Wilkin Terence J, Metcalf Bradley S, Murphy Michael J, Kirkby Joanne, Jeffery Alison N, Voss Linda D
Department of Medicine, The Peninsula Medical School, Plymouth Campus, U.K. Department Clinical Chemistry, Derriford Hospital, Plymouth PL6 8DH, U.K.
Diabetes. 2002 Dec;51(12):3468-72. doi: 10.2337/diabetes.51.12.3468.
For more than a decade, the fetal programming hypothesis has taught that insulin resistance and its associated metabolic disturbances result from poor gestational environment, for which low birth weight is a surrogate. Low birth weight, however, is now uncommon in industrialized societies. We have investigated the relevance of birth weight, "catch-up" weight, and current weight to insulin resistance in 300 contemporary British children. Insulin resistance at 5 years was not related to birth weight but was correlated with current weight and weight catch-up in both sexes, more strongly so in girls (r = 0.33, P < 0.001 vs. r = 0.18, P = 0.03), who were intrinsically more insulin-resistant than boys. Weight change merely co-correlated with current weight (r = 0.67, P < 0.01 in both sexes) and did not improve on the prediction of insulin resistance. Most important, insulin resistance at 5 years was the same in children of heavier birth weight, whose weight SD score had not changed, as in those of lighter birth weight, matched for current weight, who had experienced so-called catch-up (boys 0.89 and 0.88 units, respectively, P = 0.96; girls 1.26 and 1.13 units, P = 0.41). Insulin resistance in contemporary children seems to be a function of excess current weight rather than of low birth weight or change in weight.
十多年来，胎儿编程假说一直认为胰岛素抵抗及其相关的代谢紊乱是由不良的妊娠环境导致的，低出生体重是其一个替代指标。然而，在工业化社会中，低出生体重现在并不常见。我们研究了出生体重、“追赶”体重和当前体重与300名当代英国儿童胰岛素抵抗的相关性。5岁时的胰岛素抵抗与出生体重无关，但与当前体重以及两性的体重追赶相关，在女孩中相关性更强（r = 0.33，P < 0.001，而男孩中r = 0.18，P = 0.03），女孩本身比男孩更易患胰岛素抵抗。体重变化仅与当前体重共同相关（两性中r = 0.67，P < 0.01），并且在预测胰岛素抵抗方面并无改善。最重要的是，出生体重较重且体重标准差分数未改变的儿童，与出生体重较轻但当前体重匹配且经历了所谓追赶的儿童，5岁时的胰岛素抵抗相同（男孩分别为0.89和0.88单位，P = 0.96；女孩为1.26和1.13单位，P = 0.41）。当代儿童的胰岛素抵抗似乎是当前体重超重的结果，而非低出生体重或体重变化的结果。
