Background and aim : Anorexia nervosa (AN) is a psychiatric disorder characterised by self-induced starvation or a very reduced caloric intake, and frequently by severe life-threatening protein calory malnutrition. Its physiological consequences include amenorrhea, estrogen deficiency and osteoporosis. Osteoporosis may develop as a consequence of a lack of estrogens, low calcium or vitamin D intake, hypercortisolemia or the duration of the illness. The aim of this study was to identify the best endocrinological and nutritional indicators of bone density. Subjects and methods : The study involved 49 young females with AN and malnutrition and 24 age-matched normal controls in whom AN had been excluded on the basis of a clinical evaluation using DSM IV criteria. We studied bone density in early osteopenia, a condition in which the potential risk of fractures is certainly high and traditionally related to a variety of endocrinological and nutritional factors. Results : Bone density was significantly lower in the AN than the control group in all of the examined bone districts: bone mineral density (BMD) spine 0.89±0.19 vs 1.27±0.2 (p<0.0001), BMD neck 0.75±0.14 vs 1.08±0.17 (p<0.001), BMD Ward 0.74±0.17 vs 1.12±0.11 (p<0.0001). Non-significant differences were found in the patients who had undergone previous estrogen medication. Body mass index (BMI) correlated with bone density, but caloric and calcium intake were not significant predictors. IGF-1, a known nutritionally dependent trophic bone factor, was significantly reduced in our patients but did not correlate with BMD. Like other authors, we found a close correlation between lean body mass and BMD in neck and spine. Physical exercise, urinary free cortisol, osteocalcin and type I collagen-telopeptide (NTX) did not significantly correlate with the degree of osteopenia. Conclusions: Our data suggest the importance of nutritional factors (particularly lean body mass and BMI) in determining bone mass, and the relatively limited importance of endocrinological factors with the exception of the duration of amenorrhea as an indirect indicator of endocrinological status.

Objective: The objective of this study was to estimate basal energy expenditure and variation in anthropometrics and body composition parameters after dietetic and lifestyle treat- ment in a population of obese untreated obstructive sleep apnea syndrome (OSAS) patients. Patients and methods: Sixteen obese mild to moderate untreated OSAS patients (AHI 5-29) fol- lowed a program of dietetic lifestyle and weight management. Body composition, anthropometric measures, indirect calorimetry, blood analysis, and results of the questionnaire for the Stanford Sleepiness Scale (SSS) were recorded with follow-up at 3 months. Results: Eleven patients completed the study. Weight (p = 0.001), body mass index (BMI) (p = 0.001), neck circumference (p = 0.003), fat mass (FM) (p = 0.036), and resting metabolic rate (RMR) (p = 0.008) also in connection with FM (p = 0.008) showed meaningful associations. Mul- tivariate associations between weight and neck circumference (p = 0.025), weight and SSS score (p = 0.001), and RMR and FFM loss (p = 0.019) were also noted. Respiratory quotient was unvaried. Conclusion: The results of our study, in agreement with those of other works, confirm the impor- tance of weight decrease for OSAS therapy. A significant association between weight loss and symptomatology estimated with SSS was observed, mainly in relation to the circumference of the neck. These data confirm the hypothesis that one of the main pathogenetic factors of nocturnal ap- neas in obese patients is the deposition of adipose tissue around the upper airway. The massive re- duction in RMR was one of the reasons management of weight loss in OSAS patients is complicat- ed. Why RMR decrease is not related to a decrease of FFM and possible alterations of lipid metab- olism in OSAS patients should be analyzed further in other studies. (Nutritional Therapy & Metab- olism 2008; 26: 81-5)

Hypothalamic amenorrhea in anorexia nervosa often precedes weight loss and may persist after re-feeding and restoration of a stable normal weight. Aim: To assess the rate of persistent amenorrhea in anorexia nervosa (AN) after re-feeding and the relations of this condition with body composition changes and other endocrine parameters. Methods: A cohort of 250 female outpatients was studied to assess persistent amenorrhea prevalence after stable weight recovery. Among these, we selected 20 AN female patients (age 16.5–35), 10 with amenorrhea (group 1) and 10 with normal menses (group 2). We collected data such as age, age at menarche, age at onset of AN, actual body mass index (BMI) and at onset of AN, duration of disease. Physical activity has been evaluated as minute per day. The following data were obtained: prolactin, growth hormone, estradiol, luteinizing hormone, follicle stimulating hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, free urinary cortisol, serum calcium and phosphates, urinary calcium, phosphaturia and alkaline phosphatase. Body composition was assessed with a dual energy x-ray absorptiometry (DEXA). Results: Thirty-five patients (14%) over a cohort of 250 where still amenorrhoic after stable weight recovery. No significance was found in the evaluation of blood biochemical tests of the 2 groups. Free urinary cortisol was significantly higher in amenorrhoic patients (58.14±0.4 vs 15.91±9.5), p=0.02. The analysis of body composition has shown a per-centage of fat of 22.23±5.32% in group 1 and of 26.03%±9.1% in group 2, respectively, showing no significant differences. Amenorrhoic patients carried on doing a significantly heavier physical activity than eumenorrhoic patients. Conclusions: An adequate body composition and a well represented fat mass are certainly a necessary but not sufficient condition for the return of the menstrual cycle. Such menstrual cycle recovery would probably need other conditions at present being studied and evaluated to occur, such as secretory patterns of leptin and its correlations with adrenal function.

Scientific interest in conjugated linoleic acid (CLA) started in 1987 when Michael Pariza's team of Wisconsin University observed its inhibitory effects on chemically induced skin tumors in mice. Numerous studies have since examined CLA's role in cancer, immune function, oxidative stress, atherosclerosis, lipid and fatty acids metabolism, bone formation and composition, obesity, and diabetes. Still it's not clear yet either through which mechanisms CLA produces its numerous metabolic effects. We now know that CLA contents in cow milk fat can be enriched through dry fractionation, but this knowledge doesn't allow sufficient certainty to qualify this nutrient, as a functional food, capable of increasing well being and reducing the risk of disease.

There is a large body of evidence that depression is one of the major clinical problems in the elderly. As matter of fact, several studies have addressed their attention on mood disorders in aged subjects, suggesting different etio-pathogenetic factors. Recently growing interest has been concentrated on the role of immunological alterations related to de-pression showing contradictory data. The aim of this study was to evaluate the correlation between depression and alterations of the cytokine network in aged patients. We included 45 elderly subjects (mean age 80.1 + 12.4 years). All subjects underwent a wide bio-chemical assessment, as well as psychological (mini mental state examination: MMSE; geriatric depression scale: GDS) and self-sufficiency (activity of daily living: ADL; instru-mental activity daily living: IADL) examinations. Student's t-test and linear regression analysis were carried out for statistical evaluation. According to international criteria, we defined depressed all subjects with GDS score > 11. (n = 22). They showed higher values of tumor necrosis factor-alpha (TNF-alpha) (47.4 +/- 11.6 vs 8.7 +/- 4.0 pg/ml; p < 0.0001), and lower values of serum iron concentrations (48.3 +/- 12.2 vs 92.5 +/- 16.6 mg/dl; p < 0.0001), than the controls. No significant differences were found in the MMSE scores and serum cholesterol levels of the two groups. Moreover, the depressed subjects were further divided in 2 subgroups, on the basis of their nutritional status: 14 subjects were affected by protein-energy malnutrition (PEM), and 8 of them were well nourished subjects. PEM subjects had higher TNF-alpha, C-reactive protein (CRP) and GDS score, and lower serum iron levels than the well nourished group (p < 0.001). Therefore, our data suggest that depression is closely related to alterations of the cytokine network, particularly in subjects affected by homeostatic balance failure syndrome. Nevertheless, further studies are necessary to establish both the strength and the etio-pathogenetic meaning of this correlation.

INTRODUCTION: The aim of the present study was to evaluate the possible correlation between urinary albumin excretion (UAE), marker of endothelial dysfunction, and C-reactive protein (CRP), marker of chronic in ̄ammation of the arterial wall, in overweight and obese premenopausal women. METHODS: CRP levels and UAE rate were measured in 103 overweight (BMI 25.0 ± 29.9 Kg=m) and obese (BMI 30.0 Kg=m) premenopausal women, aged 18 ± 45 years. Other measurements included central fat accumulation, as evaluated by waist circumference, insulin resistance, as calculated by homeostasis model assessment (HOMAIR), systolic and diastolic blood pressure, and fasting plasma levels of glucose, insulin, and lipids. RESULTS: UAE was positively correlated with BMI (P< 0.01), waist circumference (P< 0.00l), diastolic blood pressure (P<0.01), triglyceride (P< 0.01), HOMAIR (P< 0.05), and CRP levels (P< 0.05), and negatively associated with HDL-cholesterol (P<0.001). After multivariate analysis, diastolic blood pressure, HDL-cholesterol, and CRP levels maintained their signi®cant correlation with UAE (P< 0.05, P< 0.01, and P< 0.01, respectively). Lastly, we observed a gradual increase in CRP plasma levels across the quartiles in which the whole population was divided according to UAE levels (F: 5.67, Pˆ0.001 for linear trend). CONCLUSION: Our study shows a strong relationship between UAE rate and CRP concentrations, irrespective of age and other anthropometric and metabolic variables. On this basis, it can be argued that in ̄ammation of the arterial wall, as indicated by higher CRP plasma levels, and endothelial dysfunction, as shown by higher UAE rate, might represent simultaneous phenomena in the development of atherosclerosis in overweight and obese premenopausal women.