Vanina Bongard

University of Toulouse, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (127)340.79 Total impact

  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):87. DOI:10.1016/S1878-6480(15)71736-2
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):71-72. DOI:10.1016/S1878-6480(15)71692-7
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):87-88. DOI:10.1016/S1878-6480(15)71737-4
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):89-90. DOI:10.1016/S1878-6480(15)71742-8
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    ABSTRACT: Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 01/2015; 182C:509-516. DOI:10.1016/j.ijcard.2015.01.019 · 6.18 Impact Factor
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    ABSTRACT: Objectives Heart‐type fatty acid–binding protein (h‐FABP), sensitive troponins, natriuretic peptides, and clinical scores such as the Pulmonary Embolism Severity Index (PESI) are candidates for risk stratification of patients with acute pulmonary embolism (PE). The aim was to compare their respective prognostic values to predict an adverse outcome at 1 month.Methods The authors prospectively included 132 consecutive patients with confirmed acute PE. On admission to the emergency department (ED), plasma concentrations of h‐FABP, sensitive cardiac troponin I‐Ultra (cTnI‐Ultra), and brain natriuretic peptide (BNP) were measured and the PESI calculated in all patients. The combined 30‐day outcomes of interest were death, cardiac arrest, mechanical ventilation, use of catecholamines, and recurrence of acute PE.ResultsDuring the first 30 days, 14 (10.6%) patients suffered complications. Among the biomarkers, h‐FABP above 6 μg/L was a stronger predictor of an unfavorable outcome (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 4.2 to 73.3) than BNP > 100 pg/mL (OR = 5.7, 95% CI = 1.6 to 20.4) or cTnI‐Ultra > 0.05 μg/L (OR = 3.4, 95% CI = 1.1 to 10.9). The PESI classified 83 of 118 patients (70.3%) with favorable outcomes and only one of 14 (7%) with adverse outcomes in low class I or II (OR = 30.8, 95% CI = 3.2 to 299.7). The areas under the receiver operating characteristic (ROC) curves (AUCs) were 0.90 (95% CI = 0.81 to 0.98) for h‐FABP, 0.89 (95% CI = 0.82 to 0.96) for PESI, 0.79 (95% CI = 0.67 to 0.90) for BNP, and 0.76 (95% CI = 0.64 to 0.87) for cTnI‐Ultra. The combination of h‐FABP with PESI was a particularly useful prognostic indicator because none of the 79 patients (59.8%) with h‐FABP < 6 ng/mL and PESI class < III had an adverse outcome.Conclusionsh‐FABP and the PESI are superior to BNP and cTnI‐Ultra as markers for risk stratification of patients with acute PE. The high sensitivity of their combination identified a large number of low‐risk patients in the ED.ResumenObjetivosLa proteína transportadora de ácidos grasos del miocardio (h‐FABP), las troponinas sensibles, los péptidos natriuréticos y las escalas clínicas como el Pulmonary Embolism Severity Index (PESI) son candidatos para la estratificación del riesgo de los pacientes con embolismo pulmonar (EP) agudo. El objetivo fue comparar sus valores pronóstico respectivos para predecir un evento adverso al mes.MetodologíaSe incluyó prospectivamente a 132 pacientes de forma consecutiva con EP agudo confirmado. Se midieron al ingreso en el servicio de urgencias (SU) las concentraciones plasmáticas de h‐FABP, troponina sensible (cTnI‐Ultra) y péptido natriurético tipo B (BNP) y se calculó la PESI en todos los pacientes. Los resultados combinados a 30 días de interés fueron muerte, parada cardiaca, ventilación mecánica, uso de catecolaminas y recurrencia del EP agudo.ResultadosDurante los primeros 30 días, 14 (10,6%) pacientes sufrieron complicaciones. Entre los biomarcoadres, la h‐FABP por encima de 6 μg/L tuvo mayor capacidad predictora de un resultado desfavorable (*odds ratio* [OR] 17,5, intervalo de confianza [IC] 95% = 4,2 a 73,3) que el BNP > 100 pg/mL (OR 5,7, IC 95% = 1,6 a 20,4) o la cTnI‐Ultra > 0,05 μg/L (OR 3,4, IC 95% = 1,1 a 10,9). El PESI clasificó 83 de 118 pacientes (70,3%) con un resultado favorable, y sólo uno de 14 (7%) en clase baja I o II tuvo un resultado adverso (OR 30,8, IC 95% = 3,2 a 299,7). Las áreas bajo la curva ROC fueron 0,90 (IC 95% = 0,81 a 0,98) para h‐FABP, 0,89 (IC 95% = 0,82 a 0,96) para PESI, 0,79 (IC 95% = 0,67 a 0,90) para BNP y 0,76 (IC 95% = 0,64 a 0,87) para cTnI‐Ultra. La combinación de la h‐FABP con la PESI fue un indicador pronóstico particularmente útil porque ninguno de los 79 pacientes (59,8%) con la h‐FABP < 6 ng/mL y clase PESI < III tuvieron un resultado adverso.ConclusionesLa H‐FABP y el PESI son superiores al BNP y la cTnI‐Ultra como marcadores para la estratificación del riesgo de pacientes con EP agudo. La alta sensibilidad de su combinación identificó un gran número de pacientes de bajo riesgo en el SU.
    Academic Emergency Medicine 10/2014; 21(10). DOI:10.1111/acem.12484 · 2.20 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 08/2014; 62:S133-S134. DOI:10.1016/j.respe.2014.05.047 · 0.66 Impact Factor
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    ABSTRACT: Objective To assess the seasonality of cardiovascular risk factors (CVRF) in a large set of population-based studies. Methods Cross-sectional data from 24 population-based studies from 15 countries, with a total sample size of 237 979 subjects. CVRFs included Body Mass Index (BMI) and waist circumference; systolic (SBP) and diastolic (DBP) blood pressure; total, high (HDL) and low (LDL) density lipoprotein cholesterol; triglycerides and glucose levels. Within each study, all data were adjusted for age, gender and current smoking. For blood pressure, lipids and glucose levels, further adjustments on BMI and drug treatment were performed. Results In the Northern and Southern Hemispheres, CVRFs levels tended to be higher in winter and lower in summer months. These patterns were observed for most studies. In the Northern Hemisphere, the estimated seasonal variations were 0.26 kg/m(2) for BMI, 0.6 cm for waist circumference, 2.9 mm Hg for SBP, 1.4 mm Hg for DBP, 0.02 mmol/L for triglycerides, 0.10 mmol/L for total cholesterol, 0.01 mmol/L for HDL cholesterol, 0.11 mmol/L for LDL cholesterol, and 0.07 mmol/L for glycaemia. Similar results were obtained when the analysis was restricted to studies collecting fasting blood samples. Similar seasonal variations were found for most CVRFs in the Southern Hemisphere, with the exception of waist circumference, HDL, and LDL cholesterol. Conclusions CVRFs show a seasonal pattern characterised by higher levels in winter, and lower levels in summer. This pattern could contribute to the seasonality of CV mortality.
    Heart (British Cardiac Society) 05/2014; 100(19). DOI:10.1136/heartjnl-2014-305623 · 6.02 Impact Factor
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    ABSTRACT: We aimed to describe current characteristics of patients admitted for acute coronary syndrome (ACS) in Western Europe and to analyse whether international in-hospital mortality variations are explained by differences in patients' baseline characteristics and in clinical management. We studied a population-based longitudinal cohort conducted in Finland, France, Germany, Greece, Portugal and Spain, and comprising 12 231 consecutive ACS patients admitted in 53 hospitals between 2008 and 2010. Baseline characteristics, clinical management and inhospital outcomes were recorded. Contextual effect of country on death was analysed through multilevel analysis. Of all patients included, 8221 (67.2%) had NSTEMI (non-ST-elevation myocardial infarction), and 4010 (32.8%) had STEMI (ST-elevation myocardial infarction). Inhospital mortality ranged from 15.1% to 4.9% for German and Spanish STEMI patients, and from 6.8% to 1.9% for Finnish and French NSTEMI patients (p<0.001 for both). These international variations were explained by differences in patients' baseline characteristics (older patients more likely to have cardiogenic shock in Germany) and in clinical management, with differences in rates of thrombolysis (less performed in Germany) and primary percutaneous coronary intervention (high in Germany, low in Greece). A remaining contextual effect of country was identified after extensive adjustment. Inhospital mortality rates of STEMI and NSTEMI patients were two to three times higher in Finland, Germany and Portugal than in Greece and Spain, with intermediate values for France. Differences in baseline characteristics and clinical management partly explain differences in outcome. Our data also suggest an impact of the healthcare system organisation.
    Heart (British Cardiac Society) 05/2014; 100(15). DOI:10.1136/heartjnl-2013-305196 · 6.02 Impact Factor
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    ABSTRACT: Guidelines for management of patients with type 2 diabetes mellitus recommend the use of hypoglycaemic drugs when lifestyle interventions remain insufficient for glycaemic control. Recent trials have provided worrying safety data on certain hypoglycaemic drugs. The aim of this study was to assess 14-year risk of all-cause mortality according to hypoglycaemic drug exposure at baseline, in a general population. Our analysis was based on the observational Third French MONICA survey on cardiovascular risk factors (1995-1997). Vital status was obtained 14 years after inclusion, and assessment of determinants of mortality was based on multivariable Cox modelling. There were 3336 participants and 248 deaths over the 14-year period. At baseline, there were 3162 (95%) non-diabetic, 46 (1%) untreated type 2 diabetic and 128 (4%) type 2 diabetic subjects with hypoglycaemic drug treatment (metformin alone (31%), sulfonylureas alone or in combination (49%), insulin alone or in combination (10%), or other treatments (9%)). After adjustment for duration of diabetes, history of diabetes complications, area of residence (centre), age, gender, educational level, alcohol consumption, smoking, blood pressure, LDL and HDL cholesterol, which all were significant and independent determinants of mortality, the hazard ratio for all-cause mortality was 3.22 [95% confidence interval: 0.87-11.9] for untreated diabetic subjects, 2.28 [0.98-5.26] for diabetics treated with metformin alone, 1.70 [0.92-3.16] for diabetics with sulfonylureas and 4.92 [1.70-14.3] for diabetic with insulin versus non-diabetic subjects. Our results support the conclusion that until more evidence is provided from randomized trials, a prudent approach should be to restrain use of insulin to situations in which combinations of non-insulin agents have failed to appropriately achieve glycemic control, as it is recommended in the current guidelines for the management of type 2 diabetes.
    PLoS ONE 04/2014; 9(4):e95671. DOI:10.1371/journal.pone.0095671 · 3.53 Impact Factor
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    ABSTRACT: Food frequency questionnaires (FFQs) are often used to evaluate individuals' food intakes in epidemiologic studies because of their simplicity and low cost. To assess the validity of a short (24 items), qualitative FFQ used in the MONA LISA-NUT study. Cross-sectional study of a representative sample in three French counties. The sample included 2,630 participants aged 35 to 65 years from the MONA LISA-NUT study. Food consumption was measured with the FFQ and via food records for 3 consecutive days. Plasma fatty acids were measured from a subset of participants. The FFQ items' validity was assessed by calculating crude and deattenuated Pearson correlation coefficients between frequencies reported by the FFQ and average weights reported by the food records. Furthermore, the validity of some items of the FFQ measuring the consumption of fatty foods was assessed by calculating Pearson correlation coefficients between frequencies of consumption of these foods and dosages of the corresponding plasma fatty acids: fish and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), olive oil and oleic acid, margarine and elaidic acid, and dairy products and pentadecanoic and heptadecanoic acids. The mean of the deattenuated Pearson correlation coefficients for all items was 0.46, with values ranging from 0.22 (fried food) to 0.77 (breakfast cereal). The correlation coefficient was ≤0.4 for one third of the 24 items. Moderate correlations were found between fish and EPA/DHA (EPA: r=0.43, 95% CI 0.33 to 0.51; DHA: r=0.39, 95% CI 0.30 to 0.47), but not for other food items. One third of the 24 items in the short, qualitative FFQ evaluated here were not sufficiently valid. However, for the food groups most commonly studied in the literature, this FFQ had the same degree of validity as other questionnaires designed to classify subjects according to their level of intake.
    Journal of the American Academy of Nutrition and Dietetics 09/2013; 114(4). DOI:10.1016/j.jand.2013.07.002 · 2.44 Impact Factor
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    ABSTRACT: Fat content of dairy foods is diverse, potentially leading to varying effects on cardiovascular risk. We studied relationships of low- and high-fat dairy products with lipids and level of cardiovascular risk (assessed by the SCORE equation), in a cross-sectional population survey conducted in three French areas. A sample of 3078 participants aged 35-64 years underwent a standardized cardiovascular risk assessment. Subjects were asked to record the types and amounts of foods and beverages they consumed over a three-consecutive-day period. Dairy products were separated into two groups: the low-fat group comprised milk (including milk in desserts and beverages), yogurts and cottage cheese, whereas other cheeses formed the high-fat group. After adjustment (including physical activity and a diet quality score), the probability of an increased cardiovascular mortality score (≥1%) decreased from the lowest to the highest quartile (Q) of low-fat dairy intake: odds ratio (OR) ORQ1 = 1; ORQ2 = 0.89 (95% confidence interval: 0.73-1.10), ORQ3 = 0.78 (0.63-0.97) and ORQ4 = 0.68 (0.55-0.85) for the first, second, third and fourth quartile, respectively. Results were notably different for high-fat dairy intake: ORQ2 = 1.02 (0.82-1.25); ORQ3 = 0.90 (0.73-1.11); ORQ4 = 1.07 (0.86-1.32). Intake of low-fat dairy products was inversely associated with low-density lipoprotein cholesterol (LDL-C), but no significant independent relationship was found with high-density lipoprotein cholesterol (HDL-C) or triglycerides. None of the lipid parameters was significantly associated with the consumption of high-fat dairy products. Participants with the highest intake of low-fat dairy products had the lowest mortality risk score and exhibited the best LDL-C profile. Such favourable associations were not observed with cheese consumption.
    09/2013; DOI:10.1177/2047487313503283
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    ABSTRACT: Prevalence and prognostic value of conduction disturbances in patients with the Brugada syndrome (BrS) remains poorly known. Electrocardiograms (ECGs) from 325 patients with BrS (47 ± 13 years, 258 men) with spontaneous (n = 143) or drug-induced (n = 182) type 1 ECG were retrospectively reviewed. Two hundred twenty-six patients (70%) were asymptomatic, 73 patients (22%) presented with unexplained syncope, and 26 patients (8%) presented with sudden death or implantable cardioverter-defibrillator appropriated therapies at diagnosis or during a mean follow-up of 48 ± 34 months. P-wave duration of ≥120 ms was present in 129 patients (40%), first degree atrioventricular block (AVB) in 113 (35%), right bundle branch block (BBB) in 90 (28%), and fascicular block in 52 (16%). Increased P-wave duration, first degree AVB, and right BBB were more often present in patients after drug challenge than in patients with spontaneous type 1 ST elevation. Left BBB was present in 3 patients. SCN5A mutation carriers had longer P-wave duration and longer PR and HV intervals. In multivariate analysis, first degree AVB was independently associated with sudden death or implantable cardioverter-defibrillator appropriated therapies (odds ratio 2.41, 95% confidence interval 1.01 to 5.73, p = 0.046) together with the presence of syncope and spontaneous type 1 ST elevation. In conclusion, conduction disturbances are frequent and sometimes diffuse in patients with BrS. First degree AVB is independently linked to outcome and may be proposed to be used for individual risk stratification.
    The American journal of cardiology 08/2013; 112(9). DOI:10.1016/j.amjcard.2013.06.033 · 3.43 Impact Factor
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    ABSTRACT: Relationship between hepatic lipase (LIPC) polymorphism and coronary artery disease (CAD) has often led to contradictory results. We studied this relation by genotyping rs1800588 in the LIPC promoter in a case-control study on CAD (the GENES study). We also investigated the relationship between this polymorphism and the ankle-brachial index (ABI), which is predictive of atherosclerosis progression and complications in patients at high cardiovascular risk. 557 men aged 45-74 with stable coronary artery disease and 560 paired controls were genotyped for rs1800588. Medical data, clinical examination including determination of ABI and biological measurements related to cardiovascular risk factors enabled multivariate analyses and multiple adjustments. CAD cases showed a higher T-allele frequency than controls (0.246 vs 0.192, p = 0.003). An interaction has been found between LIPC polymorphism and triglycerides (TG) levels regarding risk of CAD: TT-homozigosity was associated with an Odds ratio (OR) of 6.4 (CI: 1.8-22.3) when TG were below 1.5 g/L, but no association was found at higher TG levels (OR = 1.34, CI: 0.3-5.9). The distribution of LIPC genotypes was compared between CAD patients with normal or abnormal ABI and impact of LIPC polymorphism on ABI was determined. Following multiple adjustments, association of the T-allele with pejorative ABI (<0.90) was significant for heterozygotes and for all T-carriers (OR = 1.55, CI: 1.07-2.25). The -514T LIPC allele is associated with CAD under normotriglyceridemic conditions and constitutes an independent determinant of pejorative ABI in coronary patients.
    PLoS ONE 07/2013; 8(7):e67805. DOI:10.1371/journal.pone.0067805 · 3.53 Impact Factor
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    ABSTRACT: The assessment of cardiovascular risk is uniformly recommended as a decision-support for therapies aimed at preventing cardiovascular diseases. Our objective was to determine the prognostic significance of vascular markers in apparently healthy subjects. Analyses were based on the Third Toulouse MONICA Survey (1995-1997) carried out in participants aged 35-64, from the general population of South-western France. Causes of death were obtained 14 years after inclusion. There were 1132 participants (51% men). Over the 14-year follow-up period, 61 deaths were recorded, 20% due to a cardiovascular cause. Adding pulse wave velocity (PWV) to Framingham Risk Score (FRS) improved the accuracy of the risk prediction model. The C-statistic increased from 0.76 (95% confidence interval (CI): 0.64-0.89) (FRS alone) to 0.79 (95% CI: 0.64-0.95) (FRS+PWV). The Integrated Discrimination Improvement (IDI) reached 3.81% (P-value<0.001) and the net reclassification improvement (NRI) was equal to 32%. Risk prediction was also improved by integrating pulse pressure (PP) in the model (C-statistic=0.81 (95% CI: 0.66-0.96); IDI=4.99% (P-value<0.001); NRI=30%) or the number of carotid or femoral atherosclerotic plaques (C-statistic=0.78 (95% CI: 0.63-0.93); IDI=2.21% (P-value<0.001); NRI=21%). Vascular markers are independent determinants of cardiovascular mortality in apparently healthy subjects and improve risk prediction.Journal of Human Hypertension advance online publication, 21 February 2013; doi:10.1038/jhh.2013.8.
    Journal of human hypertension 02/2013; DOI:10.1038/jhh.2013.8 · 2.69 Impact Factor
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    ABSTRACT: Controlling low-density lipoprotein (LDL)-cholesterol concentration is of tremendous importance to reduce cardiovascular risk. To investigate the attainment of LDL-cholesterol targets recommended in French and European guidelines on cardiovascular prevention, according to levels of cardiovascular risk. Participants aged 35 to 74 years (n=4609) were randomly selected from the general population of three French regions. A standardized data collection was performed to assess cardiovascular risk as described in the French and European guidelines. Overall, 17.5% of participants were considered to be at high risk and 25.4% at high or very high risk, according to the French and European guidelines, respectively. Only 1.2% of participants with no cardiovascular risk factors according to the French guidelines had an LDL-cholesterol concentration above the recommended target, whereas 82.5% of high-risk subjects did not attain their goal (70.8% among high-risk subjects receiving lipid-lowering therapy). Among untreated people, the median reduction in LDL-cholesterol needed to reach target ranged from 6.6% (lowest-risk groups) to 36.0% (highest-risk subjects). When risk was classified according to the European guidelines, the majority of participants did not reach the recommended LDL-cholesterol targets, irrespective of their level of risk or lipid-lowering therapy. In a majority of primary prevention candidates with multiple risk factors and in most high-risk subjects, LDL-cholesterol targets recommended by French guidelines are not being achieved, either because of insufficient treatment or because subjects are not recognized as being at risk. More stringent targets proposed by the European guidelines are not being achieved in most cases.
    Archives of cardiovascular diseases 02/2013; 106(2):93-102. DOI:10.1016/j.acvd.2012.11.003 · 1.66 Impact Factor
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    ABSTRACT: Background/Aims: The impact of alcohol on health depends on both the total amount ingested per week and the drinking pattern. Our goal was to assess the relationship between drinking occasions and anthropometric indicators of adiposity. Methods: For this cross-sectional study, 7,855 men aged 50-59 years were recruited between 1991 and 1993 in France. Clinical and anthropometric data were obtained in a standardized clinical examination by trained staff. Alcohol intake was assessed by a questionnaire recording daily consumption of each type of alcohol during a typical week. Results: 75% of the participants drank alcohol daily (264.7 ml per week). For a given total alcohol intake and after adjustment of confounders, the number of drinking episodes was inversely correlated with body mass index (p < 0.0001) and waist circumference (p < 0.0001). The odds ratio (95% confidence interval) for obesity was 1.8 (1.3-2.4) for occasional (1-2 days/week) and 1.6 (1.2-2.1) for frequent drinkers (3-5 days/week) compared with daily drinkers. This correlation was less pronounced in moderate (<140 ml/week) than intermediate consumers (140-280 ml/week). In heavy consumers (>280 ml/week), the intake was almost always daily. The results were similar for wine and beer consumption. Conclusion: Our findings suggest that drinking occasion is a risk indicator of obesity independent of total alcohol intake.
    Annals of Nutrition and Metabolism 01/2013; 62(2):91-97. DOI:10.1159/000342839 · 2.75 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):87. DOI:10.1016/S1878-6480(13)71190-X
  • Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):85. DOI:10.1016/S1878-6480(13)71183-2
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    Proceedings of The Nutrition Society 01/2013; 72(OCE3). DOI:10.1017/S0029665113001833 · 4.94 Impact Factor

Publication Stats

2k Citations
340.79 Total Impact Points

Institutions

  • 2009–2015
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2008–2015
    • Paul Sabatier University - Toulouse III
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2006–2013
    • Centre Hospitalier Universitaire de Toulouse
      • Service d'Epidémiologie
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2003–2012
    • French Institute of Health and Medical Research
      • Unité de Épidémiologie, Systèmes d'Information, Modélisation U707
      Lutetia Parisorum, Île-de-France, France
  • 2003–2010
    • Institut Pasteur de Lille
      Lille, Nord-Pas-de-Calais, France
  • 2002–2006
    • Centre Hospitalier Universitaire de Nancy
      Nancy, Lorraine, France
  • 2004
    • Unité Inserm U1077
      Caen, Lower Normandy, France