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This study aimed to evaluate the nutritional status of elderly subjects in the general Guinean population and the associated factors. A general population, cross-sectional study was conducted among a representative sample from urban and rural areas. Socio-demographic clinical and anthropometric data were collected. Oral status was determined using the University of Nebraska Oral Status Scale. Visual acuity was assessed using the Monoyer scale. Statistical analysis of the data was carried out using the Shapiro-Wilk test, ANOVA, Kruskal-Wallis test and Chi-squared test. The standardized prevalence ratio (SPR) of the nutritional status was calculated for each region. Sample included 1,698 subjects with a mean BMI 22.6±4.3 kg/m2. A total of 50.3% had an impaired oral status and 20.3% had moderately to severely impaired visual acuity. The prevalence of undernutrition was 14.4% and obesity was 5.7%. Differences were found in the prevalence of the nutritional status between regions (p≤0.0001) with an SPR >1 for undernutrition in the Labé region (SPR 1.9, 95% CI =1.5-2.5) and for obesity in the Conakry and Kindia regions (SPR of 2.90, 95% CI =2.0-4.05 and 2.32, 95% CI =1.5-3.3, respectively). In Guinea, the prevalence of nutritional disorders was approximately 20%.

Objective:To explore the relationships between dental problems and underweight status among rural women in Burkina Faso by using nationally representative data.Design:This was a cross-sectional secondary study of primary data obtained by the 2013 WHO Stepwise Approach to Surveillance survey conducted in Burkina Faso. Descriptive and analytical analyses were performed using Student’s t test, ANOVA, the χ2 test, Fisher’s exact test and logistic regression.Setting:All thirteen Burkinabè regions were categorised using quartiles of urbanisation rates.Participants:The participants were 1730 rural women aged 25–64 years.Results:The prevalence of underweight was 16·0 %, and 24·1 % of participants experienced dental problems during the 12-month period. The women with dental problems were more frequently underweight (19·9 % and 14·7 %; P < 0·05) and had a lower mean BMI (21·1 ± 3·2 and 21·6 ± 3·7 kg/m2, P < 0·01) than those without dental problems. More risk factors for underweight were observed in less urbanised regions among elderly individuals (> 49 years old) and smokeless tobacco users. Age > 49 years, professions with inconsistent income, a lack of education, smokeless tobacco use and low BMI were factors that were significantly associated with dental problems, while residency in a low-urbanisation area was a protective factor.Conclusion:The prevalence of underweight in rural Burkinabè women is among the highest in sub-Saharan Africa, and women with dental problems are more frequently affected than those without dental problems. Public health measures for the prevention of these disorders should specifically target women aged over 49 years and smokeless tobacco users.

International audience; School feeding is important in terms of nutrition, as it contributes to the prevention of malnutrition, especially in low-income countries. However, the nutritional and hygienic quality of meals served at schools in several countries is rarely examined. We aimed to assess the quality of meals served in school canteens in Togo. We designed a descriptive cross-sectional study and collected data from eight school canteens located in Southern Togo. Hygiene compliance and potential sources of food contamination in the canteens were assessed using the 5 M approach, which evaluates the performance of hygiene parameters at each “M" i.e., medium (cooking environment), raw material (staples), cooking material (kitchenware), method (cooking) and manipulator (cooks) in the food preparation environment. Foods were sampled in each school and analysed for icrobiological (presence of Salmonella, total coliforms, and staphylococci) and nutritional (nutrient content) quality. The 5 M analysis revealed significant hygienic violations by the food preparators, as well as poor preparation conditions and utilization of low-quality raw materials in all the school canteens. Out of the 30 meal samples collected, 10 were of poor microbiological quality with the presence of total coliforms and staphylococci exceeding established limits of 10 and 100 cfu/g in 30 and 6.6% of the meals, respectively. However, none of the meals was contaminated by Salmonella spp. Nutritional analysis revealed that none of the meals served respected the nutritional balance, especially for contents in calcium, and vitamins A and C. Nonetheless, the iron content complied with the recommendations for children aged 9–13 years. Our analyses showed that several routes of contamination exist for the meals consumed in school canteens in Togo. Also, the nutritional quality of the readyto-eat foods served at school canteens needs to be improved, particularly with the inclusion in the diet of fruits and vegetables to cover the micronutrient requirements.

La denutrition chez l’enfant se traduit par un retard de croissance et une perte de poids involontaire. Elle compromet le developpement psychomoteur du jeune enfant. Elle majore le risque d’infection et augmente le risque de complications medicales et chirurgicales. L’objectif de cette recommandation de bonne pratique est de definir la denutrition chez l’enfant (< 18 ans) et de proposer des criteres afin d’ameliorer son diagnostic a l’aide d’outils adaptes.

International audience; La dénutrition est un problème majeur de santé publique qui concerne plus de 2 millions de personnes en France. Elle se traduit par une perte de poids involontaire. Elle majore le risque d’infection et réduit la force musculaire et la mobilité. Elle augmente le risque de complications médicales et chirurgicales. L’objectif de cette recommandation de bonne pratique est de définir la dénutrition chez l’adulte (

La vitamine A et ses nombreux derives sont disponibles dans diverses specialites pharmaceutiques pour le conseil ou la prescription et entrent dans la composition de complements alimentaires. Cette vitamine liposoluble joue un role important dans la formation du pourpre retinien necessaire a l’adaptation de la vision lorsque la lumiere diminue, dans la multiplication cellulaire, ainsi que dans la trophicite epitheliale et tissulaire.

Les pouvoirs publics menent des actions en faveur d’une meilleure alimentation. Par ailleurs, de nouvelles pratiques alimentaires se developpent. Elles peuvent avoir des avantages, mais presentent egalement des risques qu’il ne faut pas negliger. Une information objective doit etre disponible dans le domaine de la nutrition, qui represente un sujet important et sensible.

La nutrition joue un role important dans le processus de cicatrisation, qui est responsable d’un etat d’hypercatabolisme, d’une neoglucogenese acceleree et necessite des apports proteiques accrus. La denutrition a des consequences deleteres sur son deroulement. L’evaluation du statut nutritionnel du patient et sa prise en charge en cas d’alteration apparaissent indispensables dans le traitement des plaies, en particulier chroniques.

International audience; Purpose: Obesity is a public health problem worldwide. The eating habits of French workers need to be clarified. In particular, tachyphagia (meal lasting < 15 min) promotes weight gain. The present study aimed to investigate the presence of tachyphagia at lunchtime, the factors associated with tachyphagia, and the relationship between tachyphagia and obesity among workers. Methods: This cross-sectional study was conducted between January and May 2016 in five departments of occupational medicine. An anonymous self-administered questionnaire was used to gather general declarative data, such as weight and height (to calculate body mass index [BMI]) and information about lunchtime habits, including the time spent eating. Results: A total of 415 workers with a mean age of 41.1 ± 12.6 years were included. The mean BMI was 23.8 ± 4.6 kg/m2, and the prevalence of obesity was 15.9%. Tachyphagia occurred in 20.3% of the cases and was more frequent in younger workers. Multivariate analysis revealed that skipping meals, eating standing up, and eating fast food were positively associated with tachyphagia (p = 0.015, p = 0.028, and p = 0.027, respectively). Older age and eating with colleagues/friends were negatively associated with tachyphagia (p = 0.003 and p < 0.0001, respectively). No significant association was observed between tachyphagia and obesity. Conclusion: Our study provides important information about the lunchtime habits of workers. Maintaining commensality is crucial, particularly in young workers. Companies should play a role in organising their employees' lunch breaks. Level III Evidence obtained from well-designed cohort or case-control analytic studies.

Summary Background and aims Although the ageing of the Cameroonian population is a public health issue in the coming years, the nutritional status of the elderly is unknown. The aim of the study was to assess the nutritional status, health status and associated socio-demographic factors among elderly in Cameroon. Methods A cross-sectional study of 599 elderly (aged ≥ 60) was conducted in urban and rural areas. Several socio-demographic, sanitary, and anthropometric (weight, height, body mass index (BMI), Waist Circumference (WC), Mid-Upper Arm Circumference (MUAC)) data were collected. Nutritional status was defined according to WHO. Multinomial analysis was performed to identify factors associated with nutritional status. The threshold of statistical significance was 5%. Results The population, representative of the elderly, was aged 68.9 ± 7.2 years, with sex ratio M/F = 0.93, weight 68.5 ± 14.7 kg, BMI 24.7 ± 5.3, WC 90.1 ± 12.8 cm and MUAC 28.2 ± 5.0 cm. According to BMI, undernutrition was 19.7%, normal status 37.9%, overweight 24.9%, obesity 17.5%. The concordance for undernutrition between BMI and MUAC was weak (kappa = 0.3). In multinomial analysis, only no medication was negatively associated with undernutrition (OR = 0.3). Obesity was positively associated with the urban environment (OR = 4.8) and inactivity (OR = 2.9) and negatively associated with male gender (OR = 0.4), widowed (OR = 0.2), head of household (OR = 0.4), no income (OR = 0.3), one pathology (OR = 0.4), no medication (OR = 0.2), having normal diastolic pressure (OR = 0.2). Conclusions Undernutrition and obesity (more frequent in women, and in urban area) affect 37.2% of the elderly. These nutritional disorders are a public health problem that cannot be ignored.

Management of oropharyngeal dysphagia (OD) is mainly based on modifying liquid viscosity and solid consistency in order to preserve oral feeding while avoiding unsafe swallowing. Adding thickening powders (TP) to water is the most common practice in patients suffering from OD to liquids, but ready-to-use gelled waters (RGW) can also be proposed. The main objective of this study was to assess the efficacy of a RGW and a TP on swallowing in hospitalized patients with different OD etiologies. This open, crossover, multicenter trial recruited thirty hospitalized patients with OD to liquids, confirmed by positive 3-ounce water test or positive Practical Aspiration Screening Scheme test. The patient’s ability to swallow 120 g of a RGW (IDDSI level 4) and a drink prepared with TP (nectar viscosity; NTP, 291 cP, IDDSI level 2; or if necessary, honey; HTP, 769 cP, IDDSI level 3) was evaluated in a random order at 1- to 3-day intervals. The main criterion was the efficacy of each product, defined as the proportion of patients who successfully swallowed without immediate reflexive cough. The RGW and TP were successfully swallowed in respectively 93.3% (95% CI: 77.9–99.2) and 82.8% (95% CI: 64.2–94.2) of patients with different dysphagia etiologies (stroke, neurodegenerative diseases, or aging) and unable to swallow thin water. Taste and texture of both study products were well appreciated by patients, with a preference for the RGW over TP. Therefore, the use of these thickened products could be part of the therapeutic strategy for patients with OD to liquids.

The objective was to establish new diagnostic criteria for undernutrition for the French population, concordant for children aged

Obesity is a public health problem worldwide. The eating habits of French workers need to be clarified. In particular, tachyphagia (meal lasting 15 min) promotes weight gain. The present study aimed to investigate the presence of tachyphagia at lunchtime, the factors associated with tachyphagia, and the relationship between tachyphagia and obesity among workers.This cross-sectional study was conducted between January and May 2016 in five departments of occupational medicine. An anonymous self-administered questionnaire was used to gather general declarative data, such as weight and height (to calculate body mass index [BMI]) and information about lunchtime habits, including the time spent eating.A total of 415 workers with a mean age of 41.1 ± 12.6 years were included. The mean BMI was 23.8 ± 4.6 kg/mOur study provides important information about the lunchtime habits of workers. Maintaining commensality is crucial, particularly in young workers. Companies should play a role in organising their employees' lunch breaks. Level III Evidence obtained from well-designed cohort or case-control analytic studies.

International audience; RationaleHypermetabolism (HM) in Amyotrophic lateral sclerosis (ALS) is the reflection of a high energy metabolic level, but this alteration seems controversial. The main objective of the study was to confirm the existence of HM during ALS compared to healthy subjects.MethodsA cohort of ALS patients was compared to a control group without metabolic disorder. The assessment included anthropometric criteria measurements, body composition by bioelectric impedance analysis and resting energy expenditure (REE) by indirect calorimetry. HM was defined as a variation > +10% between measured and calculated REE. Statistical analysis used Mann-Withney and Chi2 tests. Multivariate analysis included logistic regression.Results287 patients and 75 controls were included. The metabolic level was higher in ALS patients (1500 kcal/24 h [1290–1693] vs. 1230 kcal/24 h [1000–1455], p < 0.0001) as well as the REE/fat free mass ratio (33.5 kcal/kg/24 h [30.4–37.8] vs. 28.3 kcal/kg/24 h [26.1–33.6], p < 0.0001). 55.0% of ALS patients had HM vs. 13.3% of controls (p < 0.0001). HM was strongly and positively associated with ALS (OR = 9.50 [4.49–20.10], p < 0.0001).ConclusionsHM in ALS is a reality, which affects more than half of the patients and is associated with ALS. This work confirms a very frequent metabolic deterioration during ALS. The identification of HM can allow a better adaptation of the patients' nutritional intake.

Background Aging is accompanied by a drop in the level of health and autonomy, within Western countries more and more people being cared for in nursing homes (NH). The nutritional data in NH in France remain poor, not exhaustive and not representative. The objective of the study was to assess the nutritional status, dementia and mobility patterns among residents of NH in the Limousin territory of France. Methods The study was cross-sectional, descriptive and exhaustive, conducted with the residents of 13 voluntary NH. Undernutrition was identified using French High Authority for Health criteria, and obesity if Body Mass Index >30, in the absence undernutrition criterion. The Mini Mental State examination scores was used for dementia assessment at the threshold of 24. The Mini Nutritional AssessmentTM was used for mobilitity assessment. The statistics were significant at the 5% threshold. Results 866 residents (70.6% women) included with an average age of 85.3 ± 9.3 years. Undernutrition was 27.5%, obesity 22.9%, dementia 45.7% and very low mobility 68.9%. Women were older than men, more often undernourished, more often demented and more often had very low mobility (p Conclusions Undernutrition and obesity are important problems in NH in France. Being a woman, having dementia and having a very low mobility may induce undernutrition.

International audience

International audience; Rationale: In Amyotrophic lateral sclerosis (ALS), gastrostomy is indicated when the weight loss is over 10%, in case of repeated aspirations and if the meal time duration is over 45 min. The benefit of gastrostomy on survival in ALS is unclear and its placement is probably too late. The main works on the subject studied survival from diagnosis but not from indication of gastrostomy. The aims of our work were in ALS patients with indication of gastrostomy and who accepted or refused gastrostomy to study from the indication of gastrostomy to the last assessment or death i) the evolution of nutritional and neurological status and ii) the survival.Methods: ALS patients included started follow-up in the referral ALS centre in 2006 and were all dead at 31 december 2017. They had assessment of their neurological (onset form, ALS functional rating scale revised [ALSFRS-R]), nutritional (weight, weight loss, body mass index and body composition by bioelectrical impedancemetry analysis) and respiratory status (forced vital capacity, non-invasive ventilation [NIV]). Statistical analysis was done by using Mann-Whitney test, Chi2 tests, Kaplan-Meier with Log-rank and Cox model for multivariate survival analysis. Results were expressed as median (interquartile range).Results: One hundred and fifty-five patients with indication of gastrostomy were included, 68.4% had accepted the gastrostomy placement. The median delay diagnosis-gastrostomy indication and gastrostomy indication-last assessment were 5.1 months (2.3 – 12.5) and 8.7 months (4.2 – 12.3), respectively. Patient who accepted gastrostomy were less often male (42.5% vs. 63.3%, p= 0.016) and had more often bulbar onset (57.6% vs. 26.5%, p=0.0003). Nutritional status and body composition at indication and at last assessment were not significantly different in patients with or without gastrostomy. At last assessment, in patient with gastrostomy ALSFRS-R was lower (14.0 points [10.8 – 22.0] vs. 20.5 points [12.8 – 26.3], p=0.01). Since gastrostomy indication median survival was higher in patient who accepted gastrostomy (10.3 months [6.7 – 17.5] vs 7.9 month [4.2 – 10.5], p=0.01). Gastrostomy was negatively associated with the risk of death in univariate analysis (HR: 0.64, p=0.01), but not in multivariate analysis. In multivariate analysis, weight loss (-1%/month) and ALSFRS-R slope (-1point/month) during follow-up were positively associated with the risk of death (aHR: 1.62; p=0.0002 and aHR: 2.37; p

Rationale: About 5%e10% of ALS patients suffer from frank ALS/FTD. In ALS, the increase of resting energy expenditure (REE) is a prognostic factor for the survival. No studies have investigated nutritional and metabolic status in ALS/FTD and its impact on survival. The aims of this study were i) to study nutritional and metabolic status of ALS/FTD compared to ALS patients, ii) to study the survival according to the disease and the metabolic status. Methods: Three months after diagnosis, nutritional assessments and body composition (by bioimpedance analysis) were performed in all patients. REE measured (mREE) by indirect calorimetry and calculated (cREE) by Harris and Benedict 1919 formula were used for the calculation of REE variation. Neurological (bulbar onset), functional (ALS Functional Rating Scale e Revised [ALSFRS-R]) and respiratory (Forced Vital Capacity [FVC]) assessments were collected. Survival by Log-rank test (Hazard Ratio [HR], confidence interval 95%) and multivariate analysis with Cox model were also used. Results were expressed as median (interquartile range). Results: 446 patients were included, 421 ALS patients and 25 (5.6%) ALS/FTD patients. Age at diagnosis and sex were not significantly different. ALS/ FTD patients had more bulbar onset (100.0% vs. 34.5%, p

Objectives Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population. Methods Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877). Results The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed: height (cm) = 72.75 + (1.86 × KHt [cm]) – (0.13 × age [y]) + 3.41 × sex (0: women; 1: men). This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula. Conclusion Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.

International audience; Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81–16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10–16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63–8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.

Introduction et but de l’etude L’augmentation de la variation de la depense energetique au repos (DER) dans la SLA est un facteur pronostique pour la survie principalement chez les patients avec une variation de DER > + 20 %. La mesure de DER par calorimetrie indirecte (CI) par rapport a DER predit avec la formule (Harris et Benedict [HB] 1919, HB 1984 ou Mifflin) est necessaire pour obtenir la variation de DER. Cependant, la CI n’est pas disponible dans de nombreux centres. La formule de Jesus et al. [1] est une formule validee pour predire la DER dans la SLA et peut etre utilisee en l’absence d’une CI. Le but de ce travail etait d’etudier la survie des patients SLA selon la variation de DER avec la CI ou la formule de Jesus et al. Materiel et methodes Des evaluations nutritionnelles et de la composition corporelle de la masse maigre (MM) et de la masse grasse (MG) (par impedancemetrie) ont ete realisees chez des patients SLA au moment du diagnostic. La DER a ete mesuree par CI (DERm) et par la formule de Jesus (DER Jesus) en utilisant la MM, la MG et le sexe. Le DERc a ete calcule en utilisant les formules d’HB 1919, HB 1984 et Mifflin. La variation de DER ( %) a ete calculee selon la formule : (DERm ou DER Jesus) − DERc/DERc × 100. La survie a ete etudiee par test du Log-rank (hazard ratio [HR], intervalle de confiance [IC] 95 %) selon la variation de DER inferieure ou superieure a 20 %. Resultats et analyse statistique Au total, 395 patients SLA avec un âge median a la CI de 66,8 ans (intervalle interquartile : 58,6–74,1) avec un sex-ratio de 1,1 ont ete inclus. L’indice de masse corporelle median etait de 22,4 kg/m2 (22,2–27,5). La DERm etait de 1500 kcal/24 h (1274–1708) avec la CI et pas significativement different avec la formule de Jesus : 1500 kcal/24 h (1291–1679) (p = 0,83). Avec la DERm par CI, une variation de DER de plus de 20 % a ete trouvee dans 21,0 %, 18,0 % et 43,0 % avec les formules d’HB 1919, HB 1984 et Mifflin comme DERc respectivement. Avec la DER Jesus, une variation de DER > 20 % a ete trouvee dans 5,1 %, 1,5 % et 25,6 % avec les formules d’HB 1919, HB 1984 et Mifflin comme cREE, respectivement. Une variation de DER > 20 % etait plus frequemment trouvee en utilisant la CI qu’avec la formule de Jesus (p Tableau 1 . Avec HB 1984 comme DERc, la survie n’etait pas significativement differente chez les patients SLA avec une variation de DER inferieure ou superieure a 20 %. Conclusion Bien qu’avec la formule de Jesus et al. une variation de DER > 20 % ait ete moins frequemment retrouvee qu’avec la CI, les patients SLA avec une variation de DER > 20 % avaient egalement une survie diminuee. En l’absence de CI pour evaluer le niveau metabolique des patients SLA, la formule de Jesus semble interessante associee aux formules d’HB 1919 ou Mifflin pour le calcul de la variation de DER au diagnostic de la maladie.

Introduction et but de l’etude Environ 50 a 60 % des patients avec une sclerose laterale amyotrophique (SLA) presente une augmentation de leur niveau metabolique ou hypermetabolisme. L’augmentation du niveau metabolique dans la SLA est definie par une variation de la depense energetique au repos (DER) entre DER mesuree (DERm) et DER calculee (DERc) de plus de + 10 %. Cependant, la variation de DER au cours de la SLA est un facteur pronostique de survie chez les patients avec une variation de DER superieure a + 20 %. Cette etude visait a etudier au diagnostic le seuil le plus pertinent de variation de DER selon plusieurs formules de DERc pour depister les patients presentant le plus haut risque d’evolution. Materiel et methodes Des evaluations nutritionnelles et de la composition corporelle (par impedancemetrie) ont ete effectuees chez des patients SLA. Le DERm a ete mesure par calorimetrie indirecte (CI) et la DERc a ete calculee en utilisant les formules d’Harris et Benedict (HB) 1919 et 1984, World Schofield, De Lorenzo, Johnstone, Mifflin, OMS/FAO, Owen, Fleisch, Wang, Rosenbaum et Nelson. L’evolution fonctionnelle (la pente de l’ALS Functional Rating Scale - Revised [ALSFRS-R] entre le diagnostic et la derniere evaluation) et respiratoire (pente de la capacite vitale forcee [CVF] entre le diagnostic et la derniere evaluation) et la survie par test de log-rank (Hazard Ratio [HR], intervalle de confiance [IC] a 95 %) ont ete etudies selon deux seuils de variation de DER 10 % et 20 %. Resultats et analyse statistique Au total, 315 patients SLA avec un âge median a la CI de 66,6 ans (intervalle interquartile : 56,9–74,1) et un sex-ratio de 1,0 ont ete inclus. En fonction de la formule predictive, une variation de DER de plus de 10 % et 20 % a ete observee chez 35,2 % a 76,3 % et chez 14,6 % a 53,3 % des patients SLA, respectivement. Les patients avec une variation de DER superieure a 10 % avec HB 1919 avaient une moins bonne evolution respiratoire (−3,2 %/mois [−6,2 a −1,5], p = 0,03). Les patients avec une variation de DER superieure a 20 % avec HB 1919 et HB 1984 avaient une survie plus faible (HR = 1,42, p = 0,01 ; HR = 1,38, p = 0,02, respectivement). De plus, avec ce meme seuil avec la formule de Mifflin, les patients avaient une moins bonne evolution fonctionnelle (−1,4 points/mois [−2,2 a −0,6], p = 0,02) et respiratoire (−3,5 %/mois [−6,5 a −1,5], p = 0,03) et une survie plus faible (HR = 1,42, p = 0,003). Conclusion En pratique clinique, les formules de DER, telles que HB 1919, HB 1984 ou Mifflin, peuvent etre utilisees comme valeur de reference par rapport a la CI pour depister les changements metaboliques des patients SLA. Avec ces formules, le seuil de variation de DER de 20 % semble le plus interessant pour depister au moment du diagnostic les patients SLA presentant un plus haut risque evolutif.

Introduction et but de l’etude Depuis 2019, les recommandations de la HAS pour diagnostiquer la denutrition chez les adultes (18–70 ans) ont change [1] . Les criteres phenotypiques qui, associes a un critere etiologique posent le diagnostic de denutrition sont, parmi d’autres, l’indice de masse corporelle (IMC), la perte de poids (PP), l’evaluation de la force musculaire par Hand Grip (HG) et l’indice de masse maigre (IMM = masse maigre/taille2). Un seul de ces criteres suffit. L’objectif de l’etude etait de determiner la prevalence de la denutrition chez des patients vus en consultation specialisee de Nutrition en utilisant comme critere phenotypique un de ces 4 criteres pris isolement ou en les associant. Materiel et methodes Etaient inclus tous les patients consecutifs pouvant avoir et acceptant les mesures de poids, taille, HG et IMM. Les limites d’IMC et de PP etaient celles definies par la HAS. La valeur maximale du HG etait mesuree par un appareil Jamar® (UK) selon les normes internationales (position assise standardisee, 6 mesures successives en alternant les cotes de mesure, conservation de la reponse maximale) [2] avec les limites HAS (denutrition si Resultats et analyse statistique Cent quinze patients (63,5 % de femmes) etaient inclus. Ils etaient âges de 47,5 ± 15,5 ans, d’IMC = 26,9 ± 9,3 kg/m2, de PP = 0,7 ± 9,9 kg, de HG = 32,6 ± 11,6 kg, d’IMM = 17,5 ± 3,8 kg/m2. Les prevalences de denutrition avec comme critere isole IMC, PP, HG et IMM etaient respectivement de 20,0 %, 12,1 %, 3,5 % et 34,8 %. Elle etait de 28,7 % en associant IMC et PP, de 31,3 % en associant HG, IMC et PP, de 44,3 % en utilisant les quatre criteres. HG et IMM n’etaient correles ni a l’âge, ni au sexe, ni entre eux. Ils etaient en revanche positivement correles au poids, a l’IMC (pour HG et poids r = 0,39, p Conclusion La HAS propose d’utiliser en priorite IMC et PP, et de n’utiliser HG et IMM qu’en seconde intention. Nos resultats montrent que l’IMM est le critere qui repere le plus de denutrition. La validite de ce critere reste cependant a preciser, car quasiment tous les appareils d’impedancemetrie calculent la masse maigre selon des formules non connues. L’utilisation du HG en tant que critere isole de denutrition ne semble pas justifiee. Son interet meme serait a preciser. L’association IMC + PP parait donc la solution a privilegier en pratique courante.

Introduction et but de l’etude La sclerose laterale amyotrophique (SLA) est une maladie rare de pronostic sombre. Au cours du suivi, le testing musculaire (MMT) permet de determiner la lateralite de l’atteinte fonctionnelle. L’examen impedancemetrique permet de determiner la composition corporelle des patients et donc la masse maigre (MM), reflet de la masse musculaire. Les donnees impedancemetriques peuvent etre lateralisees par hemicorps droit ou gauche. Les objectifs de ce travail etaient de determiner s’il existait un lien entre les modifications de composition corporelle lateralisees en impedancemetrie et le deficit moteur lateralise objective par le MMT, et de determiner si ce lien etait stable au cours de l’evolution de la maladie. Materiel et methodes L’etude etait observationnelle. Elle concernait les patients SLA suivis au CHU de Limoges entre juillet 2005 et janvier 2017. Les patients devaient avoir eu une evaluation impedancemetrique et un MMT realises de facon rapprochee (delai Resultats et analyse statistique 55 patients etaient inclus, avec un âge au diagnostic de 66 ± 12,6 ans et un sex-ratio hommes/femmes a 1,1. La MM en impedancemetrie etait de 45,4 ± 9,1 kg lors de l’evaluation initiale et de 44,4 ± 9,1 lors de l’evaluation finale. Le MMT initial etait a 134,9 ± 13,7 et a 98 ± 38,2 au final. La correlation entre les donnees lateralisees impedancemetriques et les donnees lateralisees au MMT etait positive, moderee, et significative lors de l’evaluation initiale (r = 0,38 [0,12–0,59], p = 0,0039) et positive, faible, et significative lors de l’evaluation finale (r = 0,27 [0–0,50], p = 0,0446). Conclusion Il existait une correlation positive entre les donnees impedancemetriques et de MMT lateralisees lors de l’evaluation initiale et finale. Du fait du caractere modere ou faible de cette association, l’impedancemetrie ne semble pas etre un bon examen pour predire l’evolution fonctionnelle neurologique.

Resume La denutrition est frequente en cancerologie. Cependant, elle est souvent detectee tardivement et sa prise en charge n’est pas toujours optimale. L’avis du patient, bien que souvent sollicite dans les decisions therapeutiques en oncologie, ne semble pas frequemment pris en compte dans le domaine nutritionnel. Dans le cadre de l’etude NutriCancer2012, nous avons interroge les patients, les proches et les medecins sur leur perception de l’impact de la denutrition et de la qualite de sa prise en charge. Parmi les 2209 patients interroges, la majorite se disait concernee par la problematique nutritionnelle avec 75 % qui consideraient indispensable une prise en charge nutritionnelle adaptee mais seulement 19 % faisaient le lien entre denutrition et fatigue. Les medecins sous-estimaient l’impact ressenti (par les patients) de la denutrition sur leur « qualite de vie ». Les medecins evoquaient le manque de moyens humains et de connaissance en nutrition et etaient plus de 80 % a solliciter la creation d’unites transversales de nutrition. Une sensibilisation du grand public, des patients et des proches des le diagnostic de cancer pourrait favoriser le depistage de la denutrition. Une meilleure formation en nutrition des medecins et la creation d’unites transversales de nutrition pourraient optimiser la prise en charge et en ameliorer l’efficacite au cours des traitements anticancereux.

Summary Background Nutritional status among elderly people living in Sub-Saharan Africa is poorly studied, even though undernutrition and obesity are known to cause many complications and are risk factors for progression and death in several diseases. The aims of this study were to assess the nutritional status of the elderly in Central Africa and to study the factors associated with nutritional disorders (undernutrition and obesity). Methods Two cross-sectional population-based studies were carried out in the capitals of Central African Republic (CAR) and Republic of Congo (ROC) between 2008 and 2009. Participants were aged ≥65 years old and underwent nutritional assessment including the following measurements: weight, height, body mass index (BMI), waist circumference (WC). Diet was also investigated. Nutritional status was defined according to the WHO BMI classification ( Results 990 elderly people underwent nutritional assessment (482 in CAR and 508 in ROC). Mean BMI was 22.7 ± 4.8 kg/m2. The prevalence of undernutrition was 19.2% and was lower in ROC than in CAR (9.5% vs. 29.5%; p Conclusions The prevalence of undernutrition is high in the elderly population of these countries, in contrast to obesity. Undernutrition and obesity are associated with different socio-economic factors and food consumption. Simple nutritional advice could contribute to improving the nutritional status of elderly people in Central Africa.

Resume Les medecins generalistes (MG) sont au centre de la prise en charge (PEC) des patients en exces de poids (EP), mais sont genes par une insuffisance de formation sur cette thematique. L’objectif de l’etude etait d’evaluer l’impact de nouveaux outils d’autoformation (diaporamas et fiches sur 8 themes differents) destines aux MG et portant sur l’EP. A partir d’enquetes aupres des MG du territoire du Limousin, des outils d’autoformation ont ete realises et diffuses par Internet et en format papier. Apres diffusion, un questionnaire d’impact sur les connaissances et pratiques a ete envoye par la poste aux 1189 MG du Limousin. Deux cent trente-trois questionnaires ont ete recus (19,6 % des envois). Les MG femmes (p = 0,006 vs les MG hommes) et les MG deja « formes » en nutrition (p = 0,02 vs les MG « non formes ») etaient les plus interesses par la prise en charge des patients en EP. Seulement 2,7 % des MG ont declare que les outils ne leur ont rien apporte. Le theme considere comme etant le plus pertinent etait le parcours de soin. Les MG femmes (p = 0,03) et les MG « non formes » (p = 0,02 a 0,04 selon les criteres) etaient particulierement beneficiaires. Au total, 71,7 % des MG ont declare avoir l’intention de diffuser les fiches aupres de leurs patients. Malgre un taux de reponse modeste, l’enquete suggere que les outils ont interesse les MG et sont utiles pour la PEC.

International audience; Rationale: Amyotrophic lateral sclerosis (ALS) is a severe neurological disease very often accompanied by malnutrition. Nutritional status and body composition are factors associated with survival. The total body bioelectric impedance analysis (BIA) with a validated equation (Desport et al.) allows to assess the body composition during this disease, but requires the appropriate equipment. Measuring body composition using the four skin folds is simple to perform but not validated in ALS. The aim of our work was to study the agreement of measurements of Fat-Free Mass (FFM) by BIA compared to the skin folds method.Methods: We included all the measurements between 2000 and 2018, for which the ALS patients had a BIA and the measurement of the four skin folds. Skin fold measurements (tricipital, bicipital, subscapular and super-iliac) were performed 3 times on each side and then averaged. The Fat Mass (FM) obtained from the formula of Siri and Durnin & Womersley, allowed us to obtain the FFMsf (weight minus FM). The BIA was performed at 50 kHz. The FFMimp in BIA was calculated using the validated equation of Desport et al. also requiring the measurement of the tricipital skin fold. The correlation between the two methods was evaluated by linear regression and the agreement by the Bland-Altman method.Results: 1045 measurements were studied. The mean age of the patients was 65.0 ± 11.6 years and the sex ration M / F ratio was of 1.1. In BIA, the mean FFMimp was of 46.1 ± 9.1 kg and FFMsf of 44.5 ± 9.3 kg. There was a good correlation between the two methods (R = 0.91, p

Introduction et but de l’etude Les donnees issues de differentes etudes epidemiologiques soutiennent le fait que le deficit biologique en vitamine C (modere et/ou a risque scorbutique) serait relativement frequent. Contrairement a la carence profonde (scorbut), l’hypovitaminose C est generalement asymptomatique ou associee a des signes generaux non specifiques. L’evaluation du statut vitaminique C s’effectue par le dosage sanguin de l’acide ascorbique total. La place du dosage biologique de l’ascorbemie dans le suivi de pathologies nutritionnelles est aujourd’hui debattue. L’objectif de l’etude etait d’evaluer i) le statut en vitamine C de patients vus en consultation de Nutrition ii) l’association entre le statut nutritionnel et la carence en vitamine C. Materiel et methodes Cette etude retrospective a ete realisee chez des patients vu en consultation externe dans une Unite Transversale de Nutrition entre janvier et octobre 2018. Le dosage de l’ascorbemie par chromatographie en phase liquide a haute performance etait realise a la suite de la consultation au laboratoire du CHU (normale: 26,1 - 84,6 μmol/L). Les donnees cliniques etaient recueillies: l’âge, le poids, l’indice de masse corporelle (IMC), le tour de taille (TT), la composition corporelle et l’angle de phase (AP) en impedancemetrie, la prise d’une supplementation vitaminique. L’analyse statistique comprenait les tests de Mann–Whitney, du chi2 et la regression logistique multivariee. Resultats et analyse statistique Un total de 295 dosages, soit 270 patients ont ete etudies (certains patients avaient eu plusieurs dosages au cours de leur suivi). L’âge moyen etait de 51,9 ± 17,2 ans et 32,2 % etaient des hommes. L’IMC moyen etait de 24,5 ± 7,9 kg/m2, 28,9 % des patients etaient denutris et 19,0 % obeses. Le taux moyen de vitamine C etait de 49,2 ± 31,1 μmol/L. 31 %des patients etaient carences (dont 55 % en hypovitaminose C et 45 % seuil scorbutique [ Conclusion Ce travail retrouve une carence en vitamine C dans pres d’un tiers des cas, y compris en dehors de situations de grande precarite et parfois en l’absence de symptomatologie specifique. Nous n’avons pas retrouve de lien entre la presence d’une carence en vitamine C et l’etat nutritionnel. Ceci pourrait justifier la pertinence du dosage de la vitamine C en consultation de Nutrition quelque soit le statut nutritionnel. Ces elements meritent d’etre etayes par de nouvelles etudes afin de valider les recommandations recentes de l’HAS.

Introduction et but de l’etude Les fausses routes (FR) sont un danger permanent chez les personnes âgees en EHPAD, et une source importante d’anxiete chez les soignants et les entourages. Dans le but de tester un nouvel outil a type de robot conversationnel (« chatbot ») de depistage et de conseil concernant les FR, l’etude evaluait les resultats obtenus avec application du questionnaire integre dans le logiciel du robot. Materiel et methodes Le questionnaire etait applique par les personnels a 50 patients aleatoires. Il reprenait les principaux elements du depistage des FR presentes par ailleurs [1] , ainsi que des elements potentiellement associes aux FR. On utilisait les tests du Chi2 et de Mann–Whitney. Resultats et analyse statistique La population incluait 74 % de femmes. L’âge moyen etait de 88,4 ± 6,1 ans, l’IMC de 24,6 ± 4,6. 86,0 % des patients avaient une pathologie neurologique. On detectait des FR (apres alimentation ou boisson : presence d’une toux ou d’une voix voilee ou d’une voix gargouillante) chez 62,0 % des patients. Lorsqu’il y avait une FR, elle etait uniquement aux solides dans 12,9 % des cas, uniquement aux liquides dans 29,0 % des cas et mixte dans 58,1 % des cas. 4 % des patients avaient une bouche seche, 12,0 % un bavage, 22,0 % des problemes dentaires, 34,0 % une duree de repas principal > 45 minutes, 50,0 % recevaient > 5 medicament/j, et 22,0 % faisaient des infections pulmonaires a repetition. 32,0 % des patients avaient une aide humaine et 18,0 % une aide materielle. Les patients qui faisaient des FR, versus ceux qui n’en faisaient pas avaient plus souvent une deglutition lente (25,8 % vs 0 % des cas, p = 0,02), des problemes dentaires (32,5 vs 5,3 % des cas, p = 0,02), un temps de repas principal > 45 minutes (51,6 vs 5,3 % des cas, p = 0,0008), des infections pulmonaires a repetition (32,3 vs 5,3 % des cas, p = 0,02). La satisfaction des soignants a la pratique des tests etait notee a 7,5 ± 1,8/10. Pour 31 % des patients avec FR, le bilan indiquait l’interet d’une mise en nutrition enterale. Pour les 69 % restants, des conseils de texture ou d’autres soins etaient prodigues (traitement de la bouche seche, du bavage, des dents, aide au repas, reduction du nombre des medicaments). Conclusion 62 % des patients faisaient des FR, en lien positif avec la presence d’une deglutition lente ou difficile, de problemes dentaires, de temps de repas longs, de pneumopathies a repetition. Les FR uniquement aux solides qui indiquent non pas un epaississement, mais une fluidifictaion de l’alimentation, n’etaient pas rares. Les bilans permettaient de corriger les modalites d’alimentation de nombreux patients. L’indice de satisfaction du questionnaire destine au robot conversationnel etait bon.

Introduction et but de l’etude La sclerose laterale amyotrophique (SLA) est une maladie neurologique d’evolution severe tres souvent accompagnee de denutrition. L’etat nutritionnel et la composition corporelle sont des facteurs associes a la survie. L’impedance bioelectrique corporelle totale (BIA) avec une equation validee permet d’evaluer la composition corporelle au cours de cette maladie, mais necessite l’appareillage adapte. La mesure de la composition corporelle a l’aide des quatre plis cutanes est simple a realiser mais non validee dans la SLA. L’objectif de notre travail etait d’etudier la concordancedes mesures de masse maigre (MM) par BIA par rapport a la technique des plis cutanes. Materiel et methodes Nous avons inclus toutes les mesures entre 2000 et 2018, pour lesquelles les patients SLA avaient eu une BIA et la mesure des 4 plis cutanes. Les mesures des pli cutanes (tricipital, bicipital, sous-scapulaire et surpra-iliaque) etaient realisees 3 fois de chaque cote puis moyennees. La masse grasse (MG) obtenue a partir avec la formule de Siri et de Durnin & Womersley, nous permettait d’obtenir la MM en retranchant MG au poids du patient. La BIA etait realisee a 50 kHz. La MM en BIA etait calculee en utilisant l’equation validee de Desport et al. necessitant aussi la mesure du plis cutane tricipital. La correlation entre les deux methodes etait evaluee par regression lineaire et la concordance par la methode de Bland-Altman. Resultats et analyse statistique Un total de 1045 mesures ont pu etre etudiees. L’âge moyen des patients etait de 65,0 ± 11,6 et le sexe ratio H/F de 1,1. En BIA, la MM moyenne etait de 46,1 ± 9,1 kg et de 44,5 ± 9,3 kg avec la methode des plis cutanes. La correlation etait bonne entre les deux methodes (R = 0,91, p Conclusion La mesure de la composition corporelle dans la SLA par methode des plis cutanes sous-estime la MM comparee a la BIA avec formule de reference. Les limites de concordance sont importantes et non acceptables en pratique clinique. Ceci suggere que cette methode bien que simple et peu couteuse ne peut pas etre utilisee de maniere fiable pour determiner la MM chez les patients SLA.

Introduction et but de l’etude La prevalence de denutrition chez les personnes âgees en etablissement d’hebergement pour personnes âgees dependants (EHPAD) est evaluee entre 15 et 40 %, mais les donnees francaises sont tres rares. Le reseau ARS Limousin Nutrition (LINUT) evalue et prend en charge du point de vue nutritionnel les residents d’EHPAD. L’objectif de l’enquete etait d’evaluer les residents de 13 EHPAD volontaires en Limousin de maniere exhaustive. Materiel et methodes Les evaluations etaient realisees entre 2008 et 2014. L’analyse etait retrospective. L’etat nutritionnel des residents etait determine grâce aux criteres de la HAS de 2007 (âge > 70 ans), ou de 2003 (âge Resultats et analyse statistique Etaient inclus 866 residents (66,6 ± 14,7 residents/EHPAD), dont 70,6 % de femmes, avec un âge moyen de 85,3 ans ± 9,3 ans, un IMC moyen de 26,4 ± 5,3 kg/m2. 45,7 % des patients etaient dements et 31,1 % avaient une mobilite reduite. La prevalence de la denutrition etait de 27,5 %, du surpoids de 16,5 %, de l’obesite de 22,9 %. Les femmes etaient plus souvent denutries que les hommes (30,7 % versus 20,0 %, p = 0,01), plus âgees (87,1 ± 8,1 versus 80,7 ± 10,4 ans, p Conclusion Cette enquete est la premiere enquete nutritionnelle exhaustive realisee en EHPAD en France. La denutrition etait presente dans 27,5 % des cas, touchant plus souvent les femmes, les residents dements et ceux a mobilite tres reduite. Cette valeur est dans la fourchette des valeurs internationales (4,8–53,3 %), cependant tres disparates quant aux recrutements et aux methodes utilisees. 22,9 % des residents etaient obeses, dans les limites publiees en institutions (16,2–28,0 %). Les prevalences de la denutrition et de l’obesite etaient bien superieures a celles des personnes âgees vivant au domicile (respectivement 2,6 % et 16,0 %) [1] .

Introduction et but de l’etude Depuis decembre 2015, le CHU de Limoges a recu une approbation de la SFNCM pour poursuivre l’activite d’encadrements des patients sous nutrition parenterale a domicile de longue duree (NPLD). L’objectif de ce travail etait de decrire l’activite de suivi des patients en NPLD de ce centre en 2016, 2017 et 2018. Materiel et methodes L’etude prospective portait sur les patients recus au CHU de Limoges pour initiation ou suivi de NPLD entre janvier 2016 et decembre 2018. L’etude relevait des donnees concernant l’activite de consultation, les patients, les modalites de realisation de la NPLD, et les complications en rapport. L’analyse statistique utilisait les tests du Chi2 ou de Fisher, de Mann Whitney, ANOVA et une regression logistique pour recherche des facteurs lies a la survenue d’episodes infectieux liees au catheter veineux central (ILCVC). Resultats et analyse statistique Trent six patients entraient dans la file active sur les 3 annees, avec une hausse de la file active annuelle de 15 a 26 patients et du nombre de consultations dediees de 83 a 159 par an. Le suivi median depuis le debut de la prise en charge etait de 7,0 mois (extremes = 1-99,5 mois), concernant des adultes majoritairement âges de plus de 55 ans (extremes = 19–88 ans), principalement issus du Limousin et des departements limitrophes. Les syndromes du grele court de type 1 (31 a 46 % selon l’annee) et 2 (15 a 20 %) etaient les causes les plus frequentes de mise sous NPLD. Les acces vasculaires les plus utilises etaient le catheter tunnelise manchonne (19 a 47 %), le catheter a chambre implantable (29 a 42 %) et le catheter central a insertion peripherique (20 a 50 %). Pres d’un patient sur deux etait encadre par un service d’hospitalisation a domicile et peu d’entre eux etaient en auto-soin. 73 a 88 % des patients beneficiaient de poches industrielles. Selon l’annee etudiee, le taux d’incidence d’ILCVC variait de 0,67 a 1,16 pour 1000 jours de NPLD et 26 a 50 % des patients presentaient une complication aigue autre qu’infectieuse. L’activite, les caracteristiques des patients, les modalites de realisation de la NPLD et la survenue de complications n’etaient pas significativement differentes selon les annees etudiees. Les patients suivis depuis le plus longtemps (p = 0,01) et beneficiant de consultations plus rapprochees (p = 0,02) presentaient significativement moins d’ILCVC. Conclusion La FA de patients en NPLD de ce centre est modeste, mais ce bilan objective un besoin croissant d’offre de soins sur un territoire vaste. Les caracteristiques des patients suivis et les pratiques semblaient proches de celles d’autres centres. L’etude confirmait l’importance du suivi rapproche et des mesures educatives en prevention des complications.

Abstract. Background & Aims: Epilepsy affects nearly 70 million people worldwide. Vitamin D deficiency may influence the balance of certain epilepsies. The purpose of this study was to determine the vitamin D status and anthropometric measurements of people with epilepsy (PWE), according to their pharmacosensitivity. Methods: Forty-six PWE, with or without drug resistance, underwent nutritional assessment after giving consent. Weight, body mass index (BMI), triceps skinfold thickness (TSF), fat mass (FM) and free fat mass (FFM) by bioelectrical impedance analysis were measured. Serum vitamin D was determined without supplementation. Deficiency was defined as a level 2. Results: Patients were aged 44.5 ± 14.3 years, with 60.9% of drug-resistance. BMI was 28.7 ± 7.0, 2.2% were malnourished and 30.4% obese according to the BMI. The average vitamin D level was 15.3 ± 9.9 ng/mL, with 87.0% of deficiency, and 40.0% of severe deficiency (

International audience; Introduction et but de l’étude: Le vieillissement de la population camerounaise sera un problème de santé publique dansles prochaines années. L’état socio-économique et nutritionnel des personnes âgées est mal connu. Une seulepublication a montré une prévalence de dénutrition de 5,5%, d'obésité de 19,0 % chez des personnes âgées de plus de55 ans en zone rurale. L’étude avait pour but de réaliser une évaluation nationale de l'état nutritionnel, de l'état de santéet des facteurs sociodémographiques associés chez des personnes âgées au Cameroun.Matériel et méthodes: L’étude était menée dans des quartiers et villages pris au hasard et auprès de 599 personnesd’âge de 60 ans et plus, dont 33,6% vivaient en zone urbaine. Des données sociodémographiques (sexe, âge,éducation), sanitaire (pathologie, traitement) et anthropométriques (poids, indice de masse corporelle (IMC), tour detaille, circonférence brachiale (CB)) étaient recueillies L'état nutritionnel était défini par la classification OMS. Etudeapprouvée par le Comité d’Ethique de l’Université de Douala. Les analyses comprenaient les tests de Mann-Whitney etdu Chi2. Significativité au seuil de 5%.Résultats et Analyse statistique : L’âge des personnes était de 68,9±7,2 ans, leur sex-ratio H/F=0,93, leur poids de 68,5±14,7 kg. Leur IMC était de 24,7±5,3 plus élevé en zone urbaine (25,7 ±5,3) que rurale (24,1±5,3, p=0,001), faiblementcorrélé aux pressions artérielles systolique (r=0,12 p=0,02) et diastolique (r=0,15 p=0,0001). Le tour de taille moyen étaitde 90,1±12,8 cm, la CB était de 28,2±5,0 cm et plus élevé en zone urbaine (p

International audience; .Background: Gastrostomy is recommended in patients with Amyotrophic Lateral Sclerosis (ALS) in the presence of weight loss over 10% as compared to usual weight, repeated aspirations or meal time duration longer than 45 min. Currently, the impact of gastrostomy on survival of ALS patients is not clear. Aims: i) to describe diagnosis factors associated with the indication for gastrostomy ii) to evaluate survival of ALS patients with gastrostomy indication according to their acceptance of feeding tube placement. Methods: Patients with ALS were included and followed in the ALS referral centre of Limoges's teaching hospital between 2006 and 2017. Neurological, nutritional and respiratory status was assessed prospectively from diagnosis to death. Statistical analysis was performed using Mann-Whitney test, Chi2 tests, Cox model and multivariate logistic regression. Results: Two hundred and eighty-five patients were included. Among the 182 for whom gastrostomy was indicated, 63.7% accepted the placement. The median time was 7.3 months [IQR: 3.2-15.0] and 2.7 months [IQR: 0.9-5.8] respectively from diagnosis to indication and from indication to placement. Weight loss >5% significantly increased the risk of death by 17% (p < 0.0001). At time of diagnosis, bulbar onset, a loss of one point in the body mass index or on the bulbar functional scale were all positively associated with indication for gastrostomy (aOR = 10.0 [95%CI: 1.96-25.0]; p = 0.002, aOR = 1.17 [95%CI: 1.02-1.36]; p = 0.025 and aOR = 1.19 [95%CI: 1.06-1.32]; p = 0.002, respectively). However, gastrostomy placement did not have any impact on survival (aHR = 1.25 [95%CI: 0.88-1.79]; p = 0.22). Conclusion: Both neurological and nutritional criteria were associated with an indication for gastrostomy at diagnosis. Gastrostomy placement had no impact on survival. The study of earlier gastrostomy placement might be of interest in further prospective studies.

Objectives Approximately 50% to 60% of amyotrophic lateral sclerosis (ALS) is characterized by an increase in metabolic rate. The Harris and Benedict (HB) 1919 formula is the equation mainly used to calculate resting energy expenditure (cREE) compared with measured REE (mREE) by indirect calorimetry (IC), but other formulas are also applied in current practice. The present study aimed to assess mREE in patients with ALS compared with 12 cREE formulas and study the relevant threshold of REE variation to screen patients with a higher evolving risk. Methods Nutritional assessments and body composition (by bioimpedance analysis) were performed in patients with ALS. mREE was measured by IC, and cREE was calculated using the HB 1919, HB 1984, World Schofield, De Lorenzo, Johnstone, Mifflin, World Health Organization/Food and Agriculture Organization, Owen, Fleisch, Wang, Rosenbaum, and Nelson formulas. Functional and respiratory evolution and survival by log-rank test according to two thresholds of REE variation (10% and 20%) were studied. Results A total of 315 patients with ALS were included in the study. The median mREE was 1503 kcal/24 h (range, 1290–1698 kcal/24 h), which was higher than all predictive equations (P 10% and 20% was found in 35.2% to 76.3% and 14.6% to 53.3% of patients with ALS, respectively. Patients with an REE variation >20% with HB 1919 and HB 1984 had a lower survival. Moreover, with this same threshold and the Mifflin formula, patients had higher functional and respiratory evolutions and lower survival. Conclusions The increase in metabolic rate is present according to the different cREE formulas used compared with IC. In clinical practice, REE formulas (e.g., HB 1919, HB 1984, or Mifflin) can be used as a reference value compared with IC to screen patients with ALS with an REE variation >20% and a higher evolving risk.