Troubles des conduites alimentaires chez le personnel soignant durant la pandémie Covid 19

Introduction

Le personnel soignant est considéré parmi les populations les plus touchées par la pandémie Covid-19. Dans cette optique, nous avons mené une étude dont l’objectif était d’étudier l’impact de cette pandémie sur le comportement alimentaire des blouses blanches ainsi que sa relation avec leur profil anthropométrique.

Matériels et méthodes

Il s’agit d’une étude transversale incluant 40 résidents en médecine exerçant dans des centres hospitalo-universitaires à Tunis. Les données ont été collectées via un questionnaire renseignant sur les mesures anthropométriques et les conduites alimentaires des participants.

Résultats

L’âge moyen était de 28,5 ± 1,8 ans. Une prédominance féminine était notée dans 77,5 % des cas. 80 % étaient sans antécédents. Une atopie, un diabète de type 2, une hypotension artérielle et des adénofibromes étaient retrouvés dans 10 %, 5 %, 2,5 % et 2,5 % des cas respectivement. 22,5 % étaient tabagiques et plus que le quart (27,5 %) étaient consommateurs réguliers d’alcool. L’activité physique était faible dans la moitié des cas, modérée dans 45 % des cas et intense dans 5 % des cas. Une infection SARS-COV 2 était retrouvée chez 44 % des participants. La forme légère était la forme prédominante (dans plus de 90 % des cas). Ils étaient tous vaccinés. L’IMC moyen était de 23,4 ± 2,6 Kg/m² avec une surcharge pondérale objectivée dans 20 % des cas (n = 8).

La consommation des compléments alimentaires était notée dans 62,5 % des cas (n = 25). Plus que la moitié des résidents (60 %) présentaient des troubles du comportement alimentaire (TCA) à type de grignotage (56 %) (n = 18), boulimie (6 %) (n = 2), binge eating disorder (9 %) (n = 3), night eating syndrome (9 %) (n = 3), hyperphagie (16 %) (n = 5) et compulsion alimentaire (26 %) (n = 8). L’impact des régresseurs (sexe, tabagisme, IMC, consommation d’alcool, activité physique, consommation de compléments alimentaires, infection SARS-COV2) sur la présence de troubles des conduites alimentaires a été étudié par le modèle de régression logistique binaire. Seule la consommation d’alcool était considérée comme facteur de risque de développer un TCA avec p = 0,05 (Odds ratio = 19).

Conclusion

Notre étude a montré que les TCA sont bel et bien fréquents chez le personnel soignant pendant la pandémie du SARS-COV2. Outre la consommation d’alcool qui s’est avérée un facteur de risque de survenue des TCA, il faut mentionner que d’autres facteurs sont à rechercher et à évaluer dans d’autres études comme le stress qui s’est amplifié durant ces conditions particulières de l’exercice médical.

Assessment of IgE- and cell-mediated immunity in pediatric patients with eosinophilic esophagitis

Summary

Eosinophilic esophagitis (EoE) is a chronic allergen/immune-mediated disease leading to esophageal dysfunction. Food allergens play critical roles in the pathogenesis and treatment of EoE via different mechanisms. This study aimed to present the characteristics and evaluate the ability of skin prick test (SPT), skin prick to prick test (SPP) (IgE-mediated), and atopic patch test (APT) (cell-mediated) individually or simultaneously to diagnose food allergy in patients suffering from EoE. This prospective study was conducted on 58 patients with EoE. Seven patients (12.1%) were positive to only one, 3 (5.2%) were simultaneously positive to two, and 32 (55.2%) were simultaneously positive to three tests. Single and double sensitizations were totally 10.4% in IgE-mediated reactions, while 36.5% in cell-mediated reactions. In contrast, poly sensitization (> 2 allergens) was 51.7% in IgE-mediated tests and 20.7% in the cell-mediated test. Multiple sensitization findings showed egg white, milk, yolk, and soy were the most frequent allergens. Our findings indicate that EoE is early onset and associated with multiple food sensitizations, particularly via IgE-mediated mechanisms. These immune-mediated responses encompass both IgE-mediated (SPT and SPP) and cell-mediated (APT) reactions simultaneously not individually. Therefore, employing multiple assays may strengthen the diagnosis of food sensitization.

Metabolic complications of obesity

Background

Obesity, through its numerous complications, influences the functional and vital prognosis, especially in situations of massive or morbid obesity. The aim of our study was to study the metabolic complications associated with obesity.

Methods

This was a descriptive cross-sectional study carried out in the first half of 2018 involving 100 obese patients attending the Obesity Unit of the National Institute of Nutrition in Tunis. Each patient received a complete clinical examination with a standard biological assessment. Obesity is defined by a body mass index ≥ 30 Kg / m2.

Results

The average age of our patients was 45.08 ± 13.9 years with a female predominance of 88%. The average weight was 103.76 ± 17.9 Kg. The average BMI was 38.95 ± 5.72 Kg / m2. The average waist circumference was 123.88 ± 13.13 cm and the average fat mass was 45.98 ± 12.22 kg. Twenty percent of our population was diabetic with an average duration of progression of 6.6. ± 4.04 years. The prevalence of dyslipidemia was high in morbidly obese patients with a rate of 18.6% compared to moderate to severe obesity at 6.4%. Arterial hypertension was noted in 33% of our population. The presence of moderate sleep apnea syndrome was noted in 31.3% of cases. Hyperuricemia was found in 8.6% of cases. Rheumatologic complications were marked by gonalgia in 26% of cases and low back pain in 6.8% of our patients.

Conclusions

Screening for complications related to obesity is necessary and essential for the comprehensive care of the obese person. Their treatment must be specific and it should not be limited to weight loss.

Key messages

Obesity. Metabolic complications.

Clinical and body composition predictors of bone turnover and mineral content in obese postmenopausal women

The purpose of this study was to determine the predictors of bone mineral density (BMD), bone mineral content (BMC), and bone turnover markers in obese postmenopausal women. In this cross-sectional study, 81 postmenopausal women aged 58.40 ± 6.08 years were analyzed. Anthropometric parameters were recorded. Serum glucose parameters, serum lipid profiles, adipokines, renal, hepatic parameters, and bone markers concentrations were determined by well-validated laboratory routine methods. BMD, BMC, and body composition were measured by Dual X-ray Absorptiometry. We found a significant correlation of BMD with age, years since menopause, anthropometric parameters, glycemia, alkaline phosphatase, fat mass, and lean mass. Multiple regression analysis demonstrated that years since menopause, waist circumference, alkaline phosphatase, trunk fat, and lean mass were independently associated to BMD. Also, age, years since menopause, anthropometric parameters, total cholesterol, alkaline phosphatase, fat mass, and lean mass were correlated to BMC. However, only waist circumference and trunk fat were independently related to BMC. Bone turnover markers were significantly correlated to the age, glycemia, HbA1c, adipokines, hepatic parameters, and lean mass. Nevertheless, only adipokines, gamma glutamyl transferase (GGT), and alkaline phosphatase were independently associated to bone turnover markers. These observations suggest that number of years since menopause, waist circumference, alkaline phosphatase, trunk fat, and lean mass were the only significant predictors of BMD. However, waist circumference seems to be a stronger predictor than trunk fat for BMC. Moreover, adiponectin, resistin, GGT, and alkaline phosphatase were significant predictors of the bone resorption (CTX-I) and the bone formation (P1NP) markers.

Positive Association of Obesity and Insulin Resistance With Bone Mineral Density in Tunisian Postmenopausal Women

The association of bone mineral density (BMD) with obesity and insulin resistance remains unclear. This study aimed to explore these associations in Tunisian menopausal women. Eighty-one postmenopausal women were recruited. Data were analyzed for obese (N = 57) and non-obese women (N = 24) and for insulin-resistant (N = 43) and non insulin-resistant women (N = 36). Anthropometric and biochemical parameters were recorded. BMD in different sites and body composition were measured using dual-energy X-ray absorptiometry. Higher BMD was observed in obese women than those non-obese in the left femur (p = 0.0067), right femur (p = 0.0108), total hip (p = 0.0077), and the whole body (p = 0.0276). Also BMD was significantly greater in insulin-resistant women than in non-insulin-resistant women when measured in the left femur and total hip. Positive correlations were recorded between BMD and anthropometric parameters, body composition parameters, and glycemia (r = 0.249, p < 0.05). Multiple linear regression analysis shows that only trunk fat (p < 0.05) and lean mass (p < 0.05) were independently and positively related to BMD, and the waist circumference was the only anthropometric parameter independently and negatively associated to BMD. BMD is improved in obese and insulin-resistant women. Also, trunk fat and lean mass are likely to be key positive independent factors for BMD.

[Metabolic profile of Tunisian obese adult]

BACKGROUND

Obesity is associated with multiple comorbidities such us metabolic and cardiovascular diseases.

AIMS

Evaluate metabolic profile and to determinate the frequency of metabolic syndrome in Tunisian obese adult.

METHODS

It's a prospective study realized in the unit of obesity research in the national institute of nutrition between April 2003 and March 2005.This study concerned two groups of subjects aged between 20 and 60 years old : Group 1 (n = 100) obese (BMI (3) 30 kg/m2) and group 2 (n= 60) controls with normal weight (BMI between 18,5 and 24,9 kg/m2).

RESULTS

Mean number of metabolic complications is significantly higher (P < 10-3) in obese (3,28 +/- 2) than in controls (1,16 +/- 1,2). Impaired fasting glucose and type 2 diabetes mellitus are respectively more frequent in obese (37 % and 16 %) than in non obese (5 % et 1,7 %). Hyperinsulinemia is significantly (P<10-3) more frequent in obese. hypertriglyceridemia, hypercholesterolemia and hyperapolipoproteinaemia B are significantly (P = 0,01, P < 10-3 et P < 10-3) more frequent in obese than in no overweight subjects. The prevalence of hyperuricemia increased significantly (P = 0,01) in overweight subjects than in normal weight subjects. Metabolic syndrome is significantly more frequent (P < 10-3) in obese (48 %) than in control (1,7 %).

CONCLUSION

Obesity, especially visceral obesity , is associated with a cluster of metabolic complications increasing the risk of coronary heart disease. We stress on the importance of primary prevention and early management of obesity.