Obesity: Valenti L

Cretikos MA, Valenti L, Britt HC, Baur LA. · NSW Public Health Officer Training Program, Centre for Epidemiology and Research, NSW Department of Health, NSW, Australia. · Med Care. · Pubmed #18953227 No free full text.

Abstract: BACKGROUND: Childhood obesity is rapidly increasing in prevalence worldwide, but healthcare capacity to address this problem seems limited. OBJECTIVE: The purpose of this study was to describe the prevalence and rate of management of childhood overweight and obesity in Australian general practice. SUBJECTS: A cross-sectional study consisting of 3978 general practitioners (GPs), randomly selected using Medicare Australia claims, who recorded 42,515 encounters with children age 2-17 including 12,925 sub-sampled encounters with self or carer-reported height and weight collected. MEASURES: Prevalence of overweight and obesity, rate of management of overweight and obesity, content of encounters in overweight and nonoverweight children, content of encounters in those managed for overweight and obesity, and management to prevalence ratio. RESULTS: A total of 29.6% of sub-sampled children were classified as overweight (18.3%) or obese (11.4%). GPs managed overweight and obesity during 215 encounters, or once per 200 encounters with children age 2-17 and once per 58 encounters with overweight or obese children. The content of encounters in overweight and non-overweight children did not differ. Children who were managed for overweight or obesity presented with these conditions as reasons for the encounter significantly more often [66.5 (95% confidence interval (CI): 59.7-73.3) vs. 1.2 (95% CI: 1.0-1.3)] and were managed for more problems, particularly depression [4.2 (95% CI: 1.5-6.9) vs. 0.8 (95% CI: 0.7-0.9)], than average per 100 encounters. Consultations for overweight or obesity were significantly longer than average [16.7 (95% CI: 14.7-18.7) vs. 12.4 (95% CI: 12.2-12.5) minutes]. CONCLUSIONS: Overweight and obesity are prevalent in children presenting to Australian general practice but GPs do not use most of the available opportunities to manage this problem.

Valenti L, Fracanzani AL, Dongiovanni P, Bugianesi E, Marchesini G, Manzini P, Vanni E, Fargion S. · Department of Internal Medicine, Universita' di Milano, Ospedale Policlinico Mangiagalli Regina Elena IRCCS, Milano, Italy. · Am J Gastroenterol. · Pubmed #17391316 No free full text.

Abstract: OBJECTIVES: Hyperferritinemia is frequently observed in nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome characterized by hepatic insulin resistance and considered high cardiovascular risk. Iron depletion by phlebotomy has been reported to decrease insulin resistance in NAFLD in small, uncontrolled studies. Aims of this study were to define the relationship between ferritin and iron stores in patients with NAFLD, the effect of iron depletion on insulin resistance, and whether basal ferritin levels influence treatment outcome. METHODS: Subjects were included if ferritin and/or ALT were persistently elevated after 4 months of standard therapy. Sixty-four phlebotomized subjects were matched 1:1 for age, sex, ferritin, obesity, and ALT levels with patients who underwent lifestyle modifications only. Insulin resistance was evaluated by insulin levels, determined by RIA and the HOMA-R index, at baseline and after 8 months. RESULTS: Baseline ferritin levels were associated with body iron stores (P<0.0001). Iron depletion produced a significantly larger decrease in insulin resistance (P=0.0016 for insulin, P=0.0042 for HOMA-R) compared with nutritional counseling alone, independent of changes in BMI, baseline HOMA-R, and the presence of the metabolic syndrome. Iron depletion was more effective in reducing HOMA-R in patients in the top two tertiles of ferritin concentrations (P<0.05 vs controls), and in carriers of the mutations in the HFE gene of hereditary hemochromatosis (P<0.05 vs noncarriers). CONCLUSIONS: Given that phlebotomy reduces insulin resistance, which is associated with liver tissue damage, future studies should evaluate the effect of iron depletion on liver histology and cardiovascular end points.

Valenti L, Dongiovanni P, Piperno A, Fracanzani AL, Maggioni M, Rametta R, Loria P, Casiraghi MA, Suigo E, Ceriani R, Remondini E, Trombini P, Fargion S. · Department of Internal Medicine, Ospedale Policlinico, Mangiagalli e Regina Elena Fondazione IRCCS, Universita' di Milano, Italy. · Hepatology. · Pubmed #17006922 No free full text.

Abstract: Hyperferritinemia, a common feature of nonalcoholic fatty liver disease (NAFLD), has been associated with steatohepatitis and fibrosis. Heterozygosity for alpha 1-antitrypsin (AAT) mutations is a cofactor of liver damage, and AAT influences inflammation and iron metabolism. This study evaluated the prevalence of the common AAT PiS/PiZ mutants in 353 patients with NAFLD, 195 of whom had hyperferritinemia, versus 114 matched controls and their influence on iron metabolism and the severity of liver damage in the 212 patients submitted to biopsy. PiS and PiZ alleles were searched for by restriction analysis. Thirty-eight patients (10.8%) carried non-MM genotypes versus 4/114 (3.5%) controls (P = .02). Patients carrying AAT mutations had higher ferritin (573 [454-966] vs. 348 [201-648]; P = .001) with similar transferrin saturation. The difference was more evident in males (P < .0001) and significant in patients not carrying HFE genotypes associated with iron overload (P = .015). The prevalence of non-MM genotypes was higher in patients with hyperferritinemia than in those without (28/195, 14% vs. 10/158, 6%, P = .016), and AAT mutations were associated with higher prevalence of sinusoidal siderosis (17/27, 63% vs. 70/180, 39%; P = .02), and sinusoidal/total iron score (46.3 +/- 38% vs. 25.1 +/- 35%, P = .01). Although ferritin was independently associated with fibrosis (P = .047), AAT mutations favoring sinusoidal iron deposition did not affect liver damage. In conclusion, AAT mutations are associated with hyperferritinemia and sinusoidal iron accumulation, but not with more severe liver damage in NAFLD.

Valenti L, Charles J, Britt H. · AIHW Australian GP Statistics & Classification Centre, University of Sydney, New South Wales. · Aust Fam Physician. · Pubmed #16894426 links to  free full text

Abstract: The BEACH program, a continuous national study of general practice activity in Australia, gathers height and weight details of patients at 40% of recorded encounters, enabling their body mass index to be calculated. Details are self reported by the patients, or by their carer in the case of young children, and recorded by the general practitioner at the encounter. This synopsis provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.

Accili D, Valenti L. · No affiliation provided · Nat Med. · Pubmed #15516912 No free full text.

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