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Une patiente en établissement d'hébergement pour personnes âgées dépendantes était atteinte de sclérose latérale primitive (SLP), qui est une maladie neuromusculaire d'évolution lente, dans son cas, très handicapante. Elle développait progressivement une obésité. La possibilité d'une sarcopénie sous-jacente était éliminée et la prise de poids était expliquée par une très faible activité physique et surtout des grignotages non contrôlés. En l'absence de traitement de la SLP, la patiente était considérée comme en situation palliative. Invoquant le respect de sa qualité de vie, elle refusait de modérer ses grignotages. Le seul recours était de prodiguer des conseils diététiques auprès de la patiente, des équipes et de sa famille. Ce cas clinique souligne la difficulté d'évaluation et de prise en charge nutritionnelles des personnes atteintes de maladies neurologiques et neuromusculaires. A patient in a nursing home suffered from primary lateral sclerosis (PLS), which is a slowly progressive neuromuscular disease, in her case, very disabling. She gradually developed obesity. The possibility of an underlying sarcopenia was eliminated, and the weight gain was explained by very low physical activity and especially uncontrolled snacking. In the absence of treatment for PLS, the patient was considered to be in a palliative situation. Invoking respect for her quality of life, she refused to moderate her snacking. The only recourse was to provide dietary advice to the patient, the teams and her family. This clinical case highlights the difficulty of nutritional assessment and management of people with neurological and neuromuscular diseases. [ABSTRACT FROM AUTHOR]

La technique du manger-main (MM) permet à des personnes ayant des handicaps neuropsychiatriques, visuels ou moteurs de s'alimenter avec la main. Les données d'utilisation de cette technique sont rares. L'objectif de l'étude était de préciser les modes d'utilisation du MM dans les établissements médico-sociaux de la région Nouvelle-Aquitaine. Un questionnaire simple sécurisé était adressé par voie électronique à 2625 établissements médico-sociaux. Les réponses étaient recueillies en automatique, et les résultats étaient présentés de manière descriptive. Au total, 3 % des établissements contactés répondaient, dont 82 % d'EHPAD, 15 % d'établissements pour adultes en situation de handicap et 2 % pour enfants en situation de handicap. Le MM ne concernait que 24 établissements et 2 % des résidents. La présentation de l'alimentation en MM était dans 42 % des cas sous forme de bouchées, 30 % de toasts et 20 % de cubes d'hydratation. Les matériels de base nécessaires étaient peu présents. L'alimentation MM était principalement proposée au déjeuner et au dîner. Les avantages ressentis du MM étaient le maintien de l'autonomie et du plaisir de manger pour les résidents, la lutte contre la dénutrition. Les principaux inconvénients ressentis étaient l'augmentation du temps de travail, l'excessive technicité du MM et les problèmes d'hygiène. La technique du MM semble avoir des avantages, mais soulève des problèmes qui pourraient être améliorés par une augmentation du temps de personnel disponible, la formation des professionnels, l'acquisition des matériels de base et l'application plus fréquente du MM lors du petit-déjeuner et des collations. L'intérêt du MM en termes de coûts mériterait d'être exploré. The finger-food (FF) technique is intended to allow people with neuropsychiatric, visual or motor disabilities to eat by taking food by hand. Data from the use of this technique are scarce. The objective of the study was to specify the modes of use of FF in medico-social establishments in the New-Aquitaine region. A simple secure questionnaire was sent electronically to the 2625 medico-social establishments. Data were collected automatically and answers were presented descriptively. In all, 3% of establishments contacted responded (n = 80, 82% from nursing homes, 15% from establishments for disabled adults and 2% from establishments for disabled children). FF concerned 24 establishments and 2% of residents. The presentation of food in FF was in 42% of cases in the form of bites, 30% of toasts and 20% of hydration cubes. The basic materials for FF were scarce. The FF diet was mainly offered at lunch and dinner. The perceived advantages of FF were the maintenance of the residents' autonomy and pleasure of eating and the fight against undernutrition. On the side of the disadvantages felt, the main ones were the increase in working time, the excessively technical nature of the method and possible hygiene problems. The FF technique seemed to have advantages, but raised problems which could probably be improved, thanks to an increase in the available staff time, the training of professionals, the acquisition of basic materials and the more frequent application of FF during breakfast and snacks. The interest of FF in terms of costs deserved to be explored. [ABSTRACT FROM AUTHOR]

La sclérose latérale amyotrophique (SLA) est une maladie neuromusculaire de pronostic sévère, entraînant des troubles qui favorisent la survenue d'une dénutrition. Celle-ci est un facteur indépendant de survie dans cette maladie. Cependant, le tube digestif est le plus souvent fonctionnel. Pour des raisons de difficultés de mise en place d'une nutrition entérale, ou de refus des patients, la nutrition parentérale (NP) a été proposée dans certains cas. L'objectif de l'étude était de faire le point sur les données de la littérature concernant la NP lors de la SLA. Les divers articles de la littérature étaient analysés dans le cadre d'un atelier thématique interprofessionnel et d'une revue détaillée. Seulement trois articles sur ce sujet étaient retrouvés, tous d'origine française. Ils étaient mono ou multicentriques, représentaient 161 patients, et un seul article était en partie prospectif. Les patients étaient sélectionnés sur les indications usuelles de la NP ou la présence d'une capacité vitale < 50 %, ou l'association d'une démence frontotemporale. Les abords veineux centraux étaient des sites d'injection ou des cathéters insérés par voie périphérique (PICC lines). La surveillance était médico-diététique. Il s'agissait de patients dont l'évolution avait été longue, et leur durée de vie sous NP était très brève. La prévalence des infections liées à la NP était dans la fourchette des valeurs usuelles, et celle des thromboses était plus élevée. La qualité de vie des patients n'était pas précisée. La NP lors de la SLA est possible chez des patients en fin d'évolution. La technique devrait être réservée aux contre-indications de la nutrition entérale, mais une discussion au cas par cas est nécessaire. L'étude présente a permis de faire des propositions de recommandations pratiques. Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease with a severe prognosis, leading to disorders that promote the occurrence of undernutrition. This is an independent factor of survival in this disease. However, the digestive tract is most often functional. For reasons of difficulty in setting up enteral nutrition, or refusal of patients, parenteral nutrition (PN) has been proposed in some cases. The objective of the study was to review literature data regarding PN during ALS. The various articles in the literature were analyzed in the framework of an interprofessional thematic workshop and a detailed review. There were only three articles on this subject, all of French origin, mono or multicentric, and representing 161 patients. Only one article was in part prospective. Patients were selected on the usual indications of PN or the presence of a vital capacity < 50%, or the combination of frontotemporal dementia. Infusions were performed using injection sites or peripherally inserted central catheters (PICC lines). The supervision was medico-dietary. These were patients whose evolution had been long, and their life under PN was very short. The prevalence of PN-related infections was in the range of usual values, and that of thromboses was higher. The quality of life of patients was not specified. PN in ALS is possible in late-stage patients. The technique should be reserved for contraindications of enteral nutrition, but a case-by-case discussion is needed. The present study made proposals for practical recommendations. [ABSTRACT FROM AUTHOR]

Résumé Introduction et objectifs Les données sur nutrition et sclérose en plaque sont discordantes et peu précises. L’objectif de cet article était de faire un point sur les facteurs nutritionnels impliqués dans la sclérose en plaque, de la prévention de la maladie à la prise en charge spécifique des patients. Résultats Parmi les paramètres environnementaux nutritionnels suspectés de participer à la pathogenèse de la sclérose en plaque, l’obésité du jeune adulte et l’insuffisance en vitamine D sont des facteurs de risque reconnus. Les données sont insuffisantes pour préciser la prévalence ou l’incidence des altérations du statut nutritionnel des patients, mais la sclérose en plaque peut exposer au risque de dénutrition, le surpoids pourrait concerner une part importante des patients, et l’obésité être moins fréquente qu’en population générale. Les causes de dénutrition lors de la sclérose en plaque sont multiples. La prévalence élevée des troubles de la déglutition impose un dépistage de ces anomalies. La prise en charge nutritionnelle doit être pluridisciplinaire et graduée, incluant des conseils d’adaptation de textures et de positionnement, des conseils diététiques, la supplémentation orale voire la nutrition entérale. L’alimentation pourrait jouer un rôle dans l’évolution de la sclérose en plaque. Les données de la littérature sont insuffisantes pour établir des recommandations quant à la prise en charge diététique spécifique lors de la sclérose en plaque. Cependant, la limitation de consommation des acides gras polyinsaturés et des acides gras trans, la réduction de l’apport sodé, l’augmentation de l’apport en acides gras polyinsaturés ou en vitamine D sont les éléments les plus fréquemment cités comme facteurs d’amélioration potentiels. Introduction and objectives Nutritional data on multiple sclerosis are discordant and have a low accuracy. The objective of this article was to focus on the nutritional factors involved in multiple sclerosis, from the prevention of disease to the specific management of patients. Results Among the many nutritional environmental parameters suspected of participating in the pathogenesis of multiple sclerosis, obesity in young adults and vitamin D deficiency are well recognized as risk factors. The literature is insufficient to specify the prevalence or incidence of nutritional alterations during pathogenesis of multiple sclerosis, but the disease may conduct to undernutrition, an excess of weight probably concerns an important proportion of patients and obesity might be less frequent than in the general population. Multiple causes of undernutrition are identified in multiple sclerosis. The high prevalence of swallowing disorders requires early detection. Nutritional management must be multidisciplinary and progressive: advice for adjusting textures and positioning, dietary advices, oral enriched supplementation and even enteral nutrition. The literature is insufficient to establish clear recommendations for specific dietary management in multiple sclerosis. Nevertheless, diet might play a role in the course of multiple sclerosis: a limited consumption of polyunsaturated fatty acids, trans fatty acids and sodium, an increased intake of polyunsaturated fatty acids or vitamin D are the most frequently cited factors which may contribute to the improvement of the disease. [ABSTRACT FROM AUTHOR]

Résumé Objectif et méthode Le plan obésité a permis la création en France de 37 Centres Spécialisés de l’Obésité (CSO) en 2012 pour assurer une double mission, la prise en charge pluridisciplinaire de l’obésité sévère ou complexe et l’organisation des filières de soins dans les régions. Ce rapport fait le bilan des trois premières années de fonctionnement des CSO, à partir des données recueillies par l’observatoire national des CSO (oNCSO), mis en place par la Direction Générale de l’Hospitalisation et de l’Offre de Soins. Résultats Le bilan était globalement positif pour l’accès aux examens paracliniques, même si tous les CSO ne disposaient pas d’absorptiomètre biphotonique (DEXA) ou de calorimétrie. Les CSO développaient d’emblée des liens avec les 12 secteurs de prises en charge étudiés par l’oNCSO, avec quelques points faibles dont la psychiatrie. L’enquête ne permettait pas de faire le point sur les effectifs réels des CSO, au vu du nombre important de données aberrantes. Tous les CSO répondants déclaraient avoir des programmes d’éducation thérapeutique orientés vers les obèses pour les filières médicale, chirurgicale et pédiatrique. L’activité des CSO en médecine, chirurgie, gynécologie obstétrique et pédiatrie était hétérogène. En 2014, environ 25 à 30 % de l’ensemble des interventions de chirurgie bariatrique étaient en France pratiqués dans les CSO. En moyenne les CSO recevaient environ 2500 patients adultes sévèrement obèses en consultation ou en hospitalisation de jour pour la filière médicale. Les résultats suggéraient une certaine fragilité des filières de gynécologie obstétrique et des filières pédiatriques. Conclusion Cette enquête déclarative, malgré de nombreuses limites, montre cependant que les CSO ont pris d’emblée une place importante dans le système de soins français. Objective and method The French Obesity Plan enabled the creation of 37 Specialized Obesity Centers (CSOs) in 2012 to ensure a dual mission, the multidisciplinary management of severe or complex obesity and the organization of care channels in the regions. This report takes stock of the first three years of operation of the CSOs, based on the data collected by the National Observatory of CSOs (oNCSO), set up by the General Directorate of Hospitalization and Care. Results The overall results were positive for access to paraclinical examinations, although all CSOs did not have a biphotonic absorptiometer (DEXA) or calorimetry. The CSOs were initially developing links with the 12 sectors of care studied by the oNCSO, with some weaknesses including psychiatry. The survey did not make it possible to take stock of the real numbers of the actual workforce of the CSOs, given the large number of outliers. All responding CSOs reported having obese-oriented therapeutic education programs for the medical, surgical, and pediatric sectors. The activities of CSOs in medicine, surgery, gynecology and obstetrics were heterogeneous. In 2014, about 25–30% of all bariatric surgery procedures were performed in the CSOs in France. On average, CSOs received about 2500 severely obese adult patients in day care or in-patient care for the medical sector. The results suggested a certain fragility of the pathways of obstetric gynecology and the pediatric pathways. Conclusion This declarative survey, despite many limitations, shows however that CSOs have taken an important place in the French care system. [ABSTRACT FROM AUTHOR]

Résumé Introduction et objectifs La dénutrition et la fragilité sont des problèmes de santé publique fréquents, en particulier chez les personnes âgées. Le ministère des Affaires sociales et de la Santé a décidé, en 2012, de promouvoir un programme pilote de sensibilisation comprenant la réalisation de 10 conférences et de trois outils électroniques ou papier sur ce sujet. Il a sollicité pour cela la Société francophone nutrition clinique et métabolisme (SFNEP), qui a choisi pour mettre en place cette action le réseau de nutrition LINUT, implanté en région Limousin, la 2 e région la plus âgée d’Europe. Méthodes Le programme a été validé par le ministère des Affaires sociales et de la Santé et la SFNEP. Les conférences avaient pour cible les professionnels de santé et le grand public, et étaient annoncées aux médias. Elles ont été évaluées par un index de satisfaction, un test de connaissances avant/après et un questionnaire appliqué un ou trois mois après la manifestation. Les outils étaient : la proposition de mettre sur les sites Internet des institutions partenaires du réseau un lien avec le site grand public de la SFNEP, la création de 12 fiches simples, électroniques et papier, traitant de divers aspects de la dénutrition chez les personnes âgées, la réalisation d’un livre de recettes en texture mixée de fruits et légumes crus, incluant leur composition nutritionnelle et un visuel. Résultats Onze conférences ont été organisées, regroupant 947 personnes (moyenne par conférence : 86,1 ± 55,4 auditeurs) sur l’ensemble de la région. La fréquentation a été plus forte si les conférences étaient adossées à des ateliers ou à la journée régionale des Comités de liaison alimentation nutrition (CLAN). Les appréciations subjectives et les tests avant/après ont été favorables, alors que le questionnaire à distance est apparu comme inadapté. Seulement 19 % des institutions sollicitées ont accepté d’intégrer le lien avec le site de la SFNEP. Les fiches électroniques et papier ont été largement diffusées et l’ouvrage de produits crus mixés a regroupé 50 recettes. La presse régionale a rendu compte de ces réunions en publiant 16 articles sur ces actions, et un reportage de la chaîne de télévision TF1 a été réalisé lors d’un atelier. Le budget alloué a été consommé conformément aux prévisions. Conclusion Un programme de ce type est applicable, et paraît efficace quant au nombre de personnes concernées par les conférences, la diffusion des outils et l’impact médiatique. Introduction and objectives Malnutrition and frailty are frequent public health problems, in particular in the elderly people. The French Ministry for the Social Affairs and Health (MSAH) decided in 2012 to promote a pilot program including the realization of 10 conferences and three electronic or paper tools on this subject. It requested in this direction the French-speaking Clinical Nutrition and Metabolism Society (SFNEP), which chose for its application the nutrition network LINUT, established in area of Limousin, the 2nd oldest area of Europe. Methods The program was validated by the MSAH and the SFNEP. The conferences had as a target the health professionals and the general public, and were announced with the media. They were evaluated by an index of satisfaction, a general knowledge before/after test and a questionnaire applied one or three months after the conferences. The tools were: the proposal to put on the websites of the institutions partners of the network a link with the site general public of the SFNEP, the creation of 12 simple, electronic and paper cards, treating various aspects of malnutrition in the elderly, the realization of one recipe book in mixed-texture of raw fruit and vegetables, including their nutritional composition and visual. Results Eleven conferences took place, involving 947 people (average: 86.1 ± 55.4) on the whole of the area. The frequentation was stronger if the conferences were leaned with workshops or the regional day of the Liaison Committees for Alimentation and Nutrition (LCANs). The subjective appreciations and the before/after tests were favourable, whereas the remote questionnaire appeared unsuited. Only 19% of the requested institutions agreed to integrate the link with the site of the SFNEP. The electronic and paper cards were widely diffused. The book included 50 mixed-texture cooking recipes. The regional press published 16 articles on these actions, and a TF1 report was carried out at the time of a workshop. The allocated budget was consumed in accordance with the forecasts. Conclusion A program of this type is applicable, and appears effective as for the number of people concerned with the conferences, the diffusion of the tools and the media impact. [ABSTRACT FROM AUTHOR]

Résumé Depuis de nombreuses années, une activité sportive intense a été suspectée de favoriser l’apparition de la sclérose latérale amyotrophique (SLA). De plus, les patients atteints se posent souvent la question d’une aggravation possible de la maladie, s’ils pratiquent une activité physique, ainsi que celle de l’efficacité de l’activité physique pour lutter contre les contractures, et de l’intérêt éventuel de l’utilisation de la créatine, qui intervient dans la phase anaérobie initiale de l’effort. Les résultats des études animales suggèrent que l’activité physique modérée a des effets globalement positifs, mais ces données ne peuvent être appliquées directement à l’homme. Les études humaines indiquent qu’une activité physique intense telle que la pratique du football ou celle du football américain pourrait être un facteur de risque de développer la SLA. Elles sont insuffisantes pour affirmer l’intérêt d’une activité physique lorsque la maladie est déclarée. L’activité physique ne permet pas d’améliorer les contractures, et l’administration de créatine ne paraît pas avoir d’effet lors de la maladie. For a long time, an intense physical activity has been suspected to be a risk factor for developing amyotrophic lateral sclerosis (ALS). Moreover, the patients would like to know if their disease may be worsened by physical activity, but also if physical activity may be useful against spasticity, and if creatine, a nitrogenous compound occurring in the first anaerobic phase of exercise may have an interest. Animal studies suggest a global favourable effect of moderate exercise, but these data cannot be strictly applied in humans. Human studies show that an intense physical activity like football or American football might be a risk factor for developing ALS. Studies are not enough powerful to indicate an interest of exercise after the onset of the disease. Physical activity does not improve the spasticity, and creatine seems not to be effective during ALS. [ABSTRACT FROM AUTHOR]

Résumé: Environ 143 000 français souffraient, en 2005, de maladie de Parkinson (MP). Les principaux problèmes nutritionnels rencontrés lors de la MP sont la dénutrition, l’adaptation alimentaire des apports protéiques et l’excès de poids après chirurgie d’électrostimulation cérébrale. La dénutrition est multifactorielle, liée à la maladie et aux traitements. Le handicap, les troubles psychologiques, les troubles de la déglutition, du goût et de l’odorat participent à l’insuffisance des apports alimentaires, de même que les troubles digestifs (gastroparésie et constipation). Les traitements de ces symptômes sont aspécifiques. Les dépenses énergétiques sont majorées par les troubles du tonus et les mouvements anormaux, avec des variations en fonction de la réponse des patients aux traitements. L’Indice de Masse Corporelle (IMC), la variation de poids et le Mini Nutritional Assessment® (MNA) sont les outils les plus souvent retenus. La dénutrition touche jusqu’à un patient sur quatre, et doit donc être dépistée et traitée. La prise en charge est sans particularité, sauf pour l’adaptation des apports protéiques. En effet, il existe une compétition au niveau digestif et de la barrière hématoméningée entre la lévodopa et certains acides aminés. En cas de mauvaise efficacité des traitements ou d’aggravation de la maladie, il est recommandé de donner les protéines lors du repas du soir, de donner la lévodopa 20 à 30minutes avant les repas, et devant des troubles neurologiques sévères de baisser les apports protéiques quotidiens. L’électrostimulation cérébrale profonde s’accompagne d’une prise de poids rapide, qui peut se compliquer d’une dyslipidémie ou d’un diabète. L’obésité peut majorer le handicap. La prise en charge à ce stade n’est pas spécifique. Les troubles de la déglutition sont la principale cause de mortalité. La mise en place d’une gastrostomie ne doit donc pas être trop tardive. [ABSTRACT FROM AUTHOR]

Abstract: Swallowing is a complex phenomenon, allowing per os feeding but with a protection of respiratory tract. Swallowing disorders are frequent, involve liquids, solids or theses two textures, and are mainly caused by neurological or otorhinolaryngological diseases. They may have severe consequences, like an alteration of quality of life for patients or their relatives, an increased risk of aspiration, of malnutrition or dehydration, and finally a possible decrease of survival. Assessment includes careful questioning and physical examination. The reference complementary investigation is videofluoroscopic evaluation. Nutritional assessment is mandatory. Taking care of swallowing disorders in a multidisciplinary manner is recommended, with interventions of physician, speech therapist, dietician, sometimes dentist or surgeon, and needs a strong contribution of the paramedical staff and the patient relatives. Enteral nutrition is recommended when repeated or severe respiratory complications occur, when the nutritional status is altered in spite of feeding enrichment, modulations of textures or use of oral nutritional supplements, or when the meals are too long. [Copyright &y& Elsevier]

Abstract: Maple syrup disease (MSD) is a rare autosomal recessive disorder caused by a decreased activity of branched-chain-ketoacid dehydrogenase, the second enzyme in the pathway of degradation of branched-chain aminoacids (leucine, isoleucine and valine). The three main clinical forms described are : classical form, at the neonatal period, marked by a severe neurological toxicity, subacute form appearing later and thiamine sensitive form. In every case, diagnosis is based on an increase of leucine, isoleucine and valine in blood and urines, with an associated presence of alloisoleucine. Diagnosis is confirmed by molecular analysis of corresponding genes. In several situations of protein catabolism, episodes of intoxication can occur. Emergency treatment for neonates and acutely sick children or adults uses hypoenergetic artificial nutrition (parenteral or enteral nutrition) without aminoacids and consequently involving only glucido-lipidic nutriments. Forty-eight hours later, proteins are progressively reintroduced. Natremia must be controlled, and a supplementation with isoleucine et valine is mandatory. Hemodialysis or hemofiltration can be necessary. Chronic treatment needs a strictly limited diet concerning branched-chain aminoacids. Natural proteins are limited as well as fruits and vegetables intakes. Lipids and sweetened food are permitted ad libitum. Food is supplemented by hyprotidic produces available in some hospital pharmacies. Oncoming of deficiencies is prevented by suplementations in minerals, vitamins, trace-elements, n–3 fatty acids and non-essential aminoacids. Follow-up is performed for children by a pediatrist and by an informed practitioner for adults. Psychomotricity and growth of children must be as normal as possible. All along the life, a metabolic equilibrium is needed and nutritional assessments are recommended at least once a year. Blood leucine level is regularly measured. A diagnosis before birth is possible when MSD has been identified in a member of the family. Pregnancy must be carefully prepared and followed. [Copyright &y& Elsevier]

Abstract: The taste is a sense, mainly oral, including five basic flavors: sweet, salty, bitter, sour and umami. It is linked with olfaction and salivation. The most frequent taste disorders are dysgeusia or hypogeusia. Ageusia is scarce and hypergeusia very uncommon. Taste assessment needs a precise discussion with the patient, in order to find a cause of the trouble. Otorhinolaryngological and neurological examinations are needed. Chemical or electrical stimulation tests are possible by a specialist. A large number of causes for taste troubles have been recognized. Age, pregnancy and menopause are physiologically involved. Many treatments have been incriminated, especially radiotherapy or chemotherapy. Oral disorders, vitamins or trace-elements insufficiency, alcohol or tobacco intoxication, salivary troubles or some psychiatric disorders are frequently in cause as well as several chronic or post-traumatic diseases. Taste troubles are deleterious on quality of life, appetite, and are well-known risk factors for malnutrition in elderly. Their treatment is difficult, needing if possible the suppression of cause. Taste enhancers can be used as well as advices by a dietician. An associated malnutrition has to be treated. [Copyright &y& Elsevier]

Abstract: A Liaison Committee for Alimentation and Nutrition (LCAN) is recommended in French hospitals since 2002. When the first 2004 national survey noted that a LCAN was established in 30% of them, the 2008 survey shows a large increase until 73%. The greater are hospitals, the more often they have a LCAN. This structure is now well established in general public and in private hospitals. Its age is about 3 years, with mainly a medical chairman. All the staffs concerned by food and nutrition are represented in LCAN, of which the main aims are nutritional care and restoration. More frequently than in 2004, LCAN has a proceedings program and is described in the hospital reception book, but a dedicated budget remains very uncommon. The largest difficulty for creating LCAN is the too small hospital size. Some hospitals probably think that the LCAN functions can be assumed by a private food provider, and this could be a serious problem because the number of hospitals using private food concession increases. Since 2004, for the whole hospitals surveyed, the mean number of dieticians remains low (0.5 full time/hospital), education on food and nutrition increases, as well as malnutrition assessment. Only 2% of hospitals have a clinical nutrition team at disposal, but with limited material capacities and interventions. [Copyright &y& Elsevier]

Abstract: The French region of Limousin uses since 2003 a health care provider for home parenteral nutrition (HPN). An evaluation of the first five years was performed in a retrospective manner, concerning 494 stays of 375 different patients, aged 60.9±12.7 years, between January 1st, 2003 and December 31, 2007. Concerning the HPN, 77.5% were made for cancer patients, 49.7% had a C Detsky index and the average of Karnovsky index was 73.5. The nutrition used in 84.2% of cases an injection site. The three administrative departments of the region received 77.3% of stays. The comparative analysis showed that age of cancer patients was higher, their Detsky index was worse, their ingesta were lower, and that they died more frequently during their follow-up than patients with digestive non-cancer disease. The small follow-up duration in digestive non-cancer patients could be due to a recruitment in perioperative period for them, or could be linked with their need of only refeeding limited sequences. This activity of HPN with a health care provider was useful, answering to a large number of demands, particularly for cancer patients. [Copyright &y& Elsevier]

Abstract: Menu Committees (MC) are frequently present in French geriatric institutions like nursing homes, but with variable functioning conditions. Their aims are theoretically to favour communication about food, and to validate menus in each institution. However, statutory frame and bibliography on MC are poor and consequently pragmatic propositions based on daily practice can be made. They give optimal aims of MC, its composition including which role each participant plays and the functioning conditions before, during and after MC. A better satisfaction of residents, medical practitioners and employees, combined with surveys showing improvements in food supply could be signs of a good efficiency for MC. [Copyright &y& Elsevier]

Abstract: Nutrition support teams (NST) are hospital transverse nutrition care structures, recently established and developed in France. In continental Europe, their prevalence is 5–10%. Nutritional assessment and care are their main actions. Education, clinical research and assessment of the practices are secondary aims of NST. Physicians, dieticians, nurses and pharmacists are the main participants. The weekly durations of work dedicated to NST are low, explaining the small number of followed patients and the limited types of actions. NST are generally integrated in another hospital division or service, and provide examinations for in or out hospitalized patients. Interventions concern internal medicine, neurology, oncology, intensive care units, with patients suffering from digestive, neurological or cancer diseases. NST financing generally comes from hospitals. NST generates benefits for patients in terms of morbidity, mortality and length of stay and consequently save money. Nutritional competence of NST participants and duration of action could be predictive of good results. As propositions, international definition of NST should be clarified, the number of NST could increase, with more numerous and educated staffs, and more time dedicated. A better quotation of nutritional interventions and a development of assessment of NST could be recommended. [Copyright &y& Elsevier]

An abnormally elevated level of resting energy expenditure (REE, measured by indirect calorimetry) has been reported in a subset of patients with sporadic amyotrophic lateral sclerosis (SALS). Hypermetabolism (measured REE/calculated REE (cREE)≥1.1, or 110%) has also been observed in transgenic mice harbouring ALS-causing mutations in the SOD1 gene. By contrast, the REE of patients with familial amyotrophic lateral sclerosis (FALS) has never been assessed. Our objective was to evaluate the metabolic and nutritional parameters of FALS patients and to compare them with those of SALS patients, and search for correlations with clinical parameters. Eleven patients with FALS (from 10 different families, none carrying a SOD1 mutation) were evaluated by indirect calorimetry in our centre. As a control group, we used a sample of 33 patients with SALS, matched for age and sex with the FALS patients. 11/11 (100%) patients with FALS were hypermetabolic, compared to 17/33 (52%) patients with SALS (p=0.009). Measured REE (mREE) and mREE/cREE (metabolic level) were significantly higher in FALS patients than in SALS patients (p=0.03 and p=0.0008, respectively). No correlation was found between metabolic measures and neurological or respiratory parameters. In conclusion, hypermetabolism appears to be a common feature of subjects with FALS, suggesting that this impairment of energy homeostasis may be genetically driven. The high metabolic level of FALS patients should be taken into account for their nutritional management (need for a high-energy diet to prevent malnutrition). [ABSTRACT FROM AUTHOR]

Malnutrition is a well-known independent survival factor in ALS patients. Total body impedance analysis (BIA) has been validated for the measurement of fat-free mass. Another physical value obtained by BIA is phase angle (PA) that has been proposed to be an index of malnutrition or a survival prognostic factor in several diseases. We measured PA in a sample of 168 ALS patients and analysed the relationships between PA and neurological, respiratory and nutritional status, and determined whether PA is an independent prognostic factor for survival in ALS. BIA was performed using an Analycor3 instrument with surface electrodes at 50 kHz and 800 µA. PA was obtained using the formula: PA =arctan (Xc/R) (in degrees) where Xc is the body reactance and R the bioelectric resistance. Relationships between quantitative variables were assessed by linear correlation coefficients and through univariate and multivariate linear regression analyses. To assess the prognostic role of PA on survival of patients, we performed survival analyses based on the Kaplan-Meier method using the log rank test, and on univariate and multivariate Cox proportional hazard model. Baseline time was time from multidisciplinary visit (T1) to death or censoring time. PA was always significantly lower in ALS patients than in healthy control subjects published in the literature. PA was lower in our ALS malnourished patients than in non-malnourished patients (3.3±1.1° versus 2.5±0.6°, p =0.003). In multivariate linear regression analysis, manual muscle testing (p<0.0001), vital capacity (p<0.001), fat-free mass (p<0.0001), time between initial signs and T1 (p<0.002) and age (p<0.001) were independently significantly linked with PA and explained 48% of PA variation. The survival of ALS patients from T1 was significantly linked with PA after adjustment on BMI, CV and time between initial signs and multidisciplinary visit, clinical form, age and sex. Patients with a PA <2.5° had a significantly poorer survival rate than patients with a PA >2.5°. We concluded that in ALS patients, PA is greatly decreased. It is related to the nutritional status of patients, and is also an independent prognostic factor of survival. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the liaison committees for alimentation and nutrition (LCAN) is to improve patients healthcare in health institutions (HI). In order to know the development of LCAN in 2004, a grid of investigation proposed by the National Alimentation and Nutrition Commitee for HI was sent by the direction for hospitalization and health organisation of the french health ministry. 30% among 779 HI had a LCAN, with its presence in HI positively linked with: existence of alimentation and nutrition trends, educational activities, clinical nutrition activity, HI dimension. LCAN worked since 2.3 years (mean), had 2.3/y commitee meetings and consisted of 9 individuals representing hospital professions and patients. The LCAN first aims were evaluation, writing documents, education and elaborating structures. 70% of LCAN wrote a programme for action, 33% a report, but there was only in 5% of cases a LCAN budget. Lack of time, means and personnels, former presence of an alimentation staff or a too small dimension were the motives for HI not to create a LCAN. Concerning all HI who gave answers, alimentation and nutrition trends existed in 58% of cases, 73% used self-management for alimentation, the median meals production was 400/d, and the median number of dieticians was 0.8. 35% of HI had an educational programme in alimentation and nutrition, 35% detected malnutrition, 24% detected obesity, 28% had a clinical nutrition activity, and only 10-11% used a network in nutrition between hospital and the community. All in all, there are more LCAN in 2004 than before, and they probably play a favourable role in HI. More educational programmes and shared structures or means between several HI are advocated. Evaluation of patients nutritional status has to be more frequent, and larger means for equipment and personnel in alimentation and nutrition could be useful. [Copyright &y& Elsevier]

In the natural progression of amyotrophic lateral sclerosis (ALS), a state of malnutrition often develops, associated with reduced oral intake, caused by difficulties with swallowing, adequate salivation, and/or anorexia. The placement of a feeding tube should be considered at the point where patients demonstrate swallowing difficulty and/or alteration in nutritional status. The goal of this prospective work was to compare, in 50 patients having definite or probable ALS, the complications after endoscopic (PEG), or radiologically-guided gastrostomy (RIG) and to evaluate their effects on survival. RIG was proposed as first-line therapy when patients had a slow vital capacity (SVC) less than 50% of the theoretical value, or in a case where PEG was refused by the patient. Thirty patients underwent PEG procedure, and 20 had RIG. Among the decisional criteria for placing a gastrostomy tube, risk of aspiration demonstrated by using videofluoroscopy was more frequently observed in the RIG group (65%) than in the PEG group (19.2%) ( p ?=?0.002). The two patient populations at time of gastrostomy placement were comparable with respect to age, gender ratio, disease duration before gastrostomy, the form and the gravity of neurological involvement as well as for nutritional criteria. The only significant difference observed between the two groups was the level of the SVC, much lower for patients undergoing RIG: 51.6±25.0% versus 67.4±26.7% than for the PEG group ( p ?=?0.03). The frequency of all complications observed at the moment of placement of gastrostomy tube and during the first month of follow-up was not significantly different between the two groups. Kaplan-Meier survival curves from the date of gastrostomy placement were not different in univariate analysis ( p ?=?0.85). In multivariate analysis, survival was not different between one group and the other ( p ?=?0.28). The major interest of the RIG technique rests on its greater feasibility and on the possibility of utilizing it in ALS patients who have significant ventilatory compromise. [ABSTRACT FROM AUTHOR]

Despite a reduction in fat-free mass (FFM), a hypermetabolism has been reported with an average of 10% in amyotrophic lateral sclerosis (ALS) patients as compared with a healthy population. The objectives of this study were to confirm the level of hypermetabolism determined by using indirect calorimetry in 168 patients with a probable or a definite ALS and to study correlations with survival. Consecutive evaluations of resting energy expenditure (REE) were performed from diagnosis to the proximity of death in 44 ALS patients. Differences with the calculated value determined a ΔREE. FFM was given by bioimpedance. At T1, REE was significantly increased by an average of 14% as compared with the calculated value. 62.3% of ALS patients were considered as hypermetabolic. REE was correlated in univariate analysis with age, sex, clinical form at onset, presence of a denutrition, weight, FFM, phase angle and ALS Functional Rating Scale (ALSFRS). In multivariate analysis, REE was linked to age and FFM. ΔREE was correlated in univariate analysis with sex, phase angle and manual muscle testing (MMT). In multivariate analysis, age and sex remained significantly correlated. During progression of ALS, REE levels remained higher than calculated values with a trend to decrease at proximity of death, whereas FFM remained stable. From T1, survival was linked to MMT, ALSFRS, vital capacity, REE and phase angle. We confirmed the existence of a stable hypermetabolic state in ALS which depends mainly on age, sex and FFM. REE is a prognostic factor for survival in univariate analysis. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Oxidative stress is involved in cellular death pathways of neurodegenerative diseases. Alzheimer’s disease, Parkinson’s disease and amyotrophic lateral sclerosis are the most frequent of these affections. In each case, there are evidences of an altered oxidative status. Oxidative stress play a role in all the pathophysiological hypothesis of Alzheimer’s disease, and several anti-oxidant compounds are efficient. In amyotrophic lateral sclerosis patients, only an association of vitamin E with riluzole, a glutamate inhibitor, has shown to have a favourable effect. The pathogenesis of Parkinson's disease implies oxidative stress in the dopaminergic neuronal death of the substantia nigra. The arguments include alterations of brain iron content, impaired mitochondrial function, alterations of protective systems. The neurotoxin 1–me´thyl–4–phe´nyl–1,2,3,6–tetrahydropyridine is a Parkinson model caused by an inhibition of the complex I of the mitochondrial respiratory chain. DATATOP study, using selegiline, an inhibitor of mono-amine oxidase with anti-oxidant properties, showed a modest neuroprotective effect of this compound but a lack of effect of vitamin E. [Copyright &y& Elsevier]

Malnutrition, present in 16–50% of ALS patients, is an independent prognostic factor for worsened survival. It is caused primarily by swallowing dysfunction, resulting from involvement of the lower sets of cranial nerves, but hypermetabolism is also implicated. Malnutrition itself can produce neuromuscular weakness and adversely affect patients' quality of life, thereby creating a vicious circle. The nutritional status of ALS patients can be assessed with dietary review and measurements of weight (W) and height (H). A body mass index (BMI = W/H[sup 2]) below 18.5–20 kg/m[sup 2] indicates a state of malnutrition. Dietary counselling is important, but rapidly becomes insufficient, particularly in bulbar-onset ALS, where enteral nutritional support is then necessary. Percutaneous endoscopic gastrostomy tube placement is well tolerated, and provides more efficient enteral nutri- tion than nasogastric tube feeding. Enteral nutrition support can improve the respiratory status of ALS patients. The effect on survival remains to be confirmed. (ALS 2000; 1:91–96). [ABSTRACT FROM AUTHOR]

Presents information on a study that determined whether carbon dioxide released from the blood without acid addition can be used to measure ...carbon dioxide atom percent. Significance of measuring the carbon dioxide enrichment; Analytical methods and calculations; Results and discussion.

Presents information on a study which determined whether carbon dioxide (CO2) released from the blood without acid addition can be used to measure (13) carbon dioxide atom percent. Subjects and methods; Results and discussion.

Le fonctionnement des établissements pour personnes âgées ou handicapées concernant l'alimentation nutrition est mal connu. Il existe en région Nouvelle-Aquitaine un centre de ressources en nutrition (Cerenut) chargé d'aider les établissements sur ces thématiques. L'étude visait à connaître les principales actions alimentation nutrition pratiquées dans les établissements médicosociaux et de santé de Nouvelle-Aquitaine, leur perception de l'intérêt des divers services proposés par Cerenut et les niveaux d'utilisation de ces services. Un questionnaire sécurisé était adressé par voie électronique à 2625 établissements. Les données déclaratives étaient recueillies en automatique durant une période d'un mois. Le nombre d'établissements répondants était de 172 (6,6 % des établissements contactés). L'utilisation des compléments nutritionnels oraux, la pesée au moins une fois/mois et la présence d'une commission de menus étaient les actions les plus souvent déclarées. L'alimentation nutrition était une préoccupation importante pour le budget des établissements. L'évaluation nutritionnelle des résidents à l'entrée, l'utilisation de temps diététique, la pratique de la nutrition entérale étaient peu fréquentes. Les établissements pour personnes handicapées étaient les plus mal lotis. Les services de Cerenut touchant à la formation des équipes étaient jugés les plus intéressants et les plus utilisés. Plusieurs actions alimentation nutrition fondamentales n'étaient pas réalisées dans les établissements enquêtés, de nature à gêner l'évaluation nutritionnelle des résidents, leur prise en charge et la valorisation de leurs séjours. Cerenut propose des formations et peut fournir aux structures des aides adaptées dans de nombreux cas. The functioning of establishments for elderly or disabled people regarding food and nutrition is poorly understood. In the French Nouvelle-Aquitaine region, there is a Nutrition Resource Center (Cerenut) responsible for helping establishments on these issues. The study aimed to find out the main food and nutrition actions practiced in medico-social and health establishments in Nouvelle-Aquitaine, their perception of the interest of the various services offered by Cerenut and the levels of use of these services. A secure questionnaire was sent electronically to 2625 establishments. Declarative data was collected automatically over a period of one month. The number of responding establishments was 172 (6.6% of establishments contacted). The use of oral nutritional supplements, weighing at least once a month and the presence of a menu committee were the most frequent actions. Nutritional issues were an important concern for establishment budgets. The nutritional assessment of residents upon entry and the use of dietary time remained infrequent, as did the practice of enteral nutrition. Establishments for people with disabilities were the worst off. Cerenut's services relating to team training were considered the most interesting and the most used. Several fundamental food and nutrition actions were not carried out in the establishments surveyed, likely to hamper the nutritional assessment of residents, their care and the enhancement of their stays. Cerenut offers training and can provide structures with appropriate assistance in many cases. [ABSTRACT FROM AUTHOR]

Aging of the Guinean population is a public health concern for the coming years, and the nutritional status of older people is virtually unknown. We also know that this population is growing and that undernutrition and obesity can affect the health of older adults. This study aimed to assess the nutritional status of older people in the general population of Guinea and its associated factors. A representative cross-sectional survey was conducted using sociodemographic, clinical, and anthropometric data (weight and height). Oral status was assessed by using the University of Nebraska Oral Status Scale. Visual acuity was assessed using the Monoyer scale. The standardized prevalence ratio (SPR) of the nutritional status was calculated for each region. The sample included 1698 subjects with a mean BMI of 22.6 ± 4.3 kg/m2. A total of 50.3% had impaired oral status and 20.3% had moderately to severely impaired visual acuity. The prevalence of undernutrition was 14.4% and of obesity 5.7%. Differences in the prevalence of nutritional status were found between regions, with an SPR > 1 for undernutrition in the Labé region (SPR 1.9, 95% CI = 1.5–2.5) and for obesity in the Conakry and Kindia regions (SPR of 2.90, 95% CI = 2.0–4.05 and 2.32, 95% CI = 1.5–3.3, respectively). In Guinea, The prevalence of nutritional disorders was approximately 20%. Screening and management of the health and nutritional status of older adults should be a national priority, and management should be adapted to each region of the country. [ABSTRACT FROM AUTHOR]

Aging of the Guinean population is a public health concern for the coming years, and the nutritional status of older people is virtually unknown. We also know that this population is growing and that undernutrition and obesity can affect the health of older adults. This study aimed to assess the nutritional status of older people in the general population of Guinea and its associated factors. A representative cross-sectional survey was conducted using sociodemographic, clinical, and anthropometric data (weight and height). Oral status was assessed by using the University of Nebraska Oral Status Scale. Visual acuity was assessed using the Monoyer scale. The standardized prevalence ratio (SPR) of the nutritional status was calculated for each region. The sample included 1698 subjects with a mean BMI of 22.6 ± 4.3 kg/m2. A total of 50.3% had impaired oral status and 20.3% had moderately to severely impaired visual acuity. The prevalence of undernutrition was 14.4% and of obesity 5.7%. Differences in the prevalence of nutritional status were found between regions, with an SPR > 1 for undernutrition in the Labé region (SPR 1.9, 95% CI = 1.5–2.5) and for obesity in the Conakry and Kindia regions (SPR of 2.90, 95% CI = 2.0–4.05 and 2.32, 95% CI = 1.5–3.3, respectively). In Guinea, The prevalence of nutritional disorders was approximately 20%. Screening and management of the health and nutritional status of older adults should be a national priority, and management should be adapted to each region of the country. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the impact of body composition on outcomes of patients with early breast cancer. Skeletal muscle mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and muscle fat infiltration or inter-muscular adipose tissue areas (IMAT), obtained by computed tomography (CT), were assessed.Methods: A total of 119 female patients who had breast cancer were included in this retrospective study. The total skeletal muscle and fat tissue areas were evaluated in two adjacent axial slices obtained at the third lumbar vertebra by CT used for disease staging. The women were assigned to either a sarcopenia or non-sarcopenia group based on their skeletal muscle index (cut-off 41.0 cm2/m2). They also were classified into high and low VAT/SAT ratio groups and assigned to either the high or low IMAT index group. The association of the body composition parameters and prognosis was statistically analyzed.Results: Among the 119 evaluable patients, 58 were sarcopenic (48.8%), 55 (46.2%) had a high VAT/SAT ratio, and 62 (52.1%) had a high IMAT index. Median follow-up was 52.4 months. Multivariate analysis revealed sarcopenia and IMAT index as independent prognostic factors for disease-free survival (p = 0.02 and p = 0.04, respectively) and overall survival (p = 0.05 and p = 0.02, respectively). BMI was not significantly associated with disease-free survival, but a trend was observed (p = 0.09).Conclusions: Sarcopenia and IMAT index are independent prognostic factors in early breast cancer; therefore, assessing body composition could be a simple and useful approach to integrate into patient management. [ABSTRACT FROM AUTHOR]

The 24-hour urine collection method is considered the gold standard for the estimation of ingested potassium and sodium. Because of the impracticalities of collecting all urine over a 24-hour period, spot urine is often used for epidemiological investigations. This study aims to assess the agreement between spot urine and 24-hour urine measurements to determine sodium and potassium intake. A total of 402 participants aged 25 to 64 years were randomly selected in South Benin. Spot urine was taken during the second urination of the day. Twenty-four-hour urine was also collected. Samples (2-mL) were taken and then stored at -20°C. The analysis was carried out using potentiometric dosage. The agreement between spot urine and 24-hour urine measurements was established using Bland-Altman plots. A total of 354 results were analyzed. Daily sodium chloride and potassium chloride urinary excretion means were 10.2±4.9 g/24 h and 2.9±1.4 g/24 h, respectively. Estimated daily sodium chloride and potassium chloride means from the spot urine were 10.7±7.0 g/24 h and 3.9±2.1 g/24 h, respectively. Concordance coefficients were 0.61 at d=-0.5 g, (d±2SD=-11 g and 10.1 g) for sodium chloride and 0.61 at d=-1 g, (d±2SD=-3.8 g and 1.8 g) for potassium chloride. Spot urine method is acceptable for estimating 24-hour urinary sodium and potassium excretion to assess sodium and potassium intake in a black population. However, the confidence interval for the mean difference, which is too large, makes the sodium chloride results inadmissible at a clinical level. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationships between dental problems and underweight status among rural women in Burkina Faso by using nationally representative data. Design: This was a cross-sectional secondary study of primary data obtained by the 2013 WHO Stepwise Approach to Surveillance survey conducted in Burkina Faso. Descriptive and analytical analyses were performed using Student's t test, ANOVA, the χ2 test, Fisher's exact test and logistic regression. Setting: All thirteen Burkinabè regions were categorised using quartiles of urbanisation rates. Participants: The participants were 1730 rural women aged 25–64 years. Results: The prevalence of underweight was 16·0 %, and 24·1 % of participants experienced dental problems during the 12-month period. The women with dental problems were more frequently underweight (19·9 % and 14·7 %; P < 0·05) and had a lower mean BMI (21·1 ± 3·2 and 21·6 ± 3·7 kg/m2, P < 0·01) than those without dental problems. More risk factors for underweight were observed in less urbanised regions among elderly individuals (> 49 years old) and smokeless tobacco users. Age > 49 years, professions with inconsistent income, a lack of education, smokeless tobacco use and low BMI were factors that were significantly associated with dental problems, while residency in a low-urbanisation area was a protective factor. Conclusion: The prevalence of underweight in rural Burkinabè women is among the highest in sub-Saharan Africa, and women with dental problems are more frequently affected than those without dental problems. Public health measures for the prevention of these disorders should specifically target women aged over 49 years and smokeless tobacco users. [ABSTRACT FROM AUTHOR]

Résumé Devant la constatation d’une hétérogénéité des pratiques de prise en charge diététique destinées aux patients obèses sans chirurgie au CHU de Limoges et dans un but d’amélioration de ces pratiques, une enquête nationale sur ce thème a été menée auprès de tous les CHU de France métropolitaine de septembre 2011 à l’été 2012, grâce à un questionnaire déclaratif renforcé par des entretiens téléphoniques. Tous les CHU ont répondu. Les enquêtes orales sur les habitudes alimentaires et le recueil d’informations portant sur le côté sensoriel et symbolique de l’alimentation sont réalisés dans 97 % des cas, un relevé écrit de la consommation alimentaire est demandé aux patients dans 82 % des cas. L’équilibre alimentaire est apprécié dans 94 % des cas, et les quantités consommées dans 71 % des cas. Une analyse cognitivo-comportementale est réalisée dans 53 % des cas. Dans près d’un quart des cas, les apports énergétiques totaux et la répartition de la ration selon les types de nutriments ne sont pas quantifiés. L’évaluation de la dépense énergétique de repos est un outil considéré comme important pour la pratique diététique, mais les méthodes utilisées s’écartent parfois des recommandations. Les hospitalisations de longue durée ne sont citées que dans 21 % des cas, suggérant que ce type de prise en charge appartient plutôt à d’autres établissements de santé que les CHU. L’utilisation d’ateliers du goût ou d’ateliers « cuisine » est peu fréquente, bien qu’ils soient a priori importants en éducation thérapeutique. Les diagrammes institutionnels de prise en charge et la réalisation d’évaluations de pratiques professionnelles sont rares ou exceptionnels. La prise en charge diététique globale est concordante avec les préconisations, mais l’enquête a permis de repérer des points qui pourraient être précisés ou développés afin d’améliorer le service rendu. Before the finding of heterogeneous practices of dietary management for obese patients without surgery in Limoges university hospital, and in order to improve these practices, a French national survey was performed from September 2011 to spring 2012 in all metropolitan university hospitals (MUH), using a declarative questionnaire. All MUH responded. Information on diet and on the sensory and symbolic part of feeding is noted in 97% of cases, a written statement of feeding is requested in 82% of cases. A balance diet is assessed in 94% of cases, and the amount consumed in 71% of cases. A cognitive-behaviour analysis is performed in 53% of cases. In nearly one case on four, total energy intakes and distribution for the different nutriments are not measured. Assessment of resting energy expenditure is considered as an important tool in dietician practice, but the methods sometimes differ recommendations. The long-term hospitalizations are cited only in 21% of cases, suggesting that rather this type of support belongs to other health care facilities than MUH. Although taste or cooking workshops seem to be important for therapeutic education, they are scarcely used. Institutional diagrams for care and evaluations of professional practices are rare or exceptional. Taking overall dietary management is consistent with the recommendations, but the survey allows recognizing several points of improvement. [ABSTRACT FROM AUTHOR]

Background: Aging is accompanied by a drop in the level of health and autonomy, within Western countries more and more people being cared for in nursing homes (NH). The nutritional data in NH in France remain poor, not exhaustive and not representative. The objective of the study was to assess the nutritional status, dementia and mobility patterns among residents of NH in the Limousin territory of France. Methods: The study was cross-sectional, descriptive and exhaustive, conducted with the residents of 13 voluntary NH. Undernutrition was identified using French High Authority for Health criteria, and obesity if Body Mass Index >30, in the absence undernutrition criterion. The Mini Mental State examination scores was used for dementia assessment at the threshold of 24. The Mini Nutritional AssessmentTM was used for mobilitity assessment. The statistics were significant at the 5% threshold. Results: 866 residents (70.6% women) included with an average age of 85.3 ± 9.3 years. Undernutrition was 27.5%, obesity 22.9%, dementia 45.7% and very low mobility 68.9%. Women were older than men, more often undernourished, more often demented and more often had very low mobility (p<0.01). Undernutrition (p<0.0001) and low mobility (p<0.0001) were significantly higher among those with dementia versus those without dementia. Very low mobility was higher among undernourished (p<0.05). Conclusions: Undernutrition and obesity are important problems in NH in France. Being a woman, having dementia and having a very low mobility may induce undernutrition. [ABSTRACT FROM AUTHOR]

Background: Kennedy's disease (KD), also known as spinal and bulbar muscular atrophy (SBMA), is a rare, adult-onset, X-linked recessive neuromuscular disease caused by CAG expansions in exon 1 of the androgen receptor gene (AR). The objective of the French national diagnostic and management protocol is to provide evidence-based best practice recommendations and outline an optimised care pathway for patients with KD, based on a systematic literature review and consensus multidisciplinary observations.Results: The initial evaluation, confirmation of the diagnosis, and management should ideally take place in a tertiary referral centre for motor neuron diseases, and involve an experienced multidisciplinary team of neurologists, endocrinologists, cardiologists and allied healthcare professionals. The diagnosis should be suspected in an adult male presenting with slowly progressive lower motor neuron symptoms, typically affecting the lower limbs at onset. Bulbar involvement (dysarthria and dysphagia) is often a later manifestation of the disease. Gynecomastia is not a constant feature, but is suggestive of a suspected diagnosis, which is further supported by electromyography showing diffuse motor neuron involvement often with asymptomatic sensory changes. A suspected diagnosis is confirmed by genetic testing. The multidisciplinary assessment should ascertain extra-neurological involvement such as cardiac repolarisation abnormalities (Brugada syndrome), signs of androgen resistance, genitourinary abnormalities, endocrine and metabolic changes (glucose intolerance, hyperlipidemia). In the absence of effective disease modifying therapies, the mainstay of management is symptomatic support using rehabilitation strategies (physiotherapy and speech therapy). Nutritional evaluation by an expert dietician is essential, and enteral nutrition (gastrostomy) may be required. Respiratory management centres on the detection and treatment of bronchial obstructions, as well as screening for aspiration pneumonia (chest physiotherapy, drainage, positioning, breath stacking, mechanical insufflation-exsufflation, cough assist machnie, antibiotics). Non-invasive mechanical ventilation is seldom needed. Symptomatic pharmaceutical therapy includes pain management, endocrine and metabolic interventions. There is no evidence for androgen substitution therapy.Conclusion: The French national Kennedy's disease protocol provides management recommendations for patients with KD. In a low-incidence condition, sharing and integrating regional expertise, multidisciplinary experience and defining consensus best-practice recommendations is particularly important. Well-coordinated collaborative efforts will ultimately pave the way to the development of evidence-based international guidelines. [ABSTRACT FROM AUTHOR]

Objective: We aimed at estimating the seroprevalence of Toxoplasma gondii (T. gondii) infection in older adults living in Central Africa and investigating its association with dementia using data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) programme.Methods: A cross-sectional multicentre population-based study was carried out among participants aged 73 (±7) years on average, living in rural and urban areas of the Central African Republic and the Republic of Congo between November 2011 and December 2012. Blood samples were collected from each consenting participant. The detection of anti-T. gondii immunoglobulin G antibodies was performed in 2014 in France using a commercially available ELISA kit. Participants were interviewed using a standardised questionnaire including sociodemographic characteristics. DSM-IV criteria were required for a diagnosis of dementia. Multivariate binary logistic regression models were used to assess the association between toxoplasmosis infection and dementia.Results: Among 1662 participants, the seroprevalence of toxoplasmosis was 63.0% (95% confidence interval (CI): 60.7-65.3) overall, 66.6% (95%CI: 63.4-69.8) in Central African Republic and 59.4% (95%CI: 56.1-62.7) in the Republic of Congo. In multivariate analyses, toxoplasmosis status was significantly associated with increasing age (P = 0.006), Republic of Congo (P = 0.002), urban area (P = 0.001) and previous occupation (P = 0.002). No associations between dementia and toxoplasmosis status or anti-T. gondii IgG titres were found.Conclusion: Toxoplasma gondii infection was not associated with dementia among older adults in Central Africa. Our findings are consistent with previous studies and add to the knowledge on the relationship between T. gondii infection and neurological disorders. [ABSTRACT FROM AUTHOR]

Résumé Objectifs En établissement d'hébergement pour personnes âgées dépendantes (EHPAD), la dénutrition est fréquente, avec des conséquences sévères. Paradoxalement, peu d'études en France ont déterminé le statut nutritionnel des résidents d'EHPAD et/ou l'influence de la consommation de compléments nutritionnels oraux (CNO) et de la pratique d'un service à l'assiette (SAA) sur l'état nutritionnel des résidents. Les objectifs de l'étude étaient de déterminer (i) l'état nutritionnel de résidents dans un EHPAD de grande taille et (ii) le lien éventuel entre la consommation de CNO, la pratique d'un SAA et la présence d'une dénutrition. Méthode L'étude était descriptive rétrospective monocentrique. Les données étaient issues de l'ensemble des dossiers médicaux consultés entre juillet 2017 et janvier 2018. Le statut nutritionnel était déterminé selon les critères français pour les adultes et les personnes âgées. Les résultats sont présentés en médiane [IQ25–75] pour les variables quantitatives, et pourcentage pour les variables qualitatives. Des analyses univariées et une analyse multivariée étaient réalisées afin d'établir une association entre la présence d'une dénutrition et les variables d'intérêt enregistrées. Résultats L'EHPAD comportait 258 places. La population d'étude était constituée de 248 résidents (âge : 88,0 [83,0–93,0] ans), dont 78,2 % de femmes, le poids était de 62,8 [52,9–74,4] kg, l'IMC de 25,7 [21,9–29,4] kg/m2, l'albuminémie de 35,8 [31,6–37,8] g/L. Au total, 39,5 % des résidents étaient dénutris, en cohérence avec les données usuelles. En analyse univariée, les résidents dénutris étaient plus âgés, consommaient plus souvent des CNO et avaient moins souvent un SAA que les non-dénutris (respectivement p = 0,002, p < 0,0001, p = 0,01). En analyse multivariée, il existait une association négative entre la présence d'une dénutrition et le niveau d'IMC, l'albuminémie et la concentration en CRP. La prise de CNO et le SAA n'étaient pas associés à la dénutrition. Conclusion L'EHPAD étudié, de grande taille, semblait représentatif des établissements publics français pour le nombre de lits, la répartition par âge et par genre des résidents. Près de 40 % des résidents étaient dénutris. L'analyse multivariée suggérait que l'utilisation des CNO et la mise en œuvre du SAA dans cet EHPAD doivent être précisées. Abstract Objectives In Nursing Homes (NH), undernutrition is frequent, with severe consequences. Paradoxically, few studies in France have determined the nutritional status of residents of NH and/or the influence of the consumption of oral nutritional supplements (ONS) and the practice of a service on the plate (SOP) on the nutritional status of the residents. The objectives of the study were to determine (i) the nutritional status of residents in a large NH and (ii) the possible link between the consumption of ONS, the practice of a SOP and the presence of undernutrition. Methods The study was retrospective descriptive transverse monocentric. The data came from all the medical files consulted between July 2017 and January 2018. The nutritional status was determined according to the French criteria for adults and the elderly. The results are presented in median [IQ25–75] for the quantitative variables, and percentage for the qualitative variables. Univariate analyzes and multivariate analyses were performed to establish an association between the presence of undernutrition and the variables of interest recorded. Results The NH included 258 seats. The study population consisted of 248 residents (age: 88.0 [83.0–93.0] years), of whom 78.2 % were women ; the weight was 62.8 [52.9–74.4] kg, BMI 25.7 [21.9–29.4] kg/m2, albumin 35.8 [31.6–37.8] g/l. In total, 39.5 % of the residents were malnourished, consistent with the usual data. In univariate analysis, undernourished residents were older, consumed more ONS, and had less SOP than non-undernourished residents (P = 0.002, P < 0.0001, P = 0.01, respectively). In multivariate analysis, there was a negative association between the presence of undernutrition and BMI level, albumin and CRP concentration. Taking ONS and SOP were not associated with undernutrition. Conclusion The NH studied, although large, seemed representative of French public institutions for the number of seats, age distribution and gender of residents. Nearly 40 % of the patients were undernourished. The multivariate analysis suggested that the use of ONS and the implementation of SOP in this NH should be better specified. [ABSTRACT FROM AUTHOR]

Résumé Introduction et objectifs La consommation de chlorure de sodium (sel) chez l'enfant est supérieure aux recommandations et, du fait de son retentissement sur la pression artérielle, sa réduction est un objectif de santé publique. C'est une mesure efficace chez l'enfant, avec la possibilité d'une prolongation de l'effet à l'âge adulte. L'objectif principal de l'étude était de diminuer d'environ 20 % la teneur en sel des menus de trois restaurants scolaires (écoles maternelles et primaires) de la ville de Limoges. Matériels et méthodes L'intervention, menée par un réseau de santé, comportait quatre phases : mesure des contenus en sel de trois repas successifs dans trois écoles, formations et discussions avec les personnels de cuisine et personnels en charge de la logistique alimentaire, interventions auprès des fournisseurs de denrées alimentaires industrielles, nouvelles mesures à distance des contenus en sel de trois repas successifs dans les mêmes établissements. Résultats Initialement, les contenus en sel des repas étaient dans tous les cas supérieurs aux apports recommandés pour un repas principal. Les formations étaient bien perçues et permettaient de confronter les pratiques et de faire 10 propositions d'action. Les interventions auprès des fournisseurs permettaient d'obtenir des denrées alimentaires moins salées. L'évaluation finale montrait une baisse des contenus en sel de 32,9 % pour les maternelles et de 32,3 % pour les primaires, et les contenus étaient très proches des valeurs recommandées. Conclusion Cette action a permis une réduction des contenus en sel dans des restaurants scolaires supérieure à l'objectif initial. Elle est la première décrite de ce type. Ceci suggère qu'une telle intervention peut-être une aide importante pour obtenir une baisse de la consommation journalière en sel chez l'enfant. Abstract Introduction and objective The consumption of sodium chloride (salt) in children is higher than the recommendations and, because of its impact on blood pressure; its reduction is a public health goal. This is a measure that seems effective in children, with the possibility of prolongation of the effect in adulthood. The main objective of the study was to reduce by approximately 20% the salt content of the menus of three school restaurants (nursery and primary schools) of the city of Limoges. Materials and methods The intervention, led by a health network, consisted of four phases: measuring the salt content of three successive meals in three schools, training and discussions with the kitchen staff and food logistics staff, interventions with food suppliers industrial foodstuffs, new remote measurements of the salt content of three successive meals in the same establishments. Results Initially, the salt content of the meals was in all cases higher than the recommended intake for a main meal. The trainings were well received and made it possible to confront the practices and to make 10 proposals of action. Interventions with suppliers made it possible to obtain less salty foods. The final evaluation showed a decrease in salt content of 32.9% for nursery and 32.3% for primary, and the contents were very close to the recommended values. Conclusion This action resulted in a reduction of salt content in school restaurants above the initial target. She is the first described of this type. This suggests that such an intervention can be an important aid in achieving a reduction in daily salt intake in children. [ABSTRACT FROM AUTHOR]

Résumé But/objectif Évaluer la teneur en iode et le niveau de contamination microbiologique des sels vendus à Dantokpa, le plus grand marché du Bénin, afin d’en apprécier la qualité tout au long de la chaîne de distribution. Matériel et méthode D’octobre à novembre 2016, 190 échantillons de sel étaient prélevés chez 18 grossistes et 172 revendeuses de sel, au marché Dantokpa de la ville de Cotonou. La teneur en iode était déterminée qualitativement en utilisant le MBI-Kit et quantitativement par spectrophotométrie. Trente échantillons tirés au sort était évalués pour leur qualité microbiologique grâce à un dénombrement de la flore mésophile aérobie totale (FMAT). Résultats Avec le MBI Kit, 47,9 % des échantillons de sel ne contenaient pas d’iode. Par spectrophotométrie, 40 % des échantillons avaient une teneur égale à 0 ppm, 59,5 % une teneur < 15 ppm et 0,53 % une teneur ≥ 15 ppm. Aucun des échantillons de sel ne respectait les recommandations béninoises du sel iodé à la vente (20–60 ppm). Pour la qualité microbiologique, 100 % des échantillons étaient contaminés par des microorganismes dont 10 % par des staphylocoques. Conclusion Cette étude révélait que les sels vendus au marché Dantokpa n’étaient pas adéquatement iodés. De plus, certains prélèvements étaient contaminés par des microorganismes halophiles. Ces résultats inquiétants soulignent la nécessité d’un renforcement de la stratégie d’iodation du sel au Bénin, tout en incluant une sensibilisation pour une meilleure qualité hygiénique du sel. Objective To evaluate the iodine content and microbiological contamination of salts sold at Dantokpa, the Benin's largest market, in order to assess quality throughout the distribution chain. Materials and methods From October to November 2016, 190 salt samples were collected from 18 wholesalers and 172 salt dealers at the Dantokpa market in the town of Cotonou. Iodine content was qualitatively determined using the MBI-Kit and quantitatively by spectrophotometry. The microbiological quality assessment involved 30 samples randomly selected to count Total Mesophilic Aerobic Flora (TMAF). Results With the MBI Kit, 47.9 % of samples did not contain iodine. By spectrophotometry, 40 % of the salts had an iodine content equal to 0 ppm, 59.5 % a content < 15 ppm and 0.53 % of the samples an iodine content ≥ 15 ppm. None of the salt samples met the Beninese recommendations of iodized salt for sale (20–60 ppm). For microbiological quality, 100 % of the samples were contaminated with microorganisms, which were staphylococci in 10 %. Conclusion This study showed that the dietary salts sold at the Dantokpa market are not adequately iodized. In addition, some samples are contaminated with halophilic microorganisms. These disturbing results highlight the need for an immediate strengthening of the salt iodization strategy in Benin while including sellers’ awareness for a better hygiene. [ABSTRACT FROM AUTHOR]

Résumé Introduction Malgré le nombre de patients impliqués, les données d’activité en nutrition artificielle à domicile en France sont rares. L’étude avait pour buts. (i) de faire le point sur l’activité de nutrition entérale et nutrition parentérale à domicile (NEAD et NPAD) gérée en 2015 en consultations externes (CE) par l’unité transversale de nutrition (UTN) du CHU de Limoges ; (ii) d’évaluer l’évolution nutritionnelle des patients suivis cette même année. Patients et méthodes Les données générales et nutritionnelles informatisées de tous les patients ayant consulté du 1 er janvier au 31 décembre 2015 pour NEAD ou NPAD étaient analysées rétrospectivement. Une analyse transversale était effectuée en termes de CE et une analyse longitudinale en termes de patients. Les tests du Chi 2 , de Mann-Whitney et de Kruskal-Wallis étaient utilisés. Résultats Cent dix-sept patients étaient évalués lors de 218 CE (âge moyen : 62,2 ± 16,6 ans ; sex-ratio H/F : 1,22 ; poids : 56,2 ± 13,5 kg, IMC 21,1 ± 4,3 kg/m 2 , 84,0 % de NEAD, 16,0 % de NPAD). En NEAD, la gastrostomie était la 1 re voie d’abord, les cancers ORL et les maladies neurologiques les principales indications. En NPAD, les cathéters centraux insérés par voie périphérique, chambres implantables et cathéters tunnellisés étaient utilisés dans des proportions proches et le syndrome de grêle court la 1 re indication. Pour les 62 patients analysés en longitudinal, le poids et le pli cutané tricipital augmentaient pour la population globale et pour les patients en NEAD ( p = 0,003). Conclusion Le descriptif des patients et des modalités de la nutrition artificielle sont proches des données usuelles, et conformes aux évolutions des pratiques. Les résultats suggèrent une amélioration de certains critères anthropométriques en NEAD et forment une base d’évaluation de l’évolution de l’activité de nutrition à domicile de l’UTN. Introduction In spite of the number of implied patients, the data of activity in home artificial nutrition in France are rare. The study had as goals: (i) to assess the activity of home enteral and parenteral nutrition (HEN and HPN) managed in 2015 in external consultations (EC) by the nutrition support team (NST) of the university hospital of Limoges; (ii) to evaluate the nutritional evolution of the followed patients this same year. Patients and methods The general and nutritional computerized data of all the patients having consulted from January 1st to December 31st, 2015 for HEN or HPN were retrospectively analyzed. A transverse analysis was carried out in terms of EC, and a longitudinal analysis in terms of patients. The Chi 2 , Mann-Whitney and Kruskal-Wallis tests were used. Results One hundred and seventeen patients were assessed at the time of 218 EC (median age: 62.2 ± 16.6 years; sex-ratio H/F: 1.22; weight: 56.2 ± 13.5 kg, IMC 21.1 ± 4.3 kg/m 2 ; 84.0 % of HEN, 16.0 % of HPN). In HEN, the gastrostomy was the 1st access used, ENT cancers and neurological diseases were the main indications. In HPN, the PICC lines, implantable sites and tunnellized catheters were used in close proportions, and the small bowel syndrome was the 1st indication. For the 62 patients longitudinally analyzed, the weight and the triceps skinfold increased for the global population and for the HEN patients ( P = 0.003). Conclusion The description of the patients and the methods of the artificial nutrition are close to the usual data, and in conformity with the evolutions of the practices. The results suggest an improvement of certain anthropometric criteria in HEN, and form a base of assessment of the evolution of the activity of home artificial nutrition of the NST. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les commissions de menus (CM) sont préconisées dans les Établissements d’hébergement pour personnes âgées dépendantes (EHPAD), mais sans précision sur leur fonctionnement. Néanmoins, des recommandations de structuration des CM ont été formulées en 2009 par le réseau de santé Limousin Nutrition (LINUT). L’objectif de l’étude était de comparer les pratiques des CM en EHPAD entre deux périodes : avant (T1) et après (T2) diffusion de ces recommandations dans les EHPAD. Méthode Une grille d’enquête était remplie par une diététicienne du réseau LINUT dans chaque EHPAD lors d’une CM à T1, puis à T2. La 1 re partie de la grille notait le nombre de résidents, le temps de coordination médicale et le nombre de personnels, le type de liaison utilisé pour l’alimentation. La seconde partie de la grille décrivait les CM. L’analyse statistique utilisait le test du Chi 2 et le test de Wilcoxon. Résultats L’enquête portait sur 27 EHPAD du territoire du Limousin entre 2009 et 2011. À T2, le nombre de places d’hébergement et le nombre de personnes employées n’étaient pas différents vs T1. La fréquence des liaisons chaudes diminuait (62,9 % vs 81,4 %, p < 0,001), au profit d’une augmentation des liaisons mixtes (7,4 % vs 25,9 %, p < 0,001). Plus de résidents étaient présents dans les CM (5,1 ± 5,7 vs 2,7 ± 5,1, p = 0,01), les diététiciennes rédigeaient plus souvent les menus (7,4 % vs 0,0 %, p = 0,003), les résidents pouvaient s’exprimer plus souvent (88,9 % vs 81,5 %, p = 0,04), de nouveaux problèmes étaient plus souvent repérés (96,3 % vs 88,5 %, p = 0,005), la possibilité de choix de menus d’exception était plus fréquente (62,9 % vs 40,7 %, p = 0,01), ainsi que l’existence de fiches techniques (51,5 % vs 29,6 %, p = 0,02). Les questionnaires de satisfaction étaient cependant moins présents (51,9 % vs 59,3 à T1, p = 0,0002), le compte rendu de la CM moins souvent diffusé aux résidents (37,0 % vs 38,5 %, p = 0,003) et au personnel (63,0 % vs 70,4 %, p = 0,0004) et très rarement mis en ligne. Conclusions La diffusion des recommandations de fonctionnement des CM a permis d’améliorer la participation des résidents, la rédaction des menus par des diététiciennes, la présence de fiches techniques et le repérage des problèmes par le personnel. La cause de l’augmentation des liaisons mixtes serait à étudier et des questionnaires de satisfaction et de consommation à appliquer plus souvent. La diffusion des comptes rendus des CM aux familles et au personnel des EHPAD doit être améliorée. Introduction The menu committees (MC) are recommended in the nursing homes (NH), but without specific operational modalities. However, a proposal for structuring the MC was made by the Limousin Regional Health Nutrition network Limousin Nutrition (LINUT) in 2009. The objective of the study was to compare the MC practices in NH between two periods: before (T1) and after (T2) diffusion of these recommendations. Methods A survey grid was applied by a LINUT dietician in each NH at T1 and T2. The first part of the survey grid took over the number of residents, the time of medical coordination, the number personnel in the different professional categories and the type of connection used for food. The second part of the grid described the MC functioning. Statistical analysis used the Chi 2 test and the Wilcoxon test. Results The survey was conducted among 27 nursing homes in Limousin, between 2009 and 2011. At T2, the number of accommodation places and of people employed in NH was not different vs T1. There was a decrease in the frequency of hot links (62.9% vs 81.4%, P < 0.001) in favour of mixed links (25.9% vs 7.4%, P < 0.001), the residents were more present (5.1 ± 5.7 vs 2.7 ± 5.1, P = 0.01), dieticians were writing more frequently menus (7.4% vs 0.0%, P = 0.003), residents could speak more often (88.9% vs 81.5%, P = 0.04), new problems were updated more frequently (96, 3% vs 88.5%, P = 0.005), the possibility of choice of out of ordinary menus and the presence of technical data were higher (respectively 62.9% vs 40.7%, P = 0.01 and 51.5% vs 29.6%, P = 0.02). However, there was a decrease in the presence of satisfaction questionnaires (51.9% vs 59.3, P = 0.0002), and the record of the MC was less diffused to residents (37.0% vs 38.5%, P = 0.003) and to staff (63.0% vs 70.4%, P = 0.0004). The record was very seldom put online. Conclusion The diffusion of recommendations operating MC helped a greater involvement of residents of NH, a menus writing more frequently by dieticians, the more frequent presence of technical data and more questions of the staff overlooked food-related problems. The cause of the increase in mixed connections would be to study and questionnaires of satisfaction and consumption interesting to achieve more frequently. The diffusion online of MC records to families and to staff of NH must be improved. [ABSTRACT FROM AUTHOR]

Background/Aims: In a population-based setting, we aimed to (i) describe weight loss (WL) of amyotrophic lateral sclerosis (ALS) patients at the time of diagnosis and (ii) evaluate the association between WL and survival. Methods: All patients recruited in the FRALim register (2000-2013) were considered to be included in this study. Time-to-death analyses were performed using a multivariable Cox model. Model discrimination and calibration were assessed. Results: Among 322 patients in the register, 261 (81%) were included. At the time of diagnosis, 50.6% of patients reported a WL of more than 5%: 14.6% with WL between 5 and 10% and 36.0% with a WL of more than 10%. WL was independently associated with survival (p = 0.002). Patients with a WL of 10% or more experienced a 45% increase in the risk of death (95% CI 6-99) with respect to patients with a WL lower than 5% or no WL. The introduction of WL significantly improved the model's discrimination achieving a survival C statistic of 79.5% (95% CI 75.6-83.5, p = 0.006) at 12 months. Conclusion: More than 50% of ALS patients experience a WL of more than 5% at the time of diagnosis. This finding highlights the need for randomized trials to evaluate the effect of nutritional interventions to improve ALS survival. [ABSTRACT FROM AUTHOR]

Résumé But/objectif Évaluer la teneur en iode des sels de cuisine prélevés au sein des ménages de la commune de Glazoué (une zone surveillée pour endémie goitreuse), et l’état d’iodation du sel (supposé riche en iode) produit et commercialisé dans la commune de Ouidah au Bénin. Méthodes De mai à octobre 2013, 147 échantillons de sel étaient prélevés dont 117 à Glazoué par un sondage à trois degrés et 30 à Ouidah par un échantillonnage raisonné. Les échantillons étaient dosés par le MBI-Kits International, puis par titrage iodométrique. Résultats À Glazoué, 90,6 % des échantillons avaient une teneur d’iode ≥ 15 ppm, 5,1 % une teneur < 15 ppm et 4,2 % une teneur nulle par la méthode du Kit, alors que par titrage iodométrique 82,9 % des échantillons avaient une teneur en iode ≥ 15 ppm ; 14,5 % une teneur < 15 ppm et 2,5 % une teneur nulle. À Ouidah, 100 % des échantillons avait une teneur en iode < 15 ppm par les deux méthodes. La moyenne d’iode des échantillons prélevés à Ouidah était plus faible que celle des échantillons de Glazoué (4,3 ± 1,1 ppm versus 28,2 ± 14,0 ppm, p < 0,001). Au total, 63,2 % des échantillons de Glazoué étaient adéquatement iodés versus 0 % à Ouidah par dosage iodométrique. Conclusion L’étude montrait que l’état d’iodation du sel consommé à Glazoué était le plus souvent satisfaisant alors qu’à Ouidah la production locale n’était pas adéquatement iodée. Ceci implique que des actions urgentes doivent être menées pour améliorer l’iodation de la production locale et que le programme d’iodation universelle du sel doit être renforcé au Bénin. Objective To assess iodine content of cooking salt collected in households of Glazoué’s town, a monitored area for endemic goiter and iodization status of salt (assumed rich in iodine) produced and marketed in the town of Ouidah in Benin. Methods From May to October 2013, 147 salt samples were collected including 117 households in Glazoué by a three-stage sample and 30 samples in Ouidah by reasoned sampling. Samples were assayed using the MBI-Kits International and titration method (gold standard). Results In Glazoué, 90.6% of samples had iodine content ≥ 15 ppm, 5.1% content of < 15 ppm and 4.2% zero content by the kit method while 82.9% of samples had ≥ 15 ppm iodine content, 14.5% iodine content of < 15 ppm and 2.5% iodine content of zero by titration method. In Ouidah, 100% of the samples had an iodine content < 15 ppm by both assays. The overall iodine mean in Ouidah samples was significantly lower than that of Glazoué samples (4.3 ± 1.1 versus 28.2 ± 14.0 ppm, P < 0.001). In total, 63.2% of samples were adequately iodized in Glazoué versus 0% in Ouidah by titration method. Conclusion This study showed that the iodization status of salt consumed in Glazoué is mostly satisfactory whereas Ouidah local production is not adequately iodized. This implies that urgent action must be taken to enhance the iodization of local production and that the universal salt iodization program should be strengthened in Benin. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les troubles de la déglutition (TD) sont fréquents dans les centres de soins de santé primaires (CSSP) et la qualité de prise en charge dès l’admission influence fortement l’état nutritionnel des patients et leur pronostic global. Les maladies neurologiques sont les plus pourvoyeuses de TD, avec une prévalence d’environ 1/3 chez les patients hémiplégiques. Dans les CSSP au Burkina Faso (BF), les infirmiers sont les premiers à évaluer ces patients, mais il n’existe pas de données relatives aux modalités de prise en charge des TD. L’objectif de cette étude était d’estimer les connaissances, attitudes et pratiques des infirmiers concernant les TD des patients hémiplégiques accueillis dans les CSSP de Bobo-Dioulasso, dont le centre de référence accueille le plus de patients hémiplégiques au BF. Méthodes Une enquête transversale, réalisée du 1 er août au 15 septembre 2014 auprès des infirmiers des CSSP des districts sanitaires urbains de Bobo-Dioulasso, a utilisé un questionnaire standardisé explorant leurs connaissances et pratiques portant sur les TD chez le sujet hémiplégique. Résultats Sur 125 infirmiers enquêtés (83,3 % des personnels visés), 82,4 % avaient déjà reçu un patient hémiplégique. Le rôle du cerveau dans la survenue d’une hémiplégie et d’un TD était connu par 56,8 % des infirmiers, 42,3 % savaient qu’un TD peut entraîner une pneumopathie de déglutition, 36,0 % connaissaient une manœuvre de sauvetage en cas de fausse route. Ils évaluaient correctement le retentissement du TD sur l’état nutritionnel dans 39,2 % des cas. Sur ce point, leurs connaissances étaient meilleures s’ils étaient plus récemment sortis de l’école de formation. Respectivement 65,6 et 1,6 % des infirmiers connaissaient le bénéfice des adaptations posturales et l’influence des caractéristiques des aliments sur la capacité à déglutir. Chez les 103 infirmiers ayant déjà reçu un hémiplégique, 68,0 % estimaient pouvoir détecter un TD par l’entretien clinique et 30,1 % ne donnaient aucun conseil au patient. En analyse multivariée, dépister un TD était associé à de bonnes connaissances sur la valeur des troubles de la voix (OR = 3,5 ; IC 95 = 1,4–8,1 ; p = 0,005). Discussion et conclusions Peu d’infirmiers étaient avertis de la liaison entre TD et hémiplégie, des enjeux et complications classiques liés aux TD. Ils avaient des pratiques variables souvent non conformes aux bonnes stratégies sur le dépistage et la prise en charge des TD. Dans un but d’amélioration des soins des patients hémiplégiques, l’enseignement en neurologie et en nutrition devrait s’accompagner de formations portant sur les TD, en insistant sur le dépistage et la prise en charge simple. Introduction Swallowing disorders are common in primary care patients, and quality of care from admission strongly influences the nutritional status of patients and overall prognosis. Neurological diseases are the main causes of swallowing disorders, which affect one third of patients with hemiplegia. In Burkina Faso (BF), nurses of primary health care centers (PHCC) are usually the first to assess and manage these patients, but there are no data related to their swallowing disorders management. This purpose aimed to assess knowledge, attitudes and practices about swallowing disorders in hemiplegic patients, among nurses of PHCC in Bobo-Dioulasso, where tertiary health centre receives the highest number of hemiplegic patients in BF. Methods A cross-sectional survey, performed among nurses of Bobo-Dioulasso urban PHCC from 2014 August 1st to September 15th, administrated a standardized questionnaire to screen their knowledge, attitudes and practices about swallowing disorders in hemiplegic patient. Results Of 125 surveyed nurses (83.3% of the targeted workers), 82.4% had prior received a hemiplegic patient. The role of brain in occurrence of hemiplegia and swallowing disorders was known by 56.8% of nurses, 42.3% knew that swallowing disorders can cause aspiration, 36.0% knew a rescue technique in case of aspiration. They correctly assessed impact of swallowing disorders on nutritional status in 39.2% of cases. On this matter, their knowledge was better when they were more recently out of training school. Respectively 65.6 and 1.6% of nurses knew the postural conditions benefit, and influence of food features on ability to swallow. Among the 103 nurses who have prior received a hemiplegic, 68.0% believed being able to detect a swallowing disorder by clinical interview, and 30.1% did not give patient advice. In multivariate analysis, detecting swallowing disorder was associated with a good knowledge of the value of voice troubles (OR = 3.5; IC 95 = 1.4–8.1; P = 0.005). Conclusion Few nurses were warned of connection between swallowing disorders and hemiplegia, classic issues and complications related to swallowing disorders. They had variable practices, mostly non in conformity with the good strategies for swallowing disorders screening and management. In order to improve hemiplegic patients care, neurological and nutritional training should be accompanied by specific training on swallowing disorders, emphasizing on screening and simple management. [ABSTRACT FROM AUTHOR]

Résumé L’acidurie mévalonique et le syndrome d’hyperimmunoglobulinémie D (HIDS) sont les deux expressions cliniques du déficit en mévalonate kinase. Peu de cas sont décrits dans le monde et l’état nutritionnel n’a jamais été précisé. Un patient qui avait souffert durant l’enfance de colite néonatale et d’épisodes fébriles récurrents avec rash, sans diagnostic étiologique, était diagnostiqué HIDS à l’âge de 28 ans, suite à un bilan pour arthrite récidivante. Il était adressé en nutrition après un suivi en endocrinologie pour retard staturo-pondéral. Il pesait 41,2 kg pour 1 m49 (indice de masse corporelle [IMC] normal à 18,6) et sa circonférence musculaire brachiale était dans une zone de dénutrition. En impédancemétrie, le volume extracelullaire (VEC) était élevé par rapport au volume intracelullaire (VIC) et l’angle de phase était abaissé, ce qui suggérait une altération cellulaire. Diverses carences vitaminiques et une hypophosphorémie étaient présentes. Des compléments nutritionnels oraux et une supplémentation vitaminique étaient introduits. Un an plus tard, la phosphorémie était améliorée, de même que certaines concentrations sanguines en vitamines mais il nécessitait toujours une supplémentation. On constatait une prise pondérale de 2,7 %, le rapport VEC/VIC et l’angle de phase étaient normalisés. Le déficit en mévalonate kinase est une maladie rare, probablement sous-diagnostiquée, à laquelle il faut savoir penser devant des épisodes fébriles récurrents dans l’enfance. Le cas décrit montre qu’une dénutrition et plusieurs carences sont possibles à l’âge adulte dans cette maladie. Mevalonic aciduria and hyperimmunoglobulin D syndrome (HIDS) are both clinical expressions of mevalonate kinase deficiency. Few cases are described in the world and nutritional status has never been clarified. A patient who previously suffered from neonatal colitis and recurrent fever with rash, without etiological diagnosis, was diagnosed with HIDS at the age of 28, following a record for recurrent arthritis. He was addressed in nutrition after endocrinological following for deficit of growth. He weighed 41.2 kg for 1 m49 height (normal body mass index [BMI] at 18.6), but midarm muscle circumference showed an undernutriution. In bioimpedance analysis, the extra-celullar volume (ECV) was high in relation to intra-celullar volume (ICV) and phase angle was low, suggesting a cellular alteration. Several vitamin deficiencies and hypophosphatemia were present. Oral nutritional supplements and vitamin supplementation were introduced. One year later, serum phosphorus and some vitamins were improved, but the patient still required supplementation. One noted a 2.7 % weight gain, and a normalization of ECV/ICV ratio and phase angle. Mevalonate kinase deficiency is a rare disease probably underdiagnosed, that can be evoked in front of recurrent episodes of fever in childhood. The case described shows that undernutrition and several deficiencies are possible in this disease, even in adults. [ABSTRACT FROM AUTHOR]

Résumé En institution comme à domicile, certains patients peuvent avoir des difficultés à se mobiliser et à se déshabiller ou refuser de se mettre en sous-vêtements. Il est donc probable que peser les patients habillés est une pratique fréquente. La surestimation du poids corporel ainsi obtenue pourrait induire une erreur d'évaluation du statut nutritionnel. L'objectif de l'étude était de déterminer dans quelle mesure peser les patients adultes habillés versus en sous-vêtements pouvait modifier leur statut nutritionnel. Cinquante et un patients étaient inclus. La pesée habillée surestimait le poids réel de 1,6 ± 0,6 kg et induisait une surestimation de classification du statut nutritionnel dans près de 14 % des cas. De plus, le poids des vêtements était différent selon le sexe et selon les conditions de température extérieure. Ces résultats suggèrent qu'il est souhaitable autant que possible de peser tous les patients adultes en sous-vêtements. Abstract In institutions and at home, some patients may have difficulty mobilizing and undressing, or refusing to put on their underwear. It is therefore likely that weighing dressed patients is a common practice. The overestimation of the body weight thus obtained could lead to an error in the evaluation of the nutritional status. The aim of the study was to determine the extent to which adult patients dressed versus underwear could alter their nutritional status. Fifty-one patients were included. Dressed weighing overestimated the actual weight of 1.6 ± 0.6 kg and induced an overestimation of nutritional status classification in almost 14% of cases. In addition, the weight of the clothes was different according to the sex and the conditions of outside temperature. These results suggest that it is desirable as much as possible to weigh all adult patients in underwear. [ABSTRACT FROM AUTHOR]

School feeding is important in terms of nutrition, as it contributes to the prevention of malnutrition, especially in low-income countries. However, the nutritional and hygienic quality of meals served at schools in several countries is rarely examined. We aimed to assess the quality of meals served in school canteens in Togo. We designed a descriptive cross-sectional study and collected data from eight school canteens located in Southern Togo. Hygiene compliance and potential sources of food contamination in the canteens were assessed using the 5 M approach, which evaluates the performance of hygiene parameters at each "M" i.e., medium (cooking environment), raw material (staples), cooking material (kitchenware), method (cooking) and manipulator (cooks) in the food preparation environment. Foods were sampled in each school and analysed for microbiological (presence of Salmonella , total coliforms, and staphylococci) and nutritional (nutrient content) quality. The 5 M analysis revealed significant hygienic violations by the food preparators, as well as poor preparation conditions and utilization of low-quality raw materials in all the school canteens. Out of the 30 meal samples collected, 10 were of poor microbiological quality with the presence of total coliforms and staphylococci exceeding established limits of 10 and 100 cfu/g in 30 and 6.6% of the meals, respectively. However, none of the meals was contaminated by Salmonella spp. Nutritional analysis revealed that none of the meals served respected the nutritional balance, especially for contents in calcium, and vitamins A and C. Nonetheless, the iron content complied with the recommendations for children aged 9–13 years. Our analyses showed that several routes of contamination exist for the meals consumed in school canteens in Togo. Also, the nutritional quality of the ready-to-eat foods served at school canteens needs to be improved, particularly with the inclusion in the diet of fruits and vegetables to cover the micronutrient requirements. • Togolese government has committed to school feeding and provides one hot meal per day. • Meals served do not contain all the food groups to ensure a balanced diet. • Iron, Ca, Vit C and Vit A intakes were variable and below recommendations. • Hygiene quality was insufficient and foods were contaminated during cooking. • Improving the quality of the meals and introducing regular inspections is recommended. [ABSTRACT FROM AUTHOR]

Résumé: Les données épidémiologiques concernant la nutrition entérale à domicile (NED) correspondent à des estimations peu précises. L’évolution très récente du cadre législatif a rendu possible les études d’incidence et de prévalence de la NED. Patients et méthodes: Il s’agit d’une étude rétrospective observationnelle, réalisée grâce aux Caisses primaires d’Assurance maladie, qui ont fourni pour les années 2011 et/ou 2012, (1) le nombre annuel de patients ayant débuté une NED, (2) le nombre annuel de patients ayant bénéficié d’un forfait de NED avec ou sans pompe. L’incidence et la prévalence ont été obtenues en rapportant ces nombres à la population cible (population « protégée » par l’Assurance maladie). Résultats: Quinze régions (39,8 millions d’habitants) ont fourni leurs données ; l’incidence moyenne de la NED était de 24,9/100000 habitants/an et la prévalence moyenne de 57,3/100000 habitants/an. Les disparités régionales sont importantes pour les taux d’incidence (13,0 à 47,6) comme ceux de prévalence (29,1 à 96,2). Les incidences et prévalences sont plus élevées que les moyennes après 40ans et surtout après 60ans. Conclusion: Il s’agit de la première étude qui détermine de manière fiable l’incidence et la prévalence de la NED en France. Ainsi la projection de ces chiffres pour une population française estimée en 2012 à 65,5 millions (INSEE) amène à une estimation d’environ 37500 patients pris en charge par an en NED. L’analyse des disparités régionales doit nécessiter des études ultérieures. [ABSTRACT FROM AUTHOR]

Malnutrition is associated with poor survival among patients with amyotrophic lateral sclerosis (ALS). This study aimed to evaluate nutritional assessment by a network during first consultations in patients' homes. Patients identified by the regional ALS centre gave their informed consent. Assessment included functional, nutritional issues, evaluation of the need for help, whether personal or the use of aids, and noted any dietary supplementation and modification of the texture of food. Forty patients were seen a mean of 7.4 months after diagnosis; 52.5% had bulbar disease, 7.5% were malnourished; 29.4 ± 10.1 kcal/kg/day were consumed and protein intake was 1.3 ± 0.5 g/kg/day. Thirty-five percent of patients were anorexic, 43.8% reported taste disorders, and 70% had dysphagia, significantly associated with salivary stasis. Only 30% of dysphagic patients ate texture-modified food, and 90% of patients with problems drinking liquids did not use a thickener. In conclusion, assessment at home by a nutritional network can be conducted promptly. Malnutrition is rare in early disease, despite the fact that patients' diets are often low in energy and dysphagia is common. Unexpected taste disorders are detected. Dysphagia is very common but inadequately addressed. Consequently, home assessment by the network led several beneficial interventions. [ABSTRACT FROM AUTHOR]