Outcomes and predictive factors of weight loss: an evaluative retrospective study in Tunisia

Introduction

Morbid over-weight is associated with adverse health outcomes such as cardio-vascular diseases, diabetes, hyperlipidemia, hypertension… Obesity treatment needs special and personalized care. Moderate loss weight from 5% to 10% is beneficial for primary reduction of these disorders.

Aim

Identify predictive factors of weight loss of at least 5% of baseline weight and describe improvement of metabolic syndrome

Methods

We performed a retrospective evaluative study in Obesity Research Unit in the National Institute of Nutrition of Tunis from October 2016 to March 2018. We included adult women, whose BMI was > =30 kg/m2. Anthropometric and biological parameters were taken in the first consultation (T0). Then, adequate and personalized care (diet, physical activity, and psychological support) was received. Monthly check-ups were done to detect eventual diet errors. Evaluations were done in 3 and 6 months (T1) and (T2). We performed univariate and then, logistic regression to determine predictive factors of successful loss weight by at least 5%.

Results

We included 73 obese women. Mean age was 42.63 +/- 11.8 yo. One third of the patients were in menopause. At T0: 83.1% have had a weak physical activity while mean BMI was 39.98 +/- 6.47 kg/m2. Fourteen patients had had hypertriglyceridemia and 43 had hypo-HDLemia. Eighteen were hypertensive. Eighteen were diabetic. At T2: mean weight loss was 5.92 +/- 4.34 kg. Fifty-seven percent of patients have successfully lose more than 5% of their baseline weight. Mean BMI was 37.59 +/- 6.51 Kg/m2. A significant improvement of rates of cholesterol and triglycerides was found. Logistic regression found that predictive factors to weight loss were successful loss weight at 1 month, diminution of TSH hormone and augmentation of Phosphorus intake.

Conclusions

A large proportion of obese women may be sensitive to moderate weight loss but a further effort is necessary to maintain effective weight loss on long term.

Key messages

Moderate weight loss is beneficial for health. Personnalized care is required to help obese women.

Prevalence of Tobacco use among Tunisian adolescents: a cross-sectional national survey

Introduction

Tobacco use initiation mostly begins before the age of 18 years old. Being concerned by the increasing prevalence of smoking among adolescents, WHO developed the Global Youth Tobacco Survey. It focuses on youth addiction to tobacco products. This survey was carried out 4 times in Tunisia. GYTS 2017 is the most recent among them.

Aim

Describe the different tobacco products prevalence and access of smokers to tobacco products and to smoke cessation.

Methods

It is a school-based survey uses a two stages cluster sample design to produce a representative samples of students aged from 13 to 15 years old. It was conducted in April and May 2017 in 67 secondary school all over the country. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics.

Results

One out of four students had ever tried to smoke a cigarette; 37.4% of boys vs. 10% of girls (p < 0.001). Lifetime cigarettes prevalence was 7.8%; 14.4% of boys vs. 1.6% of girls (p < 0.001). As for water pipe, 12.7% had ever tried to smoke, even for one or two snuffs. Lifetime water pipe use prevalence was 7.2% (13% of boys vs. 2.8% of girls, p < 0.001). Among cigarettes smokers, 62.5% were able to buy their own cigarettes. Therefore, 23.5% of cigarettes smokers and 41.5% of water pipe smokers were not able to buy their products because of their age. Sixty percent of smokers want to quit and 56.4% had already tried to stop during the year prior to the survey. Seventy-two percent had asked help to quit smoking. Eighteen percent had requested advice from a professional.

Conclusions

Cigarette and water pipe use prevalence among youth is alarming in Tunisia. Selling tobacco products to minors is not prohibited. Implementing such a law is necessary to reduce adolescents' access to cigarettes, and consequently, reduce tobacco use prevalence. Teenagers should benefit from smoke cessation programs, as well as adults.

Key messages

Tobacco prevalence among youth is alarming in Tunisia. Prohibiting tobacco sale to minors is necessary.

Effect of outdoor air pollution on respiratory deseases in the District of Tunis

Background

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most common chronic obstructive pulmonary diseases worldwide. The objective of this study was to analyze the relation between the daily levels of air pollution indicators and the number of emergency department visits (EDV) for asthma and COPD exacerbation in the District of Tunis.

Methods

We conducted a retrospective ecological study. We collected daily morbidity data from the emergency register of Ariana Mami Hospital from 1 January 2007 to 31 December 2014. We investigated the association between daily EDV for asthma or COPD exacerbation and daily concentrations levels of air pollutants by simple Pearson correlation and by binomial negative regression using generalized linear models (GLM).

Results

For morbidity data, we recorded 19127 EDV for asthma (10771, 56.3%) and COPD exacerbation (8356, 43.7%) between 2007 and 2014. We observed a rising trend in the number of EDV for COPD since 2007 with winter seasonality. Regarding the profile of air pollution in the study region, we have exceeded the thresholds of all standards for PM10, exceeding the Canadian standard for O3. However, no threshold exceeded for NO2 and SO2. In the univariate analysis, there was a positive correlation between the daily number of EDV for asthma and COPD exacerbation and NO2 ambient concentration (r = 0.121, p < 10-3) and O3 level (r = 0.066, P < 10-3). Multivariate analysis showed a significant positive association between the daily number of EDV for asthma and COPD exacerbation and NO2 daily concentration (Adjusted OR = 1.033, CI = [1.011 - 1.055], P < 10-3) with a delayed effect of 10 days for NO2 and 12 days for O3.

Conclusions

The exacerbation of asthma and COPD was correlated to the NO2 outdoor air concentration level, with an immediate and other delayed effect of 10 days, also with the 12-day lag from the elevation of O3.

Key messages

Ambient air pollution is a major risk factor for respiratory health. Reducing NO2 emissions could decrease morbidity and direct health care costs of respiratory diseases.