RESUMO
A longitudinal study with dual x-ray absorptiometry disclosed that infants born large for gestational age from mothers without diabetes mellitus and without excessive gestational weight gain tend to be long with increased adipose tissue as newborns and tall and lean as toddlers.
Assuntos
Peso ao Nascer , Composição Corporal , Macrossomia Fetal/fisiopatologia , Absorciometria de Fóton , Diabetes Mellitus , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Mães , Aumento de PesoRESUMO
OBJECTIVE: According to the concept of adipose tissue expandability, the vascular complications of obesity are related less to the amount of stored fat than to the low-grade inflammation that excess fat storage may elicit. We tested this concept in 7-year-old children by assessing whether carotid intima-media thickness (cIMT) is related to obesity measures or to circulating highly sensitive C-reactive protein (hsCRP), as a marker of low-grade inflammation. STUDY DESIGN: The study group comprised 135 asymptomatic Caucasian children (72 girls and 63 boys; mean age, 7.1±1.1 years) with normal height and weight distributions. Relationships were assessed among cIMT, hsCRP, obesity measures (ie, body mass index [BMI], total fat by bioelectric impedance, and visceral fat by ultrasound), insulin resistance (by the homeostasis model assessment for insulin resistance), and fasting serum lipid levels. RESULTS: cIMT was correlated with hsCRP, but not with BMI or body fat; the regression coefficients between cIMT and hsCRP (adjusted for age, sex, BMI, body fat, and serum lipid levels) were fairly similar across all BMI categories (ß=0.370-0.411; all P<.001 to<.0001). Serum hsCRP increased with increasing BMI, total fat, and visceral fat (all P<.001). CONCLUSION: At age 7 years, cIMT is already associated with low-grade inflammation, as measured by hsCRP, but not with BMI or body fat. These findings imply that public health strategies aimed at early prevention of cardiovascular disease may need to target low-grade inflammation rather than only BMI or adiposity.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Proteína C-Reativa/imunologia , Proteína C-Reativa/metabolismo , Espessura Intima-Media Carotídea , Fatores Etários , Biomarcadores/sangue , Índice de Massa Corporal , Peso Corporal , Criança , Feminino , Humanos , Inflamação/sangue , MasculinoRESUMO
Breast-fed infants born small-for-gestational-age (SGA) (n = 28) were found to develop lower adiposity across early infancy, when compared with appropriate-for-gestational age infants (n = 46). The SGA infants were also found to have 2-fold higher (P < .001) levels of circulating leptin at 4 months. This paradoxical hyperleptinemia in early infancy may contribute to a program that produces a process from fetal underweight to adult overweight.
Assuntos
Adiposidade/fisiologia , Aleitamento Materno , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Leptina/sangue , Composição Corporal , Feminino , Seguimentos , Humanos , Recém-Nascido , MasculinoRESUMO
OBJECTIVE: Puberty is part of a critical window in which adiposity and its correlates can be fine-tuned toward reproduction, which implies that puberty provides an opportunity to reprogram a misprogramming that occurred in early life. We tested this hypothesis in low-birthweight (LBW) girls with precocious pubarche (PP), who are at risk for hyperinsulinemic body adiposity during and beyond puberty. STUDY DESIGN: LBW girls with PP (n = 38; mean age 8 years) were randomized to remain untreated or to receive metformin across puberty (425 mg/d for 2 years, then 850 mg/d for 2 years); subsequently, all girls were monitored for 1 year without intervention. Here we report on the latter year. RESULTS: The benefits of metformin were mostly maintained during the posttreatment year so that, after 5 years, metformin therapy was associated with more lean mass; with less total, visceral, and hepatic fat; with lower circulating levels of androgens and leptin; and with elevated levels of high-molecular-weight adiponectin and undercarboxylated osteocalcin. CONCLUSION: In LBW girls with PP, pubertal metformin therapy was followed by a favorable adipokine profile and by a reduction of total, visceral, and hepatic adiposity beyond puberty.
Assuntos
Adiposidade/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Adolescente , Peso Corporal/efeitos dos fármacos , Criança , Comorbidade , Feminino , Seguimentos , Humanos , Hiperinsulinismo/epidemiologia , Hipoglicemiantes/uso terapêutico , Recém-Nascido de Baixo Peso , Recém-Nascido , Gordura Intra-Abdominal/efeitos dos fármacos , Leptina/sangue , Fígado/patologia , Imageamento por Ressonância Magnética , Metformina/uso terapêutico , Puberdade Precoce/epidemiologia , Puberdade Precoce/fisiopatologiaRESUMO
Longitudinal data collected from children ages 2 until 6 years, who were born appropriate-for-gestational-age or small-for-gestational-age, indicate that the latter have a normal body fat fraction and normal high-molecular-weight adiponectinemia at age 2 years and that they accumulate excess adipose tissue and have low adiponectin levels by age 4 to 6 years.
Assuntos
Peso ao Nascer , Composição Corporal/fisiologia , Recém-Nascido Pequeno para a Idade Gestacional , Adiponectina/análise , Adiponectina/metabolismo , Tecido Adiposo/metabolismo , Fatores Etários , Análise de Variância , Antropometria , Índice de Massa Corporal , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez , Probabilidade , Estudos Prospectivos , Valores de Referência , Medição de Risco , Fatores SexuaisRESUMO
OBJECTIVE: Girls with low birth weight (LBW) and with a history of precocious pubarche in childhood (PP) are at high risk of polycystic ovary syndrome (PCOS) in adolescence. In formerly LBW-PP girls, we examined whether initiation of insulin sensitization therapy early after menarche could prevent progression of PCOS features. Study design Twenty-four girls, small at term birth (mean weight, 2.4 kg), who presented with PP (at mean age 6.7 years) and were currently (mean age, 12.4 years) postmenarcheal, with hyperinsulinemic hyperandrogenemia but nonobese, were randomly assigned to receive metformin (850 mg/d) or no treatment for 12 months. Six-month fasting blood samples were collected, and body composition was assessed by dual-energy x-ray absorptiometry. In addition, overnight growth hormone (GH) and gonadotropin secretion was analyzed in 10 girls (6 treated; 4 untreated) at 0 and 6 months. RESULTS: At baseline, compared with healthy control subjects, LBW-PP girls had dyslipidemia, excess truncal fat, reduced lean body mass, and increased insulin-like growth factor-I and GH levels. In untreated girls, insulin sensitivity, serum androgens, lipids, total and truncal fat mass, and lean body mass significantly diverged further from normal over 12 months. In metformin-treated girls, all these abnormalities significantly reversed within 6 months, and body composition continued to improve between 6 and 12 months. CONCLUSIONS: Early metformin therapy prevents progression from PP to PCOS in a high-risk group of formerly LBW girls. This confirms the key role of hyperinsulinemic insulin resistance in the ontogeny of PCOS. Furthermore, normalization of body composition, lipid profiles, and GH secretion could reduce long-term cardiovascular risk.