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BackgroundNumerous gene loci are related to single measures of body weight and shape. We investigated if 55 SNPs previously associated with BMI or waist measures, modify the effects of fat intake on weight loss and waist reduction under energy restriction.Methods and findingsRandomized controlled trial of 771 obese adults. (RegistrationISRCTN25867281.) One SNP was selected for replication in another weight loss intervention study of 934 obese adults. The original trial was a 10-week 600 kcal/d energy-deficient diet with energy percentage from fat (fat%) in range of 20-25 or 40-45. The replication study used an 8-weeks diet of 880 kcal/d and 20 fat%; change in fat% intake was used for estimation of interaction effects. The main outcomes were intervention weight loss and waist reduction. In the trial, mean change in fat% intake was -12/+4 in the low/high-fat groups. In the replication study, it was -23/-12 among those reducing fat% more/less than the median. TFAP2B-rs987237 genotype AA was associated with 1.0 kg (95% CI, 0.4; 1.6) greater weight loss on the low-fat, and GG genotype with 2.6 kg (1.1; 4.1) greater weight loss on the high-fat (interaction p-value; p = 0.00007). The replication study showed a similar (non-significant) interaction pattern. Waist reduction results generally were similar. Study-strengths include (i) the discovery study randomised trial design combined with the replication opportunity (ii) the strict dietary intake control in both studies (iii) the large sample sizes of both studies. Limitations are (i) the low minor allele frequency of the TFAP2B polymorphism, making it hard to investigate non-additive genetic effects (ii) the different interventions preventing identical replication-discovery study designs (iii) some missing data for non-completers and dietary intake. No adverse effects/outcomes or side-effects were observed.ConclusionsUnder energy restriction, TFAP2B may modify the effect of dietary fat intake on weight loss and waist reduction.

International audience; BACKGROUND: The deleterious health effects of sedentary behaviors, independent of physical activity, are increasingly being recognized. However, associations with cognitive performance are not known. PURPOSE: To estimate the associations between different sedentary behaviors and cognitive performance in healthy older adults. METHODS: Computer use, time spent watching television (TV), time spent reading and habitual physical activity levels were self-reported twice (in 2001 and 2007) by participants in the SUpplémentation en Vitamines et MinérauX (SU.VI.MAX and SU.VI.MAX2) study. Cognitive performance was assessed at follow-up (in 2007-2009) via a battery of 6 neuropsychological tests used to derive verbal memory and executive functioning scores. Analyses (ANCOVA) were performed among 1425 men and 1154 women aged 65.6 ± 4.5 at the time of the neuropsychological evaluation. We estimated mean differences with 95% confidence intervals (95%CI) in cognitive performance across categories of each type of sedentary behavior. RESULTS: In multivariable cross-sectional models, compared to non-users, participants using the computer for \textgreater1 h/day displayed better verbal memory (mean difference=1.86; 95%CI: 0.95, 2.77) and executive functioning (mean difference=2.15; 95%CI: 1.22, 3.08). A negative association was also observed between TV viewing and executive functioning. Additionally, participants who increased their computer use by more than 30 min between 2001 and 2007 showed better performance on both verbal memory (mean difference=1.41; 95%CI: 0.55, 2.27) and executive functioning (mean difference=1.41; 95%CI: 0.53, 2.28) compared to those who decreased their computer use during that period. CONCLUSION: Specific sedentary behaviors are differentially associated with cognitive performance. In contrast to TV viewing, regular computer use may help maintain cognitive function during the aging process. CLINICAL TRIAL REGISTRATION: clinicaltrial.gov (number NCT00272428).

Resume L’obesite est reconnue par l’Organisation Mondiale de la Sante comme une « maladie » depuis 1997. Cette etape a permis la structuration d’une approche multidisciplinaire de la prise en charge, qui implique de nombreux professionnels travaillant de facon coordonnee. Il persiste cependant de nombreux defis dans ce domaine. Nous discutons plus specifiquement dans cet article : comment definir l’obesite, comment classer les patients, comment accompagner les changements de comportement, comment preparer et suivre les patients qui ont recours a la chirurgie bariatrique et comment developper une offre de soins adaptee a un nombre croissant de patients obeses demandeurs d’une prise en charge de qualite.

Serotoninergic control of food intake has been shown to be abnormal in obese persons with a decrease in serotoninergic tone. The neuroendocrine effects of intravenous I.V. administration of clomipramine (CMI), a serotonin uptake inhibitor, were studied in normal-weight (n=7) and obese subjects before (n=12) and after (n=6) dietary restriction. Under double-blind, placebo-controlled conditions, a single 12.5 mg dose of CMI was administered. There was no difference in baseline values of prolactin (PRL), corticotropin (ACTH) and cortisol in non-obese controls, obese before and obese after weight loss. CMI led to significant increases of PRL, ACTH, and cortisol concentrations in the controls as well as the obese group. The ACTH and cortisol responses to CMI in obese subjects were somewhat greater than the responses in normal-weight subjects. The area under the curve AUC for ACTH after clomipramine was 6202 +/- 976 pg/ml x 150 minutes for tile obese before weight loss and 3274 +/- 512 pg/ml x 150 minutes for the controls and the difference was significant at the level of p=0.052. The cortisol peak value after clomipramine was 163.71 +/- 14.31 ng/ml in the non-obese and 214.66 +/- 12.59 ng/ml in the obese (p=0.025). However, there was no difference in the obese subjects before and after weight loss. These data support the assumption that obese women have an abnormal sensitivity to the serotoninergic control of the hypothalamic pituitary adrenal axis (HPA), and that a mild weight loss does not significantly modify their serotoninergic tone.

Background:Increasing physical activity and decreasing sedentary time are cornerstones in the management of type 2 diabetes (T2DM). However, there are few instruments available to measure physical activity in this population. We translated the long version of the International Physical Activity Questionnaire (IPAQ-L) into French and studied its reproducibility and validity in patients with T2DM.Methods:Reproducibility was studied by 2 telephone administrations, 8 days apart. Concurrent validity was tested against pedometry for 7 days during habitual life.Results:One-hundred forty-three patients with T2DM were recruited (59% males; age: 60.9 ± 10.5 years; BMI: 31.2 ± 5.2 kg/m2; HbA1c: 7.4 ± 1.2%). Intraclass correlation coefficients (95% CI) for repeated administration (n = 126) were 0.74 (0.61−0.83) for total physical activity, 0.72 (0.57−0.82) for walking, and 0.65 (0.51−0.78) for sitting time. Total physical activity and walking (MET-min·week-1) correlated with daily steps (Spearman r = .24 and r = .23, respectively, P < .05). Sitting time (min·week-1) correlated negatively with daily steps in women (r = −0.33; P < .05).Conclusion:Our French version of the IPAQ-L appears reliable to assess habitual physical activity and sedentary time in patients with T2DM, confirming previous data in nonclinical populations.

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day.

INTRODUCTION: The melanocortin system plays an important role in energy homeostasis. Mice genetically deficient in the melanocortin-3 receptor gene have a normal body weight with increased body fat, mild hypophagia compared to wild-type mice. In humans, Thr6Lys and Val81Ile variants of the melanocortin-3 receptor gene (MC3R) have been associated with childhood obesity, higher BMI Z-score and elevated body fat percentage compared to non-carriers. The aim of this study is to assess the association in adults between allelic variants of MC3R with weight loss induced by energy-restricted diets. SUBJECTS AND METHODS: This research is based on the NUGENOB study, a trial conducted to assess weight loss during a 10-week dietary intervention involving two different hypo-energetic (high-fat and low-fat) diets. A total of 760 obese patients were genotyped for 10 single nucleotide polymorphisms covering the single exon of MC3R gene and its flanking regions, including the missense variants Thr6Lys and Val81Ile. Linear mixed models and haplotype-based analysis were carried out to assess the potential association between genetic polymorphisms and differential weight loss, fat mass loss, waist change and resting energy expenditure changes. RESULTS: No differences in drop-out rate were found by MC3R genotypes. The rs6014646 polymorphism was significantly associated with weight loss using co-dominant (p = 0.04) and dominant models (p = 0.03). These p-values were not statistically significant after strict control for multiple testing. Haplotype-based multivariate analysis using permutations showed that rs3827103-rs1543873 (p = 0.06), rs6014646-rs6024730 (p = 0.05) and rs3746619-rs3827103 (p = 0.10) displayed near-statistical significant results in relation to weight loss. No other significant associations or gene*diet interactions were detected for weight loss, fat mass loss, waist change and resting energy expenditure changes. CONCLUSION: The study provided overall sufficient evidence to support that there is no major effect of genetic variants of MC3R and differential weight loss after a 10-week dietary intervention with hypo-energetic diets in obese Europeans.

Background There is growing interest in the study of the relationships between individual health-related behaviours (e.g. food intake and physical activity) and measurements of spatial accessibility to the associated facilities (e.g. food outlets and sport facilities). The aim of this study is to propose measurements of spatial accessibility to facilities on the regional scale, using aggregated data. We first used a potential accessibility model that partly makes it possible to overcome the limitations of the most frequently used indices such as the count of opportunities within a given neighbourhood. We then propose an extended model in order to take into account both home and work-based accessibility for a commuting population. Results Potential accessibility estimation provides a very different picture of the accessibility levels experienced by the population than the more classical "number of opportunities per census tract" index. The extended model for commuters increases the overall accessibility levels but this increase differs according to the urbanisation level. Strongest increases are observed in some rural municipalities with initial low accessibility levels. Distance to major urban poles seems to play an essential role. Conclusions Accessibility is a multi-dimensional concept that should integrate some aspects of travel behaviour. Our work supports the evidence that the choice of appropriate accessibility indices including both residential and non-residential environmental features is necessary. Such models have potential implications for providing relevant information to policy-makers in the field of public health.

National audience; In the framework of the study of the Environmental links to physical activity, nutrition and health (ELIANE), we performed a systematic review of the associations between objective spatial measurements of the built environment and weight status in youth. Of the 25 identified papers, 18 reported at least one significant relationship, although only almost one-third of the associations tested were significant. Inverse relationships of weight with different walkability indices were the most consistent (7/9 papers). Weight was also positively related to spatial accessibility to convenience stores (3/6 papers), and inversely to the accessibility to recreational physical activity facilities (4/9 papers). Relationships with parks, other food retail outlets and restaurants were inconsistent. Reasons for such discrepant results are discussed. Better-built environment measures are needed. The challenge lies also in better understanding the complex pathways through which the built environment, the socioeconomic context, and the perception of their environment by the subjects impact childhood behaviors and weight status.

In men, an association between lower plasma total testosterone (PTT) and insulin resistance has been found in cross-sectional studies (1,2) and in one nested case-control study (3) without any possible conclusion in terms of causality or direction of the relationship. Indeed, to obtain such information, randomized controlled trials are needed. Until now, only one clinical trial has suggested that testosterone therapy improves insulin sensitivity in obese men (4). Cross-sectional studies concerning leptin regulation by androgens have provided no definitive conclusions as to whether the negative association between androgens and leptin level is independent (5) or dependent (6). This randomized controlled trial was designed to assess the role of androgens on insulin sensitivity and leptin regulation in healthy adult men. This study was a randomized, double-blind, unicentric, controlled, clinical trial. Three treatments (testosterone, dihydrotestosterone [DHT], and placebo) were compared in parallel groups during a 3-month period. All of the examinations were performed by only two physicians, using a standardized protocol. Blood was drawn between 8:00 a.m. and 9:30 a.m. after an overnight fast to determine fasting plasma glucose, insulin, leptin, sex hormones, lipids, coagulation and fibrinolysis parameters, hepatic enzymes, and prostate-specific antigen (PSA) and blood cell count. Then, a standard 75-g oral glucose tolerance test and a digital rectal examination were performed. In addition, between days 10 and 20, all of the subjects were monitored to measure sex hormones in order to adapt the treatment dose. The study protocol was approved by the Henri Mondor Hospital Ethics Committee. All of the included subjects gave written informed consent. Men with low levels of PTT (confirmed by two measurements) were selected from a large occupation-based population. The inclusion criteria were as follows: 1 ) either PTT ≤3.4 ng/ml [5th percentile value of PTT distribution in the 1,718 men of the TELECOM …

Bioelectrical impedance analysis (BIA) is a safe and easy method of assessing body composition. Its accuracy to predict fat mass (FM) in obesity and the change in FM following weight loss is questioned. Our objective was to compare leg-to-leg BIA to dual-energy X-ray absorptiometry (DXA) in the assessment of FM in a large population, the changes in FM after Roux-en-Y gastric bypass (RYGB) and to estimate between-method differences (bias) and limits of agreement.BIA (Tanita BC-420MA) and DXA (Hologic Discovery W) were used in 5,740 consecutive patients (mean BMI, 37.7 ± 8.2 kg/m(2)) examined in a clinical nutrition department and in 72 women undergoing RYGB (BMI, 47.2 ± 7.2 kg/m(2)). Analyses included correlations between methods and Bland Altman analysis.In the entire population, BIA significantly overestimated FM in comparison with DXA (1.1 ± 6.1 kg, 0.8 ± 5.6%). FM estimates by each method were significantly correlated in absolute value (kg; r(2) = 0.9 in the whole population), and in percentage (r(2) = 0.6). However, wide limits of agreement were observed. In surgery patients, BIA significantly overestimated FM both before and 12 months after bypass. BIA significantly overestimated changes in FM after RYGB at 3 months (2.9 ± 5.0 kg) and at 12 months (1.9 ± 3.9 kg) but not at 6 months (0.9 ± 5.0 kg; p = 0.08). Estimates of changes in FM by each method were significantly correlated (r (2) = 0.4, 0.6, and 0.9, respectively).According to the wide limits of agreement, BIA seems more interesting for epidemiological rather than individual use to evaluate body FM and FM changes in obese women undergoing RYGB.

OBJECTIVE: To identify leisure-time physical activity (LTPA) and sedentary behavior patterns, as well as to investigate their relationships with overweight. DESIGN: Cross-sectional study. SUBJECTS: Men (n=2206) and women (n=2476) aged >45 years, living in France, enrolled in the SU.VI.MAX (Supplémentation en VItamines et Minéraux AntioXydants) study. MEASUREMENTS: LTPA and sedentary behavior were assessed using the Modifiable Activity Questionnaire whereas weight and height were measured from study participants. Clusters were defined, by gender, with multiple correspondence analysis and cluster analysis successively, taking into account the type (walking, gardening, etc.) and duration of each physical activity performed, as well as the time spent watching television (TV) as typical sedentary behavior. Logistic regression models were used to assess associations with overweight. RESULTS: Four physical activity and sedentary behavior clusters were identified among men and three among women. We chose as referent cluster the cluster associating 'walking and gardening-low TV' in men and the cluster associating 'walking and gardening-high TV' in women. Compared with the referent cluster and after adjustment for age, education level, smoking status and place of residence, the likelihood of overweight (defined as body mass index >or=25 kg m(-2)) in women was lower for a 'multiple activity-low TV' cluster (odds ratio (OR)=0.66, 95% confidence interval=0.54-0.81) and for a cluster associating 'endurance physical activity-low TV' (OR=0.42 (0.29-0.60)). Compared with the referent cluster and after adjustment, the likelihood of overweight in men was decreased for the 'endurance physical activity' cluster (OR=0.66, (0.52-0.84)), whereas no significant association was found with the other clusters. CONCLUSIONS: Patterns combining specific types of physical activity and sedentary behavior were identified and differed in their relations to overweight in adults. The identification of global patterns of activity allows us to go beyond a simple decreased activity-increased body weight approach and adds to our understanding of the associations of specific forms and grouping of activity with overweight in adults.

International audience; Both obesity and insulin resistance have been related to low fat oxidation rates, which may be genetically determined. The association between variation in fat oxidation rates among obese subjects and genotype was studied for 42 common single-nucleotide polymorphisms (SNPs) in 26 candidate genes for fat oxidation, insulin resistance, and obesity, including FTO. Energy expenditure (EE) and fat oxidation were measured with indirect calorimetry during fasting and 3 h after a high fat load containing 95 energy% of fat (60% saturated fat, energy content 50% of estimated resting EE) in 722 obese subjects (541 women, 181 men) from 8 European centers. After adjustment for center and gender, -178 A>C CD36 (rs2232169) (P = 0.02), -22510 C>G SLC6A14 (women, rs2011162) (P = 0.03), and T690S C>G PCSK1 (rs6235) (P = 0.02) were related to a reduced fat oxidation, whereas 17 C>G SREBF1 (17 C>G) (P = 0.01) was related to increased fat oxidation in the fasting state. The ability to increase fat oxidation after a high fat load was increased in subjects with -174 G>C IL6 (rs1800795) (P = 0.01). Effect sizes range from 1.1 to 3.1% differences in fat oxidation (expressed as % of EE). FTO rs9939609 was not related to fat oxidation. At the same time, the results are not adjusted for multiple testing, thus none of the associations can be considered statistically significant. The results should therefore only be considered as leads to new hypotheses about effects of specific genetic polymorphisms on fasting and postprandial fat oxidation.

International audience; BACKGROUND: Transcription factor 7-like 2 (TCF7L2) rs7903146 associates with type 2 diabetes and may operate via impaired glucagon-like peptide 1 secretion, which is stimulated more by fat than by carbohydrate ingestion. OBJECTIVE: The objective was to examine the interaction between TCF7L2 rs7903146 and dietary fat and carbohydrate [high-fat, low-carbohydrate: 40-45% of energy as fat (HF); compared with low-fat, high-carbohydrate: 20-25% of energy as fat (LF)] in obese individuals' responses to a 10-wk hypoenergetic diet (-600 kcal/d). DESIGN: European, obese participants (n = 771) were randomly assigned to receive an HF or an LF diet. Body weight, fat mass (FM), fat-free mass (FFM), waist circumference (WC), resting energy expenditure (REE), fasting fat oxidation in percentage of REE (FatOx), homeostasis model assessed insulin release (HOMA-beta), and HOMA-insulin resistance (HOMA-IR) were determined at baseline and after the intervention; 739 individuals were genotyped for rs7903146. RESULTS: Average weight loss was 6.9 kg with the LF and 6.6 kg with the HF (difference between diets, NS) diet. Among individuals who were homozygous for the T-risk allele, those in the HF diet group experienced smaller weight losses (Deltaweight) (2.6 kg; P = 0.009; n = 622), smaller DeltaFFM (1.6 kg; P = 0.027; n = 609), smaller DeltaWC (3.3 cm; P = 0.010; n = 608), and a smaller DeltaHOMA-IR (1.3 units; P = 0.004; n = 615) than did the LF diet group. For C allele carriers, there were no differences between the HF and LF diet groups. For the HF diet group, each additional T allele was associated with a reduced loss of FM (0.67 kg; P = 0.019; n = 609). TCF7L2 rs7903146 was not associated with DeltaREE, DeltaFatOx, DeltaHOMA-beta, or dropout. CONCLUSION: Our results suggest that obese individuals who are homozygous for the TCF7L2 rs7903146 T-risk allele are more sensitive to LF than to HF weight-loss diets.

Diet and physical activity are considered to be major components of a healthy lifestyle. However, few studies have examined in detail the relationships between specific types of physical activity, sedentary behaviour and diet in adults. The objective of the present study was to assess differential relationships between dietary patterns, leisure-time and occupational physical activities and time spent watching television (TV), as an indicator of sedentary behaviour, in middle-aged French subjects. We performed a cross-sectional analysis using data from 1359 participants in the SUpplémentation en VItamines et Minéraux AntioXydants study, who completed a detailed physical activity questionnaire and at least six 24 h dietary records. Sex-specific dietary patterns were derived using factor analysis; their relationships with leisure-time and occupational physical activities and TV viewing were assessed using ANCOVA, after adjustment for age, educational level and smoking status. Three dietary patterns were identified in each sex. After adjustment for potential confounders, leisure-time physical activity was positively associated with a ‘healthy’ food pattern in both men (P for trend P for trend P for trend

Background Longitudinal studies on physical activity patterns around retirement age are scarce and provide divergent findings. Little is known about changes in sedentary behaviour in this context. Our aim was to investigate relationships between retirement and 3-year changes in leisure-time physical activity (LTPA) patterns and sedentary behaviour in middle-aged French adults. Methods Past-year LTPA and sedentary behaviour (watching television) were assessed in 1998 and 2001 using the Modifiable Activity Questionnaire on participants in the SU.VI.MAX (Supplementation with Antioxidants and Minerals) study. A total of 698 men and 691 women aged 45-64 were included in this analysis. Comparisons were made between subjects who had retired between 1998 and 2001 and those who continued to work, using the Chi-square test, Student t-test, Wilcoxon rank test or covariance analysis where appropriate. Results 20.1% of men and 15.6% of women retired during follow-up. The baseline LTPA level was similar between subjects who retired during follow-up and those who continued to work. Mean LTPA increased by about 2 h/week in men and women who had retired, whereas no change was observed in employed persons. The positive change in LTPA following retirement was mainly related to an increase in activities of moderate intensity, such as walking. Retirement did not modify the ranking of the most frequently performed LTPAs, but the number of participants and the duration increased through retirement. In men, the increase in time spent watching TV was more than twice as high in retirees as in workers (+40.5 vs. +15.0 min/day, P < 0.0001). The same tendency was observed among women, but was borderline non-significant (+33.5 vs. +19.9 min/day, P = 0.05). In women, retirees who increased their walking duration by 2 h/week or more also decreased time spent watching TV by 11.5 min/day. Conclusions Retirement was associated with both an increase in LTPAs and in time spent watching TV, suggesting that retirement is an important period not only for promoting physical activity, but also for limiting sedentary behaviour.

Little is known on patterns of change over time in body composition, especially lean body mass (LBM), during massive weight loss after Roux-en-Y gastric bypass (RYGB) in obese patients. We performed sequential measurements of total and regional body composition in patients after RYGB, and we compared a subsample of patients after surgery to a nonsurgical control group of similar age and body fatness. We used dual-energy X-ray absorptiometry (DXA) before and at 3, 6, and 12 months after RYGB in 42 obese women (before surgery: age 39.5 +/- 11.6 years; BMI 44.6 +/- 6.1 kg/m(2); mean +/- s.d.) and in 48 control obese women referred for nonsurgical weight management, before weight loss. During 1-year follow-up after RYGB, there was a continuous decrease in body weight (-36.0 +/- 12.5 kg at 1 year), total fat mass (FM) (-26.0 +/- 9.1 kg), as well as in trunk and appendicular FM. In contrast, the decrease in total LBM (-9.8 +/- 4.8 kg at 1 year), as well as in trunk and appendicular LBM, plateaued after 3-6 months. Rates of loss in weight, FM, and LBM were highest during the first 3-month period after RYGB (6.4 +/- 1.8, 4.1 +/- 1.7, and 2.3 +/- 1.2 kg/month, respectively), then decreased continuously for FM but plateaued for LBM. There was no evidence of a decrease in total, trunk, or appendicular LBM in weight-reduced subjects compared to the control group. In conclusion, follow-up of these obese women revealed a differential pattern of change in FM and LBM after RYGB. Despite an important loss in LBM, especially during the 3-6 months of initial period, LBM appears to be spared thereafter.

Background Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries. Methods This study was done within the framework of the EU-funded project 'Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA)', which aims to propose standardised instruments for physical activity and fitness monitoring across Europe. Quantitative studies published from 1990 up to November 2007 were systematically searched in Pubmed, Web of Science, TRIS and Geobase. In addition a survey was conducted among members of the European network for the promotion of Health-Enhancing Physical Activity (HEPA Europe) and European members of the International Physical Activity and Environment Network (IPEN) to identify published or ongoing studies. Studies were included if they were conducted among European general adult population (18+y) and used a questionnaire to assess perceptions of the physical environment. A consensus meeting with an international expert group was organised to discuss the development of a European environmental questionnaire. Results The literature search resulted in 23 European studies, 15 published and 8 unpublished. In these studies, 13 different environmental questionnaires were used. Most of these studies used adapted versions of questionnaires that were developed outside Europe and that focused only on the walkability construct: The Neighborhood Environment Walkability Scale (NEWS), the abbreviated version of the NEWS (ANEWS) and the Neighborhood Quality of Life Study (NQLS) questionnaire have been most commonly used. Based on the results of the literature review and the output of the meeting with international experts, a European environmental questionnaire with 49 items was developed. Conclusion There is need for a greater degree of standardization in instruments/methods used to assess environmental correlates of physical activity, taking into account the European-specific situation. A first step in this process is taken by the development of a European environmental questionnaire.

ObjectiveA school-based nutrition information programme was initiated in 1992 in two towns in northern France (Fleurbaix and Laventie, FL) and was followed by a number of community-based interventions. We took the opportunity to measure the outcomes in terms of childhood obesity and overweight over the next 12 years.DesignRepeated, cross-sectional, school-based survey. For the school years beginning in 1992, 2000, 2002, 2003 and 2004, the height and weight of all 5- to 12-year-old children attending school were measured in FL. In 2004, the same assessments were made in two comparison towns with similar socio-economic characteristics but no intervention.SettingFleurbaix and Laventie (intervention towns), Bois-Grenier and Violaines (comparison towns), northern France.SubjectsIn 2002, 2003 and 2004, respectively 515, 592 and 633 children were measured in FL (participation rate of 95–98 % of all eligible individuals); in the comparison towns, 349 children were measured in the 2004 school year (98 % of the towns’ school population).ResultsAfter an initial increase, trends in mean BMI and prevalence of overweight started to reverse. Compared with 2002, the age-adjusted OR for overweight in FL was significantly lower in 2003 and 2004 (but for girls only). In the 2004 school year, the overweight prevalence was significantly lower in FL (8·8 %) than in the comparison towns (17·8 %, P < 0·0001).ConclusionThese data suggest that, over a long period of time, interventions targeting a variety of population groups can have synergistic effects on overweight prevalence. This gives hope that it is possible to reverse trends towards increasing overweight by actions at the community level.

Elevated plasma concentrations of remnant-like particle cholesterol (RLP-C) are atherogenic. However, factors that determine RLP-C are not fully understood. This study evaluates which factors affect RLP-C in the fasting and postprandial state, using multiple regression analyses in a large cohort of lean and obese participants. All participants (n = 740) underwent a test meal challenge containing 95 energy % (en%) fat (energy content 50% of predicted daily resting metabolic rate). Fasting and postprandial concentrations of circulating metabolites were measured over a 3-h period. Obese participants (n = 613) also participated in a 10-wk weight loss program (-2510 kJ/d), being randomized to either a low-fat or a high-fat diet (20-25 vs. 40-45en% fat). Postprandial RLP-C was associated with fasting RLP-C, waist:hip ratio (WHR), HOMA(IR) (homeostasis model assessment index for insulin resistance) (P < 0.001), and age, independently of BMI and gender [adjusted R(2) (adj. R(2)) = 0.70). These factors were also related to fasting RLP-C (P < 0.010), along with gender and physical activity (adj. R(2) = 0.23). The dietary intervention resulted in significantly lower fasting RLP-C concentrations, independently mediated by weight loss, improvements in HOMA(IR), and the fat content of the prescribed diet. However, after inclusion of plasma triglyceride (TG), HDL-cholesterol, and FFA concentrations in the models, HOMA(IR) and WHR no longer significantly predicted fasting RLP-C, although WHR remained a predictor of postprandial RLP-C (P = 0.002). Plasma TG was strongly associated with both fasting and postprandial RLP-C (P < 0.001). In conclusion, plasma RLP-C concentrations are mainly associated with plasma TG concentrations. Interestingly, the high-fat diet was more effective at decreasing fasting RLP-C concentrations in obese participants than the low-fat diet.

The objective was to examine the relationships of self-reported physical activity (PA) by domain (leisure, occupational, other) with PA and sedentary time as measured objectively by accelerometry. Subjects were adults with low habitual PA levels from a community in northern France. Among subjects in the lowest tertile of a PA score from a screening questionnaire, 160 (37% males, age: 41.0 ± 10.8 years, BMI: 25.1 ± 4.1 kg/m2, mean ± SD) completed a detailed instrument (Modifiable Activity Questionnaire), and wore an accelerometer (Actigraph) for seven consecutive days. Relationships between questionnaire domains (occupational, leisure, and “non-occupational non-leisure”) and accelerometry measures (total activity and sedentary time) were assessed using Spearman correlation coefficients. In this population, the highest contributor to total reported PA (h/week) was occupational PA. Time spent in non-occupational non-leisure PA ranked second in women and third in men. The most frequent non-occupational non-leisure PA were shopping and household chores. In women, non-occupational non-leisure PA contributed more than occupational or leisure-time PA to total PA energy expenditure (median: 18.0, 9.1, and 4.9 MET-h/week, respectively). Total PA by accelerometry (count/day) was correlated to leisure-time PA in women (r = 0.22, P

In contrast to trunk fat mass (TFM), which is associated with cardiovascular risk markers, leg fat mass (LFM) displays independent protective effects against atherosclerosis. Little is known about the respective influence of central and peripheral adiposity on liver enzyme levels.To assess the respective influence of TFM and LFM on alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) levels, and to test whether LFM might protect against an increase of liver enzyme levels.Cross-sectional study on 1442 patients (women: 1155; men: 287) referred for overweight/obesity over 3 years. Body composition was analysed by dual-energy X-ray absorptiometry. The relationships among liver enzymes, age, weight, height, body mass index (BMI), biological indices and body composition were studied.The mean BMI was 39.7 +/- 7.9 kg/m(2) in women and 38.2 +/- 6.6 kg/m(2) in men. In women, after adjustement for confounding factors, ALT, AST and GGT were negatively and independently correlated with LFM and positively with TFM. Similar independent associations were observed for ALT and AST in men. The strongest associations were found for ALT in both women and men.As observed for cardiovascular risk factors, LFM and TFM are inversely and independently correlated with liver enzyme levels in obese patients. LFM may confer independent protective effects against obesity-associated liver damage.

Oppert Jean-Michel. Activité physique et santé : point de vue sur les recommandations de l’expertise collective INSERM. In: Les Cahiers de l'INSEP, n°41, 2008. Le sport, c'est la santé ? pp. 13-15.

There is concern that surgically-induced weight loss in obese subjects is associated with a disproportionate decrease in lean body mass (LBM) and in skeletal muscle mass (SMM), a major constituent of LBM. To address this issue, 1) we measured total and regional body composition following gastric banding in a group of obese subjects, and 2) we compared these data to those of a non-surgical control group of similar age and body size.Body composition was assessed by dual-energy X-ray absorptiometry (DEXA) before and after laparoscopic adjustable silicone gastric banding (LAGB) in 32 women (after 1 year: age 43.7+/-8.4 years, BMI 36.4+/-5.9 kg/m2, mean+/-SD), and in 117 control women (age 44.5+/-7.5 years; BMI 36.7+/-5.5 kg/m2) referred for non-surgical weight management, prior to weight loss. SMM was estimated using a published equation based on LBM of the extremities (appendicular LBM).1 year after LAGB, body weight loss (-23.7+/-11.6 kg, P10(-6)) was mainly due to decreased fat mass (-21.2+/-11.2 kg, P10(-6)), and total LBM was modestly, although significantly, decreased (-2.1+/-4.2 kg, P=0.01). Appendicular LBM (-0.7+/-2.7 kg) and total SMM (-0.9+/-3.0 kg) were not significantly modified. None of the body composition variables was significantly decreased in weight-reduced subjects compared to the control group, especially appendicular LBM and total SMM.Results provide no evidence for a decrease in appendicular LBM and total SMM with weight loss following LAGB. Follow-up of these obese patients revealed a very favorable pattern of change in total and regional body composition, with preservation of muscle mass.

International audience; Objective:To investigate the hypothesis that plasma leptin may predict adiposity changes.Design:A population-based cohort study.Setting:Fleurbaix and Laventie, in the north of France.Subjects:In all, 1175 subjects participated, of whom 946 completed measurements at baseline (1999) and follow-up (2001). After excluding 64 subjects obese at baseline, 882 subjects (478 adults, 404 children 8 years and over) were included in the analysis.Interventions:We measured plasma leptin concentrations at baseline and various adiposity parameters at baseline and follow-up. Partial correlation coefficients (r (p)) between baseline plasma leptin and each adiposity indicator at follow-up were calculated with adjustment for baseline age, pubertal stage, adiposity and familial correlations between siblings.Results:Changes in body mass index and percentage body fat were not related to baseline plasma leptin. High baseline plasma leptin predicted an increase (r (p) (P-value)) in the sum of the four skinfolds (0.18 (

Objective: The objective was to evaluate two accelerometers, the RT3 and the TriTrac-R3D for their ability to produce estimates of physical activity-related energy expenditure (PAEE) in overweight/obese adults. Research Methods and Procedures: PAEE estimates from both accelerometers were obtained in two experiments. In Experiment 1, 13 overweight/obese subjects (BMI 34.2 ± 6.4 kg/m2) were monitored over 2 weeks in everyday life, PAEE being simultaneously measured by the doubly labeled water method (DLW). In Experiment 2, 8 overweight/obese subjects (BMI 34.3 ± 5.0 kg/m2) and 10 normal-weight subjects (BMI 20.8 ± 2.1 kg/m2) were monitored during a treadmill walking protocol, PAEE being simultaneously measured by indirect calorimetry. Results: In Experiment 1, there was no significant difference between methods in mean PAEE (DLW: 704 ± 223 kcal/d, RT3: 656 ± 140 kcal/d, TriTrac-R3D 624 ± 419 kcal/d). The relative difference between methods (accelerometer vs. DLW) was −17.1% ± 16.7% for the RT3 and −20.0 ± 44.6% for the TriTrac-R3D. Correlation for PAEE between RT3 and DLW was higher than between TriTrac-R3D and DLW (r = 0.67, p < 0.05 and r = 0.36, p = 0.25, respectively). The 95% confidence interval (CI) (kcal/d) of the mean difference between methods was large, amounting to −385 to 145 for the RT3 and −887 to 590 for the TriTrac-R3D. In Experiment 2, both accelerometers were sensitive to the changes in treadmill speed, with no significant difference in mean PAEE between methods in overweight/obese subjects. Conclusions: Although both accelerometers did not provide accurate estimates of PAEE at individual levels, the data suggest that RT3 has the potential to assess PAEE at group levels in overweight/obese subjects.

Objectives: To study if genes with common single nucleotide polymorphisms (SNPs) associated with obesity-related phenotypes influence weight loss (WL) in obese individuals treated by a hypo-energetic low-fat or high-fat diet. Design: Randomised, parallel, two-arm, open-label multi-centre trial. Setting: Eight clinical centres in seven European countries. Participants: 771 obese adult individuals. Interventions: 10-wk dietary intervention to hypo-energetic (−600 kcal/d) diets with a targeted fat energy of 20%–25% or 40%–45%, completed in 648 participants. Outcome Measures: WL during the 10 wk in relation to genotypes of 42 SNPs in 26 candidate genes, probably associated with hypothalamic regulation of appetite, efficiency of energy expenditure, regulation of adipocyte differentiation and function, lipid and glucose metabolism, or production of adipocytokines, determined in 642 participants. Results: Compared with the noncarriers of each of the SNPs, and after adjusting for gender, age, baseline weight and centre, heterozygotes showed WL differences that ranged from −0.6 to 0.8 kg, and homozygotes, from −0.7 to 3.1 kg. Genotype-dependent additional WL on low-fat diet ranged from 1.9 to −1.6 kg in heterozygotes, and from 3.8 kg to −2.1 kg in homozygotes relative to the noncarriers. Considering the multiple testing conducted, none of the associations was statistically significant. Conclusions: Polymorphisms in a panel of obesity-related candidate genes play a minor role, if any, in modulating weight changes induced by a moderate hypo-energetic low-fat or high-fat diet., Editorial Commentary Background: Obesity is an important cause of death and disease, particularly in the developed world. It is understood that both environmental and genetic factors contribute towards obesity. Numerous studies have associated particular gene variants with a tendency towards obesity, but it is not known whether such gene variants affect the degree to which obese individuals will lose weight when dieting. What this trial shows: As part of a randomised trial, 771 participants were assigned to one of two different low-energy diets for 10 weeks: one low in fat or one high in fat. The researchers then did a genetic analysis of 642 participants completing the intervention, to find out whether any of 42 distinct genetic variations in 26 genes were associated with weight loss in the trial. The genetic variants were chosen for study as they were known or already thought to be associated with appetite regulation or various aspects of metabolism and fat tissue development and function. The investigators found that none of the genetic variants studied had a significant association with weight loss in the trial. It was also seen that the majority of genetic variants were not associated with efficacy of one dietary intervention over another. Strengths and limitations: Although a large number of participants was recruited into the trial, the genetic analysis involved multiple comparisons—168 tests of 42 genetic variants. This increases the likelihood that any significant associations found could have resulted from chance alone. Significant associations from this study will require additional confirmation in larger studies. Contribution to the evidence: This study adds data indicating that variation in the genes studied did not have an important influence on weight loss.

Purpose: There is a need to investigate the type, duration, frequency, and intensity of physical activity that are critical to reduce the risk of breast cancer, and if this relation differs among subgroups of women. Methods: We analyzed the relation between physical activity and breast cancer incidence between 1990 and 2002 (n = 3,424 cases), among 90,509 women of the French E3N cohort, ages between 40 and 65 years in 1990. We gave special attention to effect modification by body mass index (BMI), family history of breast cancer, parity, and hormone replacement therapy (HRT). Results: A linear decrease in risk of breast cancer was observed with increasing amounts of moderate (Ptrend < 0.01) and vigorous (Ptrend < 0.0001) recreational activities. Compared with women who reported no recreational activities, those with more than five weekly hours of vigorous recreational activity had a relative risk of 0.62 (0.49-0.78). This decrease was still observed among women who were overweight, nulliparous, had a family history of breast cancer, or used HRT. Compared with the whole cohort, among nulliparous women, the reduction of risk observed was of a higher magnitude, although the test for heterogeneity did not reach statistical significance. Conclusion: A risk reduction of breast cancer was particularly observed with vigorous recreational activity. Further investigations are needed to confirm that intensity is an important variable to consider in risk reduction and to identify the precise biological mechanisms involved in such a risk reduction. (Cancer Epidemiol Biomarkers Prev 2006;15(1):57–64)

BACKGROUND: Obesity may be associated with a lowered use of fat as a fuel, which may contribute to the enlarged adipose tissue stores. AIM: The aim of the present study was to study fatty acid use in the fasting state and in response to a high fat load in a large cohort of obese subjects (n = 701) and a lean reference group (n = 113). METHODS: Subjects from eight European centers underwent a test meal challenge containing 95 en% fat [energy content 50% of estimated resting energy expenditure (EE)]. Fasting and postprandial fat oxidation and circulating metabolites and hormones were determined over a 3-h period. RESULTS: Postprandial fat oxidation (as percent of postprandial EE, adjusted for fat mass, age, gender, center, and energy content of the meal) decreased with increasing body mass index (BMI) category (P < 0.01), an effect present only in those obese subjects with a relatively low fasting fat oxidation (below median, interaction BMI category x fasting fat oxidation, P < 0.001). Fasting fat oxidation increased with increasing BMI category (P < 0.001), which was normalized after adjustment for fat-free mass and fat mass. Furthermore, insulin resistance was positively associated with postprandial fat oxidation (P < 0.05) and negatively associated with fasting fat oxidation (expressed as percent of EE), independent of body composition. CONCLUSIONS: The present data indicate an impaired capacity to regulate fat oxidation in the obese insulin-resistant state, which is hypothesized to play a role in the etiology of both obesity and insulin resistance.

Background: Weight loss is associated with a decrease in both energy expenditure and circulating leptin levels. Whether this holds true when the influence of body composition on energy expenditure and leptin is taken into account remains controversial. The aim of the study was to assess changes in resting metabolic rate (RMR) and serum leptin adjusted for body composition during surgically induced weight loss. Methods: In 36 women (age 42.7±8.7 years; BMI 47.2±8.5 kg/m2; mean±SD) undergoing laparoscopic adjustable gastric banding (LAGB) for morbid obesity, we measured RMR (by indirect calorimetry), body composition (by dual-energy X-ray absorptiometry) and serum leptin (by immunoradiometry), immediately before and 1 year after surgery. Results: 1 year after LAGB, there were significant decreases in body weight (−23.7±11.6 kg, P

Objective: To study the relationships of time spent in sedentary occupations with the National Cholesterol Education Program—defined metabolic syndrome (MS), taking into account the habitual level of physical activity (PA). Research Methods and Procedures: This was a cross-sectional analysis in 1902 men and 1932 women 50 to 69 years of age participating in the French Supplementation with Antioxidant Vitamins and Minerals study. We assessed past-year PA, television watching or computer use, and reading during leisure with the Modifiable Activity Questionnaire. Subjects who performed at least 150 min/wk of moderate-intensity PA (3 to 6 metabolic equivalent tasks) or 60 min/wk of vigorous PA (>6 metabolic equivalent tasks) were considered as meeting recommended levels. Results: The frequency of most MS components increased with time spent in front of a screen and decreased with increasing PA levels. The likelihood to have MS, adjusted for age, education, and smoking, was decreased by one-third in subjects meeting moderate PA guidelines and by two-thirds in subjects meeting vigorous PA recommendations [odds ratio (95% CI), 0.34 (0.17 to 0.66) in women, 0.44 (0.28 to 0.68) in men] compared with those with insufficient PA. Independently of PA levels, time spent in front of a screen was positively associated with the likelihood to have the MS in women [odds ratio (95% CI), 3.30 (2.04 to 5.34)], whereas in both sexes, no association was found with time spent reading. Discussion: The relationship of the MS with a sedentary lifestyle differs according to sex and type of sedentary occupation. These results suggest the need to assess selected indicators of sedentary behavior in preventive programs.

Background Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease. However, the contribution of MetS to intermediate cardiovascular endpoints such as structure and function alterations of large arteries is still unclear. Methods A total of 917 middle-aged French men and women participating to the SUpplementation en VItamines et Mineraux AntioXydants (SU.VI.MAX) Vascular study were included. Carotid-femoral pulse wave velocity was used to assess aortic stiffness. Carotid ultrasound examination included measurements (at sites free of plaques) of intima-media thickness (IMT) at the common carotid arteries (CCA) and assessment of atherosclerotic plaques in the extracranial carotid arteries. Results Prevalence of the MetS defined by the National Cholesterol Education Program was 8.7%. Compared with subjects without MetS, subjects with MetS had significant higher mean values of CCA-IMT (P = .02) and pulse wave velocity (P = .0001). We found that MetS was not significantly related to the presence of carotid plaques. Blood pressure was the only MetS component associated with all vascular parameters. Addition of other MetS components in the multivariate models contributed poorly to the explained variance of these parameters. Conclusions The MetS is adversely associated with markers of early arterial dysfunction, such as CCA-IMT and arterial stiffness. Although the associations between MetS and these arterial parameters are related to insulin resistance, blood pressure was shown to be the most important MetS component in relation to structure and function of large arteries.

PURPOSE: Simple instruments are needed to assess habitual physical activity (PA) in obese subjects. In a multicenter European obesity project, we tested whether PA assessments by two questionnaires were correlated and similarly associated to selected obesity-related variables. METHODS: A total of 757 obese subjects (75% female; age 37.1 [7.9] yr, BMI 35.5 [4.9] kg.m(-2), mean [SD]) completed the Baecke questionnaire (assessing work, sport, and nonsport leisure activity) and the short last 7-d version of the International Physical Activity Questionnaire (IPAQ; assessing vigorous, moderate-intensity, walking activity, and sitting). We assessed percent body fat (bioimpedance), waist circumference, and fasting plasma concentrations of glucose, insulin, leptin, and FFA. Insulin sensitivity was assessed by the HOMA index for insulin resistance (HOMAIR). RESULTS: Using the IPAQ, only about one third of men and women were classified as insufficiently active. Total habitual PA assessments by the Baecke and IPAQ were significantly related (Spearman rho = 0.51 in total sample, P < or = 0.0001, with adjustment for age, gender, and center). Using principal component analysis, we built two uncorrelated indices corresponding to general obesity (determined by high body fat and leptin) and abdominal obesity (determined by high waist circumference and HOMAIR). PA scores from both questionnaires were negatively related to general and abdominal obesity indices, except for abdominal obesity with the IPAQ in men. CONCLUSIONS: Total PA assessments by the two questionnaires were found to correlate significantly, and the general pattern of associations of PA with general obesity was similar for the two questionnaires. However, the IPAQ may capture less of the relationships between PA and abdominal obesity than the Baecke, especially in men. Reporting of habitual PA in obese subjects with the IPAQ warrants further evaluation against objective assessment methods.

Objective To describe the relative contribution of 10 created food groups to total fat intake in middle-aged subjects. The relationship of added oil and fat intake with region of residence and educational level was also assessed. Design Cross-sectional study. Subjects/setting Participants of the French Supplementation en Vitamines et Mineraux Antioxydants study who completed at least six 24-hour dietary records after inclusion into the study (N=6,572). Results Added oils and fats were the main source of total fat intake. Animal fat and margarine intakes showed a significant inverse association with educational level, whereas oils with monounsaturated fatty acids (MUFA) were positively associated with education level. Animal fat intake was significantly higher in the western and northern parts of France (54.2% and 50.4%) and lower in the Mediterranean Coast (39.0%). A significant inverse gradient was found with oils with polyunsaturated fatty acids or MUFA in the southwest and the Mediterranean Coast compared with the northern part of France. Conclusions We showed a north to south gradient for animal fat intake and the opposite for oils with MUFA and polyunsaturated fatty acid in France. This gradient parallels the known disparities for cardiovascular mortality in this country. This should contribute to adapting dietary guidelines for dietary change in a public health perspective.

To study the relationships between physical activity and plasma leptin levels in children from a population-based study, taking into account puberty stages.Subjects were part of the Fleurbaix-Laventie Ville Santé (FLVS) II Study, a longitudinal study on the determinants of weight gain in children and their parents. At baseline examination, 253 girls and 257 boys aged 8-18 y were examined.: Height and weight were measured, adiposity was assessed by the sum of four skinfold thicknesses (SSK). Pubertal stage was assigned according to Tanner. Leisure-time physical activity (LTPA) was assessed by the Modifiable Activity Questionnaire and ambulatory activity by pedometer recording over a week. A fasting blood sample was obtained to determine plasma leptin and insulin levels.Plasma leptin was higher in girls compared to boys (8.3 (1.6-36.5) ng/ml vs 2.2 (0.1-15.3) ng/ml, P0.001). Multivariate analyses were performed with leptin as dependent variable, and number of steps by day, Tanner stage, insulin and SSK as independent variables. In girls, leptin was negatively correlated to number of steps/day (P0.001) and positively to SSK (P0.001) and insulinemia (P0.001). In boys, leptin was correlated to insulinemia (P0.001), SSK (P0.001), Tanner stage (P.0001), but not to physical activity.Physical activity is negatively related to leptin levels in girls only and this association is independent of fasting plasma insulin. In children, fasting insulinemia remains associated with leptin levels after taking into account adiposity, physical activity and Tanner stage.

Objective: To investigate AGT secretion in cultured adipocytes from obese patients and its relationship with obesity-related phenotypes, blood pressure, and the M235T polymorphism in the AGT gene. Research Methods and Procedures: Measurements, including anthropometry, body composition (DXA), and blood pressure, were performed in 61 overweight or obese women (BMI: 28 to 68 kg/m2). A subcutaneous abdominal adipose tissue biopsy was used for adipocyte size determination and quantification of AGT secretion in the medium of cultured adipocytes. AGT M235T genotype was determined using polymerase chain reaction-restriction fragment length polymorphism. Results: Adipose secretion of the AGT protein (range, 140 to 2575 ng/106 cells/24 h) was not significantly correlated with BMI, body fat, or blood pressure and did not vary according to the M235T polymorphism in the AGT gene. However, the AGT M235T polymorphism was associated with adipocyte size (111.6 ± 2.8, 108.8 ± 1.9, 118.2 ± 2.6 μm in MM, MT, and TT genotypes, respectively; p < 0.01) after adjustment for age and fat mass. An association between the AGT M235T polymorphism and adipocyte size (p < 0.02 adjusted for sex, age, and BMI) was found in another independent sample of 106 obese subjects (sex ratio, M/F 16/90; BMI, 29 to 70 kg/m2). Discussion: In cultured adipocytes from obese subjects, AGT secretion was not associated with body fat phenotypes, blood pressure, or fat cell size. However, results from two independent studies suggest an association between the AGT M235T polymorphism and adipocyte size.

Low-glycemic index diets are associated with a wide range of benefits when followed on a chronic basis. The chronic effects, however, of the substitution of 1 meal per day are not well known in diabetic subjects. Therefore, we aimed to evaluate whether the chronic use of a low-glycemic index breakfast (low-GIB) rich in low-GI carbohydrates and a modest amount of soluble fibers could have an effect on lipemia at a subsequent lunch, and improve glucose and lipid metabolism in men with type 2 diabetes. A total of 13 men with type 2 diabetes were randomly allocated in a double-blind cross-over design to a 4-week daily intake of a low-GI versus a high-GI breakfast separated by a 15-day washout interval. The low-GI breakfast was composed of whole grain bread and muesli containing 3 g beta-glucan from oats. Low-GIB induced lower postprandial plasma glucose peaks than the high-GIB at the beginning (baseline, P

Introduction La faisabilite du bypass gastrique laparoscopique (LGBP) a ete demontree pour les patients dits « Super-super obeses » (SSO ; Indice Masse corporelle (IMC) > 60 kg/m2). Cependant, ses resultats a long terme ne sont pas connus. Le but de notre etude est de comparer les resultats a 5 ans du LGBP chez les patients SSO et non-SSO. Materiel et Methodes De janvier 2004 a novembre 2008, 352 patients (32 SSO et 320 non-SSO) ont beneficies d’un LGBP. Toutes les donnees ont ete collectees prospectivement. Un appariement de 30 patients SSO (Groupe cas) avec 60 patients non-SSO (Groupe temoin) a ete realise sur l’âge, le sexe et la presence d’un diabete de type 2 (DT2) preoperatoire. Resultats L’IMC preoperatoire etaient de 64,1 ± 4,1 et 46,3 ± 5,6 kg/m2 (P Conclusion En se fondant sur le % PP et sur les taux de remission ou d’amelioration du DT2 ou de l’hypertension, notre etude montre des resultats identiques du LGBP a 5 ans entre les patients SSO et non-SSO.

The Modifiable Activity Questionnaire (MAQ) is a physical activity questionnaire shown to be both valid and reliable and was initially designed to be interviewer-administered. After translation and adaptation into French, the objective of the study was to compare past-year physical activity data obtained by self-administration of this questionnaire and by interviewer-administration.84 subjects (22 men, 62 women, age 36-63 yr) enrolled in an ongoing prospective study in France (the SUpplementation en VItamines et Minéraux AntioXydants or SU.VI.MAX study) completed both versions of the questionnaire in a randomized order with a mean (SD) delay of 7.9 (5.8) d between the two modes. Past-year leisure and occupational physical activity were expressed as both h x wk(-1) and MET-h x wk(-1) of activity, and television watching was expressed as h x d(-1). Analysis of variance on ranks was used to compare activity variables obtained by self-administration and interview. Agreement was assessed by nonparametric intraclass correlation coefficients.A significant effect of the mode of administration was found only for past-year leisure physical activity with lower values reported in self-administered conditions compared with interview. However, a high level of concordance between the two modes of administration was observed for all variables as shown by the intraclass correlation coefficients: 0.90 for leisure physical activity (h x wk(-1)), 0.82 for occupational activity (h x wk(-1)), 0.83 for total (leisure and occupational combined) physical activity (h x wk(-1)), and 0.97 for television viewing (h x d(-1)).The agreement between the two modes of administration of the questionnaire suggests that the self-administered version of the MAQ is a valuable tool to assess past-year physical activity and inactivity in self-administered conditions. This instrument could be used in large-scale population studies investigating the relationships between physical activity and health outcomes.

OBJECTIVE To evaluate the effect of a moderate dose of fish oil on glycemic control and in vivo insulin action in type 2 diabetic men with elevated plasma triacylglycerols and to determine the effect of the same treatment on gene expression of GLUT4, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL) in the abdominal adipose tissue. RESEARCH DESIGN AND METHODS A total of 12 type 2 diabetic men were randomly allocated to 2 months of 6 g daily of either fish oil or sunflower oil, separated by a 2- month washout interval, in a double-blind crossover design. RESULTS For glucose metabolism, 2 months of fish oil supplementation compared with sunflower oil led to similar fasting plasma insulin, glucose, and HbA1c. Basal hepatic glucose production did not increase after fish oil. There was no difference in insulin suppression of hepatic glucose production nor in insulin stimulation of whole-body glucose disposal measured by the euglycemic-hyperinsulinemic clamp. Fish oil did not ameliorate the low mRNA level of GLUT4 in adipose tissue of these patients. For lipid profile, fish oil lowered plasma triacylglycerol more than sunflower oil (P < 0.05) and tended to increase the amount of mRNA of both LPL and HSL in adipose tissue. CONCLUSIONS A moderate dose of fish oil did not lead to deleterious effects on glycemic control or whole-body insulin sensitivity in type 2 diabetic men, with preserved triacylglycerol- lowering capacities.

Objectif Cette etude decrit l’activite physique (AP) d’adultes diabetiques de type 2 (DT2) car ses caracteristiques sont mal connues et n’ont jamais ete decrites en France. Patients et methodes Nous avons administre par telephone la version longue du « International Physical Activity Questionnaire » aux adultes DT2 de l’etude ENTRED 2007–2010 vivant en metropole ayant accepte d’etre recontactes (n = 917, hommes 65 %, 62 ± 10 ans, IMC 29 ± 5 kg.m-2, HbA1c 7,1 ± 1,1 %). Nous avons recherche les caracteristiques sociodemographiques et cliniques associees a 3 categories d’AP (1 : faible; 2 : 150 minutes hebdomadaires d’AP au moins moderee; 3 : elevee, 3 000 MET-min•sem-1 d’AP au moins moderee ou 1 500 MET-min•sem-1 d’AP intense). Resultats L’AP mediane totale etait de 2079 [Q1 = 892; Q3 = 3 915] MET-min•sem-1. L’AP etait essentiellement domestique (630 [Q1 = 90; Q3 = 1 740] MET-min•sem-1) quels que soient l’âge, le sexe ou les complications cardiovasculaires, suivie par les loisirs (347 [Q1 = 0; Q3 = 1 028] MET-min•sem-1) puis les transports (198 [Q1 = 0; Q3 = 495] MET-min•sem-1). Les medianes et interquartiles de l’AP professionnelle valaient 0 car 65 % de la population n’avait pas d’emploi. Les categories 1, 2 et 3 correspondaient a 16 %, 51 % et 33 % des participants. En analyse multivariee (reference categorie 1), l’etat de sante percu comme « bon » etait associe aux categories 2 (OR = 1,70 [1,01–2,89]) et 3 (OR = 2,12 [1,18–3,83]); l’âge Conclusion Cette premiere description, ou le domaine domestique est le contributeur majeur de l’AP totale des personnes DT2 vivant en France, souligne l’importance d’une evaluation detaillee de l’AP et de la promotion des AP de loisir. La perception de l’etat de sante, fortement associee a l’AP, incite a rechercher les liens avec la qualite de vie pour determiner les barrieres a l’AP.