[Management of obesity-associated dyslipidemia : an approach based on food choices]. / Prise en charge de la dyslipidémie liée à l'obésité : une approche centrée sur l'alimentation.

Obesity is associated with elevated levels of triglycerides, sometimes LDL-cholesterol, and lower levels of HDL-cholesterol. Management should first focus on dietary advices and increased physical activity, while lipid-lowering drugs are indicated only in patients at intermediate or high cardiovascular risk. We summarize nutritional recommendations from scientific societies: although they do not always overlap, they agree on lowering consumption of dietary fat (20-35 % of total energy intake) and favoring non-saturated fatty acids. Physicians must review the intake of carbohydrates as well, by limiting added sugars and increasing dietary fibers (vegetables, wholegrain cereals, legumes and nuts). Multidisciplinary management shared between physicians and trained dieticians improves long-term healthy lifestyle.

L'obésité est associée à une élévation des triglycérides, parfois du LDL-cholestérol, et une diminution du HDL-cholestérol. La prise en charge se concentre d'abord sur les conseils nutritionnels et l'activité physique, alors qu'un traitement hypolipémiant n'est indiqué que pour un risque cardiovasculaire intermédiaire ou élevé. Nous résumons ici les recommandations des sociétés savantes, qui ne sont pas toujours congruentes, mais s'accordent sur une consommation modérée de graisses (20­35 % de l'apport énergétique) privilégiant les acides gras insaturés. Il faut aussi s'intéresser à l'apport en glucides, limiter les sucres ajoutés et augmenter les fibres (légumes, céréales complètes, légumineuses et oléagineux). Une prise en charge multidisciplinaire avec une diététicienne diplômée améliore le maintien de bonnes habitudes de vie à long terme.

Adverse metabolic outcomes in the early and late postpartum after gestational diabetes are broader than glucose control.

INTRODUCTION: Gestational diabetes mellitus is associated with an increased cardiovascular risk. To better target preventive measures, we performed an in-depth characterization of cardiometabolic risk factors in a cohort of women with gestational diabetes in the early (6-8 weeks) and late (1 year) postpartum. RESEARCH DESIGN AND METHODS: Prospective cohort of 622 women followed in a university gestational diabetes clinic between 2011 and 2017. 162 patients who attended the late postpartum visit were analyzed in a nested long-term cohort starting in 2015. Metabolic syndrome (MetS) was based on the International Diabetes Federation definition, and then having at least two additional criteria of the MetS (blood pressure, triglycerides, high-density lipoprotein (HDL) cholesterol, plasma glucose above or below the International Diabetes Federation cut-offs). RESULTS: Compared with prepregnancy, weight retention was 4.8±6.0 kg in the early postpartum, and the prevalence of obesity, pre-diabetes, MetS-body mass index (BMI) and MetS-waist circumference (WC) were 28.8%, 28.9%, 10.3% and 23.8%, respectively. Compared with the early postpartum, weight did not change and waist circumference decreased by 2.6±0.6 cm in the late postpartum. However, the prevalence of obesity, pre-diabetes, MetS-WC and MetS-BMI increased (relative increase: 11% for obesity, 82% for pre-diabetes, 50% for MetS-WC, 100% for MetS-BMI; all p≤0.001).Predictors for obesity were the use of glucose-lowering treatment during pregnancy and the prepregnancy BMI. Predictors for pre-diabetes were the early postpartum fasting glucose value and family history of diabetes. Finally, systolic blood pressure in pregnancy and in the early postpartum, the 2-hour post oral glucose tolerance test glycemia and the HDL-cholesterol predicted the development of MetS (all p<0.05). CONCLUSIONS: The prevalence of metabolic complications increased in the late postpartum, mainly due to an increase in fasting glucose and obesity, although weight did not change. We identified predictors of late postpartum obesity, pre-diabetes and MetS that could lead to high-risk identification and targeted preventions.

Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study.

INTRODUCTION: High pre-pregnancy weight and body mass index (BMI) increase the risk of gestational diabetes mellitus (GDM) and diabetes after pregnancy. To tackle weight and metabolic health problems, there is a need to investigate novel lifestyle approaches. Outside of pregnancy, higher adherence to intuitive eating (IE) is associated with lower BMI and improved glycemic control. This study investigated the association between IE and metabolic health during pregnancy and in the early postpartum period among women with GDM. METHODS: Two-hundred and fourteen consecutive women aged ≥18, diagnosed with GDM between 2015 and 2017 and completed the "Eating for Physical rather than Emotional Reasons (EPR)" and "Reliance on Hunger and Satiety cues (RHSC) subscales" of the French Intuitive Eating Scale-2 (IES-2) questionnaire at the first GDM clinic visit were included in this study. RESULTS: Participants' mean age was 33.32 ±â€¯5.20 years. Their weight and BMI before pregnancy were 68.18 ±â€¯14.83 kg and 25.30 ±â€¯5.19 kg/m2 respectively. After adjusting for confounding variables, the cross-sectional analyses showed that the two subscales of IES-2 at the first GDM visit were associated with lower weight and BMI before pregnancy, and lower weight at the first GDM visit (ß = -0.181 to -0.215, all p ≤ 0.008). In addition, the EPR subscale was associated with HbA1c and fasting plasma glucose at the first GDM visit (ß = -0.170 and to -0.196; all p ≤ 0.016). In the longitudinal analyses, both subscales of IES-2 at first GDM visit were associated with lower weight at the end of pregnancy, BMI and fasting plasma glucose at 6-8 weeks postpartum (ß = -0.143 to -0.218, all p ≤ 0.040) after adjusting for confounders. CONCLUSIONS: Increase adherence to IE could represent a novel approach to weight and glucose control during and after pregnancy in women with GDM.