Primal Health Databank: Study
| Entry No: | 0429 |
| Title: | Low nutrient intake and early growth for later insulin resistance in adolescents born preterm |
| Author(s): | Atul Singhal, Mary Fewtrell, Tim J Cole, Alan Lucas |
| Reference: | Lancet 2003; 361: 1089-97 |
| Place of Study: | UK |
| Abstract: | In animals, acceleration of neonatal growth is thought to increase the later propensity to insulin resistance and non-insulin-dependent diabetes, whereas slow growth as a consequence of undernutrition is thought to have a beneficial effect. To test this hypothesis in people, the authors measured fasting concentrations of 32-33 split proinsulin, a marker of insulin resistance, in adolescents born preterm who had participated in randomised intervention trials of neonatal nutrition, and in adolescents born at term.
They determined fasting 32-33 split proinsulin concentration in participants aged 13-16 years born preterm and randomised to receive a nutrient-enriched or lower-nutrient diet (n=216) or in a reference group born at term (n=61).
Fasting 32-33 split proinsulin concentration was greater in children given a nutrient-enriched diet (geometric mean 7·2 pmol/L, 95% CI 6·4-8·1) than in those given the lower-nutrient diet (5·9 pmol/L [5·2-6·4]; mean difference 20·6% [5·0-36·3]; p=0·01). Healthy babies born at term had similar fasting 32-33 split proinsulin concentrations (6·9 pmol/L; 6·0-8·2) to the nutrient-enriched group. In non-randomised analyses, fasting 32-33 split proinsulin concentration was associated with greater weight gain in the first 2 weeks of life (13·2% [5·4-20·9] change per 100 g weight increase; p=0·001) independent of birthweight, gestation, neonatal morbidity, and demographic, anthropometric, and socioeconomic factors.
These results suggest that relative undernutrition early in life in children born preterm may have beneficial effects on insulin resistance. They could partly explain what up to now has been regarded as fetal programming. Because postnatal factors may be more amenable to intervention, the distinction between antenatal and postnatal programming of risk factors for cardiovascular disease, as well as being of scientific importance, probably has important public-health implications. For instance, such data lend support to the benefit of undernutrition associated with colostrum and breastfeeding very early in infancy in reducing the risk of cardiovascular disease. Furthermore, they suggest that public-health interventions that aim to reduce the risk of coronary heart disease by the promotion of weight gain could even be deleterious
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| Keyword(s): | diabetes, infant feeding, insulin resistance |
| Discussion: | No discussion mentioned for this entry |
| See Also: | No related entries mentioned for this entry |
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