Personalizing Obesity Treatment: Real-World Comparison of a Very-Low-Calorie Ketogenic Diet Versus a Whole-Food Mediterranean Ketogenic Diet Davide Masi, Maria Letizia Spizzichini, Elena Colonnello, Daniel Vasquez Barahona, Lucio Gnessi, Daniele Gianfrilli, Mikiko Watanabe Metabolites, 2026 Background/Objectives: Obesity is a chronic, relapsing disease in which lifestyle modification represents the cornerstone of treatment. Among dietary strategies, ketogenic diets can induce rapid weight loss, whereas the Mediterranean diet is associated with established cardiometabolic benefits but typically produces slower weight reduction. Very-low-calorie ketogenic diets (VLCKDs) are effective for weight loss but are often limited by cost, reliance on meal replacements, and reduced long-term feasibility. This study aimed to evaluate whether a whole-food Mediterranean ketogenic diet with moderate caloric restriction (MedKD) could represent a feasible and effective alternative to VLCKD for weight loss and metabolic improvement in adults with obesity. Methods: This 3-month prospective, real-world study compared VLCKD and MedKD in adults with obesity attending a clinical nutrition program. The primary outcome was percentage weight loss. Secondary outcomes included changes in waist circumference, waist-to-height ratio, insulin resistance (HOMA-IR), lipid profile, kidney function, and treatment tolerability. Clinical and biochemical parameters were assessed at baseline and after the intervention. Group differences and time-by-group interactions were analyzed to evaluate changes over the study period. Results: Sixty-two participants were enrolled, and 55 completed the study (27 VLCKD, 28 MedKD). Baseline characteristics were generally comparable, although the MedKD group had a higher prevalence of diabetes and higher baseline insulin resistance and triglyceride levels. Both dietary interventions resulted in substantial and comparable weight loss (approximately 15% of initial body weight), accompanied by significant reductions in waist circumference and waist-to-height ratio. Insulin resistance improved in both groups, with a greater reduction in HOMA-IR observed in the MedKD group (time × group p = 0.031). Serum creatinine decreased in the VLCKD group and slightly increased in the MedKD group (p = 0.025). Changes in lipid profile were not significantly different between groups. No severe adverse events were reported. Conclusions: A whole-food Mediterranean ketogenic diet with moderate caloric restriction achieved weight loss and metabolic improvements comparable to those observed with VLCKD over three months. These findings suggest that MedKD may represent a feasible alternative to formula-based ketogenic programs, supporting more flexible and personalized dietary strategies in the clinical management of obesity.
Matched Analysis of Circulating and Adipose Tissue SIRT1 Protein Level in Human Obesity Luisa Salvatori, Francesca Megiorni, Giorgia Maria Baldazzi, Valentina Ventimiglia, Elena Gangitano, Mikiko Watanabe, Orietta Gandini, Eleonora Poggiogalle, Lucio Gnessi, Carla Lubrano, Daniele Gianfrilli, Andrea Maria Isidori, Antonio Angeloni, Stefania Mariani Nutrients, 2026 Background/Objectives: Mammalian sirtuins (SIRTs) are evolutionarily conserved proteins that are epigenetically involved in biological processes such as metabolism and longevity. SIRT1 expression is reduced in metabolic disorders and in complicated diseases such as obesity. However, whether the SIRT1 level in subcutaneous adipose tissue (SAT) matches with its circulating form in obesity is unknown. The aim of our study is to evaluate SIRT1 derived from SAT and plasma of the same subject in individuals with and without obesity to assess whether plasma measurements may provide clinically significant information. Methods: Eleven subjects with obesity (BMI ≥ 30 kg/m2) and six controls without the disease (BMI < 30 kg/m2) were enrolled, and SIRT1 was measured in SAT and plasma by ELISA. Anthropometric parameters, glycemia and transaminases were also assessed. Results: Patients with obesity showed similar levels of SIRT1 in SAT and plasma (1.28 ± 0.45 and 1.9 ± 0.25 ng/mL, respectively, p = 0.243). Patients without obesity showed higher SIRT1 levels in SAT than in plasma (4.19 ± 1.33 and 1.06 ± 0.12 ng/mL, respectively, p = 0.039). An inverse correlation between SAT-derived SIRT1 and BMI was found (r = −0.632, p = 0.007). Conclusions: In this pilot study, our results show that the plasma SIRT1 levels substantially reflect those of SAT in patients with obesity. Given the metabolic role of SIRT1, further comprehensive investigations in larger longitudinal cohorts are needed to support plasma SIRT1 as an eligible diagnostic tool for stratifying metabolic risk associated with fat mass expansion in obesity.
Capturing metabolic syndrome: new thresholds for insulin resistance and novel body composition indices Francesco Frigerio, Alessia Vitozzi, Claudia Piciocchi, Federico Ricci, Maria De Marinis, Valeria Galfano, Carla Lubrano, Stefania Mariani, Elena Gangitano, Marianna Minnetti, Luca Muzzioli, Andrea Lenzi, Massimiliano Caprio, Andrea M Isidori, Lucio Gnessi, Silvia Migliaccio, Mario Siervo, Lorenzo Maria Donini, Eleonora Poggiogalle International Journal of Obesity, 2026
Oxytocin, Weight Loss and Ketosis in Response to a Very-Low-Calorie Ketogenic Diet: An Exploratory Study Elena Gangitano, Rebecca Rossetti, Rossella Tozzi, Paola Nevi, Davide Masi, Sabrina Basciani, Orietta Gandini, Mikiko Watanabe, Mariaignazia Curreli, Lucio Gnessi, Stefania Mariani, Carla Lubrano Nutrients, 2026 Background/Objectives: Obesity is a chronic relapsing disorder associated with many comorbidities. Some evidence suggests that oxytocin (OT) has an anorexigenic effect, but its levels are often increased in obesity. This study investigates the effects of weight loss induced by a very-low-calorie ketogenic diet (VLCKD) on oxytocin levels. Methods: A total of 47 subjects with overweight or obesity, 28 females (60%) and 19 males, with a mean age of 55.5 ± 7.3 years and mean BMI 35.9 ± 4.4 kg/m2, underwent VLCKD for 45 days. We assessed anthropometric parameters, metabolic profile, body composition and OT levels at baseline (t0) and at the end of the diet (t1). Results: After weight loss, plasma OT levels significantly dropped. Baseline OT correlated with BMI, fat mass and trunk fat. A linear relationship was observed between Delta OT levels and Delta BMI. Baseline OT was an independent predictor of weight loss and directly correlated with blood ketone levels at the end of the study. An optimal serum OT cut-off that predicts ketosis occurrence was identified. Conclusions: Weight loss obtained with a VLCKD reduces OT levels in patients with excess weight. Baseline OT predicts weight loss and correlates with ketone body levels during a VLCKD.
Epicardial fat thickness is increased in menopausal patients in comparison with premenopausal patients with similar excess weight: a cross-sectional study Elena Gangitano, Giuseppe Barbaro, Lucio Gnessi, Gianluca Iacobellis, Carla Lubrano Journal of Translational Medicine, 2025 BACKGROUND: The prevalence of excess weight and ageing is notably high in contemporary Western societies. The effectiveness of body mass index (BMI) and waist circumference as tools for identifying excess weight and ectopic fat deposition, both associated with an increased cardiovascular risk, is questionable. METHODS: Our objective is to compare women affected by overweight and obesity during fertile years and menopausal time and identify easily accessible clinical parameters associated with ectopic fat deposition, providing valuable insights into cardiovascular risk. Over 1300 female patients with excess weight referred to the CASCO Centre (High Specialization Centre for the Care of Obesity) at Umberto I Polyclinic in Rome, Italy, were included. Each participant underwent a DXA scan and a cardiac ultrasound, and blood tests to verify menopausal status and evaluate metabolic profile and hepatic steatosis through indirect measurements. RESULTS: 775 patients were in the pre-menopausal phase and 617 in the post-menopausal phase. The two cohorts did not differ in BMI, total body fat and lean mass, or waist circumference. However, the post-menopausal group showed an increased visceral fat deposition, evaluated by waist-to-hip ratio and epicardial fat thickness (EFT), and a worse metabolic profile. CONCLUSION: Menopause is associated with a worsening of the metabolic features observed in obesity, with an increase in visceral fat deposition. Of note, these alterations are more pronounced despite similar BMI and waist circumference.
Cardiac autonomic neuropathy is associated with ectopic fat distribution in autoimmune but not in type 2 diabetes Renata Risi, Rocco Amendolara, Angelo Lauria Pantano, Valeria Fassino, Luca D’Onofrio, Lucia Coraggio, Daniela Luverà, Davide Masi, Mikiko Watanabe, Lucio Gnessi, Raffaella Buzzetti, Ernesto Maddaloni Cardiovascular Diabetology, 2025 BACKGROUND: Cardiac autonomic neuropathy (CAN) is a life-threatening complication of diabetes. While obesity is a well-known risk factor of dysautonomia, the association between CAN and body fat distribution has not been fully clarified, especially in autoimmune diabetes (AD). AIM: To evaluate if the association between CAN and body fat distribution differs between AD and type 2 diabetes (T2D). METHODS: Body fat distribution was evaluated by Dual X-Ray Absorptiometry in 143 people with diabetes (44 with ADand 99 with T2D) undergoing clinical screening for CAN. The association of CAN with markers of ectopic fat distribution was evaluated in multivariate regression models adjusting for confounders and testing for the interaction between diabetes type and CAN. RESULTS: A significant interaction between CAN and diabetes type was found with respect to markers of ectopic fat distribution. Specifically, people with CAN had significantly higher amount of visceral adipose tissue (530 [376-665]g versus 251[189-360]g, p = 0.001), total fat mass (22708[20200-27845]g versus 15434[12981-21879]g, p = 0,016), and trunk-to-leg ratio (0.88 [0.75-1.04] versus 0.70 [0.56-0.78], p = 0,023) compared to those without CAN only in participants with AD, but not in T2D (p-values for interaction < 0.05 for all comparisons). CONCLUSION: Ectopic fat distribution is more strongly associated with CAN in AD than in T2D. This highlights the distinct role of fat distribution in the cardiometabolic health of people with AD, suggesting the need for further studies to better understand the pathophysiology and implications of overweight in this population.
The Chronobiology of Hormone Administration: “Doctor, What Time Should I Take My Medication?” Elena Colonnello, Andrea Graziani, Rebecca Rossetti, Giacomo Voltan, Davide Masi, Carla Lubrano, Stefania Mariani, Mikiko Watanabe, Andrea Marcello Isidori, Alberto Ferlin, Lucio Gnessi Endocrine Reviews, 2025 Pharmacotherapy involving hormones and hormone-derived molecules has various potential treatment targets. This includes addressing (partial) hormonal deficiencies, pursuing osteoanabolic effects, providing contraceptive options, or supporting gender-affirming transitions. In chronotherapy, the timing of the administration of active ingredients and different pharmaceutical forms is leveraged to maximize therapeutic efficacy while minimizing adverse effects, based on the principle that it is optimal for drugs to be administered according to the body's circadian rhythms. Just as a drummer sets the pace and keeps the rhythm steady for the entire band, the physician, through the application of chronotherapy, ensures the treatment regimen is harmonized with the body's internal clock. However, while this is a consolidated aspect for several endocrine treatments, for others, it represents a novelty. The new advancements in the treatment of osteoporosis, with the latest parathyroid hormone–related protein analogue, abaloparatide, or in congenital adrenal hyperplasia with the new long-lasting hydrocortisone formulation, are notable examples. We herein summarized the state of the art regarding the hormonal circadian rhythm to discuss in depth the evidence available regarding the correct timing of commonly administered hormonal therapies in adult patients. By offering clear indications, this manuscript delves into the importance of harmonizing hormonal therapy with circadian rhythms through chronotherapy, exploring its potential to enhance therapeutic outcomes while minimizing adverse effects.
Very low-calorie ketogenic diet and liraglutide as a synergistic strategy for the treatment of obesity: A short-term, non-randomised, observational, real-world clinical evaluation Elisabetta Camajani, Davide Masi, Maria Letizia Spizzichini, Camilla Cori, Rebecca Rossetti, et al. Diabetes Obesity and Metabolism, 2025 Obesity is caused by multiple factors leading to excessive fat accumulation. The Very Low-Calorie Ketogenic Diet (VLCKD), now renamed Very Low-Energy Ketogenic Therapy,1 leads to weight loss through enhanced satiety via sustained ghrelin suppression,2 while reducing muscle loss.3, 4 As long-term maintenance through diet is challenging, pharmacotherapy is often indicated.5, 6 Liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), reduces appetite via ghrelin-independent mechanisms. Interestingly, circulating ghrelin levels may increase during treatment, potentially counteracting its anorectic effects.7, 8 Moreover, GLP-1 RAs may cause gastrointestinal adverse events and might lead to inadequate protein intake if appetite is excessively reduced.9, 10 Combining a protein-rich VLCKD with liraglutide could, therefore, provide synergistic appetite suppression via both ghrelin-dependent and ghrelin-independent pathways, potentially resulting in greater weight loss. However, this could come at the cost of increased hypoglycaemia risk due to carbohydrate restriction.11 Current guidelines acknowledge ketogenic diets even for type 2 diabetes,12 but recommendations on combining GLP-1 RAs with VLCKD are lacking, and, to the best of our knowledge, no published study has evaluated this specific combination in a real-world clinical setting. Therefore, we aimed to compare weight loss, metabolic effects and safety between VLCKD alone and VLCKD combined with liraglutide. This prospective study compared a VLCKD alone versus VLCKD combined with liraglutide (VLCKD+Lira) over 4 months. Adult participants (18–65 years, BMI >30 kg/m2, stable weight in the last 3 months) freely choose their treatment, with stratification by age, gender and BMI. Key exclusions included severe organ failure, insulin-dependent diabetes, pregnancy, psychiatric disorders affecting adherence or contraindications to GLP-1 RA therapy. The study protocol was approved by Sapienza University Ethics Committee (ref. 5475), and participants provided written informed consent. All participants, both in the VLCKD group and the combined VLCKD + liraglutide group, followed a very low-calorie ketogenic diet with meal replacements for at least 45 days. The nutritional intervention provided approximately 800 kcal/day and consisted of 4–5 meal replacements daily, alongside one portion of low-glycaemic index vegetables at lunch and dinner. The number of meal replacements was adjusted according to sex—four per day for women and five for men—to ensure adequate protein intake. The macronutrient composition included <50 g of carbohydrates daily, 1.2–1.5 g of protein per kg of ideal body weight, with fat making up the remaining caloric intake.1 Meal replacements were then gradually replaced by protein-based dishes composed primarily of egg, lean meat and fish, with extra virgin olive oil as the primary fat source. Caloric intake was progressively increased to approximately 1200 kcal/day. All participants were advised to drink at least 2 litres of water daily and received multivitamin and mineral supplementation according to current EFSA recommendations.13 No dietary carbohydrates were introduced until the end of the 4-month observation period. Participants in the VLCKD + liraglutide group were prescribed liraglutide in addition to the dietary intervention. All participants were naïve to GLP-1 receptor agonists at baseline. The initial dose was 0.6 mg daily, which was gradually uptitrated to a maximum of 1.8 mg based on individual patient tolerance. Dose adjustments were made under close medical supervision to ensure safety and optimise treatment efficacy. Clinical (weight, BMI waist circumference) and laboratory (lipids, glucose, insulin, electrolytes, renal and liver function, uric acid and HOMA-IR) assessments were performed in a fasting state at baseline and after 4 months. Safety and adherence were monitored via dietitian contact through scheduled in-person visits, with additional remote follow-ups as needed. Adherence was assessed via confirmation of ketosis (BHB >0.5 mmol/L), and standardised symptom questionnaires composed of binary (yes/no) items addressing common side effects such as nausea, constipation or fatigue were employed. Participants were instructed to avoid any additional foods or beverages not explicitly included in the dietary protocol. In all, 40 patients were deemed sufficient to detect a clinically relevant 15% weight loss (power 0.80, alpha 0.05). Foreseeing a 15% drop-out, 48 patients were enrolled. Data are expressed as mean and standard deviation or %. Non-normally distributed variables were log-transformed. A general linear repeated measures model was used to analyse continuous endpoints. The time × treatment interaction analyses were used to determine groupwise differences. The Pearson χ2 test was used for categorical variables. Analyses were performed using SPSS-27.0 (Armonk, NY, USA). All tests were two-tailed, and a p-value <0.05 was considered statistically significant. Of 62 screened patients, 48 were enrolled; the primary reason for exclusions was difficulty in matching participants across groups. Twenty patients per group completed the study, of which 17 and 15 were female, respectively. Dropouts in the VLCKD group were due to personal reasons (n = 3) or adherence difficulties (n = 1), while dropouts in the VLCKD+liraglutide group were due to economic constraints (n = 2), intolerable constipation (n = 1) and personal reasons (n = 1). The maximum liraglutide dose reached was 1.8 mg due to limited tolerability or patient preference. At baseline, groups showed no significant differences in age, gender, weight, BMI, WC, glucose or other parameters, except insulin (p = 0.006), HOMA-IR (p = 0.005), and total cholesterol (p = 0.047), which were higher in the VLCKD+liraglutide group (Table 1). Both interventions improved outcomes over time, but VLCKD+liraglutide resulted in a greater reduction in body weight (−20.8 kg vs. −14.5 kg; estimated difference 2.8 kg, 95% CI: −11.1 to 16.7; p = 0.013 for time × group interaction) (Figure 1A), and in BMI (−7.3 vs. −5.5 kg/m2; estimated difference 3.26 kg/m2, 95% CI: −0.59 to 7.1; p = 0.027 for time × group interaction) (Figure 1B). Interestingly, 95% of the VLCKD+liraglutide group reached a weight loss of 15% and over, whereas only 65% of the VLCKD group reached the threshold (p = 0.048). WC reduction was comparable, though slightly greater in the combination group. Beta-hydroxybutyrate (BHB) levels increased in both groups but were higher in the VLCKD+liraglutide group (1 ± 0.3 vs. 0.6 ± 0.4 mmol/L; estimated difference −0.44 mmol/L, 95% CI: −0.619 to −0.261; p = 0.001 for time × group interaction) (Figure 1C). Sustained ketosis (BHB >0.5 mmol/L) was achieved by all patients in VLCKD+liraglutide vs. 80% in VLCKD alone (p = 0.035). Hunger decreased in both groups similarly (Table 1). Improvements in insulin and HOMA-IR were greater with liraglutide (insulin: estimated difference 2.5 μU/mL, 95% CI: −3.7 to 8.6; HOMA-IR: 0.52, 95% CI: −0.82 to 1.86; both p ≤ 0.001 for time × group interaction) (Figure 1D,E), while glucose reductions did not significantly differ between groups (Table 1). No symptomatic hypoglycaemia was reported. Noteworthy, no patients with diabetes were enrolled. Regarding safety, liver and renal parameters remained within safe ranges. Creatinine slightly decreased in the VLCKD group compared with VLCKD+Lira (estimated difference −0.05 mg/dL, 95% CI: −0.16 to 0.06; p = 0.01 for time × group interaction), whereas aminotransferases were unchanged. Total and LDL cholesterol improved similarly in both groups, whereas HDL cholesterol remained stable only in the VLCKD+liraglutide group (estimated difference 7.65 mg/dL, 95% CI: −1.5 to 16.8; p = 0.01 for time × group interaction) (Figure 1F). Triglycerides, uric acid, and electrolyte levels showed no significant differences (Table 1). Nausea/vomiting (100% vs. 0%, p < 0.001) and constipation (80% vs. 35%, p = 0.004) were more frequent with liraglutide (Table 1), while other adverse events occurred similarly across groups. No specific patterns in tolerability were observed, and no clear characteristics could be identified to distinguish participants with lower tolerability from those who benefited most from each treatment. This study is the first to evaluate the effects of combining a GLP-1 RA with a VLCKD. Both interventions led to weight loss and metabolic improvements; however, adding liraglutide enhanced these outcomes. The greater weight reduction observed with liraglutide is likely due to its appetite-suppressing effects, which complemented the VLCKD by potentially improving dietary adherence, as indicated by higher BHB even compared with similar studies.14 The weight loss achieved with the combination therapy was markedly greater than what is typically observed with liraglutide 3 mg alone.10 Additionally, insulin sensitivity improved more markedly in the combined group, consistent with liraglutide's effects on insulin secretion and glucagon suppression.15 The combination therapy was also associated with increased gastrointestinal effects, and no participant followed the standard weekly dose uptitration. For some, the lower dose was sufficient; for others, side effects limited dose escalation, raising concerns about the combination tolerability. Interestingly, the combination led all participants to develop nausea or vomiting at some point, likely because both interventions can independently lead to these symptoms, possibly due to delayed gastric emptying.6, 16, 17 It is therefore plausible that a VLCKD may amplify the GI adverse events commonly occurring during GLP-1 RA treatment, although this should be further investigated in the future. Despite this, biochemical safety outcomes remained stable, supporting the safety of combining liraglutide with a VLCKD, at least for short-term use, and the dropout rate between the two groups was identical, confirming that the adverse events did not compromise adherence or overall treatment outcomes. The study had some limitations, including a relatively small sample size, although a priori calculation was performed and met. The absence of long-term follow-up data limits conclusions about sustained effects, although this duration is relatively extended for ketogenic interventions. The use of GLP-1 receptor agonists following carbohydrate reintroduction, as a strategy to sustain weight loss and preserve metabolic health benefits, has not been investigated and warrants evaluation in future studies. This was a non-randomised, pragmatic study design allowing patients to choose their preferred intervention, potentially introducing selection bias. However, permitting patient choice likely improved real-world adherence.18 Real-world data are indeed essential to understanding how interventions perform outside of tightly controlled experimental conditions, particularly in outpatient clinical practice where patient adherence, resource constraints and treatment variability often differ significantly from RCT environments. In addition, the lack of a liraglutide-only control group limits the interpretation of liraglutide's independent effects. Moreover, no body composition analysis was done, preventing differential muscle versus fat loss assessment. Concerning hypoglycaemia, patients only reported symptoms, and no episodes were identified; however, the absence of continuous glucose monitoring means that asymptomatic episodes could have been missed. Lastly, since no patient reached the maximum liraglutide dose approved for obesity treatment, conclusions regarding the efficacy and safety of higher doses cannot be drawn. The study also had important strengths. As the first investigation of a combined GLP-1 RA and VLCKD approach, it provides valuable preliminary evidence. Demographic and clinical characteristics matching allowed accurate comparisons. Ketosis monitoring and access to dietitian support improved dietary adherence and data quality. Moreover, sustaining ketosis over 4 months, longer than most studies, provided unique insights into the long-term direct effects of nutritional ketosis. In conclusion, combining liraglutide and VLCKD promotes enhanced weight loss and metabolic improvements, albeit with a higher rate of adverse events, warranting careful clinical monitoring. These findings are particularly timely, as liraglutide is approaching patent expiration and will likely become significantly more affordable, potentially with price reductions of at least 50%, as observed for similar agents in the past.19 Meanwhile, VLCKDs are increasingly underutilised in favour of newer pharmacological options. If Tirzepatide 15 mg induces a 20% weight loss over 12 months20 with out-of-pocket cost in Italy of ~€6500 for this time length,21 achieving a similar 20% weight loss in a much shorter time with a regimen combining VLCKD22 and liraglutide as per our study would cost ~€2300. Despite both liraglutide and VLCKD approaches being at risk of underuse in the current therapeutic landscape, our results suggest that their combination represents a highly cost-effective and clinically valuable strategy for obesity management. We thank the patients for the participation in this study. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/dom.16658. Data will be made available upon reasonable request to the corresponding authors.
Obesity may be more associated with disordered eating behaviors, somatization, insecure attachment styles, and sexual dysfunction: An exploratory study Elena Colonnello, Anna Guidi, Beatrice Di Lazzaro, Chandra Massetti, Tommaso B Jannini, Lucio Gnessi, Carla Lubrano, Erika Limoncin, Andrea Sansone, Giacomo Ciocca Journal of Sexual Medicine, 2025 Background Obesity is a challenging disease due to its multifactorial pathogenesis. However, sexual health is a poorly explored aspect in these patients, and the interaction between eating behavior, psychological factors, and sexual function remains insufficiently characterized, although it may represent a key aspect in clinical management. Aims To provide a characterization of psychological, eating, and sexual function characteristics of patients with obesity through an exploratory analysis. Methods A cross-sectional, single-center study was carried out at Umberto I Hospital of Sapienza University of Rome (Italy), where patients with obesity (body mass index ≥30 kg/m2) were recruited. Additionally, a control group of age-matched, normal-weight (body mass index = 18-25 kg/m2) subjects was enrolled online. All subjects compiled a series of validated psychometric questionnaires that evaluated psychological distress, disordered eating behaviors, attachment styles, and sexual dysfunction. Outcomes To evaluate the psychological distress, attachment style, disordered eating behavior, and sexual dysfunction in patients with obesity and to explore the correlations between these aspects. Results Seventy-two patients (45 women, mean age 51.4 ± 4.3 years and 27 men, mean age 39.6 ± 16.6 years) and 76 controls (51 women, mean age 36.8 ± 14.3 years and 25 men, mean age 39.2 ± 16.6 years) were recruited. Subjects with obesity reported significantly higher scores in somatization and paranoid ideation symptoms, higher scores in food addiction and binge eating domains, and a more fearful attachment style. Women also reported lower sexual desire, arousal, and lubrication, while men showed significantly lower erectile function, orgasmic intensity, and sexual satisfaction. Clinical implications Subjects with obesity are characterized by higher somatization, maladaptive eating behaviors, insecure attachment style, and worse sexual function compared to controls, which highlights the necessity of a multidimensional treatment approach. Strengths and limitations A large and comprehensive battery of questionnaires was employed to examine both the clinical and the control population. However, the absence of stratification by age and the small sample size prevent the generalizability of the results. Conclusion Our results highlight the intricate interplay between psychological, behavioral, and sexual factors in individuals affected by obesity. Further studies should focus on larger and more diverse samples and examine longitudinal trajectories of psychological and sexual health changes in response to weight-loss interventions, to assess how such interconnection may help to improve the personalization of care programs.
Updating obesity management strategies: an audit of Italian specialists Luca Busetto, Maria Grazia Carbonelli, Antonio Caretto, Annamaria Colao, Claudio Cricelli, Maurizio De Luca, Francesco Giorgino, Lucio Gnessi, Gerardo Medea, Giovanni Pappagallo, Ferruccio Santini, Paolo Sbraccia, Marco Antonio Zappa Eating and Weight Disorders, 2022
Exposure to artificial light at night: A common link for obesity and cancer? Giovanna Muscogiuri, Eleonora Poggiogalle, Luigi Barrea, Maria G. Tarsitano, Francesco Garifalos, Alessia Liccardi, Gabriella Pugliese, Silvia Savastano, Annamaria Colao, Annamaria Colao, Carlo Alviggi, Sara Aprano, Rocco Barazzoni, Luigi Barrea, Francesco Beguinot, Annamaria Belfiore, Giuseppe Bellastella, Silvia Bettini, Giuseppe Bifulco, Maurizio Bifulco, Caterina Brasacchio, Filomena Bottiglieri, Luca Busetto, Brunella Capaldo, Massimiliano Caprio, Felipe Casanueva, Luigi Di Luigi, Andrea Di Nisio, Laura Di Renzo, Carolina Di Somma, Lorenzo M. Donini, Katherine Esposito, Massimo Federici, Francesco Garifalos, Dario Giugliano, Lucio Gnessi, Gianluca G. Cappellari, Brunella Guida, Maria A. Guzzardi, Daniela Laudisio, Andrea Lenzi, Alessia Liccardi, Carla Lubrano, Paolo E. Macchia, Silvia Magno, Paolo Marzullo, Davide Menafra, Silvia Migliaccio, Fabrizio Muratori, Giovanna Muscogiuri, Raffaele Napoli, Caterina Pelosini, Francesca Pivari, Rosario Pivonello, Eleonora Poggiogalle, Gabriella Pugliese, Gabriele Riccardi, Alberto Ritieni, Fiammetta Romano, Domenico Salvatore, Alessandro Sanduzzi, Ferruccio Santini, Silvia Savastano, Paolo Sbraccia, Giovanni S.L. Soldati, Giovanni Spera, Maria G. Tarsitano, Dario Tuccinardi, Olga Vaccaro, Mary Venneri, Samir Sukkar, Roberto Vettor European Journal of Cancer, 2022
Spot-light on microbiota in obesity and cancer Paolo Marzullo, Silvia Bettini, Davide Menafra, Sara Aprano, Giovanna Muscogiuri, Luigi Barrea, Silvia Savastano, Annamaria Colao, Annamaria Colao, Silvia Savastano, Silvia Magno, Andrea Di Nisio, Fiammetta Romano, Giovanna Muscogiuri, Eleonora Poggiogalle, Mary Venneri, Alessia Liccardi, Maria Grazia Tarsitano, Luigi Barrea, Laura Di Renzo, Dario Tuccinardi, Massimiliano Caprio, Maria Angela Guzzardi, Caterina Pelosini, Gabriella Pugliese, Filomena Bottiglieri, Sara Aprano, Davide Menafra, Gianluca Gortan Capellari, Daniela Laudisio, Francesca Pivari, Caterina Brasacchio, Andrea Lenzi, Fabrizio Muratori, Ferruccio Santini, Luca Busetto, Paolo Sbraccia, Laura Soldati, Domenico Salvatore, Carolina Di Somma, Dario Giugliano, Lucio Gnessi, Brunella Capaldo, Gabriele Riccardi, Rocco Barazzoni, Brunella Guida, Maurizio Bifulco, Katherine Esposito, Roberto Vettor, Paolo Emidio Macchia, Felipe Casanueva, Carla Lubrano, Francesco Beguinot, Giovanni Spera, Annamaria Belfiore, Luigi Di Luigi, Alberto Ritieni, Raffaele Napoli, Olga Vaccaro, Samir Sukkar, Carlo Alviggi, Rosario Pivonello, Giuseppe Bellastella, Giovanni Scambia, Giuseppe Bifulco, and International Journal of Obesity, 2021
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