Overweight and Obesity in the Eastern Mediterranean Region

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CONCLUSION: Decreased HDLc is the main biological abnormality that

characterized MetS in Tunisian psoriatic patients. Moreover, contrary to

men, psoriatic women have shown a significantly higher prevalence of

MetS, which is, in addition to decreased HDLc, mainly attributed to

abdominal obesity.

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Clin Res Hepatol Gastroenterol. 2011 Jun 6. [Epub ahead of print]

Dietary Fiber in the Diets of Urban Tunisian Women:

Association of Fiber Intake with BMI, Waist Circumference

and Blood Chemistry: Preliminary Study.

Ben Slama F, Jebali N, Chemli R, Ben Rayana C, Achour A, Najar MF, Achour

N, Belhadj O.

Na onal Ins tute of Public Health, 67, boulevard Hédi Saîdi, Bâb Saâdoun,

1005 Tunis, Tunisia.

Abstract

BACKGROUND: The change of the way of life and the food practices in

Tunisia due inter alia to the improvement of the socioeconomic conditions

induced low fuel consumption of food with significant nutritional interest

such as those rich in food fibres which have positive effects on the

reduction and the prevention of some complications of the metabolic

diseases such as the obesity whose prevalence among Tunisian women is

increasingly high.

OBJECTIVE: We assessed the association between the mean daily fiber

intake and anthropometric parameters, the serum lipid profile and the

serum glucose concentration among urban Tunisian women.

METHODS: We conducted a 7-day food weighing method among

260 women of which 60 are obese (BMI>30kg/m(2)). The weighing method

was done by trained and experienced workers in the National Institute of

Nutrition of Tunisia. All the results were treated with the (Bilnut) software

(1991 version) to which a list of 235 special Tunisian foods was added. We

calculated their mean daily fiber intake and we prospectively evaluated the

correlations between it and the BMI, the waist circumference, total plasma

cholesterol, HDL-cholesterol, triglyceridemia and glycaemia.

RESULTS: Obese women are found to consume less fiber than non-obese

women (21.73±3.25g/day vs 26.25±2.7g/day; P<0.0001). Very high and

significant correlations were observed between dietary fiber intake and the

parameters investigated: BMI (r=-0.709, P<0.0001), waist circumference

(r=-0.790; P<0.0001), total plasma cholesterol (r=-0.488; P<0.0001),

triglyceridemia (r=-0.741; P<0.0001) and glycaemia (r=-0.557, P<0.0001).

However, we find a positive but a non significant correlation with the HDL-

cholesterol and the mean daily ﬁber intake (r=0.309; P=0.02).

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CONCLUSIONS: This study provides additional support to the inverse

association between fiber consumption and weight gain, the serum lipid

profiles, the glycaemia and the waist circumference. Our findings

emphasizes the relevance of increased the intakes of fiber from varied

sources that may help avoid weight gain among obese adults.

Mol Biol Rep. 2011 Jul 21. [Epub ahead of print]

Renin-Angiotensin System Polymorphisms in Relation to

Hypertension Status and Obesity in a Tunisian Population.

Mehri S, Mahjoub S, Hammami S, Zaroui A, Frih A, Betbout F, Mechmeche

R, Hammami M.

Laboratory of Nutrition and Vascular Health, Faculty of Medicine, Monastir,

Tunisia, mehrisounira@yahoo.fr.

Abstract

Essential hypertension (HTA) is the clinical expression of a disordered

interaction between the genetic, physiological, and biochemical systems

that under usual conditions maintain cardiovascular homeostasis. We

studied the eﬀects of the angiotensinogen M235T, angiotensin conver ng

enzyme insertion/deletion (ACE I/D), and angiotensin II receptor 1 (AT1R)

A1166C gene polymorphisms on the risk of HTA and to evaluate the

relationship between these polymorphisms and obesity. We performed

AGT, ACE and AGTR genotyping in 142 hypertensive pa ents and 191

control subjects using PCR-RFLP methods and PCR, respectively. The three

polymorphisms were significantly associated with HTA. Individuals carrying

the mutated TT of AGT, DD of ACE and CC of AT1R genotypes had an 1.67

(P = 0.032), 3.09 (P < 0.001) and 3.45 (P < 0.001)-fold increased risk of HTA.

After adjustment for sex, smoking, diabetes, dyslipidemia, BMI, triglycerides

and DD, TT and CC genotypes, BMI was independent risk factor of HTA

(OR = 3.14; P < 0.001). An associa on of BMI with ACE gene polymorphism

(P = 0.035), whereas no associa on with AGT and AT1R gene

polymorphisms was obtained. The proportion of hypertensives is as high as

21.8 and 13.4% in the overweight and the obese DD group. The present

study implies that the genotyping for the variants of RAS gene could in the

future become an important part of the clinical process of risk identification

for HTA.

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Pathol Biol (Paris). 2011 May 25. [Epub ahead of print]

Prehypertension among Adults in Great Tunis Region

(Tunisia): A Population-Based Study.

Allal-Elasmi M, Feki M, Zayani Y, Hsairi M, Haj Taieb S, Jemaa R, Sanhaji H,

Omar S, Mebazaa A, Kaabachi N.

Research laboratory LR99ES11, biochemistry laboratory, Rabta hospital,

1007 Jebbari,

Tunis

Tunisia

.

Abstract

PURPOSE: The present study aimed to determine the prevalence of

prehypertension (preHTN) and its cardiometabolic profile in Tunisians, and

to estimate the risk for coronary heart disease (CHD) according to blood

pressure status.

PATIENTS AND METHOD: This cross-sec onal study was conducted in 2004-

2005, and used a two-stage cluster sampling method to select a

representative sample of the Great Tunis population. A total of

2712 individuals (1228 men and 1484 women), aged 35 to 69 years were

included. Definition and classification of hypertension (HTN) was performed

according to guidelines from the Joint National Committee on prevention,

detection, evaluation and treatment of high blood pressure (JNC-7) report.

RESULTS: The prevalence of preHTN and HTN was 56.8% and 25.0% in

males, and 43.1% and 36.1% in females, respec vely. Subjects with preHTN

and those with HTN showed higher prevalence of diabetes, dyslipidemia,

obesity and abdominal obesity than the normotensive (NT) group. The

metabolic syndrome (MetS) was found in 8.0%, 17.8% and 53.8% of NT,

preHT and HTN subjects, respectively. The risk of developing CHD within

10 years, as predicted by the Framingham-Anderson model, was above 15%

for 3.9%, 31.1% and 65.0% among NT, preHTN and HTN subjects,

respectively. In multivariate analysis, preHTN was associated with age (OR

[95% CI], 1.02 [1.01-1.03]; P<0.01), male gender (2.51 [1.89-3.23]; P<0.001),

obesity (2.36 [1.71-3.26]; P<0.01), abdominal obesity (1.53 [1.14-2.06];

P<0.01) and smoking (0.70 [0.53-0.92]; P<0.01).

CONCLUSION: PreHTN is very common in Tunisians. It is associated with a

higher prevalence of cardiometabolic risk factors and confers a higher risk

for subsequent CHD. These findings support the recommendations of

lifestyle modification for preHTN patients.

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Nutr J. 2011 Apr 24;10:38.

Nutrition  Transition  among  Adolescents  of  a  South-

Mediterranean  Country:  Dietary  Patterns,  Association

with  Socio-Economic  Factors,  Overweight  and  Blood

Pressure. A Cross-Sectional Study in Tunisia.

Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E,

Achour N, Delpeuch F, Ben Romdhane H, Maire B.

IRD (Ins tut de Recherche pour le Développement), UMR 204 NUTRIPASS,

IRD-UM1-UM2, Montpellier, France.

Abstract

BACKGROUND: The increase in the burden of chronic diseases linked to the

nutrition transition and associated dietary and lifestyle changes is of

growing concern in south and east Mediterranean countries and

adolescents are at the forefront of these changes. This study assessed

dietary intake and association with socio-economic factors and health

outcomes among adolescents in Tunisia.

METHODS: Cross-sec onal survey (year 2005); 1019 subjects 15-19 y. from

a clustered random sample. Dietary intake was assessed by a validated

semi-quan ta ve frequency ques onnaire (134 items) as was physical

activity; the Diet Quality Index International measured diet quality; dietary

patterns were derived by multiple correspondence analysis from intakes of

43 food groups. Body Mass Index (BMI) ≥85th and 95th percen le deﬁned

overweight and obesity. Waist Circumference (WC) assessed abdominal fat.

High blood pressure was systolic (SBP) or diastolic blood pressure (DBP)

≥90th of the interna onal reference for 15-17 y., and SBP/DBP ≥120/80 mm

Hg for 18-19 y.

RESULTS: Energy intake levels were quite high, especially for females. The

macro-nutrient structure was close to recommenda ons but only 38% had

a satisfactory diet quality. A main traditional to modern dietary gradient,

linked to urbanisation and increased economic level, featured an increasing

consumption of white bread, dairy products, sugars, added fats and fruits

and decreasing consumption of oils, grains, legumes and vegetables;

regarding nutrients this modern diet score featured a decreasing

relationship with total fat and an increase of calcium intake, but with an

increase of energy, sugars and saturated fat, while vitamin C, potassium

and fibre decreased. Adjusted for age, energy and physical activity, this

modern pa ern was associated with increased overweight in males (2nd vs.

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1st ter le: Prevalence Odds-Ra o (POR) = 4.0[1.7-9.3], 3rd vs. 1st: POR =

3.3[1.3-8.7]) and a higher WC. Adjus ng also for BMI and WC, among

females, it was associated with decreased prevalence of high blood

pressure (2nd vs. 1st ter le: POR = 0.5[0.3-0.8], 3rd vs. 1st ter le: POR =

0.4[0.2-0.8]).

CONCLUSION: The dietary intake contrasts among Tunisian adolescents,

linked to socio-economic differentials are characteristic of a nutrition

transition situation. The observed gradient of modernisation of dietary

intake features associations with several nutrients involving a higher risk of

chronic diseases but might have not only negative characteristics regarding

health outcomes.

Dis

Esophagus.

2011

Apr;24(3):153-9.

doi:

10.1111/j.1442-

2050.2010.01118.x. Epub 2010 Oct 13.

Metabolic Syndrome is Associated with Gastroesophageal

Reﬂux Disease Based on a 24-Hour Ambulatory Ph

Monitoring.

Kallel L, Bibani N, Fekih M, Matri S, Karoui S, Mustapha NB, Serghini M,

Zouiten L, Feki M, Zouari B, Boubaker J, Kaabachi N, Filali A.

Department of Gastroenterology A, Rabta Hospital, Tunis, Tunisia.

lamia_kallel@yahoo.fr

Abstract

Several studies have focused on the relationship between metabolic

syndrome and gastroesophageal reflux disease (GERD). They were based on

GERD complications, whereas little is known about the association between

metabolic syndrome and objectively measured esophageal acid exposure.

The aim of our study was to assess the relationship between metabolic

syndrome and GERD based on a 24-hour pH testing. It was a cross-sectional

study including 100 consecu ve pa ents who underwent a 24-hour pH-

metry monitoring and were assessed for the five metabolic syndrome

components as well as for body mass index (BMI). Among the 100 pa ents,

54 had a pathological acid GERD. The 46 GERD-free patients represented

control group. Sex distribution was comparable between both groups but

GERD patients were older than controls (44.59 vs. 37.63 years, P= 0.006)

and more o en obese or with overweight (83.3 vs. 60.9%, P= 0.01).

Frequency of metabolic syndrome as a whole entity was higher among

pa ents with GERD than those without GERD (50 vs. 19.56%; P= 0.002) with

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a crude odds ra o of 4.11 (95% conﬁdence interval: 1.66-10.14).

Multivariate regression analysis showed that metabolic syndrome as well as

an age ≥ 30 years were independent factors associated to GERD but not

BMI and sex. Abnormal waist circumference and fasting glucose level ≥ 100

mg/L were the only independent factors among the five components of

metabolic syndrome. Metabolic syndrome but not BMI was an independent

factor associated to GERD. These results confirm the hypothesis that central

obesity is associated to GERD.

Cardiovasc Toxicol. 2011 Mar;11(1):28-37.

Grape Seed Extract Alleviates High-Fat Diet-Induced

Obesity and Heart Dysfunction by Preventing Cardiac

Siderosis.

Charradi K, Sebai H, Elkahoui S, Ben Hassine F, Limam F, Aouani E.

Laboratoire des Substances Bioactives, Centre de Biotechnologie de Borj

Cedria, Hammam-lif, Tunisia.

Abstract

Obesity is a tremendous public health problem, characterized by ectopic

accumulation of fat into non-adipose tissues, leading to oxidative stress and

chronic inflammation, in which the heart is the most severely affected

organ. We used an experimental model of high-fat-diet (HFD)-induced

obesity to analyze the link between oxidative stress and heart dysfunction.

We also studied the cardioprotective effect of a grape seed and skin extract

(GSE). Exposure of rats to HFD during 45 days induced heart hypertrophy,

inflammation as assessed by plasma CRP elevation and contractile

dysfunction as revealed after ischemia/reperfusion of Langendorff-perfused

hearts. HFD also induced cardiac steatosis and lipotoxicity, which are linked

to an oxidative stress status, worsened by increased siderosis and resulting

in Ca(2+) overload. Importantly, GSE alleviated all the deleterious effects of

HFD treatment. These studies suggest that GSE is a safe anti-obesity and

cardioprotective agent that should also find potential applications in other

inflammatory damaging conditions as stroke.

625

J Endocrinol Invest. 2011 Feb;34(2):e16-23. Epub 2010 Jul 22.

Adiponectin Expression and Metabolic Markers in Obesity

and Type 2 Diabetes.

Kouidhi S, Jarboui S, Marrakchi R, Froidevaux MS, Seugnet I, Abid H, Bchir F,

Brahem M, Demeneix B, Guissouma H, Elgaaied AB.

Laboratory of Genetics, Immunology and Human Pathology, Biology

Department, Faculté Des Sciences de Tunis, CAMPUS, El Manar University,

Tunisia.

Abstract

BACKGROUND: Adiponectin has emerged over the last decade as a key

adipokine linking obesity, insulin resistance, and Type 2 diabetes. However,

the molecular mechanisms controlling adiponectin expression in adipose

tissue are not fully elucidated. Furthermore, increasing evidence indicates

that peroxisome proliferator-activated receptor- γ (PPAR-γ) plays an

important, and beneficial, role in modulating adiponectin expression.

AIM: The aim of the present study was to assess the separate role of

obesity and Type 2 diabetes in the rela onship between endogenous PPAR-

γ signaling and adiponectin expression in subcutaneous adipose tissue.

SUBJECTS AND METHODS: Enzyme-linked immuno sor bent assay and real

time quantitative PCR analysis were carried out in overweight, obese,

and/or diabetic Tunisian patients who underwent an abdominal surgery.

RESULTS: These results collectively indicate that circulating levels of

adiponectin were decreased in all overweight, obese, and/or diabetic

(p<0.001). However, the subcutaneous mRNA expression of adiponec n

was reduced only in diabe cs (p<0.01) but presents some discrepancies in

obese individuals. Moreover, mRNA levels of adiponectin were positively

correlated with levels of mRNA encoding PPARγ and its heterodimeric

partner retinoid X receptor-α (RXR-α), in both obese and diabetic patients.

CONCLUSION: Our study on Tunisian patients shows impaired regulation of

circulating and mRNA adiponectin levels dependent of metabolic disorders

in obesity and Type 2 diabetes. The data suggest that subcutaneous adipose

tissue may play an important role in modulating adiponectin expression in

diabetes and obesity. Moreover, adiponectin mRNA could be potentially

regulated by endogenous PPARγ/RXRα-dependent pathways.

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Obes Facts. 2011;4(1):45-52. Epub 2011 Feb 16.

Walk-Run Transition Speed Training as an Efficient

Exercise Adjunct to Dietary Restriction in the

Management of Obesity: A Prospective Intervention Pilot

Study.

Beltaifa L, Chaouachi A, Zérifi R, Boussaidi L, Bouzrati I, Abid A, Elkhadi A,

Chamari K, Raies A.

Tunesian Research Laboratory Sports Performance Optimisation, National

Centre of Medicine and Science in Sports, Tunis, Tunisia.

Abstract

OBJECTIVE: The aim of this study was to test the utility of preferred walk-

run transition speed (WRTS) in exercise training adjunct to dietary

restriction for obesity management in healthy obese women.

MATERIALS AND METHODS: 37 obese women (age: 35 ± 9 years, body

mass index (BMI): 34.9 ± 4.6 kg/m(2)) were assigned to an interven on pilot

study during 6 months of restricted diet alone (RD) followed by 6 months of

RD combined with WRTS (RD and WRTS) as a training exercise. Body mass,

waist circumference (WC), fat mass (FM), fat free mass (FFM), active cell

mass (ACM), fasting glucose, serum lipids (triacylglycerol (TG), total

cholesterol (TC), high density lipoprotein cholesterol (HDL-C), apo-

lipoproteins A1 (ApoA1) and B (ApoB)], leptin and insulin concentrations,

and HOMA-IR were assessed at baseline (T0), at the end of the RD alone

(T1), and at the end of the RD and WRTS programme (T2).

RESULTS: Mean weight loss was 8.6 ± 4.9 kg and 2.2 ± 2.9 kg for (T0-T1) and

(T1-T2), respectively. Significant BMI and WC reductions were reported at

T1 and T2. FM decreased signiﬁcantly both with RD and with RD and WRTS

training whereas FFM and ACM increased with RD and WRTS training only.

TG decreased significantly with the two phases of the programme. A

significant increase in HDL-C, and a decrease in LDL-C and TC/HDL-C ratio

were noticed with RD and WRTS training. Heart rate monitored in training

improved significantly after RD and WRTS training. A significant relationship

(r = 0.542, p < 0.02) was demonstrated between reduc ons in serum lep n

and insulin concentrations observed with both RD and WRTS training.

CONCLUSION: The addition of WRTS training to RD promoted a greater

reduction in body mass, WC, FM, leptin and insulin concentrations,

improved metabolic and cardiovascular risk factors, and enhanced

cardiovascular fitness.

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