Whole-exome sequencing reveals novel variants of monogenic diabetes in Tunisia: impact on diagnosis and healthcare management

Introduction: Monogenic diabetes (MD) accounts for 3%-6% of all cases of diabetes. This prevalence is underestimated due to its overlapping clinical features with type 1 and type 2 diabetes. Hence, genetic testing is the most appropriate tool for obtaining an accurate diagnosis. In Tunisia, few cohorts of MD have been investigated until now. The aim of this study is to search for pathogenic variants among 11 patients suspected of having MD in Tunisia using whole-exome sequencing (WES). Materials and methods: WES was performed in 11 diabetic patients recruited from a collaborating medical center. The pathogenicity of genetic variation was assessed using combined filtering and bioinformatics prediction tools. The online ORVAL tool was used to predict the likelihood of combinations of pathogenic variations. Then, Sanger sequencing was carried out to confirm likely pathogenic predicted variants among patients and to check for familial segregation. Finally, for some variants, we performed structural modeling to study their impact on protein function. Results: We identified novel variants related to MD in Tunisia. Pathogenic variants are located in several MODY and non-MODY genes. We highlighted the presence of syndromic forms of diabetes, including the Bardet-Biedl syndrome, Alström syndrome, and severe insulin resistance, as well as the presence of isolated diabetes with significantly reduced penetrance for Wolfram syndrome-related features. Idiopathic type 1 diabetes was also identified in one patient. Conclusion: In this study, we emphasized the importance of genetic screening for MD in patients with a familial history of diabetes, mainly among admixed and under-represented populations living in low- and middle-income countries. An accurate diagnosis with molecular investigation of MD may improve the therapeutic choice for better management of patients and their families. Additional research and rigorous investigations are required to better understand the physiopathological mechanisms of MD and implement efficient therapies that take into account genomic context and other related factors.

Prevalence and risk factors of diabetes mellitus and hypertension in North East Tunisia calling for efficient and effective actions

Diabetes and hypertension are a serious public health problem worldwide. In the last decades, prevalence of these two metabolic diseases has dramatically increased in the Middle East and North Africa region, especially in Tunisia. This study aimed to determine the prevalence of type 2 diabetes (T2D) and High Blood Pressure (HBP) in Zaghouan, a North-East region of Tunisia. To this end, an exploratory study with stratified random sampling of 420 participants has been carried out. Various data were collected. Blood samples and urine were drawn for biochemical assay. Then, all data were analyzed using the statistical R software. Results showed an alarming situation with an inter-regional difference in prevalence of obesity (50.0%, CI 95.0%), HBP (39.0%, CI 95.0%) and T2D (32.0%, CI 95.0%). This study allowed the discovery of 24, 17 and 2 new cases of T2D, HBP and T2D&HBP respectively. The association of some socio-economic factors and biochemical parameters with these chronic diseases has been highlighted. To conclude, the health situation in the governorate of Zaghouan requires urgent interventions to better manage the growing epidemic of non-communicable diseases (NCD) in the region. This study demonstrated the importance of engaging health policy makers in road mapping and implementing national NCD prevention programs.

Vitamin Status of Obese Tunisian adults before and after Sleeve Gastrectomy

INTRODUCTION

The worldwide obesity epidemic continues unabated. Obesity and its associated health risks are considered as the major causes of morbidity and mortality. Currently, bariatric surgery is the most effective treatment for people with severe obesity resulting in sustainable weight loss and a reduced risk for co-morbidities. Sleeve gastrectomy is the most common bariatric procedure undertaken in Tunisia.

AIM

we aim to evaluate the vitamin status of the obese patients before and after sleeve gastrectomy.

METHODS

Thirty obese patients undergoing sleeve gastrectomy, were recruited from Obesity unit. In this study. A biological assessment was performed pre-operatively and controlled 6 months following the sleeve gastrectomy including: calcemia, parathyroid hormone (PTH), albuminemia and dosage of vitamin D, vitamin B9 and vitamin B12.

RESULTS

Six months post sleeve gastrectomy, vitamin deficiencies were more prevalent: the mean level of vitamin B9, vitamin B12 and vitamin D respectively, has decreased from 5.03±3.28 ng / ml to 2.71±1.52 ng / ml, from 348.06±158.92 pg/ml to 264.62±119.77 pg/ml and from 17.18±11.45 ng/ml to 11.69±8.22 ng/ml, with a statistically significant difference (p=0.008, p=0.01 and p=0.012). Sleeve gastrectomy has proven to be an effective weight loss treatment. However, nutritional deficiencies have worsened during postoperative period.

CONCLUSION

This study highlights the importance of early identification, appropriate treatment and prophylactic micronutrient supplementation.

A clinical trial about effects of prebiotic and probiotic supplementation on weight loss, psychological profile and metabolic parameters in obese subjects

INTRODUCTION

The management of obesity is difficult with many failures of lifestyle measures, hence the need to broaden the range of treatments prescribed. The aim of our work was to study the influence of pre and probiotics on weight loss psychological profile and metabolic parameters in obese patients.

METHODS

It is a clinical trial involving 45 obese patients, recruited from the Obesity Unit of the National Institute of Nutrition between March and August 2022 divided into three groups: diet only (low-carbohydrate and reduced energy diet), prebiotics (30 g of carob/day) and probiotics (one tablet containing Bifidobacterium longum, Lactobacillus helveticus, Lactococcus lactis, Streptococcus thermophilus/day). The three groups were matched for age, sex and BMI. Patients were seen after 1 month from the intervention. Anthropometric measures, biological parameters, dietary survey and psychological scores were performed.

RESULTS

The average age of our population was 48.73 ± 7.7 years, with a female predominance. All three groups showed a significant decrease in weight, BMI and waist circumference with p < .05. Only the prebiotic and probiotic group showed a significant decrease in fat mass (p = .001) and a significant increase in muscle strength with p = .008 and .004, but the differences were not significant between the three groups. Our results showed also a significant decrease in insulinemia and HOMA-IR in the prebiotic group compared to the diet-alone group (p = .03; p = .012) and the probiotic group showed a significant decrease in fasting blood glucose compared to the diet alone group (p = .02). A significant improvement in sleep quality was noted in the prebiotic group (p = .02), with a significant decrease in depression, anxiety and stress in all three groups.

CONCLUSIONS

The prescription of prebiotics and probiotics with the lifestyle measures seems interesting for the management of obesity especially if it is sarcopenic, in addition to the improvement of metabolic parameters and obesity-related psychiatric disorders.

The Role of Dietary Intake in Type 2 Diabetes Mellitus: Importance of Macro and Micronutrients in Glucose Homeostasis

The prevalence of Type 2 diabetes (T2D) is increasing worldwide. Genetics and lifestyle, especially diet, are contributing factors. Analyses of macro- and micronutrient intake across global populations may help to explain their impact on glucose homeostasis and disease development. To this end, 420 Tunisians were enrolled in a prospective cross-sectional study of daily food consumption. Various data were collected and blood samples were drawn for biochemical assay. A 24-h recall questionnaire was obtained from participants to evaluate dietary intake. Statistical analyses were conducted using Nutrilog and R software. Biochemical analyses stratified the studied population (n = 371) into three groups: diabetics (n = 106), prediabetics (n = 192) and controls (n = 73); 49 subjects were excluded. Our results showed that Tunisians had hypercaloric diets high in carbohydrates and fat with variability in the levels of some vitamins and minerals, including riboflavin and niacin, that were statistically different among groups. The lower intake of vitamin D was associated with a greater risk of T2D. Higher vitamin A and sodium intake were associated with poor glucose homeostasis, although protein intake may improve it. In perspective, nutrigenomic studies can provide insight into problematic diets and poor eating habits and offer opportunities to analyze the effects of behavioral changes that can mitigate T2D development and progression.

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.

Multiallelic Rare Variants in BBS Genes Support an Oligogenic Ciliopathy in a Non-obese Juvenile-Onset Syndromic Diabetic Patient: A Case Report

Juvenile-onset diabetes may occur in the context of a rare syndromic presentation, suggesting a monogenic etiology rather than a common multifactorial diabetes. In the present study, we report the case of a young diabetic Tunisian patient presenting learning problems, speech deficits, short stature, brachydactyly, and a normal weight. Whole exome sequencing analysis revealed five heterozygous genetic variants in BBS1, BBS4, BBS8, MKS1, and CEP290. These genes are involved in the regulation of cilium biogenesis and function. We analyzed variant combinations pathogenicity using the recently developed ORVAL tool, and we hypothesized that cumulative synergetic effects of these variants could explain the syndromic phenotype observed in our patient. Therefore, our investigation suggested a genetic diagnosis of Bardet-Biedl syndrome with an oligogenic inheritance pattern rather than a monogenic diabetes. Although there is no curative therapy for this ciliopathy at the moment, a genetic diagnosis may offer other supportive care options, including the prevention of other possible clinical manifestations of this syndrome, mainly renal abnormalities, obesity, liver fibrosis, and hypertension, as well as the genetic counseling for family members.

Assessment of the Nutritional Status of Hospitalized Type 2 Diabetic Patients

Objectives

The aim of our work was to assess the nutritional status and to determine the prevalence of undernutrition in type 2 diabetic patients hospitalized in a center specializing in Nutrition, Diabetology and Metabolic Diseases.

Methods

This is a descriptive cross-sectional prospective study, which involved 40 type 2 diabetic patients, aged 18 and over, hospitalized in department A of the National Institute of Nutrition and Food Technology. The assessment of nutritional status was carried out using clinical means (kinetics of weight loss, a dietary survey, anthropometric measurements, impedancemetry, Nutritional Risk Score 2002 for those under 70 years old and the Mini Nutritional Assessment from 70 years old) and biological (albuminemia). The positive diagnosis of malnutrition was selected according to the criteria of the High Authority of Health of 2019 for adults under 70 years, and of 2007 for elderly subjects.

Results

The mean age was 59.6 ± 11.59 years old. The average duration of diabetes was 10.83 ± 8.03 years. The mean level of glycated hemoglobin was 11.03 ± 1.97% and the Body Mass Index was 28.88 kg/m² with extremes ranging from 14.6 to 40.9 kg/m². Weight loss was noted in 48% of patients. Calorie intake was low in 30% of the patients. Protein and mono-unsaturated fatty acid low intake was noted in respectively 28% and 70% of patients. More than half of patients had deficiency in vitamin C, D, B12 and B9 as well as in zinc, calcium, magnesium and cooper. Iron and vitamin B12 low intake was more prevalent in patients with malnutrition (p = 0.043 and p = 0.003 respectively). The mean serum albumin was 37.58 ± 2.93 g/l with ranges ranging from 27.2 to 43.8 g/l. Malnutrition was diagnosed in 25% of patients and in half of the cases, it was severe.

Conclusions

Patients with type 2 diabetes mellitus are at high risk of malnutrition with a high prevalence of dietary intakes deficiencies.

Funding Sources

1. HAS. Diagnostic de la dénutrition de l'enfant et l'adulte. Service de bonnes pratiques professionnelles, 2019. 2. HAS. Stratégie de prise en charge en cas de dénutrition protéino-énergétique chez la personne âgée. Service des recommandations professionnelles. Avril 2007. 3. Anses. Actualisation des repères du PNNS: élaboration des références nutritionnelles. Saisie n° 2012-SA-0186. Avis de l'Anses. Rapport d'expertise collective. Décembre 2016.

Impact of sleeve gastrectomy on abnormalities in carbohydrate tolerance in obese adult

INTRODUCTION

Facing the repeated failures of the medical management of obesity, bariatric surgery offers a promising therapeutic option in terms of achieving weight loss and metabolic benefits.

AIM

To evaluate the impact of sleeve gastrectomy on the carbohydrate profile of a group of obese subjects.

METHODS

It is a prospective study including 40 obese patients (7 Men and 33 Women) who underwent sleeve gastrectomy between 2016 and 2018. Clinical and biological parameters were collected before the intervention, at six months and one year after. Insulin resistance was defined by a HOMA-IR index ≥2.4. Remission of diabetes was determined using the American Society for Metabolic and Bariatric Surgery's (ASMBS) criteria.

RESULTS

The mean patients' age was 34.65 ± 8.17 years. The mean body mass index (BMI) was 50.23 ± 8.3 kg/m². One year after sleeve gastrectomy, the frequency of insulin resistance, decreased from 89% to 4% (p<0.05). The evolution of carbohydrate tolerance abnormalities was marked by the diabetes and prediabetes remission in 75% and 100% of cases, respectively. The mean excess weight loss was 55.8% at 12 months.

CONCLUSION

These results have expanded our knowledge of the short-term sleeve gastrectomy's effectiveness on the carbohydrate profile of obese subjects. However, it would be interesting to check the durability of this metabolic benefit in the medium and long term.

Impact of nutrients and Mediterranean diet on the occurrence of gestational diabetes

Background: The Mediterranean diet (MedDiet) is a dietary pattern effective in terms of prevention of many diseases such as gestational diabetes mellitus (GDM). Recently, many studies have paid attention to nutritional factors during pregnancy as a modifiable contributor to GDM risk.

Objective: to investigate associations of nutrients intakes and MedDiet pattern of eating with risk of GDM.

Subjects/Methods: This study conducted on N = 120; Pregnant women with GDM (n = 60) and without controls (n = 60). The dietary habits were assessed by a dietary history method and a validated food frequency questionnaire. We calculated a MedDiet score which measures the degree of adherence to a Med Diet.

Result: A low Med Diet score was found in pregnant women with and without gestational diabetes in 46.7% and 38.8% of cases, respectively, with no significant difference. Our data showed that the higher the adherence score to the MedDiet, the lower the fasting blood glucose level and the plasma glucose 2 h post load. These findings concerned the two groups studied (P < 10⁻³). We also noted that controls had a significantly higher intake of legumes, vegetables and fish. Monounsaturated fatty acids and saturated fatty acids consumption was significantly higher in the control group (2.3 ± 0.8 vs 1.7 ± 0.7, P < 10⁻³). GDM subjects consumed significantly more dairy products and cereals (P < 10⁻³). After adjustment for confounders, no nutrient was associated with the risk of developing gestational diabetes except vitamin D intake (OR 0.29 [0.15−0.54], P < 10⁻³) which had a protective effect.

Conclusion: Our study underlines the importance of adequate vitamin D intake during pregnancy and suggests that the MedDiet may reduce the incidence of gestational diabetes.

[Nutritional status of elderly hemodialysis people in Tunisia]

INTRODUCTION

The nutritional status of old hemodialysis patients determines their prognosis. The aim of this study was to evaluate the spontaneous dietary intake of hemodialysis of elderly patients.

METHODS

This cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle hospital in Tunis. All patients went through a clinical examination to specify anthropometric measurements and a dietary survey based on food registration for 3 consecutive days to obtain a nutritional assessment.

RESULTS

The evaluation of patients' energy intake showed an average daily intake of 25.3±12.3kcal/kg of ideal weight/day. The average total energy intake of patients on dialysis and non-dialysis days was 29.7±17.7kcal/kg and 20.9±6.9kcal/kg, respectively, with a statistically significant difference (P=0.001). The average daily protein intake was 0.99±0.57g/kg on the day of no dialysis. It decreased statistically significantly (P=0.005) on the day of no dialysis at 0.73±0.28g/kg. Phosphorus consumption was excessive on dialysis and non-dialysis days respectively in 20% and 3% of cases. Deficiency of calcium intake affected the entire population studied on the day of non-dialysis. Only 6% of patients had a calcium intake satisfactory on the day of dialysis.

CONCLUSION

A lot of dietary errors were noticed in our study. The assessment of nutritional intake in elderly people with hemodialysis should be part of their management systematically.

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.

Relationship between level of education and podiatry risk in diabetic patients

CONTEXT

Diabetic foot trophic disorders and their complications leading to the risk of amputation remain a major public health problem.

OBJECTIVE

To determine the level of podiatric risk in our diabetic patients according to the classification of the International Working Group of the Diabetic Foot (IWGDF) and study the relationship between the level of education and the level of podiatry risk..

METHODS

This is a descriptive and analytical cross-sectional study including all diabetics hospitalized at the National Institute of Nutrition in Tunis for chronic diabetes imbalance, carried out over a period of two months (July - August 2019).

RESULTS

The mean age of the patients was 55.08 ± 14.22 years. The sex ratio was 0.67. The majority of our patients were type 2 diabetics (90.24%). During the clinical examination of the foot, plantar hyperkeratosis was the most noted manifestation (65.85%). Based on the IWGDF classification, 42.68% of patients had a grade 0 podiatric risk. Regarding the overall educational level, we noted 76.83% patients with a poor educational level and 23.17% patients with a satisfactory level of education. The overall educational level is significantly associated with the podiatric grade (p <0.05).

CONCLUSIONS

Therapeutic education or even podiatric education of the patient is important in the prevention of complications of the foot. Patient-centered training in foot care practice in public health facilities would reduce the rate of morbidity and mortality from complicated diabetic foot.

The objective clinical evaluation in multiple stations in nutrition : Docrimological analysis

CONTEXT

As part of its pedagogical reform, the Faculty of Medicine of Tunis integrated since 1998 the objective clinical evaluation in multiple stations (ECOSM), as sanctioning evaluation at the end of the internships. However, this method has never been evaluated in nutrition.

OBJECTIVE

Carry out a docimological analysis of the ECOSM in nutrition intended for students of the 2nd year of the Second Cycle of Medical Studies (DCEM 2).

METHODS

This was a transversal descriptive prospective study on the ECOSM for sanctioning purposes, students of DCEM 2 having carried out an internship at the National Institute of Nutrition in Tunis during the academic year 2017- 2018.

RESULTS

The general average of the ECOSM for the population studied was 13.92 ± 1.45 out of 20. Half of the stations were of acceptable difficulty. More than a third of the questions (37%) had good or excellent discrimination. For all the stations combined, the average Cronbach's alpha coefficient was 0.62, indicating an unacceptable internal homogeneity with great heterogeneity. Likewise, the Cronbach's alpha coefficients calculated for all stations and all questions were strictly less than 0.7. The flattening coefficient was negative, equal to -0.946, and the distribution curve was platykurtic.

CONCLUSIONS

At the end of this work, we recommend making students and teachers particularly aware of the importance of evaluating the various objectives during the internship before the ECOSM test in order to fill in the gaps and ensure that the internship objectives are met.

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.

Impacts of nutritional education before Ramadan fasting on dietary intake, weight and body composition in diabetic patients

BACKGROUND

The fasting period of Ramadan requires special attention for diabetic patients in particular.

AIM

To determine the impacts of a nutritional education program before Ramadan fasting (RF) on dietary intake, anthropometry and body composition.

METHODS

This was an interventional and comparative study including 54 type 2 diabetic patients, recruited at the National Institute of Nutrition. The patients were divided into two groups: an educated group who received a nutritional education session before Ramadan (n=26), and an uneducated group who did not receive any education (n=28). Food survey, anthropometry and body composition measurements were conducted before and after the month of Ramadan.

RESULTS

During RF, a significantly decrease in carbohydrate intake was observed in both educated and uneducated patients (∆=-4.1 vs. ∆=-6.25). Lipid intake was increased significantly during RF for all patients. This increase was lower in patients receiving education compared to the other group (3.4±7.43 vs. 5.25±5.7). During RF, a significant increase in protein, saturated and monounsaturated fatty acids intake was shown in the uneducated group compared to educated group (respectively, ∆=1.19±2.30 vs. ∆ =1.06±7.10, ∆=3.40±7.43 vs. ∆=5.25±5.70 and ∆=2.23±5.60 vs. ∆=2.31±5.10). The weight loss was similar between the two groups of educated (-1.05 kg) and uneducated (-0.58 kg) patients. There was no significant change in body composition during Ramadan in both groups of diabetics.

CONCLUSIONS

Nutritional education programs positively impact diabetic patients who prefer RF or insist to fast during Ramadan. These programs must be provided to diabetics before Ramadan.

Prevalence of malnutrition for elderly hemodialysis patients

INTRODUCTION

The prevalence of the terminal chronic renal failure treated by hemodialysis is rising steadily especially for the elderly. Its evolution is fraught with complications including protein-energy malnutrition. The aim of this study was to evaluate the predominance of protein-energy malnutrition among elderly hemodialysis patients.

METHODS

This cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle Hospital in Tunis. All patients went through a clinical examination, a biological assessment, a dietary survey based on food registration for 3 consecutive days and the calculation of nutritional risk scores (MNA and GNRI).

RESULTS

The Average  of hemodialysis was of 7 ± 3.8 years. The average energy intake of the patients was 25.3 ± 12.3 kcal / kg of ideal weight per day. The weight evolution during the last 6 months preceding the study was marked by a weight loss exceeding the 10 % in 12 % of the cases. A BMI less than 21 kg / m² was noted in 73.7 % of the women and 47.6 % of the men. The brachial circumference was less than 22 cm in 36.8 % of the women and 23.6 % of the men. One-third (32.5 %) of the study population had a calf circumference that is less than 31 cm. Most patients (67.5 %) had hypoalbuminaemia. The predominance of malnutrition according to the 2007 HAS criteria was 71% among hemodialysis patients. The majority of women (78.9 %) and 57.1 % of men had GNRI less than or equal to 98.

CONCLUSION

Protein-energy malnutrition is a common and serious pathological situation in elderly hemodialysis patients which can be life-threatening.

Physical Activity Level Assessed by Accelerometer and PAQ-C in Tunisian Children

BACKGROUND

Physical activity (PA) is an important agent in the prevention of chronic diseases such as obesity.

OBJECTIVES

To provide preliminary data on PA among school children and to correlate the PA with weight status.

MATERIAL AND METHODS

A total of 40 children aged between 8 and 11 years and attending Tunisian schools were recruited. The body composition was determined by using the deuterium oxide dilution technique. PA was determined by the PAQ-C (PA Questionnaire for Older Children). An objective monitoring of PA and sedentary time was achieved by using ActiGraph GT3X + accelerometers.

RESULTS

PAQ-C data demonstrate that 20% of the sample had light PA levels and 80% had moderate PA levels. Times spent in sedentary (62.37%) and light (30.80%) activities were higher than that spent in moderate and vigorous (6.83%) activities. Furthermore, almost half of the sample spent more than 60 min per day in moderate-to-vigorous intensity PA (MVPA). The average MVPA was significantly higher in normal weight than overweight and obese groups (67.68 ± 20.98 vs. 49.07 ± 19.09, p = 0.007). The proportion of overweight children who spent more than 60 min per day in MVPA was significantly higher than that of normal-weight (60.9 vs. 29.4%; p = 0.049).

CONCLUSION

This study indicates that half of school children comply with the health-based guidelines for PA and sedentary behavior. Our findings also suggest that obesity was associated with decrease in PA in Tunisian children.

Anthropometric profile of children and adolescents from diabetic pregnancies

BACKGROUND

Exposure in utero to maternal diabetes is a risk factor for obesity and type 2 diabetes. It may contribute to the current epidemic outbreak of these diseases.

AIM

to evaluate the impact of the exposure to maternal diabetes on the anthropometric profile of the offspring.

METHODS

This cross-sectional study was conducted in the department "A" of the National Institute of Nutrition. It involved 120 children and adolescents who were from 5 to 19 years old and recruited between October 2008 and November 2009. They were divided into two groups : • A first group of 80 children from diabetic mothers ; • A second control group of 40 children from non-diabetic pregnancies. They have had a clinical examination. Data about diabetic pregnancies were collected from the mothers'medical records.

RESULTS

body mass index and waist circumference of children from both groups were comparable. In both groups, two thirds of children had a normal weight (62.5 % in the first group versus 65% in the control group). Obesity is more common in children exposed to maternal hyperglycemia (31.3% versus 25% in the control group), but the difference is not statistically significant. The majority of obese children (88%) are those from diabetic mothers with type 2 or gestational diabetes.

CONCLUSION

our results underline the need for early screening for gestational diabetes and an optimal management of diabetic pregnancy to reduce the metabolic risk in the offspring.