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.

Evaluating physical activity: the AQAP questionnaire and its interpretation software.

OBJECTIVES: Updating Baecke physical activity questionnaire in French, validating this version named AQAP and developing software for a personalized interpretation of the results. METHOD: Validation conducted on 702 consultants in health prevention centers aged 18-79 years: reliability of the questionnaire when self-administered, validity according to the energy expenditure per interview and reproducibility after two weeks (n=31). After two months, assessment of the questionnaire's impact on knowledge and behaviors in 320 young adults aged 18-29 years. RESULTS: The results from self- and interviewer-administered questionnaire were correlated (Kappa>0.60). Furthermore, the total physical activity index was correlated to the energy expenditure (rho=0.39, P<0.0001). The four physical activity indexes calculated from self-administrated questionnaires barely varied at the two-week interval (P ≥ 0.23, power ≥ 77%, accepted difference ± 10%). Two months later, 80% of the participants had read the interpretation software report, 55% became conscious of their physical activity level, 43% increased their physical activity level and 42% reported being aware of the relationship between physical activity and health. CONCLUSION: AQAP characteristics are satisfactory and thus this questionnaire can be used on the general population in complement of an individual or collective action to promote physical activity and in epidemiological studies for analyzing the links between individual behaviors and health.

Comparing incident diabetes as defined by fasting plasma glucose or by HbA(1c). The AusDiab, Inter99 and DESIR studies.

AIM: We examined the ability of fasting plasma glucose and HbA(1c) to predict 5-year incident diabetes for an Australian cohort and a Danish cohort and 6-year incident diabetes for a French cohort, as defined by the corresponding criteria. METHODS: We studied 6025 men and women from AusDiab (Australian), 4703 from Inter99 (Danish) and 3784 from DESIR (French), not treated for diabetes and with fasting plasma glucose < 7.0 mmol/l and HbA(1c) < 48 mmol/mol (6.5%) at inclusion. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l and/or treatment for diabetes or as HbA(1c) ≥ 48 mmol/mol (6.5%) and/or treatment for diabetes. RESULTS: For AusDiab, incident fasting plasma glucose-defined diabetes was more frequent than HbA(1c) -defined diabetes (P(McNemar)<0.0001), the reverse applied to Inter99 (P(McNemar) < 0.007) and for DESIR there was no difference (P(McNema)=0.17). Less than one third of the incident cases were detected by both criteria. Logistic regression models showed that baseline fasting plasma glucose and baseline HbA(1c) predicted incident diabetes defined by the corresponding criteria. The standardized odds ratios (95% confidence interval) for HbA(1c) were a little higher than for fasting plasma glucose, but not significantly so. They were respectively, 5.0 (4.1-6.1) and 4.1 (3.5-4.9) for AusDiab, 5.0 (3.6-6.8) and 4.8 (3.6-6.3) for Inter99, 4.8 (3.6-6.5) and 4.6 (3.6-5.9) for DESIR. CONCLUSIONS: Fasting plasma glucose and HbA(1c) are good predictors of incident diabetes defined by the corresponding criteria. Despite Diabetes Control and Complications Trial-alignment of the three HbA(1c) assays, there was a large difference in the HbA(1c) distributions between these studies, conducted some 10 years ago. Thus, it is difficult to compare absolute values of diabetes prevalence and incidence based on HbA(1c) measurements from that time.

Waist circumference and obesity-related abnormalities in French and Cameroonian adults: the role of urbanization and ethnicity.

OBJECTIVES: To evaluate the effect of urbanization and ethnicity on correlations between waist circumference (WC) and obesity-related cardiovascular risk factors. METHODS: 1471 rural and urban Cameroonians, and 4185 French, from community-based studies, aged > or =25 years, not treated for hypertension, diabetes and dyslipidemia participated in this study. Slopes of obesity-related abnormalities with WC were compared using an interaction term between place of residence and WC. RESULTS: Women in urban Cameroon and men in France had significantly higher WC and BMI relative to their gender counterparts. Urban Cameroonians had higher abdominal adiposity, but lower BP and better metabolic profile than the French. WC was positively associated to all the obesity-related abnormalities in the three sites except to FPG (both genders) and blood lipids (women) in rural Cameroon. A 5 cm larger WC was associated with a higher increment among urban than rural Cameroonians for diastolic blood pressure (DBP) (women, 1.95/0.63 mm Hg; men, 2.56/1.44 mm Hg), HOMA-IR (women, 0.11/0.05), fasting plasma glucose (FPG) (men, 0.09/-0.01 mmol/l) and triglycerides (women, 0.06/0.01 mmol/l; men, 0.09/0.03 mmol/l), all P<0.05. A 5 cm larger WC was associated with a higher increment among urban Cameroon than French people for DBP (women, 1.95/1.28 mm Hg, P<0.01; men, 2.56/1.49 mm Hg, P<0.01), but with a lower increment for HOMA-IR (women, 0.11/0.14, P<0.05), FPG (women, 0.05/0.09 mmol/l), total cholesterol (women, 0.07/0.11 mmol/l; men, 0.10/0.13 mmol/l) and triglycerides (women, 0.06/0.11 mmol/l; men, 0.09/0.13 mmol/l) all P<0.05. CONCLUSION: Ethnicity and urbanization modify the association of WC with obesity-related metabolic abnormalities. WC cutoff points derived from Caucasians may not be appropriate for black Sub-Saharan Africans.

Prevalence of overweight in 6- to 15-year-old children in central/western France from 1996 to 2006: trends toward stabilization.

OBJECTIVE: The prevalence of overweight in children has markedly increased over the past few decades in France, as in all Western countries. We sought to describe the yearly prevalence of childhood overweight from 1996 to 2006 and to assess whether a shift in trends could be observed dating from the time the Nutrition and Health National Program (PNNS) was set up in France in 2001, in particular according to gender, age and family economic status. DESIGN: We used annual overweight prevalence of standardized 6- to 15-year-old populations (total=26 600) with weight and height measured at health examination centers in the central/western part of France between 1996 and 2006. Regression slopes of overweight prevalence were evaluated between 1996 and 2006, and specifically between 1996 and 2001, and 2001 and 2006. The annual prevalence and estimated slopes were compared in subgroups, taking into account gender, age and economic status of the family. RESULTS: The prevalence increased between 1996 (11.5%) and 1998 (14.8%) and was stable between 1998 and 2006 (15.2%). According to linear regression, the overall trend in prevalence of overweight children between 1996 and 2006 was stable (slope=0.19, P=0.08). Similarly, the prevalence of overweight increased between 1996 and 1998 in boys and girls, in 6-10 year olds, in 11-15 year olds and in non-disadvantaged children, and remained stable thereafter. The prevalence of overweight in the disadvantaged group increased between 1996 (12.8%) and 2001 (18.9%) (slope=1.16, P=0.004) and was stable between 2001 and 2006 (18.2%) (slope=0.09, P=0.78). CONCLUSION: The results of this study reveal a stable prevalence of overweight since 1998 in most groups studied, and since 2001 in the disadvantaged group.

Influence of gender and body composition on hydration and body water spaces.

BACKGROUND & AIMS: Hydration disorders are frequent in clinical practice and can be a life threatening issue in frail patients. Mild dehydration (1-2% loss of body weight) appears to impair cognitive and muscular performance. There is, however, no infallible indicator of correct hydration, and of hydration disorders. This study aim at describing total body water (TBW), extra-cellular water (ECW) and intracellular water (ICW) in a cohort of healthy subjects varying in age, gender and body composition. Two indicators of cellular hydration (TBW over fat free mass, and ICW over fat free mass) were studied. METHODS: The study cohort was made of 944 men and 874 women (mean age 42.7+/-13.1 yrs, BMI 24.3+/-3.5 kg/m(2)). All were volunteers for a preventive health examination. TBW, ECW, ICW were measured with bioelectrical impedance analysis. Body composition was assessed with the 3-compartment model. RESULTS: Values for TBW, ECW, and ICW differed with gender and with BMI categories (lean, overweight, and obese). The ratio of TBW over weight decreased with increasing BMI and was lower in women than in men. ECW (as a proportion of TBW) increased with BMI. The ratio of TBW over fat free mass decreased in obese subjects. The ratio of ICW over fat free mass was normally distributed, and decreased with BMI, more so in women than in men. CONCLUSIONS: This study provides reference values for body water spaces in healthy adults that are negatively correlated with BMI. Women and obese people display indicators of cellular dehydration, and are more at risk of dehydration.

Prevalence of sarcopenia in the French senior population.

INTRODUCTION: A muscle mass normalized for height2 (MMI) or for body weight (SMI) below 2SD under the mean for a young population defines sarcopenia. This study aimed at setting the cutoffs and the prevalence of sarcopenia in the French elderly population. Another objective was to compare the results obtained with SMI and MMI. METHODS: Muscle mass was assessed by bioelectrical impedance analysis in 782 healthy adults (< 40 years) to determine skeletal mass index (SMI, muscle mass*100/weight) and muscle mass index (MMI, muscle mass/height2). Prevalence was estimated in 888 middle aged (40-59 years) and 218 seniors (60-78 years). All were healthy people. RESULTS: For women mean-2SD were 6.2 kg/m2 (MMI) and 26.6% (SMI); for men limits were 8.6 kg/m2 (MMI) and 34.4% (SMI). In middle aged persons a small number of them were identified as sarcopenic. In healthy seniors, 2.8% of women and 3.6% of men were sarcopenic (MMI). The prevalence was 23.6% in women and 12.5% in men with SMI. MMI and SMI identified different sarcopenic populations, leaner subjects for MMI while fatter subjects for SMI. CONCLUSION: Cutoff values for the French population were defined. Prevalence of sarcopenia was different from that in the US population.

[Ten-year incidence of high blood pressure in the general population: influence of clinical parameters, and implication for screening strategies]. / Incidence à 10 ans de l'HTA dans la population générale: rôle des paramètres démographiques et cliniques, et implication pour la surveillance des normotendus.

BACKGROUND: International guidelines recommend to modulate the periodicity of hypertension screening according to the initial level of blood pressure (BP). The aim of our study was to evaluate other factors that could be useful to optimise the screening for hypertension. METHODS: 9777 normotensive volunteers (4151 men, 5626 women) aged 16 to 68, studied at a 10 year interval during systematic health check ups (standardised questionnaire, clinical examination, biological tests) were included. We determined the 10-year incidence of high BP (systolic BP >or=140 mmHg and/or diastolic BP >or=90 mmHg and/or anti-hypertensive treatment). The role of potential risk factors for hypertension was assessed. RESULTS: The 10 year incidence of high BP was 19.9%. It was associated with the initial level of BP (OR=2.02 and 1.81 per +10 mmHg of systolic and diastolic BP, respectively, p<0.0001). Initial age and BMI were strongly associated with the incidence of a high BP (OR=1.88 / + 10 years and 1.18 / + 1 kg/m2, p<0.0001) after adjustment for the initial systolic BP. In men, a low reported physical activity level, alcohol consumption, and current smoking were independent risk factors (Table1). [table: see text] CONCLUSION: These results suggest that the recommendations for the screening of hypertension should not be based solely on the initial level of BP.

Prevalence of diabetic retinopathy in children and adolescents with type-1 diabetes attending summer camps in France.

OBJECTIVE: To evaluate, using fundus photography, the prevalence of diabetic retinopathy (DR) in young diabetic subjects attending summer camps run by the Aide aux Jeunes Diabétiques Association (Aid to Young Diabetics). RESEARCH DESIGN AND METHODS: Five hundred and four children and adolescents (250 boys and 254 girls), with type 1 diabetes mellitus, aged 10-18 years (mean:13+/-2), were screened for DR using non mydriatic photography, during their stay in a holiday camp. Demographic and clinical data recorded on subjects' arrival in the camp included date of birth, height, weight, treatment, blood pressure, and duration of diabetes. HbA(1c) was determined with a DCA 2000 kit. RESULTS: Mean diabetes duration was 4.8+/-3.4 years and mean HbA(1c) was 8.5+/-1.3%. Mild non proliferative DR was diagnosed in 23 children (4.6%). Compared to subjects without DR, those with DR were significantly older (P<10(-3)), had a longer duration of diabetes (P=0.001), higher systolic blood pressure (P=0.04), and had higher (but not significantly so) HbA(1c) (P=0.15). After adjustment for age, only longer duration remained significantly associated with DR (P=0.01). CONCLUSION: The prevalence of DR in these young patients was low compared to that reported in previous studies. The decrease may be due to modern diabetes care with multiple insulin injections. However, early detection of DR in adolescents, especially in their late teens, remains important, because it allows the identification of patients at high risk of progression towards severe stages of DR.

Evidence for distinct effects of GH and IGF-I in the metabolic syndrome.

AIMS: The metabolic syndrome is a cluster of cardiovascular risk factors which include central obesity, dyslipidaemia, glucose intolerance and hypertension. These risk factors are common in patients with growth hormone (GH) deficiency, suggesting a role for the somatotropic axis in the development of metabolic syndrome. METHODS: We used factor analysis to investigate the relationships linking serum levels of GH and insulin-like growth factor I (IGF-I) to metabolic syndrome variables (high-density lipoprotein cholesterol, triglycerides, fasting glucose, blood pressure and waist circumference). We studied 359 men and 388 women from the Data from an Epidemiological Study on the Insulin Resistance syndrome (DESIR). Their age range was 30-64 years. RESULTS: Three independent latent factors explained 61% of the total variance in women and four factors explained 73% in men. In both men and women, IGF-I showed a strong positive correlation with the lipid factor and a negative correlation with the obesity/glucose factor. In women, GH showed a strong negative correlation with the obesity/glucose factor but not the lipid factor. In men, GH was unrelated to the lipid and obesity/glucose factors. The blood pressure factor was not related to GH or IGF-I. In contrast with IGF-I, GH was significantly lower in women with metabolic syndrome (1575 +/- 449 pg/ml) than in the other women (2121 +/- 520 pg/ml, P = 0.002). No significant difference was observed in men for GH or IGF-I. CONCLUSION: Our results support a link between the somatotropic axis and several features of the metabolic syndrome, and suggest distinct effects of GH and IGF-I on these parameters.

[Prevalence of symptoms of sleep apnea syndrome. Study of a French middle-aged population]. / Prévalence des symptômes du syndrome d'apnées du sommeil. Etude dans une population française d'âge moyen.

OBJECTIVE: To study the prevalence of symptoms of sleep apnoea syndrome (SAS) in a large French middle-aged population and to establish what proportion have symptoms that justify further investigation with a sleep study. METHODS: We performed a cross-sectional study of 2,195 men and 2,247 women, 33 to 69 year old (DESIR. cohort) recording responses to a self-administered "sleep" questionnaire and a general questionnaire including socio-economic characteristics and lifestyle factors. RESULTS: The prevalence of symptoms in men and women were respectively: snoring frequently (28%, 14%), frequent daytime sleepiness (14%, 18%) and frequent apnoeas (5%, 2%). Overall, 8.5% of men and 6.3% of women reported a pattern of symptoms suggestive of OSA, as they snored and had daytime sleepiness and/or apnoeas. This pattern was associated, for both sexes, with age, body mass index and after adjustment on these two factors, to a mediocre self-reported health status and treatment with benzodiazepines or other sedatives. For men only, the OSA pattern of symptoms was also associated with, hypertension, alcohol consumption and smoking. CONCLUSION: Snoring, daytime hypersomnolence and witnessed apnoeas are symptoms frequently observed in the general population. Subjects with a combination of these abnormalities suggesting a high probability of sleep apnoea syndrome and in whom a sleep study is warranted represent 7.5% of the adult population.

Five-year predictive factors of type 2 diabetes in men with impaired fasting glucose.

AIM: The outcome of 743 French men (age 20-60) with impaired fasting glucose (IFG) [blood glucose 6.1-6.9 mmol/l] at T1 was evaluated 5 years later, at T2. METHODS: Personal and family medical history, smoking, nutritional habits, physical activity, blood pressure, body mass index (BMI) and waist girth, fasting biological data were collected at T1 and T2. Predictive factors for developing diabetes were compared between those who returned to normal fasting glucose and those who had diabetes, before and after adjustment for age, BMI, glucose and triglyceride (TG) levels. RESULTS: At T2, 44%, 39%, 17% were classified as normal fasting plasma glucose (FPG), IFG or diabetic, respectively. Odd ratios for diabetes were 4.2 for men with a family history of diabetes (FHD), 3.4 if BMI > or = 25 kg/m(2), 2.9 if waist girth > or = 90 cm, 2.8 if TG > or = 2 mmol/l and 1.9 if no daily dairy products were eaten. Still significant after adjustment for age, BMI, glucose and TG levels were: FHD (P=0.001), no daily dairy products (P=0.001), high alcohol intake (P=0.02) and low physical activity (P = 0.02). CONCLUSION: No daily dairy products, high alcohol intake and low physical activity were independent predictive factors of a 5-year onset of diabetes after adjusting for BMI, FHD, triglyceride and glucose levels at baseline. For a better prevention of diabetes, these findings give clues for behaviour modifications as soon as IFG is detected.

RETRACTED: Estimation of height from knee-heel length in middle age Caucasian adults.

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Weight change and changes in the metabolic syndrome as the French population moves towards overweight: the D.E.S.I.R. cohort.

BACKGROUND: How weight change affects the metabolic syndrome (MS) and its parameters is unknown, particularly, in a leaner European population such as the French prospective D.E.S.I.R. cohort. METHODS: In 3770 D.E.S.I.R. participants (sex ratio=1) averaging 47.5 years (range 30-64), with measured weight and MS parameters at baseline (D0) and at 6 year follow-up (D6), we assessed this relationship across five weight-change classes, using stable weight as the referent group (-2 to +2 kg). We used analysis-of-covariance to assess changes in each MS parameter and logistic regression to assess incident MS, according to the National Cholesterol Education Program (NCEP). We also assessed weight-change effect on MS status between D0 and D6. RESULTS: At D0, average weight was 68.4 kg (SD 12.3); BMI was 24.8 kg/m2 (SD 3.5). From D0-D6, the cohort gained a mean 2.1 kg (median 2.0; SD 4.4). After adjustment for age and D0 weight, there was a strong linear relationship with weight change and worsening of the following MS parameters at D6: fasting insulin, waist girth, fasting glucose, fasting triglycerides, HDL cholesterol, and systolic and diastolic blood pressure (P<0.0001). After age adjustment, for every kilogram gained over 6 years, risk of developing the NCEP Syndrome increased 22% (OR 1.22; 95% CI 1.18-1.25). NCEP-MS was incident in 3% of those with stable weight compared with 21% among those gaining >9 kg; 10% of those who lost >2 kg reverted to non-NCEP-MS. CONCLUSIONS: All continuous MS measures are linearly related to weight change, and MS can resolve with modest weight loss, underscoring the importance of maintaining lifelong normal weight.

Cigarette smoking and diabetes mellitus.

OBJECTIVE: To assess whether an independent relationship between cigarette smoking and type 2 diabetes exists in both men and women selected from a French population, and to assess the effects of active smoking and smoking cessation on the prevalence of diabetes. METHODS: A population-based cross sectional study in 28,409 volunteers. RESULTS: After adjustment for age, BMI, waist-hip ratio (WHR) and alcohol, the risk of diabetes mellitus (estimated by the odds ratio) was 1.49 (1.13-1.96, P=0.004) and 1.31 (1.01-1.17, P=0.03) for current and former smoker men, respectively, as compared to non-smoker men. The risk was even higher in men aged 40 to 69. No association was found with the duration of smoking cessation. In women, the risk of diabetes associated with current smoking was much less significant [HR: 1.46 (0.92-2.22, P=0.09)], even in women aged 40 to 69 [HR: 1.60 (1.00-2.58, P=0.05)]. No relationship was found for past smoking in women. In non-diabetic men, the adjusted fasting glucose was similar in current and in non smokers, but it was higher in current smokers aged 40 to 69 (99.2 +/- 0.27 vs 98.7 +/- 0.14 mg/dl, P=0.05). It was higher in former than in non smokers (97.4 +/- 0.20 vs 96.0 +/- 0.10 mg/dl, P=0.0001), regardless of age. In non-diabetic women, the adjusted fasting glucose was lower in current than in non smokers (90.7 +/- 0.20 vs 91.4 +/- 0.12 mg/dl, P=0.0001), even in women aged 40 to 69 (93.0 +/- 0.35 vs 93.7 +/- 0.18 mg/dl, P=0.03). It was similar in former and in non smokers, regardless of the age. CONCLUSIONS: Current and past smoking are associated with a risk of diabetes mellitus essentially in men, but much less in women, and the relationship between fasting glucose and smoking appears different in men and women. No dose-relationship between the number of cigarettes smoked and diabetes mellitus was found. Smoking cessation is not associated with a reduced risk of diabetes.

Comparison of men with impaired fasting glycaemia to controls and to diabetic subjects with fasting glycaemia from 7.0 to 7.7 mmol/l: clinical, nutritional and biological status.

OBJECTIVE: To compare medical history, clinical, nutritional and biological status of non-diabetic men to subjects with impaired fasting glycemia (glycemia 6.1-6.9 mmol/l) and to newly diagnosed type 2 diabetic subjects (7.0-7.7 mmol/l) according to the criteria proposed by the American Diabetes Association. METHODS: Cross-sectional study of a cohort of 29,992 men, who were volunteers for a free periodic check-up offered by their medical insurance. Medical history, lifestyle and nutritional habits were recorded using a self-administered questionnaire. Clinical and biological data were also studied. To compare the three groups of subjects - normal, impaired fasting glycemia and newly diagnosed diabetics - three age stratified samples were randomly designed. RESULTS: Most of the well-known risk factors for developing type 2 diabetes mellitus such as overweight, abdominal obesity, familial history of diabetes mellitus, over-consumption of fat and alcohol were present in the group with impaired fasting glycaemia which presented the same risk factors as the group of subjects with fasting glycaemia from 7.0 to 7.7 mmol/l, but to a lesser degree. Hypertension was present in more than 50% of the subjects with impaired fasting glycaemia. CONCLUSION: In this cross-sectional study, impaired fasting glycaemia is associated with the risk factors of type 2 diabetes mellitus. The subjects with impaired fasting glycaemia should be considered at risk for cardiovascular disease and might take advantage from early specific intervention about their lifestyle.

The incidence and persistence of the NCEP (National Cholesterol Education Program) metabolic syndrome. The French D.E.S.I.R. study.

CONTEXT: In 2001 the "National Cholesterol and Education Program Expert Panel" gave a clinical definition of the metabolic syndrome. The frequency of this syndrome at baseline and its incidence and persistence at three years is studied in a French population. SUBJECTS: 2109 men and 2184 women from the D.E.S.I.R. longitudinal cohort study (Data from an Epidemiological Study on the Insulin Resistance syndrome) in central-western France, aged 30 to 64 years, were examined at inclusion and three years later. METHODS: Evaluation of the frequencies, incidences and persistence of the metabolic syndrome and its abnormalities. This syndrome is defined by the presence of three or more of five abnormalities: waist circumference > 102/88 cm (men/women); triglycerides > o r=1.69 mmol/l, HDL-cholesterol<1.04/1.29 mmol/l (men/women); systolic/diastolic blood pressure > or =130 and/or 85 mmHg; fasting plasma glucose > or =6.1 mmol/l. RESULTS: At baseline, 10% of men and 7% of women had the metabolic syndrome. If the syndrome was defined to include a treatment in the abnormalities (for diabetes, hypertension, dyslipidemia), the syndrome frequencies increased to 16% and 11%. However only 12% and 8% respectively, had this syndrome both at inclusion and at three years. High blood pressure was the most frequent abnormality: 70% and 47% in men and women respectively, at inclusion. The most stable abnormality was high waist circumference (80% persisted), hyperglycaemia the least stable (60% persisted). Hyperinsulinaemia did not cluster closely with this syndrome. CONCLUSIONS: The age-specific frequency of the syndrome is more than 2.5 times higher in the US than in this French cohort and this ratio increased with age. The higher frequencies of abdominal obesity and low HDL-cholesterol in women than in men suggest that these gender-specific thresholds may need to be refined.

The metabolic syndrome in smokers. The D.E.S.I.R. study.

OBJECTIVES: To test the hypothesis that smokers have a higher frequency of the metabolic syndrome, and a syndrome with different characteristics than non-smokers. MATERIAL AND METHODS: The 2,569 men and 2,637 women included in the D.E.S.I.R. study, aged 30-64 years, volunteers from ten French Social Security Health Examination Centres, were studied. The World Health Organization definition of the metabolic syndrome was adapted for this analysis, and insulin resistance was defined by a concentration above the 75(th) centile of the sex-specific distribution of fasting insulin. RESULTS: 28.1% of men and 15.1% of women were current smokers. The metabolic syndrome was twice as frequent in men than in women (22.8% vs 11.0%). Smokers and never-smokers were compared in age stratified samples. In men, the frequencies of hyperglycaemia or hypoglycaemic treatment, dyslipidaemia, microalbuminuria, and central obesity were significantly higher in smokers and 22.5% of smokers and 15.3% of non-smokers had this syndrome (p=0.001). In women, only dyslipidaemia was more frequent in smokers; in contrast smokers had lower insulin concentrations and hence a lower frequency of hyperinsulinemia. The frequency of the syndrome did not differ between women who smoked and those who did not (6.3% vs 6.0%). CONCLUSIONS: In men, the metabolic syndrome was more frequent in smokers than in non-smokers; in contrast, there was no difference for women. For both sexes, syndrome abnormalities tended to be more frequent in smokers than in non-smokers.

Impaired fasting glycaemia and undiagnosed diabetes: prevalence, cardiovascular and behavioural risk factors.

BACKGROUND: Early discovery of type 2 DM (NIDDM) is essential. The diagnostic criteria of DM have been recently modified (FBG 126 vs 140 mg/dl) and the characteristics of undiagnosed subjects in large populations must be defined. At the same time subjects with impaired FBG need to be studied mainly for their cardiovascular complications. METHODS: During 14 months, 61,724 male and female subjects (mean age 40) were explored in the French Institute for Health Protection (I.R.S.A). Clinical data, FPG, CV risk factors and dietary habits collected. Cut-off value for FPG: 110-125 mg/dl (IFG) (G2), 126-139 mg/dl defining undiagnosed diabetes with no history of diabetes. Subjects with FPG >=140 mg/dl (G4) former ADA/WHO criteria for diabetes and with the new criteria (FPG: 126-139 mg/dl) (G3) were compared to IFG (G2) and controls<110 mg/dl (G1). RESULTS: With the new criteria (>=126 mg/dl) the prevalence of unknown diabetes in the cohort was 1.2% accounting for 41% of the overall prevalence of the disease (known + unknown). This is nearly 2.5 times more than with the previous criteria, > 140 mg/dl, (1.2 vs 0.5%). In G2/G1 and G3/G2 highest FPG had higher BMI, H/W ratio, heart rate (male only G3/G2), BP, gamma GT (role of alcohol in males), uric acid and TG. A role of absence of breakfast, low dairy products consumption is found. No difference between G4 and G3 found. CONCLUSION: These results support the new criteria of FPG 126 mg/dl and suggest that it would be necessary to investigate and prevent cardiovascular risk factors as soon as fasting glycaemia is found to be over 110 mg/dl. Nutritional and behavioural education should be given at this early stage of the disease.

The BREV neuropsychological test: Part II. Results of validation in children with epilepsy.

The Battery for Rapid Evaluation of Cognitive Functions (Batterie Rapide d'Evaluation des Fonctions Cognitives: BREV) is a quick test to screen children with higher-functioning disorders and to define the patterns of their disorders. After standardization tests in 500 normally developing children aged 4 to 8 years, validation consisted of comparative evaluation of the specificity and sensitivity of the BREV with a wide reference battery in 202 children with epilepsy (108 males, 94 females; mean age 6 years 6 months, SD 1 year 8 months). Children were divided into 10 age groups from 4 to 8 years of age and represented eight epileptic syndromes. The reference battery included verbal and non-verbal intelligence assessment using the Wechsler scale, oral language assessment with a French battery for oral language study, drawing with the Rey figure, verbal and visuo-spatial memory with the McCarthy scale subtest and the Rey figure recall, and educational achievement with the Kaufman subtests. Every function evaluated with the BREV was significantly correlated with the reference battery testing a similar function (p=0.01 to 0.001). Specificity and sensitivity of the BREV verbal and non-verbal scores were correlated with those of the Wechsler scale in more than 75% of children. The BREV, therefore, appears to be a reliable test which has been carefully standardized and validated and is valuable in screening for cognitive impairment in children.