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See detailAptitude physique versus adiposité : aspects physiopathologiques et impacts cardio-métaboliques chez le sujet adulte non diabétique
Esser, Nathalie ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Médecine des Maladies Métaboliques (2010), 4

L’excès de masse grasse (adiposité), surtout abdominale, induit des effets cardio-métaboliques néfastes, alors que l’exercice musculaire et une bonne aptitude physique exercent globalement une influence ... [more ▼]

L’excès de masse grasse (adiposité), surtout abdominale, induit des effets cardio-métaboliques néfastes, alors que l’exercice musculaire et une bonne aptitude physique exercent globalement une influence favorable. Les effets délétères d’un excès de masse grasse (fatness) pourraient donc être contrecarrés par la pratique régulière d’exercices aboutissant à une bonne forme physique (fitness). Cet article analyse d’abord les différents mécanismes physiopathologiques par lesquels l’exercice physique produit des effets bénéfiques chez la personne avec excès pondéral et fait le distinguo entre la pratique d’une activité physique (exercice musculaire) stricto sensu et aptitude physique (fitness). Ensuite, il décrit les études les plus importantes ayant analysé les relations entre le niveau d’aptitude physique et le degré d’adiposité chez le sujet adulte en surpoids ou obèse non diabétique et leurs influences respectives sur le risque de survenue de troubles métaboliques (syndrome métabolique) et sur la mortalité, en particulier cardiovasculaire. [less ▲]

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See detailAptitude physique versus adiposité : impacts cardio-métaboliques respectifs chez l’enfant/adolescent et chez la personne âgée
Esser, Nathalie ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Médecine des Maladies Métaboliques (2010), 4

Le sujet adulte d’âge moyen en surpoids ou obèse est caractérisé par une adiposité exagérée, généralement combinée à une aptitude physique cardio-respiratoire déficiente. La pratique régulière d’une ... [more ▼]

Le sujet adulte d’âge moyen en surpoids ou obèse est caractérisé par une adiposité exagérée, généralement combinée à une aptitude physique cardio-respiratoire déficiente. La pratique régulière d’une activité physique d’endurance améliore le profil de risque cardio-métabolique dans cette tranche d’âge. Le manque d’activité physique chez les adolescents contribue à augmenter leur masse grasse et à induire des anomalies métaboliques, tandis que la sédentarité marquée des sujets âgés peut conduire à un excès de graisse combiné à une fonte musculaire (obésité sarcopénique). Dans ces deux tranches d’âge, les effets néfastes d’un excès de masse grasse (fatness) pourraient être contrecarrés, voire annulés, par la pratique régulière d’exercices musculaires conduisant à une meilleure aptitude physique (fitness). Cet article décrit les relations entre fitness et fatness, et les impacts cardio-métaboliques respectifs de ces deux composantes, d’une part, dans la population jeune (< 20 ans), d’autre part dans la population âgée (> 60 ans). [less ▲]

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See detailLa vignette thérapeutique de l'étudiant. Prise en charge d'une personne obèse avec syndrome métabolique
Rorive, Marcelle ULg; De Flines, Jenny ULg; Paquot, Nicolas ULg et al

in Revue Médicale de Liège (2009), 64(12), 651-656

The management of an obese person requires a careful evaluation first, a multidisciplinary approach and a stepwise therapeutic strategy. The latter should favour lifestyle modifications, eventually the ... [more ▼]

The management of an obese person requires a careful evaluation first, a multidisciplinary approach and a stepwise therapeutic strategy. The latter should favour lifestyle modifications, eventually the use pharmacological agents in good responders, and reserve bariatric surgery to well selected cases, refractory to medical treatment. Continuous motivational reinforcement is crucial for long-term success. In obese individuals at high metabolic risk, such strategy should aim at reducing the incidence of new-onset type 2 diabetes. [less ▲]

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See detailSujets « métaboliquement sains », bien qu’obèses. Première partie: diagnostic, physiopathologie et prévalence
ESSER, Nathalie ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Obésité (2009), 3

Around 30 to 50% of obese subjects are “metabolically normal” (MHO) whereas numerous nonobese subjects are “metabolically abnormal”. The distribution and function of adipose deposits seem to play a ... [more ▼]

Around 30 to 50% of obese subjects are “metabolically normal” (MHO) whereas numerous nonobese subjects are “metabolically abnormal”. The distribution and function of adipose deposits seem to play a crucial role in explaining this apparent paradox. The aim of this first article is to describe the clinical and biological characteristics that lead to the diagnosis of MHO, attempt to discover the etiopathogenesis of this syndrome and analyze the underlying pathophysiological mechanisms and, finally, to assess the prevalence of the MHO phenotype, which may vary according to the definition used and the population studied. [less ▲]

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See detailSujets « métaboliquement sains », bien qu’obèses 2ème partie : pronostic et prise en charge
Esser, Nathalie ULg; PAQUOT, Nicolas ULg; SCHEEN, André ULg

in Obésité (2009), 4

Around 30 to 50 % of obese subjects are « metabolically normal » (MHO) whereas numerous non obese subjects are « metabolically abnormal ». The distribution and the function of adipose depots seem to play ... [more ▼]

Around 30 to 50 % of obese subjects are « metabolically normal » (MHO) whereas numerous non obese subjects are « metabolically abnormal ». The distribution and the function of adipose depots seem to play a crucial role to explain this apparent discrepancy. In a first paper, we described the clinical and biological characteristics of these MHO individuals, analyzed the underlying pathophysiological mechanisms, and reported the prevalence of this syndrome in the adult population. This second paper aims at assessing the prognosis, especially regarding the risk of diabetes and cardiovascular disease, and at discussing the advantages and disadvantages of a classical therapeutic strategy of obesity among MHO individuals. [less ▲]

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See detailSujets de poids normal «métaboliquement obèses» et sujets obèses «métaboliquement sains»
Beck, Emmanuel ULg; ESSER, Nathalie ULg; Paquot, Nicolas ULg et al

in Revue Médicale de la Suisse Romande (2009), 5

Les relations entre poids corporel et anomalies métaboliques ne sont pas univoques. Ainsi, il existe des personnes non obèses métaboliquement anormales (MONW), rarement dépistées en raison d’un poids ... [more ▼]

Les relations entre poids corporel et anomalies métaboliques ne sont pas univoques. Ainsi, il existe des personnes non obèses métaboliquement anormales (MONW), rarement dépistées en raison d’un poids corporel faussement rassurant, et, à l’inverse, des sujets métaboliquement sains bien qu’ils soient obè ses (MHO). La topographie (intra-abdominale/hépatique vs sous-cutanée périphérique) et l’activité hormono-métabolique et pro-inflammatoire différente des dépôts graisseux semblent jouer un rôle déterminant pour expliquer ce paradoxe. Cet article de revue vise à décrire les grands principes de la prise en charge thérapeutique des personnes MONW, dans le but de réduire le risque accru de diabète de type 2 et de maladies cardiovasculaires, et de discuter les avantages et inconvénients d’une prise en charge classique de l’obésité chez les patients MHO. [less ▲]

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See detailBariatric surgery in patients with Type 2 diabetes: benefits, risks, indications and perspectives.
Scheen, André ULg; De Flines, Jenny ULg; De Roover, Arnaud ULg et al

in Diabètes & Métabolism (2009), 35(6 Pt 2), 537-43

Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its ... [more ▼]

Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its efficacy in obtaining marked and sustained weight loss, and is also associated with a significant improvement in glucose control and even diabetes remission. Roux-en-Y gastric bypass appears to be more effective in diabetic patients than the restrictive gastroplasty procedure. This may be explained not only by greater weight reduction, but also by specific hormonal changes. Indeed, increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) may lead to improved beta-cell function and insulin secretion as well as reduced insulin resistance associated with weight loss. The presence of T2DM in obese individuals is a further argument to propose bariatric surgery, and even more so when diabetes is difficult to manage by medical means and other weight-related complications may occur. Bariatric surgery is associated with a better cardiovascular prognosis and reduced mortality, even though acute and long-term complications are present. The observation that surgical rerouting of nutrients triggers changes in the release of incretin hormones that, in turn, ameliorate the diabetic state in the absence of weight loss has led to the recent development of innovative surgical procedures. Thus, bariatric surgery may be said to be progressing towards so-called 'metabolic surgery', which merits further evaluation in patients with T2DM within a multidisciplinary approach that involves both surgeons and endocrinologists. [less ▲]

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See detailUse of cannabinoid CB1 receptor antagonists for the treatment of metabolic disorders.
Scheen, André ULg; Paquot, Nicolas ULg

in Best Practice & Research. Clinical Endocrinology & Metabolism (2009), 23(1), 103-16

Abdominal obesity is associated with numerous metabolic abnormalities, including insulin resistance, impaired glucose tolerance/type-2 diabetes, and atherogenic dyslipidaemia with low high-density ... [more ▼]

Abdominal obesity is associated with numerous metabolic abnormalities, including insulin resistance, impaired glucose tolerance/type-2 diabetes, and atherogenic dyslipidaemia with low high-density lipoprotein (HDL) cholesterol, high triglycerides, and increased small dense low-density lipoprotein (LDL) cholesterol. A proportion of these metabolic disorders may be attributed to increased endocannabinoid activity. The selective cannabinoid 1 (CB1) receptor antagonist rimonabant has been shown to reduce body weight, waist circumference, insulin resistance, triglycerides, dense LDL, C-reactive protein (CRP), and blood pressure, and to increase HDL and adiponectin concentrations in both non-diabetic and diabetic overweight/obese patients. Besides an improvement in glucose tolerance in non-diabetic subjects, a reduction of 0.5-0.7% in haemoglobin A1C (HbA(1c)) levels was consistently observed in various groups of patients with type-2 diabetes. Almost half the metabolic changes could not be explained by weight loss, supporting direct peripheral effects of rimonabant. Ongoing studies should demonstrate whether improved metabolic disorders with CB1 receptor antagonists (rimonabant, taranabant, etc.) would translate into fewer cardiovascular complications among high-risk individuals. [less ▲]

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See detailQuelle est la nouvelle donne pour soigner les patients diabétiques de type 2 ?
Scheen, André ULg; Paquot, Nicolas ULg

in Médecine des Maladies Métaboliques (2009), 3(2), 141-146

Le traitement du diabète de type 2 est une tâche plus difficile qu’il n’y paraît en raison de la complexité de la maladie du point de vue physiopathologique, de l’adhésion imparfaite du patient aux ... [more ▼]

Le traitement du diabète de type 2 est une tâche plus difficile qu’il n’y paraît en raison de la complexité de la maladie du point de vue physiopathologique, de l’adhésion imparfaite du patient aux mesures hygiéno-diététiques, de la multiplicité croissante des médicaments disponibles, des imprécisions persistantes quant aux objectifs glycémiques et de la nécessité de proposer une stratégie de prévention cardio-vasculaire multirisques. Même si des directives générales peuvent être proposées, il convient d’individualiser le traitement en essayant d’obtenir le meilleur rapport bénéfices/risques, à un coût raisonnable. Cet article résume la nouvelle donne dans la prise en charge du diabète de type 2 au vu des résultats des dernières grandes études et du dernier document de consensus publié par l’American diabetes association (ADA) et l’European association for the study of diabetes (EASD). Il insiste sur l’importance d’une prise en charge globale individualisée et sur l’éducation thérapeutique à la fois des soignants et des soignés. [less ▲]

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See detailLe medicament du mois. Vildagliptine (Galvus) et combinaison fixe vildagliptine-metformine (Eucreas) dans le traitement du diabete de type 2.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2009), 64(3), 161-7

Vildagliptin (Galvus) is a selective inhibitor of dipeptidylpeptidase-4, an enzyme involved in the metabolism of glucagon-like peptide-1 (GLP-1) secreted by L cells of the intestine. It potentiates the ... [more ▼]

Vildagliptin (Galvus) is a selective inhibitor of dipeptidylpeptidase-4, an enzyme involved in the metabolism of glucagon-like peptide-1 (GLP-1) secreted by L cells of the intestine. It potentiates the insulin secretory response (incretin effect) by enhancing the endogenous post-prandial response of GLP-1 (incretin enhancer) in a glucose-dependent manner. Vildagliptin is indicated in the treatment of type 2 diabetes. It improves blood glucose control (HbA1c) in patients treated by diet alone, metformin, sulfonylurea, glitazone or insulin. In patients not well controlled with metformin alone, the addition of vildagliptin is as effective in reducing HbA1c as the coadministration of glimepiride or pioglitazone. Tolerance of vildagliptin is excellent, with no weight gain and no hypoglycaemic episodes. Treatment is simple, with two doses of 50 mg per day, without need of titration or home blood glucose monitoring. In Belgium, vildagliptin is currently reimbursed for the treatment of type 2 diabetes after diet failure and monotherapy with metformin. Therapy can be administered separately or by using a fixed combination vildagliptin-metformin (Eucreas), which should improve drug compliance. [less ▲]

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See detailEstimation of GFR by different creatinine- and cystatin-C-based equations in anorexia nervosa.
Delanaye, Pierre ULg; Cavalier, Etienne ULg; Radermecker, Régis ULg et al

in Clinical Nephrology (2009), 71(5), 482-91

Background: Patients with anorexia nervosa (AN) are at high risk of renal failure. Glomerular filtration rate (GFR) is overestimated when estimated by the creatinine-based equations. We have studied the ... [more ▼]

Background: Patients with anorexia nervosa (AN) are at high risk of renal failure. Glomerular filtration rate (GFR) is overestimated when estimated by the creatinine-based equations. We have studied the accuracy and precision of cystatin C-based equations. Method: 27 AN patients were included. GFR was measured with the chromium-51-ethylenediaminetetraacetate (51Cr-EDTA) method. We have compared the accuracy and precision of creatinine-based equations (MDRD and Cockcroft) with those of different new cystatin C-based equations. Results: The creatinine-based equations overestimate measured GFR, especially the MDRD study equation. All the cystatin C-based equations also overestimate measured GFR. The Cockcroft and Gault formula and the cystatin C-based equation published by Rule have the best accuracy and precision, but these last performances remain unsatisfactory. Conclusion: Both creatinine and cystatin C-based equations strongly overestimate measured in patients with AN. [less ▲]

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See detailAmelioration du controle glycemique et perte de poids sous exenatide chez des patients diabetiques de type 2: resultats d'une etude retrospective observationnelle multicentrique belge.
De Block, C.; Paquot, Nicolas ULg; Daoudi, N. et al

in Revue Médicale de Liège (2009), 64(10), 488-95

This is a retrospective analysis of medical records in 4 Belgian diabetes centres of 3 cohorts of patients with type 2 diabetes, with data available, respectively, after 3 months < or =163 patients ... [more ▼]

This is a retrospective analysis of medical records in 4 Belgian diabetes centres of 3 cohorts of patients with type 2 diabetes, with data available, respectively, after 3 months < or =163 patients exposed), 6 months (n=77) and 9 months (n=28) with exenatide therapy. This analysis mainly focuses on the 3 and 6 month cohorts. The mean HbA1 level at baseline averaged 9% and decreased by -1.3% and -1.4% at 3 and 6 months, respectively (-1.5% at 9 months). Neither the duration of diabetes nor initial body weight did influence the metabolic response. The decrease in HbA(1c) at 6 months was greater in patients with higher baseline HbA(1c):-0.5%, -1.4% and -2.4% for a baseline HbA(1c) level <8%, 8-10% and >10%, respectively. At 6 months, the composite criterion of a reduction of HbA(1c) by >1% or a final level <7% was reached by 69% of the cohort. Body weight decreased continuously over time, with a mean reduction of -2.1 kg at 3 months and -3.0 kg at 6 months (-4.9 kg at 9 months). The greater the baseline body weight, the greater the weight loss at final evaluation. Minor nausea and more rarely vomiting were observed, essentially during the first months of exenatide treatment. According to this observational study in routine practice, exenatide may be a valuable alternative to insulin for intensification of treatment of patients with type 2 diabetes after failure of oral drug combination, independently of baseline HbA(1c), body weight and duration of diabetes. [less ▲]

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See detailL'etude clinique du mois. Controle glycemique et morbimortalite cardio-vasculaire chez le patient diabetique de type 2. Resultats des etudes ACCORD, ADVANCE et VA-Diabetes.
Radermecker, Régis ULg; Philips, Jean-Christophe ULg; Jandrain, Bernard ULg et al

in Revue Médicale de Liège (2008), 63(7-8), 511-8

Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in ... [more ▼]

Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in this population remains questionable. Furthermore, the target level of glycated haemoglobin (HbA1c) to minimise the risk of diabetic complications is controversial. We report the results of three recent randomised control trials (ACCORD, ADVANCE, Veterans Affairs Diabetes), which assessed the impact on cardiovascular events of intensive glucose-lowering therapy. None of these studies was able to demonstrate a significant reduction of cardiovascular events in the intensive group as compared to the standard group. On the contrary, in ACCORD, the study with the most ambitious goal (HbA1c < 6%), the overall and cardiovascular mortality was greater in the intensive group. In contrast, in the ADVANCE trial, the mortality and the incidence of cardiovascular events were not statistically different between the two treatment groups, whereas the risk of microangiopathic complications, especially nephropathy, was significantly decreased in the intensive group (HbA1c < or = 6.5%, with modified release gliclazide as main treatment). Finally, VA-Diabetes showed that the effect of better glucose control on cardiovascular complications disappeared with duration of the disease and that the risk of cardiovascular events increased in patients with severe hypoglycaemic episodes. In the three studies, the hypoglycaemic risk was indeed increased in the intensive group, which may contribute to reduce the positive impact of better glucose control on cardiovascular complications. The best way to protect type 2 diabetic patients against coronary and cerebrovascular disease is to target all cardiovascular risk factors. [less ▲]

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See detailSujets « métaboliquement obèses » de poids normal. Première partie: diagnostic, physiopathologie et prévalence
Beck, Emmanuel ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Obésité (2008), 3(3), 184-193

Obesity, particularly abdominal obesity, is the main risk factor for metabolic syndrome. However, some non-obese individuals are metabolically abnormal and therefore probably have an increased risk of ... [more ▼]

Obesity, particularly abdominal obesity, is the main risk factor for metabolic syndrome. However, some non-obese individuals are metabolically abnormal and therefore probably have an increased risk of cardiovascular disease. The present review paper aims to describe the main characteristics of the metabolically obese normal-weight (MONW) syndrome, analyse its etiopathogenesis and pathophysiology and, finally, assess its prevalence in various populations. [less ▲]

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