Acute Functional Iron Deficiency in Obese Subjects During a Very-Low-Energy All-Protein Diet
Beguin, Yves ; ; Weber, Georges et al
in American Journal of Clinical Nutrition (1997), 66(1), 75-9
We examined whether a very-low-energy all-protein diet (VLED) would produce detectable changes in iron as well as in other trace elements. Twenty-five obese patients consumed for 2 wk a VLED containing 70 ... [more ▼]
We examined whether a very-low-energy all-protein diet (VLED) would produce detectable changes in iron as well as in other trace elements. Twenty-five obese patients consumed for 2 wk a VLED containing 70 g protein after a 1-wk period during which total daily energy intake was progressively reduced to 1.26 MJ. Serum iron fell sharply by approximately equal to 50% (P < 0.0001), and despite a small decrease in total-iron-binding capacity, transferrin saturation decreased from 30 +/- 11% to 18 +/- 5% (P < 0.0001). Serum ferritin did not change significantly but serum soluble transferrin receptor (sTfR), an indicator of iron deficiency, increased progressively from 4630 +/- 1110 to 6070 +/- 1390 micrograms/L (P < 0.0001). Changes in sTfR correlated inversely with prior changes in serum iron. Changes in iron metabolism did not translate into changes in erythropoiesis or red cell indexes, but the white blood cell count decreased from 7.3 +/- 1.6 to 6.2 +/- 1.9 x 10(9)/L (P < 0.002). There was no evidence of deficiency for the other trace elements and minerals tested. Daily supplementation with 200 mg Fe in 18 other subjects only partially corrected these observations despite some increase in iron stores. These results indicate that during a 2-wk VLED serum iron is significantly depressed, inducing functional tissue iron deficiency too short in duration to produce alterations in red blood cell indexes. These changes are not mediated by absolute iron deficiency, inflammation, or protein malnutrition but could be related to alterations in the iron storage and release behavior of the reticuloendothelial cell during energy deprivation alone. [less ▲]Detailed reference viewed: 72 (11 ULg)
Perspective in the treatment of insulin resistance.
in Human Reproduction (1997), 12 Suppl 1
Improving the action of insulin is a relatively new concept in therapy. It should, however, become more and more important because of the rapid expansion of the insulin resistance syndrome (including ... [more ▼]
Improving the action of insulin is a relatively new concept in therapy. It should, however, become more and more important because of the rapid expansion of the insulin resistance syndrome (including upper body adiposity, glucose intolerance, hypertension, dyslipidaemia, etc.) in industrialized countries and its dramatic consequences for public health. Insulin sensitivity can be improved by non-pharmacological means, essentially reduction of excessive body weight, promotion of regular physical activity and modification of dietary habits, as well as, possibly, cessation of smoking and correction of subclinical magnesium deficiency. Currently available pharmacological means mainly include the biguanide compound metformin and possibly anti-obesity agents, such as (d-) fenfluramine, fluoxetine and benfluorex. New compounds aiming at improving the action of insulin are in development, especially the thiazolidinedione derivatives (e.g. troglitazone), known as 'insulin sensitizers'. Treatment of insulin resistance may have important gynaecological applications, essentially in polycystic ovary syndrome and, possibly, after menopause. Hopefully, improving insulin sensitivity could ameliorate the cardiovascular prognosis of numerous individuals having some or all components of insulin resistance syndrome. [less ▲]Detailed reference viewed: 14 (1 ULg)
Non-insulin-dependent diabetes mellitus in the elderly.
in Bailliere's Clinical Endocrinology and Metabolism (1997), 11(2), 389-406
The prevalence of non-insulin-dependent diabetes mellitus dramatically increases with age. Older diabetic subjects have an increased frequency of complications from diabetes compared with their younger ... [more ▼]
The prevalence of non-insulin-dependent diabetes mellitus dramatically increases with age. Older diabetic subjects have an increased frequency of complications from diabetes compared with their younger counterparts and higher morbidity and mortality rates compared with age-matched non-diabetic controls. Elderly patients with diabetes are generally treated following the same approach as in younger patients: dietary therapy first, followed by oral hypoglycaemic agents and ultimately insulin. However, several specificities should be pointed out. Changes associated with ageing may affect the pharmacokinetics and pharmacodynamics of both sulphonylureas (increasing the risk of severe hypoglycaemia) and biguanides (increasing the risk of lactic acidosis). The best insulin regimen in old age is not known, but a twice-daily injection of a pre-mixed insulin preparation is usually recommended. Goals of therapy must be realistic and not cause disabling side-effects. The general practitioner plays a crucial role in the care of elderly diabetic patients, but access to a multidisciplinary specialized team may be necessary. [less ▲]Detailed reference viewed: 15 (1 ULg)
Glucose turnover in humans in the basal state and after intravenous glucose: a comparison of two models.
; ; et al
in American Journal of Physiology (1997), 273(2 Pt 1), 284-96
This study investigated the ability of two models to represent glucose kinetics in the basal steady state and during an intravenous glucose tolerance test (IVGTT). Six young nonobese male subjects were ... [more ▼]
This study investigated the ability of two models to represent glucose kinetics in the basal steady state and during an intravenous glucose tolerance test (IVGTT). Six young nonobese male subjects were studied after an overnight fast. Two bolus injections of [U-13C]glucose were given 150 min apart, the first without and the second together with concomitant injection of unlabeled glucose. [3-3H]glucose was constantly infused throughout the study and served to provide an independent means for evaluation of system responses. A linear time-invariant three-compartmental model and the two-compartment time-variant model proposed by Caumo and Cobelli were used to interpret measured time courses of [U-13C]glucose and to reconstruct endogenous glucose production and glucose removal. The ability of the two models to describe the glucose tracer time course was comparable. Simulation studies showed that the two-compartmental time-variant system better predicted measured [3-3H]glucose concentration profiles than did the three-compartmental time-invariant model. However, endogenous glucose production and the integral of excess glucose removal over basal during the IVGTT derived from the two models were almost identical. [less ▲]Detailed reference viewed: 15 (0 ULg)
Comment j'explore ... Une maladie de Basedow: de la clinique classique au diagnostic radio-immunologique.
in Revue Médicale de Liège (1997), 52(12), 788-91Detailed reference viewed: 43 (5 ULg)
Comment j'explore ... un patient avec hypotension orthostatique.
Scheen, André ; ; Marchand, Monique
in Revue Médicale de Liège (1997), 52(2), 116-9Detailed reference viewed: 29 (1 ULg)
L'hypoglycemie du patient diabetique. Recommendations of ALFEDIAM (French Language Association for the Study of Diabetes and Metabolic Diseases.
; ; et al
in Diabètes & Métabolism (1997), 23(1), 100-8Detailed reference viewed: 82 (4 ULg)
Reactivite bronchique chez les patients diabetiques.
Piéron, Maurice ; Scheen, André ; Corhay, Jean-Louis et al
in Revue des Maladies Respiratoires (1997), 14(5), 379-85
The data of the literature concerning bronchial reactivity in diabetic patients are controversial. Therefore, we studied the influence of the presence of a diabetic cardiac autonomic neuropathy (CAN) on ... [more ▼]
The data of the literature concerning bronchial reactivity in diabetic patients are controversial. Therefore, we studied the influence of the presence of a diabetic cardiac autonomic neuropathy (CAN) on the ventilatory parameters measured during a methacholine-induced bronchoconstriction test. Ten insulin-dependent diabetic patients without CAN, ten insulin-dependent diabetic patients with CAN and ten healthy volunteers, all non-smokers and free of respiratory symptoms, have undergone a functional respiratory check-up before the methacholine test. The presence of CAN was classically studied by the decrease in heart rate changes during three standardized tests (deep breathing at 6 cycles/min, Valsalva manoeuver, orthostatism) which all mainly explore the parasympathetic function. The bronchial response to methacholine was similar in the healthy subjects and in the diabetic patients without CAN. However, the fall in forced expiratory volume in 1 second induced by the highest dose of methacholine was significantly less marked in the diabetic subjects with CAN than in the two other groups. These results suggest that the diabetic autonomic neuropathy also involves the vagal innervation of the respiratory tract. [less ▲]Detailed reference viewed: 22 (0 ULg)
L'homeopathie peut-elle trouver sa legitimite dans les resultats "positifs" d'une meta-analyse?
in Revue Médicale de Liège (1997), 52(11), 694-7Detailed reference viewed: 38 (6 ULg)
La controverse a propos de la decouverte de l'insuline. L'histoire vue sous l'angle de la philatelie.
in Revue Médicale de Liège (1997), 52(12), 756-9Detailed reference viewed: 20 (1 ULg)
Comment j'explore ... le syndrome d'insulinoresistance grace a ses marqueurs biologiques.
Luyckx, Françoise ; Scheen, André ; Gielen, Jean-Louis et al
in Revue Médicale de Liège (1997), 52(10), 686-91Detailed reference viewed: 30 (1 ULg)
Le recepteur beta 3-adrenergique: un role dans la predisposition genetique a l'obesite et au diabete?
Luyckx, Françoise ; Scheen, André ; Gielen, Jean-Louis et al
in Revue Médicale de Liège (1997), 52(11), 703-8Detailed reference viewed: 92 (0 ULg)
Pharma-clinics. Le medicament du mois. Le Legalon (silymarine).
Luyckx, Françoise ; Scheen, André
in Revue Médicale de Liège (1997), 52(12), 792-6Detailed reference viewed: 207 (5 ULg)
Roles of circadian rhythmicity and sleep in human glucose regulation.
; ; Scheen, André
in Endocrine Reviews (1997), 18(5), 716-38Detailed reference viewed: 19 (0 ULg)
Determination rapide par immunodosage de l'hemoglobine glyquee sur sang capillaire comparee a une methode d'affinite pour le boronate et capture d'ions sur sang veineux.
Bozet, Marie-Claire ; Gerard, Pascale ; Scheen, André et al
in Annales de Biologie Clinique (1997), 55(2), 139-44
Measurement of glycosylated haemoglobin has become an essential tool in the management of diabetic patients. A recently developed device allows the rapid immuno-assay of HbA1c in 1 microliter capillary ... [more ▼]
Measurement of glycosylated haemoglobin has become an essential tool in the management of diabetic patients. A recently developed device allows the rapid immuno-assay of HbA1c in 1 microliter capillary blood obtained by a finger prick. In 100 ambulatory diabetic patients, we compared the results obtained with this method to those obtained in venous blood using a standard affinity chromatography laboratory method. Although both methods correlated (r = 0.88, p < 0.001), the mean +/- SD levels respectively obtained differed slightly (7.6 +/- 1.5 vs 79 +/- 1.4% p < 0.001). The 95% confidence interval of the difference was [-0.41. -0.14]. Considering a cut-off HbA1c value of 8%, as indicative of the need for treatment adjustment, 33 patients with the capillary blood immuno-assay method and 42 with the venous-blood affinity chromatography method were above that limit (Mc Nemar test, p < 0.05). In conclusion, the rapid assay of HbA1c in capillary blood can be useful for the management of some diabetic patients but the results are not readily exchangeable with those obtained from other standardized laboratory methods. Consequently, specific ranges and clinical decision limits must be determined. [less ▲]Detailed reference viewed: 193 (0 ULg)
Drug treatment of non-insulin-dependent diabetes mellitus in the 1990s. Achievements and future developments.
in Drugs (1997), 54(3), 355-68
Non-insulin-dependent diabetes mellitus (NIDDM, type 2 diabetes) is a heterogeneous disease resulting from a dynamic interaction between defects in insulin secretion and insulin action. There are various ... [more ▼]
Non-insulin-dependent diabetes mellitus (NIDDM, type 2 diabetes) is a heterogeneous disease resulting from a dynamic interaction between defects in insulin secretion and insulin action. There are various pharmacological approaches to improving glucose homeostasis, but those currently used in clinical practice either do not succeed in restoring normoglycaemia in most patients or fail after a variable period of time. For glycaemic regulation, 4 classes of drugs are currently available: sulphonylureas, biguanides (metformin), alpha-glucosidase inhibitors (acarbose) and insulin, each of which has a different mode and site of action. These standard pharmacological treatments may be used individually for certain types of patients, or may be combined in a stepwise fashion to provide more ideal glycaemic control for most patients. Adjunct treatments comprise a few pharmacological approaches which may help to improve glycaemic control by correcting some abnormalities frequently associated with NIDDM, such as obesity (serotoninergic anorectic agents) and hyperlipidaemia (benfluorex). There is intensive pharmaceutical research to find new drugs able to stimulate insulin secretion (new sulphonylurea or nonsulphonylurea derivatives, glucagon-like peptide-1), improve insulin action (thiazolidinediones, lipid interfering agents, glucagon antagonists, vanadium compounds) or reduce carbohydrate absorption (miglitol, amylin analogues, glucagon-like peptide-1). Further studies should demonstrate the superiority of these new compounds over the standard antidiabetic agents as well as their optimal mode of administration, alone or in combination with currently available drugs. [less ▲]Detailed reference viewed: 29 (0 ULg)
Plasma leptin levels, insulin secretion, clearance and action on glucose metabolism in anorexia nervosa.
Letiexhe, Michel ; Scheen, André ; Lefebvre, Pierre
in Eating and Weight Disorders [=EWD] (1997), 2(2), 79-86
From a metabolic point of view, anorexia nervosa may be viewed as a mirror image of obesity. We compared insulin secretion, clearance and action on glucose metabolism during an intravenous glucose ... [more ▼]
From a metabolic point of view, anorexia nervosa may be viewed as a mirror image of obesity. We compared insulin secretion, clearance and action on glucose metabolism during an intravenous glucose tolerance test in nine women with anorexia nervosa and in nine age-matched normal-weight controls. Insulin secretion (ISR) was derived by deconvolution of plasma C-peptide levels, insulin clearance (MCR(I)) was obtained by dividing the area under the curve (AUC(0-180 min)) of ISR by the corresponding AUC of plasma insulin levels, insulin sensitivity (S(I)) and glucose effectiveness index (S(G)) were calculated by Bergman's minimal model. The anorectic women had markedly lower BMI values (13.7+/-0.6 vs 23.2+/-0.8 kg/m2, p<0.0001) and serum basal leptin levels (2.8+/-0.6 vs 8.9+/-1.8 ng/mL, p=0.005) than control women. The anorectic women exhibited clear-cut lower fasting and post-glucose plasma insulin levels but similar corresponding plasma C-peptide concentrations when compared to controls. Consequently, ISR was similar in both groups while MCR(I) was significantly increased in anorexia nervosa (MCR(I): 3320+/-881 vs 822+/-79 mL x min(-1) x m(-2), p<0.02). The index S(I) tended to be higher in anorectic women than in normal-weight subjects, but without reaching the level of statistical significance because of a high between-subject variability (20.2+/-5.7 vs 12.5+/-2.2 10(-5) x min(-1)/pmol x L(-1), NS). The index S(G) was similar in both groups (0.022+/-0.004 vs 0.018+/-0.002 min(-1), NS). In conclusion, low plasma insulin levels observed in women with anorexia nervosa result from high MCR(I) rather than from depressed insulin secretion. Insulin sensitivity is not systematically increased and glucose effectiveness is unchanged in anorectic women when compared to normal-weight controls. [less ▲]Detailed reference viewed: 46 (0 ULg)
Pharma-clinics. Comment je traite... un patient diabétique de type 1 par pompe portable à insuline
; Scheen, André
in Revue Médicale de Liège (1996), 51(11), 678-80Detailed reference viewed: 13 (1 ULg)