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9. Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment

Author

Manckoundia P, Konaté A, Hacquin A, Nuss V, Mihai AM, Vovelle J, Dipanda M, Putot S, Barben J, and Putot A

Subjects
anemia, iron deficiency, iron metabolism, older adults, Geriatrics, RC952-954.6
Abstract

Patrick Manckoundia,1 Amadou Konaté,2 Arthur Hacquin,1 Valentine Nuss,1 Anca-Maria Mihai,1 Jérémie Vovelle,1 Mélanie Dipanda,1 Sophie Putot,1 Jérémy Barben,1 Alain Putot1 1“Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital of Dijon Burgundy, Dijon, France; 2Unit of Diagnosis and Rapid Orientation (DIAGORA), Internal Medicine Department, Hospital of Saint-Eloi, University Hospital of Montpellier, Montpellier, FranceCorrespondence: Patrick Manckoundia Service de Médecine Interne GériatrieHôpital de Champmaillot CHU, 2, Rue Jules Violle, Dijon Cedex 21079, FranceTel + 333 80 29 39 70Fax + 333 80 29 36 21Email patrick.manckoundia@chu-dijon.frAbstract: Iron is involved in many types of metabolism, including oxygen transport in hemoglobin. Iron deficiency (ID), ie a decrease in circulating iron, can have severe consequences. We provide an update on iron metabolism and ID, highlighting the particularities in older adults (OAs). There are three iron compartments in the human body: 1) the functional compartment, which consists of heme proteins including hemoglobin, myoglobin and respiratory enzymes; 2) iron reserves (IR), which consist mainly of liver stocks and are stored as ferritin; and 3) transferrin. There are two types of ID. Absolute ID is characterized by a decrease in IR. Its main pathophysiological mechanism is bleeding, which is often digestive and can be due to neoplasia, frequent in OAs. Biological assessment shows low serum ferritin and transferrin saturation (TS) levels. Furthermore, hypochromic microcytic anemia is frequent, and the serum-soluble transferrin receptor (sTfR) level is high. Functional ID, in which IR are high or normal, is due to inflammation, which is also frequent in OAs, particularly in its chronic form. Biological assessments show high serum ferritin, normal or low TS, and normal sTfR levels. Moreover, C-reactive protein is elevated, and there is moderate non-regenerative non-macrocytic anemia. The main characteristics of iron metabolism anomalies in the elderly are the high frequency of ID (20% of ID with anemia in adults ≥ 85 years) and the severity of its consequences, which include cognitive impairment in case of ID or iron overload and decrease of physical activity in case of ID. In conclusion, causes of ID are frequently intertwined in OAs as a result of the polymorbidity that characterizes them. ID can have dramatic consequences, especially in frail OAs. Thus, measuring the appropriate biological markers prevents errors in the positive diagnosis of ID type, clarifies etiology, and informs treatment-related decision-making.Keywords: anemia, iron deficiency, iron metabolism, older adults

Published
2020

23. L’augmentation du pourcentage de lymphocytes Th17 est associée à un risque d’évolution vers une forme grave d’infection à SARS-CoV-2

Author

Samson, M., primary, Nicolas, B., additional, Guilhem, A., additional, Greigert, H., additional, Ciudad, M., additional, Cladiere, C., additional, Straub, C., additional, Blot, M., additional, Piroth, L., additional, Rogier, T., additional, Devilliers, H., additional, Manckoundia, P., additional, Ghesquiere, T., additional, Francois, S., additional, Lakomy, D., additional, Audia, S., additional, and Bonnotte, B., additional

Published
2022
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26. Cervical cancer in older women, does age matter?

Author

Barben, J., primary, Mamguem Kamga, A., additional, Dabakuyo-Yonli, T.S., additional, Hacquin, A., additional, Putot, A., additional, Manckoundia, P., additional, Bengrine-Lefevre, L., additional, and Quipourt, V., additional

Published
2021
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32. Association between physical activity, growth differentiation factor 15 and bodyweight in older adults: A longitudinal mediation analysis

Author

Raffin, Jérémy, Rolland, Yves, Parini, Angelo, Lucas, Alexandre, Guyonnet, Sophie, Vellas, Bruno, Souto Barreto, Philipe, Vellas, Bruno, Guyonnet, Sophie, Carrié, Isabelle, Brigitte, Lauréane, Faisant, Catherine, Lala, Françoise, Delrieu, Julien, Villars, Hélène, Combrouze, Emeline, Badufle, Carole, Zueras, Audrey, Andrieu, Sandrine, Cantet, Christelle, Morin, Christophe, Abellan Van Kan, Gabor, Dupuy, Charlotte, Rolland, Yves, Caillaud, Céline, Ousset, Pierre‐Jean, Lala, Françoise, Willis, Sherry, Belleville, Sylvie, Gilbert, Brigitte, Fontaine, Francine, Dartigues, Jean‐François, Marcet, Isabelle, Delva, Fleur, Foubert, Alexandra, Cerda, Sandrine, Cuffi, Marie Noëlle, Costes, Corinne, Rouaud, Olivier, Manckoundia, Patrick, Quipourt, Valérie, Marilier, Sophie, Franon, Evelyne, Bories, Lawrence, Pader, Marie‐Laure, Basset, Marie‐France, Lapoujade, Bruno, Faure, Valérie, Li Yung Tong, Michael, Malick‐Loiseau, Christine, Cazaban‐Campistron, Evelyne, Desclaux, Françoise, Blatge, Colette, Dantoine, Thierry, Laubarie‐Mouret, Cécile, Saulnier, Isabelle, Clément, Jean‐Pierre, Picat, Marie‐Agnès, Bernard‐Bourzeix, Laurence, Willebois, Stéphanie, Désormais, Iléana, Cardinaud, Noëlle, Bonnefoy, Marc, Livet, Pierre, Rebaudet, Pascale, Gédéon, Claire, Burdet, Catherine, Terracol, Flavien, Pesce, Alain, Roth, Stéphanie, Chaillou, Sylvie, Louchart, Sandrine, Sudres, Kristel, Lebrun, Nicolas, Barro‐Belaygues, Nadège, Touchon, Jacques, Bennys, Karim, Gabelle, Audrey, Romano, Aurélia, Touati, Lynda, Marelli, Cécilia, Pays, Cécile, Robert, Philippe, Le Duff, Franck, Gervais, Claire, Gonfrier, Sébastien, Gasnier, Yannick, Bordes, Serge, Begorre, Danièle, Carpuat, Christian, Khales, Khaled, Lefebvre, Jean‐François, Misbah El Idrissi, Samira, Skolil, Pierre, Salles, Jean‐Pierre, Dufouil, Carole, Lehéricy, Stéphane, Chupin, Marie, Mangin, Jean‐François, Bouhayia, Ali, Allard, Michèle, Ricolfi, Frédéric, Dubois, Dominique, Bonceour Martel, Marie Paule, Cotton, François, Bonafé, Alain, Chanalet, Stéphane, Hugon, Françoise, Bonneville, Fabrice, Cognard, Christophe, Chollet, François, Payoux, Pierre, Voisin, Thierry, Delrieu, Julien, Peiffer, Sophie, Hitzel, Anne, Allard, Michèle, Zanca, Michel, Monteil, Jacques, Darcourt, Jacques, Molinier, Laurent, Derumeaux, Hélène, Costa, Nadège, Perret, Bertrand, Vinel, Claire, Caspar‐Bauguil, Sylvie, Olivier‐Abbal, Pascale, Andrieu, Sandrine, Cantet, Christelle, and Coley, Nicola

Abstract

Late‐life aging is often associated with appetite reduction and weight loss. Physical activity (PA) may prevent these processes, but the molecular mechanisms involved remain elusive. The present study investigated the putative mediating aspect of growth differentiation factor 15 (GDF‐15), a stress signalling protein involved in aging, exercise and appetite control, on the association between PA and late‐life‐associated weight loss. One thousand eighty‐three healthy adults (63.8% women) aged 70 years and over who participated in the Multidomain Alzheimer Preventive Trial were included. Bodyweight (kg) and PA levels (square root of metabolic equivalent of task‐min/week) were assessed repeatedly from baseline to the 3‐year visit, whereas plasma GDF‐15 (pg/mL) was measured at the 1‐year visit. Multiple linear regressions were performed to test the association between first‐year mean PA level, 1‐year visit GDF‐15 concentration and subsequent bodyweight changes. Mediation analyses were used to investigate whether GDF‐15 mediated the association between first‐year mean PA levels and consecutive bodyweight changes. Multiple regression analyses demonstrated that higher first‐year mean PA levels significantly predicted lower GDF‐15 and bodyweight at 1 year (B = −2.22; SE = 0.79; P= 0.005). In addition, higher 1‐year visit GDF‐15 levels were associated with faster subsequent bodyweight loss (Time × GDF‐15 interaction B = −0.0004; SE = 0.0001; P= 0.003). Mediation analyses confirmed that GDF‐15 mediated the association between first‐year mean PA levels and subsequent bodyweight changes (mediated effect ab = 0.0018; bootstrap SE = 0.001; P< 0.05) and revealed that mean PA had no direct effect on subsequent bodyweight changes (c′ = 0.006; SE = 0.008; P> 0.05). This study suggests that GDF‐15 may be one of the molecules mediating the link between PA and late‐life weight loss, but mechanistic studies are necessary to further support the present findings.

Published
2023
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33. Psychomotor disadaptation syndrome

Author

Manckoundia, P., Mourey, F, université de Bourgogne, CAPS, Service de médecine gériatrique (CHU de Dijon - Centre gériatrique de Champmaillot - EHPAD), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), and Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Posture, food and beverages, frontal dysfonction syndrome, Syndrome, Adaptation, Physiological, Backward disequilibrium, Elderly, Sub, Sensation Disorders, Humans, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Accidental Falls, Falls, France, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Gait, Postural Balance, cortico
Abstract

Psychomotor disadaptation syndrome (PDS) was first described by the Geriatrics School of Dijon (France), three decades ago, under the name «psychomotor regression syndrome». Over time, the original clinical features remained unchanged. However, progress has been made in its pathophysiology understanding and care, hence the new name, PDS, appeared in the 1990s. The PDS is also called sub-cortico-frontal dysfunction syndrome since the 2000s. It corresponds to a decompensation of posture, gait and psychomotor automatisms, related to an alteration of the postural and motor programming, which is a consequence of sub-cortico-frontal lesions. The clinical features of PDS associate backward disequilibrium, nonspecific gait disorders and neurological signs (akinesia, reactional hypertonia, impaired reactive postural responses and protective reactions, etc.). Psychological disorders of PDS are a fear of standing and walking in its acute form (the post-fall syndrome), or a bradyphrenia and anhedonia in its chronic form. The PDS occurrence results from the combination of three factors implicated in the reduction in functional reserves related to the alteration of the sub-cortico-frontal structures: ageing, chronic afflictions and acute situations, which induce a decrease in cerebral blood flow. The PDS management must be multidisciplinary, including the physician, the physiotherapist, the psychologist, nurses and care assistants.Le syndrome de désadaptation psychomotrice (SDPM) fut initialement décrit par l’école de Gériatrie dijonnaise (France), il y a trois décennies, sous l’appellation «syndrome de régression psychomotrice». Si la description clinique initiale reste inchangée, des progrès furent cependant réalisés dans sa physiopathologie et sa prise en charge, d’où le nouveau nom, SDPM, apparu dans les années 1990. Le SDPM est aussi appelé syndrome de dysfonctionnement sous-cortico-frontal depuis les années 2000. Il traduit une décompensation posturale de la marche et des automatismes psychomoteurs, liée à une altération de la programmation posturo-motrice, consécutive à des lésions sous-cortico-frontales. Le SDPM se caractérise par une rétropulsion, des anomalies aspécifiques de la marche et des signes neurologiques (hypertonie réactionnelle, diminution des réactions d’adaptation posturale et des réactions parachutes …). Les signes psychologiques sont une peur de la marche, voire du lever dans la forme aiguë (syndrome post-chute), une bradypsychie avec anhédonie dans sa forme chronique. L’apparition du SDPM résulte de l’association de trois facteurs impliqués dans la diminution des réserves fonctionnelles, diminution liée à l’altération des structures sous-cortico-frontales : vieillissement, pathologies chroniques et situations aiguës réduisant le flux sanguin cérébral. La prise en charge du SDPM est pluridisciplinaire, incluant médecins, kinésithérapeutes, psychologues et équipe soignante.

Published
2019
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42. Clostridioides difficile infection after pneumonia in older patients: Which antibiotic is at lower risk?

Author

Bonnassot, P., Barben, J., Tetu, J., Bador, J., Bonniaud, P., Manckoundia, P., Putot, A., Bonnassot, Pauline, Barben, Jeremy, Tetu, Jennifer, Bador, Julien, Bonniaud, Philippe, Manckoundia, Patrick, and Putot, Alain

Abstract

Background: Clostridioides difficile infection (CDI) is a frequent and severe complication of antibiotic treatment in older patients hospitalized for acute pneumonia (AP).Aims: We aimed to assess the burden and risk factors of CDI and to determine which of the usual antibiotics regimens is at lower risk for post-AP CDI incidence.Methods: Among patients aged >75y hospitalized for AP in all departments of a university hospital between 2007 and 2017, all the 92 patients developing a CDI were compared with 213 patients without CDI. Factors associated with 1) in-hospital and one-year mortality, 2) CDI incidence were assessed using logistic regression models.Findings: In patients with and without CDI after AP, mortality rates were respectively at 34% vs 20% in hospital and 63% vs 42% at one-year. After adjustment for confounders, CDI was associated with a two-fold risk of in-hospital and one-year mortality after pneumonia (Respective Odds Ratio (95% Confidence Interval), OR (95%CI): 1.95 (1.06-3.58) and 2.02 (1.43-7.31)). High number of antibiotics (Per antibiotic, OR (95%CI): 1.89 (1.18-3.06)), rather than antibiotics duration (Per day, OR 95%CI): 1.04 (0.96-1.11)) was associated with a higher risk of CDI. Compared with other antibiotics, use of penicillin + beta-lactamase inhibitors was associated with a lower risk of CDI (OR (95%CI): 0.43 (0.19 -0.99)) CONCLUSION: In older inpatients, CDI highly increase the burden of AP at both short and long term. If confirmed, these results suggest the preferential use of penicillin + beta-lactamase inhibitors for a lower incidence of CDI in older inpatients with AP. [ABSTRACT FROM AUTHOR]

Published
2020
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