Dietary food patterns as determinants of the gut microbiome-endocannabinoidome axis in humans.

The gut microbiota and the endocannabinoidome (eCBome) play important roles in regulating energy homeostasis, and both are closely linked to dietary habits. However, the complex and compositional nature of these variables has limited our understanding of their interrelationship. This study aims to decipher the interrelation between dietary intake and the gut microbiome-eCBome axis using two different approaches for measuring dietary intake: one based on whole food and the other on macronutrient intakes. We reveal that food patterns, rather than macronutrient intakes, were associated with the gut microbiome-eCBome axis in a sample of healthy men and women (n = 195). N-acyl-ethanolamines (NAEs) and gut microbial families were correlated with intakes of vegetables, refined grains, olive oil and meats independently of adiposity and energy intakes. Specifically, higher intakes in vegetables and olive oil were associated with increased relative abundance of Clostridiaceae, Veillonellaceae and Peptostreptococaceae, decreased relative abundance of Acidominococaceae, higher circulating levels of NAEs, and higher HDL and LDL cholesterol levels. Our findings highlight the relative importance of food patterns in determining the gut microbiome-eCBome axis. They emphasize the importance of recognizing the contribution of dietary habits in these systems to develop personalized dietary interventions for preventing and treating metabolic disorders through this axis.

Intention to adopt a healthy diet among women with and without a history of gestational diabetes: Constructs and beliefs from the theory of planned behavior.

Women with a history of gestational diabetes (GDM) have difficulty maintaining a healthy diet after delivery. The theory of planned behavior (TPB) is effective in identifying the determinants of adopting a healthy diet. The objectives were to identify the determinants of the intention to adopt a healthy diet among the TPB constructs in women with (GDM+) and without (GDM-) a history of GDM, and to identify the beliefs associated with these constructs. The study was conducted in Québec (Canada) between 2009 and 2017. Data from 213 GDM+ and 91 GDM- women were analyzed. Women completed a questionnaire on the determinants of intention to adopt a healthy diet, defined as adherence to 2007 Canada's Food Guide. The subjective norm and perceived behavioral control (PBC) constructs were associated with the intention to adopt a healthy diet among GDM+ women (ß = 2.21 and ß = 4.37, respectively, p < 0.0001), whereas among GDM- women, PBC was the only construct associated with intention (ß = 0.78; p < 0.0001). More specifically among GDM+ women, the disapproval of a family member other than the partner (ß = 1.49; p = 0.0005), not feeling capable of adopting a healthy diet with access to food treats (ß = 1.58; p < 0.0001), lack of free time (ß = 1.31; p = 0.002), lack of information about healthy eating (ß = 1.02; p = 0.015) or lack of easy recipes to prepare (ß = 0.84; p = 0.042) was associated with a lower intention to adopt a healthy diet. Overall, among GDM+ women, different beliefs related to the subjective norm and PBC could be targeted to improve the eating habits of this specific population.

The diet rapidly and differentially affects the gut microbiota and host lipid mediators in a healthy population.

BACKGROUND: Bioactive lipids produced by human cells or by the gut microbiota might play an important role in health and disease. Dietary intakes are key determinants of the gut microbiota, its production of short-chain (SCFAs) and branched-chain fatty acids (BCFAs), and of the host endocannabinoidome signalling, which are all involved in metabolic diseases. This hypothesis-driven longitudinal fixed sequence nutritional study, realized in healthy participants, was designed to determine if a lead-in diet affects the host response to a short-term dietary intervention. Participants received a Mediterranean diet (MedDiet) for 3 days, a 13-day lead-in controlled diet reflecting the average Canadian dietary intake (CanDiet), and once again a MedDiet for 3 consecutive days. Fecal and blood samples were collected at the end of each dietary phase to evaluate alterations in gut microbiota composition and plasma levels of endocannabinoidome mediators, SCFAs, and BCFAs. RESULTS: We observed an immediate and reversible modulation of plasma endocannabinoidome mediators, BCFAs, and some SCFAs in response to both diets. BCFAs were more strongly reduced by the MedDiet when the latter was preceded by the lead-in CanDiet. The gut microbiota response was also immediate, but not all changes due to the CanDiet were reversible following a short dietary MedDiet intervention. Higher initial microbiome diversity was associated with reduced microbiota modulation after short-term dietary interventions. We also observed that BCFAs and 2-monoacylglycerols had many, but distinct, correlations with gut microbiota composition. Several taxa modulated by dietary intervention were previously associated to metabolic disorders, warranting the need to control for recent diet in observational association studies. CONCLUSIONS: Our results indicate that lipid mediators involved in the communication between the gut microbiota and host metabolism exhibit a rapid response to dietary changes, which is also the case for some, but not all, microbiome taxa. The lead-in diet influenced the gut microbiome and BCFA, but not the endocannabinoidome, response to the MedDiet. A higher initial microbiome diversity favored the stability of the gut microbiota in response to dietary changes. This study highlights the importance of considering the previous diet in studies relating the gut microbiome with lipid signals involved in host metabolism. Video Abstract.

Gestational Diabetes Mellitus, Human Milk Composition, and Infant Growth.

Background: Gestational diabetes mellitus (GDM) is known to affect human milk composition. Aims of this study were to compare macronutrient and energy content of human milk of women with (GDM+) and without GDM (GDM-), to assess the association between maternal health and human milk macronutrient and energy content and association between human milk macronutrient and energy content and infant growth. Study Design and Methods: Two months after delivery, hindmilk samples were collected. Triglyceride (TG), lactose, and protein content of human milk were measured. An oral glucose tolerance test was performed. Infant weight and length at birth and 2 months were collected. Weight-for-age (WAZ) and weight-for-length z-scores were calculated. Results: Twenty-four GDM+ and 29 GDM- women were included. Protein, lactose, and energy content of human milk were similar between groups. TG concentration was higher in GDM+ than in GDM- women (6.3 ± 2.0 versus 5.3 ± 1.2, p = 0.04). This difference was no longer significant after adjustment for maternal age and infant sex (p = 0.23). Maternal age was associated with TG (r = 0.28, p = 0.04) and lactose (r = -0.30, p = 0.03), while fasting glucose was associated with proteins (r = 0.30, p = 0.03) and tended to be associated with TG (r = 0.27, p = 0.05) and energy (r = 0.24, p = 0.08). TG levels in human milk were associated with weight (ß: 0.26, 95% confidence interval [CI]: 0.02 to 0.50) and WAZ (ß: 0.40, 95% CI: 0.05 to 0.75) at 2 months among children unexposed (GDM-) to GDM, but not among children exposed (GDM+) Conclusions: In conclusion, GDM status, maternal age, and fasting glucose level were associated with human milk composition. Finally, TG in human milk was associated with infant growth among GDM- children but not among GDM+ children. ClinicalTrials.gov NCT02872402.

Influence of diet on acute endocannabinoidome mediator levels post exercise in active women, a crossover randomized study.

The extended endocannabinoid system, also termed endocannabinoidome, participates in multiple metabolic functions in health and disease. Physical activity can both have an acute and chronic impact on endocannabinoid mediators, as does diet. In this crossover randomized controlled study, we investigated the influence of diet on the peripheral response to acute maximal aerobic exercise in a sample of active adult women (n = 7) with no underlying metabolic conditions. We compared the impact of 7-day standardized Mediterranean diet (MedDiet) and control diet inspired by Canadian macronutrient intake (CanDiet) on endocannabinoidome and short-chain fatty acid metabolites post maximal aerobic exercise. Overall, plasmatic endocannabinoids, their congeners and some polyunsaturated fatty acids increased significantly post maximal aerobic exercise upon cessation of exercise and recovered their initial values within 1 h after exercise. Most N-acylethanolamines and polyunsaturated fatty acids increased directly after exercise when the participants had consumed the MedDiet, but not when they had consumed the CanDiet. This impact was different for monoacylglycerol endocannabinoid congeners, which in most cases reacted similarly to acute exercise while on the MedDiet or the CanDiet. Fecal microbiota was only minimally affected by the diet in this cohort. This study demonstrates that endocannabinoidome mediators respond to acute maximal aerobic exercise in a way that is dependent on the diet consumed in the week prior to exercise.

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes.

OBJECTIVES: To evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM-); to study the association between mother and child vegetables and fruit (VF) intakes. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred forty-two children (104 GDM+; 38 GDM-) aged 6.2 ± 2.5 years. VARIABLES: Canadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. ANALYSIS: Linear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. RESULTS: Family meals were associated with HEI-C among GDM- but not GDM+ children (ß = 9.97, P = 0.01 and ß = -0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (ß = -1.45; 95% confidence interval, -2.19 to -0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r2 = 0.09), with association of larger variance among GDM- children (r = 0.38, r2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r2 = 0.05, P = 0.02). CONCLUSIONS: The food environment at home was associated differently with the diet quality of GDM+ and GDM- children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.

Nutritional Content of Sliced Bread Available in Quebec, Canada: Focus on Sodium and Fibre Content.

Bread is a highly consumed food and an important source of nutrients in the diet of Canadians, underlining the need to improve its nutritional quality. The Food Quality Observatory (Observatory) aimed to evaluate the nutritional value of the sliced bread products available in Quebec (Canada), according to their grain type and main flour. Analyses included comparing the bread's sodium content to Health Canada's daily values (DV) and sodium voluntary targets, comparing the bread's fibre content thresholds with the source of fibre mentioned, and assessing whether the main flour was associated with the nutrient content. The nutritional values of 294 sliced breads available in Quebec were merged with sales data (from October 2016 to October 2017), with 262 products successfully cross-referenced. The results showed that 64% of the breads purchased were 'low' in fibre (i.e., below 2 g per two slices), while 47% were 'high' in sodium (i.e., above 15% DV per two slices). Attention should be paid to 100% refined grain bread and to bread with refined flour as the main flour, since they are great sellers, while showing a less favourable nutrient content. This study shows that there is room for improvement in the nutritional content of Quebec's bread offer, particularly regarding sodium and fibre content.

Impact of a hospital-wide computerised approach to optimise the quality of antimicrobial prescriptions in patients with severe obesity: a quasi-experimental study.

BACKGROUND: Rates of adherence to available recommendations for dose adjustments in patients with severe obesity are generally low. Hence, antimicrobials are often underdosed in these patients. Antimicrobial stewardship programmes can improve the use of antimicrobials in hospitalised patients. The aim of the study was to analyse the impact of an antimicrobial stewardship programme based on a computerised clinical decision support system for optimal dosing and antimicrobial use in inpatients with severe obesity. METHODS: This quasi-experimental retrospective study using interrupted time series was conducted in an academic centre in Canada from August 2008 to June 2018. The Antimicrobial Prescription Surveillance System was implemented in August 2010 (intervention 1) and specific rules targeting patients with class III obesity (body mass index ≥ 40 kg/m2) were added in June 2014 (intervention 2). Data were collected from all hospitalised adults receiving antimicrobials which required dose adjustment for severe obesity and were stratified by body mass index. Segmented regression analysis of interrupted time series was used to evaluate the impact of the Antimicrobial Prescription Surveillance System on the proportion of inappropriate days of therapy according to posology and on antimicrobial consumption. RESULTS: Overall, 65 205 antimicrobial prescriptions (68% non-obese, 25% class I-II obesity, and 7% class III obesity) were analysed. In patients with class III obesity, the intervention was associated with a decrease in the proportion of inappropriate days of therapy (trend after the first intervention, -0.8% per 2-month period [95% CI -1.1 to -0.5], p < 0.001; intercept, 11.3% [95% CI 8.2 to 14.5], p < 0.001), which led to a reduction of 35% over an eight-year period (from pre-intervention level of 19.1%). Intervention 1 resulted in a downward trend in antimicrobial consumption, followed by an increasing trend after intervention 2. In these patients, the most frequent interventions made by pharmacists targeted posology (46%). CONCLUSIONS: Antimicrobial Prescription Surveillance System had a positive impact on dosing optimisation and antimicrobial consumption in patients with class III obesity. Improving antimicrobial prescriptions in these patients is important because suboptimal dosing could be associated with unfavourable outcomes.

Nutritional value of child-targeted food products: results from the Food Quality Observatory.

OBJECTIVE: To characterise the nutritional quality of food products targeted to children, we aimed: (1) to determine if the nutritional composition of child-targeted food products is different from those for the general population and (2) to verify differences in the nutrient content of child-targeted food products between three selected food categories. DESIGN: The present study is part of the work conducted by the Food Quality Observatory, created in 2016 in the province of Quebec (Canada). Ready-to-eat (RTE) breakfast cereals (n 331), granola bars (n 310) and yoghurts and dairy desserts (n 380) were the food categories analysed. SETTING: Nutritional values and all packaging information were obtained by purchasing every product available in supermarkets, grocery stores and specialty grocery stores. Free sugars were manually differentiated from total sugars for each product. Products were classified according to two targeted consumer groups: children or general population. RESULTS: The nutrient profile of RTE breakfast cereals, granola bars and yoghurts and dairy desserts targeted to children differed from that of products intended at the general population. Child-targeted RTE breakfast cereals had the least favourable nutritional composition, with significantly higher content of carbohydrates, total sugars, free sugars and Na compared with breakfast cereals for the general population as well as child-targeted granola bars and yoghurts and dairy desserts. All child-targeted products analysed contained free sugars. CONCLUSIONS: The current study supports the relevance to further regulate marketing to children on food product packages to ensure that such marketing is not present on food products with poor nutritional quality.

Assessing nutritional value of ready-to-eat breakfast cereals in the province of Quebec (Canada): a study from the Food Quality Observatory.

OBJECTIVE: The Food Quality Observatory was created in the province of Quebec (Canada) in 2016. In this study, the Observatory aimed to generate a methodology to (1) test the use of sales data combined with nutrient values to characterise the nutritional composition of ready-to-eat (RTE) breakfast cereals offered and purchased in the province of Quebec (Canada) and (2) verify the extent to which a front-of-pack label based on the percentage of daily value (DV) for total sugar, as a strategy to improve the food supply, would be distributed in this food category. DESIGN: Nutritional information were obtained by purchasing each RTE breakfast cereal available in the Greater Montreal area. Cereals were then classified according to their processing type. SETTING: The nutritional values of 331 RTE breakfast cereals available in Quebec were merged with sales data covering the period between May 2016 and May 2017. A total of 306 products were successfully cross-referenced. RESULTS: Granola and sweetened cereals were the most available (36·6 % and 19·6 %, respectively) and purchased (19·8 % and 40·9 % of sales, respectively). When compared with other types of cereals, granola cereals had a higher energy, fat, saturated fat, protein content and a lower Na content. A larger proportion of chocolate (65 %) and sweetened cereals (49 %) were above 15 % of the DV for sugar. CONCLUSIONS: This study showed that the methodology developed generates important data to monitor nutritional quality of the food supply and ultimately contribute to improve the nutritional quality of processed foods.

Breastfeeding and growth trajectory from birth to 5 years among children exposed and unexposed to gestational diabetes mellitus in utero.

OBJECTIVES: This study aims to evaluate the association between exposure to gestational diabetes mellitus and growth trajectory from birth to 5 years and to test whether breastfeeding influences this association among children exposed and unexposed to gestational diabetes. STUDY DESIGN: Weight at 0, 6, 12, and 18 months and 2, 3, 4, and 5 years were retrospectively collected for 103 children exposed and 63 children unexposed to gestational diabetes. Weight-for-age z-score was calculated. Mixed linear model for repeated measurements were computed to test whether breastfeeding was associated differently with weight-for-age z-score of children exposed or unexposed to diabetes. RESULTS: Children exposed to gestational diabetes had greater z-score values at 6 months and 4 and 5 years (p < 0.10). Breastfeeding duration was not associated with weight-for-age z-score trajectory in any children. CONCLUSION: Children exposed to gestational diabetes had a different growth trajectory in early life, but breastfeeding duration did not seem to influence this association.

Clinical impact of accepting or rejecting a recommendation from a clinical decision support system-assisted antibiotic stewardship program.

Background: Outcomes associated with physician responses to recommendations from an antimicrobial stewardship program (ASP) at an individual patient level have not yet been assessed. We aimed to compare clinical characteristics and mortality risk among patients for whom recommendations from an ASP were accepted or refused. Methods: A prospective cohort study was performed with hospitalized adults who received intravenous or oral antimicrobials at a 677-bed academic centre in Canada in 2014-2017. We included patients with an alert produced by a clinical decision support system (CDSS) for whom a recommendation was made by the pharmacist to the attending physician. The outcome was 90-day in-hospital all-cause mortality. Results: We identified 3,197 recommendations throughout the study period, of which 2,885 (90.2%) were accepted. The median length of antimicrobial treatment was significantly shorter when a recommendation was accepted (0.26 versus 1.78 d; p < 0.001). Refusal of a recommendation was not associated with mortality (odds ratio 1.32; 95% confidence interval, 0.93 to 1.89; p = 0.12). The independent risk factors associated with in-hospital mortality were age, Charlson Comorbidity Index score, admission to a critical care unit, duration between admission and recommendation, and issuance of a recommendation on a carbapenem. Conclusions: The duration of antimicrobial treatment was significantly shorter when a recommendation originating from a CDSS-assisted ASP program was accepted. Future prospective studies including potential residual confounding variables, such as the source of infection or physiological derangement, might help in understanding whether CDSS-assisted ASP will have a direct impact on patient mortality.

Historique: Les résultats liés aux réponses des médecins aux recommandations du programme de gestion antimicrobienne (PGA) n'ont pas encore été évalués à l'égard de chaque patient. Les chercheurs ont visé à comparer les caractéristiques cliniques et le risque de mortalité chez les patients dont les recommandations provenant d'une PGA ont été acceptées ou refusées. Méthodologie: Les chercheurs ont procédé à une étude de cohorte prospective auprès d'adultes hospitalisés qui avaient reçu des antimicrobiens par voie intraveineuse ou orale à un centre universitaire de 667 lits composé de deux établissements du Canada entre 2014 et 2017. Ils ont inclus les patients pour qui s'était déclenchée une alerte produite par un système d'aide à la décision clinique (SADC) et pour qui le pharmacien avait fait une recommandation au médecin traitant. Le résultat était la mortalité toutes causes confondues après un séjour hospitalier de 90 jours. Résultats: Les chercheurs ont extrait 3 197 recommandations tout au long de l'étude, dont 2 885 (90,2 %) ont été acceptées. La durée médiane du traitement antimicrobien était considérablement plus courte lorsqu'une recommandation était acceptée (0,26 par rapport à 1,78 jour; p < 0,001). Le refus d'une recommandation n'était pas associé à la mortalité (rapport de cotes de 1,32; IC de 95 %, 0,93 à 1,89; p = 0,12). Les facteurs de risque indépendants associés à la mortalité en milieu hospitalier étaient l'âge, l'indice de Charlson, l'admission dans une unité de soins intensifs, la période entre l'admission et la recommandation, et la formulation d'une recommandation sur un carbapénem. Conclusion: La durée du traitement antimicrobien était beaucoup plus courte lorsque la recommandation d'un PGA assisté par un SADC était acceptée. De futures études prospectives incluant de potentielles variables confusionnelles résiduelles, telles que la source de l'infection ou le dérangement physiologique, pourraient contribuer à établir si un PGA assisté par un SADC aura des conséquences directes sur la mortalité des patients.

Intuitive eating is associated with elevated levels of circulating omega-3-polyunsaturated fatty acid-derived endocannabinoidome mediators.

The regulation of food intake and eating behaviours involves interactions between different systems. The endocannabinoidome, comprising several fatty acid-derived mediators, plays a central role in the regulation of food intake. Alterations of this system have been suggested to intervene in the aetiology of eating disorders. This study aimed to examine the associations between non-pathological eating behaviours and circulating endocannabinoidome mediators in a heterogeneous human population. Plasma 2-monoacyl-glycerol and N-acyl-ethanolamine congeners were measured by LC-MS/MS in a sample of 190 men and women. Eating behaviours were assessed using the Three-Factor Eating Questionnaire (TFEQ) and the Intuitive Eating Scale-2 (IES-2). Following adjustment for body mass index and age, plasma levels of omega-3 polyunsaturated fatty acid-derived 2-monoacyl-glycerols, 2-eicosapentaenoyl-glycerol (2-EPG) and 2-docosapentaenoyl-glycerol (2-DPG), were associated with higher intuitive eating scores (0.15 ≤ rho ≤ 0.20; p < 0.05). These associations were independent of the dietary intake of the fatty acid precursors of these 2-monoacyl-glycerols. However, almost no association was found between plasma levels of N-acyl-ethanolamine congeners and the TFEQ or the IES-2 scores. The results of the present study suggest the association of 2-monoacyl-glycerols, especially 2-EPG and 2-DPG, in the regulation of intuitive eating and the potential implication therein of bioactive lipids.

Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study.

The impact of adjusted treatment on clinical outcomes in patients with severe obesity is unclear. This study included adults with severe obesity admitted for bloodstream infections between 2005 and 2015. The patients were grouped according to the percentage of the appropriateness of the dosage of their antimicrobial treatment: 80-100% = good, 20-79% = moderate, and 0-19% = poor. The association between antimicrobial adjustment and a composite of unfavourable outcomes [intensive care unit stay ≥72 h, duration of sepsis >3 days, length of stay ≥7 days or all-cause 30-day mortality] was assessed using logistic regression. Of 110 included episodes, the adjustment was rated good in 47 (43%) episodes, moderate in 31 (28%), and poor in 32 (29%). Older age, Pitt bacteremia score ≥2, sepsis on day 1, and infection site were independent risk factors for unfavourable outcomes. The level of appropriateness was not associated with unfavourable outcomes. The number of antimicrobials, consultation with an infectious disease specialist, blood urea nitrogen 7-10.9 mmol/L, and hemodialysis were significantly associated with adjusted antimicrobial dosing. While the severity of the infection had a substantial impact on the measured outcomes, we did not find an association between dosing optimization and better outcomes.

Dietary fatty acid intake and gut microbiota determine circulating endocannabinoidome signaling beyond the effect of body fat.

The endocannabinoidome encompasses several fatty acid (FA)-derived mediators, including the endocannabinoid anandamide (AEA) and 2-arachidonoyl-glycerol (2-AG), which served as targets for anti-obesity drug development, and their congener N-acyl-ethanolamines (NAEs) and 2-monoacyl-glycerols (2­MAGs), which are involved in food intake and energy metabolism. Body weight and fat distribution have been suggested as determinants of peripheral endocannabinoid levels. We aimed at investigating factors, beyond body fat composition, that are associated with circulating NAE and 2-MAG levels in a heterogeneous human population. Plasma NAEs and 2-MAGs were measured using LC-MS/MS in a cross-sectional sample of healthy men and women (n = 195) covering a wide range of BMI and individuals before and after a 2-day Mediterranean diet (n = 21). Circulating levels of all 2-MAGs and NAEs, other than N-oleoyl-ethanolamine (OEA), correlated with body fat mass and visceral adipose tissue (0.26 < r < 0.54). NAE levels were elevated in individuals with elevated fat mass, while 2-MAGs were increased in individuals with predominantly visceral body fat distribution. Dietary intakes of specific FAs were associated with 2-AG and omega-3-FA-derived NAEs or 2-MAGs, irrespective of the body fat distribution. Some gut bacterial families (e.g. Veillonellaceae, Peptostreptococcaceae and Akkermansiaceae) were associated with variations in most NAEs or omega-3-FA-derived 2­MAGs, independently of fat mass and dietary FA intake. Finally, a 2-day Mediterranean diet intervention increased circulating levels of NAEs and 2-MAGs in agreement with changes in FA intake (p < 0.01). Self-reported intake and short-term dietary intervention increased in oleic acid and EPA and DHA intake as well as certain gut microbiota taxa are associated to circulating NAEs and 2­MAGs independently of adiposity measures, thus highlighting the potential importance of these variables in determining endocannabinoidome signaling in humans.

Association between lifestyle habits and adiposity values among children exposed and unexposed to gestational diabetes mellitus in utero.

AIMS: The objectives of this study were to assess the profile of lifestyle habits among children exposed (GDM+) or unexposed (GDM-) to GDM and to assess whether a healthy lifestyle profile is associated with lower adiposity values among these children. METHODS: A total of 105 GDM+ and 38 GDM- children aged 2-14 years were included. Vegetables and fruit intakes were collected using two 24-h dietary recalls. Physical activity and sedentary time were measured with accelerometers. Screen and sleep time were assessed using questionnaires. Weight, height and waist circumference were measured. Body composition was assessed by absorptiometry. RESULTS: GDM+ children had lower moderate-to-vigorous physical activity practice (p = 0.043) and fruit intake (p = 0.020) than GDM- children. Among children with an unhealthy lifestyle (meeting 0-2 lifestyle recommendations), GDM+ children had greater percentage of fat mass (p = 0.021) and android fat mass (p = 0.020) than GDM- children. Moreover, among GDM+ children, children with a healthy lifestyle (meeting 3-4 lifestyle recommendations) tended to have lower percentage of fat mass (p = 0.053) and android fat mass (p = 0.071) than those with an unhealthy lifestyle. CONCLUSION: Improving lifestyle habits among GDM+ children could represent a promising approach to prevent deteriorated adiposity values.

Is A Healthy Diet Associated with Lower Anthropometric and Glycemic Alterations in Predisposed Children Born from Mothers with Gestational Diabetes Mellitus?

Children born from mothers with gestational diabetes mellitus (GDM) are at high-risk of obesity and type 2 diabetes. To date, there is a lack of effective strategies to prevent these complications. The aim of this study was to evaluate the association between diet quality and anthropometric and glycemic profiles of children exposed (GDM+) and unexposed (GDM⁻) to GDM. A total of 104 GDM+ and 38 GDM⁻ children were included. Two 24-h dietary recall questionnaires were used to assess dietary intakes. The Healthy Eating Index adapted for the Canadian population (HEI-C) was used to assess diet quality. Spearman correlations adjusted for children's age and sex were computed. Mean age was 6.0 ± 2.5 and 6.8 ± 2.3 years for GDM+ and GDM⁻, respectively (p = 0.03). Total HEI-C score was negatively associated with the android-to-gynoid fat mass ratio (r = -0.29, p = 0.03) and homeostasis model assessment for insulin resistance (HOMA-IR) index (r = -0.22, p = 0.04) in GDM+ children only. The prevalence of being overweight or obese during childhood was 4-fold higher among GDM+ children with a HEI-C score ≤70 compared to GDM+ children with a HEI-C score >70. Results of this study show that a healthy diet is associated with a better cardiometabolic health profile in GDM+ children, including a lower risk of being overweight or obese.

Associations between fruit and vegetables intake and abnormal glucose tolerance among women with prior gestational diabetes mellitus.

PURPOSE: Women with prior gestational diabetes mellitus (GDM) are at higher risk of type 2 diabetes (T2D). The aim of this study was to investigate the association between fruit and vegetables (FV) intake and abnormal glucose tolerance (AGT) among women with prior GDM. METHODS: A total of 281 women with prior GDM have been recruited a mean of 6 years after their pregnancy in this cohort study. FV intake was obtained with a validated food frequency questionnaire (FFQ). Anthropometric and glycemic components were measured during their clinical visit and women were stratified according to normal glucose tolerance (NGT) or AGT. RESULTS: A cross-sectional analysis showed that a total of 155 women had NGT and 126 AGT. Women with AGT had significantly lower FV (6.5 ± 0.2) and vegetables servings (3.9 ± 0.2) and tended to have lower fruit servings (2.6 ± 0.2) than women with NGT (7.4 ± 0.2, 4.5 ± 0.2 and 3.0 ± 0.1, respectively) (p = 0.001, p = 0.04 and p = 0.10, respectively, adjusted for age and BMI). FV intake, per one serving increase, was associated with a reduced likelihood of having AGT [OR = 0.88 (0.81-0.97) after adjustment for age and BMI]. Vegetables or fruit intake tended to be associated with a reduced likelihood of having AGT [OR = 0.88 (0.78-1.00) and OR = 0.88 (0.76-1.02), respectively, after adjustment for age and BMI]. CONCLUSIONS: Higher intake of FV may be associated with a lower likelihood of AGT among women with prior GDM. Further studies are needed to confirm these results in this high-risk population.

Promoting fruit and vegetable intake in childbearing age women at risk for gestational diabetes mellitus: A randomised controlled trial.

This randomised controlled trial verified the efficacy of an implementation intentions intervention ( n = 24) to promote fruit and vegetable consumption among childbearing age women at risk for gestational diabetes mellitus against a control condition based on the question-behaviour effect ( n = 26). There was only a significant time effect ( F(2,85) = 5.69, p = 0.0048). Both groups increased their vegetable consumption compared to baseline at 3 months ( p = 0.0022) and 6 months ( p = 0.0042). There were no significant effects on weight, waist circumference and blood glucose levels. Implementation intentions and the question-behaviour effect appear to be effective behaviour change techniques to promote vegetable intake among this high-risk population.

Association between early introduction of fruit juice during infancy and childhood consumption of sweet-tasting foods and beverages among children exposed and unexposed to gestational diabetes mellitus in utero.

BACKGROUND: Children exposed to gestational diabetes mellitus (GDM) in utero are at high-risk of obesity. Given that nutritional habits can track from infancy to childhood, the aim of this study was to evaluate the association between the timing of fruit juice introduction in infancy and later consumption of sweet-tasting foods and beverages among children exposed (GDM+) and unexposed (GDM-) to GDM. METHODS: A total of 107 GDM+ and 59 GDM- participated in the project. Data on the timing of fruit juice introduction during infancy were retrospectively collected for 62 GDM+ and 32 GDM- children. Current dietary intakes were collected with two 24-hour dietary recall questionnaires. Children were divided into groups according to the median timing of juice introduction (9 months). RESULTS: Mean age of children was 6.3 ± 2.6 and 7.6 ± 3.7 years for GDM+ and GDM- children, respectively (p = 0.08). Mean age of fruit juice introduction was similar between groups (p > 0.05). Consuming >1 serving of fruit juice per day was 2.72 times more prevalent among GDM+ children introduced to fruit juice <9 months, compared to GDM+ children introduced ≥9 months (CI: 1.19-6.20). This association was not observed in the GDM- group. The timing of fruit juice introduction was not associated with later consumption of sweets, desserts and sweet-tasting beverages when adjustment for children's age was made among GDM+ and GDM- children. CONCLUSION: Early introduction of fruit juice in infant diet is associated with higher prevalence of consumption of >1 serving of fruit juice per day in GDM+ children.