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Early Development of Adiposity and Insulin Resistance after Catch-Up Weight Gain in Small-for-Gestational-Age Children

Endocrinology Unit (L.I.), Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; Medical Research Council Epidemiology Unit (K.O.), Cambridge CB2 2QQ, United Kingdom; Department of Paediatrics (K.O., D.B.D.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; and Department of Pediatrics (F.d.Z.), University of Leuven, B-3000 Leuven, Belgium

Address all correspondence and requests for reprints to: Lourdes Ibáñez, M.D., Ph.D., Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain. E-mail: libanez{at}hsjdbcn.org.

Context and Objective: Low birth weight followed by rapid postnatal weight gain is associated with long-term risks for central obesity and insulin resistance. However, the timing of these changes is unclear.

Setting, Design, and Patients: This was a longitudinal cohort study in low birth weight (SGA; birth weight < –2 SD; n = 29) and normal birth weight (AGA; n = 22) children from Barcelona.

Main Outcome Measures: Body composition, by dual-energy x-ray absorptiometry scan, and insulin sensitivity, assessed longitudinally at ages 2, 3, and 4 yr, were measured.

Results: Mean height, weight, and body mass index at ages 2, 3, and 4 yr were not different between SGA and AGA children. At age 2 yr, SGA children had similar body composition but were more insulin sensitive than AGA children and had lower serum IGF-I levels and lower neutrophil counts. Between ages 2 and 4 yr, despite similar gains in weight and body mass index, SGA children gained more abdominal fat and body adiposity and less lean mass than AGA children; by age 4 yr, SGA children had greater adiposity, insulin resistance, and higher neutrophil counts than AGA children (P = 0.01–0.0004). In SGA children, total and abdominal fat mass at 4 yr was more closely related to rate of weight gain between 0 and 2 yr (P = 0.002–0.0003) than between 2 and 4 yr (P = 0.04–0.1).

Conclusion: Consequent to catch-up weight gain between birth and 2 yr, SGA children showed a dramatic transition toward central adiposity and insulin resistance between ages 2 and 4 yr. Understanding the mechanisms underlying this predisposition to adverse future health could lead to specific preventive interventions during early childhood.

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