 participants with normal glucose tolerance (NGT). RESULTS-BMI, prevalence of central obesity, homeostaticmodel assessment index of insulin resistance, plasma triglycerides, fibrinogen, and CRP increased progressively across categories of glucose intolerance (P < 0.0001), with the IFG+IGT group having higher values than those with isolated IFG (0.0546.7 in women or >49.2 g/m2.7 in men) was 3.5 in IFG participants (95% CI 0.68-17.76; P = NS) and 9.76 (2.03-46.79; P = 0.004) in IFG+IGT, compared with NGT, after adjustment for age, sex, heart rate, systolic BP, and waist circumference (WC). In the overall sample, LV mass index was associated with WC (P = 0.033), CRP (P = 0.027), and 2-h oral glucose tolerance test (P = 0.001) independently of confounders. CONCLUSIONS-Cardiometabolic profile and markers of inflammation are more severely altered in men and women with both IFG and IGT compared with those with IFG alone. These individuals, in the absence of hypertension, have a 10-fold greater probability of preclinical CV disease (LV hypertrophy). © 2013 by the American Diabetes Association. Source

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