Auxological and metabolic study in small for gestational age children during 2 years follow-up

Catch-Up Growth in Full-Term Small for Gestational Age Infants: A Systematic Review

This is the first systematic review to examine the global prevalence of catch-up growth (CUG) in small for gestational age (SGA) infants who were born at full term (FT). Size at birth and subsequent growth is an important indicator of neonatal and adult health. Globally, 16% of infants are SGA at birth, ranging from 7% in industrialized countries to 41.5% in South Asia. SGA infants are at increased risk for negative developmental and adult health outcomes. Some achieve CUG but others do not. CUG has immediate and late health implications especially in low- and middle-income countries. This systematic review sought to determine the global prevalence of CUG among FT-SGA infants. We performed a literature search of MEDLINE, Pubmed, Embase, Web of Science, and Scopus, as well as grey literature databases, and identified 3137 studies. The final analysis included 11 studies. The median prevalence of CUG was 87.4% across all definitions of SGA and CUG. However, multiple definitions were used to classify SGA and CUG. Nine unique reference populations were used to classify SGA, and 6 to approximate CUG. Due to this heterogeneity, a meta-analysis could not be conducted. Program implementation for this vulnerable group of infants is dependent on proper classification. Given the wide range of definitions and reference standards used in the past, it is not possible to determine the global need for programs to address CUG for FT-SGA infants or to rationally plan any such programs. We highlight the need and propose standard definitions and references for SGA and CUG.

[Effect of metformin on insulin resistance during catch-up growth in mice with fetal growth restriction]

OBJECTIVE

To study the efficacy of metformin intervention on insulin resistance during catch-up growth in mice with fetal growth restriction (FGR).

METHODS

Mouse models of FGR were established by low protein diet feeding of the pregnant mice. Both the newborn female mice with FGR and normal control (NC) mice were randomized for feeding with a standard diet (SF) or a high-fat diet (HF) after weaning and treatment with gavage of either metformin or normal saline. The mice were examined for vaginal opening time and the estrous cycle at the age of 8 weeks. At the age of 12 weeks, 6 mice in anestrus from each group were fasted for 12 h for measurement of body weight, height, poundera index (PI), fasting blood glucose (FBG), fasting insulin (Fins), follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH), and the HOMA-IR was calculated. The reproductive capacity of female mice was assessed by mixing them with male mice at the ratio of 2:1. The 3 × 2 factorial analysis was conducted to determine the interactions between FGR, high-fat feeding and metformin.

RESULTS

Factorial analysis showed that FGR and high-fat feeding had significant effects on the PI index, Fins, HOMA-IR, vaginal opening time, and AMH (P<0.05). Metformin significantly affected the factors related to high-fat feeding including weight, PI, FPG, Fins, HOMA-IR and estrous cycle (P<0.05) and the factors related to FGR with the exception of height and FSH (P<0.05). FGR significantly affected the factors tested except for body weight (P<0.05); high-fat feeding affected all the factors but the FSH (P<0.05); metformin affected all the factors but the height and FSH (P<0.05). In the female mice treated with saline, the pregnancy rates differed significantly between FGR mice with high-fat feeding and control mice with standard feeding, and between FGR mice with standard feeding and high-fat feeding (P<0.05).

CONCLUSION

FGR mice can present with delayed puberty with rare ovulation and adulthood insulin resistance, and high-fat feeding after birth can promote the catch-up growth of FGR mice. Metformin intervention is effective for improving insulin resistance and reproductive-endocrine disorders in FGR mice during catch-up growth.

Low-birth-weight, but not catch-up growth, correlates with insulin resistance and resistin level in SGA infants at 12 months

OBJECTIVE

To investigate the insulin resistance status in SGA infants at 12 months and its relationship with auxological and metabolic parameters.

METHODS

One group of 45 SGA and one of 50 appropriate for gestational age infants were followed from birth to the end of the first year of life. At 12 months, skinfold thickness, waist circumference, and blood levels of glucose, insulin, adiponectin, leptin, resistin, visfatin, retinol-binding protein 4, IGFs, lipids profile were determined, and the HOMA-IR index was calculated.

RESULTS

The SGAs had increased insulin (5.2 ± 2.7 versus 2.9 ± 2.4 μIU/ml, p = 0.012) and HOMA-IR (1.09 ± 0.9 versus 0.59 ± 0.55, p = 0.016). In multiple regression, insulin resistance indices were independently correlated with low-birth-weight (β = -2.92, p = 0.015 for insulin, β = -2.98, p = 0.011 for HOMA-IR) but not with catch-up growth in either height or weight or any other metabolic parameter. Resistin was higher in the SGAs (5.1 ± 2.1 versus 3.9 ± 2.1 ng/ml, p = 0.03) and independently correlated with low-birth-weight but not insulin resistance. Resistin was negatively correlated with total cholesterol (R = -0.33, p = 0.007) and positively with lipoprotein(a) (R = 0.49, p = 0.001).

CONCLUSION

Low-birth-weight, but not catch-up growth or adiposity tissue hormones, was correlated with insulin resistance at 12 months in non-obese SGA infants. The higher resistin in SGA infants and its correlation with total cholesterol and lipoprotein(a) need further clarification.

The benefits of growth hormone therapy in patients with Turner syndrome, Noonan syndrome and children born small for gestational age

This review will summarize the effects of growth hormone (GH) on height, body composition, bone and psychosocial parameters in children with Turner syndrome or Noonan syndrome and those born small for gestational age. The safety of GH treatment in children with these diagnoses is also reported. Despite the reported efficacy and safety of GH in these indications, however, not all children achieve their target height potential, due in some part to poor adherence to GH therapy regimens; indeed up to 50% of children are less than fully compliant with treatment. With this in mind the present and future administration of GH therapy is discussed with respect to advances being made in the presentation of GH for injection and advances in GH injection devices. It is hoped that such progress, aimed at making the administration of GH easier and less painful for the patient will improve treatment adherence and outcome benefits.