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Résumé Introduction et objectifs La dénutrition et la fragilité sont des problèmes de santé publique fréquents, en particulier chez les personnes âgées. Le ministère des Affaires sociales et de la Santé a décidé, en 2012, de promouvoir un programme pilote de sensibilisation comprenant la réalisation de 10 conférences et de trois outils électroniques ou papier sur ce sujet. Il a sollicité pour cela la Société francophone nutrition clinique et métabolisme (SFNEP), qui a choisi pour mettre en place cette action le réseau de nutrition LINUT, implanté en région Limousin, la 2 e région la plus âgée d’Europe. Méthodes Le programme a été validé par le ministère des Affaires sociales et de la Santé et la SFNEP. Les conférences avaient pour cible les professionnels de santé et le grand public, et étaient annoncées aux médias. Elles ont été évaluées par un index de satisfaction, un test de connaissances avant/après et un questionnaire appliqué un ou trois mois après la manifestation. Les outils étaient : la proposition de mettre sur les sites Internet des institutions partenaires du réseau un lien avec le site grand public de la SFNEP, la création de 12 fiches simples, électroniques et papier, traitant de divers aspects de la dénutrition chez les personnes âgées, la réalisation d’un livre de recettes en texture mixée de fruits et légumes crus, incluant leur composition nutritionnelle et un visuel. Résultats Onze conférences ont été organisées, regroupant 947 personnes (moyenne par conférence : 86,1 ± 55,4 auditeurs) sur l’ensemble de la région. La fréquentation a été plus forte si les conférences étaient adossées à des ateliers ou à la journée régionale des Comités de liaison alimentation nutrition (CLAN). Les appréciations subjectives et les tests avant/après ont été favorables, alors que le questionnaire à distance est apparu comme inadapté. Seulement 19 % des institutions sollicitées ont accepté d’intégrer le lien avec le site de la SFNEP. Les fiches électroniques et papier ont été largement diffusées et l’ouvrage de produits crus mixés a regroupé 50 recettes. La presse régionale a rendu compte de ces réunions en publiant 16 articles sur ces actions, et un reportage de la chaîne de télévision TF1 a été réalisé lors d’un atelier. Le budget alloué a été consommé conformément aux prévisions. Conclusion Un programme de ce type est applicable, et paraît efficace quant au nombre de personnes concernées par les conférences, la diffusion des outils et l’impact médiatique. Introduction and objectives Malnutrition and frailty are frequent public health problems, in particular in the elderly people. The French Ministry for the Social Affairs and Health (MSAH) decided in 2012 to promote a pilot program including the realization of 10 conferences and three electronic or paper tools on this subject. It requested in this direction the French-speaking Clinical Nutrition and Metabolism Society (SFNEP), which chose for its application the nutrition network LINUT, established in area of Limousin, the 2nd oldest area of Europe. Methods The program was validated by the MSAH and the SFNEP. The conferences had as a target the health professionals and the general public, and were announced with the media. They were evaluated by an index of satisfaction, a general knowledge before/after test and a questionnaire applied one or three months after the conferences. The tools were: the proposal to put on the websites of the institutions partners of the network a link with the site general public of the SFNEP, the creation of 12 simple, electronic and paper cards, treating various aspects of malnutrition in the elderly, the realization of one recipe book in mixed-texture of raw fruit and vegetables, including their nutritional composition and visual. Results Eleven conferences took place, involving 947 people (average: 86.1 ± 55.4) on the whole of the area. The frequentation was stronger if the conferences were leaned with workshops or the regional day of the Liaison Committees for Alimentation and Nutrition (LCANs). The subjective appreciations and the before/after tests were favourable, whereas the remote questionnaire appeared unsuited. Only 19% of the requested institutions agreed to integrate the link with the site of the SFNEP. The electronic and paper cards were widely diffused. The book included 50 mixed-texture cooking recipes. The regional press published 16 articles on these actions, and a TF1 report was carried out at the time of a workshop. The allocated budget was consumed in accordance with the forecasts. Conclusion A program of this type is applicable, and appears effective as for the number of people concerned with the conferences, the diffusion of the tools and the media impact. [ABSTRACT FROM AUTHOR]

Abstract: Although olfactory deficiency is mainly related to facial post-traumatic accidents and various bacterial and viral infections of the respiratory area, the causal relation between other kind of diseases (in particular neurodegenerative) and olfactory deficiencies are extensively studied, in particular because of their potential applications in very early diagnostics. This paper first describes the anatomical and biological characteristics of the olfactory detection system and outlines the ones explaining the sensitivity of this perception to various pathological affections. It also describes the principles of psychophysics tests and of their use in the description and the evaluation of the various aspects of the detection of an odor (quality, intensity, pleasantness). The third part of the paper is devoted to a description, for different pathologies as infections, Parkinson, Alzheimer and cancers, of the possible causes of the olfactory associated dysfunctions and of the olfactory tests most currently used in their diagnostics. The conclusion outlines the limits of these tests, and shows some perspectives for future research. [Copyright &y& Elsevier]

Résumé La chirurgie bariatrique est reconnue comme une modalité à part entière du traitement de l’obésité sévère mais aussi de ses comorbidités. De nombreux centres de chirurgie bariatrique encouragent, voire imposent à leurs patients, une perte de poids durant la période pré-opératoire. Le but de cet article est de faire le point sur cette question et de proposer une attitude pratique dans l’attente de données concluantes. L’analyse de la littérature actuelle ne permet pas de conclure de façon univoque concernant l’intérêt de la perte de poids pré-opératoire dans le cadre de la chirurgie bariatrique. Il n’y a donc actuellement pas d’argument suffisant pour considérer que la perte de poids est un prérequis systématique à la chirurgie bariatrique. Le seul bénéfice démontré est la réduction de la taille du foie. Il reste cependant à démontrer par des études prospectives randomisées que la réduction du volume hépatique engendrée par la perte de poids pré-opératoire est accompagnée d’une réduction des complications per- et postopératoires sans risque de dénutrition. Bariatric surgery is recognized as a modality in its own right for the treatment of severe obesity but also of its comorbidities. Many centers of bariatric surgery encourage or even impose on their patients a weight loss before surgery. The purpose of this paper is to review the rationale of this practice and to propose a practical attitude in the expectation of conclusive data. The analysis of the current literature does not make it possible to conclude unequivocally about the value of preoperative weight loss in the context of bariatric surgery. There is thus currently no sufficient argument to consider that weight loss is a systematic prerequisite for bariatric surgery. The only benefit demonstrated is the reduction in liver size. It remains however to be demonstrated by randomized prospective studies that the reduction in hepatic volume caused by preoperative weight loss is accompanied by a reduction in per- and postoperative complications without any risk of undernutrition. [ABSTRACT FROM AUTHOR]

Résumé Cet article décrit la place des acteurs du parcours de soins dans les établissements de santé et en ville. À l’hôpital, les rôles de chacun dépendent de l’organisation mise en place. L’organisation transversale et la création d’unités diététique-nutrition doivent permettre d’améliorer l’efficience de la prise en charge. Cette organisation permet de définir le niveau d’intervention de chaque professionnel impliqué. Le diététicien et le médecin nutritionniste sont au centre de la prise en charge. L’enseignement en activité physique adaptée doit trouver sa place dans les parcours de soins des patients dénutris à l’hôpital comme en ville. La place du médecin nutritionniste de ville actuellement très limitée doit être discutée. Enfin le médecin généraliste, au centre de la prise en charge en ville, devrait pouvoir orienter les patients vers des plate-formes de coordination permettant aux patients d’accéder aux soins paramédicaux, actuellement non pris en charge. Ce texte reprend en grande partie la synthèse pédagogique sur l’organisation transversale de la nutrition au sein des établissements de santé et médico-sociaux, intègre les propositions faites par la Société française de nutrition clinique et métabolisme (SFNEP) pour les actions du Plan national nutrition santé 2011–2015 et propose des évolutions dans l’organisation de la filière de soin et dans le rôle des acteurs. This paper describes the role of actors in the coordinated healthcare circuit in hospital and ambulatory. At the hospital, the respective roles of each intervener depend on their organization. The transversal organization and the creation of dietetics-nutrition unit could improve the efficiency of the management. This organization sets the level of intervention of each professional involved. Dieticians and nutritionists are central to the management but teaching in adapted physical activity must find its place in the coordinated healthcare circuit of malnourished patients in the hospital and in ambulatory. The role of liberal nutritionist currently very limited has to be discussed. Finally, the general practitioner has a central role in the coordinated healthcare circuit and should have access to coordination platforms allowing patients to access to dieticians and to teachers in adapted physical activity, currently unsupported. This article largely repeats the teaching synthesis on coordinated healthcare circuit in health facilities, incorporates proposals made by the French Society of Clinical Nutrition and Metabolism (SFNEP) for actions in the “Plan National Nutrition Santé” 2011–2015 and proposes changes in the organization in the coordinated healthcare circuit and in the role of actors. [ABSTRACT FROM AUTHOR]

Résumé Les cellules Natural Killer (NK) sont non seulement des effecteurs cytotoxiques de la réponse immune innée dirigée contre les cellules tumorales ou infectées mais aussi d’importants immunorégulateurs. Leur activation résulte d’une balance entre signaux inhibiteurs ou activateurs issus de multiples récepteurs. La leptine, produit par les adipocytes, est un facteur métabolique majeur qui module le système immunitaire. L’hyperleptinémie est un facteur de risque de dysimmunité et de cancer en lien, notamment, avec une moindre vigilance anti-tumorale. Cette revue fait la synthèse de la littérature traitant de l’impact de la leptine sur les cellules NK. In vitro, la leptine, en concentration similaire à celle retrouvée en situation d’obésité, stimule non seulement l’activité métabolique mais aussi l’activité lytique des cellules NK. À l’inverse, in vivo, l’hyperleptinémie associée à un régime hypercalorique ou une obésité constitutive, n’est pas corrélée à la cytotoxicité des cellules NK ce qui laisse supposer l’émergence d’une leptinorésistance. Natural Killer (NK) cells are not just cytotoxic effectors of the innate immune response against tumors and infections but also important immunoregulators. They are activated by an intricate balance between signals provided by their inhibitory and activating receptors. Leptin, one major metabolic factor produced by adipocytes, appears to be strongly involved in obesity-induced dysimmunity and carcinogenesis. This paper reviews the studies investigating the effect of leptin on NK cells. Leptin, at level similar to that found in obesity, stimulate, in vitro , both the NK cell metabolic and lytic activities. In contrast, no significant association was observed, in vivo , between serum leptin and NK cytotoxicity whatever the model, diet-induced or constitutive obesity. These findings may be related to leptin resistance. [ABSTRACT FROM AUTHOR]

Abstract: The gut plays a central role in some pathophysiological conditions and the preservation or restoration of gut function, such as gut barrier, is a major issue. Cellular removal and protein turnover are high. Indeed, approximately 50% of proteins are synthesized every day in the human duodenal mucosa. During catabolic or inflammatory states, intestinal protein metabolism seems to be deregulated that could be involved in gut barrier dysfunction. Gut protein metabolism can also be affected by nutrients according to the type or the amount. An increasing number of studies focus on this topic but data are still limited and remain controversial. This paper aims to review the available data on the regulation of intestinal protein metabolism during pathophysiologic conditions and the influence of nutrients. [Copyright &y& Elsevier]

Abstract: Based on texts written by experts, the objective of this paper is to propose a practical approach to nutrition for clinicians, according to the nutritional status of patients and the evaluation of surgical risk. Any patient with a nutritional grade greater than or equal to 2 should benefit from nutritional support. Indeed, current data confirm that preoperative and early nutritional support in surgery at risk can reduce significantly postoperative morbidity for patients with non-malnourished (immunonutrition in cancer surgery GI), and the morbidity and mortality in malnourished patients (enteral nutrition when possible). A preoperative oral intake is recommended 2 to 3hours before elective surgery for clear fluids and 6 hours for a light meal. Moreover, a preoperative oral intake of carbohydrates (maltodextrin 12.5%) is recommended (except in diabetic patients). Postoperatively, early oral feeding (within 24hours) is recommended in the absence of cons to surgery. Glutamine is recommended in case of postoperative complications. [Copyright &y& Elsevier]

Abstract: What is the regulation of clinical research? Which administrative steps must be carried out? Who are the different actors and what are their responsibilities in the management of biomedical research? What are the characteristics of clinical research in nutrition? Which methodology should be used? The objective of this paper is to answer these questions, keeping in mind that the rules are regularly modified, and that the elements described today will not apply tomorrow. Moreover, the law does not always respond to all situations and to all questions. [ABSTRACT FROM AUTHOR]

Abstract: Thanks to a better knowledge of specific metabolic needs in the critically ill patient, clinical trials have been performed to assess the clinical efficacy of supplementation with specific substrates used as pharmaconutrients. Main pharmaconutrients of potential interest in the ICU are glutamine, arginine, n-3 polyinsaturated fatty acids and anti-oxidants. Their clinical usefulness, which varies according to the dose, the route of supplementation, and to patients categories (surgical, trauma, burned, septic...), and their underlying mechanisms of action are now better defined. After reviewing the main pathophysiological targets of each pharmaconutrient in the critically ill patient, this paper summarizes for each substrate their validated or potential indications. Beyond nutritional support, pharmaconutrition appears nowadays as a true therapeutic means in the critically ill patient. [Copyright &y& Elsevier]

Abstract: Fruits and vegetables contain high quantity of essential vitamins, antioxidants (vitamin C, carotenoids, flavonoids), minerals, fibers and water. Health professionals recommend to eat at least 5 servings of fruits and vegetables per day since people who eat more generous amounts as part of a healthful diet are likely to have reduced risk of chronic diseases in which an increased oxidative stress is potentially implicated (cardiovascular diseases, cancers…). However, more precisions should be given in order to clarify what does it really mean 5 servings with respect to the quantity, the choice, the colour and the variability of these aliments. Moreover, only a few data are available about the impact of such a diet on the oxidative stress status of an individual (plasma concentrations in antioxidants and markers of oxidative stress). The present paper was to summarize the most significant studies about this matter. [Copyright &y& Elsevier]

Abstract: The effect of oxygen in modulating metabolism has been largely investigated in vitro and in animal studies, but very little in humans. This paper focuses on recent literature regarding pathological and physiological situations characterized by chronic exposure to hypoxia, particularly in patients with chronic respiratory insufficiency and in healthy subjects staying at high altitude. The latest allow for very interesting comparison because they do not experience comorbidities observed in patients with chronic respiratory insufficiency and therefore provide a unique model to assess the specific effect of hypoxia on human body and metabolism. [Copyright &y& Elsevier]

Abstract: Oxidative stress has deleterious effects on health of the population and of selected groups of chronically and critically ill patient, that some micronutrients and dietary patterns can modulate. These beneficial effects have been attributed to the reduction of oxidative damage caused by the excessive free radical production. The paper reviews evidence of antioxidant (AOX) supplementation trials in the general population and critically ill patients. AOX vitamin and trace element intakes are low in a large part of the European population: selenium is particularly affected. AOX micronutrients have been shown to be particularly important in the prevention of cancer, cardiovascular diseases, age related ocular diseases and in aging. In animal models, targeted interventions have been associated with reduction of tissue destruction is brain and myocardium ischemia-reperfusion models. In the critically ill AOX supplements have resulted in reduction of organ failure (kidney, lung) and of infectious complications, especially when selenium is included: diagnostic categories with benefits include major burns and trauma, sepsis and SIRS. Vitamins alone have no significant effect at nutritional doses. AOX micronutrients have beneficial effects in defined models and pathologies, in the general population and in critical illness – the inclusion of selenium appears of particular importance. Further research is required to determined the optimal micronutrient combinations and the doses required according to intervention timing. [Copyright &y& Elsevier]

Abstract: Phenylketonuria is a hereditary disease induced more often by a defect in hepatic phenylalanine hydroxylase activity, enzyme-converting phenylalanine to tyrosine. This dysfunction leads to a blood phenylalanine accumulation, which induces mentally retard if no treatment. Only a preventive nutritional treatment, with low controled phenylalaline content, allows to avoid the mental after-effects. This paper details the nutritional intervention proposed for young patients with phenylketonuria. The different conversion systems and the available dietary products are presented. The dietary regimen and the clinical, dietetical, psychological and biological survey are described. Difficulties encountered and factors influencing the diet compliance are also approached. [Copyright &y& Elsevier]

Abstract: In the developed countries, the sick children are at risk of protein-energy malnutrition (PEM). Marasmus is the most common form of severe PEM in such children. Its major characteristics are low muscle and fat masses with the presence of marked facial, axillary and inguinal skinfolds. Furthermore the marastic children are irritable and depressed. When the PEM is moderate, which is more frequent, the affected children present a failure to thrive. Severe and moderate PEM have multiple functional consequences on different systems and organs with an impact on mortality, morbidity and costs. In this paper, the functional consequences on the immune system, digestive tract, liver, lung, heart, kidney, skin, bone and brain are passed in review. To end, some comments are done about the particularities of PEM in mental anorexia and obesity. [Copyright &y& Elsevier]

Many papers in the literature focused on cholecystokinin for some years. It is a group of small peptides which act at several levels in the organism. Cholecystokinin plays an important role in nutrition, food regulation and satiety signaling. This article presents the biosynthesis and structure of this family of peptides, the cholecystokinin receptors and the digestive, nutritional, metabolic and satiety control exerted by these regulatory peptides. The psychobehavioral aspects of cholecystokinin are not described here in details. [Copyright &y& Elsevier]