Are third-trimester adipokines associated with higher metabolic risk among women with gestational diabetes?

AIM: This study aimed to determine whether third-trimester adipokines during gestational diabetes (GDM) are associated with higher metabolic risk. METHODS: A total of 221 women with GDM (according to IADPSG criteria) were enrolled between 2011/11 and 2013/6 into a prospective observational study (IMAGE), and categorized as having elevated fasting blood glucose (FBG) or impaired fasting glucose (IFG, n = 36) if levels were ≥ 92 mg/dL during a 75-g oral glucose tolerance test (OGTT), impaired glucose tolerance (IGT, n = 116) if FBG was < 92 mg/dL but with elevated 1-h or 2-h OGTT values, or impaired fasting and stimulated blood glucose (IFSG, n = 69) if both FBG was ≥ 92 mg/dL and 1-h or 2-h OGTT values were elevated. RESULTS: Pre-gestational body mass index (BMI) was higher in women with IFG or IFSG compared with IGT (P < 0.001), as were leptin levels in women with IFG vs IGT [34.7 (10.5-119.7) vs 26.6 (3.56-79.4) ng/L; P = 0.008]. HOMA2-IR scores were higher in women with IFG or IFSG vs IGT (1.87 ± 1.2 or 1.72 ± 0.9 vs 1.18 ± 0.8, respectively; P < 0.001). Also, those with IFSG vs those with IGT had significantly lower HOMA2-B scores (111.4 ± 41.3 vs 127.1 ± 61.6, respectively; P < 0.05) and adiponectin levels [5.00 (1.11-11.3) vs 6.19 (2.11-17.7) µg/mL; P < 0.001], and higher levels of IL-6 [1.14 (0.33-20.0) vs 0.90 (0.31-19.0); P = 0.012] and TNF-α [0.99 (0.50-10.5) vs 0.84 (0.45-11.5) pg/mL; P = 0.003]. After adjusting for age, parity, and pre-gestational and gestational BMI, the difference in adiponectin levels remained significant. CONCLUSION: Diagnosing GDM by IADSPG criteria results in a wide range of heterogeneity. Our study has indicated that adipokine levels in addition to FBG may help to select women at high metabolic risk for appropriate monitoring and post-delivery interventions (ClinicalTrials.gov number NCP02133729).

[Long-term results of vertical banded gastroplasty for morbid obesity]. / Résultats à distance de la gastroplastie verticale calibrée pour obésité morbide.

UNLABELLED: Morbid obesity, defined by Body Mass Index (BMI) > 40 kg/m2, has an adverse effect on longevity due to a variety of illnesses. Among the numerous techniques proposed to control morbid obesity, Vertical Banded Gastroplasty (VBG) changes eating behavior. The aim of this study was to analyse the long term results of VBG. MATERIAL AND METHODS: Between October 1987 and July 1993, 62 patients, 7 men and 55 women, from 20 to 68 years old (Mean: 37.4 +/- 9 ans), underwent VBG for morbid obesity. Preoperative mean weight and BMI were 123 +/- 27 kg and 47.3 +/- 9.8 kg/m2 respectively. Associated diseases were diabetes mellitus (n = 31), hypertension (N = 29), hypercholesterolemia (N = 10), hypertriglyceridemia (N = 21) and joint diseases (N = 18). RESULTS: VBG was performed with a 50 mm marlex mesh in 20 cases and with a 47 to 50 mm silastic ring in 42 cases. On patient died 3 years later from alcoholic liver cirrhosis and 4 were lost to follow-up. With a mean follow-up of 31 months, mean weight and BMI were 86 +/- 21 kg (p < 0.001) and 32.1 +/- 9.8 kg/m2 (p < 0.001) respectively. Removal of the ring was performed in 3 cases, 1 because of neurologic complications and 2 at the patient's request. Eight patients (13%) failed to achieve satisfactory weight loss. Diabetes mellitus and hypertension resolved in 19 cases, hypercholesterolemia resolved in 7 cases and hypertriglyceridemia resolved in 11. CONCLUSION: VBG provides significant weight loss which reduces the frequency of medical disorders associated with obesity. This result was achieved in 87% of patients. The surgical procedure for morbid obesity must be decided conjointly with endocrinologist, psychiatrist and surgical staff for good long-term results.