Pub Date : 2023-12-01DOI: 10.1016/S0985-0562(24)00016-5
Sébastien Guillaume , Patrick Ritz
Overweight and obesity are common in severe and chronic psychiatric disorders. Up to 50% of patients suffering from schizophrenia or bipolar disorder are obese. The mortality rate is 4.5 times higher than in the general population, mainly due to metabolic and cardiovascular disorders. Numerous factors, interconnected by vicious circles of mutually reinforcing adverse physiological adaptations, contribute to this association. Close collaboration between mental health and somatic health specialists is essential for coordinated, individualized care. This will involve an integrative assessment to understand the factors behind the genesis of obesity, the consequences in terms of co-morbidity, and the possibilities of therapeutic options, including the ability to access treatment. Treatment paths should also include early detection of subjects at risk of weight gain, close monitoring of the metabolic effects of psychotropic drugs, hygienic-dietary measures and non-drug interventions. In addition, the role of bariatric surgery and obesity drugs requires more detailed investigations in these patients.
Pub Date : 2023-12-01DOI: 10.1016/S0985-0562(24)00006-2
Davide Masi , Mickael Massicard , Karine Clément
In recent years, increasing attention has been given to the gut microbiota because of its role in metabolic diseases, cardiovascular health, gastrointestinal disorders, and cancers. In individuals suffering from obesity, a reduction in the richness, diversity, and composition of the intestinal microbiota has often been observed, and this has been associated with metabolic traits and low-grade systemic inflammation.
Bariatric surgery has emerged as a valuable approach for reducing cardiometabolic risk. Recently, the number of bariatric surgeries has increased in parallel with the growing prevalence of severe obesity. Metabolic surgery, such as Roux-en-Y gastric bypass or Sleeve Gastrectomy, has shown promising results in terms of long-term weight loss, improved metabolic status, and even remission of comorbidities. However, it is important to note that these positive results cannot be attributed solely to food intake restriction or malabsorption. Emerging evidence suggests that bariatric surgery leads to significant changes in the intestinal microbiome, which may contribute to the beneficial effects observed on obesity-related complications. These changes could play a crucial role in reducing cardiovascular disease.
Therefore, the main objective of this review is to better understand the links between the composition of the gut microbiota after bariatric surgery and improved cardiovascular health. By exploring this complex relationship, research teams aim to shed light on the underlying mechanisms and pave the way for novel therapeutic strategies to improve cardiovascular health in patients who have undergone bariatric surgery.
Pub Date : 2023-12-01DOI: 10.1016/S0985-0562(24)00012-8
Judith Aron-Wisnewsky , Marie-Claude Brindisi
Presently in France, more than 8 million people are affected by obesity (17% of the French population), with an even higher prevalence among people from disadvantaged socio-economic backgrounds. This pathology requires a global, multi-professional, multimodal, adapted, and exhaustive management, taking into account all the associated comorbidities and the potential handicap caused by the severity of obesity. These best practice clinical recommendations, published in 2022, improves the management of patients with obesity through: (i) the development of a new clinical classification that graduates the severity of obesity beyond the sole BMI, allowing patients to be referred to the appropriate level of care; (ii) the exhaustive description of the evaluation content (medical, behavioral, psychological and social); (iii) the precision of the objectives and content of the needed therapeutic lifestyle modifications and (iv) the introduction and description of anti-obesity drug indications. These recommendations were then used by another working group to propose a guide for the care pathway of adults living with overweight and obesity (published in February 2023), and to broaden the indications for drug treatments for obesity (opinion on drugs, December 2022). Finally, these recommendations will be completed by a second part concerning the revision of the bariatric surgery recommendations (expected in 2024) in order to propose uniform and quality management of patients living with obesity.
Pub Date : 2023-12-01DOI: 10.1016/S0985-0562(24)00008-6
Albane Chavanne , David Jacobi
The fundamental impact of the Earth’s rotation on living organisms necessitates the coordination of metabolism through rhythmic processes, resulting in the emergence of molecular and autonomous circadian clocks that anticipate diurnal variations. In mammals, these clocks are organized between a hypothalamic central clock and peripheral clocks present in the various organs. The central clock ensures the adaptation of major physiological functions to ambient light, while peripheral clocks are sensitive to other factors such as meal timing. The molecular mechanisms involved in synchronizing circadian clocks among themselves and with the environment are now better understood, highlighting the detrimental effects of chronodisruption caused by social jet lag and irregular eating habits associated with modern lifestyles. Preclinical studies confirm the links between chronodisruption, obesity, and metabolic diseases, suggesting the potential benefits of resynchronization interventions such as chrononutrition or chronopharmacology. This review presents the participation of the circadian clock in metabolic homeostasis and explores its potential in the prevention and management of overweight and obesity.
In March 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared a global pandemic by the WHO. Obesity was rapidly identified as an independent risk factor for poor prognosis, with an increased risk of acute respiratory distress syndrome, cardiovascular and thrombo-embolic events, admission to intensive care and mortality. The white visceral adipose tissue, which increases in people suffering from obesity, appears to have a key role in this pathogenesis, as it constitutes a viral reservoir for SARS-CoV-2 through angiotensin 2-converting enzyme receptors. Following infection of host cells, activation of pro-inflammatory cytokines creates an environment suitable to the ‘cytokine storm’ and macrophage activation syndrome, associated with a risk of progression to acute respiratory distress syndrome. In obesity, the systemic spread of the virus, its entry and prolonged excretion into already inflamed adipose tissue can stimulate immune responses and the subsequent amplification of a cytokine cascade, worsening the course of the disease. The endothelial hyperactivation induced by SARS-CoV-2 combined with the state of hypofibrinolysis and endothelial dysfunction present in obesity increases the risk of thrombo-embolic events. The volume of visceral and epicardial adipose tissue measured by CT scan appears to be a good prognostic marker for these unfavorable outcomes. In addition, vaccine responses appear to be lower in these patients due to a weaker early humoral response, which means that prevention messages need to continue to be disseminated and booster vaccinations encouraged in this population. The aim of this review is to determine the role of adipose tissue in the poor prognosis of obese patients infected with SARS-CoV-2.
Obesity represents a growing global health issue today. Understanding the mechanisms underlying the formation, growth, and function of adipose tissue is crucial in combating this disease and its associated complications, such as type 2 diabetes and cardiovascular diseases. In France, obesity is on the rise, particularly among young adults and children. In this review, we discuss the cellular composition of white adipose tissue, highlighting recent advances in the characterisation of various cell populations. We also explore the metabolic implications of body fat distribution, emphasizing the importance of brown and beige adipose tissues in metabolism regulation. These thermogenic tissues offer significant metabolic benefits, opening up promising opportunities in research and development of therapeutic strategies to address obesity-related metabolic disorders. Furthermore, we discuss the relationship between cellular senescence and obesity-related metabolic dysfunction, along with new research in the field of intercellular communication and mitochondrial recycling. Finally, this review provides a comprehensive overview of recent developments in the understanding of obesity at adipose cells level.
Pub Date : 2023-12-01DOI: 10.1016/S0985-0562(24)00014-1
Béatrice Dubern , Christine Poitou
Rare genetic obesities are related to a neuroendocrine disorder linked to a dysfunction of the energy balance at the hypothalamic level, i.e eating behaviour and energy expenditure. More than sixty genes playing a key role in the leptin/melanocortin pathway contribute to these rare forms of obesity. The National Program for Diagnosis and Care Program (French PNDS) for Obesity of Rare Causes, available on the website of Haute Autorité de Santé, establishes recommendations for assessment and management at all ages. Eating disorders and complications related to early and severe obesity are very often associated with neuropsychological and behavioral disorders, leading to complex clinical situations. These conditions render the clinical management particularly challenging. Patients’ early genetic diagnosis is critical to allow specialized, multidisciplinary and coordinated care, with a necessary interaction between the health and social sectors and families. It also allows for personalized medicine by providing access to new drug therapies and informed discussion of bariatric surgery by improving the analysis of the benefit/risk balance. In this respect, these rare forms of obesity are a model of care for more common obesity in very vulnerable populations with disabilities, such as people with NDD (neurodevelopmental disorders) for whom the prevalence of obesity and its complications is higher than in the general population. The prevention of worsening weight gain is then based on the control of the person’s environment with a limitation of access to food and the establishment of a reassuring daily eating environment to limit impulsivity as well as the practice of an adapted, sustained and supervised physical activity. All this requires an efficient and adapted coordination of the care pathway close to the person and throughout his life.
Pub Date : 2023-12-01DOI: 10.1016/S0985-0562(24)00013-X
Anne-Françoise Pauchet-Traversat , Sabine Berrebi , Sandrine Brugère , Adeline Cancel , David Communal , Alina Constantin , Philippe Cornet , Sophie Dunoyer , Bénilde Feuvrier , Cyril Gauthier , Loïs Khul , Séverine Ledoux , Marie-Hélène Lorand-Benech , Maud Marchand , Victoire Vinant , Émilien Petit , Agnès Sallé , Florian Savignac , Claudine Schalck , membres du groupe de travail Élaboration du guide du parcours de soin « Surpoids et obésité de l’adulte ».
This guide describes the care, support and overall follow-up of adults with overweight or obesity. It reasserts the importance of early identification, coupled with a lifestyle assessment. It details the role of professionals (health, social and medico-social field, adapted physical activity, occupational health) and looks at the situations in which the person’s primary care physician may consult them.
This work was conducted jointly with the French national health insurance fund, in the context of the healthcare system transformation strategy, to meet the objectives of the “Ma santé 2022” [“My Health 2022”] program. It was produced with the assistance of a multidisciplinary working group and patient association representatives drawing on an analysis on the international literature.
To help professionals assimilate this work, the HAS proposes a summary of the critical points in the care pathway, 14 key messages to improve practices, 8 toolkit guides reiterating the role of each professional and the arrangements for sharing information with the primary care physician.
L’obésité sarcopénique (OS) est un phénotype clinique de l’obésité qui suscite un intérêt croissant en raison de ses conséquences sur la santé. Elle engendre un risque accru de comorbidités et de perturbations métaboliques dont les mécanismes étiopathogéniques sont multifactoriels et non uniquement liés au vieillissement. Elle est caractérisée par l’accumulation de graisse et par la perte de masse et de fonction musculaires, témoignant d’une dénutrition potentielle. Les avancées diagnostiques reposent sur un consensus soulignant l’importance de considérer l’adiposité, la force et la masse musculaire avec des critères spécifiques selon les populations. Sa prévalence est aussi très variable en fonction de l’âge et des pathologies concernées. Sa physiopathologie multifactorielle indique que la sarcopénie peut accroître l’adiposité, pouvant elle-même favoriser le développement de la perte musculaire. En matière de prise en charge, les approches multidisciplinaires combinent les modifications des apports alimentaires, des exercices ciblés et des interventions pharmacologiques éventuelles pour prévenir, ralentir ou inverser la progression de l’OS, mais les essais randomisés contrôlés restent rares dans le domaine. En conclusion, l’OS émerge comme un enjeu de santé critique nécessitant une meilleure caractérisation et un approfondissement de ses mécanismes de développement.
Publié par Elsevier Masson SAS. Tous droits réservés.
Sarcopenic obesity (SO) is a new clinical phenotype of obesity attracting an increasing interest due to its health consequences in an aging population. It generates an increased risk of comorbidities and metabolic disturbances whose etiopathogenic mechanisms are multifactorial and not only linked to aging. It is characterized by the accumulation of fat and loss of muscle mass and function, indicative of potential malnutrition. Diagnostic advances are based on a recent consensus emphasizing the relevance of considering adiposity, strength and muscle mass with specific criteria depending on populations specificities. Its prevalence also varies, largely dependent on age and diseases. Its multifactorial pathophysiology illustrates that sarcopenia can increase adiposity, which can itself promote the development of muscle loss. In terms of management, multidisciplinary approaches combine modifications in dietary intake, targeted exercise and possible pharmacological interventions to prevent, slow or reverse the progression of SO, but randomized controlled trials remain rare in the field. In conclusion, SO is emerging as a critical health issue requiring better characterization and deepening of its development mechanisms.
Experts suggest that people with type 1 diabetes (T1DM) should be discouraged from fasting during Ramadan, even though both adolescents and adults insist on performing their fast despite the jurisprudential excuse. The objective was to evaluate the behavior and attitudes of a population with T1DM during Ramadan and outside.
Materials and methods
A descriptive study was carried out on 63 T1DM subjects at the level of two health establishments located in the city of Constantine (eastern Algeria). The interviews took place between April 13th and May 12th, 2021 during Ramadan. The R.3.2.4 software was used for the comparison tests. The significance level retained was 0.05.
Results
The study involved 63 subjects with T1DM (30 females and 33 males) of whom 26 subjects aged < 18 years and 37 subjects aged ≥ 18 years (P = 0.001). The mean age was 21.2 ± 5.7 years (12–42 years). The average duration of pathology since diagnosis was 6.6 ± 4.5 years. Glycated hemoglobin (Hb1Ac) was between 5.60% and 16.10% with an average of 8.1 ± 0.2%. The results revealed that 28.6% of the patients practiced Ramadan fasting with an average of 13.8 ± 10.4 days. Only 31.7% consulted their doctors before observing Ramadan, 77.8% controlled their blood sugar mainly before breaking the fast. COVID-19 affected 15.9% of subjects and hyperglycemia was the most recorded diabetes-related complication.
Conclusion
Despite the health risks, subjects with T1DM insisted on fasting during the month of Ramadan. Thence it is vital to adhere to a healthy lifestyle with early clinical monitoring.
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