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Human nutrition encompasses an extremely broad range of medical, social, commercial, and ethical domains and thus represents a wide, interdisciplinary scientific and cultural discipline. The high prevalence of both disease-related malnutrition and overweight/obesity represents an important risk factor for disease burden and mortality worldwide. It is the opinion of Federation of the Italian Nutrition Societies (FeSIN) that these two sides of the same coin, with their sociocultural background, are related to a low "nutritional culture" secondary, at least in part, to an insufficient academic training for health-care professionals (HCPs). Therefore, FeSIN created a study group, composed of delegates of all the federated societies and representing the different HCPs involved in human nutrition, with the aim of identifying and defining the domains of human nutrition in the attempt to more clearly define the cultural identity of human nutrition in an academically and professionally oriented perspective and to report the conclusions in a position paper. Three main domains of human nutrition, namely, basic nutrition, applied nutrition, and clinical nutrition, were identified. FeSIN has examined the areas of knowledge pertinent to human nutrition. Thirty-two items were identified, attributed to one or more of the three domains and ranked considering their diverse importance for academic training in the different domains of human nutrition. Finally, the study group proposed the attribution of the different areas of knowledge to the degree courses where training in human nutrition is deemed necessary (e.g., schools of medicine, biology, nursing, etc.). It is conceivable that, in the near future, a better integration of the professionals involved in the field of human nutrition will eventually occur based on the progressive consolidation of knowledge, competence, and skills in the different areas and domains of this discipline.

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Western diet, high in protein-rich foods and poor in vegetables, is likely to be responsible for the development of a moderate acid excess leading to metabolism deregulation and the onset or worsening of chronic disturbances. Available findings seem to suggest that diets with high protein/vegetables ratio are likely to induce the development of calcium lithiasis, especially in predisposed subjects. Moreover, some evidence supports the hypothesis of bone metabolism worsening and enhanced bone loss following acid-genic diet consumption although available literature seems to lack direct and conclusive evidence demonstrating pathological bone loss. According to other evidences, diet-induced acidosis is likely to induce or accelerate muscle wasting or sarcopenia, especially among elderlies. Furthermore, recent epidemiological findings highlight a specific role of dietary acid load in glucose metabolism deregulation and insulin resistance. The aim of this review is to investigate the role of acid-genic diets in the development of the mentioned metabolic disorders focusing on the possible clinical improvements exerted by alkali supplementation.

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BACKGROUND: Long-chain polyunsaturated fatty acids (LC-PUFA), particularly docosahexaenoic acid (DHA) and arachidonic acid, are, respectively, n-3 and n-6 family members and play an important role in fetal and infant growth and development. Pregnancy and lactation impose special nutritional needs for the mother-fetus situation. Since the LC-PUFA required by the fetus is supplied by preferential placental transfer of preformed LC-PUFA rather than their precursor, it has been hypothesized that additional maternal supply of LC-PUFA, especially DHA, during pregnancy may improve maternal and infant outcomes. AIM: To summarize evidences of the effect of n-3 LC-PUFA intake during pregnancy and lactation on maternal and infant outcomes in order to offer a comprehensive view of this issue that should be useful for clinical practice. RESULTS: Maternal n-3 LC-PUFA supplementation may reduce risk for early preterm birth >34 weeks and seems very promising for primary allergy prevention during childhood. On the contrary, there are not sufficient data proving that the consumption of oils rich in n-3 LC-PUFA during pregnancy optimizes child's visual and neurodevelopment and reduces the risk for preeclampsia and perinatal depression; the implications of these findings remain to be elucidated. CONCLUSION: The implications of n-3 LC-PUFA supplementation on fetal development, maternal outcomes and later infant growth is worth being elucidated and is promising in its potential for a positive impact on fetal and maternal outcomes.

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BACKGROUND: Smoking is an important cause of morbidity and mortality worldwide. It is widely accepted as a major risk factor for metabolic and cardiovascular disease. Smoking reduces insulin sensitivity or induces insulin resistance and enhances cardiovascular risk factors such as elevated plasma triglycerides, decreases high-density lipoprotein cholesterol and causes hyperglycemia. Several studies show that smoking is associated with metabolic abnormalities and increases the risk of Metabolic Syndrome. The aim of this study was to estimate the prevalence of the metabolic syndrome in a group of light and heavy smokers, wishing to give up smoking. METHODS: In this cross-sectional study all the enrolled subjects voluntary joined the smoking cessation program held by the Respiratory Pathophysiology Unit of San Matteo Hospital, Pavia, Northern Italy.All the subjects enrolled were former smokers from at least 10 years and had no cancer or psychiatric disorders, nor history of diabetes or CVD or coronary artery disease and were not on any medication. RESULTS: The subjects smoke 32.3 ± 16.5 mean Pack Years. The prevalence of the metabolic syndrome is 52.1%: 57.3% and 44.9% for males and females respectively. Analysing the smoking habit influence on the IDF criteria for the metabolic syndrome diagnosis we found that all the variables show an increasing trend from light to heavy smokers, except for HDL cholesterol. A statistical significant correlation among Pack Years and waist circumference (R = 0.48, p < 0.0001), Systolic Blood Pressure (R = 0.18, p < 0.05), fasting plasma glucose (R = 0.19, p < 0.005) and HDL cholesterol (R = -0.26, p = 0.0005) has been observed. CONCLUSIONS: Currently smoking subjects are at high risk of developing the metabolic syndrome.Therapeutic lifestyle changes, including smoking cessation are a desirable Public health goal and should successfully be implemented in clinical practice at any age.

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OBJECTIVE: To evaluate the possible correlation between underreporting and anthropometric, psychological and socio-anagraphic characteristics in obese inpatients. DESIGN: Perspective longitudinal study. SUBJECTS: Forty-two obese inpatients enrolled to a multidisciplinary 3-week weight loss program in a psycho-nutritional rehabilitative structure located in Salice Terme, Northern Italy. They underwent anthropometric, dietary, clinical, and psycho diagnostic evaluation. RESULTS: Forty-two subjects were included in the study of which 29 (70 %) were females and 13 were males. Mean BMI and mean waist circumference were 42.7 ± 9.5 kg/m(2) and 125 ± 18 cm, respectively. The mean weight loss of 4.2 ± 2.2 kg in the whole sample was significantly greater in males compared to females. The waist circumference fell in equal measure in both of the sexes. Thirty patients were classified as underreporters according to Goldberg, two-thirds of which were females. In the course of the three recovery weeks, a third of the 30 subjects identified as underreporters at the beginning continued to underreport energy intake. CONCLUSION: In our study, the prevalence of underreporting was equal to over 70 % of the original sample. There was no significant difference between the weight losses achieved by the underreporter and non-underreporter groups. All the underreporters initially became partly non-underreporters during treatment. Those who gave up the practice of underreporting were patients who had a more elevated BMI, who were more susceptible to binge eating behavior and who experienced a strong uneasiness both physically and psychologically. They also had a strongly impaired quality of life.

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OBJECTIVE: The study aimed to test the reliability of a nutrition questionnaire and to assess potential associations between nutrition knowledge, food consumption and lifestyle behaviours, controlling for sociodemographic factors. DESIGN: Cross-sectional survey. SETTING: Comprehensive school in the municipality of Butera, a rural area of Sicily, South Italy. SUBJECTS: The survey was conducted between March and May 2010 on 445 students (4-16 years). RESULTS: All constructs of the questionnaire had statistically significant Cronbach's a and Pearson's correlation coefficients, showing good internal consistency and temporal stability. After controlling for covariates, nutrition knowledge was positively associated with pasta/rice, fish, vegetable and fruit intakes, and negatively with sweets, snacks, fried foods and sugary drinks consumption. Moreover, students whose parents were in the highest educational and occupational categories reported eating significantly more fruits and vegetables and less meat, sweets, snacks, fried foods and sugary drinks. Students with higher nutrition knowledge scores were less likely to have two or more snacks daily and to spend more than 3 h in sedentary activities daily (OR=0.89, 95% CI 0.83, 0.97 and OR=0.92, 95% CI 0.86, 0.99, respectively). High parental education was associated with less frequent snacking and more frequent weekly physical activity, compared with lower categories, whereas high parental occupational category was associated with daily breakfast. CONCLUSIONS: Improving nutrition knowledge in children and young adolescents may translate into educating them in good dietary habits. Moreover, nutrition intervention programmes should also involve parents to improve dietary quality and nutritional habits of the entire family.

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OBJECTIVE: A few studies link out-of-home eating to higher energy consumption, overweight and obesity in both adults and children. The present study was undertaken to investigate the nutritional value of meals available in a university cafeteria, in order to develop a target nutritional tool to help consumers make a more conscious nutritional choice. DESIGN: A cross-sectional study. SETTING: In a university cafeteria in Pavia, northern Italy, the recipes and ingredients of each meal served during the whole year were obtained from the cooks. Energy, protein, fat, carbohydrate and fibre contents were computed for each meal standardized portion. Thirteen pyramid figures, subdivided into three coloured levels, were used to depict the energy and nutrient content of each meal. SUBJECTS: Four hundred randomly selected customers were interviewed on the cafeteria nutritional proposal. RESULTS: Foods available in the cafeteria consisted of 216 items and were distributed in the pyramids according to their energy content: the lowest ones at the bottom (green level) and the highest ones at the top (red level), passing through an orange level in the middle. Energy values ranged from 460 kJ (110 kcal) for a portion of dressed vegetables to 5021 kJ (1200 kcal) for a pizza. The depicted pyramids were displayed in the cafeteria, so that customers could choose their meal according to its nutritional value. The meals' nutritional content information was perceived very helpful for customers' nutritional choices. CONCLUSIONS: Availability of nutrition information in the cafeteria was well accepted by the customers who could plan their meals according to a more balanced diet.

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The increasing need for nutrition professionals is driven by growing public interest in nutrition and the potential of nutrition to prevent and treat a variety of diet-related conditions. Health promotion units and health services face great challenges in trying to address current and future population health issues. This review describes the present state of health nutrition practice in Italy, exploring the nature, role, and utility of training for nutrition professionals to meet the increasing burden of nutrition-related diseases. Evidence suggests that the public health nutrition workforce and infrastructures lack the necessary capacity to respond to national population needs regarding food and nutrition at many levels. This situation is aggravated by the growing prevalence of nutrition-related diseases as well as by the lack of adequate academic nutrition training. The public health nutrition infrastructures need to be enhanced, as do the education and training systems. Roles and functions in health nutrition practice need to be defined and discipline-specific competencies should be integrated.

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Our objective was to assess the reliability and relative validity of a food frequency questionnaire (FFQ) among adult people. In a cross-sectional study carried out in northern Italy, 112 adults were recruited. A total of 189 food and drink items were selected according to those typically consumed by Italians. FFQ reliability was assessed by two repeated administrations at 6 weeks. The FFQ was validated using four 24-h recalls repeated in the same period of time. For the validation study, classification into quartiles from the two methods and Bland-Altman plot were also performed. The reliability study showed a good correlation between the two methods. Bland-Altman plots showed that the two methods are very likely to agree for individual energy and macronutrient intakes. The reliability and relative validity of this FFQ was good, supporting its use in assessing dietary intakes of Italians in nutritional surveillance programs and in epidemiological dietary surveys.

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OBJECTIVE: The present study aimed to estimate the lutein concentration in human milk during early lactation and its relationship with dietary lutein intake measured through the administration of a short FFQ. DESIGN: A cross-sectional study in which an FFQ was administered twice: on day 3 (T0) and day 30 (T1) postpartum; meanwhile two breast milk samples were collected. Maternal plasma samples were obtained at T0. The comparison of dietary lutein intakes and likewise lutein concentrations in breast milk at T0 and T1 were analysed with Student's t test. Pearson's correlation coefficient was used to determine the association between dietary lutein intake and lutein concentration in milk and plasma, respectively, as well as the correlation between breast milk and plasma lutein concentrations at T0. SETTING: Pavia, northern Italy. SUBJECTS: Twenty-one pregnant women, age range 24-42 years, were recruited during their last trimester on a voluntary basis. RESULTS: Both breast milk and plasma lutein concentrations were significantly correlated with dietary lutein intake (r = 0.86, P = 0.0001 and r = 0.94, P = 0.0001, respectively). There was a clear significant correlation between milk and plasma lutein concentrations (r = 0.87, P = 0.0001). Mature milk lutein concentration, although significantly reduced at T1 (P < 0.01), maintained a fairly high correlation with dietary lutein intake (r = 0.82, P = 0.0001). CONCLUSIONS: Even though milk lutein concentration decreased during early lactation, it remained significantly correlated with daily lutein intake. Therefore, while awaiting further research, dietary recommendations advising intake of fresh fruit and vegetables rich in lutein, throughout the whole duration of pregnancy and lactation, are extremely useful.

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The significant role of trace elements in human health is well documented. Trace elements are those compounds that need to be present in the human diet to maintain normal physiological functions. However, some microelements may become harmful at high levels of exposure, or, on the other hand, may give rise to malnutrition, when their exposure is too low. The aim of the present study was to provide a reliable estimate of the dietary exposure of twenty-one trace elements in a Northern Italian area. For this purpose, trace element analyses were undertaken on total diet samples collected from a university cafeteria in Pavia, Northern Italy. The average daily exposure for the adult people was calculated on the basis of food consumption frequency, portion size and trace element levels in foodstuffs. The mean exposure values satisfy the Italian RDA for all the essential trace elements, except for Fe exposure in females, and are well below the Provisional Tolerable Daily Intake for all the toxic compounds, showing that the probability of dietary exposure to health risks is overall small. As far as Fe exposure is concerned, a potential risk of anaemia in the female adult population should be considered, then studies aimed at evaluating the Fe nutritional status of adult Italian women should be addressed. In conclusion, while not excluding the possibility that the daily exposure determined in the present study may not be representative of the population as a whole, this study provides a good estimate of the Italian adult consumer exposure to twenty-one trace elements.

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OBJECTIVE: The present study evaluates eating habits and behaviors, and nutritional and food safety knowledge of a group of Italian adolescents. DESIGN: A dietary questionnaire previously constructed and tested was self-administered during school time. Each section was evaluated using a separate score. SETTING: The study was carried out as a part of a nutritional surveillance project in the Aosta Valley Region, Northern Italy. SUBJECTS: Five hundred and thirty-two adolescent subjects, aged 15.4 +/- 0.7 years, attending the second year of secondary schools participated in the study. MEASURES: We evaluated eating habits, physical activity, meaning of healthy and unhealthy dietary habits and food, self-efficacy, barriers affecting healthy food choices, nutritional and food safety, weight, height, Body Mass Index (BMI). RESULTS: Only 37.0% of the sample have satisfactory eating habits; 18.5% have a very active lifestyle; only 8.6% have quite good nutritional knowledge, 2.4% have satisfactory food safety knowledge, although 43.7% have good hygiene practices. CONCLUSIONS: The results point out unhealthy behaviors influencing adolescents' eating habits and suggest which of these must be considered in order to develop tailored nutrition interventions, improving adolescents' consciousness aimed at adopting a healthy lifestyle.

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BACKGROUND: There is increasing evidence that higher intakes of carotenoids could protect against oxidative and light damage in premature infants and may promote other health benefits in both mothers during pregnancy and lactation and in newborn infants. AIM OF THE STUDY: To develop and validate a brief quantitative food frequency questionnaire (FFQ) aimed at assessing lutein and zeaxanthin intake in women. METHODS: In this cross-sectional study, estimates of lutein and zeaxanthin intake from the FFQ were compared with a 7-day dietary record and with plasma concentrations of these carotenoids. This primary care study was conducted in Pavia, Italy. Subjects were all female volunteers, aged 20-25 years (mean age 22.7 +/- 2.1 years), university students. Of the 110 women initially recruited, 87 completed diet questionnaires and donated a blood sample. Dietary intake was assessed by the FFQ by interview and 7-day dietary records chosen as a reference standard, using photographic estimations of portion sizes. Plasma concentrations of lutein and zeaxanthin were measured by HPLC. Pearson's correlation coefficient and Bland Altman Regression analysis were used. RESULTS: Mean dietary lutein and zeaxanthin intakes were 1,107 +/- 113 microg/day from the FFQ questionnaire and 1,083 +/- 116 microg/day from the 7 day dietary records. The mean difference in intake assessed by the two methods (-24.5 +/- 38.3 microg/day) did not differ significantly from zero. Dietary intake of lutein and zeaxanthin measured with the FFQ and plasma nutrient concentration among this sample were significantly correlated (r = 0.76, P < 0.0001). Mean plasma lutein and zeaxanthin concentrations were 0.33 +/- 0.09 micromol/l. CONCLUSIONS: This FFQ could be used to assess lutein and zeaxanthin intake in adult women.

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BACKGROUND: Many human milk benefits have been well documented; nevertheless the newborn potential risk to the xenobiotic exposition may be relevant and it requires a biological monitoring in general prevention. Concerning this problem, attention should be paid to mycotoxins and heavy metals. AIM OF THE STUDY: Assessing the presence of the xenobiotics aflatoxins, ochratoxin A, lead and cadmium in human milk, defining their level of contamination and evaluate the potential risk for the newborn derived from this xenobiotic ingestion. METHODS: A study has been carried out on lactating women randomly selected in seven hospitals in Lombardy (Northern Italy). Two hundred and forty-seven puerparae were recruited; 231 women participated in the study. Women's milk samples on the third or fourth day after delivery were tested to determine aflatoxins and ochratoxin A levels. Lead and cadmium were determined in 143 women because supplemental milk could be taken only from these women. RESULTS: Aflatoxin B1 (11.4 ng/l) and aflatoxin M1 (194 ng/l) were found only in one sample,while ochratoxin A was detected in 198 samples (85.7 %) at an average value of 6.01 +/- 8.31 ng/l. A total of 75.7% of samples were positive for lead; the cadmium situation was better with 87.4% of the sample with values below detection limits (2 microg/l). A high percentage of babies (71 %) are exposed to mycotoxin levels on day 6 greater than the TDI value of 0.2 ng/kg b.w. Lead and cadmium presence in human milk presented risk respectively for 8% and 0.7% of newborns on the fourth day; 9.5% and 1.4% on the sixth day. CONCLUSIONS: The study points out that mycotoxins and lead are present in maternal milk, and the data confirm the need to continue biological monitoring in general prevention.

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The experience obtained in astronauts until now has revealed many nutritional problems during both short- and long-term missions that are still under investigation. When the manned space program evolves to the point where it involves a considerable number of people operating at great distances from the Earth for long periods of time, continuous provision of food as well as physiopathological modifications partly related to nutrition will remain a challenge. Human space missions have outlined the importance of the diet on the quality of an astronaut's life, not only because an appropriate nutritional status can be maintained only through an adequate nutrient intake, but also because food plays an important socio-psychological role.A great amount of research has been done both by the Russian and American teams in order to identify the nutritional requirements for humans during space flights. Crew members should be provided with nutritional adequate diets characterized by many different food items carefully selected according to technological techniques aimed to ensure long shelf-life periods, health, safety, satisfaction and convenience. An astronaut's nutritional status is greatly influenced by important weightlessness, environmental physiological adaptations.Changes in muscle and bone mass, modifications of gastro-intestinal functions and immune alterations may be partly limited by adequate planned dietary countermeasures.

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