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International audience; Introduction : Dans la SLA, le statut nutritionnel est associé à l’évolution de la maladie. L’objectif était d’évaluer l’impact d’une prise précoce de CNO sur l'évolution fonctionnelle, nutritionnelle et respiratoire à 6 mois, chez des patients SLA nouvellement diagnostiqués. Méthodes : Le groupe intervention bénéficiait de CNO à l’inclusion versus groupe contrôle avec CNO en cas de perte de poids. L’étude était randomisée en double aveugle et multicentrique sur 18 centres SLA français. Les variables neurologiques (forme de début, ALSFRS-R), nutritionnelles (perte de poids, IMC, composition corporelle) et respiratoire (capacité vitale forcée [CVF]) étaient relevées. L'analyse statistique a été réalisée par pattern mixture model (PMM). Résultats : 113 patients ont été inclus dans les deux groupes. L’âge moyen était de 63,2 ± 10,7 ans avec un sex-ratio H/F de 1,17 et une forme bulbaire dans 26,5% des cas. A l’inclusion, l’ALSFRS-R était de 38,6 ± 5,1 points et sa pente de -1,1 ± 0,8 points/mois. La perte de poids était de -4,9 ± 7,5% et 9,9% des patients étaient dénutris. Il n’existait pas de différence significative entre les deux groupes. Les apports énergétiques et protéiques à l’inclusion étaient de 33,5 ± 10,5 kcal/kg/j et de 1,4 ± 0,4 g/kg/j, respectivement et étaient similaires entre les deux groupes et au cours du suivi. Le PMM ne retrouvait pas de différence significative entre les deux groupes concernant l’évolution de l’ALSFRS-R. Il existait une évolution plus favorable à 6 mois de l’IMC et de la masse grasse dans le groupe intervention. En revanche, l’évolution de la CVF était similaire. Conclusion : Bien que l’IMC et la composition corporelle évoluaient plus favorablement dans le groupe intervention, cette première étude interventionnelle, contrôlée, randomisée française n’a pas permis de montrer un impact sur l’évolution fonctionnelle d’une prise précoce de CNO au cours de la SLA

International audience; Abstract 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 World Health Organization Stepwise Approach to Surveillance survey conducted in Burkina Faso. Descriptive and analytical analyses were performed using Student’s t test, ANOVA, the chi-square test, Fisher’s exact test and logistic regression. Setting: All 13 Burkinabè regions were categorized using quartiles of urbanization 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%; p49 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-urbanization 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.

International audience; Purpose: Obesity is a public health problem worldwide. The eating habits of French workers need to be clarified. In particular, tachyphagia (meal lasting < 15 min) promotes weight gain. The present study aimed to investigate the presence of tachyphagia at lunchtime, the factors associated with tachyphagia, and the relationship between tachyphagia and obesity among workers. Methods: This cross-sectional study was conducted between January and May 2016 in five departments of occupational medicine. An anonymous self-administered questionnaire was used to gather general declarative data, such as weight and height (to calculate body mass index [BMI]) and information about lunchtime habits, including the time spent eating. Results: A total of 415 workers with a mean age of 41.1 ± 12.6 years were included. The mean BMI was 23.8 ± 4.6 kg/m2, and the prevalence of obesity was 15.9%. Tachyphagia occurred in 20.3% of the cases and was more frequent in younger workers. Multivariate analysis revealed that skipping meals, eating standing up, and eating fast food were positively associated with tachyphagia (p = 0.015, p = 0.028, and p = 0.027, respectively). Older age and eating with colleagues/friends were negatively associated with tachyphagia (p = 0.003 and p < 0.0001, respectively). No significant association was observed between tachyphagia and obesity. Conclusion: Our study provides important information about the lunchtime habits of workers. Maintaining commensality is crucial, particularly in young workers. Companies should play a role in organising their employees' lunch breaks. Level III Evidence obtained from well-designed cohort or case-control analytic studies.

The alteration in nutritional status in Amyotrophic Lateral Sclerosis (ALS) patients is linked to a decrease in food intake and/or an increase in resting energy expenditure (REE). A percentage of REE variation (ΔREE) greater than 10% between the REE measured by indirect calorimetry and the REE calculated by predictive equations, defines the hypermetabolism (HM), which is described in 50 to 60% of cases of ALS. If HM is not compensated by food intake, this exposes the patient to the risk of undernutrition, a factor of poor prognosis. Screening for HM therefore appears to be essential in order to identify the situations most at risk of undernutrition and to propose adaptive measures.However, the existence of HM is not consensual, and there are still many questions about the notion of changes in REE during ALS.One study found that in 315 patients suffering from ALS, a measured REE was systematically higher than the calculated REE by 12 predictive equations (p20%. According to the 1919 Harris and Benedict equations, and their revised 1984 versions, the patients with a ΔREE>20% had an increased risk of death of 42% (p=0.01) and 38% (p=0.02), respectively. With an identical ΔREE threshold, according to Mifflin's formula, the functional (p=0.02) and respiratory (p=0.003) outcome was more deleterious and the chances of survival were impaired (p=0.003).In a second study, the metabolic level was clearly higher in 287 ALS patients compared to 78 healthy controls (1500 versus 1230 kcal/day, p20%). Compared to the subjects without HM, the patients with severe HM had a lower proportion of fat mass at diagnosis (29.7% versus 32.1%, p=0.005) and a faster trend of functional performance decline at follow-up (p=0.07). Univariate analysis of the data revealed that severe HM tended to increase the risk of death compared to the absence of HM (Hazard ratio=1.33 [0.99-1.79], p=0.055).Overall, these studies show that REE is usually increased in ALS. These changes affect all patients. HM is affecting more than half of patients and could be a marker of the disease. There is a predictive formula for the REE applicable in ALS, which represents an alternative to indirect calorimetry. HM, especially when severe, changes body composition upon diagnosis and appears to be a poor prognostic determinant for functional or respiratory performance and survival. All of this reinforces the importance of metabolic assessment, to adapt energy needs and identify the situations most at risk of deleterious evolution., L’altération de l’état nutritionnel lors de la Sclérose latérale amyotrophique (SLA) est liée à une diminution des prises alimentaires et/ou une augmentation de la dépense énergétique de repos (DER). L’hypermétabolisme (HM), défini par un pourcentage de variation de DER (ΔDER) supérieur à +10% entre la DER mesurée en calorimétrie indirecte et la DER calculée par équations prédictives, est décrit dans 50 à 60% des cas de SLA. Si l’HM n’est pas compensé par l’alimentation, il expose le patient au risque de dénutrition, facteur de mauvais pronostic. Le dépistage de l’HM apparait donc comme essentiel pour repérer les situations les plus à risque de dénutrition et proposer des mesures adaptatives. Cependant, l’existence de l’HM n’est pas consensuelle, et il persiste de nombreuses questions quant à la notion de modification de la DER lors de la SLA.Une première étude retrouvait, chez 315 patients souffrants de SLA, une DER mesurée systématiquement supérieure à la DER calculée par 12 équations prédictives (p +20%. Les patients avec une ΔDER > +20% selon les équations de Harris et Bénédict de 1919 et leurs versions révisées de 1984 avaient un risque de décès majoré, respectivement de 42% (p=0,01) et 38% (p=0,02). Avec ce même seuil de ΔDER selon la formule de Mifflin, l’évolution fonctionnelle (p=0,02) et respiratoire (p=0,003) étaient plus délétères et la survie plus altérée (p=0,003).Dans une seconde étude, le niveau métabolique était clairement plus élevé chez 287 patients souffrants de SLA en comparaison à celui de 78 témoins sains (1500 versus 1230 kcal/jour, p +20%). Comparativement aux sujets sans HM, les patients avec un HM sévère avaient une proportion de masse grasse au diagnostic plus faible (29,7% versus 32,1%, p=0,005) et une tendance au déclin fonctionnel plus rapide lors du suivi (p=0,07). En analyse univariée, l’HM sévère avait tendance à majorer le risque de décès comparativement à l’absence d’HM (Hazard ratio =1,33 [0,99-1,79], p=0,055). Au total, les études montrent que la DER est réellement augmentée lors de la SLA. Ces modifications concernent tous les patients. L’HM affecte plus de la moitié des patients et pourrait être un marqueur de la maladie. Il existe désormais une formule prédictive de la DER applicable dans la SLA, qui représente un recours à la calorimétrie indirecte. L’HM, surtout lorsqu’il est sévère, modifie la composition corporelle au diagnostic et semble être un facteur de mauvais pronostic pour l’évolution fonctionnelle, respiratoire et la survie. L’ensemble renforce l’importance de l’évaluation métabolique, pour adapter les besoins énergétiques et dépister les situations les plus à risque d’évolution délétère.

Obesity is a public health problem worldwide. The eating habits of French workers need to be clarified. In particular, tachyphagia (meal lasting 15 min) promotes weight gain. The present study aimed to investigate the presence of tachyphagia at lunchtime, the factors associated with tachyphagia, and the relationship between tachyphagia and obesity among workers.This cross-sectional study was conducted between January and May 2016 in five departments of occupational medicine. An anonymous self-administered questionnaire was used to gather general declarative data, such as weight and height (to calculate body mass index [BMI]) and information about lunchtime habits, including the time spent eating.A total of 415 workers with a mean age of 41.1 ± 12.6 years were included. The mean BMI was 23.8 ± 4.6 kg/mOur study provides important information about the lunchtime habits of workers. Maintaining commensality is crucial, particularly in young workers. Companies should play a role in organising their employees' lunch breaks. Level III Evidence obtained from well-designed cohort or case-control analytic studies.