Department of Pediatrics, Regional Institute of Maternal and Child Health, Dr SN Medical College, Jodhpur, India.
Indian J Pediatr. 2010 May;77(5):509-13. doi: 10.1007/s12098-010-0065-6. Epub 2010 Apr 17.
To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates.
Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test.
In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+/-0.23 vs 1.87+/-0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+/-9.8 vs 64.3+/-8.0 mg/dl) and fasting insulin levels (1.44+/-1.19 vs 1.73+/-1.38 microU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+/-0.3 vs 4.75+/-0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+/-9.4 vs 85.6+/-8.4 mg/dl) and fasting insulin levels (6.95+/-4.27 vs 15.73+/-3.29 microU/ml) (p<0.001). The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+/-3.3 microU/ml; p<0.001).
Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.
评估婴儿早期喂养方式对低出生体重儿（<2.5kg）空腹胰岛素水平（胰岛素抵抗标志物）的影响。
在该三级医疗中心，连续纳入胎龄>38 周、出生<10 天的 80 例低出生体重儿；其中 52 例（65%）父母同意参加研究。1 组（n=26）患儿随机接受单纯母乳喂养，2 组（n=26）接受商业化母乳强化剂强化母乳喂养。常规进行体格测量和健康状况评估。婴儿在 3 个月内每 15 天随访一次。在基线和 3 个月时测量 4 小时禁食血糖和胰岛素水平。使用 t 检验和 Mann-Whitney 检验进行统计学分析。
在单纯母乳喂养的 1 组中，与 2 组相比，平均出生体重相似（1.99+/-0.23 vs 1.87+/-0.30kg）。身长、头围和胸围无差异。平均血红蛋白水平、空腹血糖（63.9+/-9.8 vs 64.3+/-8.0mg/dl）和空腹胰岛素水平（1.44+/-1.19 vs 1.73+/-1.38μU/ml）也相似。在接受单纯母乳喂养的 1 组儿童中，3 个月随访时体重明显低于 2 组（3.40+/-0.3 vs 4.75+/-0.5kg，p<0.01）。这与空腹血糖（79.0+/-9.4 vs 85.6+/-8.4mg/dl）和空腹胰岛素水平（6.95+/-4.27 vs 15.73+/-3.29μU/ml）明显降低相关（p<0.001）。即使在调整 2 组体重增加后，差异仍持续存在（调整体重后胰岛素 11.26+/-3.3μU/ml；p<0.001）。
与单纯母乳喂养相比，3 月龄时接受强化母乳喂养的低出生体重儿空腹胰岛素水平更高。即使在调整强化奶喂养儿过度生长后，这种差异仍持续存在，提示存在不良的糖代谢编程。
