Effects of size at birth, gestational age and early growth in preterm infants on glucose and insulin concentrations at 9-12 years.
OBJECTIVE
To test the hypothesis that small size for gestation and poor postnatal growth in preterm infants is associated with higher fasting and post-load plasma glucose and insulin concentrations at 9-12 years of age.


METHODS
Prospective follow-up at 9-12 years of 385 preterm children with birth weight less than 1850 g, who had anthropometry recorded at birth, 18 months and 7 years. Fasting plasma glucose, insulin, proinsulin and 32.33 split proinsulin concentrations and glucose and insulin concentrations 30 min after a standard glucose load were measured.


RESULTS
Post-load glucose concentrations were negatively related to birth weight, independently of gestation or subsequent growth. Fasting split proinsulin and 30-min insulin concentrations were highest in children who showed the greatest increase in weight centile between birth and current follow-up, regardless of gestation. When weight during childhood was included, birthweight centile was, however, no longer statistically significant: concentrations of fasting, split, proinsulin and 30-min insulin were highest in those children who had shown the greatest increase in weight centile between 18 months of age and current follow-up, with no evidence of a greater effect in those who were smallest at 18 months.


CONCLUSIONS
Our findings suggest that fetal growth influences plasma glucose 30 min after a glucose load in preterm children at 9-12 years. In contrast, childhood weight gain is the most important factor influencing insulin concentrations and this effect is the same regardless of early size.
Fewtrell
M S
MS
University Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK.
Doherty
C
C
Cole
T J
TJ
Stafford
M
M
Hales
C N
CN
Lucas
A
A
D001786:Blood Glucose / Q000378:metabolism*; D001824:Body Constitution; D002648:Child; D005260:Female; D005865:Gestational Age; D006128:Growth; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007328:Insulin / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D011384:Proinsulin / Q000097:blood; D011498:Protein Precursors / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D011498:Protein Precursors; C070703:proinsulin, des(31,32)-; D011384:Proinsulin