Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study

AIM: To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population. METHODS: The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss > 10% in the last threesix months. Values of Malnutrition Universal Screening Tool(MUST) > 2, NRS-2002 > 3, and Mini Nutritional Assessment(MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases. RESULTS: A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition(OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients. CONCLUSION: More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.

Inflammatory Bowel Diseases: What Do We Still Need to Investigate?

Inflammatory bowel disease (IBD) including Crohn (CD) and ulcerative colitis (UC), is intestinal disorders with an unknown specific etiology. Many factors are involved in the pathogenesis: genetic, environment, nutrition, immunity and intestinal dysbiosis. In the present work, we review the most important trigger mechanisms involved in IBD, with a particular regard to the role of microbiota and fecal mass transplantation as a new therapeutic approach, that even if it can be considered safe and effective, data are necessary regarding all procedures not yet standardized and timing of treatment.

Non-alcoholic fatty liver disease:Dietary and nutraceutical approaches

Non-alcoholic fatty liver disease(NAFLD),defined as the presence of fat accumulation in imaging or histology in more than 5%of hepatocytes and exclusion of other causes for secondary hepatic fat accumulation,is one of the major causes of chronic liver disease worldwide.Metabolic syndrome is associated with an increased risk of progression from NAFLD to non-alcoholic steatohepatitis(NASH),fibrosis,and forthcoming liver failure.Also,genetic predisposition contributes to the risk of NAFLD development.This review explores the role of diets and nutraceuticals in delaying the development and the evolution of NAFLD to chronic liver disease.The Mediterranean diet,high-protein diet,lowcarbohydrate/high-fat diet,high-carbohydrate/low-fat diet,and intermittent fasting are the dietary approaches investigated given the presence of relevant literature data.Moreover,this review focused on nutraceuticals with proven efficacy in ameliorating NAFLD and grouped them into four different categories:plant-based nutraceuticals(Ascophyllum nodosum and Fucus vesiculosus,Silymarin,Berberine,Curcumin,Resveratrol,Nigella sativa,Quercetin),vitamin-like substances(vitamin E,vitamin D,vitamin C,coenzyme Q10,inositol),fatty acids(omega-3),and microbiota-management tools(probiotics).