Giuseppe Marzulli - Nutrizionista


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Marzulli G. – “Metodo Dietetico” 2013 (C)

Il metodo dietetico che ho ideato si basa sull’attenta valutazione del fabbisogno proteico del singolo individuo e l’unità di misura che si è voluta ideare per quantificarlo con precisione e facilità è il DADO. Il dado è costituito da parti, come i cubetti colorati del “cubo di Rubik”, che rappresentano le proteine i carboidrati ed i grassi. Il fabbisogno proteico sarà determinato dal numero dei dadi assegnati al paziente. Tale fabbisogno proteico sarà stabilito utilizzando la BIOIMPEDENZIOMETRIA oppure la formula di James (1976) che fornisce una stima della massa magra in base al sesso, all’altezza ed al peso corporeo e moltiplicando questa per il fattore di moltiplicazione riguardante il grado di attività fisica. Il fabbisogno proteico suggerito dai recenti LARN è di 0,8-0,9 g/kg Peso Corporeo/die. Tale range considera però il Peso Corporeo per cui ho cercato altre fonti che utilizzassero il Peso Ideale, come le linee guida della SINPE (Società Italiana Nutrizione Parenterale ed Enterale) concordi con gli studi di Shils suggerivano come range fisiologico 0,8-2 g/kg P.I./die. Definito il fabbisogno proteico personale, si può stabilire il numero dei dadi specifico per l’individuo e che caratterizzerà l’Iter nutrizionale. Il numero di dadi si determina dividendo il fabbisogno proteico per la costante “d”. Il fabbisogno proteico resterà costante per tutta la durata della dieta mentre cambieranno, da una fase all’altra della dieta, le percentuali degli altri nutrienti. Il metodo si struttura in 3 fasi a cui è assegnato il colore Rosso, Giallo e Verde e le percentuali di proteine, carboidrati e grassi saranno diverse a seconda della fase del metodo. Le tre fasi del metodo sono ispirate a tre strategie consolidate nel tempo e che ci consentono di ripristinare abitudini alimentari corrette e riportare il paziente all’alimentazione mediterranea nel giro di poco tempo. Tali strategie ci consentono di definire le percentuali dei carboidrati e dei grassi in base al fabbisogno proteico calcolato. Le fasi prendono il nome dal colore del dado ad esse assegnato che realizza, ogni volta che si assume cibo, la giusta combinazione degli alimenti quando essi sono sapientemente e scientificamente bilanciati dal nutrizionista, utilizzando i Valori Unitari del Dado per le proteine, i carboidrati ed i grassi (valori specifici per ciascuna fase), così realizzando un “pool di assorbimento” tale da produrre un segnale metabolico finalizzato all’obiettivo di ciascuna fase.

Marzulli G.
Clinical Immunology, Endocrine & Metabolic Drugs 2015; in print.

In the last years the increasing number of patients worldwide who are sensitive to dietary antigens like gluten or nickel, has contributed to identification of new diet-related immune pathologies. In particular this pathological condition is a combination of three frequent condition not still perfectly known: gluten-related syndrome defined as non-celiac gluten sensitivity (NCGS), systemic (gastrointestinal and skin) reactions to ingestion of nickel rich food that characterizes Systemic Nickel Allergy Syndrome (SNAS) and some secondary form of Lactose Intolerance (LI). The aim of this study was to implement a new exclusion diet (DICE diet) in patients with at least two of three mentioned pathologies.
Usually, for this condition, diet is represented by a list of forbidden food that doesn’t consider the initial weight and the psychological effect of this restricted diet. This is why there is a loss of the adherence’s of patients to the diet as consequence efficacy of treatment.
The new exclusion diet is developed, keeping in mind, the initial weight, considering the patient’s psychological state to ensure the respect for a sufficient time in order to reduce symptoms.
The compliance and the effects on the weight have been detected by a questionnaire during the 6-month follow up.
17 patients with at least two of three pathologies LI, SNAS and NCGS, have been treated with the DICE diet and after 6 months, 70% of them have reported symtoms’s disappearance.
We suggest that the DICE diet could be prescribed for the treatment of these diet-related immune-pathologies.

Marzulli G, Magrone T, Vonghia L, Kaneko M, Takimoto H, Kumazawa Y, Jirillo E.
Curr Pharm Des. 2014;20:864-8.

Polyphenols contained in FGM from Negroamaro (N) and Koshu (K) Vitis vinifera have been shown to exhibit several immunomodulating activities. For instance, mice affected by experimental colitis when administered with K-FGM showed an attenuation of the inflammatory process. In murine asthma, K-FGM reduced IgE production and eosinophil number in bronchial alveolar lavage fluid. In vitro, both N- and K-FGM were able to induce T regulatory cells in terms of Foxp-3 molecule expression and release of interleukin-10. In another set of experiments both N- and K-FGM were able to balance rate of proliferation/apoptosis/necrosis of normal human peripheral lymphocytes, thus indicating the property of these compounds to maintain immune homeostatic mechanisms in the host. On the other hand, N- and K-FGM inhibited human basophil degranulation, thus, confirming our previous results obtained with rat basophilic leukemia cells. Finally, N- and K-FGM also decreased oxidative burst of human polymorphonuclear cells and monocytes.Taken together, these findings imply the potential clinical usefulness of FGM administration in inflammatory/allergic conditions, such as chronic asthma.

Marzulli G, Magrone T, Kawaguchi K, Kumazawa Y, Jirillo E.
Curr Pharm Des. 2012;18:43-50.

The onset of neurodegenerative diseases has become more frequent than in the past also in relation to inappropriate dietary habits adopted in the western world. Nutraceuticals are currently investigated in order to prevent or retard the outcome of the so-called diet-related diseases, even including neurodegenerative pathologies. Here, we have in vitro studied the ability of fermented grape marc (FGM) from Negroamaro (N) and Koshu (K) Vitis vinifera to modulate the function of human peripheral blood mononuclear cells (PBMCs). Actually, both FGMs were able to increase the release and the intracellular content of inflammatory and anti-inflammatory cytokines, the induction of FoxP3 (a biomarker of T regulatory cells) and reduce the production of Granzyme B from PBMCs. Since these FGM-induced effects tend to polarize the immune response toward an anti-inflammatory pathway, the potential use of FGMs may represent a valid therapeutic measure to mitigating neuroinflammation in pathologies such as Parkinson disease and Alzheimer disease.

Magrone T, Marzulli G, Jirillo E.
Curr Pharm Des. 2012;18:34-42. Review.

Parkinson disease (PD) and Alzheimer disease (AD) are neurodegenerative processes whose frequency is dramatically increasing in the western world. Both diseases share a common pathogenic denominator characterized by an exaggerated activation of the systemic and cerebral immune system, respectively. For instance, lipopolysaccharides in PD and amyloid beta in AD trigger microglia and astrocytes to release reactive oxygen species (ROS) and proinflammatory cytokines. Infiltrating peripheral T cells once activated in the central nervous system also contribute to the neurodegenerative process. Besides innovative biotherapy, nutraceuticals or functional foods are currently investigated for their neuroprotective activities. Especially, vitamin D and polyphenols, seem to be promising therapeutic tools for inhibiting ROS formation and arresting cytokine-mediated neuroinflammation in PD and AD.

Amati L, Marzulli G, Martulli M, Chiloiro M, Jirillo E.
Curr Pharm Des. 2010;16:893-7.

Body mass index (BMI), serum cytokines and serum obesity markers were evaluated in 33 obese children before, during and after a hypocaloric diet. The cytometric bead array “human inflammatory kit” was used for the evaluation of serum interleukin (IL)-1beta, IL-6, IL-10 and tumor necrosis factor-alpha. On the other hand, the following obesity biomarkers were evaluated by means of a flowcytomix-human obesity 9 plex kit: Soluble Isoform of CD40 Ligand; Soluble Intercellular Adhesion Molecule-1; Leptin; Monocyte Chemoattractant Protein 1; Myeloperoxidase; Osteoprotegerin; Resistin and Soluble TNF-receptors. Actually, throughout the study modifications of BMI were negligible and, therefore, serum cytokines and obesity markers did not show any significant changes in comparison with baseline values. On the other hand, at the different time points considered the majority of obesity markers were higher than normal controls, thus indicating a low grade inflammation in childhood obesity. Therefore, attempts at reducing this inflammatory status in children which predisposes to the metabolic syndrome outcome are discussed.

Amati L, Marzulli G, Martulli M, Tafaro A, Jirillo F, Pugliese V, Martemucci G, D’Alessandro AG, Jirillo E.
Curr Pharm Des. 2010;16:864-9.

In a group of 14 healthy aged subjects, donkey and goat milk was administered respectively, for a period of one month. Cytokine profile [interleukin (IL)-12, IL-10, IL-1beta, IL-8, IL-6 and Tumor Necrosis Factor (TNF)-alpha] was assessed before and after milk intake by means of a cytometric bead array test. Data demonstrated that IL-12 was undetectable, while IL-10, IL-1beta and TNF-alpha were released in very low amounts. Quite interestingly, IL-8 was increased by donkey milk administration, while same cytokine was dramatically decreased following goat milk intake. Same pattern of response was noted with IL-6 even if levels of these cytokine were lower than those detectable in the case of IL-8. Taken together, these findings indicate that administration of donkey milk in the aged host is able to upregulate the immune response, while goat milk seems to reduce the exaggerated acute phase response in elderly.

Amati L, Marzulli G, Martulli M, Pugliese V, Caruso C, Candore G, Vasto S, Jirillo E.
Curr Pharm Des. 2010;16:854-8.

Ten free-living elderly were administered with a synbiotic [fermented milk containing Lactobacillus rhamnosus Gorbach and Goldin (LGG)] and oligofructose as a prebiotic for one month. Serum cytokines were evaluated before (T(0)) and after (T(1)) synbiotic administration. At T(0), values of Interleukin (IL)-12, IL-6, IL-10, IL-1beta and Tumor Necrosis Factor (TNF)-alpha were lower than normal controls, with the exception of IL-8, thus confirming previous results on the impairment of both innate and adaptive responses in elderly. At T(1), the synbiotic was able to significantly increase, depressed values of IL-1, IL-6 and IL-8 with a trend to a modest increase for the restant cytokines. In conclusion, the synbiotic used in this study seems to be very beneficial to elderly for its capacity to maintain the immune homeostasis, even if an increase in dosage and prolongation of administration time are required for a better modulation of the aged adaptive immune response.