References of "PAQUOT, Nicolas"
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See detailLa chirurgie metabolique, vers une (r)evolution de la chirurgie bariatrique ?
SCHEEN, André ULiege; DE FLINES, Jenny ULiege; RORIVE, Marcelle ULiege et al

in Revue Médicale de Liège (2011), 66(4), 183-90

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improves metabolic control in obese patients. The frequently observed remission of type 2 diabetes ... [more ▼]

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improves metabolic control in obese patients. The frequently observed remission of type 2 diabetes occurs very early, before any marked weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery. Such type of surgery is currently evaluated in patients with type 2 diabetes, but with only a moderate obesity (BMI < 35 kg/m2), or even without obesity (BMI < 30 kg/m2). The Belgian Metabolic Intervention (BMI) Study Group would like to contribute very soon to this evaluation in a multidisciplinary approach. [less ▲]

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See detailQuelle combinaison d'antidiabétiques oraux pour contrôler l'hyperglycémie chez un patient diabétique de type 2 insuffisamment équilibré sous metformine?
SCHEEN, André ULiege; Paquot, Nicolas ULiege

in Revue Médicale de Liège (2011), 66(3), 170-5

Patients with type 2 diabetes should improve lifestyle habits combined with metformin as first pharmacological compound (in absence of contra-indications). In case of failure of metformin monotherapy (due ... [more ▼]

Patients with type 2 diabetes should improve lifestyle habits combined with metformin as first pharmacological compound (in absence of contra-indications). In case of failure of metformin monotherapy (due to the progression of the disease secondary to B-cell exhaustion), another oral glucose-lowering agent should be added. Several medications may be used, with some advantages and disadvantages for each of them. The present clinical case illustrates this dilemma and should help the reasoning leading to the best pharmacological combination according to individual patient's profile. [less ▲]

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See detailLa vignette therapeutique de l'etudiant. Options therapeutiques pour controler l'hyperglycemie chez un patient diabetique de type 2 insuffisamment equilibre sous l'association metformine-sulfamide.
SCHEEN, André ULiege; Paquot, Nicolas ULiege

in Revue Médicale de Liège (2011), 66(4), 215-21

Beyond lifestyle changes, the management of type 2 diabetes comprises the administration of oral glucose-lowering agents, especially the classical metformin-sulfonylurea combination. If such a dual oral ... [more ▼]

Beyond lifestyle changes, the management of type 2 diabetes comprises the administration of oral glucose-lowering agents, especially the classical metformin-sulfonylurea combination. If such a dual oral therapy could not (any more) obtain an adequate glucose control, intensified management becomes mandatory. Several therapeutic approaches may be proposed at this stage, with some advantages and disadvantages of each of them. The present clinical case aims at illustrating such difficult therapeutic choice. We will provide the pro-contra arguments concerning each therapeutic alternative and describe the practical modalities of an appropriate management according to the patient's characteristics. [less ▲]

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See detailDe la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2
SCHEEN, André ULiege; DE FLINES, Jenny ULiege; DE ROOVER, Arnaud ULiege et al

in Médecine des Maladies Métaboliques (2011), 5(3),

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these ... [more ▼]

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures and to propose them to patients with type 2 diabetes but without severe obesity (body mass index <35 kg/m² or even <30 kg/m²). Therefore, we may progress in a near future from bariatric surgery to a so-called metabolic surgery, which may open a new paradigm for the management of type 2 diabetes. This innovative approach, promising but still insufficiently validated yet, deserves further careful evaluation in a multidisciplinary approach involving digestive surgeons, gastroenterologists, endocrinologists and diabetologists. [less ▲]

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See detailLe tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique
SCHEEN, André ULiege; DE FLINES, Jenny ULiege; DE ROOVER, Arnaud ULiege et al

in Médecine des Maladies Métaboliques (2011), 5(2), 155-161

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission ... [more ▼]

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission of diabetes occurs very early, before any significant weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. These hormonal changes result from partial stomach amputation (leading to reduced ghrelin secretion), from bypass of duodenal-jejunal foregut (leading to reduced secretion of still unknown factors that may counteract insulin secretion and/or action) and from an earlier contact of food with hindgut (leading to enhanced secretion of incretin hormones such as glucagon-like peptide-1 [GLP-1] by the ileal L cells, neuropeptide YY and oxyntomodulin). The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery. [less ▲]

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See detailHyperglycaemic clamp test for diabetes risk assessment in IA-2-antibody-positive relatives of type 1 diabetic patients
Vandemeulebroucke, E.; Keymeulen, B.; Decochez, K. et al

in Diabetologia (2010), 53

AIMS/HYPOTHESIS: The aim of the study was to investigate the use of hyperglycaemic clamp tests to identify individuals who will develop diabetes among insulinoma-associated protein-2 antibody (IA-2A ... [more ▼]

AIMS/HYPOTHESIS: The aim of the study was to investigate the use of hyperglycaemic clamp tests to identify individuals who will develop diabetes among insulinoma-associated protein-2 antibody (IA-2A)-positive first-degree relatives (IA-2A(+) FDRs) of type 1 diabetic patients. METHODS: Hyperglycaemic clamps were performed in 17 non-diabetic IA-2A(+) FDRs aged 14 to 33 years and in 21 matched healthy volunteers (HVs). Insulin and C-peptide responses were measured during the first (5-10 min) and second (120-150 min) release phase, and after glucagon injection (150-160 min). Clamp-induced C-peptide release was compared with C-peptide release during OGTT. RESULTS: Seven (41%) FDRs developed diabetes 3-63 months after their initial clamp test. In all phases they had lower C-peptide responses than non-progressors (p < 0.05) and HVs (p < 0.002). All five FDRs with low first-phase release also had low second-phase release and developed diabetes 3-21 months later. Two of seven FDRs with normal first-phase but low second-phase release developed diabetes after 34 and 63 months, respectively. None of the five FDRs with normal C-peptide responses in all test phases has developed diabetes so far (follow-up 56 to 99 months). OGTT-induced C-peptide release also tended to be lower in progressors than in non-progressors or HVs, but there was less overlap in results between progressors and the other groups using the clamp. CONCLUSIONS/INTERPRETATION: Clamp-derived functional variables stratify risk of diabetes in IA-2A(+) FDRs and may more consistently identify progressors than OGTT-derived variables. A low first-phase C-peptide response specifically predicts impending diabetes while a low second-phase response may reflect an earlier disease stage [less ▲]

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See detail"Fitness" versus "fatness": impacts cardio-metaboliques respectifs aux differents ages de la vie.
ESSER, Nathalie ULiege; Paquot, Nicolas ULiege; Scheen, André ULiege

in Revue Médicale de Liège (2010), 65(4), 199-205

Almost 35% of overweight or obese individuals are free of any metabolic disorder. This may be explained by a favourable fat distribution. However, those individuals also have a higher level of physical ... [more ▼]

Almost 35% of overweight or obese individuals are free of any metabolic disorder. This may be explained by a favourable fat distribution. However, those individuals also have a higher level of physical fitness. Therefore, deleterious cardiometabolic effects of excessive fat mass ("fatness") might be counterbalanced by regular physical activity leading to high cardiorespiratory fitness ("fitness"). The present article first analyzes the various pathophysiological mechanisms explaining why muscular exercise has beneficial effects and second, describes the relationship between "fitness" and "fatness" and their respective cardiometabolic consequences at various ages: adolescents, adults and elderly people. [less ▲]

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See detailApproche multirisque du patient diabetique de type 2: desaccord sur les valeurs cibles suite a l'etude ACCORD.
Scheen, André ULiege; Paquot, Nicolas ULiege

in Revue Médicale Suisse (2010), 6(260), 1582-7

The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk ... [more ▼]

The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines. [less ▲]

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See detailFructose and metabolic diseases: new findings, new questions.
Tappy, Luc; Lê, Kim A.; Tran, Christel et al

in Nutrition (Burbank, Los Angeles County, Calif.) (2010), 26(11-12), 1044-9

There has been much concern regarding the role of dietary fructose in the development of metabolic diseases. This concern arises from the continuous increase in fructose (and total added caloric ... [more ▼]

There has been much concern regarding the role of dietary fructose in the development of metabolic diseases. This concern arises from the continuous increase in fructose (and total added caloric sweeteners consumption) in recent decades, and from the increased use of high-fructose corn syrup (HFCS) as a sweetener. A large body of evidence shows that a high-fructose diet leads to the development of obesity, diabetes, and dyslipidemia in rodents. In humans, fructose has long been known to increase plasma triglyceride concentrations. In addition, when ingested in large amounts as part of a hypercaloric diet, it can cause hepatic insulin resistance, increased total and visceral fat mass, and accumulation of ectopic fat in the liver and skeletal muscle. These early effects may be instrumental in causing, in the long run, the development of the metabolic syndrome. There is however only limited evidence that fructose per se, when consumed in moderate amounts, has deleterious effects. Several effects of a high-fructose diet in humans can be observed with high-fat or high-glucose diets as well, suggesting that an excess caloric intake may be the main factor involved in the development of the metabolic syndrome. The major source of fructose in our diet is with sweetened beverages (and with other products in which caloric sweeteners have been added). The progressive replacement of sucrose by HFCS is however unlikely to be directly involved in the epidemy of metabolic disease, because HFCS appears to have basically the same metabolic effects as sucrose. Consumption of sweetened beverages is however clearly associated with excess calorie intake, and an increased risk of diabetes and cardiovascular diseases through an increase in body weight. This has led to the recommendation to limit the daily intake of sugar calories. [less ▲]

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See detailEffets néfastes du defaut d'observance hygiéno-diététique et médicamenteuse chez le patient diabétique
Paquot, Nicolas ULiege

in Revue Médicale de Liège (2010), 65(5-6), 326-31

The treatment of diabetes mellitus is complex and involves lifestyle modification to optimize nutrition and physical activity as well as the addition of pharmacological therapy to provide needed ... [more ▼]

The treatment of diabetes mellitus is complex and involves lifestyle modification to optimize nutrition and physical activity as well as the addition of pharmacological therapy to provide needed physiological support for insulin deficiency or for insulin resistance. Adherence to medical recommendations has been found to be associated with improved glycaemic control through HbA1c reduction but also to result in improved outcomes and reduced costs of diabetes. Despite this potential benefit of pharmacological therapy, adherence to glucose-lowering treatments is poor, ranging from 36% to 85% adherence to oral medications. The most common factors affecting medication taking in diabetic patients include regimen complexity, dosing frequency greater than twice daily, cost, poor self-confidence, insufficient education about the use of the products, depression, and adverse effects or fear of them. Several barriers to medication taking have been suggested although well-controlled trials to confirm and resolve these barriers are limited yet. Further studies are needed to test specific interventions to improve medication taking in diabetes. [less ▲]

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See detailMieux traiter le diabète : combattre l’inertie et améliorer l’adhésion au traitement.
SCHEEN, André ULiege; PHILIPS, Jean-Christophe ULiege; PAQUOT, Nicolas ULiege

in Association belge du diabète (2010), 53

Le diabète est une maladie chronique par excellence. Comme beaucoup d’autres maladies chroniques, le diabète, qu’il soit de type 1 ou plus encore de type 2, est d’origine complexe, combinant l’infl uence ... [more ▼]

Le diabète est une maladie chronique par excellence. Comme beaucoup d’autres maladies chroniques, le diabète, qu’il soit de type 1 ou plus encore de type 2, est d’origine complexe, combinant l’infl uence de facteurs génétiques et environnementaux. Le but du traitement est de corriger au mieux l’hyperglycémie chronique, mais aussi d’autres facteurs de risque (hypertension artérielle, hypercholestérolémie,…), de façon à prévenir la survenue de complications, garantir une bonne qualité de vie et améliorer l’espérance de vie. [less ▲]

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See detailReduction du risque metabolique associe a l'obesite en modulant l'exposition tissulaire au cortisol.
Iovino, Alessandra ULiege; Paquot, Nicolas ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2010), 6(260), 1608-12

The 11-beta-hydroxysteroid dehydrogenase type 1 (11HSD1) enzyme promotes the local conversion from cortisone to cortisol, especially in the liver and the adipose tissue. It may play a role in the ... [more ▼]

The 11-beta-hydroxysteroid dehydrogenase type 1 (11HSD1) enzyme promotes the local conversion from cortisone to cortisol, especially in the liver and the adipose tissue. It may play a role in the pathophysiology of abdominal obesity and the metabolic syndrome, both showing some similarities with the Cushing syndrome. Considering experimental results obtained in rodents, the inhibition of this enzyme could exert favourable metabolic effects, with significant reductions in plasma glucose, insulin resistance and dyslipidaemia. Synthetic inhibitors of 11HSD1 are currently in development with encouraging preliminary results, first in animals, and more recently in humans. Selective inhibitors of 11HSD1 may represent an innovative approach in the pharmacological management of obesity, metabolic syndrome and type 2 diabetes in a near future. [less ▲]

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

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 ULiege; Paquot, Nicolas ULiege; Scheen, André ULiege

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 ULiege; De Flines, Jenny ULiege; Paquot, Nicolas ULiege 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 ULiege; Paquot, Nicolas ULiege; Scheen, André ULiege

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 ULiege; PAQUOT, Nicolas ULiege; SCHEEN, André ULiege

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 ULiege; ESSER, Nathalie ULiege; Paquot, Nicolas ULiege 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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