[Food intake, and anthropometrical and biological parameters in adult Tunisians during Ramadan]

We evaluated the effects of fasting during Ramadan on nutritional intake and plasma lipoproteins in 20 healthy adults of normal weight. A 5-day food questionnaire was completed for every participant. Clinical investigations, anthropometrical measurements and laboratory analysis were also undertaken. Body weight, blood pressure and blood glucose were not influenced by fasting but there were non-significant modifications in the plasma lipid fractions. The total cholesterol remained unchanged. Total daily energy intake was comparable before, during and after Ramadan despite the decrease in meal frequency during fasting. Thus fasting in Ramadan did not affect dietary intake, clinical, anthropometrical and most biological parameters

Efficacy of low-dose oral sulodexide in the management of diabetic nephropathy

BACKGROUND

Diabetic nephropathy (DN) is the single greatest cause of end-stage renal disease (ESRD). Without specific interventions, microalbuminuria (incipient nephropathy) gradually progresses to macroalbuminuria (overt nephropathy) within 10-15 years in about 80% of type 1 and 30% of type 2 diabetic patients, and to ESRD within further 20 years in about 75% and 20%, respectively. A primary alteration in DN consists of decreased concentration of glycosaminoglycans (GAGs) in the glomerular extracellular matrix. This evidence has prompted interest in using exogenous GAGs and specifically sulodexide in DN treatment.

PATIENTS AND METHODS

In this uncontrolled multicenter study, diabetic patients with albumin excretion rate (AER) >or=30 mg/24 hours were treated with oral sulodexide 50 mg/day for 6 months, while receiving concomitant medication as required. Two hundred thirty-seven patients (54% males and 46% females, mean age 55 years, mean diabetes duration 11 years) were evaluated; 89% had type 2 and 11% type 1 diabetes mellitus, 67% microalbuminuria and 33% macroalbuminuria.

RESULTS

AER was significantly and progressively reduced during sulodexide treatment (p<0.0001): geometric mean after 3 and 6 months was 63.7% (95% confidence interval [95% CI], 59.3%-68.4%) and 42.7% (95% CI, 37.8%-48.2%) of baseline, respectively. The reduction was similar in type 1 and type 2 diabetes and was slightly greater in macroalbuminuric than in microalbuminuric patients. Blood pressure was slightly lowered, while fasting glucose and glycosylated hemoglobin were moderately reduced. Adverse effects were observed in 5.5% of patients, including gastrointestinal in 3.8%.

CONCLUSIONS

Sulodexide therapy was shown to reduce AER in patients with DN.

[Food intake, and anthropometrical and biological parameters in adult Tunisians during fasting at Ramadan]

We evaluated the effects of fasting during Ramadan on nutritional intake and plasma lipoproteins in 20 healthy adults of normal weight. A 5-day food questionnaire was completed for every participant. Clinical investigations, anthropometrical measurements and laboratory analysis were also undertaken. Body weight, blood pressure and blood glucose were not influenced by fasting but there were non-significant modifications in the plasma lipid fractions. The total cholesterol remained unchanged. Total daily energy intake was comparable before, during and after Ramadan despite the decrease in meal frequency during fasting. Thus fasting in Ramadan did not affect dietary intake, clinical, anthropometrical and most biological parameters.

Diabetic pregnancy in over 35 years old women

87 pregnancies in diabetic women older than 35 years at time of conception were studied. 3% were insulin-dependent diabetes mellitus (IDDM), 52% non insulin-dependent diabetes mellitus (NIDDM) and 45% gestational diabetes mellitus (GDM). Mean age was 38 +/- 3 years; BMI was 33.2 +/- 7.0 kg/m2; gestation rate was 5 +/- 3 and number of alive children was 2 +/- 2. Only 3% of pregnancies were planned. Mean time of reference to diabetic care unit was 17 +/- 10 weeks. 95% of the women required human insulin. Mean total daily insulin dose was 0.49 +/- 0.28 UI/kg/d, increasing with gestational age. Mean fasting glycemia was 6.85 +/- 1.93 mmol/l and mean post-prandial glycemia was 8.29 +/- 2.52 mmol/l. Mean time of delivery was 38 +/- 2.1 weeks (less than 37 weeks in 9%). Cesarean section was performed in 44% of 34 cases. Death in utero occurred in 11% of 54 cases, postnatal death in 4%, congenital malformations in 4%, macrosomia in 40%. 9% of infants received intensive neonatal care. No difference was found between NIDDM and GDM about outcome of pregnancy. These results underlined importance of early screening for GDM as most cases seem to be undiagnosed pregravid diabetes mellitus (DM).

Effect of tea decoction given to rats ad libitum for a relatively long time on body weight gains and iron, copper, zinc, magnesium concentrations in blood, liver, duodenum and spleen

The aim of our study was to examine the influence of tea decoction given ad libitum for 15 days on body weight gains and on nonheme iron, copper, zinc and magnesium concentrations in the blood from a semisynthetic diet provided to healthy rats. We have also evaluated the reserves of these essential minerals in the liver, duodenum and spleen. Our findings indicate that the tea decoction significantly reduced the total body weight growth in the tea group as compared to the control group (p < 0.0001). The total body weight gains for the control and tea groups were 13.2 and 2.4%, respectively. On the other hand, our data show that the tea decoction significantly reduced nonheme iron concentration in the total blood by 31.8% (p < 0.001). Similarly, the reserve of iron stored in the liver and the duodenum declined more significantly by 57% (p < 1.10(-7) and 50.5% (p < 1.10(-6)). respectively. In contrast to the inhibitory effect on iron concentration and its stored reserve, tea decoction significantly increased zinc, copper and magnesium concentrations in the total blood. Zinc, copper and magnesium concentrations increased by 29.4 (p < 0.05), 69.0 (p < 0.001) and 48.7% (p < 0.001), respectively. Moreover, tea decoction treatment did not raise the reserve of zinc or copper significantly but it increased the reserve of magnesium stored in the liver (p < 0.05).

Effect of different levels of an ascorbic acid and tea mixture on nonheme iron absorption from a typical Tunisian meal fed to healthy rats

The aim of our study was to evaluate the bioavailability of iron from a typical Tunisian meal 'couscous' provided to healthy rats with or without appropriate mixtures of tea plus ascorbic acid and to search for the optimal amount of ascorbic acid able to overcome the inhibitory effect of tea prepared under realistic Tunisian circumstances. Our findings show that a tea decoction (100 mg/ml) reduced nonheme iron absorption from couscous by 50% (16.5 vs. 33.1%; p < 0.01). In contrast, administration of 20 mg ascorbic acid increased nonheme iron absorption from couscous by more than 100% (66.8 vs. 33.1%; p < 0.001). Administration of ascorbic acid (20 mg) in a tea decoction (100 mg/ml) completely counteracted the inhibiting effect of tea and significantly improved the nonheme iron absorption from couscous (34 vs. 33% in the control group; NS). The same effect was shown when 10 mg ascorbic acid was added to the tea decoction; however, 5 mg ascorbic acid was not able to overcome the inhibitory effect of tea on nonheme iron absorption from couscous (33.1 vs. 19.4%; p < 0.01). Our findings demonstrate that a molar ratio of ascorbic acid and tea equal or superior to 0.25 or 0.50 is necessary to overcome the inhibitory effect in rats of tea prepared under Tunisian circumstances. In relation to human nutrition, for Tunisians who regularly drink tea, we suggest a much greater amount of ascorbic acid than that normally recommended for normal subjects.

Effect of tea on iron absorption from the typical Tunisian meal 'couscous' fed to healthy rats

Black and green tea decoctions are popular beverages in Tunisia, especially after eating. Our study was performed to examine the effect of graded amounts of black and green tea decoction prepared under realistic Tunisian conditions on nonheme iron absorption from a typical Tunisian meal, 'couscous', by extrinsic radioiron labeling in rats. Concentrations of 300, 200 and 100 micrograms/ml of black tea decreased dramatically nonheme iron bioavailability from couscous, but 50 micrograms/ml did not influence iron absorption. The inhibition of nonheme iron from couscous varied from 36 to 61% with black tea and 30.5% with green tea. Taken together, our findings show that the tea decoction in Tunisia has a great inhibitory power and may constitute an important factor for the development of iron deficiency anemia throughout Tunisia.

Bioavailability of iron from a traditional Tunisian meal with chickpeas fed to healthy rats

The influence of a diet of couscous with chickpeas, a traditional Tunisian meal, or one providing iron as ferrous sulfate, on the utilization of 59Fe was evaluated in studies with rats. The iron content of the couscous and chickpea preparation was 30 mg/kg dry weight. There was no difference in the relative absorption of iron from ferrous sulfate or couscous with chickpeas, suggesting that iron from this preparation may be a good dietary source of nonheme iron for rats. Couscous and chickpeas consumption in Tunisia are estimated at 13.3 and 3.2 kg per capita/year, respectively. Our results in rats indicate that these foods could contribute a large proportion of an individual's iron requirement. We conclude that the plant foods, especially the chickpeas, can be excellent sources of dietary-available iron.