Henda Jamoussi

Background: Disordered eating behaviors (DEBs) and psychological distress may complicate type 2 diabetes mellitus (T2DM) care. Objective: To estimate the frequency of DEB screening positivity and examine associated characteristics in a Tunisian T2DM clinic sample. Methods: This cross-sectional study included 400 adults assessed between January and April 2023 using the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire; Bulimic Investigatory Test Edinburgh (BITE); four-item Perceived Stress Scale (PSS-4); and Hospital Anxiety and Depression Scale (HADS). Exploratory analysis estimated crude prevalence ratios (PRs). Adjusted odds ratios (aORs) came from a logistic model including age, sex, body mass index (BMI), diabetes duration, and PSS-4. Separate secondary models replaced PSS-4 with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) or depression subscale (HADS-D). Results: DEB positivity was 26.8% (107/400; 95% confidence interval [CI], 22.6–31.3%). Crude DEB prevalence was higher in women than men (30.4% versus 19.2%; PR, 1.58; 95% CI, 1.06–2.35), in participants with HADS-A ≥11 versus 2, 1.083; 95% CI, 1.042–1.126), and higher PSS-4 (aOR per point, 1.133; 95% CI, 1.067–1.203). HADS scores were positively associated in separate adjusted models. Glycated hemoglobin (HbA1c) was high in both groups (10.36% versus 9.91%; difference, 0.45 percentage points; 95% CI, −0.01 to 0.92). Conclusions: Approximately one-quarter of this clinic sample had a positive DEB screen. Associations with psychological symptoms support attention to eating concerns and emotional well-being in diabetes care. However, cross-sectional data limit causal interpretation, and future longitudinal studies are warranted.

Background: Malnutrition and sarcopenia are highly prevalent in intensive care settings and are associated with adverse clinical outcomes. Aim: The study aimed to evaluate the association between nutritional care, nutritional status, and patient outcomes in intensive care units. Methods: This prospective observational study at a Tunisian tertiary hospital investigated nutritional status and management of 100 intensive care unit patients, each of whom was followed for seven days after ICU admission. Malnutrition Risk was assessed by NUTRIC and MNA scores. The severity of disease was assessed using the APACHE II and SOFA scores. Malnutrition was diagnosed using body mass index and weight loss. Sarcopenia was assessed through grip strength, calf circumference, and psoas muscle area. Nutritional management was evaluated using calculations of caloric and protein intake. Clinical outcomes included the need for intubation, difficulty with oxygen weaning, healthcare-associated infections, and the development of pressure ulcers. Results: The participants had a mean age of 54.85 ± 17.25 years, with a slight male predominance (53 males, 47 females). Pre-existing metabolic conditions affected 80% of patients, including hypertension (40 patients), diabetes (36), and obesity (18). The primary reasons for admission were respiratory disorders (25%), infectious diseases (23%), and metabolic disorders (16%). The mean APACHE II score was 15.91 ± 6.84, and the mean NUTRIC score was 3 ± 1.66; 27% were classified as at high risk of malnutrition. The prevalence of malnutrition reached 50% (28% moderate, 22% severe). Only 31% received adequate caloric intake, while 84% had insufficient protein intake. Malnourished patients required intubation more frequently (50% versus 22.5%; p = 0.014), experienced greater difficulty with oxygen weaning (78.4% versus 48.6%; p = 0.008), and developed pressure ulcers more often (43.5% versus 6%; p < 0.001). Sarcopenic patients showed similar patterns for intubation (51.4% versus 18.9%, p = 0.003), oxygen weaning difficulty (77.5% versus 46.9%, p = 0.007), and pressure ulcers (39.2% versus 6.7%, p < 0.001). Conclusions: Malnutrition and sarcopenia are highly prevalent in intensive care patients and are associated with severe complications, including prolonged mechanical ventilation and pressure ulcer development. Inadequate nutritional support remains common despite known consequences. Early comprehensive nutritional assessment and appropriate management from admission are essential to improve outcomes in critically ill patients.

Background: Perioperative immunonutrition, including arginine and omega-3 fatty acids, has been proposed to support postoperative recovery by modulating immune function. Aim: To evaluate the effects of perioperative arginine and omega-3 supplementation on postoperative infectious complications, mortality, hospital length of stay, intensive care unit duration, and inflammatory markers in patients undergoing gastrointestinal cancer surgery. Methods: In this Pilot Open-Label randomized trial, 35 adult patients scheduled for elective gastrointestinal cancer surgery at Salah Azaiez Institute were randomly assigned to receive either perioperative immunonutrition (n = 18; three daily capsules of omega-3 and one sachet of Arginine+ for 7 days preoperatively and 7 days postoperatively) or standard care (n = 17). Primary endpoints were postoperative infectious complications and 1-month mortality. Secondary endpoints included hospital length of stay, ICU duration, and postoperative biochemical markers. Results: No statistically significant differences were observed between groups in 1-month mortality (p = 0.324), hospital length of stay (median 7 vs. 7 days, p = 0.392), or ICU duration (median 5 vs. 6 days, p = 0.601). Urinary tract infection (5.9% vs. 11.1%, p = 0.939) and wound infection rates (5.9% vs. 11.1%, p = 0.581) were comparable. Importantly, postoperative C-reactive protein and other inflammatory markers did not differ significantly between groups (CRP: 165 vs. 175 mg/L; intergroup p = 0.798). Conclusions: In this trial, perioperative immunonutrition with arginine and omega-3 fatty acids did not improve postoperative clinical outcomes or inflammatory markers in patients undergoing gastrointestinal cancer surgery. At the administered dose and within a small, heterogeneous cohort, immunonutrition did not provide additional benefit beyond standard care. Larger, adequately powered multicenter trials with optimized dosing are required to clarify its role in gastrointestinal oncology.

Background: Gustatory dysfunction represents an underrecognized complication that may influence dietary behaviors and metabolic control. Previous investigations have suggested alterations in taste in patients with diabetes, yet the relationship between disease duration and specific taste modalities remains incompletely characterized. Aim: This study aimed to (i) compare orosensory detection thresholds for lipid and sweet tastes between patients with recent type 2 diabetes mellitus (rT2DM) (duration ≤ 5 years) and chronic type 2 diabetes mellitus (cT2DM) (duration > 5 years), and (ii) determine whether diabetes duration is associated with alterations in chemosensory function in a North African population. Methods: A cross-sectional comparative pilot study was conducted at the National Institute of Nutrition and Food Technology in Tunis, Tunisia, from April to June 2021. Sixty-seven patients with type 2 diabetes mellitus (T2DM) receiving oral antidiabetic medication were recruited through systematic sampling and divided into two groups: rT2DM (n = 30, duration ≤ 5 years) and cT2DM (n = 37, duration > 5 years). Orosensory detection thresholds for lipid taste were assessed using eight ascending concentrations of linoleic acid ranging from 0.018 to 12 mmol/L. In contrast, sweet taste thresholds were evaluated using a sucrose concentration series ranging from 0.01 to 5 mmol/L. The three-alternative forced-choice method with an ascending-concentration presentation was employed for both taste modalities. Detection thresholds were defined as the lowest concentration at which participants correctly identified the taste quality. Results: Patients with cT2DM exhibited significantly elevated orosensory detection thresholds compared to those with rT2DM for both taste modalities tested. The median linoleic acid detection threshold was 6.000 mmol/L in cT2DM versus 0.058 mmol/L in rT2DM (p < 0.001), representing a 107-fold increase in detection threshold. For sweet taste, the median sucrose detection threshold was 1.0 mmol/L in cT2DM compared with 0.5 mmol/L in rT2DM (p < 0.001), indicating a 2-fold increase in the threshold. In the overall patient cohort, the duration of diabetes was positively correlated with both fat taste perception thresholds (r = 0.657, p < 0.001) and sweet taste perception thresholds (r = 0.466, p < 0.001). However, when analyses were performed by diabetes duration-based subgroups, these correlations were observed only for fat taste perception in cT2DM, with no statistically significant correlations found in rT2DM. In multivariate linear regression analyses adjusted for age, body mass index, and sex/gender, the duration of diabetes remained independently associated with fat and sweet taste perception. Conclusions: Extended T2DM duration is associated with substantial elevations in orosensory detection thresholds for both lipid and sweet tastes in a North African population. These findings suggest that disease chronicity may contribute to chemosensory impairment, potentially influencing dietary preferences and metabolic control in patients with diabetes.

This study focuses on the genetic and clinical characterization of Monogenic Forms of Diabetes (MFD), which are frequently underdiagnosed or misclassified due to clinical similarities with type 1 and type 2 diabetes. Researchers performed Exome Sequencing on 11 Tunisian patients suspected of having MFD. The pathogenicity of genetic variants was assessed using filtering and bioinformatics prediction tools. The ORVAL online tool was used to predict the likelihood of combinations of pathogenic variants. Sanger sequencing confirmed likely pathogenic predicted variants in patients and assessed familial segregation. We identified 15 potentially pathogenic variants in 14 genes linked to MFD, including MODY-3, and isolated diabetes with low penetrance for Wolfram syndrome. Additionally, syndromic forms such as partial familial lipodystrophy types 2 and 4, and Wolfram syndrome were detected. Five patients exhibited characteristics of unspecified MFD. This study underscores the importance of genetic screening in individuals with diabetes who have a family history of the disease, particularly those with associated comorbidities. Our findings emphasize the crucial role of genetic testing in refining diabetes classification, leading to more accurate diagnoses. Therefore, integrating genetic research into clinical practice is essential to improving healthcare outcomes for patients with diabetes.

Background: Childhood obesity is a growing public health challenge, with altered taste perception potentially influencing food choices and contributing to weight gain. Objective: To determine detection thresholds for linoleic acid (fat taste) and sucrose (sweet taste) in children aged 6–12 years, and to explore associations with obesity, dietary intake, and food preferences. Methods: In this cross-sectional study, 100 Tunisian children (mean age: 8.05 ± 1.44 years; 54% girls; 45 obese, 55 non-obese) were recruited from an educational support center in Nabeul. Taste sensitivity was evaluated using the 3-alternative forced choice (3-AFC) method with ascending concentrations of linoleic acid (0.018–12.0 mM) for fat taste and sucrose (0.00125–0.32 mol/L) for sweet taste. Participants were categorized as tasters or non-tasters based on detection thresholds. Anthropometric measurements, 24 h dietary recalls, food frequency questionnaires, and food preference assessments were also conducted. Results: Low taste sensitivity was common (93% for sweet, 49% for fat). Girls were more often fat tasters than boys (68.6% vs. 31.4%, p = 0.003). Children with obesity had higher fat taste thresholds (median 3.00 mM, range 0.37–12.0) than non-obese peers (median 1.50 mM, range 0.018–6.0; p = 0.012), indicating reduced fat taste sensitivity. Linear regression showed a significant positive association between fat taste threshold and BMI (p = 0.001), meaning higher detection thresholds corresponded to higher BMI. Sweet taste thresholds did not differ significantly between children with and without obesity (p = 0.731). Sweet non-tasters consumed more sucrose (85.9 ± 64.9 g/d vs. 70.3 ± 62.3 g/d; p = 0.033) and reported more frequent table sugar use (p = 0.047). Fat non-tasters consumed more magnesium (425 ± 414 mg/d vs. 287 ± 60.8 mg/d; p = 0.026) and fiber (22.9 ± 7.51 g/d vs. 20.3 ± 5.32 g/d; p = 0.048) and reported higher intake frequencies of cheese (p = 0.039), sour cream (p = 0.004), and fast food (p = 0.012). Food preferences reflected similar patterns, with non-tasters generally rating high-fat or high-sugar foods more favorably. While most children demonstrated high detection thresholds, girls showed significantly higher fat taste sensitivity compared to boys (p = 0.03). Children with obesity exhibited significantly higher fat taste detection thresholds compared to non-obese children (p = 0.012), with thresholds ranging from 0.37 to 12.0 mM versus 0.018 to 6.0 mM, respectively. No significant difference was observed for sweet taste perception between weight groups (p = 0.731). Conclusions: Nearly half of the children exhibited reduced fat taste sensitivity, which was moderately associated with obesity and positively linked to BMI.

Background: Sarcopenia is a critical complication in hemodialysis patients, associated with poor clinical outcomes, increased morbidity, and reduced quality of life. Despite this, its significance, prevalence, and risk factor data in developing countries remain limited. Objective: This study aimed to determine the prevalence of sarcopenia and identify its independent risk factors in patients undergoing maintenance hemodialysis, while evaluating its impact on physical performance, nutritional intake, and quality of life. Methods: A multicenter cross-sectional study was conducted across three hemodialysis units in Tunisia. Sarcopenia was diagnosed using EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria based on muscle strength, muscle mass, and physical performance. Handgrip dynamometry, mid-arm and calf circumferences, gait speed, Short Physical Performance Battery (SPPB), and Timed Up and Go (TUG) test were employed. Nutritional intake was assessed using a 7-day food history. Quality of life and functional status were evaluated using the SF-36 and Barthel Index, respectively. Logistic regression was used to identify independent predictors of sarcopenia. Results: Among 118 patients (mean age 56.74 ± 14.44 years), the prevalence of sarcopenia was 42.4% (n = 50). Sarcopenic individuals exhibited significantly poorer physical performance than their non-sarcopenic counterparts. Marked reductions were observed in handgrip strength (p < 0.001, d = −1.60, very large), SPPB scores (p < 0.001, d = −1.55, very large), and increased TUG time (p < 0.001, d = 1.46, very large), indicating substantial functional impairment. Limb circumferences were also significantly lower in the sarcopenic group, including calf circumference (p = 0.002, d = −1.39, large) and mid-arm circumference (p = 0.013, d = −0.87, large). Gait speed was slower (p = 0.010, d = −0.40, small to moderate). Health-related quality of life was significantly compromised in sarcopenic individuals, with lower SF-36 total scores (p = 0.001, d = −1.96, very large) and reduced functional independence as measured by the Barthel Index (p = 0.010, d = −0.97, large). Hemoglobin levels were also significantly lower in the sarcopenic group (p = 0.048, d = −0.96, large). Dietary assessment revealed lower fiber intake (p = 0.006, d = 1.80, very large) and reduced magnesium consumption (p = 0.020, d = 0.94, large) among individuals with sarcopenia. In the multivariate logistic regression analysis, diabetes mellitus (OR = 2.14, 95% CI: 1.30–3.67, p < 0.001) and longer duration of hemodialysis (OR = 1.56, 95% CI: 1.20–2.71, p = 0.028) were identified as independent predictors of sarcopenia. A lower SPPB score (OR = 0.48, 95% CI: 0.35–0.65, p < 0.001) was associated with sarcopenia. Conclusion: Sarcopenia is highly common among hemodialysis patients and is independently linked to diabetes, treatment duration, and reduced physical performance. It significantly affects the quality of life and ability to perform daily activities. Routine screening with simple functional tests is crucial, especially in high-risk patients. Early intervention should include physical rehabilitation, nutritional support, and strict blood sugar management to decrease sarcopenia-related complications.

Background: Taste changes are common during pregnancy and can have a significant impact on dietary habits. Objective: This study aimed to investigate the influence of the perception of sweet and fat taste on diet in pregnant diabetic women. Methods: This cross-sectional observational study included 66 pregnant women, 33 with gestational diabetes and 33 with pre-gestational type 2 diabetes. Taste perception tests were conducted to evaluate thresholds for detecting sweet and fatty tastes. Dietary surveys were used to assess daily nutrient intake, and various biochemical parameters, such as glycemia, HbA1c, and cholesterol, were analyzed. Results: The low-fat taster group (threshold > 0.75 mmol/L) included more patients with diabetes compared to those with gestational diabetes. All diabetic patients had low sucrose perception. Although pregnant women with gestational diabetes detected sweetness at high concentrations, pregnant women with diabetes detected it at lower concentrations (0.012 ± 0.023 mmol/L vs. 0.006 ± 0.005 mmol/L; p = 0.3). High-fat tasters exhibited elevated glycemia compared to low-fat tasters (6.04 ± 1.88 mmol/L vs. 7.47 ± 3.4 mmol/L; p = 0.03). They also had higher cholesterol (p = 0.04) and lower HDL-C levels (4.96 ± 1.04 mmol/L vs. 1.36 ± 0.29 mmol/L; p = 0.03). High-fat tasters showed more frequent daily consumption of oil, butter, cheese, and chocolate. The highly sweet tasters had higher cholesterol levels and lower LDL levels. Individuals who reported being highly sensitive to sweet taste consumed more daily oil, sweetened yogurt, or cream desserts, as well as white sugar. Conclusions: These findings indicate that altered sensitivity to fat and sweet tastes is associated with different dietary habits and metabolic profiles in pregnant women with diabetes. Specifically, reduced sensitivity to the taste of fat is associated with higher consumption of high-fat foods and poorer lipid profiles. In contrast, sensitivity to sweet taste correlates with an increased intake of sugary and fatty foods. Understanding these taste-related behaviors can help develop personalized nutritional strategies to improve metabolic control and maternal–fetal outcomes in this high-risk group.

Background: Probiotics can modulate the microbiota and decrease uric acid levels. Objectives: This meta-analysis aimed to assess the effects of probiotics on uric acid levels. Methods: The keywords “probiotics”, “uric acid”, “gout”, “hyperuricemia” were searched in PubMed Medline, EMBASE, Web of Science, and Google Scholar. The search was limited to the English, French, Italian, and Spanish languages, and to the period between 1 January 2000 to 30 August 2024. We included RCTs and observational studies comparing probiotics to placebo. We excluded studies reporting (1) prebiotics, symbiotics, or postbiotics, (2) animal studies, and (3) case reports, commentaries, or reviews. Two independent reviewers performed quality assessment and data extraction. This meta-analysis was performed according to the PRISMA 2020 and AMSTAR 2 guidelines. The main outcome measure was uric acid levels “after–before” probiotic versus placebo interventions. Forest plots summarized the data using a random model. Results: Nine studies included 394 patients, of whom 201 were treated with probiotics and 193 with placebo. There was a statistically significant difference in favor of the probiotic group compared with the control group regarding the main outcome measure. However, substantial heterogeneity was noted, explained (after applying subgroup analysis and meta-regression) by the following moderators: continent, diseased/healthy, male sex, and monostrain probiotics. Conclusions: This meta-analysis demonstrates that probiotics reduced uric acid levels in Asian males who had disease and were treated with monostrain probiotics.