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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.
Tunis Med. 2011 Jan;89(1):50-4.
Prevalence and Risk Factors of Overweight and Obesity in
Elementary Schoolchildren in the Metropolitan Region of
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,
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.
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,
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
Tunis Med. 2010 Nov;88(11):799-803.
[Results of Laparoscopic Treatment of Morbid Obesity:
Report of 27 Cases].
[Article in French]
El Ajmi M
Service de chirurgie générale, hôpital des FSI, La Marsa, Tunisia.
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
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.
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,
Clinical Laboratory of Physiology, Physiology and Functionnal Testing
Department 99/UR 08-67, Medical School of Sousse, Sousse, Tunisia.
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)).
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.
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 <
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
subjects. This indicates that the subcutaneous adipose plays an important
role in impaired adipokine regulation, and consequently in developing
Diabetes Metab. 2010 Jun;36(3):204-8. Epub 2010 Mar 4.
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,
, Tunisia. email@example.com
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
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]
, Haj Mouhamed D, Mechri A, Neffati F, Douki W, Gaha L, Najjar MF.
Laboratoire de Biochimie-Toxicologie, Hôpital Universitaire de Monastir, Tunisie.
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.
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
Obesity (Silver Spring). 2010 May 6. [Epub ahead of print]
WITHDRAWN: Effect of Obesity at the Pathologic
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 = BMI < 30
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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