Whincup P H, Cook D G, Adshead F, Taylor S J, Walker M, Papacosta O, Alberti K G
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Diabetologia. 1997 Mar;40(3):319-26. doi: 10.1007/s001250050681.
In adults low birthweight and thinness at birth are associated with increased risk of glucose intolerance and non-insulin-dependent diabetes mellitus. We have examined the relations between size at birth (birthweight, thinness at birth) and levels of plasma glucose and serum insulin in children, and compared them with the effects of childhood size. We performed a school-based survey of 10-11-year-old British children (response rate 64%) with measurements made after an overnight fast. One group of children (n = 591) was studied fasting while the other (n = 547) was studied 30 min after a standard oral glucose load (1.75 g/kg). Serum insulin was measured by a highly specific ELISA method. Birthweight was assessed by maternal recall and thinness at birth using birth records. Neither fasting nor post-load glucose levels showed any consistent relationship with birthweight or ponderal index at birth. After adjustment for childhood height and ponderal index, both fasting and post-load insulin levels fell with increasing birthweight. For each kg increase in birthweight, fasting insulin fell by 16.9% (95% confidence limits 7.1-25.8%, p = 0.001) and post-load insulin by 11.6% (95% confidence limits 3.5-19.1%, p = 0.007). However, the proportional change in insulin level for a 1 SD increase in childhood ponderal index was much greater than that for birthweight (27.2% and -8.8%, respectively, for fasting insulin). We conclude that low birthweight is not related to glucose intolerance at 10-11 years, but may be related to the early development of insulin resistance. However, in contemporary children obesity is a stronger determinant of insulin level and insulin resistance than size at birth.
在成年人中，出生时低体重和消瘦与葡萄糖耐量异常及非胰岛素依赖型糖尿病的风险增加相关。我们研究了儿童出生时的体型（出生体重、出生时消瘦情况）与血浆葡萄糖水平和血清胰岛素水平之间的关系，并将其与儿童期体型的影响进行了比较。我们对10 - 11岁的英国儿童进行了一项基于学校的调查（应答率64%），测量在过夜禁食后进行。一组儿童（n = 591）在禁食状态下接受研究，另一组（n = 547）在标准口服葡萄糖负荷（1.75 g/kg）后30分钟接受研究。血清胰岛素通过高度特异性的ELISA方法测量。出生体重通过母亲回忆评估，出生时消瘦情况使用出生记录评估。禁食和负荷后葡萄糖水平均未显示出与出生体重或出生时 ponderal 指数有任何一致的关系。在对儿童身高和 ponderal 指数进行调整后，禁食和负荷后胰岛素水平均随出生体重增加而下降。出生体重每增加1 kg，禁食胰岛素下降16.9%（95%置信区间7.1 - 25.8%，p = 0.001），负荷后胰岛素下降11.6%（95%置信区间3.5 - 19.1%，p = 0.007）。然而，儿童期 ponderal 指数每增加1个标准差，胰岛素水平变化的比例远大于出生体重增加时的变化比例（禁食胰岛素分别为27.2%和 - 8.8%）。我们得出结论，出生时低体重与10 - 11岁时的葡萄糖耐量异常无关，但可能与胰岛素抵抗的早期发展有关。然而，在当代儿童中，肥胖比出生时的体型是胰岛素水平和胰岛素抵抗更强的决定因素。
