1. Dietetics and Nutrition in the Mediterranean By Dr. Alberto Fatticcioni

2. Obesity and BMI Obesityis a conditionof excess body fat. Obesity is currently defined using body mass index (BMI). BMI is calculated as weight (kg)/ height squared (m²) and is indipendent of sex. BMI is significantly correlated with total body fat content and it’s now internationally accepted as a means of identifying overweight and obesity. The risks of developing type 2 diabetes, heart disease and cancer all increase as BMI increases, with the lower risk generally seen at BMIs of 22 to 25 kg/m². Mortality increases gradually above a BMI to 25 kg/m².

3. Obesity and BMI

4. Obesity: epidemiology Obesityis a conditionof excess body fat. For the first time in history, most US adults are overweight or obese, and as such they have substantially increased morbidity and mortality from hypertension, stroke, coronary artery disease, dyslipidemia, type 2 diabetes, sleep apnea and numerous other conditions. Higher BMI also increases all-cause mortality.

5. Obesity: epidemiology According to NHANES 1999-2000 (National Health and Nutrition Examination Surveys), an estimated 64% of persons in the United States are overweight (BMI 25-30) or obese (BMI ≥30); that is 8% higher than 1988-1994 and 17% higher than in 1971-1974. Among adults 20 to 74 years old, the estimated prevalence of obesity (BMI ≥30) doubled between NHANES 1976-1980 AND NHANES 1999-2000 from approximately 15 to 31%. The consequences for the health care system are important for the obesity-related comorbidities.

6. Obesityas a disorderofenergybalance Obesity can develop only as a result of an imbalance between energy intake and energy expenditure. High energy intake leads to obesity only if it is not matched by high energy expenditure, and low energy expenditure leads to obesity only if it is not matched by low energy intake. When intake is lower than expenditure, negative energy balance occurs, and body energy stores are reduced. When energy intake exceeds expenditure, positive energy balance occurs, and body energy stores are increased.

7. Obesityas a disorderofenergybalance COMPONENTS OF ENERGY BALANCE (positive or negative) Energy intake We take in energy in the foods we eat. The major macronutrient sources of dietary energy are fat, carbohydrates, protein and alchool. Energy expenditure Resting Energy Expenditure Physical Activity Energy Expenditure Thermic Effect of Food

8. Obesityas a disorderofenergybalance Energy expenditure Total energy expenditure (TEE) is the sum of resting energy expenditure, thermic effect of food and physical activity-related energy expenditure. Resting Energy Expenditure REE The majority of human energy expenditure is through the body’s metabolism at rest, comprises 60 to 80% of (TEE) in most people. REE is the energy required by the body to maintain basic physiologic functions such as pumping blood, making hormones and maintaining body temperature (in average muscle 25%, brain 20% and liver 22% of REE)

9. Obesityas a disorderofenergybalance Energy expenditure Total energy expenditure (TEE) is the sum of resting energy expenditure, thermic effect of food and physical activity-related energy expenditure. Physical Activity Energy Expenditure PAEE Is the component of energy expenditure that is most under voluntary control because it is influenced most strongly by the amount of PA. PAEE is the most variable component of energy expenditure and can easily range from 10% of TEE in sedentary persons to 40% of TEE in active persons.

10. Obesityas a disorderofenergybalance Energy expenditure Total energy expenditure (TEE) is the sum of resting energy expenditure, thermic effect of food and physical activity-related energy expenditure. Thermic Effect of Food TEF TEF is the increase in energy expenditure associated with digestion, absorption and storage of ingested macronutrients, usually 7 to 10% of the total caloric content of the meal. The energy cost of a meal is associated with the macronutrient composition of food consumed, with the TEF higher for protein, than for carbohydrates and fat.

12. Kcalories on 100 grams of vegatables 9 Kcal Fennels 11 Kcal Zucchine 12 Kcal Chicory 13 Kcal Red radicchio 14 Kcal Cucumber 15 Kcal Escarole 16 Kcal Endive 17 Kcal Chard 18 Kcal Eggplant, Green beans, turnip 19 Kcal Lettuce, Beetroot

13. Top 10 richest protein and lowest kilocalorie food/100g 43 Kcal/11 g egg white 57 Kcal/11 g octopus 68 Kcal/13 g squid, /14 g ray 71 Kcal/14 g shrimp, /17 g cod 72 Kcal/14g cuttlefish, /11 g palourde 78 Kcal/16 g John dory, /16 g ombrine 80 Kcal/16 g dogfish, /19 g pike 83 Kcal/17 sole 84 Kcal/12 mussel 86 Kcal/15 trout

15. fruit (at least 4 pieces or 400 g a day)

16. legumes and pulses

17. grains, pasta and/or bread (mostlywhole)

18. olive oil and nuts

19. water (more than 2 liters per day)

20. wine duringmeals ( maximum 2 glasses per day)

21. seafood (fish, shellfish, mollusc), 4-6 times a week

22. yoghurt, 2 - 4 times per week

23. cheese, 1 - 4 times per week

24. milk, 1 - 2 times per week

25. eggs, 1 - 4 eggs per week (maximun 1 per day)

26. poultry, 1 - 2 times per week

27. redmeat, 0 - 1 time a week

29. Diabetesmellitus: classification Metabolicderangements in the metabolismofglucose and profoundabnormalities in the metabolismoffat, protein, and othersubstancescharacterize the patologyofdiabetes. A heterogeneous disorder both genetically and clinically, all classifications of diabetes have in common hyperglycemia, attributable to either insulin insufficiency or insulin resistance. Insulin-dependent diabetes mellitus (type 1) Non-insulin-dependent diabetes mellitus (type 2)

30. Etiologicclassificationofdiabetes Diabetes Type 1 diabetes (beta-cell destruction with lack of insulin) Type 2 diabetes (insulin resistance with relative insulin deficiency) Other specific types: genetic defects of beta-cell function; genetic defects of insulin action; diseases of the exocrine pancreas; endocrinopathies (acromegaly); drug or chemical-induced; infectious; Gestational diabetes mellitus

31. Diabetesmellitus: classification Type 1 diabetesaccountsforapproximately 5% ofdiabetes and ismanifestedbyinsulindeficiencycausedbydestructionof the pancreaticbeta-cells. Type 2 diabetesaccountsforabout 90% ofdiabetes and iscaracterizedbytwoprimarydefect: insulinresistence (diminishedtissuesensitivitytoinsulin) and impaired beta cellfunction (delayed or inadequateinsulinrelease. Othercauses account for the remaining 5% ofdiabetes in the UnitedStates

32. Criteriafordiagnosisofdiabetes Symptoms of diabetes plus casual plasma glucose values of ≥ 200 mg/dL. Casual is defined as any time of day without regard to time since last meal. Classic symptoms of diabetes include polydipsia, polyuria and unexplained weight loss. Fasting plasma glucose value ≥ 126 mg/dL. Fasting is defined as no energy intake for at least 8 hours. 2-hour postload plasma glucose value of ≥ 200 mg/dL during an oral glucose tolerance test.

33. Diabetesmellitus: roleofhormones Glucosehomeostasisisorchestratedbyanexquisite interplay ofpancreatic and guthormones. The mostimportant are insulin and glucagon. Insulinis the hormoneprimarilyresponsiblefor the metabolism and storageof the body fuelsthat are ingested. The pancreas sustains a basal level of insulin release and secrets additional insulin in response to increased blood glucose after a meal. The postprandial secretion of insulin promotes glucose, amino acids, and fat uptake bi tissues (primarily liver, adipose and muscle tissue) where the glucose is used or stored.

34. Diabetesmellitus: roleofhormones Insulin production decreasesasthe blood glucose level decreases. Glucagon, is secreted by the pancreatic αcells in responsetodecreasedbloodglucoselevels and under conditionsof stress. Glucagonstimulatesglucosereleasefromliver. The balancebetweeninsulin and glucagonlevelsisvitalfornormalglucosehomeostasis, fatty acid metabolism, and proteinpreservation.

37. fruit (at least 4 pieces or 400 g a day)

38. legumes and pulses

39. grains, pasta and/or bread (mostlywhole)

40. olive oil and nuts

41. water (more than 2 liters per day)

42. wine duringmeals ( maximum 2 glasses per day)

43. seafood (fish, shellfish, mollusc), 4-6 times a week

44. yoghurt, 2 - 4 times per week

45. cheese, 1 - 4 times per week

46. milk, 1 - 2 times per week

47. eggs, 1 - 4 eggs per week (maximun 1 per day)

48. poultry, 1 - 2 times per week

49. redmeat, 0 - 1 time a week