[Neuroendocrine Regulation of Feeding-behavior]

We review current neuroendocrine concepts about feeding behavior. Digestive or metabolic inputs are conveyed to the hypothalamus by endocrine and neuroendocrine pathways (insulin, cholecystokinin). The hypothalamus regulates feeding behavior both quantitatively and qualitatively through several neuroendocrine mediators (neuropeptide Y, galanin, GHRH...). The hypothalamus also integrates, by its communicative network, inputs from the cortex, the sub-cortex, the peripheral metabolism and it modifies consequently the feeding behavior. These neuroendocrine models are developped from many experimental observations both in normal and obese animals

Characterization of type 2 diabetes mellitus in first generation Italian migrants to Belgium

Type 2 diabetes mellitus is a major metabolic disease in developed countries, and preferentially affects low-income groups and/or people from Southern extraction. Migrants are especially at risk. In Belgium, a large population of workers emigrated in the 50s and 60s, especially from rural areas of Southern Italy and Sicily. We tested the hypothesis that type 2 diabetes mellitus' phenotype in these Italian migrants could differ from that observed in autochthonous Belgian subjects. We retrospectively compared the clinical files of 485 patients with type 2 diabetes either of Belgian (n=445) or Italian origin (n=40). Italians were younger at diagnosis (46 +/- 14 vs. 52 +/- 13 years, P75%). We further compared this Italian group to 115 Belgians subjects matched for age, sex, and education. Known duration of diabetes (16 years), smoking and drinking habits, use of oral hypoglycaemic, antihypertensive and hypolipaemic drugs, complications, CRP, estimated glomerular filtration rate, micro-albuminuria prevalence, blood pressure, insulin sensitivity/beta-cell function estimated by HOMA modelling, as well as fat mass indirectly estimated by impedancemetry were not significantly different between the two populations. There was a non significant trend toward higher HbA1c (8.7 +/- 2 vs. 8.2 +/- 2%, NS) in Italian subjects whose LDL-cholesterol was however significantly lower (105 +/- 31 vs. 120 +/- 33 mg.dL-1, P<0.01) as well as folic acid (5 +/- 1.7 vs. 6.7 +/- 4, P<0.001). Insulin dose was higher (0.77 +/- 0.4 vs. 0.48 +/- 0.3 IU.day-1, P<0.001) and abdominal obesity less prevalent in males (33 vs. 58%, P<0.01) of this group. Thus, Italian diabetic subjects in Belgium exhibit higher insulin requirements despite similar/better BMI, known duration of diabetes, HOMA indices, use of oral antidiabetic drugs, abdominal obesity and slightly higher HbA1c. This points towards different dietary habits, as do the differences in folic acid and LDL-cholesterol; different patterns of exercise may also play a role. Higher family record of diabetes may be genetic, but may also be biased by tighter family structure in subjects of Italian extraction

Identification of Chronic Heart Failure Patients with a High 12-Month Mortality Risk Using Biomarkers Including Plasma C-Terminal Pro-Endothelin-1

OBJECTIVES: We hypothesised that assessment of plasma C-terminal pro-endothelin-1 (CT-proET-1), a stable endothelin-1 precursor fragment, is of prognostic value in patients with chronic heart failure (CHF), beyond other prognosticators, including N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS: We examined 491 patients with systolic CHF (age: 63±11 years, 91% men, New York Heart Association [NYHA] class [I/II/III/IV]: 9%/45%/38%/8%, 69% ischemic etiology). Plasma CT-proET-1 was detected using a chemiluminescence immunoassay. RESULTS: Increasing CT-proET-1 was a predictor of increased cardiovascular mortality at 12-months of follow-up (standardized hazard ratio 1.42, 95% confidence interval [CI] 1.04-1.95, p = 0.03) after adjusting for NT-proBNP, left ventricular ejection fraction (LVEF), age, creatinine, NYHA class. In receiver operating characteristic curve analysis, areas under curve for 12-month follow-up were similar for CT-proET-1 and NT-proBNP (p = 0.40). Both NT-proBNP and CT-proET-1 added prognostic value to a base model that included LVEF, age, creatinine, and NYHA class. Adding CT-proET-1 to the base model had stronger prognostic power (p<0.01) than adding NT-proBNP (p<0.01). Adding CT-proET-1 to NT-proBNP in this model yielded further prognostic information (p = 0.02). CONCLUSIONS: Plasma CT-proET-1 constitutes a novel predictor of increased 12-month cardiovascular mortality in patients with CHF. High CT-proET-1 together with high NT-proBNP enable to identify patients with CHF and particularly unfavourable outcomes