Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany.
Pediatr Diabetes. 2010 Sep;11(6):431-7. doi: 10.1111/j.1399-5448.2009.00624.x. Epub 2009 Dec 30.
Former small for gestational age (SGA) children are at risk of both obesity and insulin resistance. Longitudinal studies are required to assess a possible relationship between former SGA status and insulin resistance independent of weight status. We hypothesized that obese children with former appropriate for gestational age (AGA) status improve their insulin resistance during weight loss more effectively compared to obese children with former SGA status.
A 1-yr longitudinal follow-up study design was adopted in the primary care setting and 341 obese children [8% SGA, mean age 10.5 +/- 0.1 yr, body mass index (BMI) 27.7 +/- 0.2, BMI-standard deviation score (SDS) 2.47 +/- 0.02] were taken for the study. Outpatient 1-yr intervention was based on exercise, behavior and nutrition therapy. We measured insulin resistance index following the Homeostasis model assessment model (HOMA), blood pressure, lipids, glucose, and insulin in all children before and after the 1-yr intervention.
In a multiple linear regression analysis adjusted for age, gender, and pubertal stage, changes of HOMA were significantly related to changes of BMI-SDS (-2.55 per loss of 1 BMI-SDS unit; p < 0.001) and SGA status (+2.05 for SGA children; p < 0.001). Changes of BMI-SDS together with gender and age explained 10% of the variance of changes of HOMA, while SGA status explained an additional 4%. After adjustment for age, sex, pubertal stage, and BMI-SDS, former SGA status was not significantly related to any other considered cardiovascular risk factor.
Change of weight status predicted change of HOMA in obese children participating in a lifestyle intervention. Changes of HOMA were also predicted by former SGA status supporting that former SGA status influences insulin resistance.
既往宫内生长受限（SGA）的儿童存在肥胖和胰岛素抵抗的风险。需要进行纵向研究，以评估既往 SGA 状态与胰岛素抵抗之间的关系，而不考虑体重状况。我们假设，与既往 SGA 状态的肥胖儿童相比，既往适合胎龄（AGA）状态的肥胖儿童在减肥过程中改善胰岛素抵抗的效果更好。
采用初级保健环境中的 1 年纵向随访研究设计，对 341 名肥胖儿童（8%为 SGA，平均年龄 10.5±0.1 岁，体重指数（BMI）27.7±0.2，BMI-标准差评分（SDS）2.47±0.02）进行研究。门诊 1 年干预基于运动、行为和营养治疗。在 1 年干预前后，我们使用稳态模型评估（HOMA）模型测量了所有儿童的胰岛素抵抗指数、血压、血脂、血糖和胰岛素。
在调整年龄、性别和青春期阶段的多元线性回归分析中，HOMA 的变化与 BMI-SDS 的变化（每损失 1 BMI-SDS 单位减少 2.55；p<0.001）和 SGA 状态（SGA 儿童增加 2.05；p<0.001）显著相关。BMI-SDS 的变化与性别和年龄一起解释了 HOMA 变化的 10%，而 SGA 状态解释了另外的 4%。在调整年龄、性别、青春期阶段和 BMI-SDS 后，既往 SGA 状态与任何其他考虑的心血管危险因素均无显著相关性。
在参加生活方式干预的肥胖儿童中，体重状态的变化预测了 HOMA 的变化。HOMA 的变化也与既往 SGA 状态相关，这表明既往 SGA 状态会影响胰岛素抵抗。
