School of Public Health, Peking University Health Science Center, Beijing, China.
Academy of Occupational Health and Occupational Medicine, Shandong, China.
Eur J Clin Nutr. 2021 Aug;75(8):1193-1204. doi: 10.1038/s41430-020-00831-z. Epub 2020 Dec 17.
Infants with congenital deficiency have high risk of glucose metabolism disorder, and often experience rapid growth in early childhood. However, the role of rapid growth on glucose metabolism is controversial. We conducted a systematic review and meta-analysis to examine the association of rapid growth with fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR). We searched EMBASE and Medline for English articles, and CNKI and WANFANG database for Chinese articles. Studies measuring the associations between rapid growth and insulin or HOMA-IR were included. Relevant information was extracted independently by two reviewers. Random effects model was adopted for combined and stratified analyses. At last, twenty-two relevant studies for insulin and 20 for HOMA-IR were identified. Rapid growth was associated with high insulin (weighted mean differences [WMD] 5.544, 95% confidence interval [CI] [1.436, 9.653], P = 0.008) and high HOMA-IR (WMD 0.194, 95% CI [0.098, 0.290], P < 0.001). This elevated association was statistically significant in rapid growth subjects that were >6 years old, full-term, and from developed countries. However, rapid growth among low birth weight subjects did not lead to high insulin and HOMA-IR, but decreased HOMA-IR among preterm children (WMD -0.305, 95% CI [-0.607, -0.004], P = 0.047). Follow-up age was positively correlated with HOMA-IR (r = 0.095, P < 0.001). This meta-analysis suggested that rapid growth would result in high insulin and HOMA-IR, especially for full-term infants. However, rapid growth is relatively harmless for subjects who are <6 years old, low birth weight or SGA, and is even protective for preterm subjects.
患有先天性缺陷的婴儿发生葡萄糖代谢紊乱的风险较高，且在儿童早期常经历快速生长。然而，快速生长对葡萄糖代谢的作用仍存在争议。我们进行了一项系统评价和荟萃分析，以检验快速生长与空腹胰岛素和稳态模型评估的胰岛素抵抗（HOMA-IR）之间的关系。我们检索了 EMBASE 和 Medline 中的英文文献，以及 CNKI 和 WANFANG 数据库中的中文文献。纳入了测量快速生长与胰岛素或 HOMA-IR 之间关联的研究。由两名评审员独立提取相关信息。采用随机效应模型进行合并和分层分析。最后，确定了 22 项关于胰岛素的相关研究和 20 项关于 HOMA-IR 的相关研究。快速生长与高胰岛素（加权均数差 [WMD] 5.544，95%置信区间 [CI] [1.436，9.653]，P = 0.008）和高 HOMA-IR（WMD 0.194，95% CI [0.098，0.290]，P < 0.001）相关。在年龄大于 6 岁、足月和来自发达国家的快速生长受试者中，这种升高的相关性具有统计学意义。然而，低出生体重受试者的快速生长并未导致高胰岛素和 HOMA-IR，但使早产儿的 HOMA-IR 降低（WMD -0.305，95% CI [-0.607，-0.004]，P = 0.047）。随访年龄与 HOMA-IR 呈正相关（r = 0.095，P < 0.001）。这项荟萃分析表明，快速生长会导致高胰岛素和 HOMA-IR，尤其是对足月婴儿而言。然而，对于年龄小于 6 岁、低出生体重或 SGA 的受试者，快速生长的危害相对较小，甚至对早产儿具有保护作用。
