He Hua, Zhu Wen-Ting, Nuyt Anne Monique, Marc Isabelle, Julien Pierre, Huang Rong, Dubois Lise, Wei Shu-Qin, Zhang Jun, Levy Emile, Fraser William D, Luo Zhong-Cheng
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Department of Behavioral Pediatrics and Child Primary Care, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China.
Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke J1H 5N4, Canada.
J Clin Endocrinol Metab. 2021 Jul 13;106(8):e3049-e3057. doi: 10.1210/clinem/dgab178.
Small-for-gestational-age (SGA) is an indicator of poor fetal growth "programming" an elevated risk of type 2 diabetes in adulthood. Little is known about early-life endocrine characteristics in SGA subtypes. Stunting (short) and wasting (skinny) are considered distinct SGA phenotypes in neonatal prognosis.
This work aimed to assess whether SGA infants with stunting or wasting have similar alterations in neonatal endocrine metabolic health biomarkers.
This was a nested case-control study based on the 3D (Design, Develop, and Discover) birth cohort in Canada. The study subjects were 146 SGA (birth weight < 10th percentile) and 155 optimal-for-gestational age (OGA, 25th-75th percentiles) infants. Stunting was defined as birth length less than the 10th percentile, and wasting as body mass index less than the 10th percentile for sex and gestational age, respectively. Main outcome measures included cord plasma concentrations of insulin-like growth factor I (IGF-I), proinsulin, leptin, high-molecular-weight (HMW) adiponectin, and ghrelin.
Comparing to OGA infants adjusted for maternal and neonatal characteristics, SGA infants with either stunting only or wasting only had lower cord plasma IGF-I and leptin concentrations. HMW adiponectin concentrations were lower in SGA infants with wasting only (P = .004), but similar in SGA infants with stunting only (P = .816). Only SGA infants with both stunting and wasting had substantially lower proinsulin (P < .001) and higher ghrelin concentrations (P < .001) than OGA infants.
This study is the first to demonstrate that SGA infants with wasting only are characterized by low HMW adiponectin concentrations, whereas those with stunting only are not. SGA with both stunting and wasting are characterized by low proinsulin and high ghrelin concentrations.
小于胎龄儿（SGA）是胎儿生长发育不良的一个指标，预示着成年后患2型糖尿病的风险升高。目前对于SGA各亚型的早期内分泌特征知之甚少。发育迟缓（身材矮小）和消瘦（体重过轻）在新生儿预后方面被认为是不同的SGA表型。
本研究旨在评估发育迟缓或消瘦的SGA婴儿在新生儿内分泌代谢健康生物标志物方面是否有相似的改变。
这是一项基于加拿大3D（设计、开发和发现）出生队列的巢式病例对照研究。研究对象为146例SGA（出生体重低于第10百分位数）婴儿和155例适于胎龄儿（OGA，第25 - 75百分位数）婴儿。发育迟缓定义为出生身长低于第10百分位数，消瘦分别定义为按性别和胎龄计算的体重指数低于第10百分位数。主要观察指标包括脐血血浆中胰岛素样生长因子I（IGF - I）、胰岛素原、瘦素、高分子量（HMW）脂联素和胃饥饿素的浓度。
与根据母体和新生儿特征进行调整后的OGA婴儿相比，仅发育迟缓或仅消瘦的SGA婴儿脐血血浆IGF - I和瘦素浓度较低。仅消瘦的SGA婴儿HMW脂联素浓度较低（P = 0.004），而仅发育迟缓的SGA婴儿中该浓度相似（P = 0.816）。与OGA婴儿相比，只有同时存在发育迟缓和消瘦的SGA婴儿胰岛素原浓度显著降低（P < 0.001）且胃饥饿素浓度升高（P < 0.001）。
本研究首次表明，仅消瘦的SGA婴儿的特征是HMW脂联素浓度低，而仅发育迟缓的婴儿则不是。同时存在发育迟缓和消瘦的SGA婴儿的特征是胰岛素原浓度低和胃饥饿素浓度高。
