1
|
Chalopin S, Bel Lassen P, Genser L, Aron-Wisnewsky J, Poitou C, Ciangura C, Torcivia A, Oppert JM, Bedock D, Faucher P. Management of Severe Malnutrition Post-bariatric Surgery Using Artificial Nutrition. Obes Surg 2024; 34:363-370. [PMID: 38123784 DOI: 10.1007/s11695-023-06842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/12/2023] [Accepted: 09/24/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Bariatric surgery (BS) results in major and sustained weight loss and improves comorbidities in patients with obesity but can also lead to malnutrition, especially through severe malabsorption and/or surgical complications. Little is known about the efficacy of artificial nutrition (AN) in this setting. METHODS In this case series, we describe data from consecutive severely malnourished patients after BS (resectional and non-resectional), managed by AN at our hospital unit over a 4-year period. RESULTS Between January 2018 and June 2022, 18 patients (mean ± SD age 42.2 ± 10.4 years, 94% women) required AN following BS complications. At the time of AN initiation, more than half of the patients (53%) had multiple revisional surgeries (up to four). Mean BMI was 49.7 ± 11.3 kg/m2 before BS and 29.6 ± 9.6 kg/m2 when AN was initiated. Most patients (n=16, 90%) received enteral nutrition. AN management resulted in weight regain (+4.7kg ± 8.0, p=0.034), increased serum albumin (+28%, p=0.02), pre-albumin (+88%, p=0.002), and handgrip strength (+38%, p=0.078). No major AN complication nor death was observed. Median total AN duration was 4.5 months [1-12]. During follow-up, the cumulative duration of hospitalization was 33 days [4-88] with a median of 2.5 hospitalizations [1-8] per patient. CONCLUSION Malnutrition can occur after any BS procedure, and AN when required in this setting appears safe and effective on nutritional parameters. It is important to recognize the potential risk factors for malnutrition, which include excessive weight loss resulting from surgical complications, eating disorders, multiple revisional BS, and pregnancy.
Collapse
Affiliation(s)
- Sarah Chalopin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Pierre Bel Lassen
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
- Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France
| | - Laurent Genser
- Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne University, Paris, France
| | - Judith Aron-Wisnewsky
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
- Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
- Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France
| | - Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne University, Paris, France
| | - Jean-Michel Oppert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Dorothée Bedock
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Pauline Faucher
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
2
|
Oppert JM, Ciangura C, Bellicha A. Physical activity and exercise for weight loss and maintenance in people living with obesity. Rev Endocr Metab Disord 2023; 24:937-949. [PMID: 37142892 DOI: 10.1007/s11154-023-09805-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
Physical activity and exercise training programs are integral part of a comprehensive obesity management approach. In persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight loss compared to the absence of training. However the magnitude of effect remains modest amounting to only 2-3 kg additional weight loss on average. Comparable effects have been observed for total fat loss. Exercise training, specifically aerobic training, is also associated with decreased abdominal visceral fat as assessed by imaging techniques, which is likely to benefit cardiometabolic health in persons with obesity. Based on data from controlled trials with randomization after prior weight loss, the evidence for weight maintenance with exercise training is as yet not conclusive, although retrospective analyses point to the value of relatively high-volume exercise in this regard. Resistance (i.e. muscle-strengthening) training is specifically advised for lean mass preservation during weight loss. Given the relatively limited effect of exercise training on weight loss as such, the changes in physical fitness brought about by exercise training cannot be overlooked as they provide major health benefits to persons with obesity. Aerobic, as well as combined aerobic and resistance training, increase cardiorespiratory fitness (VO2max) while resistance training, but not aerobic training, improves muscle strength even in the absence of a significant change in muscle mass. Regarding the overall management strategy, adherence in the long term to new lifestyle habits remains a challenging issue to be addressed by further research.
Collapse
Affiliation(s)
- Jean-Michel Oppert
- Department of Nutrition, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, 75013, France.
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, F-93017, France.
- Department of Nutrition, Pitié-Salpêtrière hospital, 47-83 boulevard de l'Hôpital, Paris, 75013, France.
| | - Cécile Ciangura
- Department of Nutrition, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, 75013, France
- Department of Diabetology, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, 75013, France
| | - Alice Bellicha
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, F-93017, France
| |
Collapse
|
3
|
Daouadji-Ghazouani A, Aron-Wisnewsky J, Torcivia A, Irigoin-Guichandut M, Poitou C, Faucher P, Ciangura C, Lassen PB, Clément K, Vaillant JC, Oppert JM, Genser L. Correction: Follow-Up, Safety, and Satisfaction with Tele-bariatric Follow-Up Implemented During the COVID-19 French Lockdown: a 2-Year Follow-Up Study. Obes Surg 2023:10.1007/s11695-023-06612-4. [PMID: 37099253 PMCID: PMC10132429 DOI: 10.1007/s11695-023-06612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Ahmed Daouadji-Ghazouani
- Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Judith Aron-Wisnewsky
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approaches (NutriOmics), Sorbonne Université, Paris, France
| | - Adriana Torcivia
- Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Marc Irigoin-Guichandut
- Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Christine Poitou
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approaches (NutriOmics), Sorbonne Université, Paris, France
| | - Pauline Faucher
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Cécile Ciangura
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Pierre Bel Lassen
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approaches (NutriOmics), Sorbonne Université, Paris, France
| | - Karine Clément
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approaches (NutriOmics), Sorbonne Université, Paris, France
| | - Jean-Christophe Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Jean-Michel Oppert
- Department of Nutrition, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Laurent Genser
- Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- INSERM, Nutrition and Obesity: Systemic Approaches (NutriOmics), Sorbonne Université, Paris, France.
| |
Collapse
|
4
|
Lambert F, Chalopin S, Bedock D, Ciangura C, Aron-Wisnewsky J, Faucher P, Aviles Marquez L, Louhou R, Poitou C, Oppert JM, Bel Lassen P. From Dyspnea to Skin Grafting: The Difficulties of Managing a Patient with Extreme Obesity. Obes Facts 2023; 16:212-215. [PMID: 36521446 PMCID: PMC10028363 DOI: 10.1159/000527092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/11/2022] [Indexed: 12/23/2022] Open
Abstract
While the prevalence of severe obesity is increasing worldwide, caregivers are often challenged with the management of patients with extreme weight. A 30-year-old woman (weight 245 kg, body mass index 85 kg/m2) presented with dyspnea, for which investigations led to suspect pulmonary embolism. The patient's weight made it impossible to perform adapted imaging; thus, an empirical anticoagulant treatment was initiated. A hematoma of the thigh occurred as a consequence of a transient antivitamin K overdose, leading to a 15-cm necrotic wound worsened by a state of malnutrition. Multidisciplinary and comprehensive care was performed including wound trimming, antibiotics, skin grafting, treatment of malnutrition, and psychological support, but with marked difficulties due to the lack of adapted medical equipment and facilities as well as appropriate medical guidelines. Overall, 7 months of hospitalization including 4 months of physiotherapy and rehabilitation were needed before the patient could return home. This case highlights how difficult managing patients with extreme obesity can be and points to the importance for healthcare systems to adapt to the specific needs of these patients and to design specific guidelines for treatment dosage and malnutrition prevention and treatment in this setting.
Collapse
Affiliation(s)
- Flora Lambert
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
| | - Sarah Chalopin
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
| | - Dorothée Bedock
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
| | - Cécile Ciangura
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
| | - Judith Aron-Wisnewsky
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Nutrition & Obesities: Systemic Approaches Research Group (NutriOmics), Paris, France
| | - Pauline Faucher
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
| | - Laura Aviles Marquez
- Nutrition department, Assistance Publique Hôpitaux de Paris, Hôpital Maritime de Berck, Berck, France
| | - Rufin Louhou
- Nutrition department, Assistance Publique Hôpitaux de Paris, Hôpital Maritime de Berck, Berck, France
| | - Christine Poitou
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Nutrition & Obesities: Systemic Approaches Research Group (NutriOmics), Paris, France
| | - Jean-Michel Oppert
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
| | - Pierre Bel Lassen
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH Ile-de-France, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Nutrition & Obesities: Systemic Approaches Research Group (NutriOmics), Paris, France
- *Pierre Bel Lassen,
| |
Collapse
|
5
|
Rives-Lange C, Poghosyan T, Phan A, Van Straaten A, Girardeau Y, Nizard J, Mitanchez D, Ciangura C, Coupaye M, Carette C, Czernichow S, Jannot AS. Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery. JAMA Surg 2023; 158:36-44. [PMID: 36350637 PMCID: PMC9647576 DOI: 10.1001/jamasurg.2022.5450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/23/2022] [Indexed: 11/11/2022]
Abstract
Importance Metabolic and bariatric surgery (MBS) is the most efficient therapeutic option for severe obesity. Most patients who undergo MBS are women of childbearing age. Data in the scientific literature are generally of a low quality due to a lack of well-controlled prospective trials regarding obstetric, neonatal, and child outcomes. Objective To assess the risk-benefit balance associated with MBS around obstetric, neonatal, and child outcomes. Design, Setting, and Participants The study included 53 813 women on the French nationwide database who underwent an MBS procedure and delivered a child between January 2012 and December 2018. Each women was their own control by comparing pregnancies before and after MBS. Exposures The women included were exposed to either gastric bypass or sleeve gastrectomy. Main Outcomes and Measures The study team first compared prematurity and birth weights in neonates born before and after maternal MBS with each other. Then they compared the frequencies of all pregnancy and child diagnoses in the first 2 years of life before and after maternal MBS with each other. Results A total of 53 813 women (median [IQR] age at surgery, 30 [26-35] years) were included, among 3686 women who had 1 pregnancy both before and after MBS. The study team found a significant increase in the small-for-gestational-age neonate rate after MBS (+4.4%) and a significant decrease in the large-for-gestational-age neonate rate (-12.6%). The study team highlighted that compared with pre-MBS births, after MBS births had fewer occurrences of gestational hypertension (odds ratio [OR], 0.16; 95% CI, 0.10-0.23) and gestational diabetes for the mother (OR, 0.39; 95% CI, 0.34-0.45), as well as fewer birth injuries to the skeleton (OR, 0.27; 95% CI, 0.11-0.60), febrile convulsions (OR, 0.39; 95% CI, 0.21-0.67), viral intestinal infections (OR, 0.56; 95% CI, 0.43-0.71), or carbohydrate metabolism disorders in newborns (OR, 0.54; 95% CI 0.46-0.63), but an elevated respiratory failure rate (OR, 2.42; 95% CI, 1.76-3.36) associated with bronchiolitis. Conclusions and Relevance The risk-benefit balance associated with MBS is highly favorable for pregnancies and newborns but may cause an increased risk of respiratory failure associated with bronchiolitis. Further studies are needed to better assess the middle- and long-term benefits and risks associated with MBS.
Collapse
Affiliation(s)
- Claire Rives-Lange
- Université de Paris-Cité, F-75015, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France
| | - Tigran Poghosyan
- Université de Paris-Cité, F-75015, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, Oeso-Gastrique et Bariatrique, Hôpital Bichat, Centre de Recherche Sur l'inflammation, Inserm UMR 1149, Paris, France
| | - Aurelie Phan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexis Van Straaten
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'informatique médicale, biostatistiques et santé publique, Hôpital Européen Georges Pompidou, Paris, France
| | - Yannick Girardeau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'informatique médicale, biostatistiques et santé publique, Hôpital Européen Georges Pompidou, Paris, France
| | - Jacky Nizard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de gynécologie obstétrique, Hôpital Pitié-Salpêtrière, Paris, France
- Inserm U1150, CNRS UMR 7222, Sorbonne Université, Paris, France
| | - Delphine Mitanchez
- Service de néonatalogie, Hôpital Bretonneau, Université François Rabelais, F-37000 Tours, France
- INSERM UMR 938 Centre de Recherche Saint Antoine, F-75012 Paris, France
| | - Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, CSO Ile de France Centre, France
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de l'Obésité (CINFO), Hôpital Louis Mourier, Colombes, France
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université de Paris, Paris, France
| | - Claire Carette
- Université de Paris-Cité, F-75015, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France
- Centre d'investigation clinique, Inserm 1418, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sébastien Czernichow
- Université de Paris-Cité, F-75015, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Sophie Jannot
- Université de Paris-Cité, F-75015, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'informatique médicale, biostatistiques et santé publique, Hôpital Européen Georges Pompidou, Paris, France
- HeKA INSERM, INRIA, Centre de Recherche des Cordeliers Paris, France
| |
Collapse
|
6
|
Verger E, Selleret L, Nizard J, Bachelot A, Dubreuil S, Ciangura C. Recherche des facteurs associés à l’obtention d’une naissance chez des femmes en situation d’infertilité et d’obésité sévère : expérience du parcours OPIOM. Annales d'Endocrinologie 2022. [DOI: 10.1016/j.ando.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
7
|
Phan A, Rives-Lange C, Ciangura C, Carette C, Dupont C, Levy R, Bachelot A, Czernichow S. Bariatric surgery and human fertility. Ann Endocrinol (Paris) 2022; 83:196-198. [PMID: 35443158 DOI: 10.1016/j.ando.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Aurélie Phan
- Hôpital Européen Georges Pompidou, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Sud, Paris.
| | - Claire Rives-Lange
- Hôpital Européen Georges Pompidou, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Sud, Paris; Université Paris Cité, Paris
| | - Cécile Ciangura
- Hôpital Pitié Salpêtrière, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Centre; APHP, Paris
| | - Claire Carette
- Hôpital Européen Georges Pompidou, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Sud, Paris; Université Paris Cité, Paris
| | - Charlotte Dupont
- Sorbonne Université, INSERM, Centre de Recherche St-Antoine, CRSA, F-75012 Paris, France; Service de Biologie de la Reproduction CECOS, Hôpital Tenon, AP-HP.Sorbonne-Université, 75020 Paris, France
| | - Rachel Levy
- Sorbonne Université, INSERM, Centre de Recherche St-Antoine, CRSA, F-75012 Paris, France; Service de Biologie de la Reproduction CECOS, Hôpital Tenon, AP-HP.Sorbonne-Université, 75020 Paris, France
| | - Anne Bachelot
- Hôpitaux Pitié Salpêtrière, service d'Endocrinologie et Médecin de la Reproduction, IE3M, Centre de référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Maladies Gynécologiques Rares, Institute of Cardiometabolism and Nutrition, ICAN, Sorbonne université, Paris
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Sud, Paris; Université Paris Cité, Paris
| |
Collapse
|
8
|
Ciangura C, Coupaye M. [Pregnancy after bariatric surgery]. Rev Prat 2022; 72:185-187. [PMID: 35289530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PREGNANCY AFTER BARIATRIC SURGERY Pregnancy after bariatric surgery is a high-risk pregnan¬cy that requires multidisciplinary management. Although maternal pathologies (gestational diabetes and gravid hypertension) and the risk of macrosomia are greatly reduced, the risk of prematurity and small for gestatio¬nal age is increased. Nutritional needs are specific, and require adapting supplements and reinforcing biological monitoring during pregnancy and lactation, taking into account the specificities of interpretation of biological results in this context. Surgical complications are rare (displacement of the gastric band, occlusion due to internal hernia after Roux-en-Y gastric bypass) but must be systematically evoked in the presence of vomiting or abdominal pain because the maternal-fetal prognosis depends on the rapidity of surgical management. A postoperative conception delay of at least 12 months should be respected and effective contraception pres¬cribed in this perspective. Long-term cohort studies are necessary to better understand the long-term outcomes for children.
Collapse
Affiliation(s)
- Cécile Ciangura
- Service de nutrition, hôpital La Pitié-Salpêtrière, bâtiment IE3M, Paris, France, Centre spécialisé et intégré de prise en charge de l'obésité Île-de-France Centre
| | - Muriel Coupaye
- Service des explorations fonctionnelles, centre intégré nord-francilien de prise en charge de l'obésité (CINFO), hôpital Louis-Mourier (AP-HP), Colombes, et université de Paris, France, Inserm UMR 1149
| |
Collapse
|
9
|
Verger E, Selleret L, Nizard J, Bachelot A, Dubreuil S, Ciangura C. Recherche des facteurs associés à l’obtention d’une naissance chez des femmes en situation d’infertilité et d’obésité sévère : expérience du parcours OPIOM. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Timsit J, Ciangura C, Dubois-Laforgue D, Saint-Martin C, Bellanne-Chantelot C. Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges. Front Endocrinol (Lausanne) 2022; 12:802423. [PMID: 35069449 PMCID: PMC8766338 DOI: 10.3389/fendo.2021.802423] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Heterozygous loss-of-function variants of the glucokinase (GCK) gene are responsible for a subtype of maturity-onset diabetes of the young (MODY). GCK-MODY is characterized by a mild hyperglycemia, mainly due to a higher blood glucose threshold for insulin secretion, and an up-regulated glucose counterregulation. GCK-MODY patients are asymptomatic, are not exposed to diabetes long-term complications, and do not require treatment. The diagnosis of GCK-MODY is made on the discovery of hyperglycemia by systematic screening, or by family screening. The situation is peculiar in GCK-MODY women during pregnancy for three reasons: 1. the degree of maternal hyperglycemia is sufficient to induce pregnancy adverse outcomes, as in pregestational or gestational diabetes; 2. the probability that a fetus inherits the maternal mutation is 50% and; 3. fetal insulin secretion is a major stimulus of fetal growth. Consequently, when the fetus has not inherited the maternal mutation, maternal hyperglycemia will trigger increased fetal insulin secretion and growth, with a high risk of macrosomia. By contrast, when the fetus has inherited the maternal mutation, its insulin secretion is set at the same threshold as the mother's, and no fetal growth excess will occur. Thus, treatment of maternal hyperglycemia is necessary only in the former situation, and will lead to a risk of fetal growth restriction in the latter. It has been recommended that the management of diabetes in GCK-MODY pregnant women should be guided by assessment of fetal growth by serial ultrasounds, and institution of insulin therapy when the abdominal circumference is ≥ 75th percentile, considered as a surrogate for the fetal genotype. This strategy has not been validated in women with in GCK-MODY. Recently, the feasibility of non-invasive fetal genotyping has been demonstrated, that will improve the care of these women. Several challenges persist, including the identification of women with GCK-MODY before or early in pregnancy, and the modalities of insulin therapy. Yet, retrospective observational studies have shown that fetal genotype, not maternal treatment with insulin, is the main determinant of fetal growth and of the risk of macrosomia. Thus, further studies are needed to specify the management of GCK-MODY pregnant women during pregnancy.
Collapse
Affiliation(s)
- José Timsit
- Department of Diabetology, Université de Paris, AP-HP, Cochin-Port-Royal Hospital, DMU ENDROMED, Paris, France
- PRISIS National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
- Monogenic Diabetes Study Group of the Société Francophone du Diabète, Paris, France
| | - Cécile Ciangura
- PRISIS National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
- Monogenic Diabetes Study Group of the Société Francophone du Diabète, Paris, France
- Department of Diabetology, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Danièle Dubois-Laforgue
- Department of Diabetology, Université de Paris, AP-HP, Cochin-Port-Royal Hospital, DMU ENDROMED, Paris, France
- PRISIS National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
- Monogenic Diabetes Study Group of the Société Francophone du Diabète, Paris, France
- INSERM U1016, Cochin Hospital, Paris, France
| | - Cécile Saint-Martin
- PRISIS National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
- Department of Medical Genetics, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, DMU BioGeM, Paris, France
| | - Christine Bellanne-Chantelot
- PRISIS National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
- Monogenic Diabetes Study Group of the Société Francophone du Diabète, Paris, France
- Department of Medical Genetics, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, DMU BioGeM, Paris, France
| |
Collapse
|
11
|
Abstract
Physical activity and exercise have many benefits in persons with obesity, helping with weight loss, body fat loss, abdominal visceral fat loss and possibly with weight maintenance after weight loss. The effect of exercise training (endurance or endurance plus resistance or high-intensity interval training) alone on weight loss as outcome appears relatively modest, amounting to only a few kg. However, endurance training during weight loss has been shown to increase V̇O2max and resistance training during weight loss leads to lower loss in lean body mass and increased muscle strength. In addition, higher physical activity levels improve cardiovascular risk, whatever weight variations. Specifically, physical activity or exercise is part of lifestyle measures for prevention of type 2 diabetes and substantially helps with metabolic control in patients with type 2 diabetes. The importance of physical activity counselling and exercise prescription in the management strategy will depend on specific treatment objectives as defined for a given patient, including weight loss, prevention of weigh regain, prevention of cardio-metabolic comorbidities, lean body mass preservation but also improvement in quality of life or development of social links. The 5 A's strategy consisting in: Ask, Assess, Advise, Agree, Assist (or Arrange) appears well adapted in this setting. Professionals need to be aware of the many barriers patients with obesity may meet on their way to increase habitual physical activity as specific solutions should be proposed. A major challenge is how to improve adherence to new physical activity habits over time.
Collapse
Affiliation(s)
- Jean-Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière university hospital (AP-HP), Sorbonne university, Centre for research on human nutrition (CRNH IdF), Institute of cardiometabolism and nutrition (ICAN), 47-83 boulevard de l'Hôpital 75013 Paris, France; Nutritional Epidemiology Research Team (EREN), Inserm U1153/Inrae U1125/Cnam/USPN, 74 rue Marcel Cachin 93017 Bobigny, France.
| | - Alice Bellicha
- Department of Nutrition, Pitié-Salpêtrière university hospital (AP-HP), Sorbonne university, Centre for research on human nutrition (CRNH IdF), Institute of cardiometabolism and nutrition (ICAN), 47-83 boulevard de l'Hôpital 75013 Paris, France; INSERM, Nutrition and obesities: systemic approaches (NutriOmics), Sorbonne University, 91 boulevard de l'Hôpital 75013 Paris, France
| | - Cécile Ciangura
- Department of Nutrition, Pitié-Salpêtrière university hospital (AP-HP), Sorbonne university, Centre for research on human nutrition (CRNH IdF), Institute of cardiometabolism and nutrition (ICAN), 47-83 boulevard de l'Hôpital 75013 Paris, France
| |
Collapse
|
12
|
Ciangura C, Bachelot A. [Contraception in women with obesity]. Med Sci (Paris) 2021; 37:882-887. [PMID: 34647876 DOI: 10.1051/medsci/2021147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Obese women are at high risk of unintended pregnancy. In addition, obesity is an important risk factor for venous thromboembolism events and arterial thrombosis. All of these data are to be considered in choosing a contraceptive method for obese women. The metabolic changes and the increased body mass of these women may be the cause of a reduction in the effectiveness of hormonal contraception. The progestin-only contraceptives (progestin only pills and etonogestrel subdermal implant) and the intra-uterine devices are the preferred contraceptive methods in women with obesity. The combined estrogen-progestin contraceptives may be proposed in young obese women without other cardiovascular risk factor. Obesity per se does not seem to increase the risk of failure of most contraceptive methods. Bariatric surgery is a complex situation. Contraception is needed for at least 12 months after surgery. Some bariatric surgery such as bypass can induce gastrointestinal malabsorption. In this situation, all oral contraceptives are not recommended because of a higher risk of failure.
Collapse
Affiliation(s)
- Cécile Ciangura
- Service de nutrition, ICAN (Institut de cardiométabolisme et nutrition), Hôpital Pitié Salpêtrière, Sorbonne Université, 47-83 boulevard de l'hôpital, 75013 Paris, France
| | - Anne Bachelot
- Endocrinologie et médecine de la reproduction, Centre de référence des maladies endocriniennes rares de la croissance et du développement, Centre de référence des pathologies gynécologiques rares, Hôpital universitaire Pitié Salpêtrière, 47-83 boulevard de l'hôpital, 75013 Paris, France
| |
Collapse
|
13
|
Dupont C, Didon S, Ciangura C, Selleret L, Bachelot A, Lévy R, Sermondade N. Impact of Bariatric Surgery-Induced Weight Loss on Ovarian Reserve in Women with Obesity: A Systematic Review. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte Dupont
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Samia Didon
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Cécile Ciangura
- Service de Nutrition, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Lise Selleret
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Anne Bachelot
- Service d'Endocrinologie et Médecine de la Reproduction, IE3M, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Maladies Gynécologiques Rares, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Rachel Lévy
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Nathalie Sermondade
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| |
Collapse
|
14
|
Rives-Lange C, Girardeau Y, Poghosyan T, Ciangura C, Coupaye M, Carette C, Nizard J, Jannot AS, Czernichow S. Étude de la natalité avant et après chirurgie bariatrique. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Quilliot D, Coupaye M, Ciangura C, Czernichow S, Sallé A, Gaborit B, Alligier M, Nguyen-Thi PL, Dargent J, Msika S, Brunaud L. Recommendations for nutritional care after bariatric surgery: Recommendations for best practice and SOFFCO-MM/AFERO/SFNCM/expert consensus. J Visc Surg 2021; 158:51-61. [PMID: 33436155 DOI: 10.1016/j.jviscsurg.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nutritional care after bariatric surgery is an issue of major importance, especially insofar as risk of deficiency has been extensively described in the literature. Subsequent to the deliberations carried out by a multidisciplinary working group, we are proposing a series of recommendations elaborated using the Delphi-HAS (official French health authority) method, which facilitates the drawing up of best practice and consensus recommendations based on the data of the literature and on expert opinion. The recommendations in this paper pertain to dietary management and physical activity, multivitamin and trace element supplementation and the prevention and treatment of specific deficiencies in vitamins B1, B9, B12, D and calcium, iron, zinc, vitamins A, E and K, dumping syndrome and reactive hypoglycemia.
Collapse
Affiliation(s)
- D Quilliot
- French Speaking Society of Clinical Nutrition and Metabolism (SFNCM), France.
| | - M Coupaye
- French Association for the Study and Research on Obesity (AFERO), France
| | - C Ciangura
- French Association for the Study and Research on Obesity (AFERO), France
| | - S Czernichow
- French Speaking Society of Clinical Nutrition and Metabolism (SFNCM), France
| | - A Sallé
- French Association for the Study and Research on Obesity (AFERO), France
| | - B Gaborit
- French Association for the Study and Research on Obesity (AFERO), France
| | - M Alligier
- French Obesity Research Center of Excellence (FORCE), France
| | - P-L Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHRU Nancy, Nancy, France
| | - J Dargent
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| | - S Msika
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| | - L Brunaud
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| |
Collapse
|
16
|
Bel Lassen P, Poitou C, Genser L, Marchelli F, Aron-Wisnewsky J, Ciangura C, Jacques F, Moreau P, Oppert JM, Clément K. COVID-19 and its Severity in Bariatric Surgery-Operated Patients. Obesity (Silver Spring) 2021; 29:24-28. [PMID: 32875723 DOI: 10.1002/oby.23026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Obesity is a major risk factor for severe forms of coronavirus disease (COVID-19), but little is known about the post-bariatric surgery (BS) setting. The prevalence of likely COVID-19 and its risk factors in patients followed up after BS was assessed. METHODS A total of 738 patients who underwent BS and were followed up at a university medical center were surveyed. A retrospective comparison of characteristics at baseline, 1 year after BS, and at the time of lockdown was performed between patients with COVID-19-likely events (CL) based on a combination of reported symptoms and those for whom COVID-19 was unlikely. RESULTS CL occurred in 62 (8.4%) patients, among whom 4 (6.4%) had a severe form requiring hospitalization and 1 (1.6%) died. The CL group had a higher proportion of persistent type 2 diabetes (T2D) at last follow-up (36.2% vs. 20.3%, P = 0.01). BMI at the time of lockdown was lower in the CL group (30.2 ± 5.1 vs. 32.8 ± 6.5 kg/m2 ; P < 0.01) with higher percent weight loss since BS in the CL group. Severe forms of COVID-19 requiring hospitalization were associated with persistent T2D at the last follow-up visit. CONCLUSIONS In BS patients, CL were associated with persistent T2D and lower BMI.
Collapse
Affiliation(s)
- Pierre Bel Lassen
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Christine Poitou
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Laurent Genser
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
- Digestive Surgery Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Florence Marchelli
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Judith Aron-Wisnewsky
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Cécile Ciangura
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
| | - Flavien Jacques
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Pauline Moreau
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
| | | | - Jean-Michel Oppert
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
| | - Karine Clément
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, CRNH-Ile de France Paris, Sorbonne Université, Paris, France
- INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| |
Collapse
|
17
|
Mitanchez D, Jacqueminet S, Lebbah S, Dommergues M, Hajage D, Ciangura C. Relative Contribution of Gestational Weight Gain, Gestational Diabetes, and Maternal Obesity to Neonatal Fat Mass. Nutrients 2020; 12:nu12113434. [PMID: 33182482 PMCID: PMC7698189 DOI: 10.3390/nu12113434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
Maternal nutritional and metabolic status influence fetal growth. This study investigated the contribution of gestational weight gain (GWG), gestational diabetes (GDM), and maternal obesity to birthweight and newborn body fat. It is a secondary analysis of a prospective study including 204 women with a pregestational body mass index (BMI) of 18.5-24.9 kg/m2 and 219 women with BMI ≥ 30 kg/m2. GDM was screened in the second and third trimester and was treated by dietary intervention, and insulin if required. Maternal obesity had the greatest effect on skinfolds (+1.4 mm) and cord leptin (+3.5 ng/mL), but no effect on birthweight. GWG was associated with increased birthweight and skinfolds thickness, independently from GDM and maternal obesity. There was an interaction between third trimester weight gain and GDM on birthweight and cord leptin, but not with maternal obesity. On average, +1 kg in third trimester was associated with +13 g in birthweight and with +0.64 ng/mL in cord leptin, and a further 32 g and 0.89 ng/mL increase in diabetic mothers, respectively. Maternal obesity is the main contributor to neonatal body fat. There is an independent association between third trimester weight gain, birthweight, and neonatal body fat, enhanced by GDM despite intensive treatment.
Collapse
Affiliation(s)
- Delphine Mitanchez
- Department of Neonatology, Bretonneau Hospital, François Rabelais University, 37000 Tours, France
- INSERM, UMR_S 938 Saint Antoine Research Centre, Sorbonne University, 75012 Paris, France
- Correspondence: ; Tel.: +33-2-47-47-47-49
| | - Sophie Jacqueminet
- Department of Diabetology, Institute of Cardiometabolism And Nutrition (ICAN), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, 75013 Paris, France; (S.J.); (C.C.)
| | - Said Lebbah
- Clinic Research Unit, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, 75013 Paris, France;
| | - Marc Dommergues
- Department of Gynaecology and Obstetrics, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, 75013 Paris, France;
| | - David Hajage
- INSERM, Public Health Department, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Centre of Pharmacoepidémiology (Cephepi), Sorbonne University, 75013 Paris, France;
| | - Cécile Ciangura
- Department of Diabetology, Institute of Cardiometabolism And Nutrition (ICAN), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, 75013 Paris, France; (S.J.); (C.C.)
- Department of Nutrition, Institute of Cardiometbolism And Nutrition (ICAN), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, 75013 Paris, France
| |
Collapse
|
18
|
Amouyal C, Klatzmann D, Tibi E, Salem JE, Halbron M, Popelier M, Jacqueminet S, Ciangura C, Bourron O, Andreelli F, Hartemann A, Rosenzwajg M. Pregnant type 1 diabetes women with rises in C-peptide display higher levels of regulatory T cells: A pilot study. Diabetes Metab 2020; 47:101188. [PMID: 32891755 DOI: 10.1016/j.diabet.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
AIM During pregnancy of type 1 diabetes (T1D) women, a C peptide rise has been described, which mechanism is unclear. In T1D, a defect of regulatory T cells (Tregs) and its major controlling cytokine, interleukin-2 (IL2), is observed. METHODS Evolution of clinical, immunological (Treg (CD4+CD25hiCD127-/loFoxp3+ measured by flow cytometry and IL2 measured by luminex xMAP technology) and diabetes parameters (insulin dose per day, HbA1C, glycaemia, C peptide) was evaluated in 13 T1D women during the three trimesters of pregnancy and post-partum (PP, within 6 months) in a monocentric pilot study. Immunological parameters were compared with those of a healthy pregnant cohort (QuTe). RESULTS An improvement of beta cell function (C peptide rise and/or a decrease of insulin dose-adjusted A1c index that estimate individual exogenous insulin need) was observed in seven women (group 1) whereas the six others (group 2) did not display any positive response to pregnancy. A higher level of Tregs and IL2 was observed in group 1 compared to group 2 during pregnancy and at PP for Tregs level. However, compared to the healthy cohort, T1D women displayed a Treg deficiency CONCLUSION: This pilot study highlights that higher level of Tregs and IL2 seem to allow improvement of endogenous insulin secretion of T1D women during pregnancy.
Collapse
Affiliation(s)
- C Amouyal
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, UMRS U1269, Paris, France.
| | - D Klatzmann
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France; Sorbonne Université, INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
| | - E Tibi
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France
| | - J-E Salem
- Clinical Investigation Centre Paris-Est, CIC-1421, UNICO-GRECO Cardio-oncology Program, INSERM, Department of Pharmacology, Sorbonne Université, Paris, France; Department of Medicine and Pharmacology, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Halbron
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - M Popelier
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - S Jacqueminet
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - C Ciangura
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - O Bourron
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Institute of Cardiometabolism and Nutrition, Paris, France
| | - F Andreelli
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, UMRS U1269, Paris, France
| | - A Hartemann
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Institute of Cardiometabolism and Nutrition, Paris, France
| | - M Rosenzwajg
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France; Sorbonne Université, INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
| |
Collapse
|
19
|
Ciangura C, Coupaye M, Deruelle P, Gascoin G, Calabrese D, Cosson E, Ducarme G, Gaborit B, Lelièvre B, Mandelbrot L, Petrucciani N, Quilliot D, Ritz P, Robin G, Sallé A, Gugenheim J, Nizard J. Correction to: Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-Partum Management after Bariatric Surgery. Obes Surg 2020; 30:3650-3651. [PMID: 32504370 DOI: 10.1007/s11695-020-04479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the original article, due to an XML tagging error the name of Véronique Taillard was omitted from the list of members of the French Study Group for Bariatric Surgery and Maternity (the BARIA-MAT Group). The correct list is as follows.
Collapse
Affiliation(s)
- Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Nutrition and Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, 47- 83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Explorations Fonctionnelles, Colombes, University Paris Diderot, Paris, France
- Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France
- Collège National des Gynécologues et Obstétriciens Français, (CNGOF), Paris, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- Société Française de Néonatologie et Société Française de Pédiatrie, Paris, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Digestive Surgery, Colombes, University Paris Diderot, Paris, France
| | - Emmanuel Cosson
- Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Bondy, 10 UMR U557 INSERM/U11125 INRA/CNAM, University Paris13, Bobigny, France
- Société Francophone du Diabète (SFD), Paris, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Departemental Hospital, La Roche-sur-Yon, France
| | - Bénédicte Gaborit
- Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France
- Assistance Publique-Hôpitaux de Marseille, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Bénédicte Lelièvre
- Laboratory of Pharmacology and Toxicology, Angers University Hospital, Angers, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, University Paris Diderot, Paris, France
| | - Niccolo Petrucciani
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Division of Digestive Surgery and Liver Transplantation, UPEC University, Créteil, France
| | - Didier Quilliot
- Department of Diabetology-Endocrinology-Nutrition, CHRU Nancy, INSERM 954, University of Lorraine, Nancy, France
- Société Francophone Nutrition Clinique et Métabolisme (SFNCM), Paris, France
| | - Patrick Ritz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital, UMR1027, Paul Sabatier University, Toulouse, France
| | - Geoffroy Robin
- Collège National des Gynécologues et Obstétriciens Français, (CNGOF), Paris, France
- Department of Medical Gynecology, and Sexology and Department of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, Lille, EA4308 "gametogenesis and gamete quality", Lille University, Lille, France
| | - Agnès Sallé
- Department of Diabetology-Endocrinology-Nutrition, Angers University Hospital, Angers, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, University of Nice, Nice, France
- Porte des Pierres, Dorées, France
| | - Jacky Nizard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Gynecology and Obstetrics, Sorbonne University, Paris, France
| |
Collapse
|
20
|
Ciangura C, Coupaye M, Deruelle P, Gascoin G, Calabrese D, Cosson E, Ducarme G, Gaborit B, Lelièvre B, Mandelbrot L, Petrucciani N, Quilliot D, Ritz P, Robin G, Sallé A, Gugenheim J, Nizard J. Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-partum Management After Bariatric Surgery. Obes Surg 2020; 29:3722-3734. [PMID: 31493139 DOI: 10.1007/s11695-019-04093-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Emerging evidence suggests that bariatric surgery improves pregnancy outcomes of women with obesity by reducing the rates of gestational diabetes, pregnancy-induced hypertension, and macrosomia. However, it is associated with an increased risk of a small-for-gestational-age fetus and prematurity. Based on the work of a multidisciplinary task force, we propose clinical practice recommendations for pregnancy management following bariatric surgery. They are derived from a comprehensive review of the literature, existing guidelines, and expert opinion covering the preferred type of surgery for women of childbearing age, timing between surgery and pregnancy, contraception, systematic nutritional support and management of nutritional deficiencies, screening and management of gestational diabetes, weight gain during pregnancy, gastric banding management, surgical emergencies, obstetrical management, and specific care in the postpartum period and for newborns.
Collapse
Affiliation(s)
- Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Nutrition and Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Explorations Fonctionnelles, Colombes, University Paris Diderot, Paris, France.,Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.,Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Société Française de Néonatologie et Société Française de Pédiatrie, Paris, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Digestive Surgery, Colombes, University Paris Diderot, Paris, France
| | - Emmanuel Cosson
- Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Bondy, 10 UMR U557 INSERM/U11125 INRA/CNAM, University Paris13, Bobigny, France.,Société Francophone du Diabète (SFD), Paris, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Departemental Hospital, La Roche-sur-Yon, France
| | - Bénédicte Gaborit
- Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France.,Assistance Publique-Hôpitaux de Marseille, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Bénédicte Lelièvre
- Laboratory of Pharmacology and Toxicology, Angers University Hospital, Angers, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, University Paris Diderot, Paris, France
| | - Niccolo Petrucciani
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Division of Digestive Surgery and Liver Transplantation, UPEC University, Créteil, France
| | - Didier Quilliot
- Department of Diabetology-Endocrinology-Nutrition, CHRU Nancy, INSERM 954, University of Lorraine, Nancy, France.,Société Francophone Nutrition Clinique et Métabolisme (SFNCM), Paris, France
| | - Patrick Ritz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital, UMR1027, Paul Sabatier University, Toulouse, France
| | - Geoffroy Robin
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France.,Department of Medical Gynecology, and Sexology and Department of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, Lille, EA4308 "gametogenesis and gamete quality", Lille University, Lille, France
| | - Agnès Sallé
- Department of Diabetology-Endocrinology-Nutrition, Angers University Hospital, Angers, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, University of Nice, Nice, France.,Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (SOFFCOMM), Porte des Pierres Dorées, France
| | - Jacky Nizard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Gynecology and Obstetrics, Sorbonne University, Paris, France
| | | |
Collapse
|
21
|
Sola-Gazagnes A, Faucher P, Jacqueminet S, Ciangura C, Dubois-Laforgue D, Mosnier-Pudar H, Roussel R, Larger E. Disagreement between capillary blood glucose and flash glucose monitoring sensor can lead to inadequate treatment adjustments during pregnancy. Diabetes & Metabolism 2020; 46:158-163. [DOI: 10.1016/j.diabet.2019.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022]
|
22
|
Bellicha A, Giroux C, Ciangura C, Menoux D, Thoumie P, Oppert JM, Portero P. Vertical Jump on a Force Plate for Assessing Muscle Strength and Power in Women With Severe Obesity: Reliability, Validity, and Relations With Body Composition. J Strength Cond Res 2020; 36:75-81. [PMID: 32218061 DOI: 10.1519/jsc.0000000000003432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bellicha, A, Giroux, C, Ciangura, C, Menoux, D, Thoumie, P, Oppert, J-M, and Portero, P. Vertical jump on a force plate for assessing muscle strength and power in women with severe obesity: reliability, validity, and relations with body composition. J Strength Cond Res XX(X): 000-000, 2020-Muscle strength and power, particularly when assessed during multijoint movements such as vertical jump (VJ), are important predictors of health status and physical function. Vertical jump is mainly used in athletes, also in untrained or older adults, but has not yet been used in subjects with obesity. We aimed to assess the following in this population: (a) the reliability of VJ parameters, (b) their validity compared with isokinetic testing, and (c) their relations with body composition. In 20 women with severe obesity (mean [SD] age: 41.1 [11.6] years; body mass index: 43.9 [4.4] kg·m) without severe orthopedic disorders, VJ parameters, knee extension torque, and body composition were assessed using a force plate, an isokinetic dynamometer, and dual-energy x-ray absorptiometry, respectively. Excellent reliability was found for absolute peak power and peak force in VJ (intraclass correlation coefficient [95% confidence interval]: 0.95 [0.88-0.98] and 0.90 [0.77-0.96], respectively), and moderate to good validity of peak power and peak force compared with isokinetic torque (r = 0.79 and r = 0.67, respectively; all p < 0.01). Positive relations were found between peak force and peak power during VJ and lean body mass (r = 0.89 and r = 0.60, respectively; p < 0.01) and a negative relation was found between peak velocity or VJ height and fat mass (r = -0.65 and -0.64, respectively; p < 0.01). These results suggest that VJ on a force plate is a reliable and valid test for assessing muscle strength and power in severely obese subjects. Vertical jump testing is easy to implement, which can facilitate its use in both research and clinical testing in this setting (ClinicalTrials.govID: NCT03325764).
Collapse
Affiliation(s)
- Alice Bellicha
- Laboratory Bioengineering, Tissues and Neuroplasticity (BIOTN EA7377), University Paris-Est, Créteil, France.,Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France
| | - Caroline Giroux
- Laboratory Bioengineering, Tissues and Neuroplasticity (BIOTN EA7377), University Paris-Est, Créteil, France
| | - Cécile Ciangura
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France.,Department of Nutrition, Assistance Publique-Ho[Combining Circumflex Accent]pitaux de Paris (AP-HP), Pitie[Combining Acute Accent]-Salpe[Combining Circumflex Accent]trie[Combining Grave Accent]re Hospital, Sorbonne Université, Paris, France
| | - Diane Menoux
- Department of Physical and Rehabilitation Medicine, Assistance Publique-Ho[Combining Circumflex Accent]pitaux de Paris (AP-HP), Rothschild Hospital, Sorbonne University, Paris, France
| | - Philippe Thoumie
- Department of Physical and Rehabilitation Medicine, Assistance Publique-Ho[Combining Circumflex Accent]pitaux de Paris (AP-HP), Rothschild Hospital, Sorbonne University, Paris, France.,Agathe Team, INSERM UA1150, Paris, France
| | - Jean-Michel Oppert
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France.,Department of Nutrition, Assistance Publique-Ho[Combining Circumflex Accent]pitaux de Paris (AP-HP), Pitie[Combining Acute Accent]-Salpe[Combining Circumflex Accent]trie[Combining Grave Accent]re Hospital, Sorbonne Université, Paris, France
| | - Pierre Portero
- Laboratory Bioengineering, Tissues and Neuroplasticity (BIOTN EA7377), University Paris-Est, Créteil, France
| |
Collapse
|
23
|
Mitanchez D, Ciangura C, Jacqueminet S. How Can Maternal Lifestyle Interventions Modify the Effects of Gestational Diabetes in the Neonate and the Offspring? A Systematic Review of Meta-Analyses. Nutrients 2020; 12:nu12020353. [PMID: 32013197 PMCID: PMC7071184 DOI: 10.3390/nu12020353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 12/15/2022] Open
Abstract
Gestational diabetes (GDM) has deleterious effects on the offspring. Maternal obesity and excessive gestational weight gain (GWG), often associated with diabetes, also contribute to these adverse outcomes. OBJECTIVES To assess the benefit for the offspring of maternal lifestyle interventions, including diets and physical activity, to prevent or to improve GDM and to limit excessive GWG. METHOD Systematic review of meta-analyses published in English between December 2014 and November 2019. RESULTS Lifestyle interventions to reduce the risk of GDM reported a decreased risk of 15% to 40%, with a greater effect of exercise compared to diet. Combined lifestyle interventions specifically designed to limit GWG reduced GWG by 1.6 kg in overweight and obese women, and on average by 0.7 to 1 kg in all pregnant women. In these trials, adverse neonatal outcomes were poorly studied. Combined lifestyle interventions in women with GDM significantly reduced fetal growth. Altogether, lifestyle interventions reduced the risk of preterm birth and shoulder dystocia, but individually, diets or exercise alone had no effect on neonatal adverse outcomes. CONCLUSION Specific maternal, neonatal and offspring benefits of lifestyle interventions during pregnancy to prevent or improve GDM control or to limit GWG still require clarification.
Collapse
Affiliation(s)
- Delphine Mitanchez
- Department of Neonatology, Bretonneau Hospital, François Rabelais University, F-37000 Tours, France
- INSERM UMR_S 938 Centre de Recherche Saint Antoine, F-75012 Paris, France
- Correspondence: ; Tel.: +33-2-47-47-47-49; Fax: +33-2-47-47-87-28
| | - Cécile Ciangura
- Department of Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), APHP, University Hospital Pitié-Salpêtrière, F-75013 Paris, France; (C.C.); (S.J.)
| | - Sophie Jacqueminet
- Department of Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), APHP, University Hospital Pitié-Salpêtrière, F-75013 Paris, France; (C.C.); (S.J.)
| |
Collapse
|
24
|
Ciangura C. Reply to the Letter to the Editor "Guidelines Regarding Management of a Surgical Emergency During Pregnancy After Bariatric Surgery". Obes Surg 2019; 30:1130-1131. [PMID: 31853862 DOI: 10.1007/s11695-019-04347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Cécile Ciangura
- Departments of Nutrition and Diabetology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital (AP-HP), Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, 47-83 boulevard de l'hôpital, 75013, Paris, France.
| | | |
Collapse
|
25
|
Donath X, Saint-Martin C, Dubois-Laforgue D, Rajasingham R, Mifsud F, Ciangura C, Timsit J, Bellanné-Chantelot C. Next-generation sequencing identifies monogenic diabetes in 16% of patients with late adolescence/adult-onset diabetes selected on a clinical basis: a cross-sectional analysis. BMC Med 2019; 17:132. [PMID: 31291970 PMCID: PMC6621990 DOI: 10.1186/s12916-019-1363-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/10/2019] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Monogenic diabetes (MgD) accounts for 1-2% of all diabetes cases. In adults, MgD is difficult to distinguish from common diabetes causes. We assessed the diagnosis rate and genetic spectrum of MgD using next-generation sequencing in patients with late adolescence/adult-onset diabetes referred for a clinical suspicion of MgD. METHODS This cross-sectional study was performed in 1564 probands recruited in 116 Endocrinology departments. Inclusion criteria were the absence of diabetes autoantibodies, and at least two of the three following criteria: an age ≤ 40 years and a body mass index (BMI) < 30 kg/m2 at diagnosis in the proband or in at least two relatives with diabetes, and a family history of diabetes in ≥ 2 generations. Seven genes (GCK, HNF1A, HNF4A, HNF1B, ABCC8, KCNJ11, and INS) were analyzed. Variant pathogenicity was assessed using current guidelines. RESULTS Pathogenic variants were identified in 254 patients (16.2%) and in 23.2% of EuroCaucasian patients. Using more stringent selection criteria (family history of diabetes in ≥ 3 generations, age at diabetes ≤ 40 years and BMI < 30 kg/m2 in the proband, EuroCaucasian origin) increased the diagnosis rate to 43%, but with 70% of the identified cases being missed. GCK (44%), HNF1A (33%), and HNF4A (10%) accounted for the majority of the cases. HNF1B (6%), ABCC8/KCNJ11 (4.4%), and INS (2.8%) variants accounted for 13% of the cases. As compared to non-monogenic cases, a younger age, a lower BMI and the absence of diabetes symptoms at diagnosis, a EuroCaucasian origin, and a family history of diabetes in ≥ 3 generations were associated with MgD, but with wide phenotype overlaps between the two groups. In the total population, two clusters were identified, that mainly differed by the severity of diabetes at onset. MgDs were more prevalent in the milder phenotypic cluster. The phenotypes of the 59 patients (3.8%) with variants of uncertain significance were different from that of patients with pathogenic variants, but not from that of non-monogenic patients. CONCLUSION Variants of HNF1B and the K-ATP channel genes were more frequently involved in MgD than previously reported. Phenotype overlapping makes the diagnosis of MgD difficult in adolescents/adults and underlies the benefit of NGS in clinically selected patients.
Collapse
Affiliation(s)
- Xavier Donath
- Department of Diabetology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Descartes University, DHU AUTHORS, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Cécile Saint-Martin
- Department of Genetics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47/83 boulevard de l'Hôpital, 75013, Paris, France.,PRISIS Reference Center for Rare Diseases, Paris, France
| | - Danièle Dubois-Laforgue
- Department of Diabetology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Descartes University, DHU AUTHORS, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,PRISIS Reference Center for Rare Diseases, Paris, France.,INSERM U1016, Cochin Hospital, 22 rue Méchain, 75014, Paris, France
| | - Ramanan Rajasingham
- Department of Diagnostic and Interventional Radiology, and Neuroradiology, Bretonneau Hospital, University Hospital of Tours, 2 boulevard Tonnellé, 27000, Tours, France
| | - François Mifsud
- Department of Diabetology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Descartes University, DHU AUTHORS, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Cécile Ciangura
- PRISIS Reference Center for Rare Diseases, Paris, France.,Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - José Timsit
- Department of Diabetology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Descartes University, DHU AUTHORS, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,PRISIS Reference Center for Rare Diseases, Paris, France
| | - Christine Bellanné-Chantelot
- Department of Genetics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47/83 boulevard de l'Hôpital, 75013, Paris, France. .,PRISIS Reference Center for Rare Diseases, Paris, France.
| | | |
Collapse
|
26
|
Popelier M, Ciangura C, Flahault C, Louot C, Vanier A, Sachon C, Grimaldi A, Malavia M, Hartemann A. Évaluation de deux approches de médecine narrative, le théâtre du vécu et un atelier d’écriture, dans une prise en charge éducative intégrée de patients diabétiques de type 1. ACTA ACUST UNITED AC 2019. [DOI: 10.1051/tpe/2019003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
La détresse émotionnelle liée au diabète impacte la qualité de vie et l’équilibre métabolique ce qui rend indispensable l’exploration du vécu de la maladie. Nous avons comparé 2 approches de médecine narrative, un atelier d’écriture où le patient écrit « une lettre à son diabète » (LAMD) et le « théâtre du vécu » (TDV) où un récit est transformé en une saynète qui est interprétée par des comédiens professionnels, mise en scène par le patient à l’aide du directeur d’acteurs. Deux groupes de patients diabétiques de type 1 hospitalisés dans le cadre d’un séjour d’éducation thérapeutique ont été randomisés dans une session soit avec LAMD (n = 27) soit avec TDV (n = 28). Deux questionnaires portant sur la détresse émotionnelle liée au diabète (PAID) et sur ses représentations du diabète (IPQR) ont été réalisés en début de programme et 3 mois plus tard et les résultats comparés par un test de Wilcoxon apparié. Une analyse qualitative menée par une psychologue a été effectuée chez 11 patients 3 mois après l’intervention. Nous n’avons pas observé de différence significative sur l’évolution du score des questionnaires entre les 2 approches mais l’analyse qualitative suggère un effet positif des 2 processus narratifs, plus marqué pour le TDV.
Collapse
|
27
|
Bellicha A, Ciangura C, Poitou C, Portero P, Oppert JM. Activité physique et chirurgie bariatrique : quand ? quoi ? comment ? avec quelle efficacité ? – Que dit la littérature ? NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Bellicha A, Ciangura C, Poitou C, Portero P, Oppert JM. Effectiveness of exercise training after bariatric surgery-a systematic literature review and meta-analysis. Obes Rev 2018; 19:1544-1556. [PMID: 30156007 DOI: 10.1111/obr.12740] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/18/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
We aimed to conduct a systematic review and meta-analysis of controlled trials assessing exercise training programs in patients with obesity undergoing bariatric surgery. We systematically searched exercise training studies performed after bariatric surgery published up to June 2017. Studies reporting changes in body composition, physical fitness, functional capacity, objectively measured physical activity, quality of life or relevant health outcomes were included. The review protocol is available from PROSPERO (CRD42017069380). Meta-analyses were conducted using random-effects models when data were available from at least five articles. Twenty articles were included, describing 16 exercise training programs, of which 15 were included in the meta-analysis. Overall, exercise training was associated with higher weight loss (mean difference: -2.4 kg, 95% CI: -4.2; -0.6, I2 = 49%, n = 12), higher fat mass loss (-2.7 kg, 95% CI: -4.5; -1.0, I2 = 50%, n = 8) and improved VO2 max and functional walking (standardized mean difference: 0.86, 95% CI: 0.29; 1.44, I2 = 57%, n = 6; 1.45, 95% CI: 0.32; 2.58, I2 = 89%, n = 6, respectively). Exercise training was not associated with lean body mass changes. In conclusion, exercise training programs performed after bariatric surgery were found effective to optimize weight loss and fat mass loss and to improve physical fitness, although no additional effect on lean body mass loss was found.
Collapse
Affiliation(s)
- A Bellicha
- Laboratory Bioengineering, Tissues and Neuroplasticity (BIOTN EA7377), University Paris-Est, Créteil, France.,Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, Paris, France
| | - C Ciangura
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, Paris, France.,AP-HP, Pitie-Salpetriere University Hospital, Department of Nutrition, Sorbonne University, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Paris, France
| | - C Poitou
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, Paris, France.,AP-HP, Pitie-Salpetriere University Hospital, Department of Nutrition, Sorbonne University, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Paris, France.,INSERM, UMRS NutriOmics Team, Paris, France
| | - P Portero
- Laboratory Bioengineering, Tissues and Neuroplasticity (BIOTN EA7377), University Paris-Est, Créteil, France
| | - J-M Oppert
- Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, Paris, France.,AP-HP, Pitie-Salpetriere University Hospital, Department of Nutrition, Sorbonne University, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Paris, France
| |
Collapse
|
29
|
Mitanchez D, Jacqueminet S, Nizard J, Tanguy ML, Ciangura C, Lacorte JM, De Carne C, Foix L'Hélias L, Chavatte-Palmer P, Charles MA, Dommergues M. Effect of maternal obesity on birthweight and neonatal fat mass: A prospective clinical trial. PLoS One 2017; 12:e0181307. [PMID: 28750045 PMCID: PMC5531500 DOI: 10.1371/journal.pone.0181307] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/20/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To discriminate the effect of maternal obesity and gestational diabetes on birth weight and adipose tissue of the newborn. METHODS Normal BMI women (group N, n = 243; 18.5≤ BMI<25 kg/m2) and obese women (group Ob, n = 253; BMI≥30 kg/m2) were recruited in a prospective study between 15 and 18 weeks of gestation. All women were submitted to a 75g oral glucose tolerance test in the second and third trimester. First trimester fasting blood glucose was also obtained from Ob women. All women with one measurement above normal values were considered positive for gestational diabetes and first treated by dietary intervention. When dietary measures were not efficient, they were treated by insulin. Neonatal anthropometrics, sum of skinfolds and cord serum hormones were measured. RESULTS 222 N and 226 Ob mothers and their newborns were included in the analysis. Diabetes was diagnosed in 20% and 45.2% of N and Ob women, respectively. Birth weight was not statistically different between groups (boys: 3456g±433 and 3392g±463; girls: 3316g±402 and 3391g±408 for N and Ob, respectively). Multivariate analysis demonstrated that skinfold thickness and serum leptin concentrations were significantly increased in girls born to women with obesity (18.0mm±0.6 versus 19.7mm±0.5, p = 0.004 and 11.3ng/mL±1.0 versus 15.3ng/mL±1.0, p = 0.02), but not in boys (18.4mm±0.6 versus 18.5mm±0.5, p = 0.9 and 9.3ng/mL±1.0 versus 9.0ng/mL±1.0, p = 0.9). Based on data from 136 N and 124 Ob women, maternal insulin resistance at 37 weeks was also positively related to skinfold in girls, only, with a 1-point increase in HOMA-IR corresponding to a 0.33mm±0.08 increase in skinfold (p<0.0001). CONCLUSIONS Regardless of gestational diabetes, maternal obesity and insulin resistance were associated with increased adiposity in girls only. Persistence of this sexual dimorphism remains to be explored during infancy.
Collapse
Affiliation(s)
- Delphine Mitanchez
- Department of Perinatality, APHP, GHUEP, Armand Trousseau Hospital, Paris, France.,Sorbonne Universities, UPMC University Paris 06, Paris, France
| | - Sophie Jacqueminet
- Department of Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), APHP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jacky Nizard
- Sorbonne Universities, UPMC University Paris 06, Paris, France.,Department of Gynecology and Obstetrics, APHP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Marie-Laure Tanguy
- Department of Clinical Research, APHP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Cécile Ciangura
- Department of Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), APHP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jean-Marc Lacorte
- Sorbonne Universities, UPMC University Paris 06, Paris, France.,Endocrine and Oncologic Biochemistry, APHP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Céline De Carne
- Department of Perinatality, APHP, GHUEP, Armand Trousseau Hospital, Paris, France
| | - Laurence Foix L'Hélias
- Department of Perinatality, APHP, GHUEP, Armand Trousseau Hospital, Paris, France.,Sorbonne Universities, UPMC University Paris 06, Paris, France
| | | | - Marie-Aline Charles
- Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris City Research Centre, Villejuif, France.,Univ Paris Descartes, Sorbonne Paris Cité, UMR1153, Paris, France
| | - Marc Dommergues
- Sorbonne Universities, UPMC University Paris 06, Paris, France.,Department of Gynecology and Obstetrics, APHP, University Hospital Pitié-Salpêtrière, Paris, France
| |
Collapse
|
30
|
|
31
|
Faucher P, Poitou C, Carette C, Tezenas du Montcel S, Barsamian C, Touati E, Bouillot JL, Torcivia A, Czernichow S, Oppert JM, Ciangura C. Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control. Obes Surg 2016; 26:2370-8. [DOI: 10.1007/s11695-016-2106-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
32
|
Ciangura C, Faucher P. [What type of physical activity to recommend for patients with type 2 diabetes?]. Rev Prat 2015; 65:1054-1055. [PMID: 26749705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
33
|
Bellanné-Chantelot C, Coste J, Ciangura C, Fonfrède M, Saint-Martin C, Bouché C, Sonnet E, Valéro R, Lévy DJ, Dubois-Laforgue D, Timsit J. High-sensitivity C-reactive protein does not improve the differential diagnosis of HNF1A-MODY and familial young-onset type 2 diabetes: A grey zone analysis. Diabetes Metab 2015; 42:33-7. [PMID: 25753245 DOI: 10.1016/j.diabet.2015.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 12/13/2022]
Abstract
AIM Low plasma levels of high-sensitivity C-reactive protein (hs-CRP) have been suggested to differentiate hepatocyte nuclear factor 1 alpha-maturity-onset diabetes of the young (HNF1A-MODY) from type 2 diabetes (T2D). Yet, differential diagnosis of HNF1A-MODY and familial young-onset type 2 diabetes (F-YT2D) remains a difficult challenge. Thus, this study assessed the added value of hs-CRP to distinguish between the two conditions. METHODS This prospective multicentre study included 143 HNF1A-MODY patients, 310 patients with a clinical history suggestive of HNF1A-MODY, but not confirmed genetically (F-YT2D), and 215 patients with T2D. The ability of models, including clinical characteristics and hs-CRP to predict HNF1A-MODY was analyzed, using the area of the receiver operating characteristic (AUROC) curve, and a grey zone approach was used to evaluate these models in clinical practice. RESULTS Median hs-CRP values were lower in HNF1A-MODY (0.25mg/L) than in F-YT2D (1.14mg/L) and T2D (1.70mg/L) patients. Clinical parameters were sufficient to differentiate HNF1A-MODY from classical T2D (AUROC: 0.99). AUROC analyses to distinguish HNF1A-MODY from F-YT2D were 0.82 for clinical features and 0.87 after including hs-CRP. For the grey zone analysis, the lower boundary was set to miss<1.5% of true positives in non-tested subjects, while the upper boundary was set to perform 50% of genetic tests in individuals with no HNF1A mutation. On comparing HNF1A-MODY with F-YT2D, 65% of patients were classified in between these categories - in the zone of diagnostic uncertainty - even after adding hs-CRP to clinical parameters. CONCLUSION hs-CRP does not improve the differential diagnosis of HNF1A-MODY and F-YT2D.
Collapse
Affiliation(s)
- C Bellanné-Chantelot
- Department of Genetics, AP-HP, Hôpital Pitié-Salpétrière, Université Pierre-et-Marie-Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - J Coste
- Unit of Biostatistics and Epidemiology, AP-HP, Hôtel Dieu; Unit Research APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Lorraine Université, 75004 Paris, France
| | - C Ciangura
- Department of Diabetology, AP-HP, Hôpital Pitié-Salpétrière, Université Pierre-et-Marie-Curie, 75013 Paris, France
| | - M Fonfrède
- Department of Medical Biochemistry, AP-HP, Hôpital Pitié-Salpétrière, 75013 Paris, France
| | - C Saint-Martin
- Department of Genetics, AP-HP, Hôpital Pitié-Salpétrière, Université Pierre-et-Marie-Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Bouché
- Department of Diabetology, AP-HP, Hôpital Lariboisière, 75010 Paris, France
| | - E Sonnet
- Department of Endocrinology, CHU de Brest, 29609 Brest, France
| | - R Valéro
- Department of Nutrition, Metabolic diseases, Endocrinology, AP-HM, Hôpital de la Timone, Aix-Marseille Université, 13385 Marseille, France
| | - D-J Lévy
- Department of Diabetology, AP-HP, Hôpital Cochin, Université Paris-Descartes, 75014 Paris, France
| | - D Dubois-Laforgue
- Department of Diabetology, AP-HP, Hôpital Cochin, Université Paris-Descartes, 75014 Paris, France
| | - J Timsit
- Department of Diabetology, AP-HP, Hôpital Cochin, Université Paris-Descartes, 75014 Paris, France
| | | |
Collapse
|
34
|
Ciangura C, Nizard J, Poitou-Bernert C, Dommergues M, Oppert JM, Basdevant A. [Pregnancy and bariatric surgery: Critical points]. ACTA ACUST UNITED AC 2015; 44:496-502. [PMID: 25724602 DOI: 10.1016/j.jgyn.2015.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/26/2014] [Accepted: 01/19/2015] [Indexed: 02/03/2023]
Abstract
More than 200,000 people underwent obesity surgery in France. Most of them are women. Pregnancy after bariatric surgery is becoming a common situation. This surgery results in major nutritional and gastro-intestinal tract modifications that may influence or be influenced by pregnancy, and yields benefits as well as complications. A multidisciplinary management including a nutritionist, an obstetrician, an anesthesiologist, and a bariatric surgeon is required. The aim of this review is to analyze the impact of bariatric surgery on pregnancy and vice versa, and to identify the key points of this management.
Collapse
Affiliation(s)
- C Ciangura
- Pôle cœur et métabolisme, centre intégré de l'obésité, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Nizard
- Service de gynécologie obstétrique, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - C Poitou-Bernert
- Service de nutrition, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, 75013 Paris, France; Institute of cardiology metabolism and nutrition (ICAN), université Pierre-et-Marie-Curie, 75013 Paris, France
| | - M Dommergues
- Service de gynécologie obstétrique, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - J M Oppert
- Pôle cœur et métabolisme, centre intégré de l'obésité, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Institute of cardiology metabolism and nutrition (ICAN), université Pierre-et-Marie-Curie, 75013 Paris, France
| | - A Basdevant
- Pôle cœur et métabolisme, centre intégré de l'obésité, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Institute of cardiology metabolism and nutrition (ICAN), université Pierre-et-Marie-Curie, 75013 Paris, France.
| |
Collapse
|
35
|
Ciangura C, Faucher P, Oppert JM. Activité physique, nutrition et obésité. NUTR CLIN METAB 2014. [DOI: 10.1016/j.nupar.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
36
|
Rangé H, Poitou C, Boillot A, Ciangura C, Katsahian S, Lacorte JM, Czernichow S, Meilhac O, Bouchard P, Chaussain C. Orosomucoid, a new biomarker in the association between obesity and periodontitis. PLoS One 2013; 8:e57645. [PMID: 23526947 PMCID: PMC3602453 DOI: 10.1371/journal.pone.0057645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/24/2013] [Indexed: 11/28/2022] Open
Abstract
Epidemiological data indicate an association between periodontitis and obesity. The biological mechanisms of this relationship remain unclear. A cross-sectional study was conducted to evaluate the relationship between periodontitis and the common systemic inflammatory markers in 32 morbidly obese patients recruited in a Clinical Nutrition department. Periodontal condition was evaluated using pocket depth (PD) measurement, a classical clinical marker of ongoing periodontitis. Major periodontal risk factors were recorded (age, gender, diabetes and smoking status), as well as plasma levels of inflammatory markers (CRP, orosomucoid, IL-6) and adipokines (adiponectin, leptin). All patients included in the sample exhibited evidence of periodontitis, 16 of whom were diagnosed as having severe disease. Adjusted logistic regression analysis indicated that the severity of periodontitis was associated with the plasma level of orosomucoid (p<0.04) after adjustment for age, gender and smoking. Our study thus suggests that the severity of periodontitis, in morbidly obese patients, is associated with the increase of orosomucoid levels.
Collapse
Affiliation(s)
- Hélène Rangé
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France
- INSERM U698, Cardiovascular Hematology, Bioengineering and Remodeling, Bichat Hospital, AP-HP, Paris 7-Denis Diderot University, Paris, France
| | - Christine Poitou
- Nutrition and Endocrinology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
- CRNH-Ile de France, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- INSERM U872, Team 7 Nutriomics, Cordeliers Research Center, Paris, France
- Paris 6-Pierre et Marie Curie University, UMR S 872, Paris, France
| | - Adrien Boillot
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Cécile Ciangura
- Nutrition and Endocrinology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
- CRNH-Ile de France, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Sandrine Katsahian
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris 7-Denis Diderot University, Paris, France
| | - Jean-Marc Lacorte
- Department of Endocrinology and Oncology Biochemistry, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Sébastien Czernichow
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Department of Nutrition, Ambroise Paré Hospital, AP-HP, Versailles St-Quentin University, Boulogne-Billancourt, France
| | - Olivier Meilhac
- INSERM U698, Cardiovascular Hematology, Bioengineering and Remodeling, Bichat Hospital, AP-HP, Paris 7-Denis Diderot University, Paris, France
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France
- * E-mail:
| | - Catherine Chaussain
- Service of Odontology, Bretonneau Hospital, AP-HP, Paris 5-Descartes University, EA 2496, U.F.R. of Odontology, Paris, France
| |
Collapse
|
37
|
Julia C, Ciangura C, Capuron L, Bouillot JL, Basdevant A, Poitou C, Oppert JM. Quality of life after Roux-en-Y gastric bypass and changes in body mass index and obesity-related comorbidities. Diabetes Metab 2013; 39:148-54. [PMID: 23313223 DOI: 10.1016/j.diabet.2012.10.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 02/01/2023]
Abstract
AIM Dynamics of improvement in health-related quality of life (QoL) after bariatric surgery have never been fully assessed, and neither has the potential influence of body mass index (BMI) and comorbidity modification. The objective of this study was to investigate early and medium-term changes in QoL following Roux-en-Y gastric bypass (RYGB), and their relationship to BMI and comorbidity variations. METHODS A total of 71 obese subjects (80% women, mean age 42.1±11.2 years, mean baseline BMI 47.6±6.2kg/m(2)) undergoing RYGB filled in QoL questionnaires (SF-36) before and 3, 6 and 12 months after surgery. QoL was assessed using repeated-measures Anova, with associations between its changes and changes in BMI and comorbidities (diabetes, hypertension, dyslipidaemia, sleep apnoea, knee pain) assessed by mixed-effects models. RESULTS Physical QoL scales (physical component summary, PCS) significantly increased over time (from 38.9±9.3 to 52.6±7.9; P<0.001) as did other physical SF-36 scales (all P<0.001), whereas mental QoL summary scale did not vary significantly (from 45.7±9.5 to 48.6±11.5; P=0.072). Major changes in QoL occurred at 3 months after surgical intervention to reach values comparable to those in the general population. PCS was mostly associated with changes in either BMI or comorbidity status except for diabetes, dyslipidaemia and sleep apnoea. CONCLUSION Results show that improvements in physical QoL after RYGB are observed as early as 3 months after intervention, and are independently associated with weight loss and improvements in comorbidities.
Collapse
Affiliation(s)
- C Julia
- Department of Nutrition, Pitié-Salpêtrière Hospital (AP-HP), University Pierre-et-Marie-Curie-Paris 6, Human Nutrition Research Center Île-de-France (CRNH IdF), 83, boulevard de l'Hôpital, 75013 Paris, France
| | | | | | | | | | | | | |
Collapse
|
38
|
Rangé H, Léger T, Huchon C, Ciangura C, Diallo D, Poitou C, Meilhac O, Bouchard P, Chaussain C. Salivary proteome modifications associated with periodontitis in obese patients. J Clin Periodontol 2012; 39:799-806. [PMID: 22780105 DOI: 10.1111/j.1600-051x.2012.01913.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2012] [Indexed: 12/20/2022]
Abstract
AIM To identify changes in the salivary protein/peptide profiles by differential proteomics in obese patients with or without periodontitis. MATERIAL AND METHODS Periodontal examinations and whole saliva samples were obtained from 38 obese patients (mean age: 45.1 ± 7.3 years, mean BMI: 49.3 ± 9 kg/m(2) ) including 13 periodontitis and 25 non-periodontitis subjects, and 19 healthy controls (mean age: 44.2 ± 6.4 years, mean BMI: 21.5 ± 2.1 kg/m(2) ). Surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) was used to compare the whole saliva polypeptide profiles. RESULTS The SELDI-TOF-MS analysis detected eight putative markers. Six of them were increased and identified in obese subjects versus controls (albumin, α and β haemoglobin chains, α-defensins 1, 2 and 3). Alpha-defensins were less abundant in saliva of periodontitis obese patients (36.47 ± 19.84 μA) versus non-periodontitis obese patients (43.44 ± 30.34 μA), whereas α-defensins were more abundant in obese patients (40.99 ± 26.66 μA) versus controls (27.1 ± 23.98 μA). CONCLUSIONS Periodontal status modifies the salivary proteome in obese patients. Alpha-defensins may play a role in gingival inflammation, and be involved in the higher susceptibility of obese patients to periodontal diseases.
Collapse
Affiliation(s)
- Hélène Rangé
- Department of Periodontology, Service of Odontology, Garancière Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Bariatric surgery (gastric banding, gastric bypass, sleeve gastrectomy, bilio-pancreatic diversion) is the most efficient long-term treatment concerning weight loss, comorbidities and quality of life improvement, and mortality reduction for massive obesity and complicated obesity. These benefits need to be compared to immediate and late adverse events. The adverse events involve operative risk, surgical, nutritional, and sometimes psychological events. This review describes the various surgical techniques and their complications. Then, it discusses the modalities to prepare, follow-up and take care of these surgical patients to improve the results and avoid the complications.
Collapse
Affiliation(s)
- C Ciangura
- Pôle d'endocrinologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | | |
Collapse
|
40
|
Abstract
Physical activity is a cornerstone in the medical management of obesity and could be important for weight loss following bariatric surgery. This review aims to describe the evolution of physical activity following massive weight loss induced by bariatric surgery, and to identify the relationship between physical activity and amount of weight loss. A literature search identified 20 publications (19 studies) reporting physical activity data in relation to bariatric surgery. All studies were observational. Self-assessment of physical activity was used in all the studies. Objective measures (pedometry) were used in two studies. The time frame for physical activity assessment varied: before surgery in two publications, after surgery in nine, and longitudinal pre- to post-operative evolution in nine. The latter nine publications found an increase in physical activity after bariatric surgery. In 10/13 studies where it was described, there was a positive relationship between physical activity level and amount of weight loss. In conclusion, observational evidence of self-reported physical activity suggests that physical activity increases after bariatric surgery and that physical activity is associated with surgically induced weight loss. However, these findings warrant further evaluation using objective measures of physical activity and testing in controlled trials.
Collapse
Affiliation(s)
- D Jacobi
- CHRU de Tours, Service de Médecine Interne et Nutrition, Tours, France
| | | | | | | |
Collapse
|
41
|
|
42
|
Ciangura C, Nocca D, Lindecker V. [Guidelines for clinical practice for bariatric surgery]. Presse Med 2010; 39:953-9. [PMID: 20810234 DOI: 10.1016/j.lpm.2010.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 02/04/2010] [Accepted: 03/16/2010] [Indexed: 02/05/2023] Open
Abstract
Bariatric surgery is intended for subjects with BMI ≥ 40 kg/m(2) or ≥ 35 kg/m(2) with comorbidities. In any case, the indication can only be envisaged in patients who have had access to specialized medical care, and agree with a prolonged medical follow-up. After 60 years old, physiological age and comorbidities need to be highly considered. In genetic obesity and craniopharyngioma, surgery is exceptional. Main contraindications consist in severe disorders in feeding behaviour, non-stabilized psychiatric disorders, alcoholism, drug addiction, inability to participate in prolonged medical follow-up. Surgical process includes many important stages: preparation and information by a multidisciplinary team (identify contraindication, give optimal information, look for and treat comorbidities [as sleep apneoas syndrome, diabetes, cardiopulmonary disease], assess nutritional and psychological status and feeding behaviour); the decision of intervention during a concerted analysis by a multidisciplinary team; follow-up (for life) led to screen for nutritional deficiencies and surgical complications, to reinforce diet and physical activity counselling, to adapt to new situations (as pregnancy), and advise psychological care if necessary.
Collapse
Affiliation(s)
- Cécile Ciangura
- Groupe hospitalier Pitié Salpêtrière (AP-HP), pôle d'endocrinologie, service de nutrition, 75651 Paris cedex 13, France.
| | | | | |
Collapse
|
43
|
Lloret Linares C, Ciangura C, Bouillot JL, Coupaye M, Declèves X, Poitou C, Basdevant A, Oppert JM. Validity of Leg-to-Leg Bioelectrical Impedance Analysis to Estimate Body Fat in Obesity. Obes Surg 2010; 21:917-23. [DOI: 10.1007/s11695-010-0296-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
44
|
Affiliation(s)
- C Ciangura
- Pôle d'endocrinologie de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | | |
Collapse
|
45
|
Ciangura C. [Physical activity in type 2 diabetes]. Rev Prat 2010; 60:490-494. [PMID: 20465122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There are numerous beneficial effects of physical activity for diabetes mellitus treatment and prevention. Irrespective of diet or weight loss, exercise training reduces HbA1c by an amount that should reduce diabetic complications, improves cardiorespiratory fitness that is a predictor of mortality, and improves body composition. Endurance training is usually prescribed, but resistance training is nowadays recommended. Prior to initiating physical programm, medical screening (usual diabetic complications, cardiovascular status) is needed. To allow a long term behavioural change, individually tailored advice and special attention to barriers are needed.
Collapse
Affiliation(s)
- Cécile Ciangura
- Pôle endocrinologie, groupe hospitalier La Pitié-Salpêtrière, AP-HP, 75651 Paris Cedex 13.
| |
Collapse
|
46
|
Abstract
Obesity is the most important lifestyle-related risk factor for type 2 diabetes (T2DM). The prevalence of T2DM in adolescents is increasing in parallel with the increasing incidence of major obesity. In adult obese subjects, the greatest degree of T2DM prevention, improvement or recovery has been reported in patients who have undergone bariatric surgery. However, few studies are available on the benefits and risks of bariatric surgery in adolescents with T2DM. The indications for obesity surgery in this population are unusual, and should only be considered in academic settings after comprehensive interdisciplinary evaluation.
Collapse
Affiliation(s)
- C Ciangura
- Pôle d'Endocrinologie, Faculté de Médecine Pierre & Marie Curie -Paris 6 University-CNRH-IDF, AP-HP, Pitié-Salpêtrière, Paris, France
| | | |
Collapse
|
47
|
Basdevant A, Ciangura C. [Obesity, a disease]. Bull Acad Natl Med 2010; 194:13-24. [PMID: 20669556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Obesity has been considered as a disease by the World Health Organisation since 1997. It was previously considered a simple risk factor and a manifestation of consumer society. This recognition was based on several developments, including epidemiological data showing the worldwide spread of the disease; the increasing health expenditure due to the obesity-related increase in type 2 diabetes; and progress in pathophysiological concepts. Obesity is a chronic and progressive disease. Management approaches range from prevention to surgery, and must be adapted to the individual situation.
Collapse
Affiliation(s)
- Arnaud Basdevant
- Pôle endocrinologie, diabètologie, nutrition, Hôpital de la Pitié-Salpêtrère, 47 bid de l'Hôpital, 75651 Paris cedex 13.
| | | |
Collapse
|
48
|
Basdevant A, Ciangura C. [New insights into obesity]. Bull Acad Natl Med 2009; 193:1259-1269. [PMID: 20120157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Central to obesity is an energy imbalance due to increased calorie intake and/or decreased energy expenditure, as well as a genetic or non genetic biological predisposition. New advances in obesity research point to a role of primary changes in fat storage capacity. Modifications of the cellular composition and structure of adipose tissue, characterized by inflammation and fibrosis, can lead to an "organ disease" that is partially irreversible, thus explaining long-term treatment resistance. This organ disease may lead to local and systemic disorders. A possible role of the gut flora is one especially interesting line of research.
Collapse
Affiliation(s)
- Arnaud Basdevant
- Pôle d'Endocrinologie de la Pitié Salpêtrière, AP-HP, 47 bld de l'Hôpital, 75651 Paris cedex 13.
| | | |
Collapse
|
49
|
Basdevant A, Ciangura C. [Leptin: from gene to energy balance]. Bull Acad Natl Med 2007; 191:887-895. [PMID: 18225443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The amount of stored energy (fat mass) results from a complex interplay of biological factors responding to variations in energy intake and expenditure that depend on behavior and environmental conditions. Leptin plays a key role in this homeostasis. This adipocyte-derived cytokine not only informs the brain about the level of energy stores but is also involved in energy metabolism in the periphery, as well as in reproduction, bone metabolism and immunity. Complete leptin deficiency is very rare, while partial leptin deficiency is more frequent. Hyperleptinemia is frequent in common obesity, indicating a state of leptin resistance. Therapeutic use of leptin remains limited.
Collapse
Affiliation(s)
- Arnaud Basdevant
- Université Pierre et Marie Curie-Paris 6, UMRS Inserm 755, Paris, F-75006 France.
| | | |
Collapse
|
50
|
Poitou Bernert C, Ciangura C, Coupaye M, Czernichow S, Bouillot JL, Basdevant A. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab 2007; 33:13-24. [PMID: 17258928 DOI: 10.1016/j.diabet.2006.11.004] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Accepted: 11/07/2006] [Indexed: 12/20/2022]
Abstract
In recent years, the recourse to obesity surgery to treat morbid obesities has grown. The number of "malabsorptive" interventions, such as the gastric bypass (RYGB: Roux-en-Y gastric bypass) increases each year. The RYGB, which combines two mechanisms promoting weight loss, restriction and malabsorption, has proven its effectiveness in term of weight loss and improvement of obesity-associated co-morbidities. However this intervention involves a profound change in digestive physiology and is the source of nutritional and metabolic complications. The deficits observed most frequently concern proteins, iron, calcium, vitamin B12 and vitamin D. The deficiencies in vitamin B1 are rare but potentially serious. Multidisciplinary follow-up is essential to ensure prevention, diagnosis and treatment of these complications. Based on an analysis of the literature, this article summarizes the various nutritional complications observed after RYGB and the means to diagnose it. It proposes practical recommendations for follow-up, preventive supplementation and treatment of these deficiencies, both generally and in the more specific case of a pregnancy after RYGB.
Collapse
Affiliation(s)
- C Poitou Bernert
- Nutrition Department, Reference Clinic for Obesity, APHP, Hôtel-Dieu, 75181 Paris cedex 04, France.
| | | | | | | | | | | |
Collapse
|