Giapros Vasileios I, Challa Anna S, Cholevas Vasileios I, Evagelidou Eleni N, Bairaktari Eleni T, Andronikou Styliani K
J Pediatr Endocrinol Metab. 2014 Nov;27(11-12):1145-50. doi: 10.1515/jpem-2013-0327.
Low vitamin D [25(OH)D] levels have been associated with type-2 diabetes mellitus. Children born large for gestational age (LGA) may exhibit increased indices of insulin resistance early in life.
This study aims to prospectively examine serum 25(OH)D and parathormone (iPTH) levels in LGA and appropriate for gestational age (AGA) prepubertal children, in relation to the severity of macrosomia and insulin resistance.
Children were examined at age 5-7.5 years, 38 born LGA and 39 AGA, matched for age, gender, body weight, height and body mass index (BMI). Twenty-one LGA had birth weights in the 90th-97th percentile and 17 >97th percentile. Fasting serum levels of glucose, insulin, 25(OH)D, and iPTH were measured. The homeostasis model assessment for insulin resistance (HOMA-IR) was estimated.
The insulin resistance indices were higher in the LGA >97th percentile subgroup than in the AGA group: HOMA-IR 1.53±0.66 vs. 1.04±0.53 and fasting insulin 6.92±3.1 vs. 4.78±2.2 μIU/mL (but similar to the AGA group), and in the LGA 90th-97th percentile subgroup: HOMA-IR 1.17±0.61 and insulin 5.53±2.2. There was no difference in 25(OH)D among the three subgroups. The iPTH was higher in the LGA >97th percentile subgroup than in the AGA group (26.8±7.6 and 22.6±7.2 pg/mL, respectively, p<0.05), although it was not correlated with insulin resistance indices. Birth weight was correlated negatively with fasting insulin and HOMA-IR in the entire cohort, independent of age, sex, waist circumference, and BMI (β=0.37, p<0.01 and β=0.30, p<0.05, respectively), while waist circumference was positively correlated with HOMA-IR (R=0.40, p<0.001).
Birth weight and current body composition appear to affect glucose homeostasis in LGA prepubertal children, while the serum levels of 25(OH)D and iPTH appear to be uninvolved.
低维生素D[25(OH)D]水平与2型糖尿病有关。大于胎龄儿（LGA）出生的儿童在生命早期可能表现出胰岛素抵抗指标增加。
本研究旨在前瞻性地检测LGA和适于胎龄儿（AGA）青春期前儿童的血清25(OH)D和甲状旁腺激素（iPTH）水平，并分析其与巨大儿严重程度和胰岛素抵抗的关系。
对5至7.5岁的儿童进行检查，38名LGA出生儿童和39名AGA出生儿童，在年龄、性别、体重、身高和体重指数（BMI）方面进行匹配。21名LGA出生儿童的出生体重在第90至97百分位，17名出生体重>第97百分位。测量空腹血清葡萄糖、胰岛素、25(OH)D和iPTH水平。评估胰岛素抵抗的稳态模型评估（HOMA-IR）。
出生体重>第97百分位的LGA亚组的胰岛素抵抗指数高于AGA组：HOMA-IR为1.53±0.66 vs. 1.04±0.53，空腹胰岛素为6.92±3.1 vs. 4.78±2.2 μIU/mL（但与AGA组相似）；出生体重在第90至97百分位的LGA亚组：HOMA-IR为1.17±0.61，胰岛素为5.53±2.2。三个亚组之间的25(OH)D没有差异。出生体重>第97百分位的LGA亚组的iPTH高于AGA组（分别为26.8±7.6和22.6±7.2 pg/mL，p<0.05），尽管它与胰岛素抵抗指数无关。在整个队列中，出生体重与空腹胰岛素和HOMA-IR呈负相关，独立于年龄、性别、腰围和BMI（β=0.37，p<0.01和β=0.30，p<0.05），而腰围与HOMA-IR呈正相关（R=0.40，p<0.001）。
出生体重和当前身体组成似乎影响LGA青春期前儿童的葡萄糖稳态，而血清25(OH)D和iPTH水平似乎与之无关。
