Background:NutriNet-Salud Mexico is a digital health information system, e-epidemiology instrument, online, open and free, to recording and analysis the determinants of dietary habits and nutritional status of the Mexican population, for the prevention of overweight, obesity and noncommunicable diseases for the period 2018-2028.Objective:Describe the design, development and implementation of NutriNet-Salud Mexico from the French model NutriNet-Santé France 2008-2018.Method:NutriNet-Salud Mexico platform is the basis for the development of health information system for prospective cohort study, scheduled for a period of 10 years (2018-2028), with a dedicated website, and its development will enable to have multiple study populations within an initial set of five self-applicable questionnaires validated in Mexican population.Results:The information will enable to develop applied research, learn and monitor food contributions and nutritional status of the population, assess the impact of public health actions on feeding behavior and nutritional status, comparing populations between countries (Mexico, France, Belgium and Switzerland) and national institutes, universities and states.Conclusions:NutriNet-Salud Mexico will provide information for assist in research and public action, especially to guide public policies on nutrition Mexico. The scientific elements will make appropriate nutritional recommendations to different populations and access to a representative nominal population sample with low-cost, in real-time, and with dual approach to e-epidemiology: cohort study to identify causality and cross-sectional studies (descriptive research, monitoring and evaluation).

Few large long-term prospective cohorts have assessed the evolution of antidiabetic treatment after bariatric surgery (BS). The aim of our study was to study, under real life conditions and at a national level, remission and occurrence of antidiabetic treatment over 6 post-operative years after BS, compared to a matched control group, using the French national health insurance database. Each patient undergoing primary BS in France in 2009 was matched on age, sex, BMI categories and antidiabetic treatment with one control patient hospitalised for obesity in 2009 who had no BS between 2005-2015. Reimbursements of antidiabetic treatment were extracted from the French National Health Insurance database (SNIIRAM) between 2008-2015. Mixed-effects logistic regression models analysed factors of remission or occurrence of antidiabetic treatment over 6 years. In 2009, 15,650 patients (85% female; 1,633 with antidiabetic treatment) had undergone primary BS: gastric banding (AGB) 48%, gastric bypass (GBP) 28%, sleeve gastrectomy (SG) 24%. For patients with antidiabetic treatment at baseline, discontinuation of treatment at 6 years was more frequent after BS than in controls (50% vs. 9%; P<0.001). In multivariate analysis, the main predictive factors of discontinuation were overall (OR; 95%CI): GBP=16.7 (13.0-21.4); SG= 7.3 (5.5-9.5), AGB=4.3 (3.3-5.6), no baseline insulin (5.9 (4.5-7.7)) and no hypolipidemic treatment (1.5 (1.1-1.6)). For patients without antidiabetic treatment at baseline, occurrence of treatment at 6 years was much less frequent after BS than in controls (1% vs. 12%; P<0.001). All types of procedures were protective factors: GBP=0.06 (0.04-0.09), SG=0.08 (0.06-0.1), AGA=0.16 (0.14-0.19). Our large study confirms that BS leads to a significant discontinuation rate of antidiabetic treatment compared to baseline and to non-surgical obese controls over 6 post-operative years, as well as to a lower occurrence rate of antidiabetic treatment, with GBP being the most effective procedure.

La chirurgie bariatrique chez les jeunes âgés de moins de 20 ans soulève des questions cliniques, organisationnelles, éthiques. Cet article porte sur le parcours clinique initial, c’est-à-dire de la demande de chirurgie à la prise de décision. Il s’agit de clarifier les enjeux pour le jeune, sa famille, et son pédiatre ou son médecin traitant. La prise en charge multifocale dans des centres hyperspécialisés doit - d’emblée - s’inscrire dans la durée.

A novel kinetic model accounting for the observed asymptotic approach of the degree of polymerization (DP) to a limiting value significantly greater than unity on prolonged degradation is derived and applied to the solid-state degradation of cellulose (Kraft paper) and poly(acrylic acid) (PAA) under isothermal and non-isothermal conditions. Experimental data were fitted using two iterative computer algorithms: one for isothermal DP data and the other for non-isothermal DP data obtained under a linear temperature ramp. The apparent activation energy for the solid-state recombination of chain radicals was found to be low in each case and was attributed to the proximity of free radicals being facilitated by restrictions imposed by the polymer matrix. The application of the model to non-isothermal DP yielded rate parameters that could be reconciled with those obtained from isothermal analyses, suggesting the novel approach has much merit for the future study of polymer degradation.

More than 200,000 people underwent obesity surgery in France. Most of them are women. Pregnancy after bariatric surgery is becoming a common situation. This surgery results in major nutritional and gastro-intestinal tract modifications that may influence or be influenced by pregnancy, and yields benefits as well as complications. A multidisciplinary management including a nutritionist, an obstetrician, an anesthesiologist, and a bariatric surgeon is required. The aim of this review is to analyze the impact of bariatric surgery on pregnancy and vice versa, and to identify the key points of this management.

Depuis quinze ans, plus de 200 000 interventions de chirurgie de l’obésité ont été réalisées en France, en majorité chez des femmes. La grossesse chez la femme opérée de chirurgie bariatrique est devenue une situation commune. La chirurgie entraîne des modifications nutritionnelles et digestives importantes qui peuvent influencer ou être influencées par la grossesse. Le suivi de la « grossesse bariatrique » nécessite une approche pluridisciplinaire réunissant nutritionniste, obstétricien, anesthésiste et chirurgien. Le but de cette revue est d’analyser les principaux effets de la chirurgie bariatrique sur la grossesse et réciproquement et d’identifier les points clé de la prise en charge en pratique.

Les enquêtes épidémiologiques ObEpi évaluent depuis 1997 tous les 3 ans la prévalence du surpoids et de l’obésité des Français. Cette analyse décrit la population diabétique de type 2 (DT2) de l’enquête ObEpi 2012 selon les caractéristiques démographiques, sociales, propres de la maladie et les comorbidités associées. 20 000 foyers du panel Kantar Health ont reçu par voie postale un questionnaire auto administré de janvier à mars 2012. Les questionnaires de 25 714 adultes de 18 ans et plus représentatifs de la population française ont été complétés. 5,5 % des Français ont un DT 2. Leur âge moyen est de 65,9 ans et l’ancienneté moyenne du DT2 de 9,9 ans. Ils comprennent 55 % d’hommes. Leur IMC moyen est de 29,9 (29,4 hommes/30,6 femmes, p < 0,01). L’obésité (IMC ≥ 30) est de 43,1 % (39,9 % hommes/47 % femmes, p < 0,01). Les comorbidités traitées sont fréquentes : HTA 59,1 % ; dyslipidémie 59,9 % ; infarctus 7,0 % ; angor 3,8 % ; revascularisation 7,8 % ; insuffisance cardiaque 7,4 % ; apnée du sommeil 8,3 % ; arthrose 10,7 %. Traitement DT2 : injectable (13,6 % insuline ; 3,9 % GLP1), ADO (76,6 %, [19, 2 % iDDPIV]). Ressenti financier dégradé, 65,0 % des DT2 déclarent « être juste ou y arriver difficilement ou sans faire de dettes ». La situation diabétologique reste préoccupante : par rapport à la population non diabétique de mêmes âge et sexe, toutes les valeurs des DT2 sont significativement en leur défaveur. Elles sont voisines de celles d’Entred 2007 sauf pour l’IMC un peu plus élevé dans ObEpi, le ressenti financier qui s’est détérioré et les traitements. De manière surprenante, alors que l’obésité est plus fréquente chez les femmes, la population DT2 dans ObEpi et Entred est plus masculine.

Context: The care of patients with hypothalamic obesity is challenging. Objective: To compare body composition, basal metabolic rate (BMR) and metabolic outcomes of adults, with lesional or genetic hypothalamic obesity, with obese patients suffering from primary obesity, once matched for body mass index (BMI). Design and patients: Adults with hypothalamic obesity of genetic origin (Prader Willi syndrome (PWS)) or acquired hypothalamic damage (HD), such as craniopharygioma, were compared with obese control candidates awaiting bariatric surgery (C), with a BMI between 35 and 65 kg m − 2 , and aged between 18 and 50 years. Main outcome measures: Body composition measured by whole-body dual-energy X-ray absorptiometry scanning, BMR using indirect calorimetry, hormonal and metabolic assessments. Results: A total of 27 adults with a genetic diagnosis of PWS, 15 obese subjects with HD and 206 obese controls with similar BMI were studied. Compared with the control group, PWS patients had an increased percentage of fat mass (FM), and a decreased percentage of android FM. The BMR of PWS patients was significantly lower than controls and highly correlated with lean body mass in PWS and C patients. Body composition of HD was similar with those of obese patients. A trend toward an increased prevalence of diabetes in HD patients and of cytolysis in PWS was observed in comparison with primary obese patients. Conclusion: Genetic and lesional hypothalamic obesities have different consequences for phenotypic features such as body composition or BMR compared with primary obese patients. The mechanisms of adipose tissue development and metabolic complications may be different between genetic and lesional obesities.

L’obésité est classiquement définie à partir de seuils d’indice de masse corporels associés à une augmentation de la morbidité et de la mortalité. Cette approche est pertinente en termes d’analyse populationnelle mais elle connaît des limites au niveau individuel. Les progrès en épidémiologie, physiopathologie et clinique de l’obésité doivent orienter vers de nouveaux phénotypes et de nouvelles nosographies d’obésités, à inclure dans un cadre plus général, celui des maladies du tissu adipeux.

The aim of the current study is to utilize two different methodologies to estimate the prevalence and burden of type 2 diabetes (T2D) and obesity among the adult population in France. Two separate representative data sources were used for the adult French population. Data from the French respondents of the EU National Health and Wellness Survey (NHWS) (N=15,051) and the OBEPI survey (N=25,286) were used. The NHWS is an internet-based annual survey and the OBEPI is a mailed survey conducted every three years, validated by the French authorities. Prevalence information for T2D, comorbid treatments, and BMI were analyzed using both data sources. The humanistic and economic burden of T2D was analyzed only from the NHWS data. From NHWS, 44.3% of respondents from France were male and the average age was 45.1 years (SD=15.5). From OBEPI, 47.8% were male and the average age was 48.2 years (SD=17.8). A total of 30.5% (OBEPI=31.9%) and 15.6% (OBEPI=14.5%) of the French population were estimated to be overweight and obese, respectively. A total of 4.4% (from NHWS) and 4.8% (from OBEPI) of the adult French population reported suffering from T2D. Among these patients, 15.1% and 80.5% were taking an insulin and oral treatment, respectively (12.4% by OHA+insulin and 76.0% by OHA only as estimated by OBEPI). From NHWS, a significant burden was observed among patients with T2D as they reported significantly lower levels physical quality of life (using the SF-12v2; 42.6 vs. 50.1, p<.05) and significantly greater work impairment (26.7% vs. 18.2%, p<.05) and physician visits (8.7 vs. 5.5, p<.05). Both internet and mailed survey methodologies provided consistent prevalence estimates of diabetes and obesity among the French population. Further, despite the high prevalence of treatment, significant effects are observed on health outcomes among T2D patients, highlighting the unmet need.

Éclosion de petites entreprises et bouquets d'alliances avec les géants de la pharmacie, le séquençage du génome est déjà devenu un business aux États-Unis. Quelles sont les stratégies déployées par les industriels ? Un aperçu sur ces chercheurs de gènes qui espèrent toucher le jackpot avec l'information génétique en ouvrant une nouvelle ère au diagnostic et au médicament.

Background. Obesity is characterized by chronic low-grade inflammation that may lead to emotional distress and behavioural symptoms. This study assessed the relationship between adiposity, low-grade inflammation, eating behaviour and emotional status in obese women awaiting gastric surgery and investigated the effects of surgery-induced weight loss on this relationship.Method. A total of 101 women with severe or morbid obesity awaiting gastric surgery were recruited. Assessments were performed before and at 1 year post-surgery and included the measurement of neuroticism and extraversion using the revised Neuroticism-Extraversion-Openness personality inventory (NEO-PI-R) and eating behaviour using the Three-Factor Eating Questionnaire (TFEQ). Blood samples were collected for the measurement of serum inflammatory markers [interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP)] and adipokines (leptin, adiponectin).Results. At baseline, body mass index (BMI) was positively correlated with inflammatory markers and adipokines. Regression analyses adjusting for age and diabetes revealed that baseline concentrations of IL-6 and hsCRP were associated with the depression and anxiety facets of neuroticism, with higher inflammation predicting higher anxiety and depression. This association remained significant after adjusting for BMI. Gastric surgery induced significant weight loss, which correlated with reduced inflammation. After controlling for BMI variations, decreases in inflammatory markers, notably hsCRP, were associated with reduced anxiety and TFEQ-cognitive restraint scores.Conclusions. These findings indicate strong associations between adiposity, inflammation and affectivity in obese subjects and show that surgery-induced weight loss is associated concomitantly with reduced inflammation and adipokines and with significant improvement in emotional status and eating behaviour. Inflammatory status appears to represent an important mediator of emotional distress and psychological characteristics of obese individuals.

L’objectif de cette étude était d’analyser l’effet de la cohorte de naissance dans l’évolution de la prévalence de l’obésité après prise en compte de l’âge et de la période d’enquête. Pour chaque année d’enquête ObEpi (1997, 2000, 2003, 2006), des données sur le poids et la taille ont été obtenues par des questionnaires envoyés à 20 000 ménages représentatifs de la population nationale. La prévalence de l’obésité a été analysée à l’aide d’un modèle logistique, avec l’âge, la période et la cohorte comme variables explicatives. Étant donné la relation linéaire entre ces variables, seuls les effets non linéaires peuvent être estimés de manière unique dans un modèle avec certaines contraintes imposées par le statisticien. Un écart important à la linéarité a été noté pour l’effet cohorte uniquement: nous avons observé une accélération de l’augmentation de la prévalence de l’obésité pour les sujets nés à partir du milieu des années 1960, aussi bien pour les hommes que pour les femmes, mais de façon plus prononcée pour les femmes. Ces résultats suggèrent que, comparés aux anciennes générations, les hommes et les femmes nés après les années 1960 ont été exposés à un environnement qui a augmenté leur susceptibilité à l’obésité tout au long de la vie.

L’obésité, facteur de morbimortalité, est considérée comme un véritable problème de santé publique. En gynécologie, ses conséquences sur la fertilité et la contraception sont sévères : infertilité, résultats décevants en assistance médicale à la procréation (AMP), fausses couches spontanées, malformations congénitales, complications obstétricales et néonatales, diminution de l’efficacité des contraceptifs oraux. Ces conséquences sont généralement corrigées par une perte de poids obtenue par le biais des méthodes médicochirurgicales ou comportementales. Le gynécologue devrait donc participer à une prise en charge pluridisciplinaire de l’obésité avant de répondre à une demande de contraception hormonale ou d’AMP.Obesity is a growing public health problem because of the morbimortality factors linked to it. In obstetrics and gynecology, consequences on fertility and contraception are notable: infertility, low assisted reproductive technologies (ART) results, miscarriages, congenital abnormalities, obstetrical and neonatal complications, low hormonal contraception efficacy. These effects are partially corrected by weight loss which can be achieved by behavioural, medical or surgical treatment. Gynaecologists should always participate in a multidisciplinary management of obesity before hormonal contraception or ART.