Our letter discusses the concept of 'Nutritional Prevention Hesitancy', comparing it to the well-studied phenomenon of 'Vaccine Hesitancy'. Both hesitancies can be fueled by 'infodemics', the rapid spread of accurate and inaccurate information that can lead to public confusion and mistrust in authoritative sources. Drawing parallels between the two, the text highlights that nutritional prevention hesitancy can result in individuals not adopting evidence-based nutritional strategies, potentially leading to poorer health outcomes. The text emphasizes the critical role of diet in preventing diseases such as heart disease, diabetes, and certain types of cancer, and underscores the need for multifaceted strategies to combat misinformation and promote healthier dietary habits.

Italy's National Prevention Plan 2020-25 is the first to address nutritional prevention, highlighting its importance in combating chronic diseases. This letter discusses the relationship between food safety, nutritional security, and the need for nutritional prevention in the plan. Chronic diseases, such as cardiovascular disease, cancer, and diabetes, are significant public health concerns in Italy, with poor nutrition being a critical risk factor. Incorporating nutritional prevention can promote healthy eating habits, food security and sustainability, reduce healthcare costs, and promote social cohesion and equality. Successful implementation will require cooperation among the government, the private sector, and the civil society to ensure healthier food choices and prevent chronic diseases in Italy.

The WHO Global Action Plan on physical activity underlines the binomial "diet and physical activity" for the maintenance of well-being state. The adequate nutritional intake is required for sport and can be achieved by a well-adjusted diet without adding artificial food supplements, whose abuse can even represent a risk and appear as an antechamber of doping. Within a national doping prevention project, a peer education tool was realized in the form of a book and e-book, based on the principle of the Mediterranean Diet as an effective nutritional support in sport and physical activity. This health-literacy book contains recipes from all Italian regions revised for their capability to satisfy sport nutritional needs.

Background and aims: To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and haemorrhagic strokes. The present review was conducted in the framework of the work carried out through 2015 and 2016 for the preparation of the Italian Guidelines for the Prevention and Treatment of Stroke, 8th Edition, by ISO-SPREAD (Italian Stroke Organization and the Stroke Prevention and Educational Awareness Diffusion). Methods and results: Systematic review of articles focused on primary prevention of stroke published between January 2013 to May 2016 through an extensive search of the literature using MEDLINE/PUBMED, EMBASE and the Cochrane Library. Articles were ranked according to the SIGN methodology while the GRADE system was used to establish the strength of recommendations. As a result of our literature search, we examined 87 meta-analyses overall (mainly of prospective studies), a few isolated more recent prospective studies not included in the meta-analyses, and a smaller number of available randomized controlled trials and caseecontrol studies. Based on the analysis of the above articles, 36 Syntheses of the available evidence and 36 Recommendations were eventually prepared. The present documentwas developed by organizing the available evidence into three individual areas (nutrients, food groups and dietary patterns) to provide a systematic and user-friendly overview of the available evidence on the relationship between nutrition and primary prevention of stroke. Yet analysis of foods and food patterns allowed translating the information about nutrients in a tool more amenable to use in daily life also in the light of the argument that people eat foods rather than nutrients. Conclusions: The present literature review and dietary recommendations provide healthcare professionals and all interested readers with a useful overview for the reduction of the risk of total, ischemic and haemorrhagic stroke through dietary modifications. (C) 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V.

Excess dietary sodium chloride (salt) intake is etiologically related to hypertension and cardiovascular disease (CVD). Moderate reduction of salt intake reduces blood pressure (BP) and is expected to contribute to reduce the risk of CVD. Previous community-based trials to reduce BP by means of salt reduction were very successful. The initial positive results of national strategies of dietary salt intake reduction in several European countries, driven by the initiative of the World Health Organisation (WHO) and non-governmental organisations such as the World Action of Salt and Health (WASH), have paved the way for action in other European Union (EU) member states. In Italy, several initiatives aiming at reduction of salt intake at the population level have been recently undertaken. These initiatives include i) the evaluation of current dietary habits promoted by the Working Group for Dietary Salt Reduction in Italy (GIRCSI); ii) the chemical analysis of the bread salt content, a major source of sodium intake in Italy, and the agreement between the bakers' associations and the Ministry of Health for a gradual reduction of the bread salt content; iii) the implementation of educational campaigns to increase population awareness, iv) the involvement of the food catering system. In the immediate future, food reformulation must be extended to other food categories in collaboration with industry, foods' salt targets ought to be defined, the food labelling system must be improved and population salt awareness must be further increased through educational campaigns. The GIRCSI Working Group is committed to pursue these objectives.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Lazio District, by pointing out the guidelines of the "Obesity and Overweight for Lazio District Plan" (DGR no1166, 23/12/05), enacts the "National Prevention Plan 2005-2007". The Public Health Service for Food and Nutrition has been the main player of the Plan; the District and Department of Health of the District had a technical and organizational support role. Within the development of the Plan for prevention of obesity of ASL RMB, a technical multidisciplinary group was constituted and three more programs were developed, all of them were dedicated to promotion and support of breast-feeding, prevention of obesity and overweight in childhood and adulthood. The educational activity concerning promotion and support of breast-feed ing actively involved operators from consultory rooms and hospital staff from ASL. The reports about nutritional surveillance allowed a careful analysis of the service conditions and priorities. Special criticality facets have been pointed out such as the high prevalence of overweight (31%) and obesity (7%), the habit of skipping breakfast, a low fruit and vegetables consumption, a generally sedentary lifestyle and, during the intervention, the parents' low involvement. In geriatric age cases, a high malnutrition risk both for overnutrition and undernutrition was found in the elderly groups that were checked; the diets' nutritional density as well as the physical activity aspect recover an important role in the intervention planning. Moreover the discussions with catering companies were an important aspect in order to make several target groups aware. The globally considered experience highlighted positive elements of mobilization, consensus, reorientation of activities and resources, giving proof of the significance of integration concerning specifical aims of different company services. Nevertheless, the carrying on of such activities needs resource investments in the specifical area and enlargement of activities especially for the multisector-based efforts.

Background and Purpose— A systematic review of the prospective studies addressing the relationship of overweight and obesity to major stroke subtypes is lacking. We evaluated the occurrence of a graded association between overweight, obesity, and incidence of ischemic and hemorrhagic stroke by a meta-analysis of cohort studies. Methods— A search of online databases and relevant reviews was performed. Inclusion criteria were original article in English, prospective study design, follow-up ≥4 years, indication of number of subjects exposed, and number of events across body mass index categories. Crude unadjusted relative risk (RR) and 95% CI were calculated for each study for overweight or obese compared with normal-weight categories. Log-transformed values and SE were used to calculate the pooled RR with random effects models; publication bias was checked. Additional analyses were performed using the multivariate estimates of risk reported in the individual studies. Results— Twenty-five studies were included, with 2 274 961 participants and 30 757 events. RR for ischemic stroke was 1.22 (95% CI, 1.05–1.41) for overweight and 1.64 (95% CI, 1.36–1.99) for obesity, whereas RR for hemorrhagic stroke was 1.01 (95% CI, 0.88–1.17) and 1.24 (95% CI, 0.99–1.54), respectively. Subgroup and meta-regression analyses ruled out gender, population average age, body mass index and blood pressure, year of recruitment, year of study publication, and length of follow-up as significant sources of heterogeneity. The additional analyses relying on the published multivariate estimates of risk provided qualitatively similar results. Conclusions— Overweight and obesity are associated with progressively increasing risk of ischemic stroke, at least in part, independently from age, lifestyle, and other cardiovascular risk factors.

Background: To test whether supplementary antioxidants and n–3 fatty acids, alone or in combination, could improve functional status in stroke survivors. Methods: We performed a randomized, double-blind, placebo-controlled clinical trial in 72 stroke patients (47 males; age 65.3 ± 12.9 years) admitted to a rehabilitation hospital for sequelae of first-ever ischemic stroke, and divided them into 4 subgroups. Group 1 patients received daily oral antioxidants, group 2 received n–3 polyunsaturated fatty acids, group 3 both supplements, and group 4 placebo, all for 12 months. No difference at baseline was observed among groups in neurological severity or in disability. All measures were repeated after 6 and 12 months of treatment. All major clinical events were recorded. Results: At baseline, 25% of the patients had a low plasma vitamin status, and 48.5% was at risk of undernutrition. At the 1-year follow-up, we observed a trend for lower mortality (p = 0.060) in subgroups treated with n–3 fatty acids, but without significant differences in rehabilitation result status among groups. Conclusions: Malnutrition is widely observed in patients admitted to a rehabilitative hospital for stroke rehabilitation, and dietary supplementation, even if not able to improve rehabilitation results, is likely to reduce mortality at the 1-year follow-up.

The purpose of the study was to test a nutrition education intervention to promote a higher consumption of vegetables, pulse and fruit among children. The study involved 274 children of primary school (third and fourth grade). The sample was divided in three groups: A (exposed to intervention without taste education activities), B (exposed to intervention with taste education activities), C (control group not exposed to any intervention). Before starting the intervention on pupils, all teachers were properly trained and parents participated to informative/formative meetings. The teachers were also provided with didactic units to implement on children. The efficacy of intervention was evaluated by measuring food target not eaten at school lunch, before and after the implementation of intervention; it showed less plate waste for vegetables (side dishes) for both groups A and B (53.2% vs 44%) and (23.3% vs 8.1%) respectively, while for fruit only group A reduced to half its reject. The differences were however not significant. No increasing consumption was observed for soups or pasta prepared with vegetables or legumes. According to these preliminary results, we observed for some vegetable food items a better dietary behaviour trend among children of both groups who received the intervention compared with controls.

The objective of this study is to obtain reliable data from recent surveys carried out in Italy on the prevalence of overweight (OW) and obesity (OB) in children. We searched in MEDLINE/PubMed, Google and Google Scholar and we included the surveys that fulfilled the following criteria: English or Italian language, time period January 2000-April 2008, target of 6-11 years; BMI evaluated according to IOFT cut-offpoints. Search terms included overweight, obesity, children, Italy, associated with AND/OR. 41 studies have been selected; the percentage of OW varied between 14.7% and 31.3% and OB between 4.3% and 27.3%. In girls, OW values ranged from 11.5% to 34.7% and in boys from 12.6% to 30.1%; in girls, the percentage of OB varied between 4.7% and 29.2%, in boys between 4.4% and 25.8%. There were some variations in the prevalence of OW and OB among diferent regions. The highest values were in Central and Southern Italy, except for Sardinia, where the values were similar to that of Northern Italy. Beyond BMI, the most frequently collected variables were dietary pattern, physical activity, and lifestyle. School is the main site of investigation; third grades (8-9 years) is the most studied age group. The urgency to develop actions to contrast obesity in childhood is confirmed by the prevalence values observed in the Italian regions.