[Effect of protein restriction on renal function and nutritional status of type 1 diabetes at the stage of renal impairment]

In an effort to slow the deterioration of renal function, several authors have recommended in the diabetic stage renal disease with moderate renal impairment decreased protein intake to 0.7 or 0.3 g / kg / day associated with energy intake of at least 30 to 35 kcal / kg / day. However, in clinical practice this proved difficult to achieve without exposing patients to the risk of under nutrition. To evaluate the effects of a protein restricted diet on the development of diabetic nephropathy and the nutritional status of diabetic patients with renal impairment at the stage of moderate renal impairment compared with those of a group of diabetics with the same characteristics put under basal diabetic diet. Prospective study of 57 diabetic patients in moderate stage renal disease of middle age [32 +/- 0.6 years] followed at the National Institute of Nutrition of Tunis in 2010. Our patients were separated into two groups [group A comprising 30 patients, put on diabetic diet basal and group B comprising 27 patients used in protein-deficient diet: 0.6 to 0.7 g / kg /d]. We followed the evolution of certain parameters: glomerular filtration rate [GFR], serum albumin, albuminuria, nutritional risk index [NRI] and we analyzed dietary intake at D0, D90 and D180. Renal function in patients in group B improved as demonstrated by the trend towards higher GFR. It increased from day 0 to day 90 and at day 180. In parallel, there was a beneficial effect on albuminuria which was reduced from 380 +/- 56 mg/24h on day 0, to 322 +/- 50mg/24h at day J90 and 302 +/- 16 mg/24h at day 180. In group A, the opposite phenomena occurred. The patients in Group B have also reduced their overall caloric intake to less than 1800 kcal / day making sure that the balance of their diet quality could no longer be assured the result has a tendency to under nutrition noted more frequently in the latter group [NRI0 = 97.90%, NRI 90= 90.10%, NRI180=90,0%]. In the literature these results were found by several studies. The protein-deficient diet [0.6 to 0.7 g/ kg /d] must be integrated into the overall care of diabetic renal insufficiency with moderate renal impairment but requires rigorous repeated dietary interviews and customized to avoid malnutrition can result

[What is the place of artificial sweeteners in the food of our diabetics?]

Artificial Sweeteners are food additives increasingly developed by the food industry. Study of the consumption of sweeteners in diabetic patients. This prospective cross study performed using a questionnaire to 100 patients recruited at random outpatients of the National Institute of Nutrition. Data on the BMI,the blood sugar were found in clinical records. 94% of diabetics have at least heard of sweeteners and 50% use it regularly. Sweetener table are the most consumed sweeteners, in order of frequency Saccharin, Sucralose and Aspartame, used to sweeten coffee and tea. The trade products "light" are consumed by 29% of patients. Yet consumers have no real information on these products. There was no statistically significant correlation between the consumption of sweeteners and BMI, balance and diabetes evolution. A statistically significant correlation was found between consumption and socio-economic and cultural development of patients. The education of diabetic patients should include information of patients on these sweeteners, their interest, their against-indications and adverse reactions

[Association of type 1 diabetes and celiac disease: the lived for this double pathology]

the association of diabetes type 1 and celiac disease seems to pose many problems diagnostic, therapeutic and psychological. Aim of our work is to study in eight patients with type 1 diabetes associated with celiac disease their daily experience and the constraints that this pathological association imposes. This cross-sectional study involved eight patients with type 1 diabetes and celiac disease known for at least 1 year. All patients were given a thorough interrogation specifying the regular monitoring of the two diseases and the quality of the observance of the diabetic dietary and gluten-free diet, as well as an assessment of impact of diabetes. the caloric intake in relation to the recommendations is very insufficient. Taking snack is not respected. There is also the consumption of certain foods containing gluten masked and regular consumption of sucrose by our patients despite a long-term evolution of diabetes [19 +/- 6 years] and celiac disease [11 +/- 7.8 years]. Half of patients have degenerative complications of diabetes. In light of these results, a frequent evaluation of nutrition education in these patients and a psychological care seems necessary

[Is the respiratory function altereted during the diabetes mellitus?]

Because of its wealth in blood capillaries and conjunctive fabric the lung is a potential body targets of microvascular diabetic complications. The purpose of this work is to evaluate the respiratory function among 23 diabetics patients, while being helped of measurements of volumes and respiratory flows as well as pulmonary broadcasting capacity of CO. The measured parameters were the total pulmonary capacity [CPT], the vital capacity [CV], the functional residual capacity [CRF], residual volume [VR], maximum expiratory volume in 1 second [VEMS], the coefficient of Tiffeneau [VEMS/CV] and the expiratory flow of point [EPD]. The pulmonary broadcasting capacity of carbon monoxide [DLCO] was measured. Residual volume [VR] was on average of 76, 53 +/- 19, 76% of the theoretical values, it was decreased among 12 patients. The functional residual capacity [CRF] on average of 86, 11 +/- 19, 47% of the theoretical values, found was decreased among 10 patients. The pulmonary diffusion [DLCO/VA], which varies approximately 10% with the change of position at the healthy subject, was normal in sitting position among studied patients [114, 93 +/- 24, 18%] and decreased only by 3, 64 +/- 9, 63% in position upright. Moreover, this variation was all the more weak as the rate of albuminuria was high. Thus, the repercussions of the diabetes over the respiratory function exist, but remain often infraclinic because of the broad ventilatory reserve available to the human being. In addition, the absence of variation of DLCO/VA according to the position could constitute an invaluable index precociously to detect the lesions of the pulmonary capillary bed among patients presenting a nephropathy diabetic

[Vitamins A, E and leptin in obese and non insulin dependent diabetes group]

At the obese ones, there is an imbalance between the free defenses antioxydants and radicals from where the installation of an oxydative stress, responsible for the development of non-insulin dependent diabetes. Our objectives was to evaluate the levels of vitamins A, E and of leptin, to search the link witch could exist between vitamins and leptin. We proportioned the rates in vitamins A, E and in leptine at 30 obese subjects diabetic of type 2 including 12 men and 18 women of average age [50,93 +/- 6,13] years not carrying pathologies other than the diabetes and obesity compared to 30 witnesses who theirs are paired according to the age and the sex. Our results chows that levels of antioxidants did not differ between the two groups but we find a non significant decrease in vitamin El [TC +TG] ratio [1,86 +/- 0,38 VS 2,11 +/- 0,74 ; p=0,08] and significant increase of vitamin A level in women obese with non-insulin-diabetes mellitus compared with control group of women [0,69 +/- 0,16 V.S 0,55 +/- 0,15 ; p=0,01]. Moreover a negative and significative correlation between vitamin E and leptin [r=0,452 p=0,01], and a negative and no significative correlation between vitamin A and leptin [2=-0,221 ; p>0,05] were observed. the rate of vitamin A, is different for each sex with share. The vitamin E could have a negative control on the secretion of the leptin

[Tunisian children reference for body mass index and prevalence of obesity]

The prevalence of obesity in children is known to be increasing rapidly worldwide but few population-based surveys have been undertaken in North Africa and in the Middle East. Report the means of body mass index with values corresponding to the different percentiles in boys and girls by age from a large nationally representative sample of the Tunisian children population. The second aim was to estimate the prevalence of obesity and over weight in children and adolescent using the 85th and 95th body mass index percentile respectively derived from the U.S.A first National Health and Nutrition Survey and also the International cut off points for body mass index for overweight and obesity proposed by the International Obesity Task Force and Rolland Cachera. We have used data from the Tunisian National Nutrition Survey, a cross sectional health study providing a large nationally representative sample of the Tunisian population including 3885 children and adolescent. The mean of BMI was of 16.63 +/- 2.58 Kg/m[2] among boys and 17.36 +/- 3.52 Kg/m[2] a in girls. The BMI increased with age and more precociously in girls [10 years] that in boys [13-14 years]. The rnean+2SD of the BMI approached the 95th percentile. It is noticed that our 85th percentile and 95th percentile as well in the girls and in boys were lower than the same percentiles of the children of other countries [NHANES I, IOTF] and that our 97th percentile is higher than that of the French according to tables of Roland Cachera. By considering the NHANES I and the IOTF, the prevalence of obesity were rather weak [<5%] but high according to the tables of Roland Cachera [3 to 11%]. The prevalence of obesity was low in 1996 according to references of the NHANES I and IOTF but high according to tables' of Roland Cachera. Prevention of obesity by a healthy way of life remains the most effective means in the long and undoubtedly less expensive realizing programs of regular monitoring

[Malitus diabetes of elderly patients: therapeutic recommendations]

In the elderly diabetic patient, therapeutic decision is very delicate because of the psycho-social pathological ground at this age. The emergence of new concepts of ageing and frailty made it possible to re-examine the plasma glucose goals and to build strategies of prevention and treatment adapted to the clinical and biological profiles of elderly subjects

Protective role of polyunsaturated fatty acids epsilon-3 in age related macular

Many studies showed a protective role of omega -3 polyunsaturated fatty acids [AGPI epsilon S] against diseases related to aging, including cardiovascular diseases and diseases of the retina. Docosahexaenoic acid [DHA], the AGPI epsilon 3 having the most significant biological effect, has anti-inflammatory and anti-apoptotic properties on the photoreceptors and could have beneficial effects on the occurrence of age-related macular degeneration. An increase in the consumption of AGPI epsilon 3-rich food [fish, nuts..] could be of interest in decreasing the incidence of this very frequent retinal disease

[Blood pressure and type 2 diabetes mellitus: impact of the insulin therapy]

The incidence of arterial hypertension is by 2-3 times with diabetics than with non-diabetics. Ethiopathogenesis of arterial hypertension in type 2 diabetes is multifactorial insulin-resistance, obesity, hyperlipoproteinemia, age, smoking and probably method of treatment [insulin therapy]. The aim of this retrospective study is to evaluate, over 5 years period, the level of blood pressure and the frequency's progression of arterial hypertension in 35 type 2 diabetes patients treated with insulin. Comparison of 35 type 2 diabetes patients treated with insulin to 35 controls treated with oral hypoglycemic agents. No significant differences were found over 5 years period in mean systolic blood pressure, mean diastolic blood pressure and frequency of arterial hypertension. However, frequency of arterial hypertension was correlated with mean dose of insulin. Our study confirms the long-term results found in the literature reading effects of insulin therapy on blood pressure in diabetic patients