Dietary fat intake and polymorphisms at the PPARG locus modulate BMI and type 2 diabetes risk in the D.E.S.I.R. prospective study.

CONTEXT: Fat-rich diets are involved in many disorders such as obesity and type 2 diabetes (T2D). The Pro12Ala variant of peroxisome proliferator-activated receptor-γ (PPARγ) is known to modulate body mass index (BMI) and T2D risk. OBJECTIVE: Our aim was to study the interaction effect between PPARγ gene (PPARG) polymorphisms Pro12Ala and 1431C>T and fat intake on incident T2D and BMI in a 9-year prospective cohort drawn from the French general population, the D.E.S.I.R. (Data from an Epidemiological Study on the Insulin Resistance Syndrome) study (n=4676). METHODS: Nutritional intake was assessed by a food frequency self-questionnaire completed by each participant. Statistical analyses included logistic regression, analysis of covariance and haplotype analysis, with adjustment for confounding variables. RESULTS: A high fat consumption (the third sex-specific tertile of fat intake, as a percentage of energy intake) was associated with an increased T2D risk among ProPro and CC homozygotes (P(interaction)=0.05, odds ratio (OR) (95% confidence interval (95% CI))=1.73 (1.19-2.52) P=0.004 and OR=1.85 (1.27-2.71) P=0.001, respectively) but not in Ala and T carriers. There was a significant interaction effect between Pro12Ala and 1431C>T on BMI (P(interaction)=0.004); Ala was associated with lower BMI in CC homozygotes and with higher BMI in T carriers while the opposite was found for ProPro. There was also an interaction effect between Pro12Ala and dietary fat intake on BMI (P(interaction)=0.02); AlaAla individuals had a higher BMI than Pro carriers among high fat consumers (27.1 ± 1.0 versus 24.9 ± 0.1 for AlaAla and Pro+, respectively). There was no interaction effect between the 1431C>T single-nucleotide polymorphism and fat intake on BMI. CONCLUSION: Our results indicate strong genetic and nutritional interaction effects on BMI and T2D risk at the PPARG locus in a general population.

Intensifying glycaemic control with insulin reduces adiponectin and its HMW isoform moderately in type 2, but not in type 1, diabetes.

INTRODUCTION: As the impact of diabetes control was not tested on adiponectin (ADPN) levels, this study was designed to assess whether or not controlling hyperglycaemia can affect ADPN. PATIENTS AND METHODS: A total of 15 T1D and 48 T2D patients with HbA(1c) greater than 10% were studied at the time of hospitalization for uncontrolled diabetes. Total, and high-, medium- and low-molecular-weight (HMW, MMW, LMW) ADPN were measured at the time of study inclusion, on days 1 and 8, and at 1, 3 and 6 months after insulin treatment. RESULTS: While diabetes control improved, total and HMW APDN decreased on days 1 and 8, but remained steady thereafter in T2D patients. In T1D patients, ADPN levels remained unchanged throughout the study. CONCLUSION: Glycaemic control with insulin reduces ADPN in T2D patients in the short-term, but was ineffective in T1D.

Use and utility of ankle brachial index in patients with diabetes.

Ankle brachial index (ABI) is a simple method to screen peripheral arterial disease (PAD) and to evaluate cardiovascular (CV) prognosis in the general population. Measuring it requires a hand-held Doppler probe but it can be done also with an automatic device. ABI is an effective tool for clinical practice or clinical studies. However, in diabetic patients, it has some specific caveats. Sensitivity of the standard threshold of 0.9 appears to be lower in diabetic patients with complications. Moreover, highly frequent arterial medial calcifications in diabetes increase ABI. It has been demonstrated that measurements >1.3 are well correlated with both an increased prevalence of PAD and CV risk. Therefore, ABI thresholds of less than 0.9 and more than 1.3 are highly suspicious for PAD and high CV risk in diabetic patients. However, when there is concomitant clinical peripheral neuropathy or high risk of arterial calcification, the efficiency of ABI seems to be limited. In this case, other methods should be applied, toe pressure, in particular. Thus, the ABI could be used in patients with diabetes, but values should be interpreted with precision, according to the clinical situation.

[Case report: positive signals from automated blood-culture system with negative direct Gram examination]. / A propos d'hémocultures détectées positives en système automatisé mais dont l'examen direct est négatif.

Detection of positive haemoculture is usually managed by an automated system. When a bottle is detected positive but that the Gram coloration does not reveal germs by direct examination, transfer onto chocolate blood agar generally allows to confirm or infirm bacteraemia. In light of a case of Fusobacterium nucleatum bacteraemia, we discuss the opportunity of pairing it with an enrichment broth. M. N, hospitalized in the hepatogastroenterology department, runs a fever of undetermined origin. Three pairs of blood samples are collected on May 7th, 2004, another pair on May 9th, 2004 and a last pair on May 10th, 2004. They are incubated in a Bactec 9120 analyzer. A positive signal is detected in the two last anaerobic haemocultures pairs after four days of incubation, but in both cases, the Gram coloration does not bring germs to light. A systematic transfer of the broth onto chocolate blood agar with incubation under CO2 enriched atmosphere and anaerobiosis is carried out. After 24 hours, the solid media remain sterile. The samples found positive by the Bactec(TM) are then transferred onto Schaedler broth in order to favour a potential growth of fastidious germs. The culture will prove to be positive only in this enrichment medium, allowing the identification of F. nucleatum. An hepatic abscess will then be revealed in the patient. It thus appears judicious to associate an enrichment medium with transplanted solid medium when the context is evocative of a real infection (clinic, positivity delays...).