Gérard Lasfargues

Comparative study of the acute lung toxicity of pure cobalt powder and cobalt-tungsten carbide mixture in rat.

Alveolitis progressing to lung fibrosis has been reported in workers exposed to cobalt containing dust (e.g., tungsten carbide-cobalt mixture as produced by the hard metal industry) but rarely following exposure to pure cobalt dust (e.g., in cobalt-producing factories). We have previously demonstrated that tungsten carbide-cobalt mixture is more toxic toward rat alveolar macrophages in vitro than pure cobalt metal powder. The present study was undertaken to compare in female rats the acute pulmonary response (lung weight, lung histology, cellular and biochemical analyses of bronchoalveolar lavage fluid, and mortality) following the intratracheal instillation of pure cobalt (Co) particles (median particle size, d50:4 microns), pure tungsten carbide (WC) particles (d50:2 microns), tungsten carbide-cobalt (WC-Co) powder (d50:2 microns; cobalt 6.3%, tungsten 84%, carbon 5.4%) and crystalline silica (d50 less than 5 micron) used as pneumotoxic reference material. WC alone (15.67 mg/100 g body wt) behaves as an inert dust producing only a mild accumulation of macrophages in the alveolar duct walls. Co alone (1.0 mg/100 g) only causes a moderate inflammatory response. An identical amount of Co given as WC-Co mixture (16.67 mg/100 g; corresponding to 1.0 mg Co/100 g) produces a severe alveolitis and fatal pulmonary edema. Cellular and biochemical characteristics of bronchoalveolar lavage fluid collected 24 hr after the intratracheal instillation of WC (1.0 mg/100 g) or Co (0.06 mg/100 g) are not significantly different from those of control animals instilled with sterile saline. On the contrary, bronchoalveolar lavage fluid changes following administration of the WC-Co mixture (1.0 mg/100 g; corresponding to 0.06 mg Co/100 g) are very similar to those induced by crystalline silica (1.0 mg/100 g). The amount of cobalt excreted in urine is significantly higher when the animals are exposed to WC-Co powder as compared to an equivalent amount of pure cobalt particles, suggesting an increased bioavailability of cobalt metal when combined with tungsten carbide. This study demonstrates that the acute lung toxicity of tungsten carbide-cobalt mixture is much higher than that of each individual component and may explain why lung fibrosis is rarely if ever induced by exposure to pure cobalt dust.

Apolipoprotein E genotype and plasma lipid levels in caucasian diabetic patients

OBJECTIVE Apo E polymorphism has been shown to affect lipid profiles in non-diabetic and diabetic populations. We evaluated the relationship between Apo E phenotype and fasting lipid plasma levels in type 2 diabetes patients. METHODS Two hundred and ten French type 2 diabetic patients (115 men and 95 women) without any lipid lowering drugs were studied. Fasting lipids were measured by usual methods and Apo E genotype was established for each patient: PCR was followed by digestion of the amplification product with restriction enzymes and separation of the fragments by polyacrylamide gel. RESULTS Genotypes epsilon3/epsilon3, epsilon2/epsilon3 and epsilon3/epsilon4, epsilon2/epsilon2 and epsilon2/epsilon4 were found in 68.1%, 14.8%, 15.7%, 1.0% and 0.5%, respectively. No patient had the epsilon4/epsilon4 genotype. Lipid plasma levels were compared between E3 group (epsilon3/epsilon3) as a reference and E2 (epsilon2/epsilon2 or epsilon2/epsilon3) or E4 (epsilon3/epsilon4 or epsilon2/epsilon4). Total cholesterol, LDL cholesterol and Apo B levels were lower in the E2 group. Total cholesterol, LDL cholesterol and Apo B levels were higher in the E4 group. HDL cholesterol levels were increased in the E4 group, as only previously observed in Japanese populations. CONCLUSION These results agree with those already reported in diabetic patients of several western European countries. E4 allele carriers have a greater cardio-vascular risk and this could be partially explained by the metabolic variation in lipid metabolism induced by E4 with higher LDL cholesterol and Apo B levels. These results observed in French diabetic subjects without any lipid-lowering drugs may be used as a reference for other studies performed in France.

Comparison of men with impaired fasting glycaemia to controls and to diabetic subjects with fasting glycaemia from 7.0 to 7.7 mmol/l: clinical, nutritional and biological status

OBJECTIVE To compare medical history, clinical, nutritional and biological status of non-diabetic men to subjects with impaired fasting glycemia (glycemia 6.1-6.9 mmol/l) and to newly diagnosed type 2 diabetic subjects (7.0-7.7 mmol/l) according to the criteria proposed by the American Diabetes Association. METHODS Cross-sectional study of a cohort of 29,992 men, who were volunteers for a free periodic check-up offered by their medical insurance. Medical history, lifestyle and nutritional habits were recorded using a self-administered questionnaire. Clinical and biological data were also studied. To compare the three groups of subjects - normal, impaired fasting glycemia and newly diagnosed diabetics - three age stratified samples were randomly designed. RESULTS Most of the well-known risk factors for developing type 2 diabetes mellitus such as overweight, abdominal obesity, familial history of diabetes mellitus, over-consumption of fat and alcohol were present in the group with impaired fasting glycaemia which presented the same risk factors as the group of subjects with fasting glycaemia from 7.0 to 7.7 mmol/l, but to a lesser degree. Hypertension was present in more than 50% of the subjects with impaired fasting glycaemia. CONCLUSION In this cross-sectional study, impaired fasting glycaemia is associated with the risk factors of type 2 diabetes mellitus. The subjects with impaired fasting glycaemia should be considered at risk for cardiovascular disease and might take advantage from early specific intervention about their lifestyle.

Perturbation du métabolisme lipidique chez des travailleurs postés consultants de centres d’examens de santé

AIMS To describe cardiovascular risk factors and metabolic disturbances in a French population including shift workers and study whether possible changes were noticeable after non-shift to shift work transition within the last five years. METHODS The study population included 4764 attendees of two health examinations (5 years apart), between January 1996 and October 2008, in 11 health examination centres. Clinical, biological and metabolic factors together with their changes over a five-year period were compared between attendees who kept a non-shift daytime job, those who kept working shift and those who switched from non-shift daytime to shift work over the last 5 years. RESULTS At baseline, working shift was, independently of lifestyle or BMI, significantly related to more elevated plasma triglycerides (β=0.04, P=0.05) and rate of hypertriglyceridemia (β=0.27, P=0.01), lower plasma HDL-C levels (β=-2.03, P=0.006) and less hypertension (β=-0.25, P=0.01) compared to non-shift daytime work. In men, a slightly more elevated yet non significant proportion of hypertriglyceridemia was observed with the transition from non-shift daytime to shift work within the last 5 years in comparison to men who kept a non-shift daytime job (13.9% vs. 11.0% P=0.17). CONCLUSION Our results are in agreement with previous studies showing a deleterious effect of shift work on lipid metabolism. In our population, triglycerides and HDL-C levels were the main parameters negatively influenced by shift work. Consequently, a regular biological monitoring together with the promotion of healthy behaviours should be provided to shift workers before negative consequences of working shift become noticeable.

Deprivation and health risk indicators in full-time permanent workers

BACKGROUND Association between deprivation and health is well established, particularly among unemployed or fixed-term contract or temporary contract subjects. This study aimed to assess if this relationship existed as well in full-time permanent workers. METHODS Biometrical, biological, behavioural and psychosocial health risk indicators and an individual deprivation score, the Evaluation of Precarity and Inequalities in Health Examination Centres score, were recorded from January 2007 to June 2008, in 34 905 full-time permanent workers aged 18-70 years, all volunteers for a free health examination. Comparisons of the behavioural, metabolic, cardiovascular and health risk indicators between quintiles of the deprivation score with adjustments on age and socioeconomic categories were made by covariance analysis or logistic regression. RESULTS For both genders, degradation of nutritional behaviours, metabolic and cardiovascular indicators and health appeared gradually with deprivation, even for deprivation score usually considered as an insignificant value. The absence of only one social support or one social network was associated with a degradation of health. Full-time permanent workers with the poorest health risk indicators had more frequent social exclusion signs. These results were independent of socioeconomic categories and age. CONCLUSION Understanding how deprivation influences health status may lead to more effective interventions to reduce social inequalities in health. The deprivation Evaluation of Precarity and Inequalities in Health Examination Centres score is a relevant tool to detect subjects who could benefit from preventive interventions. Our findings suggest that this deprivation score should be used as a health risk indicator even in full-time permanent workers. Assessing deprivation is useful to design and evaluate specific intervention programmes.

Article originalPromouvoir un meilleur comportement nutritionnel chez les travailleurs postés avec horaires de nuitPromote better nutritional behaviours among shift workers with night shift

AIM Shift work, especially including a night shift, is associated with degradation of physical, social and psychosocial health as well as poor well-being. Food imbalance and low physical activity contributed to the negative effects on health. Our objective was to promote a healthier nutritional behaviour according to the French national nutrition and health program recommendations (PNNS). METHODS A one-year nutritional intervention with personalised dietetic counselling was proposed to 235 shift workers with night shift who came for a health prevention exam in one of the centres of the Institut Inter-Régional pour la Santé between 2009 and 2011. The intervention was three dietary interviews: at baseline with definition of goal setting, at 3 months for advice and support and at one-year for the evaluation. At 6 months, a personalised reminder letter was send. Compliance with the PNNS recommendations and level of physical activity were evaluated at baseline and at one-year by a self-administered questionnaire. Changes between baseline and follow-up were compared by paired t-tests or McNemar-tests. RESULTS The rate of follow-up was 57.4%. At the end of the study, subjects improved their compliance with PNNS guidelines concerning sweetened products (P<0.001), water (P=0.02) and salt (P=0.05), increased their leisure physical activity (P=0.001) and decreased their daily energy intakes (P<0.001). CONCLUSION A structured intervention can improve nutritional behaviours of shift workers. This intervention enabled to inform and alert on the risk related to this work schedule and promote better nutritional behaviours.

Promote better nutritional behaviours among shift workers with night shift.

AIM Shift work, especially including a night shift, is associated with degradation of physical, social and psychosocial health as well as poor well-being. Food imbalance and low physical activity contributed to the negative effects on health. Our objective was to promote a healthier nutritional behaviour according to the French national nutrition and health program recommendations (PNNS). METHODS A one-year nutritional intervention with personalised dietetic counselling was proposed to 235 shift workers with night shift who came for a health prevention exam in one of the centres of the Institut Inter-Régional pour la Santé between 2009 and 2011. The intervention was three dietary interviews: at baseline with definition of goal setting, at 3 months for advice and support and at one-year for the evaluation. At 6 months, a personalised reminder letter was send. Compliance with the PNNS recommendations and level of physical activity were evaluated at baseline and at one-year by a self-administered questionnaire. Changes between baseline and follow-up were compared by paired t-tests or McNemar-tests. RESULTS The rate of follow-up was 57.4%. At the end of the study, subjects improved their compliance with PNNS guidelines concerning sweetened products (P<0.001), water (P=0.02) and salt (P=0.05), increased their leisure physical activity (P=0.001) and decreased their daily energy intakes (P<0.001). CONCLUSION A structured intervention can improve nutritional behaviours of shift workers. This intervention enabled to inform and alert on the risk related to this work schedule and promote better nutritional behaviours.

Promouvoir un meilleur comportement nutritionnel chez les travailleurs postés avec horaires de nuit

AIM Shift work, especially including a night shift, is associated with degradation of physical, social and psychosocial health as well as poor well-being. Food imbalance and low physical activity contributed to the negative effects on health. Our objective was to promote a healthier nutritional behaviour according to the French national nutrition and health program recommendations (PNNS). METHODS A one-year nutritional intervention with personalised dietetic counselling was proposed to 235 shift workers with night shift who came for a health prevention exam in one of the centres of the Institut Inter-Régional pour la Santé between 2009 and 2011. The intervention was three dietary interviews: at baseline with definition of goal setting, at 3 months for advice and support and at one-year for the evaluation. At 6 months, a personalised reminder letter was send. Compliance with the PNNS recommendations and level of physical activity were evaluated at baseline and at one-year by a self-administered questionnaire. Changes between baseline and follow-up were compared by paired t-tests or McNemar-tests. RESULTS The rate of follow-up was 57.4%. At the end of the study, subjects improved their compliance with PNNS guidelines concerning sweetened products (P<0.001), water (P=0.02) and salt (P=0.05), increased their leisure physical activity (P=0.001) and decreased their daily energy intakes (P<0.001). CONCLUSION A structured intervention can improve nutritional behaviours of shift workers. This intervention enabled to inform and alert on the risk related to this work schedule and promote better nutritional behaviours.

Impact d’une intervention nutritionnelle sur les paramètres biométriques et biologiques chez des sujets français hyperglycémiques

Resume L’efficacite d’une intervention de prevention du diabete en collaboration avec le medecin traitant et basee sur les recommandations du Programme National Nutrition Sante (PNNS) a ete evaluee. Les participants hyperglycemiques, âges de 25–69 ans, recrutes lors d’un examen de prevention en 2005–2007, ont beneficie d’un entretien dietetique avec definition d’objectifs nutritionnels, rappel de ces objectifs a 6 mois, puis evaluation a 1 an. Une reduction des facteurs de risque biometriques et biologiques etait associee au gain d’une recommandation PNNS.