Metabolic Syndrome In Later Life Research Articles

Association between early life famine exposure and risk of metabolic syndrome in later life.

BackgroundPrevious studies reported that famine exposure had an effect on metabolic syndrome (MetS). However, there is an inadequacy of study regarding the association between famine exposure, adulthood general obesity, and the risk of MetS.MethodsA total of 8883 subjects aged ≥40 years from Jiading community in Shanghai were included. We defined famine exposure subgroups as nonexposed (1963–1974), fetal exposed (1959–1962), childhood exposed (1949–1958), and adolescence exposed (1941–1948). MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP‐ATP III) criteria.ResultsCompared with the nonexposed group, the risks of MetS were increased in the fetal‐, childhood‐, and adolescence‐exposed groups with odds ratios (OR) and 95% confidence intervals (CI) of 1.48 (1.23–1.78), 1.89 (1.63–2.20), and 2.34 (1.99–2.74), respectively. After adjusting for sex, age, smoking status, drinking status, education, body mass index (BMI), and physical activity, the increased risk of MetS related to the fetal‐exposed and childhood‐exposed groups with OR and 95% CI of 1.42 (1.04–1.94) and 1.50 (1.02–2.21), respectively, were observed only in women. Famine exposure was significantly associated with MetS among individuals with a BMI < 23 kg/m2 (p for interaction between BMI categories and famine exposure = 0.0002 in the whole cohort), while there existed a gender difference (p = 0.0023 in females, p = 0.4484 in males). When evaluating the joint effects of the combination of famine exposure in early life and general obesity in adulthood on MetS, we observed the highest estimate in participants with both adulthood general obesity and fetal famine exposure (OR 17.52; 95% CI, 10.07–30.48) compared with those without famine exposure nor adulthood obesity.ConclusionsObesity in adulthood significantly further aggravated the risk of MetS in individuals who experienced early life undernutrition, especially in females.

Newer Insights Into Fetal Growth and Body Composition.

Based on epidemiological and experimental evidence, the origins of childhood obesity and early onset metabolic syndrome can be extended back to developmental processes during intrauterine life. It is necessary to actively investigate antecedent conditions that affect fetal growth by developing reliable measures to identify variations in fetal fat deposition and body composition. Recently, the resolution of ultrasonography has remarkably improved, which enables better tissue characterization and quantification of fetal fat accumulation. In addition, fetal fractional limb volume has been introduced as a novel measure to quantify fetal soft tissue volume, including fat mass and lean mass. Detecting extreme variations in fetal fat deposition may provide further insights into the origins of altered fetal body composition in pathophysiological conditions (i.e., fetal growth restriction or fetal macrosomia), which are predisposed to the metabolic syndrome in later life. Further studies are warranted to determine the maternal or placental factors that affect fetal fat deposition and body composition. Elucidating these factors may help develop clinical interventions for altered fetal growth and body composition, which could potentially lead to primary prevention of the future risk of metabolic dysfunction.

436 Diet for mental health in pregnancy: nutrients of importance based on large observational cohort data

The Barker hypothesis suggests an adverse environment in utero predisposes offspring to greater risk of metabolic syndrome in later life. Therefore, it is important to optimise maternal health in terms of diet and well-being, to facilitate better health outcomes for mother and child. We aimed to determine associations between dietary intakes and well-being in a pregnant cohort. This is retrospective cohort analysis of a combination of 3 studies; The ROLO Study (a Randomised cOntrol trial of a LOw glycaemic index diet in pregnancy), the PEARS study (Pregnancy Exercise And nutrition Research Study with smartphone app support) and an RCT of a probiotic study. All data were collected prior to intervention (approx. 16 weeks). 3 day food diaries were used to determine dietary intakes. The WHO-5 item Well-Being Index was used to determine mental well-being. Initial associations were determined using Pearson correlations, and further defined using multiple regression analysis adjusted for age, BMI, HP index and METs. There were 1521 women included in the analysis; mean age 32 years and BMI 27kg/m2. 96% were Caucasian and 60% had 3rd level education. Average HP index was 5.78 (moderate income level). Average activity level was 440 METs. 27% had low well-being, with 59% being the average score. Results of the regression analysis showed the following to have significant effect on well-being; fibre (B = 0.074, p=0.018), Magnesium (B=0.084, p=0.009), Niacin (B=0.092, p=0.004), thiamine (B=0.073, p=0.018) and folate (b=0.077, p=0.024). Nutrition and well-being appear to be related in early pregnancy, and may play a key role in creating a favourable in utero environment. The findings support research on the gut-brain axis demonstrating fibre can modulate gut microbial health, a determinant of well-being. Fibre and Magnesium are principle nutrients in both the DASH and Mediterranean diets, which have can improve mental health. These data suggest nutritional intervention strategies may improve mental and physical health in mothers which may in turn benefit offspring.

Gestational lipid profile as an early marker of metabolic syndrome in later life: a population-based prospective cohort study

BackgroundIn pregnancy lipid levels increase with gestation resembling an atherogenic lipid profile. Currently it is unclear whether gestational lipid levels are associated with an adverse cardiovascular risk profile later in life. The aim of this study is to assess the association between gestational lipid levels and lipid levels and prevalence of the metabolic syndrome (MS) six years after pregnancy.MethodsIn plasma of 3510 women from the Generation R Study; a prospective population-based cohort, we measured lipid levels (total cholesterol, triglycerides and high-density lipoprotein cholesterol [HDL-c]), and low-density lipoprotein cholesterol (LDL-c), remnant cholesterol and non-HDL-c were calculated in early pregnancy (median 13.2 weeks, 90% range [10.5 to 17.1]) and six years after pregnancy (median 6.5 years, 90% range [6.2 to 7.8]). MS was assessed six years after pregnancy according to the NCEP/ATP3 criteria. We also examined the influence of pregnancy complications on these associations.ResultsGestational lipid levels were positively associated with corresponding lipid levels six years after pregnancy, independent of pregnancy complications. Six years after pregnancy the prevalence of MS was 10.0%; the prevalence was higher for women with a previous placental syndrome (13.5%). Gestational triglycerides and remnant cholesterol in the highest quartile and HDL-c in the lowest quartile were associated with the highest risk for future MS, independent of smoking and body mass index.ConclusionsGestational lipid levels provide an insight in the future cardiovascular risk profile of women in later life. Monitoring and lifestyle intervention could be indicated in women with an unfavorable gestational lipid profile to optimize timely cardiovascular risk prevention.

Obesity and Gestational Diabetes in Pregnant Care and Clinical Practice.

Obesity and Gestational Diabetes Mellitus (GDM) are the most frequent pathologies affecting mothers and offspring during pregnancy. Both conditions have shown a sustained increase in their prevalence in recent years, and they worsen the outcome of pregnancy and the long-term health of mothers. Obesity increases the risk of GDM and pre-eclampsia during pregnancy and elevates the risk of developing metabolic syndrome in later life. Offspring of obese mothers have an increased risk of obstetric morbidity and mortality and, consistent with the developmental origins of health and disease, a long term risk of childhood obesity and metabolic dysfunction. On the other hand, GDM also increases the risk of pre-eclampsia, caesarean section, and up to 50% of women will develop type 2 diabetes later in life. From a fetal point of view, it increases the risk of macrosomia, large-for-gestational-age fetuses, shoulder dystocia and birth trauma. The insulin resistance and inflammatory mediators released by a hypoxic trophoblast are mainly responsible for the poor pregnancy outcome in obese or GDM patients. The adequate management of both pathologies includes modifications in the diet and physical activity. Drug therapy should be considered when medical nutrition therapy and moderate physical activity fail to achieve treatment goals. The antenatal prediction of macrosomia is a challenge for physicians. The timing and the route of delivery should consider adequate metabolic control, gestational age, and optimal conditions for a vaginal birth. The best management of these pathologies includes pre-conception planning to reduce the risks during pregnancy and improve the quality of life of these patients.

Interplay between early-life malnutrition, epigenetic modulation of the immune function and liver diseases.

Early-life nutrition plays a critical role in fetal growth and development. Food intake absence and excess are the two main types of energy malnutrition that predispose to the appearance of diseases in adulthood, according to the hypothesis of 'developmental origins of health and disease'. Epidemiological data have shown an association between early-life malnutrition and the metabolic syndrome in later life. Evidence has also demonstrated that nutrition during this period of life can affect the development of the immune system through epigenetic mechanisms. Thus, epigenetics has an essential role in the complex interplay between environmental factors and genetics. Altogether, this leads to the inflammatory response that is commonly seen in non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome. In conjunction, DNA methylation, covalent modification of histones and the expression of non-coding RNA are the epigenetic phenomena that affect inflammatory processes in the context of NAFLD. Here, we highlight current understanding of the mechanisms underlying developmental programming of NAFLD linked to epigenetic modulation of the immune system and environmental factors, such as malnutrition.

Fetal and childhood malnutrition during the Korean War and metabolic syndrome in adulthood.

Koreans experienced unexpected shortages of food and refugee life during the Korean War (1950-1953). In the present study, we used the Korean War as a natural experiment for early life malnutrition with the aim of evaluating the risk for metabolic syndrome in adulthood according to participant exposure status during the Korean War. We used data from 25 708 participants from the fourth through seventh Korean National Health and Nutrition Examination Survey, a nationally representative database of Korea. By years of birth, we divided the study participants into non-exposed (1959-1963 and 1954-1958), fetal-exposed (1951-1953), early childhood-exposed (1946-1950), late-childhood-exposed (1941-1945), and adolescent-exposed (1936-1940) groups according to participants' ages during the Korean War. We calculated the risk for metabolic syndrome in adult life using logistic regression analysis. Compared with the non-exposed group, women exposed to the Korean War while in utero and during early childhood were associated with increased risk for abdominal obesity and elevated triacylglycerol levels, whereas men showed low high-density lipoprotein cholesterol levels. Fetal and early childhood exposure increased the risk for metabolic syndrome in adults compared with the non-exposed group (fetal-exposed men: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.93-1.76; fetal-exposed women: OR, 1.35; 95% CI, 1.01-1.80; early-childhood-exposed men OR, 1.25; 95% CI, 0.82-1.90; and early-childhood-exposed women OR, 1.41; 95% CI, 0.97-2.06). Fetal and early childhood experiences during the Korean War were associated with increased risk for some components of metabolic syndrome. The present study suggested that early life malnutrition due to the Korean War may be associated with metabolic syndrome in later life.

1012: Maternal Inflammation: potential mediators and effects on pregnancy outcomes

Elevated circulating levels of inflammatory markers (complement factor 3 and CRP) have been linked with adverse pregnancy outcomes and metabolic derangements in the non-pregnant adult population. Lifestyle interventions hold potential to ameliorate these effects. We sought to investigate the effect of the PEARS antenatal lifestyle intervention on maternal complement factor 3 (C3) and C-reactive protein (CRP) concentrations in the 3rd trimester and to assess the relationship between these inflammatory markers and maternal and fetal glucose and lipid metabolism and pregnancy outcomes Secondary analysis of women recruited as part of the PEARS lifestyle intervention study. The PEARS study was a randomised control trial that assessed the effect of a complex antenatal behaviour-change intervention supported by a smartphone-app, compared with usual antenatal care, on the incidence of gestational diabetes mellitus (GDM) in overweight and obese pregnancies. 405 women with C3 and CRP levels at either randomization and/or 28-weeks with corresponding glucose, insulin, c-peptide, HOMA2-IR and lipid profiles were included in the analysis. Data pertaining to diagnoses of GDM, PET or PIH, delivery < 37 weeks, low birth weight defined as birth weight < 2500g, IUGR defined as estimated fetal weight (EFW) < 10th centile and cord bloods were also included in the analysis The PEARS intervention had no effect on levels of circulating maternal C3 and CRP levels in the 3rd trimester. A diagnosis of PET, PIH or GDM was not associated with maternal C3 or CRP in early or late pregnancy. Maternal C3 but not CRP was significantly higher in those that gave birth <37 weeks (p= 0.02 and 0.04) and in those that delivered an infant <2500g (p=0.02). Maternal C3, not CRP, was a significant predictor of maternal insulin resistance (B = 0.007, p= 0,002), early total cholesterol (B= 0.005, P= 0.026) and 28 week LDL (B= 0.01, p= 0.003). Maternal C3 or CRP was not related to fetal glucose or lipid metabolism Higher maternal C3 concentrations were associated with pre-term birth, low birth weight and maternal insulin resistance and lipid metabolism. These findings suggest C3 as a potential biomarker to predict women at risk for poor pregnancy outcomes and the metabolic syndrome in later life

Growth and Clinical Variables in Nitrogen-Restricted Piglets Fed an Adjusted Essential Amino Acid Mix: Effects of Free Amino Acid–Based Diets

Excess protein intake in early life has been linked to obesity and metabolic syndrome in later life. Yet protein, and in particular the essential amino acids (EAAs), need to be present in adequate quantity to support growth. With the use of a piglet model restricted in dietary amino acids (AAs), we compared the efficacy and safety of a standard formula with a low-AA formula containing an adjusted AA composition. Female piglets (3-7 d old; Landrace × Yorkshire × Duroc) were fed 1 of 4 isoenergetic AA-based formulas for 14 d (700 kJ·kg body weight-1·d-1). The formulas contained a set control amount (44 g/L) and AA compositions referred to as the experimental standard (ST-100, n=22), or 20% or 50% lower total AAs (respectively, ST-80, n=19 and ST-50, n=13), or 20% lower total AAs with an optimally adjusted EAA composition (O-80, n=17). A series of clinical and paraclinical endpoints were measured. Growth rates were similar for ST-100, O-80 and ST-80 piglets (all ∼15 g·kg-1·d-1), whereas ST-50 had a markedly lower weight gain relative to all groups (all P<0.05). Relative to ST-100, all groups with reduced AA intake showed ∼16% reduction in plasma albumin and ∼30% reduction in plasma urea (both P<0.05). The absolute leucine oxidation rate was ∼30% lower for O-80 than for ST-100 piglets (P<0.05). These data show that a 20% reduction in total AA intake for both the control (ST-80) and the adjusted AA (O-80) formula did not have any short-term adverse effects on growth in artificially reared, AA-restricted piglets. The lower absolute leucine oxidation rate observed in O-80 supports the development of an infant formula with an improved AA composition and a moderate reduction in total protein to support adequate growth in healthy infants.

Alterations in the placental methylome with maternal obesity and evidence for metabolic regulation.

The inflammatory and metabolic derangements of obesity in pregnant women generate an adverse intrauterine environment, increase pregnancy complications and adverse fetal outcomes and program the fetus for obesity and metabolic syndrome in later life. We hypothesized that epigenetic modifications in placenta including altered DNA methylation/hydroxymethylation may mediate these effects. Term placental villous tissue was collected following cesarean section from lean (prepregnancy BMI<25) or obese (BMI>30) women. Genomic DNA was isolated, methylated and hydroxymethylated DNA immunoprecipitated and hybridized to the NimbleGen 2.1M human DNA methylation array. Intermediate metabolites in placental tissues were measured by HPLC-ESI-MS, ascorbate levels by reverse phase HPLC and gene expression by RT-PCR. Differentially methylated and hydroxymethylated regions occurred across the genome, with a 21% increase in methylated but a 31% decrease in hydroxymethylated regions in obese vs lean groups. Whereas increased methylation and decreased methylation was evident around transcription start sites of multiple genes in the GH/CSH and PSG gene clusters on chromosomes 17 and 19 in other areas there was no relationship. Increased methylation was associated with decreased expression only for some genes in these clusters. Biological pathway analysis revealed the 262 genes which showed reciprocal differential methylation/ hydroxymethylation were enriched for pregnancy, immune response and cell adhesion-linked processes. We found a negative relationship for maternal BMI but a positive relationship for ascorbate with α-ketoglutarate a metabolite that regulates ten eleven translocase (TET) which mediates DNA methylation. We provide evidence for the obese maternal metabolic milieu being linked to an altered DNA methylome that may affect placental gene expression in relation to adverse outcomes.

Cord Blood Adipocyte Fatty Acid-Binding Protein Levels Correlate With Gestational Age and Birth Weight in Neonates.

Infants born small for gestational age (SGA) have increased risk for obesity and metabolic syndrome, but the underlying mechanisms are not fully elucidated. Adipocyte fatty acid-binding protein (AFABP) is an adipokine that has been implicated in modulation of insulin sensitivity and lipid metabolism. Higher plasma AFABP levels are associated with increased risk of metabolic syndrome and cardiovascular morbidity in adults. Alterations in AFABP levels during fetal growth have not been characterized. To examine AFABP levels in neonatal cord blood in relation to gestational age and birth weight. A cross-sectional study of 361 neonates born at a tertiary academic center. Plasma AFABP levels were measured by enzyme-linked immunosorbent assay. For comparison, venous samples from 26 adults were analyzed. AFABP levels were higher in neonates compared with adults (P < 0.01). Preterm infants had higher AFABP levels [48.2 (31.2 to 73.3) ng/mL] compared with full-term infants [35.8 (25.1 to 51.5)] ng/mL, P < 0.01). There was a negative correlation between AFABP and gestational age (r = 0.28, P = 0.02). Among full-term infants, AFABP levels in SGA infants were lower [28.6 (24.2 to 37.3) ng/mL], compared with appropriate for gestational age [36.1 (25.5 to 50.4) ng/mL] and large for gestational age infants [45.0 (24.6 to 62.4) ng/mL, P < 0.05]. These associations may reflect the higher metabolic activity during fetal development. AFABP may also be involved in fetal growth and the association between SGA status and obesity and metabolic syndrome in later life.

Nutraceuticals as Lipid-Lowering Treatment in Pregnancy and Their Effects on the Metabolic Syndrome.

Maternal nutrition and lifestyle before and during pregnancy influence both mother and offspring's health and can be correlated with the metabolic syndrome in later life. Findings from animal and human studies indicate that nutrition during pregnancy has an important role in microbiological, metabolic, physiologic and immunologic development and homeostasis. A low nutritional intake in early pregnancy may represent a risk for adverse effects during pregnancy as well as on birth outcome. It seems that dietary supplementation with probiotics in perinatal period may represent safe and practical approach in dealing with the most common adverse pregnancy outcomes such as obesity and gestational diabetes. The SPRING (Study of Probiotics in the prevention of Gestational diabetes) will give important answers about potential benefits of probiotics in pregnant women who are obese and overweight and otherwise at the high risk for complications during pregnancy. Fish oil supplementation during the last trimester of pregnancy showed no effects on plasma lipids and lipoproteins in offspring, as well as on their adiposity. The effect of hypercholesterolemia during pregnancy on both mothers and child needs to be further investigated as it could have a biological role. The guidelines for the eventual clinical approach currently do not exist. Potential benefits of nutraceuticals on several metabolic parameters have been suggested. Limited evidence does not allow to draw final conclusions on preventive health strategies and dietary patterns that should be promoted during pregnancy. Further prospective and intervention studies are needed to establish it. Healthy lifestyle and dietary advice with appropriate supplements usage should be considered.

Longitudinal changes in adiponectin multimer levels in preterm infants

BackgroundPreterm infants have altered adiponectin levels at term-equivalent age and have a higher risk of developing components of the metabolic syndrome in later life than term infants. AimsTo investigate the longitudinal changes in adiponectin levels in preterm infants and to compare the levels between term and preterm infants. Study designA cohort study. SubjectsThe study subjects were 43 term infants and 42 preterm infants born at ≤34-week gestation. Outcome measuresSerum levels of total adiponectin (T-Ad) and high-molecular-weight adiponectin (HMW-Ad) were measured in 42 preterm infants at term-, 6month-, and 12month-equivalent ages. Moreover, the levels in 43 term infants investigated previously were reviewed. ResultsIn preterm infants, T-Ad and HMW-Ad levels at the 12month-equivalent age were lower than at the term- and 6month-equivalent ages (all values p<0.001), which was consistent with previous results in term infants. The difference in ratios of HMW-Ad to T-Ad between term and preterm infants continued at the 6month-equivalent age but disappeared at the 12month-equivalent age. Multiple regression analyses revealed that HMW-Ad levels at term-equivalent age were only a significant determinant of the changes in HMW-Ad between the term- and 12month-equivalent ages in preterm infants (p<0.001). ConclusionsThe HMW-Ad levels decline till the 12month-equivalent age in both term and preterm infants. The changes in HMW-Ad level during infancy might be determined at least to a certain degree up to term-equivalent age in preterm infants.

Parity and risk of metabolic syndrome among Chinese women.

Studies regarding the effects of parity on metabolic syndrome in later life have produced conflicting results. The purpose of this study was to explore the association between parity and the risk of metabolic syndrome and its components in a population of Chinese women. A cross-sectional study was performed in a total of 13,358 women (mean age 61.5 years) with at least one live birth from the Dongfeng-Tongji cohort study. Each woman completed baseline questionnaires and received baseline examination, including a physical examination and laboratory tests. Participants were categorized into four groups according to parity (one, two, three, four or more live births). The metabolic syndrome was defined according to the International Diabetes Foundation criteria. Logistic regression was conducted to examine the association between parity and metabolic syndrome, with adjustment of potential confounders. In this study sample, the prevalence of metabolic syndrome was 38.6% (5,156 of 13,358). After adjusting for demographic, lifestyle, and reproduction-related factors, women with two, three, or four or more live births had 1.18 times (95% confidence interval [CI], 1.05-1.32), 1.44 times (95% CI, 1.24-1.67), and 1.52 times (95% CI, 1.26-1.83), respectively, higher odds of having metabolic syndrome compared with those with one live birth. Furthermore, parity showed a positive association with waist circumference and a negative association with high-density lipoprotein cholesterol. Multiparity was associated with increasing risk of metabolic syndrome independent of main covariates in this population of Chinese women. The findings suggested that multiparity may be a risk factor for metabolic syndrome.

Subsequent risk of metabolic syndrome in women with a history of preeclampsia: data from the Health Examinees Study.

BackgroundTo investigate whether preeclampsia is independently associated with risk of future metabolic syndrome and whether any such primary associations are modified by different ages at first pregnancy.MethodsBased on the Health Examinees Study, a cross-sectional analysis was conducted. Data of women (n = 49 780) who had experienced at least 1 pregnancy during their lifetime and had never been diagnosed with any metabolic disorder before their pregnancy were analyzed using multiple logistic regression models. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated after adjusting for age, lifestyle characteristics, and reproductive factors. A stratified analysis was also conducted to estimate the extent of the primary association between preeclampsia and future metabolic syndrome by age at first pregnancy.ResultsWomen with a history of preeclampsia had significantly increased odds of developing metabolic syndrome (adjusted OR 1.23; 95% CI, 1.12–1.35), central obesity (adjusted OR 1.36; 95% CI, 1.25–1.47), elevated blood pressure (adjusted OR 1.53; 95% CI, 1.41–1.67), or elevated fasting glucose (adjusted OR 1.13; 95% CI, 1.03–1.25) in later life. In the stratified analysis, women who first became pregnant at ages >35 years and had preeclampsia were found to be at significantly increased likelihood of metabolic syndrome later in life (adjusted OR 4.38; 95% CI, 1.62–11.9).ConclusionsOur findings suggest that preeclampsia increases the risk of metabolic syndrome in later life, and late age at first pregnancy can further exacerbate this risk.

Small for Gestational Age and Magnesium: Intrauterine magnesium deficiency may induce metabolic syndrome in later life.

Magnesium deficiency during pregnancy as a result of insufficient or low intake of magnesium is common in developing and developed countries. Previous reports have shown that intracellular magnesium of cord blood platelets is lower among small for gestational age (SGA) groups than that of appropriate for gestational age (AGA) groups, suggesting that intrauterine magnesium deficiency may result in SGA. Additionally, the risk of adult-onset diseases such as insulin resistance syndrome is greater among children whose mothers were malnourished during pregnancy, and who consequently had a low birth weight. In a number of animal models, poor nutrition during pregnancy leads to offspring that exhibit pathophysiological changes similar to human diseases. The offspring of pregnant rats fed a magensium restricted diet have developed hypermethylation in the hepatic 11β-hydroxysteroid dehydrogenase-2 promoter. These findings indicate that maternal magnesium deficiencies during pregnancy influence regulation of non-imprinted genes by altering the epigenetic regulation of gene expression, thereby inducing different metabolic phenotypes. Magnesium deficiency during pregnancy may be responsible for not only maternal and fetal nutritional problems, but also lifelong consequences that affect the offspring throughout their life. Epidemiological, clinical, and basic research on the effects of magnesium deficiency now indicates underlying mechanisms, especially epigenetic processes.

Dietary proteins and IGF I levels in preterm infants: determinants of growth, body composition, and neurodevelopment.

It has been demonstrated that a high-protein diet in preterm born infants during the first weeks of life may enable a growth rate equal to that seen in utero and may also result in a better long-term neurodevelopmental outcome. This diet may limit immediate postnatal growth retardation and may hence lower the risk of increased fat deposition after birth leading to the metabolic syndrome in later life. Insulin-like growth factor I (IGF I) has proven to play an important role in early postnatal growth of preterm infants, but also seems to have a persisting influence on body composition in childhood. Furthermore, increased IGF I concentrations in preterm infants have been associated with improved neurodevelopmental outcome. This review will elaborate on the role of dietary proteins and IGF I on growth, body composition, and neurodevelopment of preterm infants. Possible causal pathways will be explored and areas for future research will be proposed.

Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea National Health and Nutrition Examination Surveys.

To examine whether adulthood and/or childhood sex-specific socio-economic disparities are associated with metabolic syndrome and its components in a developed non-Western setting. Based on the Fourth Korea National Health and Nutrition Examination Surveys, 14 888 people aged ≥ 20 years were analysed to evaluate the effect of adult and childhood socio-economic status on metabolic syndrome. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Logistic regression analyses were conducted to calculate the odds ratios for metabolic syndrome and each component of metabolic syndrome in later life. The age-standardized prevalence of metabolic syndrome was 26.6% for men and 21.3% for women. Compared with the highest level of education, men with the lowest education level were significantly less likely to have metabolic syndrome (odds ratio 0.76, 95% CI 0.60-0.96), whereas the opposite association was found in women (odds ratio 3.29, 95% CI 2.45-4.42). Men who were manual labourers and economically inactive had a lower prevalence of metabolic syndrome compared with those with non-manual jobs (odds ratio 0.82, 95% CI 0.69-0.98 and odds ratio 0.79, 95% CI 0.64-0.99, respectively), but the reverse association was observed in women (odds ratio 1.34, 95% CI 1.04-1.73 and odds ratio 1.40, 95% CI 1.09-1.81, respectively). A significant interaction between combined adulthood and childhood socio-economic status on the presence of metabolic syndrome was observed (P<0.05). Our findings suggest that sex-specific socio-economic disparities in childhood and adulthood have differential effects on the prevalence of metabolic syndrome and its individual components in Korea.

Вопросы оценки постнатального роста недоношенных детей Часть 2. Догоняющий рост недоношенных детей

The term catch-up growth is now widely used in neonatology and pediatrics to describe the growth of preterm infants. Catch-up growth — is a compensatory strengthening of the body's growth after a period of slow growth. The lower the gestational age of the premature baby, the more intense catch-up growth in the future.Catch-up growth is considered an important criterion for evaluating nursing preterm infants. Formation of catch-up growth is seen as a favorable outcome. Evaluation of catch-up growth is carried out with the use of percentiles and standard deviations (Z - score). Catch-up growth has a positive effect on neurological outcome. Catch-up growth achieved if the growth rates are between 5 and 10 percentile. The values of growth are satisfactory if they are located at the 10th percentile and above. Catch-up growth is achieved with a standard deviation greater than minus 2 (Z - score). The optimal parameters are considered indicators located within two standard deviations of the mean.Estimation of the growth should be carried out optimally weekly. Growth curves help to determine when the catch-up growth begins. After discharge from the hospital catch-up growth continues. Catch-up growth occurs within the first year of life. The critical period for catch-up growth are considered the first 6 months. Subsequently, the growth rate decreases. The growth is not sufficient, if the values are below the 3 percentile. About 50% of the causes impaired growth is due to the shortage of supply. Premature babies can have problems with food and after discharge from the hospital. The very rapid growth may lead to the development of metabolic syndrome in later life. Low birth weight is associated with increased risk of hypertension, stroke, and diabetes. Compensatory growth often occurs with excessive deposition of fat. In assessing the growth necessary to accommodate the growth of muscle mass and fat mass. Maintaining optimal growth rate is important for the prevention of metabolic syndrome. Requires a meta-analysis of all published growth curves for premature babies to determine the optimal postnatal growth.

Heart rate variability in low birth weight growth restricted children during sleep and wake stages

Intrauterine growth restricted (IUGR) individuals have greater predisposition to develop a metabolic syndrome in later life manifesting itself as obesity, hypertension, type 2 diabetes or cardiovascular disease. Poor fetal growth may alter the regularity mechanism of cardiac autonomic system that is involved in the development of these diseases. The malfunctioning of the cardiac autonomic system assessed by decrease in heart rate variability (HRV) is associated with negative cardiovascular outcomes. This study is aimed at investigating the risk of development of coronary heart disease in IUGR children in later life. For that purpose HRV analysis of normal and growth restricted children was performed during sleep and wake stages. The study group consisted of 9–10years old, 32 normal, 20 low birth weight IUGR children. The standard time domain HRV metrics (mean RR, SDNN, RMSSD, NN50 and pNN50) and Poincaré indices (SD1 and SD2) were used to analyse and compare the RR-interval time series of these groups. The IUGR children showed lower HRV as compared with normal children during both sleep and wake stages. The significantly decreased HRV during sleep provide an evidence of autonomic derangement that may be associated with higher risk of lethal arrhythmias in the IUGR children in later life.