Imidazole propionate is increased in diabetes and associated with dietary patterns and altered microbial ecology

Microbiota-host-diet interactions contribute to the development of metabolic diseases. Imidazole propionate is a novel microbially produced metabolite from histidine, which impairs glucose metabolism. Here, we show that subjects with prediabetes and diabetes in the MetaCardis cohort from three European countries have elevated serum imidazole propionate levels. Furthermore, imidazole propionate levels were increased in subjects with low bacterial gene richness and Bacteroides 2 enterotype, which have previously been associated with obesity. The Bacteroides 2 enterotype was also associated with increased abundance of the genes involved in imidazole propionate biosynthesis from dietary histidine. Since patients and controls did not differ in their histidine dietary intake, the elevated levels of imidazole propionate in type 2 diabetes likely reflects altered microbial metabolism of histidine, rather than histidine intake per se. Thus the microbiota may contribute to type 2 diabetes by generating imidazole propionate that can modulate host inflammation and metabolism

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

An improved non-denaturing method for the purification of spiralin, the main membrane lipoprotein of the pathogenic bacteria Spiroplasma melliferum

Spiralin is the most abundant protein of several species of spiroplasmas, helical, motile bacteria pathogenic for arthropods and plants. This amphiphilic protein is anchored to the outer face of the plasma membrane by a lipoylated N-terminal cysteine. Although spiroplasma pathogenicity in mammals is controversial, it was shown that spiralin is highly immunogenic and endowed with immunomodulatory activity. In this paper, we describe a high performance method for the purification of Spiroplasma melliferum spiralin under non-denaturing conditions. The protein was selectively extracted with 3-[(3-cholamidopropyl) dimethylammonio]-1-propyl sulfonate (CHAPS) from the membrane pre-treated with sodium dodecyl-N-sarcosinate (Sarkosyl), and purified to homogeneity by cation-exchange HPLC with an overall yield of ∼60%. Detergent-depleted, water-soluble micelles of spiralin displaying a mean diameter of 170Å, as evidenced by transmission electron microscopy, were obtained by dialysis detergent removal. Circular dichroism spectroscopy and cross immunoprecipitation assay of the purified spiralin strongly suggested that this purification method could retain the structural characteristics of the native spiralin. The strategy developed to purify spiralin (two successive selective extractions of membrane proteins with mild detergents followed by ion-exchange chromatography) should prove useful for the purification of membrane lipoproteins of other bacteria of the class Mollicutes including different pathogens for humans, animals and plants

Just the tip of the iceberg: difficulties in assessing and managing extreme obesity in routine clinical care

International audienceAs obesity prevalence increases worldwide, healthcare professionals are often faced with challenging cases associated with massive obesity. A 33-year-old woman (weight 342 kg, body mass index = 100 kg/m²) presented with respiratory failure, limb edema and ascites. Abdominal CT scan became feasible after initial weight loss and showed a large pelvic mass in contact with the left ovary. The surgical removal performed despite a high-risk profile led to the diagnosis of a giant mucinous borderline tumor whose growth was due to delayed care and responsible for multiple severe complications: sepsis, anemia, esophagitis, constipation, anorexia due to mechanical compression, undernutrition, sarcopenia and lower limb edema contributing to a severe disability. After 7 months under specialized care, her weight decreased to 180 kg, complications were treated and disability improved. This case, showing that, despite barriers, a multidisciplinary approach makes quality of care possible even in massively obese patients, is an educational example to reduce stigma. A 33-year-old woman with extreme obesity (weight 342 kg, body mass index = 100 kg/m²) was admitted to the emergency department with respiratory failure, limb edema and ascites. Her weight had increased over the last months with worsening of her general health status. As her corpulence limited physical examination and excluded standard imaging investigations, she was empirically treated with anticoagulants and antibiotics for a possible pulmonary embolism and pneumonia. She also received a loop diuretic and continuous positive airway pressure was initiated. After initial improvement of her respiratory status, she was transferred to a post-acute rehabilitation department. Ascites remained unchanged despite draining and diuretic treatment. After 5 months under medical supervision and following a controlled diet, she had lost a large amount of weight (−92 kg) but remained disabled, bedridden and needed assistance from 6 professionals for routine hygienic care. She was referred to our obesity clinic for specialized nutritional care and etiological investigation of ascites. Ascites aspiration revealed a liquid exudate without bacterial pathogens. There was no evidence for hepatitis, cardiac or renal failure. Abdominal and pelvic intra-vaginal ultrasound performed at the patient's bed did not show any effusion in the Douglas pouch or behind the liver. However, we observed a very large abdominal mass of a multicystic nature. Because of technical difficulties, the ultra-sonographer could not exclude or confirm an ovarian-related disease. Although she had experienced substantial weight loss, the patient's body shape still prevented performing standard imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI). A duodenal echo-endoscopy and a proctoscopy were performed and did Christine Poitou and Margot Denis contributed equally to this work

Physical Activity in Patients with Prader-Willi Syndrome—A Systematic Review of Observational and Interventional Studies

International audiencePhysical activity (PA) is an important aspect of the management of patients with Prader-Willi syndrome (PWS). However, the day-to-day implementation of PA programs is particularly challenging in these patients. This systematic review aimed (1) to describe habitual PA and sedentary behavior and (2) to assess the effects of PA interventions and to describe their implementation process, in children and adults with PWS. A systematic search of controlled trials, single-group interventions, observational, and qualitative studies published up to December 2020 was performed. Twenty-five studies were included. Habitual PA was found to be lower in patients with PWS compared to controls without obesity or with non-syndromic obesity. Habitual PA was positively associated with lean body mass and bone parameters in children with PWS, and these finding were strengthened by intervention studies reporting an increase in both outcomes after a PA program. PA programs also improved physical function (muscle strength, walking distance, and coordination), without significant effect on weight and fat mass. Attendance to exercise sessions was usually high and no serious adverse effect was reported. In conclusion, supervised PA programs are beneficial for children and adults with PWS. Support should be provided to families to facilitate their implementation in real-life setting

Resistance Training and Protein Supplementation Increase Strength After Bariatric Surgery: A Randomized Controlled Trial

International audienceOBJECTIVE: Physical activity and dietary regimens to optimize health outcomes after bariatric surgery are not well known. This study aimed to determine whether resistance training with dietary protein supplementation is effective in maintaining body composition and physical fitness after obesity surgery.METHODS: Seventy-six women with obesity undergoing Roux-en-Y gastric bypass were randomly assigned at the time of surgery to receive either usual care (controls [CON], n = 22), usual care and additional (whey) protein intake (PRO, n = 31), or usual care, additional protein intake, and supervised strength training for 18 weeks (PRO+EX, n = 23). The primary outcome was pre- to 6-month postsurgery change in lean body mass (by dual-energy x-ray absorptiometry). Secondary outcomes included changes in muscle strength (by one-repetition maximum testing).RESULTS: Loss over time in lean body mass did not differ between groups (CON: mean,-8.8 kg; 95% CI: -10.1 to -7.5 kg; PRO: mean, -8.2 kg; 95% CI: -9.3 to -7.1 kg; PRO+EX: mean, -7.7 kg; 95% CI: -9.0 to -6.5 kg; P = 0.899). The increase in relative lower-limb muscle strength was higher in the PRO+EX group (+0.6 [0.3 to 0.8]) versus +0.1 (-0.1 to 0.4) and +0.2 (0.0 to 0.4) kg/kg body mass in CON and PRO groups, respectively (P = 0.021).CONCLUSIONS: Loss in muscle strength observed after bariatric surgery can be overcome by resistance training with additional protein intake

Effects of the COVID-19 pandemic and lockdown on the mental and physical health of adults with Prader-Willi syndrome

International audienceBackground: Prader-Willi syndrome (PWS) is a neurodevelopmental disorder with hypothalamic dysfunction leading to obesity and behavioral disabilities, including eating disorders (EDs). We evaluated the effects of the COVID-19 infection and lockdown on mental and physical health in PWS. At the end of April, 85 adults with PWS completed a self-administered questionnaire, including lockdown conditions, physical activity (PA), ED, and medical and behavioral outcomes. Body weight was measured at home and self-reported.Results: Patients (52.9% women, 44.8% disomic) were assessed, with a mean age of 28.05 ± 8.73 years and body mass index (BMI) of 36.76 ± 10.74 kg/m2. Seventy percent lived in the Paris region (France) and were confined with their parents. The mean weight change was 0.96 ± 3.28 kg. We compared patients showing weight loss (n = 39, - 3.30 ± 2.93 kg) to patients showing weight gain (n = 22, + 2.35 ± 1.54 kg): the BMI was lower (34.60 ± 9.18 versus 40.45 ± 9.45 kg/m2, p = 0.02), PA increased (25.6% versus 4.5%, p = 0.04), and EDs improved (51.3% versus 13.6%, p = 0.005). Behavioral disorders increased for 12.9% of the cohort. Three individuals (3.5%) were diagnosed with non-severe COVID-19.Conclusion: Lockdown during the COVID-19 pandemic was associated with positive effects for most French adults with PWS, with weight loss probably associated with a more favourable environment during this period. We observed no severe forms of COVID-19

Diabetes Metab

Objectifs La cinétique de l’amélioration de la qualité de vie liée à la santé (QdV) après chirurgie bariatrique n’a pas été bien étudiée, de même que l’influence potentielle des modifications de l’indice de masse corporelle (IMC) ou des comorbidités associées à l’obésité. L’objectif de cette étude était d’analyser la cinétique à court et moyen terme de la QdV et ses relations avec les modifications de l’IMC et des comorbidités dans un échantillon de patients qui avaient bénéficié d’un bypass gastrique de type Roux-en-Y (BPGRY). Méthodes Soixante et onze patients obèses (80 % de femmes, âge moyen 42,1 ± 11,2 ans, IMC moyen préopératoire 47,6 ± 6,2 kg/m2) qui avaient bénéficié d’un BPGRY ont rempli un questionnaire de QdV (SF-36) en préopératoire et à trois, six et 12 mois postopératoires. Les modifications de QdV ont été analysées par Anova pour mesures répétées et les associations entre les modifications de la QdV et les modifications de l’IMC ou des comorbidités (diabète, hypertension artérielle, dyslipidémie, syndrome d’apnées du sommeil, gonalgies) ont été analysées par des modèles mixtes. Résultats La composante physique résumée de la QdV (PCS) augmentait significativement avec le temps (de 38,9 ± 9,3 à 52,6 ± 7,9, P < 0,001), de même que les autres échelles de QdV physique (tous les P < 0,001) alors que la composante mentale résumée (MCS) n’augmentait pas significativement (de 45,7 ± 9,5 à 48,6 ± 11,5, P = 0,072). Les modifications les plus importantes de la QdV avaient lieu dès trois mois postopératoires, et rejoignaient des valeurs comparables à celles de la population générale. La PCS était associée aux modifications de l’IMC et des comorbidités, excepté pour le diabète, la dyslipidémie ou le syndrome d’apnées du sommeil. Conclusions Nos résultats montrent que l’amélioration de la QdV physique après BPGRY est observée dès le troisième mois après l’intervention, et est associée de manière indépendante à la perte de poids et à l’amélioration des comorbidités.Dynamics of improvement in health-related quality of life (QoL) after bariatric surgery have never been fully assessed, and neither has the potential influence of body mass index (BMI) and comorbidity modification. The objective of this study was to investigate early and medium-term changes in QoL following Roux-en-Y gastric bypass (RYGB), and their relationship to BMI and comorbidity variations. A total of 71 obese subjects (80% women, mean age 42.1±11.2 years, mean baseline BMI 47.6±6.2kg/m(2)) undergoing RYGB filled in QoL questionnaires (SF-36) before and 3, 6 and 12 months after surgery. QoL was assessed using repeated-measures Anova, with associations between its changes and changes in BMI and comorbidities (diabetes, hypertension, dyslipidaemia, sleep apnoea, knee pain) assessed by mixed-effects models. Physical QoL scales (physical component summary, PCS) significantly increased over time (from 38.9±9.3 to 52.6±7.9; P<0.001) as did other physical SF-36 scales (all P<0.001), whereas mental QoL summary scale did not vary significantly (from 45.7±9.5 to 48.6±11.5; P=0.072). Major changes in QoL occurred at 3 months after surgical intervention to reach values comparable to those in the general population. PCS was mostly associated with changes in either BMI or comorbidity status except for diabetes, dyslipidaemia and sleep apnoea. Results show that improvements in physical QoL after RYGB are observed as early as 3 months after intervention, and are independently associated with weight loss and improvements in comorbidities

Effect of exercise training after bariatric surgery: A 5-year follow-up study of a randomized controlled trial

International audienceBackground and objectives We previously showed in a 6-month randomized controlled trial that resistance training and protein supplementation after bariatric surgery (Roux-en-Y gastric bypass, RYGB) improved muscle strength without significant effect on weight loss and body composition changes. We performed a 5-year follow-up study in these subjects with the aim 1) to assess the longterm effect of this exercise training intervention and 2) to analyze associations between habitual physical activity (PA) and weight regain at 5 years