Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, INSULIN-RESISTANCE, PLACENTAL RESTRICTION, YOUNG LAMB, ADIPOSITY, SENSITIVITY, OBESITY, RISK, Adiposity, Birth Weight, Child, Child, Preschool, Growth, Humans, Infant, Newborn, Infant, Small for Gestational Age, Insulin, Intra-Abdominal Fat, Longitudinal Studies, 1103 Clinical Sciences, 1114 Paediatrics and Reproductive Medicine, 3202 Clinical sciences

Abstract:

Context: The sequence of prenatal growth restraint and infantile catch-up of weight is by the age of 4 yr associated with hyperinsulinemic adiposity. We studied whether the adiposity of post-catchup children born small-for-gestational-age (SGA) is further amplified between age 4 and 6 yr, and whether visceral fat excess has already emerged by the age of 6 yr. Setting: University Hospital. Study Population and Design: Longitudinal cohort (age 2-6 yr) of 22 children born appropriate-for-gestational-age (AGA) and 29 born SGA. Auxological, endocrine, metabolic and body composition (by absorptiometry) assessments at 2, 4 and 6 yr; visceral fat assessment (by magnetic resonance imaging) at 6 yr. Main Outcomes: fasting glucose, insulin, IGF-I; neutrophil-over-lymphocyte ratio (N/L); lean mass; total, abdominal and visceral fat mass. Results: Between age 4-6 yr, the relative adiposity of SGA children was further amplified. Between age 2-6 yr, SGA children gained more total and abdominal fat, and raised their insulin, IGF-I and N/L more than did AGA children (all p<0.0001). At age 6, the average amount of visceral fat was in SGA children more than 50% higher than in AGA children (P<0.005). The 0-2 yr increment in weight Z-score together with the 2-6 yr increment in fasting insulin accounted for 62% of visceral fat variability at age 6. Conclusion: The amount of visceral fat is in post-catchup SGA children excessive by the age of 6 yr. In populations at risk for type 2 diabetes or metabolic syndrome after fetal growth restraint, the time window for early intervention may have to be advanced into prepubertal childhood.