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    Actual macronutrient composition of the Mediterranean diet and its association with adiposity and inflammation: a cross-sectional real-life study
    (Springer Science and Business Media LLC, 2025-11-11)
    Claudia Vetrani
    ;
    Evelyn Frias-Toral
    ;
    Annamaria Di Martino
    ;
    Federica Cantelli
    ;
    Chiara Graziadio
    Background and objectives The Mediterranean diet (MD) relies on a specific food consumption pattern that has been given pleiotropic effects on human health. However, even foods typically considered beneficial within the MD framework may vary in macronutrient composition, potentially leading to imbalanced or unhealthy dietary profiles despite overall adherence. To date, no study has evaluated the total energy intake and percentage macronutrient composition in a cohort of adult individuals stratified by their adherence to MD. We aimed to investigate the total energy intake and macronutrient composition among individuals stratified by adherence to MD, and its association with indices of adiposity and inflammation. Methods A cross-sectional study was conducted in 1342 volunteers. Participants underwent clinical examination (anthropometry, body composition, and high-sensitivity C-reactive protein assessment), and nutritional data collection, including adherence to MD (PREDIMED questionnaire) and habitual diet composition (7-day food records). The associations between PREDIMED score, macronutrient composition, and clinical outcomes were explored by Pearson’s correlation. Linear regression analysis was used to assess the macronutrient that best predicted adherence to MD. Results Participants with high adherence to MD (H-MD) presented lower intake of carbohydrate, while higher protein and fat amounts than individuals with medium (M-HD) or low (L-MD) adherence to MD. The H-MD group showed lower adiposity (body mass index, waist circumference, and fat mass) and C-reactive protein concentrations than individuals in the M-MD and L-MD groups p < 0.001 for all comparisons). Linear regression analysis showed low carbohydrate intake as the best predictor of high PREDIMED score (β: -0.875; p < 0.001). Conclusion H-MD is characterised by lower carbohydrate, higher protein and fat intakes than those usually reported in nutritional recommendations. This profile was significantly associated with lower adiposity and inflammation. A low carbohydrate amount was the best predictor of H-MD, suggesting that dietary carbohydrate should be on the lower side of the recommended range.
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    Item type:Publication,
    Use of phase angle as an indicator of overtraining in sport and physical training
    (Springer Science and Business Media LLC, 2024-11-29)
    Giuseppe Annunziata
    ;
    Antonio Paoli
    ;
    Evelyn Frias-Toral
    ;
    Stellario Marra
    ;
    Francesco Campa
    The use of bioelectrical impedance analysis (BIA) is now well established in healthcare as an essential support tool for patient management in various clinical settings. Its use in sports is rapidly expanding due to the valuable insights it offers, helping to better structure athletes’ diets and training programs, thereby optimizing their performance. In the context of sport, however, there is a consensus regarding the importance of proper interpretation of BIA-derived data, which cannot be limited to mere estimation of body composition. In this sense, therefore, the evaluation and interpretation of raw bioelectrical parameters, including resistance, reactance, and phase angle (PhA) is of relevant importance. The assessment of PhA is particularly significant in the context of sports, as it is closely linked to key factors such as muscle mass, strength, and overall muscle quality. However, the existing relationship between PhA and systemic, and loco-regional inflammation, which, in a broader sense, is the rationale behind its use for assessing and monitoring localised muscle damage. Thus, the importance of PhA monitoring during training becomes evident, as it plays a crucial role in assessing and potentially identifying functional impairments, such as overtraining syndrome, as well as muscle injury and related changes in fluid distribution, at an early stage. The aim of this review is to provide the scientific basis necessary to consider the use of whole-body PhA as an indicator of overtraining.
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    Very low-calorie ketogenic diet (VLCKD): a therapeutic nutritional tool for acne?
    (Springer Science and Business Media LLC, 2024-03-31)
    Ludovica Verde
    ;
    Evelyn Frias-Toral
    ;
    Sara Cacciapuoti
    ;
    ;
    Matteo Megna
    Background: Acne, a chronic inflammatory disease impacting the pilosebaceous unit, is influenced significantly by inflammation and oxidative stress, and is commonly associated with obesity. Similarly, obesity is also associated with increased inflammation and oxidation. The role of diet in acne remains inconclusive, but the very low-calorie ketogenic diet (VLCKD), known for weight loss and generating anti-inflammatory ketone bodies, presents promising potential. Despite this, the effects of VLCKD on acne remain underexplored. This study aimed to investigate the efficacy of a 45-day active phase of VLCKD in reducing the clinical severity of acne in young women with treatment-naïve moderate acne and grade I obesity. Methods: Thirty-one women with treatment-naïve moderate acne, grade I obesity (BMI 30.03–34.65 kg/m2), aged 18–30 years, meeting inclusion/exclusion criteria, and consenting to adhere to VLCKD were recruited. Baseline and post-intervention assessments included anthropometric measurements, body composition, phase angle (PhA), trimethylamine N-oxide (TMAO) levels, and reactive oxygen metabolite derivatives (dROMs) as markers of inflammation, dysbiosis, and oxidative stress, respectively. A comprehensive dermatological examination, incorporating the Global Acne Grading System (GAGS) and the Dermatology Life Quality Index (DLQI), was conducted for all women. Results: VLCKD resulted in general improvements in anthropometric and body composition parameters. Significantly, there were significant reductions in both the GAGS score (Δ%: − 31.46 ± 9.53, p < 0.001) and the DLQI score (Δ%: − 45.44 ± 24.02, p < 0.001) after the intervention. These improvements coincided with significant decreases in TMAO (p < 0.001) and dROMs (p < 0.001) levels and a significant increase in PhA (Δ%: + 8.60 ± 7.40, p < 0.001). Changes in the GAGS score positively correlated with changes in dROMs (p < 0.001) and negatively with PhA (p < 0.001) even after adjusting for Δ% FM. Changes in the DLQI score positively correlated with changes in dROMs (p < 0.001) and negatively with PhA (p < 0.001) even after adjustment for Δ% FM. Conclusion: Given the side effects of drugs used for acne, there is an increasing need for safe, tolerable, and low-cost treatments that can be used for acne disease. The 45-day active phase of VLCKD demonstrated notable improvements in acne severity, and these improvements seemed to be attributable to the known antioxidant and anti-inflammatory effects of VLCKD.