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Beyond dietary therapy: addressing weight stigma awareness in medical students
(Springer Science and Business Media LLC, 2025-08-22)
Giuseppe Annunziata
;
Giordano Bruno Zonzini
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Evelyn Frias-Toral
;
Raynier Zambrano-Villacres
;
Alexander Bertuccioli
Background The growing prevalence of obesity worldwide has drawn increased attention to the issue of weight stigma. Discriminatory attitudes related to body weight are evident across various settings, including those that should ideally offer support to individuals with obesity, such as schools and sports facilities. This research aimed to examine weight-related stigma among university students enrolled in healthcare-related academic programs. Methods To measure weight stigma, researchers administered the Italian version of the Attitude Toward Obese Persons (I-ATOP) questionnaire to 201 students from the University of Urbino (Italy) and the University of Malaga (Spain). The analysis explored variations in stigma levels based on gender, BMI classification, nationality, Italian regional location, level of academic education, medical history, and lifestyle factors. Results The participant pool was predominantly female (58.2%) and Spanish (66.7%), with an average age of 22.86 ± 3.08 years and a mean BMI of 22.80 ± 3.25 kg/m, placing most respondents in the normal weight range. Nearly half (47.8%) demonstrated a low degree of stigmatising attitudes. Within the sample, significantly lower stigma levels were reported among female and Spanish students (> = 0.001 and > = 0.011, respectively), as well as among those without a history of eating disorders (> = 0.017) and those who engaged in physical activity (> = 0.029). Additionally, stigma showed a notable decline in relation to higher educational attainment ConclusionThis pilot study reveals the presence of weight stigma even within healthcare education settings, where future health professionals are being trained. These findings underscore the urgent need for comprehensive educational strategies aimed at fostering inclusive and nonjudgmental attitudes toward individuals with obesity. Importantly, the assessment and management of weight stigma should extend beyond nutritional therapy alone, recognizing its psychological, social, and structural dimensions. Integrating this broader perspective into healthcare curricula is thus essential to improve the quality of care for individuals living with one of the most prevalent and complex chronic conditions.
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Differential impact of coffee quantity and sweetening on body composition parameters and inflammation
(Frontiers Media SA, 2025-09-17)
Giuseppe Annunziata
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Evelyn Frias-Toral
;
Francesco Campa
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Maria Antonieta Touriz Bonifaz
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Ludovica Verde
Background: Coffee is the most consumed and popular beverage worldwide. The health benefits of its regular, moderate consumption are well known, and include antioxidant and anti-inflammatory effects, as well as metabolic effects, reducing the risk of obesity and related diseases. The available literature, however, provides no information about the effect of coffee consumption on body composition (BC) and inflammation. The present cross-sectional observational study aims to investigate the effect of coffee consumption on BC and inflammation-related parameters, as well as the possible impact of adding sugar and the frequency of consumption. Coffee consumption habits, preference for adding sugar and frequency of daily consumption were assessed in 2,556 adults (1,080 men and 1,476 women). BC was assessed using Bioelectrical Impedance Analysis (BIA), whilst high-sensitivity C-reactive protein (hs-CRP) levels were monitored for inflammatory status. Results: A total of 1,855 subjects (680 men and 1,175 women) were included in the statistical analysis. Compared to non-consumers, coffee consumers showed lower body mass index (BMI), waist girth (WG), and hs-CRP levels, and higher skeletal muscle mass (SMM), appendicular SMM (ASMM), phase angle (PhA), and standardised PhA (SPA) (p< 0.001 for all). The same trend was observed for unsweetened coffee consumers compared to subjects consuming sweetened coffee. With increasing coffee consumption, BMI, WG, and hs-CRP generally decreased, whilst SMM and ASMM showed a bell-shaped trend with peak values in those consuming 2–3 cups per day. Similarly, PhA and SPA values were highest among moderate coffee consumers. Conclusion: These findings suggest that moderate coffee consumption, particularly unsweetened coffee, is associated with more favourable body composition and inflammatory profiles. Given the observational design, causality cannot be established. Nevertheless, the results may inform dietary guidance aimed at supporting muscle maintenance and mitigating obesity-related metabolic risk.
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Unlocking the potential: very-low-energy ketogenic therapy in obesity-related disorders
(Informa UK Limited, 2025-01-16)
Daniel Simancas-Racines
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Claudia Reytor-González
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ZAMBRANO ESPINOSA, ANA KARINA
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Giuseppe Annunziata
;
Angelo Michele Carella
The Very Low-Energy Ketogenic Therapy (VLEKT) is a structured, multi-phase dietary regimen characterized by a carbohydrate intake of less than 50 g/day and a daily caloric intake of fewer than 800 kcal, which induces ketosis and facilitates significant weight loss. Evidence suggests that this nutritional therapy can improve glycemic control, lipid profiles, and blood pressure, making it a promising option for managing type 2 diabetes (T2D) and reducing cardiovascular risk. These benefits are achieved through reductions in triglycerides and low-density lipoprotein cholesterol (LDL-c), alongside increases in high-density lipoprotein cholesterol (HDL-c). However, the effects of the VLEKT on lipid metabolism remain controversial. The review emphasizes the urgent need for further research to validate the long-term safety and efficacy of the VLEKT. It also highlights the critical role of personalized dietary plans, supervised by healthcare professionals, to optimize health outcomes and address individual patient needs.
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Weight loss, changes in body composition and inflammatory status after a very low-energy ketogenic therapy (VLEKT): does gender matter?
(Springer Science and Business Media LLC, 2024-10-19)
Giovanna Muscogiuri
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Ludovica Verde
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Evelyn Frias-Toral
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REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Giuseppe Annunziata
Background: Considering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT). Methods: Participants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index—BMI –, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention. Results: At baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = − 11.63 ± 1.76 vs − 8.95 ± 1.65 kg, p < 0.001), fat mass (Δ% = − 30.84 ± 12.00 vs -21.36 ± 4.65 kg, p = 0.002), and hs-CRP levels (Δ% = − 41.42 ± 21.35 vs − 22.38 ± 17.30 mg/L, p = 0.003). Of interest, in males phase angle values are statistically improved compared to female (Δ% = 17.11 ± 9.00 vs 7.05 ± 3.30°, p < 0.001). Conclusion: These findings underscore the importance of considering sex-specific responses in personalized obesity treatment strategies, particularly dietary interventions like VLEKTs. Graphical Abstract: (Figure presented.)
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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
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Antonio Paoli
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Evelyn Frias-Toral
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Stellario Marra
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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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Nutritional Strategies for Battling Obesity-Linked Liver Disease: the Role of Medical Nutritional Therapy in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Management
(Springer Science and Business Media LLC, 2025-01-11)
SIMANCAS RACINES, DANIEL ALEJANDRO
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Giuseppe Annunziata
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Ludovica Verde
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Federica Fascì-Spurio
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REYTOR GONZÁLEZ, CLAUDIA MARÍA
Purpose of Review: This narrative review explores the role of Medical Nutritional Therapy (MNT) in managing Metabolic-Associated Steatotic Liver Disease (MASLD), previously known as nonalcoholic fatty liver disease. It aims to examine the effectiveness of specific nutritional strategies in preventing and treating this obesity-linked liver disease. Recent Findings: Emerging evidence underscores the benefits of the Mediterranean diet, low-carbohydrate diets, and intermittent fasting in reducing liver fat, improving insulin sensitivity, and mitigating inflammation. Supplementing with vitamin E, omega-3 fatty acids, and silymarin can potentially reduce liver fibrosis and promote liver health. Summary: MNT is a key intervention for MASLD management, emphasizing dietary patterns, caloric restriction, and nutraceutical supplementation. Integrating these strategies with lifestyle modifications, including regular physical activity, offers a comprehensive approach to improving metabolic and liver outcomes in patients with MASLD. Further research is needed to refine and personalize these therapeutic interventions.

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