Hépatopathie et diabète de type 2

La maladie hépatique chronique la plus souvent liée au diabète est la « non-alcoholic fatty liver disease » ou NAFLD, pathologie caractérisée par l'accumulation excessive de graisse dans le parenchyme hépatique. La relation entre NAFLD et diabète de type 2 peut être vue comme un « mauvais mariage », en soulignant que chaque entité s'alimente des aspects négatifs de l'autre

Quelle relation entre alcool et obésité ?

Les prévalences de la consommation d’alcool et de l’obésité ne cessent d’augmenter. L’objectif de cette revue de la littérature est de donner un aperçu de l’association entre ces deux problématiques sanitaires et socio-économiques. L’éthanol, agissant sur la régulation cérébrale de la faim et de la satiété ainsi que sur le système mésolimbique de la récompense, est à considérer comme une substance orexigène. En outre, il bloque la bêta-oxydation des lipides, prédisposant à leur stockage. Malgré des évidences scientifiques discordantes, qui sont cependant conditionnées par des biais et limitations, les experts sont d’accord de considérer la consommation de boissons alcoolisées comme un probable facteur contribuant à l’incrémentation du taux d’obésité observé lors des dernières décennies.The prevalence of alcohol consumption and obesity continues to increase. The aim of this literature review was to give an overview of the association between these two health and socioeconomic problems. Ethanol must be considered as an orexigenic molecule, acting on the cerebral regulation of hunger and satiety and on the mesolimbic reward system. Moreover, studies showed that alcohol blocks the fatty acid beta oxidation, promoting the storage of lipids. Observational and experimental studies struggle to find a solid correlation between the two entities, but they have several biases and limitations. Experts agree to consider ethanol ingestion as a potential contributing factor of the higher obesity rates observed in the last decades

Stéatopathie non alcoolique (NAFLD) et diabète : le mauvais mariage

La stéatopathie non alcoolique (NAFLD), dont la prévalence est à la hausse, est une pathologie fortement liée au diabète de type 2 (DT2) par la résistance à l’insuline et le stress oxydatif. Une association multifactorielle avec le diabète de type 1 (DT1) a été récemment mise en évidence. Le dépistage de la NAFLD vise l’identification des formes plus sévères (NASH avec fibrose) et une orientation correcte vers les hépatologues. Il s’adresse à des sous-groupes à risque, dont les patients avec un DT2. La pierre angulaire du traitement de la NAFLD est la perte pondérale, les mesures hygiéno-diététiques, la pharmacologie de l’obésité ou la chirurgie bariatrique. Pour les patients avec NAFLD et DT2, il faut considérer en priorité les analogues du GLP-1 et les agonistes PPAR, capables de faire régresser la NASH, et les iSGLT2, efficaces sur la simple stéatose

NADPH Oxidases Connecting Fatty Liver Disease, Insulin Resistance and Type 2 Diabetes: Current Knowledge and Therapeutic Outlook

Nonalcoholic fatty liver disease (NAFLD), characterized by ectopic fat accumulation in hepatocytes, is closely linked to insulin resistance and is the most frequent complication of type 2 diabetes mellitus (T2DM). One of the features connecting NAFLD, insulin resistance and T2DM is cellular oxidative stress. Oxidative stress refers to a redox imbalance due to an inequity between the capacity of production and the elimination of reactive oxygen species (ROS). One of the major cellular ROS sources is NADPH oxidase enzymes (NOX-es). In physiological conditions, NOX-es produce ROS purposefully in a timely and spatially regulated manner and are crucial regulators of various cellular events linked to metabolism, receptor signal transmission, proliferation and apoptosis. In contrast, dysregulated NOX-derived ROS production is related to the onset of diverse pathologies. This review provides a synopsis of current knowledge concerning NOX enzymes as connective elements between NAFLD, insulin resistance and T2DM and weighs their potential relevance as pharmacological targets to alleviate fatty liver disease

Perte de poids : quand l’image du corps ne suit pas

L’image corporelle, définie comme la « vision interne » qu’une personne a d’elle-même, est multifactorielle. L’insatisfaction corporelle, qui représente sa version négative, est associée avec des troubles du comportement alimentaire, la sédentarité et la prise de poids. Certains patients visent une amélioration de leur image corporelle avec la perte pondérale. Si nombre d’études confirment une association bénéfique entre perte de poids et amélioration de l’image du corps, certains éléments, notamment les antécédents de régimes stricts et la présence de troubles alimentaires ou d’autres psychopathologies semblent prédisposer à la persistance de l’insatisfaction corporelle. La prise en charge de l’insatisfaction corporelle repose sur le renforcement de l’estime de soi, une hygiène de vie correcte et l’éducation aux médias

How Do Geriatric Scores Predict 1-Year Mortality in Elderly Patients with Suspected Pneumonia?

Background: Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. We aimed to assess the ability of scores that evaluate patients' comorbidities (cumulative illness rating scale-geriatric, CIRS-G), malnutrition (mini nutritional assessment, MNA) and functionality (functional independence measure, FIM) to predict 1-year mortality in a cohort of older patients having a suspicion of pneumonia.Methods: Our prospective study included consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia enrolled in a monocentric cohort from May 2015 to April 2016. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality.Results: 200 patients were included (51% male, mean age 83.8 ± 7.7). Their 1-year mortality rate was 30%. FIM (p Conclusion: Long-term prognosis of patients hospitalized for pneumonia was poor and we identified that scores assessing comorbidities and malnutrition seem to be important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients' prognosis, levels and goals of care.</p

Kinetics of inflammatory biomarkers to predict one-year mortality in older patients hospitalized for pneumonia: a multivariable analysis

Objectives: Long-term mortality is increased in older patients with pneumonia. We aimed to test whether residual inflammation is predictive of one-year mortality after pneumonia. Methods: Inflammation biomarkers (C-reactive protein [CRP], interleukin [IL]-6 and IL-8, tumor necrosis factor-α, serum amyloid A, neopterin, myeloperoxidase, anti-apolipoprotein A-1, and anti-phosphorylcholine IgM) were measured at admission and discharge in older patients hospitalized for pneumonia in a prospective study. Univariate and multivariate analyses were conducted using absolute level at discharge and relative and absolute differences between admission and discharge for all biomarkers, along with usual prognostic factors. Results: In the 133 included patients (median age, 83 years [interquartile range: 78-89]), one-year mortality was 26%. In univariate analysis, the relative difference of CRP levels had the highest area under the receiver operating characteristic curve (0.70; 95% confidence interval [CI] 0.60-0.80). A decrease of CRP levels of more than 67% between admission and discharge had 68% sensitivity and 68% specificity to predict survival. In multivariate analysis, lower body mass index (hazard ratio=0.87 [CI 95% 0.79-0.96], P-value=0.01), higher IL-8 (hazard ratio=1.02 [CI 95% 1.00-1.04], P-value=0.02), and higher CRP (1.01 [95% CI 1.00-1.02], P=0.01) at discharge were independently associated with mortality. Conclusion: Higher IL-8 and CRP levels at discharge were independently associated with one-year mortality. The relative CRP difference during hospitalization was the best individual biomarker for predicting one-year mortality.</p