Change in women's eating habits during the menstrual cycle.

OBJECTIVES: During the menstrual cycle, the influence of hormonal variations on dietary habits in women has been suggested by several studies. In this context, our work aimed to assess the spontaneous food intake and the anthropometric parameters of women at different periods of their menstrual cycles. METHODS: This prospective study included 30 healthy women with regular periods (28 to 30 days), aged between 18 and 45. We assessed the spontaneous food intake and the anthropometric measurements (weight and waist circumference) of the participants, during the follicular, peri-ovulatory and luteal phases of their menstrual cycles. RESULTS: Our results showed a slight but significant increase in body weight during the luteal phase (P=0.022) and the follicular phase (P=0.017) compared with the peri-ovulatory phase, without any significant change in waist circumference. The caloric intake increased during the peri-ovulatory (P<0.001) and the luteal phases (P<0.001), compared with the follicular phase, with a significant increase in carbohydrate (P<0.001), lipid (P=0.008) and protein (P=0.008) intake. CONCLUSIONS: Our study showed a significant decrease in women's weight during the peri-ovulatory phase, with a significant increase in caloric intake during the luteal phase of the menstrual cycle. Divergent results have been reported by other authors and the physiopathology of these changes is still poorly understood.

Gender-specific associations of genetic variants with metabolic syndrome components in the Tunisian population.

AIM OF THE STUDY: Recent genome-wide association studies (GWASs) have identified many genetic variants associated with metabolic syndrome (MetS). However, their contribution to MetS in ethnic groups in Tunisia is largely unexplored. In this study, we aim to examine the associations of related loci with a risk of metabolic syndrome in a sample of Tunisians. MATERIALS AND METHODS: Overall seven polymorphisms rs7265718, rs10401969, rs762861, rs12310367, rs1562398, rs2059807, rs4420638 located at C20orf152, CILP2, LRPAP1, ZNF664, KLF14, INSR, APOE, respectively, were analyzed in 356 samples from the Tunisian population. Anthropometric and biochemical parameters were assessed. Metabolic syndrome was defined according to the International Diabetes Federation (IDF). RESULTS: We find that LRPAP1-rs762861 C allele increases susceptibility to MetS (OR = 1.39, 95% CI = 0.99-1.95, p = 0.041). Separate analysis in men and women revealed the association of rs762861 among females (OR = 1.6, 95% CI = 1.057-2.41, p = 0.021), but not among males (OR = 0.953, 95% CI = 0.51-1.78, p = 0.882). ZNF664-rs12310367 was also found to be associated with body mass index (BMI) in women (p = 0.01) and not in men (p = 0.18). KLF14-rs1562398 was significantly correlated with impaired fasting glucose (p = 0.004) only in men. CONCLUSIONS: Our results reveal new candidate genes for MetS in the Tunisian population and suggest that the genetic basis of this syndrome is gender dependent. Further studies are necessary to understand why these associations differ between males and females.

Association of rs9939609 Polymorphism with Metabolic Parameters and FTO Risk Haplotype Among Tunisian Metabolic Syndrome.

BACKGROUND: Variants in the fat mass and obesity-associated (FTO) gene are associated with obesity and type 2 diabetes mellitus. AIM OF THE STUDY: This study aims to assess the association of the rs9939609 variant and haplotypes in FTO gene with metabolic syndrome (MetS) components in a Tunisian population sample. METHODS: A total of 685 Tunisian subjects were genotyped for the rs9939609T>A using TaqMan allelic discrimination assay. Two variants rs1421085T>C and rs8057044A>G already genotyped in a previous study were used to test haplotype association of the FTO gene. RESULTS: Genotype distribution of the variant rs9939609 was different between MetS and controls (P = 0.017). Individuals carrying TA genotypes had a significantly increased risk independently of body mass index or age (P = 0.009). The variant rs9939609 was also associated with impaired fasting glucose (IFG) (P = 0.002). Among the eight haplotypes in the population, the haplotype GCA was significantly associated with a higher risk of developing the MetS, higher systolic blood pressure, and higher levels of fasting glucose and triglycerides (TGs) in the total sample and females, separately. Separate analysis by gender revealed a protective haplotype TGT among women (P = 0.023). CONCLUSIONS: FTO haplotypes have a strong influence on blood pressures and TG and IFG levels. These findings provide evidence that FTO gene may play a critical role in leading to MetS in Tunisian population.

Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences.

Responses of GH-secreting adenomas to multimodal management of acromegaly vary widely between patients. Understanding the behavioral patterns of GH-secreting adenomas by identifying factors predictive of their evolution is a research priority. The aim of this study was to clarify the relationship between the T2-weighted adenoma signal on diagnostic magnetic resonance imaging (MRI) in acromegaly and clinical and biological features at diagnosis. An international, multicenter, retrospective analysis was performed using a large population of 297 acromegalic patients recently diagnosed with available diagnostic MRI evaluations. The study was conducted at ten endocrine tertiary referral centers. Clinical and biochemical characteristics, and MRI signal findings were evaluated. T2-hypointense adenomas represented 52.9% of the series, were smaller than their T2-hyperintense and isointense counterparts (P<0.0001), were associated with higher IGF1 levels (P=0.0001), invaded the cavernous sinus less frequently (P=0.0002), and rarely caused optic chiasm compression (P<0.0001). Acromegalic men tended to be younger at diagnosis than women (P=0.067) and presented higher IGF1 values (P=0.01). Although in total, adenomas had a predominantly inferior extension in 45.8% of cases, in men this was more frequent (P<0.0001), whereas in women optic chiasm compression of macroadenomas occurred more often (P=0.0067). Most adenomas (45.1%) measured between 11 and 20 mm in maximal diameter and bigger adenomas were diagnosed at younger ages (P=0.0001). The T2-weighted signal differentiates GH-secreting adenomas into subgroups with particular behaviors. This raises the question of whether the T2-weighted signal could represent a factor in the classification of acromegalic patients in future studies.

Histiocytosis X revealed by diabetes insipidus and skin lesions.

Langerhans cell histiocytosis is part of a larger group of syndromes described as histiocytoses. The disease may involve single or multiple systems including skin and nervous system. Here we report an adult case where Langerhans cell histiocytosis presented with diabetes insipidus and cutaneous ulcers.

[Continuous glucose monitoring in glimipiride plus metformin treated type 2 diabetic patients during the month of Ramadan]. / Enregistrement continu du glucose pendant Ramadan chez des diabétiques de type 2 sous glimépiride et metformine.

BACKGROUND: Fasting during Ramadan may be a cause of poor glycaemic control in diabetic patients. AIM: To assess glucose excursions during Ramadan by using a continuous glucose monitoring system (CGMS). METHODS: The interstitial glucose level was recorded over 72 hours during Ramadan and three months later, in five type 2 diabetic patients, aged 56 ± 5, treated with glimepiride and metformin. RESULTS: During Ramadan, four patients experienced at least one episode of low glucose level (<0.7 g/l) during the monitoring. The frequency of these episodes was 0.6 episode/d with an average duration of 36 mn / d. These episodes occurred in the morning in half of the cases and in the hour before breaking the fast in 37.5 % of the cases. Four patients experienced at least one episode of high glucose level (>1.8 g/l), with an average duration of 403 mn /d and with a frequency of two episodes /d. More than half episodes (53) occurred after the breaking of the fast. After Ramadan, CGM records showed at least one episode of low glucose in two patients with an average duration of 58 mn /d and a frequency of 1.3 episodes/d. Three patients experienced at least one episode of high glucose level with an average duration of 525 mn /d and a frequency of 1.46 episodes/day. CONCLUSION: The blood glucose profile of our patients during Ramadan is characterized by important glycaemic excursions.

Hypocalcaemia due to hypoparathyroidism in ß-thalassemia major. A study of a new case.

AIM: To report a new case of hypoparathyroidism in a child with ß-thalassemia major CASE: We report a case of a 17-year-old Tunisian girl with transfusion-dependent thalassemia major presented with paresthesia and pubertal delay. Laboratory investigations showed hypocalcaemia and hyperphosphatemia. Parathyroid hormone level was low (2 ng/l, normal range: 12-72 ng/l) than expected for the degree of hypocalcaemia. Serum ferritin concentration was 1770ng/ml. The patient was started on oral daily calcium supplementation, Alfa calciferol and intensive iron chelation therapy. Follow-up after 6 and 12 months revealed normal Calcium and ECG showed QT interval within normal range. CONCLUSION: Investigating calcium homeostasis at regular intervals and early management of any abnormality can preclude the occurrence of complications.

[Distribution and prevalence of dyslipidemia in Tunisia: results of the Tunisian National Nutrition Survey]. / Distribution et prevalence des dyslipidemies en Tunisie: resultats de l'Enquete Nationale de Nutrition.

UNLABELLED: The aims of the study were to study the distribution of cholesterol and triglycerides and to assess the prevalence of dyslipemia in Tunisian adult population. METHODS: The Tunisian National Nutrition Survey (TNNS) was a cross sectional study performed on a total of 7860 adult subjects and was conducted on 1996-1997. The TNNS included 3087 adults over 20 years old. RESULTS: The mean values of cholesterol (CT) were more elevated in urban than rural area (p<0.001), and in females than in males (p<0.007). The overall prevalence of hypercholesterolemia (CT > 6.2 mmol/l) was 8.4% and that of hypertriglyceridemia (TG > 1.70 mmol/l) was 21%. The prevalence of borderline high cholesterol (> or =5.2-< 6.2 mmol/l) was 17%; These prevalences were more elevated in urban than rural areas (p <0.001) and increased with age in both genders (p < 0.001). The multiple adjusted odd ratio of the prevalence of hypercholesterolemia showed a positive correlation with female sex (OR 1.40 p <0.01), high waist circumference (OR 2.51 in men and 3.04 in women p < 0001) and urban residency (OR 1.35 p = 0.03). CONCLUSION: Our study showed the metabolic consequences of westernization style life in our country and should be the starter to preventive adequate policy.

Molecular basis of pituitary development defects.

UNLABELLED: Over the last twenty years, the progress made in molecular biology have led to the identification of many transcription factor genes, whose mutations has been reported as causes of familial hypopituitarism. AIM: Based on a literature review, this study is intending to highlight the role of some transcription factors in the development of the anterior pituitary gland and to analyse the involvement of their dysfunction in some cases of congenital hypopituitarism. METHODS: Litterature review. RESULTS: These transcription factors are nuclear proteins expressed specifically in certain target cells, in order to control genes expression. Their role is fundamental in embryonic and foetal development, and particularly in pituitary ontogenesis. Together, they direct the formation of anterior pituitary gland, the differentiation, the expansion and the definitive function of the five pituitary cell types. In this report, after introducing the different stages of anterior pituitary development and differentiation of its cell lines, we will briefly highlight the clinical phenotypes associated with alterations of different transcription factor genes in both murine models and humans.

Food intake and high density lipoprotein cholesterol levels changes during ramadan fasting in healthy young subjects.

During the holy month of Ramadan, it is obligatory for all adult healthy Muslims to abstain from food, drink and smoking each day from dawn to sunset. The aims of our study were to evaluate the effects of Ramadan fasting on plasma lipids, lipoproteins and the change of food consumption in healthy subjects. Thirty young healthy and normal weighted adults (9 males and 21 females) were evaluated during three periods: 3 weeks before Ramadan (T0); the 4th week of Ramadan (T1) and 3 weeks after the end of Ramadan (T2). Main Clinical and biological parameters investigated were: body weight, blood glucose, plasma triglycerides (TG), plasma total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and. low density lipoprotein cholesterol (LDL-c) Body weight, and blood glucose were unchanged. There was a significant increase of the mean daily caloric intake, the lipids intake particularly mono-unsaturated and poly-unsaturated fatty acids (p < 0.001) and cholesterol intake (p < 0.001) during Ramadan with a decrease of the meal frequency. There was also a significant increase of plasma total cholesterol and HDL-cholesterol. The most striking finding was a significant increase in the HDL-Cholesterol during Ramadan +20% (p < 0.02). This increase was lost after Ramadan. Fasting Ramadan affects beneficially serum lipoprotein metabolism in young adult healthy subjects with an increase of HDL-cholesterol.

[Hypothalamic-pituitary Langerhans cell histiocytosis in adults]. / Atteinte hypothalamo-hypophysaire dans l'histiocytose de l'adulte.

INTRODUCTION: Langerhans cell histiocytosis is a rare entity. Involvement of the pituitary region is frequently delayed and rarely studied. CASES: We report some clinical and paraclinical particularities of the disease in four women. Diabetes insipidus was the initial symptom in all cases, accompanied by panhypopituitarism at initial presentation in one woman. Hypopituitarism was diagnosed from 6 months to 4 years after the diabetes insipidus in the other cases, and systemic lesions appeared 3 to 6 years thereafter. Magnetic resonance imaging of the hypothalamic-pituitary axis found tumors in two patients and infundibular thickening in the other two. One patient also had a partially empty sella. DISCUSSION: In adults, pituitary involvement seems to occur predominantly in women, and panhypopituitarism is possible at initial presentation. The clinical polymorphism of Langerhans cell histiocytosis makes this disease difficult and often slow to diagnose.