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1.
Artigo em Inglês | MEDLINE | ID: mdl-33760279

RESUMO

BACKGROUND: Asthma is a heterogeneous disease in which the interaction of genetic and environmental factors plays a major role. The significance of blood eosinophil is unclear. The aim of the study was to determine the significance of blood eosinophil count in moderate to severe asthmatic children of preschool and school age. METHODS: This was a prospective cross-sectional study performed from 2011 to 2015 including children from the Severe Asthma Molecular Phenotype (SAMP) cohort at Trousseau Hospital (Paris, France). We included children with severe and moderate asthma, or severe and moderate recurrent wheeze, aged from 1 to 15 years at the time of exploration. RESULTS: We analyzed data from 402 children: 248 of preschool age and 154 of school age. Blood eosinophil count third quartile thresholds were 322 and 600 cells/µL for the preschool- and school-age groups, respectively. In multivariate analysis, a blood eosinophil count over this threshold was associated with elevated total IgE (OR=5.33; P<0.01), multiple hospitalizations for asthma attacks (OR=4.96; P=0.03), and a maternal history of asthma (OR=4.91; P=0.01) in preschool children; and with staphylococcal toxin-specific IgE (OR=2.75; P=0.03) in children of school age. Random forest analysis reinforced these results. CONCLUSION: High blood eosinophil count is linked to both atopic features and control of asthma with different parameters associated with these features depending on age.

3.
Obes Facts ; 14(1): 163-168, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33498054

RESUMO

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors - within health systems and at a national level - along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity - not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33257776

RESUMO

Cord blood transplantation (CBT) is associated with low risk of leukemia relapse. Mechanisms underlying antileukemia benefit of CBT are not well understood, however a previous study strongly but indirectly implicated cells from the mother of the cord blood (CB) donor. A fetus acquires a small number of maternal cells referred to as maternal microchimerism (MMc) and MMc is sometimes detectable in CB. From a series of 95 patients who underwent double or single CBT at our center, we obtained or generated HLA-genotyping of CB mothers in 68. We employed a technique of highly sensitive HLA-specific quantitative-PCR assays targeting polymorphisms unique to the CB mother to assay CB-MMc in patients post-CBT. After additional exclusion criteria, CB-MMc was evaluated at multiple timepoints in 36 patients (529 specimens). CB-MMc was present in seven (19.4%) patients in bone marrow, peripheral blood, innate and adaptive immune cell subsets, and was detected up to 1-year post-CBT. Statistical trends to lower relapse, mortality, and treatment failure were observed for patients with vs. without CB-MMc post-CBT. Our study provides proof-of-concept that maternal cells of the CB graft can be tracked in recipients post-CBT, and underscore the importance of further investigating CB-MMc in sustained remission from leukemia following CBT.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33038591

RESUMO

BACKGROUND: Safe and cost-effective biological surrogate markers to evaluate the severity and threshold dose of peanut allergy (PA) reactions during an oral food challenge (OFC) are lacking. OBJECTIVE: To evaluate biological markers associated with the severity and threshold dose of an allergic reaction during an OFC in a population of children with PA. METHODS: Demographic and biological parameters of children with peanut OFC and basophil activation test (BAT) results were collected. Patients were stratified into 2 severity groups (mild-to-moderate and severe) and 2 cumulative threshold dose groups: low (LCTG) ≤100 mg crushed peanut and high >100 mg. RESULTS: Among the 68 children included, there was a 96% concordance between the OFC and BAT result for the diagnosis of PA. Of the 56 children with a positive OFC and BAT to peanut (median age: 8.8 years), the severity of an allergic reaction and the cumulative threshold dose were not correlated (P = .24). Higher Ara h 2-specific IgE and FcεRI-positive control values were both associated with severe reactions to peanut. Combining these 2 markers led to a 92% sensitivity (84%-97%) and an 82% specificity (71%-89%) for severe reactions in all subjects. For children in the LCTG, a 4-variable composite marker, including age, normalized basophil sensitivity (EC50), and FcεRI- and fMLP-positive control values, resulted in a 97% sensitivity (89%-99%) and 61% specificity (49%-71%). CONCLUSION: Distinct composite markers including BAT allergen-specific and non-allergen-specific parameters appear to be associated with severity and cumulative threshold dose in children with PA.

6.
Obes Facts ; 13(4): 439-452, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32791497

RESUMO

Accumulating evidence suggests that obesity is a major risk factor for the initiation, progression, and outcomes of coronavirus disease 2019 (COVID-19). The European Association for the Study of Obesity (EASO), as a scientific and medical society dedicated to the promotion of health and well-being, is greatly concerned about the concomitant obesity and COVID-19 pandemics and their impact on health and society at large. In this perspective, we will address the inherent immunological perturbations and alterations in the renin-angiotensin-aldosterone system in patients with obesity and COVID-19, and discuss how these impairments may underlie the increased susceptibility and more detrimental outcomes of COVID-19 in people with obesity. Clearly, this has important implications for preventive measures, vaccination, and future therapeutic strategies to combat COVID-19. Furthermore, we will highlight important knowledge gaps and provide suggestions for future research and recommendations for policy actions. Since many new reports on COVID-19 rapidly appear, the present perspective should be seen as a focus for discussion to drive forward further understanding, research initiatives, and clinical management of COVID-19.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Obesidade/complicações , Obesidade/imunologia , Pneumonia Viral/imunologia , Coronavirus , Infecções por Coronavirus/terapia , Suscetibilidade a Doenças , Humanos , Tolerância Imunológica/imunologia , Imunocompetência/imunologia , Pandemias , Peptidil Dipeptidase A , Pneumonia Viral/terapia , Prognóstico , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco
7.
Obes Facts ; 13(4): 430-438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32659766

RESUMO

The World Health Organization declared COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, a pandemic on March 12, 2020. COVID-19 is causing massive health problems and economic suffering around the world. The European Association for the Study of Obesity (EASO) promptly recognised the impact that the outbreak could have on people with obesity. On one side, emerging data suggest that obesity represents a risk factor for a more serious and complicated course of COVID-19 in adults. On the other side, the health emergency caused by the outbreak diverts attention from the prevention and care of non-communicable chronic diseases to communicable diseases. This might be particularly true for obesity, a chronic and relapsing disease frequently neglected and linked to significant bias and stigmatization. The Obesity Management Task Force (OMTF) of EASO contributes in this paper to highlighting the key aspects of these two sides of the coin and suggests some specific actions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Obesidade/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Idoso , Infecções por Coronavirus/transmissão , Suscetibilidade a Doenças , Humanos , Pessoa de Meia-Idade , Obesidade/complicações , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/transmissão , Fatores de Risco , Índice de Gravidade de Doença , Vacinação , Carga Viral , Organização Mundial da Saúde
10.
PLoS One ; 15(2): e0228179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32107489

RESUMO

BACKGROUND: Switzerland, like other high-income countries, is facing a major public health challenge with the increasing burden of non-communicable diseases. Discussions are currently on-going in Switzerland regarding the implementation of a Front-of-Pack nutrition label (FoPL) as a public health measure to guide consumers towards healthier food choices, and the Nutri-Score represents an alternative supported by multiple actors. To date, no studies have investigated the performance of the Nutri-Score among Swiss consumers. This study aimed to compare the response of Swiss consumers to five FoPLs (Health Star Rating system, Multiple Traffic Lights, Nutri-Score, Reference Intakes and Warning symbol) in terms of perception and understanding of these labels and effects on food choices. METHODS: In 2019, 1,088 Swiss consumers were recruited and asked to select one product from among a set of three foods with different nutritional profiles and then classify the products within the sets according to their nutritional quality. Tasks were performed in situations without a label and then with one of the five FoPLs-depending on the group in which they were randomized-on the pack. Finally, participants were questioned on their perceptions regarding the label to which they were exposed. RESULTS: All FoPLs were favorably perceived, with marginal differences between FoPLs. The Nutri-Score demonstrated the highest percentage of improvement in food choices and the highest overall performance in helping consumers rank the products according to their nutritional quality. CONCLUSION: Overall, the Nutri-Score was the most efficient FoPL in informing Swiss consumers of the nutritional quality of food products, and as such could be a useful tool to improve food choices and reduce the burden of chronic diseases in Switzerland.


Assuntos
Comportamento do Consumidor , Rotulagem de Alimentos/métodos , Valor Nutritivo , Adolescente , Adulto , Feminino , Preferências Alimentares , Humanos , Conhecimento , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Percepção , Inquéritos e Questionários , Suíça , Adulto Jovem
11.
Obes Facts ; 13(1): 1-28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945762

RESUMO

Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.


Assuntos
Variação Biológica da População , Prova Pericial , Anamnese/normas , Obesidade/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Variação Biológica da População/fisiologia , Comportamento de Escolha , Dieta , Europa (Continente) , Humanos , Obesidade/diagnóstico , Prognóstico , Projetos de Pesquisa/normas
12.
Front Immunol ; 10: 2592, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31787977

RESUMO

Mutations in the tetratricopeptide repeat domain 7A (TTC7A) gene cause very early onset inflammatory bowel diseases (VOIBD) or multiple intestinal atresia associated with immune deficiency of various severities, ranging from combined immune deficiency to mild lymphopenia. In this manuscript, we report the clinical, biological and molecular features of a patient born from consanguineous parents, presenting with recurrent lymphoproliferative syndrome and pan-hypergammaglobulinemia associated with chronic intestinal pseudo obstruction (CIPO). Genetic screening revealed the novel c.974G>A (p.R325Q) mutation in homozygosity in the TTC7A gene. The patient's phenotype differs significantly from that previously associated with TTC7A deficiency in humans. It becomes closer to the one reported in the ttc7a-deficient mice that invariably develop a proliferative lymphoid and myeloid disorder. Functional studies showed that the extreme variability in the clinical phenotype couldn't be explained by the cellular phenotype. Indeed, the patient's TTC7A mutation, as well as the murine-ttc7 mutant, have the same functional impact on protein expression, DNA instability and chromatin compaction, as the other mutations that lead to classical TTC7A-associated phenotypes. Co-inheritance of genetic variants may also contribute to the unique nature of the patient's phenotype. The present case report shows that the clinical spectrum of TTC7A deficiency is much broader than previously suspected. Our findings should alert the physicians to consider screening of TTC7A mutations in patients with lymphoproliferative syndrome and hypergammaglobulinemia and/or chronic intestinal pseudo-obstruction.


Assuntos
Pseudo-Obstrução Intestinal/etiologia , Transtornos Linfoproliferativos/etiologia , Deficiência de Proteína , Proteínas/fisiologia , Animais , Células Cultivadas , Doença Crônica , Consanguinidade , Feminino , Humanos , Lactente , Pseudo-Obstrução Intestinal/genética , Transtornos Linfoproliferativos/genética , Masculino , Camundongos , Proteínas/genética
13.
Nat Rev Rheumatol ; 15(11): 673-686, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31597952

RESUMO

Rheumatic diseases affect a wide range of individuals of all ages, but the most common diseases occur more frequently in women than in men, at ratios of up to ten women to one man. Despite a growing number of studies on sex bias in rheumatic diseases, sex-specific health care is limited and sex specificity is not systematically integrated into treatment regimens. Women and men differ in three major biological points: the number of X chromosomes per cell, the type and quantities of sex hormones present and the ability to be pregnant, all of which have immunological consequences. Could a greater understanding of these differences lead to a new era of personalized sex-specific medicine? This Review focuses on the main genetic and epigenetic mechanisms that have been put forward to explain sex bias in rheumatic diseases, including X chromosome inactivation, sex chromosome aneuploidy and microchimerism. The influence of sex hormones is not discussed in detail in this Review, as it has been well described elsewhere. Understanding the sex-specific factors that contribute to the initiation and progression of rheumatic diseases will enable progress to be made in the diagnosis, treatment and management of all patients with these conditions.


Assuntos
Epigênese Genética , Predisposição Genética para Doença , Medicina de Precisão/métodos , Doenças Reumáticas/genética , Feminino , Humanos , Masculino , Fatores Sexuais
15.
Sci Rep ; 9(1): 12880, 2019 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501466

RESUMO

The X chromosome, hemizygous in males, contains numerous genes important to immunological and hormonal function. Alterations in X-linked gene dosage are suspected to contribute to female predominance in autoimmunity. A powerful example of X-linked dosage involvement comes from the BXSB murine lupus model, where the duplication of the X-linked Toll-Like Receptor 7 (Tlr7) gene aggravates autoimmunity in male mice. Such alterations are possible in men with autoimmune diseases. Here we showed that a quarter to a third of men with rheumatoid arthritis (RA) had significantly increased copy numbers (CN) of TLR7 gene and its paralog TLR8. Patients with high CN had an upregulated pro-inflammatory JNK/p38 signaling pathway. By fluorescence in situ hybridization, we further demonstrated that the increase in X-linked genes CN was due to the presence of an extra X chromosome in some cells. Men with RA had a significant cellular mosaicism of female (46,XX) and/or Klinefelter (47,XXY) cells among male (46,XY) cells, reaching up to 1.4% in peripheral blood. Our results present a new potential trigger for RA in men and opens a new field of investigation particularly relevant for gender-biased autoimmune diseases.


Assuntos
Artrite Reumatoide/sangue , Artrite Reumatoide/genética , Dosagem de Genes , Mosaicismo , Receptor 7 Toll-Like/genética , Receptor 8 Toll-Like/genética , Artrite Reumatoide/metabolismo , Artrite Reumatoide/patologia , Estudos de Casos e Controles , Cromossomos Humanos X/genética , Cromossomos Humanos Y/genética , Humanos , Masculino , RNA Mensageiro/genética , Transdução de Sinais , Receptor 7 Toll-Like/metabolismo , Receptor 8 Toll-Like/metabolismo
16.
Clin Obes ; 9(6): e12335, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415133

RESUMO

Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6-month lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) z-score and cardiovascular disease (CVD) risks factors in children with obesity. This 6-month randomized controlled trial with a 6-month follow-up included 74 pre-pubertal children with obesity (7.5-11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatrician + 4 hours dietician) or group treatment (35 hours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI z-score; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intima-media thickness and incremental elastic modulus (Einc); endothelium-dependent and independent dilation (nitroglycerin-mediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and high-sensitivity C-reactive protein (hs-CRP). Compared to controls, at 6 months, abdominal fat and hs-CRP were reduced in both interventions. The group intervention was also effective in reducing BMI (-0.55 kg/m2 ; 95% confidence interval -1.16 to 0.06) and BMI z-score (-0.08; -0.15 to 0.00) at 6 months and BMI, BMI z-score, WC, NTGMD, total and abdominal fat at 12 months. Abdominal fat and low-grade inflammation were significantly decreased in both interventions. High-intensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population.


Assuntos
Doenças Cardiovasculares/terapia , Obesidade Pediátrica/terapia , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/psicologia , Espessura Intima-Media Carotídea , Criança , Dieta Saudável , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Insulina/sangue , Estilo de Vida , Masculino , Obesidade Pediátrica/metabolismo , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/psicologia , Fatores de Risco , Resultado do Tratamento , Circunferência da Cintura
17.
Int J Obes (Lond) ; 43(8): 1653, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30940916

RESUMO

This paper was originally published under a standard licence. This has now been amended to a CC BY licence in the PDF and HTML.

18.
Obes Facts ; 12(2): 131-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30844811

RESUMO

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO's proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.


Assuntos
Técnicas de Diagnóstico Endócrino/normas , Obesidade/classificação , Obesidade/diagnóstico , Adiposidade , Pesquisa Biomédica/normas , Pesquisa Biomédica/tendências , Índice de Massa Corporal , Doença Crônica , Técnicas de Diagnóstico Endócrino/tendências , Humanos , Obesidade/epidemiologia , Obesidade/etiologia , Sociedades Científicas/normas , Terminologia como Assunto
20.
Obes Facts ; 12(1): 40-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673677

RESUMO

The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs' education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5-10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).


Assuntos
Manejo da Obesidade/normas , Obesidade/terapia , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Adulto , Comorbidade , Europa (Continente)/epidemiologia , Clínicos Gerais/organização & administração , Clínicos Gerais/normas , Humanos , Obesidade/epidemiologia , Manejo da Obesidade/métodos , Manejo da Obesidade/organização & administração , Qualidade de Vida , Circunferência da Cintura , Perda de Peso
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