Bouhours-Nouet Natacha, Dufresne Sylvie, de Casson Florence Boux, Mathieu Elisabeth, Douay Olivier, Gatelais Frédérique, Rouleau Stéphanie, Coutant Régis
Department of Pediatric Endocrinology, University Hospital, 4 Rue Larrey, 49000 Angers, France.
Diabetes Care. 2008 May;31(5):1031-6. doi: 10.2337/dc07-1647. Epub 2008 Jan 25.
Low birth weight (LBW), no early catch-up weight, and subsequent fat accumulation have been associated with increased risks of insulin resistance from childhood onward and later cardiovascular disease. We sought to clarify the effects of high birth weight (HBW) and postnatal weight gain on insulin resistance.
A total of 117 obese children aged 10.4 +/- 2.4 years were divided into three groups according to fetal growth after exclusion of maternal diabetes. They were comparable for age, sex, puberty, and percent body fat. Customized French birth weight standards, adjusted for maternal characteristics and gestation number, identified subjects with true altered fetal growth: 32 had increased fetal growth according to customized standards (HBWcust), 52 were eutrophic, and 33 had restricted fetal growth according to customized standards (LBWcust). Fat distribution by dual-energy X-ray absorptiometry, insulin sensitivity indexes from an oral glucose tolerance test (OGTT), and leptin, adiponectin, and visfatin levels were compared between groups.
The HBWcust subjects had a higher adiponectin level, higher whole-body insulin sensitivity index (WBISI), and lower hepatic insulin resistance index, lower insulin and free fatty acid concentrations during OGTT, and lower trunk fat percent than eutrophic (P < 0.05) and LBWcust subjects (P < 0.05). Besides birth weight, weight gain between 0 and 2 years was a positive predictor (P < 0.05) of WBISI, whereas weight gain after 4 years was a negative predictor (P < 0.05).
HBW and early weight gain may program insulin sensitivity and adipose tissue metabolism and contribute to so-called metabolically healthy obesity.
低出生体重（LBW）、无早期追赶性体重增加以及随后的脂肪堆积与儿童期起胰岛素抵抗风险增加以及后期心血管疾病相关。我们试图阐明高出生体重（HBW）和出生后体重增加对胰岛素抵抗的影响。
排除母亲患有糖尿病的情况后，根据胎儿生长情况将117名10.4±2.4岁的肥胖儿童分为三组。他们在年龄、性别、青春期和体脂百分比方面具有可比性。根据母亲特征和妊娠次数调整的定制法国出生体重标准，确定了胎儿生长真正改变的受试者：根据定制标准，32名胎儿生长增加（HBWcust），52名营养正常，33名胎儿生长受限（LBWcust）。比较了各组之间通过双能X线吸收法测得的脂肪分布、口服葡萄糖耐量试验（OGTT）的胰岛素敏感性指数以及瘦素、脂联素和内脂素水平。
与营养正常组（P<0.05）和LBWcust组受试者（P<0.05）相比，HBWcust组受试者脂联素水平更高、全身胰岛素敏感性指数（WBISI）更高、肝脏胰岛素抵抗指数更低、OGTT期间胰岛素和游离脂肪酸浓度更低、躯干脂肪百分比更低。除出生体重外，0至2岁之间的体重增加是WBISI的正向预测因子（P<0.05），而4岁后的体重增加是负向预测因子（P<0.05）。
高出生体重和早期体重增加可能会设定胰岛素敏感性和脂肪组织代谢，并导致所谓的代谢健康型肥胖。
