Lower Metabolic Risk Research Articles

Dietary patterns in men and women are simultaneously determinants of altered glucose metabolism and bone metabolism

We hypothesized that diet would have direct effects on glucose metabolism with direct and indirect effects on bone metabolism in a cohort of Canadian adults. We assessed dietary patterns (Prudent [fruit, vegetables, whole grains, fish, and legumes] and Western [soft drinks, potato chips, French fries, meats, and desserts]) from a semiquantitative food frequency questionnaire. We used fasting blood samples to measure glucose, insulin, homeostatic model assessment insulin resistance (HOMA-IR), 25-hydroxyvitamin D (25OHD), parathyroid hormone, bone-specific alkaline phosphatase (a bone formation marker), and serum C-terminal telopeptide (CTX; a bone resorption marker). We used multivariate regression models adjusted for confounders and including/excluding body mass index. In a secondary analysis, we examined relationships through structural equations models. The Prudent diet was associated with favorable effects on glucose metabolism (lower insulin and HOMA-IR) and bone metabolism (lower CTX in women; higher 25OHD and lower parathyroid hormone in men). The Western diet was associated with deleterious effects on glucose metabolism (higher glucose, insulin, and HOMA-IR) and bone metabolism (higher bone-specific alkaline phosphatase and lower 25OHD in women; higher CTX in men). Body mass index adjustment moved point estimates toward the null, indicating partial mediation. The structural equation model confirmed the hypothesized linkage with strong effects of Prudent and Western diet on metabolic risk, and both direct and indirect effects of a Prudent diet on bone turnover. In summary, a Prudent diet was associated with lower metabolic risk with both primary and mediated effects on bone turnover, suggesting that it is a potential target for reducing fracture risk.

The Effects of Bariatric Surgery-Induced Weight Loss on Adipose Tissue in Morbidly Obese Women Depends on the Initial Metabolic Status.

Adipose tissue (AT) dysfunction in obesity is commonly linked to insulin resistance and promotes the development of metabolic disease. Bariatric surgery (BS) represents an effective strategy to reduce weight and to improve metabolic health in morbidly obese subjects. However, the mechanisms and pathways that are modified in AT in response to BS are not fully understood, and few information is still available as to whether these may vary depending on the metabolic status of obese subjects. Abdominal subcutaneous adipose tissue (SAT) samples were obtained from morbidly obese women (n = 18) before and 13.3 ± 0.37months after BS. Obese women were stratified into two groups: normoglycemic (NG; Glu < 100mg/dl, HbA1c <5.7%) or insulin resistant (IR; Glu 100-126mg/dl, HbA1c 5.7-6.4%) (n = 9/group). A multi-comparative proteomic analysis was employed to identify differentially regulated SAT proteins by BS and/or the degree of insulin sensitivity. Serum levels of metabolic, inflammatory, and anti-oxidant markers were also analyzed. Before surgery, NG and IR subjects exhibited differences in AT proteins related to inflammation, metabolic processes, the cytoskeleton, and mitochondria. BS caused comparable weight reductions and improved glucose homeostasis in both groups. However, BS caused dissimilar changes in metabolic enzymes, inflammatory markers, cytoskeletal components, mitochondrial proteins, and angiogenesis regulators in NG and IR women. BS evokes significant molecular rearrangements indicative of improved AT function in morbidly obese women at either low or high metabolic risk, though selective adaptive changes in key cellular processes occur depending on the initial individual's metabolic status.

The effect of moderate intensity exercise in the postprandial period on the inflammatory response to a high-fat meal: an experimental study.

BackgroundConsuming a high-fat meal (HFM) may lead to postprandial lipemia (PPL) and inflammation. Postprandial exercise has been shown to effectively attenuate PPL. However, little is known about the impact of postprandial exercise on systemic inflammation and whether PPL and inflammation are associated. The purpose of this study was to determine whether moderate intensity exercise performed 60 min following a true-to-life HFM would attenuate PPL and inflammation.MethodsThirty-nine young adults (18–40 year) with no known metabolic disease were randomized to either a control group (CON) who remained sedentary during the postprandial period or an exercise (EX) group who walked at 60 % VO2peak to expend ≈ 5 kcal/kgbw one-hour following the HFM. Participants consumed a HFM of 10 kcal/kgbw and blood draws were performed immediately before, 2 h and 4 h post-HFM.ResultsAt baseline, there were no differences between EX and CON groups for any metabolic or inflammatory markers (p > 0.05). Postprandial triglycerides (TRG) increased from baseline to 4 h in the EX and CON groups (p < 0.001), with no differences between groups (p = 0.871). High density lipoprotein cholesterol (HDL-C) decreased in both groups across time (p < 0.001) with no differences between groups (p = 0.137). Interleukin-6 (IL-6) was significant as a quadratic function over time (p = 0.005), decreasing from baseline to 2 h then increasing and returning to baseline at 4 h in all participants with no difference between groups (p = 0.276). Tumor necrosis factor-alpha (TNF-α) was not different from baseline to 4 h between groups (p > 0.05). There was an increase in soluble vascular adhesion molecule (sVCAM-1) from baseline to 4 h (p = 0.027) for all participants along with a group x time interaction (p = 0.020). Changes in TRG were associated with changes in interleukin-10 (IL-10) from 0 to 2 h (p = 0.007), but were not associated with changes in any other inflammatory marker in the postprandial period (p > 0.05).ConclusionsDespite significant increases in PPL following a HFM, moderate intensity exercise in the postprandial period did not mitigate the PPL nor the inflammatory response to the HFM. These results indicate that in populations with low metabolic risk, PPL and inflammation following a HFM may not be directly related.

Abstract IA44: Obesity, body fat distribution, and cancer risk in the Multiethnic Cohort Study

Abstract Obesity is estimated to explain 15-20% of all cancer deaths in the U.S. Our current understanding of the mechanisms involved is only partial, especially for the two most common obesity-related cancers (breast and colorectal), and has not led to effective interventions. As the current obesity epidemic continues unabated, particularly among the poor and lower middle class, it is feared that the recent progress in lowering cancer rates and in improving the nation's health may be reversed, and health disparities worsened. Evidence suggests that the main U.S. ethnic/racial populations not only have different mean levels of body mass index (BMI) but also varying patterns of fat distribution. Compared to whites, African Americans experience a higher prevalence of obesity, with greater amounts of superficial abdominal subcutaneous fat which carries a lower metabolic risk than visceral fat or deep subcutaneous fat. In contrast, Asians have lower total adiposity but more visceral fat and experience higher rates of metabolic diseases. Hispanics have more overall and visceral adiposity and Native Hawaiians have high obesity rates; both groups are also at high risk for metabolic diseases. This heterogeneity in BMI levels and types of obesity existing among these 5 ethnic groups represented in the Multiethnic Cohort (MEC) offers a unique setting to study obesity and cancer. Similarly, the marked differences observed in the incidence of obesity-related cancers among the five ethnic/racial groups in the MEC reflect those described by SEER in their source populations. In addition, we observed striking ethnic/racial differences in the BMI-cancer association. For example, for breast cancer, the association was strongest for Native Hawaiians and Japanese Americans and occurred starting at low levels of excess BMI (&amp;gt;25 kg/m2). In contrast, the association in the other groups occurred only at high BMI levels (&amp;gt;30 kg/m2), if at all. A similar pattern was seen for colorectal cancer and diabetes. We interpret these differences as supporting an important role for body fat distribution, in addition to amount, in determining cancer risk. This has been suggested by a number of studies that assessed central obesity with waist and hip measurements. However, there is a critical need for a more comprehensive study of body fat distribution patterns (assessed by reference imaging methods) in U.S. ethnic/racial minorities and their association with cancer risks. We have initiated a large study within the MEC that will: 1) describe amount and distribution of body fat among older adults of five major U.S. ethnic/racial populations using whole body DXA and abdominal MRI; 2) identify nutritional, behavioral, biochemical, hormonal, genetic, metabolomic and gut microbiome determinants of these fat distribution patterns; 3) investigate inter-relationships among these factors to better understand the causes of obesity; 4) build integrated predictive signatures for these body fat compartments; and 5) test prospectively these predictive signatures for associations with breast and colorectal cancer risks in the MEC. Citation Format: Loic Le Marchand. Obesity, body fat distribution, and cancer risk in the Multiethnic Cohort Study. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA44.

Gender differences in mood stabilizer medications prescribed to Veterans with serious mental illness

BackgroundMood stabilizer medications (MSMs) can induce significant weight gain and other metabolic side effects. Research suggests that women are more susceptible to psychotropic medication-induced metabolic side effects than men. We examined gender differences in the likelihood of receiving an MSM with a lower liability for weight gain using data from the U.S. Department of Veterans Affairs (VA) healthcare system. MethodsWe identified 3823 VA patients with a schizophrenia or bipolar disorder diagnosis who initiated treatment with a MSM between 10/2006 and 9/2011. We used multivariable logistic regression analysis to examine gender differences in the likelihood of incident prescription of MSMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and demographic, mental health, and physical health characteristics. ResultsOverall, 47% of women were prescribed a low metabolic risk MSM compared to 26% of men (p<0.0001). In multivariable analysis, women were 2.19 times as likely as men to be prescribed a low metabolic risk MSM (95% CI: 1.84–2.60, p<0.0001). Several demographic and clinical covariates were also independently related to prescribing of MSMs by level of metabolic risk. LimitationsThis study used retrospective administrative data collected from a VA healthcare system database, which does not allow us to understand the context in which MSM treatment decisions were made. ConclusionsPrescribing choices for MSMs by VA mental health prescribers and female Veterans may reflect a growing awareness of the potential adverse health consequences of these treatments in women.

MON-PP027: Sarcopenic Obesity, But not Obesity is Associated with Incident Frailty, Institutionalisation and Mortality in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

Little is known about the relationship between low muscle mass (LMM) and metabolic risk factors in adolescents. We hypothesized that LMM in adolescents is associated with metabolic syndrome (MetS) and its components in Korean adolescents. This cross-sectional study included 1420 participants (749 males and 671 females), aged 12 to 19 years, who participated in the 2009-2011 Korea National Health and Nutrition Examination Surveys. Appendicular skeletal muscle mass was divided by body weight, and any value below the lower quintile of the study population, according to each age and sex category, was considered to represent LMM. A participant was considered to have MetS if he/she demonstrated at least 3 of the National Cholesterol Education Program–Adult Treatment Panel III criteria. The overall prevalence of MetS was 4.9%, with a prevalence of 7.1% in males and 2.3% in females. Low muscle mass significantly increased the risk of MetS, after adjusting for potential covariates (odds ratio [OR], 5.28; 95% confidence interval, 2.76-10.13). Similarly, the ORs for the MetS components were significantly higher in individuals with LMM than in those without LMM. In the subgroup analysis, LMM was significantly associated with MetS in both adolescent boys and girls. In addition, the adjusted OR was significantly higher in individuals with LMM than in those without, after stratifying the groups by age. In conclusion, our results suggest that adolescents with LMM may have a high risk of MetS. Public health initiatives are needed to develop interventions for preventing and treating LMM in adolescents.

Behavioral and Biological Correlates of Metabolic Risk in Portuguese Children

Low levels of moderate-to-vigorous physical activity (MVPA), high levels of sedentary behavior, excess weight, and unhealthy nutritional habits are associated with the development of metabolic risk (MR) in youth. A high percentage of Portuguese children do not attain the recommended daily MVPA levels, and obesity has become a prevalent condition in this population. PURPOSE: To analyze the effects of MVPA, sedentariness, weight status and nutritional habits on MR in a sub-sample of the Portuguese ISCOLE (International Study of Childhood Obesity, Lifestyle and the Environment) study. METHODS: Height, weight, maturity offset, MR, MVPA and sedentariness were collected in 389 children (mean age 10.5 years; 219 girls) from 23 schools located in Porto, Portugal. Mean MVPA (min/day) and mean sedentary time (min/day), defined as ≥574 activity counts and ≤25 activity counts using 15 seconds epochs, respectively, were assessed using the GT3X+ Actigraph accelerometer over at least 4 days (1 weekend day) with a minimum of 10 hours/day of monitoring. Time watching TV and nutritional habits were obtained from a questionnaire; TV time was categorized in <2 h/day and ≥ 2h/day, and dietary scores were derived for each child using a food frequency questionnaire and two components were created, named “unhealthy food” and “healthy food”. World Health Organization BMI cut-points were used to classify children as normal weight or overweight/obese. Maturity- and sex-standardized residuals for waist circumference, glucose, triglycerides, HDL-cholesterol and mean arterial blood pressure were computed and then summed to compute a MR score (zMR). Linear regression analysis was used and all analyses were done in SPSS 20. RESULTS: Only 35.2% of children achieved 60 min/day of MVPA, and 50.4% of children were classified as overweight/obese. Mean MVPA was negatively associated with zMR (β=−0.018, p=0.013), while weight status was positively associated (β =1.903, p<0.001). No significant effect (p>0.05) was found for nutritional habits, time watching TV or sedentary time. CONCLUSIONS: Children with higher MVPA levels tend to have lower MR and those who are overweight/obese have higher MR. These results highlight the need to promote strategies to increase MVPA levels among youth in order to reduce weight gain and minimize MR development.

Young subjects with increased central adiposity have lower metabolic risk when cardiorespiratory fitness is augmented

Young subjects with increased central adiposity have lower metabolic risk when cardiorespiratory fitness is augmented

Associations among self-reported diabetes, nutritional status, and socio-demographic variables in community-dwelling older adults

Objective:The aim of this study was to describe relationships between self-reported diabetes mellitus and its treatment, according to demographic and socioeconomic data, as well as indicators of nutritional status in community-dwelling older adults.Methods:This is a population-based and a cross-sectional study derived from the multicentric survey "Frailty in Brazilian Elderly". The random sample consisted of 881 community-dwelling older adults aged 65 years and older from the city of Campinas. The self-reported variables were: age, gender, family income (minimum salaries), education (years of education); and absolute data (yes versusno) regarding unintentional weight loss and weight gain, diabetes, and its treatment. Anthropometric variables were collected by trained examiners following classic protocols. Body mass index was classified as: underweight &lt;23; normal weight ≥23 and &lt;28; overweight ≥28 and &lt;30; and obesity ≥30. Waist-to-hip ratio, indicator of abdominal adiposity, was classified according the metabolic risk, for male and female, respectively: low 0.90-0.95 and 0.80-0.85; moderate 0.96-1.00 and 0.86-0.90; and high &gt;1.00 and &gt;0.90.Results:The variables most associated with diabetes were obesity (OR=2.19), abdominal adiposity (OR=2.97), and unintentional weight loss (OR=3.38). The lack of diabetes treatment was associated with advanced age (p=0.027), lower educational level (p=0.005), and low metabolic risk (p=0.004).Conclusion: Self-reported diabetes was associated with obesity but mostly with abdominal adiposity and unintentional weight loss. Not being treated for diabetes mellituswas associated with advanced age, lower levels of education, and lower abdominal adiposity.

Improving metabolic and cardiovascular health at an early psychosis intervention program in vancouver, Canada.

Psychotic disorders most commonly appear during the late teenage years and early adulthood. A focused and rapid clinical response by an integrated health team can help to improve the quality of life of the patient, leading to a better long-term prognosis. The Vancouver Coastal Health early psychosis intervention program covers a catchment area of approximately 800,000 people in the cities of Vancouver and Richmond, Canada. The program provides a multidisciplinary approach to supporting patients under the age of 30 who have recently experienced first-break psychosis. The program addresses the needs of the treatment environment, medication, and psychological therapies. A critical part of this support includes a program to specifically improve patients’ physical health. Physical health needs are addressed through a two-pronged, parallel approach. Patients receive routine metabolic health assessments during their first year in the program, where standard metabolic parameters are recorded. Based on the results of clinical interviews and laboratory tests, specific actionable interventions are recommended. The second key strategy is a program that promotes healthy lifestyle goal development. Patients work closely with occupational therapists to develop goals to improve cardiometabolic health. These programs are supported by an active research environment, where patients are able to engage in studies with a focus on improving their physical health. These studies include a longitudinal evaluation of the effects of integrated health coaching on maintaining cardiometabolic health in patients recently admitted to the program, as well as a clinical study that evaluates the effects of low versus higher metabolic risk antipsychotic drugs on central adiposity. An additional pharmacogenomic study is helping to identify genetic variants that may predict cardiometabolic changes following treatment with antipsychotic drugs.

The direction of shift-work rotation impacts metabolic risk independent of chronotype and social jetlag – An exploratory pilot study

The aim of this pilot study was to explore the risk of metabolic abnormalities in steel workers employed in different shift-work rotations. Male workers in a steel factory [16 employed in a fast clockwise rotation (CW), 18 in slow counterclockwise rotation (CC), 9 day workers (DW); mean age 43.3 ± SD 6.8 years] with at least 5 years experience in their current work schedule participated. All workers provided fasting blood samples between 06:00 and 08:00 h for plasma glucose, insulin, apo-lipoproteins A and B (ApoA, ApoB), high- and low-density lipoproteins (HDL and LDL), total cholesterol (tCH), triglycerides (TG), minimally oxidized (mox) LDL, C-reactive protein (CRP), interleukin-8 (IL-8) and serum 25-hydroxyvitamin D (25(OH)D). HOMA index (homeostatic model assessment) was calculated to evaluate insulin resistance, beta cell function and risk of diabetes. Information on demographics, health, stimulants, sleep, social and work life, chronotype (phase of entrainment) and social jetlag (difference between mid-sleep on workdays and free days) as a surrogate for circadian disruption was collected by questionnaire. Neither chronotype nor social jetlag was associated with any of the metabolic risk blood markers. There were no significant differences in 25(OH)D, ApoA, ApoB, CRP, HDL, IL-8, insulin, LDL, mox-LDL, mox-LDL/ApoB ratio, tCH and TG levels between the three work groups. Although we did observe absolute differences in some of these markers, the small sample size of our study population might prevent these differences being statistically significant. Fasting glucose and HOMA index were significantly lower in CW compared to DW and CC, indicating lower metabolic risk. Reasons for the lower fasting glucose and HOMA index in CW workers remains to be clarified. Future studies of workers in different shift rotations are warranted to understand better the differential effects of shift-work on individual workers and their health indices.

Antipsychotic switching in bipolar disorders: a systematic review

With the increasingly widespread use of antipsychotics in bipolar disorder (BD), switching among these agents and between antipsychotics and mood stabilizers has become more common, in particular, since the introduction of the novel atypical antipsychotics with mood stabilizer properties. This systematic review aims to provide a comprehensive update of the current literature in BD about the switching of antipsychotics, among them and between them and mood stabilizers, in acute and maintenance treatment. We conducted a comprehensive, computerized literature search using terms related to antipsychotic switching in BD in the PubMed/Medline, PsycINFO, CINAHL database; the Cochrane Library and; the Clinicaltrials.gov web up to January 9th, 2013 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 4160 articles. After excluding duplications, reviews, case reports and studies that did not fulfil the selection criteria, 8 studies were included. Not only have few articles on antipsychotic switching been published but also recruitment in most studies included mixed samples of patients. In general, antipsychotic switching, regardless of the route of drug administration, was well tolerated and no interference was shown in antipsychotic effectiveness during the interchange of drugs. Metabolic improvement was perceived when the switch involved antipsychotics with a low metabolic risk profile. The evidence-base for antipsychotic switching in BD is scant, and little controlled data is available. Switch from quetiapine to lithium and from risperidone to olanzapine has proven successful. Switching to antipsychotics with low metabolic risk had some positive impact on several safety measures. In stabilized patients, the plateau cross-taper switch may be preferred.

Habitual energy intake and obesity trend in Malaysia

was decreased, while their fat free mass was relatively stable. It indicated that adequate nutrition and consistent physical exercise program in climbing could maintain normal body composition. In addition, biochemical parameters were also normal and stable, except for fairly significant fluctuation in two climbers probably due to genetic factor. Albumin and globulin were normal as well. On the other hand, triglyceride levels fairly decreased to almost below the normal value. Conclusions: The current study indicated that adequate nutritional intake and consistent physical exercise could maintain normal body composition, as the indicator of low metabolic disorder risk, despite exposure to physical stress and high impact climbing activity in terms of frequency as well as duration.

Prevalence and perceptions of overweight and obesity in Aboriginal and non‐Aboriginal young people in custody

To describe prevalence of and risk factors for overweight, obesity and self-perceived weight gain of Aboriginal and non-Aboriginal Australian young people in custody at baseline and over 12 months of follow-up. Prospective cohort study of youths in custody in New South Wales, from August 2009, with follow-up at 3, 6 and 12 months. Body mass index at baseline, categorised as overweight or obese using international cut-points; waist-to-height ratio (WHtR) at baseline, categorised as increased metabolic risk (≥ 0.5) or low metabolic risk (< 0.5); and self-perceived weight change at follow-up. At baseline, 452 youths were incarcerated, 361 (79.9%) consented to participate, and complete anthropometry measurements were taken for 303 (67.0%). At 3, 6 and 12 months, there were 231 (76.2%), 158 (52.1%) and 143 (47.2%) participants, respectively. Two-hundred and sixty-four (87.1%) were male, 151 (49.8%) were Aboriginal, and 145 (47.9%) had been incarcerated for < 3 months at baseline. One hundred and forty-five (47.9%) were overweight or obese and 112 (37.0%) had a WHtR of ≥ 0.5 at baseline. However, only 72 (24.1%) perceived themselves as overweight at baseline, and 154 (71.6%) perceived a weight increase since incarceration despite improvements in diet and exercise. Longer incarceration time was strongly associated with overweight and obesity in Aboriginal youths at baseline and with self-perceived weight gain in non-Aboriginal youths at follow-up. Overweight and obesity were highly prevalent but poorly recognised in young people in custody. A longer incarceration time had the strongest association with overweight obesity and self-reported weight gain. From a population health and policy perspective, changes to the liberal food environment and the approach to increasing physical activity in custody are warranted.

Cardiorespiratory Fitness Associates with Metabolic Risk Independent of Central Adiposity

This study sought to analyze the associations between cardiorespiratory fitness (CRF), waist circumference (WC) and metabolic risk in children and adolescents. Participants were 633 subjects (58.7% girls) ages 10-18 years. Metabolic risk score (MRS) was calculated from HDL-cholesterol, triglycerides, fasting glucose and mean arterial pressure. MRS was dichotomized into low and high metabolic risk (HMRS). CRF was defined as the maximal oxygen uptake (VO₂max) estimated from the 20 m Shuttle Run Test. The first quartile of CRF was set as the low fitness group. The fourth quartile of WC was defined as high central adiposity. With adjustments for age, sex and WC, CRF was correlated with MRS (r=-0.095; p<0.05). WC was correlated with MRS (r=0.150; p<0.001) after adjustments for age, sex and CRF. Participants who had low fitness levels, presented higher levels of MRS (p<0.001) compared to those who were fit, even after adjustment for age, sex and WC. In comparison with subjects who were fit with normal central adiposity, an increased odds ratio (OR) for being at HMRS was found for participants who were of low fitness level with high central adiposity (OR=2.934; 95%CI= 1.690-5.092) and for those who were of low fitness with normal central adiposity (OR=2.234; 95%CI=1.116-4.279). Results suggest that CRF relates to MRS independently of central adiposity.

Estimating the risk after gestational diabetes mellitus: can we improve the information from the postpartum OGTT?

Risk stratification after pregnancy with gestational diabetes mellitus (GDM) is based on screening with the 2-h oral glucose tolerance test (OGTT). Actually, prediabetes and diabetes are diagnosed by impaired fasting [fasting plasma glucose (FPG)] and 120 min-postload glucose levels (120'-PLG). We hypothesized that the clinical information could be improved by including measurements at different time points from the OGTT in the medical decision-making process. One hundred ten women with previous gestational diabetes (pGDM) and 41 controls were included 3-6 mo after delivery and underwent specific metabolic assessments: 3-h OGTT, frequently sampled intravenous glucose tolerance test (FSIGT) with markers of inflammation and endothelial function. pGDMs were annually invited for reexaminations for a maximum of 10 yr. Multiple linear regression suggested that postload glucose levels at 60 min (60'-PLG) were a better predictor for insulin sensitivity [β: -0.10, 95% confidence interval (CI) -0.14 to -0.05, P < 0.001] and disposition index (DI) (β: -0.07, 95% CI -0.12 to -0.02, P = 0.004) estimated from the FSIGT compared with other time points during the OGTT. The association between 60'-PLG and insulin secretion was of particular importance in women after GDM. We further identified associations of 60'-PLG with ultrasensitive C-reactive protein, plasminogen activator inhibitor 1, tissue plasminogen activator, endothelial-leukocyte adhesion molecule 1, and intercellular adhesion molecule (ICAM)-1. There appeared to be no interactions between females with pGDM and controls, suggesting comparable effects. We observed that 60'-PLG levels were closely related to the later onset of diabetes independent from the routinely measured FPG and 120'-PLG levels. Our data suggest that the sole interpretation of FPG and 120'-PLG of the OGTT leads to significant loss of information. Particularly 60'-PLG was shown to distinguish women at low or high metabolic and cardiovascular risk.

Distinct Developmental Signatures of Human Abdominal and Gluteal Subcutaneous Adipose Tissue Depots

Fat distribution differs in men and women, but in both sexes, a predominantly gluteal-femoral compared with abdominal (central) fat distribution is associated with lower metabolic risk. Differences in cellular characteristics and metabolic functions of these depots have been described, but the molecular mechanisms involved are not understood. Our objective was to identify depot- and sex-dependent differences in gene expression in human abdominal and gluteal sc adipose tissues. Abdominal and gluteal adipose tissue aspirates were obtained from 14 premenopausal women [age 27.5 ± 7.0 yr, body mass index (BMI) 27.3 ± 6.2 kg/m(2), and waist-to-hip ratio 0.82 ± 0.04] and 21 men (age 29.7±7.4 yr, BMI 27.2 ± 4.5 kg/m(2), and waist-to-hip ratio 0.91 ± 0.07) and transcriptomes were analyzed using Illumina microarrays. Expression of selected genes was determined in isolated adipocytes and stromal vascular fractions from each depot, and in in vitro cultures before and after adipogenic differentiation. A total of 284 genes were differentially expressed between the abdominal and gluteal depot, either specifically in males (n = 66) or females (n = 159) or in both sexes (n = 59). Most notably, gene ontology and pathway analysis identified homeobox genes (HOXA2, HOXA3, HOXA4, HOXA5, HOXA9, HOXB7, HOXB8, HOXC8, and IRX2) that were down-regulated in the gluteal depot in both sexes (P = 2 × 10(-10)). Conversely, HOXA10 was up-regulated in gluteal tissue and HOXC13 was detected exclusively in this depot. These differences were independent of BMI, were present in both adipocytes and stromal vascular fractions of adipose tissue, and were retained throughout in vitro differentiation. We conclude that developmentally programmed differences may contribute to the distinct phenotypic characteristics of peripheral fat.

Relationship between the adoption of preventive practices and the metabolic profile of women with prior gestational diabetes mellitus

Women with prior gestational diabetes mellitus (GDM) are encouraged to adopt healthy lifestyle behaviours to prevent or delay type 2 diabetes. The objective was to examine the association between the adoption of preventive practices and the metabolic profile of women with prior GDM. Analyses included 181 women who had GDM between 2003 and 2010. The preventive practices examined included (i) regular physical activity (≥150 min·week(-1)) assessed with the International Physical Activity Questionnaire; (ii) a healthy diet (score derived from the Alternate Healthy Eating Index and associated with a lower metabolic risk) evaluated from a food frequency questionnaire; and (iii) exclusive breastfeeding (≥6 months). Women were classified according to the number of preventive practices adopted. Waist circumference, weight, and height were measured and body mass index (BMI) was calculated. Fasting insulinemia and glycemia were obtained and Matsuda index for insulin sensitivity was calculated. Nearly one-third of women adopted none of the listed preventive practices. For each increase of 1 preventive practice adopted, women were 30% less likely to have a BMI ≥ 25 kg·m(-2) (odds ratio (OR): 0.70, 95% confidence interval (CI) (0.50-0.98)), they were 34% less likely to have a waist circumference ≥ 88 cm (OR: 0.66, 95%CI (0.47-0.92)) and they were 33% less likely to have a Matsuda index for insulin sensitivity < 9.69 (OR: 0.67, 95%CI (0.48-0.94)). These results suggest that women with prior GDM who adopt the recommended preventive practices in the years following delivery are less likely to have lower insulin sensitivity, less likely to be overweight-obese, and less likely to be characterized by abdominal obesity.

Relationship between Low Muscle Strength and Metabolic Risk Factors in Obese Postmenopausal Women: A Pilot Study

ObjectiveTo examine the relationship between low muscle strength and the metabolic profile in obese postmenopausal women. MethodsForty-seven obese postmenopausal women were recruited (age: 60 ± 5 y; body mass index: 34.1 ± 3.5 kg/m2). Obesity was defined as a fat mass % >40. Subjects were considered as having low muscle strength levels based on a cut-point of handgrip strength measurement of <28.56 kg. Outcome measures were anthropometric measurements, body composition (dual-energy x-ray absorptiometry [DXA]), handgrip strength and cardiometabolic risk factors (i.e. lipid profile, insulin sensitivity). ResultsNo significant differences were observed between women with low and normal handgrip strength for anthropometric measurements, body composition and lipid profile. However, we observed that insulin (p=0.049), glucose (p=0.036) and homeostatic model assessment (p=0.048) were significantly lower, and insulin sensitivity (Matsuda index) significantly higher (p=0.042) in women with low muscle strength compared to women with normal muscle strength. ConclusionLow muscle strength seems to be associated with a better insulinemic profile in obese postmenopausal women.

Metabolic risk profile of schoolchildren and joint physical activity with an adult in the household: Multilevel analysis

We aim to examine the relationship between metabolic risk (MR) profile and physical activity (PA) with an adult within the household. A total of 4761 schoolchildren (54% boys) aged 10-16 years old were categorized as either at high MR or low MR profile based on their weight and systolic blood pressure status. We assessed the frequency of PA with an adult within the household and fitness. Multilevel regressions were used to determine the likelihood of being at MR in schoolchildren. The proportion of males and females who engage in PA with adults daily was 17.4% and 10.4%, respectively. 16.5% male and 17.2% female did not engage in any PA with adults at all. Compared with those engaging in PA daily with adults in their household, schoolchildren who have reported no such PA were 54% (OR 1.54, 95% CI, 1.07-2.20) likely to have an elevated MR profile. Those who sometimes do PA with adult were 25% (OR 1.25, 95% CI, 0.82-1.93) more likely to have a higher MR profile. After adjusting for PA and fitness, PA with adults remains a determinant of MR profile in males. Compared with those that reported they daily did, schoolchildren were more likely to be unfit if they either sometimes engaged in PA with adults (OR 2.11, 95% CI, 1.44-3.09) or never (OR 2.89, 95% CI, 1.89-4.43). Joint PA with an adult within household could increase schoolchildren's fitness level and may reduce the risk of metabolic diseases.