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

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

Marine toxin C17-SAMT causes major structural damage to vital organs in mice following subchronic toxicity trials.

C17-sphinganine analog mycotoxin (C17-SAMT) has been characterized as the contaminant responsible for the atypical toxicity reported in mussels from the Bizerte lagoon (northern Tunisia) over the past decade. C17-SAMT exhibited common symptoms of toxicity in mice, including flaccid paralysis and severe respiratory distress, followed by rapid death. To determine the potential health risks of this neurotoxin, we assessed its subchronic toxicity according to the recommendations of OCDE n° 407. The body weight and the structural changes of vital organs were recorded. Biochemical and hematological parameters were also quantified. Macroscopic observations showed that mice treated with 0.9, 9, and 90 µg/kg C17-SAMT had significantly reduced stomach weights, swollen and fragile intestines, and signs of nephritis with renal abscesses. Transaminase assays pointed out that exposure to C17-SAMT can lead to transaminitis. Above-average lactate dehydrogenase values were recorded in both the treated and satellite groups. Hematology data showed a significant reduction in red blood cell counts in high-dose-treated group. Reductions in hemoglobin and hematocrit were also recorded. Mean leukocyte counts were significantly elevated in the high-, mid-dose treated and satellite groups. At the microscopic level, we noted myocardial atrophy and hyperemia. In the lungs, we noted necrosis associated with macrophages perivascular infiltration and congestion. The kidneys showed mild inflammation and glomerular atrophy. The stomach exhibited mucosal atrophy, while a thin colon and distended small intestine were observed in high-dose-treated group. The liver was affected by vascular congestion, inflammatory infiltration, and lobular necrosis that evolved into acute hepatitis. Lesions, such as inflammatory infiltration and mild necrosis of the liver, cortical abscess with central necrosis in the kidney, and mild congestion of cardiac tissue were recorded in the satellite group.

The first exome wide association study in Tunisia: identification of candidate loci and pathways with biological relevance for type 2 diabetes.

Introduction: Type 2 diabetes (T2D) is a multifactorial disease involving genetic and environmental components. Several genome-wide association studies (GWAS) have been conducted to decipher potential genetic aberrations promoting the onset of this metabolic disorder. These GWAS have identified over 400 associated variants, mostly in the intronic or intergenic regions. Recently, a growing number of exome genotyping or exome sequencing experiments have identified coding variants associated with T2D. Such studies were mainly conducted in European populations, and the few candidate-gene replication studies in North African populations revealed inconsistent results. In the present study, we aimed to discover the coding genetic etiology of T2D in the Tunisian population. Methods: We carried out a pilot Exome Wide Association Study (EWAS) on 50 Tunisian individuals. Single variant analysis was performed as implemented in PLINK on potentially deleterious coding variants. Subsequently, we applied gene-based and gene-set analyses using MAGMA software to identify genes and pathways associated with T2D. Potential signals were further replicated in an existing large in-silico dataset, involving up to 177116 European individuals. Results: Our analysis revealed, for the first time, promising associations between T2D and variations in MYORG gene, implicated in the skeletal muscle fiber development. Gene-set analysis identified two candidate pathways having nominal associations with T2D in our study samples, namely the positive regulation of neuron apoptotic process and the regulation of mucus secretion. These two pathways are implicated in the neurogenerative alterations and in the inflammatory mechanisms of metabolic diseases. In addition, replication analysis revealed nominal associations of the regulation of beta-cell development and the regulation of peptidase activity pathways with T2D, both in the Tunisian subjects and in the European in-silico dataset. Conclusions: The present study is the first EWAS to investigate the impact of single genetic variants and their aggregate effects on T2D risk in Africa. The promising disease markers, revealed by our pilot EWAS, will promote the understanding of the T2D pathophysiology in North Africa as well as the discovery of potential treatments.

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

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

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

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

Changes in Antioxidant Defense Capability and Lipid Profile after 12-Week Low- Intensity Continuous Training in Both Cigarette and Hookah Smokers: A Follow-Up Study.

To examine the impact of low-intensity continuous training program on antioxidant defense capability and lipid profile in male cigarette or hookah smokers. Forty-three male adults participated in a 12-week continuous training program at an intensity of 40% of VO2max. All subjects were subjected to anthropometric, physical and biochemical tests before and after the training program. The increase of Glutathione reductase (GR) and Superoxide dismutase (SOD) is significant only for cigarette smokers (CS) and hookah smokers (HS) groups. The Malondialdehyde (MDA) decrease and α-tocopherol increase are significant only for HS group. GPx was increased in NS, CS and HS by 2.6% (p< 0.01), 2% (p< 0.05) and 1.7% (p< 0.05) respectively. Likewise, significant improvements of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and TC/HDL-C ratio were observed in three groups. En contrast no significant changes were recorded in triglycerides (TG). Also, significant reduction of total cholesterol (TC) for CS group (p< 0.01) and HS groups (p< 0.05). This continuous training program appears to have an important role in lipid levels improving and oxidative stress attenuation.

The effect of a 12-week moderate intensity interval training program on the antioxidant defense capability and lipid profile in men smoking cigarettes or hookah: a cohort study.

AIM: To examine the impact of interval training program on the antioxidant defense capability and lipid profile in men smoking cigarettes or hookah unable or unwilling to quit smoking. METHODS: Thirty-five participants performed an interval training (2 : 1 work : rest ratio) 3 times a week for 12 weeks at an intensity of 70% of VO2max. All subjects were subjected to a biochemical test session before and after the training program. RESULTS: The increase of total antioxidant status (TAS), glutathione peroxidase (GPx), and α-tocopherol, is significant only for cigarette smokers (CS) and hookah smokers (HS) groups. The decrease of malondialdehyde (MDA) and the increase of glutathione reductase (GR) are more pronounced in smokers groups compared to those of nonsmokers (NS). Superoxide dismutase (SOD) increases in NS, CS, and HS groups by 10.1%, 19.5%, and 13.3%, respectively (P < 0.001). Likewise, a significant improvement of high-density lipoprotein cholesterol (HDL-C) and TC/HDL-C ratio was observed in CS and HS groups (P < 0.05). CONCLUSION: Although the interval training program does not have a significant effect on blood lipid levels, it seems to be very beneficial in the defense and prevention programs of oxidative stress.

Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training.

INTRODUCTION: Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers. AIM: To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers. METHODS: Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity (VO2max). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program. RESULTS: As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved VO2max (4.4 and 4.7%, respectively), v VO2max (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively). CONCLUSIONS: After 12 weeks of interval training program, the increase of VO2max and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved. Intermittent training should be advised in the clinical setting for subjects with adverse health behaviors.

Effect of low-intensity continuous training on lung function and cardiorespiratory fitness in both cigarette and hookah smokers.

BACKGROUND: The decline in cardiorespiratory fitness and lung function was higher in smokers. Training method could mitigate some of the negative consequences of smoking among smokers unable or unwilling to quit. OBJECTIVE: To examine the effects of continuous training on lungs functional capability and cardiorespiratory fitness in smokers. METHODS: Fifteen cigarette smokers, 14 hookah smokers, and 14 nonsmokers were assigned to low-intensity continuous training (20-30 minutes of running at 40% of maximum oxygen uptake (O2max)). Lung function and cardiorespiratory fitness parameters were determined using respectively spirometer and treadmill maximal exercise test. RESULTS: Continuous training improved forced expiratory volume in one second (FEV1) and forced expiratory flow at 50% of FVC (FEF50 %) in all participants, smokers and nonsmokers (p < 0.05). In contrast, forced vital capacity (FVC) improvement was significant only among cigarette smokers (CS) (+1.7±2.21%, p < 0.01) and hookah smokers (HS) (+1.3±1.7 %, p < 0.05). Likewise, an improvement in cardiorespiratory fitness in both smokers groups without significant changes in diastolic blood pressure (DBP) for CS group and in velocity at maximum oxygen uptake (vO2max) for HS group. CONCLUSION: The low-intensity continuous training improves cardiorespiratory fitness and reduces lung function decline in both cigarette and hookah smokers. It seems to be beneficial in the prevention programs of hypertension. It could have important implications in prevention and treatment programs in smokers unable or unwilling to quit.

Triacylglycerols and aliphatic alcohols from fruits of three Tunisian Pistacia lentiscus populations.

BACKGROUND: The search for other sources of vegetable oils by the exploitation and the enhancement of other oil plants will be needed to meet the demands of the international market. This study aims to determine the triacylglycerol (TAG) molecular species and aliphatic alcohol compositions of unexploited fruits of three Tunisian Pistacia lentiscus (lentisc) populations from the Korbous, Tebaba and Rimel areas of Tunisia. RESULTS: Results show that the content of total TAG varies from 738.32 mg g(-1) of total lipid in the Tebaba population to 981.15 mg g(-1) of total lipid in the Korbous population. Furthermore, 14 species of TAG were detected in the three studied populations. In addition, 13 aliphatic compounds were identified and classified into two groups: (1) aliphatic alcohols with fewer than 20 carbon atoms (hexadecanol, heptadecanol, (Z)-octadec-9-en-1-ol, octadecanol and nonadécanol); and (2) the policosanol group (eicosenol, docosenol, docosanol tetracosanol, hexacosanol octacosanol and triacontanol). The Tebaba population showed a distinct composition compared to Korbous and Rimel where heptadecanol is the major compound. CONCLUSION: Quantitatively, the most abundant TAG species are those constituted by palmitic, oleic and/or linoleic acid. Furthermore, the significant difference observed at the oil composition is associated with a remarkable station effect.

Analysis of pecan nut (Carya illinoinensis) unsaponifiable fraction. Effect of ripening stage on phytosterols and phytostanols composition.

Changes in 4-desmethylsterol, 4-monomethylsterol, 4,4-dimethylsterol and phytostanol composition were quantitatively and qualitatively investigated during the ripening of three varieties of Tunisian-grown pecan nuts (Mahan, Moore and Burkett). These components have many health benefits, especially in lowering LDL-cholesterol and preventing heart disease. The phytosterol composition of whole pecan kernel was quantified by Gas Chromatography-Flame Ionisation Detection (GC-FID) and identified by Gas Chromatography-Mass Spectrometry (GC-MS). Fifteen phytosterols and one phytostanol were quantified. The greatest amount of phytosterols (2852.5mg/100g of oil) was detected in Mahan variety at 20 weeks after the flowering date (WAFD). Moore had the highest level of phytostanols (7.3mg/100g of oil) at 20 WAFD. Phytosterol and phytostanol contents showed a steep decrease during pecan nut development. Results from the quantitative characterisation of pecan nut oils revealed that ß-sitosterol, Δ5-avenasterol, and campesterol were the most abundant phytosterol compounds at all ripening stages.

Flaxseed hull: Chemical composition and antioxidant activity during development.

Changes in the chemical composition and antioxidant activity of flaxseed hull during maturation were investigated. P129 hull variety was studied at four maturation stages (St1, St2, St3, and St4). Significant variation in proximate composition and flaxseed hull oil characteristics were observed. A significant increase in the carbohydrates content of the hull was observed during development. The main methyl esters were linolenic acid (48.95 - 51.52 %), oleic acid (20.27-23.41%) and linoleic acid (15.62-17.70%). The highest polyunsaturated fatty acids (PUFA) were found to be 67.14 % at the first stage of maturity (St1). Flaxseed hull oil was of good quality, containing an abundance of omega-3 essential fatty acids. The iodine value increased, while the saponification value of oil decreased during seed development. The decrease in ascorbic acid content was steady. The maximum level of total phenolic acid content (128.3 mg/100 g oil) was reached at 7 DAF. The antioxidant activity of oilseed was assessed by means of 2, 2-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging assay. Radical scavenging activity for green hull was 52.74% and mature hull was 69.32%.

Phenolic compounds in flaxseed: a review of their properties and analytical methods. An overview of the last decade.

Flaxseed has been used for centuries for oil extraction. In recent years it has attracted considerable interest as a result of studies which attribute potential health benefits to its components. Among the compounds that present biological activity, phenolic compounds are of special interest. The dietary lignan secoisolariciresinol diglucoside (SDG) reaches high concentrations in flaxseed. Flaxseed contains also other phenolic compounds, such as phenolic acids. Considering the importance of the phenolic fraction of flaxseed, high performance analytical methods have been developed to characterize its complex phenolic pattern. The understanding of the nature of these compounds is crucial for their possible exploitation in drugs and functional foods.

Gas chromatography-mass spectrometry screening for phytochemical 4-desmethylsterols accumulated during development of Tunisian peanut kernels (Arachis hypogaea L.).

4-Desmethylsterols, the main component of the phytosterol fraction, have been analyzed during the development of Tunisian peanut kernels ( Arachis hypogaea L.), Trabelsia (AraT) and Chounfakhi (AraC), which are monocultivar species, and Arbi (AraA), which is a wild species, by gas chromatography-mass spectrometry. Immature wild peanut (AraA) showed the highest contents of beta-sitosterol (554.8 mg/100 g of oil), campesterol (228.6 mg/100 g of oil), and Delta(5)-avenasterol (39.0 mg/100 g of oil) followed by peanut cultivar AraC with beta-sitosterol, campesterol, and Delta(5)-avenasterol averages of 267.7, 92.1, and 28.6 mg/100 g of oil, respectively, and similarly for AraT 309.1, 108.4, and 27.4 mg/100 g of oil, respectively, were found. These results suggest that, in immature stages, phytosterol contents can be important regulator factors for the functional quality of peanut oil for the agro-industry chain from plant to nutraceuticals.