I. Bourdel-marchasson - Academia.edu (original) (raw)
Papers by I. Bourdel-marchasson
Cahiers de Nutrition et de Diététique, 2013
La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2001
Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study ... more Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study of their risk factors and consequences is of interest. Among 1,565 subjects referred to a short-term geriatric unit, patients hospitalised for a year for an acute event and unable to move themselves were followed up for the occurrence of nosocomial infections. Among these 402 immobilised patients (age: 86.3 +/- 7.6 years), 102 nosocomial infections occurred in 91 patients (22.6%), whereas the estimation of the incidence in the total hospitalised population (1,565 subjects, age: 85.1 +/- 6.2 years) was 9.4% (95% confidence interval [CI] 8.3-11.2). Forty-seven point seven percent of nosocomial infections were urinary tract nosocomial infections, 27.5% were lower respiratory nosocomial infections, 9.2% were cutaneous nosocomial infections, 7.3% were septicaemia and 8.2% were of unknown origin. The relative risk (RR) of NI linked to functional dependency for mobility was 5.5 (95% CI: 3.93-7....
Transplantation proceedings, 2000
T HE ROLE of mitochondrial dysfunction in primary graft nonfunction following transplantation is ... more T HE ROLE of mitochondrial dysfunction in primary graft nonfunction following transplantation is of fundamental importance. Adenosine triphosphate (ATP) content has been well correlated with organ viability 1 and mitochondrial function is crucial in phosphate potential recovery after ischemia-reperfusion. However, it is still unclear to which extent organ dysfunction is linked to mitochondrial dysfunction. The occurrences of excess of cytosolic calcium 2 and oxygen-free radicals meet the conditions for the mitochondrial permeability transition pore (MTP) opening during postichemic reperfusion. In order to test this assumption, we used cyclosporine (CyA), a specific inhibitor of the MTP opening, on a model of perfused rat liver. The liver energetic status was continuously assessed by 31 P-NMR and mitochondrial functions were studied using top down control analysis. The results point out that ischemia in itself is not responsible for mitochondrial damages, whereas the reperfusion phase led to both mitochondrial and liver dysfunctions, which were prevented by 0.2 mol/L CyA. These data demonstrate the role of the MTP opening during reperfusion in the dysfunctions occurring during the transplantation process. 5
Revue d'épidémiologie et de santé publique, 1999
We exemplify the use of a marginal approach with proportional hazards model when failure times ar... more We exemplify the use of a marginal approach with proportional hazards model when failure times are correlated. The marginal distribution for each failure time is formulated by the Cox proportional hazards model, while the dependence structure is unspecified. However, a correct variance-covariance estimate of the regression coefficients that takes into account the intra-group correlation is proposed. The program MULCOX2 which implements this statistical methodology is used to assess the effect of a nutritional supplementation intervention on pressure ulcer development on critically ill older patients from a multicentric trial (involving 19 wards). We compare the results obtained with those of the usual Cox regression. The naive approach yields much smaller standard error estimates of the regression parameters than the robust approach. In our example, the results obtained with the marginal approach do not modify the conclusions: a nutritional supplementation intervention tends to decr...
The British Journal of Diabetes & Vascular Disease, 2012
Residents of care homes with diabetes are a vulnerable group, lacking comprehensive assessment, m... more Residents of care homes with diabetes are a vulnerable group, lacking comprehensive assessment, monitoring, and specialist access. This study aimed to determine whether a short-term patient centred intervention strategy might benefit people with diabetes living in residential care homes.
Nutrition, 2000
The purpose of this study was to assess the effect of nutritional supplementation on dietary inta... more The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to speciality and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. Nutritional intake was monitored by using estimates in units of quarters validated by comparison with weight measurement. There were 672 subjects older than 65 y, and 295 were in the nutritional intervention group versus 377 in the control group. The patients were similar for age, sex ratio, and C-reactive protein. In comparison with the control group, the nutritional intervention group included more patients with stroke, heart failure, and dyspnea and fewer with antecedent falls, delirium, lower limb fractures, and digestive disease. The nutritional intervention group had a lower risk of pressure ulcers according to the Norton score but was less dependent (Kuntzman score) and had a lower serum albumin level. During the trial, energy and protein intakes were higher in the nutritional intervention group (day 2: 1081 Ϯ 595 kcal versus 957 Ϯ 530 kcal, P ϭ 0.006; 45.9 Ϯ 27.8 g protein versus 38.3 Ϯ 23.8 g protein in the control group, P Ͻ 0.001). At 15 d, the cumulative incidence of pressure ulcers was 40.6% in the nutritional intervention group versus 47.2% in the control group. The proportion of grade I cases relative to the total number of cases was 90%. Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P Ͻ 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P ϭ 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P Ͻ 0.001); Norton score Ͻ10 versus Ͼ14: 1.28 (1.01 to 1.62, P ϭ 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P ϭ 0.04). In conclusion, it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements. This intervention was associated with a decreased risk of pressure ulcer incidence. Nutrition 2000;16:1-5.
Diabetic Medicine, 1998
We describe the 5-year mortality and its risk factors in a cohort of elderly people with and with... more We describe the 5-year mortality and its risk factors in a cohort of elderly people with and without known diabetes mellitus. The PAQUID cohort was representative of the population older than 65 living in Gironde, south-west France. Potential mortality risk factors were collected during a baseline evaluation, using a health questionnaire, from 68.9% of a randomly selected sample of over-65s in 1988. A total of 237 subjects (8.5%) had diabetes. Annual review occurred for 5 years and cause of any death was ascertained from family doctors. After 5 years, 623 people (22.3%) had died, of whom 576 were non-demented; 30.0% of the diabetic group versus 20.3% of the non-diabetic group had died. Survival of the known diabetic group was lower than that of the non-diabetic group (p < 0.001), although this excess mortality was significant only in the 65 to 75 age range (relative risk 1.8; 95% confidence interval 1.2 to 2.8, p = 0.04). Cardiovascular mortality rate did not differ between the diabetic and non-diabetic groups (RR 1.2 [0.8-2.0]). Death related to neoplasia was significantly higher in the known diabetic group (RR 2.2 [1.2-3.3], p = 0.01). In the final model, integrating diabetes as a mortality risk factor in the total cohort, known diabetes at the baseline examination was an independent risk factor for mortality (RR 1.4 [1.0-1.8], p = 0.01), in addition to tobacco use, hypertension and functional dependency. These results confirm suggestions that diabetes increases mortality in the over-65 age group, perhaps with an adverse interaction with other pathology.
Diabetes & Metabolism, 2005
All available estimations agree that the French population is aging and that the proportion of di... more All available estimations agree that the French population is aging and that the proportion of diabetics in the elderly population is increasing. The prevalence of diabetes could be about 10% in the over 65 y population. The fact that diabetes has an effect on brain function is widely accepted, but there are very few studies providing pertinent details. Diabetes is known to affect brain function, potential consequences including cognitive decline, dementia, depression, and stroke. These complications are frequently associated, leading to poor quality-of-life with considerable social and economic impact. While the results of different studies can be contradictory, there is an overall trend towards the conclusion that diabetes, often associated with high blood pressure, contributes to cognitive decline in elderly diabetics as well as to an increased frequency and severity of cerebral vascular events. These considerations point out the importance of proper management of diabetes in the elderly population and the need for cooperative studies to determine the role of diabetes and different cardiovascular risk factors in the development of dementia, stroke, and depressive syndromes whose consequences are probably underestimated.
Biochimica et Biophysica Acta (BBA) - Bioenergetics, 2010
The process of skeletal muscle aging is characterized by a progressive loss of muscle mass and fu... more The process of skeletal muscle aging is characterized by a progressive loss of muscle mass and functionality. The underlying mechanisms are highly complex and remain unclear. This study was designed to further investigate the consequences of aging on mitochondrial oxidative phosphorylation in rat gastrocnemius muscle, by comparing young (6 months) and aged (21 months) rats. Maximal oxidative phosphorylation capacity was clearly reduced in older rats, while mitochondrial efficiency was unaffected. Inner membrane properties were unaffected in aged rats since proton leak kinetics were identical to young rats. Application of top-down control analysis revealed a dysfunction of the phosphorylation module in older rats, responsible for a dysregulation of oxidative phosphorylation under low activities close to in vivo ATP turnover. This dysregulation is responsible for an impaired mitochondrial response toward changes in cellular ATP demand, leading to a decreased membrane potential which may in turn affect ROS production and ion homeostasis. Based on our data, we propose that modification of ANT properties with aging could partly explain these mitochondrial dysfunctions.
Diabetes & Metabolism, 2011
Aim -The Clinical Guidelines provide an opportunity to summarise the interpretation of relevant c... more Aim -The Clinical Guidelines provide an opportunity to summarise the interpretation of relevant clinical trial evidence for older people with diabetes. They are intended to support clinical decisions in older people with diabetes and the primary focus is enhancing high quality diabetes care by the use of best available evidence.
Cahiers de Nutrition et de Diététique, 2013
La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2001
Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study ... more Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study of their risk factors and consequences is of interest. Among 1,565 subjects referred to a short-term geriatric unit, patients hospitalised for a year for an acute event and unable to move themselves were followed up for the occurrence of nosocomial infections. Among these 402 immobilised patients (age: 86.3 +/- 7.6 years), 102 nosocomial infections occurred in 91 patients (22.6%), whereas the estimation of the incidence in the total hospitalised population (1,565 subjects, age: 85.1 +/- 6.2 years) was 9.4% (95% confidence interval [CI] 8.3-11.2). Forty-seven point seven percent of nosocomial infections were urinary tract nosocomial infections, 27.5% were lower respiratory nosocomial infections, 9.2% were cutaneous nosocomial infections, 7.3% were septicaemia and 8.2% were of unknown origin. The relative risk (RR) of NI linked to functional dependency for mobility was 5.5 (95% CI: 3.93-7....
Transplantation proceedings, 2000
T HE ROLE of mitochondrial dysfunction in primary graft nonfunction following transplantation is ... more T HE ROLE of mitochondrial dysfunction in primary graft nonfunction following transplantation is of fundamental importance. Adenosine triphosphate (ATP) content has been well correlated with organ viability 1 and mitochondrial function is crucial in phosphate potential recovery after ischemia-reperfusion. However, it is still unclear to which extent organ dysfunction is linked to mitochondrial dysfunction. The occurrences of excess of cytosolic calcium 2 and oxygen-free radicals meet the conditions for the mitochondrial permeability transition pore (MTP) opening during postichemic reperfusion. In order to test this assumption, we used cyclosporine (CyA), a specific inhibitor of the MTP opening, on a model of perfused rat liver. The liver energetic status was continuously assessed by 31 P-NMR and mitochondrial functions were studied using top down control analysis. The results point out that ischemia in itself is not responsible for mitochondrial damages, whereas the reperfusion phase led to both mitochondrial and liver dysfunctions, which were prevented by 0.2 mol/L CyA. These data demonstrate the role of the MTP opening during reperfusion in the dysfunctions occurring during the transplantation process. 5
Revue d'épidémiologie et de santé publique, 1999
We exemplify the use of a marginal approach with proportional hazards model when failure times ar... more We exemplify the use of a marginal approach with proportional hazards model when failure times are correlated. The marginal distribution for each failure time is formulated by the Cox proportional hazards model, while the dependence structure is unspecified. However, a correct variance-covariance estimate of the regression coefficients that takes into account the intra-group correlation is proposed. The program MULCOX2 which implements this statistical methodology is used to assess the effect of a nutritional supplementation intervention on pressure ulcer development on critically ill older patients from a multicentric trial (involving 19 wards). We compare the results obtained with those of the usual Cox regression. The naive approach yields much smaller standard error estimates of the regression parameters than the robust approach. In our example, the results obtained with the marginal approach do not modify the conclusions: a nutritional supplementation intervention tends to decr...
The British Journal of Diabetes & Vascular Disease, 2012
Residents of care homes with diabetes are a vulnerable group, lacking comprehensive assessment, m... more Residents of care homes with diabetes are a vulnerable group, lacking comprehensive assessment, monitoring, and specialist access. This study aimed to determine whether a short-term patient centred intervention strategy might benefit people with diabetes living in residential care homes.
Nutrition, 2000
The purpose of this study was to assess the effect of nutritional supplementation on dietary inta... more The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to speciality and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. Nutritional intake was monitored by using estimates in units of quarters validated by comparison with weight measurement. There were 672 subjects older than 65 y, and 295 were in the nutritional intervention group versus 377 in the control group. The patients were similar for age, sex ratio, and C-reactive protein. In comparison with the control group, the nutritional intervention group included more patients with stroke, heart failure, and dyspnea and fewer with antecedent falls, delirium, lower limb fractures, and digestive disease. The nutritional intervention group had a lower risk of pressure ulcers according to the Norton score but was less dependent (Kuntzman score) and had a lower serum albumin level. During the trial, energy and protein intakes were higher in the nutritional intervention group (day 2: 1081 Ϯ 595 kcal versus 957 Ϯ 530 kcal, P ϭ 0.006; 45.9 Ϯ 27.8 g protein versus 38.3 Ϯ 23.8 g protein in the control group, P Ͻ 0.001). At 15 d, the cumulative incidence of pressure ulcers was 40.6% in the nutritional intervention group versus 47.2% in the control group. The proportion of grade I cases relative to the total number of cases was 90%. Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P Ͻ 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P ϭ 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P Ͻ 0.001); Norton score Ͻ10 versus Ͼ14: 1.28 (1.01 to 1.62, P ϭ 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P ϭ 0.04). In conclusion, it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements. This intervention was associated with a decreased risk of pressure ulcer incidence. Nutrition 2000;16:1-5.
Diabetic Medicine, 1998
We describe the 5-year mortality and its risk factors in a cohort of elderly people with and with... more We describe the 5-year mortality and its risk factors in a cohort of elderly people with and without known diabetes mellitus. The PAQUID cohort was representative of the population older than 65 living in Gironde, south-west France. Potential mortality risk factors were collected during a baseline evaluation, using a health questionnaire, from 68.9% of a randomly selected sample of over-65s in 1988. A total of 237 subjects (8.5%) had diabetes. Annual review occurred for 5 years and cause of any death was ascertained from family doctors. After 5 years, 623 people (22.3%) had died, of whom 576 were non-demented; 30.0% of the diabetic group versus 20.3% of the non-diabetic group had died. Survival of the known diabetic group was lower than that of the non-diabetic group (p < 0.001), although this excess mortality was significant only in the 65 to 75 age range (relative risk 1.8; 95% confidence interval 1.2 to 2.8, p = 0.04). Cardiovascular mortality rate did not differ between the diabetic and non-diabetic groups (RR 1.2 [0.8-2.0]). Death related to neoplasia was significantly higher in the known diabetic group (RR 2.2 [1.2-3.3], p = 0.01). In the final model, integrating diabetes as a mortality risk factor in the total cohort, known diabetes at the baseline examination was an independent risk factor for mortality (RR 1.4 [1.0-1.8], p = 0.01), in addition to tobacco use, hypertension and functional dependency. These results confirm suggestions that diabetes increases mortality in the over-65 age group, perhaps with an adverse interaction with other pathology.
Diabetes & Metabolism, 2005
All available estimations agree that the French population is aging and that the proportion of di... more All available estimations agree that the French population is aging and that the proportion of diabetics in the elderly population is increasing. The prevalence of diabetes could be about 10% in the over 65 y population. The fact that diabetes has an effect on brain function is widely accepted, but there are very few studies providing pertinent details. Diabetes is known to affect brain function, potential consequences including cognitive decline, dementia, depression, and stroke. These complications are frequently associated, leading to poor quality-of-life with considerable social and economic impact. While the results of different studies can be contradictory, there is an overall trend towards the conclusion that diabetes, often associated with high blood pressure, contributes to cognitive decline in elderly diabetics as well as to an increased frequency and severity of cerebral vascular events. These considerations point out the importance of proper management of diabetes in the elderly population and the need for cooperative studies to determine the role of diabetes and different cardiovascular risk factors in the development of dementia, stroke, and depressive syndromes whose consequences are probably underestimated.
Biochimica et Biophysica Acta (BBA) - Bioenergetics, 2010
The process of skeletal muscle aging is characterized by a progressive loss of muscle mass and fu... more The process of skeletal muscle aging is characterized by a progressive loss of muscle mass and functionality. The underlying mechanisms are highly complex and remain unclear. This study was designed to further investigate the consequences of aging on mitochondrial oxidative phosphorylation in rat gastrocnemius muscle, by comparing young (6 months) and aged (21 months) rats. Maximal oxidative phosphorylation capacity was clearly reduced in older rats, while mitochondrial efficiency was unaffected. Inner membrane properties were unaffected in aged rats since proton leak kinetics were identical to young rats. Application of top-down control analysis revealed a dysfunction of the phosphorylation module in older rats, responsible for a dysregulation of oxidative phosphorylation under low activities close to in vivo ATP turnover. This dysregulation is responsible for an impaired mitochondrial response toward changes in cellular ATP demand, leading to a decreased membrane potential which may in turn affect ROS production and ion homeostasis. Based on our data, we propose that modification of ANT properties with aging could partly explain these mitochondrial dysfunctions.
Diabetes & Metabolism, 2011
Aim -The Clinical Guidelines provide an opportunity to summarise the interpretation of relevant c... more Aim -The Clinical Guidelines provide an opportunity to summarise the interpretation of relevant clinical trial evidence for older people with diabetes. They are intended to support clinical decisions in older people with diabetes and the primary focus is enhancing high quality diabetes care by the use of best available evidence.