The Impact of Early Nutrition in Premature Infantson Later

shiliangyin

OBJECTIVES. Children born prematurely have decreased insulin sensitivity. The etiology
of this insulin resistance is unknown. The aim of this study was to evaluate
infant nutrition and its influence on insulin sensitivity and postnatal growth in
children born
32 weeks’ gestation.
      METHODS.A total of 56 healthy, developmentally normal, prepubertal children, aged
4 to 10 years were recruited. Thirty-seven were born
32 weeks’ gestation, and 19
were control subjects born at term with a birth weight
10th percentile. Insulin
sensitivity (104 min1 U/mL) was calculated from a 90-minute frequently
sampled intravenous glucose tolerance test. Perinatal, nutritional, and growth data
were obtained retrospectively from both neonatal and early infancy records in the
premature cohort.
     RESULTS. Children born prematurely had decreased insulin sensitivity when compared
with those born at term (13.8 vs 30.6). Neonatal nutrition was not correlated
with insulin sensitivity; however, all of the infants had inadequate protein in
the first month followed by excessive fat intake thereafter. Premature children
with greater weight gain had lower insulin sensitivity. Higher carbohydrate intake
in the first month of life was associated with greater weight gain from birth. No
relationship was seen between weight gain and either protein or lipid intake.
    CONCLUSIONS. Prematurely born children are insulin resistant and have suboptimal
neonatal nutrition. Greater childhood weight gain magnifies this reduction in
insulin sensitivity and seems to be associated with early nutrition. We speculate
that a high carbohydrate neonatal diet may lead to greater weight gain and a
greater reduction in insulin sensitivity in this group.     From  Fiona M. Regan, MBBSa, Wayne S. Cutfield, FRACPb, Craig Jefferies, FRACPb, Elizabeth Robinson, MScc, Paul L. Hofman, FRACPb