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Medical challenges

Heart, blood vessels, lungs, endocrine glands, liver, kidneys, digestive tract, skin, bones, joints... not a single family today is spared the great many diseases affecting these organs. And in the space of two generations, obesity has become a plague in our affluent societies.

Cardiovascular, respiratory, metabolic and nutritional diseases are very common and have devastating complications, and they therefore represent a major public health issue. Diabetes, hyperlipidaemia, obesity, kidney failure and atherosclerosis lead to cardiovascular diseases that are, alongside cancer, the main cause of death in industrialised societies.

HEK-293 (Human Embryonic Kidney) cell line from human kidney epithelial tissue (confocal microscopy) ; © Inserm, O. Trassard

HEK-293 (Human Embryonic Kidney) cell line from human kidney epithelial tissue (confocal microscopy)

Coronary disease, strokes and chronic heart failure account for 75% of cerebrovascular diseases and are alone responsible for 29% of deaths annually. Thrombotic diseases are very prevalent, arterial thrombosis (ischaemic diseases) and venous thrombosis (thrombo-embolic disease) are the world's leading cause of death. The prevalence of constitutional haemorrhagic diseases is limited, but their social and economic impact is significant, as in the case of haemophilia.

Respiratory diseases (asthma, chronic obstructive pulmonary disease, COPD; pulmonary fibroses) affect millions of people in France and their incidence is increasing. COPD alone already represents the third-largest cause of death in Europe (sixth in the world).

The prevalence of diabetes and glucose intolerance has now reached 7.1% and 5.6%, respectively, in France, affecting nearly 4 million people.

This prevalence follows a steadily rising trend, galloping in certain countries, parallel to that for obesity, that affects more than 15% of the adult population, but also the child and teenage populations. Hyperlipidaemia, obesity and diabetes are the cause of serious complications: vision disorders and blindness, strokes and heart attacks, neurological disorders, amputations, respiratory, liver and kidney problems.

These diseases, all cardiovascular risk factors, are all the more severe in their medical impact as they are often combined in the same patient. There has even been talk of a truemetabolic syndrome in patients presenting visceral (abdominal) obesity, dyslipidaemia (increased level of triglycerides and/or low level of HDL-cholesterol), high blood pressure, diabetes, blood clotting problems and kidney disorders (microalbuminuria). These are often associated with non-vascular complications such as hepatic steatoses, which generally lead to cirrhosis or arthrosis, for which obesity is itself a considerable aggravating factor. Very diverse populations are affected. In particular, several epidemiological studies suggest that people of non-European origins are most exposed to the risk.

Paradoxically, our societies are also facing the problem of malnutrition. It is estimated that nutritional deficiencies are still causing the deaths of 3 million children annually, essentially in developing countries. But malnutrition also affects 40% of patients suffering from chronic diseases, 30% to 50% of patients admitted to hospital (taking all illnesses combined), aggravating both the morbidity and mortality of patients. Normal ageing is also accompanied by frequent disruption to food intake leading to various deficiencies.

Diseases of the bones and joints are also a concern for the French, particularly due to ageing of the population. On their own they represent half of chronic diseases in people over 65 and are a major cause of invalidity (arthrosis is the second largest handicap factor in men, the fourth in women). Among the over 50s, one women in four and one man in eight will be affected by osteoporosis during their lives.

Skin diseases include a proportion of allergic complaints (atopic dermatitis, contact eczema, occupational dermatoses, photo-allergies, urticaria and skin accidents due to oral administration of a drug (toxicodermatitis)) and a proportion of chronic inflammatory disorders (psoriasis, atopic dermatitis, pelada, etc.). Among this latter group, psoriasis, affects between two and three million people in France and is associated with a significant change in the quality of life, often leading to a severe social handicap. The impact of this dermatosis on the quality of life is as significant as that caused by asthma, diabetes or chronic cardiac ischaemic diseases. The social cost of psoriasis is therefore considerable. Ageing of the population is accompanied is increasingly frequently accompanied by chronic vascular complaints of the lower limbs. Their treatment is complex and should be multi-disciplinary, ideally as part of a care network led by dermatologists specialised in the field of cicatrisation.

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