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Biomedical subjects

B Balkau

Publications and source records attributed to B Balkau.

At least 55 records · Page 3Linked to original sources
PubMed2001

Hyperglycaemia: link to excess mortality.

Asymptomatic diabetes is defined by chronic hyperglycaemia. The 2-h post-challenge glucose level is not generally used in practice and consequently not recommended for diagnosis, so diabetes is defined from fasting hyperglycaemia. Several large studies have been used to evaluate the impact of different diagnostic definitions on the risk of premature death. Meta-analysis of component studies in the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study showed that for all-cause mortality fasting glucose did not carry an independent risk but the 2-h post-challenge glucose carried a significant risk after adjusting for factors including fasting glucose. Increasing fasting glucose also did not carry a significant excess risk for cardiovascular mortality but there was an overall significant relative risk with increasing 2-h post-challenge glucose. Analysis of 20-year follow-up data from the combined Whitehall, Paris and Helsinki studies demonstrated that after adjusting for other risk factors men in the upper 20 per cent of the 2-h glucose distribution and those in the upper 2.5 per cent for fasting glucose had a significantly higher risk of all-cause mortality compared with men in the lower 80 per cent of each distribution. Analysis of the Paris Prospective study alone showed that all-cause mortality was highest in those with isolated 2-h post-challenge hyperglycaemia. In men without known diabetes there were J-shaped relationships between both fasting and 2-h glucose and all-cause, cardiovascular and cancer mortalities. Fasting and 2-h glucose levels are highly correlated and hyperglycaemia by either definition is undoubtedly a risk factor for premature death, whatever the cause.

Adult↗
PubMed2000

Association between heart rate-corrected QT interval and coronary risk factors in 2,894 healthy subjects (the DESIR Study). Data from an Epidemiological Study on the Insulin Resistance syndrome.

In the prospective Data from an Epidemiological Study on the Insulin Resistance Syndrome, 2,894 healthy subjects aged 30 to 64 years had determinations of fasting glucose, insulin, serum lipid and fibrinogen concentrations, blood pressures, body mass index, and waist-hip ratio, as well as tobacco and alcohol consumptions and physical activity. A 12-lead electrocardiogram with automatic measurement of the QT interval was recorded and the formula used for heart rate correction was based on the best-fit regression between QT and heart rate. The QT duration was influenced by glucose homeostasis in both sexes, and increased in men with physical activity; there was a dose-effect relation for men who smoked.

Adult↗
PubMed2000

Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts.

AIMS/HYPOTHESIS: The American Diabetes Association recommended that only a single fasting plasma glucose of greater than or equal to 7.0 mmol/l should be used for diagnosing diabetes in epidemiological studies and did not recommend using a 2-h oral glucose tolerance test. We evaluated the effect of diagnostic changes on the prevalence of diabetes and on the choice of subjects diagnosed with diabetes. METHODS: Existing epidemiological data collected from Asian people between 30 and 89 years of age, was re-analysed separately in 11 population-based studies (n = 17,666), 6 pre-selected hyperglycaemic cohorts (n = 12,221) and one suspected diabetic cohort (n = 8382). RESULTS: Among the 11 population-based studies, the new fasting glucose criteria resulted in an overall reduction of 1.8% in the prevalence of diabetes, which ranged from a reduction of 4.8% to an increase of 1.7% in the different studies. Of 1215 subjects diagnosed with diabetes by either criteria, only 449 met both criteria, a concordance of 37%. More than half of the diabetic subjects had isolated post-challenge hyperglycaemia and three quarters of the subjects with impaired glucose tolerance, according to the 2-h glucose criteria, were normal according to the fasting glucose criteria. Subjects diagnosed as diabetic based only on the 2-h glucose criteria were, on average, older than those with diabetes according to the fasting criteria. CONCLUSION/INTERPRETATION: The fasting and the 2-h glucose criteria diagnose different groups of subjects. It would therefore be inappropriate to use the fasting glucose criteria alone for screening diabetes in Asian populations.

Adult↗
PubMed2000

Puberty-associated differences in total cholesterol and triglyceride levels according to sex in French children aged 10-13 years.

PURPOSE: To assess the relationships between lipid levels and sexual maturity, independently of age-related differences, and to investigate possible differences related to sexual maturity across the percentiles of the lipid distributions. METHODS: Fasting serum total cholesterol and triglyceride concentrations were measured in 6577 boys and 6605 girls, aged from 10 to 13 years, with different Tanner stages. The total cholesterol and triglyceride mean and percentile levels were estimated according to age and Tanner stage by ordinary least squares and percentile regression models, separately in both sexes. RESULTS: In boys and girls, total cholesterol levels were significantly associated with pubertal stage after controlling for age. At age 12, the estimated mean levels in boys varied from 4.82 mmol/L for Tanner 1 to 4.41 for Tanner 5. The corresponding values were 5.05 and 4.62 mmol/L in girls, for whom the association with maturity was stronger in the upper than in the lower percentiles (p < 0.0001); between the extreme Tanner stages, the 95th percentiles of total cholesterol differed by 0.80 mmol/L, in comparison to 0.19 mmol/L for the 5th percentiles. Therefore, 1. 8% of girls and 0.7% of boys were classified differently whether Tanner stage was used or not to assess hypercholesterolemia (concentrations in the upper 5% of the distributions). Triglycerides were positively related to sexual maturity independently of age, but the discrepancies between classifications were lower; 1.1% in girls and 0.4% in boys. CONCLUSIONS: Our findings emphasize the importance of sexual maturity, even for a given age, for interpreting lipid levels in children.

Adolescent↗
PubMed2000

The habitual diet in rural and urban Cameroon.

OBJECTIVE: To evaluate the habitual diet of a rural and urban population in Cameroon, Central Africa. SETTING: An urban area-Cité Verte Housing District, Yaoundé (1058 subjects); and a rural area-three villages in Evodoula, Cameroon (746 subjects). SUBJECTS: Cameroonian men and women of African origin (1058 urban, and 746 rural), aged 24-74 y. METHODS: The habitual diet was estimated with an interviewer-administered food frequency questionnaire. MAIN OUTCOME MEASURES: Macro- and micronutrient intake. RESULTS: The intake of energy, fat and alcohol was higher in rural men and women than in urban subjects. In rural women, the intake of carbohydrates and protein was also higher. The intakes of fibre, iron, carotene, zinc, potassium, and of the vitamins C, D and E were all higher in rural men and women than in their urban counterparts. The intake of retinol was lower in rural subjects than in urban subjects. Eight of the 10 foods eaten in the highest amount and contributing most to energy intake differed between the rural and urban population. CONCLUSION: The habitual diet in rural Cameroon contains more fat and alcohol than the diet in urban Cameroon. The high physical activity in the rural area may explain the lower levels of the cardiovascular risk factors in this area compared to those of the urban dwellers. SPONSORSHIP: This work was supported by a grant from the European Union (contract no. TS3*CT92-0142) and by the Conseil Régional d'Ile de France and INSERM. European Journal of Clinical Nutrition (2000) 54, 150-154

Adult↗
PubMed2000

Underreporting of energy intake in four populations of African origin.

OBJECTIVE: To investigate the frequency of dietary underreporting in four African populations in different geographic and cultural settings. SUBJECTS: Seven-hundred and forty three men and women from rural Cameroon, 1042 men and women from urban Cameroon, 857 men and women from Jamaica and 243 male and female African Caribbeans from the UK. Subjects who reported dieting or weight control were excluded. MEASUREMENTS: Habitual dietary intake was estimated with a quantitative food frequency questionnaire, developed specifically for each country. Underreporting was defined using three cut-off levels for energy intake/estimated basic metabolic rate (EI/BMRest), based on age, sex and weight, in each site. RESULTS: The EI/BMRest was highest in rural Cameroonian men at 3.07 (95% confidence interval: 2.97, 3.17) and women at 2.84 (2.74, 2.94), intermediate in urban Cameroon and Jamaica and lowest in the UK men and women at 1.44 (1.26, 1.62) and 1.41 (1.21, 1.61). This trend existed even after adjustment for age, BMI and education (P for trend<0.0001). The trend in the frequency of underreporting using the lowest cut-off level for EI/BMRest of 1.15 was 6% and 6% in rural Cameroon for women and men, respectively, 4% and 5% in urban Cameroon, 24% and 19% in Jamaica and 28% and 39% in the UK. With higher cut off levels this trend was similar. CONCLUSION: The results suggest that the frequency of dietary underreporting differs between societies and that Westernization may be one of the factors underlying this phenomenon.

Adult↗
PubMed2000

Insulin resistance, lipid and fatty acid concentrations in 867 healthy Europeans. European Group for the Study of Insulin Resistance (EGIR).

BACKGROUND: Insulin resistance, dyslipidaemia and abnormal nonesterified fatty acid (NEFA) metabolism are features of the 'metabolic syndrome', but the mechanisms of these relationships are uncertain. MATERIALS AND METHODS: We studied associations between insulin resistance and lipoprotein concentrations by retrospective analysis of euglycaemic hyperinsulinaemic clamp data from 867 normoglycaemic subjects in 21 European centres. Data on NEFA concentrations were available in a subgroup of 541 subjects from 9 clinical centres. These subjects' characteristics do not vary significantly from those of the whole cohort. RESULTS: After adjustment for the effects of age, sex, obesity and intercentre variability, regression analysis showed relationships between triglycerides and markers of insulin sensitivity. There were significant correlations between triglycerides and fasting plasma glucose (P < 0.0001), fasting plasma insulin (P < 0.0001) and mean glucose infusion rate at steady state (M-value, P < 0.0001). Indices of insulin resistance were related to NEFA concentrations. Fasting NEFA were negatively correlated with the M-value (P < 0.0001). Non-esterified fatty acids at steady state were positively correlated with fasting markers of insulin resistance: fasting plasma glucose (P < 0.05), fasting plasma insulin (P < 0.005) and negatively correlated with the M-value (P < 0.0005). There were relationships between fasting concentrations of plasma lipids and of NEFAs. Non-esterified fatty acids at steady state correlated with fasting triglycerides (P < 0.0001), but not with any of the other plasma lipoprotein concentrations. The associations of fasting triglycerides with the M-value and with NEFAs at steady state were independent of each other. All these associations were independent of obesity and geographical location CONCLUSION: The results in this large cohort of healthy European subjects suggest that triglyceride concentrations depend upon both insulin's gluco-regulation (estimated by glucose uptake) and antilipolytic insulin action (measured by NEFA levels) during an euglycaemic clamp.

Adolescent↗
PubMed2000

Association between high von willebrand factor levels and the Thr789Ala vWF gene polymorphism but not with nephropathy in type I diabetes. The GENEDIAB Study Group and the DESIR Study Group.

BACKGROUND: A genetic susceptibility for diabetic kidney disease is suspected since diabetic nephropathy occurs in only 30 to 40% of type I diabetic patients. As elevated von Willebrand factor (vWF) plasma concentrations have been reported to precede the development of microalbuminuria in type I diabetes, we addressed a possible implication of vWF as a genetic determinant for diabetic nephropathy. METHODS: Three known vWF gene polymorphisms were genotyped in a group of 493 type I diabetic subjects, all showing proliferative retinopathy, but with various stages of renal involvement, which ranged from no microalbuminuria, despite a mean duration of diabetes of 31 years, to advanced nephropathy (GENEDIAB Study): Thr789Ala (Rsa I), M-/M+ (Msp I) (intron 19), and Ala1381Thr (Hph I). Plasma vWF and factor VIII (F VIII) levels were also measured in this population. RESULTS: Plasma vWF and F VIII levels were increased in diabetic subjects with nephropathy (P < 0.001) or with coronary heart disease (CHD; P < 0.001), but there was no interaction of both conditions on plasma levels. The Msp I polymorphism (M-/M+) was weakly associated with nephropathy (P = 0. 04), but this association was not more significant when other risk factors were used in a logistic regression analysis. The vWF Thr789Ala polymorphism was associated with CHD (P = 0.002) and with plasma vWF levels. Logistic regression analysis indicated an independent and codominant effect of the Thr789Ala polymorphism on CHD, but not on nephropathy, with a maximal risk for Ala/Ala homozygotes (OR = 4.2, 95% CI, 1.8 to 9.9, P = 0.0008). CONCLUSION: It is unlikely that polymorphisms in the vWF gene contribute to the risk for nephropathy in type I diabetic patients. However, the Thr789Ala polymorphism might affect the risk for CHD in this population through modulation of plasma vWF levels.

Adolescent↗
PubMed2000

The DECODE study. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe.

The current criteria for the diagnosis of diabetes used in France are now based on those published by the American Diabetes Association in 1997: fasting plasma glucose >/= 7.0 mmol/l (126 mg/dl) (previously >/= 7.8 mmol/l (140 mg/dl)), 2-hour glucose >/= 11.1 mmol/l (200 mg/dl) following a 75g oral glucose tolerance test. However, while the American Diabetes Association recommended that the post charge test not be used, both the World Health Organisation and the French Language Association for the study of Diabetes and Metabolic diseases (ALFEDIAM) retained this test. The DECODE (Diabetes Epidemiology: Collaborative analysis of Diagnostic criteria in Europe) study analysed the effect of these changes on the prevalence of diabetes, and whether the changes were justified by the mortality in the various glycaemic groups, using epidemiological data on close to 30,000 subjects from twenty European epidemiological studies. The prevalence of diabetes, using fasting rather than the 2-hour glucose concentrations (as had previously been recommended for epidemiological studies) resulted in changes in the prevalence of diabetes, an increase or a decrease, depending on the population studied. The fasting criteria tended to diagnose younger and more obese subjects than the 2-hour criteria. The subjects who would now be diabetic with the new fasting diagnostic criteria suffered a high mortality, similar to that of other diabetic subjects, thus the new criteria can be justified. However, the diabetic subjects who only have a post-charge diabetic hyperglycaemia (>/= 11.1 mmol/l (200 mg/dl)), are now even less likely to be screened as diabetic, despite the fact that they have a risk of premature death of the same order as other diabetic subjects.

Blood Glucose↗
PubMed1999

Diabetes as a risk factor for sudden death.

Although a family history of sudden death was a risk factor for sudden death in the Paris Prospective Study I, diabetes was also a strong risk factor, with a similar risk after accounting for other cardiovascular risk factors. Diabetes, however, was not a risk factor for death by myocardial infarction.

Adult↗
PubMed1999

Tissue-type plasminogen activator antigen and consumption of dairy products. The DESIR study. Data from an Epidemiological Study on Insulin Resistance Syndrome.

We investigated whether tissue-type plasminogen activator antigen (t-PA-Ag) was associated with intake of meat, fish, or dairy products. The study population comprised 295 women and 299 men aged 30-64 years, which was a random sample from the D.E.S.I.R. (Data from an Epidemiological Study on the Insulin Resistance syndrome) study comprising 5214 men and women in total. T-PA-Ag was measured in fasting blood samples and the habitual intake of foods was assessed by several questions on a food frequency questionnaire. Cross-sectional data were analyzed. The mean t-PA-Ag concentration was 3.28 ng/mL (SD, 1.26) in men and 2.52 ng/mL (SD, 1.22) in women. The concentration of t-PA-Ag was inversely associated with the consumption of milk and milk products in women (p for trend: 0.15) and in men (p for trend: 0.04). The difference between subjects with a low and a high milk consumption was 13% in women and 19% in men. Similar results were observed for consumption of cheese. The concentration of t-PA-Ag was 21 and 8% lower for women and men with a high cheese consumption, respectively, compared to those with a low consumption. Further analyses showed that the association of t-PA-Ag with milk and milk product consumption was independent of cheese consumption and vice versa. No association between meat or fish intake and t-PA-Ag was observed. The results of this study indicate that, if confirmed by others, a high intake of dairy products may influence fibrinolysis by an effect on t-PA-Ag.

Adult↗
PubMed1999

Estimation of the prevalence of orally treated diabetes in France using a pharmacoepidemiologic approach: comparison between 1981 and 1992.

PURPOSE: Non-insulin-dependent diabetes may become a public health problem in the next decade, given the increasing life expectancy of populations and because the baby-boom generation will reach the age at risk. Moreover a modification of the diagnostic criteria may increase the number of diabetic patients. We studied the evolution of diabetes prevalence. METHODS: A non-specific household survey, performed every 10 years was used. Patients who bought an oral antidiabetic drug during these studies were classified as diabetics. RESULTS: In 1980-81 and 1991-92 the crude diabetes prevalences were not significantly different even if there was a trend to increase (1.27% and 1.41%, respectively). When the 1980-81 prevalence was standardized to the age distribution of the 1991-92 sample, the trend disappeared (prevalence 1980-81:1.35%). CONCLUSION: There was no increase in an individual's risk of diabetes. However the crude prevalence tended to increase because of the changing age structure of the population. On-going studies are needed to follow the prevalence of diabetes during the next decade.

Journal Article↗
PubMed1999

Histopathological study of primary biliary cirrhosis and the effect of ursodeoxycholic acid treatment on histology progression.

The semiquantitative histopathological analysis of the liver biopsies obtained before and after 4 years of ursodeoxycholic acid (UDCA) therapy in a cohort of primary biliary cirrhosis (PBC) patients is reported. The relationships between elementary histological lesions before treatment and their progression under therapy were assessed. At baseline, two independent groups of lesions, each of which participate in the development of fibrosis, were individualized, i.e., florid bile duct lesions and ductopenia on one hand and lymphocytic piecemeal necrosis, ductular proliferation, and lobular necroinflammatory changes on the other hand. Four years of UDCA therapy were associated with a significant decrease in the prevalence of florid interlobular bile duct (ILBD) lesions, of epithelioid granuloma (P <.001) without any aggravation in the severity of bile duct paucity. Lobular inflammation and necrosis markedly improved (P <.001) whereas the degree of severity of the lymphocytic piecemeal necrosis and ductular proliferation at entry and at 4 years were similar. Worsening of fibrosis was observed in 14 patients (12 of them had a one grade progression) whereas stabilization was noted in 30 of the remaining patients. Severity of both the lymphocytic piecemeal necrosis and lobular inflammation and necrosis at entry was significantly associated with the progression of fibrosis. The results suggest that UDCA therapy influences the process leading to bile duct destruction. Patients with severe lymphocytic piecemeal necrosis and lobular inflammation may need additional therapeutic intervention because they have increased risk of fibrosis progression.

Bile Ducts↗
PubMed1999

Clinical and biochemical expression of the histopathological lesions of primary biliary cirrhosis. UDCA-PBC Group.

BACKGROUND/AIMS: This study aimed to assess the relationships which may link elementary histological lesions with symptoms and biochemistries in primary biliary cirrhosis. METHODS: We studied 103 patients with primary biliary cirrhosis who participated in a double-blind, placebo-controlled trial of UDCA treatment and in whom liver biopsy specimens obtained at entry were reassessed. Relationships between histological features, fatigue, pruritus and biochemistries were calculated by using exact tests for 2 ordinal variables. RESULTS: The degrees of severity of fatigue and pruritus were significantly and exclusively related to the presence of florid interlobular bile duct lesions (p<0.01 and p<0.02, respectively). The only laboratory parameter associated with the presence of interlobular bile duct florid lesion was IgM level. The most discriminant biochemical test for interlobular bile duct paucity was gamma glutamyltranspeptidase activity. The degree of severity of both lymphocytic hepatocellular piecemeal necrosis and lobular inflammation and necrosis was mainly associated with increased gammaglobulin and IgG levels and to a lesser extent with increased IgM and aspartate aminotransferase levels. The extent of fibrosis was mainly associated with gammaglobulin levels and to a lesser degree with serum albumin, bilirubin and IgG levels. CONCLUSIONS: Symptoms and biochemistries classically used to assess primary biliary cirrhosis reflect in part the degree of severity of the main elementary histological lesions. We propose that the picture of primary biliary cirrhosis results from the clinical and biochemical expression of three distinct processes, e.g., bile duct inflammation and destruction, parenchymal inflammation and necrosis, and fibrosis. The various combinations of these processes may explain why the spectrum of primary biliary cirrhosis varies from typical primary biliary cirrhosis to mixed type of primary biliary cirrhosis and autoimmune hepatitis and suggests that the response to therapies may depend on the predominance of each process in a given patient.

Adrenal Cortex Hormones↗
PubMed1999

Relationships between abdominal body fat distribution and cardiovascular risk factors: an explanation for women's healthier cardiovascular risk profile. The D.E.S.I.R. Study.

OBJECTIVE: To assess whether the extent of abdominal fat distribution, as measured by the waist to hip ratio (WHR), might account for the sex differences in the levels of cardiovascular risk factors. DESIGN: Cross-sectional age-matched study. SUBJECTS: 1264 men and 1264 premenopausal women, aged 30-49 y, free from known cardiovascular diseases and diabetes, included in the prospective study, D.E.S.I.R. MEASUREMENTS: (1) body mass index (BMI), WHR and blood pressures; (2) fasting concentrations of blood glucose, insulin, lipids and lipoprotein subfractions, and apolipoproteins; and (3) smoking status, physical activity, and alcohol consumption. RESULTS: After taking into account age and BMI, there were gradual relationships, within and across sexes, between WHR and the levels of most lipids and lipoproteins, of fasting glucose and insulin, and, to a lesser extent, of blood pressures. In particular, men and women with similar BMI and WHR had similar levels of triglycerides. Multivariate regression analysis showed that the variance of cardiovascular risk factors explained by the model was increased when sex was included, after controlling for age, BMI and lifestyle habits (all P<0.01). If WHR was included in the model, sex had no additional effect on total cholesterol (P>0.09 for change in total r2 ) or triglycerides (P>0.40 for change in total r2). In contrast, for other cardiovascular risk factors, adjustment for covariates and WHR did not fully eliminate the sex differences, although WHR increased the variance explained with or without additional control for sex (all P<0.01). CONCLUSION: The continuous increase of cardiovascular risk factors with WHR, especially for lipids and lipoproteins, suggests that the abdominal body fat distribution may partially explain the relative unhealthier cardiovascular risk profile of men.

Abdomen↗
PubMed1999

Insulin resistance: an independent risk factor for cardiovascular disease?

Population-based studies have shown that patients with type 2 diabetes have a higher cardiovascular morbidity and mortality and an increased all-cause mortality compared with non-diabetic subjects. In non-diabetic subjects, hyperinsulinaemia not only has been associated with an increased cardiovascular risk, but is also related with a number of other cardiovascular risk factors--hyperglycaemia, hypertension, dyslipidaemia, and a central body fat distribution--that constitute the insulin resistance syndrome and are also characteristic of type 2 diabetes. After 23 years of follow-up in the Paris Prospective Study, both fasting and 2-h insulin concentrations were related with all-cause mortality in a U-shaped fashion, with low and high concentrations being associated with an increased risk, independently of other risk factors; in contrast, while high insulin levels carried an increased risk for cardiovascular and coronary heart disease mortality, this was not independent of other risk factors.

Body Composition↗