Revue medicale de la Suisse romande最新文献

The subjective global assessment (SGA) defines nutritional and functional status of patients with the aim of identifying who could benefit from a nutritional intervention. The SGA was designed to evaluate the nutritional risk of infectious complications among the surgical patients. Later on, it became largely utilized to evaluate the nutritional status of other groups of patients, because it is reliable and easy to use. However, it is important to verify that the SGA is an adequate test also in other clinical situations. This review analyses recent literature regarding the actual utilization of the SGA in clinical situations frequently associated to malnutrition: kidney diseases, AIDS, cancer, aging. The reproducibility of SGA depends on the experience of the caregiver administering it. Its validation compared to more objective parameters like visceral proteins or body composition is not always obvious. In several studies the SGA does not seem enough sensitive to detect a beginning of malnutrition. Its specificity and predictive validity were demonstrated in all of the clinical situations analyzed. In conclusion, the SGA is a tool adequate to identify patients with a nutritional risk and who would benefit of a nutritional intervention aiming at preventing associated complications.

Nutritional status has a prognostic value in the clinical evolution of patients who are malnourished, are becoming malnourished or are in process of being rehabilitated. The evaluation of nutritional status is based on a comprehensive approach, and includes body composition measurement by bio-impedance analysis (BIA). BIA determines the quantity of body fat-free and fat mass and has a precision around 4%. The reliability of BIA depends on the use of body composition prediction equations that are adapted to the subjects studied and on the inclusion of various anthropometric parameters (weight, height, sex, age, race, etc). BIA remains imprecise in the presence of abnormal distribution of body compartments (ascites, dialysis, lipodystrophy) or of extreme weights (cachexia, severe obesity). Multi-frequency or segmental BIA were developed to overcome hydration abnormalities and variations in body geometry. However, these techniques require further validation. This review discusses the indications and limitations of BIA.

Obesity and insulin resistance are reaching epidemic proportions worldwide. Over the past decade, nitric oxide (NO) has emerged as a key player in the regulation of the metabolic and cardiovascular homeostasis. Here we will review recent data obtained in mice with disruption of the genes encoding for each of the three nitric oxide synthase isoforms. These data demonstrate that both defective and augmented NO synthesis have detrimental effects on the regulation of the metabolic and cardiovascular system. These observations provide the rationale for the use of NO-donors and/or inhibitors of NO overproduction in the treatment of insulin resistance.

The effect of oxygen in modulating metabolism has been largely investigated in vitro and in animal studies, but very little in humans. Body weight loss and muscle fatigability is a common finding in chronic obstructive pulmonary diseases, often difficult to reverse despite an optimal nutritional intake. The aim of this paper is to review recent literature regarding pathological and physiological situations characterized by hypoxia exposure, particularly chronic obstructive pulmonary diseases and high altitude staying.

Epidemiological studies demonstrate an association between insulin resistance, hypertension and cardiovascular morbidity. Over the past decade, evidence has accumulated indicating that short-term insulin administration, in addition to its metabolic effects, also has important cardiovascular actions. The sympathetic nervous system and the L-arginine-nitric oxide pathway have emerged as central players in the mediation of insulin's cardiovascular actions. The underlying mechanisms and the factors that may govern the interaction between insulin and these two major cardiovascular regulatory systems have been studied extensively in healthy people and insulin-resistant subjects. Here we summarize the current understanding and gaps in knowledge on insulin's cardiovascular actions in humans, and discuss possible pathophysiological consequences of their alteration. Based on recent new insight, we propose that a genetic and/or acquired defect of nitric oxide synthesis could represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states, all of which may predispose to cardiovascular disease.

Obesity/insulin resistance ("diabesity") and the associated long term complications are reaching epidemic proportions worldwide. Recent evidence in experimental animals and humans shows that nitric oxide (NO) plays a key role in glucose and cardiovascular homeostasis. Pharmaceutical drugs releasing small and physiological amounts of NO may represent potential new treatments for insulin resistance.

No rates of pregnancy termination are available for Switzerland as a whole. In the canton of Vaud, however, pregnancy termination has been monitored for over ten years. The annual incidence (10.9 per 1000 residents in 2002) is one of the lowest recorded worldwide, but considerable variations are observed depending on age and on nationality; the incidence for non-Swiss nationals being three times higher than for Swiss nationals. As in the past, and in line with legislative changes that came into effect in October 2002, the vast majority of pregnancy terminations take place before the twelfth week of pregnancy. Repeat termination is relatively frequent: a quarter of those requesting termination in 2002 reported previous experience of pregnancy termination. In parous women, one in five requests for termination occurs less than one year after the birth of the last child. These data indicate that contraceptive counselling should be reinforced at the time of childbirth and following pregnancy termination.

MUST (Malnutrition Universal Screening Tool) is a nutritional screening tool easy to use by any trained care-giver and valid for any adult patient. It considers body mass index, weight change and acute disease effect equally and determines a malnutrition risk score. If necessary, anthropometric measures may be simpliyfied by alternative methods. MUST is reliable between different healthcare settings et promotes detection and management of malnutrition during the patient medical course.