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Insulin resistance and body composition in preterm born children during prepubertal ages
Feyza Darendeliler1, Firdevs Bas, Ruveyde Bundak
1Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. feyzad@istanbul.edu.tr
Insights
Premature infants born appropriate for gestational age (AGA) and small for gestational age (SGA) do not exhibit insulin resistance if they achieve catch-up growth. Intrauterine growth restriction, not prematurity itself, impacts future metabolic health.
Area of Science:
- Pediatric Endocrinology
- Metabolic Health
- Growth and Development
Background:
- Premature infants may develop childhood insulin resistance due to intrauterine or postnatal environmental factors.
- Understanding the metabolic consequences of prematurity and growth patterns is crucial for long-term health.
- Insulin resistance in childhood can have significant implications for metabolic and cardiovascular health.
Purpose of the Study:
- To evaluate insulin resistance and body composition in preterm infants born AGA or SGA.
- To examine the relationship between insulin resistance, body composition, and the IGF-I/IGFBP-3 axis in preterm children.
- To compare metabolic and body composition parameters between preterm and term-born children.
Main Methods:
- Ninety-three preterm children (SGA and AGA) and 86 term-born children (SGA and AGA) were assessed at approximately 4 years of age.
- Measurements included glucose, insulin, IGF-I, IGFBP-3, IGFBP-1, leptin levels, and body composition via dual-energy X-ray absorptiometry.
- Insulin resistance was determined using basal insulin levels and the homeostasis model assessment for insulin resistance (HOMA-IR).
Main Results:
- Preterm AGA and SGA children with catch-up growth and normal BMI did not show increased insulin resistance compared to term-born peers.
- Term SGA children exhibited significantly higher insulin levels and HOMA-IR compared to preterm SGA children.
- IGF-I levels were lower in preterm AGA children than in term AGA children, while body composition and leptin levels did not differ significantly between groups.
Conclusions:
- Premature infants achieving appropriate catch-up growth and normal BMI do not present with insulin resistance.
- Elevated insulin levels in term SGA children suggest that third-trimester intrauterine growth restriction adversely affects future metabolic outcomes.
- The findings highlight the importance of catch-up growth in mitigating metabolic risks associated with prematurity.
Background:
Premature born children may show insulin resistance in childhood which may be due to intrauterine or postnatal adverse environmental factors.
Objective:
Aim of this study was to evaluate insulin resistance and body composition in preterm born children born appropriate for gestational age (AGA) or small for gestational age (SGA) and relations with IGF-I, IGFBP-3 axis.
Methods:
Ninety-three preterm born children grouped as premature SGA (n = 30) and premature AGA (n = 63) were evaluated at age 4.6 +/- 0.2 years and 4.7 +/- 0.1 years with respect to their glucose, insulin, IGF-I, IGFBP-3, IGFBP-1, leptin levels and body composition by dual-energy X-ray absorptiometry. Their data were compared to that of body mass index (BMI) matched term SGA (n = 42) and term AGA (n = 44) children of age 4.5 +/- 0.2 and 3.8 +/- 0.1 years. All children had height appropriate for their target height. Insulin resistance was evaluated by basal insulin and homeostasis model assessment for insulin resistance (HOMA-IR).
Results:
Basal insulin level was similar in preterm AGA (4.3 +/- 1.4 pmol/l) and term AGA (7.9 +/- 6.4 pmol/l) children at similar and normal BMI levels. Preterm SGA children had insulin levels (5.0 +/- 3.6 pmol/l) similar to preterm AGA children but significantly lower than that in term SGA children (23.7 +/- 20.8 pmol/l) (P = 0.001). Similar results were obtained for HOMA-IR. Term SGA children had also significantly lower IGFBP-1 levels. Body composition, leptin and IGFBP-3 did not differ between the respective groups. IGF-I was lower in preterm AGA (5.0 +/- 0.6 nmol/l) than in term AGA (8.3 +/- 1.2 nmol/l) (P < 0.001) children.
Conclusions:
Premature born AGA and SGA children do not have insulin resistance when compared to term children if they have made a catch-up growth appropriate for their target height and have normal BMI. The similar insulin levels in preterm SGA and preterm AGA children together with increased insulin levels in term SGA children points to the fact that it is the intrauterine restriction in the third trimester that has an adverse effect on future adverse metabolic outcome.
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