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Previous studies of AN showed low-grade inflammation. Are low-grade inflammation and circulating lymphocytes associated with chronic conditions?Peripheric blood cytokines were measured using Luminex™ technology in a chronic AN cohort (mean = 67.42 months), compared to Constitutional Thinness (CT), Constitutional Obesity (CO), and Healthy Controls (HC). Secondarily a prospective cohort of chronic AN (mean = 54.11 months) was recruited to compare the functional lymphocyte profile in blood by flow cytometry to CT and HC.In the AN group, most cytokine concentrations were lower than in CT and HC groups. The IL-23 (98.02 pg/ml) was elevated related to HC and CO, and the IL-10 (4.178 pg/ml) was elevated versus CO. In the CT group, IL-9 (0.06216 pg/ml) was elevated compared to AN. The AN group had high Treg (9.259% of CD4The chronic state of AN and CT is surprisingly non-inflammatory with elevated Treg cells. These results suggest that maintaining a dysregulated response to intestinal antigens may contribute to maintaining AN.

Background: In Anorexia Nervosa (AN), association of weight gain recovery above WHO’s lower limits, and classical nutritional markers normalization appears to be mandatory, but not always sufficient, to restore menses. This may worry both patient and practitioner and disrupt medical care. Therefore, this study was designed to evaluate the ability of anthropometric and hormonal factors to predict menses resumption in anorexia nervosa once normal weight was normalized. Method: AN patients recovering a normal BMI but not their menses (ANRec) were evaluated twice, at visit 1, and 6 months later if bodyweight was maintained over this period (visit 2). The 46 ANRec patients reaching visit 2 were separated into two groups: 20 with persistent amenorrhea (PA-ANRec) and 26 with recovered menses (RM-ANRec). Anthropometric and plasma levels of several hormones, Luteinizing Hormone (LH) pulse and LH response to gonadotrophin releasing hormone (GnRH) injection were then compared between groups at visit 1. Results: RM-ANRec presented with higher plasma level of follicular Stimulating hormone (FSH), Estradiol, inhibin B, LH/GnRH and ghrelin compared to PA-ANRec. ROC curves analyses showed that LH pulses’ number ≥2, LH/GnRH ≥ 33 UI/l and Inhibin B >63 pg/ml predicted menses resumption with high specificity (87, 100 and 100% respectively) and sensitivity (82, 80 and 79% respectively). Conclusions: LH pulses’ number≥2, LH/GnRH≥33UI/l or Inhibin B≥63pg/ml can predict accurately menses resumption in still amenorrheic weight-normalized AN patients if they do not lose weight nor practice intense exercise. Negative parameters could help clinician and patient to maintain efforts to achieve individual metabolic set-point.

Anorexia nervosa (AN) is an eating disorder characterised by voluntary dietary restriction leading to severe undernutrition. Hypoglycaemia is mostly described through severe case reports and is always evaluated by fasting or post-meal blood glucose, showing nothing about hypoglycaemia's length or duration. The interest of continuous interstitial glucose monitoring (CGM), largely used in diabetes mellitus, has never been evaluated in AN patients.Glycaemia cycles in AN patients were assessed using CGM over 5 days and then analysed according to food intake.Mean glycaemia was within normal range. 91% of the patients presented with at least one episode with glycaemia under 70 mg/dl. Within the 24 h, the percentage of time spent with a glycaemia under 70 mg/dl was of 20.82 ± 3.90% with a maximum of 52%. We found 2.52 ± 0.33 hypoglycaemia events per 24 h, including 21.11 ± 3.76% at night. CGM parameters correlated with cortisol and IGF1 plasma levels. Comparison with estimated carbohydrate intakes discriminated concordant and non-concordant estimations depending on patient.AN patients display chronic prolonged mild hypoglycaemia all over the nycthemeron despite normal fasting glycaemia. Associated adaptive increased counter-regulatory hormones might protect AN patients from deeper hypoglycaemia. CGM allowed testing food intake self-estimation reliability of AN patients and could be a very useful biofeedback tool.

International audience; OBJECTIVE: This study assessed the impact of a history of metabolic and bariatric surgery (MBS) on the clinical outcomes in patients with type 2 diabetes (T2D) and severe obesity hospitalized for COVID-19. METHODS: In this post hoc analysis from the nationwide observational CORONADO (Coronavirus SARS-CoV2 and Diabetes Outcomes) study, patients with T2D and a history of MBS were matched with patients without MBS for age, sex, and BMI either at the time of MBS or on admission for COVID-19. The composite primary outcome (CPO) combined invasive mechanical ventilation and/or death within 7 and 28 days following admission. RESULTS: Out of 2,398 CORONADO participants, 20 had a history of MBS. When matching for BMI at the time of MBS and after adjustment for diabetes duration, the CPO occurred less frequently within 7 days (3 vs. 17 events, OR: 0.15 [0.01 to 0.94], p = 0.03) and 28 days (3 vs. 19 events, OR: 0.11 [0.01 to 0.71], p = 0.02) in patients with MBS (n = 16) vs. controls (n = 44). There was no difference in CPO rate between patients with MBS and controls when matching for BMI on admission. CONCLUSIONS: These data are reassuring regarding COVID-19 prognosis in patients with diabetes and a history of MBS compared with those without MBS.

International audience; Capillary network of skeletal muscle has a crucial role in oxygen supply and is strongly associated with the phenotype and metabolic profile of muscle fibers. Abundant literature has explored capillarization of skeletal muscle in different populations and in response to different interventions. Capillary and fiber type identification techniques have considerably evolved over the last decades, but to the best of our knowledge, no validated immunohistochemical method has yet been developed to simultaneously identify capillaries (using CD31), the three different muscle fiber types, and basal lamina. Nine human muscle biopsies of vastus lateralis were stained using 5 different methods to test: the reliability of different CD31 antibodies for capillary identification, the reliability between single-section or serial-section methods, and the intra-experimenter reproducibility in visual detection of capillaries. High reliability for the different antibodies directed against capillaries was observed for capillary contacts (CC) measurements (intra-class correlations (ICC) [ICC95%] of 0.89 [0.72; 0.96] for type I fibers, 0.93 [0.81; 0.97] for type IIA fibers, 0.88 [0.71; 0.96] for type IIX fibers, 0.95 [0.86; 0.98] for all fiber types) as well as a high level of similarity between single and serial sections methods. A strong similarity in capillary analysis between the different methods was obtained for each sample measurements. Analysis of Lin's concordance correlation coefficients and Bland and Altman's graphics showed a strong intra-experimenter reproducibility. This article proposes two time- and tissue-sparing immunohistochemical methods to accurately assess a complete fiber typing (type I, IIA, and IIX) along with muscle capillarization on a single muscle section.

International audience; BackgroundConstitutional thinness (CT), a non‐malnourished underweight state with no eating disorders, is characterized by weight gain resistance to high fat diet. Data issued from muscle biopsies suggested blunted anabolic mechanisms in free‐living state. Weight and metabolic responses to protein caloric supplementation has not been yet explored in CT.MethodsA 2 week overfeeding (additional 600 kcal, 30 g protein, 72 g carbohydrate, and 21 g fat) was performed to compare two groups of CTs (12 women and 11 men) to normal‐weight controls (12 women and 10 men). Bodyweight, food intake, energy expenditure, body composition, nitrogen balance, appetite hormones profiles, and urine metabolome were monitored before and after overfeeding.ResultsBefore overfeeding, positive energy gap was found in both CT genders (309 ± 370 kcal in CT‐F and 332 ± 709 kcal in CT‐M) associated with higher relative protein intake per kilo (1.74 ± 0.32 g/kg/day in CT‐F vs. 1.16 ± 0.23 in C‐F, P < 0.0001; 1.56 ± 0.36 in CT‐M vs. 1.22 ± 0.32 in C‐M, P = 0.03), lower nitrogen (7.26 ± 2.36 g/day in CT‐F vs. 11.41 ± 3.64 in C‐F, P = 0.003; 9.70 ± 3.85 in CT‐M vs. 14.14 ± 4.19 in C‐M, P = 0.02), but higher essential amino acids urinary excretion (CT/C fold change of 1.13 for leucine and 1.14 for arginine) in free‐living conditions. After overfeeding, CTs presented an accentuated positive energy gap, still higher than in controls (675 ± 540 in CTs vs. 379 ± 427 in C, P = 0.04). Increase in lean mass was induced in both controls genders but not in CTs (a trend was noticed in CT women), despite a similar nitrogen balance after overfeeding (5.06 ± 4.33 g/day in CTs vs. 4.28 ± 3.15 in controls, P = 0.49). Higher anorectic gut hormones' tone, glucagon‐like peptide 1 and peptide tyrosine tyrosine, during test meal and higher snacking frequency were noticed before and after overfeeding in CTs.ConclusionsThe blunted muscle energy mechanism, previously described in CTs in free‐living state, is associated with basal saturated protein turn over suggested by the concordance of positive nitrogen balance and an increased urine excretion of several essential amino acids. This saturation cannot be overpassed by increasing this spontaneous high‐protein intake suggesting a resistance to lean mass gain in CT phenotype.

International audience; A growing interest in constitutional thinness has been observed in the last decades, but the publications however cover various fields of study and report equivocal results. The present work systematically reviewed any clinical trials enrolling participants with constitutional thinness and bibliographic researches were performed between December 2018 and June 2020. From a total of 1 212 records initially identified, 402 records were removed as duplicates, 381 articles were excluded based on titles or abstracts and 390 references were excluded against eligibility criteria. Thirty-nine articles were finally included in the systematic review. The results showed that constitutionally thin people seem to be underweight but not underfat and present a fat-free mass as blunted as anorexic patients, despite being a little less underweight. The meta-analysis confirmed that constitutionally thin people present normal energy intake and revealed a trend toward a higher resting metabolic rate to fat-free mass ratio which suggests a highly metabolic fat-free mass. Contrary to patients with anorexia nervosa, constitutionally thin people present normal levels of insulin-like growth factor 1, estradiol, growth hormone, follicle-stimulating hormone, and luteinizing hormone. An intermediate level of leptin between anorexic and control participants was however observed in constitutional thinness. While all the studies reported normal free triiodothyronine and cortisol levels in constitutionally thin individuals, a higher fasting free triiodothyronine level (p = 0.033) and a lower 24 h mean cortisol level (p = 0.005) were observed for the first time. Present results give robust evidence that constitutionally thin people present an atypical phenotype highly different from anorexia nervosa.

International audience; Constitutional thinness is defined as a state of severe underweight with a body mass index similar to anorectic patients (BMI < 17.5 kg/m(2)), in the absence of any eating disorders or other obvious disruptive factors impacting energy balance. The analysis of body composition is essential as a first approach to characterize constitutional thinness and might help identify new discriminating differences between constitutional thinness and anorexia nervosa. A meta-analytical approach was performed to compare body composition of constitutionally thin, anorectic, and normal-weight subjects from all available studies found in the literature. The statistical analysis was carried out on large sample sizes: n = 205 females with constitutional thinness, n = 228 normal-weight control females, and n = 258 females with anorexia nervosa. Despite being as underweight as anorectic patients, constitutionally thin participants paradoxically presented higher percentages of fat mass than anorectic patients (18.9% vs. 11.4%, respectively; SMD [95% CI]: 1.62 [1.16; 2.08]), even found in the normal healthy ranges. Constitutionally thin people, however, display as low fat-free mass as anorectic patients. These observations question the use of high-fat diets in this population and bring new insights for nutrition and/or training strategies directed toward muscle mass gain. The present results give new elements to further distinguish constitutional thinness from anorexia nervosa and reinforce the need to better investigate the atypical phenotype of constitutional thinness.

International audience

Constitutional thinness (CT) is a nonpathological state of underweight. The current study aimed to explore skeletal muscle energy storage in individuals with CT and to further characterize muscle phenotype at baseline and in response to overfeeding. Thirty subjects with CT (15 females, 15 males) and 31 normal-weight control subjects (16 females, 15 males) participated in the study. Histological and enzymological analyses were performed on muscle biopsy specimens before and after overfeeding. In the skeletal muscle of CT participants compared with controls, we observed a lower content of intramuscular triglycerides for type I (−17%, p < 0.01) and type IIA (−14%, p < 0.05) muscle fibers, a lower glycogen content for type I (−6%, p < 0.01) and type IIA (−5%, p < 0.05) muscle fibers, a specific fiber-type distribution, a marked muscle hypotrophy (−20%, p < 0.001), a low capillary-to-fiber ratio (−19%, p < 0.001), and low citrate synthase activity (−18%, p < 0.05). In response to overfeeding, CT participants increased their intramuscular triglycerides content in type I (+10%, p < 0.01) and type IIA (+9%, p < 0.01) muscle fibers. CT individuals seem to present an unusual muscle phenotype and different adaptations to overfeeding compared with normal-weight individuals, suggesting a specific energy metabolism and muscle adaptations. ClinicalTrials.gov registration no. NCT02004821. Novelty Low intramuscular triglycerides and glycogen content in skeletal muscle of constitutionally thin individuals. Low oxidative capacity, low capillary supply, and fiber hypotrophy in skeletal muscle of constitutionally thin individuals. Increase in intramuscular triglycerides in constitutional thinness in response to overfeeding.

The existing literature about the definition and diagnostic criteria of constitutional thinness (CT) appears equivocal. The present work systematically reviewed the criteria used in the diagnosis of adult individuals with CT (PROSPERO registration number: CRD42019138236). Five electronic bibliographic databases were searched between December 2018 and November 2019: MEDLINE, Embase, CENTRAL (Cochrane Library), Google Scholar and Clinical Trials. Search terms were combined with Medical Subject Headings terms. The search strategy included any clinical trials that enrolled adults with CT. Studies were systematically excluded if the state of thinness was not due to a well-identified constitutional origin. From the 689 references after duplicate removal, 199 studies were excluded based on title and 164 based on abstract. According to the inclusion and exclusion criteria, 291 other studies were removed. Finally, thirty-five studies remained at the end of the process. The analysis of these studies showed high heterogeneity in the diagnostic criteria of CT. A real need emerged to adopt a common terminology and to systematically exclude potential non-constitutional origins of thinness such as eating disorders, associated pathology or over-exercising, with validated tools. Weight history, physiological menses and weight gain resistance are also important criteria to consider. The present systematic review revealed that our medical and scientific approaches of CT need to be harmonised in terms of terminology and diagnostic criteria. Although further studies are needed, we finally proposed recommendations and a decision tree to help in the recognition and diagnosis of CT.

International audience; Aim: To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D).Methods: From th e CORONAvirus-SARS-CoV-2 and Diabetes Outcomes(CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19–related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status.Results: Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m2, reference group), 726 (36.9%) overweight (25-29.9 kg/m2) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m2) and 314 (16.0%) with class II/III obesity (≥35 kg/m2). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years.Conclusions: Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.

Objectif Comparer le risque d’hypothyroidies 3 mois post dose d’iode pour le traitement des adenomes (AT) et des goitres multi nodulaires toxiques (GMNT) selon la methode (petites doses fixes (MF) ou calculees (MC)). Methode Etude retrospective sur 254 patients : 77 AT (31 MC et 40 MF (3 mCi)) et 177 GMNT (63 MC et 83 MF(10 mCi)). La distribution de la TSH 3 mois post dose a ete analysee selon la methode et la dosimetrie. Resultats AT : 96,8 % de dose unique pour la MC vs 92,5 % (p = 0,7981) ; la premiere dose recue est diminuee pour la MF (126,7 ± 46,6MBq (3,4 ± 1,2mCi) vs 322,6 ± 4,8MBq, p 10mU/l) pour la MC vs 2,5 % (p = 0,0106) ; 10 % d’hypothyroidie pour une dose entre 5 et 10mCi. Pas d’hypothyroidie pour des doses inferieures (p = 0,0798). GMNT : 73,9 % de dose unique pour la MC vs 84 % (p = 0,1636) ; la premiere dose recue est diminuee pour la MF (236,4 ± 121,4Mbq (6,4 ± 3,3 mCi) vs 357,5 ± 95,2Mbq, p Discussion Une dose fixe de 3 mCi pour les AT et de 10 mCi pour les GMNT permet de controler l’hyperthyroidie en reduisant l’hypothyroidie sequellaire en diminuant la dosimetrie appliquee.

Objective To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. Design Retrospective, observational, ambulatory study. Setting University hospital. Patient(s) Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m 2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA). Intervention(s) Gonadotropin-releasing hormone pulsatile therapy. Main Outcome Measure(s) Baseline E 2 , LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies. Results The Rec-AN group displayed higher basal E 2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E 2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA. Conclusion(s) This study showed increased gonadal status and higher E 2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.

Background Constitutional thinness (CT) is a natural state of underweight (13–17.5 kg/m2) without the presence of any eating disorders and abnormal hormonal profile, and with preserved menses in women. We previously conducted a four-week fat overfeeding study showing weight gain resistance in CT women and one of our main results was the identification of an energy gap: a positive energy balance (higher energy intake than energy expenditure). Objective This new overfeeding study is designed to confirm the energy gap and propose mechanistic hypothesis. Design A 2-week overfeeding (daily consumption of one bottle of Renutryl® Booster (600 kcal, 30 g protein, 72 g carbohydrate, 21 g fat) on top of the dietary intake) is performed to compare 15 women and men in each CT group (Body Mass Index [BMI] Results and conclusions Data inter-linking will be able to be established with results of this study. The findings could possibly open to therapeutic approaches to help CT patients to gain weight as well as provide a better understanding of energy regulation with regard to treat obesity (resistance to weight loss), a mirror image of CT (resistance to weight gain).

Epub ahead of print; BACKGROUND:Constitutional thinness (CT) is a state of low but stable body weight (BMI ≤18 kg/m2). CT subjects have normal-range hormonal profiles and food intake but exhibit resistance to weight gain despite living in the modern world's obesogenic environment.OBJECTIVE:The goal of this study is to identify molecular mechanisms underlying this protective phenotype against weight gain.METHODS:We conducted a clinical overfeeding study on 30 CT subjects and 30 controls (BMI 20-25 kg/m2) matched for age and sex. We performed clinical and integrative molecular and transcriptomic analyses on white adipose and muscle tissues.RESULTS:Our results demonstrate that adipocytes were markedly smaller in CT individuals (mean ± SEM: 2174 ± 142 μm 2) compared with controls (3586 ± 216 μm2) (P < 0.01). The mitochondrial respiratory capacity was higher in CT adipose tissue, particularly at the level of complex II of the electron transport chain (2.2-fold increase; P < 0.01). This higher activity was paralleled by an increase in mitochondrial number (CT compared with control: 784 ± 27 compared with 675 ± 30 mitochondrial DNA molecules per cell; P < 0.05). No evidence for uncoupled respiration or "browning" of the white adipose tissue was found. In accordance with the mitochondrial differences, CT subjects had a distinct adipose transcriptomic profile [62 differentially expressed genes (false discovery rate of 0.1 and log fold change >0.75)], with many differentially expressed genes associating with positive metabolic outcomes. Pathway analyses revealed an increase in fatty acid oxidation ( P = 3 × 10-04) but also triglyceride biosynthesis (P = 3.6 × 10-04). No differential response to the overfeeding was observed in the 2 groups.CONCLUSIONS:The distinct molecular signature of the adipose tissue in CT individuals suggests the presence of augm ented futile lipid cycling, rather than mitochondrial uncoupling, as a way to increase energy expenditure in CT individuals. We propose that increased mitochondrial function in adipose tissue is an important mediator in sustaining the low body weight in CT individuals. This knowledge could ultimately allow more targeted approaches for weight management treatment strategies. This trial was registered at clinicaltrials.gov as NCT02004821.

Activation of ghrelin is controlled by the enzyme ghrelin- O-acyl transferase (GOAT). In humans, localization of this acylation is poorly understood. The aim of this study is to explore GOAT localization and activation in the human liver by evaluating both bioactive and non-bioactive ghrelin in the bloodstream entering and leaving the liver and to simultaneously evaluate GOAT mRNA expression in the liver. A healthy part of oncologic hepatic tissue collected from nine patients undergoing hepatectomy was used to evaluate GOAT mRNA expression by quantitative real-time polymerase chain reaction (RT-qPCR). Simultaneously, blood from the portal vein, the suprahepatic vein, the subclavicular vein, and the radial artery was also sampled to assay total and acylated ghrelin. Acylated ghrelin level was significantly increased in the suprahepatic vein compared with the portal vein level (385 ± 42 ng/ml vs. 268 ± 24 ng/ml, P = 0.04). Suprahepatic-to-portal vein ratio for acylated ghrelin (acylation ratio) is 1.4 ± 0.1. Mean expression of GOAT mRNA in the liver, expressed as 2−∆Ct·µg total RNA−1·1 µl of liver tissue−1 was at 0.042 ± 0.021 arbitrary units. GOAT mRNA expression in the liver was correlated with acylated-to-total ghrelin ratio in the suprahepatic vein ( P = 0.016, R = 0.75) and with the acylation liver ratio ( P = 0.05, R = 0.61). Blood concentration of acylated ghrelin was found significantly increased after its passage through the liver, suggesting that acylation can occur in the liver. RT-qPCR data confirmed the presence of GOAT in the liver, with a positive correlation between GOAT expression and acylated ghrelin liver ratio. This study strongly suggests that the liver is a site of ghrelin acylation in humans. NEW & NOTEWORTHY Although the activation of ghrelin by the enzyme ghrelin- O-acyl transferase (GOAT) is yet well demonstrated, its localization, especially in humans, remains poorly understood. We explored GOAT localization and activation in the human liver by simultaneously evaluating both bioactive and non-bioactive ghrelin in the bloodstream entering and leaving the liver and also GOAT mRNA expression in the liver. We therefore showed for the first time, to our knowledge, that GOAT localized in the liver is active and takes part in ghrelin activation.

International audience; Aim Constitutional thinness (CT) is a rare condition of natural low body weight, with no psychological issues, no marker of undernutrition and a resistance to weight gain. This study evaluated the skeletal muscle phenotype of CT women by comparison with a normal BMI control group. MethodsResultsTen CT women (BMI

Objectifs Explorer l’evolution du poids et les reponses metaboliques musculaire et proteiques de patients presentant une maigreur constitutionnelle (MC) face a une surnutrition proteique afin de mieux caracteriser le gap energetique paradoxal et le metabolisme musculaire alteres retrouves dans cette population. Methode Poids corporel, balance energetique, composition corporelle, equilibre azote et metabolome urinaire ont ete compares avant et apres 2 semaines de surnutrition (600 kcal, 30 g proteines, 72 g glucides, 21 g lipides) chez des MC (12 femmes, MC-F, 11 hommes, MC-H) et des temoins de poids normal (12 femmes, C-F, 10 hommes, C-H). Resultats En basal, on retrouve le gap energetique chez les MC (309 ± 370Kcal chez les MC-F et 332 ± 709Kcal chez les MC-M) associe a un apport relatif en proteines superieur (MC ; 1,65 ± 0,34 g/kg/jour ; C : 1,18 ± 0,27 ; p Discussion Bilan azote positif et excretion urinaire d’AAE accrue suggerent un metabolisme energetique musculaire emousse et un turn-over proteique sature ne pouvant etre depasses par la surnutrition proteique chez les MC.

Purpose The opioid system role in anorexia nervosa (AN) pathophysiology is still unclear since conflicting results were reported on peripheral and cerebrospinal fluid opioids levels. The study main aim was to evaluate cerebral AN opiate receptor availability by using [11C] diprenorphine, a ligand with non-selective binding. Methods In vivo [11C]diprenorphine cerebral non-displaceable binding potential (BPND) evaluated by PET imaging was compared between three groups : 17 undernourished restrictive-type AN patients (LeanAN), 15 AN patients having regained normal weight (RecAN) and 15 controls. A lower BPND may account for an increased opioid tone and vice versa. Serum hormones and endogenous opioids levels, eating-related and unspecific psychological traits were also evaluated. Results Compared to controls, LeanAN and RecAN patients had decreased [11C]diprenorphine BPND in middle frontal gyrus, temporo-parietal cortices, anterior cingulate cortex and in left accumbens nucleus. Hypothalamo-pituitary (H-P), left amygdala and insula BPND was found decreased only in LeanAN and that of putamen only in RecAN. LeanAN presented higher dynorphin A and enkephalin serum levels than in controls or RecAN. Inverse correlations were found in total group between : 24 h mean serum cortisol levels and anterior cingulate gyrus or insula BPND; eating concern score and left amygdala BPND. Positive correlation were found between leptin and hypothamus BPND; LH and pituitary BPND. Conclusions Low opiate receptor availability may be interpreted as an increased opioid tone in areas associated with both reward/aversive system in both AN groups. The relationship between the opioid receptors activity and hypercorticism or specific psychometric scores in some of these regions suggests adaptive mechanisms facing anxiety but also may play a role in the disease perpetuation.

Aims Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Materials and methods Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves’ disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Results Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves’ disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves’ disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves’ disease (13%) (ns: P > 0.05). Conclusion Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications that could occur, especially vocal ones. Long-term follow-up is necessary to detect recurrence, which can occur more than 20 years after partial thyroidectomy surgery. Surgery allows early diagnosis of 12.5% of papillary carcinomas.

Pancreatic polypeptide (PP) is a gut hormone that acts on Y4 receptors to reduce appetite. Obese humans display a reduced postprandial increase in PP and remain fully sensitive to the anorectic effects of exogenous PP. The utility of PP as an anti-obesity treatment is limited by its short circulating half-life. Insight into the mechanisms by which PP is degraded could aid in the design of long-acting PP analogs. We investigated the role of peptidases in PP degradation to determine whether inhibition of these enzymes enhanced PP plasma levels and bioactivity in vivo. Dipeptidyl peptidase IV (DPPIV) and neprilysin (NEP) were two peptidase found to cleave PP. Limiting the effect of both peptidases improved the in vivo anorectic effect of PP and PP-based analogs. These findings suggest that inhibiting the degradation of PP using specific inhibitors and/or the design of analogs resistant to cleavage by DPPIV and NEP might be useful in the development of PP as an anti-obesity pharmacotherapy., The degradation sites of pancreatic polypeptide (PP) by kidney and liver tissue preparations were investigated and used to create longer lasting anorectic analogs of PP.

Introduction Constitutional thinness (CT) is an underweight state characterized by normal menstruations and no change in feeding behaviour. Thinness is the only resemblance between Anorexia Nervosa (AN) and CT. Removal of amenorrhea from the new DSM 5 definition of AN might result in misdiagnosis between these two populations. The objective of this study was to compare CT, AN and Control subjects in terms of biological, anthropometric, and psychological markers in order to better distinguish AN from CT subjects. Materials and methods Body composition, nutritional markers, pituitary hormones, bone markers and psychological scores were evaluated in three groups of young women: fifty-six CT, forty restrictive-type AN and fifty-four Control subjects. For every marker, a receiver Operator Characteristics (ROC) curve was calculated to evaluate the accuracy of differentiation between AN and CT groups. Results For most studied parameters, CT subjects were similar to Controls but dramatically different from AN subjects. DEBQ Restrained Eating subscale score was identified by ROC data analysis as the only psychological parameter tested to successfully differentiate AN from CT. Free-T3 and Leptin were shown to be powerful markers to differentiate AN and CT populations as they were highly specific and sensitive ones. Conclusion The exclusive use of psychological testing criteria is not always sufficient to differentiate AN and CT patients. Minimally, additional testing of Free T3 levels, which is cheap and widely accessible for general practitioners, should be completed to avoid misdiagnosis which could result in the implementation of ineffective treatment plans and social stigmatization for CT women.

La maigreur constitutionnelle (MC) pose trois questions : le diagnostic differentiel avec l’anorexie mentale restrictive (AM), la clinique, les bases physiopathologiques. La maigreur definie par l’OMS represente 4 % de la population francaise dans les etudes Obepi toutes etiologies confondues. En l’absence de criteres reconnus, la frequence de la MC est difficile a etablir. C’est par elimination des symptomes de l’AM regroupe dans le DSM-IV puis 5 dans une population de meme tranche d’âge que l’evidence de la MC est apparue. Les echelles psychiatriques montrent une difference de maitrise perfectionnisme et perseverance entre les groupes, l’absence de deni de maigreur et le souhait de grossir exprimes par les MC. Sur le plan somatique, pour un meme IMC entre 14,5 et 16,5 kg/m2, les marqueurs nutritionnels leptine, T3, IGF1, masse grasse sont differents. La presence des regles a l’arret de la pilule est une constante dans la MC ce qui remet en cause la nouvelle definition DSM-5 qui supprime l’amenorrhee secondaire de la definition. Differentier AM et CT evitera la stigmatisation de ces dernieres. La MC se rencontre dans les deux sexes avec souvent un caractere hereditaire. Elle s’exprime tout au long de la vie, sans cassure de la courbe de poids. Outre le bilan nutritionnel, les axes hormonaux gonado, cortico, thyreo, somatotrope et prolactinique sont normaux. La diminution de la masse osseuse avec osteoporose dans 50 % des cas des l’âge de 20 ans represente la seule complication, non expliquee par le decouplage osseux rapporte dans l’AM. Il n’y a pas a ce jour de marqueur specifique de la MC ce qui oblige a proposer des bilans diagnostics complets. La MC s’explique par la diminution, de la masse grasse composes de petits adipocytes, de la masse musculaires dont la repartition des fibres montre moins de fibres lentes oxydatives (type I) plus de fibres rapides glycolytiques (type IIa et IIx) et de la masse osseuse. La balance energetique entre l’apport alimentaire et les depenses est positive. On note une resistance a la prise de poids sous le complement de 600 Kcal de lipides par jour en plus de l’apport habituel pendant un mois, compare aux temoins. Si la ghreline est normale (elevee dans AM) le PYY s’eleve apres les repas expliquant un comportement alimentaire particulier fait de repas principaux plus legers compenses par des collations multiples. La MC, qui n’est pas une AM, de physiologie encore mal connue, represente une situation en miroir de « l’obesite saine ». Toute comprehension de l’une rejaillira sur l’autre situation.

Pancreatic polypeptide (PP), peptide YY (PYY) and neuropeptide Y (NPY), members of the PP-fold family share a high degree of sequence homology. Nuclear magnetic resonance (NMR) and X-ray crystallography studies have shown these peptides can adopt a tightly organized tertiary structure called the PP-fold, which has long been assumed to be the active structure of this family of peptides. To date, however, no studies have been completed with PYY and PP which confirm if the PP-fold structure is important for their physiological actions. The aim of the study was to test if PYY and PP locked into the PP-fold maintained biological activity. Therefore, we designed and produced analogs of PP and PYY in a cyclic conformation with two cysteine amino acid substitutions at the N-terminus and at position 27. These were oxidized to form a cysteine disulfide bond locking the peptides into the PP-fold structure. Studies demonstrate that the cyclic analogs have both similar in vivo activity to their parent molecules, and affinity for the Y2 and Y4 receptors. Results suggest that the proposed PP and PYY-fold is likely to be their biologically active conformation.

INTRODUCTION Interleukin-7 (IL-7) is a cytokine involved in energy homeostasis as demonstrated in rodents. Anorexia nervosa is characterized by restrained eating behavior despite adaptive orexigenic regulation profile including high ghrelin plasma levels. Constitutional thinness is a physiological condition of resistance to weight gain with physiological anorexigenic profile including high Peptide YY plasma level. Healthy obesity can be considered as a physiological state of resistance to weight loss with opposite appetite regulating profile to constitutional thinness including low Peptide YY plasma level. No studies in IL-7 are yet available in those populations. Therefore we evaluated circadian plasma levels of IL-7 in anorexia nervosa compared to constitutional thinness, healthy obese and control females. MATERIALS AND METHODS 10 restrictive-type anorexia nervosa women, 5 bingeing/purging anorexia nervosa woman, 5 recovered restrictive anorexia nervosa women, 4 bulimic females, 10 constitutional thinness women, 7 healthy obese females, and 10 normal weight women controls were enrolled in this cross-sectional study, performed in endocrinology unit and academic laboratory. Twelve-point circadian profiles of plasma IL-7 levels were measured in each subject. RESULTS 24h mean IL-7 plasma levels (pg/ml, mean±SEM) were decreased in restrictive-type anorexia nervosa (123.4±14.4, p

Introduction et but de l’etude La maigreur constitutionnelle est un etat physiologique de sous-poids (IMC 2 ) dans lequel ne sont observes ni les troubles du comportement alimentaire, ni les alterations hormonales secondaires a la denutrition classiquement relevees dans l’anorexie mentale. L’axe gonadotrope n’est pas affecte et les patientes ne presentent pas d’amenorrhee. Il a ete observe chez ces patientes une resistance a la prise de poids lors d’une periode de 4 semaines de surnutrition lipidique, suggerant ainsi que les maigreurs constitutionnelles utilisent des voies energetiques specifiques pour resister a la prise de poids [1] . Le metabolisme du tissu musculaire etant un determinant majeur de la depense energetique, l’objectif de cette etude etait de comparer le phenotype musculaire de patientes presentant une maigreur constitutionnelle avec celui de sujets temoins. Materiel et methodes Dix patientes presentant une maigreur constitutionnelle avec un IMC 2 et dix femmes temoins (IMC de 18,5 a 25 kg/m 2 ) appariees en âge ont ete recrutees. Leur composition corporelle a ete mesuree par DEXA. Des biopsies musculaires du vaste externe ont permis de prelever des echantillons musculaires. Des analyses immunohistochimiques ont ete realisees sur des coupes seriees pour analyser la typologie musculaire et la surface de section des fibres ainsi que la capillarisation et l’activite de la cytochrome-C oxydase pour chaque type de fibre musculaire. Cette etude a ete acceptee par le comite de protection des personnes de Saint-Etienne. Resultats Les resultats sont presentes sous forme de moyenne ± SEM. Ils etaient consideres comme significatifs pour des valeurs de p ≤ 0,05. Les patientes constitutionnellement maigres avaient une masse maigre, une masse grasse et une densite minerale osseuse plus faibles que les temoins ( p p r = 0,64, p ) ainsi qu’une diminution significative de plusieurs indices de capillarisation tels que le nombre de capillaires par fibre ou l’indice LC/PF et ce pour chaque type de fibre. Enfin, l’analyse des colorations de cytochrome-C oxydase a permis de mettre en evidence une baisse significative de l’activite de cette enzyme dans les fibres de type I. Conclusion Il semble donc qu’outre une masse musculaire inferieure aux sujets temoins, les patientes constitutionnellement maigres possedent un phenotype musculaire specifique avec une proportion plus faible de fibres oxydatives de type I et un profil moins oxydatif. Il serait interessant d’approfondir ces resultats en etudiant d’eventuelles differences sur le plan fonctionnel entre les personnes constitutionnellement maigres et les temoins en termes d’aptitudes cardiovasculaires ou neuromusculaires.

OBJECTIVE To compare the efficacy of the diabetic retinopathy (DR) screening with digital camera by endocrinologists with that by specialist and resident ophthalmologists in terms of sensitivity, specificity, and level of “loss of chance.” RESEARCH DESIGN AND METHODS In a cross-sectional study, 500 adult diabetic patients (1,000 eyes) underwent three-field retinal photography with a digital fundus camera following pupillary dilatation. Five endocrinologists and two ophthalmology residents underwent 40 h of training on screening and grading of DR and detection of associated retinal findings. A κ test compared the accuracy of endocrinologist and ophthalmology resident screening with that performed by experienced ophthalmologists. Screening efficiency of endocrinologists was evaluated in terms of “loss of chance,” i.e., missed diagnoses that required ophthalmologist referrals. RESULTS The mean weighted κ of DR screening performed by endocronologists was similar to that of ophthalmology residents (0.65 vs. 0.73). Out of 456 DR eyes, both endocrinologists and ophthalmology residents misdiagnosed only stage 1 DR (36 and 14, respectively), which did not require ophthalmologist referral. There were no significant differences between endocrinologists and ophthalmology residents in terms of diabetic maculopathy and incidental findings except for papillary cupping and choroidal lesions, which were not the main purpose of the study or of the training. CONCLUSIONS The endocrinologist with specific training for DR detection using a three-field digital fundus camera with pupillary dilatation can perform a reliable DR screening without any loss of chance for the patients when compared with identical evaluation performed by experienced ophthalmologists.

Summary Constitutional thinness (CT) and anorexia nervosa (AN) are two categories of severely underweight subjects. Some appetite-regulating hormones display opposite levels in AN and CT. While levels of ghrelin, an orexigenic hormone, fit with the normal food intake in CT, the lack of efficacy of increased ghrelin levels in AN is not clear. Obestatin is a recently described peptide derived from the preproghrelin gene, reported to inhibit appetite in contrast to ghrelin. The aim of this study was to determine whether the circadian profile of obestatin, total and acylated ghrelin levels is different in CT subjects when compared with AN patients. Six-points circadian profiles of plasma obestatin, acylated ghrelin, total ghrelin and other hormonal and nutritional parameters were evaluated in four groups of young women: 10 CT, 15 restricting-type AN, 7 restored from AN and 9 control subjects. Obestatin circadian levels were significantly higher inAN (p < 0.0001) while no difference was found between CTand control subjects. Acylated and total ghrelin were found increased in AN. Acylated ghrelin/obestatin and total ghrelin/obestatin were found decreased in AN compared to CTor C subjects (p < 0.05). The percentage of acylated ghrelin was found decreased in CT group (p < 0.05). The decreased ghrelin/obestatin ratio found in AN might participate in the restraint in nutriment intake of these patients. In contrast, in CTa lower percentage of acylated over total ghrelin might be considered in the aetiology of this condition.

Constitutional thinness (CT) is characterized by a low and stable body mass index (BMI) without any hormonal abnormality. To understand the weight steadiness, energetic metabolism was evaluated. Seven CT, seven controls, and six anorexia nervosa (AN) young women were compared. CT and AN had a BMI 2. Four criteria were evaluated: 1) energy balance including diet record, resting metabolic rate (RMR) (indirect calorimetry), total energy expenditure (TEE) (doubly labeled water), physical activity; 2) body composition (dual-energy X-ray absorptiometry); 3) biological markers (leptin, IGF-I, free T3); 4) psychological profile of eating behavior. The normality of free T3 (3.7 ± 0.5 pmol/l), IGF-I (225 ± 93 ng/ml), and leptin (8.3 ± 3.4 ng/ml) confirmed the absence of undernutrition in CT. Their psychological profiles revealed a weight gain desire. TEE (kJ/day) in CT (8,382 ± 988) was not found significantly different from that of controls (8,793 ± 845) and AN (8,001 ± 2,152). CT food intake (7,565 ± 908 kJ/day) was found similar to that of controls (7,961 ± 1,452 kJ/day) and higher than in AN (4,894 ± 703 kJ/day), thus explaining the energy metabolism balance. Fat-free mass (FFM) (kg) was similar in CT and AN (32.5 ± 2.9 vs. 34.1 ± 1.9) and higher in controls (37.8 ± 1.6). While RMR absolute values (kJ/day) were lower in CT (4,839 ± 473) than in controls (5,576 ± 209), RMR values adjusted for FFM were the highest in CT. TEE-to-FFM ratio was also higher in CT than in controls. Energetic metabolism balance maintains a stable low weight in CT. An increased energy expenditure-to-FFM ratio differentiates CT from controls and could account for the resistance to weight gain observed in CT.

Clinical and biological aspects of restrictive anorexia nervosa (R-AN) are well documented. More than ten thousand articles since 1911 and more than six hundred in 2013 have addressed R-AN psychiatric, somatic and biological aspects. Genetic background, ineffectiveness of appetite regulating hormones on refeeding process, bone loss and place of amenorrhea in the definition are widely discussed and reviewed. Oppositely, constitutional thinness (CT) is an almost unknown entity. Only 32 articles have been published on this topic since 1953. Similar symptoms associating low BMI, low fat and bone mass are reported in both CT and R-AN subjects. Conversely, menses are preserved in CT women and almost the entire hormonal profile is normal, except for leptin and PYY. The aim of the present review is to alert the clinician on the confusing clinical presentation of these two situations, a potential source of misdiagnosis, especially since R-AN definition has changed in DSM-5.

We postulated that dynamic alterations in QT interval adaptation could characterize patients with anorexia nervosa (AN) and could be restored after weight gain. To assess ventricular repolarization features, we evaluated the QT dynamicity along RR intervals from 24-hour electrocardiographic data of patients with AN before and after refeeding. Ten young women with AN (19 +/- 3 years) were included in the study. The QT/RR slope was found significantly enhanced compared with normals (-1.82 +/- 0.62 vs -1.40 +/- 0.30; p0.05). This slope returned to normal range values after refeeding. The QT/RR slope was significantly correlated with the body mass index (r = 0.59; p0.007) in the patient group.

Introduction/objectifs L’anorexie mentale (AM) se caracterise par une denutrition associee a une amenorrhee hypothalamique fonctionnelle. La reprise de poids ne s’accompagne pas toujours du retour des regles et la pompe LHRH peut alors traiter l’infertilite. L’objectif de l’etude est de comparer les resultats cliniques et hormonaux de ce traitement chez des AM gueries toujours en amenorrhee et des patientes en amenorrhee hypothalamique (AH) sans trouble du comportement alimentaire (TCA). Materiel/methode Dix-neuf patientes AM gueries (AM-Ren), 15 patientes en AH secondaire (AHS) et 7 patientes en AH primaire (AHP) ont etes incluses dans cette etude retrospective. Resultats Le taux basal d’estradiol est significativement plus eleve chez les AM-Ren que chez les AHS et les AHP (p = 0,001 et p = 0,0001), le taux basal de FSH est significativement plus eleve chez les AM-Ren que chez les AHP (p = 0,009). Sous pompe LHRH, l’estradiol est significativement plus eleve chez les AM-Ren que chez les AHS (p = 0,0032) et les AHP (p = 0,0032). La LH sous pompe est significativement plus elevee chez les AM-Ren que chez les AHP (p = 0,013). Chez les AM-Ren, le taux d’ovulation est de 84 % et le taux d’accouchement de 63 %. Discussion Malgre un bilan gonadotrope basal moins perturbe et une bonne reponse a la pompe LHRH, les AM-Ren ne retrouvent pas leurs regles. Il pourrait exister des facteurs autres que le poids pouvant expliquer l’inertie de l’axe gonadotrope, non explores en pratique ou inconnus a ce jour.

Objectif Le freinage de la TSH par la levothyroxine chez les patients porteurs d’un cancer thyroidien papillaire differentie pourrait etre associe a une alteration de la qualite osseuse. Les recommandations recentes proposent d’ailleurs de raccourcir le temps de freinage en fonction du risque thyroidien. Pourtant les donnees de la litterature sont variables en termes de micro-architecture. Cette etude se propose donc d’evaluer la micro-architecture osseuse par high-resolution peripheral quantitative computed tomography (HR-pQCT, XtremeCT ; Scanco© Medical AG, Suisse) dans un groupe de femmes sous traitement freinateur. Patients et methodes Trente-deux patientes post-menopausees sous traitement freinateurs depuis plus de 10 ans ont beneficie d’une evaluation de la densite minerale osseuse par dual-energy X-ray absorptiometry (DXA), de la micro-architecture osseuse par HR-pQCT, et des marqueurs osseux (osteocalcine et cross laps). Resultats La TSH etait a 0,10 ± 0,03 mUI/L, avec une duree moyenne de freinage a 17,9 ± 1,2 ans. Les marqueurs osseux etaient comparables dans les deux groupes. La densite minerale osseuse et le T-score des patientes n’etaient pas alteres (DXA). Mais la densite corticale du radius (Dcomp, HR-PQCT) etait diminuee chez les patientes (Dcomp/radius : 816,7 ± 24,5 g/cm3 vs 863,3 ± 11,3 g/cm3 chez les temoins, p = 0,04). L’aire trabeculaire est preservee. Discussion Cette etude montre un possible effet deletere du freinage de la TSH dans le cancer thyroidien papillaire differentie sur la micro-architecture corticale et non trabeculaire et non vu au DXA. Ces resultats preliminaires doivent etre confirmes pour pouvoir etudier l’impact sur les fractures.

Objectifs La ghreline necessite d’etre octanoylee par la ghreline-o-acyl-transferase (GOAT) pour etre active. Les lieux de cette acylation sont encore mal connus. Cette etude se propose donc d’explorer la localisation de la GOAT et son action au niveau du foie en evaluant les formes actives et non actives de la ghreline dans le courant sanguin autour du foie ainsi que l’expression mRNA de la GOAT dans le foie. Patients et methodes Neuf patients subissant une hepatectomie ont beneficie d’un prelevement hepatique pour evaluer l’expression mRNA de la GOAT par quantitative real time polymerase chain reaction (RTqPCR). En parallele, des prelevements ont ete realises au niveau de la veine porte (VP), la veine suprahepatique (VSH), la veine subclaviculaire et l’artere radiale pour doser la ghreline totale et acylee. Resultats La ghreline acylee est revenue significativement elevee dans la VSH par rapport a la VP (385 ± 42 ng/mL vs. 268 ± 24 ng/mL, p = 0,04). Le ratio de ghreline acylee entre la VSH et la VP (ratio d’acylation) a ete calcule a 1,4 ± 0,1 et l’expression moyenne de mRNA de la GOAT dans le foie (2−?Ct/μg total RNA/1 μL of tissu hepatique) a 0,042 ± 0,021 unites arbitraires et significativement correle au ratio ghreline totale/ghreline acylee au niveau de la VSH (p = 0,016, R = 0,75) et au ratio d’acylation (p = 0,05, R = 0,61). Discussion Ces donnes confirment la presence de la GOAT dans le foie avec une augmentation des taux de ghreline acylee correles suggerant fortement que l’acylation de la ghreline peut avoir lieu dans le foie chez l’humain.

Objectif La ghreline orexigene est elevee, mais variable dans l’anorexie mentale restrictive pure (AMR), dont la sensation de faim est elle-meme variable et peu etudiee. Aucune etude a ce jour n’a evalue simultanement sensation de faim et taux de ghreline chez les AMR. Cette etude se propose donc de verifier l’hypothese d’un lien entre la ghreline totale et octanoylee et la sensation de faim dans l’AMR. Patients et methodes Dix patientes AMR (criteres DSM-IV) avec sensation de faim conservee (score total EVA faim sur 24 h15 et presence des trois pics preprandiaux (score 3), 10 autres sans sensation de faim (score total EVA faim sur 24 h ≤ 5 et absence des trois pics preprandiaux (score ≤ 2), 10 patientes maigreurs constitutionnelles (MC, meme IMC, mais sans trouble du comportement alimentaire) et 10 femmes de poids normal et sans TCA ont incluses. La ghreline a ete evaluee en 12 points sur 24 heures Resultats Les MC, les AMR ayant perdu la sensation de faim et les temoins ont des cycles de score de faim comparables. Les 3 groupes ont des ghreline totales et octanoylees comparables. Les AMR ayant conserve leur sensation de faim ont une ghreline significativement plus elevee que les 3 autres groupes. Discussion La ghreline est globalement elevee dans l’AMR ayant conserve la sensation de faim et comparable aux temoins pour les autres. Cette etude preliminaire pourrait modifier la prise en charge de reprise de poids en agissant en fonction des taux de ghreline.

Introduction La leptine est une hormone anorexigene qui est parfois tres elevee chez les obeses. On evoque donc le concept de « resistance a la leptine ». Pour des IMC > 35 kg/m², la leptine mais devient extremement variable entre les individus. L’objectif de notre etude etait d’analyser les parametres expliquant ces differences chez des patients obeses candidats a une chirurgie bariatrique. Patients et methodes Nous avons etudie les relations entre leptinemie, metabolisme energetique et composition corporelle chez 147 patients avant une chirurgie bariatrique. Resultats Nous avons toujours analyse separement les hommes et les femmes puisque la leptine est plus elevee chez la femme. La leptine est correlee a la masse grasse totale et a la masse grasse du tronc chez la femme. Elle est associee negativement a l’âge chez la femme. En revanche, cette variabilite n’est pas expliquee dans notre etude par le tour de taille, le tour de hanche, le bilan lipidique, l’etat nutritionnel le metabolisme energetique qu’il soit mesure par calorimetrie indirecte ou calcule. Des tendances se revelent concernant les sous-types de comportement alimentaires mais les effectifs des sous-groupes etaient faibles. Conclusion Notre etude montre que la leptine ne suit plus une croissance exponentielle avec la masse grasse dans l’obesite morbide, notamment chez les hommes. Cette dissociation entre la leptine et la masse grasse n’a pas ete expliquee par les autres parametres nutritionnels evalues. Il reste a approfondir la relation entre la leptine et le type de comportement alimentaire. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.