Prevalence of metabolic syndrome in Tunisian overweight and obese children.

AIMS: To assess the prevalence of metabolic syndrome (MS) and its parameters in a cohort of overweight and obese Tunisian schoolchildren and to investigate the involvement of leptin, and insulin in MS development via obesity. METHODS: A total of 306 schoolchildren between 10- 12 years: obese (n=35), overweight (n=99) and normal weight (n=172) were included in the study. Height, weight, waist circumference were measured and body mass index (BMI) was calculated. A blood sample was collected from each subject to measure glycemia, triglycerides, HDL cholesterol, leptin and insulin. MS diagnosis was based on criteria of  the International Diabetes Federation. RESULTS: Prevalence of MS was 14.3% in obese children compared to 1% in overweight and 0% in controls (p0.001). Abdominal obesity and hypertension  were the most frequent parameters (88.6% and 25.7% respectively) in obese children. Leptin levels were significantly higher in children with MS (p0.001). In obese children, leptin was positively correlated to waist circumference (r=0.55; p=0.001) and insulin (r=0.52; p=0.002). After adjustment for BMI, leptin remained correlated with insulin (r=0.47; p0.001). CONCLUSION: MS is relatively common among Tunisian overweight and obese children. Obesity is an important risk factor for MS development. Early management of childhood obesity is necessary to avoid metabolic complications.

Postmenopausal hypertension, abdominal obesity, apolipoprotein and insulin resistance.

This study aimed to evaluate the association of abdominal obesity, apolipoprotein and insulin resistance (IR) with the risk of hypertension in postmenopausal women. We analyzed a total of 242 women aged between 35 and 70 years. Blood pressure (BP), anthropometric indices, lipid profile, fasting glucose, insulin, C-reactive protein (CRP) and apolipoprotein concentrations were measured. Homeostasis model assessment (HOMA) was used to assess IR. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or current treatment with antihypertensive drugs. Women with hypertension showed significantly higher mean values of age, SBP and DBP, waist circumference (WC), fasting plasma glucose (FPG), insulin, HOMAIR and the apolipoprotein B (apoB). When analyses were done according to the menopausal status, higher prevalence of hypertension was observed in postmenopausal women (72.8% vs. 26.0%, p < 0.001) compared to their premenopausal counterparts. Postmenopausal women showed also significantly higher mean values of SBP and DBP, WC, HOMAIR and apoB. Multivariate linear regression analysis revealed that SBP was significantly affected by WC (p = 0.034), apoB (p = 0.038) and log HOMAIR (p = 0.007) in postmenopausal women. The interaction models revealed significant interaction between WC, apoB and log HOMAIR (WC×apoB×log HOMAIR) on SBP (p = 0.001) adjusted for age. In a multivariate logistic regression, adjusting for age and apoB, WC (p = 0.001), log HOMAIR (p = 0.007) and menopause (p = 0.008) were significantly associated with higher risk for hypertension. These results suggest that changes in WC, apoB and IR accompanying menopause lead to a greater prevalence of hypertension in postmenopausal women.

[Alterations in lipidic metabolism in hemodialysis patients]. / Altérations du métabolisme lipidique chez les hémodialysés.

BACKGROUND: Chronic kidney failure is associated with dyslipidemia and accelerated atherosclerosis. AIM: To study lipidic metabolism alterations in patients with chronic kidney failure on hemodialysis. METHODS: The study interested 45 hemodialysis patients with a mean age of 49.04 ±15.92 years old and 45 healthy controls. A blood sample was collected from each patient and control to measure total cholesterol, triglycerides, HDL- cholesterol, LDL-cholesterol, apolipoproteins AI and B100, lipoprotein (a) and C Reactive Protein. RESULTS: A significant increase of serum triglycerides (p= 0.002), lipoprotein (a) (p = 0.001) and C Reactive Protein (p = 0.008) was observed in patients when compared with healthy controls. A significant decrease of serum total cholesterol (p=0.01), HDLcholesterol (p<0.001), LDL-cholesterol (p=0.005) and apolipoprotein AI (p<0.001) was also observed in patients. CONCLUSION: Disorders of lipidic metabolism are frequent in hemodialysis patients. These alterations can lead to cardiovascular disease in uremic patients.

Relationship of C-reactive protein with components of the metabolic syndrome in a Tunisian population.

BACKGROUND: C-reactive protein (CRP) is an independent risk factor of diabetes and cardiovascular disease and it is proposed as a component of metabolic syndrome (MS). This study was undertaken to investigate the relationship between CRP and various characteristics of the MS in a sample of the Tunisian population METHODS: One hundred and forty nine patients with MS and 152 controls, aged 35-70 years were recruited. Waist circumference (WC), blood pressure, HDL-cholesterol (HDL-C), triglycerides (TG), glucose, insulin and CRP were measured. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR). MS was defined by NCEP-ATPIII report RESULTS: CRP levels were significantly higher in MS group (4.41±3.73 mg/L vs. 2.68±2.59 mg/L, p<0.001) compared to without MS group. For both sexes, CRP increased as the number of MS components increased (p=0.015 for men and p<0.001) after adjustment for age, smoking, alcohol intake and, for women, menopause. There were statistically significant positive correlations for log CRP with WC, log TG, and log HOMA-IR in both sexes adjusted for confounding factors listed above. A significant negative correlation was found between HDL-C and log CRP only in women. In both sexes, WC was identified, by multiple linear regression models, as significant independent predictor of CRP level variability. HDL-C showed also a significant contribution only in women CONCLUSIONS: The present study provides evidence that CRP levels are elevated in MS subjects. In addition, WC and HDL-C are significant predictors of the CRP elevation.

Association between C-reactive protein and type 2 diabetes in a Tunisian population.

The aim of this study was to investigate the association of CRP levels with type 2 diabetes (T2D) and its related variables in a sample of the Tunisian population. Our sample included 129 patients with T2D and 187 control subjects. Body mass index (BMI), plasma lipids, glucose, insulin, and CRP concentrations were measured for each participant. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. T2D was defined as a fasting plasma glucose (FPG) level ≥ 7.0 mmol/L, the use of anti-diabetic drugs, or both. Statistical analyses were performed using SPSS 11.5. A significant difference in mean values of BMI, plasma lipids, FPG, insulin, and HOMA-IR was observed between subjects with and without T2D. CRP level was significantly higher in subjects with T2D than those without (p = 0.023), and this result persisted even after adjustment for age, gender, BMI, smoking, and alcohol consumption. In both diabetes statuses, log CRP was significantly associated with FPG, insulin, and HOMA-IR. Subjects with elevated CRP levels (>5 mg/L) had an increased risk of T2D (OR = 2.02, 95% CI 1.18-3.46, p = 0.010) than those whose CRP levels were less or equal to 5 mg/L. Even after adjustment for potentially confounding factors, the risk of T2D was still increased in subjects with elevated CRP levels (OR = 1.91, 95% CI 1.08-3.36, p = 0.025). These results suggest that elevated CRP levels are independently associated with T2D.

The Apolipoprotein B/Apolipoprotein A 1 ratio in relation to metabolic syndrome and its components in a sample of the Tunisian population.

OBJECTIVE: This study was undertaken to investigate the relationship between the Apolipoprotein B/Apolipoprotein A 1 (ApoB/ApoA 1) ratio and various characteristics of the metabolic syndrome (MetS) in a sample of the Tunisian population. METHODS: The study included 330 adults aged 35-74 (172 patients with MetS and 158 controls). Waist circumference (WC), blood pressure (BP), HDL-cholesterol (HDL-C), triglycerides (TG), glucose, insulin, and apolipoprotein concentrations were measured. Homeostasis model assessment (HOMA) was used to assess insulin resistance (IR). MetS was defined by NCEP-ATPIII report. RESULTS: The ApoB/ApoA 1 ratio was significantly higher in patients with MetS versus normal control subjects (p<0.001). Mean values of ApoB/ApoA 1 ratio increased significantly as the numbers of MetS components increased in men (p<0.001) and women (p<0.001). ApoB/ApoA 1 ratio showed statistically significant associations with WC, HDL-C, TG, systolic and diastolic BP, and HOMA-IR. After adjusting for age and gender, the high ApoB/ApoA 1 ratio was significantly associated with the presence of MetS (odds ratio [OR]=6.10), IR (OR=1.88), and with each of the MetS components, including: high WC (OR=2.43), High TG (OR=6.14), and low HDL-C (OR=6.92). CONCLUSIONS: Our findings suggest that the ApoB/ApoA 1 ratio is strongly associated with MetS and its components, as well as with IR.

C677t polymorphism of MTHFR and G80A polymorphism of RFC genes and their relation with homocysteine levels in obese Tunisian children.

AIMS: To investigate the frequencies of C677T polymorphism in MTHFR gene and G80A polymorphism in RFC gene in obese and no obese Tunisian children and to assess their relation with homocysteine (tHcy), folate and vitamin B12 levels. METHODS: We have studied 31 obese compared to 22 no obese children. tHcy was assessed by fluorescence-immunoassay ; folate and vitamin B12 by radioimmunoassay. C677T and G80A mutations were detected using pyrosequencing. RESULTS: There were no differences in tHcy levels between obese and no obese, (10,34 ± 4,86µmoll/l vs11,00 ± 4,26µmoll/l). We found no difference for the allelic frequencies of the C677T polymorphism (29.03 % vs 30.95 %) and of the G80A polymorphism (64.52 % vs 59.52 %). Mean levels of tHcy, folic acid and vitamin B12 were not significantly different according to MTHFR and RFC genotypes. CONCLUSION: We demonstrated no difference in tHcy, folates, vitamin B12 levels and allelic frequencies of C677T and G80A polymorphisms in MTHFR and RFC genes between obese and no obese Tunisian children. These two polymorphisms don't seem to have any impact on homocysteine, folate and vitamin B12 status in the two populations.

Deletion polymorphism of glutathione S-transferases M1 and T1 in the Tunisian population.

BACKGROUND: Glutathione S-transferases (GST) play a vital role in cellular defense against environmentally toxic compounds. These enzymes present a genetic deletion polymorphism, which varies with ethnicity. AIM: To evaluate the frequencies of homozygous deletion of GSTM1 and GSTT1 genes in Tunisian population. METHODS: On the basis of multiplex PCR protocol, the frequency of the deleted genotypes of GSTM1 and GSTT1 genes was evaluated on 145 healthy Tunisian subjects. RESULTS: We found that 34.6% of the individuals had the GSTM1 null genotype, 16.6% had the GSTT1 null genotype and 4.82% had a double deletion of both GSTM1 and GSTT1. CONCLUSION: The distribution of GSTM1 null in Tunisians is rather in the range of black populations and is lower than that reported in Asians, Arabs and Caucasians. However the frequency of GSTT1 null is in the range of several populations studied except Asians. The double deletion frequency seems lower than that described in different populations.

Serum leptin concentration in Tunisian non obese children.

Leptin, an adipocyte-derived peptide hormone, is thought to play a key role in the regulation of body fat mass. Beyond this function, it appears to be an integral component of various hypothalamo-pituitary-endocrine feedback loops. Because childhood and puberty are periods of major metabolic and endocrine changes, we investigated leptin levels in 348 non overweight, non obese children (147 boys, 201 girls, age: 6-12 years) and then correlated these levels with age, anthropometric data, pubertal stage and insulin. A blood sample was collected from each subject to measure leptin and insulin levels by radioimmunoassay. Pubertal stage was assigned by physical examination, according to Tanner criteria for breast development in females and genital development in males. The results showed an increase in leptin levels in an age related way (r = 0.32, p < 0.0001 in girls; r = 0.21, p = 0.011 in boys) following a pattern that paralleled body weight (r = 0.6 in girls; r = 0.56 in boys; p < 0.0001) and BMI (r = 0.59 in girls; r = 0.6 in boys, p < 0.0001), suggesting that body fatness is a regulator of leptin levels in both girls and boys. A significant gender difference (3.39 +/- 2.79 ng/mL in girls vs 1.99 +/- 2.08 ng/mL in boys, p < 0.0001) with an increase during pubertal development in girls was also showed, while the levels remained constant in boys from Tanner stages T1 to T3. A correlation between leptin and insulinemia was noted in girls (r = 0.38, p < 0.0001) but not in boys, suggesting that insulinemia could be a stimulator of leptin synthesis in girls.

[Premature rupture membrane at term with unfavourable cervix]. / Rupture prématurée des membranes à terme sur col défavorable.

BACKGROUND: Between expectant attitude in hospital and labour induction, management of and premature rupture membrane at term stay controversial. AIM: The aim of our study was to evaluate the management rupture of the membranes at term with unfavourable cervix. MATERIAL AND METHODS: We conducted a retrospective study. An expectant delay of 24 hours had been followed by induction labour in women with favourable Bishop. Maturation by prostaglandins E2 (PGE2) was performed in case of unfavourable cervix. We administrate one dose each 24 hours (3 doses maxima). Over, labour induction by ocytocine was started. The prescription of antibioprophylaxis is systematic until delivery. RESULTS: We included 137 patients. 51% of patients had a spontaneous labour during the expectant delay. There was no significant difference in neonatal and maternal morbidity in case of expectant management of premature rupture membrane at term. CONCLUSION: Based on our findings and a review of the literature, an expectative of 24 hours is interesting in case if unfavourable conditions. Prostaglandin E2 maturations can be performed in unfavourable cervixes.

[Erythropoietin in cancer patients with anemia]. / Erythropoietine chez des patients cancereux anemiques.

OBJECTIVE: The aim of this study is to evaluate the endogenous erythropoietin production in cancer patients with anemia. METHODS: Our prospective study interested 99 cancer patients with anemia from 17 to 80 years old, during the period going from March 2002 to December 2004, and 31 healthy individuals with anemia caused by iron deficiency. A blood sample was collected from each patient, as well as healthy individuals to measure serum erythropoietin, C reactive protein and ferritin. RESULTS: The increase of serum erythropoietin was significantly lower in patients than in healthy individuals (P < 0.05). 25.2% of our cancer patients have inflammatory anemia and 74.7% presented microcytic anemia associated with increase of serum ferririn and CRP. These values were significantly higher than in healthy individuals (p < 0.05). CONCLUSION: Anemia in cancer patients results from activation of inflammatory system, which inhibit erythropoietin production. Apart from etiologic treatments, anemia can be treated with recombinant human erythropoietin.

[Biological investigation of thyroid cancer]. / Exploration biologique du cancer de la thyroide.

Thyroid carcinomas represent the most common endocrine malignancy, and several biological markers are proposed according to the different types of this cancer: for papillary cancer, thyroglobulin constitutes an excellent prognostic factor and rearrangements of ret oncogene can be useful in diagnosis. In sporadic medullary carcinoma, calcitonin is a diagnosis marker of choice, and coupled with ACE, can prevent relapse. Regarding familial medullary carcinoma, mutation screening in ret oncogene leads to early detection of new cases.

[Genetic polymorphism of gluthation-S transferases and N-acetyl transferases 2 and nasopharyngeal carcinoma: the Tunisia experience]. / Polymorphisme génétique des enzymes gluthation-S transférases et N-acétyl-transférases 2 dans le cancer du nasopharynx en Tunisie.

Interindividual differences observed in the metabolism of xenobiotics have been attributed to the genetic polymorphism of genes, which code for enzymes involved in detoxification. This genetic variability seems to be associated with the individual's susceptibility to certain cancers, including nasopharyngeal carcinoma. In this study, we have investigated the genotypic frequencies of DNA polymorphisms of two detoxification's genes: the gluthatione-S-transferase (GST) and the N-acetyl transferase 2 (NAT2). The study has included 45 patients with nasopharyngeal carcinoma compared to 100 healthy Tunisian controls. The presence of the GSTM1 null and GSTT1 null polymorphism was screened by using a multiplex PCR procedure. A PCR-RFLP method was used to detect polymorphism for the most common alleles of the NAT2 gene. Allelic frequencies between the two groups were compared using a chi2 test and odds ratio with 95% confidence intervals were calculated. The results indicate that the genotypic frequency of GSTM10/0 between controls and patients was significantly different. This genotype confers an increased risk of nasopharyngeal carcinoma (Odds Ratio = 2.12, [0.64-4.7]). However, genotypic frequencies of NAT2*6/NAT2*6 were significantly higher in the group of nasopharyngeal carcinoma patients. The calculated Odds Ratio showed an association between this genotype and nasopharyngeal carcinoma. In conclusion, the increase of nasopharyngeal carcinoma risk in Tunisia seems to be associated with GSTM10/0 and NAT2*6/6 genotype.

[Serum lactate dehydrogenase and its isoenzymes in nasopharyngeal carcinoma in Tunisia]. / Profil serique de la lacticodeshydrogenase et de ses isoenzymes dans le cancer du nasopharynx.

Our prospective study interested 41 patients, from 13 to 70 years old, and present a nasopharyngeal carcinoma confirmed histologically, during the period going from September 1999 to March 2000, and 45 healthy controls. A blood sample was collected from each patient before any treatment, as well as controls to measure serum LDH and its isoenzymes. Two groups of patients were selected after a period varying from 12 to 37 months with a mean of 29 months: 29 with favourable evolution, 12 with non favourable evolution. The mean serum total LDH and its isoenzymes values were significantly higher in patients than those in controls with values of variable p of 0.001 to 0.05. A significant correlation was found between ganglionnary extension and serum values of total LDH, LDH3 and LDH5. No significant difference were observed between the means serum total LDH before treatment and the clinical evolution of patients. Diagnostic contribution of total LDH is limited, by its ubiquitary character, but could constitute for LDH3 a good marker of the disease progression.

[Contribution of serum Cyfra 21-1 in nasopharyngeal carcinoma in Tunisia]. / Apport du dosage sérique du Cyfra 21-1 dans le cancer du cavum en Tunisie.

Cyfra 21-1 is a recognised marker for epidermoid lung and head and neck carcinomas oriented to the cytokeratin 19 that is expressed particularly in malignant epithelial cells. The aims of this study were to evaluate the importance of the use of this marker in nasopharyngeal carcinoma (NPC). Our prospective study interested 41 patients (33M/8F) with a mean age of 44 years (13 to 70) with 8 of them aged less than 30 years, presenting a nasopharyngeal carcinoma histologically confirmed from September 1999 to March 2000 and 45 healthy controls without evidence neoplasm. Undifferentiated forms represent 90.2% of cases and lesions are staged T2, T3 and T4 in 2.4%, 36.6% and 61% of cases, while N1, N2 and N3 represent 9.8%, 26.8% and 41.5% of cases. A blood sample was collected from each patient and control before any treatment, as well as controls to measure Cyfra 21-1 by immunoenzymatic assay, 2 groups of patients were selected after a period varying from 4 to 37 months with a median of 29 months: 27 patients with favourable evolution (without evidence of disease after initial treatment), 12 patients with non favourable evolution (1 death, 2 cases of loco-regional relapse and 9 patients with metastatic disease). 2 patients were lost to follow-up. The results showed that the mean serum Cyfra 21-1 values were significantly higher in patients with NPC than those in controls (p = 0.001). A significant correlation was found between the serum Cyfra 21-1 level before treatment and the clinical outcome of patients (p = 0.0009). Patients having a favourable evolution have the lowest level. Seric level of Cyfra 21-1 at diagnosis of NPC may play a predictive role to evaluate the risk of metastatic disease and prognosis.