[Disribition and prevalence of dyslipidemia in Tunisia: results of Tunisian national nutrition survey]

The aims of the study were to study the distribution of cholesterol and triglycerides and to assess the prevalence of dyslipemia in Tunisian adult population. The Tunisian National Nutrition Survey [TNNS] was a cross sectional study performed on a total of 7860 adult subjects and was conducted on1996-1997. The TNNS included 3087 adults over 20 years old. The mean values of cholesterol [CT] were more elevated in urban than rural area [p<0,001], and in females than in males [p<0.007]. The overall prevalence of hypercholesterolemia [CT >6, 2 mmol/l] was 8, 4% and that of hypertriglyceridemia [TG > 1, 70 mmol/l] was 21%. The prevalence of borderline high cholesterol [>-/ 5, 2 - < 6, 2 mmol/l] was 17%: These prevalences were more elevated in urban than rural areas [p<0,001] and increased with age in both genders [p<0,001]. The multiple adjusted odd ratio of the prevalence of hypercholesterolemia showed a positive correlation with female sex [OR 1.40 p <0, 01], high waist circumference [OR 2.51 in men and 3, 04 in women p <0001] and urban residency [OR1.35 p = 0, 03]. Our study showed the metabolic consequences of westernization style life in our country and should be the starter to preventive adequate policy

Diabetes education the Arab world. A call for action

Diabetes education is effective for improving clinical outcomes and quality of life. The barriers to patient education in the Arab World include: Attitude of the administration and policy makers, the negative view of health professionals and patients towards education, lack of curriculum / programs, lack of trained/certified personnel in the field of Therapeutic Patient Education [TPE], economic barriers, misconcepts, environmental and ecological barriers, lack of legislation for food labels, lack of premises for TPE, the absence of a positive role for the patients in their therapeutic choices, unawareness of patients about their rights, lack of time for both the patient and health care providers and high prevalence of illiteracy. Strategic plans should address all these barriers. Content areas that need to be addressed are determined in collaboration with the patient. Any health care professional can provide diabetes education. The lack of trained personnel in the domain of TPE in our region dictates the need to fill this gap by adopting a strategic plan, implemented in successive steps, starting by the formation of a number of Health Care Professionals [HCPs] in short term training. This document is a call for action, inviting all who are concerned with diabetes to establish national diabetes programs in the Arab World, and to start to undertake educational initiatives

[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

Recommendations for management of hyperglycemia in type 2 diabetes in the Arab Countries based on the consensus statement from the American Diabetes Association [ADA] and the European Association for the Study of Diabetes [EASD]

We would like to emphasize that stepwise interventions will help to achieve glycemic goals. Unfortunately there are barriers to effective management of hyperglycemia in type 2 diabetes, particularly in much of the Arab world [38]. We would like to emphasize that antihyperglycemic therapies with the possible exception of TZD should be titrated frequently [at intervals of days to at most weeks] based on glucose levels achieved and tolerability. Most patients can achieve A1C levels less than 7% in a matter of a few months. Suboptimal healthcare systems impede achievement of glycemic goals. Other barriers to effective management include insufficient communication with patients due to limited physician consultation time. This often contributes to inappropriate prescription of medications which patients cannot afford or will not tolerate and contributes to poor adherence. A multidisciplinary team approach to diabetes care - involving diabetologists, primary care providers, diabetes specialist nurses, pharmacists, dieticians and health educators, among others, with the patient at the centre of the team - has been demonstrated to improve both glycemic control and patient quality of life [39]. Equally or arguably more critical to optimizing patient outcomes is adequate treatment of comorbid conditions [e.g. dyslipidemia, hypertension, hypercoagulability] and early complications [e.g. retinopathy, microalbuminuria and the insensate foot]. A team approach with appropriate attention to patient education, motivation and adherence is critical to success, even if the team is just a patient and a primary care provider working together in a context of mutual respect with shared goals, understanding of their individual roles and open communication [40]. We strongly feel that these basic principles should guide every practitioner working with every patient with type 2 diabetes to ensure optimal care in their individual circumstance with an overall aim of reducing the proportion of patients who do not achieve control of diabetes with its asso-ciated omorbidities and complications from current levels of more than 60% [41,42]. Putting into consideration the local concerns mentioned above, our group supports the ADA/EASD consensus algorithm. Our aim is to highlight specific barriers in the Arab world and to adapt these recommendations to be more consistent with local circumstances in our countries

[Food intake and high density lipoprotein cholesterol levels changes during ramadan fasting in healthy young subjects]

During the holy month of Ramadan, it is obligatory for all adult healthy Muslims to abstain from food, drink and smo-king each day from dawn to sunset. The aims of our study were to evaluate the effects of Ramadan fasting on plasma lipids, lipoproteins and the change of food consumption in healthy subjects. Thirty young healthy and normal weighted adults [9 males and 21 females] were evaluated during three periods: 3 weeks before Ramadan [TO]: the 4th week of Ramadan [T1] and 3 weeks after the end of Ramadan [T2]. Main Clinical and biological parameters investigated were: body weight. blood glucose, plasma triglycerides [TG], plas-ma total cholesterol [TC], high density lipoprotein cholesterol [HDL-c] and. low density lipoprotein cholesterol [LDL-c] Body weight, and blood glucose were unchanged. There was a significant increase of the mean daily caloric intake, the lipids intake particularly mono-unsaturated and poly-unsatu-rated fatty acids [p < 0,001] and cholesterol intake [p<0.001] during Ramadan with a decrease of the meal frequency. There was also a significant increase of plasma total cholesterol and HDL-cholesterol. The most striking finding was a significant increase in the HDL-Cholesterol during Ramadan +20% [p<0,02]. This increase was lost after Ramadan. Fasting Ramadan affects beneficially serum lipoprotein metabolism in young adult healthy subjects with an increase of HDL-cho-lesterol

Association maladie coelioque et syndrome de Bartter a propos d'une observation

Coeliac disease is a chronic disease in which a characteristic mucosal lesion of the small bowel impairs nutriment absorption. Genetic, immunologic and possible environnemental factors are involved in its pathogenesis. Insulin-dependant diabetes mellitus [4-5%], thyroid disease [14%] seem to be more common in patients with coeliac disease. We report a case of coeliac disease associated to Bartter's syndrom