Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide ...is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED).
Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.
AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4-7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1-13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2-9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt.
There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Role of Allelic Variants Gly972Arg of IRS-1 and Gly1057Asp of IRS-2 in Moderate-to-Severe Insulin Resistance of Women With
Polycystic Ovary Syndrome
Samira Ait El Mkadem 1 ,
Corinne Lautier 1 ,
...Françoise Macari 1 ,
Nicolas Molinari 1 ,
Patrick Lefèbvre 2 ,
Eric Renard 2 ,
Jean Christophe Gris 1 ,
Gérard Cros 1 ,
Jean Pierre Daurès 1 ,
Jacques Bringer 2 ,
Morris F. White 3 and
Florin Grigorescu 1
1 Molecular Endocrinology Laboratory, Institut Universitaire de Recherche Cilnique, Montpellier, France
2 Department of Endocrinology, Lapeyronie Hospital, Montpellier, France
3 Joslin Diabetes Center, Boston, Massachusetts
Abstract
To assess the role of insulin receptor, insulin receptor substrate (IRS)-1, and IRS-2 genes in insulin resistance, we explored
the genomic DNA in women with polycystic ovary syndrome (PCOS) and a variable degree (mean ± SE) of insulin resistance (homeostasis
model assessment index for insulin resistance HOMA IR 3.2 ± 0.6, n = 53; control subjects 1.56 ± 0.34, n = 102) using direct sequencing. Whereas no novel mutations were found in these genes, gene-dosage effects were found on fasting
insulin for the Gly972Arg IRS-1 variant and on 2-h plasma glucose for the Gly1057Asp IRS-2 variant. The Gly972Arg IRS-1 variant
was more prevalent in insulin-resistant patients compared with non–insulin-resistant individuals or control subjects (39.3
vs. 4.0 and 16.6%, P < 0.0031, respectively). A multivariate model that included BMI as a variable revealed significant effects of the Gly1057Asp
IRS-2 variant on insulin resistance ( P < 0.016, odds ratio OR 7.2, 95% CI 1.29–43.3). HOMA IR was higher in carriers of both IRS variants than in those with IRS-2 mutations only or those with wild-type variants (6.2
± 2.3, 2.8 ± 0.5, and 1.8 ± 0.2, respectively; P < 0.01), and it was significantly associated with this genotype ( P < 0.0085, OR 1.7, 95% CI 1.09–2.99). We conclude that polymorphic alleles of both IRS-1 and IRS-2, alone or in combination,
may have a functional impact on the insulin-resistant component of PCOS.
Footnotes
Address correspondence and reprint requests to Florin Grigorescu, IURC, Molecular Endocrinology, 641 Ave. Du Doyen Gaston
Giraud, 34093 Montpellier Cedex 5, France. E-mail: florin{at}iurc1.iurc.montp.inserm.fr .
Received for publication 18 August 2000 and accepted in revised form 21 May 2001.
AUC, area under the curve; AUC gluc , AUC for glucose; AUC ins , AUC for insulin; FSH, follicle-stimulating hormone; LH, leutenizing hormone; HOMA IR , homeostasis model assessment index for insulin resistance; IGT, impaired glucose tolerance; IR, insulin receptor; IRS, IR
substrate; OGTT, oral glucose tolerance test; OR, odds ratio; PCOS, polycystic ovary syndrome; PCR, polymerase chain reaction;
UTR, untranslated region.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
7.
Not Available Galtier, Florence; Bringer, Jacques
Bulletin de l'Académie nationale de médecine,
06/2015, Volume:
199, Issue:
6
Journal Article
Peer reviewed
The vast majority of patients with type 2 diabetes (T2DM) are overweight or obese. Overweight is associated with cardiovascular risk factors and an increased risk of cardio- vascular morbidity and ...mortality in T2DM. Weight loss delays or prevents T2DM in prediabetes, and improves glycemic control, in overt T2DM. Weight loss was also associated with a reduction in cardiovascular risk factors in several observational studies. However, the only randomized trial conducted among overweight or obese patients with T2DM (Look AHEAD) has shown the difliculty in maintaining a significant weight loss in the long term and to demonstrate a beneficial effect of weight loss on cardiovascular morbidity and mortality. Most interventional studies show a reduction of sleep apnea, improved metabolic control, pre- vention of depression, improved quality of life and greater mobility after sustained weight los6 in patients with T2DM. The substantial weight loss obtained by bariatric surgery is associa- ted with a reduction in overall cardiovascular morbidity andmortality in the long term, there- fore this option must be considered early enough in the management of obese T2DMpatients, particularly in those not responding to education and intensive monitoring. Physicians should therefore promote a sustained weight loss in all T2DM patients in order of benefit to the individual beyond the current lack of evidence on the benefits of lifestyle management in terms of cardiovascular morbidity and mortality.
Obesity and pregnancy : complications and cost GALTIER-DEREURE, F; BOEGNER, C; BRINGER, J
The American journal of clinical nutrition,
05/2000, Volume:
71, Issue:
5
Conference Proceeding, Journal Article
Peer reviewed
Open access
The prevalence of obesity is currently rising in developed countries, making pregravid overweight one of the most common high-risk obstetric situations. Although the designs and populations of ...published studies vary widely, most authors agree that pregravid overweight increases maternal and fetal morbidity. Even moderate overweight is a risk factor for gestational diabetes and hypertensive disorders of pregnancy, and the risk is higher in subjects with overt obesity. Compared with normal weight, maternal overweight is related to a higher risk of cesarean deliveries and a higher incidence of anesthetic and postoperative complications in these deliveries. Low Apgar scores, macrosomia, and neural tube defects are more frequent in infants of obese mothers than in infants of normal-weight mothers. The regional distribution of fat modulates the effects of weight on carbohydrate tolerance, hemodynamic adaptation, and fetal size. Maternal obesity increases perinatal mortality. Long-term complications include worsening of maternal obesity and development of obesity in the infant. The average cost of hospital prenatal and postnatal care is higher for overweight mothers than for normal-weight mothers, and infants of overweight mothers require admission to neonatal intensive care units more often than do infants of normal-weight mothers. Preconception counseling, careful prenatal management, tight monitoring of weight gain, and long-term follow-up could minimize the social and economic consequences of pregnancies in overweight women.
Full text
Available for:
CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Effect of topical basic fibroblast growth factor on the healing of chronic diabetic neuropathic ulcer of the foot. A pilot,
randomized, double-blind, placebo-controlled study.
J L Richard ,
C ...Parer-Richard ,
J P Daures ,
S Clouet ,
D Vannereau ,
J Bringer ,
M Rodier ,
C Jacob and
M Comte-Bardonnet
Department of Dietetics and Diabetology, Centre Medical, Le Grau du Roi, France.
Abstract
OBJECTIVE--To assess the efficacy and safety of topical human recombinant basic fibroblast growth factor (bFGF) on the healing
of diabetic neurotrophic foot ulcers. RESEARCH DESIGN AND METHODS--Seventeen diabetic patients suffering from chronic neuropathic
ulcer of the plantar surface of the foot entered a pilot, randomized, double-blind study comparing local application of bFGF
with placebo. Main inclusion criteria were a typical neuropathic ulcer of Wagner grade I-III, more than 0.5 cm in the largest
diameter, with an abnormally high vibration perception threshold in the absence of significant peripheral vascular disease
or wound infection. bFGF or placebo was applied daily during the 6 weeks as inpatients then twice a week for 12 weeks. Evolution
of ulcer size was assessed through weekly clinical examination and computerized photographs. RESULTS--In the bFGF group, three
of nine ulcers healed compared with five of eight in the placebo group (NS). The weekly reduction in ulcer perimeter and area
was identical in both groups, as was the rate of linear advance from entry to the 6th week of treatment (bFGF: 0.053 +/- 0.048
mm vs. placebo: 0.116 +/- 1.129 mm): the same result was obtained at the 11th week. Moreover, percent healed area at the end
of the study did not differ significantly. No side effects were observed during bFGF application. CONCLUSIONS--Topical application
of bFGF has no advantage over placebo for healing chronic neuropathic diabetic ulcer of the foot. Because diabetes causes
significant wound-healing defects, we hypothesized that using a single growth factor might be insufficient to accelerate wound
closure of diabetic ulcers.
PDF
