Ibáñez Lourdes, Suárez Larisa, Lopez-Bermejo Abel, Díaz Marta, Valls Carme, de Zegher Francis
Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.
J Clin Endocrinol Metab. 2008 Mar;93(3):925-8. doi: 10.1210/jc.2007-1618. Epub 2007 Dec 18.
The sequence of prenatal growth restraint and infantile catch-up of weight is by the age of 4 yr associated with hyperinsulinemic adiposity. We studied whether the adiposity of post-catch-up children born small for gestational age (SGA) is further amplified between age 4 and 6 yr and whether visceral fat excess has already emerged by the age of 6 yr.
The study took place at a university hospital.
A longitudinal cohort (age 2-6 yr) of 22 children born appropriate for gestational age (AGA) and 29 born SGA were studied. Auxological, endocrine, metabolic, and body composition (by absorptiometry) assessments were made at 2, 4, and 6 yr, and visceral fat was assessed (by magnetic resonance imaging) at 6 yr.
Outcome measures included fasting glucose, insulin, IGF-I, neutrophil to lymphocyte ratio, lean mass, and total, abdominal, and visceral fat mass.
Between ages 4-6 yr, the relative adiposity of SGA children was further amplified. Between ages 2-6 yr, SGA children gained more total and abdominal fat and raised their insulin, IGF-I, and neutrophil to lymphocyte ratio more than did AGA children (all P<0.0001). At age 6 yr, the average amount of visceral fat was in SGA children more than 50% higher than in AGA children (P<0.005). The 0- to 2-yr increment in weight Z-score together with the 2- to 6-yr increment in fasting insulin accounted for 62% of visceral fat variability at age 6 yr.
The amount of visceral fat is in post-catch-up SGA children excessive by the age of 6 yr. In populations at risk for type 2 diabetes or metabolic syndrome after fetal growth restraint, the time window for early intervention may have to be advanced into prepubertal childhood.
产前生长受限及婴儿期体重追赶的过程到4岁时与高胰岛素血症性肥胖相关。我们研究了小于胎龄儿（SGA）在追赶生长后4至6岁期间肥胖是否会进一步加剧，以及6岁时内脏脂肪过多的情况是否已经出现。
该研究在一家大学医院进行。
对22名适于胎龄儿（AGA）出生的儿童和29名SGA出生的儿童进行了纵向队列研究（年龄2至6岁）。在2岁、4岁和6岁时进行了体格学、内分泌、代谢和身体成分（通过吸收法）评估，并在6岁时通过磁共振成像评估了内脏脂肪。
结局指标包括空腹血糖、胰岛素、胰岛素样生长因子-I（IGF-I）、中性粒细胞与淋巴细胞比值、瘦体重以及总脂肪量、腹部脂肪量和内脏脂肪量。
在4至6岁期间，SGA儿童的相对肥胖进一步加剧。在2至6岁期间，SGA儿童比AGA儿童获得了更多的总脂肪和腹部脂肪，并且胰岛素、IGF-I水平以及中性粒细胞与淋巴细胞比值升高得更多（所有P<0.0001）。在6岁时，SGA儿童的平均内脏脂肪量比AGA儿童高50%以上（P<0.005）。体重Z评分从0至2岁的增加量与空腹胰岛素从2至6岁的增加量共同解释了6岁时内脏脂肪变异性的62%。
SGA儿童在追赶生长后到6岁时内脏脂肪量过多。在胎儿生长受限后有患2型糖尿病或代谢综合征风险的人群中，早期干预的时间窗可能需要提前到青春期前儿童期。
