miR-26b在ob/ob小鼠组织中的表达研究

目的 观察miRNA-26b(miR-26b)在野生型C57/BL6J小鼠和瘦素基因遗传性缺陷ob/ob小鼠组织中的表达特征,以及瘦素对3T3-L1成熟脂肪细胞中miR-26b表达的调控.方法 取16周龄C57/BL6J小鼠和ob/ob小鼠的心脏、肝脏、脾、胰、肾脏、肺、小肠、骨骼肌、白色脂肪组织和棕色脂肪组织,采用实...     

Contraception et obésité

Obesity prevalence in industrialized countries has been dramatically increasing for several decades. Obese women are sexually active but they use fewer contraceptive methods and are at high risk of unintended pregnancy. In addition, obesity is an important risk factor for venous thromboembolism events and arterial thrombosis (myocardial infarction and ischemic stroke). All these data are to be considered when choosing a contraceptive method for obese women. The purpose of this paper is to exhaustively review contraceptive methods available in France in 2017 and to evaluate the benefits–risks balance of each of them in obese women.     

Asthme et obésité

Introduction

Asthma is a chronic disease whose prevalence continues to increase. Obesity is a comorbidity makes it difficult to support and control of asthma.

Material and Methods

A retrospective study on 39 cases of obese asthmatics, whose body mass index (BMI) exceeds 30 kg/m², followed by allergy consultation service between January 2007 and August 2009.

Results

These 31 women and 8 men aged between 23 and 79 years (average age: 48.5 years). Diabetes is associated in 2 cases, hypertension in 5 cases and a sick syndrome in one case. The asthma was intermittent in 17 cases (43.5%), mild persistent in 7 cases (18%), moderate persistent in 11 cases (28.25%) and severe persistent in 4 cases (10.25%). The gastro-esophageal reflux was found in 25% of cases, an allergic rhinitis in 41% cases, conjunctivitis in 28% of cases, eczema in 7.6% cases, food allergy in 10% of cases especially Fish and drug in 0.7% cases mostly aspirin. A family atopy was noted in 10% of cases. The recommended treatment based on inhaled corticosteroids and béta2mimétiques long duration of action in 22 cases associated with xanthine in 4 cases, antihistamines and nasal corticosteroids in 16 cases and inhibitors of proton pump in 10 cases. Asthma is well controlled in 60% of cases, partially controlled in 30% of cases and uncontrolled in10% of cases. The flow volume curve done in all our patients had obstructive ventilatory disorder objectified in 89.7% and mixed in 10.3%. The obstructive ventilatory disorder wasmild in 60%of cases, moderate in 28.6% cases and severe in 11.4%.

Conclusion

According to this study the female and the difficulty of controlling asthma in the obese population.     

Sucres, addiction et obésité

This review begins with an in-depth analysis of the medical concept of addiction and then describes recent research on food and sugar addiction and its role in obesity. Clinical research has established the existence of an addiction to food and refined sugars (ex. sucrose, fructose) whose prevalence is particularly high in some obese people. Food or sugar addiction is associated with functional changes in brain circuits involved in reinforcement learning, motivation and impulse control. These changes are similar to those seen in drug addiction (e.g., cocaine). Preclinical research on animals has shown that these brain changes can be caused by chronic overconsumption of high-sugar (or high-fat) foods. However, not all individuals (obese or not) go on to develop food and sugar addiction, suggesting the presence of an initial vulnerability whose origin remains to be understood.     

Modèle animaux d’obésité

Animal models provide major contribution to our understanding of the physiological, environmental, genetic and epigenetic bases of obesity. Most rodent models of obesity have been investigated since the early fifties, but it??s only more recently that the mechanisms underlying their phenotype were identified, thanks to the development of molecular biology. This article reviews various models of rodent obesity, naturally occurring or created by researchers: nutritional obesity induced by a high fat diet, hypothalamic obesity resulting from lesions in areas controlling food intake and genetic obesity due to spontaneous mutations in crucial genes for energy balance, such as leptin and leptin receptor genes. Each model provides information related to specific aspects of human obesity, particularly in the field of monogenic obesities that are rare but often severe as in leptin-deficient patients. Models of obese rodents represent precious and necessary tools to explore the complexity of energy balance regulation and for innovative therapeutic intervention in obesity, of which the success of leptin treatment for leptin-deficient patients is a striking example.     

Particularités de la ventilation chez le patient obèse

There is an increasing trend in the prevalence of obesity in intensive care units (ICU). Obesity is associated with an increase in abdominal pressure that markedly affects respiratory mechanics and is associated with a reduction in functional residual capacity, the leading cause of atelectasis formation during anesthesia. Obese patients are prone to respiratory complications related to ventilation, especially acute respiratory distress syndrome (ARDS). Ventilation of obese patients in the ICU has to take into account these pathophysiological characteristics. Preoxygenation using pressure support ventilation with a positive end-expiratory pressure (PEEP) between 5 and 10 cmH₂O is recommended, followed by lung protective mechanical ventilation using low tidal volume, calculated on ideal rather than actual body weight (6 ml/kg), and high PEEP (10 cmH₂O), provided the absence of severe hemodynamic alteration. The use of recruitment maneuvers (like applying a pressure of 40 cmH₂O during 40 seconds) should be considered in these patients prone to atelectasis formation. Mechanical ventilation can be performed using either volume-or pressurecontrolled mode, according to the each center specific expertise. Prone position should be considered in obese patients with ARDS, allowing significant improvement in the PaO₂/ FiO₂ ratio. Finally, despite high resource utilization, the prognosis of obese patients receiving mechanical ventilation seems to be similar to that of non-obese patients.     

��valuation de la fonction r��nale du sujet ob��se

Obesity is clearly associated with the development and increased risk of chronic kidney disease (CKD). The question of which tools are better for clarifying this risk arises in obese patients. CKD is defined by two parameters: glomerular filtration rate (GFR) and proteinuria (albuminuria). The different ways of estimating GFR will be discussed. Due to a lack of proportionality between lean mass and fat mass gains, plasma creatinine and Cochcroft formula are no longer recommended for estimating GFR. There is no formula specifically developed and validated for obesity. Currently, the formula of Modification of Diet in Renal Disease (MDRD) is the preferred method, as recommended by K/DIGO 2010 (Kidney Disease Outcome Quality Initiative) for a human with normal weight. As far as proteinuria, is concerned 24 hours urine collection must be abandoned in favour of proteinuria/creatinuria ratio form a urine sample. This ratio is expressed in mg/g and this classification into three grades is part of the evaluation of CKD in obese patients.     

Pathologies r??nales li??es ?? l??ob??sit??

Obesity is now recognized as an independent risk factor for chronic kidney disease and end-stage renal failure. The most frequent histological lesions are glomerulomegaly and focal and segmental glomerulosclerosis, the latter having a better evolution than the idiopathic form. Mechanisms leading to these lesions involve modifications of the glomerular hemodynamic and activation of many cytokines and growth factors secondary to hyperlipidemia, hyperinsulinemia and hyperleptinemia.     

Le syndrome obésité-hypoventilation: revue de la littérature

Obesity-hypoventilation syndrome (OHS) is a combination of obesity and hypercapnic chronic respiratory failure, without any other causes of hypercapnia. OHS is frequently associated with obstructive sleep apnea hypopnea syndrome (80%). Its prevalence is increasing in relation to the epidemics of obesity in Occidental countries. Clinical presentation including dyspnea and fatigue is not specific and may explain that OHS is under-recognized, responsible for many recurrent admissions in the intensive care unit for acute hypercapnic respiratory failure, generally associated with clinical right ventricular failure.Without any treatment, patients with OHS have a lower quality of life with increased healthcare expenses by recurrent hospitalisations and are at a higher risk for the development of pulmonary hypertension, metabolic and vascular morbidities as well as early mortality, in comparison to eucapnic obese patients. Available treatments include home continuous or bi-level positive airway pressure therapy, well-tolerated and effective to reduce mortality as well as different approaches for weight loss including bariatric surgery.     

Souffrances et croyances chez 1000 sujets en surpoids ou obèses en France

Abstract

Few studies take into consideration overweight and obese subjects outside the consultation room. This study aims to better understand the experiences of these subjects, their suffering, perceived causes of their weight gain and perception of their weight loss.

Subjects and methods

A telephone survey was conducted of a representative sample of 1000 overweight (OW) (75.8%) or obese OB [24.6%] subjects.

Results

1) Suffering: 58% of the obese subjects and 30% of the OW subjects feel that they are much too fat. The more the subjects believe their excess weight to be an obstacle to their social life, the more they diet. Sadness, loneliness, suffering increase in line with Body Mass Index: suffering is mentioned by 28% of the OW subjects and 52% of the OB (P < 0.001). Obese women are twice as likely to express their suffering as OB men (65 vs 33%, P < 0.001); 2) perceived causes of OW or obesity: diet is the first cause cited (39%), with major differences between the gender: 58% of men as opposed to 22% of women quote diet as the most important factor (P < 0.01). Half of the subjects believe their diet is too rich, although 2/3 consider they have a normal, healthy diet. Eight percent say that their OW is principally caused by a psychological problem; 3) diet and weight loss: weight loss is accompanied by various fears: losing one’s jolly image, losing one’s freedom, fear of becoming irritable or depressive; and above all no longer being able to eat what one wants (61% of OB subjects). The more the subjects diet, the more they are afraid of becoming irritable and aggressive (19% for those who never diet as opposed to 37% for three who have dieted three times or more [P < 0.001]).

Conclusion

Suffering grows in line with weight gain, more so in women than in men. But most subjects are afraid of losing weight because they fear the psychological consequences of restrictive diets…     

Propositions du Groupe de réflexion sur l’obésité et le surpoids pour une politique de santé publique en matière d’obésité

GROS (Groupe de réflexion sur l’obésité et le surpoids — Discussion Group on Obesity and Overweight, www.gros.org") is proposing another obesity prevention policy, taking into account current information regarding weight regulation, and considering the numerous factors at play. These factors are biological, psychological, social, economic and cultural. We propose ten obesity prevention measures, focused on fighting factors related to the deregulation of body fat and the promotion of factors favouring and protecting proper weight regulation. Six public health measures would facilitate the fight against deregulation factors: 1) fighting against the discrimination and stigmatisation of the obese, which promotes the loss of dietary control and the use of iatrogenic weight loss methods; 2) fighting against the demonisation of foods, which concretely leads to the same results; 3) promoting information and reassuring nutritional education; 4) demedicalising eating; 5) fighting against the hegemony of thinness; 6) improving the ethics of medical practice and the slimming trade. Four public health measures would aim at the promotion of regulation factors: 7) promoting food service industry conditions favourable to weight regulation; 8) promoting nutritional education taking into account the cultural, gastronomic, social, religious or philosophical dimensions of the act of eating; 9) developing the diversity of eating cultures; 10) promoting reconciliation with the body. Ten measures could more specifically apply to children and adolescents: 1) implementing anti-discrimination laws; 2) fighting against the stigmatisation of infantile obesity; 3) screening out cognitive restriction in parents; 4) passing on knowledge and eating cultures; 5) promoting active lifestyles; 6) promoting the social connection; 7) teaching critical reading of the world of images; 8) informing the medical fraternity of the dangers of norms and diets in children and adolescents.     

Chirurgie de l’incontinence urinaire à l’effort chez la femme obèse

Obesity is an established risk factor for SUI. Among overweight women, a weight loss program improves urinary incontinence with a reduction in the frequency of self-reported urinary incontinence episodes and may be suggested as a first-line therapy. Success rates after TVT are similar among obese patients and normal-weight patients, and TVT is the prime procedure to treat SUI in obese patients. Obesity does not appear as a risk factor for intra- and postoperative complications.     

Les contraintes mécaniques respiratoires au repos et à l’effort du sujet obèse

Obesity directly affects respiratory mechanics. Obese subjects usually show changes in certain lung volumes, respiratory compliance, and respiratory behaviour. Dyspnea is the limiting symptom usually experienced by these subjects. The aim of this review is to clarify the impact of obesity on different aspects of respiratory mechanics, at rest and during exercise.     

Prise en charge ventilatoire et mobilisation précoce du patient obèse en réanimation

Following World Health Organization, obesity is considered as the first noninfectious epidemic in history. Globally, this characteristic is linked to more deaths than underweight. Obesity is defined as a body mass index (BMI) greater than 30 kg/m². Obesity is a chronic progressive disease. Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. In European intensive care units (ICU), a third of the patients have a BMI ≥ 30 kg/m² and 7% a BMI > 40 kg/m². In the medical literature concerning these ICU obese patients, there is no significant difference in terms of mortality and length of hospital stay in comparison to normal weight population. There would be even better survival at 30 days and 1 year after the admission. The obese patient requires, however, particular attention to medical procedures, the practice of physiotherapy, and nursing procedures. Appropriate medical facilities and sufficient staff are important for proper care. The ventilation strategy should be adapted to limit the atelectasis and hypoxemia. Using a current volume adapted to the theoretical ideal weight of the patient and a positive expiratory pressure sufficiently (≥ 10 cmH₂O) associated with recruitment maneuvers is necessary for the prevention of barotrauma limiting on alveolar distension. The physiotherapist has an important role before, during, and after extubation. Concerning the respiratory management, the physiotherapist’ role is various. He or she must fight against the restrictive syndrome by positioning correctly the patient and he or she must train the diaphragm and clear the bronchial secretions. The use of continuous positive airway pressure may be necessary as “preventive or curative” to provide ventilatory support, restore as quickly as possible lung volumes, and reduce postoperative complications. Concerning muscular system, the mobilization must be early. It is feasible and safe. It helps to fight against the risk of thromboembolism, skin necrosis, prolongedmechanical ventilation, muscle deconditioning (weakness and atrophy), and ICU acquired weakness. According to the literature, early mobilization might reduce the length of ICU and hospital stay and also hospital costs.     

Les moyens mis en œuvre pour perdre du poids chez 1000 sujets en surpoids ou obèses

Abstract

Losing weight is an important concern for overweight (OW) subjects. What strategies do those patients adopt to lose weight?

Patients and method

A survey was conducted of a representative sample of 1000 OW (body mass index [BMI]: 25-29.9 kg/m²) or obese (OB) [BMI ≤ 30 kg/m²] subjects aged between 18 and 70.

Results

Among the subjects, 75.8% were OW and 24.2% OB. Seventy-six percent of the OW subjects (men [M]: 68.1%-women [F]: 81.2%) and 85% of the OB subjects (M: 77%-F: 90%) had already experienced the need to lose weight (F > M, P < 0.01). Sixty-six percent of the OW and 85% of the OB subjects had already voluntarily tried to lose weight (OB > OW, P < 0.001). Of those attempts undertaken at their own initiative, 79% of the subjects went on a diet and 65% tried physical exercise (OB < OW, P < 0.05). Among those who had voluntarily tried to lose weight, 49% had consulted a physician (general practitioner > specialist, P < 0.001) or a dietician (OB > OW, P < 0.001), (F > M, P < 0.05). Sixty-three percent of the entire population, (OB > OW, P < 0.001), had already attempted at least one diet. Among the subjects who had dieted, 57% experienced difficulty in complying with the diet regularly (OB > OW, P < 0.05), 48% tended to discontinue the diet prematurely (OB > OW, P < 0.001) and 26% considered that diets did not work for them. Thirty-seven percent of the entire population were aware that slimming drugs were available, but only 12% were considering using them.

Conclusion

Most of the OW and OB subjects had attempted to lose weight. Most has attempted dieting, but difficulties were frequently experienced. Few subjects were considering using a slimming drug. The strategies available appeared disappointing while the need to lose weight was very frequently experienced.     

Le patient obèse est-il responsable ? Aider au cheminement de la culpabilité au vivre-avec la maladie

According to WHO, obesity is a chronic disease. But the aim of the obese patient when he meets a specialist is not the same as the others patients who suffer from a chronic disease. Contrary to the diabetic who treats his disease in order to avoid complications, the obese wants to loose weight, that is to say to heal obesity. How can we explain this difference? Actually, it??s easy: we consider that the obese is obese because he eats too much. If he eats less, he won??t be obese anymore. It means he is responsible for his condition, and can also be responsible for his change. However, if it was that simple, obesity would not increase so much in Western countries. Are obeses really responsible for their condition, and can they really change it ? The problem comes from the fact that the obese, considered as responsible by his circle, society, medicine, is actually guilty of his condition. He is not in conformity, he has to change. This guilt, far from helping him to change, will, on the contrary, makes him rejecting all kinds of responsibilities. How can the medical help him to accept and to face a chronic disease ? How can we help him to act in front of obesity, to gain his own responsibility, which won??t be guilt anymore, and to avoid the suffering of this disease ?     

Dysfonctions du système nerveux sympathique et de la signalisation catécholaminergique chez l’obèse

The sympathetic nervous system (SNS) has an essential role in the maintenance of metabolic, gastrointestinal and cardiovascular homeostasis. Activation of SNS involves noradrenaline release by noradrenergic fibers and adrenaline secretion by adrenal medulla. The SNS has a major role in the control of adipose tissue function both directly, on adipocytes and adipose tissue vessels, and due to effects on pancreatic hormones secretion. Although a number of previous findings on SNS activity evaluation in humans provided inconsistent findings, various alterations of SNS effects on metabolism have been now implicated in the development and the maintenance of obesity. SNS activity to the skeletal muscle, evaluated via muscle sympathetic nerve activity (MSNA), is related to early renal, cardiac and endothelial dysfunctions in the obese. Reduced SNS activity has been claimed to represent a risk factor for weight gain. However, elevated SNS activity is present in obesity. Increased baseline SNS activity and blunted SNS-mediated thermogenic response to a meal may play a role in the progression of obesity related metabolic and cardiovascular diseases. Alterations of fat cell adrenergic receptor-mediated responses have been reported in the obese; they suggest an adaptation of adipose tissue to the level of SNS activity. This review provides an overview of physiological aspects of the SNS involvement in normal and obese subjects. Physiological and pathological changes in SNS activity are summarized. Modifications occurring in adipose tissue function and fat cell responsiveness to noradrenaline and adrenaline are also considered.     

Proposition de modèle d’organisation d’un centre spécialisé en obésité

The prevalence of obesity in France has obliged health professionals to organize themselves. The obese patients were primarily going to bariatric surgical centers. Under the auspices of the French Ministry of Health, a plan was initiated, focused on three areas: research, prevention and treatment. The aim of an obesity center so defined is mostly the treatment of the patients. Themulti-factorial nature of obesity requires a multidisciplinary treatment, but the combined action of these different actors is still poorly defined. This paper presents an example of a bariatric center that deals with a large amount of patients. We address the organization, management of surgical patient, and non surgical patient, and the follow-up of these patients.     

Prévalence et facteurs corrélés à une faible estime de soi chez le sujet obèse

Objective

To assess the prevalence of low self-esteem in a clinical population of obese individuals, to evaluate the impact of obesity on self-esteem by comparing obese patients to controls, and to identify the correlates of low self-esteem in obese patients.

Methods

A cross-sectional study including 60 obese patients (age ≥ 15 years and body mass index: BMI ≥ 30 kg/m²) and 60 healthy controls (age ≥ 15 years and BMI ≥ 25 kg/m²) was conducted. Self-esteem was assessed using the “Rosenberg Self-Esteem Scale” (RSES). Binge eating disorder (BED) was diagnosed using the “Binge Eating Scale” (BES). Quality of life was assessed by the “Quality of life, Obesity and Dietetics” scale (QOLOD), and depression and anxiety symptoms by the “Hospital Anxiety and Depression Scale” (HADS).

Results

The prevalence of a low self-esteem in obese patients was about 68.3%.It was higher than in the control group (P = 0.003; OR = 1.9). Low self-esteem was correlated to age (≤ 20 years) (P = 0.003), male gender (P = 0.045), celibacy (P = 0.001), young age of onset of obesity (R = 0.474; P = 0.001), high weight at the age of 20 years (R = ?0.5; P < 0.001), high current weight (R = ?0.427; P = 0.041), high BMI (R = ?0.482; P < 0.001), high BED score (R = ?0.471; P < 0.001), high anxiety score (R = <0.501; P < 0.001), high depression score (R = ?0.718; P < 0.001), and impaired physical (R = 0.457; P < 0.008), psychosocial (R = 0.474; P < 0.001), and global quality of life (R = 0.519; P < 0.001).

Conclusion

This study confirms the previously reported negative impact of obesity on self-esteem. It focused on the clinical and sociodemographic correlates of low self-esteem in obesity, specifically, young age, high weight at young age, depression, and impaired quality of life.