Background: Preterm infants represent around 10% of births worldwide and have increased risk of adverse metabolic outcomes in later life. The approach to feeding preterms must balance the need to promote brain growth by providing adequate nutrients whilst avoiding potentially harmful excess nutrition.
Objective: To investigate the association between patterns of weight gain in infancy and childhood with later insulin sensitivity in adolescents who were born preterm.
Design, setting and participants: Growth was assessed at regular intervals during the neonatal period, and early childhood. Subjects were reassessed in adolescence and underwent a short oral glucose tolerance test and assessment of fat mass using dual X-ray absorptiometry. Earlier growth parameters were compared with body compositional data and insulin sensitivity derived using the homeostatic model assessment.
Results: 153 children were reviewed, 102 consented to venepuncture at a median age of 11.5 years. Median birthweight was 1365 g and mean gestation was 30.8±2.2 weeks. Neither gestation nor birthweight SDS were associated with adolescent insulin sensitivity. Increase in weight SDS between birth and discharge was positively associated and increase in weight SDS between discharge and term negatively associated with later insulin sensitivity. In both periods, the association only remained significant for those born small for gestational age (SGA). Increase in childhood weight SDS and current fat mass index were negatively associated with subsequent insulin sensitivity.
Conclusions: Enhanced weight gain at a critical stage in early life may improve insulin sensitivity in adolescence. Although higher rates of pre-discharge weight gain do not appear harmful in SGA infants, rapid weight catch-up immediately following hospital discharge is associated with decreased later insulin sensitivity. The interactions between fetal, neonatal and infant weight gain and subsequent markers of the metabolic syndrome are complex, but suggest the potential for early nutritional care to modify later chronic disease risk.
13 Nov 2013
British Society for Paediatric Endocrinology and Diabetes