Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA.
Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Pediatr Res. 2022 Sep;92(3):653-661. doi: 10.1038/s41390-021-01904-w. Epub 2021 Dec 16.
Accumulating evidence indicates that obesity and cardiometabolic risks become established early in life due to developmental programming and infants born as large for gestational age (LGA) are particularly at risk. This review summarizes the recent literature connecting LGA infants and early childhood obesity and cardiometabolic risk and explores potential preventive interventions in early infancy. With the rising obesity rates in women of childbearing age, the LGA birth rate is about 10%. Recent literature continues to support the higher rates of obesity in LGA infants. However, there is a knowledge gap for their lifetime risk for adverse cardiometabolic outcomes. Potential factors that may modify the risk in early infancy include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. The early postnatal period may be a critical window of opportunity for active interventions to mitigate or prevent obesity and potential adverse metabolic consequences in later life. A variety of promising candidate biomarkers for the early identification of metabolic alterations in LGA infants is also discussed. IMPACT: LGA infants are the greatest risk category for future obesity, especially if they experience rapid postnatal growth during infancy. Potential risk modifying secondary prevention strategies in early infancy in LGA infants include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. LGA infants may be potential low-hanging fruit targets for early preventive interventions in the fight against childhood obesity.
越来越多的证据表明，由于发育编程，肥胖和心脏代谢风险在生命早期就已确立，而出生时为巨大儿（LGA）的婴儿风险尤其高。这篇综述总结了近期将 LGA 婴儿与幼儿肥胖和心脏代谢风险联系起来的文献，并探讨了婴儿期早期潜在的预防干预措施。随着育龄妇女肥胖率的上升，LGA 的出生率约为 10%。最近的文献继续支持 LGA 婴儿肥胖率较高的观点。然而，对于他们一生中发生不良心脏代谢结局的风险，目前仍存在知识空白。可能会改变婴儿期早期风险的潜在因素包括出生后早期追赶性生长、减少体脂生长轨迹、延长母乳喂养时间以及保持健康的肠道微生物群。婴儿期早期可能是积极干预以减轻或预防肥胖及其在以后生活中潜在不良代谢后果的关键机会窗口。还讨论了各种有前途的候选生物标志物，用于早期识别 LGA 婴儿的代谢变化。影响：LGA 婴儿是未来肥胖的最大风险类别，尤其是如果他们在婴儿期经历快速的出生后生长。LGA 婴儿在婴儿期早期潜在的风险调节二级预防策略包括出生后早期追赶性生长、减少体脂生长轨迹、延长母乳喂养时间以及保持健康的肠道微生物群。LGA 婴儿可能是对抗儿童肥胖症的早期预防干预的潜在低挂果实目标。
