Yada K K, Gupta Rajeev, Gupta Arvind, Gupta Mukesh
Department of Paediatrics, SMS Medical College, Jaipur, India.
Indian J Med Res. 2003 Nov;118:197-203.
BACKGROUND & OBJECTIVES: Foetal undernutrition may have important role in adult insulin resistance and diabetes but insulin kinetics in very early life has not been well studied. The present study was undertaken to determine insulin levels in low birth weight neonates and compare with the levels in normal weight and high birth weight neonates.
Ten 7 day old children each of low birth weight (< 2500 g, Group 1), normal birth weight (2500-3500 g, Group 2) and high birth weight (> 3500 g, Group 3) selected successively over a period of one month were studied. All children were normally delivered at full term and were not suffering from any major illness. Detailed anthropometry was performed, a 6 h fasting blood sample was obtained for blood glucose, lipids, insulin and C-peptide estimation; 60 min after an intravenous glucose load a second sample was obtained for glucose and insulin. Insulin resistance was calculated using the homeostasis model assessment (HOMA).
Levels of total cholesterol, triglycerides, low density and high density lipoprotein cholesterol and glucose were not significantly different in the three groups. Mean fasting and post-glucose load insulin levels (microU/ml) were 2.78 +/- 2.23 and 3.28 +/- 2.04 in Group 1, 1.67 +/- 1.20 and 2.60 +/- 2.32 in Group 2 and 3.37 +/- 2.08 and 4.40 +/- 3.05 in Group 3 and fasting C-peptide levels (microg/ml) were 0.296 +/- 0.22, 0.208 +/- 0.09 and 0.327 +/- 0.23 respectively. There was no inter-group difference in insulin-glucose ratio, insulin levels adjusted for ponderal index and HOMA indices. A significant inverse quadratic correlation (U-shaped curve) of body weight with insulin (fasting and post-glucose) and C-peptide levels was observed (P < 0.05).
INTERPRETATION & CONCLUSION: Both low and high birth weight term neonates have high fasting and post-glucose insulin levels. This U-shaped trend suggests influence of foetal undernutrition (environmental) as well as genetic factors in these children.
胎儿期营养不足可能在成人胰岛素抵抗和糖尿病中起重要作用，但生命早期的胰岛素动力学尚未得到充分研究。本研究旨在测定低出生体重新生儿的胰岛素水平，并与正常体重和高出生体重新生儿的水平进行比较。
在一个月的时间里，依次选取10名出生7天的低出生体重儿（<2500克，第1组）、正常出生体重儿（2500 - 3500克，第2组）和高出生体重儿（>3500克，第3组）进行研究。所有儿童均为足月顺产，且未患任何重大疾病。进行详细的人体测量，采集6小时空腹血样以测定血糖、血脂、胰岛素和C肽水平；静脉注射葡萄糖负荷60分钟后，采集第二份血样测定血糖和胰岛素水平。使用稳态模型评估（HOMA）计算胰岛素抵抗。
三组儿童的总胆固醇、甘油三酯、低密度和高密度脂蛋白胆固醇以及血糖水平无显著差异。第1组空腹和葡萄糖负荷后胰岛素水平（微单位/毫升）分别为2.78±2.23和3.28±2.04，第2组分别为1.67±1.20和2.60±2.32，第3组分别为3.37±2.08和4.40±3.05，空腹C肽水平（微克/毫升）分别为0.296±0.22、0.208±0.09和0.327±0.23。胰岛素 - 葡萄糖比值、根据体重指数调整的胰岛素水平和HOMA指数在组间无差异。观察到体重与胰岛素（空腹和葡萄糖负荷后）及C肽水平呈显著的二次负相关（U形曲线）（P<0.05）。
低出生体重和高出生体重的足月新生儿空腹和葡萄糖负荷后胰岛素水平均较高。这种U形趋势表明胎儿期营养不足（环境因素）以及遗传因素对这些儿童有影响。
