Breast feeding and insulin levels in low birth weight neonates: a randomized study.
OBJECTIVE
To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates.


METHODS
Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test.


RESULTS
In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+/-0.23 vs 1.87+/-0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+/-9.8 vs 64.3+/-8.0 mg/dl) and fasting insulin levels (1.44+/-1.19 vs 1.73+/-1.38 microU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+/-0.3 vs 4.75+/-0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+/-9.4 vs 85.6+/-8.4 mg/dl) and fasting insulin levels (6.95+/-4.27 vs 15.73+/-3.29 microU/ml) (p<0.001). The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+/-3.3 microU/ml; p<0.001).


CONCLUSIONS
Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.
Gupta
Mukesh
M
Department of Pediatrics, Regional Institute of Maternal and Child Health, Dr SN Medical College, Jodhpur, India. mukeshg4@gmail.com
Zaheer
Jora
Rakesh
R
Kaul
Vijay
V
Gupta
Rajeev
R
D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007333:Insulin Resistance; D008297:Male; D018709:Statistics, Nonparametric
D001786:Blood Glucose
Diabetes. 1999 Dec;48(12):2422-9
10580432
Circulation. 2005 Sep 27;112(13):2061-75
16186441
Pediatrics. 2002 Feb;109(2):194-9
11826195
BMJ. 2001 Apr 21;322(7292):949-53
11312225
Am J Epidemiol. 2007 Apr 15;165(8):849-57
17215379
Circulation. 2004 Mar 9;109(9):1108-13
14993136
Indian Pediatr. 2007 Mar;44(3):177-84
17413193
Diabet Med. 1995 Apr;12(4):330-6
7600749
Circulation. 2005 Aug 23;112(8):e110
16116063
Cochrane Database Syst Rev. 2002;(1):CD003517
11869667
Lancet. 2003 Mar 29;361(9363):1089-97
12672313
Indian J Med Res. 2003 Nov;118:197-203
14723485
Eur Heart J. 2004 May;25(9):778-86
15120889
N Engl J Med. 2004 Feb 26;350(9):865-75
14985484
Pediatrics. 2001 Sep;108(3):703-11
11533340
Pediatrics. 2002 Sep;110(3):597-608
12205266
Ann Intern Med. 2000 Aug 1;133(3):176-82
10906831
BMJ. 2003 Nov 22;327(7425):1189-95
14630752
Lancet. 2001 Feb 10;357(9254):413-9
11273059
JAMA. 2008 Dec 24;300(24):2886-97
19109117
Int J Obes Relat Metab Disord. 2004 Oct;28(10):1247-56
15314625
Pediatrics. 2002 Jul;110(1 Pt 1):73-82
12093949
Pediatr Clin North Am. 2001 Feb;48(1):87-104
11236735