Characteristics of Ischemic Stroke Despite Oral Anticoagulant Use For Atrial Fibrillation.

Oral anticoagulation (OAC) prevents stroke in atrial fibrillation, yet a residual stroke risk remains. In this single-center retrospective analysis of acute ischemic stroke patients despite OAC, suboptimal OAC treatment is common (30%: inappropriate dosing (17%); patient non-adherence (13%)). Other causes of stroke included OAC interruption (14.5%), a competing stroke mechanism (11.0%), and undetermined breakthrough stroke in 44.5%. Overall, easily modifiable causes of ischemic stroke despite OAC are common. Accordingly, strategies to improve treatment compliance, including appropriate dosing along with guideline-based risk factor and periprocedural OAC management, should be emphasized to improve secondary stroke prevention in this patient population.

Effect of liraglutide on food consumption, appetite sensations and eating behaviours in overweight people with type 1 diabetes.

AIMS: To investigate the effects of 24 weeks of treatment with liraglutide added to basal/bolus insulin on energy intake, appetite sensations and eating behaviours in overweight/obese participants with type 1 diabetes (T1D). METHODS: In a double-blinded crossover fashion, 15 participants were randomly assigned (1:1) to receive placebo or liraglutide for 24 weeks including a 1-month titration period from 0.6 to 1.2 to 1.8 mg, in addition to their insulin. The treatment was followed by a 1-month wash-out period. Participants were then assigned to the other treatment for another 24 weeks. Food intake was measured, visual analogue scales and Three-Factor Eating Questionnaires were completed. Paired rank tests were used to compare the variables. RESULTS: When treated with liraglutide, participants modified their ad libitum food consumption with decreased total intake and % fat and increased carbohydrates. Their appetite sensations were modified: fasting desire to eat, hunger and prospective food consumption were significantly reduced. The sensation of fullness was prolonged for a few hours after a standardized breakfast. Restraint and disinhibition were significantly reduced by liraglutide. CONCLUSIONS: In this randomized clinical trial, the addition of liraglutide to basal/bolus insulin therapy for 24 weeks in overweight/obese individuals with T1D significantly improved their food consumption, appetite sensations and eating behaviours.

Beyond glycaemic control: A cross-over, double-blinded, 24-week intervention with liraglutide in type 1 diabetes.

AIMS: To investigate the effects of 24 weeks of treatment with liraglutide added to basal/bolus insulin on anthropometric and metabolic parameters in overweight participants with type 1 diabetes. METHODS: In a double-blinded cross-over fashion, 15 participants were randomly assigned (1:1) to receive placebo (saline solution) or liraglutide for 24 weeks including a 1-month titration period from 0.6 to 1.2 to 1.8 mg, in addition to their insulin. The treatment was followed by a 1-month wash-out period. Participants were then assigned to the other treatment for another 24 weeks. Paired rank tests were used to compare the metabolic parameters. RESULTS: There was no treatment effect on HbA1c nor on insulin dose. Heart rate was increased by about 8 beats per minute with liraglutide. There were significant reductions in metabolic measures: weight, body mass index, waist and hip circumferences, body fatness, computed tomography scan abdominal and mid-thigh measurements, systolic and diastolic blood pressures (all P ≤ .05). There was no increase in time spent in hypoglycaemia with liraglutide. CONCLUSIONS: The addition of liraglutide to basal/bolus insulin therapy for 24 weeks in overweight/obese individuals with type 1 diabetes improved the anthropometric and metabolic profiles without an increase in hypoglycaemia. Clinical Trials.gov No: NCT01787916.

Dietary intakes in the nutritional management of gestational diabetes mellitus.

PURPOSE: Changes were examined in energy intakes and percentage of energy from macronutrients in response to nutritional intervention in women with gestational diabetes mellitus (GDM). METHODS: The study included 17 women with GDM and 27 women with normal glucose tolerance (controls). Women with GDM were followed by a multidisciplinary team; they received dietary counselling by a registered dietitian, and were prescribed diets with 40% to 45% energy from carbohydrate (CHO), 20% to 25% from protein, and 30% to 35% from fat. Dietary intakes were assessed with food frequency questionnaires before the intervention (26.9 ± 3.8 weeks) and after the intervention (32.6 ± 0.6 weeks). RESULTS: After the intervention, women with GDM reduced their total energy intake to reach lower values than did controls (P value for time-group interaction =0.05). A concomitant reduction in total CHO and glucose intakes in women with GDM led to significantly lower values compared with intakes in controls (P values for time-group interaction =0.001 for all). The post-intervention rate of weight gain in women with GDM was within the Institute of Medicine (IOM)-recommended values, while the post-intervention rate of weight gain in controls was above IOM-recommended values (0.30 ± 0.27 versus 0.61 ± 0.50 kg/week, P≤0.05). CONCLUSIONS: These results suggest that this multidisciplinary medical and nutritional intervention was effective in the achievement of prescribed macronutrient distribution and controlling gestational weight gain in Canadian women with GDM.

Effect of exercise on food consumption and appetite sensations in subjects with diabetes.

AIM: Evaluate appetite sensations following 60-min moderate intensity exercise and to predict energy intake in adults with diabetes. METHODS: Visual analogue scales measured appetite sensations before and after a fixed test meal. Fasting appetite sensations, 1h post-prandial area under the curve (AUC) and the satiety quotient predicted energy intake. Two measures of energy intake were recorded: (1) following an ad libitum test lunch and (2) a 3-day self-report dietary record. Appetite sensations were assessed in a control condition (rest, C) and when two exercise sessions were performed: one associated with a free (F) blood glucose decrease and one with limited blood glucose decreases i.e. maintained (M) above 4 mmol/l by dextrose infusion. RESULTS: 16 generally well-controlled (HbA1c: 7.0 ± 0.6%) subjects (12 with type 1 diabetes, 4 with type 2 diabetes) ate 1020 ± 519, 1170 ± 282 and 1020 ± 304 kcal (NS between conditions nor diabetes type) during the buffet meal following the C, F and M conditions, respectively. Exercise induced a mean blood glucose decrease of 3.7 ± 0.6 and 3.1 ± 0.6 mmol/l for the F and M conditions, respectively. The greater the blood glucose decrease, the greater the appetite sensations of hunger and prospective food consumption measured fasting and before the test meal (all p<0.05) in the whole group. One-hour post-prandial AUC for hunger and desire to eat represented the strongest predictors of ad libitum test lunch energy intake (p<0.05), especially in type 1 diabetes. CONCLUSIONS: These results suggest that appetite sensations are predictors of spontaneous energy intake in both diabetes type. Moderate intensity exercise for 60 min induced a positive effect by lowering blood glucose which was associated with appetite sensations. These results support the glucostatic theory of food intake control which protects against exercised-induced blood glucose declines.

Cord blood C-peptide levels relate to the metabolic profile of women with and without gestational diabetes.

Plasma C-peptide reflects the insulin-secretory activity of pancreatic ß-cells which modulates fetal growth. Cord blood C-peptide levels were measured in women with gestational diabetes mellitus (GDM) and in women with normal glucose tolerance (NGT). Forty-one women underwent a 75-g oral glucose tolerance test (18 GDM, 23 NGT). Cord blood C-peptide (p = 0.09) and glucose levels (p = 0.08) from newborns of GDM women tended to be higher than those from NGT women. In the entire group, cord blood C-peptide correlated with maternal insulin, fasting C-peptide, insulin sensitivity, interleukin-6, weight and body mass index measured at screening (ρ from 0.34 to 0.48, all p < 0.05) and tended to correlate with offspring weight (ρ = 0.28, p = 0.08). Newborns of GDM women tended to have elevated cord blood C-peptide which correlated with maternal insulin, insulin sensitivity and anthropometric measures at diagnosis and with offspring characteristics. This suggests that insulin-secretory activity of the newborn is related to maternal metabolic parameters.

Impact of a mother's weight history on her offspring.

OBJECTIVE: To explore the relationship between maternal lifelong body weight history and anthropometric measurements in the offspring. METHODS: We studied a prospective sample of 48 pregnant women with either gestational diabetes mellitus (GDM, n = 21) or normal glucose tolerance (NGT, n = 27). Reported maternal weight at birth, 20 years of age and 30 years of age, and pre-pregnancy and maximal weight outside pregnancy were obtained by questionnaire. BMI was calculated using data from the questionnaire. Maternal anthropometric parameters were measured during pregnancy. Offspring anthropometrics were obtained at birth and eight weeks later. RESULTS: Maternal weight at birth, weight or BMI at 20 years of age and at 30 years of age, and maximal weight or BMI did not differ between groups. In all women, maternal birth weight, BMI at 20 years of age, and maximal BMI correlated with newborn birth weight (ρ = 0.39, 0.37, and 0.27, respectively, P ≤ 0.05), with newborn length (ρ = 0.46, 0.32, and 0.30 respectively, P < 0.05), and with infant weight eight weeks later (ρ = 0.43, 0.30, and 0.31, respectively, P < 0.05). Reported maternal BMI at 30 years of age correlated with infant weight (ρ = 0.31) and cranial circumference (ρ = 0.33) at eight weeks of life (P < 0.05). Besides gestational age, maternal weight at screening was the most significant predictor of infant birth weight. CONCLUSION: Several parameters of maternal weight history were related to offspring anthropometric measurements in early life in a sample of women with and without GDM.

Circulating interleukin-6 concentrations during and after gestational diabetes mellitus.

OBJECTIVE: Recent studies have shown that high interleukin-6 (IL-6) secretion may aggravate insulin resistance in pregnancy and participate in the pathogenesis of gestational diabetes mellitus (GDM). The aim of this study was to determine whether the presence of GDM is associated with elevated IL-6 concentrations and whether this association remains after delivery, independent of body mass index. DESIGN: Longitudinal study. SETTING: Hospital-based. SAMPLE: Forty-seven women were screened for GDM with a 75g oral glucose tolerance test at 26.1±3.7 weeks of pregnancy following the Canadian Diabetes Association guidelines (20 GDM, 27 control subjects). MAIN OUTCOME MEASURES: Interleukin-6 levels were measured by ELISA at the time of GDM screening and two months post-partum. RESULTS: Interleukin-6 concentrations were significantly higher in women with GDM compared with control women at the time of GDM screening (1.47±0.72 vs. 0.90±0.32pg/mL, p≤0.01). Similar results were obtained two months post-partum, where IL-6 levels remained significantly higher in women with GDM compared with control women (1.88±0.85 vs. 1.41±0.87pg/mL, p≤0.05). Interleukin-6 concentrations were significantly correlated with the Matsuda insulin sensitivity index, measured at the two time points (r=-0.60, p≤0.01 and r=-0.34, p≤0.05). The Matsuda insulin sensitivity index was an independent and significant predictor of IL-6 concentrations at the time of GDM screening, explaining 35.6% of the variance (p≤0.0001) in this variable. IL-6 concentration measured at GDM screening was identified as an independent and significant predictor of post-partum IL-6 concentrations, explaining 28.6% of the variance (p≤0.001). CONCLUSIONS: These results show that GDM is associated with elevated IL-6 levels independent of obesity levels, both during pregnancy and after delivery.

Sex hormone-binding globulin levels and obesity in women with gestational diabetes: relationship with infant birthweight.

Our objective was to determine whether sex hormone-binding globulin (SHBG) concentrations are associated with gestational diabetes mellitus (GDM) and whether this association is independent of prepregnancy body mass index (BMI). The relationship between maternal SHBG concentrations and birthweight in the offspring was also examined. The study included 47 women (20 with GDM, 27 controls). GDM screening and fasting serum SHBG measurements were performed at 26.1 ± 3.7 weeks of pregnancy. A trend was observed for significantly lower SHBG concentrations in GDM patients (179 ± 36 vs. 195 ± 36 nmol/l, p ≤ 0.08). Prepregnancy BMI and BMI at the time of GDM screening were both correlated with SHBG concentrations (r = -0.49 and r =  -0.53, respectively; p ≤ 0.001). In multivariate regression analyses, only prepregnancy BMI or BMI at the time of GDM screening remained significant predictors of GDM risk [odds ratio (OR):1.23, 95% confidence interval (CI):1.06-1.47, p ≤ 0.01 and OR:1.18, 95% CI:1.02-1.39, p ≤ 0.02] while SHBG level did not. On the other hand, 10.7% of the variance in birthweight was explained by SHBG concentrations (p ≤ 0.01) independent of the presence of GDM, parity, maternal age, maternal prepregnancy BMI, maternal height, and offspring sex. In conclusion, although SHBG concentration is not an independent predictor of GDM risk when obesity is considered, it is a significant predictor of infant birthweight independent of GDM and prepregnancy BMI.

Evaluation of fetal liver volume by tridimensional ultrasound in women with gestational diabetes mellitus.

OBJECTIVE: To evaluate the effect of gestational diabetes mellitus (GDM) on fetal liver growth during the third trimester. METHODS: We performed a longitudinal study of pregnant women recruited at the time of GDM screening (24 to 28 weeks of gestation), with follow-up visits at 32 weeks, 36 weeks, and delivery. Women with GDM were followed with nutritional recommendations and insulin when necessary according to the Canadian Diabetes Association guidelines. Fetal liver volume was evaluated using 3-D ultrasound at each antenatal visit, and fetal liver growth was compared between women with and without GDM. RESULTS: Twenty-seven women were recruited, 10 with normal glucose tolerance (NGT) and 17 with confirmed GDM, five who required insulin and 12 who were treated by diet only. We found no difference in fetal liver volume between groups at any of the three visits, and median birth weight was also similar between groups. On the other hand, we found a strong correlation between fetal liver volume at 36 weeks' gestation and birth weight (ρ = 0.61, P < 0.001). CONCLUSIONS: In our preliminary study, we found that fetal liver volume could be a strong predictor of infant birth weight independent of GDM status. This suggests that fetal liver volume of offspring of women with NGT is similar to that of offspring of women with GDM treated following recommended targets. Larger studies are required.

Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study.

AIM: To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol. METHODS: Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring. RESULTS: Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI - 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from - 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (- 1.56 mmol/L; 95% CI - 2.18, - 0.95, p < 0.001). CONCLUSION: Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed. TRIAL REGISTRATION: NCT02834689.

Exercise and newer insulins: how much glucose supplement to avoid hypoglycemia?

PURPOSE: To determine the glucose supplement required to prevent hypoglycemia during moderate-intensity exercise in Type 1 diabetic patients using newer analog insulins. METHODS: Nine subjects performed 60 min of ergocycle exercise (50% VO2max), 3 h after a standard breakfast in three different conditions. Subjects were randomly assigned to preexercise liquid glucose supplement of 0 g of glucose (0G), 15 g of glucose (15G), and 30 g of glucose (30G). Blood glucose (BG) was measured before, during, and following the exercise. All subjects used Humulin N (N) and analog insulin Humalog (Lispro). A dextrose infusion was initiated when BG fell below 5 mmol x L(-1). RESULTS: There was no significant difference in the magnitude of the decrease in BG exercise-induced when comparing the three experimental conditions. However, the quantity of dextrose infused was significantly higher in the 0G (10.5 +/- 3.2 g) than in the 15G (3.5 +/- 1.8 g) or the 30G conditions (1.6 +/- 1.0 g). The addition of a glucose supplement (15G or 30G) significantly prolonged the delay before the need for dextrose infusion (31.7 +/- 7.5, 51.3 +/- 4.2, and 55.6 +/- 2.6 min; 0G, 15G, and 30G, respectively). The quantity of dextrose infusion was plotted against the three preexercise glucose supplements and a regression equation obtained. Solving this equation, a glucose supplement of 40 g was estimated in order to maintain BG levels within the normal range during and after exercise. CONCLUSION: For 60 min of late postprandial exercise followed by 60 min of recovery, an estimated 40 g of a liquid glucose supplement, ingested 15 min prior exercise, would seem likely to help maintain safe BG levels in subjects using N-Lispro.

Relation between energy intake and glycemic control in physically active young adults with type 1 diabetes.

OBJECTIVES: To examine the relationships between daily energy expenditure, energy intake and glycemic control in young adults with type 1 diabetes. DESIGN: Cross-sectional study. METHODS: Energy expenditure (kcal kg(-1)d(-1)) and duration of participation in physical activity were measured from a 3-d activity diary and categorized according to their intensity on a 1-9 scale. Energy intake was measured by a 3-d food record. Glycemic control was measured using the HbA1c. RESULTS: Energy expenditure and intake were assessed in 35 young adults with type 1 diabetes (age: 28 ± 7 years). Participants with higher energy expenditure from moderate to intense physical activity (categories 6-9) presented higher proportion of energy intake derived from carbohydrate and lower proportion of lipids in the diet with significantly higher HbA(1c) values (7.3 ± 1.0% vs 6.7 ± 0.6%). CONCLUSIONS: These results suggest that highly physically active individuals with type 1 diabetes consume more carbohydrates than lipids, a strategy that may affect their glycemic control. Further studies are needed to develop interventions to improve glycemic control in highly active individuals with type 1 diabetes.

Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM.

INTRODUCTION: The effects of glargine/glulisine insulin regimen on exercise blood glucose (BG) and strategies to limit exercise-induced hypoglycemia are not well documented. Intermittent high-intensity exercise has been proposed to prevent hypoglycemia, but its effect in participants with type 1 diabetes using glargine/glulisine is unknown. METHODS: The study used a repeated-measures design with three randomly ordered exercise conditions. Eleven participants completed 60 min of moderate-intensity exercise at 50% VO(2peak) for all conditions. These conditions varied as follows: participants ingested 0 g of glucose preexercise (0G + MOD), 30 g of glucose preexercise (30G + MOD), or 0 g of glucose preexercise but performed brief high-intensity intervals interspersed every 2 min (0G + MOD/INT) during exercise. If BG fell <4 mmol·L(-1), a 20% dextrose solution was started to maintain BG between 4 and 5 mmol·L(-1). RESULTS: Consuming 30 g of glucose before exercise (30G + MOD) resulted in a higher preexercise BG (11.7 ± 2.7 mmol·L(-1)) compared with 0 g of glucose before exercise (0G + MOD, 7.8 ± 4.0, and 0G + MOD/INT, 9.2 ± 3.5mmol·L(-1)), P < 0.05. A dextrose infusion was required in 7/11, 4/11, and 1/11 participants for 0G + MOD, 0G + MOD/INT, 30G + MOD conditions, respectively, P < 0.02. The duration and the quantity of dextrose infused were greatest in the 0G + MOD condition, moderate in the to 0G + MOD/INT condition, and minimal in the 30G + MOD condition, P < 0.01. CONCLUSION: Our results suggest that both moderate-intensity exercise with a 30-g preexercise glucose beverage or interspersed with intermittent high-intensity sprints may be safe strategies to prevent hypoglycemia in glargine/glulisine users.

Androgens in the maternal and fetal circulation: association with insulin resistance.

OBJECTIVE: To examine maternal insulin resistance in relationship with maternal and fetal androgen levels as well as with term placenta mRNA and protein abundance of steroidogenic enzymes implicated in androgen dynamics. METHODS: The study included 20 women with gestational diabetes mellitus and 27 controls tested using a 120 min., 75 g oral glucose tolerance test. Maternal and fetal plasma concentrations of total testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone (DHEA) were measured by high-performance gas chromatography and chemical ionization mass spectrometry at 26.1 ± 3.7 weeks of pregnancy. RESULTS: Glycemic response to oral glucose over 120 min. as well as Matsuda insulin sensitivity and HOMA insulin resistance (HOMA-IR) indices were significantly associated with maternal testosterone levels (r = 0.31, r = -0.37 and r = 0.35 respectively, p ≤ 0.05 for all). Among male offspring, a positive association between maternal and fetal testosterone levels was observed (r = 0.43, p ≤ 0.05). Testosterone levels were higher in the cord blood of newborns from insulin-resistant mothers compared to newborns from insulin-sensitive mothers (0.48 ± 0.36 nmol/L vs. 0.29 ± 0.18 nmol/L p ≤ 0.05). No difference was observed in mRNA abundance or protein expression of placental steroidogenic enzymes according to the degree of maternal insulin resistance. CONCLUSION: Our results demonstrate a possible association between fetal and maternal androgen concentrations in relationship with insulin resistance.

Nutritional strategies to prevent hypoglycemia at exercise in diabetic adolescents.

UNLABELLED: Studies on nutritional strategies to prevent exercise-induced hypoglycemia in adolescents with type 1 diabetes are scarce. OBJECTIVE: This study aimed to compare the effect of two food strategies on blood glucose (BG) during and after 60 min of moderate-intensity exercise. METHODS: Subjects performed exercise 120 min after breakfast in three conditions: 1) standardized breakfast + preexercise placebo beverage (PL), 2) standardized breakfast + preexercise CHO beverage (8 mg of CHO·kg of body weight·min of exercise; CHO), or 3) protein-supplemented breakfast (8 mg of protein·kg of body weight·min of exercise added to the standardized breakfast) + preexercise placebo beverage (PROT). As soon as BG falls <4 mmol·L or symptomatic hypoglycemia occurred during exercise, the session was stopped and CHO tablets were provided to correct hypoglycemia. RESULTS: Ten subjects (age = 14.0 ± 1.5 yr) participated in all conditions. BG decreased by 6.0 ± 1.9, 1.0 ± 3.1, and 4.6 ± 1.9 mmol·L in PL, CHO, and PROT conditions, respectively (P < 0.05). The proportion of subjects reaching hypoglycemic values or sensations of hypoglycemia was significantly different between conditions with 4/10, 1/10, and 0/10 in the PL, CHO, and PROT conditions (P < 0.05). CONCLUSIONS: The preexercise CHO beverage induced the least dramatic BG decrease during exercise. The PROT breakfast induced an overall similar BG drop compared to PL, a larger BG drop compared to CHO, but a similar rate of hypoglycemia compared to CHO. Our results suggest that taking CHO supplement before unplanned exercise is still the best strategy to prevent exercise-induced hypoglycemia in an adolescent population. However, a protein supplement strategy may also have some benefits in limiting the rate of hypoglycemia during and immediately after exercise.

Influence of Physical Activity Participation on the Associations between Eating Behaviour Traits and Body Mass Index in Healthy Postmenopausal Women.

Available data reveals inconsistent relationships between eating behaviour traits and markers of adiposity level. It is thus relevant to investigate whether other factors also need to be considered when interpreting the relationship between eating behaviour traits and adiposity. The objective of this cross-sectional study was thus to examine whether the associations between variables of the Three-Factor Eating Questionnaire (TFEQ) and adiposity are influenced by the level of physical activity participation. Information from the TFEQ and physical activity was obtained from 113 postmenopausal women (56.7 ± 4.2 years; 28.5 ± 5.9 kg/m(2)). BMI was compared between four groups formed on the basis of the physical activity participation and eating behaviour traits medians. In groups of women with higher physical activity participation, BMI was significantly lower in women who presented higher dietary restraint when compared to women who had lower dietary restraint (25.5 ± 0.5 versus 30.3 ± 1.7 kg/m(2), P < .05). In addition, among women with lower physical activity participation, BMI was significantly lower in women presenting a lower external hunger than in those with a higher external hunger (27.5 ± 0.8 versus 32.4 ± 1.1 kg/m(2), P < .001). Our results suggest that physical activity participation should also be taken into account when interpreting the relationship between adiposity and eating behaviour traits.

Weight gain measures in women with gestational diabetes mellitus.

BACKGROUND: Gestational diabetes mellitus (GDM) and excessive gestational weight gain have significant implications for the health of both mother and child. Our objective was to detail gestational weight gain in women in relationship to GDM. METHODS: Data were collected by retrospective reviews of medical records in women who delivered between January and December 2007 at the Laval University Medical Center (Quebec, Canada). The analysis included 294 women (55 GDM and 239 controls) for whom gestational weight gain was calculated by the difference between maternal weight measured at delivery, or at the last prenatal visit (≥37th week), and prepregnancy self-reported weight. Gestational weight gain and rate of weight gain were also calculated for each trimester and until GDM screening. Gestational weight gain was compared to the 2009 recommendations by the Institute of Medicine (IOM). Women with GDM were diagnosed and treated according to the Canadian Diabetes Association guidelines. RESULTS: Weight gain in the first trimester was significantly higher in GDM patients compared to controls (3.40 ± 0.42 vs. 1.87 ± 0.16 kg, p ≤ 0.01) and was above IOM recommendations, whereas weight gain in the third trimester was significantly lower in GDM patients compared to controls (4.11 ± 0.36 vs. 6.35 ± 0.18 kg, p ≤ 0.0001). Prepregnancy body mass index (BMI) and first trimester weight gain were both significant and independent predictors of GDM (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.17, and OR 1.25, 95% CI 1.10-1.42, respectively). CONCLUSIONS: First trimester gestational weight gain may need more clinical attention, as it has been identified as an independent and significant risk factor for GDM independent of traditional risk factors, including preconception obesity.

The contribution of visceral adiposity and mid-thigh fat-rich muscle to the metabolic profile in postmenopausal women.

This study explored the relationship between muscle fat infiltration derived from mid-thigh computed tomography (CT) scan, central fat distribution and insulin sensitivity in postmenopausal women. Mid-thigh CT scans were used to measure low attenuation muscle surface (LAMS) (0-34 Hounsfield units (HU)), which represented a specific component of fat-rich muscle. Whole-body insulin sensitivity (M/I) was evaluated by an euglycemic-hyperinsulinemic clamp. A group of 103 women aged 57.0 ± 4.4 years was studied. Women with higher levels of LAMS presented higher metabolic risk features, particularly elevated fasting, 2-h plasma glucose (2hPG) concentrations and diminished M/I (P < 0.05). To further study the contribution of muscle fat infiltration and central adiposity on metabolic parameters, we divided the whole group based on the median of LAMS and visceral adipose tissue (VAT). As expected, the best metabolic profile was found in the Low-LAMS/Low-VAT group and the worst in the High-LAMS/High-VAT group. Women with Low-LAMS/High-VAT presented similar metabolic risks to those with High-LAMS/High-VAT. There was no difference between High-LAMS/Low-VAT and Low-LAMS/Low-VAT, which presents the most healthy metabolic and glycemic profiles as reflected by the lowest levels of cardiovascular disease risk variables. This suggests that High-LAMS/Low-VAT is also at low risk of metabolic deteriorations and that High-LAMS, only in the presence of High-VAT seems associated with deteriorated risks. Although increased mid-thigh fat-rich muscle was related to a deteriorated metabolic profile, VAT appears as a more important contributor to alterations in the metabolic profile in postmenopausal women.