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Le Le Journal Journal de de la la Mdecine Mdecine Nutritionnelle Nutritionnelle et et Fonctionnelle Fonctionnelle Pratique Pratique
N 1, N 1, Janvier Janvier 2006 2006 ( ( paratre paratre tous tous les les mois) mois)
Editorial Editorial
Chers ChersDocteurs Docteurs Tout Tout d'abord, d'abord, nous nous vous vous prsentons prsentons nos nos meilleurs meilleurs vux vux pour pour l'anne l'anne 2006. 2006. Nous Nous avons avons l'honneur de vous faire parvenir le premier numro de votre nouveau mensuel: l'honneur de vous faire parvenir le premier numro de votre nouveau mensuel: NUTRICASUS .. NUTRICASUS Ce CeJournal Journalest estvotre votrejournal. journal.Il Ilse seveut veutun unoutil outilde decommunication communicationet et de de formation formation continue continue dans dans le le domaine domaine de de la la mdecine mdecine nutritionnelle nutritionnelle et et fonctionnelle. fonctionnelle. NUTRICASUS vous prsentera prsentera NUTRICASUS vous chaque mois un cas clinique mettant en vidence l'intrt de la biologie nutritionnelle chaque mois un cas clinique mettant en vidence l'intrt de la biologie nutritionnellepour pouraider aider efficacement vos patients atteints des affections les plus frquentes ou dsirant conserver efficacement vos patients atteints des affections les plus frquentes ou dsirant conserver ou ou optimiser leur capital sant. Des rfrences scientifiques validant les concepts dcrits seront optimiser leur capital sant. Des rfrences scientifiques validant les concepts dcrits seront incluses. incluses. NUTRICASUS tentera galement galement de de rpondre rpondre aux aux questions questions les les plus plus souvent souvent poses poses NUTRICASUS tentera par rapport la biologie nutritionnelle tant au niveau scientifique que logistique. par rapport la biologie nutritionnelle tant au niveau scientifique que logistique. Enfin Enfin ouvre un espace pour vous permettre de vous exprimer librement par rapport NUTRICASUS ouvre un espace pour vous permettre de vous exprimer librement par rapport NUTRICASUS la mdecine nutritionnelle. En esprant que NUTRICASUS deviendra votre compagnon la mdecine nutritionnelle. En esprant que NUTRICASUS deviendra votre compagnon incontournable incontournable dans dans votre votre pratique, pratique, nous nous vous vous ritrons ritrons nos nos souhaits souhaits de de sant sant et et de de succs succs pour pour2006. 2006. Nutritionnellement Nutritionnellementvtre vtre
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NUTRICASUS NUTRICASUS
Le Le Journal Journal de de la la Mdecine Mdecine Nutritionnelle Nutritionnelle et et Fonctionnelle Fonctionnelle Pratique Pratique
2
300
175
Carences Carences en en Vitamines Vitamines A A et et E, E, taux taux de de zinc zinc et et slenium trop bas avec excs de cuivre, taux slenium trop bas avec excs de cuivre, taux de de ferritine ferritinebasse basseet etoxydation oxydationdes desLDL LDLtraduite traduitepar parun un taux tauxlev levd'anticorps d'anticorpsanti-LDL anti-LDLoxyds. oxyds.
50
Rsultat normal
ZN
CU
FERI
TRF
SAT OHDGACLDL
39
68 132
73
74 126
86
59 141
121
78 122
74
67 133
79
77 123
71
77 123
132
74 126
17
19 181
108
70 130
53
67 133
98
82 118
300
50 150
Valeurs de Rfrence en %:
HOMOCYSTEINEMIE: 17,6 M
Hyperhomocystinmie Hyperhomocystinmie(valeur (valeursant santdoit doittre treaux aux alentours alentoursde de7M) 7M)
NUTRICASUS NUTRICASUS
Le Le Journal Journal de de la la Mdecine Mdecine Nutritionnelle Nutritionnelle et et Fonctionnelle Fonctionnelle Pratique Pratique
L'implication L'implicationdu dusyndrome syndrome de de rsistance rsistance l'insuline l'insuline dans dans le dveloppement du diabte de type II le dveloppement du diabte de type II et et des des ses ses complications complications n'est n'est plus plus dmontrer. dmontrer. De De nombreuses nombreuses tudes tudes exprimentales exprimentales et et cliniques cliniques ont ont galement galement montr montr un rle majeur de la carence en acides un rle majeur de la carence en acides gras gras omga-3 omga-3 et et de de l'excs l'excs d'acides d'acides gras gras saturs, saturs, du du stress stress oxydant oxydant notamment notammentau auniveau niveaudes desmembranes membranescellulaires cellulairesansi ansique que des troubles des ractions de mthylation traduits par des troubles des ractions de mthylation traduits parune une hyperhomocystinmie. hyperhomocystinmie.
Proposed Proposedmechanisms mechanismsfor forthe theinduction inductionof ofinsulin insulinresistance resistance by oxidative stress. by oxidative stress. Bloch-Damti Bloch-DamtiA, A,Bashan BashanN. N. Antioxid Redox Signal. Antioxid Redox Signal.2005 2005Nov-Dec;7(11-12):1553-67. Nov-Dec;7(11-12):1553-67. In Indiabetes diabetes(type (type11and andtype type2), 2),increased increasedflux fluxof offree freefatty fattyacids acids and and glucose glucose is is associated associated with with increased increased mitochondrial mitochondrial reactive reactive oxygen oxygen species species (ROS) (ROS) production production and, and, as as aa consequence, consequence, increased increased oxidative oxidative stress. stress. ROS ROS have have been been shown shown to to activate activate various various cellular cellular stress-sensitive stress-sensitive pathways, pathways, which which can can interfere interfere with withcellular cellularsignaling signalingpathways. pathways.Exposure Exposureof ofdifferent differentcell celllines lines to to micromolar micromolar concentrations concentrations of of hydrogen hydrogen peroxide peroxide leads leads to to the the activation activationof ofstress stresskinases kinasessuch suchas asc-Jun c-JunN-terminal N-terminalkinase, kinase,p38, p38, IkappaB IkappaB kinase, kinase, and and extracellular extracellular receptor receptor kinase kinase 1/2. 1/2. This This activation activation is is accompanied accompanied by by aa down-regulation down-regulation of of the the cellular cellular response response to to insulin, insulin, leading leading to to aa reduced reduced ability ability of of insulin insulin to to promote glucose uptake, and glycogen and protein synthesis. promote glucose uptake, and glycogen and protein synthesis.The The mechanisms mechanismsleading leadingto tothis thisdown-regulation down-regulationin inoxidized oxidizedcells cellsare are complicated, involving increased serine/threonine complicated, involving increased serine/threonine phosphorylation phosphorylationof ofinsulin insulinreceptor receptorsubstrate-1 substrate-1(IRS1), (IRS1), impaired impaired insulin-stimulated redistribution of IRS1 and insulin-stimulated redistribution of IRS1 and phosphatidylinositol-kinase phosphatidylinositol-kinase between between cytosol cytosol and and low-density low-density microsomal microsomal fraction, fraction, followed followed by by aa reduced reduced protein protein kinase-B kinase-B phosphorylation and GLUT4 translocation phosphorylation and GLUT4 translocation to to the the plasma plasma membrane. membrane. In In addition, addition, prolonged prolonged exposure exposure to to ROS ROS affects affects transcription transcription of of glucose glucose transporters: transporters: whereas whereas the the level level of of GLUT1 GLUT1 is is increased, increased, GLUT4 GLUT4 level level is is reduced. reduced. As As can can be be expected, expected, administration administration of of antioxidants antioxidants such such as as lipoic lipoic acid acid in in oxidized oxidized cells, cells, in in animal animal models models of of diabetes, diabetes, and and in in type type 22 diabetes diabetes shows shows improved improved insulin insulin sensitivity. sensitivity. Thus, Thus, oxidative oxidative stress stress is is presently presently accepted accepted as as aa likely likely causative causative factor factor in in the the development developmentof ofinsulin insulinresistance. resistance.
n-3 n-3 long-chain long-chain polyunsaturated polyunsaturated fatty fatty acids acids in in type type 22 diabetes: diabetes: aa review. review. Nettleton NettletonJA, JA,Katz KatzR. R. JJAm AmDiet DietAssoc. Assoc.2005 2005Mar;105(3):428-40. Mar;105(3):428-40. Historically, Historically,epidemiologic epidemiologicstudies studieshave havereported reportedaa lower lower prevalence prevalence of of impaired impaired glucose glucose tolerance tolerance and and type type 22 diabetes diabetes in in populations populations consuming consuminglarge largeamounts amountsof ofthe then-3 n-3long-chain long-chainpolyunsaturated polyunsaturatedfatty fatty acids (n-3 LC-PUFAs) found mainly in fish. acids (n-3 LC-PUFAs) found mainly in fish. Controlled Controlled clinical clinical studies studies have have shown shown that that consumption consumption of of n-3 n-3 LC-PUFAs LC-PUFAs has has cardioprotective effects in persons with type 2 diabetes cardioprotective effects in persons with type 2 diabetes without without adverse adverse effects effects on on glucose glucose control control and and insulin insulin activity. activity. Benefits Benefits include include lower lower risk risk of of primary primary cardiac cardiac arrest; arrest; reduced reduced cardiovascular cardiovascular mortality, mortality, particularly particularly sudden sudden cardiac cardiac death; death; reduced reduced triglyceride triglyceride levels; increased high-density lipoprotein levels; improved levels; increased high-density lipoprotein levels; improvedendothelial endothelial function; function; reduced reduced platelet platelet aggregability; aggregability; and and lower lower blood blood pressure. pressure. These Thesefavorable favorableeffects effectsoutweigh outweighthe themodest modestincrease increasein inlow-density low-density lipoprotein lipoprotein levels levels that that may may result result from from increased increased n-3 n-3 LC-PUFA LC-PUFA intake. intake. Preliminary Preliminary evidence evidence suggests suggests increased increased consumption consumption of of n-3 n-3 LC-PUFAs LC-PUFAswith withreduced reducedintake intakeof ofsaturated saturatedfat fatmay mayreduce reducethe therisk riskof of conversion conversion from from impaired impaired glucose glucose tolerance tolerance to to type type 22 diabetes diabetes in in overweight overweight persons. persons. Reported Reported improvements improvements in in hemostasis, hemostasis, slower slower progression progression of of artery artery narrowing, narrowing, albuminuria, albuminuria, subclinical subclinical inflammation, oxidative stress, and obesity inflammation, oxidative stress, and obesity require require additional additional confirmation. confirmation.Expected Expectedhealth healthbenefits benefitsand andpublic publichealth healthimplications implications of of consuming consuming 11 to to 22 g/day g/day n-3 n-3 LC-PUFA LC-PUFA as as part part of of lifestyle lifestyle modification in insulin resistance and type 2 diabetes are discussed. modification in insulin resistance and type 2 diabetes are discussed.
Hyperhomocysteinemia Hyperhomocysteinemiacorrelates correlateswith withinsulin insulinresistance resistanceand andlow-grade low-gradesystemic systemicinflammation inflammationin inobese obeseprepubertal prepubertalchildren. children. Martos MartosR, R,Valle ValleM, M,Morales MoralesR, R,Canete CaneteR, R,Gavilan GavilanMI, MI,Sanchez-Margalet Sanchez-MargaletV. V. Metabolism. Metabolism.2006 2006Jan;55(1):72-7. Jan;55(1):72-7.Obesity Obesityis isan anindependent independentrisk riskfactor factorfor forthe thedevelopment developmentof ofcardiovascular cardiovasculardisease diseasefrequently frequentlyassociated associated with withhypertension, hypertension,dyslipemia, dyslipemia,diabetes, diabetes,and andinsulin insulinresistance. resistance.Higher Higherhomocysteine homocysteine(Hcy) (Hcy)levels levelsare areobserved observedin inthe thehyperinsulinemic hyperinsulinemicobese obese adults adultsand andsuggest suggestthat thatHcy Hcycould couldplay playaarole rolein inthe thehigher higherrisk riskof ofcardiovascular cardiovasculardisease diseasein inobesity. obesity.We Weanalyzed analyzedtotal totalHcy Hcylevels levelsin inobese obese prepubertal prepubertalchildren childrenand andtheir theirpossible possibleassociation associationwith withboth bothmetabolic metabolicsyndrome syndromeand andvarious variousinflammatory inflammatorybiomarkers biomarkersand andleptin. leptin.We Westudied studied 43 43 obese obese children children (aged (aged 6-9 6-9 years) years) and and an an equal equal number number of of nonobese nonobese children, children, paired paired by by age age and and sex. sex. The The obese obese subjects subjects presented presented significantly significantlyelevated elevatedvalues valuesfor forinsulin insulin(P (P= =.003), .003),C-reactive C-reactiveprotein protein(P (P= =.033), .033),and andleptin leptin(P (P< <.001). .001).No Nosignificant significantdifferences differenceswere werefound found in inHcy Hcylevels levelsbetween betweenthe theobese obeseand andnonobese nonobesechildren. children.However, However,Hcy Hcyconcentration concentrationwas wassignificantly significantlyhigher higherin inthe thehyperinsulinemic hyperinsulinemicobese obese children childrenthan thanin inthe thenormoinsulinemic normoinsulinemicgroup group(P (P= =.002). .002).Using Usingmultivariant multivariantregression regressionanalysis, analysis,in inthe theobese obesegroup, group,corrected correctedfor forage ageand andsex, sex, the thehomeostasis homeostasismodel modelassessment assessmentfor forinsulin insulinresistance resistance(P (Ppartial partial= =.001) .001)and andleptin leptin(P (Ppartial partial= =.02) .02)are areindependent independentpredictive predictivefactors factorsfor for Hcy. Hcy.In Inthe thecontrol controlgroup, group,corrected correctedfor forage ageand andsex, sex,the thehomeostasis homeostasismodel modelassessment assessmentfor forinsulin insulinresistance resistance(P (Ppartial partial= =.005) .005)and andleptin leptin(P (P partial partial= =.031) .031)also alsoare areindependent independentpredictive predictivefactor factorfor forHcy. Hcy.Increased Increasedplasma plasmaHcy, Hcy,particularly particularlyin inhyperinsulinemic hyperinsulinemicobese obesechildren, children,may maybe be causally causallyinvolved involvedin inthe thepathogenesis pathogenesisof ofatherosclerosis atherosclerosisand/or and/orcardiovascular cardiovasculardisease, disease,both bothof ofwhich whichare arecommon commonin inobesity. obesity.
NUTRICASUS
Le Le Journal Journal de de la la Mdecine Mdecine Nutritionnelle Nutritionnelle et et Fonctionnelle Fonctionnelle Pratique Pratique
Agenda Agenda ::
28/03 28/03 29/03 29/03 13/06 13/06 14/06 14/06 Bruxelles Bruxelles Lige Lige Bruxelles Bruxelles Lige Lige
22-23-24/06 La La Calderona Calderona 22-23-24/06 Valencia Valencia (Espagne) (Espagne) Le Le programme programme dtaill dtaill sera sera prsent prsent dans dans le le prochain prochain Nutricasus. Nutricasus.
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