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Goëau-Brissonnière M, Rives-Lange C, Phan A, Kourti E, Rassy N, Lu E, Barsamian C, Czernichow S, Carette C. Real-life use of liraglutide 3 mg in obesity management: The SAX-RL study. Diabetes Obes Metab 2024; 26:5488-5491. [PMID: 39169527 DOI: 10.1111/dom.15845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 08/23/2024]
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Czernichow S, Ziegler O, Clément K, Coupaye M, Laville M. Assessing worldwide trends of underweight and obesity. Lancet 2024; 404:1642-1643. [PMID: 39461787 DOI: 10.1016/s0140-6736(24)02097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 09/19/2024] [Indexed: 10/29/2024]
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Pers YM, Nguyen C, Borie C, Daste C, Kirren Q, Lopez C, Ouvrard G, Ruscher R, Argenson JN, Bardoux S, Baumann L, Berenbaum F, Binard A, Coudeyre E, Czernichow S, Dupeyron A, Fabre MC, Foulquier N, Gérard C, Hausberg V, Henrotin Y, Jeandel C, Lesage FX, Liesse B, Mainard D, Michel F, Ninot G, Ornetti P, Oude-Engberink A, Rat AC, Richette P, Roren A, Thoumie P, Walrand S, Rannou F, Sellam J. Recommendations from the French Societies of Rheumatology and Physical Medicine and Rehabilitation on the non-pharmacological management of knee osteoarthritis. Ann Phys Rehabil Med 2024; 67:101883. [PMID: 39490291 DOI: 10.1016/j.rehab.2024.101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 07/23/2024] [Accepted: 08/05/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Although non-pharmacological therapies for knee osteoarthritis (OA) are essential pillars of care, they are often poorly considered and inconsistently applied. OBJECTIVES Under the umbrella of the French Society of Rheumatology (SFR) and the French Society of Physical Medicine and Rehabilitation (SOFMER), we aimed to establish consensual recommendations for the non-pharmacological management of people with knee OA. METHODS A group of fellows performed a systematic literature review on the efficacy and safety of non-pharmacological modalities (up to October 2021). The fellows then took part in discussions with a multidisciplinary group of experts to draft a list of recommendations. The list was then submitted to an independent reading committee who rated their level of agreement with each recommendation. Each recommendation was assigned a strength of recommendation and a level of evidence. RESULTS Five general principles were unanimously accepted: (A) the need to combine non-pharmacological and pharmacological measures; (B) the need for personalized management; (C) the need to promote adherence; (D) the need for adapted physical activity; and (E) the need for person-centered education. Specific positive or negative recommendations were defined for 11 modalities: (1) unloading knee brace; (2) kinesiotaping or knee sleeves; (3) shoes and/or insoles; (4) using a cane; (5) physical exercise program; (6) joint mobilization; (7) electro- or thermo-therapy; (8) acupuncture; (9) weight loss; (10) thermal spa therapy; and (11) workplace accommodation. CONCLUSIONS These SFR/SOFMER recommendations provide important and consensual knowledge to assist health professionals in decision-making for non-pharmacological treatments for knee OA.
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Renard D, Tuffet S, Dieudé P, Claudepierre P, Gossec L, Fautrel B, Molto A, Miceli-Richard C, Richette P, Maheu E, Carette C, Czernichow S, Jamakorzyan C, Rousseau A, Berenbaum F, Beauvais C, Sellam J. Factors associated with dietary practices and beliefs on food of patients with rheumatic and musculoskeletal diseases: A multicentre cross-sectional study. Joint Bone Spine 2024; 92:105778. [PMID: 39303938 DOI: 10.1016/j.jbspin.2024.105778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 07/28/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES To investigate dietary practices and beliefs of patients with rheumatic and musculoskeletal diseases (RMDs) and associated factors. METHODS In 2019-2020, a cross-sectional multicentre study enrolled patients with inflammatory arthritis (IA) (rheumatoid arthritis [RA], axial spondyloarthritis [axSpA]) or hand osteoarthritis (HOA) from secondary- and tertiary-care centres. A self-administered questionnaire explored dietary practices and patients' perceived effects of diet, foods and beverages on symptoms. Univariable and multivariable analyses investigated factors associated with diets and patients' views. RESULTS Of 448 included patients, data for 392 were analysed (123 with RA, 161 with axSpA, 108 with HOA), 26% were on or had been on at least one exclusion diet (mostly cow's milk- and gluten-free diets in IA, mostly cow's milk-free diet and detox/fasting in HOA). Only 5% of patients followed the Mediterranean diet. Among patients who had tried a diet, 51% reported a decrease in pain. Overall, 42% of patients identified at least one food or beverage that increased or decreased pain. On multivariable analyses, dieting or the perceived effect of food on pain was associated with health beliefs (positive or negative), the use of complementary and alternative medicines, and lack of support or information from healthcare professionals. Patients had received little dietary information from their physicians. CONCLUSIONS This study provides insights into patients' dietary practices and factors associated with these practices, including patients' health beliefs and insufficient support by health professionals, in RMDs.
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Castera L, Garteiser P, Laouenan C, Vidal-Trécan T, Vallet-Pichard A, Manchon P, Paradis V, Czernichow S, Roulot D, Larger E, Pol S, Bedossa P, Correas JM, Valla D, Gautier JF, Van Beers BE. Prospective head-to-head comparison of non-invasive scores for diagnosis of fibrotic MASH in patients with type 2 diabetes. J Hepatol 2024; 81:195-206. [PMID: 38548067 DOI: 10.1016/j.jhep.2024.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND & AIMS Non-invasive scores have been proposed to identify patients with fibrotic, metabolic dysfunction-associated steatohepatitis (MASH), who are at the highest risk of progression to complications of cirrhosis and may benefit from pharmacologic treatments. However, data in patients with type 2 diabetes (T2DM) are lacking. The aim of this multicenter prospective study was to perform a head-to-head comparison of FAST (FibroScan-aspartate aminotransferase [AST]), MAST (MRI-AST), MEFIB (magnetic resonance elastography [MRE] plus FIB-4), and FNI (fibrotic NASH index) for detecting fibrotic MASH in patients with T2DM. METHODS A total of 330 outpatients with T2DM and biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD) from the QUID-NASH study (NCT03634098), who underwent FibroScan, MRI-proton density fat fraction and MRE at the time of liver biopsy were studied. The main outcome was fibrotic MASH, defined as NAS ≥4 (with at least one point for each parameter) and fibrosis stage ≥2 (centrally reviewed). RESULTS All data for score comparisons were available for 245 patients (median age 59 years, 65% male, median BMI 31 kg/m2; fibrotic MASH in 39%). FAST and MAST had similar accuracy (AUROCs 0.81 vs. 0.79, p = 0.41) but outperformed FNI (0.74; p = 0.01) and MEFIB (0.68; p <0.0001). When using original cut-offs, MAST outperformed FAST, MEFIB and FNI when comparing the percentage of correctly classified patients, in whom liver biopsy would be avoided (69% vs. 48%, 46%, 39%, respectively; p <0.001). When using cut-offs specific to our population, FAST outperformed FNI and MAST (56% vs. 40%, and 38%, respectively; p <0.001). CONCLUSION Our findings show that FAST, MAST, MEFIB and FNI are accurate non-invasive tools to identify patients with T2DM and fibrotic MASH in secondary/tertiary diabetes clinics. Cut-offs adapted to the T2DM population should be considered. IMPACT AND IMPLICATIONS Among patients with type 2 diabetes (T2DM), identifying those with metabolic dysfunction-associated steatohepatitis and significant fibrosis, who are the most at risk of developing clinical liver-related outcomes and who may benefit from pharmacologic treatments, is an unmet need. In this prospective multicenter study, we compared four non-invasive scores, three based on imaging (MRI or ultrasound technologies) and one on laboratory blood tests, for this purpose, using original and study-specific cut-offs. Our findings show that FAST, MAST, MEFIB and FNI are accurate non-invasive tools to identify patients with T2DM and fibrotic MASH in secondary/tertiary diabetes clinics. Cut-offs adapted to the T2DM population should be considered. TRIAL REGISTRATION NUMBER NCT03634098.
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Carette C, Okamba-Belle D, Hirlemann M, Wack M, Domenge O, Jannot AS, Czernichow S, Rives-Lange C, Fayol A, Hulot JS. Systematic Brain Natriuretic Peptide Measurement for Cardiac Screening in Patients with Severe Obesity: The OLECOEUR Study. Obes Facts 2024; 17:296-302. [PMID: 38583425 PMCID: PMC11149975 DOI: 10.1159/000538766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 04/05/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION Heart failure (HF) is difficult to diagnose in obese patients because of cardiovascular and pulmonary comorbidities associated with physical deconditioning, all of which lead to dyspnea. METHODS The OLECOEUR study is a prospective screening for HF using systematic brain natriuretic peptide (BNP) measurement in ambulatory patients with obesity from a department of Nutrition (Paris, France). Clinical, biological, and echocardiographic data were extracted from electronic medical records. RESULTS We included 1,506 patients middle-aged (mean age: 47.2 ± 14.6 years old) with severe obesity (mean body mass index: 40.4 ± 6.6 kg/m2). Patients with BNP ≥35 pg/mL had left heart remodeling including thicker interventricular septum (10.4 ± 2.0 vs. 9.6 ± 1.8 mm; p = 0.0008), higher left ventricular mass (89.9 ± 24.3 vs. 77.2 ± 20.0 g/m2; p = 0.0009), and significant changes in both left and right atria consistent with a higher proportion of prior atrial fibrillation. Markers of right heart remodeling on echocardiography were also significantly higher (pulmonary artery systolic pressure: 33.3 ± 17.3 vs. 24.5 ± 6.3 mm Hg; p = 0.0002). CONCLUSION The OLECOEUR study shows left and right subclinical cardiac remodeling in obese patients screened for HF with systematic dosing of BNP with usual cut-off of 35 pg/mL.
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Gatta-Cherifi B, Mohammedi K, Cariou T, Poitou C, Touraine P, Raverot G, Brue T, Chanson P, Illouz F, Grunenwald S, Chabre O, Sonnet E, Cuny T, Bertherat J, Czernichow S, Frison E, Tabarin A. Impact of exenatide on weight loss and eating behavior in adults with craniopharyngioma-related obesity: the CRANIOEXE randomized placebo-controlled trial. Eur J Endocrinol 2024; 190:257-265. [PMID: 38450721 DOI: 10.1093/ejendo/lvae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
IMPORTANCE A major issue in the management of craniopharyngioma-related obesity (CRO) is the ineffectiveness of the current therapeutic approaches. OBJECTIVE To study the efficacy of glucagon-like peptide-1 analogs compared with placebo in adults with obesity CRO. DESIGN A double-blind multicenter superiority randomized clinical in trial in two parallel arms. SETTING Eleven French University Hospital Centers. PARTICIPANTS Adults with CRO (body mass index > 30 kg/m²) without the sign of recurrence of craniopharyngioma in the past year. INTERVENTIONS Exenatide or placebo injected subcutaneously twice a day during 26 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the mean change in body weight at week 26 in the intention-to-treat population. Secondary outcomes were eating behavior, calories intake, energy expenditure, cardiovascular, metabolic risk factor, quality of life, and the tolerance profile. RESULTS At week 26, weight decreased from baseline by a mean of -3.8 (SD 4.3) kg for exenatide and -1.6 (3.8) kg for placebo. The adjusted mean treatment difference was -3.1 kg (95% confidence interval [CI] -7.0 to 0.7, P = 0.11). Results were compatible with a higher reduction of hunger score with exenatide compared with placebo (estimated treatment difference in change from baseline to week 26: -2.3, 95% CI -4.5 to -0.2), while all other outcomes did not significantly differ between groups. Adverse events were more common with exenatide versus placebo, and occurred in, respectively, 19 (95%) participants (108 events) and 14 (70%) participants (54 events). CONCLUSIONS AND RELEVANCE Combined with intensive lifestyle interventions, a 26-week treatment with exenatide was not demonstrated superior to placebo to treat craniopharyngioma-related obesity.
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Fabron C, Laville M, Aron-Wisnewsky J, Disse E, Gatta-Cherifi B, Jacobi D, Montastier E, Oppert JM, Gaillard L, Detournay B, Czernichow S. Out-of-Pocket Expenses in Households of People Living with Obesity in France. Obes Facts 2023; 16:606-613. [PMID: 37879296 PMCID: PMC10870127 DOI: 10.1159/000533342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/28/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND/OBJECTIVES Overweight and obesity result in a substantial economic burden in both low- and high-income countries. Moreover, this burden is often underestimated because it only partially accounts for unreimbursed out-of-pocket expenses (OOPE) related to obesity. The objective of our study was not only to evaluate OOPE incurred by people with obesity in relation to their disease with respect to direct medical expenditures and direct non-medical expenditures but also the proportion of people living with obesity who have forgone obesity-related healthcare due to the costs of such care. METHODS An observational descriptive survey was conducted among people with class II/III obesity attending six obesity treatment centers in France. Volunteer adult participants completed a written/phone questionnaire on their related expenditures over the last 6 months for current expenditures and over the last 5 years for occasional ones. The costs were expressed in 2022 EUR. RESULTS 299 people participated (age: 46 years [SD: 13.9], women: 72%, BMI ≥40 kg/m2: 62% and 48% with comorbidities). 65% had a professional activity. 83% declared that they had OOPE related to obesity representing annually EUR 2027/individual on average (5% of the household revenue), including weight loss and nutritional products, vitamins, meal programs, gym memberships, psychologists, but mainly adapted clothing, additional travel costs, and others. 15% of the respondents had to modify their professional activity due to obesity and 15% forwent some medical care in the last 12 months. CONCLUSIONS OOPE is a significant part of the economic burden of obesity. Despite some limitations due to the specificities of the participants and because some costs may be more related to social activities affected by obesity than to healthcare, it seems important to consider these expenditures in cost estimates for obesity.
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Rives-Lange C, Czernichow S, Jannot AS. Is Maternal Metabolic Bariatric Surgery the Best Solution to Tackle the Childhood Obesity Pandemic?-Reply. JAMA Surg 2023; 158:892. [PMID: 37099316 DOI: 10.1001/jamasurg.2023.0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Branche O, Buscail C, Péneau S, Baudry J, Poitou C, Oppert JM, Czernichow S, Kesse-Guyot E, Touvier M, Julia C, Bellicha A. Correlates of Weight Bias in Adults From the NutriNet-Santé Study. Am J Prev Med 2023; 65:201-212. [PMID: 37479421 DOI: 10.1016/j.amepre.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Explicit weight bias is an underlying cause of weight stigma, but its associations with individual characteristics are not well known. This study aimed to assess explicit weight bias in French adults and to explore the associations with weight status and sociodemographic characteristics. METHODS Adults from the NutriNet-Santé cross-sectional study (France, 2020, n=33,948, 52% women after weighting procedures) completed the Anti-Fat Attitudes Questionnaire assessing three dimensions: Dislike (antipathy toward people with obesity), Fear of fat (concerns about body weight), and Willpower (belief in weight controllability). Associations with weight status and sociodemographic characteristics were examined using multivariable ANCOVA models in 2022. RESULTS Fear of fat and Willpower scores were higher than Dislike scores (mean [SD]=4.0 [2.0], 3.3 [1.7] and 1.9 [1.3], respectively). Fear of fat was higher among women, whereas Dislike and Willpower were higher among men (all p<0.0001). Obesity was associated with greater Fear of fat scores (p<0.0001, mean difference versus normal-weight participants [95% CI]=0.35 [0.24, 0.46] in women, 0.36 [0.17, 0.56] in men), lower Dislike scores (-0.38 [-0.45, -0.32] in women, -0.43 [-0.56, -0.30] in men), and lower Willpower scores (-1.00 [-0.18, -0.90] in women, -0.40 [-0.57, -0.23] in men). In both genders, lower income was associated with lower Dislike, Fear of fat, and Willpower scores (all p<0.0001), and lower education was associated with greater Fear of fat and Willpower scores (all p<0.0001). CONCLUSIONS Explicit weight bias was driven by the fear of gaining weight and the belief in weight controllability. This study provides new insights into which population subgroups should be targeted by interventions aimed at reducing explicit weight bias.
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Paquet S, Sassenou J, Ringa V, Czernichow S, Zins M, Ozguler A, Rigal L. Women with type 2 diabetes have LDL cholesterol levels higher than those of men, regardless of their treatment and their cardiovascular risk level. Nutr Metab Cardiovasc Dis 2023; 33:1254-1262. [PMID: 37088650 DOI: 10.1016/j.numecd.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS Several works have shown that control of the principal cardiovascular risk factors, especially LDL-C, is poorer among women with type 2 diabetes than men with this disease. Our objectives were to compare the statin treatments and LDL-C levels between men and women with type 2 diabetes, according to the potency of the statin they take, while taking their cardiovascular risk level into account. METHOD AND RESULTS This is a descriptive cross-sectional study within the French CONSTANCES cohort. At inclusion, each individual completed several self-administered questionnaires. Data were then matched to their health insurance fund reimbursement data. The study population comprises cohort members with pharmacologically treated type 2 diabetes. We identified 2541 individuals with type 2 diabetes; 2214 had an available LDL-C value. In the total sample, treatment by statins did not differ between men and women, while the women had a higher mean LCL-C level than men. The analyses stratified by cardiovascular risk showed that women at very high cardiovascular risk received significantly less frequent statin delivery than men (OR = 0.72 [0.56-0.92]; p = 0.01). At the same time, women received the same rate of high-potency statins as men. Women taking equivalently potent statins had significantly higher LDL-C levels than men did. CONCLUSION For the same cardiovascular risk level and the same statin treatment, women had an LDL-C level higher than that of men. They thus present a residual cardiovascular risk that justifies intensification of their statin treatment if tolerance allows.
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Rassy N, Van Straaten A, Carette C, Hamer M, Rives-Lange C, Czernichow S. Association of Healthy Lifestyle Factors and Obesity-Related Diseases in Adults in the UK. JAMA Netw Open 2023; 6:e2314741. [PMID: 37234008 DOI: 10.1001/jamanetworkopen.2023.14741] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Importance A healthy lifestyle is associated with a reduced risk of cardiovascular disease in adults with obesity. Little is known about the associations between a healthy lifestyle and the risk of other obesity-attributable diseases in this population. Objective To examine the association between healthy lifestyle factors and the incidence of major obesity-related diseases in adults with obesity compared with those with normal weight. Design, Setting, and Participants This cohort study evaluated UK Biobank participants aged 40 to 73 years and free of major obesity-attributable disease at baseline. Participants were enrolled from 2006 to 2010 and prospectively followed up for disease diagnosis. Exposures A healthy lifestyle score was constructed using information on not smoking, exercising regularly, no or moderate alcohol consumption, and eating a healthy diet. For each lifestyle factor, participants scored 1 if they met the criterion for a healthy lifestyle and 0 otherwise. Main Outcomes and Measures The risk of outcomes according to the healthy lifestyle score in adults with obesity compared with those with normal weight were examined using multivariable Cox proportional hazards models with Bonferroni correction for multiple testing. The data analysis was performed between December 1, 2021, and October 31, 2022. Results A total of 438 583 adult participants in the UK Biobank were evaluated (female, 55.1%; male, 44.9%; mean [SD] age, 56.5 [8.1] years), of whom 107 041 (24.4%) had obesity. During a mean (SD) follow-up of 12.8 (1.7) years, 150 454 participants (34.3%) developed at least 1 of the studied diseases. Compared with adults with obesity and 0 healthy lifestyle factors, individuals with obesity who met all 4 healthy lifestyle factors were at lower risk of hypertension (HR, 0.84; 95% CI, 0.78-0.90), ischemic heart disease (HR, 0.72; 95% CI, 0.65-0.80), arrhythmias (HR, 0.71; 95% 0.61-0.81), heart failure (HR, 0.65; 95% CI, 0.53-0.80), arteriosclerosis (HR, 0.19; 95% CI, 0.07-0.56), kidney failure (HR, 0.73; 95% CI, 0.63-0.85), gout (HR, 0.51; 95% CI, 0.38-0.69), sleep disorders (HR, 0.68; 95% CI, 0.56-0.83), and mood disorders (HR, 0.66; 95% CI, 0.56-0.78). The lifestyle profiles associated with the lowest risks included a healthy diet and at least 1 of the 2 healthy behaviors of physical activity and never smoking. Compared with adults with normal weight, those with obesity were at higher risk of several outcomes, irrespective of the lifestyle score (adjusted HRs ranged from 1.41 [95% CI, 1.27-1.56] for arrhythmias to 7.16 [95% CI, 6.36-8.05] for diabetes for adults with obesity and 4 healthy lifestyle factors). Conclusion and Relevance In this large cohort study, adherence to a healthy lifestyle was associated with reduced risk of a wide range of obesity-related diseases, but this association was modest in adults with obesity. The findings suggest that although a healthy lifestyle seems to be beneficial, it does not entirely offset the health risks associated with obesity.
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Gaborit B, Fernandes S, Loubet P, Ninove L, Dutour A, Cariou B, Coupaye M, Clement K, Czernichow S, Carette C, Resseguier N, Esterle L, Kali S, Houssays M, de Lamballerie X, Wittkop L, Launay O, Laville M. Early humoral response to COVID-19 vaccination in patients living with obesity and diabetes in France. The COVPOP OBEDIAB study with results from the ANRS0001S COV-POPART cohort. Metabolism 2023; 142:155412. [PMID: 36731720 PMCID: PMC9886395 DOI: 10.1016/j.metabol.2023.155412] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with diabetes and obesity are populations at high-risk for severe COVID-19 outcomes and have shown blunted immune responses when administered different vaccines. Here we used the 'ANRS0001S COV-POPART' French nationwide multicenter prospective cohort to investigate early humoral response to COVID-19 vaccination in the sub-cohort ('COVPOP OBEDIAB') of patients with obesity and diabetes. METHODS Patients with diabetes (n = 390, type 1 or 2) or obesity (n = 357) who had received two vaccine doses and had no history of previous COVID-19 infection and negative anti-nucleocapsid (NCP) antibodies were included and compared against healthy subjects (n = 573). Humoral response was assessed at baseline, at one month post-first dose (M0) and one-month post-second dose (M1), through percentage of responders (positive anti-spike SARS-CoV-2 IgG antibodies (Sabs), geometric means of Sabs; BAU/mL), proportion of individuals with anti-RBD antibodies, and proportion of individuals with anti-SARS-CoV-2-specific neutralizing antibodies (Nabs). Potential clinical and biological factors associated with weak response (defined as Sabs < 264 BAU/mL) and presence of non-reactive anti-RBD antibodies at M1 were evaluated. Univariate and multivariate regressions were performed to estimate crude and adjusted coefficients with 95 % confidence intervals. Poor glycemic control was defined as HbA1c ≥ 7.5 % at inclusion. RESULTS Patients with diabetes, particularly type 2 diabetes, and patients with obesity were less likely to have positive Sabs and anti-RBD antibodies after the first and second dose compared to controls (p < 0.001). At M1, we found Sabs seroconversion in 94.1 % of patients with diabetes versus 99.7 % in controls, anti-RBD seroconversion in 93.8 % of patients with diabetes versus 99.1 % in controls, and Nabs seroconversion in 95.7 % of patients with diabetes versus 99.6 % in controls (all p < 0.0001). Sabs and anti-RBD seroconversion at M0 and M1 were also significantly lower in obese patients than controls, at respectively 82.1 % versus 89.9 % (p = 0.001; M0 Sabs), 94.4 % versus 99.7 % (p 0.001; M1 Sabs), 79.0 % vs 86.2 % (p = 0.004 M0 anti-RBD), and 96.99 % vs 99.1 % (p = 0.012 M1 anti-RBD). The factors associated with low vaccine response (BAU < 264/mL) in patients with diabetes were chronic kidney disease (adjusted OR = 6.88 [1.77;26.77], p = 0.005) and poor glycemic control (adjusted OR = 3.92 [1.26;12.14], p = 0.018). In addition, BMI ≥ 40 kg/m2 was found to be associated with a higher vaccine response (adjusted OR = 0.10 [0.01;0.91], p = 0.040) than patients with BMI < 40 kg/m2. CONCLUSION COVID-19 vaccine humoral response was lower in patients with obesity and diabetes one month after second dose compared to controls, especially in diabetic patients with CKD or inadequate glycemic control. These findings point to the need for post-vaccination serological checks in these high-risk populations.
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Castera L, Laouenan C, Vallet-Pichard A, Vidal-Trécan T, Manchon P, Paradis V, Roulot D, Gault N, Boitard C, Terris B, Bihan H, Julla JB, Radu A, Poynard T, Brzustowsky A, Larger E, Czernichow S, Pol S, Bedossa P, Valla D, Gautier JF. High Prevalence of NASH and Advanced Fibrosis in Type 2 Diabetes: A Prospective Study of 330 Outpatients Undergoing Liver Biopsies for Elevated ALT, Using a Low Threshold. Diabetes Care 2023:148710. [PMID: 37043830 DOI: 10.2337/dc22-2048] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/02/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Most people with type 2 diabetes (T2DM) and nonalcoholic steatohepatitis (NASH) or advanced fibrosis (AF) remain undiagnosed, resulting in missed opportunities for early intervention. This multicenter, prospective study assessed the yield of using routinely available data to identify these patients. RESEARCH DESIGN AND METHODS A total of 713 outpatients with T2DM, screened in four diabetology clinics for nonalcoholic fatty liver disease according to American Diabetes Association criteria, were referred to hepatologists for further work-up (Fibrosis-4 and vibration-controlled transient elastography [VCTE]). A liver biopsy was proposed when ALT levels were persistently >20 IU/L in female patients or >30 IU/L in male patients, in the absence of other liver disease. RESULTS Liver biopsies were performed in 360 patients and considered adequate for reading after central review for 330 specimens (median patient age, 59 years; male patients, 63%; median BMI and HbA1C values, 32 and 7.5%, respectively). Prevalence of NASH, AF, and cirrhosis were 58%, 38%, and 10%, respectively. Liver lesions were independently associated with the components of metabolic syndrome but not with the micro- and macrovascular complications of T2DM. Models based on routinely available data with or without VCTE had good accuracy to predict AF (respectively: area under the receiver operating characteristic curve [AUROC], 0.84 and 0.77; and correctly classified 59% and 45%) and NASH (respectively: AUROC, 0.82 and 0.81; 44% and 42%). CONCLUSIONS Despite the use of a low ALT threshold, prevalence of NASH (58%) or AF (38%) was high. Routinely available data had a high yield in identifying patients with T2DM with AF and/or NASH requiring further liver assessment.
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Carette C, Rives-Lange C, Czernichow S. Medications for the treatment of obesity. J Visc Surg 2023; 160:S12-S14. [PMID: 36725455 DOI: 10.1016/j.jviscsurg.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
After several years with no real therapeutic alternatives, the management of obesity is entering a new era with the development of new surgical and endoscopic bariatric techniques, digital therapeutics and the arrival of new classes of drugs. New medication treatments aim to reduce food intake, targeting the hypothalamic regulation of food intake and satiety. The mechanism of their action remains poorly understood but, combines weight reduction and amelioration of cardiometabolic risk factors with a favorable benefit-risk balance and known side effects, mainly digestive. The future will tell us how these drugs will find their place in the management of this chronic disease that is obesity.
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Czernichow S, Rassy N, Malaab J, Loussikian P, Mebarki A, Khadhar M, Poghosyan T, Fagherrazi G, Carette C, Schück S, Rives-Lange C. Patients' and caregivers' perceptions of bariatric surgery: A France and United States comparative infodemiology study using social media data mining. Front Digit Health 2023; 5:1136326. [PMID: 37143935 PMCID: PMC10151923 DOI: 10.3389/fdgth.2023.1136326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023] Open
Abstract
Background People are conversing about bariatric surgery on social media, but little is known about the main themes being discussed. Objective To analyze discussions regarding bariatric surgery on social media platforms and to establish a cross-cultural comparison of posts geolocated in France and the United States. Methods Posts were retrieved between January 2015 and April 2021 from general, publicly accessed sites and health-related forums geolocated in both countries. After processing and cleaning the data, posts of patients and caregivers about bariatric surgery were identified using a supervised machine learning algorithm. Results The analysis dataset contained a total of 10,800 posts from 4,947 web users in France and 51,804 posts from 40,278 web users in the United States. In France, post-operative follow-up (n = 3,251, 30.1% of posts), healthcare pathways (n = 2,171, 20.1% of the posts), and complementary and alternative weight loss therapies (n = 1,652, 15.3% of the posts) were among the most discussed topics. In the United States, the experience with bariatric surgery (n = 11,138, 21.5% of the posts) and the role of physical activity and diet in weight-loss programs before surgery (n = 9,325, 18% of the posts) were among the most discussed topics. Conclusion Social media analysis provides a valuable toolset for clinicians to help them increase patient-centered care by integrating the patients' and caregivers' needs and concerns into the management of bariatric surgery.
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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: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [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.
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Rives-Lange C, Zimmer A, Merazka A, Carette C, Martins-Bexinga A, Hauw-Berlemont C, Guerot E, Jannot A, Diehl J, Czernichow S, Hermann B. Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge. Clin Nutr 2022; 41:3026-3031. [PMID: 34134915 PMCID: PMC8142813 DOI: 10.1016/j.clnu.2021.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Malnutrition following intensive care unit (ICU) stay is frequent and could be especially prominent in critically ill Coronavirus Disease 2019 (COVID-19) patients as they present prolonged inflammatory state and long length stay. We aimed to determine the prevalence of malnutrition in critically ill COVID-19 patients both at the acute and recovery phases of infection. METHODS We conducted a prospective observational study including critically ill COVID-19 patients requiring invasive mechanical ventilation discharged alive from a medical ICU of a university hospital. We collected demographic, anthropometric and ICU stay data (SAPS2, recourse to organ support and daily energy intake). Nutritional status and nutritional support were collected at one month after ICU discharge (M1) by phone interview and at 3 months after ICU discharge (M3) during a specialized and dedicated consultation conducted by a dietitian. Malnutrition diagnosis was based on weight loss and body mass index (BMI) criteria following the Global Leadership Initiative on Malnutrition. Primary outcome was the prevalence of malnutrition at M3 and secondary outcomes were the evolution of nutritional status from ICU admission to M3 and factors associated with malnutrition at M3. RESULTS From march 13th to may 15th, 2020, 38 patients were discharged alive from the ICU, median [IQR] age 66 [59-72] years, BMI 27.8 [25.5-30.7] kg/m2 and SAPS2 47 [35-55]. Thirty-three (86%) patients were followed up to M3. Prevalence of malnutrition increased during the ICU stay, from 18% at ICU admission to 79% at ICU discharge and then decreased to 71% at M1 and 53% at M3. Severe malnutrition prevailed at ICU discharge with a prevalence of 55% decreasing 32% at M3. At M3, the only factors associated with malnutrition in univariate analysis were the length of invasive mechanical ventilation and length of ICU stay (28 [18-44] vs. 13 [11-24] days, P = 0.011 and 32 [22-48] vs. 17 [11-21] days, P = 0.006, respectively), while no ICU preadmission and admission factors, nor energy and protein intakes distinguished the two groups. Only 35% of undernourished patients at M3 had benefited from a nutritional support. CONCLUSION Malnutrition is frequent, protracted and probably underrecognized among critically ill Covid-19 patients requiring invasive mechanical ventilation with more than half patients still being undernourished three months after ICU discharge. A particular attention should be paid to the nutritional status of these patients not only during their ICU stay but also following ICU discharge.
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Hanras E, Boujut E, Ruffault A, Messager D, Rives-Lange C, Barsamian C, Carette C, Lucas-Martini L, Czernichow S, Dorard G. Vegetarianism and weight status: What are the differences in eating styles, impulsivity, and emotional competences? A preliminary study. Obes Res Clin Pract 2022; 16:288-294. [PMID: 35931649 DOI: 10.1016/j.orcp.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 12/18/2022]
Abstract
Recent studies suggest that vegetarian diets may be recommended to promote weight loss in individuals living with obesity. However, limited studies have examined psychological factors (e.g., eating styles, impulsivity) among individuals who have adopted this type of diet, even though these factors are known to play a role in being overweight. The primary objective of the present study was to compare these characteristics in participants living with obesity or those with normal-weight across diet types. Participants were recruited from two hospital nutrition departments and the general population. They completed a diagnostic interview assessing the presence of an eating disorder, followed by self-administered questionnaires measuring dysfunctional eating styles (DEBQ), impulsivity (UPPS), and emotional competence (PEC). Vegetarian participants living with obesity engaged in more dysfunctional eating styles than did normal-weight omnivores and experienced more emotional difficulties than did both normal-weight omnivores and vegetarians. In contrast, there were no significant differences between omnivore participants living with obesity and those in the other groups. Moreover, participants living with obesity had comparable emotion regulation abilities to normal-weight participants. These results suggest that emotion regulation deficits can more likely be explained by the presence of psychopathological traits than by being overweight or one's choice of diet.
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Mifsud F, Messager D, Jannot AS, Védie B, Balanant NA, Poghosyan T, Flamarion E, Carette C, Lucas-Martini L, Czernichow S, Rives-Lange C. Response to the letter by Onishi and al. regarding “Clinical diagnosis, outcomes and treatment of thiamine deficiency in a tertiary hospital”. Clin Nutr 2022; 41:2045-2046. [PMID: 35970664 DOI: 10.1016/j.clnu.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022]
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Sermondade N, Dupont C, Faure C, Léger D, Czernichow S, Lévy R, Caetano G. P-687 Sleep parameters and sleep disorders in male and female subjects presenting idiopathic infertility: the ALIFERT case-control study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To evaluate the association between sleep parameters, sleep disorders and idiopathic infertility.
Summary answer
Some sleep parameters, such as bedtime, sleep latency and chronotypes, might be associated with male and female fertility.
What is known already
Some studies suggested that sleep might play an important role in reproductive health. Short sleep duration might interfere with the menstrual cycle, sperm parameters or natural fertility. The biological clock chronotype was found to be associated with fertility, with altered sperm parameters in the “evening” type and more reproductive troubles in the “intermediate” type when compared to the “morning” type. Irregular and night work schedules were also associated with some degree of fertility dysfunction, such as irregular menstrual cycles, a longer time to pregnancy, or male infertility. However, the interrelations between sleep and fertility are not fully elucidated.
Study design, size, duration
Fertile and infertile couples were recruited in the ALIFERT cross-sectional case–control multicentric study, between September 2009 and December 2013. The study group consisted of 94 infertile men and 95 infertile women, presenting with a primary idiopathic infertility of more than 12 months. The control group consisted in 85 fertile men and 86 fertile women who had a spontaneously conceived child under 2 years of age with a time to pregnancy less than 12 months.
Participants/materials, setting, methods
Male and female participants answered the French version of the Pittsburgh Sleep Quality Index, including questions about sleep timing and duration and symptoms of sleep disorders. Sleep parameters were compared between infertile and fertile participants for each sex, and between partners. The Wilcoxon-Mann-Whitney test was used to compare differences in sleep parameters due to a non-normal distribution, and the Fisher's exact test was used for qualitative variables.
Main results and the role of chance
Bedtime was significantly later for infertile compared to fertile male participants (p = 0.03). Infertile female participants had significantly later wake time, greater sleep latency and sleep apnea symptoms compared to fertile female participants (p ≤ 0.02). Fertile participants of both sexes were more frequently moderate morning types compared to infertile participants (p ≤ 0.04). No differences were observed regarding total sleep time, time spent in bed, sleep efficacy, insomnia, hypersomnia, or periodic leg movement symptoms. Infertile couples had more frequently different chronotypes than fertile couples (p = 0.02). Differences in wake time between partners were significantly greater among infertile couples (p < 0.01), but no differences were observed for bedtime, time spent in bed and total sleep time (p ≥ 0.22).
Limitations, reasons for caution
Sleep parameters were evaluated based on self-reported questionnaire. Further studies including objective measures of sleep will be needed to allow a more objective determination of sleep parameters. A discussion about mechanistic hypothesis should also be considered to better understand the links between sleep and fertility.
Wider implications of the findings
Sleep could be an original and innovative parameter to consider in the reproduction field. Further investigation is needed to elucidate how sleep and reproductive functions are interrelated and how sleep might constitute a useful modifiable target in infertility management.
Trial registration number
NCT01093378
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Saget S, Kappeler L, Grandjean V, Leneuve P, Berthaut I, Faure C, Czernichow S, Racine C, Lévy R, Dupont C. Association between metabolic disorders and seminal plasma miRNA levels: a pilot study. Basic Clin Androl 2022; 32:9. [PMID: 35668388 PMCID: PMC9171949 DOI: 10.1186/s12610-022-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess weight and metabolic disorders have a negative impact on male reproductive functions. The mechanisms involved are numerous and complex and epigenetic mechanisms may also be involved, notably through the small non-coding RNAs. Among them, microRNAs (miRNAs) are of particular interest. This preliminary study aimed to identify the miRNAs differentially enriched in seminal plasma related to metabolic disorders and if some are also associated with spermatic parameters alterations. One hundred and sixty men between 18 to 45 years, partners of infertile couple, were included in this cohort. The miRNAs associated with metabolism were selected from the literature and assayed by quantitative real-time PCR using TaqMan gene expression assays. A subset of those with an interesting profile in seminal plasma were secondarily tested in blood. RESULTS Among the 11 selected miRNAs, seven were detected in seminal plasma (miR10b, miR19a, miR19b, miR34b, miR34c, miR133b, miRlet7c). A negative correlation was observed between seminal miR19a levels and metabolic syndrome, blood glucose and C-peptide. Seminal miR19b levels were also negatively correlated with metabolic syndrome. Seminal miR34c levels were negatively correlated with body mass index (BMI) and waist circumference. Seminal miR133b levels were positively correlated with BMI, waist circumference and leptin levels. Interestingly, modifications of miRNAs in seminal plasma seem specific since highlighted above correlations were not retrieved in the blood plasma for the miR19a, 19b, 10b, 34c. CONCLUSION Few metabolic and anthropometric disorders are correlated with the level of specific miRNAs in seminal plasma. Further studies will be required to decipher if other small non-coding RNAs may also be correlated with metabolic and anthropometric disorders and to assess their potential implication in the alteration of reproductive functions in men with obesity or metabolic disorders. CLINICAL STUDY Metabolic Syndrome and Male Infertility (Metasperme): Trial registration: NCT01974947 . Registered 18 July 2013.
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Soubrier M, Viguier M, Peyrin-Biroulet L, Czernichow S. AB1457 OPALE: A PROSPECTIVE OBSERVATIONAL STUDY OF THE REAL-WORLD USE OF AN ADALIMUMAB BIOSIMILAR AND EVALUATION OF NUTRITIONAL STATUS ON THE THERAPEUTIC RESPONSE. PATIENTS NUTRITIONAL STATUS AT BASELINE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundChronic inflammatory diseases treatment has been greatly improved since the introduction of TNF inhibitors and later, of their biosimilars. In addition, epidemiological and interventional studies suggest a pathophysiological or therapeutic role, respectively, of nutrition in Inflammatory Rheumatic Diseases (IRDs).ObjectivesThe objective of the OPALE observational study was to describe in real life the profile of patients treated with an adalimumab biosimilar and to assess the impact of nutrition on disease evolution and response to treatment.MethodsThe study planned a one-year follow-up of patients with at least three visits: inclusion, six months and one year. In this study, 754 patients treated with Fresenius-Kabi adalimumab were included: 54.4 % of patients with an IRD, 42.8 % with Inflammatory Bowel Disease (IBD) and 2.8 % patients with a psoriasis. Patients’ condition was assessed using a Clinical Global Impression of disease scale (CGI, primary end point of the study). Nutritional status was assessed through clinical data (weight, BMI (Body Mass Index), abdominal circumference) and the available biological analyses results. Screening for sarcopenia was based on a SARC-F score ≥ 4. Nutritional behavior was assessed using a diet questionnaire with a list of 48 foods divided into 6 classes (Fruits & vegetables, meat, fish & eggs, dairy products & fats, starchy foods, sweet foods and drinks). Foods voluntarily withdrawn due to illness and those avoided at acute flare-ups were recommended to be reported. This analysis aims to describe IRD patients’ nutritional status at baseline.ResultsFrom 754 included patients, 410 patients presented with an IRD (Psoriatic Arthritis (PsA), n= 80 / Rheumatoid Arthritis (RA), n=102 / SpondyloArthritis (SpA), n=228). Mean patients’ age was 47.7± 14.1 years, 56% are female, mean BMI was 26.0 ± 5.4 kg/m2. From this IRD population, 28.5% of patients have a family history of chronic inflammatory disease.Mean disease duration was of 6.4 ± 8.4 years. Concerning the previous IRD treatment, 47.4% of patients had previously been treated by methotrexate among them 58% were still receiving this treatment at inclusion. Among IRD patients recruited in OPALE study, 72.8% received Fresenius Kabi adalimumab as their first biotherapy. Most of patients were assessed on the CGI scale as markedly ill (50.7%) or moderately ill (29.9%) and 110 patients (37.3%) had a score ≥ 4 on the SARC-F questionnaire (mean age 48.9 ± 14.1 years and mean BMI 27.2 ±5.6 kg/m2).Concerning the disease history at baseline, the descriptive analysis of self-administered questionnaire shows that 68.3% of patients may have changed their nutritional behavior because of their illness, by banishing several foods (mean number: 12.7 ± 10.1). These restrictions are increased during flare-ups: 32.7% of patients removed an average of 6.0 ± 5.8 additional foods number. These changes are in part based on the patients’ own beliefs: 17% of them consider that certain foods can improve their illness, 35% of patients think they have identified the foods likely to make it worse (Table 1).Table 1.Patient-reported influence of certain foods on diseasePsARASpATOTAL IRD(n=60)(n=72)(n=177)(n=309)Patients identifying foods with negative influence21225810137.5% [24.9% - 51.5%]32.4% [21.5% - 44.8%]36.0% [28.6% - 44.0%]35.4% [29.9% - 41.3%]Patients identifying foods with positive influence912274816.4% [7.8% - 28.8%]17.6% [9.5% - 28.8%]17.2% [11.7% - 24.0%]17.1% [12.9% - 22.1%]ConclusionThese preliminary baseline data from OPALE observational study confirm the risk of decreased muscle mass in IRD. Mean BMI of patients screened for sarcopenia is higher than that of non-sarcopenic patients (respectively 27.2 ± 5.6 kg/m2 and 25.6 ± 4.8 kg/m2; p=0.02). These results plead for a systematic screening for sarcopenia in IRD patients. The risk of sarcopenia could be further aggravated by inappropriate nutritional behaviors aimed at excluding food groups, which would justify dietary education of these IRD patients.Disclosure of InterestsMartin SOUBRIER Consultant of: Fresenius Kabi, Manuelle VIGUIER Consultant of: Fresenius Kabi, Laurent Peyrin-Biroulet Consultant of: Fresenius Kabi, Sebastien Czernichow Consultant of: Fresenius Kabi
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Sigaux J, Mathieu S, Nguyen Y, Sanchez P, Letarouilly JG, Soubrier M, Czernichow S, Flipo RM, Sellam J, Daïen C. Impact of type and dose of oral polyunsaturated fatty acid supplementation on disease activity in inflammatory rheumatic diseases: a systematic literature review and meta-analysis. Arthritis Res Ther 2022; 24:100. [PMID: 35526074 PMCID: PMC9077862 DOI: 10.1186/s13075-022-02781-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/19/2022] [Indexed: 01/13/2023] Open
Abstract
Background Polyunsaturated fatty acid (PUFA) supplementation has been reported to improve disease activity in inflammatory rheumatic diseases (IRDs). However, data are often conflicting and studies insufficiently large to draw conclusions. This systematic literature review and meta-analysis aimed to better estimate the effect of oral supplementation with omega (n)-3 and n-6 PUFA on IRD activity in terms of duration, dose, type, and source. Methods The literature was searched in PubMed, EMBASE, and Cochrane Library databases up to October 2020. Studies were reviewed in accordance with PRISMA guidelines. The effect of PUFA supplementation on disease activity was expressed as the standardized mean difference (95% CI). Metaregression and subgroup analyses involved type of IRD, Jadad score, PUFA source (animal or vegetable), and doses. Results We obtained 42 references; 30 randomized controlled studies were included comparing the effects of PUFA versus control on disease activity (710 IRD patients receiving PUFA supplementation and 710 controls, most with rheumatoid arthritis). We found a significant improvement in pain, swollen and tender joint count, Disease Activity Score in 28 joints, and Health Assessment Questionnaire score in IRD patients receiving PUFA supplementation as compared with controls, with a significant decrease in erythrocyte sedimentation rate but not C-reactive protein level. Although meta-regression revealed no difference by IRD type or source or dose of PUFA supplementation, subgroup analysis revealed more parameters significantly improved with animal- than vegetable-derived PUFAs and 3- to 6-month supplementation. Most studies examined high-dose supplementation (>2 g/day). Conclusion PUFA consumption, especially omega-3 from animal source >2 g/day, may improve IRD activity and might be an adjuvant therapy in rheumatoid arthritis. Trial registration The protocol was registered at PROSPERO (CRD42021253685). Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02781-2.
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Faucher P, Carette C, Jannot AS, Gatta-Cherifi B, Van Straaten A, Piquet MA, Raverot G, Alligier M, Batisse T, Ziegler O, Drui D, Bretault M, Farigon N, Slim K, Genser L, Poghosyan T, Vychnevskaia K, Blanchard C, Robert M, Gronnier C, Poitou C, Czernichow S. Five-Year Changes in Weight and Diabetes Status After Bariatric Surgery for Craniopharyngioma-Related Hypothalamic Obesity: a Case-Control Study. Obes Surg 2022; 32:2321-2331. [PMID: 35524022 DOI: 10.1007/s11695-022-06079-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Craniopharyngiomas are tumors located in the hypothalamic region which leads to obesity in about 50% of cases. Long-term efficacy and safety of bariatric surgery are lacking in this peculiar population. The aim of this study is to determine the 5-year weight loss and resolution of type 2 diabetes (T2D) after bariatric surgery in patients operated on craniopharyngioma who had developed hypothalamic obesity. MATERIALS AND METHODS This is a multicenter french retrospective case-control study. Subjects with craniopharyngioma (n = 23) who underwent sleeve gastrectomy (SG) (n = 9) or Roux-en-Y gastric bypass (RYGB) (n = 14) (median age 35 years [25;43] and BMI 44.2 kg/m2 [40.7; 51.0]; 8/23 with T2D) were individually matched to 2 subjects with common obesity for age, gender, preoperative body mass index, T2D, and type of surgery. RESULTS TWL% after 1 and 5 years was lower in the craniopharyngioma group than in the control group: 23.1 [15.4; 31.1] (23/23) vs 31.4 [23.9; 35.3] at 1 year (p = 0.008) (46/46) and 17.8 [7.1; 21.9] (23/23) vs 26.2 [18.9; 33.9] at 5 years (p = 0.003) (46/46). After RYGB, TWL% was lower in the craniopharyngioma group compared to the control group (p < 0.001) and comparable after SG both at 1 and 5 years. No difference between the two groups was observed in T2D remission rate and in early and late adverse events. No hormonal deficiency-related acute disease was reported. CONCLUSIONS Bariatric surgery induced a significant weight loss in the craniopharyngioma group at 1 and 5 years, but less than in common obesity. SG may be more effective than RYGB but this remains to be demonstrated in a larger cohort.
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