Regan Fiona M, Cutfield Wayne S, Jefferies Craig, Robinson Elizabeth, Hofman Paul L
Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
Pediatrics. 2006 Nov;118(5):1943-9. doi: 10.1542/peds.2006-0733.
Children born prematurely have decreased insulin sensitivity. The etiology of this insulin resistance is unknown. The aim of this study was to evaluate infant nutrition and its influence on insulin sensitivity and postnatal growth in children born < or = 32 weeks' gestation.
A total of 56 healthy, developmentally normal, prepubertal children, aged 4 to 10 years were recruited. Thirty-seven were born < or = 32 weeks' gestation, and 19 were control subjects born at term with a birth weight > 10th percentile. Insulin sensitivity (10(-4) min(-1) microU/mL) was calculated from a 90-minute frequently sampled intravenous glucose tolerance test. Perinatal, nutritional, and growth data were obtained retrospectively from both neonatal and early infancy records in the premature cohort.
Children born prematurely had decreased insulin sensitivity when compared with those born at term (13.8 vs 30.6). Neonatal nutrition was not correlated with insulin sensitivity; however, all of the infants had inadequate protein in the first month followed by excessive fat intake thereafter. Premature children with greater weight gain had lower insulin sensitivity. Higher carbohydrate intake in the first month of life was associated with greater weight gain from birth. No relationship was seen between weight gain and either protein or lipid intake.
Prematurely born children are insulin resistant and have suboptimal neonatal nutrition. Greater childhood weight gain magnifies this reduction in insulin sensitivity and seems to be associated with early nutrition. We speculate that a high carbohydrate neonatal diet may lead to greater weight gain and a greater reduction in insulin sensitivity in this group.
早产出生的儿童胰岛素敏感性降低。这种胰岛素抵抗的病因尚不清楚。本研究的目的是评估孕周≤32周出生儿童的婴儿营养及其对胰岛素敏感性和出生后生长的影响。
共招募了56名健康、发育正常、青春期前的4至10岁儿童。其中37名出生时孕周≤32周，19名作为对照，足月出生且出生体重>第10百分位数。胰岛素敏感性（10⁻⁴ min⁻¹ μU/mL）通过90分钟频繁采样静脉葡萄糖耐量试验计算得出。早产队列的围产期、营养和生长数据通过回顾新生儿和婴儿早期记录获得。
与足月出生的儿童相比，早产出生的儿童胰岛素敏感性降低（13.8对30.6）。新生儿营养与胰岛素敏感性无关；然而，所有婴儿在出生后第一个月蛋白质摄入不足，此后脂肪摄入过量。体重增加较多的早产儿童胰岛素敏感性较低。出生后第一个月较高的碳水化合物摄入量与出生后的体重增加较多有关。体重增加与蛋白质或脂肪摄入之间均无关联。
早产出生的儿童存在胰岛素抵抗且新生儿营养欠佳。儿童期体重增加较多会放大这种胰岛素敏感性的降低，且似乎与早期营养有关。我们推测，高碳水化合物的新生儿饮食可能导致该组儿童体重增加更多且胰岛素敏感性降低更明显。
