Italian Society of Obesity XI National Congress

Oral communications 1—pathophysiology

CO01 Nocturnal hypoxia indexes are associated with left ventricular remodeling and diastolic dysfunction in obstructive sleep apnea patients

M. Maggi¹, G. Maiolino¹, V. Bisogni², S. Carlucci¹, G. Federici¹, D. Soranna³, A. Zambon⁴, M. F. Pengo⁵, C. Lombardi⁵, L. Busetto¹, R. Vettor¹, G. Parati⁵

¹Clinica Medica 3, Department of Medicine, DIMED, University of Padova, Padova, Italy; ²A.O. San Camillo-Forlanini, Rome, Italy; ³IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy; ⁴Department of Statistic and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; ⁵IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO01

Objective: Obstructive sleep apnea (OSA) affects left ventricular mass index (LVMI), LV end-diastolic diameter, LV ejection fraction (LVEF), and diastolic function. The apnea/hypopnea index (AHI), used to diagnose and define the severity of OSA, poorly predicts cardiovascular damage, cardiovascular events, and mortality. Therefore, we aimed to assess if other polygraphic indices of OSA severity might predict cardiac remodeling.

Method: We enrolled two cohorts of subjects referred for possible OSA to the IRCCS Istituto Auxologico Italiano, Milano, and the Clinica Medica 3, Padova. All patients underwent home sleep apnea testing and echocardiography. Based on AHI the cohort was divided into no-OSA (AHI < 15 events/hour) and moderate-severe OSA (AHI ≥15 events/hour). At stepwise multiple regression analysis we identified the covariates among clinical and polygraphic variables, independently associated to four echocardiographic variables, i.e., LVMI, LVEF, LV end-diastolic volume (LVEDV), early and late ventricular filling velocity ratio (E/A).

Results: 162 patients were enrolled in the study. Compared to patients with no-OSA, those with moderate-severe OSA showed higher LV remodeling [LVEDV 48.4 ± 11.5 ml/m2 vs. 54.1 ± 14.0 ml/m2, respectively, p = 0.005] and lower LVEF (65.3 ± 5.8% vs. 61.6 ± 7.8%, respectively, p = 0.002), whereas no difference in LVMI and E/A was found. At multivariate linear regression analysis, the only polygraphic independent predictor of LVEDV was the percentage of time with SatO2 < 90% (β = 0.262), while the independent predictors of E/A were AHI (β = − 0.379) and oxygen desaturation index (β = − 0.422). None of the polygraphic variables were associated to LVMI and LVEF.

Conclusions: Our study indicates that nocturnal hypoxia-related indexes were associated with LV remodeling and diastolic dysfunction in OSA patients. These results support the adoption of hypoxia indexes in the evaluation of OSA patients, especially in those at a greater cardiovascular risk.

CO02 Arterial stiffness and phase angle: is there a link?

B. Pala¹, L. Pennazzi², P. Tifi¹, M. C. Alivernini¹, G. Nardoianni¹, E. Barbato¹, G. Tocci¹

¹Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; ²Faculty of Medicine and Surgery “A. Gemelli”, Obstetrics-Gynecological Nursing Sciences, Catholic University of the Sacred Heart, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO02

Introduction: Obesity, dyslipidemia, and hypertension often coexist and are associated with chronic low-grade inflammation, which can promote development and progression of cardiac remodeling and Arterial Stiffness (AS). Phase Angle (PhA) is a parameter obtained from Bioelectrical Impedance Analysis (BIA) and has been proposed as an indicator of cellular health in chronic inflammatory states. However, it is currently unclear whether increased AS may correlate with PhA in obesity.

Aim: To investigate their potential relationship in a group of postmenopausal females who are overweight or obese, with arterial hypertension on stable treatment, stratified by Body Mass Index (BMI) categories.

Methods: A single-centre, cross-sectional study was conducted in treated and untreated post-menopausal women, aged 50–65 years, who consecutively underwent full BP assessment and non-invasive assessment of cardiac and vascular function. Body composition, including PhA, was assessed using a phase-sensitive BIA system. AS was non-invasively determined by measuring Pulse Wave Velocity (PWV) using a validated cuff-based oscillometry device (Mobil-O-Graph). Multiple linear regression analysis was performed to analyze the data.

Results: We included 50 women, among whom the majority had grade I obesity (45%); 33% were classified as overweight, while 11% had grade II obesity and 11% had grade III obesity. Preliminary analysis showed no significant differences in abdominal circumference (p = 0.06), waist-to-hip ratio (p = 0.101), total and LDL cholesterol (p = 0.7), systolic (p = 0.959) and diastolic (p = 0.6) blood pressure levels. However, there was a significant positive association between higher levels of AS and BMI (p < 0.048). Additionally, a significant positive association was also observed between PWV and phase angle (PhA) (r = 0.25, p < 0.01), indicating a potential link between AS and body composition.

Conclusions: We observed a novel association between PWV and PhA in the context of women with obesity. Our findings suggest that PhA, as a marker of cell membrane integrity and inflammation, may have potential utility in predicting AS and identifying high-risk obese women.

CO03 Evaluation of cardiac function in sepsis-related cardiomyopathy shows different recovery pattern in patients with obesity

L. Molinari¹, A. Di Vincenzo¹, B. Barbato¹, M. Marchegiani¹, M. Noale², S. Pavone¹, G. M. Pontesilli¹, A. Postal¹, C. Purificati¹, E. Reni¹, S. Bettini¹, G. Camporese³, C. Dal Prà¹, R. Fabris¹, A. Scarda¹, L. Spiezia³, L. Busetto¹, M. Rossato¹, R. Vettor¹

¹Clinica Medica 3, Azienda Ospedale-Università di Padova, Padova, Italy; ²Scienze biomediche, Azienda Ospedale-Università di Padova, Padova, Italy; ³Medicina Generale, Azienda Ospedale-Università di Padova, Padova, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO03

Data from epidemiological studies suggest a counterintuitive protective effect of obesity during sepsis, but this clinical paradox is often questioned. In the context of metabolic cardiomyopathy patients with obesity primarily suffer in terms of diastolic function, especially if a dilated form is present. It is possible that the obesity paradox of sepsis lies in the presence of a yet dilated heart which may better adapt to the flow changes that characterize the hyperacute phase of sepsis.

This is a prospective, monocentric observational ongoing study conducted at Clinica Medica 3, University-Hospital of Padua, enrolling one hundred patients with sepsis. Echocardiography was performed twice during hospitalization. Several parameters related to contractile and diastolic function, as well as ventricular-arterial coupling were evaluated. The data collected in an interim analysis showed some differences between the two groups: during the acute phase patients with obesity showed a lower reduction of ejection fraction from the baseline, despite not reaching the statistical significance (60% from 64% in the first group, 56% from 63% in the second one). Both patients with obesity and normal weight showed ventricular-arterial decoupling in the acute phase, but while the first ones maintained this alteration, lean patients recovered at baseline status. One normal-weight patient had diastolic dysfunction during acute phase, which was resolved at discharge. Conversely, one patient with obesity had persistent diastolic dysfunction.

Despite preliminary, these results suggest that the prognosis of patients with sepsis may be related to the transition from a state of normality to an altered one, rather than the state itself of the pump or diastolic dysfunction. In conclusion our study highlights the importance of obesity on cardiac function in patients with sepsis and the development of specific echocardiography parameters for better stratification risk and outcome prediction.

CO04 Evening glucocorticoid exposure and eating habits in patients with Addison's disease

M. Fosci¹, L. Puglia¹, F. Pigliaru¹, S. Corrias¹, F. Boi¹, A. Loviselli¹, F. Velluzzi¹

¹Endocrinology and Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO04

Addison's disease (AD) is a rare endocrine disorder characterized by lacking production of glucocorticoid (GC) by the adrenal glands. Conventional replacement therapy (RT), namely hydrocortisone (HC) or cortisone acetate (CA) two or three times a day, exposes to supraphysiological doses of cortisol, especially during the evening, as opposed to once-daily, dual-release hydrocortisone (DR-HC). This study is aimed at evaluating whether GC exposure may influence eating habits.

We enrolled 16 AD patients and compared their Salivary Cortisol Curves (SCC) at baseline (T0) with the SCCs of 22 healthy subjects. The AD patients were divided into 3 groups according to the different RT: 5 with DR-HC, 7 with HC, and 4 with CA. The afternoon/evening SCC was assessed by collecting saliva at 15:00, 19:00, and 23:00. Salivary Cortisol was evaluated at 19:00 (SC19, ng/ml) as well as to what extent the therapy-induced SCC replicated the physiological one through the assessment of time in range (TIR, %).

The group with the best TIR was DR-HC (90%), followed by CA (58%); the worst was HC (37%), because of its higher SC19 (5.74 ± 5.04 ng/ml) than DR-HC (0.59 ± 0.11 ng/ml) and CA (1.72 ± 0.80 ng/ml). Eating habits were investigated through two questionnaires validated for adherence to the Mediterranean Diet (MD): PREDIMED (PREDI) and Mediterranean Diet Score (MDS). A positive correlation was found between TIR and PREDI (Spearman Rho 0.564, p: 0.023).

Afterward, HC and CA RT were switched to DR-HC with the purpose of improving TIR and all AD patients were re-evaluated 3–6 months after RT change (T1). A statistically significant improvement of both PREDI (T0: 6.14 ± 2.73 vs. T1: 7.57 ± 2.51, p: 0.034) and MDS (T0: 31.29 ± 7.06 vs. T1: 37,0 ± 6.32 p: 0.016) was found in HC, the only group that significantly changed the CSS by reducing CS19 values (T0: 5.74 ± 5.04 ng/ml vs T1: 1.12 ± 0.34 ng/ml). No significant differences were observed for the other two groups between the T0 and T1.

The TIR–PREDI positive correlation suggests that evening GC exposure may direct food choice: high cortisol levels may lead to food seeking such as sweets and sugary drinks, whose consumption is investigated by PREDI and not by MDS. Reducing evening overdosing may decrease comfort food seeking and consequently increases adherence to the MD.

CO05 Higher unacylated plasma concentration is independently associated with lower fat mass in a general population cohort

G. Gortan Cappellari¹, A. Semolic¹, P. Vinci¹, M. Zanetti¹, R. Barazzoni¹

¹Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO05

Rationale: Unacylated ghrelin (UnAG) is emerging as a modulator of tissue and systemic metabolism, with reported beneficial impact on catabolic pathways including inflammation and insulin resistance, resulting in enhanced muscle mass in rodent models, with potential beneficial impact in the clinical setting. The impact of UnAG levels on adipose tissue mass, as well as its potential role as an independent modulator of body composition, is however currently unknown.

Methods: We investigated the associations between fat mass (bioelectrical impedence) and ghrelin profile [total (TG), acylated (AG) and unacylated hormone (UnAG)] in 176 randomly selected individuals from the North-East Italy MoMa population study (Age:58 ± 17y; M/F:93/83 BMI:26.4 ± 5.1 kg/m²). Caloric intake was estimated from food frequency questionnaires.

Results: Total, acylated and unacylated ghrelin were all negatively associated with body fat (% of body weight; p < 0.05) in the study cohort. In multiple regression analysis, this finding was found to be independent of age, BMI, waist circumference and other metabolic syndrome parameters, as well as caloric and fat dietary intake, only for TG and UnAG (p < 0.01; for AG p = NS). Moreover, only UnAG was associated with fat mass also independently of skeletal muscle mass (p < 0.05).

Conclusions: In subjects from a North-East Italy general population cohort, UnAG plasma levels are negatively associated with fat mass independently of potential metabolic and dietary confounding factors, as well as other body compartments. These results suggest that UnAG should be further investigated as a potential direct modulator of adipose tissue metabolism.

CO06 Fasting metabolic flexibility in prediabetes

A. Foppiani¹, R. S. De Amicis¹, F. Sileo¹, A. Leone¹, S. Bertoli¹, A. Battezzati¹

¹ICANS-DIS, DeFENS, University of Milan, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO06

Metabolic flexibility cannot be easily clinically assessed, but the respiratory exchange ratio (RER) measured via indirect calorimetry can indicate substrate utilization. When indirect calorimetry is performed to measure resting metabolic rate, a normal RER should reflect a lipolytic metabolism (close to 0.7). We aimed to describe fasting glucose metabolism in relation to RER in patients seeking a nutritional intervention.

In 10,175 patients (7222 (71%) females, median (quartiles) age of 46 (36, 55) years, and BMI of 28.3 (25.0, 32.3) kg/m²) a greater RER was associated with higher fasting values of glucose, insulin and higher insulin resistance (HOMA-IR), controlling for sex, age, and BMI (differences going from a RER of 0.7 to 1 RER for glucose 1.7 (95% CI 0.66, 2.8; p = 0.002), for insulin 1.9 (95% CI 1.3, 2.6; p =  < 0.001), and for HOMA-IR 0.49 (95% CI 0.32, 0.66; p ≤ 0.001)).

As an higher RER relates to an altered glucose metabolism, within the whole sample we selected patients with prediabetes with 1 year follow-up. We matched 86 patients having either a RER indicating a lipolytic metabolism (< 0.775) or glycolytic metabolism (> 0.925). Patients were matched for sex, age, BMI, waist circumference, and arm muscle area. The high RER group had a lower probability of normalizing fasting glucose level within 1 year (log(OR) -0.89 (95% CI -1.8, -0.03; p = 0.046)), with higher fasting glucose levels at followup (5.4 (95% CI 0.98, 9.9; p = 0.017)). Moreover, while losing similar weight than the low RER group (− 0.55 (95% CI -3.7, 2.6; p = 0.7)), they lost a lower amount of fat mass (1.2 (95% CI 0.02, 2.4; p = 0.047)).

Our results suggest than an higher RER relates to a dysfunctional glycolytic metabolism at rest. We also show that prediabetic patients with higher RER are more likely to not respond to a lifestyle intervention, warranting a more intensive treatment for this subgroup. This lower probability of success doesn’t seem related to a lower adherence to the proscription, as weight loss was similar across RER categories, but to a lower weight loss quality.

Oral communications 2—nutrition

CO07 The effects of eight weeks of very low calorie ketogenic diet (VLCKD) on liver health in subjects with overweight and obesity

R. Zupo¹, F. Castellana¹, S. De Nucci², L. Lampignano³, M. Di Chito², V. Triggiani⁴, G. De Pergola²

¹Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis,” Research Hospital, Castellana Grotte, Bari, Italy; ²Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis,” Research Hospital, 70013 Castellana Grotte, Bari, Italy; ³Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis,” Research Hospital, 70013 Castellana Grotte, Bari, Italy; ⁴Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO07

Very low-calorie ketogenic diets (VLCKD) are widely employed in successful weight-loss strategies. Herein, we evaluated the efficacy and safety of a VLCKD on non-alcoholic fatty liver disease (NAFLD) and parameters commonly associated with this condition in overweight and obese subjects who did not take any drugs. This prospective, real-life study included thirty-three participants who followed a VLCKD for 8 weeks. NAFLD was diagnosed using transient elastography (FibroScan). Data on anthropometric measurements, bioimpedance analysis, and biochemical assays were gathered both before and after the dietary intervention. BMI (kg/m²) (from 33.84 ± 6.55 to 30.89 ± 6.38, p < 0.01), waist circumference (cm) (from 106.67 ± 15.51 to 98.64 ± 16.21, p < 0.01), and fat mass (Kg) (from 38.47 ± 12.59 to 30.98 ± 12.39, p < 0.01) were significantly lower after VLCKD. CAP (db/m), the FibroScan parameter quantifying fatty liver accumulation, showed a significant reduction after VLCKD (from 266.61 ± 67.96 to 223 ± 64.19, p < 0.01). After VLCKD, the fatty liver index (FLI), a benchmark of steatosis, also revealed a significant decline (from 62.82 ± 27.46 to 44.09 ± 31.24, p < 0.01). Moreover, fasting blood glucose, insulin, triglycerides, total cholesterol, LDL-cholesterol, ALT, γGT, and FT3 blood concentrations, as well as insulin resistance (quantified by HOMAIR) and systolic and diastolic blood pressure levels, were significantly lower after VLCKD (p < 0.01 for all the parameters). By contrast, HDL-cholesterol, 25 (OH) vitamin D, and FT4 blood concentrations were higher after VLCKD (p < 0.01 for all parameters). The variation (δ) of CAP after VLCKD did not show a correlation with the δ of any other parameter investigated in this study. We conclude that VLCKD is a helpful approach for NAFLD independent of changes in factors commonly associated with NAFLD (obesity, fat mass, insulin resistance, lipids, and blood pressure) as well as vitamin D and thyroid hormone levels.

CO08 Very low-calorie ketogenic diet (vlckd): a tool to resynchronize the “owl” with obesity?

L. Verde¹, A. Docimo², S. Savastano², A. Colao², G. Muscogiuri²

¹Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy; ²Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO08

Obesity has been linked to circadian rhythm misalignment, and vice versa. As the ketogenic diet improves sleep structure in subjects with sleep disorders and it is well known that sleep plays an important role in the maintenance of physiological circadian rhythm, we investigated the effect of Very Low-Calorie Ketogenic Diet (VLCKD) on circadian rhythm (in terms of sleep quality and chronotype) in individuals with obesity.

Sixty-four individuals (6 M/58F, aged 43.45 ± 14.96 years, BMI 35.40 ± 5.67 kg/m²) underwent the VLCKD. Of these 45 have completed the protocol. In all subjects’ anthropometric parameters, body composition, sleep quality (through Pittsburgh Sleep Quality Index (PSQI)) and chronotype (through Morningness-Eveningness questionnaire (MEQ)) were assessed at baseline (T0), at the visit of the maximum ketosis (T1) and the end of the VLCKD (T2).

As expected, individuals significantly decreased weight, body mass index, waist circumference and fat mass both at T1 and T2 (p < 0.001 for all). Overall, at T0 participants showed poor sleep (PSQI score ≥ 5). Thus, a significant improvement in sleep quality was observed when PSQI score at T1 (6.51 ± 3.34 vs 6.73 ± 3.83, p = 0.001) and T2 (4.69 ± 2.72 vs 6.73 ± 3.83, p < 0.001) were compared with T0. Regarding the chronotype, significant improvements were observed by comparing MEQ score of T1 (56.58 ± 8.98 vs 55.51 ± 9.68, p = 0.006) and T2 (55.94 ± 10.36 vs 55.51 ± 9.68, p = 0.034) with T0.

VLCKD may help resynchronize the circadian rhythm of individuals with obesity by improving sleep quality and promoting weight loss, which could reduce inflammation and improve metabolic function.

CO09 Efficacy and durability of a very low calorie ketogenic diet protocol on metabolic parameters

E. Camajani¹, A. Feraco¹, A. Persichetti², A. Armani¹, S. Proietti³, M. Lombardo¹, S. Basciani⁴, M. Caprio¹

¹San Raffaele Roma Open University, Department of Human Sciences and Promotion of the Quality of Life, Rome, Italy; ²Service of Pharmacovigilance, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy; ³Unit of Clinical and Molecular Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy; ⁴La Sapienza University of Rome, Experimental Medicine, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO09

Very low calorie ketogenic diet (VLCKD) is a valuable treatment for patients with Metabolic Syndrome (MetS) and visceral obesity. After the VLCKD phase it is essential to gradually reintroduce carbohydrates in order to switch towards a Mediterranean approach. The aim of this study was to evaluate the efficacy and durability of a VLCKD protocol on cardiometabolic parameters related to MetS. 29 patients with MetS [12 males and 17 females, age 56.7 ± 6.4 years, body mass index (BMI) 35.3 ± 3.9 kg/m²)] followed a VLCKD for 45 days (≤ 800 kcal/day). After the VLCKD phase (45 days), they followed a low calorie diet (LCD, 1200 kcal) with a low carbohydrate content (60–80 g/day) for 45 days. Subsequently, patients were switched to a hypocaloric Mediterranean diet (HMD-1500 kcal) with 120-130 g/day carbohydrate content and monitored for additional 60 days (150 days). Anthropometric indexes, blood chemistry, and body composition were assessed. Body weight [− 8.7 ± 3.3, p < 0.001], BMI [− 3.2 ± 1.0 kg/m2, p < 0.001], blood pressure (− 9.1 ± 14.2 mmHg, p = 0.002], waist circumference [− 6.4 ± 3.0 cm, p < 0.001], HOMA index [− 4.3 ± 5.8, p < 0.001], total and low-density lipoprotein cholesterol (LDL) [− 49.5 ± 31.2 mg, p < 0.001; − 36.7 ± 20.6 mg, p < 0.001 respectively] and triglycerides [− 65.9 ± 93.6 mg, p < 0.001] markedly decreased in all participants during VLCKD phase (day 45). Importantly, body weight [− 3.5 ± 1.7 kg, p < 0.001], BMI [-1.3 ± 0.6 kg/m², p < 0.001], total and LDL cholesterol [− 21.4 ± 20.8 mg, p < 0.001; − 19.2 ± 17.2 mg, p < 0.001, respectively] showed a further significance decrease during LCD phase (day 90), as compared to the end of VLCKD phase. Noteworthy, a significant reduction of visceral adipose tissue (VAT) was observed at the end of VLCKD phase [− 103.5 ± 128.7 cm3, p < 0.001], as well as the end of LCD phase [− 80.5 ± 120.3 cm³, p = 0.002]. Importantly, a trend in body weight reduction [− 0.6 ± 1.5 kg, p = 0.125] was observed at the end of HMD phase (day 150), compared with the end of LCD phase (day 90). Our study confirms that VLCKD protocol is an effective strategy in the management of obesity and its metabolic comorbidities, due to its pleiotropic effects, particularly on the reduction of visceral adipose tissue. Indeed, favourable effects on body weight and metabolic risk factors persist also after the reintroduction of carbohydrates.

CO10 Adherence to Mediterranean diet and cytokeratin 18 fragment plasma levels as early markers of liver damage in subjects with visceral obesity

G. Pugliese¹, G. de Alteriis¹, G. Muscogiuri¹, V. Cossiga², G. Perruolo³, M. di Tolla³, P. Formisano³, F. Morisco², F. Zumbolo¹, A. Colao¹, S. Savastano¹

¹Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Naples, Italy; ²Dipartimento di Medicina Clinica e Chirurgia, Sezione di Epatologia, Università “Federico II” di Napoli, Naples, Italy; ³Dipartimento di Scienze Mediche Traslazionali, Università “Federico II” di Napoli, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO10

Visceral obesity is a main risk factor of Non-alcoholic Fatty Liver Disease (NAFLD). A nutritional approach in line with the Mediterranean Diet (MD) plays a key role in NAFLD management, but its effects on NAFLD progression to fibrosis are less known. Circulating levels of cytokeratin 18 (CK18) and its cleavage forms, CK18M30 and CK18M65 are early indicators of inflammation and NAFLD progression to fibrosis, while CK18M30/CK18M65 ratio, an index of apoptotic/necrotic hepatocyte death, is a positive prognostic marker in liver diseases.

Aim of the study was to investigate the association between adherence to MD, assessed with the PREDIMED score (PS) at baseline and after a 3-month nutritional intervention, with anthropometric and metabolic parameters, CK18M30 and CK18M65 plasma levels (determined by ELISA) and liver ultrasound and elastography (FibroScan), in a population of subjects with visceral obesity according to NCEP ATP III criteria.

Among 48 patients 54.8% had class III obesity, and almost all (93.8%) had hepatic steatosis, of which 58.3% in a severe form, 60.4% presented fibrosis (stiffness ≥ 4 kPa), but only 7 subjects (14.6%) had hypertransaminasemia. The majority of the subjects had a moderate adherence to MD (75%).

At baseline PS correlated significantly with liver stiffness (r = − 0.36; p < 0.05), but not with CK18M30 and CK18M65 levels. In the group with medium/high adherence to MD, liver stiffness (p = 0.009), CK18M30 and CK18M65 values were lower (p < 0.001) compared to the group with low adherence. After nutritional intervention (23 patients), PS and CK18M30/CK18M65 ratio increased (p < 0.001 and p = 0.003, respectively), despite no changes in anthropometric and metabolic parameters, transaminases and liver stiffness. DPS was also significantly associated with CK18M30/CK18M65 ratio (r = 0.424; p < 0.001).

In conclusion, CK18M30 and CK18M65 levels and liver stiffness are lower in subjects with visceral obesity and high/medium adherence to MD than in their counterparts with low adherence. Despite the absence of differences in anthropometric and metabolic parameters, transaminase levels and fibrosis, the increase in adherence to MD modifies the ratio between hepatocyte apoptosis/necrosis, expressed by the increased CK18M30/CK18M65 ratio, as an early index of the beneficial effects of MD on NAFLD.

CO11 Emotional eating and adherence to the Mediterranean diet in an Italian adult population

C. Di Rosa¹, C. Spiezia¹, F. Diadema¹, S. Manfrini², Y. M. Khazrai¹

¹Research Unit of Food Science and Human Nutrition, Department of Science and Technology for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21—00128 Rome, Italy; ²Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200—00128 Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO11

Background and aim: The Mediterranean diet (MD) is one of the healthiest nutritional models. Emotional mechanisms can interfere with eating behavior and adherence to healthy dietary patterns. The aim of this observational study was to assess how emotional eating affects MD adherence in adult populations.

Materials and methods: two online questionnaires were issued in October-December 2022: the Emotional Eaters Questionnaire (EEQ) and the Mediterranean Diet adherence questionnaire. EEQ assessed the level of emotional eating: no emotional eaters (NO EE) (score 0–5), low emotional eaters (LEE) (score 6–10) and very emotional eaters (VEE) (score 11–30). MD adherence observed daily food consumption with a score ranging from 0 (non-adherent) to 18 (very adherent).

Results: 200 volunteers (59% female, mean age 36.1 ± 14.45 y., mean BMI 23.8 ± 3.7 kg/m²) completed both questionnaires. Participants were divided into two groups according to BMI: 67% normal weight (NW) and 33% overweight (OW) then in sub-groups according to EE score. NW NO EE and LEE had high MD adherence (p = 0.009, r = − 0.467 and p = 0.002, r = -0.405, respectively) and no issues controlling food intake. OW NO EE subjects had problems controlling cereals intake (p = 0.071, r = 0.775), while OW LEE subjects could not stop eating sweets (p = 0.003, r = − 0.557), ate less fruit (p = 0.028, r = − 0.432) and consumed dairy products (p = 0.037, r = 0.411) when feeling guilty, alone and stressed. NW VEE consumed less legumes when craving specific foods (p = 0.042, r = − 0.291) and when overwhelmed by the foods they tried to be more adherent to MD (p = 0.035, r = 0.301). Craving of certain foods led the OW group to a low MD adherence (p = 0.038, r = − 0.375).

Conclusion: Emotional eating is relevant to both NW and OW subjects. Nutritional counseling can help people manage their emotions and avoid excessive food consumption. Further studies are needed to better understand mechanisms involved in eating behaviour.

CO12 Relationship between olfactory function, body weight, and lifestyle in a sample of the sardinian general population

F. Velluzzi¹, F. Ambrosini¹, M. Fosci¹, M. Onida¹, A. Deledda¹, R. Crnjar², G. Sollai²

¹Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, Presidio Ospedaliero San Giovanni di Dio, 09124 Cagliari, Italy; ²Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO12

Olfactory function exerts an important influence on eating behavior and food choices, which in turn can affect body weight. This study aims to evaluate the relationship between the olfactory function, anthropometric indices and dietary habits in 100 individuals recruited as part of a lifestyle survey in the general Sardinian population. The study sample has been equally divided by sex and life environment (Urban and Rural groups); weight, height, Body Mass Index (BMI), Waist Circumference (WC), and the Mediterranean Diet Score, (MDS) were assessed. The olfactory function was evaluated by means of the Identification test (Id-test; score 0–16) of the “Sniffin’s Sticks”, and the relationship between the Id-score and BMI, WC, and MDS was analyzed. A significant association between BMI values and Id-score (p < 0.001) was found in the whole sample. Regarding the environment, in the Urban group, individuals with obesity showed a lower Id-score than those with normal weight or overweight (p < 0.001), while in the Rural group, both individuals with obesity and overweight showed a lower Id-score than those with normal weight (p < 0.001). Moreover, in Urban and Rural groups, individuals classified as hyposmic, showed higher BMI values than normosmic ones (p ≤ 0.015), and among hyposmics, Urban individuals had higher BMI values than the Rural ones (p = 0.042). As regards sex, the hyposmic status was associated with higher BMI values both in males and females (p ≤ 0.010), while among normosmics, males showed higher BMI values than females (p = 0.0036). The Pearson’s analysis showed in Urban and Rural groups and in both sexes, a significant negative correlation between Id-score and BMI and WC values (p < 0.012 and p < 0.017 respectively), and a positive correlation between Id-score and MDS (p < 0.037). Our results highlight a significant relationship between olfactory function, excess weight, and lifestyle. Particularly, a lower Id-score is associated with overweight or obesity, while a higher Id-score is associated with a higher adherence to the MD.

Oral communications 3—clinic

CO13 Perceptions, attitudes and behaviours among adolescents living with obesity, caregivers and healthcare professionals in Italy: the action teens study

C. Maffeis¹, L. Busetto², M. Wasniewska³, D. Di Pauli⁴, C. Maccora⁵, A. Lenzi⁶

¹Department of Surgery, Dentistry, Gynecology and Pediatrics, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy; ²Department of Medicine, University of Padova, Padova, Italy; ³Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; ⁴Independent Researcher Rovereto (TN), Rovereto, Italy; ⁵Novo Nordisk, Rome, Italy; ⁶Department of Experimental Medicine, Section Pathophysiology, Endocrinology and Food Sciences, University of Rome La Sapienza, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO13

Background: The ACTION Teens cross-sectional, online survey study (NCT05013359) was conducted in 10 countries in 2021. It aimed to identify perceptions, attitudes, behaviours and barriers to effective obesity care among 5275 adolescents living with obesity (ALwO), 5389 caregivers of ALwO (CGs) and 2323 healthcare professionals (HCPs) treating ALwO. Results for the Italian cohort are reported herein.

Methods: In Italy, the ACTION Teens survey was completed by 649 ALwO (12– < 18 years old), 455 CGs and 252 HCPs.

Results: Over two-thirds (69%) of ALwO thought their weight was above normal, while fewer than half (46%) of CGs perceived their ALwO’s weight as above normal. In total, 52% of ALwO were at least somewhat worried about their weight, while only 34% of CGs thought their ALwO was at least somewhat worried. Similarly, a greater proportion of ALwO than CGs worried about their/their ALwO’s weight affecting future health (87 vs 72%) and reported they/their ALwO made a weight loss (WL) attempt in the past year (60 vs 33%). More CGs than HCPs believed ALwO would slim down with age (49 vs 17%). The most common motivator for ALwO WL reported by ALwO and CGs was wanting to be more fit/in better shape (38% and 30%, respectively); according to HCPs it was improved social life/popularity (73%). Lack of hunger control and not liking to exercise were the most common ALwO WL barriers selected by ALwO (25%) and CGs (22%), respectively; HCPs most often agreed that unhealthy eating habits (93%) are a barrier. Family/friends (25%) and search engines (e.g. Google; 24%) were the information sources most commonly used for weight management by ALwO, while for CGs it was doctors (29%) and family/friends (27%).

Conclusion: CGs appeared to underestimate the impact of obesity on ALwO. Key motivators and barriers for WL were perceived differently among ALwO, CGs and HCPs. The finding that the internet is a top information source for ALwO suggests a need for new communication/education strategies.

CO14 The association between binge eating behaviour and glycometabolic risk factors is mediated by bmi and body composition in people with overweight and obesity

A. Leone¹, R. De Amicis², A. Foppiani¹, F. Menichetti¹, A. Battezzati³, S. Bertoli²

¹International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy; ²ICANS-DIS, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy; Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy; ³ICANS-DIS, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan; Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO14

Binge eating behavior (BE) has been associated to an increased risk of diabetes. However, it is unclear whether it contributes to increased glycometabolic risk regardless of lifestyle, excess body weight, and body composition. We carried out a cross-sectional study of 4799 subjects free of diabetes (68% women, mean age: 47 ± 13 years) with overweight (53.8%) and obesity (46.2%) recruited at the International Center for the Assessment of Nutritional Status (ICANS, University of Milan). All patients underwent a medical examination, anthropometric evaluation (weight, height and body fat by body skinfold), ultrasound measurements of abdominal visceral (VAT) and subcutaneous (SAT) fat, and blood sampling to measure glucose and insulin concentrations. Smoking and physical activity were investigated and the adherence to the Mediterranean diet was assessed by MEDAS questionnaire. BE was assessed using the Binge Eating Scale (BES) questionnaire (range score: 0–46). People with a BES score ≥ 18 were categorized as having BE. Overall, 18.4% of subjects had BE, with the prevalence increasing with increasing obesity severity (15.0% in overweight, 20.4% in class 1 obesity, 25.5 in class 2 obesity, 30.1% in class 3 obesity, p < 0.001). In the linear regression model adjusted for sex and age, BES was significantly associated with glucose (β = 0.05, 95%CI: 0.01, 0.08, p < 0.013), insulin (β = 0.10, 95%CI: 0.07,0.13, p < 0.001) and HOMA index (β = 0.03, 95%CI: 0.02, 0.04, p < 0.001). The association between BES and glycometabolic risk factors remained significant after inclusion of lifestyle factors (smoking, physical activity and adherence to the Mediterranean diet) in the model. However, after inclusion of BMI, total and abdominal fat, the association was lost. In conclusion, BE is associated with the severity of obesity. The contribution of BE to the glycometabolic risk appears to be mediated by excess body weight and body composition.

CO15 Clinical and demographic evaluation of a population of overweight/obese women with breast cancer

D. Capoccia¹, C. Gaita¹, G. Guarisco¹, M. Chinucci¹, G. Morsello¹, R. Parisella², S. Piroli², F. Ricci², E. Falco³, A. Calogero³, F. Leonetti¹

¹Dipartimento Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma, Polo Pontino, UOC Diabetologia U, Ospedale SM Goretti, Latina, Rome, Italy; ²Breast Unit, Ospedale SM Goretti Latina; ³Dipartimento Scienze e Biotecnologie Medico-Chirurgiche Latina, Latina, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO15

Background: Obesity and diabetes (DM) are risk factors for the development of breast cancer (BC), increasing the risk of triple negative (TNBC), luminal B breast cancer, metastasis and death, both pre and post-menopause.

AIM: to describe a population of overweight/obese women with BC in order to evaluate anthropometric and clinical characteristics relating to histological data.

Methods: 129 women with BMI > 25 kg/m² were enrolled, divided into four groups on the basis of the degree of overweight/obesity, and into two groups on the basis of the presence or absence of DM2. We analyzed weight, BMI, age at the onset of BC, presence or absence of metastases, time of exposure to previous estrogen or progestogen therapy, or both.

Results: 53/129 overweight (BMI 25–29.9) and 76/129 obese (BMI > 30) women were studied. Among the obese women, 44 showed BMI 30–34.9 (I° degree), 25 BMI 35–39.9 (II° degree) and 7 BMI > 40 (III° degree). The age of oncological diagnosis was anticipated in the higher degree of obesity (56,7 vs 61,3 years, in II° and III° degrees respectively, p = 0.005). The oncological diagnosis in premenopause was in 60% of women with II° and III° degree of obesity and in 30% of women with overweight and I °degree obesity. The presence of metastases was higher in obese than in overweight women. In the analysis of diabetic vs non-diabetic patients, a significant increase in diabetics was observed for the age at oncological diagnosis (65 vs 59.6 years,p = 0.04) and for the presence of metastases (24% vs 12.2%, p = 0.04). The oncological diagnosis in premenopause was more prevalent in diabetic women, showing that diabetes anticipates the onset of BC (36% vs 30.6%, p = 0.03). There was no apparent difference in the prevalence of TNBC histotype among the various degree of obesity. Lymph node invasion increased progressively with the increase of BMI.

Conclusions: obesity and diabetes anticipate the diagnosis of BC and increase the oncological diagnosis in the premenopause, positively relating with the presence of metastases and lymph node invasion.

CO16 Overvaluation of shape and weight and weight bias internalization in patients seeking treatment for obesity

R. Dalle Grave¹, B. Segattini ¹, G. Cattaneo¹, M. Chimini¹, A. Dalle Grave¹, L. Dametti¹, M. Manuela¹, S. Calugi¹

¹Casa di Cura Villa Garda Garda (VR), Garda (Verona), Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO16

Objective: The study aims to assess weight-bias internalization, restraint, eating, shape, and weight concern networks in seeking-treatment patients with obesity with or without overvaluation of shape and weight.

Methods: Overall, 2113 patients with obesity consecutively seeking treatment in a clinical center for obesity were recruited from January 2016 to February 2023. Body mass index was measured, and expert clinicians administered the Eating Disorder Examination (EDE) interview to assess the eating disorder psychopathology and overvaluation of shape and weight. Patients also completed the Weight Bias Internalization Scale (WBSI) to assess internalized weight stigma.

Results: 599 patients with obesity presented with clinical overvaluation of shape and weight, and 1514 without. Network analysis showed that the most central and highly interconnected nodes in the network of patients with overvaluation of shape and weight were related to depression and hate for being overweight (items of WBSI), preoccupation with food, eating, and calories, fear of losing control of the eating and social eating (items of EDE). Nodes highly interconnected in the network of patients without overvaluation of shape and weight were empty stomach, desire to lose weight, and dissatisfaction with body shape (items of EDE). The network comparison test identified similar global strength. However, network structure invariance differed significantly, indicating that the two networks were structurally dissimilar. No bridge nodes were identified in the two networks.

Discussion: The network structures in patients seeking treatment with obesity with and without overvaluation of shape and weight and including weight-bias internalization are structurally different, with different core features defining the networks. These data indicate the importance of considering the role of weight-bias internalization in patients with obesity and overvaluation of shape and weight.

CO17 Genetic variants in genes related to monogenic obesity in children and adolescents with obesity: an Italian single centre experience

A. Morandi¹, A. Maguolo¹, M. Corradi¹, C. Panzeri ¹, E. Fornari², F. Olivieri², C. Piona¹, F. Emiliani², C. Maffeis¹

¹Department of Surgery, Dentistry, Gynecology and Pediatrics, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy; ²Pediatria B, Az. Ospedaliera Universitaria Integrata Verona, Verona, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO17

Introduction: Non-syndromic monogenic forms account for 5–15% of the diagnoses of obesity in Europe.We screened our paediatric patients with a severe early-onset non-syndromic obesity, for monogenic obesity, to assess the prevalence of this disorder in our patient sample.

Methods: From January 2020 to December 2022, a custom panel including 16 genes (LEPR, POMC, ADCY3, PCSK1, CARTPT, SIM1, MRAP2, LEP, NTRK2, BDNF, KSR2, MAGEL2, SH2B1, MC4R, MC3R, GNAS) was analysed through NGS with iSeq100 Illumina platform in a total of 91 (45 males; 11.5 ± 6.5 years old) unrelated probands with severe (BMI > 99th WHO percentile) early-onset (< 5 years) non-syndromic obesity, at the Paediatrics B Unit of the University Hospital of Verona. The analysis was extended to first- and second-degree relatives when appropriate to help the variant pathogenicity interpretation. The InterVar Software (https://wintervar.wglab.org/) with manual adjustments was used to perform the variant pathogenicity interpretations according to the ACMG/AMP 2015 guidelines.

Results: Pathogenic or likely pathogenic heterozygous variants were identified in 10 subjects (3 males): 5 with 4 variants overall on MC4R (3 missense and 1 introducing stop codons); 2 with missense variants on POMC (one never reported in literature); other 3 probands with 3 missense variants: 1 on SIM1, 1 on NTRK2, and 1 on LEPR, never reported in literature, were identified. The mean age at the diagnosis was 9.1 years ± 5.3 SD with a mean WHO BMI SDS of 4.0 ± 0.0 SD. The patient with NTRK2 variant showed hyperphagia, attention deficit hyperactivity disorder and aspecific EEG alterations.

Conclusion: In our cohort of patients with early severe obesity, we found an 11% prevalence of diagnosed monogenic forms. This finding is in line with recent evidence showing a significant prevalence of monogenic obesity. Genetic analysis is crucial to identify individuals with mutations within the leptin/melanocortin pathway who may be candidates for targeted treatments.

CO18 Is body weight reduction the best predictor of efficacy after bariatric surgery? Results of a cluster analysis in a single center

L. Lotito¹, E. Franco², C. Sciacovelli², V. Pasquali², F. Pippa², E. Capobianco², F. Balsamo³, P. Bernante⁴, A. Paccapelo⁵, U. Pagotto², S. Garelli⁶

¹Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy; ²Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy; ³Center of metabolic and bariatric surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁴Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy; 3 Center of metabolic and bariatric surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁵Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, Bologna, Italy; ⁶Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO18

Introduction: Obesity is defined by WHO as a chronic pathological process that requires intervention. Lifestyle modification and pharmacotherapy are good therapeutic options, but their use is limited by poor weight loss outcomes and durability. Nowadays, bariatric surgery is the most effective treatment for morbid obesity, nevertheless, some patients report insufficient weight loss or weight regain. Predictive factors responsible for these results are unclear. To this extent, cluster analysis of patients undergoing bariatric surgery is a valid strategy to analyze simultaneously a wide pool of data and releasing the process from defining a priori criteria for efficacy.

Methods: Data of 80 subjects attending the Division of Endocrinology and Bariatric Surgery Unit at the IRCCS Azienda Ospedaliero-Universitaria of Bologna were analyzed. Three timepoints were considered (before surgery, 6 and 12 months after surgery) and hierarchical cluster analysis was applied. The variables included in the analysis were: weight parameters (body weight, BMI, excess body weight—EBW, excess body weight loss—EBWL), obesity comorbidities and related drugs and metabolic laboratory data.

Results: The analysis identified two groups of patients (G1 and G2). The pre-surgical difference between groups is that G1 consisted of subjects with less severe metabolic derangement compared to G2: lower values of hematocrit and ferritin (signs of OSAS and steatosis), and better glucose and lipid profile. After surgery, G1 showed greater weight reduction compared to G2 (1 year after surgery: EBW 10.6 ± 10.9 kg vs 18.8 ± 9.4 kg (P = 0.011), EBWL 80.0 ± 21.8 kg vs 63,8 ± 15,6 kg (P = 0.013)), but no difference in laboratory parameters was present anymore. In G2 a higher proportion of subjects stayed on obesity-related medications compared to G1.

Conclusion: In our study, higher degree of obesity and greater number of comorbidities before surgery were associated with poorer weight loss and lower comorbidities remission rate after surgery. Nevertheless, metabolic control and medical treatments did improve similarly in all patients after surgery. These data underline the importance to redefine efficacy parameters after bariatric surgery, beyond body weight loss; also, they suggest to consider this therapeutic option even in very complex obese patients.

Oral communications 3—basic science

CO20 Dapagliflozin counteracts the pro-apoptotic effects of the secretome of visceral adipose cells from obese subjects in human cardiac progenitor cells via the SGLT2 co-transporter

G. Palma¹, C. Caccioppoli¹, R. D'Oria¹, V. A. Genchi¹, I. Calderoni¹, A. Braun², T. Bottio¹, G. Santarpino³, A. Cignarelli¹, A. Natalicchio¹, L. Laviola¹, A. Pezzolla¹, A. D. Milano¹, F. Giorgino¹, S. Perrini¹

¹Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica, Università degli Studi di Bari Aldo Moro, Bari, Italy; ²GVM Care & Research Bari, Bari, Italy ³GVM Care & Research, Lecce, Bari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO20

SGLT2 inhibitors have been shown to counteract heart failure outcomes in subjects with type 2 diabetes and obesity. We investigated the mechanisms of the protective action of Dapagliflozin (DAPA), an SGLT2 inhibitor, in human cardiac progenitor cells (hCPC) exposed to the conditioned medium (CM) from abdominal visceral (AV) and epicardial (E) adipose stem cells (ASC) and from AV mature adipocytes from obese subjects. ASC and mature adipocytes were isolated from AV adipose tissue biopsies of 27 obese (Ob) and 19 non-Ob subjects (n-Ob), and from E adipose tissue biopsies of 9 Ob and 10 non-Ob subjects, respectively. hCPC were isolated from right auricle biopsies of 10 healthy non-Ob donors. Exposure of hCPC to the CM of adipose cells from Ob, but not from non-Ob subjects, induced apoptosis, c-Jun phosphorylation, and impairment of actin filaments, as assessed by ELISA assay and immunofluorescence, respectively, while these effects were not observed when the hCPC were pretreated with DAPA. The CM of adipose cells from Ob compared to n-Ob subjects displayed a different pattern of pro-inflammatory and anti-inflammatory cytokines. The levels of pro-inflammatory cytokines such as RANTES and MIP1β were increased in the CM from AV-ASC with higher BMI (p < 0.05), while the levels of anti-inflammatory factors such as GCSF in the CM of E-ASC were inversely correlated with BMI (p < 0.05). SGLT2 was found to be expressed as both mRNA and protein in the hCPC, and silencing of SGLT2 with a specific siRNA attenuated the capacity of DAPA to counteract the pro-apoptotic effects of the CM. In conclusion, we show that: i) in human obesity, the CM of both AV- and E-ASC and mature adipocytes is characterized by pro-inflammatory cytokines that induce stress kinase activation and apoptosis in the hCPC; ii) hCPC express SGLT2 mRNA and protein; iii) DAPA prevents the hCPC damage induced by the CM through an SGLT2-dependent mechanism.

CO21 Lipid remodelling capacity in human peripheral blood mononuclear cells: a link to metabolic disease?

R. Risi¹, G. Bidault², S. Virtue², A. Vidal-Puig²

¹Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy; ²Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital Cambridge, Cambridge, UK

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO21

Introduction: Obesity associates with cardiometabolic diseases but factors predicting their development in individuals at similar level of adiposity are still to be uncovered. According to the AT expandability hypothesis, the incapacity of adipocytes to meet the increasing lipid storage demand leads to ectopic fat deposition in key organs and cells, such as adipose tissue macrophages, leading to inflammation and cardiometabolic diseases. Saturated fatty acids (SFAs), such as palmitate, cause macrophages metabolic activation and their circulating levels correlate with cardiometabolic disease.Macrophages transform SFAs into less toxic forms through a lipid-remodelling system made by two enzymes, Stearoyl-CoA desaturase (SCD) and Elongase of very-long-chain fatty acids 6 (ELVOL6), maintaining lipid homeostasis and escaping from lipotoxicity.

Hypotheeesis: (1) Macrophages' resilience from lipotoxicity depends on their lipid remodelling capacity; (2) Macrophages' lipid remodeling ability is reflected by other circulating cells (PBMCs and monocytes).

Aim: To evaluate palmitate remodelling capacity in circulating PBMCs, monocytes and monocytes-derived macrophages from unknown human donors and its association with lipotoxicity.

Methods: PBMCs, monocytes and monocytes-derived macrophages were isolated from unknown donors. The three cell types were treated with increasing doses of stably-labelled 13C palmitate. After 16–18 h, cellular lipids were analysed by GC–MS lipid analysis to evaluate the lipid remodelling capacity of the cells (SCD and ELVOL6 activity). Gene expression analysis was performed to assess lipotoxicity.

Results: PBMCs, monocytes and macrophages performed lipid remodeling in response to palmitate exposure. Lipid remodeling capacity was different between donors and associate with markers of lipotoxicity. The ability to transform palmitate was lower in monocytes and PBMCs, compared to macrophages. Lipid remodeling ability of macrophages was reflected by monocytes, but not by PBMCs.

Conclusion: Blood-derived mononuclear cells from unknown human donors show a measurable adaptive response to palmitate, which was variable between individuals. Further step will be the evaluation of the lipid remodeling capacity in humans with known cardiometabolic profile.

CO22 Increased fibrosis and mast cells infiltration in a case of multiple symmetric lipomatosis (MSL)

G. Scabia¹, S. Greco², P. Pellegrino², P. Ciarmelo², A. Dattilo³, R. Semple⁴, G. Gatti⁵, A. Giacomina⁵, E. Statuti⁶, G. Fiacchini⁶, S. Berrettini⁶, G. Ceccarini⁶, F. Santini⁶, M. Maffei¹, S. Cinti²

¹CNR, Institute of Clinical Physiology, Pisa, Italy; ²Department of Experimental and Clinical Medicine, Marche Polytechnic, University Ancona, Ancona Italy; ³Scuola Superiore Sant'Anna Pisa, Pisa, Italy; ⁴University of Edinburgh, Edinburgh, UK; ⁵University Hospital Pisa, Pisa, Italy; ⁶University of Pisa, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO22

Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by symmetric overgrowth of lipomatous tissue (LT) in the subcutaneous adipose tissue (SAT) usually in the dorsal part of the neck invariably sparing legs and arms.

We herein describe the case of a male patient affected by MSL. The patient, without alterations of SAT distribution until the age of 35, showed a massive accumulation of SAT in the neck/back and in the chest areas. He tested negative for mutations in the genes coding for MFN 1 or 2 (described in other MSL), and did not present metabolic abnormalities.

Electron microscopy revealed 5 main abnormal features: excessive collagen accumulation, alterations of mitochondrial shape, abundant infiltration of mast cells with signs of degranulation, loss of inter-adipocyte junctions, signs of endothelial and pericyte hyperplasia. qPCR executed on 2 different biopsies from the same patient and on 8 biopsies from healthy age-sex matched controls confirmed higher expression of collagen and mast cells markers in the MSL patient. Leptin and adiponectin were also more abundant in the MSL biopsies.

These data were combined to build a model of interpretation, in which mast cells exert two pivotal actions: 1. histamine release, as suggested by their degranulation in MSL, may cause reduction of gap junctions, which in turn causes an increase in extracellular space, eventually filled by overproduction of collagen 2. increased adipogenesis as suggested by rodent studies demonstrating that the absence of mast cells impairs correct adipocyte differentiation. MC promote in fact lipid uptake by macrophages and foam cell formation. In response to high glucose levels, mast cells release 15-deoxy-delta prostaglandin J2, which binds PPARγ in pre-adipocytes promoting their transition to adipocytes.

Conclusion: Mast cells recruitment into SAT could thus represent a main determinant of MSL excessive fat accumulation as well as of its peculiar ultrastructure.

CO23 Protein kinase CK2: a potential therapeutic target in liposarcoma

A. Pilatone¹, C. Borgo², G. Spolverato³, C. Benna³, S. Pucciarelli³, M. Sbaraglia¹, A. Dei Tos¹, S. Richter⁴, L. Busetto¹, R. Vettor¹, M. Ruzzene², G. Milan¹

¹Department of Medicine, Internal Medicine 3, University of Padua, Center for the Study and the Integrated Treatment of Obesity, Padua Hospital, Padua, Italy; ²Department of Biomedical Sciences, University of Padua, Padua, Italy; ³Department of Surgery Oncology and Gastroenterology, University of Padua, Padua, Italy; ⁴Department of Molecular Medicine, University of Padua, Padua, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO23

Liposarcomas (LPSs) are a group of rare malignant adipocytic tumors among which the most common subtypes are Well-Differentiated LPS (WDLPS) and DeDifferentiated LPS (DDLPS). Due to their resistance to conventional radiotherapy and chemotherapy, novel and more effective systemic treatments are under investigation to ameliorate LPS patient prognosis¹. In the present study, we investigated CK2 as a possible therapeutic target. This protein is a constitutively active Ser/Thr kinase, composed of 2 catalytic (α/α’) and 2 regulatory (β) subunits, whose up-regulation is associated with both carcinogenesis and adipose tissue (AT) pathological expansion in patients with obesity and diabetes².

Here we aimed to characterize the expression of CK2 subunits in LPS cell lines and patient samples, and evaluated the effects of CK2 inhibitors, alone or in combination with other drugs, on LPS cell viability.

We analyzed CK2α/α’ and β protein levels and the phosphorylation of CK2-specific targets, by Western Blot, and we found that they are higher in the fibroblast-like 93T449 human LPS cell line (ATCC-CRL 3034) than in control human lung fibroblasts. Similarly, WDLPS and DDLPS patient samples displayed higher protein level of CK2 subunits and higher phosphorylation of CK2 targets compared to non-tumor control AT biopsies.

All the tested CK2 chemical inhibitors (CX-4945, SGC-CK2-1, TDB)² were able to induce cell death when used for 93T449 cell treatment and assayed by MTT viability test. Moreover, when used in combined treatments, they sensitize cells to other compounds, significantly reducing the effective doses of conventional or still unapproved chemotherapeutic drugs. In conclusion, our results suggest that CK2 is a promising druggable target in LPS.

References

1. Jones, R. L. et al. J. Clin. Oncol. 36, 151–159 (2018).

2. Borgo, C. et al. Signal Transduct. Target. Ther. 6, 1–20 (2021).

CO24 Morphological characterization of adipose tissue from patients affected by lipedema

S. Michelini¹, S. Greco², N. Vaia³, V. Puleo⁴, P. Pellegrino², A. Giordano², S. Michelini⁵, K. Herbst ⁶, G. Goteri⁷, S. Castorina⁸, P. Ciarmela², S. Cinti²

¹Servizio di Diagnostica e Riabilitazione Vascolare Ospedale di Marino, Roma, Rome, Italy; ²Medicina Sperimentale e Clinica, Ancona, Italy; ³Chirurgia Plastica, Ricostruttiva ed Estetica, European Hospital, Roma, Rome, Italy; ⁴Dipartimento di Scienze e Sanità pubblica Università Cattolica Policlinico Gemelli, Roma, Rome, Italy; ⁵Medicina Fisica e Riabilitazione Università La Sapienza, Ospedale S. Andrea, Roma, Rome, Italy; ⁶Total Lipedema Care, California, US; ⁷Department of Biomedical Sciences and Public Health, Ancona, Italy; ⁸Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Catania, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):CO24

Lipedema is a pathology of unknown origin that mainly affects women. It is characterized by abnormal bilateral symmetrical increased subcutaneous fat in the limbs, with no involvement of the trunk. While fat accumulation in obese patients does not cause specific symptoms, in patients with lipedema the abnormal increase of fat causes pain, increased vascular fragility and easy bruising. A specific ultrastructural characterization of fat from patients suffering for lipedema has not been reported jet.

We sought to compare adipose tissue of 10 normal weight patients affected by lipedema (stage II) by comparing the morphology of affected and healthy areas (20 biopsies). We also studied fat biopsies from 10 obese and 15 lean patients for comparison.

We performed: light microscopy, morphometry and ultrastructural (TEM) analyses.

Data showed, as common characteristic feature of affected areas, a peculiar aspect of capillary vessels. They showed: 1-hypercellularity either due to endothelial as well as perivascular cells; 2-thickened and reticulated basal membrane; 3-irregular shape with apparent hyperplasia of endothelial cells; 4-degenerative aspects in endothelial cells; 5-presence of several pericytes embedded in the basal membrane; 6-dense calcium deposits.

Adipocytes showed: variable amount of cytoplasmic calcium deposits and frequent signs of degenerative alterations.

Morphometry data showed an increased size of adipocytes from affected area compared to non-affected area in 8/10 patients.

Our data showed that the adipose tissue from normal weight women affected by lipedema has characteristic morphological alterations, never present in lean and obese patients and quite specific of the affected areas. Considering our previous data on the origin of adipocytes from endothelial cells, our results strongly point to endothelial cells of fat capillaries as the key abnormal cell type in the lipedema pathogenesis.

Best poster 1

BP01 Ketogenic diet prevents the development of atherosclerosis in apolipoprotein E knockout mice

V. Marzolla¹, A. Armani², C. Mammi¹, S. Gorini², E. Camajani³, M. Caprio²

¹Laboratory of Cardiovascular Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy; ²Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy; Laboratory of Cardiovascular Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy; ³Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP01

Higher aldosterone (aldo) levels are associated with increased risk of cardiovascular ischemic events and mortality. It has been demonstrated that aldo accelerates the development of atherosclerosis in apolipoprotein E knockout mice (ApoE KO). Ketogenic diet (KD) positively impacts several cardiovascular risk factors, yet its effect on atherosclerosis is elusive. We hypothesize that KD protects from development of atherosclerotic plaques in ApoE KO mice, a murine model of atherosclerosis. Eight-week-old male ApoE KO mice were fed a KD (90.5% Kcal from fat, 0.4% Kcal from carbohydrate, 9.1% Kcal from protein) or a moderate high fat diet (HFD) (42% Kcal from fat, 42.7% Kcal from carbohydrate, 15.2% Kcal from protein) and treated with aldo (6 μg/mouse per day) or vehicle through osmotic mini-pumps. Cholesterol content was comparable in KD and HFD. After 4 weeks of treatment, we analysed the atherosclerotic plaque size, lipid and collagen content. We assessed vascular inflammation in speciments of thoracic aorta by analysing pro-inflammatory and anti-inflammatory genes. In ApoE KO mice treated with aldo, KD determined a significant improvement in glucose tolerance, compared to mice fed a HFD, without any significant effect on body weight. Beta-hydroxybutyrate levels were always significantly higher in KD-mice, confirming nutritional ketosis in KD-mice. Analysis of aortic root showed that aldo treatment determined a significant increase in atherosclerotic plaque size and lipid content in HFD-mice. Such effects were significantly reduced in KD-mice, suggesting a favorable impact of ketosis in preventing atherosclerosis development. Plaque fibrosis did not differ among treatment groups. Finally, we observed a significant reduction in vascular inflammatory markers in KD-mice, when compared to HFD-mice. In particular, KD determined a reduction in gene expression of pro-inflammatory markers (ICAM-1, VCAM-1, IL-6, TNF-α, MCP-1) with the concomitant up-regulation of anti-inflammatory markers (Arg-1, RETNLA, CCL5), compared to HFD. The study suggests KD as a potential non-pharmacological approach to prevent atherosclerosis development in subjects with high cardiovascular risk.

BP02 The effects of very low calorie ketogenic diet (vlckd) on cardio-metabolic profile in patients with obesity

R. M. Natale¹, V. Trapanese¹, F. Giofrè¹, C. Vatalaro¹, F. Cosentino¹, M. Melina¹, G. Armentaro¹, A. Sciacqua¹, F. Arturi¹

¹Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia” di Catanzaro, Catanzaro, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP02

Background: Very low calorie ketogenic diet (VLCKD) has been proposed as an effective intervention for obesity. Hyperketonemia induced by VLCKD is associated with beneficial cardiovascular effects. In addition, ketogenic diet is able to prevent mitochondrial fission, improve mitochondrial function, suppress oxidative stress and attenuate cardiac myocytes apoptosis in the heart of mice.

Aim: To evaluate the role of VLCKD on cardio-metabolic risk factors, cardiac dysfunction and myocardial remodelling in obese patients.

Materials and methods: Ten obese patients treated with VLCKD were enrolled. All patients were characterized from an anthropometric, cardio-metabolic and echocardiographic point of view at baseline and 8 weeks after VLCKD treatment. In addition, each patient underwent measurement of global myocardial work efficiency (GWE), a novel indicator that accounts for deformation and afterload, which may provide additional value for assessment of myocardial function. The insulin resistance was evaluated by HOMA-IR.

Results: As expected, all the patients experienced a significant reduction in body weight and an overall improvement of body composition parameters after VLCKD. Weight (kg) (from 105.1 ± 18.2 to 83.7 ± 16.7, P < 0.05), BMI (kg/m²) (from 40.1 ± 4.7 to 31.8 ± 4.8, P = 0.002) and waist circumference (cm) (from 115 ± 13.6 to 101.8 ± 12.4, p < 0.05) were significantly lower after VLCKD treatment. VLCKD treatment improved also significantly fasting glucose (P < 0.05), fasting insulin (P = 0.004), HOMA IR (P < 0.001), lipid profile and blood pressure. In addition, we observed an improved in left ventricular end-diastole volume, left ventricular end-systole volume, left ventricular mass and left ventricular mass index. Interestingly, a significantly changes in GWE was observed (P < 0.05).

Conclusion: Although preliminary, our data suggest that VLCKD treatment is able to reduce cardio-metabolic risk factors and to improve cardiac dysfunction and myocardial function.

BP03 Effects of Vlckd-induced weight loss on the cardiometabolic risk profile of patients with obesity

E. Colonnello¹, R. Risi¹, F. Cipriani¹, M. C. Massari¹, G. M. Baldazzi¹, S. Migliaccio², M. Watanabe¹, S. Mariani¹, C. Lubrano¹, S. Basciani¹, L. Gnessi¹

¹Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy; ²Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP03

Introduction: Obesity, in particular visceral adiposity, is associated with cardiovascular morbidity and mortality. Among the markers of this prothrombotic, proinflammatory state in patients with obesity, increased Visceral Adiposity Index (VAI), increased number of platelets (PLT) and their hyperactivation, as reflected by an increased mean platelet volume (MPV), have been found. This study examined the correlation of a very low-carbohydrate ketogenic diet (VLCKD)-induced weight loss with systolic (SBP) and diastolic (DBP) blood pressure and other markers of cardiometabolic risk in a cohort of patients with obesity.

Methods: 48 subjects with obesity (19 males, 29 females, mean age: 55.2 ± 7.3; mean BMI = 35.9 ± 4.3) were enrolled at the Center of High Specialization for the treatment of Obesity), Policlinico Umberto I, Rome. At baseline (t0) and after 12 weeks of VLCKD (t1), all patients underwent clinical and biochemical evaluation and DXA examination for body composition.

Results: At t0, VAI was positively correlated with BMI and inversely with HDL and total lean mass. At t1, a significant weight reduction (mean reduction: -12.8 kg, p < 0.001) was observed. Total fat, trunk fat and waist circumference (all p < 0.001) decreased significantly, concomitant with good preservation of lean mass. Total cholesterol (p = 0.001), triglycerides (p = 0.003), SBP and DBP (p < 0.001) were significantly reduced. However, as no significant effects were seen on HDL, VAI reduction was not significant. While no significant effects were observed on MPV, PLT count significantly decreased (p < 0.001).

Discussion and conclusion: VLCKD is associated with an improvement of the cardiometabolic risk profile of patients with obesity at 12 weeks. Particularly, a significant reduction in PLT is observed, suggesting an amelioration of thrombotic and cardiovascular risk.

BP04 A mildly hypocaloric ketogenic diet as potential therapeutic tool in women with polycystic ovary syndrome

R. Rossetti¹, V. Strinati¹, A. Caputi¹, R. Risi¹, M. L. Spizzichini¹, A. Mondo², L. Spiniello², A. Giancotti², L. Gnessi¹, C. Lubrano¹, M. Watanabe¹

¹Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy; ²Department of Maternal and Child Health and Urologynecological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP04

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder of women in fertile age, presenting with anovulatory oligomenorrhea, hyperandrogenism and polycystic ovaries, frequently associated with metabolic syndrome. Causal treatment is not available, with guidelines suggesting lifestyle modification as the first therapeutic approach. The ketogenic diet (KD) is effective in the short-term treatment of several metabolic conditions. Some studies suggest that there may be a role for PCOS, although mostly very low-calorie approaches in obesity were leveraged, and only short-term evaluations being available.

Aim: We aimed to assess the persistence of the effect of an isocaloric or mildly hypocaloric KD in patients with PCOS and normal or excessive weight.

Methods: 22 patients with PCOS and oligomenorrhea were enrolled (18% normal weight, 18% overweight, 64% obese). All followed a KD with no meal replacements for 45 days, then legumes and fruit were reintroduced as source of carbohydrates, and 13 completed the study. The patients were assessed before starting the diet and after 6 months. Anthropometric data (weight, BMI, waist circumference), body composition (DEXA), pelvic ultrasound, blood chemistry, hirsutism and menstrual cycles frequency were recorded.

Results: Over 4 months after the end of the KD, all patients maintained improvements in body composition, ovarian volume and menstrual frequency. The Ferriman-Gallwey score showed a reduction in hirsutism in both lean and overweight. Moreover, FSH and LH had a trend towards improvement, but testosterone remained stable, suggesting that the results may not depend on androgens.

Conclusions: our study showed that KD in PCOS has beneficial effects in the medium term, even in normal-weight women and it could represent a valid and well tolerated therapeutic option. Moreover, not leveraging meal replacements represent a cost-effective alternative to commonly used very low calorie approaches, with comparable results.

BP05 Dynamics of gut microbiota and clinical variables after long-term (12 months) ketogenic and Mediterranean diets in Drug-naïve patients with type 2 diabetes mellitus and obesity

A. Deledda¹, V. Palmas², L. Puglia¹, M. Fosci¹, G. Sanna², V. Heidrich³, G. Camabarau¹, A. Lai⁴, M. Melis¹, E. Loi¹, A. Loviselli¹, A. Manzin², F. Velluzzi¹

¹Obesity and Endocrinology Units, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; ²Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; ³Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil; ⁴Diabetologia, P.O. Binaghi Cagliari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP01

Type 2 diabetes mellitus (T2DM) is a progressive chronic metabolic disease that has increasingly spread worldwide, enhancing the mortality rate, particularly from cardiovascular diseases. Lifestyle improvement through diet and physical activity is, together with drug treatment, the cornerstone of T2DM management. The Mediterranean diet (MD) is usually recommended, but recently, scientific societies have promoted a very low-calorie ketogenic diet (VLCKD), a multiphasic protocol that limits carbohydrates and then gradually reintroduces them, with a favorable outcome on body weight and metabolic parameters. The gut microbiota (GM) modifications have been linked to overweight/obesity and metabolic alterations typical of T2DM. Diet is known to affect GM, but only a few studies have investigated the effects of VLCKD on GM, especially in T2DM.

We have extended the results obtained from a previous study, which evaluated the effect of nutritional intervention (NI) up to three months, to a 12-month follow-up in the same patients. We have compared the clinical parameters, the quality of life and the GM of 11 patients with recently diagnosed T2DM and overweight or obesity, randomly assigned to a VLCKD (KETO group:6 patients) or hypocaloric MD (MEDI group:5 patients); data were recorded at baseline (T0), after two (T2), three (T3), six (T6) and twelve months (T12) of NI. The GM analysis was performed through Next Generation Sequencing of the V3 and V4 hypervariable region of the 16S rRNA gene on the MiSeq Illumina platform. The results showed that VLCKD had significant effects on GM composition over time, while MD showed no significant results at T6 nor T12. In the KETO group, a significant increase in beneficial microbial taxa such as Verrucomicrobiota phylum with its members Verrucomicrobiae, Verrucomicrobiales, Akkermansiaceae and Akkermansia was observed until T6, while their significant reduction was observed from T6 to T12. Moreover, alterations linked to some metabolic pathways were found exclusively in the KETO group.

In conclusion, both dietary approaches allowed patients to improve their state of health, but VLCKD has shown better results on anthropometric indices as well as on GM profile, especially up to T6 of NI.

BP06 The road to precision nutrition: studying the relationship between chronotype and taste thresholds in subjects with obesity

S. P. Mambrini¹, R. De Amicis¹, C. Cattaneo², M. Scacchi³, E. Pagliarini², S. Bertoli¹

¹International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan; Istituto Auxologico Italiano, Milan, Italy; ²Sensory & Consumer Science Lab (SCS_Lab), Department of Food, Environmental and Nutritional Milano; ³Department of Clinical Sciences and Community; Istituto Auxologico Italiano Health, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP06

Introduction: Many physiological events follow circadian rhythmicity include sleeping, eating, hormone and neurotransmitter secretion. Circadian disruption, typical of serotine subjects, can result in disorders such as diabetes, obesity. Is known as serotine subjects have a higher incidence of eating disorder such as binge eating or food addiction. We also know how subjects with obesity have altered taste thresholds for both sweet and savory. Considering this, the purpose of this pilot study is to investigate the relationship between chronotype and taste thresholds in subjects with severe obesity.

Methods: The taste thresholds of sweet and salty and chronotype were assessed in a sample of 34 obese subjects. An ISO13301:2018 (E) methodology, i.e., 3-Alternative-Forced-Choice (3-AFC), was used to determine the taste thresholds of the sample. The assessment of chronotype was carried out through the Reduced Morningness-Eveningness Questionnaire (rMEQ).

Results: statistical analysis showed that serotine subjects have a higher BMI than morning subjects (R = − 0.350, p < 0.012), as expected. In addition, Pearson's correlation returned a significant negative correlation between salty taste thresholds and chronotype: serotine subjects presented significantly higher thresholds (low sensitivity) for salty taste compared to morning subjects (R = − 0.322 p < 0.032). For sweet taste, on the other hand, only a negative trend between threshold and chronotype was observed.

Discussion: the results of this study could provide novel indications for a precision nutrition, suggesting also the use of the relation between chronotype and taste thresholds in the dietary intervention.

BP07 Can NAFLD regress by replacing just one portion of starchy carbohydrates with green leafy vegetables?

S. De Nucci¹, R. Rinaldi¹, M. Di Chito¹, R. Donghia², V. Giannuzzi³, E. Shahini³, R. Cozzolongo³, P. L. Pesole⁴, S. Coletta⁴, G. De Pergola¹, G. Giannelli⁵

¹Unità di Geriatria e Medicina Interna, Istituto Nazionale di Gastroenterologia – IRCCS "Saverio de Bellis" Castellana Grotte, Bari, Italy; ²Unità di Data Science, Istituto Nazionale di Gastroenterologia—IRCCS "Saverio de Bellis" Castellana Grotte, Bari, Italy; ³Unità di Gastroenterologia, Istituto Nazionale di Gastroenterologia—IRCCS "Saverio de Bellis" Castellana Grotte, Bari, Italy; ⁴Istituto Nazionale di Gastroenterologia—IRCCS "Saverio de Bellis" Castellana Grotte, Bari, Italy; ⁵Direzione Scientifica, Istituto Nazionale di Gastroenterologia—IRCCS "Saverio de Bellis Castellana Grotte, Bari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP07

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease globally, whose prevalence rose in Italy, levying a considerable burden on the national healthcare system. The gold standard treatment for NAFLD is weight loss and lifestyle interventions. The aim of the study was to ascertain the effects of a diet enriched by green leafy vegetables, and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three months period. 24 patients with obesity and NAFLD, who do not take medication, enrolled in the National Institute of Gastroenterology—IRCCS “Saverio de Bellis” completed the clinical trial consisting of swapping one portion of carbohydrates-rich food for one portion of green leafy vegetables. The additional portion of vegetables was considered to be 200 g. The population under study had a median age of 47.5 years and included mainly women (70.8%). All patients underwent fibroscan, blood tests, anthropometric measurements, and bioelectrical impedance analysis before and after dietary intervention. We found that Fatty Liver Index used to predict fatty liver and the FAST score (FibroscanAST), a fibroscan-derived parameter identifying the risk of progressive NASH, were both significantly improved after changes in diet. BMI, waist circumference, neck circumference, fat mass and extracellular water were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c, triglycerides, AST and γGT. Fibres reduced and slowed the absorption of carbohydrates and lipids, lowering the energy density of the meal and increasing the sense of satiety. Furthermore, polyphenols and bioactive compounds of vegetables had antioxidant and anti-inflammatory properties preventing disease progression. In conclusion, we demonstrate that just one single daily diet change, such as replacing only one portion of starchy carbohydrates with one portion of vegetables, is enough to improve, after only three months, the degree of NAFLD.

BP08 Relationship between ultra-processed foods consumption and adherence to the Mediterranean diet, in a group of women with overweight/obesity

M. S. Lonardo¹, E. Fiorillo¹, C. Gautiero¹, M. Di Lorenzo¹, M. Chiurazzi¹, D. Palmieri¹, N. Cacciapuoti¹, A. Belfiore¹

¹Department of Clinical Medicine, University of Study of Naples Federico II, 80131 Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP08

The term "ultra-processed foods" (UPFs) refers to industrial preparations with substances not routinely used in cooking. The increased consumption of UPFs has coincided with an increased prevalence of noncommunicable diseases in many countries, suggesting a possible association with health status. Finally, UPFs interfere with satiety signals, and their satisfying nature can cause true addiction, resulting in increased of overall food intake

The purpose of this study was to assess UPFs consumption in relation to overweight and obesity and to evaluate the possible relationship between Mediterranean Diet (MD) adherence and UPFs consumption.

31 female subjects (Body Mass Index, BMI ≥ 25 kg/m²) attending at Outpatients Clinic of the I.P. “Diet Therapy in transplantation, renal failure and chronic pathology”, University of Naples Federico II, were enrolled. Anthropometric measurements were evaluated at baseline as well as the NFFQ (NovaFood Frequancy Questionaire), for assessment of UPFs consumption and the PREDIMED for assessment of adherence to the MD, were administered.

Then, the population was stratified by BMI classes (Group 1, n° 9 BMI 25–29,9 kg/m²; Group 2, n°10 BMI 30–39,9 kg/m²; Group 3, n°12 BMI > 40 kg/m²).

The consumption of UPFs was: 198.2 ± 86.1 g/day (15 ± 5.4% of energy intake); 355.9 ± 78.7 g/day (25 ± 5.4% of energy intake); 506.6 ± 174.3 g/day (27 ± 8.2% of energy intake) (Group 1, Group2, Group 3, respectively; p < 0.002).

In addition, as BMI increased, a decrease in MD adherence (PREDIMED score) was observed: 7.7 ± 1.2; 6.1 ± 0.3; 4.6 ± .7. (Group 1, Group 2, Group 3, respectively (p < 0.001).

Our results suggest an association between higher BMI, higher daily consumption of UPFs and lower adherence to MD. Further studies are needed to clarify the association between consumption of UPFs and health status.

BP09 Neurophysiological evidence of improved cognitive and attentional control toward food images in obese individuals after laparoscopic sleeve gastrectomy

F. Moltrer¹, G. Testa², S. Schiff³

¹Azienda Ospedale Università di Padova, Padova, Italy; ²Universidad Internacional de La Rioja, Logroño, La Rioja, Logroño, Spain; ³Dipartimento di Medicina DIMED—Università degli Studi di Padova, Padova, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP09

Obesity has been associated with enhanced attentional bias and poor cognitive control, especially in presence of food-related stimuli. Initial evidence for cognitive improvement after surgery exist however, neurophysiological correlates of these processes are poorly investigated, and longitudinal studies are needed.

The aim of the study was to assess neurocognitive changes 12 month after LSG.

Twenty-three obese individuals were tested before and 12 months after bariatric surgery. Cognitive control and attentional bias toward food were investigated with two choices reaction time task (a modified Simon task with central presentation of distracting food and non-food images) and a neutral condition without distracters. All participants were evaluated in fasted state. Electroencephalography was recorded from 29 electrodes on the scalp and event-related brain potentials (ERPs) P2, N2 and P3 amplitudes and latencies were obtained for each participant.

Behavioral results showed that in obese individuals’ food-distracting images interfered with goal-directed behaviors during task execution. Interesting a reduction of this food-related interference is observed post bariatric surgery.

Neurophysiological results showed that ERPs indices of general attention (P2) and cognitive control (N2) were enhanced after LSG. Higher N2 amplitude in frontal electrodes after surgery may suggest higher recruitment of frontal areas during conflict detection processes post-LSG.

In conclusion, the present findings suggest motivational and attentional bias toward food-stimuli which interferes with cognitive control in obese candidates for bariatric surgery is reduced post-LSG. Neurophysiological indices suggested mechanisms of selective attention and cognitive control in obese individuals’ candidate to bariatric surgery ameliorate post-LSG, possibly reflecting a general neurocognitive improvement.

Best poster 2

BP10 Digital therapy for obesity app (DTXO) for obesity treatment: quantitative and qualitative evaluation of patient and physicians perceptions using focus groups

R. De Amicis¹, G. Castelnuovo², P. Capodaglio³, L. Gilardini⁴, S. P. Mambrini⁴, G. Pietrabissa², L. Cavaggioni⁴, G. Piazzolla⁵, C. Galeone⁶, A. Ferri⁷, F. Santafede⁸, S. Bertoli¹

¹IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy 2 ICANS-DIS, DeFENS, University of Milan, Milan, Italy; ² Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy; 4 Department of Psychology, Catholic University of Milan, Milan, Italy; ³Orthopaedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy; 6 Dept. Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, It Milano, Turin, Italy; ⁴IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy; ⁵Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy; ⁶ Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy; 9 Biostatistics & Outcome Research, Statinfo, Milan, Italy; ⁷Advice Pharma Group S.r.l Milano; ⁸Advice Pharma Group S.r.l., Information Technology Unit Milano, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP10

Digital Therapy is a promising strategy for weight loss interventions in overweight and obesity. Recently, AdvicePharma Group, with Theras Lifetech and the Nutrition and Obesity Research Laboratory of IRCCS Auxologico, developed the Digital Therapy for Obesity App (DTxO), a Medical Device to simultaneously administer a life-style weight loss program (LS-WLp), consisting of energy-reduced diet, physical activity, and cognitive-behavioral program.

This work aims to estimate the usability of DTxO in patients with obesity exposed to an experimental LS-WLp program.

Two focus groups, one of 8 adult patients with obesity and one of 5 physicians, were conducted for one week to collect quantitative and qualitative data. The activities performed were the APP use simulation, questionnaires and open-ended questions. For the physician side, open discussion and brainstorming consensus meetings were performed. The Net Promoter Score (NPS), an index ranging from -100 to 100, used as a proxy for gauging the customer’s overall satisfaction with a company’s product, was calculated.

Patients (50.75 [38–66] years; BMI of 36.6 [31.2–40.5] kg/m², 75% female) were already used to monitor their weight or their physical exercise using apps. All reported the dietary section, with shopping list and videorecipes, as the most useful of the DTxO. Exercises were well described, motivational phrases useful, and spontaneous activities easy to be inserted. Patients underlined the importance of keeping moderated the mindfulness exercises length and the questionnaires amount. They suggested to receive awards and a review to obtain a comprehensible language. The calculated NPS was 38. Physicians perceived interface as clear, not burdensome, properly supporting the correct use. Some underlined the importance of keeping information at minimum levels; the interoperability was well appreciated.

DTxO received an overall positive evaluation by patients: sections regarding diet, exercise program and behavioural activities were considered a support to self-tracking. Pop ups and notifications were approved, and more were requested as nudges. The NPS showed an acceptable result. Physicians positively evaluated the platform, the information collected was perceived as sufficient and comprehensive.

BP11 Use of an innovative anthropometric software for the management of obese patients in therapy with liraglutide

M. Mattioli¹, L. Valerii¹, L. Di Netti¹, D. Angelino², M. Serafini², E. D'Agostino³, P. De Cristofaro¹

¹Centro regionale di riferimento SIO Castellalto, Teramo (TE), Italy; ²Bioscienze e tecnologie agro-alimentari e ambientali, Università di Teramo, Teramo, Italy; ³ASL Teramo, Teramo, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP11

Introduction: Liraglutide therapy has brought great advantages in obesity management, but it’s crucial to identify excessive food intake reduction cases, where the lean mass (LM) loss can be consistent and undervalued. An appropriate therapy should aim to reduce the central adiposity meanwhile preserving the LM. For these reasons, the use of an adequate software to monitor the anthropometric parameters is essential.

Methods: We have conducted a retrospective study on weight loss, achieved in 3 months, in 2 different groups (A and B) of obese patients (BMI > 30). Patients < 18 and > 75 years, with comorbidities (diabetes and serious pathology) were excluded. Group A, 27 patients (11 M and 16 F, mean age of 50 ± 16), followed an equilibrated personalized diet (− 300/600 kcal), meanwhile Group B, 36 patients (11 M e 25 F, mean age 53 ± 14), followed a diet (same as for group A) with the addition of Liraglutide at increasing dosage, starting with 0.6 mg/die and adding 0.6 mg/die every 10 days until reaching 1,8 mg/die. Only 3 patients proceded to 2.4 mg/die and only 2 patients took 3 mg/die.We monitored the parameters majorly correlated with central adiposity and individual metabolic risk by using the anthropometric software “Morphogram®”. All reported data was analyzed with 2 tails sample T test. Among all parameters, we focused on a new index, called VA + (exceeding Abdominal Volume), that monitors the excessive abdominal adiposity volume variations (liters), and the Waist to Thigh Ratio (WTR), which is negatively correlated with the LM loss and with insulin-resistance.

Results: Group B showed substantial reductions on all parameters considered.The use of the AV + index showed that group B had a major selective central adiposity loss (p = 0.001), while the WTR (p = 0.034) reduction confirmed the conservation of LM and the insulin-resistance reduction.

Conclusions: Appropriate monitoring of liraglutide therapy allows the reduction of side effects and the preservation of LM.

BP12 Evaluation of the utility and the effectiveness of the remote body composition monitoring in overweight or obese adult subjects during a lifestyle intervention

B. Russo¹, A. Maiorino², S. De Taddeo², M. Menduni², I. Simonelli³, F. Picconi¹, S. Frontoni¹

¹Unità Operativa Complessa di Endocrinologia, Diabetologia e Malattie Metaboliche, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy; ²Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Rome, Italy, ³Centro di Ricerca, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP12

Objectives: The widely used method to evaluate body composition (BC) in clinical practice is bioelectrical impedance analysis (BIA). In the last years, remote visits have been activated and the need to implement remote monitoring systems through new technologies of telemedicine emerged. In this regard, a new BIA device that allows remote monitoring of BC has been developed. The study aims to evaluate the utility and the effectiveness of the remote BC monitoring in overweight or obese subjects during a lifestyle intervention.

Methods: 40 overweight or obese adult subjects (≥ 18 years and BMI ≥ 25 kg/m²) were enrolled. All subjects were divided in 2 groups: 20 subjects with remote BC monitoring (BIA-R) and 20 subjects with ambulatorial monitoring of BC (BIA-A). At the baseline (V0) both groups have undergone an ambulatorial nutritional visit during which anthropometric and BC assessments have been performed and low caloric diet and physical activity have been prescribed. Over the 3 months follow-up (V1-V3) the anthropometric values, BC and quality of life (QoL) were evaluated in all groups during remote or ambulatorial nutritional visits.

Results: At the V3, a greater significant reduction of BMI were observed in BIA-R compared to BIA-A (BIA-R mean -8.2% vs BIA-A mean − 4.8%, p = 0.022). A significant and similar reduction of fat mass (FM) and waist circumference (CV) over the 3 months was observed in the 2 groups (FM: BIA-R mean − 13.5% vs BIA-A mean − 12.0%, CV: BIA-R mean − 6.8% vs BIA-A mean − 5.3%). At the V3, the % of free-fat mass (FFM) resulted increased in both BIA-R and BIA-A groups (% FFM: BIA-R mean 2.40% vs BIA-A mean 3.27%). The QoL improved over the 3 months in both groups.

Conclusion: Subjects overweight or obese treated with nutritional and physical activity intervention, who were followed with remote BC monitoring showed clinically significant weight loss and improvement of BC and QoL. Therefore, this study highlights the utility and the effectiveness of the remote BC in the management of overweight and obesity.

BP13 Eating disorders and weight loss success in a semi-residential obesity treatment program

S. Martinelli¹, L. Gilardini¹, M. Croci¹, L. Pasqualinotto¹, G. Redaelli¹, P. Toja¹, S. Bertoli²

¹Obesity Unit-Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano Milan, Italy; ²Obesity Unit-Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico ICANS, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP13

Binge eating (BE) behaviour and food addiction (FA) are common in subjects with obesity. It is unclear the relation between these behaviour and anthropometric measure, cardiovascular risk factors and the weight loss success. The aim of this study is to determine whether eating disorders (ED) influence the effectiveness of a weight loss intervention in subjects with obesity. We analyse data from 313 patients (19.2% males, mean age 52.6 ± 12.3 years, BMI 38.1 ± 5.2 kg/m²) affected by obesity who entered our 3 month multidisciplinary weight loss intervention, which included medical, psychological, nutritional and physical activity sessions. Anthropometric measures, body composition, blood pressure (BP), levels of glucose, insulin, lipids and uric acid were assessed before and after the intervention. Presence of BE and FA was assessed by Binge Eating Scale and the Yale Food Addiction Scale, respectively. ED were identified in 36.1% of participants (13.7% BE, 10.5% FA and 11.8% BE + FA). Subjects with ED were younger than those without (50.2 ± 13.6 vs 53.9 ± 11.4 yrs, p < 0.01), but they were similar in degree of obesity, sex, level of blood pressure, blood glucose, lipids and uric acid. Eleven per cent of subjects did not conclude the program (44% of subjects with ED and 35% of subjects with normal eating behaviour, NS). Mean weight loss was − 5.3 ± 2.7% and 54.7% of subjects lost ≥ 5% of weight. There were no differences between subjects with and without ED. The intervention significantly reduces some cardiovascular risk factors, such as systolic and diastolic blood pressure (127.8 ± 13.2 vs 121.3 ± 10.9 mmHg and 81.6 ± 6.9 vs 77.9 ± 5.9 mmHg, p < 0.001), LDL cholesterol (121.3 ± 31.1 vs 112.9 ± 29.3 mg/dl, p < 0.001) and uric acid (5.7 ± 1.3 vs 5.4 ± 1.3 mg/dl, p < 0.001). The improvement in the cardiovascular profile was independent of the presence of the ED. A 3 month lifestyle modification program induced a ≥ 5% weight loss in more than half of subjects and reduced cardiovascular risk factors. The presence of eating disorder seems not to influence the success of the intervention.

BP14 Remission disease and intensive weight loss in new onset diabetes patients after subcutaneous therapy with semaglutide associated with lifestyle interventions

M. Del Prete¹, F. Vignati¹, G. Di Sacco¹, L. Gavazzi¹, D. Dellepiane¹, F. Muratori¹

¹Division of Endocrinology and Diabetology, Sant’Anna Hospital – ASST Lariana, Como, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP14

Introduction: Semaglutide (S), is indicated for the treatment of adults with type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise. S is also approved by the European Medicines Agency (EMA) for the long-term treatment of obesity or overweight. Here, we report the efficacy of subcutaneous S therapy, either alone or in combination with other antidiabetic drugs in obese T2DM patients.

Patients and methods: We retrospectively evaluated 55 obese new onset diabetic patients (32 F; 23 M; mean age: 58.7 ± 10.4 years) treated with S for Weight loss and glycemic control. S was administered as monotherapy or in combination with metformin or other antidiabetic drugs. S was administered once-weekly subcutaneously at starting dose of 0.25 mg and with monthly increases up to 1.0 mg. All patients were required to follow dietary and behavioral therapy with concomitant drug treatment. Aim of this study was to evaluate efficacy and safety of S in this setting of patients.

Results: At baseline, mean Weight was 103.8 ± 25.2 kg and mean body mass index (BMI) was 39.5 ± 9.7 kg/m². After 12-month follow up, patients achieved a mean Weight of 98.8 ± 26.0 kg and mean BMI of 35.4 ± 8.2 kg/m², with a mean Weight and mean BMI reduction respectively of − 13.2 ± 10.2 kg and − 4.8 ± 3.7 kg/m². At baseline mean glycated hemoglobin was of 7.8 ± 1.4% and after 12-month follow up was 6.2 ± 0.7%, with a mean percentage reduction of − 20.6 ± 12.4%. All patients had improved glycated hemoglobin (HbA1C), while 28 patients achieved normalized glycemic values and HbA1C (mean HbA1C 5.7 ± 0.4%). Subcutaneously S therapy was well tolerated, and no patients experienced severe adverse events as nausea and vomiting.

Conclusions: Our real-life results confirm the efficacy and safety data of subcutaneously S therapy in obese diabetic patients. Furthermore, these data show that S induces not only improvement in HbA1C but also remission of the disease in several patients with a recent onset of diabetes.

BP15 Weight loss effects of Semaglutide in a cohort of type 2 diabetic patients in a real-life setting

V. Pasquali¹, F. Pippa¹, E. Franco¹, C. Sciacovelli¹, E. Capobianco¹, U. Pagotto¹, S. Garelli²

¹Unità Operativa Complessa di Endocrinologia e Prevenzione e Cura del Diabete, IRCSS Azienda Ospedaliero-Universitaria di Bologna. Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy; ²Unità Operativa Complessa di Endocrinologia e Prevenzione e Cura del Diabete, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP15

Introduction: Semaglutide is a GLP1 receptor agonist (GLP1-RA) with subcutaneous administration. It is one of the main treatment options for type 2 diabetes mellitus (T2DM), both for hypoglycemic benefits and for weight loss induction in overweight-obese subjects.

Objectives: Evaluation of short-term effects (≤ 12 months) of Semaglutide 1 mg on weight parameters (body weight, patients loosing > 5%, BMI) and glycemic control in overweight/obese patients with T2DM naïve at GLP1-RA (Naïve) or switched from other GLP1-RAs (Switch). Furthermore, investigation of predictive factors influencing weight loss.

Results: We retrospectively evaluated patients with T2DM and BMI ≥ 25 kg/m2 attending our Clinic from 2021 to 2023, treated with Semaglutide with at least 6 months follow-up.

We analyzed 314 subjects: baseline data in Table 1.

Table 1. (abstract BP15) Baseline data

		Naïve (n = 174)	Switch (n = 140)	P-value (Chi Square)
		Mean ± sd	Mean ± sd
Age, y		61 ± 11	64 ± 10	0.109
BMI, kg/m2		37 ± 6	35 ± 5	0.001
Body weight, kg		106 ± 19	100 ± 17	0.164
HbA1c, mmol/mol		66 ± 17	63 ± 14	< 0.001
Duration of diabetes, y		12 ± 9	18 ± 8	0.427
Insulin concomitant therapy, %		41	53	0.033
Gliflozin concomitant therapy, %		4	6	0.034
Sex, %
Female		41	45	0.519
Male		59	55

After 6 and 12 months of treatment, body weight and BMI decreased in both groups, greatly in Naïve one; the same was for HbA1c. The fraction of patients that lost > 5% of body weight was higher for Naïve both at 6 and 12 months follow-up compared to Switch (52.8%vs 25.7%; 36.8vs21%, respectively); moreover, a greater rate of Naive patients lost more than 10% of body weight (16% vs 2%, respectively). As expected, being naives at GLP1-RA, as well as having higher weight and BMI at baseline, was associated with greater weight reduction. Longer diabetes duration, older age and concomitant insulin treatment were negatively correlated with weight loss. Finally, glycated hemoglobin, sex and concomitant gliflozin treatment did not statistically influence weight loss after six months.

Conclusion: Semaglutide ameliorates glycemic control and induces a significant weight loss with a higher efficacy in T2DM patients naïve to GLP1-RA. Younger age, shorter diabetes duration and absence of insulin treatment are predictors of a greater weight loss. Our experience confirms previous observations about the efficacy of semaglutide on metabolic profile and obesity.

BP16 A multi-center, real-life experience on weight loss effect of naltrexone–bupropion in patients with obesity

A. Basolo¹, S. Garelli², P. Fierabracci³, S. Bechi Genzano¹, C. Sciacovelli¹, E. Franco⁴, G. Salvetti¹, F. Pippa², G. Ceccarini¹, V. Pasquali², G. Scartabelli¹, E. Capobianco², R. Jaccheri¹, A. Calderone¹, P. Piaggi⁵, U. Pagotto², F. Santini¹

¹Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy; ²Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy; ³Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy; ⁴Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁵Department of Information Engineering, University of Pisa, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP15

Objective: In patients with overweight or obesity, the use of Naltrexone–Bupropion (NB) leads to greater weight loss compared to placebo. This retrospective study aimed at evaluating, in a real-life setting, the efficacy of NB therapy in patients recruited from 2 different obesity centers in Italy.

Methods: 133 patients with obesity or overweight with at least one weight-related comorbidity were recruited from 2 different Italian centers and started treatment with Naltrexone–Bupropion. 37 patients discontinued the treatment within 120 days for several reasons including, among others, gastrointestinal issues, headache and dizziness. 96 (84 women, 12 men), mean ± SD age 48 ± 11 years (21–74) and mean BMI 37.8 ± 6.4 (27.1–76.1) were included for further analysis. 50 patients reached the maximum dose of NB.

Results: In patients who achieved the maximum dosage of drug (50/96) the mean body weight change at the last visit on treatment was -5.3 ± 6.1 kg (− 7.1%), 40% patients lost ≥ 5%, 14% lost ≥ 10% and 6% lost ≥ 15% of the initial weight. Early and final weight loss were positively associated. No change in systolic, diastolic blood pressure and heart rate was observed. The overall incidence of side effects was 24% (23/96).

Conclusion: In a real-life setting, the treatment of patients with overweight and obesity was similar to those reported by the major RCCTs. The combination between data of RCCTs and real-life findings may help to overcome the respective limitations increasing the power of the results.

Best poster 3

BP19 Anthropometric and clinical features of a cohort of patients with acquired partial lipodystrophy

S. Magno¹, G. Ceccarini¹, F. Corvillo², C. Pelosini³, D. Gilio¹, L. Palladino¹, M. Paoli³, S. Fornaciari⁴, G. Pandolfo⁵, S. Sanchez-Iglesias⁶, P. Nozal⁷, M. Curcio⁴, M. R. Sessa³, M. Lopez-Trascasa², D. Araujo-Vilar⁶, F. Santini¹

¹Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy; ²Complement Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain; ³Chemistry and Endocrinology Laboratory at University Hospital of Pisa, Pisa, Italy; ⁴Division of Transfusion Medicine and Transplant Biology, University Hospital of Pisa, Pisa, Italy; ⁵Division of Transfusion Medicine and Transplant Biology, University Hospital of Pisa, Naples, Italy; ⁶Thyroid and Metabolic Diseases Unit (U.E.T.eM.), Centro Singular de Investigación en Medicina Molecular e Enfermidades Crónicas (CIMUS-IDIS), School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; ⁷Immunology Unit, La Paz University Hospital, Madrid, Spain

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP19

Background: The Barraquer-Simons syndrome (BSS) is an acquired form of lipodystrophy characterized by the loss of subcutaneous fat in the face, the upper limbs and the trunk. The pathogenesis of the disease is not entirely known and may involve autoimmune mechanisms. In this retrospective observational study we evaluated the anthropometric, clinical and metabolic characteristics of a cohort of BSS patients.

Subjects and Methods: 26 patients diagnosed with BSS based on internationally established criteria, were evaluated for anthropometric parameters, biochemical tests, as well as variants in the LMNB2 gene.

Results: Patients were mostly females (73%); the onset of fat loss occurred predominantly during childhood (77%) at a median age of 8 years. Among various anthropometric measures, the ratio between the proportion of fat mass in upper limbs/lower limbs, as assessed by dual energy X-ray absorptiometry (DEXA), showed the best predictive value for diagnosis. Leptin (mean ± SD: 10.23 ± 11.43) and adiponectin (mean ± SD: 8.7 ± 4.6) serum levels fell in the normal range for age, sex and BMI. 11.5% of BSS patients had diabetes, 34.6% dyslipidemia, and 26.9% hepatic steatosis. Furthermore, 75% of children and 50% of adults had C3 hypocomplementemia. A single variant in the LMNB2 gene was found in one patient.

Conclusions: BSS has a childhood onset and metabolic complications are quite common. Fat distribution assessed by DEXA is an useful tool for clinicians to identify the disease. C3 hypocomplementemia may be used as additional diagnostic supportive criteria but prevalence of C3 hypocomplementemia may be lower than previously reported.

BP20 Inflammatory response and coagulation profile in patients with obesity during sepsis: the Riso study

L. Molinari¹, A. Di Vincenzo¹, B. Barbato¹, M. Marchegiani¹, M. Noale², S. Pavone¹, G. M. Pontesilli¹, A. Postal¹, C. Purificati¹, E. Reni¹, S. Bettini¹, G. Camporese³, C. Dal Prà¹, R. Fabris¹, A. Scarda¹, L. Spiezia³, L. Busetto¹, M. Rossato¹, R. Vettor¹

¹Clinica Medica 3, Azienda Ospedaliera-Università di Padova, Padova, Italy; ²Scienze Biomediche, Azienda Ospedaliera-Università di Padova, Padova, Italy; ³Medicina Generale, Azienda Ospedaliera-Università di Padova, Padova, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP20

Retrospective studies suggest that obesity is associated with better sepsis survival but the mechanisms explaining this paradox remain unclear.

This is a prospective, monocentric observational study conducted at Clinica Medica 3, University-Hospital of Padua, evaluating the relationship between clinical outcomes, metabolic, inflammatory biomarkers and coagulation profile in septic patients with obesity. The goal of this study is to investigate the impact of obesity on sepsis by recruiting one hundred patients with sepsis, stratified according to BMI.

An interim analysis on twenty patients was performed. Body weight reduction during sepsis is directly correlated with disease severity defined by MEWS II, APACHE II (r = 0.7, r = 0.8, p < 0.05). Higher severity scores were found in I grade and II grade obesity while similar results in grade III obesity and normal-weight patients were observed. Patients with obesity had faster clot formation with CFT values (r = -0.8 p < 0.05) directly correlating with BMI. In addition they had greater clot firmness with MCF values (r = 0.7 p < 0.05) showing a direct correlation with BMI. Although not statistically significant, patients with obesity seem to have less extrinsic pathway activation during the hyperacute phase, whereas normal-weight subjects had higher activation of the intrinsic pathway. Antithrombin reserves seem to be more depleted in normal-weight patients (p < 0.05). During the hyperacute phase, normal-weight patients showed a greater increase in white blood cells, particularly the neutrophil fraction, which inversely correlates with BMI (p < 0.05). An opposite trend was observed for IL-8 and procalcitonin, which levels raised more in normal-weight subjects.

The results may suggest the role of the different inflammatory and coagulation profile as an explanation of the different clinical outcome. Despite preliminary, these data support further efforts in future studies to develop tailored treatment strategies and improve patients outcomes.

BP21 Prediction of early and long-term hospital readmission in patients hospitalised due to severe obesity: a retrospective cohort study

I. Comazzi¹, F. Bioletto², V. Ponzo², A. Brunani³, G. Ciccone⁴, A. Evangelista⁴, F. Rahimi¹, S. Bo¹

¹Dietetica e Nutrizione Clinica, Turin, Italy; ²Bioletto 2 – Ospedale Le Molinette, Università di Torino, Turin, Italy; ³Brunani 3 – Ospedale San Giuseppe, Piancavallo (VB), Italy; ⁴Evangelista e Ciccone 4 – Città della Salute e della Scienza di Torino, Università di Torino, Turin, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP21

Patients with obesity are at increased risk of hospitalization compared to the general population, with high hospitalization-related healthcare costs. Our aim was evaluating the predictors of hospital readmission in a cohort of patients hospitalised for the management of severe obesity.

All the patients residing in Piedmont (North-Western Italy) and admitted for severe obesity between 1^st January 2009 and 31^st December 2018 to the Istituto Auxologico Italiano (IAI) in Piancavallo were included. Anthropometric and health status data were collected from the medical records of the index admission at the IAI. To determine readmissions, hospital discharge records (HDRs) from any hospital in Italy, between 2 years before the index admission until the 31^st December 2019, were identified from the regional database by a deterministic record-linkage procedure through the unique anonymous identifier code.

Of the 1136 enrolled patients, 158 patients (13.9%) underwent bariatric and death was registered in 71 (6.3%) cases. During the observation period, a total of 2066 hospitalization occurred with a rate of 0.34 hospitalizations per person-year; 194 (9.4%) and 444 (21.5%) hospitalizations occurred within 30 and 90 days from the previous hospital discharge respectively. Predictors of readmission within 30 days were age (HR = 1.02, 95%CI 1.00–1.05, p = 0.024), serum creatinine (HR = 1.34, 1.12–1.60, p = 0.001), and admissions in the previous 2-years (HR = 1.23, 1.14–1.30, p < 0.001). The same factors were identified as predictors of readmission occurring within 90-days with the addition of diabetes mellitus (HR = 1.24, 1.00–1.55, p = 0.050).

BMI was not a predictor of early readmission after a hospital discharge for obesity treatment, while serum creatinine, age, and previous hospital admissions were. The identification of higher-risk patients would allow healthcare professionals to better manage the follow-up and treatment of these individuals.

BP22 ESPEN-EASO algorythm for diagnosis of sarcopenic obesity (SO) in older adults

G. Gortan Cappellari¹, A. Semolic¹, M. Zanetti¹, P. Vinci¹, M. Lus¹, M. Bruckbauer², G. Guarnieri¹, L. Busetto³, L. M. Donini⁴, R. Barazzoni¹

¹Department of Medical, Surgical and Health Sciences, University of Trieste Trieste, Italy; ²General Prectitioner, ASFo Maniago (PN), Maniago (PN), Italy; ³Department of Medicine, University of Padua, Padua, Italy; ⁴Department of Experimental Medicine, Sapienza University, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP22

Background: Aging and obesity are synergistic sarcopenia risk factors (RF). Their association in sarcopenic obesity (SO) enhances morbidity and mortality, but consensus on SO diagnostic criteria is limited. ESPEN and EASO issued a consensus Algorithm (EE) for SO diagnosis, and we investigated EE implementation to identify SO in older adults (> 65-years), as well as underlying SO-associated metabolic RF.

Methods: Older participants from the Italian MoMa study for screening of metabolic syndrome in primary care (n = 76) underwent muscle function (Hand-Grip Strength: HGS) and body composition (Bioelectrical Impedance Analysis: BIA) assessment. Positive EE screening [EES = obesity or ↑waist circumference (WC) + clinical SO suspicion] led to EE diagnostic procedure (HGS + BIA; SO = ↓HGS + ↓Skeletal Muscle Index). Further potential metabolic RF [insulin resistance (IR: HOMA) and plasma acylated (AG) and unacylated (UnAG) ghrelin] were studied, and their predictive value assessed from 5 year-prior observations.

Results: 61 individuals had positive screening (EES +) and 7 had SO (9% of cohort)). EES + individuals with (SO +) or without SO (SO-) had comparable age, sex and body mass index (BMI) or WC (P > 0.5). Individuals with negative screening (EES−, n = 15) had comparable sex, BMI and WC to SO- and SO + , with lower age (EE suspicion factor). No EES- individuals had SO based on HGS and BIA. SO + had selectively higher IR, AG and plasma AG/UnAG ratio (P < 0.05 vs EES-/EES +), and both IR and ghrelin profile predicted 5-year SO risk independent of age, sex and BMI. Algorithm sensitivity was 100%.

Conclusions: The EE algorithm was effectively implemented in free-living older adults, with 12% SO prevalence. Based on EE, IR and high AG/UnAG ghrelin ratio are additional RF for age-related SO. Results provide the first EE-based evaluation of SO prevalence in older adults, and they support IR and plasma ghrelin profile as SO risk factors in this setting.

BP23 Neck circumference as a simple marker of nafld progression in patients with metabolic syndrome

M. Palumbo¹, A. Salvati², M. Brunetto², S. Camastra¹

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; ²Hepatology Unit, Santa Chiara Hospital of Pisa, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP23

Introduction: Obesity and Metabolic Syndrome (MS) are characterized by high prevalence of NAFLD. Non-invasive methods such as liver stiffness measurement (LSM) by transient elastography (TE FibroScan) have been recommended to evaluate the progression in fibrosis. However, TE may not be available in resource-limited settings.

AIM: to identify the key determinants and simple markers of NAFLD progression in patients with MS.

Methods: We measured in 143pts with MS and BMI > 25 kg/m², waist circumference (WC), body weight (BW), BMI, neck circumference (NC), hormonal, metabolic markers. Insulin sensitivity from OGTT (OGIS), Fatty Liver Index (FLI), FIB4 score were calculated. In 94pts CAP (controlled attenuation parameter) and LSM were measured by liver ultrasound combined with TE. Based on LSM we identified 3 groups of pts Low Fibrosis (LSM ≤ 6.6 kPa, 45 pts), Medium Fibrosis (6.6 < LSM ≤ 12; 35pts), High Fibrosis (LSM > 12 kPa;14pts), cirrhosis was excluded.

Results: More than 80% of pts had FLI > 60. FLI was directly related to BW, FM%, BMI, NC (for all p < 0.0001) and to metabolic indices (Insulin, Uric Acid, HOMA, p < 0.02), and inversely related to HDL, OGIS, 25-OHvitaminD (p < 0.04. LSM was directly related to BW, WC, CAP (p < 0.001), Triglycerides, gGT, FLI, FIB4, p < 0.03. In 73 patients NC was available and directly related to LSM and CAP (p = 0.0001). NC increased in relation to the degree of fibrosis, LF 42.1 ± 0.7; MF 43.9 ± 0.7; HF 47.6 ± 1.4 cm, p < 0.001. In a multiple regression model NC, BMI, FIB4 explained 30% of LSM variability (p = 0.0001), in stepwise regression NC was the main determinant of LSM (F = 17.8).

Conclusion: In patients affected by MS and obesity: (a)FLI is elevated in more than 80% of patients and associated with the main characteristics of MS. (b)Liver stiffness measurement, index of liver damage progression, correlates with metabolic and anthropometric variables and NC may be an important predictor of fibrosis in patients with NAFLD when liver cirrhosis has not yet developed.

BP24 Non-HDL cholesterol and apolipoprotein b in a hypertensive population: role of adiposity and insulin resistance

R. Sarzani¹, F. Giulietti², S. Biondini¹, E. Fausti¹, M. Allevi¹, M. Pepa¹, S. Scorcella¹, F. Spannella¹

¹University "Politecnica delle Marche", IRCCS INRCA Ancona, Ancona, Italy; ²IRCCS INRCA Ancona, Ancona, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP24

Introduction: Non-HDL cholesterol (non-HDLc) and apolipoprotein B (ApoB) indirectly measure all atherogenic or potentially atherogenic circulating lipoproteins. In patients with essential hypertension, atherogenic dyslipidemia and insulin resistance (IR) due to overweight/obesity are highly prevalent. Aim: evaluate how adiposity and IR affect non-HDLc and ApoB levels in essential hypertensive patients.

Methods: We performed a cross-sectional study on 272 consecutive patients referred to our Hypertension Centre and not taking lipid-lowering drugs. Body mass index (BMI) and waist circumference (WC), measured to the nearest 0.1 cm at the midpoint between the lowest rib and the iliac crest, were used to assess adiposity. IR was evaluated with HOMA-IR index, calculated according to the formula: HOMA-IR = [glucose] (mmol/l) × [insulin] (µU/ml)/22.5.

Results: Mean age: 50.2 ± 14.5 years; male prevalence: 65.1%; mean BMI: 27.9 ± 4.8 kg/m²; mean WC: 99.1 ± 13.1 cm; mean Non-HDLc: 156.2 ± 48.6 mg/dl; mean ApoB100: 113.8 ± 36.4 mg/dl; median HOMA-IR index: 2.4 (1.7–4.0). The prevalence of overweight/obesity and IR was 76.0% and 48.6%, respectively. We found a fair correlation between non-HDLc and ApoB (r = 0.588; p < 0.001). Overweight/obese patients showed higher prevalence of IR (57.4% of overweight/obese). We found no linear association of both BMI and WC neither with ApoB nor with non-HDLc (all p > 0.05), while a negative correlation was found with HDLc (r = -0.295; p < 0.001 for BMI and r = -0.224; p = 0.009 for WC) and a positive correlation with triglycerides (r = 0.222; p = 0.004 for BMI). A significant correlation emerged between HOMA-IR index and ApoB100 (r = 0.280; p = 0.016), independently of BMI.

Conclusion: In our study, the excess adiposity is directly linked to HDLc and triglycerides, while IR is directly linked to ApoB levels. Although there is a close association between IR and obesity, not all overweight/obese patients had IR, IR that probably plays a major role in atherogenic lipoprotein levels than just obesity.

BP25 Linking eating behavior patterns with glicometabolic assessment: the role of psychometry in patients with obesity

C. Massetti¹, E. Colonnello¹, R. Rossetti¹, V. Strinati¹, M. E. Spoltore¹, D. Masi¹, G. Ciocca², M. Watanabe¹, L. Gnessi¹, C. Lubrano¹

¹Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy; ²Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP25

Introduction: Different eating behavior profiles can be observed in people with obesity. Uncontrolled eating is associated with higher energy intake and body mass index (BMI). Emotional eating is associated with increased BMI but also higher psychological distress, anxiety, depressive symptoms and “neuroticism” trait. But whether and how such profiles impact the glicometabolic pattern is still understudied.

Methods: A total of 71 patients (45 females, 26 males, mean age: 46.6, mean BMI: 39.6 kg/m²) with obesity presenting at our clinic in Umberto I Hospital were recruited. They underwent a complete physical examination, collection of anthropometric measures, blood samples for glicometabolic and hormonal analysis, and body composition assessment. They compiled a series of psychometric questionnaires, including the EBA-O (Eating Behaviors Assessment for Obesity), which evaluates the presence of 5 pathological eating behaviors: food addiction, night eating, binge eating, sweet eating and hyperphagia.

Results: In our sample, binge eating, night eating and hyperphagia negatively correlated with age (p = 0.035, p = 0.044 and p = 0.038,respectively). The total score of EBAO (mean = 1.97 ± 1.52) significantly correlated with the levels of triglycerides (p = 0.031), especially the domains of food addiction (p = 0.021); moreover, triglycerides showed a positive trend of correlation with night eating (p = 0.063). A positive correlation trend was also observed between food addiction and fasting glycemia levels (p = 0.086).

Discussion and conclusion: Promising, recent exploratory research findings have shown that patients with obesity may be phenotyped according to their pathological eating behaviors. For instance, night eating may be associated with an elevated risk of dyslipidemia and cardiovascular disease. The preliminary results of our study suggest that eating behavior assessment may be a quick, useful tool to be integrated into the clinical evaluation of patients with obesity to predict the risk of developing dysmetabolism.

BP26 Prediction and evaluation of handgrip strength in male patients with obesity

R. Sammarco¹, R. Natale¹, C. Nasti¹, A. Morena¹, A. Marzano¹, F. Pasanisi¹, M. Marra¹

¹Medicina Clinica e Chirurgia, Federico II Napoli, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP26

Background: Handgrip strength (HGS) is used in clinical practice to assess muscular function in various clinical disorders. We aimed to evaluate HGS in males with obesity and the predictors of HGS were identified among anthropometric parameters and body composition.

Methods: 196 male outpatients divided in three groups of BMI (GR 1: BMI 30–39.9 kg/m², n. 101; GR 2:BMI 40–49.9 kg/m², n. 62; GR 3 BMI > 50 kg/m², n. 33) age range 18–65 y, were studied:

HGS was measured with a dynamometer and body composition was estimated by bioimpedance analysis (BIA). Phase angle (PhA) was calculated as follows: arctan (Xc/R) • (180/P), and body composition (fat free mass FFM and fat mass FM) was calculated using the Sun equation. Finally, a multivariate regression analysis was performed to assess the main predictors of HGS.

Results: GR1: age 37.2 ± 14.3 yrs, weight 108 ± 13 kg, height 175 ± 8 cm, BMI 35.0 ± 2.9 kg/m²; GR2: age 37.1 ± 17.3 yrs, weight 132 ± 14 kg, height 173 ± 8 cm, BMI 44.1 ± 2.7 kg/m²; GR3: age 36.5 ± 10.5 yrs, weight 174 ± 23 kg, height 175 ± 8 cm, BMI 56.7 ± 4.8 kg/m². Age and height were not significantly different between groups in group 1, PhA was 6.68 ± 0.84 degree and HGS 41.3 ± 10.5 kg; in group 2, PhA was 6.31 ± 1.03 degree and HGS 38.2 ± 9.0 kg; in group 3, PhA was 6.31 ± 1.09 degree and HGS 42.3 ± 10.7 kg. PhA and HGS were not significantly different between groups.

Pearson correlation coefficients between HGS and both anthropometric and body composition were calculated. Height (r = 0.395, p < 0.01) and phase angle (r = 0.328, p < 0.01) showed a correlation with HGS.

Multivariate regression analysis, considering both anthropometric (age, weight, height) and body composition parameters (FFM, FAT, FAT % and PhA) showed that height and PhA were the main predictors of HGS (r = 0.502, p < 0.01; SEE = 8.86 kg).

Conclusion: Our findings show that height among anthropometric variables and PhA among BIA parameters are the main predictors of HGS in males with obesity whereas body weight seems to be not associated with the HGS.

Keywords: BMI, body composition, muscle strength, phase angle.

BP27 Impact of abdominal obesity on SARS-COV-2 anti-trimeric spike antibody dynamics after BNT162B2 booster dose in a large cohort of Italian health care workers

C. Dubini¹, C. Meregalli¹, C. Bertolini², V. Milani³, F. Ambrogi⁴, S. Boveri³, R. Cardani⁵, L. V. Renna⁵, M. B. Trevisan¹, T. Cuppone⁶, A. Vignati¹, F. Sorrentino¹, V. Scravaglieri¹, L. Menicanti³, E. Costa⁷, G. Lacobellis⁸, E. Nisoli⁹, M. Carruba⁹, M. M. Corsi Romanelli¹⁰, A. E. Malavazos¹¹

¹Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy; ²Vaccination Unit, ASST Fatebenefratelli Sacco, Milan, Italy; ³Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy; ⁴ Scientific Directorate, IRCCS Policlinico San Donato, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy; ⁵Biobank BioCor, Service of Laboratory Medicine1-Clinical Pathology, IRCCS Policlinico San Donato, San Donato Milanese, Italy; ⁶Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy; ⁷Service of Laboratory Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Italy; ⁸Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miami, US; ⁹Department of Medical Biotechnology and Translational Medicine, Centre for Study and Research on Obesity, University of Milan, Milan, Italy; ¹⁰Department of Biomedical Sciences for Health University of Milan. Director Department of Clinical and Experimental Pathology Istituto Auxologico Italiano, Milan, Italy; ¹¹Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP27

Background: The mRNA-based vaccine BNT162b2 has shown high efficacy against SARS-CoV-2 infection and a severe course of the COVID-19 disease even in subject with general obesity and abdominal obesity. However, little is known about the long-term durability of the induced immune response resulting from the vaccination. In this observational study, we evaluated the role of abdominal obesity and SARS-CoV-2 infection (pre and post vaccination cycle) on antibody response after BNT162b2 booster dose in health care workers.

Methods: IgG neutralizing antibodies against the Trimeric-complex (IgG-TrimericS) were measured at eight time points: at baseline, after 21 days after vaccine dose 1, after 1, 3, 6 and 9 months after dose 2, and after 1 and 3 months after booster dose. Nucleocapsid antibodies were assessed at baseline and at the end of the study to detect SARS-CoV-2 infection. Waist circumference was measured to determine abdominal obesity.

Results: Among 1060 subjects, 511 provided blood samples at all-time points. To evaluate the three-months difference in absolute variation of IgG-TrmicericS levels starting from booster dose we used multivariable linear regression that showed evidence of interaction between abdominal obesity and SARS-CoV-2 infection status (p = 0.016). Specifically, abdominal obesity is associated with higher absolute IgG-TrimericS variation in prior infected individuals, regardless of possible confounders and IgG-TrimericS levels at booster dose (p = 0.0125). No interaction was evinced using BMI in the same regression model (p = 0.418).

Conclusions: In our longitudinal observational study, we presented data on antibody levels up to 12 months after vaccination with two doses of BNT162b2 m-RNA vaccine and after the booster dose in a cohort of health care workers. Our results demonstrated the efficacy of vaccination in developing antibodies to COVID-19 even in subjects with abdominal obesity who had already come into contact with the virus.

Best poster 4

BP28 Long term metabolic effects of sleeve gastrectomy: 15 years of follow up

D. Capoccia¹, G. Morsello¹, M. Chinucci¹, C. Gaita¹, G. Guarisco¹, G. Silecchia², F. Leonetti¹

¹Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino Latina, ²Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP28

Background: bariatric surgery (BS) has a profound impact on type 2 diabetes (DM2), in terms of resolution/improvement. The remission of DM2 after (BS) varies depending on the surgical procedure and decreases with long-term follow-up (FU).

Aim: to assess the long-term effects (15 years) of the Sleeve Gastrectomy (SG) on weight, DM2 and renal function.

Methods: we analyzed 15 DM2 patients underwent SG in 2008 and followed up 15 years. Partial remission (PR) or complete remission (CR) was defined after at least two years, with glycated hemoglobin (A1c) < 6.5% or 6% and fasting plasma glucose < 126 or < 100 mg/dl respectively, in the absence of hypoglycemic therapy. We analyzed data regarding the duration of diabetes BS and weight regain (WR) after 13–15 years as possible predictors of remission of DM2.

Results: after 15 years, patients moved from severe obesity to first class of obesity. Minimum weight was 74 ± 16,86 kg after 2 years. The % of patients with CR and PR of DM2 was 40% (3 with PR and 3 with CR). C-peptide before SG was higher in the group of patients with diabetes remission (R 7.17 ± 2.54 vs NR 2.6 ± 1.43). The A1c levels were lower before SG in the group of patients with diabetes remission (R 6.5 ± 0.54% vs NR 8.42 ± 2.2%). The duration of diabetes before SG was shorter in the group of patients with diabetes remission (R 1.4 ± 0.55 y vs NR 6.43 ± 6.7 y). WR was lower in patients with diabetes remission (R 28,5 ± 13,2% vs NR 32,3 ± 29,1%). Creatinine unchanged after SG in all groups.

Table 1 (abstract BP28)

	Pre bariatric surgery	Post bariatric surgery
Age (years)	48.33 ± 6.69	61.53 ± 6.94
Weight (Kg)	116.92 ± 24.83	88.4 ± 24.31
BMI (Kg/m2)	43.04 ± 5.33	34.38 ± 6.26
Creatinine (mg/dl)	0.77 ± 0.13	0.84 ± 0.34
Glycemia (mg/dl)	157.71 ± 47.84	109.13 ± 27.21
A1c (%)	7.6 ± 1.92	6.3 ± 1.33

	Remission (R)	No remission (NR)
Baseline c-peptide (ng/dl)	7.17 ± 2.54	2.6 ± 1.43
Baseline A1c (%)	6.5 ± 0.54	8.42 ± 2.2
Duration of diabetes (year)	1.4 ± 0.55	6.43 ± 6.7
Weight regain (%)	28.5 ± 13,2	32.3 ± 29.1

Conclusions: There are very few data on the long-term follow-up of SG. Our data reinforce the well-known association between BS and DM2 remission or improvement. Preoperative diabetes duration, A1c and c-peptide are predictors of therapeutic success. Weight regain is lower in patients with shorter duration of DM as well as in remission. Renal function was maintained throughout FU.

BP29 Prevalence of obesity-related biochemical hypogonadism, role of bariatric surgery and predictors of recovery

A. Bombardieri¹, N. Fralassi², A. Bufano¹, C. Ciuoli¹, N. Benenati¹, S. Caprio¹, I. S. Gabriele¹, M. D. L. A. Simon Batzibal¹, I. Sannino¹, M. G. Castagna¹

¹Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy; ²Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence Firenze, Florence, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP29

Introduction: Obesity and testosterone (T) deficiency are conditions often interwinged. Body Mass Index (BMI) increase is associated with T reduction and hypogonadism (HG) in men with obesity (up to 68.5%). Weight loss after bariatric surgery (BS) rise T levels in male, without consensus on preferable surgical approach.

Aim of the study: Estimate prevalence of obesity-related gonadal dysfunction among men with severe obesity and response to BS as resolution/improvement of this condition, according to different BS techniques.

Patients and methods: We retrospectevely evaluated 413 male with obesity (mean BMI 44.7 ± 8.3 kg/m2 and age 46.3 ± 12.7 years). Patients with known primary HG, pituitary disease or using gonadal-interfering drugs were excluded. A subgroup of them (61.7%) underwent BS: 141 (55.3%) with a restrictive approach and 104 (40.8%) with a restrictive-malabsorptive one. Anthropometric, metabolic and hormonal evaluations were performed at baseline and 3–6 months after surgery. Threshold of 2.64 ng/ml defined lower total testosteronemia (TT).

Results: In whole population mean TT was 2.56 ± 1.04 ng/ml. TT significantly related to weight (p < 0.0001), BMI (p < 0.0001), excess weight (p < 0.0001),waist circumference (p = 0.001), and HOMA-IR (p = 0.05). HG prevalence was 62% in whole population and a significant correlation was observed between HG and obesity grade (p = 0.0006). At multivariate analysis, only BMI independently associated with HG (p = 0.01).

At pre-BS evaluation 69.5% of patients were hypogonadal. Post-BS TT increased (3.72 ± 1.26 ng/ml vs 2.51 ± 0.99 ng/ml, p < 0.001) and 80% of patients normalized TT.

Predictors of TT recovery were higher TT at baseline (p < 0.001), higher excess weight loss % (%EWL)(p = 0.0031) and remission of metabolic syndrome (p = 0.01). In multivariate analysis, both pre-surgical TT and %EWL were independently associated with recovery (p = 0.001 and p = 0.02, respectively). Higher eugonadism recovery (86.2%) was observed in restrictive-malabsorptive surgery (versus 71.6% restrictive techniques, p = 0.02).

Conclusions: Gonadal dysfunction is among the most prevalent morbidities in patients with severe obesity and should be ruled out in diagnostic workup. Considering the excellent outcome, BS should be offered to patients with obesity-associated gonadal dysfunction.

BP30 Effects of weight loss induced by bariatric surgery on quality of life, body image perception and sexual function in obese women

L. Di Gioia¹, E. Rossi², G. P. Sorice¹, A. Braun³, I. Caruso¹, A. Barbone¹, V. A. Genchi¹, G. Palma¹, G. Viola⁴, A. Cignarelli¹, A. Natalicchio¹, L. Laviola¹, A. Pezzolla¹, A. Bertolino⁴, F. Giorgino¹, S. Perrini¹

¹Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy; ²Rossi 2 – Medicina Interna, Endocrinologia, Andrologia e Malattie Metaboliche, Dipartimento dell’Emergenza e dei Trapianti di Organi (D.E.T.O.)Università degli Studi di Bari, Bari, Italy; ³General Surgery GVM Bari-Conversano, Bari, Italy; ⁴Department of Basic Medical Sciences, Neurosciences and Sense Organs (DSMBNOS), University of Bari Aldo Moro, Bari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP30

Purpose: Weight loss induced by bariatric surgery improves metabolic and anthropometric parameters in obese subjects, even though a comprehensive assessment about its impact on quality of life (QoL) and sex life is lacking. This observational cross-sectional study was conducted to examine the effects of bariatric surgery on self-reported health-related quality of life, body image perception and sexual function in obese woman.

Methods: The Body Uneasiness Test (BUT) to assess self-perception of body image, the Short Form-12 (SF-12) to evaluate QoL as per the physical (PCS) and mental (MCS) domains, and the Female Sexual Function Index (FSFI) to screen for sexual dysfunctions were administered to evaluate psychometric outcomes at short (< 12 months; Group A, n = 169) and medium (13 months—54 months; Group B, n = 201) interval of time after bariatric surgery.

Results: Along with weight loss induced by bariatric surgery, in both groups (Group A: -30.4% [10.4]; Group B -41.5% [8.7]) patients reported significant clinical improvements in QoL and sexual functioning, including remarkable improvement in weight phobia, body image concerns, avoidance, compulsive self-monitoring, and depersonalization, as compared to baseline features. In overall population, there was an increase of the PCS (53.3 ± 7.2 vs 31.9 ± 21.4, p < 0.001) and MCS (50.5 ± 8.8 vs 39.6 ± 12.5, p < 0.001) scores, that fell within the normal range of healthy individuals. All patients showed a significant improvement of the global severity index of the BUT (1.9 ± 1.1 vs 3.7 ± 0.9, p < 0.001). After bariatric surgery, patients also had a significant improvement of the FSFI (26.8 ± 9.7 vs 19.6 ± 8.8, p < 0.001), with an increase of non-dysfunctional, sexually active women from 26.2% to 78.2%. Significant correlations were found between the extent of weight loss and the improvement of all the psychometric parameters. In addition, weight loss and improvement in overall quality of life were strongly associated with the reduction in the number of drugs to treat obesity-related comorbidities in both groups.

Conclusion: Bariatric surgery is an efficient and safe treatment for obesity and the ensuing change in appearance is only the epiphenomenon of improved mental, physical and sexual health.

BP31 Spexin levels in patient affected by severe obesity and treated with bariatric surgery: a Prospectic study

G. Iraci Sareri¹, S. Caprio¹, A. Bombardieri¹, M. D. L. A. Simon Batzibal¹, L. Distefano¹, I. Sannino¹, A. Bufano¹, N. Benenati¹, C. Ciuoli¹, M. G. Castagna¹

¹Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP31

Introduction: Spexin (S) is a peptide expressed by white fat tissue, hypothalamus and other endocrine organs (i.e. pancreas, thyroid, adrenal, ovary, testis). Recently a negative correlation between S and gluco-lipidic metabolism, energy homeostasis, appetite/food intake has been reported.

Aim: We aimed to explore serum S levels in severe obese patients and to evaluate the changes of S after bariatric surgery.

Methods: We enrolled 53 patients with morbid obesity (mean Body Mass Index 46.3 ± 6.9 kg/m², 62.3% females and 37.7% males) who underwent bariatric surgery (29 patients gastric bypass, 24 sleeve gastrectomy). Fifty-five normal weight patients were enrolled as control group. Serum S levels were assessed at baseline both in study population and in the control group; in obese patients S levels were also assessed at 3 and 6 month follow up after surgery. Moreover Hunger Satiety Rating Scale (HSRS) was administered to obese patients to evaluate hunger/satiety state before and after surgery (a 10 score scale, 1 stands for extreme hunger, 10 for a nauseous sense of fullness, 5 neutral state).

Results: Mean S levels at baseline were significantly lower in the study group (635 ± 386 pg/ml) compared with control group (1564 ± 289.7 pg/ml, < 0.0001). At 3 and 6 months after surgery S levels significantly increased compared to presurgical levels (957 ± 432.6 pg/ml and 1389.5 ± 390.3 pg/ml, respectively, p < 0.001). Furthermore, at 6 months after surgery, S levels were similar to that in the control group (1389 ± 390.3 pg/ml vs 1552.1 ± 279.7 pg/ml p = 0.07). No correlation was found between S levels increase and pre-surgery BMI, type of surgical approach and Excess Weight Loss % post-surgery. Regarding the HSRS, before surgery, no differences were found about S levels between patients with score > 5 and < 5 (p = 0.8). After bariatric surgery all patients had a score > 4 and, dividing patients into two groups (score 4–7 and 8–10), patients with higher scores had lower S values (1530 ± 259 pg/ml and 1231 ± 522 pg/ml, respectively, p = 0.03).

Conclusions: Weight loss after bariatric surgery effects an increase in serum S levels, overlapping those observed in normal weight people. This could be due to remodulating effect of energy homeostasis and food-intake as well as to improvement of gluco-lipid metabolism, promoted by bariatric surgery.

BP32 Cardiac remodeling in patients with obesity after bariatric surgery: a meta-analysis of echocardiographic studies

B. Gusella¹, S. Bettini¹, L. Tibaldo¹, R. Fabris¹, C. Dal Prà¹, A. Scarda¹, M. Foletto², R. Vettor¹, L. Busetto¹, G. Maiolino¹

¹Dipartimento di Medicina DIMED Padova, Padova, Italy; ²DIDAS Chirurgia Padova, Padova, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP32

Objective: Obesity is a condition associated with cardiomyopathy and heart failure, resulting in increased morbidity and mortality. While bariatric surgery remains the most effective treatment of obesity, the impact of surgery on improving cardiac structure and function in obese patients is still controversial. The aim of this study is to provide a comprehensive and updated meta-analysis on the effects of bariatric surgery on cardiovascular risk profile, evaluated through echocardiography (TTE).

Methods: Three investigators independently carried out a systematic search including 3 databases (MEDLINE, Web of Science, Scopus) from inception to October 17th, 2022, to identify all studies comparing obese patients (BMI ≥ 30 kg/m2) with weight loss obtained through bariatric surgery and TTE carried out before and after the intervention.

Results: We selected 34 studies with a total of 1385 patients. Bariatric surgery was associated to a decrease in left ventricular (LV) mass indexed to body surface area (MD = -5.3 g/m², 95% CI 2.2–8.4, p < 0.001) and to height^2.7 (MD = − 8 g/m^2.7, 95% CI 2.8–13.2, p = 0.003), LV end diastolic diameter (MD = 1.6 mm, 95% CI 0.8–2.3, p < 0.001), LV end-systolic diameter (MD = 0.66 mm, 95% CI − 0.2–1.5, p = 0.12) and left atrial diameter (MD = 1.6 mm, 95% CI 0.6–2.6, p = 0.003).There was a reduction of LV global longitudinal strain (MD = 3.27%, 95% CI 2.4–4.1, p < 0.001) and improvement of LV diastolic function, as reflected by the increase of E/A ratio (MD = -0.16, 95% CI − 0.2 to − 0.1, p < 0.001), mitral annulus septal e' (MD = -1.2 cm/s, 95% CI − 1.9 to − 0.6, p < 0.001) and lateral e' (MD = -3.1 cm/s, 95% CI − 5.2 to − 1, p = 0.004), with ensuing decreased E/e' ratio (MD = 0.97, 95% CI 0.3–1.7, p = 0.006).

Conclusions: This meta-analysis supports the concept that bariatric surgery improves the cardiovascular risk profile via a reduction of LV mass and improvement of cardiac remodeling and diastolic function.

BP33 The effects of batriatic surgery on cardio-metabolic profile and cardiac remodeling

F. Giofrè¹, M. C. Pelle¹, V. Trapanese¹, C. Vatalaro¹, F. Cosentino¹, M. Melina¹, C. Cloro², A. Sciacqua¹, C. Segura Garcia¹, G. Currò¹, F. Arturi¹

¹Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia” di Catanzaro, Catanzaro, Italy; ²Azienda Ospedaliera “S.S. Annunziata”, Cosenza, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP33

Background: Obesity is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure.

Objective: Aim of our study was to evaluate the impact of bariatric surgery, and therefore of anthropometric and cardio-metabolic variations, on cardiac structure and function.

Methods: Twenty-eight obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The IR has been assessed by HOMA-IR.

The patients were divided into two groups: the first group (10 patients) carried out a follow-up at 6 months post-surgery; the second group (18 patients) at 12 months post-surgery.

Results: As expected, an improvement in the anthropometric and metabolic profile in patients treated with bariatric surgery was observed. Echocardiographic data showed a significant increase in the Ejection Fraction (P < 0.001) and the E / A Ratio (P < 0.001) 6 months after bariatric surgery, a significant reduction in the Interventricular Septum thickness at 6 months (P < 0.001) and at 12 months (P < 0.002) post-surgery and a significant reduction in the Left Ventricular Mass at 6 months (P = 0.02) and at 12 months (P = 0.05) after bariatric surgery. A reduction no significant in the Left Ventricular posterior wall thickness has been observed.

Conclusions: Our data showed an increase of the systolic function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo‑diastolic function.

BP34 Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese subjects treated with metabolic surgery: a real-world, retrospective study

C. Greco¹, F. Passerini², S. Coluccia¹, M. Teglio¹, M. Bondi³, F. Mecherì⁴, V. Trapani⁴, A. Volpe⁴, P. Toschi⁵, B. Madeo³, M. Simoni¹, V. Rochira¹, D. Santi¹

¹Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; ²Division of Internal Medicine and Metabolism, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy; ³Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy; ⁴Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy; ⁵Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP34

Background: Potential negative effects of metabolic surgery on skeletal integrity remains a concern, since long-term data of different surgical approaches are poor.

Purpose: This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric by-pass (RYGB) and sleeve gastrectomy (SG).

Methods: A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery.

Results: 123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after surgery and remained stable during follow up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery (p < 0.001) and this decrease remained among follow up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery. No significant change in osteoporosis/osteopenia rate was detected 1 and 2 years after surgery (p = 0.109). However, a significant BMD reduction was detected at femoral site after surgery (p = 0.032 and p < 0.001, respectively), also after adjustment for gender.

Conclusion: We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set-point is characterized by a phosphate serum increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health.

BP35 TSD-OC as a measure of disability in morbid obese patients before and after sleeve gastrectomy

L. Valzolgher¹, S. Mirpourian², M. Müller³, A. Corradi⁴, M. Kob²

¹Division of Clinical Nutrition, Bolzano Hospital, Bolzano, Italy; ²Division of Clinical Nutrition, Bolzano Hospital, Bolzano, Italy; ³Department of General Surgery, Bolzano Hospital, Bolzano, Italy; ⁴Department of General Surgery, Bolzano Hospital, Bolzano, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP35

Background: Morbid obesity is frequently associated with social and functional disability, with significant impact on the quality of life. TSD-OC is a 36-item questionnaire for Obesity-related Disabilities developed by the Italian Society of Obesity in 2009 and validated in the Italian population. It is divided into 7 sections: pain, stiffness, ADL, indoor mobility, housework, outdoor activities, occupational activities, and social life, that reflect the areas of common problems.

Aim: to retrospectively measure disability using TSD-OC in morbid obese patients before (T0) and 12–24 months (T1) after sleeve gastrectomy.

Methods: 69 adult patients with morbid obesity (mean BMI: 43,6 ± 6,2 kg/m²; range: 41.1–58.0; female/male: 78.3/21.7%) were assessed with the 36-item TSD-OC questionnaire before (T0) and 12–24 months (T1) after sleeve gastrectomy. The overall score was calculated as a sum of the VAS (0–10) scored in each item, divided by the maximal score. Disability was defined with a cut off > 33%. BMI was calculated at T0 and T1.

Results: At T1 mean BMI was 31,1 ± 4,5 kg/m² (range: 22.7–42.2) and mean weight loss (%TBWL): 28,0 ± 10.2%. Mean TSD-OC % at T0 was 36.0 ± 20.1% and decreased significantly to 22.6 ± 36.8% at T1 (p < 0.0001). The prevalence of disability in the initial population was 56.5% and dropped to 4.3% in the follow up after surgery. Moreover a reduction in the score at T1 was observed in each section of the TSD-OC.

Conclusions: morbid obesity is associated with important disability, as it was observed also in our initial sample. Our observations, with the limitation of our small sample, show a tendency to improvement of disability after bariatric surgery. To what extent this may be due to weight loss or to other factors is an interesting question that will need to be further investigated by larger and randomized studies.

BP36 The impact of obstructive sleep Apnoea syndrome (OSAS) on bariatric surgery outcomes

S. Caprio¹, A. Bufano¹, N. Benenati¹, I. Sannino¹, G. Iraci Sareri¹, A. Bombardieri¹, M. Simon Batzibal¹, C. Ciuoli¹, A. Cartocci², M. G. Castagna¹

¹Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università di Siena, Siena, Italy; ²Dipartimento di Biotecnologie Mediche, Università di Siena, Siena, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):BP36

Introduction: OSAS and obesity often coexist and, in patients undergoing bariatric surgery, OSAS increases surgical risk. When OSAS is diagnosed, c-PAP is usually discontinued after the surgery. If OSAS persists and compromises weight loss and metabolic recovery is still a matter of debate.

Aim of the study: We evaluated how OSAS affects weight loss, metabolic recovery and weight regain after surgery.

Materials and methods: We retrospectively evaluated 213 patients with obesity; among them 162 (76%) patients had OSAS. All patients underwent gastric by-pass and were evaluated before surgery, and after 6 and 12 months. At baseline we evaluated anthropometric data and the prevalence of comorbidities obesity-related including metabolic syndrome (MS). At 6 and 12 months persistence of comorbidities was reassessed and Excess Weight Loss (EWL%) was calculated. Weight Regain (WR) at 3 years follow-up years was defined if greater than 10% than maximal weight loss.

Results: At baseline patients with OSAS were older (age 43.7 ± 9.7 years vs 39.2 ± 9.7 years, p = 0.002), had higher BMI (48.1 ± 6.9 kg/m2 vs 45.6 ± 6.2 kg/m2, p = 0.02) and larger waist circumference (131.3 ± 14.7 cm vs 122.7 ± 14.6 cm, p = 0.0004). MS was diagnosed in 47.1% of patients without OSAS and 56.8% of patients with OSAS (p = 0.2). After 6 months, patients with OSAS had higher BMI (p = 0.027) and waist circumference (p < 0.0001), but the two groups showed similar EWL% (p = 0.2). Remission from MS was seen in 75% of patients with OSAS and 83.4% of patients without OSAS (p = 0.4).At 12 months, patients with OSAS still had higher BMI (p = 0.0031) and larger waist circumference (p = 0.0006), but also presented less EWL% (p = 0.0215) and lower remission rate from MS (p = 0.02) than patients without OSAS. At the multivariable analysis using as independent factor BMI, age, sex and presence of OSAS and as outcome EWL% at 12 months, patients with OSAS showed significantly lower EWL% than patients without OSAS (p = 0.031); also age (p < 0.001) and male gender (p < 0.001) influenced significantly weight loss. Three years after the surgery, EWL% (p = 0.1) and WR (p = 0.38) did not differ in the two groups.

Conclusions: The presence of OSAS is an independent factor for worse early surgery outcomes. It would be important to persist with c-PAP therapy in the postoperative period, until OSAS recovery can be assessed.

Poster

P01 Treating adolescents with obesity: long-term impacts of multidisciplinary therapy on inflammatory state

D. C. L. Masquio¹, R. M. D. S. Campos², A. D. P. Ganen¹, B. D. Netto³, J. P. D. Carvalho-Ferreira⁴, F. D. C. Corgosinho⁵, A. R. Dâmaso.⁶

¹Centro Universitário São Camilo, São Paulo, Brazil; ²Universidade Federal De São Paulo, Escola Paulista de Medicina, São Paulo, Brazil; ³Universidade Federal do Paraná, Curitiba, Brazil; ⁴Universidade Estadual de Campinas, Campinas, Brazil; ⁵Universidade Federal de Goiás, Goiânia,Brazil; ⁶Universidade Federal de São Paulo, Escola Paulista De Medicina, São Paulo, Brazil

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity2023, 28(Suppl 1):P01

Background: Obesity is associated with inflammatory condition, which increases the risks of cardiovascular disease development and precocious mortality. The present study aims to verify the effects of one-year of multidisciplinary therapy on cardiometabolic risks factors and inflammatory profile in adolescents with obesity.

Methods: Twenty-two obese adolescents underwent a one-year multidisciplinary therapy (MT) involving clinical, nutritional, psychological and physical exercise approach. Body composition, metabolic, inflammatory and cardiovascular risk biomarkers were analyzed before and after therapy. Visceral and subcutaneous fat were determined ultrassonographically. Homeostasis Model Assessment Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) equation estimated Insulin Sensitivity (Fig. 1).

Results: After MT, significant reduction in body mass, adiposity, glucose, insulin and lipid profile were observed. Hyperleptinemia state was reduced from 77.3% to 36.4%. Inflammatory and cardiovascular biomarkers were improved such as PAI-1, ICAM-1, leptin, leptin/adiponectin ratio and adiponectin/leptin ratio. Simple regression analysis revealed that metabolic alterations were associated with visceral fat and waist circumference. Adiponectin and leptin/adiponectin ratio were associated with HOMA-IR.

Conclusion: The multidisciplinary therapy in long-term promoted improvements on cardiometabolic risks factors and inflammatory state avoid the development of cardiovascular diseases in adolescents with obesity.

Keywords: obesity, leptin, adiponectin, insulin resistance, cardiometabolic risk.

Fig. 1 (abstract P01)

Multidisciplinary clinical therapy to treat adolescents with obesity.

Funding

CNPq 305240/2021-8 and FAPESP (2017∕07372-1; 2013/041364; 2011/50356-0; 2011/50414-0).

P02 Exogenous ketone bodies: a simple answer to a complex matter

L. Cenci¹, A. Lodi²

¹Research and development, GM spa Vicenza, Italy; ²Kerix Lab, Vicenza, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P02

Ketogenic diet: After a few days of reduced carbohydrate consumption, glucose reserves become insufficient both for normal fat oxidation via the supply of oxaloacetate in the Krebs cycle and for the supply of glucose to the central nervous system. The alternative energy source is derived from the overproduction of acetyl coenzyme A. This condition, called ketogenesis, leads to the production of higher-than-normal levels of so-called ketone bodies (β-hydroxybutyrate, acetoacetic acid, acetone) with some physiological effects.

Synthetic ketogenic compounds: Exogenous ketones come in two different forms:

• Ketone salts: these are β-hydroxybutyrate sodium salts. Most commercial products provide 8–12 g of ketones and 1 g of sodium per serving and therefore have a significant impact on the body's salt and fluid balance.

• Ketone esters: these are complex compounds where β-hydroxybutyrate is linked to an alcohol and they do not have the problem of a potential accumulation of salts linked to the use.

The use of a dose of these compounds (280 mg of β-hydroxybutyrate per kg of body weight) can bring the blood level of ketones to around 3 mmol/L within 60 min for the esters, within 90 min for the salts. However, this is a transitory peak, the values drop rapidly, reaching around 2.5 mmol/L for the esters, to return to the baseline values within about four hours.

Conclusions: From a chemist’s perspective, the field of synthetic ketogenic compounds is vast and virtually unexplored. Palatability, caloric density, solubility, and gastrointestinal tolerance are all attributes that can be improved. Nowadays synthetic ketogenic compounds have not been shown to be able to induce the physiological effects (for example: weight loss, type 2 diabetes treatment, management of the neurological disorder and polycystic ovary syndrome) produced by the endogenous ketones body.

P03 Serum adiponectin as a diagnostic tool in patients with generalized lipodystrophy and progeroid syndromes

C. Pelosini¹, N. Tyutyusheva², G. Ceccarini³, S. Magno³, M. Paoli¹, D. Gilio³, M. R. Sessa¹, S. Bertelloni², F. Santini³

¹SVD Laboratorio Chimica e Endocrinologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; ²UO Pediatria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; ³Centro Obesità e Lipodistrofie, UO Endocrinologia 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P03

Introduction: Generalized Lipodystrophies (GL) are extremely rare disorders characterized by a reduction of body fat, without evidence of nutritional deprivation or a catabolic state, associated with reduction of synthesis and secretion of adipocyte-specific proteins, including leptin and adiponectin. Progeroid syndromes (PS) are characterized by accelerated aging and are usually associated with severe lipodystrophy. Anorexia nervosa (AN) is among the diseases to be considered in the differential diagnosis of GL and PS.

Aim: Aim of this study was to investigate the differences between serum leptin and High Molecular Weight (HMW) adiponectin in patients with GL and PS compared to patients with AN.

Subjects and methods: Serum fasting leptin and adiponectin were assayed in 6 patients with GL (congenital or acquired), 5 patients with PS, 11 patients with AN and 12 normal weight subjects (NW). Leptin concentration was measured by ELISA (Mediagnost Reutlingen, Germany) while HMW adiponectin was measured by an automated CLEIA technology (Fujirebio Inc., Tokyo, Japan).

Results: Individual values of serum leptin and HMW adiponectin in patients with GL, PS, AN or NW are shown in the figure.

Fig. 1 (abstract P03)

.

Conclusions: Serum leptin concentrations are reduced to a similar degree in the three groups of patients, proportionally to the extent of fat loss. Serum concentrations of adiponectin are extremely low in patients with GL or PS while they are within the range of normal weight subjects in patients with AN. Serum adiponectin can be regarded as an useful tool to discriminate between lipodystrophy syndromes (GL or PS) and AN.

P04 Brown–pink transdifferentiation in mice adipose organ

D. Piomelli¹, M. Razzoli², S. McGonigle³, A. Bartolomucci⁴, M. Maffei⁵, S. Cinti⁶

¹Departments of Anatomy and Neurobiology, Biological Chemistry and Pharmacology, University of California, Irvine, California, US; ²Department Integrative Biology and Physiology, Minneapolis, US; ³Department of Integrative Biology and Physiology, Minneapolis, US; ⁴Department of Integrative Biology and Physiology and Dipartimento di Medicina e Chirurgia Università di Parma, Minneapolis, US; ⁵CNR Institute of Clinical Physiology, Pisa, Italy; ⁶Medicina Sperimentale e Clinica, Ancona, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P04

The adipose organ consists of white and brown adipocytes. White adipocyte stores energy molecules to return them to the body in the intervals between meals. Brown adipocytes burn the same type of molecules to produce heat. Their coexistence in the organ is explained by their peculiar property of trans-differentiating reversibly into the two phenotypes.

In females, the subcutaneous component of the adipose organ also performs another function of vital importance for the survival of the species: breastfeeding.

Outside of lactation, the udder is composed exclusively of adipose tissue infiltrated by branching ducts that converge in a nipple. The glandular component that produces milk is formed only in pregnancy and lactation.

Morphology, BrdU, lineage tracing and explant data mainly from our laboratory indicate that the milk-producing glands derive from direct transdifferentiation of adipocytes. Since the mammary glands newly formed in late pregnancy are formed by cells with abundant cytoplasmic lipids, we have named them pink adipocytes on the basis of the color of the organ in this functional period.

In mice, mammary adipose tissue is composed of both white and brown adipocytes. The latter are about 65% in Sv129 mice and about 13% in B6 mice. Since we demonstrated that pink-brown transdifferentiation occurs post-nursing, we investigated whether pink-brown transdifferentiation occurs during pregnancy.

Preliminary data indicate that the phenomenon does not occur directly but requires a passage through the brown-white transdifferentiation. The transforming cells assume the expression of titin which is a protein highly expressed by the brown adipocytes of animals exposed to THC in the adolescent period and probably related to their assumption of the characteristic of resistance to obesity.

These data suggest that titin could play a role in brown–pink transdifferentiation, also taking into account that some pink adipocytes with abundant lipids resulted titin-immunoreactive.

P05 Semaglutide: will the diet be unnecessary?

L. Cenci¹

¹Research and development GM spa Vicenza, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P05

Glucagon‐like peptide (GLP-1), an incretin hormone secreted from the L‐cells in the small intestine, stimulates insulin and inhibits glucagon secretions from the pancreatic islets in a glucose‐dependent fashion. GLP‐1 has been shown to enhance satiety, reduce hunger and lower energy intake. GLP‐1 receptor agonists have been shown to reduce body weight and blood glucose levels in people who are overweight or obese, with or without diabetes. Furthermore, activation of GLP‐1 receptors in the human brain helps to regulate appetite and food reward. Semaglutide (S) has 94% structural homology with native human GLP‐1 with three important modifications which give S an extended half‐life of approximately one week. In Italy, S are available in table or injection for the management of type 2 diabetes in adults, but it is also utilized off-label for the management of obesity. The efficacy and safety of S for weight management in combination with reduced caloric intake and increased physical activity were evaluated in four 68-week, double-blind, randomised, placebo-controlled studies, which enrolled a total of 4684 patients. On average, S treatment demonstrated a 15% weight loss. The therapy resulted in statistically significant improvements in waist circumference, blood pressure, and physical activity compared to the placebo. Efficacy was demonstrated regardless of age, gender, race, ethnicity, baseline body weight, BMI, presence of type 2 diabetes, and renal function. Within a year after discontinuing S participants regained two-thirds of their previous weight loss: long-term treatment needed? In weight management, S mainly involves adverse gastrointestinal effects: during the trial period, nausea occurred in 43.9% of patients and diarrhoea in 29.7%. The use of S has increased dramatically worldwide, both as an antidiabetic and for the control of obesity, however, as history shows, there are no effective long-term alternatives to adopting a healthy lifestyle.

P06 A dissonance-based group approach to address the internalized weight stigma in patients with obesity: theory and general organization

R. Dalle Grave¹

¹Casa di Cura Villa Garda, Garda (Verona), Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P06

Knowledge about internalized weight stigma and the interventions to reduce it are at an early stage. Psychoeducation interventions seem ineffective, and a randomized controlled trial comparing behavioral weight loss with or without cognitive behavioral intervention for weight bias internalization found no significant differences between groups in week 52 change on the Weight Bias Internalization Scale (WBI) or Weight Self-Stigma Questionnaire.

The limited efficacy of the prior program to reduce internalized stigma led us to develop a dissonance-based intervention (DBI) that utilizes dissonance-based persuasion principles from social psychology. Although DBIs have been used successfully to change attitudes and behaviors in eating disorder prevention, it has not yet been applied to the management of internalized stigma in patients with obesity. The theory holds that dissonance occurs when an action conflicts with a personal belief. Once this incompatibility has been reached, the resulting discomfort motivates people to change their beliefs to produce greater coherence. The rationale of the intervention is that if people find themselves voluntarily supporting arguments contrary to weight stigma, this will lead to less adherence to the internalized weight stigma beliefs. The intervention encourages patients with obesity to voluntarily criticize the weight stigma through a series of verbal, written, and behavioral exercises. It is theorized that these activities produce cognitive dissonance intended to be resolved by reducing the intensity of the individual's adherence to the internalized weight stigma beliefs. The intervention is delivered in three hours and a half session over three consecutive weeks to a group of 3–6 patients with a score of WBI > 4. The group aims to exploit members' social cohesion and promote attitudinal change by listening to peers. Exercises are used both within and between sessions to facilitate the acquisition of skills.

P07 Weight outcomes with setmelanotide over 3 years in patients with POMC or LEPR deficiency obesity

K. Clément¹, M. Wabitsch², E. Van den Akker³, J. Argente⁴, A. Navarria⁵, M. Srinivasan⁵, G. Yuan⁵, S. Malhotra⁶, E. Fabrizi⁷, P. Kühnen⁸

¹Assistance Publique Hôpitaux de Paris, Nutrition Department Pitié, Salpêtrière Hospital, Paris, France; ²Division of Pediatric Endocrinology and Diabetes, Center for Rare Endocrine Diseases, Department of Pediatrics and Adolescent Medicine University of Ulm, Ulm, Germany; ³Division of Pediatric Endocrinology, Department of Pediatrics, Sophia Children’s Hospital and Obesity Center CGG, Erasmus University Medical Center, Rotterdam, The Netherlands; ⁴Department of Pediatrics and Pediatric Endocrinology, Universidad Autónoma de Madrid, University Hospital Niño Jesús, CIBER “Fisiopatología de la obesidad y nutrición”, Madrid, Spain; ⁵Rhythm Pharmaceuticals, Inc. Boston, MA, USA; ⁶Harvard Medical School Boston, MA, USA; ⁷Rhythm Pharmaceuticals, Inc., Rome, Italy; ⁸Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt, Universität zu Berlin, Institute for Experimental Pediatric Endocrinology Berlin, Germany

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P07

Objective: Rare variants in the melanocortin-4 receptor (MC4R) pathway are associated with early-onset, severe obesity and hyperphagia. Setmelanotide, an MC4R agonist, reduced body mass index (BMI) and decreased hunger in patients with obesity due to biallelic variants in genes encoding proopiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) in Phase 3 trials. The current analysis assesses the durability of setmelanotide efficacy over 3 years in the subgroup of patients who achieved clinically beneficial weight loss.

Methods: Patients aged ≥ 6 years with POMC, including PCSK1, or LEPR deficiency obesity who demonstrated clinical benefit and acceptable safety after treatment with setmelanotide in a prior (index) trial continued treatment in a long-term extension trial (NCT03651765). Age-appropriate weight measures and safety were assessed. Changes in weight-related measures from index trial baseline were evaluated in patients who achieved ≥ 10% weight reduction (age ≥ 18 years) or ≥ 0.3-point BMI Z score reduction (age < 18 years) after 1 year of treatment.

Results: Across all patients (N = 24), mean (SD) percent changes in BMI were − 24.8% (8.2%; n = 24), − 21.0% (13.0%; n = 23), and − 24.0% (17.9%; n = 15) at 12, 24, and 36 months, respectively. In patients ≥ 18 years old (n = 11), mean (SD) percent changes in weight were − 25.1% (7.7%; n = 11), − 22.9% (12.5%; n = 11), and − 24.4% (13.2%; n = 8) at 12, 24, and 36 months, respectively. In patients < 18 years old (n = 13), mean (SD) reductions in BMI Z score were observed at Month 12 (− 1.31 [0.66]; n = 13), 24 (− 1.10 [0.79]; n = 11), and 36 (− 1.01 [1.22]; n = 4). No new safety issues were observed during long-term treatment.

Conclusions: Patients who achieved ≥ 10% body weight or ≥ 0.3-point BMI Z score reduction at 1 year demonstrated persistent and clinically significant benefit at 3 years, supporting long-term use of setmelanotide in adult and pediatric patients with obesity due to POMC and LEPR deficiency.

P08 Cost-effectiveness analysis of surgical and non-surgical weight loss interventions in end-stage knee osteoarthritis and obesity: a markov state model

V. Spuntarelli¹, S. Panunzi², M. Pompa², S. Maltese³, A. De Gaetano², E. Lembo¹, C. Guidone¹, S. R. Bornstein⁴, G. Mingrone⁵, A. Gasbarrini⁶, E. Capristo⁷

¹Patologie dell'Obesità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; ²CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy; ³CNR-IRIB, Consiglio Nazionale delle Ricerche, Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy; ⁴Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität and Dept. of Diabetes, Faculty of Life Sciences & Medicine, King’s College London Dresda, London, UK; ⁵Patologie dell’Obesità, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore and Dept. of Diabetes, Faculty of Life Sciences & Medicine, King’s College London Roma, London, UK; ⁶Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy; ⁷Patologie dell’Obesità, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P08

Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability and pain among older adults and knee osteoarthritis accounts for almost 4/5 of worldwide OA. Obesity is a relevant risk factor for both incidence and progression of the disease, leading to the need for arthroplasty and exposing to a greater risk of revision after primary operation.

Aim of this study was to assess the cost-effectiveness of bariatric surgery and non-surgical weight loss (BS-WL, NS-WL) management in avoiding or delaying TKA in subjects with end-stage knee osteoarthritis and obesity.

A state-transition Markov model was built and implemented in Matlab. The model simulated the outcomes and costs in 3000 potential subjects followed for 25 years and equally distributed in three arms: TKA-only, BS-WL and NS-WL management. Model inputs were derived from published literature and internet sources. A deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the model and of the assumptions. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were computed to establish the effectiveness of a strategy. BS-WL increased QALY from 7·70, when TKA-only was performed as a primary procedure, to 8·96, while NS-WL slightly increased this value to 7·86. BS-WL ICER was $23,888, far below the willingness-to-pay threshold of $50,000. The NS-WL ICER was $51,246, slightly above the threshold. The percentage of subjects needing first revision was higher after TKA-only (26·4%) and lower in both BS-WL (16·9%) and NS-WL (24·8%). One way sensitivity analysis showed that the most sensitive parameter was BS-WL success in losing weight; variation of 20% of the key input parameters produced BS-WL ICER always below threshold.

In conclusion, bariatric surgery is more effective than non-surgical weight loss in delaying or avoiding TKA in subjects with severe obesity, also reducing the need for primary and secondary surgical revision.

P09 Identification and validation of specific cut-off points of skeletal muscle mass index (SMI) to assess sarcopenia in patients with severe obesity

A. Bufano¹, A. Cartocci², N. Benenati¹, C. Ciuoli¹, M. S. Batzibal¹, A. Bombardieri¹, S. Caprio¹, G. Iraci Sareri¹, I. Sannino¹, A. Tirone³, C. Voglino³, G. Vuolo³, M. G. Castagna¹

¹Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy; ²Department of Medical Biotechnologies, University of Siena, Siena, Italy; ³Department of Surgical Sciences, Bariatric Surgery Unit, University of Siena, Siena, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P09

Background and aim of the study: Bioelectrical Impedance Analysis (BIA) is the most used tool in clinical practice to evaluate body composition for patients with obesity. Skeletal Muscle Index (SMI) defined by BIA has been proposed for the definition of sarcopenia but there is currently no univocal cut-offs about it. We aimed (1) to determine the prevalence of sarcopenia in patients with severe obesity using the current cut-offs of SMI, (2) redefine a specific cut-offs of SMI, (3) validate the new cut-off and (4) re-determine the prevalence of sarcopenia. Methods: We retrospectively evaluated 300 patients, 74% female and 26% male, mean age 42.6 ± 9 years, with morbid obesity (mean BMI 46.7 ± 6.5 kg/m²) followed at the Unit of Endocrinology from January 2014 to December 2020. Skeletal Muscle Mass (SMM) was calculated through BIA equation by Janssen et al., whereas SMI was calculated as SMM normalized for squared height.

Results: Prevalence of sarcopenic obesity using the cut-off points reported by De Rosa et al. (7.3 kg/h² for females and 9.5 kg/h² for males) was 2.3%. We calculated the prevalence of sarcopenia by using new cut-offs: using the cut-off obtained from standard deviation method (8.2 kg/h² for females and 10.2 kg/h² for males), a prevalence of 14.7% was observed, whereas using the cut-off calculated through K-means unsupervised cluster (9.2 kg/h² for female and 11.3 kg/h² for male), the prevalence reached to 47.6%. Assuming that through cut-offs calculated with cluster method it was possible to identify a greater share of patients with sarcopenic obesity, we validate them by a second sample consisting of 300 patients with morbid obesity (BMI 44.9 ± 6.7 kg/m2): the rate of sarcopenic patients was still high to that observed in the training cohort (56%); after matching procedure (for BMI and age), the rate of sarcopenic patients was similar in the two groups (50.2% in validation group and 53% in training group, p = 0.6).

Conclusions: The new cut-off calculated with cluster analysis could better identify sarcopenia in patients with morbidly obesity. However, further studies are needed to validate these cut-offs in different patient cohorts.

P10 Long-term efficacy of setmelanotide in patients with Bardet-Biedl syndrome

J. Argente¹, A. M. Haqq², K. Clément³, W. K. Chung⁴, H. Dollfus⁵, E. Forsythe⁶, P. Beales⁷, G. Á. Martos-Moreno¹, J. A. Yanovski⁸, R. S. Mittleman⁹, G. Yuan⁹, E. Fabrizi¹⁰, R. M. Haws¹¹

¹Department of Pediatrics and Pediatric Endocrinology, Universidad Autónoma de Madrid, Madrid, Spain; ²Division of Pediatric Endocrinology, University of Alberta Edmonton, AB, Canada; ³Assistance Publique Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France; ⁴Division of Molecular Genetics, Department of Pediatrics, Columbia University New York, NY, USA; ⁵Hôpitaux Universitaires de Strasbourg, CARGO and Department of Medical Genetics Strasbourg, Strasbourg, France; ⁶Genetics and Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health London, UK; ⁷Genetics and Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health London, UK; ⁸Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Bethesda, MD, USA; ⁹Rhythm Pharmaceuticals, Inc. Boston, MA, USA; ¹⁰Rhythm Pharmaceuticals, Inc., Rome, Italy; ¹¹Marshfield Clinic Research Institute Marshfield, WI, USA

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P10

Objective: Bardet-Biedl syndrome (BBS) is a rare genetic disease characterized by hyperphagia (pathologic insatiable hunger) and early-onset, severe obesity believed to be driven by impaired signaling in the melanocortin-4 receptor (MC4R) pathway. In a Phase 2 and a pivotal Phase 3 trial, treatment with the MC4R agonist setmelanotide produced beneficial reductions in weight, body mass index (BMI), BMI Z score, and hunger in patients with BBS at ~ 1 year. The current analysis is the first to assess the continued long-term efficacy of setmelanotide administration in patients with BBS over ~ 2 years.

Methods: Patients with BBS aged ≥ 6 years were eligible for this observational long-term extension (LTE) trial (NCT03651765) if they completed an index trial in which they received setmelanotide and demonstrated clinical benefit and acceptable safety as determined by the investigator. Study objectives included evaluating changes in body weight and assessing safety and tolerability. The current analysis reports outcomes after ~ 1 year of additional setmelanotide administration during the LTE trial, relative to index trial baseline.

Results: At their enrollment in their index trial, participants’ (54 subjects) baseline mean (standard deviation [SD]) BMI was 42.2 (9.2) kg/m², body weight in patients ≥ 18 years old was 132.3 (20.9) kg, and BMI Z score in patients < 18 years old was 3.5 (0.76). Across age groups, after 18 and 24 months of treatment, mean (SD) percent change in BMI was − 9.5% (10.5%; n = 30) and − 14.3% (11.6%; n = 19), respectively. Mean (SD) percent change in body weight in those ≥ 18 years old after 18 and 24 months was − 8.6% (10.3%; n = 15) and − 14.9% (10.4%; n = 6), respectively. The mean (SD) change in BMI Z score in patients < 18 years old after 18 and 24 months was − 0.83 (0.50; n = 13) and − 0.72 (0.54; n = 12), respectively. No new safety signals were observed. One patient discontinued for an adverse event (hallucination; unlikely to be related).

Conclusions: Clinically beneficial effects of setmelanotide on body weight-related measures continued to be observed in patients with BBS for up to 2 years. 1 patient discontinued the LTE trial due to an adverse event, suggesting setmelanotide continued to have clinical benefit and was generally well tolerated. These data support long-term use of setmelanotide in patients with BBS.

P11 Differences in the characteristics of gut microbiota and metabolome in adult subjects with healthy and unhealthy obesity

V. A. Genchi¹, N. Serale², F. M. Calabrese², M. Vacca², G. Celano², L. Gesualdo¹, M. De Angelis², F. Giorgino¹, S. Perrini¹

¹Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica, Università degli Studi di Bari Aldo Moro, Bari, Italy; ²Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari Aldo Moro, Bari, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P11

Obesity is a worldwide health problem increasing the risk for cardio-metabolic diseases. Studies suggest that metabolically healthy obese (MHO) are at lower risk of cardio-metabolic diseases than metabolically unhealthy obese (MUHO) ones. The role of microbiota in the development of these two different obesity phenotypes is still unknown. The aim of this study was to characterize gut microbiota and metabolome composition in MHO and MUHO considering their clinical data and dietary conditions.

Blood samples and food questionnaires were collected from healthy controls, MHO and MUHO. The gut microbiota was characterized in faecal samples by quantitative PCR. Gas chromatography coupled with mass spectrometry was performed for the analysis of untargeted metabolites and short-chain fatty acids.

The amount of Clostridium coccoides was lower in MUHO than in healthy controls (q-value = 0.0003). Lactobacillus genus (q-value = 0.015) and Lactiplantibacillus plantarum (q-value = 0.015) species were higher in MHO, while Prevotella (q-value = 0.03), Desulfovibrio (q-value = 0.02), and Lactiplantibacillus plantarum (q-value = 0.04) enriched the microbiome of MUHO. The level of Acetone, beta-Myrcene, Tetradecane, 1,5,9- Undecatriene-2,6,10-trimethyl, 7-Hexadecanol, Estragole, alpha-Terpineol, Undec-6-en- 2-one, 5,9-Undecadien-2-one-6,10-dimethyl, 2-Piperidinone, Nonanoic acid, 2,4- Ditertbutylphenol, and 6-Pentadecen-1-ol metabolites were significantly different among the three groups. Lower presence of Butanoic acid was also observed in MUHO.

Lower proportions of Lactobacillus genus and Clostridium coccoides, higher proportions of Prevotella, Desulfovibrio, and Lactiplantibacillus plantarum, and metabolome diversity could be indicators of metabolic unhealthy obesity. The differences in microbiota and metabolome of MHO and MUHO suggest that some characteristics of gut microbiota and metabolome could be involved in the link between morbid obesity and cardio-metabolic diseases.

P12 Diagnostic therapeutic assistance path (PDTA) for the integrated treatment of adult obesity

I. Favara¹, E. Bison¹, A. Boscaro¹, A. Merlo¹, G. Sanguin¹, F. Tonello¹, E. Di Flaviano¹

¹Policlinico di Abano Terme, Abano, Terme (Pandova), Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P12

Overweight and obesity represent two of the most concerning clinical conditions in Italy to date. ISTAT data document how within the Veneto region alone 430,000 citizens are affected by theese conditions.In this regard, have been allocated to the Regional Plans (PDTA).

The PDTA aims to manage the clinical and organizational processes to facilitate the preventive, therapeutic and care pathway. PDTAs promote the creation of territorial networks to support people with overweight and obesity and establishes a multilevel organization. The first level consists of contracted territorial care, which is followed by the second level of territorial support, which includes Prevention Department, Spoke centers and clinical-nutritional network. Finally, the third level is represented by highly specialized Hub centers for severe obesity conditions.Inclusion criteria are based on Body Mass Index (BMI) ranges.

Intake and identification of the most functional pathway takes place following a thorough assessment of the patient's health condition by a multidisciplinary team.

Nutritional Outpatient Clinic. This type of pathway is indicated for individuals with grade I overweight and obesity without complications.

Outpatient Spoke Centers. Spoke centers are for patients with overweight or grade I obesity with or without complications, or in grade III obesity conditions.

Operative unit of psychological-metabolic nutritional rehabilitation polyclinic Abano Terme. In patients with grade II obesity with complications, grade III obesity resistant to the outpatient route due to psychiatric psychological conditions, referral to the psychological-metabolic nutritional rehabilitation unit at the Abano Terme polyclinic.

Outpatient bariatric surgery pathway. In cases of grade II obesity with complications or grade III obesity that do not respond to nutritional and pharmacological therapies, the bariatric surgery pathway is evaluated.

P13 Residential weight-loss intervention for obesity: physical and psychological effects

I. Favara¹, E. Bison¹, A. Boscaro¹, A. Merlo¹, G. Sanguin¹, F. Tonello¹, E. Di Flaviano¹

¹Policlinico di Abano Terme, Abano, Terme (Pandova), Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P13

Severe obesity is a chronic relapsing disease associated with increased risk of morbidity and mortality, impaired quality of life, and severe disability. This study aimed to evaluate the effects of recovery of healthy eating behavior and body weight reduction on perceived health quality, improvement of autonomy and obesity-related disabilities, and psychological symptoms in patients with obesity (with and without binge-eating disorder). The proposed treatment is intensive residential cognitive-behavioral therapy. The study was conducted at the Operative unit of psychological-metabolic nutritional rehabilitation polyclinic Abano Terme: 316 obese patients were evaluated during 28 days. The measures used were: the Test of Obesity-Related Disability (TSD-OC), the 36-Item Short-Form Health Survey (SF-36), the Eating Disorder Examination Questionnaire (EDE-Q 6.0 Italian version), the Binge Eating Scale (BES), and the Symptom Checklist (SCL-90). Moreovere, bodyweight and height were collected on the first and on the last week of admission to the intensive residential program. Our hypothesis was confirmed. We recorded significant improvements in the variables considered, both in perceived fitness and psychological health.

Further research on the follow-up of these patients may complement the data collected in the present work. It would be interesting to evaluate changes in the scales used in relation to any increase or decrease in body weight.

P14 Preliminary results of a clinical study about the adherence to a very low calorie ketogenic diet (VLCKD) on infertile patients with overweight or obesity before IVF

A. Piontini¹, S. Guffanti², V. De Gennaro Colonna³, E. Marchiori², M. R. Ingenito⁴, A. Riccaboni⁵, A. E. Nicolosi⁵, E. Somigliana⁵, A. Santelia⁶, A. Marsili⁷, L. Vigna²

¹Transfusion Center-Obesity and Work Center Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ²Obesity and Work Center, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ³Clinical Science and Community Department (DISCCO), Università degli Studi di Milano-Obesity and Work Center, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁴Dietetic Service and Direzione Medica di Presidio, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁵PMA (Procreazione Medicalmente Assistita), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁶Endocrinology Coop Milano Persona, Milan, Italy; ⁷Endocrinology, San Rossore Clinic, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P14

Introduction: Overweight and obesity are usually related to irregular and/or anovulatory periods, sub-clinical infertility and pregnancy negative outcome.

Methods: Mangiagalli In Vitro Fertilization (IVF) Centre selected women with overweight or obesity (average age 35 y.o, average BMI 37,31 kg/m²) waiting for IVF and referred them to Obesity and Work Centre.

This study is articulated in 3 stages: T0 (first visit), T1 (after 3 months of VLCKD, based on a commercial meal replacement (Isomed), T2 (after 3 months of LCD transition diet), T3 (after 3 months of hypocaloric diet).

We reported the first 3 months of the study (T0-T1 stage), with the purpose to evaluate the weight loss and the blood parameters’ trend after the VLCKD.

Results: On 48 selected patients 11 have never started. About the remaining 37. 3 have not completed T0-T1 stage yet. 34 patients have finished 3 months of VLCKD. About the 34 patients the average weight loss is 15,0 kg (15.4% lost from the weight on T0) and the following blood parameters are significantly decreased (P-Value < 0.05, T0 vs T1): glycemia (95.8 vs 85.3), insulin (22.9 vs 11.5), HOMA-IR Index (5.4 vs 2.0), HbA1C (35.4 vs 31.7), Chol TOT (193.3 vs 173.9), Chol LDL (124 vs 108.9), Tryglicerides (117.7 vs 84.9). Furthermore the PCR has a slight decrease (0.57 vs 0.48).

Conclusions: Some metabolic parameters’ improvements occurred in the study population. These improvements will be verified in the course of the study project. The VLCKD is a useful dietetic approach in infertile women with overweight or obesity, that need a rapid weight loss before IVF.

P15 Psychological well-being perception on vlckd in overweight-obesity women with infertility

G. Agnelli¹, D. M. Conti¹, A. Piontini², V. De Gennaro Colonna³, G. Gambino¹, M. R. Ingenito⁴, A. Marsili⁵, L. Vigna¹

¹Obesity and Work Center, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ²Transfusion Center-Obesity and Work Center UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ³Clinical Science and Community Department (DISCCO), Università degli Studi di Milano-1Obesity and Work Center, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁴Dietetic Service and Direzione Medica di Presidio, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoObesity and Work Center, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁵Endocrinology, San Rossore, Clinic, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P15

Aims: Aims of the study are to evaluate variations of psychological well-being perception and of relationship with food in women with infertility and overweight-obesity on a VLCKD (very low calories ketogenic diet).

Material and methods: A group of women (N = 30) on a VLCKD with an indication of weight loss due to hypofertility were selected and examined at the beginning of the trial (T0) and after 3 months (T1).

The following tests are also administered to integrate clinical examinations:

Binge Eating Scale (BES, cut -off 16), to exclude binge eating disorders.

Psychological General Well-Being Index (PGWBI 0–110, corresponding to the maximum level of perceived psychological well-being) for the perception of psychic and social well-being.

Symptom Check list 90 (SCL-90) to detect any presence of psychopathological disorders.

Results: The SCL-90 showed no indicators of psychic symptoms, suggesting a possible tendency to "normalize" experiences. The PGWBI move from an average score of 76.27 (s.d. 19.96) to 86.29 (sd 10.16) at T1, highlighting an improvement of well-being perception both in personal and relational level. The BES went from 12.12 (sd 6.69), a value that could indicate emotional use of food, to 7.50 (sd 6.44) at T1 suggesting an improvement in the eating behavior of the patients.

Conclusions: The rapid weight loss obtained with VLCKD in the patients enrolled in our study seems to suggest an improvement in perceived well-being and in the awareness of dysfunctional eating behaviors, moreover a greater sense of perceived self-efficacy during the treatment.

P16 Exploring the relationship between impulsivity toward food-reward and bariatric surgery in severe obese individuals

F. Moltrer¹, G. Testa², S. Schiff³

¹Azienda Ospedale Università di Padova, Padova, Italy; ²Universidad Internacional de La Rioja, Logroño, La Rioja, Spain; ³Dipartimento di Medicina DIMED—Università degli studi di Padova, Padova, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P16

In severe obese individuals a tendency to choose more often an immediate but smaller reward instead of attend to receive a greater one delayed in time was frequently observed. This effect seems to be greater when decision involves food-related rewards. Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure which limits food consumption and produce changes of those hormones that regulate hunger and appetite. Beyond physiological and endocrinal changes induced by LSG, improvement in cognitive functions after surgery has been recently showed. The present study aims to evaluate if LSG modulates inter-temporal decision-making toward food and non-food rewards.

Twenty-our severe obese were studied with three inter-temporal tasks with different types of reward (i.e. Euro, discount vouchers, and food), one-month pre-LSG and one-year post-LSG, after significant weight loss.

Obese individuals are more impulsive toward immediate rewards compared to normal-weight individuals. Interestingly, impulsivity toward food-related reward seems to partially improve post-LSG, especially in those individuals that show lower fasting glycaemia levels.

P17 Impact of the type-2-diabetes duration on the different metabolic response to GLP-1RAS

D. Moriconi¹, E. Rebelos¹, L. Bonvicini¹, A. Troilo¹, A. Bourdakis², M. Nannipieri¹

¹Medicina clinica e sperimentale, Università di Pisa, Pisa, Italy; ²Internal Medicine Clinic; Trikala General Hospital, Trikala, Greece

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P17

Background and aims: Glucagon-like peptide-1 receptor agonists (GLP1-RA) are antihyperglycemic medications which have shown benefit on several metabolic parameters. However, it is currently unknown if this benefit are the same regardless of the duration of diabetes. The aim of this study was to evaluate the impact on lipid profile, liver enzymes and kidney function in patients with different duration of type-2-diabetes (T2D).

Materials and methods: Observational real-life study; 78 patients (46 women) with T2D and BMI > 30 kg/m² were treated with GLP-1RA. During the study, the remaining antidiabetic and lipid-lowering therapy was not modified. Patients were evaluated at baseline, 6 and 12 months with clinical examination and blood tests. The cohort were then divided in two groups, Short and Long, on the basis of the length of diabetes, respectively < 10 or ≥ 10 years.

Results: At baseline, the two groups were similar for sex, BMI, blood pressure values and type of GLP-1RA distribution, while the Short group was younger. Regarding blood chemistry parameters, at baseline no differences were found in fasting blood glucose, HbA1c, liver enzymes, kidney function, triglycerides and fatty liver index (FLI), while the Short group had higher values of LDL (p = 0.043). Twelve months after treatment, the levels of HDL and eGFR did not undergo statistically significant changes, while we assisted to a significant reduction in BMI, AST, ALT, album-to-creatinine ratio and fasting glucose, without differences between the two groups. Interestingly, although the positive effect on the reduction of HbA1c, GGT, LDL and triglycerides was present in both groups, it was significantly greater in the Short group (p interactions < 0.05 for all parameters). Finally, we assisted to a greater reduction in FLI in the Short group, and the difference remained significant after adjustment for delta-BMI (p = 0.042; St.β 0.34).

Conclusion: While the beneficial impact of GLP-1RA on weight loss does not appear to be affected by the T2D duration, the effect of GLP-1RA on key metabolic parameters seems to be more pronounced in patients with shorter disease duration.

P18 MIR-22 represents a key regulator of lipid homeostasis and a therapeutic target for obesity

R. Panella¹

¹Center for RNA Medicine, Department of Clinical Medicine Copenhagen SV, Copenhagen, Denmark

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P18

Obesity is a growing public health problem, affecting almost 2 billion people worldwide. It is associated with increased risk of type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease (NAFLD) and cancer. Here we identify microRNA-22 (miR-22) as an essential rheostat involved in the control of lipid and energy homeostasis as well as the onset and maintenance of obesity, using 2 different mice models to prove it.

We demonstrate miR-22 overexpression promotes obesity and hepatic steatosis while its loss-of-function protects against these phenotypes even when mice are fed with high fat diet. Genetic ablation of miR-22 favors metabolic rewiring towards higher energy expenditure and browning of white adipose tissue. Our findings thus identify a critical non-coding RNA that can control multiple metabolic relevant phenotype as a single genetic factor. More important the effect of miR-22 inhibition on body weight is not correlated to any decrease in appetite nor food consumption, providing an alternative to GLP1 agonist treatment that have big impact on appetite.

P19 Efficacy of liraglutide 3.0 mg as adjunct to diet and exercise on weight loss: a retrospective study in 189 consecutive overweight and obese patients

L. Gavazzi¹, M. Del Prete¹, F. Vignati¹, G. Di Sacco¹, D. Dellepiane¹, F. Muratori¹

¹Division of Endocrinology and Diabetology, Sant’Anna Hospital – ASST Lariana, Como, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P19

Introduction: Liraglutide (L), a glucagon-like peptide-1 (GLP-1) receptor agonist, is one of medications currently approved by for chronic weight (W) management. In this retrospective study we report the effects on W loss achieved with L and/or diet and physical activity alone in a court of 189 consecutive overweight and obese patients followed in our unit.

Patients and methods: We retrospectively assessed 189 obese patients consecutively admitted to our observation to lose W. Of these, 109 patients (92 F—17 M; mean age 47.0 ± 10.7 years) were treated with L and 80 (52 F—28 M; mean age 55.9 ± 15.4 years) with diet and physical activity alone. All patients were required to follow dietary and behavioral therapy alone or with concomitant drug treatment. L was administered once-daily subcutaneously at starting dose of 0.6 mg and with the achievement of 3.0 mg in two months from the starting therapy. The aim of this study was to evaluate the efficacy of L and/or diet and physical activity alone on W loss.

Results: At the first visit, mean W and mean body mass index (BMI) were respectively 93.3 ± 17.9 kg and 33.9 ± 5.5 kg/m² for L group and 99.3 ± 15.4 kg and 34.9 ± 5.5 kg/m² for diet and physical activity group. After 6-month follow up, patients treated with L had a mean W of 80.7 ± 16.1 kg and mean BMI of 29.3 ± 5.0 kg/m², with a mean percentage W and mean BMI reduction respectively of -14.1 ± 4.7% and -4.8 ± 1.8 kg/m². After 6-month follow-up, patients treated with diet and exercise alone had a mean W of 85.8 ± 16.7 kg and mean BMI of 32.0 ± 5.1 kg/m², with a mean percentage W and mean BMI reduction respectively of -10.1 ± 7.9% and -3.2 ± 2.3 kg/m². There was a significant difference in terms of reduction in mean percentage W (p = 0.0002) and mean BMI (p < 0.0001) between the two groups.

Conclusions: Our results confirm the efficacy of real-life therapy with L in addition to diet and physical activity in obese patients and are consistent with data obtained from the clinical trials.

P20 A novel heterozygous mutation in the insulin receptor gene in a boy with metabolic syndrome and diabetes onset: a case report

E. Fornari¹, V. Mancioppi², A. Maguolo³, S. Costantini², F. Olivieri², C. Piona³, M. Marigliano³, A. Sabbion², G. Contreas², A. Morandi³, C. Maffeis³

¹Pediatria B, Az. Ospedaliera Universitaria Integrata Verona, Verona, Italy; ²Pediatria B, Az Ospedaliera Univeristaria Integrata Verona, Verona, Italy; ³Department of Surgery, Dentistry, Gynecology and Pediatrics, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P20

A 15-year-old boy was admitted to the Pediatric Emergency Room for recurrent presyncopes associated with vertigo and abdominal pain. FH positive for early onset Type 2 Diabetes Mellitus (T2DM), hypercholesterolemia, and cardiovascular disease. Lab: glycemia 260 mg/dL, no ketoacidosis, HbA1c 11%. Clinical examination: BMI 23.6 kg/m2 (+ 0.65 DS), WC 96 cm (> 90^th percentile), BP 131/70 mmHg (systolic > 95th percentile): initial diagnosis: diabetes mellitus. Treatment: insulin (0.5 units/kg) with rapid improvement of glycemic control. Blood tests at follow-up (negativity for ZnT8, GAD, IA2 and anti-Insulin antibodies, non-predisposing HLA, normal C-peptide) excluded the diagnosis of T1DM. The genetic analysis (NGS), conducted for high LDL-ch. in familial hypercholesterolemia, showed a heterozygous mutation (c.894G > A, p.Gln298), with paternal inheritance, in the Lipa A gene (LIPA). High blood pressure, after excluding secondary hypertension, was treated with Ramipril.

Through the findings of clinical and laboratory examinations, type A insulin resistance syndrome was considered, and INSR gene mutation analyses were performed (NGS). A novel heterozygous variant in intron 6 (RefSeq NM_000208.3: c.1483 + 5G > A) was found, also present in the mother with a previous diagnosis of T2DM. This mutation, which to date has never been reported in the literature to be associated with diabetes, could affect the recognition of the 5' donor splicing site of intron 6, which is essential for the correct processing of the primary transcript. This hypothesis is supported by all the splicing prediction software used (NNSPLICE 0.9, Human Splicing Finder, SpliceAI etc.). Metformin therapy was started while insulin was gradually discontinued, and the boy’s glycemic control remain optimal (HbA1c 6.8%).

Written consent to publish had been obtained.

P21 A clinical case of severe obesity and severe respiratory insufficiency, diabetes mellitus and arterial hypertension: a positive evolution given by current therapies and careful clinical management

M. Del Prete¹, G. Di Sacco¹, F. Vignati¹, L. Gavazzi¹, D. Dellepiane¹, F. Muratori¹

¹Division of Endocrinology and Diabetology, Sant’Anna Hospital, ASST Lariana, Como, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P21

In November 2018 a 53-year-old female patient was referred to our endocrinology service. Her weight (W) was 148 kg and body mass index (BMI) 57.81 kg/m². She had severe bronchial asthma and bariatric therapy was contraindicated for this reason. She was on oxygen, corticosteroids, basal-bolus insulin, antihypertensive, uric acids, and pain medications. Glycated hemoglobin (HbA1c) was 11.8%, creatinine 2.4 mg/dl, estimated glomerular filtration rate (eGFR) 32.5. At that time the patient was hospitalized with progressive reduction of corticosteroids and placed in nutritional intervention and amino acid supplementation. Rapid insulin therapy was withdrawn, glargine insulin was gradually reduced with the introduction of liraglutide and empagliflozin. At hospital discharge W was 138 kg and the patient showed improvement in glycemia, renal and respiratory functions, uric acid, hypertension and pain. Antihypertensive therapy was simplified, steroid was taken at lower dose, allopurinol and pain drugs were discontinued. The patient continued to take bronchodilators for bronchial asthma and oxygen at night. In June 2019, HbA1c was 6.8%, W 110 kg with further improvement of renal function and normalization of eGFR. The patient was no longer taking oxygen and glargine insulin was discontinued. In September 2021 HbA1c was 6.1% and W 96 kg. Liraglutide was switched to semaglutide while empagliflozin was discontinued. Steroid was discontinued in March 2022 and biological therapy for bronchial asthma was started. In September 2022 W was 90 kg and HbA1c 5.6%. The patient takes oxygen and prednisone therapy only in exacerbations of bronchial asthma which, after the initiation of biological therapy, occurred twice in one year.

Conclusions: Multidisciplinary management of the patient was essential. Alongside this, the innovative metabolic therapies (GLP-1 agonists and SGLT2 inhibitors) and a determined and constant clinical management have allowed the patient to return to a normal life.

Written informed consent has been obtained from the patient for the publication of this report.

P22 Taking care of the obese patient: care paths from surgery to clinical practice

F. Iaropoli¹, F. Corallo², G. Maresca², G. Pintabona³, L. Bonanno², V. Lombardo¹, A. Quartarone², E. Morini²

¹UOC Chirurgia Ospedale IRCCS-Piemonte Messina, Messina, Italy; ²Dip. Neuroscienze IRCCS-Piemonte Messina, Messina, Italy; ³UOC Messina, Messina, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P22

Introduction: The treatment of obesity goes to lifestyle correction to bariatric surgery depending on the severity of the case. The aim of our study is to compare the impact of sleeve gastrectomy with dietary treatment (Mediterranean diet MD) in patients with obesity, comparing weight loss, improvement in inflammatory and bone profile after treatment.

Materials and methods: 118 patients, diagnosed with severe obesity were recruited. 60 (mean age 43 years) underwent bariatric surgery (GROUP A) and 58 (mean age 48 years) underwent a dietary regimen (GROUP B). All patients were evaluated before (T0) and after 18 months (T1) beyond surgical or dietary treatment. Group A underwent robotic or laparoscopic sleeve gastrectomy, while Group B underwent dietary treatment based on the Mediterranean diet (MD). Evaluation included haematochemical examinations, Bioimpedance analysis (BIA) and Dual X-ray Absorptiometry (DEXA) BMI, FM%, platelets (PLT), neutrophils, C-reactive protein (CRP), Bone Mineral Density (BMD), Trabecular Bone Score (TBS), Z-score, T-score, Intermuscular adipose tissue (IMAT) and Vitamin D3.

Results: In group A we find significant differences in all clinical variables (p < 0.001), whereas, in group B we only find significant differences (p < 0.001) in BMI, platelets, neutrophils, PCR, Z-score, T-score, TBS and Vit D3. Furthermore, significant correlations are shown in both groups between FM and weight, between FM and height and between FM and BMI. Finally, intergroup analysis at T0 shows significant differences between the groups in BMI, platelets, neutrophils and PCR, while at T1 in BMI, platelets and neutrophils.

Discussions and conclusions: In the bariatric group, we find clinical variables such as BMI, FM%, platelets, neutrophils, PCR, TBS, T-score, Z-score, Z-score neck, BMD, BMD neck and Vitamin D3 significantly improved after the first follow-up of surgery. While in the group of patients undergoing dietary treatment alone we find significant differences in BMI, PLT, neutrophils, PCR, TBS, Z-score and vitamin D3 after the first follow-up. Analysis of our data also demonstrates the effectiveness of bariatric surgery on osteoporosis/osteopenia by determining statistically significant changes in the indices of inflammation.

P23 Possible use of liraglutide in overweight/obese subjects with impaired resting energy expenditure

M. R. Ritacco¹, E. Lapini¹, V. R. Pullara¹, E. Zorzetto¹, A. Monti¹, F. Selmi¹, V. Zaccheroni¹

¹Centro Obesità e Nutrizione Clinica Villa Igea Forlì, Forlì, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P23

The effect of liraglutide was tested in subjects with proven refractoriness to weight loss after lifestyle intervention and demonstrated deficit in resting energy expenditure and/or lipid oxidation by indirect calorimetry.

32 overweight-obesity subjects (5 M and 27 F) (median BMI 33.2 kg/m²) with deficit in resting energy expenditure and/or lipid oxidation measured by indirect calorimetry were observed. The subjects were classified: group 1 -subject treated with Liraglutide 1.8–3.0 mg per day + diet therapy- and group 2- subjects treated with specific supplementation (a-lipoic acid or amino acids) + diet therapy-.

Results: Group 1: pre-treatment (4 months) weight 95.2 ± 27.4 kg and abdominal circumference 105.0 ± 22.6 cm, initial therapy weight 98.1 ± 28.4 kg and abdominal circumference 108.5 ± 20.02 cm. Weight after 3–6 months 94.4 ± 30.9 kg and abdominal circumference 103.1 ± 21.7 cm. Group n.2: pre-treatment (4 months) weight 91 ± 20.3 kg and abdominal circumference 106.6 ± 20.7 cm, initial therapy weight 90.6 ± 20.1 kg and abdominal circumference 106.4 ± 19.2 cm. Weight after 3–6 months 90.3 ± 19.4 kg and abdominal circumference 105.4 ± 19.6 cm.

The subjects treated with liraglutide showed a weight reduction unlike the subjects treated with supplementation, suggesting a direct effect of liraglutide on both quantitative and qualitative energy expenditure.

About half of the subjects in group 1, 3–6 months after the start of the therapy, suspended the treatment with maintenance of the result in 50% of cases and partial recovery in the remaining 50%. No one continued to lose weight after therapy stop. Additional studies are needed to determine a new indication of liraglutide in subjects with metabolic deficit.

P24 Healthy vs unhealthy obesity: evaluation of dietary habits

N. Cacciapuoti¹, S. Di Rienzo¹, M. Di Lauro¹, C. Cervellera¹, C. Gautiero¹, M. S. Lonardo¹, E. C. Liguori¹, B. Guida¹

¹Department of Clinical Medicine and Surgery, University of Study of Naples Federico II Napoli, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P24

Obesity is a chronic and relapsing disease that negatively affect health. It’s cause of increased morbidity and mortality, associated with high cardiometabolic (CM) risk and cancer. However, data from observational independent studies show that not all obese subjects are burdened by the same CM-risk. Hence, the hypothesis of Healthy Obesity (MHO) and Unhealthy Obesity (MUO), the last one defined by BMI ≥ 30 kg/m² plus at least 3 items among the 5 of NCEP ATP III criteria.

The aim of this study was to evaluate eating habits in a group of 27 obese subjects (11 MUO) to identify dietary habits that could lead to the increased CM-risk characteristic of MUO.

Subjects were enrolled among ones attending at Outpatients Clinic of the I.P. “Diet therapy in transplantation, renal failure and chronic pathology”, University of Naples Federico II. Anthropometric measurements were detected as well as dietary habits by Food Frequency Questionnaire and PREDIMED Questionnaire. The endogenous non-carbonic acid net production was assessed by protein intake/potassium ratio, salt intake by 24 h-urinary sodium.

Results of this preliminary study show that there is a better adherence to the Mediterranean Diet (MD) in MHO subjects (p < 0.05). Moreover, MUO showed a significant grater salt intake than MHO (16.4 g/day ± 6.37 vs 11.3 g/day ± 3.7, p < 0.05). Even if no significant, we observed a higher acid load in MUO compared to MHO and a direct linear correlation (p < 0.05,R = 0.418) was observed between salt intake and acid load. No significant difference about macronutrients intake was observed in both groups.

To our knowledge, currently there are no literature data showing differences in dietary quality between MUO and MHO, so our preliminary results are original. In conclusion, the poor adherence to MD, the higher salt consumption and acid load could explain the increased dietary related CM-risk typical of MUO. This preliminary observation must be confirmed on a larger population by longitudinal studies.

P25 Efficacy in prevention and treatment of micronutrient deficiencies and tolerability of a medical nutrition product (Bariatrifast) after bariatric surgery: a 1-year monocentric prospective observational cohort study

S. Bechi Genzano¹, D. Gilio¹, G. Salvetti¹, A. Basolo¹, J. Vitti¹, R. Iaccheri¹, V. Angeli¹, D. Troiani¹, A. Calderone¹, C. Lippi¹, S. Magno¹, A. Meola¹, G. Scartabelli¹, P. Fierabracci¹, G. Ceccarini¹, F. Santini¹

¹Obesity and Lipodistrophy Center of the Endocrinology Unit 1, AOUP Pisa, Pisa, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P25

Objective: Bariatric surgery (BS) is an effective intervention for severe obesity and its comorbidities. Micronutrient and vitamin deficiencies can occur as a consequence of anatomic and physiological changes due to surgery. This monocentric prospective observational study aimed at evaluating the efficacy in prevention and treatment of micronutrient deficiencies and the tolerability of a medical nutrition product (Bariatrifast, BIOITALIA S.r.l., Italy) in patients with obesity following BS.

Methods: We recruited 20 patients with severe obesity, admitted at the Obesity and Lipodystrophy Center of the Endocrinology Unit (Pisa) who underwent BS (10 sleeve gastrectomy, SG, 10 gastric bypass, GB), mean age 49.9 years, weight 123.5 kg, BMI 43.3 kg/m². The study included a baseline visit prior to surgery (visit 1, V1), and follow-up visits at 1, 3, 6 and 12 months after surgery (visit 2–5, V 2–5). Each visit included medical examination and blood sampling (blood count, serum ferritin, folate, vitamin B12, PTH, 25 OH vitamin D3, ionized calcium). Following bariatric surgery, patients started the daily oral multivitamin and mineral supplement.

Results: All patients achieved a significant weight loss (mean: 34.8 kg). Good adherence to oral supplementation was achieved (median 97.6%). At V5, serum concentration of vitamin B12 and 25-OH Vitamin D3 increased (mean increase 360 ng/L and 23 mcg/L, respectively). When stratified by type of surgery, levels of Vitamin D and B12 tended to be higher in the SG group compared to BP. Folate concentration showed a tendency to increase in both groups. The serum levels of the other parameters were maintained within the normal range in all patients. Bariatrifast was replaced with an oral product containing a lower dose of vitamin B12 in 7 patients who achieved serum levels of Vit. B12 > 1.000 ng/L. No adverse events were reported.

Conclusion: Following SG or GB, Bariatrifast prevents deficit of micronutrients and it is well tolerated.

P26 Effect of a lifestyle intervention in children/adolescent with obesity: differences according to sex

M. Croci¹, L. Gilardini¹, L. Pasqualinotto¹, S. Martinelli¹, S. Bertoli²

¹Obesity Unit-Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy; ²Obesity Unit-Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P26

Obesity is a heterogeneous condition, yet sex/gender is rarely considered in the clinical care of this disease. The aim of this study is to to determine whether the effectiveness of a weight loss intervention in children/adolescent with obesity differs between boys and girls. We analyse data from patients affected by obesity aged 6 to 18 years old who entered our 3-month multidisciplinary weight loss intervention, which included medical, psychological and nutritional sessions, from 2012 to 2022. Information regarding family history of obesity, birth weight, breastfeeding were collected from parents. Anthropometric measures, body composition, blood pressure (BP), levels of glucose, insulin, lipids, uric acid and transaminase were assessed before and after the intervention. 569 subjects were admitted to the programme and 472 concluded the intervention (age 12.3 ± 2.7 years, BMI z score 2.3 ± 0.2, males 47%, waist circumference 101.8 ± 13.0 cm, fat mass 42.1 ± 6.2%). At baseline boys were more frequent at Tanner I, had higher BMI z score (p < 0.05), systolic BP (p < 0.01), HDL cholesterol (p < 0.05), transaminases (p < 0.01), uric acid (p < 0.0001) and lower fat mass (p < 0.0001) and triglycerides levels compared to girls and similar age and waist. After 3 months, decrease in fat mass (− 5.0 ± 5.8 vs − 1.5 ± 4.7%, p < 0.0001) and BMI z score (− 3.7 ± 3.6 vs − 3.1 ± 3.0%, p < 0.05) was higher in boys than in girls. Blood pressure, triglycerides, insulin resistance and transaminases significantly decreased in boys and in girls. Uric acid and LDL cholesterol decreased significantly only in boys. In conclusion a 3-month lifestyle intervention resulted in a significant reduction in BMI z score and fat mass, especially in boys. There was an improving in cardiovascular risk factors in both sexes, but uric acid and LDL cholesterol significantly decreased only in boys.

P27 Effects of liraglutide on body composition for obesity therapy: preliminary data on gender differences

M. S. Lonardo¹, R. Trio², N. Cacciapuoti², M. Di Lorenzo², M. Chiurazzi², C. Gautiero², A. Riccio², B. Guida²

¹Department of Clinical Medicine, University of Study of Naples Federico II, 80131 Naples, Italy; ²Department of Clinical Medicine, University of Study of Naples Federico II, 80131 Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P27

Among the drugs approved for the obesity (Ob) treatment, liraglutide (a GLP-1 analogue) is showing the best efficacy in terms of weight loss. At present, there are still insufficient data on its effects on body composition (BC) changes during weight loss (WL).

Conventional bioimpedance analysis (BIA) applied to any condition in which there is violation of the assumption of constant tissue hydration (73%), as Ob, propagate prediction errors. To solve these problems, the direct use of raw electrical data obtained from BIA analysis has been proposed, through bioelectrical impedance vector analysis (BIVA).

The aim of our study is to evaluate the effects of liraglutide on the body composition of subjects with Ob after WL.

27 subject with Ob (11 M; BMI 46.2 kg/m²), attending at Outpatients Clinic of the I.P. “Diet Therapy in transplantation, renal failure and chronic pathology”, University of Naples Federico II, were enrolled and divided into two groups. Group A (subjects treated for 3 months with hypocaloric diet, HD and liraglutide therapy); Group B (subjects treated for 3 months with HD). Anthropometric measurements s well as BC assessment were performed at baseline (T0) and after 3 months of treatment (T1).

At T1, the ΔBMI% in the two groups was not statistically significant (Group A 5.72% vs Group B 5.61% p > 0.05). In Group A, the vector length (VL) assessed by BIVA was significantly longer at T1 vs T0 (p < 0.05), a data not confirmed in Group B.

The two groups stratified by gender show a significant increased VL at T1 vs T0 only in men (244.6 vs 215.3, p < 0.05) belonging to Group A without change in PA. No significant difference neither in VL or PA in the other subgroups was found. So we hypothesize a reduction in ECW and FM without loss of BCM in male belonging to Group A.

Aware of the small sample size, our results suggest that liralutide could have a diuretic effect in men with Ob. Further studies will certainly be needed to confirm these preliminary data.

P28 Sarcopenic obesity and isolated low muscle mass or function are prevalent among patients with type 2 diabetes

P. Moro¹, S. Boussetta¹, F. Leva¹, C. C. Berra¹, L. Luzi¹, C. Conte²

¹Diploma Endocrinologia, Nutrizione e Malattie Metaboliche, IRCCS MultiMedica, Milan, Italy; ²Diploma Scienze Umane e Promozione della Qualità della Vita, Università Telematica San Raffaele Roma, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P28

Introduction: Diabetes is one of the suspicion factors for the screening of sarcopenic obesity (SO) according to the ESPEN-EASO recommendations. We implemented routine screening for SO, and assessed the proportion and characteristics of pts with SO among outpatients with obesity (OB) and type 2 diabetes (T2D).

Methods: Pts with T2D underwent assessment of skeletal muscle mass (MM) by bioelectrical impedance analysis (BIA) and muscle function (MF) by handgrip strength test. SO was defined as abdominal obesity (AO, waist circumference [WC] ≥ 88 and 102 cm in women and men, respectively) plus low skeletal muscle index (SMI, MM/weight) and low MF, based on the cut-points recommended by ESPEN-EASO. The level of physical activity (PA) was estimated with the IPAQ questionnaire.

Results: We collected data from 175 pts (65.1%M, median [IQR] age 70 [63;77] yrs). Of these, 109 (62.3%) had AO. Among pts with AO (56.0%M, age 70 [63; 78] years, BMI 30.8 [27.6; 33.7] kg/m²), 7.3%, 35.8% and 56.9% had normal weight, overweight (OW) or OB defined by BMI. SO was diagnosed in 14 (12.8%) of those with AO. The proportion of males was similar (53.7% vs. 71.4% in no SO and SO, respectively, p = 0.212). Median age (71.0 [63.0; 79.0] vs. 66.5 [59.0; 72.5] years, p = 0.117), rates of OW/OB (91.6% vs. 100.0%, p = 0.593), and rates of low PA (56.8% vs. 71.4%, p = 0.301) were similar. Of note, 23.2% and 15.8% of pts without SO had isolated low SMI or MF, respectively.

In elderly subjects only, BMI positively correlated with total MM (Spearman’s rho 0.375, p < 0.001) and MF (0.235, p = 0.039) but not with SMI (-0.088, p = ns). WC strongly correlated with total MM and MF (Figure) in subjects aged either < 65yrs (0.401, p = 0.023; 0.498, p = 0.004 for MM and MF, respectively) or ≥ 65yrs (0.550, p < 0.001; 0.323, p = 0.004), but not with SMI.

Conclusion: The proportion of pts with AO and low SMI, low MF or both (SO) is high among pts with T2D. Abdominal adiposity (WC) might play a role in the impairment of MM and MF.

Fig. 1 (abstract P28)

.

P29 Phase angle (PHA) variation in obese subjects treated with a GLP-1 analogue: an observational study

V. Spuntarelli¹, M. Capotosto¹, E. Santoleri Paesler¹, M. Scialabba¹, G. Mingrone², A. Gasbarrini³, E. Capristo²

¹UOC Patologie dell'Obesità, Medicina Interna, UCSC Roma, Rome, Italy; ²UOC Patologie dell'Obesità, Medicina Interna, UCSC Roma, IRCCS Policlinico Gemelli, Rome, Italy; ³Dipartimento Medicina Interna, UCSC Roma, IRCCS Policlinico Gemelli, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P29

Background: Phase angle (PhA) is a good marker of nutrional status in many clinical conditions. It is used among obese patients (PT) in different settings, due to the higher variability of the two main measured parameters (resistance: R, and reactance: Xc). Taking into account the great variability in body composition changes occuring in obese subjects with weight loss therapy, PhA measurement is able to add relevant information to body mass index (BMI) alone in these PT. The improvement in clinical status associated with weight loss is linked to a positive change in PhA. Glucagon—like Peptide 1 (GLP-1) receptor analogues play a relevant role in obesity treatment coupled with lifestyle modifications (LSM).

The aim of our observational study is to evaluate PhA variations among obese PT who were treated with LSM alone or LSM + Liraglutide.

Methods: Thirty non diabetic adult PT (20F/10 M, BMI: 35.7 kg/m²) were consecutively enrolled and evaluated at 0, 3 and 6 months after LSM. Fifteen PT underwent Liraglutide subcutaneously (LG) dose escalation for the whole period. Both groups followed a hypocaloric diet (small daily calorie deficit: 300–800 kcal according to the clinical condition), and a gradual exercise scheme. At each follow-up visit lab profile, anthropometric parameters and bioelectrical impedance analysis (BIA) were assessed. Statistical analysis was performed by ANOVA.

Results: After 6 months LG showed an average weight loss of -19.2 ± 2.4 kg while LSM group of -10.8 ± 1.7 kg (p < 0.05). BMI decreased of 6.24 ± 1.7 points in LG compared to 3.98 ± 1.2 points in LSM group (p < 0.05). LG showed a higher increase in R (480.01 Ω ± 54.23 at time 0 vs 489.62 Ω ± 50.20 after 6 months, p < 0.01) and of Xc (42.33 Ω ± 4.96 at time 0 vs 51.23 Ω ± 7.64 after 6 months p < 0.05) than LSM group, with a significant variation in PhA in the LG (5.52° ± 1.02 at time 0 vs 5.99° ± 0.98 after 6 months, p < 0.01). Fat mass showed a significantly higher decrease in the LG (38.6% ± 4.2 at time 0 vs 32.0 ± 4.0 after 6 months, p < 0.001) than the LSM group (39.9% ± 4.0 at time 0 vs 35.1 ± 3.5 after 6 months, p < 0.01).

Conclusions: PhA meaurement represents a useful tool in obese people who undergo an appropriate weight loss intervention. LG has a key role added to LSM in body weight and fat mass reduction.

P30 Efficacy of a 3-month very low-calorie ketogenic diet (VLCKD) on liver steatosis and fibrosis by transient elastography in patients with obesity

V. Trapanese¹, F. Giofrè¹, R. M. Natale¹, C. Vatalaro¹, F. Cosentino¹, M. Melina¹, T. V. Fiorentino¹, F. Andreozzi¹, F. Arturi¹

¹Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia” di Catanzaro, Catanzaro, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P30

Background: Currently the treatment of metabolic dysfunction-associated fatty liver disease (MAFLD) is based on weight loss.

Aim: The aim of this study was to investigate the effects of Very Low-Calorie Ketogenic Diet (VLCKD) on liver steatosis and fibrosis in patients with obesity.

Materials and methods: Ten patients treated with VLCKD have been enrolled. The inclusion criteria were a BMI > 30 kg/m² and a fatty liver index (FLI), a predictor of hepatic steatosis, > 60. At baseline and 3 months after VLCKD treatment, an antrhopometric (body weight, body mass index and waist circumference) and cardio-metabolic evaluation has been performed. Liver steatosis and fibrosis were assessed by using a transient elastography (FibroScan) to measure the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. Significant liver steatosis was defined as CAP ≥ 280 dB/m and significant liver fibrosis, as LSM ≥ 8.0 kPa. The insulin resistance was evaluated by HOMA-IR.

Results: Weight (kg) (105 ± 18.2 vs 83.7 ± 16.7, P < 0.05), BMI (kg/m²) (40.1 ± 4.7 vs 31.8 ± 4.8, P = 0.002) and waist circumference (cm) (115 ± 13.6 vs 101.8 ± 12.4, p < 0.05) were significantly lower 3 months after VLCKD treatment. VLCKD improved also significantly fasting glucose (P < 0.05), fasting insulin (P = 0.004), HOMA IR (P < 0.001), lipid profile and blood pressure. In addition, also the CAP values were significantly lower than at baseline (215,8 ± 62,33 dB/m vs 301,5 ± 68,31 dB/m, respectively; P < 0.05) with a mean CAP reduction of 85,7 ± 33,11 dB/m. Similarly, LSM values were lower after 3 months of VLCKD than at baseline (4.56 ± 1.3 kPa vs 6 ± 2.9 kPa, respectively).

Conclusion: In conclusion, although preliminary, our data suggested that VLCK diet can induce a significantly reduction in body weight and an improvement in cardiometabolic parameters, in liver steatosis and fibrosis in patients with obesity. Then the VLCKD can represent a helpful approach for the treatment of MAFLD.

P31 Iron deficiency in a population of adults with severe obesity

D. Laudisio¹, C. Graziadio¹, G. Pugliese¹, G. de Alteriis¹, A. Colao¹, S. Savastano¹

¹Università degli Studi di Napoli Federico II, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P31

Introduction: Several studies, have suggested that excess body mass index (BMI) is associated with iron deficiency (ID).The aim of this study was to investigate the iron homeostasis in a group of patients with severe obesity, particularly evaluating the relationship between serum iron levels, visceral obesity, body fat mass, and biomarkers of low-grade inflammation.

Materials and methods: This was a cross-sectional observational study performed at Endocrinology Unit of the Federico II University, Naples. All the subjects, underwent a multidisciplinary evaluation including: screening blood tests; anthropometric measurements; and body composition by using a BIA phase-sensitive system.

Results: A total of 114 participants (mean age 40.96 ± 12.54 years; 77.5% women) met the inclusion criteria and were enrolled for data analysis. Weight and BMI were respectively 121.20 ± 22.33 kg and 44.94 ± 7.29 kg/m². A significant inverse correlation was found between iron serum levels and CRP (r =− 0.259, p = 0.008), fibrinogen (r =− 0.261, p = 0.006), BMI (r =—0.186, p = 0.04), WC (r =—0.265, p = 0.004), fat mass % (r =− 0.285, p = 0.003). To compare the relative predictive power of CRP levels, ibrinogen levels, BMI, WC, fat mass % on iron serum levels, we performed a multiple linear regression analysis. The WC entered at the first step (p = 0.001), followed by fat mass (p = 0.047) and CRP (p = 0.047). Subjects were grouped into four groups (Q1-Q4) in ascending order according to the interquartile range of the WC. The WC were divided in quartiles as follows: lowest quartile ≤ 120 cm, second quartile = 120–130 cm, third quartile = 131–144 cm, highest quartile ≥ 144 cm. Statistical differences in iron serum levels were noted between the groups. The lowest serum iron levels were found in Q4 group (p = 0.02).

Conclusion: Visceral obesity is associated with anaemia among the study population. BMI, WC, fat mass and biomarkers of inflammation were inversely related to serum iron in patients with obesity. In particular, elevated central obesity identified by WC were associated with a decrease in serum iron concentration. The decrease in the serum iron concentration associated with central obesity, may be attributed to the high inflammatory status, reflected by an increase in CRP and fibrinogen concentration with obesity.

P32 Leukocyte reduction as a new putative marker of reduction of inflammation during very low-calorie ketogenic diet (VLCKD) in obesity

L. Verde¹, A. Docimo², S. Savastano², A. Colao², G. Muscogiuri²

¹Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy; ²Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P32

The very low-calorie ketogenic diet (VLCKD) is a promising nutritional tool to reduce obesity-related inflammation. Several markers such as C-reactive protein (CRP) and phase angle are used in clinical routine to monitor its anti-inflammatory effect. Therefore, as white blood cells (WBCs) also increase in obesity and are a telltale of inflammation, we wanted to investigate the effects of VLCKD on WBC counts and whether WBC could be an additional marker to monitor changes in the inflammatory state in individuals with obesity during VLCKD.

Fifteen individuals (3 M/12F, aged 40.20 ± 17.72 years) with overweight or obesity (BMI 37.79 ± 7.05 kg/m²) undergoing VLCKD. Anthropometric parameters, body composition analysis and blood biochemistry were performed at baseline and after 31 days of active phase of VLCKD.

As expected, after VLCKD, individuals significantly decreased weight (p < 0.001), waist circumference (p = 0.001) and fat mass (p = 0.002). Levels of blood glucose (p = 0.030), insulin (p = 0.017), HOMA-IR (p = 0.017) and total cholesterol (p = 0.016) also decreased significantly at the end of VLCKD. At baseline, all subjects had WBC in the normal range, tending towards the high limit (7.39 ± 1.86 × 10³/mm³) while, after VLCKD, significant reductions in WBC (6.33 ± 1.44 × 10³/mm³, p = 0.038) were observed. At the same time, CRP was also significantly reduced (2.09 ± 1.85 vs 1.38 ± 1.71, p = 0.025).

The findings of the study suggest that VLCKD may have a beneficial effect on reducing inflammation in individuals with obesity, as evidenced by the significant reductions in WBC counts and CRP levels. WBC counts could be an additional marker to monitor changes in the inflammatory state in subjects with obesity during VLCKD.

P33 Gender-differences in metabolic control and diabetic complications in subjects with weight excess: Also chronotype matters?

A. Docimo¹, L. Verde², S. Savastano¹, A. Colao¹, L. Barrea³, G. Muscogiuri¹

¹Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia ed Andrologia, Università Federico II, Naples, Italy; ²Department of Public Health, University of Naples Federico II, Naples, Italy; ³Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Naples, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P33

Introduction: It has been reported a gender-difference in terms of metabolic control and prevalence of complications in type 2 diabetes (T2D). Thus, we aim to investigate if chronotype categories could play a role in determining this difference in subjects with T2D and weight excess.

Methods: We used an online questionnaire on the Google Form platform, filled out by the diabetologists, to evaluate the data of the patients. We collected: BMI, fasting blood glucose (FBG), HbA1c, diabetic complications and chronotype categories.

Results: We analyzed 84 subjects with T2D and overweight/obesity (M/F: 53.6/46.4%; age: 63.3 ± 11 years; BMI: 30.3 ± 4.3 kg/m²). The 16.7% of them showed a morning chronotype (MC) (M/F: 41.4%/58.6%), 48.8% an intermediate chronotype (IC) (M/F: 61%/39%) and 34.5% an evening one (EC) (M/F: 57.1%/42.9%). In the all cohort an inverse correlation of chronotype score has been found with BMI (r = -0.259; p = 0.017), FBG (r = -0.300; p = 0.005) and HbA1c (r = -0.473; p < 0.001). In males subgroup chronotype score inversely correlated with BMI (r = -0.0342; p = 0.021) and FBG (r = -0.351; p = 0.018). In both males (r = -0.492; p = 0.001) and females (r = -0.511; p = 0.001) chronotype score correlation with HbA1c remained significant. In addition we found that females with EC had a higher prevalence of diabetic nephropathy (p = 0.001) and coronary heart disease (p = 0.031) compared to males with EC.

Conclusion: A more EC is associated mostly to a higher Hb1Ac, BMI and FBG in males while it was associated with a higher Hb1AC in females. In addition, EC determines an increased risk of developing diabetes-related micro and macrovascular complications in females.

P34 Changing food choices: high protein foods push people away from the mediterranean diet

K. Vaccaro¹, F. Danza², G. Guarino², R. Bracale²

¹Fondazione Censis, Dipartimento Sanità e Previdenza, Piazza di Novella, 2, Roma, Italia. Roma; ²Dipartimento di Medicina e Scienze per la Salute, Università del Molise, Campobasso, Italia. Campobasso

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P34

Introduction: The importance for health and physical well-being continues to drive the growth of the food industry with the production and sale of new food products. The attention to physical fitness, especially in young adults, has led over time to a change in food choices and habits with more attention paid to the quality and nutrient content of the products consumed.

Objective: The purpose of this study is to highlight how attention to physical fitness led to an increased consumption of high-protein foods with a consequent departure from the Mediterranean diet.

Methods and results: This analysis is based on IRi data on the trend of food consumption (percentage increase in sales in value) between January and April 2022 compared to 2021. From data processing, there was a 169% increase in sale of products with a high protein content including puddings, yoghurts, desserts, bars, drinks, cereals, spreads and other variety of products.

Conclusion: In recent years we have observed the beginning of the discovery of new food products, often little known, which have become protagonists on the scene of national consumption. Over time, the new food choices have led Italian citizens to gradually move away from the healthy Mediterranean diet. In particular we verify that the younger sections of the population prefer a hight protein content, both animals and plants, with the risk of nutritional deficiencies, obesity and cardiovascular disease.

P35 Preliminary results of a low-carb diet enriched with a protein powder with inositol in patients with metabolic syndrome

D. Ojeda Mercado¹, D. Dellepiane¹, F. Cappelletti¹, P. Gastaldi¹, F. Muratori²

¹U.O. Gastroenterologia e Nutrizione Clinica, Turin, Italy; ²Unità Complessa di Endocrinologia, Diabetologia e Nutrizione Clinica dell'Ospedale Sant'Anna, Como, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P35

Introduction: Metabolic syndrome is a cluster of comorbid conditions including obesity, hypertension, disordered carbohydrate and lipid metabolism.

Methods: Diet intervention: Total daily energy content of the diet was determined on an individual basis. This diet was comprised of 55% carbohydrate, 25% fat, 20% protein and 30 g of fiber. No alcoholic beverages were allowed. Within the protein quota was included a protein powder with inositol. At the beginning of the study and after 4 weeks, we collected different parameters included anthropometric data, blood tests and liver elastography.

Results: Eleven participants, between 25 and 70 years of age, with a body mass index ranging from 25 to 41 kg/m², were included in the study. At T₀ the mean insulin value was 27.90 [8–139.5], the mean glycaemic value was 109.1 [93–168], the mean HOMA index was 9.41 [1.84–57.81], the mean AST value was 33.9 (23–40), the ALT value was 60.1 (25–120), the GGT value was 134.9 (14–954), the total cholesterol mean value was 205.1 (468–250), Triglycerides was 139.6 (70–240) and the mean of kPa was 4.3 (3.3–6.3). Compared to the total participants enrolled in the study, at the moment 7 reached T₁ and the mean insulin value is 27.49 [5.4–113], the mean glycaemic value is 96.83 [70–126] equal to a decrease of 11.24%, the average HOMA index is 7.81 [1.27–35.12] equal to a 17% reduction, the average AST value is 27.83 (23–34) equal to a reduction of 17.90%, the value of ALT is 41.16 (21–59) equal to a reduction of 31.51%, the value of GGT is 63.66 (15–220) equal to a reduction of 52.80%, the total cholesterol value is 180 (154–234) equal to a reduction of 12.23%, the value of triglycerides is 114.5 (66–182) equal to a 17.97% reduction and the average kPa value is 4.25 (3.4–5.4) equal to a 1.16% reduction while the weight is 79.51 kg [65.3–91.5] with a BMI of 29.80 kg/m² [24.18–32.80] and a weight reduction percentage (EWL%) of 10.46%.

Discussion and conclusion: The present analysis provided initial data that will be used and will be compared with future data.

P36 A multidisciplinary team approach for a group of patients with obesity: a pilot project

A. Piontini¹, M. R. Ingenito², D. M. Conti³, E. Caglioni⁴, C. Dal Rì³, A. Di Stasio³, G. Agnelli³, E. Bezze³, L. Vigna³

¹Centro trasfusionale, Centro Obesità e Lavoro, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ²Servizio Dietetico Direzione Medica di Presidio, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ³Centro Obesità e Lavoro, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁴Centro Obesità e Lavoro, UOC Medicina del Lavoro, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico-Scuola di Specializzazione in Scienza dell’alimentazione, Università degli Studi di Milano, Milan, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P36

Background: Obesity is a chronic and multifactorial disease. Therefore, we need to use a multidisciplinary treatment to manage this disease.

In this respect, we started a pilot project with a multidisciplinary team (MT: physician, dietitian, psychologist and physiotherapist) and with groups of patients enrolled at Obesity and Work Centre of Policlinico Hospital of Milan.

Aim: Our aim is to offer a therapeutic path through a group treatment to develop patients’ empowerment in three areas: nutritional, psychological and physical.

Methods: 16 px (BMI > 27, age > 18y), with previous weight loss failure, attended 12 group therapeutic encounters once a week with all MT (a total of 3 h per day, each hour with a single specialist of the multidisciplinary team).

We evaluated clinical and biochemical parameters in four steps: T0 at beginning, T1 after 12 weeks, a follow-up T2 and T3, at 6 and 9 months respectively from the kick-off.

Results: The percentage of patients who achieved the set goals from T0 to T1 is reported (a variation of 5% was expected):

• Nutritional area: weight loss in 25%, improvement in food education survey in 62.5%

• Reduction of risk factors associated with obesity: systolic BP in 81.3%, diastolic BP in 68.8%, LDL-C 56.3%, PCR in 50%, HbA1c in 43,8%, HOMA IR in 50%

• Physiotherapy area: 6MWT in 56.3%, Hand Grip Test in 81.3%, Functional Reach Test in 81.3%

• Psychological area: PGWBI test in 18.8%

Conclusions: The main objective was to provide a dedicated space to patients, both individually and collectively, in which they can develop their awareness and therefore their healing potential.

At the same time, this therapeutic path can represent for the patient a valid standard of care accessible in terms of time and costs.

P37 Vascular stiffening and PHA after dietary regimens in a Chort of women in menopause, obese or overweight, with arterial hypertension on stable treatment: a preliminary analysis

B. Pala¹, L. Pennazzi², G. Marincola³, M. C. Alivernini¹, G. Nardoianni¹, E. Barbato¹, G. Tocci¹

¹Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; ²Faculty of Medicine and Surgery “A. Gemelli”, Obstetrics-Gynecological Nursing Sciences, Catholic University of the Sacred Heart, Rome, Italy; ³Bariatric and Metabolic Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P37

Introduction: Obesity and overweight are closely linked to various comorbidities such as hypertension and insulin resistance, which may contribute to the development of many cardiovascular diseases. In recent years, low-carbohydrate dietary patterns, such as the Ketogenic Diet (KD), along with Intermittent Fasting (IF), have gained attention for their potential benefits in improving insulin sensitivity and promoting weight loss.

Aim: To investigate the effects of KD, IF, on clinic systolic blood pressure (BP) and other cardio-metabolic parameters in overweight or obese post-menopausal women with treated essential hypertension.

Methods: This was a single-centre, prospective, randomized, parallel-group trial on post-menopausal women, aged 50–65 years, with treated essential hypertension and Body Mass Index (BMI) ≥ 25 kg/m². Participants were randomly assigned to one of three dietary interventions (KD, IF, Free Diet [FD]) for 6 months. Body composition, including Phase Angle (PhA), clinic systolic/diastolic BP levels, and Arterial Stiffness (AS), including Pulse Wave Velocity (PWV), were evaluated as study outcomes. The primary outcome was the modulation of systolic BP.

Results: Preliminary data analysis of eighteen patients who completed the six-month follow-up period showed higher mean reduction in systolic BP in KD group compared to IF and FD groups after dietary treatment (− 12.01 ± 13.24 mmHg, + 5.42 ± 10.1 mmHg, and + 3.75 ± 5.51 mmHg, respectively; p = 0.019). No significant difference was observed for diastolic BP among groups (p = 0.773). At the end of the follow-up, we also observed a significant reduction in the percentage of Total Weight Loss in the KD group (7.07% ± 3.11) compared to IF (4.79% ± 2.65) or FD (0.65% ± 2.89) group (p < 0.01). The mean reduction in PWV was also found to be higher in the KD group compared to IF and CRT groups (0.81 ± 0.89, 0.21 ± 0.31, and 0.15 ± 0.19 cm/sec, respectively; p = 0.013). However, no significant difference was found in PhA after different dietary regimens, although a slight increase in PhA was reported only in the KD group.

Conclusions: Based on our preliminary findings, while all the dietary regimens resulted in a significant reduction in the percentage of total weight loss, only KD showed significant modulation and reduction in cardiovascular parameters.

P38 Pulse wave velocity and body mass index in essential hypertension

B. Pala¹, G. Nardoianni¹, M. Carducci¹, E. Ramjeeawon¹, E. Barbato¹, M. Volpe¹, G. Tocci¹

¹Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P38

Introduction: Arterial stiffness (AS), as defined by increased Pulse Wave Velocity (PWV) or augmentation index (AI@75), are now recognized as marker of vascular hypertension-mediated organ damage (HMOD). Their role in hypertensive outpatients with different grades of obesity has not been clarified yet.

Aim: To investigate different markers of AS in a large cohort of adult outpatients with essential uncomplicated hypertension, stratified by Body Mass Index (BMI) categories.

Methods: A single-centre, cross-sectional study was conducted in treated and untreated adult hypertensive outpatients of both sexes, aged more than 20 years, who consecutively underwent full BP assessment and non-invasive assessment of cardiac and vascular HMOD. All BP measurements were performed and BP thresholds were set according to European guidelines. AS was non-invasively determined by measuring Pulse Wave Velocity (PWV) using a validated cuff-based oscillometry device (Mobil-O-Graph).

Results: We included 1062 outpatients, among whom 365 (34.4%) had normal weight (controls), 445 (41.9%) were overweight and 252 (23.7%) grade I-II obesity. Overweight hypertensive patients showed significantly higher PWV (9.9 ± 5.7 vs. 9.2 ± 2.3; P = 0.031) and lower AI@75 levels (20.7 ± 13.5 vs. 23.1 ± 13.5; P = 0.042) compared to control group. However, the same parameters resulted not significantly different between normal and obese outpatients with essential hypertension. Similar trends were observed both in the presence or in the absence of antihypertensive therapies.

Conclusions: Our findings seem to suggest a revers U-shaped distribution of PWV and AI@75 in overweight adult outpatients with essential compared hypertension compared to those with obesity or normal weight.

P39 Patterns of eating and sexual behavior in people with obesity seeking weight loss treatment: an exploratory study

E. Colonnello¹, F. Cipriani², C. Massetti², G. Veroi², S. Mariani², A. Sansone³, E. A. Jannini³, G. Ciocca⁴, L. Gnessi², C. Lubrano²

¹Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome; Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; ²Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy; ³Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; ⁴Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy

Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity 2023, 28(Suppl 1):P39

Introduction: Obesity is a complex and challenging disease. Besides weight loss, psychological distress and sexual dysfunctions should also be considered in clinical management.

Objectives: We aimed to identify profiles of individuals with obesity based on clinical, psychological, eating and sexual behavior characteristics, to assess how these profiles impact the evolution of obesity and the adherence to a weight loss program. The objective of our exploratory study is to help paving the way to the personalization of obesity treatment strategies.

Methods: A total of 71 patients with obesity (45 females, 26 males, mean age: 46.6, mean BMI: 39.6 kg/m²) presenting at our clinic in Umberto I Hospital were recruited. A control population of 76 individuals (51 females, 25 males, mean age: 37.6, mean BMI: 23.2 kg/m²) was also recruited online. Both groups compiled a series of psychometric questionnaires, including the EBA-O (Eating Behaviors Assessment for Obesity), the Female Sexual Function Index (FSFI), the IIEF-15 (International Index of Erectile Function), the Orgasmometer and Orgasmometer-F.

Results: In males, sexual satisfaction, erectile function and orgasmic domains of IIEF-15 (p = 0.01, p = 0.004 and p = 0.04, respectively), as well as Orgasmometer (p = 0.04) were significantly worse in the population with obesity compared to controls. In males with obesity, desire negatively correlated with BMI (p = 0.01). In females, desire, arousal and lubrication domains of FSFI were significantly worse in the population with obesity ( p = 0.01, p = 0.01, p = 0.04, respectively). In females with obesity, the total score of EBAO was significantly higher (p = 0.01), especially for food addiction and binge eating domains (p = 0.001 and p = 0.003), and the orgasm intensity negatively correlated with hyperphagia (p = 0.04).

Conclusion: Obesity has been identified as a risk factor for sexual dysfunction and disordered eating behaviors. Describing different obesity-related behavioral phenotypes, as characterized by certain eating patterns, specific health and sexual comorbidities, could help clinicians to better guide and personalize interventions.