Prevalence of malnutrition risk among older French adults with culinary dependence

International audienceOBJECTIVE: The term 'culinary dependence' denotes a situation in which someone delegates all or part of their daily meal-related activities to a third party. The present study aimed to explore nutritional risk among older people (≥65 years) with culinary dependence. METHOD: The first survey included 559 people either living at home without help, with help unrelated to food activities, with help related to food activities or living in nursing home. The second survey included 319 people with food help provided by a caregiver, by meals-on-wheels or by a nursing home. Nutritional status was assessed with the Mini-Nutritional Assessment. Sociological background and wellness variables (health, cognitive and mental status) were collected. RESULTS: The first survey found a strong association between culinary dependence and nutritional risk. About half of the people who delegated their food-related activities were malnourished or at risk of malnutrition compared with only 4% for people with no help and 12% for people with help unrelated to food activity. According to the second survey, this prevalence varied slightly depending on who the tasks were delegated to (46% for those who had the support of a caregiver; 60% for those who used a meals-on-wheels service; 69% for those living in nursing home). According to multivariate analyses, dependence categories, depressive symptoms and cognitive status were identified as independent determinants of malnutrition. CONCLUSION: Without inferring a causal relationship between dependence and malnutrition, there is a strong need for care structures to take into account the issue of malnutrition when developing services targeting older people

Generalized vascular dysfunction in metabolic syndrome with and without type 2 diabetes: a cross sectional study.

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Metabolic Syndrome Individuals With and Without Type 2 Diabetes Mellitus Present Generalized Vascular Dysfunction

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Impact of a lifestyle program on vascular insulin resistance in metabolic syndrome subjects: the Resolve study.

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Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: effects of a 3-month lifestyle intervention program

International audienceBackground: Growing evidence demonstrates subtle left ventricular myocardial dysfunction in patients with metabolic syndrome (MetS), with central obesity, glucose intolerance and inflammation emerging as important contributors. Whether these results can be translated to the right ventricle (RV) is not yet fully elucidated. Furthermore, although lifestyle intervention favorably impacts MetS components and inflammatory biomarkers, its effect on RV myocardial function remains unknown today. Methods: Thirty-nine MetS adults free of diabetes were enrolled in a three month lifestyle intervention program including diet and physical exercise, and compared with forty healthy controls. Blood biochemistry, echocardiography including tissue Doppler imaging (TDI), and vector velocity imaging of the RV free wall to assess global longitudinal strain (GLS) and strain rates (SR) were obtained at baseline and after the intervention. Results: Compared with controls, MetS patients presented similar right atrial and RV morphology but reduced systolic (P = 0.04) and early diastolic (P = 0.02) velocities of the tricuspid annulus. They showed attenuated RV GLS (−21.4 ± 4.5vs-25.7 ± 4.9%, P < 0.001) as well as early diastolic (P = 0.003) and systolic (P < 0.001) SR. Multiple regression analyses revealed log PAI-1 active, (P < 0.001), log adiponectin, (P = 0.01), LV mass indexed (P = 0.004) and central fat (P = 0.03) as independent predictors of RV GLS (R 2 = 0.46, P < 0.001). Biological markers of MetS and inflammation as well as RV GLS (−21.8 ± 3.8vs-24.3 ± 3.0%, P = 0.009) and systolic (P = 0.003) and early diastolic (P = 0.01) SR, but not TDI indexes, significantly improved after diet and exercise training, and vector velocity imaging data in MetS following the lifestyle intervention no longer differed from controls. Conclusions: MetS is associated with subtle impairments in both RV free wall diastolic and systolic myocardial function which could be partly related to central-obesity induced changes in pro-and anti-inflammatory cytokines and left ventricular remodeling. The favorable impact of healthy dieting and physical activity on RV free wall mechanics indicates that cellular and sub-cellular alterations responsible for the RV myocardial abnormalities are probably not permanent and modifiable throughout adequate interventional strategies. Trial registration: American National Institutes of Health database NCT00917917

Consommation médicamenteuse et Syndrome Métabolique : place de l’activité physique et de la nutrition

National audienceContexte: La surcharge pondérale du SMet entraîne une constellation d’anomalies cardio-métaboliques, dont chacune est le plus souvent traitée par un médicament spécifique. Si le bénéfice biologique de l’activité physique/nutrition sur le SMet est bien démontré, aucune étude ne rapporte le coût de leur consommation médicamenteuse ni l’impact de ces interventions. Objectifs: 1). Calculer le coût de la consommation médicamenteuse d’un patient SMet.2). Démontrer le bénéfice d’une modification de l’hygiène de vie en termes de consommation médicamenteuse. Méthode: Cent sujets atteints de SMet, n'ayant pas d'activité physique, ont participé à un programme résidentiel de trois semaines avec une activité physique importante supervisée et une diète restrictive. 29/100 avaient un diabète de type 2(DT2). Afin d’autonomiser les patients, des cours quotidiens leur ont été dispensés. Puis les patients ont été suivis pendant un an avec pour consigne de poursuivre le même programme. Résultats: A J0, les patients consommaient en moyenne 1814±109 comprimés par an, pour un coût/patient/an des traitements de 747±106 euros. Pour le sous-groupeDT2, le coût annuel par patient est significativement plus élevé que pour le groupe entier SMet: 1352±309 euros. L’intervention est suivie d’une diminution significative à chaque temps de mesure du coût de la consommation médicamenteuse pour le groupe SMet : 747±106 (D0), 722±106 (D20), 696±106 (M3), 687±106 (M6), 673±102 (M12); D0 vs. D20, M3, M6: p<.001; D0 vs. M12: p<.05; D20 vs. M3, M6: p<.05. Pour le sous-groupe DT2, ce bénéfice n’est significatif que jusqu’au 3e mois: 1352±309 (D0) ,1325±311 (D20), 1305±313 (M3), 1307±309 (M6) ,1239±291 (M12); D0 vs. D20, M3: p<.05.Conclusion: Nous rapportons pour la première fois l’efficacité de l’activité physique et d’une prise en charge nutritionnelle sur la consommation médicamenteuse à long terme d’un patient Smet

Paradoxical dissociation between heart rate and heart rate variability following different modalities of exercise in individuals with metabolic syndrome: The RESOLVE study

Aims: To analyse the effects of different modalities of exercise training on heart rate variability (HRV) in individuals with metabolic syndrome (MetS). Methods and results: Eighty MetS participants (aged 50–70 years) were housed and managed in an inpatient medical centre for 21 days, including weekends. Physical activity and food intake/diet were intensively monitored. Participants were randomly assigned into three training groups, differing only by intensity of exercise: moderate-endurance-moderate-resistance (re), high-resistance-moderate-endurance (Re), and moderate-resistance-high-endurance (rE). HRV was recorded before and after the intervention by 24-hour Holter electrocardiogram. Although mean 24-hour heart rate decreased more in Re than re (–11.6 ± 1.6 vs. –4.8 ± 2.1%; P = 0.010), low frequency/high frequency decreased more in re than Re (–20.4 ± 5.5% vs. + 20.4 ± 9.1%; P = 0.002) and rE (–20.4 ± 5.5% vs. –0.3 ± 11.1%; P = 0.003). Very low frequency increased more in Re than re (+121.2 ± 35.7 vs. 42.9 ± 11.3%; P = 0.004). For all HRV parameters, rE ranged between re and Re values. Low frequency/high frequency changes were linked with visceral fat loss only in re (coefficient 5.9, 95% CI 1.9–10.0; P = 0.004). By day 21, HRV parameters of MetS groups (heart rate –8.6 ± 1.0%, standard deviation of R-R intervals + 34.0 ± 6.6%, total power + 63.3 ± 11.1%; P  <  0.001) became closer to values of 50 aged-matched healthy controls. Conclusions: A 3-week residential programme with intensive volumes of physical activity (15–20 hours per week) enhanced HRV in individuals with MetS. Participants with moderate intensity of training had greater improvements in sympathovagal balance, whereas those with high intensity in resistance training had greater decreases in heart rate and greater increases in very low frequency. Modality-specific relationships were observed between enhanced HRV and visceral fat loss. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00917917

Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE* randomized trial

International audiencea r t i c l e i n f o Background: Opinions differ over the exercise modalities that best limit cardiovascular risk (CVR) resulting from visceral obesity in individuals with metabolic syndrome (MetS). As little is known about the combined effects of resistance and endurance training at high volumes under sound nutritional conditions, we aimed to analyze the impact of various intensities of physical activity on visceral fat and CVR in individuals with MetS. Methods: 100 participants, aged 50–70 years, underwent a diet restriction (protein intake 1.2 g/kg/day) with a high exercise volume (15–20 h/week). They were randomized to three training groups: moderate-resistance–moderate-endurance (re), high-resistance–moderate-endurance (Re), or moderate-resistance– high-endurance (rE). A one-year at-home follow-up (M12) commenced with a three-week residential program (Day 0 to Day 21). We measured the change in visceral fat and body composition by DXA, MetS parameters , fitness, the Framingham score and carotid-intima–media-thickness. Results: 78 participants completed the program. At D21, visceral fat loss was highest in Re (−18%, p b .0001) and higher in rE than re (− 12% vs. − 7%, p b .0001). Similarly, from M3, visceral fat decreased more in high-intensity-groups to reach a visceral fat loss of −21.5% (Re) and − 21.1% (rE) > −13.0% (re) at M12 (p b .001). CVR, MetS parameters and fitness improved in all groups. Visceral fat loss correlated with changes in MetS parameters. Conclusion: Increased intensity in high volume training is efficient in improving visceral fat loss and carotid-intima–media-thickness, and is realistic in community dwelling, moderately obese individuals. High-intensity-resistance training induced a faster visceral fat loss, and thus the potential of resistance training should not be undervalued (ClinicalTrials.gov number: NCT00917917)