Nutritional status: causal and risk factors, intra and inter-population variability
h 8.30-9-15: Registration, distribution of material.
h 9-15-9.30: Overview on the programme and presentation of lecturers (E. Marini, prof. Univ. Cagliari, Italy).
h 9.30-10.15: Nutritional status: definition, causal factors and risk factors (E. Rebato, prof. Univ. País Vasco, Spain). Nutritional status can be defined as the condition of health of a person that is influenced by the intake and utilisation of nutrients. It is determined by a complex interaction between internal/constitutional factors (age, sex, genotype, physical health, life history) and external environmental factors (food safety and security, cultural, social and economic circumstances, behavioural factors and diseases). Alterations in nutritional status have strong effects, both positive and negative, on health along life, leading to slow or no growth of body, to various diseases, and even to death. Young children, pregnant women, lactating mothers and older people are particularly sensitive to the risks of inadequate nutrition.
h 10.15-11: Intra-population variability: life cycle and sexual dimorphism (P. Montero, prof. Univ. Autonoma Madrid, Spain). Sexual dimorphism in body size, body fat and fat distribution exist in every human population. During the process of growth and development, men reach a higher average height and gain more muscle mass than women do, and women accumulate a higher percentage of fat mass. Fat distribution also changes during the life cycle.
h 11-11.30: coffee break
h 11.30-13: Inter-population variability and secular trends (E. Marini, prof. Univ. Cagliari, Italy). High malnutrition prevalence is observable all over the world but with different distributions according to the type of malnutrition considered. Overnutrition and obesity mostly occur in North America, Europe and western Pacific regions, while undernutrition is still common in Low- and Middle-Income Countries (LMICs). Hoewever, in the last decades a worrying increment of the prevalence of overweight/obesity in children and adults is discernible also in LMICs. This phenomenon is related to the progressive abandonment of traditional diets, the concomitant adoption of a “Western-type” life style (with the consumption of cheap, high-calories but low-quality foods), and the decrease in daily energy expenditure, due to more sedentary habits.
h 13-14.30: lunch
h 14.30-16.30: Laboratory: international databases on nutritional status (O. Comandini, PhD, Univ. Cagliari, Italy). The information on nutritional status in different populations can be retrieved from large open access databases, such as the ones published by the World Health Organization, or by survey research programs, such as the National Health and Nutrition Examination Survey (NHANES), the Demographic and Health Survey (DHS), the Multiple Indicator Cluster Survey (MICS). The characteristics of these databases, the procedure for use and possible applications will be discussed and experimented.
August, 29: Anthropometric assessment of nutritional status
h 9-11: Anthropometric techniques (M. Micheletti Cremasco, Prof. Univ. di Torino, Italy). Anatomical and anthropometrical bases and principles of body measurement will be presented: anthropometric terms and definitions, landmarks, instruments and measuring conditions. Technical error of measurement will be discussed. Three-dimensional body-scanning and anthropometric traditional methods will be compared.
h 11-11.30: coffee break
h 11.30-13: Laboratory: anthropometry (M. Micheletti Cremasco, Prof. Univ. di Torino, Italy). A practical session of anthropometric measurements will be realized and the technical error of measurement evaluated.
h 13- 14.30: lunch
h 14.30-16.30: Analysis of anthropometric data (O. Comandini, PhD, Univ. Cagliari, Italy). The methods for assessing nutritional status (percentiles and z-scores) using national and international anthropometric standards and the more common anthropometric indicators of malnutrition (stunting, wasting, underweight, overweight, obesity) will be showed. Practical examples of analysis will be presented.
August, 30: Body composition
h 9-10: Body composition (R. Buffa, PhD, Univ. Cagliari, Italy). Body composition refers to the quantity of different body components, varying from elements to tissues and organs. Its analysis is integral to research in many nutrition areas; including energy, protein, and lipid metabolism, bone mineral homeostasis, and water balance.
The several chemical components found in the human body can be classified into five main groups: lipids, water, proteins, carbohydrates (i.e. glycogen), and minerals. To simultaneously measure several chemical compartments in an individual subject by multicompartment models have been developed, namely, two, three, and four compartment models.
h 10-11: Techniques for the evaluation of body composition (A.M. Silva, prof. Univ. Lisbon, Portugal). Standard and innovative total body and segmental body composition techniques will be discussed in relation to underlying theoretical bases and to key methodological and operative aspects such as precision, feasibility, safety and operative costs.
h 11-11.30: coffee break
h 11.30-13: Bioelectrical impedance analysis: principles, equipments, applications (L.A. Gobbo, prof. São Paulo State Univ., Brazil). The bioelectrical impedance is a simple, inexpensive, and non-invasive method of evaluation of body composition. BIA is widely used in the clinical and scientific field in view of its good predictive validity of fat-free mass, as well as total body water and its intra- and extra-cellular fractions. From these possibilities, associations with different clinical conditions have been established (chronic and transmissible diseases) in addition to nutritional and athletic status. With new multifrequency equipment, new possibilities of evaluations have been proposed and also new variables for the evaluation of the health status of patients in different clinical conditions have been made available to the scientific community in an attempt to propose prognoses for different chronic diseases.
h 13-14.30: lunch
h 14.30-16.30: Laboratory: total body and segmental bioimpedance (P.Lussu, Dr Univ. Cagliari, Italy; E. Mereu, PhD, Univ. Cagliari; V. Succa, Dr Univ. Cagliari, Italy). A practical session of total body and segmental impedance measurements will be realized.
August, 31: Bioelectrical impedance vector analysis (BIVA)
h 9-9.30: General principles of BIVA (E. Marini, prof. Univ. Cagliari, Italy). Bioelectrical impedance vector analysis (BIVA) is a technique for measuring two-compartments body composition and hydration status. BIVA does not refer to predictive equations and/or assumptions on body composition, thus overcoming a possible source of error. It is based on the direct analysis of bioelectrical values (resistance, R, and reactance, Xc, measured at 50 kHz and 800 μA) and of the derived variables impedance ([R2+Xc2]^0.5) and phase angle (arctangent Xc/R 180/ᴫ). A resistance–reactance graph (R–Xc graph) allows the analysis of bioelectrical vectors in relation to reference values (tolerance ellipses) or for inference on group differences (confidence ellipses).
h 9.30-11: Classic BIVA (L. Nescolarde, prof. Univ. Politècnica de Catalunya, Barcelona, Spain). In the classic BIVA approach, the two components of the impedance vector (R and Xc) are normalized by the height of the subject (R/H and Xc/H), to remove the effect of conductor length. Variations of the bioelectrical vectors along the major axis of the tollerance ellipses indicate changes in tissue hydration (dehydration towards the upper pole, fluid overload towards the lower pole). Variations along the minor axis indicate differences in the content of body cell mass in soft tissues (more cell mass on the left side). Classic BIVA has been clinically validated both in healthy and pathological populations. Reference values for different populations and age groups are available.
h 11-11.30: coffee break
h 11.30 – 13: Specific BIVA (R. Buffa, PhD, Univ. Cagliari, Italy). Specific BIVA uses the same vectorial approach of classic BIVA but differs from the classic procedure in that it standardizes bioelectrical values for height and transverse areas, rather than just body height. Phase angle is unaffected by the correction. The major axis of specific tolerance ellipses refers to variations of the relative quantity of fat mass, with higher values towards the upper right pole. The minor axis refers to variations associated with changes of phase angle, and are indicative of body cell mass (left side: more cell mass; right side: less cell mass) and extracellular/intracellular water ratio (right lower area: higher values, indicative of low body cell mass and muscle mass in particular). Specific BIVA has been validated against DXA. Reference values for different populations and age groups are available.
h 13-14.30: lunch
h 14.30-16.30: Laboratory: BIVA (P.Lussu, Dr Univ. Cagliari, Italy; E. Mereu, PhD, Univ. Cagliari, Italy; V. Succa, Dr Univ. Cagliari, Italy). Classic and specific BIVA will be applied to data collected in previous laboratory activities and selected from other databases. The free software for classic BIVA and specific BIVA will be used.
h.16.30-17.0: final test
September, 1 (public conference): Variability of nutritional status in human populations: case studies
Coordinator: E. Marini (prof. Univ. Cagliari, Italy)
h 9.0-9.15: Phase angle and specific BIVA: a multicenter international collaboration (AM. Silva, prof. Univ. Lisbon, Portugal).
h 9.15-9.30: Bioelectrical Impedance Vector Analysis (BIVA) and localized BIA (LBIA) in elite athletes (L. Nescolarde, prof. Univ. Politècnica de Catalunya, Barcelona, Spain).
h 9.30-9.45: Nutritional status of children in sub Saharan Africa (O. Comandini, PhD, Univ. Cagliari, Italy).
h 9.45-10.0: Nutritional status of Gitans (E. Rebato, prof. Univ. Pais Vasco, Spain).
h 10.0-10.15: Nutritional status of Italian immigrants (S. Toselli, Prof. Univ. Bologna, Italy).
h 10.30-11.0: coffee break
h 11.00-11.15: Nutritional status of newborns (breastfeeding patterns) and obesity in childhood (P. Montero, prof. Univ. Autonoma Madrid, Spain).
h 11.15-11.30: Nutritional status of athletes (M. Micheletti Cremasco, Prof. Univ. di Torino, Italy).
h 11.30-11.45: Nutritional status of the elderly population (E. Marini, Prof. Univ. Cagliari, Italy).
h 11.45-12.0: Effect of physical exercise on nutritional status in the elderly (L.A. Gobbo, prof. São Paulo State Univ., Brazil).
h 12.0-12.15: Discussion
h 12.15-12.45: Final test
h 12.45-13.0: Conclusion and certificates‘ delivery
Limited to students and lecturers of the school:
h 13.00-14.0: lunch
h 14.0-15.0: Transfer to Cagliari