Phytoestrogènes et os : de nouvelles données

Osteoporosis is a greater public health problem.Ecological studies have shown that femoral neck fractures was lesser in asian populations.It has been suggested that diet might play a role in this observation. Among foods, soybean and soyfoods seemed able to play this role because of their isoflavones content. They are experimentally weak estrogens which may bind to bone estrogen receptors (β especially). They also probably act through others mechanisms such as enzymes, particularly tyrosine kinase.In vitro studies and in vivo studies in animal models and in humans have shown two kinds of effects, a bone resorption inhibiting effect and a bone formation stimulating effect. A beneficial effect is not observed in non human female primate.Observational studies give inconsistent results, according to age, kind of bone, population, isoflavones dosage. Asian epidemiologic studies, and in a lesser extend western studies, show within these populations a positive correlation between isoflavones intakes and bone mineral density. Recently a Chinese prospective study has established a relationship between isoflavones intakes and bone fracture during a four years follow-up.Some clinical trials with defectives methodology demonstrate a lack of effect on bone mineral density; most of clinical trials show favourable results on femoral and spinal bone mineral density, sometimes on forearm, never of calcaneum. Two recent studies with red clover are also positive. Results in clinical trials are provided with higher dosages than in epidemiologic studies. The variability of observed effects could be due to producers or non-equol producers. These data are discussed.However we are still lacking for histological and histomorphometric data and for clinical trials on the fractures’ risk.To-day phytoestrogens cannot be considered as an anti-osteoporotic treatment. But it is not excluded than soy and/or soy isoflavones may become future means used in bone-loss prevention.     

Le syndrome métabolique : une entité à haut risque métabolique et cardiovasculaire

The association between abdominal obesity, insulin-resistance, type 2 diabetes, arterial hypertension and dyslipidemia has been known for many years. Metabolic syndrome has been recently recognized by both WHO and NCEP ATP III with the definition including a cluster of metabolic abnormalities. Metabolic syndrome is common with its prevalence increasing with age. Metabolic syndrome represents an averse metabolic state since it confers an increased risk for both type 2 diabetes and cardiovascular disease. Targeting physical inactivity and obesity with lifestyle changes is the cornerstone of the prevention and treatment of the metabolic syndrome. Further studies are warranted to better determine the value of therapies directed specifically at insulin-resistance in individuals with metabolic syndrome.     

Évaluation des sites francophones spécialisés dans l’obésité accessibles au public

Obesity has now become a major public health issue. Obese people have at their disposal a huge amount of information and search for data related to their disease increasingly via the internet, while they don’t have sufficient medical knowledge.Using net scoring we have selected the ten best web sites dealing with obesity, in compliance with strict/harsh requirements. They include quality contents even though they might be criticised somehow. The internet must remain a means of finding help and advice for obese people. This source of information for motivated people, is an additional tool but cannot replace a traditional health care system.     

L’endothéliopathie : son risque et rôle des facteurs métaboliques

Endothelial dysfunction (ED) has been demonstrated in diabetics, insulin resistant obese patients, patients with hypercholesterolemia or hypertension, and also in smokers. The role played by hyperglycemia, and an excess in free fatty acids and leptin has been evoked. ED may be considered as a vascular integrator of various metabolic disorders and some nutritional factors. Evidence for ED is based on pharmacological tests using acetylcholine in particular, or functional tests like the forearm-mediated vasodilation, but also on the measurement of blood markers or microalbuminuria. ED plays a pathophysiological role in atherothrombosis, tissue ischemia, hypertension and microangiopathic complications of diabetes. ED is an ubiquitous disorder which involves the whole artery network and microcirculation. ED may also contribute to insulin resistance. It may be reversed when improving metabolic disorders and lowering blood pressure. In addition, some oral hypoglycemic agents, lipid or blood pressure lowering drugs are able to improve endothelium function through pleiotropic effects. Various antioxidant agents exert also short-term beneficial effects on the endothelium but their therapeutic effects remain to be defined.     

Mechanisms underlying the antihypertensive effects of garlic bioactives

Cardiovascular disease remains the leading cause of death worldwide with hypertension being a major contributing factor to cardiovascular disease–associated mortality. On a population level, non-pharmacological approaches, such as alternative/complementary medicine, including phytochemicals, have the potential to ameliorate cardiovascular risk factors, including high blood pressure. Several epidemiological studies suggest an antihypertensive effect of garlic (Allium sativum) and of many its bioactive components. The aim of this review is to present an in-depth discussion regarding the molecular, biochemical and cellular rationale underlying the antihypertensive properties of garlic and its bioactive constituents with a primary focus on S-allyl cysteine and allicin. Key studies, largely from PubMed, were selected and screened to develop a comprehensive understanding of the specific role of garlic and its bioactive constituents in the management of hypertension. We also reviewed recent advances focusing on the role of garlic bioactives, S-allyl cysteine and allicin, in modulating various parameters implicated in the pathogenesis of hypertension. These parameters include oxidative stress, nitric oxide bioavailability, hydrogen sulfide production, angiotensin converting enzyme activity, expression of nuclear factor–κB and the proliferation of vascular smooth muscle cells. This review suggests that garlic and garlic derived bioactives have significant medicinal properties with the potential for ameliorating hypertension and associated morbidity; however, further clinical and epidemiological studies are required to determine completely the specific physiological and biochemical mechanisms involved in disease prevention and management.     

Effects of Flavonoid-Containing Beverages and EGCG on Endothelial Function

Abnormalities of the vascular endothelium contribute to all stages of atherosclerosis from lesion development to clinical cardiovascular disease events. Recognized risk factors, including diabetes mellitus, hypertension, dyslipidemia, cigarette smoking, and sedentary lifestyle are associated with endothelial dysfunction. A variety of pharmacological and behavioral interventions have been shown to reverse endothelial dysfunction in patients with cardiovascular disease. A large number of epidemiological studies suggest that dietary factors, including increased intake of flavonoid-containing foods and beverages, reduce cardiovascular risk, and recent studies have shown that such beverages have favorable effects on endothelial function. These studies have engendered interest in the development of dietary supplements or drugs that would allow for more convenient and higher dose administration of flavonoids and might prove useful for prevention or treatment of cardiovascular disease. In this paper, we will review the contribution of endothelial dysfunction to the pathogenesis and clinical expression of atherosclerosis and recent data linking flavonoid and EGCG consumption to improved endothelial function and reduced cardiovascular risk.     

Effects of flavonoid-containing beverages and EGCG on endothelial function

Abnormalities of the vascular endothelium contribute to all stages of atherosclerosis from lesion development to clinical cardiovascular disease events. Recognized risk factors, including diabetes mellitus, hypertension, dyslipidemia, cigarette smoking, and sedentary lifestyle are associated with endothelial dysfunction. A variety of pharmacological and behavioral interventions have been shown to reverse endothelial dysfunction in patients with cardiovascular disease. A large number of epidemiological studies suggest that dietary factors, including increased intake of flavonoid-containing foods and beverages, reduce cardiovascular risk, and recent studies have shown that such beverages have favorable effects on endothelial function. These studies have engendered interest in the development of dietary supplements or drugs that would allow for more convenient and higher dose administration of flavonoids and might prove useful for prevention or treatment of cardiovascular disease. In this paper, we will review the contribution of endothelial dysfunction to the pathogenesis and clinical expression of atherosclerosis and recent data linking flavonoid and EGCG consumption to improved endothelial function and reduced cardiovascular risk.     

Les phytostérols et les phytostanols: quelle place pour la prévention cardiovasculaire?

Phytosterols are natural plant compounds. Phytostanols are derived from phytosterols’ hydrogenation. Both they inhibit intestinal dietary cholesterol absorption by competition, and they decrease LDL cholesterol by 8-15%, in a dose-dependant manner. They impair carotenoids bioavailability. A very small and variable part of phytosterols and phytostanols is absorbed. No epidemiological data is available for assessing the beneficial of plant sterols intake and cardiovascular risk. In the other hand there are many studies which have shown paradoxically a positive relationship between serum phytosterols concentrations and increase of the coronary heart disease risk. Other studies have established a link between the phytosterols’ absorption and their plasma and arterial plaque levels. Phytosterols and cholesterol hyperabsorbers subjects would be particularly involved in this unfavourable issue. Phytostanols could have a different effect from that point of view. In animal studies, data are less inconsistent with, in most of the studies, a lesser progression of atheroma lesions, perhaps due to an anti-inflammatory effect of phytosterols in atheroma plaque. The place of phytosterols and phytostanols in the therapeutic step for cardiovascular prevention is actually not defined. Many queries are still open. Complementary studies are needed for improving the clinical indications and the efficiency of these compounds.     

机关职业人群高尿酸血症与心血管疾病危险因素相关性调查

目的调查机关职业人群高尿酸血症(HUA)患病率,分析心血管疾病危险因素与HUA患病的相关性。方法对北京市2014~2016年参加健康体检的4 735名机关干部和公务员进行横断面调查,应用Logistic回归分析HUA患病率与超重或肥胖、高血压、高血糖和血脂异常检出率的相关性。结果总体HUA患病率为8.91﹪,其中男性为9.86%,女性为5.87%,男性HUA患病率高于女性(P<0.01)。男性HUA患病的独立危险因素为血脂异常、高血压、超重或肥胖(P<0.01);女性HUA患病的独立危险因素为年龄、血脂异常、高血糖、高血压、超重或肥胖(P<0.05)。结论 HUA的发生与心血管疾病危险因素中的超重或肥胖、血脂异常和高血压的关联强度较为明显,需建立以饮食治疗和改善生活方式为基础的干预措施,以减少相关危险因素的暴露水平。     

Nutrition et accident vasculaire cérébral

Nutrition is an important factor to take into account in the management of stroke. Within the framework of primary and secondary prevention, different risk factors are now well known and designed as target, among them numerous nutritional factors like overweight or obesity, diabetes, dyslipidemia. At the opposite, stroke favours troubles of the glycoregulation and is a risk factor of malnutrition. Malnutrition has to be detected and treated because of its negative effects on morbidity and mortality. Dysphagia is one of the main causes of malnutrition, in particular if it do not regress rapidly. In this case, enteral nutrition is indicated and a gastrostomy is preferred if enteral nutrition has to be prolonged. In order to reduce morbidity and mortality, different nutritional interventions are yet to be evaluated.     

Comportements alimentaires de l’enfant et attitudes parentales: le point de vue de la psychologie expérimentale

Children show a clear preference, throughout development, for high energy density foods, and particularly for sweet and/or fat products. Most parents disapprove of this behavior, in the present context of high obesity prevalence and widespread acceptance of thinness as a model. Children’s appetite for such foods has adaptive value, so far as the growing child has not lost his/her ability for energy adjustment. A few studies suggest that excessive control over children’s food choices contributes to a loss of the child’s capacity to energy adjustment. Education models that include both the teaching of rules and adjustments to the child’s requests seem to facilitate the acquisition of adequate eating behaviors, which favor a varied diet and body weight control.     

De quelques maux de la prévention contemporaine. Le cas de l’obésité et du surpoids

Overweight and obesity are considered major public health issues, and many preventive campaigns are designed to prevent unhealthy eating habits among the French. But these campaigns may be ineffective, and even sometimes counterproductive. Firstly, because prevention is a moral enterprise that can lead to stigmatizing targeted people. Secondly, because the ‘merchandization’ of prevention fuels a ‘dietary cacophony’. Thirdly, the medicalisation of overweight/obesity involves some shortcomings: it can prevent us from understanding eating habits, and many general physicians are insufficiently trained to take care of overweight or obese patients.     

Place du diététicien dans l’équipe de soutien nutritionnel : évolution d’une profession

Recognised 30 years ago, hospital nutritional depletion remains a major problem of public health which concerns from 30% to 50% of all patients at admission. The circular DHOS/E 1 n? 2002-186 of the 29 March 2002, recommending the implementation of both the committee for food-nutrition (CLAN: Comité de Liaison Alimentation Nutrition) and the nutrition support team within the hospital, is the result of 10 years effort in regard to food-nutrition and the accreditation process in health care. The dietician, previously accountable for the quality of food and dietary services, has now the opportunity to play a leading role within the nutritional care team for the screening and treatment of nutritional depletion. However, the initial training and the present status of the dietician don’t allow him to follow this evolution effectively. Updating of his training and the redefinition of his missions seem indispensable to respond to today's health care needs. This will help to ensure that above legal recommendation can be applied.     

Les progrès de l'alimentation animale pour satisfaire les critères de qualité : du producteur au consommateur !

Consumers’expectations have drastically changed over the last twenty years. Animal products are more and more transformed into ready-to-cook even ready-to-eat products. To the performance target, have been added consumers’desires such as quality, health and transformers’constraints for homogeneity and capacity for further processing. The nutritionist becomes the scientist of the compromise. He has to reach performance with quality with the help of feed complements and additives such as amino acids, vitamins, trace minerals. He can use rapid evaluation tool to adapt complementation to the actual batch of raw materials as well as exogenous enzymes to better access the valuable nutrients. By modifying the feeding strategy and feed composition, the nutritionist is able to contribute to satisfy human needs: from polyunsaturated fatty acids to vitamins and health benefits. Furthermore, the overall target is to guarantee the sustainability of animal productions.     

Multiplicity of garlic health effects and Alzheimer's disease

The epidemiological, clinical and laboratory data have shown that garlic contains many biologically active compounds which are beneficial to human health in general. Among all, one garlic-preparation called aged garlic extract, is proven to be safer. Although additional studies are warranted in humans, compelling evidence supports the health effects attributed to aged garlic extract and its implications in preventing or reducing the risk of cardiovascular ailments, stroke and cancer. Recently, the beneficial effects of garlic and its constituents on neuronal physiology and brain functions are beginning to emerge. However, this field is still in infancy and not yet fully explored. This review encompasses multiple health effects of garlic and its constituents with reference to neuroprotection. Possible potential of dietary garlic as an alternative herbal pharmacotherapy for Alzheimer's disease is discussed.     

Peer Reviewed: Lifestyle Interventions for Hypertension and Dyslipidemia Among Women of Reproductive Age

Introduction

Hypertension and dyslipidemia often precede cardiovascular disease. Lifestyle modifications help prevent these conditions, and referrals for women may be possible during reproductive health care visits. However, screening recommendations vary, which may affect screening rates. The objectives of this systematic review were to 1) assess the available literature on the effectiveness of lifestyle interventions, 2) review hypertension and dyslipidemia screening recommendations for consistency, and 3) report prevalence data for hypertension and dyslipidemia screening among women of reproductive age.

Methods

We conducted a systematic literature search (January 1990-November 2010) for 1) randomized controlled trials on the impact of lifestyle interventions on cardiovascular disease risk factors in women of reproductive age, 2) evidence-based guidelines on hypertension and dyslipidemia screening, and 3) population-based prevalence studies on hypertension or dyslipidemia screening or both.

Results

Twenty-one of 555 retrieved studies (4%) met our inclusion criteria. Lifestyle interventions improved lipid levels in 10 of 18 studies and blood pressure in 4 of 9 studies. Most guidelines recommended hypertension screening at least every 2 years and dyslipidemia screening every 5 years, but recommendations for who should receive dyslipidemia screening varied. One study indicated that 82% of women of reproductive age received hypertension screening during the preceding year. In another study, only 49% of women aged 20 to 45 years received recommended dyslipidemia screening.

Conclusions

Lifestyle interventions may offer modest benefits for reducing blood pressure and lipids in this population. Inconsistency among recommendations for dyslipidemia screening may contribute to low screening rates. Future studies should clarify predictors of and barriers to cholesterol screening in this population.     

Diabetes, hypertension, and dyslipidemia in Mexican Americans and non-Hispanic whites

BACKGROUND: Ethnic disparities in healthcare quality have been documented, but knowledge of differences in cardiovascular risk factor prevalence, awareness, treatment, and control between Mexican Americans and non-Hispanic whites remains incomplete. METHODS: Cross-sectional analysis in 2005 of nationally representative data collected from 2256 Mexican-American and 4624 non-Hispanic white adults aged 20 years and over who participated in the 1999-2002 National Health and Nutrition Examination Survey. RESULTS: Type 2 diabetes is significantly more prevalent in Mexican Americans (13% age and gender adjusted) than in non-Hispanic whites (8%); however, Mexican Americans are more likely to be both diagnosed (77% vs 65%) and treated (63% vs 47%). There is no significant difference in the adjusted prevalence of hypertension, at 28% for non-Hispanic whites compared to 26% for Mexican Americans. Mexican Americans have a slightly lower adjusted prevalence of dyslipidemia, at 31% versus 35%. Awareness of hypertension and dyslipidemia are significantly lower in Mexican Americans (57% vs 71% for hypertension, and 33% vs 56% for dyslipidemia). Treatment rates for hypertension and dyslipidemia are also significantly lower in Mexican Americans (42% vs 61% for hypertension; 14% vs 30% for dyslipidemia). Multivariate logistic regression controlling for age, gender, education, and access to care indicate that Mexican Americans are significantly more likely than non-Hispanic whites to be aware and treated for their diabetes, but significantly less likely to be aware and treated for their hypertension or dyslipidemia. CONCLUSIONS: The significantly higher prevalence of diabetes in Mexican Americans, in contrast to hypertension and dyslipidemia, may sensitize healthcare providers to its detection and treatment. Communicating the importance of hypertension and dyslipidemia is essential for eliminating disparities.     

湖南省13个监测点60岁及以上老人肥胖指标与高血压及血脂异常的切点研究

目的 探讨体质指数(body mass index,BMI)、腰围(waist circumference,WC)、腰高比(waist-to-height ratio,WHtR)三类肥胖指标判定的肥胖率分别与湖南省13个监测点60岁以上老人高血压、血脂异常的相关性,预测高血压及血脂异常患病风险的能力。 方法 采用具有省级代表性的中国慢性病与危险因素调查数据,通过受试者工作特征曲线分析,确定湖南省老年人不同肥胖指标预测高血压及血脂异常适宜的BMI、WC、WHtR切点。 结果 湖南省13个监测点60岁以上老年人超重肥胖率(BMI≥24)为42.91%,中心性肥胖率为31.26%,WHtR≥0.5的肥胖率68.97%。以高血压为因变量绘制受试者工作特征曲线,显示男、女性WHtR的曲线下面积相对较高,其切点值分别为0.50、0.53;以血脂异常为因变量,结果显示BMI的曲线下面积最高,其切点值分别为21.40、22.06。 结论 评价肥胖的不同指标对高血压及血脂异常的预测效果不同,其中腰高比在预测老年人高血压中的效果最好;BMI是诊断老年人血脂异常的最佳简易指标。     

Pauvreté, monoparentalité et alimentation: Une étude de cas dans le nord de la France

The survey was carried out in the North of France. Its purpose was to examine the link between poverty and food. The results underline that the marital and social situations of the interviewed persons were more important to understand their meal patterns, than their low level of resources. When the spouse is left, there is no more familial interest to have meal together, and then we observed that women spend less time to cook. On the opposite, food can, in other cases, play a positive role in dealing with poverty. Thus, provisioning and cooking appear as social activities which allow isolated people to keep a social life. In both cases, the meal is maintained, and the difference sets at the level of preparation. In conclusion, the article invites to reconsider the ways of cooking in poverty situations. It suggests that we should change the representations of an elaborate meal which doesn’t necessarily needs fresh products, but also appertized and frozen products. In this way, we should partly solve the constraint of cost and time of preparation.