Impact of short-duration lifestyle intervention in collaboration with general practitioners in patients with the metabolic syndrome.

AIM: As the constantly progressing metabolic syndrome is accompanied by an increased risk of type 2 diabetes and cardiovascular complications, it is essential to take appropriate, non-pharmacological, cost-effective measures immediately after the diagnosis has been made. The purpose of our prospective, non-controlled, 6-month study was to determine the impact of lifestyle interventions involving patients' behaviour in collaboration with their general practitioners (GPs). METHODS: We recruited 95 patients (46 men and 49 women, aged 45 to 60 years) who presented with the metabolic syndrome. Each patient received a copy of the national French recommendations (PNNS) leaflet, containing guidelines aimed to balance dietary intake and increase daily physical activity. Socioeconomic status was estimated using the EPICES score. Following a less than 1 hour face-to-face interventional session with each patient to present the lifestyle-modification goals, we contacted each patient's GP by phone to advise on measures to reinforce these lifestyle modifications. RESULTS: The percentage of patients presenting with the metabolic syndrome decreased by 52.4% after 6 months. Hypertension, triglycerides and waist circumference decreased by 30.5, 29.3 and 22.0%, respectively, in the study patients. Rates of compliance to PNNS goals at the last follow-up versus baseline were: for drinks, 63.0% versus 22.2%; for sweet products, 91.4% versus 49.4%; for fat, 91.4% versus 80.3%; and for increased exercise, 26.9% versus 6.4%. CONCLUSION: Short-term, single lifestyle modifications targeting the metabolic syndrome in collaboration with GPs was effective in decreasing most of the parameters of the syndrome. However, no factors predictive of success were identified.

Metabolic syndrome and psychosocial deprivation. Data collected from a Paris suburb.

AIM: The association between the metabolic syndrome (MetS) and socioeconomic deprivation has already been recognized. The aim of this study was to examine the relationship between MetS and psychosocial deprivation, and to determine whether or not this relationship is independent of gender, age and obesity. SUBJECTS AND METHODS: The sample included 17074 subjects, aged 16-91 years, who attended the Health Examination Centre of the National Health Insurance Service at Bobigny (a northern suburb of Paris). Exclusion criteria were known diabetes and current lipid-lowering treatment. MetS was defined according to NCEP-ATP III criteria. Psychosocial deprivation was analyzed using the Evaluation of Deprivation and Inequalities by Health Examination Centres (EPICES) score, which includes 11 validated questions and ranges from zero to 100. Psychosocial deprivation was defined as a score greater than or equal to 40. RESULTS: The sample included slightly more women (52.5%) than men, and 52.5% were considered to be deprived. These subjects were slightly older (41 vs 40.2 years, P<0.0001). Around half of the study population benefited from social help. MetS prevalence was higher in the deprived group (11.5% vs 9.4%; P<0.0001), and this was confirmed for every age group. Similarly, the prevalence of all MetS components, except for blood glucose, was significantly higher. The deprivation rate increased with the number of MetS criteria in the non-obese. In a multiple logistic regression, female gender (OR=1.50), age (OR>14 for those over 50 compared with those aged 16-19 years) and deprivation (OR=1.22) were independent predictors of MetS. Taking obese and non-obese populations separately, deprivation remained an independent predictor of MetS only in the non-obese (OR=1.30). CONCLUSION: Psychosocial deprivation is an independent determinant of MetS in non-obese people, and elderly psychosocially deprived women, even if not obese, are at a particularly high risk of MetS. Educational efforts need to be developed to prevent MetS and its consequences in this population.

[Microalbuminuria, a marker of artery rigidity and cardiac dysfunction]. / La microalbuminurie, un marqueur de rigidité artérielle de dysfonctionnement cardiaque.

INTRODUCTION: Microalbuminuria is considered as a marker of endothelial dysfunction and is associated with an increase in cardiovascular risk. The aim of this study was to evaluate this parameter as a potential marker of artery rigidity and left ventricle (LV) function. SUBJECTS AND METHODS: We included 375 subjects referred to a health assessment center. They were 228 men and 147 women aged in means of 52.7 and 53.1 years, respectively. Among this population, 57 had type 2 diabetes, 28 of them with hypertension, 65 were hypertensive but free of diabetes, and 39 were free of diabetes but exhibited a metabolic syndrome (NCEP-ATP III). Urinary albumin excretion rate (UAER) was determined. Artery rigidity was evaluated by pulse pressure of the brachial artery (plethysmographic method), pulse pressure of the radial artery and aorta and pulse wave velocity (PWV) measured by aplanation tonometry (SphygmoCor). LV afterload was appreciated by LV telesystolic pressure and coronary perfusion by the diastolic area/systolic area ratio for aortic pressure curve (Buckberg index). RESULTS: UAER correlated with PWV in the overall population (p<0.0001) and in the diabetic sub-group (p<0.001). In the overall population UAER correlated with LV telesystolic pressure (p=0.006) but not with Buckberg index. In the overall population and the diabetic subgroup, the artery rigidity indexes correlated strongly with LV telesystolic pressure, and radial and aortic pulse pressure correlated negatively with Buckberg index. CONCLUSION: These data suggest that 1) microalbuminuria may be considered as a marker of artery rigidity, in line with experimental data which indicate the deleterious role of endothelial dysfunction on artery compliance; 2) artery rigidity is a potent determinant of LV afterload and coronary perfusion, in particular in diabetic patients.

Migrant adults with diabetes in France: Influence of family migration.

AIM: To explore the influence of migration and this parameters on the control of diabetes. METHODS: A cohort of migrant patients with type 2 diabetes was recruited in a center affiliated to the French national insurance system situated in a department with important migratory phenomenon. Patients fulfilled a questionnaire about diabetes, their migration history, and the EPICES score (deprivation score). We have explored by univariate and multivariate analysis if any of the characteristics of migration could be related to the control of diabetes. This cohort was compared to a non-migrant control group of age and sex-matched patients. RESULTS: We included 72 patients, 36 women and 36 men from 20 different countries. The mean age was 57.7 ± 9.6 years. A migration for family reunification was associated with better diabetes equilibrium (Risk of having an HbA1c ⩾8% (63.9 mmol/mol): OR 0.07 (95% IC [0.005-0.86], p = 0.04). The migrant patients who wished to share their time between France and country of origin during their retirement had a better glycaemic control than the migrant patients who would like to go alone into their country (OR 0.08 [0.01-0.78], p = 0.03). Compared to the non migrant group, the EPICES score was higher in the migrant group (52.8 vs. 28.3, p < 0.05), HbA1c was also higher in the migrant group (8.4 vs. 6.7% (68 vs. 50 mmol/mol)). CONCLUSIONS: We may fear that migrants share an increased risk of uncontrolled diabetes. Individual migration could be a risk factor of uncontrolled diabetes. Knowing the migration history of migrant patients is fundamental to understand some barriers of care.

[Role of vagosympathetic balance in obesity-induced hypertension]. / Rôle de la balance vagosympathique dans l'hypertension associée à l'obésité.

A sympathetic hyperactivity is a common feature in hypertension, type 2 diabetes (T2D), ageing and obesity-induced hypertension. This increase in sympathetic activity may lead to an elevation of arterial rigidity. By contrast, cardiac parasympathetic impairment is observed in these pathologies. Recently we showed in a model of rats with massive obesity (ventromedial hypothalamic lesions) that an enhanced vagal activity may be protective against hypertension. The aim of the present study was to evaluate the influence of an increase in sympathetic activity and a change in vagal activity on arterial rigidity and hypertension in T2D patients. Fourteen hypertensive T2D patients aged 54 +/- 2 years were compared to 22 elderly normotensive subjects (75 +/- 1 years: 11 controls and 11 T2D) and 34 middle aged normotensive subjects (43 +/- 1 years; 17 controls and 17 T2D). Cardiovascular vagosympathetic activity was investigated by spectral analysis of heart rate (HR) and blood pressure (BP) (Finapres) during 6 min at a controlled breathing rate (12 cycles/min). BP and the low frequencies of systolic BP (LF-SBP) were significantly (p<0.01) higher in hypertensive T2D and elderly patients. Pulse pressure (PP) and the high frequencies of HR (HF-HR) were lower in hypertensive T2D patients. PP was positively correlated to LF-SBP (r=0.58; p=0.03) only in hypertensive T2D patients. Diastolic BP was negatively correlated to HF-HR in elderly control subjects (r=-0.63; p=0.03) but not in hypertensive T2D patients. The present results suggest that: sympathetic nervous system activity is enhanced in subjects over 70 years without any aggravating effect of T2D and in middle-aged hypertensive patients with type 2 diabetes; the increase in pulse pressure, an index of arterial rigidity, in elderly subjects may result from sympathetic override; the decrease in the cardiac sympathovagal balance, mainly due to a high vagal activity, may be protective against the occurrence of hypertension in patients with type 2 diabetes.

[Food habits of adults in France. Epidemiological data]. / Comportements alimentaires des adultes en France. Données épidémiologiques.

During the year 1990, 43,440 men and women aged from 17 to 69 years accepted to fill the NAQA questionnaire (18 items) on feeding habits, as part of a routine health examination. The frequency of consumptions and the amounts of food consumed are reported here according to sex. Mean energy intake was 2,586 kcal for men and 1,758 kcal for women and consisted of: fats 102 and 74 g respectively, sucrose 60 and 35 g, proteins 95 and 72 g, alcohol 24 and 4 g, calcium 1,128 and 982 mg and cholesterol 457 and 341 mg. For both men and women 16 percent and 16.8 percent respectively of non-alcohol intakes were made of proteins and 38 percent and 38.6 percent of lipids. Calcium intake was low in 7.5 percent of the subjects. Data analysis by sex and 10-year age groups showed a decrease of fats and sucrose rations and stability of protein rations as the subjects were growing older. These results were similar to those of a recent survey performed with the food history technique. The data obtained by us are an interesting source of information for Public Health epidemiology. They are compared with those found in the literature and discussed.

[Validity of a short self-administered dietary questionnaire compared with a dietetic interview]. / Validité d'un auto-questionnaire alimentaire court par comparaison avec un entretien diététique.

The dietary intakes of 250 men and women aged from 17 to 60 years were evaluated by means of a self-administered questionnaire. The purpose of this study was to develop and optimise a self-administered questionnaire deliberately reduced to 20 questions. The results were compared with those of a dietetic interview using the diet history method. The correlation coefficients for the main nutrients were determined by multivariate regression analysis and were found to fall in the 0.44-0.80 range (P less than 0.001). It is concluded that the self-administered questionnaire is satisfactory and valid as compared with the diet history method. The degree of validity reached is such that efficient epidemiological studies can be conducted at small cost, and the subjects at risk due to the main dietary errors listed in the contemporary French population can be detected.

Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population.

BACKGROUND/OBJECTIVES: Lower-income subgroups consume fewer servings of fruit and vegetables (FVs) compared with their more advantaged counterparts. To overcome financial barriers, FV voucher delivery has been proposed. SUBJECTS/METHODS: In a 12-month trial, 302 low-income adults 18-60 years old (defined by evaluation of deprivation and inequalities in health examination centers, a specific deprivation score) were randomized into two groups: dietary advice alone ('advice'), or dietary advice plus FV vouchers ('FV vouchers') (10-40 euros/month) exchangeable for fresh fruits and vegetables. Self-reported data were collected on FV consumption and socioeconomic status at baseline, 3, 9 and 12 months. Anthropometric and blood pressure measurements were conducted at these periods, as well as blood samples obtained for determination of vitamins. Descriptive analyses, multiple linear regression and logistic regression were performed to evaluate the impact of FV. RESULTS: Between baseline and 3-month follow-up, mean FV consumption increased significantly in both the 'advice' (0.62±1.29 times/day, P=0.0004) and 'FV vouchers' groups (0.74±1.90, P=0.002), with no difference between groups. Subjects in the FV vouchers group had significantly decreased risk of low FV consumption (<1 time/day) compared with those in the advice group (P=0.008). No change was noted in vitamin levels (vitamin C and ß-carotene). The high number of lost-to-follow-up cases did not permit analysis at 9 or 12 months. CONCLUSION: In the low-income population, FV voucher delivery decreased the proportion of low FV consumers at 3 months. Longer-term studies are needed to assess their impact on nutritional status.

Patients' impatience is an independent determinant of poor diabetes control.

AIMS: Some individuals have a preference for the present rather than for the future. We investigated the impact of this impatient relationship to temporality on adherence to medication and HbA(1c) level in type 2 diabetic patients. METHODS: An observational, cross-sectional monocenter study in 90 patients consulting for a health check-up at a Center for Preventive Medicine. We used questionnaires assessing adherence to medication, impatience in a fictive monetary choice (preferring a smaller amount now to a higher amount later) and in daily life situations, foresight, locus of control, and social deprivation. RESULTS: Impatience in the monetary choice was associated with non-adherence to medication (P=0.005). In a multivariate logistic regression model, the risk of observing HbA(1c)≥7% was associated with a long duration of diabetes (OR 5.2, CI 1.7-15.7, P=0.003), monetary impatience (OR=5.1, CI 1.7-15.4, P=0.004), a high "chance and other people" score of the locus of control (OR=5.1, CI 1.7-15.7, P=0.004), a suboptimal foresight (OR 3.9, CI 1.2-12.0, P=0.02). A decision-tree analysis (CHAID algorithm) showed that in this cohort of 90 patients, the 11 people who were adherent to medication, patient in the monetary scenario, had optimal foresight, and gave importance neither to chance nor to other people, had all HbA(1c) below 7%. CONCLUSION: An impatient relationship to temporality was found associated with non-adherence to medication and uncontrolled HbA(1c) in type 2 diabetic patients. Treatment strategies for chronic diseases should be tailored according to this novel dimension of psychology.

Android fat distribution by age and sex. The waist hip ratio.

The waist hip ratio, an indicator of upper body fat distribution, is an early sign of atherogenic disease and diabetes risk. The distribution of the waist hip ratio in 18,393 members of the French population aged 17 to 60 years is described according to sex and five year age groups. Men had a higher mean waist hip ratio (0.913 vs 0.791, p < 0.001) and women a higher standard deviation (0.074 vs 0.067, p < 0.001). The distributions overlapped by only 33%. Sex-specific figures show the waist hip dispersion according to age. If this parameter is a reliable clinical indicator in cardiovascular and metabolic epidemiology these descriptive data are essential. They precede the study of possible associations between the waist hip ratio and the risk factors for insulin resistance, atherogenic diseases and diabetes.

Relations among night work, dietary habits, biological measure, and health status.

A cross-sectional study was conducted to investigate dietary intake, behavioral habits, and clinical and metabolic differences in night workers compared to day workers and to evaluate the metabolic differences associated with diet and body habits that occur between these two groups. Dietary habits, biological parameters, and health status were collected in 1,200 night workers and in an equal number of day workers, matched for gender, age, and socioeconomic status. Our findings demonstrated that night workers had poorer dietary habits and metabolic profile compared to day workers with a similar overall health status. These differences were associated with a higher prevalence of some cardiovascular risk factors such as smoking and obesity.