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Elevated ghrelin levels in preterm born children during prepubertal ages and relationship with catch-up growth
Feyza Darendeliler1, Firdevs Bas, Ruveyde Bundak
1Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey. feyzad@istanbul.edu.tr
Insights
Preterm children exhibit elevated ghrelin levels in prepuberty, irrespective of catch-up growth (CUG). Term small for gestational age (SGA) infants show lower ghrelin, potentially linked to higher insulin levels.
Area of Science:
- Pediatric Endocrinology
- Growth and Development
- Metabolic Research
Background:
- Ghrelin, a key hormone regulating appetite and growth, plays a role in postnatal development.
- Ghrelin levels are influenced by nutritional status and gestational age, impacting early childhood growth trajectories.
- Understanding ghrelin's role in preterm infants is crucial for assessing their long-term growth and metabolic health.
Purpose of the Study:
- To investigate ghrelin and insulin levels in prepubertal children born preterm, categorized as appropriate for gestational age (AGA) or small for gestational age (SGA).
- To examine the relationship between these hormone levels and catch-up growth (CUG) in preterm children.
- To compare these findings with term-born children (AGA and SGA) to establish normative data and identify specific patterns.
Main Methods:
- A prospective cross-sectional study involving 84 preterm children (SGA and AGA) and BMI-matched term children (SGA and AGA).
- Hormonal assessment of ghrelin and insulin levels at approximately 4.7 years of age.
- Catch-up growth (CUG) quantified using Delta height and Delta weight SDS, comparing birth size to recent anthropometric measurements.
Main Results:
- Preterm children (SGA and AGA) demonstrated significantly higher ghrelin levels compared to term-born children (SGA and AGA).
- Ghrelin levels were similar between preterm SGA and AGA groups, despite greater CUG in preterm SGA infants.
- Term SGA children exhibited elevated insulin levels compared to all other groups, with no significant correlation found between ghrelin and CUG.
Conclusions:
- Preterm children maintain elevated ghrelin levels during prepuberty, independent of their catch-up growth status.
- Term SGA children display distinct hormonal profiles with lower ghrelin and higher insulin levels compared to preterm infants.
- These findings highlight differential hormonal regulation in SGA infants based on gestational age, with implications for growth and metabolic programming.
Background:
Ghrelin, the natural ligand of the GH secretagogue receptor, has potent orexigenic effect. Ghrelin levels are negatively associated with insulin secretion, increased in anorexia, and reduced in obesity. Increased ghrelin levels may be associated with early postnatal growth in preterm born children.
Objective:
Aim of this study was to evaluate ghrelin and insulin levels at prepubertal ages in preterm born children born appropriate for gestational age (AGA) or small for gestational age (SGA) and relationships with catch-up growth (CUG) in a prospective cross-sectional study.
Methods:
Eighty-four preterm born children grouped as preterm SGA (n=28) and preterm AGA (n=56) were evaluated at age 4.7+/-0.2 and 4.7+/-0.1 years with respect to their ghrelin and insulin levels. Their data were compared with that of body mass index matched term SGA (n=35) and term AGA (n=44) children of age 4.6+/-0.2 and 3.8+/-0.1 years. All children had height appropriate for their target height. CUG was defined as the difference between birth size and recent size and expressed as Delta height and Delta weight SDS.
Results:
Preterm SGA and preterm AGA children had similar ghrelin levels (1717.0+/-166.9 and 1656.5+/-103.8 pg/ml), although Delta height and Delta weight SDS in preterm SGA were significantly higher than in preterm AGA children (P<0.001). Ghrelin levels in both preterm groups were higher than term SGA (469.2+/-132.5 pg/ml) and term AGA children (659.6+/-143.3 pg/ml; P<0.001 for all). Delta Height and Delta weight SDS of the term SGA children were similar to that of preterm SGA children. Ghrelin did not have correlation with CUG but had inverse correlation with recent anthropometric indices. Insulin was significantly higher in term SGA children than other groups (P<0.001).
Conclusions:
Preterm children have higher ghrelin levels at prepubertal ages regardless of the magnitude of their CUG. Term SGA children, on the other hand, behave differently and have lower ghrelin levels than preterm children at prepubertal ages, which may be related to elevated insulin levels in this group.
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