Overweight and Obesity in the Eastern Mediterranean Region
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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 adiponectin 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.
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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Tunis Med. 2011 Jan;89(1):50-4. Prevalence and Risk Factors of Overweight and Obesity in Elementary Schoolchildren in the Metropolitan Region of Tunis, Tunisia. Boukthir S, Essaddam L, Mazigh Mrad S, Ben Hassine L, Gannouni S, Nessib F, Bouaziz A, Brini I, Sammoud A, Bouyahia O, Zouari B. Ministere de la Sante Publique, Tunis , Tunisie. Abstract BACKGROUND: Local data about prevalence of obesity in emerging countries are rather scarce. Risk factors for obesity, well known in most industrialized countries, are poorly understood in Tunisia.
associa ons with possible risk factors in a group of 6-12 year- old schoolchildren in Tunis, Tunisia.
schoolchildren (6-12 years; mean: 9.7 ± 1.5 years) was conducted in Tunis. Personal and parental data were collected by questionnaires completed by parents. Height and weight were measured and body mass index was calculated. Prevalence of overweight and obesity was defined based on international agreed cut-off points. Results: Prevalence of overweight and obesity was 19.7% and 5.7%, respec vely. Risk factors associated with overweight were: high degree- educated mother and father: 17.3% vs 11.7% (p=.01) (OR (95%CI): 1.58; 1.09-2.29) and 26% vs 17.4% (p=.002) (OR: 1.66; 1.21-2.29), respec vely; mother, father high in occupa onal hierarchy: 7.2% vs 3.6% (p=0.009) (OR: 2.1; 1.2-3.7) and 14% vs 9% (p=.014) (OR: 1.6; 1.1-2.48), respec vely. Overweight children had a significantly higher consump on of bread (p=.044), of snack intake (p=0.046) and of so drink consump on (p=.035). CONCLUSIONS: Prevalence of overweight and obesity in this cohort are 19.7% and 5.7%, respectively. Substantial differences in food choices in families with the highest socio-economic status are among risk factors contributing to obesity development.
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Pathol Biol (Paris). 2010 Dec;58(6):426-9. Epub 2009 Mar 14. TCF7L2 Is Associated with Type 2 Diabetes in Nonobese Individuals from Tunisia. Bouhaha R, Choquet H, Meyre D, Abid Kamoun H, Ennafaa H, Baroudi T, Sassi R, Vaxillaire M, Elgaaied A, Froguel P, Cauchi S. Laboratory of Genetics, Immunology and Human Pathologies, Faculty of Sciences of Tunis, 2092 Tunis, Tunisia
. Abstract The transcrip on factor 7-like 2 (TCF7L2) rs7903146 T allele was associated with type 2 diabetes (T2D) in most popula ons worldwide. In individuals of European descent, the associa on with T2D was recently found to be modulated by obesity status. However, further studies are necessary to clarify if whether interaction exists among subjects of non-European descent. In the present study, we analyzed the associa on of rs7903146 with T2D in 90 nonobese (Body Mass Index [BMI] <25kg/m(2)), 171 overweight (25≤BMI<30kg/m(2)) et 98 obese (BMI≥30kg/m(2)) individuals from Tunisia. The T allele was nominally associated with T2D in nonobese subjects (Odds Ra o [OR]=3.24 [1.10-9.53], P=0.021) whereas no effect was detected in overweight (P=0.3) and obese (P=0.22) individuals. Consequently, the same risk allele decreased suscep bility to obesity in T2D subjects (OR=0.47 [0.23-0.94], P=0.029) but not in normoglycemic controls (P=0.44). When analyzed all together, no allelic association was observed with T2D (P=0.20) whereas an artefactual associa on with decreased obesity (0.59 [0.38-0.90], P=0.013) was detected. As in Europeans, TCF7L2 is therefore not a risk factor for obesity in Tunisians, but its effect on T2D risk is modulated by obesity. In conclusion, the TCF7L2 rs7903146 T allele is nominally associated with T2D suscep bility in nonobese individuals from Tunisia.
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Tunis Med. 2010 Nov;88(11):799-803. [Results of Laparoscopic Treatment of Morbid Obesity: Report of 27 Cases]. [Article in French] Baraket O , El Ajmi M , Chouchene A , Rezgui H
, Elkateb F , Khouni H
, Balti W
, Balti H
. Service de chirurgie générale, hôpital des FSI, La Marsa, Tunisia. Abstract BACKGROUND: Prevalence of obesity is increasing steadily. It exposes the patient to numerous complications and represents a serious public health issue. Various treatments were tried. Surgery is actually a credible alternative. Many techniques can be made by laparoscopic approach. AIM: To evaluate early and late results of laparoscopic treatment of morbid obesity by two techniques: gastric banding adjustable and gastric by-pass. METHODS: From May 2001 to July 2007, 27 pa ents were laparoscopically operated on for severe obesity in our department. Twenty four patients were treated with a gastric banding and 3 pa ents with gastric bypass. The primary endpoint was: excessive weight loss (EWL), BMI variations and patients' satisfaction. The secondary endpoints were mortality, morbidity and conversion. RESULTS: The mean age was 36 years. There were 4 males and 23 females. The mean preopera ve weight was 122.4 kg (range: 87-152) and the mean body mass index (BMI) was 42,5 kg/m2 (range 36.5-52 kg/m2). The mean opera ng me was 129 minutes (range: 50-300). The mean hospital stay was 4.76 days (range: 3-8). There were no postopera ve deaths. Early complica on was present in 3 pa ents. Late complica ons were present in one patient. No conversion to laparotomy was necessary. BMI decreased from 42.9 to 31 kg/m2 and EWL reached 43%; CONCLUSION: The results of our experience are encouraging with an acceptable complication rate and no death. Laparoscopic treatment can be done with good results.
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Int J Obes (Lond). 2010 Jun;34(6):1078-85. Epub 2010 Mar 16. Obesity Induced Bronchopulmonary Hyperresponsiveness in Tunisian Women. Chouchane A, Miâdi-Messaoud H, Ghannouchi I, Rouatbi S, Zbidi A, Tabka Z, Ben-Jebria A. Clinical Laboratory of Physiology, Physiology and Functionnal Testing Department 99/UR 08-67, Medical School of Sousse, Sousse, Tunisia. chouchane_afef@hotmail.com Abstract OBJECTIVE: The specific objective of this investigation was to determine whether bronchopulmonary responsiveness (BPR) to methacholine (MCH) was associated with the body mass index (BMI) of Tunisian women.
and 63 obese) were recruited and examined in the Clinical Laboratory of Physiology located in the Medical School of Sousse. The average ages (+/- s.e.) of the three categories of lean, overweight and obese subjects were 27.7+/-1.1, 33.2+/-1.7 and 37.5+/-1.3 years, respec vely. Their corresponding mean BMIs (+/-s.e.) were 21.9+/-0.3, 27.7+/-0.2 and 36.5+/- 0.8 kg m(-2), respec vely.
screened for their lung status by measuring their pulmonary function testing parameters using a whole body plethysmograph. BPR was assessed, using a cumulative concentration response curve technique, by measuring with a spirometer the decrease in forced expiratory volume in 1 s (FEV(1)) in response to a cumulative dose of MCH. RESULTS: A er adjus ng for age, significant differences in both FEV(1) and forced vital capacity (VC) were found between the obese and lean groups (P<0.01), as well as between the obese and overweight groups (P<0.01). In addi on, forced expiratory flow between 25 and 75% of VC was significantly different between the obese and lean groups (P<0.001), as well as between the lean and overweight groups (P=0.015). The mean maximum fall of FEV(1) in response to MCH challenge was significantly higher for the obese group (12.0%) than for the overweight (9.8%) or the lean (6.6%) group (P<0.01). Furthermore, the efficacy of the MCH agonist promo ng the maximal response (E(max)) and its potency or effec ve dose producing 50% of the maximal response (ED(50)) were both associated with BMI (the higher the BMI, the higher the E(max) and the lower the ED(50)). 632
CONCLUSION: Our data clearly show that obesity affects pulmonary function performance in Tunisian women by potentially promoting their bronchial hyperreactivity as suggested by the significant correlation between their BMI and the efficacy of the MCH, as well as its potency.
is Med. 2010 Aug;88(8):569-72. Relationship between Subcutaneous Adipose Tissue Expression of Leptin and Obesity in Tunisian Patients. Kouidhi S, Jarboui S, Clerget Froidevaux MS, Abid H, Demeneix B, Zaouche A, Benammar Elgaaied A, Guissouma H. Laboratoire de Génétique, Immunologie et Pathologies Humaines, Département de Biologie, Faculté des Sciences de Turnis, Université Tunis- el Manar, Tunisie. Abstract BACKGROUND: The incidence of obesity has dramatically increased in overall the world. It is a consequence of imbalance between energy intake and energy expenditure. Leptin is a fat derived adipokine that has emerged over the past decade as a key hormone in the regulation of food intake and energy expenditure. Elevated leptin levels are found in obese humans, suggesting a role of leptin in regulating body weight and adiposity. AIM: The aim of this study was to investigate the change of leptin mRNA expression level and its correlation with obesity and several metabolic variables in Tunisian patients.
analysis was carried out among two groups who underwent an abdominal surgery: controls (n = 9) and obese pa ents (n = 7).
markedly increased in obese pa ents (p < 0.01). It was posi vely correlated with measures of obesity waist circumference (WC) (r = 0, 71, p < 0.01) and body mass index (BMI) (r = 0, 68, p < 0.01). Interes ngly, lep n gene expression was also correlated to insulin resistance index (r = 0, 72, p < 0.01).
CONCLUSION: The present study is the first investigation of leptin regulation in subcutaneous adipose tissue of Tunisian population. Our data showed that leptin levels are higher in obese subjects than in control
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subjects. This indicates that the subcutaneous adipose plays an important role in impaired adipokine regulation, and consequently in developing metabolic disorder.
Diabetes Metab. 2010 Jun;36(3):204-8. Epub 2010 Mar 4. The Metabolic Syndrome: Prevalence, Main Characteristics and Association with Socio-Economic Status in Adults Living in Great Tunis. Allal-Elasmi M, Haj Taieb S, Hsairi M, Zayani Y, Omar S, Sanhaji H, Jemaa R, Feki M, Elati J, Mebazaa A, Kaabachi N. Research Laboratory LR99ES11, Biochemistry Laboratory, Rabta Hospital, Tunis , Tunisia. monia_elasmi@yahoo.fr Abstract AIMS: This study aimed to determine the prevalence of the metabolic syndrome (MetS) and its association with socio-economic status in the population of Great Tunis.
aged 35-70 years and living in the Great Tunis region, all of whom were recruited between March 2004 and June 2005. The sample was weighted by using the inverse of the response rate according to governorate, district and gender. The MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: In the studied population, the overall prevalence of the MetS was 31.2%, and it was significantly more frequently seen in women than in men (37.3% vs 23.9%, respec vely; P<0.001), as were abdominal obesity (69% vs 21.6%, respec vely; P<0.001), high blood pressure (50.3% vs 43.1%, respec vely; P<0.001) and low HDL cholesterol (40.6% vs 33.6%, respec vely; P<0.001), the most common characteris cs of the MetS. Also, the prevalence of the MetS increased with age in both genders, but more so in women. In those aged greater than 55 years, the prevalence of MetS was 56.7% in women and 30.7% in men. An inverse rela onship was observed between level of education and prevalence of the MetS in women, with the highest prevalence being in illiterate women and the lowest in those who were university graduates. CONCLUSION: The prevalence of the MetS is markedly high within the population of Great Tunis and especially in women. As these findings 634
predict future increases in cardiovascular disease in these populations, substantial efforts need to be made to fight against obesity and sedentary lifestyles to ameliorate the expected poor health outcomes.
Ann Biol Clin (Paris). 2010 May-Jun;68(3):277-84. [Obesity and dyslipidemia in Tunisian bipolar subjects]. [Article in French] Ezzaher A , Haj Mouhamed D, Mechri A, Neffati F, Douki W, Gaha L, Najjar MF. Laboratoire de Biochimie-Toxicologie, Hôpital Universitaire de Monastir, Tunisie. ezzaher.asma@yahoo.fr Abstract This study aims to investigate the prevalence of obesity and overweight and their association with lipid parameters in bipolar patients. Our study included 130 pa ents with bipolar disorder and 130 control subjects aged respec vely 37.9 +/- 12.1 and 37.2 +/- 13.1 years. Obesity was evaluated by body mass index (BMI). Concentrations of total cholesterol, triglycerides, cLDL and cHDL were determined by enzyma c methods and ApoA1, ApoB and Lp(a) by techniques immunoturbidimetric. The prevalence of obesity in pa ents is 30.1% vs 12.3% in controls. A significant increase in BMI was noted in patients compared with controls regardless of sex and tobacco status and in pa ents aged less than 35 years and those consumers of alcohol. The majority of obese and overweight patients are treated with valproic acid. We found increase in cholesterol (4.41 +/- 1.02 vs 3.90 +/- 0.98 mmol/L), in cLDL (2.13 +/- 1.09 vs 1.29 +/- 0.56 mmol/L) and in Lp(a) (236 +/- 207 vs 163 +/- 150 mg/L) and decrease in HDLc (0.98 +/- 0.28 vs 1.09 +/- 0.36 mmol/L), more frequent at the obese pa ents and those presenting an overweight. In conclusion, in bipolar patients, obesity and overweight are frequent and associated with perturbations in lipid profile particularly an increase in total cholesterol, cLDL and Lp(a) and decrease in cHDL that increase the risk of cardiovascular disease.
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Nutr Metab Cardiovasc Dis. 2010 Mar 19. [Epub ahead of print] The G3057A LEPR Polymorphism is Associated with Obesity in Tunisian Women. Ben Ali S, Sediri Y, Kallel A, Ftouhi B, Haj-Taib S, Omar S, Sanhaji H, Feki M, Elasmi M, Slimene H, Jemaa R, Kaabachi N. Research Laboratory LR99ES11, Biochemistry Department, Rabta University Hospital, Tunis, Tunisia.
(rs62589000) LEPR polymorphism on obesity risk and plasma lep n, insulin, and lipid levels in a sample of the Tunisian population.
and 317 controls par cipated in this study. The G3057A genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS: In the entire study sample, no significant differences in genotype frequencies were observed between obese patients and controls. However, stratified analysis by gender revealed a quantitative increase in the variant allele (33.3% vs. 25.8%; chi(2)=4.90, p=0.026) in obese women (but not men) compared to controls. When a dominant model of inheritance was assumed, the GA+AA genotypes were more prevalent in these obese female pa ents than in controls (58.3% vs. 47.8%; chi(2)=4.08, p=0.044). Unconditional logistic regression showed that in women only, obesity risk was significantly higher for homozygotes for the variant allele (OR=2.73, 95% CI 1.03-7.21) and for carriers of GA+AA genotypes (OR=1.53, 95% CI 1.01-2.31) compared with homozygotes for the normal allele. The associa on between the G3057A LEPR variant and obesity remained statistically significant even after adjustment for age. No relationship was found between the G3057A LEPR polymorphism and lep n and insulin levels. Additionally, this LEPR gene variant had no effect on plasma lipid concentrations.
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Obesity (Silver Spring). 2010 May 6. [Epub ahead of print] WITHDRAWN: Effect of Obesity at the Pathologic Response to Neoadjuvant Chemotherapy among Premenopausal Tunisian Women with Breast Cancer. Kacem M, Awatef M, Amel L, Jihen M, Slim BA. Department of Medical Oncology, CHU Farhat Hached, Sousse, Tunisia.
In this article, we evaluated BMI and response to neoadjuvant chemotherapy (NC) in premenopausal Tunisian women with operable breast cancer. From May 2006 to July 2009, 800 pa ents were diagnosed and received NC from CHU Farhat Hached (Sousse, Tunisia). Patients were categorized as obese (BMI >/=30 kg/m(2)), overweight (25 kg/m(2)), or normal/underweight (BMI <25 kg/m(2)). Logis c regression was used to examine associations between BMI and pathologic complete response (pCR). Breast cancer-specific, progression-free, and overall survival times were examined using the Kaplan-Meier method and Cox propor onal hazards regression analysis. Median age was 42 years; 27% of patients were obese, 25% were overweight, and 48% were normal or underweight. In the univariate model, there was a significant difference in pCR to NC for obese compared with normal/underweight patients. In multivariate analysis, there was no significant difference in pCR for obese compared to normal weight patients. Overweight and the combination of overweight and obese patients were significantly less likely to have a pCR (odds ra o (OR) = 0.59; 95% confidence interval (CI), 0.37-0.95; and OR = 0.67; 95% CI, 0.45-0.99, respec vely). Higher BMI was associated with worse pCR to NC. So, its association with worse overall survival suggests that greater attention should be focused on this risk factor to optimize the care of breast cancer patients.
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