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Item
#6
Undernutrition
of Preterm Infants Protects Against Insulin Resistance
Investigators
suggest that guidelines advocating nutrition to "normalize"
growth in infancy may actually increase adult morbidity and therefore
should be changed.
A
marker for insulin resistance was lower in a group of adolescents that
were born prematurely and randomized to an undernutrition cohort,
according to the results of a study published in the March 29 issue of
The Lancet.
"Whether
our results can be generalized to full-term infants requires further
research," senior author Alan Lucas, MD, from the Institute of
Child Health in London, U.K., says in a news release. "We
recognize that preterm infants are different to those born at term in
many respects — most notably that they have medical problems related
to prematurity itself. Nevertheless, even if our findings are not
generalizable they could still apply to the 6% of the population born
preterm."
The
investigators tested fasting concentrations of 32–33 split
proinsulin, a marker for insulin resistance, in 216 adolescents born
prematurely in the 1980s who had participated in randomized trials of
infant nutrition, and in 61 adolescents born at term who received
"normal" nutrition in the first few weeks of infancy.
Compared
with both preterm infants given a high-nutrient diet and with healthy
children born at term, adolescents given a relatively low-nutrient
diet early in infancy had a 20% decrease in fasting proinsulin
concentration. This marker was associated with greater weight gain in
the first two weeks of life (13.2% change per 100 g weight increase;
95% confidence interval, 5.5% - 20.9%; P = .001), independent
of birthweight, gestation, neonatal morbidity, and demographic,
anthropometric, and socioeconomic factors.
The
authors suggest that associations between low birthweight for
gestation and later cardiovascular risk factors may reflect early
postnatal rather than antenatal factors. "We have shown for the
first time in human beings the importance of a lower nutrient intake
and slower growth early in postnatal life in favorably programming a
key health outcome," they write. "Our findings, therefore,
could partly explain what up to now has been regarded as the fetal
origins of adult disease."
They
suggest that relative undernutrition associated with colostrum and
breast-feeding very early in infancy may reduce cardiovascular risk.
"If confirmed in infants not born prematurely, our findings would
suggest that public-health interventions that aim to reduce the risk
of coronary heart disease by the promotion of weight gain in infancy
could even be deleterious," they conclude. "Consequently,
present recommendations for infant feeding need to be reappraised as
new data emerge." Lancet.
2003;361:1089-1097
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DID
YOU KNOW:
Young women
with type 1 diabetes are 30 times more likely than other women their
age to die of heart disease. Young
women with type 1 (insulin-dependent) diabetes face a huge heart risk.
They are 30 times more likely than other women their age to die of
heart disease. This is according to a report presented at a diabetes
meeting in Glascow, Scotland.
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