M. Romon

Increased triglyceride levels in shift workers

PURPOSEnTo assess an independent relationship between shift work and serum lipid levels.nnnDESIGNnCross-sectional survey.nnnSETTINGnTwo plants of northern France: a chemical one and a nuclear power station.nnnPARTICIPANTSnAll the shift workers of the chemical plant and of one part of the nuclear station. One hundred nine persons were selected, 25 were excluded or absent during the study, and 11 refused to participate. Day workers matched with shift workers according to age, educational level, birthplace, and occupational physical activity level served as controls; 109 were selected, 26 were excluded or absent, and 10 refused to participate.nnnMAIN OUTCOME MEASURESnFasting venous plasma concentration of total cholesterol, triglyceride, and high-density lipoprotein (HDL) cholesterol; dietary intake assessed by a 3-day record, smoking habits, and body mass index (BMI).nnnRESULTSnShift workers had significantly higher levels of serum triglyceride (1.26 versus 1.03 mmol/L, p = 0.01). Cholesterol and HDL cholesterol levels were similar for the two groups. There was no difference in energy and nutrient intake, but day workers had a higher alcohol intake (15.64 g/d versus 9.3 g/d, p = 0.03). Multivariate analysis conducted with triglycerides as dependent variable and shift work, BMI, smoking, age, leisure time physical activity level, energy intake, and alcohol intake as independent variables confirmed that shift work has a significant explanatory power for triglyceride levels (beta = 0.134, p = 0.0005).nnnCONCLUSIONnThis study confirms that shift work is associated with an increase of triglyceride levels independent of dietary intake. We did not find any influence of shift work on cholesterol and HDL cholesterol. Despite this latter fact, our findings are to be considered in the explanation of coronary risk among shift workers. Further studies are needed to elucidate the mechanism of this relative hypertriglyceridemia: stress induced by shift work or diurnal rhythm disturbances.

Higher carbohydrate intake is associated with decreased incidence of newborn macrosomia in women with gestational diabetes.

OBJECTIVEnTo study the influence of energy and macronutrient intake on infant birthweight in women with gestational diabetes mellitus undergoing intensive management.nnnDESIGNnThis prospective study evaluated the impact of intensive management of gestational diabetes on maternal and fetal morbidity, and addressed the relationship between food intake and infant birthweight.nnnSETTINGnFifteen maternity hospitals in northern France.nnnSUBJECTSnNinety-nine women with gestational diabetes or gestational mild hyperglycemia diagnosed between 24 and 34 weeks of gestation were surveyed. After 1 was excluded because of a premature birth and 18 were excluded as underreporters, 80 women were included in the final analysis. Diet intake was assessed by a dietary history at the first interview, and by two 3-day diet records at the 3rd and 7th week after diagnosis.nnnRESULTSnIn a forward-stepwise regression analysis (controlling for maternal age; smoking; parity; prepregnancy BMI; pregnancy weight gain; gestational duration; infant sex; fasting and 2-hour postprandial serum glucose; insulin therapy; and energy, fat, protein and carbohydrate intake during treatment) infant birthweight was positively associated with gestational duration (beta = +0.34, P<.002), and negatively with smoking (beta = -0.27, P<.02) and carbohydrate intake (beta = -0.24, P<.03). There were no large-for-gestational-age infants among women whose carbohydrate intake exceeded 210 g/day.nnnCONCLUSIONnFor women with gestational diabetes undergoing intensive management, higher carbohydrate intake is associated with decreased incidence of macrosomia.nnnAPPLICATIONnThese findings suggest that nutrition counseling in gestational diabetes must be directed to maintain a sufficient carbohydrate intake (at least 250 g per day), which implies a low-fat diet to limit energy intake. A careful distribution of carbohydrate throughout the day and the use of low-glycemic index foods may help limit postprandial hyperglycemia.

Long-term metabolic outcome and quality of life after laparoscopic adjustable gastric banding in obese patients with type 2 diabetes mellitus or impaired fasting glucose

The long‐term outcome of type 2 diabetes mellitus after laparoscopic adjustable gastric banding (LAGB) is unknown.

Postprandial Leptin Response to Carbohydrate and Fat Meals in Obese Women

Objective: To assess the postprandial leptin responses to a carbohydrate and a fatty meal in obese subjects and its association with postprandial insulin response. Methods: Eight obese and 11 lean women were given, in a random order, an isocaloric carbohydrate meal (3.43 MJ, 166g of carbohydrates, 38g of proteins) or fat meal (3.35 MJ, 70g of fat, 36g of proteins) or remained fasting. Blood samples were collected hourly during the nine hours after the meal for leptin, insulin, C-peptide and glucose determinations. Results: In obese subjects, as in lean subjects, postprandial leptin response, calculated as the increment above fasting values, was higher after the carbohydrate meal than after the fatty meal (p < 0.01). However, after the carbohydrate meal, postprandial leptin increment was lower (p < 0.05) in obese subjects than in lean controls. In contrast, there was no difference in postprandial leptin response between lean and obese subjects after the fatty meal. Correlation analyses showed that the area under the postprandial leptin response curve (leptin AUC) was correlated to insulin AUC in lean (r = 0.70, p < 0.01), but not in obese subjects. Conclusion: These results indicate that postprandial leptin response is lower after a carbohydrate meal in obese women than in lean controls, suggesting an impairment of postprandial leptin regulation in obese women.

Comparison between fat intake assessed by a 3-day food record and phospholipid fatty acid composition of red blood cells: Results from the monitoring of cardiovascular disease-Lille study

We investigated the relationship between assessment of fatty acid intake by a 3-day food record and by capillary gas chromatography of erythrocyte phospholipid fatty acid. The study was performed in a sample of 244 men aged 45 to 66 years from the general population who were participating in the Monitoring of Cardiovascular Disease (MONICA)-Lille survey. The relationship between each nutrient and food item and erythrocyte phospholipid fatty acid was investigated by a regression model on proportion including each food item and nutrient as a dependent variable and percentage of fatty acid and covariables (nonalcoholic energy intake, age, alcohol intake, and smoking) as independent variables. Polyunsaturated fat and linoleic acid intake were positively correlated with linoleic acid content of erythrocytes (beta = 0.641 and 0.604, respectively, P < .001). Monounsaturated and saturated fat intake were correlated with oleic acid (beta = 0.375 and 0.373, respectively, P < .01). Fish intake correlated positively with docosahexaenoic acid (DHA) (beta = 0.383, P < .001) and negatively with arachidonic acid (beta = -0.509, P < .01). These data confirm, on a group level, a good relationship between assessment of polyunsaturated fat intake by a 3-day record and linoleic acid content of erythrocyte membranes. These data suggest that erythrocyte oleic acid content is a marker of both saturated and monounsaturated fat intake.

The relationship between the phospholipid fatty acid composition of red blood cells, plasma lipids, and apolipoproteins

This study examined the relationship between the fatty acid composition of red blood cell phospholipids and lipid markers of atherosclerotic risk in an urban male population aged 45 to 66 years. There was a surprisingly significant positive association between the docosahexaenoic acid ([DHA] 22:6n-3) content of erythrocyte phospholipids and the following risk markers: plasma cholesterol (P < .01), low-density lipoprotein (LDL) cholesterol (P < .01), apolipoprotein (apo) B (P < .05), and apo B-containing lipoprotein particles (P < .05) recognized by a monoclonal antibody (LpBL3). On the other hand, phospholipid alpha-linolenate was positively correlated with apo A-I and high-density lipoprotein (HDL) cholesterol levels (P < .05), while arachidonate showed an inverse relationship with plasma cholesterol (P < .05). There was a negative association between palmitoleic acid and apo B (P < .01) and LpBL3 (P < .001); the latter showed a negative association with stearic acid (P < .001). These interesting findings emphasize the beneficial effect on atherosclerotic risk markers of dietary n-6 polyunsaturated and monounsaturated fatty acids, and suggest that long-chain n-3 polyunsaturated fatty acids (DHA) could have an adverse effect on some of the lipid risk markers.

Blood ketone monitoring : a comparison between gestational diabetes and non-diabetic pregnant women

AIMnTo measure ketonemia in a control population of pregnant women and in a population of women with gestational diabetes (GDM). To define a normal ketonemia threshold for the controls and to determine whether or not this value could play a role in the clinical management of women with GDM.nnnMETHODnFifty-six women with a normal OGTT and 49 women with GDM were included and monitored from the 25th to the 37th week of pregnancy. Control subjects agreed to perform glycaemia and ketonemia self-monitoring 3 times a day. In addition, women with GDM were asked to measure their postprandial glycaemia. Glycaemia and ketonemia measurements were performed using Optium meters. Subjects kept a 24-hour food record twice a week.nnnRESULTSnThe mean ketonemia was lower in the control group than in the GDM group (0.01+/-0.10 vs. 0.04+/-0.009 mmol/l; P<0.001). Ketonemia values measured before the midday meal and prior to the evening meal were lower for control subjects than for GDM patients (P=0.002 and P=0.005). Fasting ketonemia was unrelated to ketonuria in the GDM group, whereas there was a correlation in the control group (P=0.006). At least one chronic increase in ketonemia levels was observed in 47% of the women with GDM, compared with only 12% of controls. The lowest levels of evening glycaemia correlated with the highest levels of ketonemia; women with GDM reported lower food and carbohydrate intakes than controls (P<0.001).nnnCONCLUSIONnThis work has enabled the establishment of ketonemia reference standards in non-diabetic pregnant women. If ketonemia does indeed indicate overly restrictive dietary behavior, this parameter could be employed for monitoring adherence to the nutritional recommendations for GDM.

P96 Dénutrition chez les patients diabétiques hospitalisés pour lésion du pied

Introduction La denutrition chez les patients diabetiques hospitalises pour lesion du pied est peu etudiee. Pourtant, ils sont a risque de denutrition (âge, situation d’agression souvent chronique, hospitalisations frequentes, …). L’objectif de cette etude etait d’evaluer a l’entree la prevalence de la denutrition chez des patients hospitalises pour une lesion du pied et de determiner les facteurs associes a la denutrition dans cette population. Materiels et Methodes Tous les patients diabetiques hospitalises dans notre service pour lesion du pied entre le 1ermai et le 30 septembre 2009 ont ete inclus. Ont ete recueillies les donnees anthropometriques, biologiques, les caracteristiques de la lesion et la duree d’hospitalisation. Nous avons utilise les criteres de denutrition de la Haute Autorite de Sante de 2003 et 2007. Les tests statistiques utilises etaient un test ANOVA pour les variables quantitatives et un test du KHI2 pour les variables qualitatives. Resultats 54 patients (41 hommes ; moyenne d’âge 64,7 ± 13,3 ans) ont ete inclus. La prevalence de la denutrition etait de 45 %. Les patients denutris etaient significativement plus âges (70,8 ± 11,8 vs 58,6 ± 11,2 ans, p Discussion La duree totale d’hospitalisation durant la periode d’etude etait plus importante chez les patients denutris (23,3 ± 20,1 vs 13,7 ± 12,7 jours, p = 0,14). Conclusion La prevalence de la denutrition dans cette population est au moins aussi elevee que dans le reste de la population des patients hospitalises. Les patients denutris sont plus âges, presentent des lesions plus grandes et plus souvent arteritiques, et sont plus longtemps hospitalises que les patients non denutris. Une prise en charge rapide et efficace de la denutrition est donc indispensable.

O12 Évolution du diabète de type 2 cinq ans apres mise en place d’un anneau gastrique ajustable

Objectif Evaluer levolution du diabete de type 2 (DT2) chez les patients souffrants dobesite severe (IMC > 40 kg/m 2 ), 5 ans apres la realisation dun cerclage gastrique cœlioscopique par anneau gastrique ajustable (AGA). Patients et methodes 143 patients consecutifs (48±6 kg/m 2 , 40±9 ans) ayant beneficie dun AGA avant 2002, dont 23 patients atteints de DT2 et 53 patients prediabetiques, ont ete inclus dans cette etude de cohorte. Cent quarante patients, dont 22 diabetiques, ont ete evalues a 5 ans (>95 %). Resultats Le DT2 na pas influence la perte de poids ou le taux de complications postoperatoires. Chez les patients atteints de DT2, lamaigrissement (41±25 % de perte dexces de poids) etait associe apres 5 ans a une diminution significative (p Nottingham Health Profile ). Un controle satisfaisant de la glycemie (HbA1c Conclusion Chez les patients obeses atteints de DT2, lAGA induit une amelioration a long terme du metabolisme glycemique et des comorbidites associees, mais ne permet que rarement une remission complete du DT2.

CA-197: Utilité du holter glycémique au cours de la grossesse après chirurgie bariatrique

Objectif Notre etude decrit le profil glycemique des femmes enceintes apres chirurgie bariatrique, alors que peu de donnees existent dans la litterature. Patients et Methodes 12 femmes enceintes operees dune chirurgie bariatrique (8 procedures malabsorptives et 4 restrictives) ont beneficie entre 24 et 28 semaines damenorrhees, de la pose dun holter glycemique durant 72 h, ainsi que dune hyperglycemie provoquee par voie orale (75 g-HGPO). Nos donnees ont ensuite ete comparees par test-T aux valeurs de reference de Yogev et al.*, etablies chez des femmes enceintes, non diabetiques, obeses ( n =15) et non obeses ( n =42). *Yogev et al. Am J Obstet Gynecol. 2004. Resultats Chez nos 12 patientes, lindice de masse corporelle pre-gestationnel median etait de 34,4kg/m 2 (mi n =20,3 ; max=55,2), et ne differait pas du groupe de reference obese. Le pourcentage de temps passe par jour avec un taux de glucose interstitiel (GI) p =0,01) et le pic de GIPP plus precoce ( p =0,003) comparativement aux valeurs du groupe de reference obese ; le GIPP a 1h etait plus haut compa-rativement au groupe de reference non obese ( p =0,01). Ces differences etaient portees essentiellement par les 7 patientes ayant eu un gastric bypass , qui presentaient de plus un taux de GIPP a 2 h ( p =0,006), et un taux de GI nocturne ( p =0,03) plus bas comparativement au groupe de reference non obese. Aucune difference netait observee sur les taux de GI a jeun et de GI des 24h LHGPO netait pas interpretable chez 4/12 patientes du fait dune intolerance totale et avait revele un diabete gestationnel chez 2/8 patientes. Conclusions Notre etude pilote a permis dobserver une importante variabilite glycemique nycthemerale chez les femmes enceintes apres chirurgie bariatrique et suggere lutilisation du holter glycemique pour analyser le profil glycemique chez ces femmes pour qui lHGPO est difficilement realisable.