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Vincenzo Bacci, MD,Vincenzo Bacci, MD,
FACEFACE
Our topics for today
 Mediterranean diet: tradition andMediterranean diet: tradition and
healthhealth
 Carbohydrates: th...
Our topics for today
Mediterranean diet:Mediterranean diet:
tradition and healthtradition and health
 Carbohydrates: the...
MeditMediterraneanerranean DietDiet?? In 1000 BC…In 1000 BC…
 DietDiet - from- from δαιταδαιτα = lifestyle= lifestyle
 M...
MediMediterraneanterranean DietDiet :: in 1970…in 1970…
 In the 50’s and 60’s Ancel e Margaret KeysIn the 50’s and 60’s A...
Mediterranean region: commonMediterranean region: common
features and differencesfeatures and differences
 In the Mediter...
MediMediterraneanterranean DietsDiets: at lest three: at lest three
different stylesdifferent styles
 Spain, Greece, Sout...
The food
prejudice
map
Google:
…..sono conosciuti per
+ gastronomia *
http://www.peperosso.info/index.php/story/2006/01/20...
Health in Italy:
Life expectancy at birth - 2006
81.4
80.3
79.9
79.9
79.8
79.4
78.7
78
72.9
71.6
68.6
65.9
65 70 75 80 85
...
Health in Italy:
Life expectancy at birth - 2012
Health in Italy: life expectancy 2011
estimate
 ITALYITALY
 Life expectancy at birth: total population:Life expectancy a...
EU Cardiovascular mortality 2004-2008
EU cancer mortality 2004-2008
 Not a dietNot a diet
 Rather, lifestyle with frugal eatingRather, lifestyle with frugal eating
 Mostly disappeared due...
An example of disappearance
of the mediterranean lifestyle
and its benefits: Crete 1986
 Active lifestyle: 15 Km daily wa...
An example of disappearance
of the mediterranean lifestyle
and its benefits: Crete 2009
 Sedentary lifestyle: driving…Sed...
Mediterranean pyramid ? Plate?… or a
temple?
www.piramideitaliana.it
The Mediterranean Diet Temple
Sparingly
“bearing” foods
Condiments and wine
Mediterranean diet cultural heritage
 Since 2010 the MediterraneanSince 2010 the Mediterranean
diet is included in the UN...
 Mediterranean diet: tradition and healthMediterranean diet: tradition and health
 Carbohydrates: the winners in ItalyCa...
Carbohydrates in the Mediterranean diet:
many healthy features
 Starches:(calories, fibers, no fats)Starches:(calories, f...
Carbs in the
traditional Italian diet
 Calories about 60%Calories about 60%
 Simple carbs 10-12%Simple carbs 10-12%
 Mo...
The Mediterranean Diet Temple: carbohydrates
Sparingly
“bearing” foods
Condiments and wine
Changes in Italy: the last
century
Novecento
Bertolucci 1976
The Italian diet in 1900: high calories
 High energy consumption: >3000 cal/dayHigh energy consumption: >3000 cal/day
Mis...
The Italian diet in 1900: high carbs, high calories
 Poor income:Poor income: grains derivatives and legumesgrains deriva...
The Italian diet in 1900:
high carbs, high calories
 Pane e acqua (= breadPane e acqua (= bread
and water) in prisonersan...
The Italian diet in 2000:
lower carbs
 Today low energy expenditure (sedentaryToday low energy expenditure (sedentary
whi...
Trends in food consumption
United States: The Revis family of North
Carolina Food expenditure for one week:
$341.98
Italy: The Manzo family of Sicily
Food expenditure for one week:
214.36 Euros or $260.1
Trends in food consumption in Italy - 1
 Caloric intake: decreasingCaloric intake: decreasing
 From 2,600 cal in 1960 to...
Caloric consumption in Italy
Trends in food consumption in Italy - 1
 Caloric intake: decreasingCaloric intake: decreasing
 From 2,600 cal in 1960 to...
Trends in food consumption in Italy 2
 Sweets: low consumptionSweets: low consumption
 25 kg vs 58 Kg in UK25 kg vs 58 K...
Alcohol in Italy
Alcohol in Italy (1)
 18.6% of youngsters age 11-15 drink18.6% of youngsters age 11-15 drink
alcohol regularly, often bin...
Alcohol in Italy (2)
 19.7% of boys and 15.3% of19.7% of boys and 15.3% of
girls under 15 had at least onegirls under 15 ...
Alcohol in Italy: regulations (3)
 Forbidden to serve alcohol below age 15Forbidden to serve alcohol below age 15
 Allow...
A little wine protects
 373 men born between 1900 and 1920373 men born between 1900 and 1920
enrolled in the Zutphen Stud...
Decreased events by light alcohol
consumption
Bread consumers in the world
 In Italy breadIn Italy bread
consumption increasedconsumption increased
from 43 Kg in 2001 ...
Pasta and bread
 High consumption of pasta andHigh consumption of pasta and
bread: (Italy: 28 Kg pasta andbread: (Italy: ...
179179
167167
8989
159159
207207
3232
1717
3636
41 potato41 potato
2626
Italian
consumption
per year in
pounds
Recent consumption changes in Italy
(from 2009 to 2010)
 Beef -4.6%Beef -4.6%
 Wine -3.4%Wine -3.4%
 Fish -2.9%Fish -2....
Italians drifting away from
mediterranean foods
 6,500 individuals surveyed in 2007-20086,500 individuals surveyed in 200...
Pasta dish: nutritionally balancedPasta dish: nutritionally balanced
proteins 11 g fat 10 g carbs 57 g
 Pasta 70 gPasta 7...
Pasta is cheap in Italy!
 Cost of a pastaCost of a pasta
serving inserving in
Euros in 2007Euros in 2007
 (pasta, tomato...
Food consumption in Italy: pasta
ItalyItaly
VenezuelaVenezuela
GreeceGreece USAUSA
SwedenSweden
0
5
10
15
20
25
30
Data 20...
Pasta: how and when?
 In a low calorie diet:In a low calorie diet:
 70-80 g with simple tomato sauce70-80 g with simple ...
Pizza: nutritional facts
330 g330 g caloriescalories proteinsproteins carbscarbs fatsfats
BiancaBianca
(white)(white)
9609...
Carbs now: justifiable changes
 The observed decrease in consumption ofThe observed decrease in consumption of
bread and ...
Our diet now: unhealthy
changes
 Seed oils (polyunsaturated) instead of olive oilSeed oils (polyunsaturated) instead of o...
Carbs, GI and obesity
 The notion that high-GI foods lead toThe notion that high-GI foods lead to
obesity is questionable...
Carbs are not related to obesity
 Fiber rich carb rich foods have a highFiber rich carb rich foods have a high
satiating ...
The mediterranean diet
protects against obesity
 EPIC – PANACEA PROJECTEPIC – PANACEA PROJECT
 Epidemiological study in ...
EPIC - PANACEA
 Traditional mediterranean diet: includesTraditional mediterranean diet: includes
olive oilolive oil
 Ada...
EPIC - PANACEA
 Both traditional and adaptedBoth traditional and adapted
mediterranean diets are protectivemediterranean ...
 Mediterranean diet: tradition and healthMediterranean diet: tradition and health
 Carbohydrates: the winners in ItalyCa...
Obesity
in Italy
Health in Italy: obesity
Italy Vs. fattest nations in the worldItaly Vs. fattest nations in the world
0
20
40
60
80
100
% ...
Obesity in Europe 2007
EU adults smoke and obesity 2009
Obesity: latest data and trends
 In Italy obesity and overweight haveIn Italy obesity and overweight have
increased with ...
Obesity prevalence
in adults 2009
Obesity prevalence
in adults 2009
Energy need in Italy 1961-2001
Obesity in Italy: children
 In 2000:In 2000:
 25% of children obese or overweight25% of children obese or overweight
 2...
Obesity in Italy: children
Obesity in Italy: children
 Italian vs. Danish children age 3-6 yearsItalian vs. Danish children age 3-6 years
 In kinde...
Obesity and
Diabetes in children
ITALY USA
IGT 11% 23%
IFG 1%
DMT2 0.5% 2.5%
Metabolic
syndrome
22% 45%
Bambin Gesu Hospit...
Sedentary lifestyle in Europe
Obesity and cycling in Europe
Sedentary lifestyle in Italy
 Only 20% regularly practice sportsOnly 20% regularly practice sports
 60-65% of the Italia...
Italian TV and obesity
 In early afternoon, soap opera time forIn early afternoon, soap opera time for
housewives, there ...
Food advertising in Italian TV
0
10
20
30
40
50
60
70
80
90
USA UK Italy
food ads
junk food
Food ads as % of ads; junk as ...
Obesity in Italy - dieting
Source: Istututo Auxologico Survey 1999
overweight obese general
population
prevalence
13
18
11...
Methods to loose weight in
Italy
D’Amicis, Physical Activity Survey 1998
0 20 40 60 80
Diet
gym
diet & gym
drugs
other
not...
What Italians do about obesity?
 Nothing: 30%Nothing: 30%
 Self-dieting: 14%Self-dieting: 14%
 Consult nutritionist or ...
Obesity day
 Every year since 2001Every year since 2001
 More than 150 centersMore than 150 centers
nationwidenationwide...
 Mediterranean diet: tradition and healthMediterranean diet: tradition and health
 Carbohydrates: the winners in ItalyCa...
Diet therapy in Italy
Diet therapy debate in Italy
 biologists can only suggest dietarybiologists can only suggest dietary
guidelines to improv...
History of popular diets
Dissociated (HayDissociated (Hay
1930)1930)
Very popular in Italy - separation betweenVery popula...
History of popular diets
MediterraneanMediterranean
(1990)(1990)
Often prescribed by nutritionistsOften prescribed by nutr...
Zone diet vs. Mediterranean Diet
Barry Sears vs Eugenio Del Toma
 Eugenio Del Toma:Eugenio Del Toma:
 rules are complica...
Zone diet vs. Mediterranean Diet
 Typical Mediterranean dietTypical Mediterranean diet
 Proteins 15% fats 25% carbsProte...
Zone diet vs. Mediterranean Diet
 Typical Zone dietTypical Zone diet
 Proteins 30% fats 30% carbs 40%Proteins 30% fats 3...
Medit vs Zone vs Low-fat diets
Mediterranean diet and
diabetes
 Newly diagnosed diabetics who were overweightNewly diagnosed diabetics who were overweig...
Lemme Diet
 Recent popular commercial dietRecent popular commercial diet
 Combination of dissociated low carbCombination...
Lemme Diet: typical week
 BF: turkey and coffeeL: beef and coffeeBF: turkey and coffeeL: beef and coffee
D: swordfish and...
The last craze:
the TISANOREICA
 Another variationAnother variation
of ketogenic dietof ketogenic diet
 Package withPack...
The last craze:
the TISANOREICA diet
 Very aggressive promotional tacticsVery aggressive promotional tactics
 TV shows, ...
The last craze:
the TISANOREICA diet
 Followed by VIP: BerlusconiFollowed by VIP: Berlusconi
The last craze:
the TISANOREICA diet
 Followed by VIP: WittstockFollowed by VIP: Wittstock
Dimagenina
 Intragastric BulkingIntragastric Bulking
Agent – non-Agent – non-
prescriptionprescription
 2-3 capsules bef...
Enteral chetogenic nutrition
“NEC”
 Very recent and commerciallyVery recent and commercially
successful modality offered ...
Enteral chetogenic nutrition
“NEC”
 In addition to enteralIn addition to enteral
feeding:feeding:
 Proton pumpProton pum...
NEC protocol
 Cycles of 10 days withCycles of 10 days with
3-week intervals3-week intervals
 Claimed weight lossClaimed ...
Position statement 2011
•NEC is not a treatment for obesity
•It is different from PSMF and EN
•Should be called “fasting w...
Bariatric surgery in Italy
Bariatric procedures
Bariatric surgery vs diet: SOS 2010
Number of bariatric procedures : 18,363Number of bariatric procedures : 18,363
Number of centers: 122Number of centers: 12...
SICOB Registry – 2011
types of procedures
SICOB Registry – 2011
mortality
 Purely restrictivePurely restrictive
 Endoscopic placement andEndoscopic placement and
removal with sedationremoval wit...
To collect italian experience on BIB
18 centers18 centers
patients n. 3824patients n. 3824
(may 2000 – july 2007)
G.I.L.B
30
35
40
45
0 1 2 3 4 5 6
RESULTSRESULTS ( n = 3824)( n = 3824)
6 months BMI: 36.96 months BMI: 36.9±±6.4 (range:6.4 (rang...
Gastric occlusion: 5 (0.24%)
BIB early rupture: 9 (0.4%)
*Esophagitis: (EGDS diagnosis): 3 (0.15%)
Gastric ulcer: 1 (0.04%...
(weight loss < 10 % of initial weight)
FAILURES = 12.4%FAILURES = 12.4%
(sweet eaters, bulimic, grazing pts.)
Italian expe...
MAJOR COMPLICATIONSMAJOR COMPLICATIONS
Gastric OcclusionGastric Occlusion 19 (0.49%)(0.49%)
Gastric PerforationGastric Per...
M/F 301/652
Age 37.5 (19-69) years
BMI 41.2 (30.7-56.5) kg/m2
%EW 61.3 % (34-117.6)
March 1998 – June 2009
1,010 placement...
Female
Age < 35 years
BMI < 40
Predictive Factors
P < 0.05
EWL%:EWL%: nsns
At removalAt removal
Results
LONG TERM FOLLOW-U...
98%98%
51 %51 %
75 %75 %
% Pts
Post-placement symptoms
65 %65 %
(1-2 days)
(1 day)
(1-2 days)
(2-3 days)
Genco series Marc...
Imaz I et al meta-analysis Obes Surg 18:841, 2008
1.8%
0.9%
0.6%
0.3%
0.2%
0.2%
0.1%
0.1%
0.1%
Imaz I et al meta-analysis Obes Surg 18:841, 2008
2 patients
parameter N of patients result
Weight loss vs
placebo BMI
39 – 3.2
Weight loss vs
placebo Kg
39 - 6.7
Weight loss BMI 3,20...
Meta-analysis conclusions
• Weight loss 14.7 Kg, less than 30-40 Kg of
bariatric surgery
• Weight loss 12.2% of initial we...
Evidence based review of
BIB for weight loss
• Safe in selected patients
• Effective in two thirds of the
patients
• Mean ...
2-year weight loss: BIB vs diet
Genco A et al Obesity Surgery 2008
30
32
34
36
38
40
42
44
0 6 12
Group A (BIB+Diet)
Group B (BIB+BIB)
Sequential BIB insertion
BIB placement
BMI
BIB removal...
ten
commandaments
on obesity
follow a balanced and varied diet; have an active lifestyle
avoid "do-it-yourself" diets
alte...
All the world
loves Italy
because it is old
but still
glamorous.
Because it eats
and drinks well
but is rarely fat
or drun...
Carb obesity and food culture in italy 2012
Carb obesity and food culture in italy 2012
Carb obesity and food culture in italy 2012
Carb obesity and food culture in italy 2012
Carb obesity and food culture in italy 2012
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Carb obesity and food culture in italy 2012

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A presentation about Mediterranean Diet in Italy, changing dietary habits in the last century, life expectancy and mortality. A more detailed discussion about carbohydrates in the Italian way of eating. Obesity prevalence and trends; obesity therapies including popular diets and bariatric surgery.

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Transcript of "Carb obesity and food culture in italy 2012"

  1. 1. Vincenzo Bacci, MD,Vincenzo Bacci, MD, FACEFACE
  2. 2. Our topics for today  Mediterranean diet: tradition andMediterranean diet: tradition and healthhealth  Carbohydrates: the winners inCarbohydrates: the winners in ItalyItaly  Obesity: an ongoing battleObesity: an ongoing battle  Obesity: the Italian weaponsObesity: the Italian weapons
  3. 3. Our topics for today Mediterranean diet:Mediterranean diet: tradition and healthtradition and health  Carbohydrates: the winners in ItalyCarbohydrates: the winners in Italy  Obesity: an ongoing battleObesity: an ongoing battle  Obesity: the Italian weaponsObesity: the Italian weapons
  4. 4. MeditMediterraneanerranean DietDiet?? In 1000 BC…In 1000 BC…  DietDiet - from- from δαιταδαιτα = lifestyle= lifestyle  Mediterranea - fromMediterranea - from MEDITERRANEVSMEDITERRANEVS = (sea)= (sea) in the middle of landsin the middle of lands  lifestyle and nutritional habits developed over the centuries by the populations that originated Greek e Roman civilizations
  5. 5. MediMediterraneanterranean DietDiet :: in 1970…in 1970…  In the 50’s and 60’s Ancel e Margaret KeysIn the 50’s and 60’s Ancel e Margaret Keys,, make the first observation on nutrition andmake the first observation on nutrition and health on the southern Italy and Cretehealth on the southern Italy and Crete populationspopulations  ““Seven Countries Study - How to eat wellSeven Countries Study - How to eat well and stay well - The Mediterranean Diet” isand stay well - The Mediterranean Diet” is published inpublished in 1977.1977.
  6. 6. Mediterranean region: commonMediterranean region: common features and differencesfeatures and differences  In the Mediterranean regionIn the Mediterranean region mortality andmortality and cardiovascular morbidity are lowercardiovascular morbidity are lower than otherthan other western regionswestern regions  In general the eating pattern is balanced and similar toIn general the eating pattern is balanced and similar to thethe theoretical cardioprotective compositiontheoretical cardioprotective composition  On the other hand we observe important differences inOn the other hand we observe important differences in socioeconomic conditions, traditional eating habits andsocioeconomic conditions, traditional eating habits and recent trends in the different countries of the area.recent trends in the different countries of the area.
  7. 7. MediMediterraneanterranean DietsDiets: at lest three: at lest three different stylesdifferent styles  Spain, Greece, South-Spain, Greece, South- central Italycentral Italy  Cereals, olive oil, fibers,Cereals, olive oil, fibers, little animal fat (cheese)little animal fat (cheese)  France:France:  Abundant animal fatsAbundant animal fats (butter, cheeses, foi gras),(butter, cheeses, foi gras), red wine (French paradox )red wine (French paradox )  Middle East, NorthMiddle East, North Africa:Africa:  Grains (couscous, rice)Grains (couscous, rice) legumes, nuts, no alcohollegumes, nuts, no alcohol
  8. 8. The food prejudice map Google: …..sono conosciuti per + gastronomia * http://www.peperosso.info/index.php/story/2006/01/20/the_food_prejudice_italian_map
  9. 9. Health in Italy: Life expectancy at birth - 2006 81.4 80.3 79.9 79.9 79.8 79.4 78.7 78 72.9 71.6 68.6 65.9 65 70 75 80 85 Japan Canada Italy France Spain Greece UK USA China Egypt India Russia
  10. 10. Health in Italy: Life expectancy at birth - 2012
  11. 11. Health in Italy: life expectancy 2011 estimate  ITALYITALY  Life expectancy at birth: total population:Life expectancy at birth: total population: 81.8 years81.8 years  male: 79.2 yearsmale: 79.2 years  female: 84.5 yearsfemale: 84.5 years  USAUSA  Life expectancy at birth: total population:Life expectancy at birth: total population: 78.4 years78.4 years  male: 75.9 yearsmale: 75.9 years  female: 80.9 yearsfemale: 80.9 years Source: Indexmundi.com
  12. 12. EU Cardiovascular mortality 2004-2008
  13. 13. EU cancer mortality 2004-2008
  14. 14.  Not a dietNot a diet  Rather, lifestyle with frugal eatingRather, lifestyle with frugal eating  Mostly disappeared due to theMostly disappeared due to the internationalization and globalizationinternationalization and globalization  Many really traditional dishes nowMany really traditional dishes now emarginatedemarginated  Energy expenditure drastically reducedEnergy expenditure drastically reduced Mediterranean diet: pleasure wellbeing culture
  15. 15. An example of disappearance of the mediterranean lifestyle and its benefits: Crete 1986  Active lifestyle: 15 Km daily walkingActive lifestyle: 15 Km daily walking  Traditional dietTraditional diet  Mean weight of a Cretan man 63 KgMean weight of a Cretan man 63 Kg  Longevity (life exp. 78 and 81 years)Longevity (life exp. 78 and 81 years)  Low cardiovascular diseasesLow cardiovascular diseases
  16. 16. An example of disappearance of the mediterranean lifestyle and its benefits: Crete 2009  Sedentary lifestyle: driving…Sedentary lifestyle: driving…  Unhealthy dietUnhealthy diet  Mean weight of a Cretan man 83 KgMean weight of a Cretan man 83 Kg  Increasing morbid obesityIncreasing morbid obesity  higher cardiovascular diseaseshigher cardiovascular diseases
  17. 17. Mediterranean pyramid ? Plate?… or a temple? www.piramideitaliana.it
  18. 18. The Mediterranean Diet Temple Sparingly “bearing” foods Condiments and wine
  19. 19. Mediterranean diet cultural heritage  Since 2010 the MediterraneanSince 2010 the Mediterranean diet is included in the UNESCOdiet is included in the UNESCO list celebrating the world'slist celebrating the world's "intangible cultural heritage”"intangible cultural heritage”  It encompasses more than just food.It encompasses more than just food.  It promotes social interaction,It promotes social interaction,  it has given rise to a considerable body ofit has given rise to a considerable body of knowledge, songs, maximsknowledge, songs, maxims  It is rooted in respect for the territory andIt is rooted in respect for the territory and biodiversitybiodiversity
  20. 20.  Mediterranean diet: tradition and healthMediterranean diet: tradition and health  Carbohydrates: the winners in ItalyCarbohydrates: the winners in Italy  Obesity: an ongoing battleObesity: an ongoing battle  Obesity: the Italian weaponsObesity: the Italian weapons Our topics for today
  21. 21. Carbohydrates in the Mediterranean diet: many healthy features  Starches:(calories, fibers, no fats)Starches:(calories, fibers, no fats)  Cereals (pane, pasta)Cereals (pane, pasta)  Legumes (peas, beans)Legumes (peas, beans)  Vegetables:(fibers, water, volume,Vegetables:(fibers, water, volume, minimal calories, no fats, antioxidants)minimal calories, no fats, antioxidants)  Fruits :(fibers, water, volume, fewFruits :(fibers, water, volume, few calories, no fats)calories, no fats)
  22. 22. Carbs in the traditional Italian diet  Calories about 60%Calories about 60%  Simple carbs 10-12%Simple carbs 10-12%  Mostly fructose in fruitsMostly fructose in fruits  Complex carbs in high fiber foodsComplex carbs in high fiber foods  Usually good glycemic indexUsually good glycemic index  Legumes with soluble fibersLegumes with soluble fibers  Pasta al dentePasta al dente  Scarce consumption of potatoes inScarce consumption of potatoes in Southern ItalySouthern Italy
  23. 23. The Mediterranean Diet Temple: carbohydrates Sparingly “bearing” foods Condiments and wine
  24. 24. Changes in Italy: the last century Novecento Bertolucci 1976
  25. 25. The Italian diet in 1900: high calories  High energy consumption: >3000 cal/dayHigh energy consumption: >3000 cal/day Miseria e nobilta’ (Toto’) 1954
  26. 26. The Italian diet in 1900: high carbs, high calories  Poor income:Poor income: grains derivatives and legumesgrains derivatives and legumes were cheap sources of proteins and calorieswere cheap sources of proteins and calories with a good aminoacid combinationswith a good aminoacid combinations (“pasta e fagioli”(pasta and beans))(“pasta e fagioli”(pasta and beans)) Amarcord (Fellini) 1973
  27. 27. The Italian diet in 1900: high carbs, high calories  Pane e acqua (= breadPane e acqua (= bread and water) in prisonersand water) in prisoners  Pane e olio / bruschettaPane e olio / bruschetta (bread and oil) in(bread and oil) in peasantspeasants  Pater noster…PanemPater noster…Panem nostrum cotidiánum danostrum cotidiánum da nobis hodie = Ournobis hodie = Our Father… Give us thisFather… Give us this day our daily breadday our daily bread  Bread up to 90% of caloriesBread up to 90% of calories  (10% “companatico” = other food with bread)(10% “companatico” = other food with bread) Toto’
  28. 28. The Italian diet in 2000: lower carbs  Today low energy expenditure (sedentaryToday low energy expenditure (sedentary white collar, falsely hyperactive executive, evenwhite collar, falsely hyperactive executive, even modern agricultural worker) and abundance ofmodern agricultural worker) and abundance of cheap foodcheap food  Bread, pasta and legumesBread, pasta and legumes considered a badconsidered a bad choice in a diet which must have limited caloricchoice in a diet which must have limited caloric intakeintake  A portion of steak supplies essential aminoacidsA portion of steak supplies essential aminoacids with 150 calories as 100 g ofwith 150 calories as 100 g of breadbread (290 cal) or(290 cal) or beansbeans (280 cal)(280 cal)
  29. 29. Trends in food consumption
  30. 30. United States: The Revis family of North Carolina Food expenditure for one week: $341.98
  31. 31. Italy: The Manzo family of Sicily Food expenditure for one week: 214.36 Euros or $260.1
  32. 32. Trends in food consumption in Italy - 1  Caloric intake: decreasingCaloric intake: decreasing  From 2,600 cal in 1960 to 2,200 nowFrom 2,600 cal in 1960 to 2,200 now  Starch: high consumptionStarch: high consumption  122 Kg vs 89 Kg a year in Europe122 Kg vs 89 Kg a year in Europe  28 Kg pasta28 Kg pasta  Fish: increasingFish: increasing  From 13 Kg in 1980 to 21 Kg nowFrom 13 Kg in 1980 to 21 Kg now  Fruits and vegetables (incl. cereals and grains:Fruits and vegetables (incl. cereals and grains: increasingincreasing  From 150 Kg in 1950 to 360 Kg nowFrom 150 Kg in 1950 to 360 Kg now  Only Greeks have higher consumptionOnly Greeks have higher consumption
  33. 33. Caloric consumption in Italy
  34. 34. Trends in food consumption in Italy - 1  Caloric intake: decreasingCaloric intake: decreasing  From 2,600 cal in 1960 to 2,200 nowFrom 2,600 cal in 1960 to 2,200 now  Starch: high consumptionStarch: high consumption  122 Kg vs 89 Kg a year in Europe122 Kg vs 89 Kg a year in Europe  28 Kg pasta28 Kg pasta  Fish: increasingFish: increasing  From 13 Kg in 1980 to 21 Kg nowFrom 13 Kg in 1980 to 21 Kg now  Fruits and vegetables (incl. cereals and grains:Fruits and vegetables (incl. cereals and grains: increasingincreasing  From 150 Kg in 1950 to 360 Kg nowFrom 150 Kg in 1950 to 360 Kg now  Only Greeks have higher consumptionOnly Greeks have higher consumption
  35. 35. Trends in food consumption in Italy 2  Sweets: low consumptionSweets: low consumption  25 kg vs 58 Kg in UK25 kg vs 58 Kg in UK  Sugar 24 kg vs 32 kg in EuropeSugar 24 kg vs 32 kg in Europe  Milk: low consumptionMilk: low consumption  57 L vs 93 L in Europe57 L vs 93 L in Europe  Alcohol: decreasingAlcohol: decreasing  From 16 L in 1970 to 6.9 L nowFrom 16 L in 1970 to 6.9 L now  Wine from 104 L in 1952 to 52 L in 2002Wine from 104 L in 1952 to 52 L in 2002  Beer from 4 L in 1952 to 30 L in 2002Beer from 4 L in 1952 to 30 L in 2002
  36. 36. Alcohol in Italy
  37. 37. Alcohol in Italy (1)  18.6% of youngsters age 11-15 drink18.6% of youngsters age 11-15 drink alcohol regularly, often binge drink onalcohol regularly, often binge drink on weekendsweekends  Higher consumption in Emilia andHigher consumption in Emilia and Veneto; lower in Campania and CalabriaVeneto; lower in Campania and Calabria  20% of teenagers get intoxicated on20% of teenagers get intoxicated on weekends (ISTAT survey 2007)weekends (ISTAT survey 2007)
  38. 38. Alcohol in Italy (2)  19.7% of boys and 15.3% of19.7% of boys and 15.3% of girls under 15 had at least onegirls under 15 had at least one alcoholic drink in 2008.alcoholic drink in 2008.  Above age11 79% of men andAbove age11 79% of men and 53% of women drink alcohol.53% of women drink alcohol.  Binge drinking occurs inBinge drinking occurs in 12.1% of men and 2.8% of12.1% of men and 2.8% of women and in 16% ofwomen and in 16% of youngsters (18-24)youngsters (18-24) (ISTAT 2008-2010 surveys)(ISTAT 2008-2010 surveys)
  39. 39. Alcohol in Italy: regulations (3)  Forbidden to serve alcohol below age 15Forbidden to serve alcohol below age 15  Allowed to sell alcohol to anyoneAllowed to sell alcohol to anyone  Forbidden to serve alcohol in disco barsForbidden to serve alcohol in disco bars after 2 amafter 2 am  Allowed to sell beer in a bar in front ofAllowed to sell beer in a bar in front of the discothe disco
  40. 40. A little wine protects  373 men born between 1900 and 1920373 men born between 1900 and 1920 enrolled in the Zutphen Study assessedenrolled in the Zutphen Study assessed repeatedly between 1960 and 2000repeatedly between 1960 and 2000  Drinking up to half a glass of wine dailyDrinking up to half a glass of wine daily may increase longevity by 5 years inmay increase longevity by 5 years in men, but more studies are neededmen, but more studies are needed J Epidemiol Community Health. Published online April 30, 2009
  41. 41. Decreased events by light alcohol consumption
  42. 42. Bread consumers in the world  In Italy breadIn Italy bread consumption increasedconsumption increased from 43 Kg in 2001 to 55from 43 Kg in 2001 to 55 kg in 2006 (200 g perkg in 2006 (200 g per person per day)person per day)  In 2005 out of 22,876,000In 2005 out of 22,876,000 Italian families,Italian families, 12,870,000 buy fresh12,870,000 buy fresh bread daily and 844.000bread daily and 844.000 make bread at home.make bread at home. (ISTAT survey)(ISTAT survey)  There is a recent trend inThere is a recent trend in decreasing breaddecreasing bread consumptionconsumption 0 50 100 Germany Ireland Italy UK USA France Ukraine Canada
  43. 43. Pasta and bread  High consumption of pasta andHigh consumption of pasta and bread: (Italy: 28 Kg pasta andbread: (Italy: 28 Kg pasta and 122 Kg total grains122 Kg total grains derivatives/person/year Vs. 89 kgderivatives/person/year Vs. 89 kg average in EU)average in EU)
  44. 44. 179179 167167 8989 159159 207207 3232 1717 3636 41 potato41 potato 2626 Italian consumption per year in pounds
  45. 45. Recent consumption changes in Italy (from 2009 to 2010)  Beef -4.6%Beef -4.6%  Wine -3.4%Wine -3.4%  Fish -2.9%Fish -2.9%  Olive oil +3,7%Olive oil +3,7%  Cereals +0.6% (but decr. bread & pasta )Cereals +0.6% (but decr. bread & pasta )  Pork +0.6%Pork +0.6%
  46. 46. Italians drifting away from mediterranean foods  6,500 individuals surveyed in 2007-20086,500 individuals surveyed in 2007-2008  MAI index = calories fromMAI index = calories from mediterranean foods/calories from nonmediterranean foods/calories from non –mediterraneans foods–mediterraneans foods  Only <20% of individuals MAI >2Only <20% of individuals MAI >2  Worse categories:Worse categories:  Children, teenagersChildren, teenagers  Northwest, SouthNorthwest, South Osservatorio Grana Padano 2008
  47. 47. Pasta dish: nutritionally balancedPasta dish: nutritionally balanced proteins 11 g fat 10 g carbs 57 g  Pasta 70 gPasta 70 g  Proteins 7.7 gProteins 7.7 g  Fat 0.7 g Carbs 52.5 gFat 0.7 g Carbs 52.5 g  Tomato sauce 60 gTomato sauce 60 g  Proteins 1.8 g CarbsProteins 1.8 g Carbs 2.1 g2.1 g  Cheese 5 gCheese 5 g  Prot 1.8 g Fat 01.4 gProt 1.8 g Fat 01.4 g  Carbs 2.5 gCarbs 2.5 g  Butter 10 gButter 10 g  Fat 8 gFat 8 g
  48. 48. Pasta is cheap in Italy!  Cost of a pastaCost of a pasta serving inserving in Euros in 2007Euros in 2007  (pasta, tomato,(pasta, tomato, parmesan,parmesan, olive oil, onion)olive oil, onion)
  49. 49. Food consumption in Italy: pasta ItalyItaly VenezuelaVenezuela GreeceGreece USAUSA SwedenSweden 0 5 10 15 20 25 30 Data 2007
  50. 50. Pasta: how and when?  In a low calorie diet:In a low calorie diet:  70-80 g with simple tomato sauce70-80 g with simple tomato sauce  In a hypercaloric dietIn a hypercaloric diet  120-140 g with ragu sauce or120-140 g with ragu sauce or cheese saucecheese sauce  As side dish to complement aAs side dish to complement a protein-rich meal (meat or cheese)protein-rich meal (meat or cheese)  As a complete meal with some richAs a complete meal with some rich sauce (seafood and tomatoes…)sauce (seafood and tomatoes…)  As fast foodAs fast food  Often found in Italian bars atOften found in Italian bars at lunch timelunch time
  51. 51. Pizza: nutritional facts 330 g330 g caloriescalories proteinsproteins carbscarbs fatsfats BiancaBianca (white)(white) 960960 2626 190190 2020 RossaRossa (marinara)(marinara) 820820 2323 136136 2121 MargheritaMargherita 930930 1818 175175 1818 CapricciosaCapricciosa 980980 5252 170170 2525
  52. 52. Carbs now: justifiable changes  The observed decrease in consumption ofThe observed decrease in consumption of bread and legumesbread and legumes and increase inand increase in consumption of meat may be justified inconsumption of meat may be justified in terms of adequate aminoacid intake andterms of adequate aminoacid intake and decreased need of total caloriesdecreased need of total calories
  53. 53. Our diet now: unhealthy changes  Seed oils (polyunsaturated) instead of olive oilSeed oils (polyunsaturated) instead of olive oil  Sweets, cakesSweets, cakes, high caloric density foods, high caloric density foods  Sweetened beveragesSweetened beverages  Superalcoholic beverages instead of wineSuperalcoholic beverages instead of wine  Sausages and cheese instead of fresh foodSausages and cheese instead of fresh food
  54. 54. Carbs, GI and obesity  The notion that high-GI foods lead toThe notion that high-GI foods lead to obesity is questionable..obesity is questionable..  Many populations that eat a largeMany populations that eat a large quantity of high-GI foods, such asquantity of high-GI foods, such as Southeast Asians, have significantlySoutheast Asians, have significantly lower body weight than populations wholower body weight than populations who consume a lower quantity of theseconsume a lower quantity of these carbohydrates.carbohydrates.
  55. 55. Carbs are not related to obesity  Fiber rich carb rich foods have a highFiber rich carb rich foods have a high satiating powersatiating power  For the same weight, carbs have less thanFor the same weight, carbs have less than half of the calories of fats (4 vs 9)half of the calories of fats (4 vs 9)  Converting carbs to fats burns moreConverting carbs to fats burns more calories than converting alimentary fatscalories than converting alimentary fats to fat depositsto fat deposits
  56. 56. The mediterranean diet protects against obesity  EPIC – PANACEA PROJECTEPIC – PANACEA PROJECT  Epidemiological study in Europe onEpidemiological study in Europe on relations between nutrition/cancer andrelations between nutrition/cancer and lifestyle/obesitylifestyle/obesity  367,000 individuals followed for 5 ± 2367,000 individuals followed for 5 ± 2 yearsyears
  57. 57. EPIC - PANACEA  Traditional mediterranean diet: includesTraditional mediterranean diet: includes olive oilolive oil  Adapted mediterranean diet: includesAdapted mediterranean diet: includes vegetable oilsvegetable oils  Questionnaires on 9 diet componentsQuestionnaires on 9 diet components with a scoring system to assess adherencewith a scoring system to assess adherence to the mediterranean modelto the mediterranean model
  58. 58. EPIC - PANACEA  Both traditional and adaptedBoth traditional and adapted mediterranean diets are protectivemediterranean diets are protective against weight gainagainst weight gain  More benefit in youngest individualsMore benefit in youngest individuals  More benefit in Southern EuropeMore benefit in Southern Europe (Greece, Italy and Spain)(Greece, Italy and Spain)
  59. 59.  Mediterranean diet: tradition and healthMediterranean diet: tradition and health  Carbohydrates: the winners in ItalyCarbohydrates: the winners in Italy Obesity: an ongoing battleObesity: an ongoing battle  Obesity: the Italian weaponsObesity: the Italian weapons
  60. 60. Obesity in Italy
  61. 61. Health in Italy: obesity Italy Vs. fattest nations in the worldItaly Vs. fattest nations in the world 0 20 40 60 80 100 % overweight 44 68 69 74 90 Italy Greece Egypt USA Tonga, Samoa 2007 estimates
  62. 62. Obesity in Europe 2007
  63. 63. EU adults smoke and obesity 2009
  64. 64. Obesity: latest data and trends  In Italy obesity and overweight haveIn Italy obesity and overweight have increased with a tendency to stabilizeincreased with a tendency to stabilize since 2005 (ISTAT data)since 2005 (ISTAT data)  overweight prevalence about 35%overweight prevalence about 35%  obesity prevalence about 10%obesity prevalence about 10%  obesity prevalence projected in 2025obesity prevalence projected in 2025 14%14% ((Società Italiana dell’Obesità (SIO) data)Società Italiana dell’Obesità (SIO) data)  These figures are much less dramaticThese figures are much less dramatic than in USA. In 2005 60.5%than in USA. In 2005 60.5% ofof American adults were overweightAmerican adults were overweight,, 23.9% obese, and23.9% obese, and 3.0% morbidly obese3.0% morbidly obese..
  65. 65. Obesity prevalence in adults 2009
  66. 66. Obesity prevalence in adults 2009
  67. 67. Energy need in Italy 1961-2001
  68. 68. Obesity in Italy: children  In 2000:In 2000:  25% of children obese or overweight25% of children obese or overweight  2009 survey on 8-year old children (Okkio2009 survey on 8-year old children (Okkio salute):salute):  11.1% obese11.1% obese  22.9% overweight22.9% overweight  Geography: combined prevalenceGeography: combined prevalence in Campania 49%in Campania 49% in Valle d’Aosta 23%in Valle d’Aosta 23%
  69. 69. Obesity in Italy: children
  70. 70. Obesity in Italy: children  Italian vs. Danish children age 3-6 yearsItalian vs. Danish children age 3-6 years  In kindergarten 20% of Italian children areIn kindergarten 20% of Italian children are overweight or obeseoverweight or obese  Lower vegetables consumption (27,5% raw, 40%Lower vegetables consumption (27,5% raw, 40% cooked) vs. 65%cooked) vs. 65%  50% never play outside (vs. 1%)50% never play outside (vs. 1%)  Only 20% practice sports (vs. 50%)Only 20% practice sports (vs. 50%)  13.2% watch TV for > 2 hours (vs.3%)13.2% watch TV for > 2 hours (vs.3%)  on weekends 25% vs. 22.7%on weekends 25% vs. 22.7% Periscope (Pilot European regional interventions for smart childhood obesity prevention in early age) 2009
  71. 71. Obesity and Diabetes in children ITALY USA IGT 11% 23% IFG 1% DMT2 0.5% 2.5% Metabolic syndrome 22% 45% Bambin Gesu Hospital, Rome 2007
  72. 72. Sedentary lifestyle in Europe
  73. 73. Obesity and cycling in Europe
  74. 74. Sedentary lifestyle in Italy  Only 20% regularly practice sportsOnly 20% regularly practice sports  60-65% of the Italian population is sedentary -60-65% of the Italian population is sedentary - no sports or less than one hour a weekno sports or less than one hour a week  Progressive decrease of sports activity with ageProgressive decrease of sports activity with age  50% of Italians practice sports till age 14, 35%50% of Italians practice sports till age 14, 35% at 20-24, 25% at 25-34 yearsat 20-24, 25% at 25-34 years
  75. 75. Italian TV and obesity  In early afternoon, soap opera time forIn early afternoon, soap opera time for housewives, there are more commercials onhousewives, there are more commercials on  sweet drinks, snacks, cheeses andsweet drinks, snacks, cheeses and merendinemerendine ANDAND  slimming and diet productsslimming and diet products (SIAN survey 2001, Collegno)(SIAN survey 2001, Collegno)
  76. 76. Food advertising in Italian TV 0 10 20 30 40 50 60 70 80 90 USA UK Italy food ads junk food Food ads as % of ads; junk as % of food Caroli 2001
  77. 77. Obesity in Italy - dieting Source: Istututo Auxologico Survey 1999 overweight obese general population prevalence 13 18 11 0 2 4 6 8 10 12 14 16 18
  78. 78. Methods to loose weight in Italy D’Amicis, Physical Activity Survey 1998 0 20 40 60 80 Diet gym diet & gym drugs other nothing women men
  79. 79. What Italians do about obesity?  Nothing: 30%Nothing: 30%  Self-dieting: 14%Self-dieting: 14%  Consult nutritionist or physician at leastConsult nutritionist or physician at least once: 56%once: 56%  60% don’t know the Mediterranean diet60% don’t know the Mediterranean diet characteristicscharacteristics 2009 ISTAT survey
  80. 80. Obesity day  Every year since 2001Every year since 2001  More than 150 centersMore than 150 centers nationwidenationwide  Practical info on obesityPractical info on obesity to the general publicto the general public  Promotion of obesityPromotion of obesity clinics in public hospitalsclinics in public hospitals
  81. 81.  Mediterranean diet: tradition and healthMediterranean diet: tradition and health  Carbohydrates: the winners in ItalyCarbohydrates: the winners in Italy  Obesity: an ongoing battleObesity: an ongoing battle Obesity: the Italian weaponsObesity: the Italian weapons
  82. 82. Diet therapy in Italy
  83. 83. Diet therapy debate in Italy  biologists can only suggest dietarybiologists can only suggest dietary guidelines to improve health but cannotguidelines to improve health but cannot prescribe a therapeutic diet which shouldprescribe a therapeutic diet which should exclusively given by physicians (Italianexclusively given by physicians (Italian Supreme Court 2011)Supreme Court 2011)
  84. 84. History of popular diets Dissociated (HayDissociated (Hay 1930)1930) Very popular in Italy - separation betweenVery popular in Italy - separation between proteins and carbohydratesproteins and carbohydrates Weight WatchersWeight Watchers (J. Nidetch 1960)(J. Nidetch 1960) In Italy since 1973. Italian version: DietaIn Italy since 1973. Italian version: Dieta punti (Razzoli) very popular in the pastpunti (Razzoli) very popular in the past Atkins (1972)Atkins (1972) ScarsdaleScarsdale In Italy brief popularity of version based onIn Italy brief popularity of version based on high protein bread (pane di Rivalta)high protein bread (pane di Rivalta) Pritikin (1975)Pritikin (1975) Ornish (1990)Ornish (1990) Recently popular in the hard versionRecently popular in the hard version (minestrone)(minestrone) Beverly HillsBeverly Hills (Mazel, 1980)(Mazel, 1980) manymany Herbalife (1980)Herbalife (1980) Italian version - multilevel marketingItalian version - multilevel marketing
  85. 85. History of popular diets MediterraneanMediterranean (1990)(1990) Often prescribed by nutritionistsOften prescribed by nutritionists MontignacMontignac Italian version – low Glycemic index dietItalian version – low Glycemic index diet Zona (Sears, 1995)Zona (Sears, 1995) Italian versionsItalian versions DukanDukan Italian version now popular – low fat, veryItalian version now popular – low fat, very high proteins – no scientific data, “one ofhigh proteins – no scientific data, “one of the worst diets in 2011 (Brit Diet Assoc)the worst diets in 2011 (Brit Diet Assoc)
  86. 86. Zone diet vs. Mediterranean Diet Barry Sears vs Eugenio Del Toma  Eugenio Del Toma:Eugenio Del Toma:  rules are complicated and difficult to followrules are complicated and difficult to follow on a long term periodon a long term period  In human nutrition, psychological aspects areIn human nutrition, psychological aspects are essentialsessentials  We prefer tastes, smells and situationsWe prefer tastes, smells and situations associated with past happy memoriesassociated with past happy memories  The best prevention of obesity is to eat withoutThe best prevention of obesity is to eat without disrupting our emotionsdisrupting our emotions
  87. 87. Zone diet vs. Mediterranean Diet  Typical Mediterranean dietTypical Mediterranean diet  Proteins 15% fats 25% carbsProteins 15% fats 25% carbs 60%60%  Corrected Mediterranen dietCorrected Mediterranen diet  Proteins 20% fats 25% carbsProteins 20% fats 25% carbs 55%55%  Proteins =Proteins = white meats, fish,white meats, fish, legumes, fresh cheeseslegumes, fresh cheeses  fats =fats = olive oilolive oil  carbs =carbs = fruits and vegetables,fruits and vegetables, bread, pasta, ricebread, pasta, rice
  88. 88. Zone diet vs. Mediterranean Diet  Typical Zone dietTypical Zone diet  Proteins 30% fats 30% carbs 40%Proteins 30% fats 30% carbs 40%  Carbs: relatively more fruits andCarbs: relatively more fruits and vegetables, much less starches, barley, oatvegetables, much less starches, barley, oat  Fats: olive oil, more Omega-3Fats: olive oil, more Omega-3  ““When compared to all of the popular diets, theWhen compared to all of the popular diets, the Mediterranean diet is the most similar to the Zone inMediterranean diet is the most similar to the Zone in terms of balance and moderation coupled with commonterms of balance and moderation coupled with common sense.You should consider the Mediterranean diet as asense.You should consider the Mediterranean diet as a less sophisticated version of the Zone. “less sophisticated version of the Zone. “  (from www.drsears.com(from www.drsears.com))
  89. 89. Medit vs Zone vs Low-fat diets
  90. 90. Mediterranean diet and diabetes  Newly diagnosed diabetics who were overweightNewly diagnosed diabetics who were overweight better managed their disease by eating abetter managed their disease by eating a Mediterranean diet rich in fish, fruits andMediterranean diet rich in fish, fruits and vegetables instead of one low in fat (AHA diet)vegetables instead of one low in fat (AHA diet)  >200 patients followed for 4 years>200 patients followed for 4 years  BMI – 1.2 vs 0.9BMI – 1.2 vs 0.9  Risk of need for medications decreased by 32%Risk of need for medications decreased by 32% Annals Int Med Sept 2009
  91. 91. Lemme Diet  Recent popular commercial dietRecent popular commercial diet  Combination of dissociated low carbCombination of dissociated low carb dietsdiets  Exclusions: salt, sugar, sweeteners,Exclusions: salt, sugar, sweeteners, bread, milk, dairybread, milk, dairy  Meat and pasta cannot be combinedMeat and pasta cannot be combined
  92. 92. Lemme Diet: typical week  BF: turkey and coffeeL: beef and coffeeBF: turkey and coffeeL: beef and coffee D: swordfish and coffeeD: swordfish and coffee  BF: pasta oil redpepper and coffeeL:BF: pasta oil redpepper and coffeeL: chicken breast and coffeeD: sole andchicken breast and coffeeD: sole and coffeecoffee  BF: artichokes and coffeeL: beef andBF: artichokes and coffeeL: beef and coffeeD: fish and coffeecoffeeD: fish and coffee
  93. 93. The last craze: the TISANOREICA  Another variationAnother variation of ketogenic dietof ketogenic diet  Package withPackage with proteinprotein supplements andsupplements and herbal extractsherbal extracts  www.gianlucamech.itwww.gianlucamech.it
  94. 94. The last craze: the TISANOREICA diet  Very aggressive promotional tacticsVery aggressive promotional tactics  TV shows, Italian Parliament,TV shows, Italian Parliament, international meetingsinternational meetings
  95. 95. The last craze: the TISANOREICA diet  Followed by VIP: BerlusconiFollowed by VIP: Berlusconi
  96. 96. The last craze: the TISANOREICA diet  Followed by VIP: WittstockFollowed by VIP: Wittstock
  97. 97. Dimagenina  Intragastric BulkingIntragastric Bulking Agent – non-Agent – non- prescriptionprescription  2-3 capsules before2-3 capsules before meals with watermeals with water  Rapid volume increaseRapid volume increase  Degradation in 1 hourDegradation in 1 hour  Often cramps and painOften cramps and pain
  98. 98. Enteral chetogenic nutrition “NEC”  Very recent and commerciallyVery recent and commercially successful modality offered in a somesuccessful modality offered in a some Italian centersItalian centers  Nasogastric tube feeding of proteinsNasogastric tube feeding of proteins and electrolytes (<300 cal/day)and electrolytes (<300 cal/day)  2 mm NG tube connected to a pump2 mm NG tube connected to a pump  2 L of water mixed with a aminoacid2 L of water mixed with a aminoacid concentrate 35-40 g at 85 ml/hrconcentrate 35-40 g at 85 ml/hr
  99. 99. Enteral chetogenic nutrition “NEC”  In addition to enteralIn addition to enteral feeding:feeding:  Proton pumpProton pump inhibitorsinhibitors  LaxativesLaxatives  VitaminsVitamins  mineralsminerals
  100. 100. NEC protocol  Cycles of 10 days withCycles of 10 days with 3-week intervals3-week intervals  Claimed weight lossClaimed weight loss  9-13% in the first9-13% in the first cyclecycle  7- 10% in the7- 10% in the second cyclesecond cycle
  101. 101. Position statement 2011 •NEC is not a treatment for obesity •It is different from PSMF and EN •Should be called “fasting with low protein intake” •There are no EBM data and no publications •Effectiveness, role and risk are still to be defined
  102. 102. Bariatric surgery in Italy
  103. 103. Bariatric procedures
  104. 104. Bariatric surgery vs diet: SOS 2010
  105. 105. Number of bariatric procedures : 18,363Number of bariatric procedures : 18,363 Number of centers: 122Number of centers: 122 SICOB Registry – June 2011
  106. 106. SICOB Registry – 2011 types of procedures
  107. 107. SICOB Registry – 2011 mortality
  108. 108.  Purely restrictivePurely restrictive  Endoscopic placement andEndoscopic placement and removal with sedationremoval with sedation  Temporary measure limitedTemporary measure limited to six monthsto six months  Not yet FDA-approved inNot yet FDA-approved in USAUSA 500-600 ml saline with methylene blue Intragastric balloonIntragastric balloon
  109. 109. To collect italian experience on BIB 18 centers18 centers patients n. 3824patients n. 3824 (may 2000 – july 2007) G.I.L.B
  110. 110. 30 35 40 45 0 1 2 3 4 5 6 RESULTSRESULTS ( n = 3824)( n = 3824) 6 months BMI: 36.96 months BMI: 36.9±±6.4 (range:6.4 (range:27-50 Kg/m27-50 Kg/m22 )) BMI Months 44.244.2 36.936.9 - 7.3- 7.3 Italian experienceItalian experience (G.I.L.B)(G.I.L.B)
  111. 111. Gastric occlusion: 5 (0.24%) BIB early rupture: 9 (0.4%) *Esophagitis: (EGDS diagnosis): 3 (0.15%) Gastric ulcer: 1 (0.04%) Gastric acute dilation 2 (0.1%) POST-PLACEMENT 22/ 2009 (1.1%) COMPLICATIONS:
  112. 112. (weight loss < 10 % of initial weight) FAILURES = 12.4%FAILURES = 12.4% (sweet eaters, bulimic, grazing pts.) Italian experienceItalian experience (G.I.L.B)(G.I.L.B) GILBGILB
  113. 113. MAJOR COMPLICATIONSMAJOR COMPLICATIONS Gastric OcclusionGastric Occlusion 19 (0.49%)(0.49%) Gastric PerforationGastric Perforation 5 (0.13%) ** Gastric UlcerGastric Ulcer 10 (0.26%) Bowel OcclusionBowel Occlusion 3 (0.07%) 3737 / 3824 (0.96%)/ 3824 (0.96%) (Prior Gynecological surgery)(Prior Gynecological surgery)
  114. 114. M/F 301/652 Age 37.5 (19-69) years BMI 41.2 (30.7-56.5) kg/m2 %EW 61.3 % (34-117.6) March 1998 – June 2009 1,010 placements BIB - Policlinico Umberto I Dr. Genco’s series
  115. 115. Female Age < 35 years BMI < 40 Predictive Factors P < 0.05 EWL%:EWL%: nsns At removalAt removal Results LONG TERM FOLLOW-UP (5 YEARS)LONG TERM FOLLOW-UP (5 YEARS) AFTER BIB TREATMENT IN OBESE PATIENTSAFTER BIB TREATMENT IN OBESE PATIENTS
  116. 116. 98%98% 51 %51 % 75 %75 % % Pts Post-placement symptoms 65 %65 % (1-2 days) (1 day) (1-2 days) (2-3 days) Genco series March 1998 – March 2007 700 BIB placements
  117. 117. Imaz I et al meta-analysis Obes Surg 18:841, 2008 1.8% 0.9% 0.6% 0.3% 0.2% 0.2% 0.1% 0.1% 0.1%
  118. 118. Imaz I et al meta-analysis Obes Surg 18:841, 2008 2 patients
  119. 119. parameter N of patients result Weight loss vs placebo BMI 39 – 3.2 Weight loss vs placebo Kg 39 - 6.7 Weight loss BMI 3,200 - 5.7 Weight loss Kg 3,608 - 14.7 IGB – Efficacy/effectiveness at 6 months Imaz I et al meta-analysis Obes Surg 18:841, 2008
  120. 120. Meta-analysis conclusions • Weight loss 14.7 Kg, less than 30-40 Kg of bariatric surgery • Weight loss 12.2% of initial weight, more than 10% considered beneficial for comorbidities • Efficacy (vs placebo) – 6.7 Kg, better than sibutramine (4.4 kg) and orlistat (2.9 Kg) • Low rate of complications Imaz I et al meta-analysis Obes Surg 18:841, 2008
  121. 121. Evidence based review of BIB for weight loss • Safe in selected patients • Effective in two thirds of the patients • Mean Weight loss 17.8 Kg • Improvement of comorbidities • No data of predictive factors and long term results Dumonceau EBM review Obes Surg 18:1611, 2008
  122. 122. 2-year weight loss: BIB vs diet Genco A et al Obesity Surgery 2008
  123. 123. 30 32 34 36 38 40 42 44 0 6 12 Group A (BIB+Diet) Group B (BIB+BIB) Sequential BIB insertion BIB placement BMI BIB removal p = 0,04 BMI BIBBIB DIETDIET
  124. 124. ten commandaments on obesity follow a balanced and varied diet; have an active lifestyle avoid "do-it-yourself" diets alternating restrictions and binges may cause weight gain do not follow friends' diets, they may not be appropriate for you remember: often mass-media promotes diets have no scientific value do not fast or follow excessivey restrictive diets with exclusion of entire classes of nutrients assess your health conditions before starting a diet ask your physician or nutritionist before taking supplements invasive weight-loss therapies should be prescribed only by physicians bariatric surgery should be performed only in morbidly obese individuals and requires long-term clinical and nutritional followups follow a balanced and varied diet; have an active lifestyle avoid "do-it-yourself" diets alternating restrictions and binges may cause weight gain do not follow friends' diets, they may not be appropriate for you remember: often mass-media promotes diets have no scientific value do not fast or follow excessivey restrictive diets with exclusion of entire classes of nutrients assess your health conditions before starting a diet ask your physician or nutritionist before taking supplements invasive weight-loss therapies should be prescribed only by physicians bariatric surgery should be performed only in morbidly obese individuals and requires long-term clinical and nutritional followups
  125. 125. All the world loves Italy because it is old but still glamorous. Because it eats and drinks well but is rarely fat or drunk.  Ian Fisheran Fisher in thein the NewNew York Times,York Times, DecemberDecember 13, 200713, 2007
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