[Anti-obesity drugs : from previous disappointments to new hopes].

Both physicians and patients dream of an efficacious and safe pharmacological approach to treat obesity. Unfortunately, most anti-obesity drugs prescribed since the fifties were associated with an unfavourable risk profile that led to numerous withdrawals. Medications issued from pharmaco-chemistry that mainly target brain amines to reduce appetite have been abandoned because of potential cardiovascular and neuropsychiatric toxicities.

[When bariatric surgery "bypasses" controlled alcohol consumption].

Obesity is a complex disease with significant morbidity and mortality. Its management is a major health issue. Obesity surgery is currently the most effective treatment for this condition.

What is the nutritional status of patients with prolonged disorders of consciousness? A retrospective cross-sectional study.

Background: Nutritional status of patients with disorders of consciousness (DoC) is poorly studied.

Objectives: To evaluate the relationship between nutritional status (body mass index, daily calories intake) and clinical variables (level of consciousness, time since injury, diagnosis, etiology and spastic muscle overactivity; SMO,) in patients with prolonged DoCor emerging. Our main hypotheses are i) patients with lower level of consciousness (UWS) have worse nutritional status compared to patients in minimally conscious state (MCS) and ii) SMO could influence nutritional status.

[Bempedoic acid and inclisiran : two new drugs to treat hypercholesterolemia].

Last European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines on dyslipidemia published in 2019 recommend an LDL-cholesterol goal < 1.4 mmol/l (< 55 mg/dl) for people at very high cardiovascular risk. They propose combinations of lipid lowering therapies in addition to statins if necessary to meet this objective, which is very rarely reached in this at risk population.

[Severe COVID-19, a new complication to be added to numerous comorbidities associated to obesity].

Obesity is associated with a huge number of well-known comorbidities. Nowadays, it represents a higher risk of severe COVID-19 infection, which may lead to the requirement of a mechanical ventilation in intensive care units and premature death. The increase in relative risk of poor prognosis in presence of obesity is particularly high in patients at a younger age.

[Pregastroplasty psychological assessment at the CHU of Liege using the BIPASS].

Obesity is a chronic disease that has become a major public health problem with a prevalence that has doubled in the past two decades in most industrialized and developing countries. Currently, bariatric surgery represents the most effective treatment for extreme or severe overweight (BMI ? 40 kg/m² or ? 35 kg/m2 with weight-related comorbidities). Pre-operative bariatric surgery psychiatric and psychological assessment is essential for various reasons.

[Strategies of home parenteral nutrition in adult patients in 2020].

Home parenteral nutrition (HPN) is increasingly used to allow patients to return home despite a partial or total dependency on artificial intravenous feeding. The follow-up, carried by a multidisciplinary team, is essential. The general practitioner (GP) is on the front line and establishes a network between the home nursing team and the hospital staff.

[Long-term management after bariatric surgery].

The number of bariatric surgery interventions has increased over the past 10 years. The effectiveness of bariatric surgery is currently well demonstrated. However, the need to organize a careful medical follow-up of these patients is essential to ensure a positive evolution over the long term.

[Metabolic complications and nutritional deficiencies related to excessive alcohol consumption].

Metabolic disturbances associated with chronic alcohol consumption, among which those affecting glucose regulation, lipid profile, uric acid and nutritional status, are described. In fact, alcohol abuse can lead to overweight and obesity, but also to protein-caloric malnutrition. Finally, we will discuss concerns about vitamin and mineral deficiencies that may be observed in alcoholic people and can contribute to aggravate somatic complications.

[Management of hypertriglyceridaemia].

Hypertriglyceridaemia is a common finding in medical practice. The reduction of triglyceride levels may contribute to reduce the cardiovascular risk (at least in patients with low HDL cholesterol) and to avoid the occurrence of acute pancreatitis (in case of severe hypertriglyceridaemia). The discovery of causes of hypertriglyceridaemia (comorbidities, medications) may lead to specific measures.

[Hereditary diffuse gastric cancer : case serie of 8 patients from a single family and literature review].

Hereditary diffuse gastric cancer is a form of gastric cancer associated, in about 40 % of cases, with a germline mutation of the CDH1 gene. The management of patients with a pathogenic mutation of this gene is based on total prophylactic gastrectomy because, until proven otherwise, endoscopic monitoring is insufficient. We report a series of eight patients with pathogenic CDH1 mutation who underwent total prophylactic gastrectomy in our centre.

[Assessment of a digestive malabsorption syndrome].

Malabsorption syndrome is a complex clinical entity that needs to be carefully explored. Patients present frequently chronic diarrhoea associated with weight loss. These symptoms affect patient's quality of life.

[Nutrition in the elderly].

Ageing of the body predisposes to a high incidence of undernutrition in the elderly person wherever he or she is living, but the prevalence of malnutrition is particularly high in hospitalized or instutionalized patients. Early detection of malnutrition is important because malnutrition may have significant consequences and evaluation of nutritional status has to be a routine screening in the elderly. There is no single parameter which supplies a full assessment of the patient's nutritional status.

[European guidelines for the management of diabetes, prediabeties and cardiovascular disease. First part. Management of diabetes and cardiovascular risk factors].

The patient with prediabetes or diabetes has a high or very high risk of cardiovascular diseases.We summarize the recent guidelines jointly published by the European Society of Cardiology and the European Society for the Study of Diabetes. In this first article, we focus mainly on the preventive approaches of cardiovascular diseases in patients with prediabetes or (type 1 or type 2) diabetes.

[Alcoholism, an addiction leading to multiple somatic complications].

Alcoholism is, after smoking, the most common addiction in our society. It is associated with multiple familial, social and professional negative consequences. In addition, alcohol disturbs cellular metabolism and its excessive chronic consumption may lead to multiple dysfunctions that can provoke somatic complications targeting numerous tissues or organs.

[Clinical evaluation of an obese person].

Obesity is increasingly prevalent in our society and medical consultations for evaluation and management of weight excess are frequent. Before considering a therapeutic strategy, a careful initial clinical assessment is mandatory. The diagnostic approach of an obese person should be similar as for any other chronic pathology.

[Metabolic surgery: an increasing place in the management of diabetes].

Bariatric surgery becomes more and more important in the management of the obese patient with type 2 diabetes, especially in case of failure of medical approaches. Metabolic improvement results not only from weight loss and the subsequent reduction in insulin resistance, but also from modifications of digestive hormones (especially incretins) that contribute to promote insulin secretion. This new paradigm, moving from bariatric surgery to metabolic surgery, opens new perspectives.

[Obesity: a model of complex interactions between genetics and environment].

Obesity is explained by the joint actions of genetic susceptibility and environmental factors, such as a westernized lifestyle (sedentary lifestyle, calorie-dense foods), inducing an obesogenic environment. The search for obesity susceptibility genes remains complex, despite recent adavances made in the obesity genetics field. Except very rare monogenic type obesity, common obesity is thought to be polygenic and the genetic contribution to interindividual variation in common obesity has been estimated at 40-70 %.

Normal life expectancy for paraganglioma patients: a 50-year-old cohort revisited.

The objective of this study was to assess the long-term survival of patients with a paraganglioma of the head and neck compared with the survival of the general Dutch population. This historic cohort study was conducted using nationwide historical data of paraganglioma patients. We retrieved a cohort of 86 patients diagnosed with a paraganglioma of the head and neck between 1945 and 1960 in the Netherlands.

[Obesity, insulin resistance and type 2 diabetes: risk factors for breast cancer].

Obesity and type 2 diabetes are two risk factors of breast cancer, especially after menopause. Underlying mechanisms are multiple and include hyperinsulinism due to insulin resistance (insulin, as insulin-like-growth factor -IGF-, is a growth factor), hyperleptinaemia associated with hypoadiponectinaemia, and high levels of estrogens resulting from aromatization of androgens in adipose tissue. In presence of type 2 diabetes associated with obesity, hyperglycaemia might provide energy substrate promoting tumour growth.

[Metabolic surgery: an evolution (or revolution) of bariatric surgery?].

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improves metabolic control in obese patients. The frequently observed remission of type 2 diabetes occurs very early, before any marked weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure.

Management of metabolic syndrome and associated cardiovascular risk factors.

Patients with metabolic syndrome have a 1.5- to 3-fold increase in the risk of coronary heart disease and stroke. The association between metabolic syndrome and cardiovascular diseases raises important questions about the underlying pathological processes, especially for designing targeted therapeutic interventions.

Bariatric surgery in patients with type 2 diabetes: benefits, risks, indications and perspectives.

Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its efficacy in obtaining marked and sustained weight loss, and is also associated with a significant improvement in glucose control and even diabetes remission. Roux-en-Y gastric bypass appears to be more effective in diabetic patients than the restrictive gastroplasty procedure.

[Management of an obese person with metabolic syndrome].

The management of an obese person requires a careful evaluation first, a multidisciplinary approach and a stepwise therapeutic strategy. The latter should favour lifestyle modifications, eventually the use pharmacological agents in good responders, and reserve bariatric surgery to well selected cases, refractory to medical treatment. Continuous motivational reinforcement is crucial for long-term success.

[Optimisation of pharmacological therapy in a patient with a newly diagnosed type 2 diabetes].

The diabetic patient, when type 2 diabetes is newly diagnosed, raises a therapeutic problem commonly observed in clinical practice, which is more complex than expected at first glance. The physician has to select the most appropriate antidiabetic oral agent as first choice, to consider the potential of using combined glucose-lowering therapies, to fix glycaemic target taking into account the individual benefit/risk ratio, and to offer the best protection against cardiovascular complications. The present clinical case illustrates such therapeutic problem describing a patient with a high cardiovascular risk profile who experienced a hypoglycaemic episode after the prescription of glibenclamide following the discovery of a moderate hyperglycaemia.