A. Zbidi

Effects of two-month physical-endurance and diet-restriction programmes on lipid profiles and insulin resistance in obese adolescent boys

AIM The aim of this study was to assess the impact of a two-month programme of physical endurance and dietary restriction, alone and combined, on plasma lipids and insulin resistance in obese adolescents. METHODS A total of 24 obese adolescent boys participated in programmes of either dietary restriction (R), physical endurance at the point of maximum lipid oxidation (LIPOX(max)) (E) or diet combined with training (R+E). Anthropometric characteristics, metabolic measures and biochemical analyses were performed in all subjects before and after the interventions. An estimated insulin resistance was calculated using the homoeostasis model assessment (HOMA-IR) index. RESULTS At the end of the two-month programmes, adolescents in the R+E group showed greater reductions in body mass index (-3.9+/-0.7 kg/m(2)) and waist circumference (-12.3+/-4.8 cm) (P<0.001) than either the R or E group. A significant decrease (P<0.01) in HOMA-IR index (-2.13+/-0.11), plasma triglycerides, LDL and total cholesterol was also seen in the R+E group. Moreover, at the end of the programme, the ratio of HDL cholesterol to triglycerides was significantly increased from baseline in the R+E group (0.93+/-0.09 vs. 0.68+/-0.11; P<0.01). CONCLUSION Compared with either moderate physical endurance or dietary restriction, a combination of both resulted in a significant decrease in cardiovascular risk factors and HOMA-IR index in obese adolescent boys.

The forgotten message from gold: FVC is a primary clinical outcome measure of bronchodilator reversibility in COPD.

BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the use of forced expiratory volume in 1s (FEV(1)) to assess airways reversibility. The American Thoracic Society (ATS) and the European Respiratory Society (ERS) recommend FEV(1) and/or forced vital capacity (FVC). This study assessed whether FVC detects reversibility in more chronic obstructive pulmonary disease (COPD) patients than FEV(1) after acute short-acting bronchodilator inhalation. METHODS Plethysmographic data of 168 consecutive stable male COPD patients who underwent reversibility testing were analyzed. RESULTS Seventy-seven patients showed a clinically significant increase in FVC, whereas only 49 patients showed a clinically significant increase in FEV(1). Thus, FVC detected reversibility in 57% more patients than FEV(1). Of the 90 patients showing clinically significant reversibility, FEV(1) did not detect 41 patients that FVC detected, indicating a 45% difference. CONCLUSION FEV(1) underestimates acute bronchodilation effects. FVC should thus be a primary clinical outcome measure of bronchodilator reversibility in COPD, as it detects reversibility in more patients. This message, forgotten by GOLD, should be promoted in future consensus statements.

Spirometric profile of narghile smokers

INTRODUCTION Studies of the spirometric profiles of narghile smokers are few, have some methodological limits (i.e. small sample size), and present contradictory conclusions. AIMS (i) To determine the percentage of narghile smokers with obstructive ventilatory defect (OVD) and/or restrictive ventilatory defect (RVD) or static hyperinflation (SHI); (ii) to compare the chronological and estimated lung ages. POPULATION AND METHODS INCLUSION CRITERIA men aged 20 to 60 years, narghile smokers (>1 narghile-year [NY]). EXCLUSION CRITERIA cigar or cigarette smokers and comorbidity. Narghile use quantification: NY and kg of cumulative tobacco use (1 NY=9.125 kg of cumulative tobacco use). DEFINITIONS Large airway obstructive ventilatory defect (OVD): forced expired volume in one second (FEV(1))/forced vital capacity (FVC) less than lower limit of normal (LLN). Small airway OVD: FVC more than LLN and decrease (less than LLN) of one or more peripheral flows. RVD: total lung capacity (TLC) less than LLN. SHI: residual volume (RV) more than upper limit of normal. SPIROMETRIC MEASURES: (Vmax 22 Series/6200 Autobox, SensorMedics, Yorba Linda, California, USA with measurement of functional residual capacity by nitrogen washout). Measurements were made according to international recommendations. RESULTS One hundred and ten narghile smokers were included (34±10 years; 1.76±0.07m; 84±14kg). Thirty-six percent of the subjects had SHI; 14% had small airway OVD; 14% had RVD, and 6% had large airway OVD. Estimated lung age was higher than chronological lung age (47±18 years vs. 34±10 years, P<0.05). CONCLUSION Narghile use accelerates lung ageing. This study provides the health authorities with valid arguments to fight this blight on society, which increasingly involves children and pregnant women.

Facteurs influençant les variables ventilatoires des Tunisiennes âgées de 45 ans et plus.

Resume Introduction Nos objectifs sont d’analyser l’effet des facteurs influencant les variables ventilatoires (VV) des Tunisiennes saines âgees ≥ 45 ans et de determiner l’effet de la parite sur les VV. Methodes Un questionnaire medical avec une evaluation d’un score d’activite sportive et 2 niveaux de scolarisation et socio-economique est realise. La parite a ete introduite sous formes numerique, dichotomique (G1 : ≤ 3, et G2 : ≥ 4), et 3 classes (C1 : 4). Une etude plethysmographique, avec mesure de la conductance bronchique et de la pression inspiratoire maximale est realisee. Resultats 108 femmes sont incluses. Selon les regressions lineaires multiples ascendantes, et par ordre decroissant, les facteurs influencant suivants sont releves : âge et taille, parite, poids et activite journaliere, niveau de scolarisation et l’activite de loisir, enfin l’indice de masse corporelle et l’activite physique. Avec une parite elevee, et surtout chez les âgees ≥ 60 ans, il y a une tendance obstructive sans composante restrictive associee, et une diminution de la force des muscles inspiratoires. L’effet de la parite est age independant. Conclusions Les facteurs qui influencent les VV des Tunisiennes âgees ≥ 45 ans sont multiples. Les VV declinent avec une parite elevee.INTRODUCTION The aim of this study was to analyse the factors influencing pulmonary function and inspiratory muscle strength in healthy Tunisian women aged >or=45 years and in particular to determine the effect of parity. METHODS A medical questionnaire together with an evaluation of sporting activity score and 2 levels for schooling and socio-economic status was administered. Parity was introduced as numeric, as dichotomous (G1:<or=3; G2: >or=4) and in 3 classes (C1:<2; C2:=3-4; C3: > 4). Plethysmography with measurement of airway conductance and maximal inspiratory pressure was performed. RESULTS 108 women were included. According to the ascending multiple linear regression, and in decreasing order, the following influencing factors are noted: Age and height, parity, weight and daily activity, schooling level, and finally leisure activity, body mass index, and physical activity. With high parity, and especially in women aged >or=60 years, there was a decrease in inspiratory muscle strength and an obstructive tendency, without associated restrictive component. Parity effects are age independent. CONCLUSIONS Factors influencing the pulmonary function of healthy Tunisian women aged >or=45 years are multiple. Lung function declines with increasing parity.

Quelle définition faut-il choisir pour le déficit ventilatoire obstructif ?

Resume Introduction Il n’existe pas de consensus clair en ce qui constitue un deficit ventilatoire obstructif (DVO). Selon l’ American Thoracic Society et l’ European Respiratory Society , c’est un rapport entre le volume expiratoire force seconde (VEMS) et la capacite vitale lente (CV) Global initiative for chronic Obstructive Lung Disease ou le British Thoracic Society, c’est un rapport VEMS/capacite vitale expiratoire forcee (CVF) Methodes Un questionnaire medical est realise. Les donnees anthropometriques sont determinees. Les debits expiratoires et les volumes pulmonaires sont mesures a l’aide d’un plethysmographe. Resultats Cent vingt et un (81 %) hommes parmi les 150 adresses sont inclus. Le pourcentage des hommes ayant un DVO est de 56,1 % (VEMS/CV Conclusion Le deficit ventilatoire obstructif est recommandation dependant.

North African reference equation for peak nasal inspiratory flow

AIM To assess, in healthy North African subjects, the applicability and reliability of a previously published reference equation and normal values for peak nasal inspiratory flow, and to calculate a peak nasal inspiratory flow reference equation in this population. SUBJECTS AND METHODS Anthropometric data were recorded in 212 volunteers (100 females and 112 males) aged 13-27 years. Peak nasal inspiratory flow was measured several times. Univariate and multiple linear regression analyses were used to determine the reference equation. RESULTS The previously published reference equation and normal values did not reliably predict peak nasal inspiratory flow in the study population. In our subjects, the reference equation (r2 = 30 per cent) for peak nasal inspiratory flow (l/min) was 1.4256 × height (m) + 33.0215 × gender (where 0 = female, 1 = male) + 1.4117 × age (years) - 136.6778. The lower limit of normal was calculated by subtracting from the peak nasal inspiratory flow reference value (84 l/min). CONCLUSION This is the first published study to calculate a reference equation for peak nasal inspiratory flow in North African subjects. This equation enables objective evaluation of nasal airway patency in patients of North African origin.

Aptitude aérobie sous-maximale et qualité de vie des fumeurs exclusifs de narguilé

BACKGROUND It is well known that oxidative stress is increased significantly by regular water-pipe smoking (WPS). This could lead to muscle dysfunction and thus to impairments of exercise and quality of life (QOL). Considering the impressive number of WP smokers, we intend to investigate the potential effect of WPS on submaximal exercise capacity and QOL. AIMS (1). To evaluate the submaximal exercise capacity by the 6-minutes walking test (6-MWT). (2). To compare the deficiency, incapacity and QOL data of exclusive WPS with those of two control groups (never smokers and exclusive cigarette smokers). (3). To determine the factors influencing the 6-minutes walk distance (6-MWD) of WPS subjects. METHODS A multicentre study including 180 exclusive WPS [> or =5 WP-year] men aged > or =40 years. Cigar or cigarette smoking, contraindications to the 6-MWT or cortico-steroid therapy will be exclusion criteria. QOL evaluation, spirometry, electrocardiogram and two 6-MWT will be performed. Signs of exercise impairment will be: 6-MWD< or =lower limit of normal, end of walk dyspnoea > or =5/10, haemoglobin saturation fall > or =5 points. Data from WPS subjects will be compared with those from 90 never smoking subjects and 90 exclusives cigarettes smokers. EXPECTED RESULTS (1). WPS will affect significantly the submaximal exercise capacity. (2). Resting spirometric, 6-MWT and QOL data of exclusive WPS subjects will be significantly reduced compared to never smoking subjects. (3). The 6-MWDs of exclusive WPS subjects will be significantly influenced by cumulative WP consumption, by resting spirometric data, by obesity and by physical activity score.

Six-minute walk test in non-insulin-dependent diabetes mellitus patients living in Northwest Africa

Introduction International recommendations of the exploration of non-insulin-dependent diabetes mellitus (NIDDM) are focused on deficiency and not incapacity. Aims (1) To estimate the incapacity of NIDDM patients through the 6-minute walk test (6MWT) data. (2) To determine their 6-minute walk distance (6MWD) influencing factors (3) To compare data of NIDDM patient group (PG; n = 100) with those of two control groups (CG): CG1 (n = 174, healthy nonobese and nonsmoker); CG2 (n = 55, obese nondiabetic free from comorbidities). Population and methods The anthropometric, socioeconomic, clinical, metabolic, and 6MWT data of 100 NIDDM patients (45 females) were collected. Results Total sample means ± standard deviation of age, weight, and height were 54 ± 8 years, 81 ± 14 kg, and 1.64 ± 0.09 m. (1) Measured 6MWD (566 ± 81 m) was significantly lower than the theoretical 6MWD (90% ± 12%). The profile of the PG carrying the 6MWT, was as follows: 23% had an abnormal 6MWD; at the end of the 6MWT, 21% and 12% had, respectively, a low heart rate and a high dyspnea (>5/10), and 4% had desaturation during the walk. The estimated “cardiorespiratory and muscular chain” age (68 ± 16 years) was significantly higher than the chronological age. (2) The factors that significantly influenced the 6MWD (r2 = 0.58) are included in the following equation: 6MWD (m) = −73.94 × gender (0, male; 1, female) – 3.25 × age (years) + 7.33 × leisure activity score – 35.57 × obesity (0, no; 1, yes) + 32.86 × socioeconomic level (0, low; 1, high) – 27.67 × cigarette use (0, no; 1, yes) + 8.89 × resting oxyhemoglobin saturation – 105.48. (3) Compared to the CGs, the PG had a significantly (P < 0.05) lower 6MWD (100%+9% and 100%+8%, respectively, for the CG1 and CG2). Conclusion NIDDM seems to accelerate the decline of the submaximal aerobic capacity evaluated through the 6MWD.

Effect of rehabilitation program on endocrinological parameters in patients with COPD and in healthy subjects.

Abstract Background: Skeletal muscle wasting commonly occurs in patients with chronic obstructive pulmonary disease (COPD) and has been associated with the presence of systemic inflammation and endocrinological disturbance. The aim of this study is to analyze the effect of rehabilitation program on the balance of anabolic versus catabolic hormone in patients with COPD and in healthy subjects. Methods: Nineteen patients with COPD and 16 age-matched healthy subjects undertooked exercise training 3 days/week for 8 weeks. Before and after the training program the concentration of growth hormone (GH), Insulin-Like Growth Factor-1 (IGF-1), Insulin-like Growth Factor-Binding Protein 3 (IGF-BP3), testosterone and cortisol in serum were determined. The exercise measurements included a 6-Minute Walking Test (6MWT). Results: After 8 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. Growth hormone, Insulin-like Growth Factor-1 and Insulin-like Growth Factor-Binding Protein 3 increased significantly after rehabilitation training (p < 0.01). The rehabilitation program improves the testosterone/cortisol ratio (T/C ratio) in both groups. There is a significant improvement in the 6-Minute Walking distance (6MWD) in both groups (p < 0.01). Dyspnea and heart rate at rest and at the peak of the 6-Minute Walking Test (6MWT) decreased significantly after training program (p < 0.01). Conclusion: Pulmonary rehabilitation induces an improvement of the anabolic process and reduces proteine distruction by the modifications in endocrinological factors regulating skeletal muscle in patients with COPD.

Establishment of reference serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels of Tunisian children during childhood and adolescence

Background: The aim of the present study is to establish age- and sex-related reference ranges of serum IGF-I and IGF binding protein-3 (IGFBP-3) levels in a pattern of Tunisian children. Subjects and methods: Two hundred healthy Tunisian children (103 boys and 97 girls), aged between 6 and 16 yr, were considered in the study. Results: Mean serum levels of IGF-I and IGFBP-3 are observed to be higher in girls compared to boys of the same age interval. However, these differences were statistically significant only in pubertal ages (11–14 yr) for IGF-I and in pre-pubertal ages (6–10 yr) for IGFBP-3 (p<0.05). Steeper variations in IGF-I concentrations were obtained earlier in girls than in boys (11–12 vs 12–13 yr, Tanner stage 3–4). Peak of IGF-I levels are observed at almost the same age interval (12–14 yr). IGFBP-3 levels significantly increased at steeper variations of IGF-I for both sexes followed by steady values. Conclusions: Variations of IGF-I and IGFBP-3 with the considered parameters (sex, age, and puberty stage), which concord with previous studies on various populations, emphasize the importance of locally established reference levels to construct a SD score prediction model. Establishment of reference serum IGF-I and IGFBP-3 ranges during childhood and adolescence in Tunisian subjects can help to enhance the diagnostic efficiency of IGF-I and IGFBP-3 in evaluating growth disorders in our population.