Chiavaroli Valentina, Marcovecchio Maria Loredana, de Giorgis Tommaso, Diesse Laura, Chiarelli Francesco, Mohn Angelika
Department of Paediatrics, University of Chieti, Chieti, Italy; Center of Excellence on Aging, "G. d'Annunzio" University Foundation, University of Chieti, Chieti, Italy.
Department of Paediatrics, University of Chieti, Chieti, Italy.
PLoS One. 2014 Aug 12;9(8):e104278. doi: 10.1371/journal.pone.0104278. eCollection 2014.
Subjects born small (SGA) and large (LGA) for gestational age have an increased risk of cardio-metabolic alterations already during prepuberty. Nevertheless, the progression of their cardio-metabolic profile from childhood to adolescence has not been fully explored. Our aim was to assess potential changes in the cardio-metabolic profile from childhood to adolescence in subjects born SGA and LGA compared to those born appropriate (AGA) for gestational age.
This longitudinal study included 35 AGA, 24 SGA and 31 LGA subjects evaluated during childhood (mean age (± SD) 8.4 ± 1.4 yr) and then re-assessed during adolescence (mean age 13.3 ± 1.8 yr). BMI, blood pressure, insulin resistance (fasting insulin, HOMA-IR) and lipids were assessed. A cardio-metabolic risk z-score was applied and this consisted in calculating the sum of sex-specific z-scores for BMI, blood pressure, HOMA-IR, triglycerides and triglycerides:high-density lipoprotein cholesterol ratio.
Fasting insulin and HOMA-IR were higher in SGA and LGA than AGA subjects both during childhood (all P<0.01) and adolescence (all P<0.01). Similarly, the clustered cardio-metabolic risk score was higher in SGA and LGA than AGA children (both P<0.05), and these differences among groups increased during adolescence (both P<0.05). Of note, a progression of the clustered cardio-metabolic risk score was observed from childhood to adolescence within SGA and within LGA subjects (both P<0.05).
SGA and LGA subjects showed an adverse cardio-metabolic profile during childhood when compared to AGA peers, with a worsening of this profile during adolescence. These findings indicate an overtime progression of insulin resistance and overall estimated cardiovascular risk from childhood to adolescence in SGA and LGA populations.
小于胎龄儿（SGA）和大于胎龄儿（LGA）在青春期前就已经有发生心脏代谢改变的风险增加。然而，他们从儿童期到青春期的心脏代谢状况进展尚未得到充分研究。我们的目的是评估与适于胎龄儿（AGA）相比，SGA和LGA出生的儿童从儿童期到青春期心脏代谢状况的潜在变化。
这项纵向研究纳入了35名AGA、24名SGA和31名LGA受试者，在儿童期（平均年龄（±标准差）8.4±1.4岁）进行评估，然后在青春期（平均年龄13.3±1.8岁）重新评估。评估了体重指数、血压、胰岛素抵抗（空腹胰岛素、稳态模型评估胰岛素抵抗指数）和血脂。应用了心脏代谢风险z评分，其包括计算体重指数、血压、稳态模型评估胰岛素抵抗指数、甘油三酯和甘油三酯：高密度脂蛋白胆固醇比值的性别特异性z评分之和。
在儿童期（所有P<0.01）和青春期（所有P<0.01），SGA和LGA受试者的空腹胰岛素和稳态模型评估胰岛素抵抗指数均高于AGA受试者。同样，SGA和LGA儿童的综合心脏代谢风险评分高于AGA儿童（均P<0.05），且这些组间差异在青春期增加（均P<0.05）。值得注意的是，在SGA和LGA受试者中均观察到从儿童期到青春期综合心脏代谢风险评分的进展（均P<0.05）。
与AGA同龄人相比，SGA和LGA受试者在儿童期表现出不良的心脏代谢状况，在青春期这种状况会恶化。这些发现表明SGA和LGA人群从儿童期到青春期胰岛素抵抗和总体估计心血管风险呈随时间进展的趋势。
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