Obésité, corpulence et souci de minceur: inégalités sociales en France et aux États-Unis

Obesity is not comparable in France and in the United States, from its width, its evolution, its age and gender distribution. Between 1970 and 2000, obesity progressed very quickly in the United States, whereas we can observe a stability in France until the middle of the 1990′s, then a deterioration. For as much, for 30 years, the relations between obesity among women - and more largely corpulence - and social hierarchy have been marked in the two countries: obesity concerns more the people - especially the women - of the working-class categories, the least rich and the least graduate people. With equal corpulence, people of the working-class categories, even if they share some of the standards of thinness, are much less concerned about excesses of weight: the women most touched by obesity belong to the groups where the average corpulence is highest and where the attention to weight is the least strong. A preventive policy of public health concerning the members of theses working-class categories could be a good objective.     

Éducation des familles et de l'enfant en nutrition artificielle à domicile

The techniques of artificial nutrition came of age since the seventies (1969 for enteral nutrition and 1973 for parenteral nutrition). Artificial nutrition has considerably modified the outcome of a great number of children with severe digestive tract pathologies or many other disorders making impossible or ineffective oral food administration. There are currently two techniques of artificial nutrition: enteral nutrition (the most physiological using the digestive tract) and parenteral nutrition (by central venous line, more demanding and more complications). Home parenteral and enteral nutrition emerged with new realities: increase in the number of children needing a nutritional assistance, increase in the number of indications and a constant need to make autonomous the child and the family leading to a better quality of life. The best care for these children needs a multidisciplinary approach (physicians, nurses, dieteticians, pharmacists, speech therapist, psychologists…) and a close relation between primary care and hospital. This also requires a significant investment of parents who are sometimes assisted by private nurses. Parents are thus educated with techniques of enteral nutrition and parenteral nutrition: use of the material, training with the care, learning the action to be taken in case of problem. They have thus a role of caregiver: heavy responsibility necessary to the return at home of their child. The educational role of the hospital team thus takes a paramount importance with the aim to provide an optimal home return and the most adequate care by the family.     

Les unités transversales de nutrition : bilan et perspectives

Nutrition support teams (NST) are hospital transverse nutrition care structures, recently established and developed in France. In continental Europe, their prevalence is 5–10%. Nutritional assessment and care are their main actions. Education, clinical research and assessment of the practices are secondary aims of NST. Physicians, dieticians, nurses and pharmacists are the main participants. The weekly durations of work dedicated to NST are low, explaining the small number of followed patients and the limited types of actions. NST are generally integrated in another hospital division or service, and provide examinations for in or out hospitalized patients. Interventions concern internal medicine, neurology, oncology, intensive care units, with patients suffering from digestive, neurological or cancer diseases. NST financing generally comes from hospitals. NST generates benefits for patients in terms of morbidity, mortality and length of stay and consequently save money. Nutritional competence of NST participants and duration of action could be predictive of good results. As propositions, international definition of NST should be clarified, the number of NST could increase, with more numerous and educated staffs, and more time dedicated. A better quotation of nutritional interventions and a development of assessment of NST could be recommended.     

Synthèse et étude préliminaire de l'activité psychotrope d'alkylamino et iminopyrrolo[1,2-a]indoles

La synthèse de nouveaux pyrrolo[1,2-a]indoles est décrite. Le test d'habituation révèle in vivo pour certains dérivés une activité psychostimulante non amphétaminique.     

Étude de la cytotoxicitéin vitro de dérivés du carbazole III. 3-Amino et 3-nitro-1,4-diméthyl-9H-carbazoles diversement substitués en position 6

La synthèse d'une série de 3-nitro et 3-amino-1,4-diméthyl-9H-carbazoles diversement substitués en positions 6 et 8 est décrite. Leur activité cytotoxique, évaluée in vitro au moyen de la culture clonogénique de la leucémie L1210, dépend fortement de la nature et de la position des substituants. Le plus cytotoxique d'entre eux, le dérivé 3-amino 6-hydroxy, présente une cytotoxicité comparable à celle de l'acétate de N2-méthyl-9-hydroxy ellipticinium (NMHE). Ces résultats et ceux présentés dans les deux publications précédentes, permettent une discussion détaillée des relations structure-activité dans la série du 9H-carbazole et du 1,4-diméthyl 9H-carbazole et suggèrent, pour les dérivés du 3-amino 1,4-diméthyl 9H-carbazole, un mécanisme d'action proche de celui des dérivés de l'ellipticine.     

Synthèse par SRN et évaluation de l'activité amoebicide de nouveaux dérivés quinoléiniques

Des dérivés quinoléiniques porteurs de chaînes carbonées, soufrées ou phosphorées, ainsi que des furoquinoléines sont obtenus à partir du Clioquinol (Vioforme) par des réactions de substitution nucléophile radicalaires en chaîne (S_RN¹) inédites dans cette famille d'hétérocycles. Une évaluation de leur activité in vitro est effectuée sur des cultures d'Entamoeba histolytica et de Trichomonas vaginalis.     

Stratégie de prise en charge nutritionnelle de l'enfant et de l'adolescent (Nutrition orale, entérale, parentérale)

Children are especially threatened by malnutrition, because of the high protein-energy cost of growth. Any nutritional deficiency is the source of protein energy malnutrition, which compounds the problems of underlying disease. The protein-energy cost of catch-up growth is particularly high, and should lead to a rigorous adjustment of nutritional supply to prevent metabolic disorders associated with refeeding syndrome (directly related to the homeostatic change secondary to severe protein energy malnutrition). If the gastrointestinal tract can be used for refeeding, it should be used (oral or enteral nutrition). When the gastrointestinal tract is unable to meet the protein and energy requirements, parenteral nutrition is required. Catch-up growth may be achieved by using appropriate nutritional support.     

Définition et évolution du statut nutritionnel au cours d'une greffe osseuse allogénique (15 malades): Rôle de la nutrition parentérale et de l'apport azoté

Our work concerned 15 patients (9 males, 6 females) with a mean age of 29.5 years, having a hematologic malignant disease and undergoing allogenic bone marrow transplantation.We studied :

1. The metabolic disorders induced by the conditioning regimen (chemotherapy and total body irradiation) pregraft accompanying cytolysis (day −7, −5, −2).

2. The corrective effect of a total parenteral nutrition introduced 2 days before the transplantation and pursued during 30 days post-graft (day −2 to day 30).

3. The interest of a high calorie intake (BEE × 2) and, after randomisation, of a variable nitrogen intake (24% of the total calorie intake for group A [8 patients] and 14% for group B [7 patients]). The patient characteristics of these two groups were closely comparable. Urinary parameters were studied daily (3-methylhistidine, cratinine, nitrogen) and blood parameters weekly (transferrin, pre-albumin, albumin, retinol binding protein).

We observed globally :

-- An excellent result of the nutritional support without significant weight loss;

-- protein catabolism stopped with a recovery of synthesis of RBP after day 7 and pre-albumin from day 7;

-- a decrease in muscle catabolism.

The randomized study showed :

-- a significant difference in nitrogen excretion between group A and group B;

-- earlier and better protein synthesis recovery in group A, particularly with regard to RBP and pre-albumin.

In conclusion, we recommend for the patients undergoing bone marrow transplantation :

-- nutritional support should be introduced before the conditioning regimen;

-- a high calorie intake (BEE × 2) with a nitrogen intake between 14% and 24% of the total calorie intake;

-- cyclic parenteral nutrition should be pursued during the second and third month post-graft.

Consommation d’huiles et matières grasses en France : relations avec le niveau d’étude et la région de résidence dans la cohorte SU.VI.MAX

The relationships between intake of added oils and fats with region of residence and educational level were also assessed. Our objective was to describe the relative contribution of ten created food groups to total fat intake in middle-aged subjects.Subjects were participants of the SU.VI.MAX study who completed at least six 24-h dietary records after inclusion into the study (n=6572).Added oils and fats were the main source of total fat intake. Animal fat (AF) and margarine intakes showed a significant inverse association with educational level, whereas oils with mono-unsaturated fatty acids (MUFA) were positively associated with education level. AF intake was significantly higher in the Western and Northern parts of France (54.2 and 50.4%) and lower in the Mediterranean Coast (39.0%). A significant inverse gradient was found with oils with poly-unsaturated fatty acids (PUFA) or MUFA in the Southwest and the Mediterranean Coast compared to the Northern part of France.We showed a north to south gradient for animal fat intake and the opposite for oils with MUFA and PUFA in France This gradient parallels the known disparities for cardiovascular mortality in this country. This should contribute to adapt dietary guidelines for dietary change in a public-health perspective.