Abstract
BackgroundFetal growth restriction (FGR) followed by rapid weight gain during early life has been suggested to be the initial sequence promoting central adiposity and insulin resistance. However, the link between fetal and early postnatal growth and the associated anthropometric and metabolic changes have been poorly studied.Methodology/Principal FindingsOver the first year of post-natal life, changes in body mass index, skinfold thickness and hormonal concentrations were prospectively monitored in 94 infants in whom the fetal growth velocity had previously been measured using a repeated standardized procedure of ultrasound fetal measurements. 45 infants, thinner at birth, had experienced previous FGR (FGR+) regardless of birth weight. Growth pattern in the first four months of life was characterized by greater change in BMI z-score in FGR+ (+1.26+/−1.2 vs +0.58 +/−1.17 SD in FGR−) resulting in the restoration of BMI and of fat mass to values similar to FGR−, independently of caloric intakes. Growth velocity after 4 months was similar and BMI z-score and fat mass remained similar at 12 months of age. At both time-points, fetal growth velocity was an independent predictor of fat mass in FGR+. At one year, fasting insulin levels were not different but leptin was significantly higher in the FGR+ (4.43+/−1.41 vs 2.63+/−1 ng/ml in FGR−).ConclusionEarly catch-up growth is related to the fetal growth pattern itself, irrespective of birth weight, and is associated with higher insulin sensitivity and lower leptin levels after birth. Catch-up growth promotes the restoration of body size and fat stores without detrimental consequences at one year of age on body composition or metabolic profile. The higher leptin concentration at one year may reflect a positive energy balance in children who previously faced fetal growth restriction.
Highlights
A robust regulatory physiologic system has evolved to maintain relative constancy of weight, an equilibrium broken by modern lifestyles leading to the development of obesity, type 2 diabetes and other metabolic disorders
Early catch-up growth is related to the fetal growth pattern itself, irrespective of birth weight, and is associated with higher insulin sensitivity and lower leptin levels after birth
Catch-up growth promotes the restoration of body size and fat stores without detrimental consequences at one year of age on body composition or metabolic profile
Summary
A robust regulatory physiologic system has evolved to maintain relative constancy of weight, an equilibrium broken by modern lifestyles leading to the development of obesity, type 2 diabetes and other metabolic disorders. In most cases but not all, this catch-up follows a phase of growth restriction during fetal development This sequence represents a specific and relevant model to evaluate the auxological and metabolic consequences of early acceleration of postnatal growth. Some observations have emphasized that fetal growth restriction followed by rapid weight gain during early postnatal life may be a sequence promoting central adiposity, insulin resistance and type 2 diabetes and cardiovascular diseases [12,13]. Fat mass excess and altered insulin sensitivity are suggested to be early events detectable at one year of age in children born SGA who experienced weight catch-up [14]. Fetal growth restriction (FGR) followed by rapid weight gain during early life has been suggested to be the initial sequence promoting central adiposity and insulin resistance. The link between fetal and early postnatal growth and the associated anthropometric and metabolic changes have been poorly studied
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