Nitrites and nitrates from additives and natural sources and risk of cardiovascular outcomes

 

Nitrates and nitrites are used as food additives in processed meats. They are also commonly ingested from water and several foods. Evidence suggests a beneficial role of dietary nitrites and nitrates in lowering blood pressure. However, associations between exposure to nitrites and nitrates from natural sources and food additives, separately, and risks of hypertension and cardiovascular disease (CVD) have not been investigated. We aimed to study these associations in the French population based prospective cohort NutriNet-Santé. Overall, 104,817 adults were included. Associations between exposure to nitrites and nitrates (evaluated using repeated dietary records, linked to a food composition database accounting for commercial brands of industrial products) and risks of hypertension and cardiovascular disease were assessed using multivariable Cox proportional hazard models. During follow-up, 3810 incident cases of hypertension were ascertained, and 2075 cases of CVD, 1004 of cerebrovascular diseases and 1079 or coronary heart diseases were diagnosed. Participants with higher exposure to nitrites from food additives and specifically those highly exposed to sodium nitrite (e250) had a higher hypertension risk compared with those who are not exposed to nitrites from food additives (HR = 1.19 (95% CI 1.08-1.31), P = 0.002, and 1.19 (95% CI 1.07-1.31), P = 0.002, P < 0.001), respectively). There was no evidence for an association between total nitrites or nitrites from natural sources, or dietary nitrates with hypertension risk (all P-values>0.3). There was no evidence for associations between dietary nitrites, or nitrates with risks of cardiovascular, cerebrovascular or coronary heart diseases (all P-values>0.2). In conclusion, we found that higher exposure to nitrites from food additives was associated with higher risk of hypertension. Our results do not support a potential protective association between dietary nitrites or nitrates and cardiovascular outcomes.

Key messages

• These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

• Our findings do not support any protective impact of nitrites and nitrates on cardiovascular health.

Nitrites and nitrates dietary exposure from natural sources and additives and type-2 diabetes risk

 

Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives. The epidemiological evidence linking exposure to nitrites/nitrates with type-2 diabetes (T2D) risk is scarce. We aimed to study these associations in a large population based prospective cohort study. Overall, 104,168 adults from the French NutriNet-Santé cohort study (median follow-up time 6.7 years) were included. Associations between intakes of nitrites and nitrates (evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products) and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). During follow-up, 969 incident T2D cases were ascertained. Total nitrites and nitrites from natural sources were both positively associated with higher T2D risk (HRtertile 3 vs.1=1.29 (95% CI 1.06-1.56), Ptrend=0.004, and 1.27 (95% CI 1.05-1.54), Ptrend=0.01, respectively). Participants with higher exposure to nitrites from food additives (i.e. above the sex-specific median), and specifically those having higher exposure to sodium nitrite (e250) had a higher T2D risk compared with those who were not exposed to food additive nitrites (HRtertile 3 vs.1=1.58 (95% CI 1.28-1.94), Ptrend<0.001, and 1.59 (95% CI 1.30-1.96), Ptrend<0.001), respectively). There was no evidence for an association between nitrates of any source and T2D risk (all Ptrend>0.4). In this large prospective cohort, a higher dietary exposure to nitrites (from both natural sources and food additives) was associated with higher T2D risk. These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

Key messages

• A high exposure to dietary nitrites (from both natural and food additive sources) is associated with an increased risk of type-2 diabetes.

• These findings support further regulations concerning the use of nitrites as food additives in processed meats.

Artificial sweeteners and risk of cardiovascular diseases in the prospective NutriNet-Santé cohort

Background

Artificial sweeteners are widely used today by the food industry as sugar alternatives. Potential adverse effects of these food additives on cardiovascular disease (CVD) have been suggested in experimental studies, but data from studies involving humans remain very limited. Previous cohorts have focused on artificially sweetened beverages. Our objective was to study the associations between artificial sweeteners from all dietary sources, overall and by molecule (aspartame, acesulfame-potassium and sucralose), and risk of CVDs (overall, coronary heart and cerebrovascular).

Methods

The study included 103,388 participants of the web-based NutriNet-Santé cohort (2009-2021). Artificial sweetener intakes were assessed using repeated 24h dietary records including names and brands of industrial products consumed. Multi-adjusted Cox proportional hazard models were performed. Exposure to artificial sweeteners were coded as 3-category variables: non-consumers, lower consumers (artificial sweetener intake below the sex-specific median) and higher consumers (above the sex-specific median).

Results

Compared to non-consumers, higher consumers of total artificial sweeteners had increased risk for CVD (n = 1502 incident cases, HR = 1.17 [1.01-1.35], P-trend=0.04) and more specifically cerebrovascular diseases (n = 777, HR = 1.34 [1.10-1.62], P = 0.004). Higher consumption of aspartame was associated with increased cerebrovascular diseases (HR = 1.29 [1.03-1.60], P = 0.01). Higher consumption of acesulfame-K was associated with a higher risk of CVD (HR = 1.24 [1.04-1.47], P = 0.02) and cerebrovascular diseases (HR = 1.29 [1.02-1.64], P = 0.1). No association was detected for coronary heart diseases (n = 730 incident cases).

Conclusions

These findings suggest a direct association between higher artificial sweetener consumption and increased CVD risk, in particular cerebrovascular. These results provide key novel information for the ongoing re-evaluation of sweeteners by the European Food Safety Authority.

Key messages

• In this large-scale prospective cohort (n = 103,388), artificial sweeteners (especially aspartame and acesulfame-K) were associated with increased risks of cardiovascular and cerebrovascular diseases.

• These results provide key insights to feed EFSA’s expertise for the ongoing risk assessment of artificial sweeteners.

Trans fatty acid intake and risk of type 2 diabetes in the NutriNet-Santé prospective cohort

 

Type 2 diabetes (T2D) is one of the most common noncommunicable diseases worldwide, with an increasing prevalence and a considerable global health burden. Substantial evidence has linked consumption of trans fatty acids (TFAs) to an increased risk of cardiovascular disease. However, the effects of T2D remain unclear. We aimed to investigate the associations between different types of TFAs (total, ruminant, industrial and corresponding specific isomers) and risk of T2D in the NutriNet-Santé prospective cohort. Overall, 105,551 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2021) were included (mean age at baseline=42.7y (SD = 14.6y), 79.2% women). Dietary intake data, including usual TFA intake, were collected using repeated 24-hour dietary records (n = 5.7 [SD = 3.1]). Associations between sex-specific quartiles of dietary intake of TFAs and type 2 diabetes risk were assessed using multivariable Cox proportional hazard models adjusted for known risk factors. A total of 969 incident type 2 diabetes cases occured during follow-up. Total TFAs was associated with higher T2D risk (HRfor quartile 4 versus 1=1.38; 95% CI = 1.11-1.73; Ptrend<0.001). This association, specifically observed for industrial TFAs (HR = 1.45; 95% CI = 1.15-1.83; Ptrend<0.001), was mainly driven by elaidic acid (HR = 1.37; 95% CI = 1.09-1.72; Ptrend<0.001) and linolelaidic acid (HR = 1.29; 95% CI = 1.04-1.58; Ptrend=0.07). In contrast, ruminant trans fatty acids were not significantly associated with the risk of T2D. In this large prospective cohort, higher dietary intakes of total and industrial TFAs were associated with increased T2D risk. These findings support WHO's recommendation to eliminate industrially-produced TFAs from the food supply worldwide. As such, consumers should be advised to limit the consumption of food products containing partially hydrogenated oils (main vector of iTFAs) as this, specifically, may contribute to lower the substantial global burden of T2D.

Key messages

• Higher dietary intakes of total and industrial trans fatty acids were associated with increased type 2 diabetes risk.

• Our findings support WHO’s recommendation to eliminate industrially-produced TFAs from the food supply worldwide.

Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort

Background

Acrylamide is classified as a probable human carcinogen by the IARC but epidemiological evidence on the carcinogenicity of acrylamide from dietary sources is limited. This study aimed to investigate the associations between dietary acrylamide and breast cancer risk in the NutriNet-Santé cohort.

Methods

This prospective cohort study included 80,597 French women (mean [SD] age at baseline: 40.8 [14] years) during a mean (SD) follow-up of 8.8 (2.3) years. Acrylamide intake was evaluated using repeated 24h dietary records (n = 5.5 [SD 3.0]), linked to a comprehensive food composition database. Associations between acrylamide intake and breast cancer risk (overall, premenopausal and post-menopausal) were assessed by Cox hazard models adjusted for known risk factors.

Results

The mean (SD) dietary acrylamide intake was 30.1 (21.9) µg/d (main contributors: coffee, potato fries and chips, pastries and cakes, and bread). During follow-up, 1016 first incident breast cancer cases were diagnosed (431 premenopausal, 585 postmenopausal). A borderline significant positive association was observed between acrylamide intake and breast cancer risk overall (HRQ4 vs Q1= 1.21 [95% CI: 1.00-1.47]) and a positive association was observed with premenopausal cancer (HRQ4 vs Q1= 1.40 [95% CI: 1.04-1.88]). Restricted cubic spline analyses suggested evidence for non-linearity of these associations, with higher HR for intermediate (Q2) and high (Q4) exposures. Receptor-specific analyses revealed a positive association with estrogen receptor-positive breast cancer, which represented 86% of total cancer cases. Acrylamide intake was not associated with post-menopausal breast cancer.

Conclusions

Results from this large prospective cohort study suggest the potential deleterious role of dietary acrylamide in breast cancer etiology, especially in premenopausal women, and provide new insights that should encourage further mitigation strategies to reduce the content of acrylamide in food.

Key messages

Food additive emulsifiers and cancer risk: results from the French prospective NutriNet-Santé cohort

Background

Food additive emulsifiers are found in thousands of industrial foods and may exert deleterious effects on gut microbiota and carcinogenesis according to experimental studies. However, their associations with cancer risk has not been investigated yet. This study aimed to investigate these associations in a large population-based prospective cohort.

Methods

This study included 102,485 French adults from the NutriNet-Santé cohort (42.1y [14.5], 78.8% female, 2009-2021). Food additive emulsifier intakes were estimated using repeated 24h dietary records linked to brand-specific food composition databases on food additives. Associations with incident cancer risk were assessed using Multivariable Cox models.

Results

3,511 incident cancer cases were diagnosed during follow-up (1,026 breast, 431 prostate, and 279 colorectal cancers). Intakes of sodium citrate (E331, HR = 1.12 [1.02-1.23], p-trend=0.009), xanthan gum (E415, HR = 1.11 [1.02-1.21], p-trend=0.02), and mono- and diglycerides of fatty acids (E471, HR = 1.17 [1.06-1.28], p-trend=0.001 and total: E471, E472a-b-c-e, HR = 1.11, [1.02-1.22], p-trend=0.02) were associated with increased overall cancer risk. Higher intakes of E331 (p-trend = 0.046), sodium stearoyl-2-lactylate (E481, p-trend=0.01), total lactylates (E481-482, p-trend=0.01), total celluloses (E460-468, p-trend=0.03), carob bean gum (E410, p-trend=0.01), and E471 (p-trend=0.006) were associated with increased overall breast cancer risk. Higher intakes of carrageenan (E407, p-trend=0.04), E415 (p-trend=0.02), and triphosphates (E451, p-trend=0.03) were associated with increased post-menopausal breast cancer risk.

Conclusions

These results are the first to investigate and report direct associations between cancer risk and exposures to seven individual and three groups of food additive emulsifiers. If replicated, they may have an important public health impact, considering the omnipresence of these additives in industrial foods globally.

Key messages

• This study is the first to precisely assess exposures to food additive emulsifiers in a population-based study.

• Intakes of food additive emulsifiers were associated with increased risk of cancer.

Fermentable Oligo-, Di-, Monosaccharides and Polyols and cancer risk in the NutriNet-Santé cohort

Background

Fermentable Oligosaccharides, Disaccharides and Monosaccharides And Polyols (FODMAPs), which are found in a variety of foods (dairy products, fruit, legumes, refined grains, sugary beverages, etc.) have been involved in risk for gastrointestinal disorders. In view of their pro-inflammatory potential and their interactions with the gut microbiota, their contribution to the etiology of other chronic diseases such as cancer has been postulated. However, no epidemiological study has investigated this hypothesis so far. Our objective was to investigate the associations between FODMAP intake (total and by type) and cancer risk (overall, breast, prostate and colorectal).

Methods

104,909 French adults from the NutriNet-Santé prospective cohort (2009-2020) were included (median follow-up time=7.7y). FODMAP intakes were obtained from repeated 24h-dietary records linked to a detailed food composition table. Associations between FODMAPs and cancer risks were assessed by Cox proportional hazard models adjusted for a large range of lifestyle, sociodemographic and anthropometric variables.

Results

Total FODMAP intake was associated with increased overall cancer risk (n = 3,374 incident cases, Hazard Ratio for quintile 5 vs quintile 1=1.21, 95% confidence interval 1.02-1.44, P-trend=0.04). Oligosaccharides seemed to be the FODMAP type particularly associated with cancer risk: a trend was observed for overall cancer (HR = 1.10 (0.97-1.25) P-trend=0.04) and colorectal cancer (n = 272, HR = 1.78 (1.13-2.79) P-trend=0.02). Associations remained stable across a series of sensitivity analyses.

Conclusions

Our findings suggest a potential role of FODMAPs in cancer onset. Further epidemiological and experimental studies are needed to confirm these results and provide data on the potential underlying mechanisms.

Key messages

In this large-scale prospective cohort of French adults, FODMAP intake was associated with increased cancer risk. These associations need to be studied in other prospective cohorts, in order to clarify FODMAPs role in cancer development.

Artificial sweeteners and cancer risk in the prospective NutriNet-Santé cohort

Background

Added sugars' deleterious effects have been established for several chronic diseases, leading food industries to turn towards high-intensity sweeteners. Their safety is debated and findings remain contrasted regarding their role in the etiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies but epidemiological data are lacking.

Thus, our objective was to investigate the associations between sweetener intakes (total from all dietary sources, and most frequently consumed: acesulfame-K e950, aspartame e951 and sucralose e955) and cancer risk (overall and by sites).

Methods

Overall, 102,046 adults from the French NutriNet-Santé prospective cohort (2009-2021) were included. Consumption of sweeteners was obtained by repeated 24h-dietary records including brands and commercial names of industrial products. Associations between sweeteners and cancer incidence were assessed by multi-adjusted Cox hazard models.

Results

Compared to non-consumers, high-consumers had higher risk of overall cancer (n = 2527, hazard ratio=1.12, 95% confidence interval=1.00-1.25, P-trend=0.005). In particular, acesulfame-K (HR = 1.18 [1.04-1.34] P = 0.003) and aspartame (HR = 1.20 [1.05-1.38] P = 0.001) were associated with increased cancer risk. Similarly, higher risks were observed for breast (n = 723, HR = 1.25 [1.02-1.53] P = 0.01, HR = 1.39 [1.11-1.74] P = 0.003 and HR = 1.33 [1.05-1.69] P = 0.007 for total sweeteners, e950 and e951, respectively) and obesity-related cancers (n = 1509, HR = 1.16 [1.00-1.33] P = 0.02, HR = 1.23 [1.04-1.45] P = 0.01 and HR = 1.22 [1.02-1.45] P = 0.01 for total sweeteners, e950 and e951, respectively).

Conclusions

These results suggest that artificial sweeteners (especially e950 and e951), which are found in > 12,000 foods and beverage references worldwide, may be associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of sweeteners by the European Food Safety Authority.

Key messages

In this large-scale prospective cohort of French adults, intake of high-intensity artificial sweetener intake (especially acesulfame-K and aspartame) was associated with higher risk of cancer. These results provide novel insights to feed EFSA’s expertise for the ongoing risk assessment of artificial sweeteners.

Dietary trans fatty acid intakes and cancer risk: results from the NutriNet-Santé cohort

 

Dietary trans fatty acids (TFAs) are either natural (ruminant sources) or industrially generated by partial hydrogenation of vegetable oils. Increasing evidence demonstrated their role as cardiovascular risk factors. Their involvement in cancer etiology is suspected, but epidemiological evidence is limited so far. We aimed to investigate the associations between different types of TFAs (total, ruminant [rTFAs], industrial [iTFAs] and corresponding specific isomers) and the risk of cancer in the NutriNet-Santé prospective cohort (2009-2020). Overall, 104,909 participants were included. Usual TFA intake was estimated from validated repeated 24-h dietary records. Associations between sex-specific quartiles of dietary intake of TFA and cancer risk were assessed using multi-adjusted Cox proportional hazard models. A total of 3,374 incident cancer cases occured during follow-up (including 982 breast and 405 prostate cancers). Total TFAs was associated with higher prostate cancer risk (1.34[1.25;1.87] Ptrend=0.005). rTFAs were associated with increased overall cancer risk (HRfor quartile 4 versus 1: 1.21[1.06;1.39] Ptrend=0.03), in particular the conjugated linoleic acid isomer (CLA) (1.19[1.04;1.36] Ptrend=0.04). These associations were specifically observed for breast cancer, in particular before menopause (rTFAs: 1.78[1.11;2.87] Ptrend=0.006; CLA: 2.013[1.25;3.23] Ptrend=0.003). Several iTFAs were associated with overall (1.18[1.06;1.31] Ptrend=0.02 for transdocosenoic acid), breast (isomer 18:2t: 1.30[1.06;1.58] Ptrend=0.01; hexadecenoic acid: 1.28[1.05-1.56] Ptrend=0.02) and prostate (transdocosenoic acid: 1.52[1.09;2.12] Ptrend=0.07) cancer risks. In this large prospective study, several types of TFAs were associated with increased overall, breast and prostate cancer risks. Although further studies are needed to better understand underlying mechanisms, these results support the WHO's goal of achieving industrially produced TFAs elimination from food supplies.

Key messages

Higher intake of dietary trans fatty acids is associated with an increased risk of various cancers. Our findings support WHO’s global recommendation of eliminating industrially produced TFAs by 2023.

Total and added sugar intakes, sugar types and cancer risk: results from the NutriNet-Santé cohort

Background

Excessive sugar is now recognized as a key risk factor for several cardiometabolic diseases. In contrast, the associations between sugars and cancer risk in cohort studies have been less investigated, and data is lacking regarding differential effect of sugar types and sources. Experimental data suggest that sugars could play a role in cancer etiology, through obesity but also through inflammatory and oxidative mechanisms and insulin resistance. Our objective was to study the associations between total and added sugar intake and cancer risk, accounting for sugar types and sources.

Methods

101,279 French adults from the NutriNet-Santé prospective cohort study (2009-2019) were included. Sugar intake was assessed using repeated 24h-dietary records, designed to register participants' usual consumption for more than 3,500 food and beverage items. Associations with cancer risk were assessed by multi-adjusted Cox proportional hazard models.

Results

Sugar intake was associated with increased cancer risk (2,503 cases, Hazard Ratio Quartile 4 vs 1=1.17, 95% Confidence Interval 1.00-2.37, P trend=0.02). This association was mainly driven by breast cancer (783 cases, HR Q4 vs Q1=1.51 (1.14-2.00); P trend=0.0007) and remained significant even when weight-gain during follow-up was accounted for. Associations were more specifically observed for added sugars (P trend=0.02), free sugars (P trend=0.007), sucrose (P trend=0.01), and sugars from milk-based desserts (P trend=0.02), from sugary drinks (P trend=0.002), and from dairy products (P trend=0.01).

Conclusions

These results suggest that sugar (especially added sugar), of which intake is increasing in Western countries, may represent a modifiable risk factor for cancer prevention, adding to its well-established effect on dental and cardiometabolic health. These findings provide important and novel insights to the current debate on the implementation of sugar taxation, marketing regulation, and other sugar-related policies.

Key messages

In this large-scale prospective cohort of French adults, sugar intake (especially added sugar) was associated with higher cancer risk. These results suggest that (added) sugar may represent a modifiable risk factor for cancer prevention, adding novel insights to current debates on implementing sugar-related public health policies.

Adherence to the new WCRF cancer prevention recommendations associates with a decreased cancer risk

Background

Cancer remains one of the leading causes of death worldwide. In 2018, following its summary report, the World Cancer Research Fund (WCRF) issued its recommendations for cancer prevention based on the nutritional risk factors with a sufficient level of evidence. Our objective was to study whether adherence to these new recommendations leads to a reduced risk of cancer.

Methods

This study included 80,604 participants from the NutriNet-Santé population-based cohort study (2009-2019). Adherence to the 2018 WCRF recommendations was assessed using the operationalized score on a 7-point scale, proposed by Shams-White et al (Nutrients 2019), including: weight, physical activity, fruit and vegetables, dietary fibers, ultra-processed foods, red and processed meat, sugary drinks and alcohol. Usual dietary intakes were assessed using repeated 24h-dietary records and physical activity level using the IPAQ questionnaire. Multi-adjusted Cox proportional hazard models were used for the analyses.

Results

A total of 2,438 incident cancer cases were diagnosed during follow-up (median: 7.4 years). The median WCRF 2018 adherence score was 3.75 (IQR: 3.25-4.50). An increase of 1-point increment in the score was associated with a decreased risk of cancer overall (HR = 0.90; 95%CI 0.86-0.90; P<.0001), and of obesity-related cancers (n = 1549 cases, HR = 0.89; 0.84-0.94; P<.0001), aerodigestive cancers (n = 390, HR = 0.83; 0.74-0.93; P = 0.001), breast cancer (n = 749, HR = 0.92; 0.85-1.00; P = 0.04) and a non-significant trends for prostate (n = 332, HR = 0.89; 0.79-1.01; P = 0.07) and colorectal (n = 218, HR = 0.88; 0.76-1.03; P = 0.1) cancers.

Conclusions

Our results suggest that a higher adherence to the WCRF 2018 recommendations for cancer prevention is associated to a decreased risk of cancer. Given the consistency between overall food-based dietary guidelines and the WCRF cancer recommendations, our result support their general promotion to the general public and transposition as public health actions.

Key messages

Following the recommendations for cancer prevention issued by the WCRF in 2018 can contribute to decrease the burden of cancer. The WCRF cancer recommendations are consistent with overall food-based dietary guidelines and should be promoted to the general public and transposed as public health actions.

Sugary drinks, artificially sweetened beverages and cardiovascular disease in NutriNet-Santé cohort

Introduction

Sugary drinks consumption has increased worldwide in recent years and evidence demonstrating their detrimental impact on cardio-metabolic health is accumulating. Artificially sweetened beverages (ASB) are marketed as a healthier alternative, but their cardio-metabolic impact is being debated in the scientific community. This study aimed to investigate the relationships between the consumption of ASB, sugary drinks and the risk of first incident cardiovascular disease (CVD) in a large prospective cohort.

Methods

The French NutriNet-Santé cohort was launched in 2009. Every 6 months participants are asked to fill 3 validated web-based 24-hour dietary records. All major health events reported by participants were validated based on their medical records by a committee of physicians. Data were also linked to national health insurance system and to the French national cause of specific mortality registry. For each type of beverage, 3 categories were defined as follows: non-consumers, low consumers and high consumers (separated by sex-specific median among consumers). Multi-adjusted Cox proportional hazard models with age as the primary time scale were performed.

Results

A total of 104,761 participants were included. During follow-up (2009-2019), 1,379 first incident cases of CVD occurred. Compared to non-consumers, higher consumers of sugary drinks had a higher risk of overall CVD (HR = 1.21, 95% CI 1.04 to 1.40, Ptrend=0.009). Higher consumers of ASB had also a significantly higher risk of CVD (HR = 1.30, 95% CI 1.00 to 1.71, Ptrend =0.04).

Conclusions

Both sugary drinks and ASB were similarly associated with CVD risk. The health effects of non-nutritive sweeteners is currently being debated based on contrasted epidemiological results. Mechanistic data suggests metabolic effects through gut microbiota perturbation and body weight gain. To imply a causal link, they need replication in other large-scale prospective cohort as well as further mechanistic investigations.

Key messages

Higher consumption of sugary drinks and ASB was associated with higher risk of CVD, suggesting that ASB might not be a healthy substitute for sugary drinks when considering cardiovascular health. These data provide additional arguments to feed the current debate on taxes, labeling and regulation of sugary and artificially sweetened beverages.

Polyradiculonévrite inflammatoire démyélinisante chronique et atteinte du système nerveux autonome

INTRODUCTION

Involvement of the autonomic nervous system during Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is rare. Localised hyperhydrosis and Claude Bernard Horner (CBH) syndrome have never been reported in patients with CIDP.

CASE REPORT

We report the case of a 65-year-old right handed man who presented with hyperhydrosis localised to the right hemithorax and hemiface and a left CBH syndrome. After an extensive workup, the patient was found to have CIDP as the only cause of autonomic nervous system involvement. The symptoms resolved slowly after three courses of intravenous immunoglobulins.

CONCLUSION

Signs of autonomic nervous system involvement can be observed in CIDP as in Guillain-Barré syndrome. This case report shows that immunomodulatory treatment can be effective against dysautonomia in CIDP.

Post-operative rigidity after fentanyl administration

A case of thoraco-abdominal rigidity leading to respiratory failure is described in the post-operative period in an elderly patient who received a moderate dose of fentanyl. This was successfully reversed by naloxone. The mechanisms possibly implicated in this accident are discussed.

Altered capillary permeability in neurogenic pulmonary oedema

Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.

[Management of anesthesia for surgery of the abdominal aorta]

Anesthesia and post operative care of patients requiring abdominal aorta surgery are frequently complicated because of associated ischemic cardiopathy or respiratory insufficiency. Pre operative evaluation indicates the optimal peri-operative strategy and the need to appropriate peri-operative monitoring. This applies to patients with a previous history of myocardial infarction or with a poorly or not controlled cardiac insufficiency. The use of Swan-Ganz catheters allows monitoring of the hemo-dynamic parameters during operation, especially at the moment of clamping or unclamping of the aorta. Vasodilators and optimal volume loading allow myocardial adaptation and reduce the incidence of myocardial infarction, the main cause of peri-operative death. To perform these operations in the best conditions requires a close medicosurgical cooperation in specialized teams.

[Post-operative course in tetraplegics after urological surgers (author's transl)]

The authors report their experience with 33 tetraplegics undergoing surgery. The operations were varied, endoscopic (resection of the bladder neck, of the prostate or striate sphincter, lithot-itiasis) or surgical (lombotomies, transintentinal cutaneous ureterostomies). The post-operative course may be dramatic or even fatal (acute hypertension with cerebral haemorrhage). Respiratory insufficiency poses no particular problem and can be controlled. Epidural anaesthesia maintained for several days makes it possible to avoid the more serious problems: -- autonomic hyperreflectivity, -- delayed resolution of ileus and digestive complication. The authors hence use epidural anaesthesia routinely and are satisfied with the technique.