Preterm birth and later insulin resistance:: effects of birth weight and postnatal growth in a population based longitudinal study from birth into adult life
Preterm birth and later insulin resistance:: effects of birth weight and postnatal growth in a population based longitudinal study from birth into adult life
复制标题
DOI：
10.1007/s00125-005-0118-y
复制
发表时间：
2006-03-01
期刊：
影响因子：
8.2
通讯作者：
Wit, JM
中科院分区：
文献类型：
--
作者：
Finken, MJJ;Keijzer-Veen, MG;Wit, JM
目的/假设：2型糖尿病的风险增加与足月妊娠后低出生体重有关，包括婴儿期和成年期体重增加对这种风险的放大。早产也与胰岛素抵抗有关，但迄今为止进行的研究还没有提供成年期的随访。我们研究了(1)低出生体重（作为标准差评分[SDS]）和婴儿体重增加对妊娠32周前出生的19岁儿童胰岛素抵抗的影响，以及(2)低出生体重SDS与婴儿体重增加之间以及低出生体重与成人身体组成之间对胰岛素抵抗的相互作用。方法：这是一项前瞻性随访研究，来自早产儿和小胎龄婴儿项目队列的346名受试者，在19岁时测量空腹血糖、胰岛素和c肽水平。胰岛素抵抗采用稳态模型计算（稳态模型评估胰岛素抵抗指数[HOMA-IR]）。结果：出生体重SDS与结局无关。婴儿体重快速增加至产后3个月与胰岛素水平升高呈弱相关（p=0.05）。成人肥胖与胰岛素、c肽水平和HOMA-IR呈正相关（均p < 0.001）。在这些参数上，出生体重SDS与成人脂肪量之间存在统计学上的交互作用（p=0.002 ~ 0.03）。结论/解释：在非常早产的受试者中，3个月前婴儿体重的快速增加预示着19岁时胰岛素水平的升高，但相关性较弱。成人肥胖强烈预测较高的胰岛素和c肽水平以及HOMA-IR。成人脂肪量对这些参数的影响取决于其与出生体重SDS的相互作用。
Aims/hypothesis: An increased risk of type 2 diabetes mellitus is associated with low birthweight after full-term gestation, including amplification of this risk by weight gain during infancy and adult body composition. Premature birth is also associated with insulin resistance, but studies conducted so far have not provided follow-up into adulthood. We studied the effects of (1) lower birthweight (as standard deviation score [SDS]) and infancy weight gain on insulin resistance in 19-year-olds born before 32 weeks of gestation, and (2) the interaction between lower birthweight SDS and infancy weight gain, as well as between lower birthweight and adult body composition, on insulin resistance. Methods: This was a prospective follow-up study in 346 subjects from the Project on Preterm and Small-for-gestational-age infants cohort, in whom fasting glucose, insulin and C-peptide levels were measured at 19 years. Insulin resistance was calculated with homeostatic modelling (homeostatic model assessment for insulin resistance index [HOMA-IR]). Results: Birthweight SDS was unrelated to the outcomes. Rapid infancy weight gain until 3 months post-term was weakly associated with higher insulin level (p=0.05). Adult fatness was positively associated with insulin and C-peptide levels and HOMA-IR (all p < 0.001). On these parameters, there was a statistical interaction between birthweight SDS and adult fat mass (p=0.002 to 0.03). Conclusions/interpretation: In subjects born very preterm, rapid infancy weight gain until 3 months predicted higher insulin levels at 19 years, but the association was weak. Adult obesity strongly predicted higher insulin and C-peptide levels as well as HOMA-IR. The effect of adult fat mass on these parameters was dependent on its interaction with birthweight SDS.