Prevalence of metabolic syndrome and its risk factors among Belgian adults

Background

Metabolic syndrome (MetS) is a growing public health concern. It is characterized by the presence of at least three of these five risk factors including abdominal obesity, high triglycerides, hypertension, high blood sugar, and low HDL-cholesterol. Individuals with MetS are at increased risk to develop cardiovascular diseases and type 2 diabetes. A better understanding of this syndrome is essential to implement public health prevention actions. The aim of this study is to investigate the prevalence of MetS and its association with risk factors in the Belgian adult population.

Methods

This study was conducted on the first Belgium Health Examination Survey of 2018 among adults aged 18-90 (n = 1184). MetS was defined based on the Revised-Adult Treatment Panel III (R-ATP III) criteria. Association between risk factors (i.e. socio-demographic and health behavior determinants) and MetS was investigated through a multiple logistic regression (adjusted odds ratio (OR) and 95%CI).

Results

Among the 963 participants with complete data (49 ±15yrs, 51.3% men), we observed an overall prevalence of MetS of 30.9% (95%CI: 27%-35%). MetS is significantly associated with older age (OR 10.2; 95%CI 3.6-28.9), low education (OR 2.6; 95%CI 1.2-5.7), an increasing number of chronic diseases (OR 1.3; 95%CI 1.1-1.5) and BMI. ORs for overweight (BMI > 25 kg/m2), obesity (BMI > 30 kg/m2), and severe obesity (BMI > 35 kg/m2) are respectively 3.8 (95%CI 1.9-7.3), 22.6 (95%CI 9.3-54.8) and 65.9 (95%CI 15.9-271.9). No significant associations were found with gender, region, smoking status, alcohol consumption and physical activity.

Conclusions

Our results showed a high prevalence of MetS in the Belgian population. Identifying MetS high risk groups based on the socio-demographic and behavioral determinants is of major importance to establish preventive measures for cardiovascular diseases and diabetes of the Belgian population.

Key messages

The overall prevalence of MetS is almost 31% in the Belgian population. Age, education, overweight, obesity and chronic diseases are factors associated with the presence of MetS.

Symptomatic Efficacy of Pharmacological Treatments for Knee Osteoarthritis: A Systematic Review and a Network Meta-Analysis with a 6-Month Time Horizon

INTRODUCTION

Several pharmacological treatments aiming at a better symptomatic control of osteoarthritis (OA) are used in daily practice but their efficacy is often disputed. The purpose of this network meta-analysis (NMA) is to assess the efficacy on pain and function of the drugs that are most widely prescribed against knee OA.

METHODS

Medline, Scopus, and Cochrane database of systematic reviews were searched for randomized controlled trials published up to August 2019 and assessing the efficacy of knee OA treatments using a 6-month time horizon. Pain and function changes from baseline were the primary outcomes. A Bayesian network meta-analysis was run and standardized mean differences (SMDs) with 95% credibility intervals (95% CrIs) were calculated.

RESULTS

9697 references were identified and 80 RCTs were concordant with our inclusion criteria (79 studies involving 15,609 individuals reported pain outcomes and 55 studies involving 13,655 individuals reported function outcomes). A significant decrease in pain was observed for the intra-articular (IA) combination of hyaluronic acid (HA) and triamcinolone (SMD - 0.49, 95% CrI - 0.78; - 0.19), vitamin D (SMD - 0.31, 95% CrI - 0.56; - 0.06), IA HA (SMD - 0.29, 95% CrI - 0.40; - 0.17), prescription-grade crystalline glucosamine sulfate (pCGS) (SMD - 0.29, 95% CrI - 0.58; - 0.004), and prescription-grade chondroitin sulfate (pCS) (SMD - 0.26, 95% CrI - 0.44; - 0.08). Significant improvements in physical function were found with pCGS (SMD - 0.44, 95% CrI - 0.66; - 0.21), vitamin D (SMD - 0.30, 95% CrIs - 0.49; - 0.11) and IA HA (SMD - 0.21, 95% CrIs - 0.31; - 0.11).

CONCLUSION

Six months of treatment with IA HA, pCGS, pCS, vitamin D and the combination of IA HA and triamcinolone improve pain and/or physical function in patients suffering from knee OA.

The detection of hospitalized patients at risk of testing positive to multi-drug resistant bacteria using MOCA-I, a rule-based "white-box" classification algorithm for medical data

BACKGROUND

Multi-drug resistant (MDR) bacteria are a major health concern. In this retrospective study, a rule-based classification algorithm, MOCA-I (Multi-Objective Classification Algorithm for Imbalanced data) is used to identify hospitalized patients at risk of testing positive for multidrug-resistant (MDR) bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), before or during their stay.

METHODS

Applied to a data set of 48,945 hospital stays (including known cases of carriage) with up to 16,325 attributes per stay, MOCA-I generated alert rules for risk of carriage or infection. A risk score was then computed from each stay according to the triggered rules.Recall and precision curves were plotted.

RESULTS

The classification can be focused on specifically detecting high risk of having a positive test, or identifying large numbers of at-risk patients by modulating the risk score cut-off level. For a risk score above 0.85,recall (sensitivity) is 62 % with 69 % precision (confidence) for MDR bacteria, recall is 58 % with 88 % precision for MRSA. In addition, MOCA-I identifies 38 and 21 cases of previously unknown MDR and MRSA respectively.

CONCLUSIONS

MOCA-I generates medically pertinent alert rules. This classification algorithm can be used to detect patients with high risk of testing positive to MDR bacteria (including MRSA). Classification can be modulated by appropriately setting the risk score cut-off level to favor specific detection of small numbers of patients at very high risk or identification of large numbers of patients at risk. MOCA-I can thus contribute to more adapted treatments and preventive measures from admission, depending on the clinical setting or management strategy.

Case report: An infantile lethal form of Albright hereditary osteodystrophy due to a GNAS mutation

Germline loss-of-function GNAS mutations are associated with multiple phenotypes, depending on the parental origin of the mutant allele. Here, we describe an infantile lethal form of atypical pseudohypoparathyroidism type 1a or 1c with severe Albright's hereditary osteodystrophy phenotype, underlying the extremely variable expressivity of this syndrome.

[Benevolent Lies and Divine Truths: Information-giving Practices in the Era of Medical Paternalism, Brussels (1870-1930)]

Mostly based on Belgian and French-language source material (such as hospital archives, medical ethics, Catholic nursing manuals, etc.), this article sheds light on the way that information around serious illnesses was managed in the late 19th and early 20th century. It is suggested that information-giving practices were largely defined by the paternalistic nature of pre-mid-20th century medicine and although these practices aimed to the same objective, their content varied greatly according to the medical professionals or caregivers involved (doctors, catholic nurses, priests). The patients' and their families' reactions are examined as well. With the ambition to better flesh out the history of the therapeutic relationship, we argue that the interactions between patients and the various actors of the medical world were in continuity with the broader social dynamics of the time.

The isolated sympathetic spinal cord: Cardiovascular and sudomotor assessment in spinal cord injury patients: A literature survey

OBJECTIVES

To present a comprehensive approach to the assessment of the severity of the autonomic lesion in spinal cord injury (SCI) patients, with regard to the level of lesion. To discuss how to assess an isolated sympathetic spinal cord that has lost supraspinal control (sympathetically complete lesion).

METHOD

PubMed was searched for articles related to cardiovascular (mainly cold pressor test, respiratory and postural challenges) and sudomotor (sympathetic skin responses) tests that have been used. The results of these evaluations are analysed with regard to the site of stimulation (above or below the lesion) according to three types of SCI that offer typical autonomic reactions (tetraplegics, paraplegics at T6 and at T10).

RESULTS

Non-invasive cardiovascular and sudomotor testing allows the assessment of the isolated sympathetic spinal cord in SCI patients. Typical responses are found in relation with the level of the sympathetic lesion. Its definition would allow comparison with the somatic motor and sensory level of lesion of SCI patients and provide additional aid to the classification of those patients.

CONCLUSION

For research purposes on the integrity of the spinal sympathetic pathways, a battery of test approach is probably needed, using a combination of stimuli above and below the lesion, evaluating both cardiovascular and sudomotor pathways.

Retrovirus-mediated gene transfer into T cells: 95% transduction efficiency without further in vitro selection

This study was designed to retrovirally transduce T cells by a protocol that would be simple, short, cost effective, applicable for clinical use, and efficient enough to avoid further selection of transduced T cells. Because retrovirally mediated infection is depending on the cell cycle, we first optimized the conditions for activating T cells in the presence of immobilized CD3 monoclonal antibodies and recombinant interleukin 2. Cell cycle analysis indicated that CD8+ and total T cells reach a maximum of cycling within 4 days whereas CD4+ T cells attain their maximum of cycling only by day 6. Taking into account these data, CD4+, CD8+, and total T cells were preactivated for 5 and 3 days, respectively, and then infected for 24 hr with supernatant containing retrovirus pseudotyped with gibbon-ape leukemia virus envelope, using a cell centrifugation protocol. Results show that approximately 95% of CD4+, CD8+, and total T cells can be transduced, this transduction efficiency being significantly higher than that obtained with amphotropic retrovirus vectors. Furthermore, under permanent growth stimulation, transduced T cells can be expanded approximately 1,000-fold in 4 weeks of culture with maintenance of transgene expression. However, Immunoscope analysis revealed alterations of T cell repertoire diversity after 2-3 weeks in culture that was not due to retroviral transduction per se. Overall, these data provide evidence that T cells can be transduced at levels that may alleviate the need for both further selection of transduced cells and in vitro expansion, thereby preserving the repertoire diversity of the transduced T cells to be reinfused.

The outcome of the parasitic process initiated by Leishmania infantum in laboratory mice: a tissue-dependent pattern controlled by the Lsh and MHC loci

Human visceral leishmaniasis is mainly due to intracellular protozoan parasites of the Leishmania donovani complex, i.e., L. donovani and L. infantum (or L. chagasi). A mouse model has been established to monitor 1) the parasitic process initiated by L. infantum in three tissues they invade, and 2) parameters of the acquired immune response they trigger. Mice congenic at the Lsh locus and mice of inbred strains differing at the MHC locus have been inoculated by the i.v. route with L. infantum. The parasitic process has been evaluated by the follow-up of the parasitic load in the liver, the spleen, and, for the first time, in the bone marrow using a very sensitive limiting dilution assay. As previously established for L. donovani, the early outcome of L. infantum is also under the control of the Lsh locus in the liver; genes of the MHC complex are involved in the development of the subsequent acquired immune response. "Cure" or "noncure" haplotypes are the same for the two species of Leishmania; as far as the cure haplotype is concerned, whatever the tissues being screened, the parasites are never totally cleared, although the liver is the tissue in which the best parasite load reduction is achieved. Through immunostaining, it was established that sialoadhesin-positive stromal bone marrow macrophages contain parasites; such long-lived mononuclear phagocytes could be the host cells where the parasite can find "safe targets" unreactive to the dominant effector immune mechanism triggered by the replicative stage of the parasites.

The outcome of the parasitic process initiated by Leishmania infantum in laboratory mice: a tissue-dependent pattern controlled by the Lsh and MHC loci

Human visceral leishmaniasis is mainly due to intracellular protozoan parasites of the Leishmania donovani complex, i.e., L. donovani and L. infantum (or L. chagasi). A mouse model has been established to monitor 1) the parasitic process initiated by L. infantum in three tissues they invade, and 2) parameters of the acquired immune response they trigger. Mice congenic at the Lsh locus and mice of inbred strains differing at the MHC locus have been inoculated by the i.v. route with L. infantum. The parasitic process has been evaluated by the follow-up of the parasitic load in the liver, the spleen, and, for the first time, in the bone marrow using a very sensitive limiting dilution assay. As previously established for L. donovani, the early outcome of L. infantum is also under the control of the Lsh locus in the liver; genes of the MHC complex are involved in the development of the subsequent acquired immune response. "Cure" or "noncure" haplotypes are the same for the two species of Leishmania; as far as the cure haplotype is concerned, whatever the tissues being screened, the parasites are never totally cleared, although the liver is the tissue in which the best parasite load reduction is achieved. Through immunostaining, it was established that sialoadhesin-positive stromal bone marrow macrophages contain parasites; such long-lived mononuclear phagocytes could be the host cells where the parasite can find "safe targets" unreactive to the dominant effector immune mechanism triggered by the replicative stage of the parasites.

Parasite-host relationships: in-situ study of Leishmania spp. in resistant and susceptible mice

The host's skin is a critical tissue in the natural life cycle of the Leishmania spp. known to cause an 'asymptomatic' infectious process or cutaneous or visceral leishmaniasis in mammals. The dermis, once disturbed by the inoculation of infective parasites, becomes a site of dynamic events, the progression of which depends upon both host and parasite characteristics. Whatever the final site of the morbidity caused by the parasites, whether it be cutaneous, visceral or muco-cutanous, this site reflects the parasite and host's ability to create a pro- or anti-parasite micro-environment. The characteristics of this environment are now amenable to analysis in situ, as illustrated by the study of the cutaneous processes initiated by inoculation of Leishmania major in laboratory mice.

Transient inducible events in different tissues: in situ studies in the context of the development and expression of the immune responses to intracellular pathogens

Intracellular pathogens whether facultative like Mycobacterium sp., e.g. Bacillus Calmette Guérin, Listeria monocytogenes or strictly intracellular like Leishmania sp. initiate either asymptomatic infectious processes or disease depending both on factors of the host (genetic as well as environmental ones) and the infectious/pathogenic agents. In this contribution, we first summarized informations which justify to develop in situ analysis to decipher the sequential events that result in different modes/classes of immune responses. How the mode of the immune response is determined remains a main question to address. Although it has recently become clear, in vitro, that immunocompetent cells and their cytokines are critical to set on a stable mode of immune response, acting on naive T cells, this area deserves more in vivo studies. Indeed, peripheral T cells, at different stages of differentiation, may exist in vivo (a) naive/virgin, (b) experienced, (c) effector T cells, depending on the level of stimulation of the immune system by either endogenous or exogenous (e.g. gut flora) signals. The three chosen examples illustrate our contributions in this field focusing on three different non-lymphoid tissues which may become infected: bone marrow (Bacille de Calmette Guérin), liver (Listeria monocytogenes), skin (Leishmania major). These three illustrations also allow to attract attention on the interest of using mice of genetically different strains the immune response of which is set up under different modes.

Training of speech therapists and a psychological profile of the profession

The psychological professional profile of 20 speech therapists has been investigated by Achtnich's BBT test. The results show three trends common to the profession: choice of the social factor, intense need for imagination and creativity, desire of self-assertion. However, the need for information and acquisition of new knowledge and control of activity is virtually absent among the sample tested.

Influence of rifampicin, phenobarbital and cimetidine on mixed function monooxygenase in extensive and poor metabolizers of debrisoquine

The effect of enzyme induction by rifampicin and phenobarbital and enzyme inhibition by cimetidine on the hepatic mixed-function monooxygenase (MFO) was investigated in 11 non-smokers, healthy male volunteers. Five were classified as extensive metabolizers (EM) of debrisoquine and 6 as poor metabolizers (PM). Rifampicin (600 mg/day), phenobarbital (100 mg/day) and cimetidine (1.2 g/day) were given for 8, 14 and 4 days, respectively. In PM on rifampicin, the debrisoquine metabolic ratio (MR) was significantly reduced, even reaching a value less than 12.6 in 2 subjects but on phenobarbital and cimetidine, the MR was not significantly modified. In PM on rifampicin and phenobarbital, the urinary excretion of 6 beta-hydroxycortisol was significantly enhanced but not in EM on these drugs. In both groups on cimetidine, salivary antipyrine half-life was lengthened and on rifampicin, it was shortened. In EM and PM on cimetidine, the total oral clearance of antipyrine was lowered but on rifampicin it was solely increased in PM. Regarding the metabolic clearance to the three main urinary antipyrine metabolites, that of norantipyrine (NORA) was significantly increased in PM on rifampicin. In PM on cimetidine, the metabolic clearance of NORA and hydroxymethylantipyrine (HMA) was reduced but in EM that of hydroxyantipyrine was additionally decreased. In PM on rifampicin, the induction of the hepatic mixed-function oxidase system, assessed by the urinary excretion of 6 beta-hydroxycortisol, the salivary antipyrine half-life and total oral clearance and the metabolic clearance of urinary NORA, were shown. On the other hand in PM, cimetidine, a probe drug used for inhibition of the MFO system, made it impossible to distinguish PM from EM.

Simvastatin (MK 733) in heterozygous familial hypercholesterolemia: a two-year trial

Simvastatin (MK 733), a new competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, given in daily doses of 20 mg and 40 mg for 104 weeks, has been shown to lower the serum total cholesterol and low density lipoprotein cholesterol level by more than 30% and the serum apoprotein B level by 20% in 19 adult patients with heterozygous familial hypercholesterolemia. A slight but non-significant increase of high density lipoprotein cholesterol levels was shown throughout the trial with significant elevation of the serum apoproteins AI and AII only observed at week 52. Mild and transient clinical or biochemical (increases of creatine phosphokinase and transaminases) side effects, observed in some patients, did not necessitate the withdrawal of the medication. Full ophthalmological examinations did not reveal ocular disturbances, particularly no apparent increase of lens opacities, during the trial. Simvastatin seems to be an effective and safe drug as monotherapy in the treatment of heterozygous familial hypercholesterolemia.

Plasma glucose, insulin, glucagon and prolactin during long lasting lactation

Circulating levels of glucose and particularly those of insulin are significantly lower in African mothers (Kivu, Zaire) nursing their infants than in non pregnant and non lactating women of the same area. Furthermore, the glycemia and the insulinemia increase relatively less after a glucose load in the breastfeeding mothers. The lack of glucose available to the mammary gland may explain the low volumes of milk produced by the lactating mothers in this region of Africa.