Growth Trajectories of Body Mass Index during Childhood: Associated Factors and Health Outcome at Adulthood.

OBJECTIVE: To identify body mass index (BMI) trajectories from birth to age 10 years and to assess their association with child and parental characteristics and with adult nutritional status and metabolic risk factors. STUDY DESIGN: Retrospective cohort study with 1188 subjects aged 20-60 years. Childhood growth was assessed using measured weight and height data collected retrospectively from health booklets, which also provided information on gestational age, birth weight, and early nutrition. Height, weight, waist circumference, fasting blood glucose, lipids profile, and blood pressure were measured at adulthood. Participants self-reported parental silhouette based on a 9-figural scale. Group-based modeling was applied to identify BMI trajectories. Associations were assessed using ANOVA and multiple logistic regression. RESULTS: Five growth trajectories following or crossing BMI percentiles emerged: stable-25th (15.3% of the sample), stable-50th (35.9%), stable-75th (28.0%), ascending-75th (19.2%), and ascending-obesity (1.6%). Overall, associated factors from early life were mother's corpulence (higher in the ascending-obesity group), gestational age (higher in the stable-50th, stable-75th, and in the ascending-obesity groups), and birth weight (higher in the ascending-obesity group) (all P < .05). Childhood trajectories were associated with adult BMI and waist circumference (higher in the stable-75th and in the ascending groups) (all P < .0001). CONCLUSIONS: This study shows heterogeneity in patterns of growth trajectories. Specific trajectories were associated with greater BMI and waist circumference during adulthood. Monitoring growth trajectories may improve chronic disease prevention.

Assessment of the ecological bias of seven aggregate social deprivation indices.

BACKGROUND: In aggregate studies, ecological indices are used to study the influence of socioeconomic status on health. Their main limitation is ecological bias. This study assesses the misclassification of individual socioeconomic status in seven ecological indices. METHODS: Individual socioeconomic data for a random sample of 10,000 persons came from periodic health examinations conducted in 2006 in 11 French departments. Geographical data came from the 2007 census at the lowest geographical level available in France. The Receiver Operating Characteristics (ROC) curves, the areas under the curves (AUC) for each individual variable, and the distribution of deprived and non-deprived persons in quintiles of each aggregate score were analyzed. RESULTS: The aggregate indices studied are quite good "proxies" for individual deprivation (AUC close to 0.7), and they have similar performance. The indices are more efficient at measuring individual income than education or occupational category and are suitable for measuring of deprivation but not affluence. CONCLUSIONS: The study inventoried the aggregate indices available in France and evaluated their assessment of individual SES.

Let's move our health! The experience of 40 physical activity motivational workshops / Bougeons notre santé ! L'expérience de 40 ateliers de motivation à l'activité physique.

Aims: To set up physical activity promotion workshops in health centres to help people with a sedentary lifestyle achieve an adequate level of physical activity. Methods: This health programme, called 'Bougeons Notre Santé' (Let's move our health) has been implemented since 2006 by four health centres in the Pays de la Loire region, in France. This article describes implementation of the programme, its feasibility, how it can be integrated into a global preventive approach and its outcomes on promoting more physical activity. The "Let's move our health!" programme comprises four group meetings with participants over a period of several months. At these meetings, participants discuss, exchange and monitor their qualitative and quantitative level of physical activity. Realistic and achievable goals are set in consultation with each participant in relation to their personal circumstances and are monitored with a pedometer and a follow-up diary. Support on healthy eating is also provided. This programme is an opportunity to promote health and refer participants to existing local resources. Results: Forty groups, comprising a total of 275 people, have participated in the programme since 2006. After the four meetings, participants had increased their physical activity level by an average of 723 steps per day and 85% reported that they had changed their eating habits. Conclusion: This health promotion programme is feasible and effective: an increase in the physical activity of participants was observed, together with a favourable impact on perceived health, well-being and social links. These workshops are integrated into a network of associations and institutional partners and could be implemented by similar social or health organisations.

Seasonal variations do not affect the superiority of fecal immunochemical tests over guaiac tests for colorectal cancer screening.

The aim of this study was to compare the seasonal variation in performance of a faecal immunochemical test for haemoglobin (FIT) and a guaiac test (gFOBT) for colorectal cancer screening. From June 2009 to May 2011, 18,290 screening participants (50-74 years old) performed OC-SENSOR quantitative FIT (1 sample) and Hemoccult II gFOBT (3 stool samples with 2 spots/sample). Referral for colonoscopy required a minimum of one positive spot (gFOBT), or a positive FIT [cut-off 150 ng haemoglobin/mL buffer (i.e. 30 µg haemoglobin/g feces)]. The performance of tests for detection of advanced neoplasia was compared according to seasons using Receiver Operating Characteristics (ROC) curves, at various FIT cut-off values. The positivity rate of FIT was significantly lower in the summer compared with other seasons (2.3% versus 3.0%, p = 0.03), whilst the positivity rate of gFOBT increased in the autumn (1.8% versus 1.5%, p = 0.11). FIT was clinically more effective than gFOBT over the four season-specific ROC curves. At the cut-off concentration used in the study, the season-specific FIT/gFOBT ratios for true positive rates were: 2.8 (Autumn), 2.5 (Winter), 3.0 (Spring), 3.7 (Summer), and for false positive rates: 1.2 (Autumn), 1.5 (Winter), 1.8 (Spring), 0.9 (Summer). Therefore, in this study with this cut-off concentration and in spite of lower positivity rate in summer, the seasonal variations of performance of OC-SENSOR FIT led to improved gain in specificity in the summer, without a decrease in gain in sensitivity compared with gFOBT.

Type 2 diabetes-related genetic risk scores associated with variations in fasting plasma glucose and development of impaired glucose homeostasis in the prospective DESIR study.

AIMS/HYPOTHESIS: Genome-wide association studies have firmly established 65 independent European-derived loci associated with type 2 diabetes and 36 loci contributing to variations in fasting plasma glucose (FPG). Using individual data from the Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) prospective study, we evaluated the contribution of three genetic risk scores (GRS) to variations in metabolic traits, and to the incidence and prevalence of impaired fasting glycaemia (IFG) and type 2 diabetes. METHODS: Three GRS (GRS-1, 65 type 2 diabetes-associated single nucleotide polymorphisms [SNPs]; GRS-2, GRS-1 combined with 24 FPG-raising SNPs; and GRS-3, FPG-raising SNPs alone) were analysed in 4,075 DESIR study participants. GRS-mediated effects on longitudinal variations in quantitative traits were assessed in 3,927 nondiabetic individuals using multivariate linear mixed models, and on the incidence and prevalence of hyperglycaemia at 9 years using Cox and logistic regression models. The contribution of each GRS to risk prediction was evaluated using the C-statistic and net reclassification improvement (NRI) analysis. RESULTS: The two most inclusive GRS were significantly associated with increased FPG (ß = 0.0011 mmol/l per year per risk allele, p GRS-1 = 8.2 × 10(-5) and p GRS-2 = 6.0 × 10(-6)), increased incidence of IFG and type 2 diabetes (per allele: HR GRS-1 1.03, p = 4.3 × 10(-9) and HR GRS-2 1.04, p = 1.0 × 10(-16)), and the 9 year prevalence (OR GRS-1 1.13 [95% CI 1.10, 1.17], p = 1.9 × 10(-14) for type 2 diabetes only; OR GRS-2 1.07 [95% CI 1.05, 1.08], p = 7.8 × 10(-25), for IFG and type 2 diabetes). No significant interaction was found between GRS-1 or GRS-2 and potential confounding factors. Each GRS yielded a modest, but significant, improvement in overall reclassification rates (NRI GRS-1 17.3%, p = 6.6 × 10(-7); NRI GRS-2 17.6%, p = 4.2 × 10(-7); NRI GRS-3 13.1%, p = 1.7 × 10(-4)). CONCLUSIONS/INTERPRETATION: Polygenic scores based on combined genetic information from type 2 diabetes risk and FPG variation contribute to discriminating middle-aged individuals at risk of developing type 2 diabetes in a general population.

HbA1c, fasting and 2 h plasma glucose in current, ex- and never-smokers: a meta-analysis.

AIMS/HYPOTHESIS: The relationships between smoking and glycaemic variables have not been well explored. We compared HbA1c, fasting plasma glucose (FPG) and 2 h plasma glucose (2H-PG) in current, ex- and never-smokers. METHODS: This meta-analysis used individual data from 16,886 men and 18,539 women without known diabetes in 12 DETECT-2 consortium studies and in the French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) and Telecom studies. Means of three glycaemic variables in current, ex- and never-smokers were modelled by linear regression, with study as a random factor. The I (2) statistic was used to evaluate heterogeneity among studies. RESULTS: HbA1c was 0.10% (95% CI 0.08, 0.12) (1.1 mmol/mol [0.9, 1.3]) higher in current smokers and 0.03% (0.01, 0.05) (0.3 mmol/mol [0.1, 0.5]) higher in ex-smokers, compared with never-smokers. For FPG, there was no significant difference between current and never-smokers (-0.004 mmol/l [-0.03, 0.02]) but FPG was higher in ex-smokers (0.12 mmol/l [0.09, 0.14]). In comparison with never-smokers, 2H-PG was lower (-0.44 mmol/l [-0.52, -0.37]) in current smokers, with no difference for ex-smokers (0.02 mmol/l [-0.06, 0.09]). There was a large and unexplained heterogeneity among studies, with I (2) always above 50%; I (2) was little changed after stratification by sex and adjustment for age and BMI. In this study population, current smokers had a prevalence of diabetes that was 1.30% higher as screened by HbA1c and 0.52% lower as screened by 2H-PG, in comparison with never-smokers. CONCLUSION/INTERPRETATION: Across this heterogeneous group of studies, current smokers had a higher HbA1c and lower 2H-PG than never-smokers. This will affect the chances of smokers being diagnosed with diabetes.

A population-based comparison of immunochemical fecal occult blood tests for colorectal cancer screening.

BACKGROUND & AIMS: Quantitative fecal immunochemical tests (FITs) identify individuals with colorectal cancer with greater levels of accuracy than guaiac tests. We compared the performances of 2 FITs in a population undergoing screening for colorectal cancer. METHODS: We collected fecal samples from 19,797 individuals in France (age, 50-74 y) who participated in a colorectal cancer screening program, from June 2009 through May 2011. Samples were analyzed using the Magstream (Fujirebio Inc, Tokyo, Japan) and OC Sensor (Eiken Chemical Co, Tokyo, Japan) (2 samples each) FITs, as well as the Hemoccult II guaiac test (SKD, Villepinte, France) (3 samples each). Colonoscopies were performed for patients with positive results from all 3 tests. The cut-off values for levels of hemoglobin in buffer and stools were 55 ng/mL and 180 µg/g for the Magstream and 150 ng/mL and 30 µg/g for the OC Sensor, respectively. Results from the FITs were compared with those from the guaiac test for cut-off values for stool samples, positivity rates, and the receiver operating characteristic curve values. The numbers needed to screen and the numbers needed to scope to detect an advanced neoplasia (cancer, adenoma ≥10 mm, or high-grade dysplasia) were calculated. RESULTS: A positive test result was found in 1224 participants (6.2%); 1075 (87.8%) underwent a colonoscopy examination. Of these, 334 were found to have advanced neoplasia. Considering the cut-off values associated with the positivity rate of Hemoccult II (1.6%), the numbers needed to screen were 239 for Hemoccult II, 166 for a 1-sample Magstream FIT, and 129 for a 1-sample OC Sensor FIT; the numbers needed to scope were 3.3, 2.3, and 1.8, respectively. For the same false-positive rate as Hemoccult II (0.98%), the true-positive rates for Magstream and OC Sensor FITs were 0.65% and 0.90% respectively, compared with 0.42% for Hemoccult II. The OC Sensor FIT had a greater area under the receiver operating characteristic curve value than the Magstream FIT. CONCLUSIONS: Based on results from a large, population-based study, the OC Sensor FIT identifies patients with colorectal cancer with greater accuracy than the Magstream FIT. ClinicalTrials.gov number: NCT01251666.

Deprivation and health risk indicators in full-time permanent workers.

BACKGROUND: Association between deprivation and health is well established, particularly among unemployed or fixed-term contract or temporary contract subjects. This study aimed to assess if this relationship existed as well in full-time permanent workers. METHODS: Biometrical, biological, behavioural and psychosocial health risk indicators and an individual deprivation score, the Evaluation of Precarity and Inequalities in Health Examination Centres score, were recorded from January 2007 to June 2008, in 34 905 full-time permanent workers aged 18-70 years, all volunteers for a free health examination. Comparisons of the behavioural, metabolic, cardiovascular and health risk indicators between quintiles of the deprivation score with adjustments on age and socioeconomic categories were made by covariance analysis or logistic regression. RESULTS: For both genders, degradation of nutritional behaviours, metabolic and cardiovascular indicators and health appeared gradually with deprivation, even for deprivation score usually considered as an insignificant value. The absence of only one social support or one social network was associated with a degradation of health. Full-time permanent workers with the poorest health risk indicators had more frequent social exclusion signs. These results were independent of socioeconomic categories and age. CONCLUSION: Understanding how deprivation influences health status may lead to more effective interventions to reduce social inequalities in health. The deprivation Evaluation of Precarity and Inequalities in Health Examination Centres score is a relevant tool to detect subjects who could benefit from preventive interventions. Our findings suggest that this deprivation score should be used as a health risk indicator even in full-time permanent workers. Assessing deprivation is useful to design and evaluate specific intervention programmes.

Parental history of type 2 diabetes, TCF7L2 variant and lower insulin secretion are associated with incident hypertension. Data from the DESIR and RISC cohorts.

AIMS/HYPOTHESIS: The relationship between insulin secretion and the incidence of hypertension has not been well characterised. We hypothesised that both a parental history of diabetes and TCF7L2 rs7903146 polymorphism, which increases susceptibility to diabetes because of impaired beta cell function, are associated with incident hypertension. In a separate cohort, we assessed whether low insulin secretion is related to incident hypertension. METHODS: Nine year incident hypertension was studied in 2,391 normotensive participants from the Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) cohort. The relationship between insulin secretion and 3 year incident hypertension was investigated in 1,047 non-diabetic, normotensive individuals from the Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) cohort. Insulin secretion during OGTT was expressed in relation to the degree of insulin resistance, as assessed by a hyperinsulinaemic-euglycaemic clamp. RESULTS: In the DESIR cohort, a parental history of diabetes and the TCF7L2 at-risk variant were both associated with hypertension incidence at year 9, independently of waist circumference, BP, fasting glucose, insulin levels and HOMA-IR at inclusion (p = 0.02 for parental history, p = 0.006 for TCF7L2). In the RISC cohort, a lower insulin secretion rate during the OGTT at baseline was associated with both higher BP and a greater risk of hypertension at year 3. This inverse correlation between the insulin secretion rate and incident hypertension persisted after controlling for baseline insulin resistance, glycaemia and BP (p = 0.007). CONCLUSIONS/INTERPRETATION: Parental history of diabetes, TCF7L2 rs7903146 polymorphism and a reduced insulin secretion rate were consistently associated with incident hypertension. A low insulin secretion rate might be a new risk factor for incident hypertension, beyond insulin resistance.

The association between cystatin C and incident type 2 diabetes is related to central adiposity.

BACKGROUND: Cystatin C has recently been shown to be associated with incident type 2 diabetes. This study aims to validate this association and to study the impact of baseline adiposity. METHODS: We investigated the 3-year diabetes incidence in 2849 participants from the French Data of an Epidemiological Study on the Insulin Resistance syndrome study, without overt kidney disease. Odds ratios (ORs) associated with cystatin C were adjusted for classical diabetes risk factors and interactions between cystatin C and these risk factors were studied. RESULTS: Baseline serum cystatin C was significantly associated with incident diabetes on univariate analysis (OR/1 SD of log cystatin C: 1.74; 95% confidence interval [CI] 1.33-2.28; P=0.0001) and after adjustment for age and gender (OR 1.55; 95% CI 1.15-2.10; P=0.0039). This association was independent of serum creatinine-derived measures of baseline renal function and independent of fasting plasma glucose and HbA1c. When body mass index (BMI), waist circumference or baseline insulin resistance index were used as covariates, there was an interaction with cystatin C level. Cystatin C was associated only with incident diabetes for people with BMI, waist circumference or insulin resistance index≥median value with OR (95% CIs), respectively: 1.35 (0.98-1.84, P=0.0625); 1.39 (1.01-1.91, P=0.0441) and 1.41 (1.02-1.94, P=0.0398). CONCLUSIONS: Cystatin C was associated with 3-year incident diabetes but only in people with central adiposity or insulin resistance. This should be considered in further studies assessing the clinical relevance of its prognostic value.

Dairy products and the metabolic syndrome in a prospective study, DESIR.

OBJECTIVE: In previous cross-sectional analyses of the Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) cohort, we have found inverse associations between dairy product consumption and metabolic syndrome (MetS) traits. We have now analyzed in a prospective way the influence of dairy product and calcium consumption at inclusion on the 9-year cumulative incidence of the MetS and associated traits in the French prospective study with a 9-year follow-up, DESIR. METHODS: After exclusion of diabetic subjects and those being on a diet at inclusion, 3417 men and women who completed a food frequency at baseline could be studied. Logistic regression models were used to study associations between dairy products and dietary calcium density at baseline and incident MetS and impaired fasting glycemia/type 2 diabetes (IFG/T2D) after adjusting for gender, age, and lifestyle parameters (alcohol, smoking, physical activity, fat intake). An additional model adjusting for the same covariates and for body mass index (BMI) was also used. Associations between dairy products and continuous variables were studied by repeated measures analysis of covariance, using the same covariates. RESULTS: Total dairy product consumption, dairy (except cheese) consumption, and dietary calcium density were inversely associated with incident MetS and IFG/T2D. Cheese consumption was negatively associated with incident MetS but not with glycemic disorders. All parameters were associated with lower diastolic blood pressure and triglycerides (average over the 9-year period) and with a lower BMI gain in the same period. Higher total dairy and cheese intake and calcium density were associated with a lower increase in waist circumference and triglycerides during the 9-year follow-up. CONCLUSION: In the French general population, these results show beneficial effects of dairy product consumption on the metabolic syndrome and glycemic disorders. Therefore, dairy product consumption could be protective against cardiovascular risk.

[Age and sex variations of HbA(1C) in a French population without known diabetes aged 6 to 79 years]. / Évolution de l'HbA(1C) en fonction de l'âge et du sexe dans une population française de sujets sans diabète connu âgés de 6 à 79 ans.

HbA(1C) is being used for screening and diagnosing diabetes. We determined mean values of HbA(1C) according to age and sex in a large population without known diabetes, in a wide age range 6-79  years. 5,138 men and women without known diabetes aged 6-79  years participated in a routine health examination provided by their medical insurance. HbA(1C) was assessed on an HPLC analyzer aligned with a DCCT method. HbA(1C) was approximately normally distributed in both men and women. Mean (SD) HbA(1C) were, for men vs women, in percentages 5.3 (0.4) vs 5.2 (0.3), in mmol/mol 34 (5) vs 34 (4) and in estimated blood glucose in mmol/L 5.83 (0.67) vs 5.75 (0.53). HbA(1C) increased with age by 0.08% every 10  years and this was attenuated to a 0.04% increase after adjustment on fasting plasma glucose. Between 15 and 49  years, women had lower values than men (p < 0.0001), but no sex differences were observed before and after this age range. In our population, 0.6% had HbA(1C) greater or equal to 6.5% and 88% (96% of men and 73% of women) of them had fasting plasma glucose greater or equal to 6,1 mmol/L. Threshold of 6.0% selected 2.8% of our population.

Stay-at-Home Orders During the COVID-19 Pandemic, an Opportunity to Improve Glucose Control Through Behavioral Changes in Type 1 Diabetes.

OBJECTIVE: To investigate the impact of coronavirus disease 2019 lockdown on glycemic control and associated factors in people living with type 1 diabetes. RESEARCH DESIGN AND METHODS: An observational evaluation from a self-reported questionnaire on behavioral changes and glycemic information from flash glucose monitoring (FGM) during the lockdown in 1,378 individuals living with type 1 diabetes who used a French dedicated nationwide web application (CoviDIAB). RESULTS: The main outcome was the change of the mean glucose level 2 months before and 1 month after the lockdown. We found that mean glucose improved from 9.1 ± 1.7 mmol/L to 8.7 ± 1.7 mmol/L (P < 0.001). Factors associated with better glycemic control were a decrease of alcohol consumption (odds ratio [OR] 1.75 [95% CI 1.04-2.94]), an increase in the frequency of FGM scans (OR 1.48 [1.04-2.10]) and in the number of hypoglycemia events (OR 1.67 [1.13-2.46]), and an easier diabetes control perception (OR 1.71 [1.18-2.49]). CONCLUSIONS: Our findings suggest that lockdown has a positive impact on glycemic control in people with type 1 diabetes.

[French shift workers seen at health centres have an increased risk of lipid disorders]. / Perturbation du métabolisme lipidique chez des travailleurs postés consultants de centres d'examens de santé.

AIMS: To describe cardiovascular risk factors and metabolic disturbances in a French population including shift workers and study whether possible changes were noticeable after non-shift to shift work transition within the last five years. METHODS: The study population included 4764 attendees of two health examinations (5 years apart), between January 1996 and October 2008, in 11 health examination centres. Clinical, biological and metabolic factors together with their changes over a five-year period were compared between attendees who kept a non-shift daytime job, those who kept working shift and those who switched from non-shift daytime to shift work over the last 5 years. RESULTS: At baseline, working shift was, independently of lifestyle or BMI, significantly related to more elevated plasma triglycerides (ß=0.04, P=0.05) and rate of hypertriglyceridemia (ß=0.27, P=0.01), lower plasma HDL-C levels (ß=-2.03, P=0.006) and less hypertension (ß=-0.25, P=0.01) compared to non-shift daytime work. In men, a slightly more elevated yet non significant proportion of hypertriglyceridemia was observed with the transition from non-shift daytime to shift work within the last 5 years in comparison to men who kept a non-shift daytime job (13.9% vs. 11.0% P=0.17). CONCLUSION: Our results are in agreement with previous studies showing a deleterious effect of shift work on lipid metabolism. In our population, triglycerides and HDL-C levels were the main parameters negatively influenced by shift work. Consequently, a regular biological monitoring together with the promotion of healthy behaviours should be provided to shift workers before negative consequences of working shift become noticeable.

[Promote better nutritional behaviours among shift workers with night shift]. / Promouvoir un meilleur comportement nutritionnel chez les travailleurs postés avec horaires de nuit.

AIM: Shift work, especially including a night shift, is associated with degradation of physical, social and psychosocial health as well as poor well-being. Food imbalance and low physical activity contributed to the negative effects on health. Our objective was to promote a healthier nutritional behaviour according to the French national nutrition and health program recommendations (PNNS). METHODS: A one-year nutritional intervention with personalised dietetic counselling was proposed to 235 shift workers with night shift who came for a health prevention exam in one of the centres of the Institut Inter-Régional pour la Santé between 2009 and 2011. The intervention was three dietary interviews: at baseline with definition of goal setting, at 3 months for advice and support and at one-year for the evaluation. At 6 months, a personalised reminder letter was send. Compliance with the PNNS recommendations and level of physical activity were evaluated at baseline and at one-year by a self-administered questionnaire. Changes between baseline and follow-up were compared by paired t-tests or McNemar-tests. RESULTS: The rate of follow-up was 57.4%. At the end of the study, subjects improved their compliance with PNNS guidelines concerning sweetened products (P<0.001), water (P=0.02) and salt (P=0.05), increased their leisure physical activity (P=0.001) and decreased their daily energy intakes (P<0.001). CONCLUSION: A structured intervention can improve nutritional behaviours of shift workers. This intervention enabled to inform and alert on the risk related to this work schedule and promote better nutritional behaviours.

Comparison between copeptin and vasopressin in a population from the community and in people with chronic kidney disease.

CONTEXT: Vasopressin plays a central role in water homeostasis but it has also been recognized to be associated with adverse effects in several chronic diseases. Recently, copeptin has been increasingly used as a surrogate for vasopressin, as they are co-secreted, and copeptin is easier to measure. However, the relationship between plasma concentrations of copeptin (P(cop)) and vasopressin (P(vp)) has only been studied in relatively small numbers of selected people. OBJECTIVE: This study sought to evaluate the relationship between P(vp) and P(cop) in a community-based population and in people with chronic kidney disease (CKD). DESIGN, SETTING, AND PARTICIPANTS: P(vp), P(cop), and urinary osmolarity (Uosm) were compared in 500 participants of the DESIR study, and in 83 ambulatory people with CKD. RESULTS: Median [interquartile range] of P(cop) and P(vp) in the DESIR study were 4.13 [3.58] pmol/L and 0.92 [1.93] pmol/L, respectively. Log-transformed P(cop) and P(vp) concentrations correlated significantly and positively (r = 0.686, P < .001) and they correlated inversely with estimated U(osm) (P < .001). Copeptin explained only approximately half of the vasopressin variation. In CKD, P(cop) and P(vp) both increased with decreasing estimated glomerular filtration rate (eGFR), but P(cop) increased much faster than P(vp). The P(cop)/P(vp) ratios in the lower and upper quintile groups of eGFR were 14.3 [18.3] and 5.3 [4.5], P < .001, respectively. CONCLUSIONS: This study in a normal population, the largest ever with measurements of both peptides, shows that copeptin and vasopressin concentrations correlated well. But their relationship is distorted in CKD, suggesting that the peptide clearances differ when the renal function is impaired.

[Determination of full blood count normal reference values for adults in France]. / Étude des valeurs normales de l'hémogramme chez l'adulte: un besoin pour une meilleure interprétation et pour l'accréditation du laboratoire.

The full blood count (FBC) is the most prescribed laboratory test in France. Due to the lack of data, there is a great variability in reference values of the FBC, between medical laboratories. The aim of this work was to provide normal reference values for FBC in adults. These normal values were defined in a population of 33 258 healthy adults, 19 612 men and 13 646 women. These values were determined after excluding subjects having conditions in order to modify, either directly or indirectly, FBC parameters. For each parameter, we provide results for values of standard parameters, by sex and age, from 16 to 69 years. In addition, we present FBC values from a population of 339 subjects aged over 69 years with no comorbidities. These normal values are proposed to be used in everyday practice. They make it possible to distinguish, without ambiguity, a normal situation from a pathological situation. Moreover, they can be applied to the entire metropolitan France.

Full blood count normal reference values for adults in France.

AIMS: To determine full blood count (FBC) normal reference values for adults. METHODS: FBC normal values for healthy adults were defined, after establishing preanalytical conditions, in a population of 33 258 subjects, 19 612 men and 13 646 women. The values were established after excluding from this population all people having conditions liable to modify, directly or indirectly, FBC parameters. RESULTS: Results for values of standard parameters are provided in detail for each parameter, by sex and by age group from 16 to 69 years of age. In addition, we present FBC values from a population of 339 subjects aged over 69 years with no comorbidities. CONCLUSIONS: These normal values are proposed for use in everyday practice. They make it possible to distinguish, without ambiguity, a normal situation from a pathological situation. Moreover, they might be used over all mainland France.

Blood microbiota dysbiosis is associated with the onset of cardiovascular events in a large general population: the D.E.S.I.R. study.

AIM: We recently described a human blood microbiome and a connection between this microbiome and the onset of diabetes. The aim of the current study was to assess the association between blood microbiota and incident cardiovascular disease. METHODS AND RESULTS: D.E.S.I.R. is a longitudinal study with the primary aim of describing the natural history of the metabolic syndrome and its complications. Participants were evaluated at inclusion and at 3-, 6-, and 9-yearly follow-up visits. The 16S ribosomal DNA bacterial gene sequence, that is common to the vast majority of bacteria (Eubac) and a sequence that mostly represents Proteobacteria (Pbac), were measured in blood collected at baseline from 3936 participants. 73 incident cases of acute cardiovascular events, including 30 myocardial infarctions were recorded. Eubac was positively correlated with Pbac (r = 0.59; P<0.0001). In those destined to have cardiovascular complications, Eubac was lower (0.14±0.26 vs 0.12±0.29 ng/µl; P = 0.02) whereas a non significant increase in Pbac was observed. In multivariate Cox analysis, Eubac was inversely correlated with the onset of cardiovascular complications, (hazards ratio 0.50 95% CI 0.35-0.70) whereas Pbac (1.56, 95%CI 1.12-2.15) was directly correlated. CONCLUSION: Pbac and Eubac were shown to be independent markers of the risk of cardiovascular disease. This finding is evidence for the new concept of the role played by blood microbiota dysbiosis on atherothrombotic disease. This concept may help to elucidate the relation between bacteria and cardiovascular disease.