Does diet quality mediate socioeconomic differences in metabolic syndrome in the French West Indies?

Background

Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region, and the contribution of diet to explain these inequalities has not yet been studied. We investigated the association between socioeconomic position and the prevalence of metabolic syndrome (MetS), and explored whether this association was mediated by diet quality in the French West Indies.

Methods

This cross-sectional analysis included 1,144 adults (≥16 y) from a multistage sampling survey, representative of the Guadeloupean and Martinican population. The prevalence of MetS was assessed using the Joint Interim Statement. Dietary intakes were estimated using 24hours dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and prevalence of MetS, and the potential mediating effect of diet quality in this association were assessed using multivariable logistic regression models adjusted for sociodemographic factors.

Results

MetS prevalence adjusted for age and sex was 21% and 30% among Guadeloupean and Martinican, respectively. Compared to those with a high education level, low- and middle-educated subjects were more likely to be at risk of MetS (OR = 1.9; 95%CI = [1.0-3.6] and OR = 2.7; 95%CI = [1.4-5.1], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.2; 95%CI = [1.1-4.2]). The DQI-I explained 11% of the overall variation in MetS due to education.

Conclusions

Socioeconomic inequalities in MetS prevalence were found in a Caribbean population but diet quality contributed only to socioeconomic inequalities due to education. Future public health measures need to target specifically populations with limited financial resources and low education.

Key messages

Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial.

What can dietary patterns tell us about the Caribbean nutrition transition?

Background

Given the public health urgency facing the increasing rates of obesity and chronic diseases in the Caribbean, characterization of the nutrition transition and population groups at higher nutritional risk is needed. We identified dietary patterns in the French West Indies (FWI) and their association with individual characteristics.

Methods

This cross-sectional analysis included 1,144 Guadeloupeans and Martinicans from a representative survey. To identify dietary patterns, principal component analysis was performed using 25 food groups, followed by a clustering procedure classifying subjects in independent clusters. Their associations with health status, Diet Quality Index-International (DQI-I), food supply behaviors, sociodemographic and economic characteristics were studied using multivariable models.

Results

Four dietary patterns were identified, representing 25%, 24%, 31% and 20% of the sample: (1) a “healthy” cluster characterised by a high DQI-I, composed of high educated individuals; (2) a “traditional” cluster with a high DQI-I and high intakes of traditional dishes, formed mostly by women and older persons, with a high obesity prevalence (26%); (3) a “western” cluster with a low DQI-I, high intakes of sweetened beverages, snacks and fast foods, composed mainly of young subjects, buying their fruits, vegetables and tubers only or mainly in supermarkets; and (4) a “transitional” cluster with high intakes of bread, processed meat, sauces, alcoholic and sweetened beverages but conversely high intakes of tubers, legumes, fish and low intakes of biscuits and cakes, formed mainly by middle age men, self-employed or manual workers, and 35% had metabolic syndrome.

Conclusions

The dietary patterns identified reflect different steps of dietary change as described by Popkin, suggesting an ongoing nutrition transition in the FWI. This characterization provides useful information for public health actions regarding population groups at higher nutritional risk.

Key messages

Four diversified dietary patterns were identified suggesting an ongoing nutrition transition in the French West Indies. Demographic and socioeconomic characteristics associated with dietary patterns, especially age, reflecting a generational contrast, provided needed information to guide future public health measures.

Bilateral methachronous testicular germ cell tumor and testicular microlithiasis in a child: Genetic analysis and insights. A case report

OBJECTIVES

To report our experience with a case of a child with bilateral testicular micro-lithiasis (TML) who developed bilateral metachronous testicular germ cell tumor (TGCT) and determine the most appropriate follow-up and care management in children with testicular micro calcifications in regards to the theoretical risk of testicular cancer.

CASE REPORT

A 12 year-old boy was diagnosed with TGCT and TML. Ten years after complete remission, he presented with a recurrence on the contralateral testis. Genetic screening was performed on both resected and the patient's karyotype was analyzed.

RESULTS

Blood karyotype was normal. Aberrations were found in the tumor karyotype. CGH array showed alterations in chromosome arm 12p.

DISCUSSION

TML is frequently associated with testicular malignancy in adults: in 16.9% of cases the normal contralateral testicle develops TML in TGCT. Recent works of literature find no relationship between TML and cancer in general, but in patients with additional risks, the relationship becomes stronger. Some authors suggest that environmental components and genetics are determinant factors. This is highly suspected in our reported case. It would seem that TML is not a precancerous lesion per se, but rather a marker of an at-risk situation. Long term evolution is uncertain and regular self-palpation that starts before puberty is the only way to ensure proper screening and monitoring.

CONCLUSION

TML have been suspected to be a sign of testicular dysgenesis syndrome, which yields a risk of developing TGCT in case of noxious associations. In patients with a history of TGCT contralateral TML is alarming and aggressive surgical management should be discussed. Therapeutic education of these patients on self-palpation is the best way to ensure proper follow-up.

Reproducibility and relative validity of a brief quantitative food frequency questionnaire for assessing fruit and vegetable intakes in North-African women

BACKGROUND

In the context of a rapidly increasing prevalence of noncommunicable diseases, fruit and vegetables could play a key preventive role. To date, there is no rapid assessment tool available for measuring the fruit and vegetable intakes of North-African women. The present study aimed to investigate the reproducibility and relative validity of an eight-item quantitative food frequency questionnaire that measures the fruit and vegetable intakes (FV-FFQ) of Moroccan women.

METHODS

During a 1-week period, 100 women, living in the city of Rabat, Morocco (aged 20-49 years) completed the short FV-FFQ twice: once at baseline (FV-FFQ1) and once at the end of the study (FV-FFQ2). In the mean time, participants completed three 24-h dietary recalls. All questionnaires were administered by interviewers. Reproducibility was assessed by computing Spearman's correlation coefficients, intraclass correlation (ICC) coefficients and kappa statistics. Relative validity was assessed by computing Wilcoxon signed-rank tests and Spearman's correlation coefficients, as well as by performing Bland-Altman plots.

RESULTS

In terms of reproducibility, Spearman's correlation coefficient was 0.56; ICC coefficient was 0.68; and weighted kappa was 0.35. In terms of relative validity, compared with the three 24-h recalls, the FV-FFQ slightly underestimated mean fruit and vegetable intakes (-10.9%; P = 0.006); Spearman's correlation coefficient was 0.69; at the individual level, intakes measured by the FV-FFQ were between 0.39 and 2.19 times those measured by the 24-h recalls.

CONCLUSIONS

The brief eight-item FV-FFQ is a reliable and relatively valid tool for measuring mean fruit and vegetable intakes at the population level, although this is not the case at the individual level.

Microdeletions including YWHAE in the Miller-Dieker syndrome region on chromosome 17p13.3 result in facial dysmorphisms, growth restriction, and cognitive impairment

BACKGROUND

Deletions in the 17p13.3 region are associated with abnormal neuronal migration. Point mutations or deletion copy number variants of the PAFAH1B1 gene in this genomic region cause lissencephaly, whereas extended deletions involving both PAFAH1B1 and YWHAE result in Miller-Dieker syndrome characterised by facial dysmorphisms and a more severe grade of lissencephaly. The phenotypic consequences of YWHAE deletion without deletion of PAFAH1B1 have not been studied systematically.

METHODS

We performed a detailed clinical and molecular characterization of five patients with deletions involving YWHAE but not PAFAH1B1, two with deletion including PAFAH1B1 but not YWHAE, and one with deletion of YWHAE and mosaic for deletion of PAFAH1B1.

RESULTS

Three deletions were terminal whereas five were interstitial. Patients with deletions including YWHAE but not PAFAH1B1 presented with significant growth restriction, cognitive impairment, shared craniofacial features, and variable structural abnormalities of the brain. Growth restriction was not observed in one patient with deletion of YWHAE and TUSC5, implying that other genes in the region may have a role in regulation of growth with CRK being the most likely candidate. Using array based comparative genomic hybridisation and long range polymerase chain reaction, we have delineated the breakpoints of these nonrecurrent deletions and show that the interstitial genomic rearrangements are likely generated by diverse mechanisms, including the recently described Fork Stalling and Template Switching (FoSTeS)/Microhomology Mediated Break Induced Replication (MMBIR).

CONCLUSIONS

Microdeletions of chromosome 17p13.3 involving YWHAE present with growth restriction, craniofacial dysmorphisms, structural abnormalities of brain and cognitive impairment. The interstitial deletions are mediated by diverse molecular mechanisms.

The crystal structure of CD8 in complex with YTS156.7.7 Fab and interaction with other CD8 antibodies define the binding mode of CD8 alphabeta to MHC class I

The CD8alphabeta heterodimer interacts with class I pMHC on antigen-presenting cells as a co-receptor for TCR-mediated activation of cytotoxic T cells. To characterize this immunologically important interaction, we used monoclonal antibodies (mAbs) specific to either CD8alpha or CD8beta to probe the mechanism of CD8alphabeta binding to pMHCI. The YTS156.7 mAb inhibits this interaction and blocks T cell activation. To elucidate the molecular basis for this inhibition, the crystal structure of the CD8alphabeta immunoglobulin-like ectodomains were determined in complex with mAb YTS156.7 Fab at 2.7 A resolution. The YTS156.7 epitope on CD8beta was identified and implies that residues in the CDR1 and CDR2-equivalent loops of CD8beta are occluded upon binding to class I pMHC. To further characterize the pMHCI/CD8alphabeta interaction, binding of class I tetramers to CD8alphabeta on the surface of T cells was assessed in the presence of anti-CD8 mAbs. In contrast to YTS156.7, mAb YTS105.18, which is specific for CD8alpha, does not inhibit binding of CD8alphabeta to class I tetramers, indicating the YTS105.18 epitope is not occluded in the pMHCI/CD8alphabeta complex. Together, these data indicate a model for the pMHCI/CD8alphabeta interaction similar to that observed for CD8alphaalpha in the CD8alphaalpha/pMHCI complex, but in which CD8alpha occupies the lower orientation (membrane proximal to the antigen presenting cell), and CD8beta occupies the upper position (membrane distal). The implication of this molecular assembly for the function of CD8alphabeta in T cell activation is discussed.

[Analysis of 1697 cases of childhood malaria treated using intra-rectal Quinimax (QIR) in the Tilaberi health district in Niger]

Management of malaria attacks with vomiting or other complications in rural areas of Africa raises the often insurmountable challenge of transferring patients to medical centers better equipped than health dispensaries providing initial care. In addition intramuscular quinine can lead to complications. Since intrarectal administration of quinine could help to resolve these problems, it should be included in the therapeutic algorithm. The purpose of this study was to validate the safety, acceptability, tolerance, and efficacy of Intra-Rectal Quinimax (QIR) for treatment of children (0 to 10 years) in the rural Tilaberi region of Niger where malaria is endemic. Of the 3012 children enrolled in the study, a total of 1697 benefited from treatment with treatment using QIR. Thirty-five percent of the cases treated involved complicated malaria attacks. Use of QIR caused no problem in terms of safety or acceptability. Duration of surveillance following treatment using QIR in children is particularly important to prevent early evacuation of the product that was observed in 16% of cases. No short-term side effects were observed. Contraindications for QIR were observed in 10% of the patients enrolled in the study. Success and mortality rates were not statistically different after intrarectal and intramuscular administration. A survey to evaluate the skill of care providers was carried out at the onset of the study. The presentation and functionality of the QIR kit was validated by care providers.

CD4+ T-cell responses to Epstein-Barr virus (EBV) latent-cycle antigens and the recognition of EBV-transformed lymphoblastoid cell lines

There is considerable interest in the potential of Epstein-Barr virus (EBV) latent antigen-specific CD4+ T cells to act as direct effectors controlling EBV-induced B lymphoproliferations. Such activity would require direct CD4+ T-cell recognition of latently infected cells through epitopes derived from endogenously expressed viral proteins and presented on the target cell surface in association with HLA class II molecules. It is therefore important to know how often these conditions are met. Here we provide CD4+ epitope maps for four EBV nuclear antigens, EBNA1, -2, -3A, and -3C, and establish CD4+ T-cell clones against 12 representative epitopes. For each epitope we identify the relevant HLA class II restricting allele and determine the efficiency with which epitope-specific effectors recognize the autologous EBV-transformed B-lymphoblastoid cell line (LCL). The level of recognition measured by gamma interferon release was consistent among clones to the same epitope but varied between epitopes, with values ranging from 0 to 35% of the maximum seen against the epitope peptide-loaded LCL. These epitope-specific differences, also apparent in short-term cytotoxicity and longer-term outgrowth assays on LCL targets, did not relate to the identity of the source antigen and could not be explained by the different functional avidities of the CD4+ clones; rather, they appeared to reflect different levels of epitope display at the LCL surface. Thus, while CD4+ T-cell responses are detectable against many epitopes in EBV latent proteins, only a minority of these responses are likely to have therapeutic potential as effectors directly recognizing latently infected target cells.

Perceptions of healthy and desirable body size in urban Senegalese women

OBJECTIVE

To examine the cultural ideals for body size held by urban Senegalese women; to determine the body size that women associate with health; and to estimate the change in prevalence of female obesity in an urban neighbourhood of Dakar.

DESIGN

Cross-sectional, population-based study in the subject's home, using a structured interviewer-administered questionnaire, conducted in the same Dakar neighbourhood as that of a previous survey conducted in 1996.

SUBJECTS

A total of 301 randomly selected women, aged 20-50 y, living in a specific Dakar neighbourhood, Senegal.

MEASUREMENTS

A total of 32 items concerning body satisfaction, social status, health and individual attributes to associate with one of six photographic silhouettes; body mass index (BMI), waist circumference, waist-to-hip ratio by anthropometry; and measures of economic status.

RESULTS

In all, 26.6% of women were overweight (BMI 25-29.9 kg/m2) and 18.6% were obese (BMI > or =30 kg/m2) compared with 22.4 and 8.0% respectively in 1996. Overweight was the most socially desirable body size, although obesity itself was seen as undesirable, associated with greediness and the development of diabetes and heart disease. Lay definitions of overweight and normal weight differed substantially from health definitions, as one-third of the sample saw the 'overweight' category as normal. Over a third of women with BMI > or =25 kg/m2 wanted to gain more weight.

CONCLUSION

There has been a sharp rise in the prevalence of obesity in Senegalese women living in a Dakar neighbourhood over the last 7 y. In general, overweight body sizes (but not obese) were seen in a positive light. The finding that the term 'overweight' made little sense to these Senegalese women could have important implications for developing public health policies.

Modelling Principles in Livestock System Graphic Approaches

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The marking of livestock in traditional pastoral societies

The marking of animals has been practised in all pastoral systems since time immemorial. Using a series of examples representative of the major pastoral civilisations of the world, the author presents the techniques used (branding and ear incisions, either separately or in combination). In the light of the characteristics common to pastoral societies, the following points are analysed: a) the manner in which the marks used by these societies have been conserved or modified in the course of vertical (inherited) or lateral changes of ownership b) the content and meaning of the messages conveyed by the marks c) the various functions of the marks, namely: collective or individual identification, establishment of rights, protection against theft. In conclusion, the mark of the lineage is seen as symbolic of the founding pact of the pastoral system, uniting a community of humans, a community of animals and a territory. Traditional livestock marking systems are generally not used for health purposes. Moreover, the characteristics of these traditional systems are not compatible with the requirements of modern traceability. Nevertheless, these systems could be adapted, as is the case for the marking of the reindeer herds of the Lapps in Norway, which has been given legal value and has been made mandatory.