Berry Mary J, Jaquiery Anne L, Oliver Mark H, Harding Jane E, Bloomfield Frank H
1Department of Paediatrics and Child Health,University of Otago,PO Box 7343, Wellington South, 6242,New Zealand.
2Liggins Institute,University of Auckland,Private Bag 92019, Auckland, 1142,New Zealand.
Br J Nutr. 2016 Dec;116(11):1912-1925. doi: 10.1017/S0007114516004013. Epub 2016 Dec 15.
The perinatal environment has a major influence on long-term health and disease risk. Preterm birth alters early-life environment and is associated with altered metabolic function in adulthood. Whether preterm birth per se or the early nutritional interventions used to support growth in preterm infants underpins this association is unknown. Lambs born preterm, following dexamethasone induction of labour, or spontaneously at term were randomised to receive nutrient supplementation, analogous to the milk fortifier used clinically or water as a control for the first 2 weeks after birth. Thereafter, nutrition was not different between groups. Growth was monitored, and the glucose-insulin axis function was assessed in juvenile (4 months) and adult life (14 months). Early nutrition influenced adult metabolic function and body composition to a greater extent than preterm birth. In supplemented females, arginine-stimulated insulin secretion was increased in preterm but reduced in term-born juveniles compared with controls (repeated-measures ANOVA P<0·01). In supplemented preterm males, adult weight, ponderal index (PI) and fasting insulin concentrations were elevated compared with preterm controls (weight, 75 (sem 3) v. 69 (sem 2) kg; PI, 48·0 (sem 2·1) v. 43·7 (sem 1·7) kg/m3; fasting insulin, 0·19 (sem 0·02) v. 0·10 (sem 0·02) ng/ml). Conversely, supplemented term-born males had reduced adult weight, PI and fasting insulin concentrations compared with term-born controls (weight, 64 (sem 2) v. 70 (sem 2) kg; PI, 44·4 (sem 1·8) v. 48·2 (sem 1·7) kg/m3; fasting insulin, 0·09 (sem 0·02) v. 0·14 (sem 0·02) ng/ml; all group×supplement interactions P<0·05). Adult metabolic health may reflect both gestational age at birth and early nutrition. Human studies are urgently needed to investigate the adult sex-specific health implications of neonatal nutritional strategies.
围产期环境对长期健康和疾病风险有重大影响。早产会改变早期生活环境，并与成年后的代谢功能改变有关。早产本身或用于支持早产儿生长的早期营养干预措施是否是这种关联的基础尚不清楚。通过地塞米松引产早产出生的羔羊，或足月自然出生的羔羊，在出生后的前2周被随机分组，分别接受类似于临床使用的牛奶强化剂的营养补充或作为对照的水。此后，各组之间的营养状况没有差异。监测生长情况，并在幼年（4个月）和成年期（14个月）评估葡萄糖-胰岛素轴功能。早期营养对成年代谢功能和身体成分的影响比早产更大。在补充营养的雌性中，与对照组相比，精氨酸刺激的胰岛素分泌在早产的幼年羊中增加，但在足月出生的幼年羊中减少（重复测量方差分析P<0.01）。在补充营养的早产雄性中，与早产对照组相比，成年体重、 ponderal指数（PI）和空腹胰岛素浓度升高（体重，75（标准误3）对69（标准误）kg；PI，48.0（标准误2.1）对43.7（标准误1.7）kg/m3；空腹胰岛素，0.19（标准误0.02）对0.10（标准误0.02）ng/ml）。相反，与足月出生的对照组相比，补充营养的足月出生雄性成年体重、PI和空腹胰岛素浓度降低（体重，64（标准误2）对70（标准误2）kg；PI，44.4（标准误1.8）对48.2（标准误1.7）kg/m3；空腹胰岛素，0.09（标准误0.02）对0.14（标准误0.02）ng/ml；所有组×补充剂交互作用P<0.05）。成人代谢健康可能反映出生时的胎龄和早期营养状况。迫切需要进行人体研究，以调查新生儿营养策略对成人特定性别的健康影响。
