This research aimed to explore the relation of social jetlag (SJL) with perceived appetite, and hormones involved in hunger regulation in healthy subjects in free-living conditions (study registration number: ACTRN12618001182280). Eighty normally diurnally active men and women were enrolled in 4 study groups according to the presence of SJL and sleep deprivation (2 groups with SJL with or without sleep deprivations and 2 groups without SJL with or without sleep deprivation) matched 1:1:1:1 for age, gender, and body mass index. Appetite was assessed in fasting state, by measuring acylated ghrelin level and using 100 mm visual analog scales. Persons with SJL had a higher perceived appetite for pork, poultry, fish, eggs, milk, and dairy products and higher acylated ghrelin levels than those without SJL. When considering the presence of sleep deprivation, subjects with SJL, with and without sleep deprivation, reported a higher perceived appetite than group with sleep deprivation alone. They also reported later meal times for lunch and dinner, had more frequently a snack before sleep and reported eating more frequently while watching TV or playing on computer, suggesting poorer eating habits in these subjects. In conclusion, independent of sleep duration, SJL is associated with an increased appetite for caloric dense food, suggesting an increased incentive value of food in these subjects and an anticipated pleasure of ingesting these foods.

In this retrospective case-control study conducted in Cluj-Napoca, Romania, we assessed the effect of ulcerations/amputations on hospitalization costs of patients with diabetes. Patients with (Group 1) or without (Group 2) ulcerations/amputations (case-control ratio 3:1) admitted to a single diabetes center between 2012–2017 were included. The effects of hospitalization days, age, duration of diabetes, body mass index and glycated hemoglobin (HbA1c) on total costs was explored using a multivariate linear regression analysis, enter model. Overall, 876 patients were included (Group 1: 682, 323 [47.4%] with amputations; Group 2: 194). Median (interquartile range) total expenses in Group 1 were 40% higher compared to Group 2 (€724 [504; 1186] vs €517 [362; 645], p < 0.001). Significant differences were observed between hospitalization costs (p < 0.001), cost of food (p < 0.001), medication (p = 0.044), drugs administered at the emergency room/intensive care unit (p < 0.001) and other expenses (p = 0.003). Hospitalization costs represented 80.5% of total expenses in Group 1 and 76.3% in Group 2. In multivariate analysis, hospitalization days influenced significantly the total costs in both groups (p < 0.001); in Group 2, the effect of HbA1c was also significant (p = 0.021). Diabetic foot ulcers and subsequent amputations most likely impose a significant economic burden on the Romanian public healthcare system.

This research aimed to explore in free-living condition, in healthy normal weight subjects, the effect of social jetlag (SJL) and sleep deprivation on resting-state brain connectivity and synchronization, as assessed by resting-state fMRI, and their association with appetite. We found abnormal local functional synchronization in resting-state, as depicted by altered regional homogeneity (ReHo), in posterior cerebellar regions in subjects with SJL and/or sleep deprivation. We also found altered intrinsic global connectivity patterns, as depicted by altered degree of centrality (DC), in cerebellar regions in these subjects. In our sample, ReHo was correlated with appetite in fasting state in subjects with SJL and in those with sleep deprivation, while DC was correlated with appetite only in subjects with SJL. The effect size evaluation showed that 21.1% to 35.7% of the variance in appetite of subjects with SJL was explained by altered ReHo and DC; in subjects with sleep deprivation 21.2% to 61.3% of the variance in appetite was explained by altered ReHo. This analysis provides the first evidence of abnormal resting-state local functional synchronization and intrinsic global connectivity patterns in healthy subjects with SJL in real-life settings. These changes were independent of sleep deprivation and correlated with appetite.