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Díez López I, Cernada M, Galán L, Boix H, Ibañez L, Couce ML. Small for gestational age: concept, diagnosis and neonatal characterization, follow-up and recommendations. An Pediatr (Barc) 2024; 101:124-131. [PMID: 39127580 DOI: 10.1016/j.anpede.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/12/2024] [Indexed: 08/12/2024] Open
Abstract
Newborns who do not reach a weight appropriate for their gestational age and sex can be classified in different ways. This article defines the concepts of small for gestational age (SGA) and intrauterine growth restriction, as well as the underlying causes of these conditions, with the goal of establishing consensus definitions for these patients, in whom treatment with growth hormone throughout childhood may be indicated and who may be at risk of developing endocrine or metabolic disorders in puberty and adulthood. Most SGA children experience spontaneous catch-up growth that is usually completed by age 2 years. In SGA children who remain short, treatment with recombinant human growth hormone is effective, increasing adult height. Small for gestational age infants with rapid catch-up growth and marked weight gain are at increased risk of premature adrenarche, early puberty, polycystic ovary syndrome (girls), insulin resistance and obesity, all of which are risk factors for type 2 diabetes and metabolic syndrome in adulthood. The SGA status can affect different areas of neurodevelopment and manifest at different stages in life; neurodevelopmental outcomes are better in SGA infants with spontaneous catch-up growth. Due to the potential risks associated with SGA, adequate characterization of these patients at birth is imperative, as it allows initiation of appropriate follow-up and early detection of abnormalities.
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Affiliation(s)
- Ignacio Díez López
- Departamento de Pediatría, UPV-EHU, Servicio de Pediatría. HU Araba, OSI Araba, BIOARABA, Vitoria, Spain
| | - María Cernada
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Laura Galán
- Servicio de Pediatria, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Hector Boix
- Unidad de Cuidados Intensivos Neonatales, Hospital Quironsalud, Barcelona, Spain
| | - Lourdes Ibañez
- Servicio de Endocrinología, Hospital Sant Joan de Déu, Universidad de Barcelona, CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain.
| | - Maria L Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, RICORS-SAMID, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
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Perge K, Capel E, Senée V, Julier C, Vigouroux C, Nicolino M. Ciliopathies are responsible for short stature and insulin resistance: A systematic review of this clinical association regarding SOFT syndrome. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09894-w. [PMID: 39017987 DOI: 10.1007/s11154-024-09894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
SOFT syndrome (Short stature-Onychodysplasia-Facial dysmorphism-hypoTrichosis) is a rare primordial dwarfism syndrome caused by biallelic variants in POC1A encoding a centriolar protein. To refine the phenotypic spectrum of SOFT syndrome, recently shown to include metabolic features, we conducted a systematic review of all published cases (19 studies, including 42 patients). The SOFT tetrad affected only 24 patients (57%), while all cases presented with short stature from birth (median height: -5.5SDS([-8.5]-[-2.8])/adult height: 132.5 cm(103.5-148)), which was most often disproportionate (90.5%), with relative macrocephaly. Bone involvement resulted in short hands and feet (100%), brachydactyly (92.5%), metaphyseal (92%) or epiphyseal (84%) anomalies, and/or sacrum/pelvis hypoplasia (58%). Serum IGF-I was increased (median IGF-I level: + 2 SDS ([-0.5]-[+ 3])). Recombinant human growth hormone (rhGH) therapy was stopped for absence/poor growth response (7/9 patients, 78%) and/or hyperglycemia (4/9 patients, 45%). Among 11 patients evaluated, 10 (91%) presented with central distribution of fat (73%), clinical (64%) and/or biological insulin resistance (IR) (100%, median HOMA-IR: 18), dyslipidemia (80%), and hepatic steatosis (100%). Glucose tolerance abnormalities affected 58% of patients aged over 10 years. Patients harbored biallelic missense (52.4%) or truncating (45.2%) POC1A variants. Biallelic null variants, affecting 36% of patients, were less frequently associated with the SOFT tetrad (33% vs 70% respectively, p = 0.027) as compared to other variants, without difference in the prevalence of metabolic abnormalities. POC1A should be sequenced in children with short stature, altered glucose/insulin homeostasis and/or centripetal fat distribution. In patients with SOFT syndrome, rhGH treatment is not indicated, and IR-related complications should be regularly screened and monitored.PROSPERO registration: CRD42023460876.
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Affiliation(s)
- Kevin Perge
- Pediatric Endocrinology, Diabetology and Metabolism Department, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.
- Claude Bernard University, Lyon 1, Lyon, France.
- Paris University, Institut Cochin, INSERM U1016, CNRS UMR-8104, Paris, France.
| | - Emilie Capel
- Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Valérie Senée
- Paris University, Institut Cochin, INSERM U1016, CNRS UMR-8104, Paris, France
| | - Cécile Julier
- Paris University, Institut Cochin, INSERM U1016, CNRS UMR-8104, Paris, France
| | - Corinne Vigouroux
- Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
- Department of Molecular Biology and Genetics, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
| | - Marc Nicolino
- Pediatric Endocrinology, Diabetology and Metabolism Department, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France
- Claude Bernard University, Lyon 1, Lyon, France
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Zhang L, Liu J, Gao D, Li D. Role of ghrelin in promoting catch-up growth and maintaining metabolic homeostasis in small-for-gestational-age infants. Front Pediatr 2024; 12:1395571. [PMID: 38903769 PMCID: PMC11187245 DOI: 10.3389/fped.2024.1395571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Small-for-gestational age (SGA) has been a great concern in the perinatal period as it leads to adverse perinatal outcomes and increased neonatal morbidity and mortality, has an impact on long-term health outcomes, and increases the risk of metabolic disorders, cardiovascular, and endocrine diseases in adulthood. As an endogenous ligand of the growth hormone secretagotor (GHS-R), ghrelin may play an important role in regulating growth and energy metabolic homeostasis from fetal to adult life. We reviewed the role of ghrelin in catch-up growth and energy metabolism of SGA in recent years. In addition to promoting SGA catch-up growth, ghrelin may also participate in SGA energy metabolism and maintain metabolic homeostasis. The causes of small gestational age infants are very complex and may be related to a variety of metabolic pathway disorders. The related signaling pathways regulated by ghrelin may help to identify high-risk groups of SGA metabolic disorders and formulate targeted interventions to prevent the occurrence of adult dwarfism, insulin resistance-related metabolic syndrome and other diseases.
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Affiliation(s)
- Li Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jingfei Liu
- Department of Neonatology, Dalian Women and Children’s Medical Group, Dalian, China
| | - Dianyong Gao
- Department of Orthopedics, Lushunkou District People’s Hospital, Dalian, China
| | - Dong Li
- Department of Neonatology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Dorrepaal DJ, Goedegebuure WJ, van der Steen M, Bos D, Hokken – Koelega AC. Cerebral white matter hyperintensities in adults born small for gestational age at 12 years after cessation of childhood growth hormone treatment: a prospective cohort study including untreated controls. EClinicalMedicine 2024; 72:102637. [PMID: 38779170 PMCID: PMC11109348 DOI: 10.1016/j.eclinm.2024.102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Background Increased cerebrovascular morbidity was reported in adults born small for gestational age (SGA) who were treated with growth hormone (GH) during childhood compared to the general population. Yet, previous studies lacked an appropriate control group which is a major limitation. We prospectively studied cerebral white matter hyperintensities (WMHs) in adults born SGA at 12 years after cessation of childhood GH-treatment (SGA-GH), compared to appropriate controls. Methods In this prospective cohort study, performed between May 2016 and December 2020, total WMHs, periventricular WMHs (PVWMHs) and deep WMHs (DWMHs) were the primary outcomes of the study, they were qualitatively assessed using 3 Tesla (T) Magnetic Resonance Imaging (MRI) and scored using the Fazekas scale in SGA-GH adults and in 3 untreated control groups: adults born SGA with persistent short stature (SGA-S), adults born SGA with spontaneous catch-up growth to a normal height (SGA-CU) and adults born appropriate for gestational age with a normal height (AGA). Regression analyses were performed in the total cohort to evaluate the associations of GH-treatment and birth characteristics with WMHs. Findings 297 adults were investigated (91 SGA-GH, 206 controls). Prevalence of total WMHs was 53.8% (95% CI 43.1-64.3) in SGA-GH, 40.5% (95% CI 25.6-56.7) in SGA-S, 73.9% (95% CI 61.9-83.7) in SGA-CU and 41.1% (95% CI 31.1-51.6) in AGA adults. No statistically significant differences in total WMHs, PVWMHs and DWMHs were found between SGA-GH compared to SGA-S and AGA adults. Highest prevalence of all type of WMHs was found in SGA-CU adults compared to all groups. Higher prevalence of total WMHs was associated with lower birth weight standard deviation score (SDS), but not with GH-treatment. Interpretation Our findings suggest that GH-treatment in children born SGA has no negative impact on the prevalence of all type of WMHs at 12 years after GH cessation compared to appropriate controls. SGA-CU adults had the highest prevalence of all type of WMHs around age 30 years. Funding Novo Nordisk.
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Affiliation(s)
- Demi J. Dorrepaal
- Department of Pediatrics, Erasmus MC - University Medical Center-Sophia Children's Hospital, 3015 CN, Rotterdam, the Netherlands
| | - Wesley J. Goedegebuure
- Department of Pediatrics, Erasmus MC - University Medical Center-Sophia Children's Hospital, 3015 CN, Rotterdam, the Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus MC - University Medical Center-Sophia Children's Hospital, 3015 CN, Rotterdam, the Netherlands
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center, 3015 CN, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC - University Medical Center, 3015 CN, Rotterdam, the Netherlands
| | - Anita C.S. Hokken – Koelega
- Department of Pediatrics, Erasmus MC - University Medical Center-Sophia Children's Hospital, 3015 CN, Rotterdam, the Netherlands
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Rojo-Trejo ME, Robles-Osorio ML, Rangel B, García OP, Becerra-Hernández MF, Cárdenas-Rodríguez L, Sabath E. Appendicular Muscle Mass Index as the Most Important Determinant of Bone Mineral Content and Density in Small for Gestational Age Children. Clin Pediatr (Phila) 2024:99228241242515. [PMID: 38581300 DOI: 10.1177/00099228241242515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Preterm small for gestational age (SGA) children are at increased risk for low bone mineral content later in life; however, data on SGA children born at term are scarce. We included 44 SGA and 57 adequate for gestational age (AGA) children aged 6 to 11 years to compare bone mineral density (BMD) and bone mineral content (BMC) and to identify which anthropometric and biochemical values influence bone mineralization in these children. Fat mass, appendicular skeletal muscle mass index (ASMMI), BMC, and BMD were significantly lower in SGA children than in AGA (P ≤ .005). Appendicular muscle mass index correlated with BMC(TBLH,FN,L1-L4) and BMD(TBLH,FN,L1-L4) in both groups (r2 = 0.7, P < .05). In multivariate analysis, ASMMI was strongly associated with BMC and BMD in both groups. There were no differences in clinical biomarkers, calcium intake, and physical activity between the groups. Achieving adequate muscle mass contributes to adequate bone mineralization and a lower risk for low BMC and BMD in SGA children.
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Affiliation(s)
| | | | - Beatriz Rangel
- Nutrition School, Universidad Autónoma de Querétaro, Querétaro, México
| | - Olga P García
- Nutrition School, Universidad Autónoma de Querétaro, Querétaro, México
| | | | | | - Ernesto Sabath
- Nutrition School, Universidad Autónoma de Querétaro, Querétaro, México
- Renal Division and Metabolic Unit, Hospital General de Querétaro, Queretaro, México
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Wang L, Su Z, Li YC, Cao BY, Su C, Gong CX. Relationship of Glucagon-like Peptide 1 and Peptide YY with Catch-up Growth in Children Born Small for Gestational Age. J Clin Res Pediatr Endocrinol 2024; 16:69-75. [PMID: 37847108 PMCID: PMC10938530 DOI: 10.4274/jcrpe.galenos.2023.2023-5-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023] Open
Abstract
Objective Children born small for gestational age (SGA) are at a greater risk of developing insulin resistance, type 2 diabetes, and cardiovascular disease in adulthood. Gastrointestinal peptides, some secreted by intestinal L cells, regulate glucose and lipid metabolism and act on the hypothalamus to regulate energy homeostasis. The aim of this study was to explore whether gastrointestinal peptides are involved in metabolic disorders in SGA, which remains unclear. Methods The secretion of glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) were investigated in prepubertal children born SGA, the differences between catch-up growth and persistent short stature were compared, and correlation with glucose and lipid metabolism was analyzed. GLP-1, PYY, insulin-like growth factor 1, glucose, insulin, and lipid concentrations were analyzed in prepubertal children aged 4-10 years, stratified into three groups: short-SGA (SGA-s), catch-up growth SGA, and normal growth appropriate for gestational age (AGA). Results Fasting GLP-1 and PYY concentrations were significantly lower in the SGA group than in the AGA group (p<0.05), and the GLP-1 level in infants born SGA with catch-up growth was lower than that in the SGA-s group (p<0.05). In the SGA population, GLP-1 showed a weak negative correlation with catch-up growth (r=-0.326) and positive correlation with fasting insulin (r=0.331). Conclusion Lower GLP-1 concentrations may be associated with abnormal glucose metabolism in prepubertal children born SGA with catch-up growth. This is indirect evidence that impaired intestinal L cell function may be involved in the development of metabolic complications in SGA children.
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Affiliation(s)
- Li Wang
- National Center for Children’s Health, Capital Medical University, Beijing Children’s Hospital, Clinic of Endocrinology, Beijing, China
- Shenzhen Children’s Hospital, Clinic of Endocrinology, Shenzhen, China
| | - Zhe Su
- Shenzhen Children’s Hospital, Clinic of Endocrinology, Shenzhen, China
| | - Yu-Chuan Li
- National Center for Children’s Health, Capital Medical University, Beijing Children’s Hospital, Clinic of Endocrinology, Beijing, China
| | - Bing-Yan Cao
- National Center for Children’s Health, Capital Medical University, Beijing Children’s Hospital, Clinic of Endocrinology, Beijing, China
| | - Chang Su
- National Center for Children’s Health, Capital Medical University, Beijing Children’s Hospital, Clinic of Endocrinology, Beijing, China
| | - Chun-Xiu Gong
- National Center for Children’s Health, Capital Medical University, Beijing Children’s Hospital, Clinic of Endocrinology, Beijing, China
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Burton JJN, Alonso LC. Overnutrition in the early postnatal period influences lifetime metabolic risk: Evidence for impact on pancreatic β-cell mass and function. J Diabetes Investig 2024; 15:263-274. [PMID: 38193815 PMCID: PMC10906026 DOI: 10.1111/jdi.14136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Overconsumption of energy-rich foods that disrupt caloric balance is a fundamental cause of overweight, obesity and diabetes. Dysglycemia and the resulting cardiovascular disease cause substantial morbidity and mortality worldwide, as well as high societal cost. The prevalence of obesity in childhood and adolescence is increasing, leading to younger diabetes diagnosis, and higher severity of microvascular and macrovascular complications. An important goal is to identify early life conditions that increase future metabolic risk, toward the goal of preventing diabetes and cardiovascular disease. An ample body of evidence implicates prenatal and postnatal childhood growth trajectories in the programming of adult metabolic disease. Human epidemiological data show that accelerated childhood growth increases risk of type 2 diabetes in adulthood. Type 2 diabetes results from the combination of insulin resistance and pancreatic β-cell failure, but specific mechanisms by which accelerated postnatal growth impact one or both of these processes remain uncertain. This review explores the metabolic impact of overnutrition during postnatal life in humans and in rodent models, with specific attention to the connection between accelerated childhood growth and future adiposity, insulin resistance, β-cell mass and β-cell dysfunction. With improved knowledge in this area, we might one day be able to modulate nutrition and growth in the critical postnatal window to maximize lifelong metabolic health.
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Affiliation(s)
- Joshua JN Burton
- Division of Endocrinology, Diabetes and Metabolism and the Joan and Sanford I. Weill Center for Metabolic Health, Weill Cornell MedicineNew York CityNew YorkUSA
| | - Laura C Alonso
- Division of Endocrinology, Diabetes and Metabolism and the Joan and Sanford I. Weill Center for Metabolic Health, Weill Cornell MedicineNew York CityNew YorkUSA
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Hansen C, Davison B, Singh GR. Small for gestational age and anthropometric body composition from early childhood to adulthood: the Aboriginal Birth Cohort study. Front Public Health 2024; 12:1349040. [PMID: 38450125 PMCID: PMC10915257 DOI: 10.3389/fpubh.2024.1349040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Background In Australia the estimated rate of small for gestational age (SGA) births is 9% among non-Indigenous births compared to 14% among Aboriginal and Torres Strait Islanders. There is limited research investigating the effect of being born SGA on body composition later in life in Indigenous Australians. Methods Using data from the Aboriginal Birth Cohort longitudinal study, we compared the body composition of those born SGA to non-SGA by analysing anthropometric measures (height, weight, waist circumference, fat percentage [FAT%], body mass index [BMI], waist-to-height ratio, and A body shape index [ABSI]) collected at four follow-up periods (from childhood to adult). For cross-sectional analyses, linear regression models were employed to assess factors associated with anthropometric measures. For longitudinal analyses linear mixed models were employed to assess differences in anthropometric measures among SGA versus non-SGA individuals while adjusting for repeated measures. Results The analytic baseline cohort were those who participated in Wave 2 (n = 570). In cross-sectional analyses, across all waves those born SGA had smaller anthropometric z-scores compared to non-SGA individuals (β ranging from -0.50 to -0.25). Participants residing in urban environments were significantly larger in Waves 2 to 4 (β ranged 0.26 to 0.65). Those born SGA had higher ABSI scores in Waves 2 and 4 (β 0.26 and 0.37, respectively). In longitudinal analyses, those born SGA had smaller measures of body composition across the life course; these differences were larger in urban communities. In remote communities those born SGA had significantly higher ABSI scores during adolescence and young adulthood, and this difference was not observed in urban communities. Conclusion Indigenous Australians born SGA are smaller anthropometrically later in life compared to their non-SGA counterparts. In remote communities, those born SGA had higher levels of central adiposity compared to non-SGA.
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Affiliation(s)
- Craig Hansen
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Belinda Davison
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gurmeet R. Singh
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Northern Territory Medical Program, Flinders University, Darwin, Darwin, NT, Australia
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Dorrepaal DJ, Goedegebuure WJ, Smagge L, van der Steen M, van der Lugt A, Hokken-Koelega ACS. Cerebrovascular Abnormalities in Adults Born SGA at 12 Years After Growth Hormone Cessation Compared to Controls. J Clin Endocrinol Metab 2024; 109:e1185-e1193. [PMID: 37855389 PMCID: PMC10876403 DOI: 10.1210/clinem/dgad622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT Increased cerebrovascular morbidity was reported in adults born small for gestational age (SGA) who were treated with growth hormone (GH) during childhood compared to the general population. However, previous studies did not have an appropriate control group, which is a major limitation. OBJECTIVE To study cerebrovascular abnormalities (aneurysms, previous intracerebral hemorrhages and microbleeds) using magnetic resonance imaging (MRI) in adults born SGA at 12 years after cessation of childhood GH treatment (SGA-GH) compared to appropriate controls. METHODS In this single-center, prospective study, brain MRIs were performed between May 2016 and December 2020 on a 3T MRI system. MRI images were scored by 2 neuroradiologists who were blinded to patient groupings. Participants included adults born SGA previously treated with GH and 3 untreated control groups: adults born SGA with persistent short stature (SGA-S), adults born SGA with spontaneous catch-up growth to a normal height (SGA-CU) and adults born appropriate for gestational age with a normal height (AGA). The intervention was long-term GH treatment during childhood and the main outcome measure was cerebrovascular abnormalities. RESULTS A total of 301 adults were investigated. Aneurysms were found in 6 adults: 3 (3.6%) SGA-GH, 1 (2.9%) SGA-S and 2 (2.2%) AGA adults, without differences between SGA-GH adults and the controls. Previous intracerebral hemorrhages were only found in 2 SGA-S adults (4.8%). Microbleeds were found in 17 adults: 4 (4.3%) SGA-GH, 4 (9.5%) SGA-S, 3 (4.3%) SGA-CU and 6 (6.3%) AGA adults, without differences between SGA-GH adults and the controls. CONCLUSION Our findings suggest that SGA-GH adults at 12 years after GH cessation have no increased prevalence of cerebrovascular abnormalities compared to appropriate controls. Further research is needed to confirm our findings.
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Affiliation(s)
- Demi Justine Dorrepaal
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Wesley Jim Goedegebuure
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Lucas Smagge
- Department of Radiology, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands
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Zamojska J, Niewiadomska-Jarosik K, Kierzkowska B, Gruca M, Wosiak A, Smolewska E. Lipid Profile in Children Born Small for Gestational Age. Nutrients 2023; 15:4781. [PMID: 38004175 PMCID: PMC10674326 DOI: 10.3390/nu15224781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Lipid disorders are one of the risk factors for cardiovascular diseases. The aim of the study was to estimate the lipid profile in early childhood in the population of Polish children born small for gestational age (SGA). MATERIALS AND METHODS The study included 140 patients (93 SGA children and 47 controls) aged 5 to 11 years. All the subjects underwent a physical examination and blood laboratory tests for the glucose and lipid profiles. The SGA group was divided into subgroups, i.e., symmetrical and asymmetrical intrauterine growth restriction (IUGR). RESULTS Blood sample analysis revealed higher levels of total cholesterol (SGA group 190.61 ± 24.66 mg/dL vs. controls 143.23 ± 23.90; p < 0.001). The analysis of particular cholesterol fractions showed significantly higher mean values of triglycerides and LDL cholesterol as well as lower mean values of HDL cholesterol in SGA children. Children in both groups did not differ significantly in terms of weight or body mass index. A statistically significantly higher glucose concentration was observed in SGA patients with the symmetrical type of IUGR. Analyzing the differences regarding metabolic factors, we obtained a statistically significant difference only in fasting glucose concentration (asymmetrical IUGR = 90.56 ± 10.21 vs. symmetrical IUGR = 98.95 ± 14.79; p < 0.001). CONCLUSIONS Children born SGA, even those not suffering from overweight or obesity in their early childhood, have an abnormal lipid profile, which may contribute to the development of cardiovascular diseases in adulthood.
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Affiliation(s)
- Justyna Zamojska
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 90-419 Lodz, Poland; (K.N.-J.); (B.K.); (M.G.); (E.S.)
| | - Katarzyna Niewiadomska-Jarosik
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 90-419 Lodz, Poland; (K.N.-J.); (B.K.); (M.G.); (E.S.)
| | - Beata Kierzkowska
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 90-419 Lodz, Poland; (K.N.-J.); (B.K.); (M.G.); (E.S.)
| | - Marta Gruca
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 90-419 Lodz, Poland; (K.N.-J.); (B.K.); (M.G.); (E.S.)
| | - Agnieszka Wosiak
- Institute of Information Technology, Lodz University of Technology, 90-924 Lodz, Poland;
| | - Elżbieta Smolewska
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 90-419 Lodz, Poland; (K.N.-J.); (B.K.); (M.G.); (E.S.)
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Yu Y, Lyo V, Groth SW. The impact of maternal bariatric surgery on long-term health of offspring: a scoping review. Pediatr Res 2023; 94:1619-1630. [PMID: 37340100 DOI: 10.1038/s41390-023-02698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
While pregnancy post-bariatric surgery has become increasingly common, little is known about whether and how maternal bariatric surgery affects the next generation. This scoping review aimed to collate available evidence about the long-term health of offspring following maternal bariatric surgery. A literature search was conducted using three databases (PubMed, PsycINFO, EMBASE) to obtain relevant human and animal studies. A total of 26 studies were included: 17 were ancillary reports from five "primary" studies (three human, two animal studies) and the remaining nine were "independent" studies (eight human, one animal studies). The human studies adopted sibling-comparison, case-control, and single-group descriptive designs. Despite limited data and inconsistent results across studies, findings suggested that maternal bariatric surgery appeared to (1) modify epigenetics (especially genes involved in immune, glucose, and obesity regulation); (2) alter weight status (unclear direction of alteration); (3) impair cardiometabolic, immune, inflammatory, and appetite regulation markers (primarily based on animal studies); and (4) not affect the neurodevelopment in offspring. In conclusion, this review supports that maternal bariatric surgery has an effect on the health of offspring. However, the scarcity of studies and heterogenous findings highlight that more research is required to determine the scope and degree of such effects. IMPACT: There is evidence that bariatric surgery modifies epigenetics in offspring, especially genes involved in immune, glucose, and obesity regulation. Bariatric surgery appears to alter weight status in offspring, although the direction of alteration is unclear. There is preliminary evidence that bariatric surgery impairs offspring's cardiometabolic, immune, inflammatory, and appetite regulation markers. Therefore, extra care may be needed to ensure optimal growth in children born to mothers with previous bariatric surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Victoria Lyo
- Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA
- Center for Alimentary and Metabolic Science, University of California Davis, Sacramento, CA, 95817, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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12
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李 墨, 丁 瑛, 崔 红, 姜 丽, 王 子, 来 艳, 李 白, 丁 文. [Characteristics of the left heart structure and function in 86 term neonates with intrauterine growth restriction]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1016-1021. [PMID: 37905757 PMCID: PMC10621062 DOI: 10.7499/j.issn.1008-8830.2304045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/16/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To study the left heart structure and functional characteristics of term neonates with intrauterine growth restriction (IUGR). METHODS This study included 86 term neonates with IUGR admitted to the Neonatal Ward of Beijing Friendship Hospital, Capital Medical University from January 2019 to January 2022 as the IUGR group, as well as randomly selected 86 term neonates without IUGR born during the same period as the non-IUGR group. The clinical data and echocardiographic data were compared between the two groups. RESULTS The analysis of left heart structure and function showed that compared with the non-IUGR group, the IUGR group had significantly lower left ventricular mass, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, end-diastolic interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume, left ventricular end-systolic volume, and stroke volume (P<0.05) and significantly higher ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness, proportion of neonates with a mitral peak E/A ratio of ≥1, and cardiac index (P<0.05). The Spearman correlation analysis suggested that stroke volume was positively correlated with birth weight and body surface area (rs=0.241 and 0.241 respectively; P<0.05) and that the ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness was negatively correlated with birth weight and body surface area (rs=-0.229 and -0.225 respectively; P<0.05). CONCLUSIONS The left ventricular systolic function of neonates with IUGR is not significantly different from that of neonates without IUGR. However, the ventricular septum is thicker in neonates with IUGR. This change is negatively correlated with birth weight and body surface area. The left ventricular diastolic function may be impaired in neonates with IUGR.
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Affiliation(s)
| | | | | | | | | | | | | | - 文虹 丁
- 首都医科大学附属北京安贞医院小儿心脏科北京100029
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13
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Wasniewska M, Pepe G, Aversa T, Bellone S, de Sanctis L, Di Bonito P, Faienza MF, Improda N, Licenziati MR, Maffeis C, Maguolo A, Patti G, Predieri B, Salerno M, Stagi S, Street ME, Valerio G, Corica D, Calcaterra V. Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040735. [PMID: 37189984 DOI: 10.3390/children10040735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity.
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Affiliation(s)
- Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Giorgia Pepe
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Tommaso Aversa
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Turin, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Improda
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Giuseppina Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16128 Genova, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Stagi
- Health Sciences Department, University of Florence and Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Elisabeth Street
- Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli "Parthenope", 80133 Napoli, Italy
| | - Domenico Corica
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20157 Milano, Italy
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14
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Hokken-Koelega ACS, van der Steen M, Boguszewski MCS, Cianfarani S, Dahlgren J, Horikawa R, Mericq V, Rapaport R, Alherbish A, Braslavsky D, Charmandari E, Chernausek SD, Cutfield WS, Dauber A, Deeb A, Goedegebuure WJ, Hofman PL, Isganatis E, Jorge AA, Kanaka-Gantenbein C, Kashimada K, Khadilkar V, Luo XP, Mathai S, Nakano Y, Yau M. International Consensus Guideline on Small for Gestational Age (SGA): Etiology and Management from Infancy to Early Adulthood. Endocr Rev 2023; 44:539-565. [PMID: 36635911 PMCID: PMC10166266 DOI: 10.1210/endrev/bnad002] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/31/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
This International Consensus Guideline was developed by experts in the field of SGA of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Besides, it presents long-term consequences of SGA birth and new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, and the metabolic and cardiovascular health of young adults born SGA after cessation of childhood-GH-treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardio-metabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at age of 3-4 years, should be referred for diagnostic work-up. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033-0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3-4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.
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Affiliation(s)
- Anita C S Hokken-Koelega
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome 'Tor Vergata', Children's Hospital, Rome, Italy.,Diabetology and Growth Disorders Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, the Sahlgrenska Academy, the University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Veronica Mericq
- Institute of Maternal and Child Research, faculty of Medicine, University of Chile
| | - Robert Rapaport
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | | | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas "Dr. Cesar Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Steven D Chernausek
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Andrew Dauber
- Division of Endocrinology, Children's National Hospital, Washington, DC 20012, USA
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City and College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Wesley J Goedegebuure
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Alexander A Jorge
- Unidade de Endocrinologia Genética (LIM25) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Xiao-Ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sarah Mathai
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Yuya Nakano
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mabel Yau
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
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15
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Joint Effects of Prenatal Folic Acid Supplement with Prenatal Multivitamin and Iron Supplement on Obesity in Preschoolers Born SGA: Sex Specific Difference. Nutrients 2023; 15:nu15020380. [PMID: 36678251 PMCID: PMC9863758 DOI: 10.3390/nu15020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Prenatal maternal nutrient supplementation has been reported to be associated with offspring obesity, but the reports are inconsistent and have mainly ignored the differences between the total children population and children born small for gestational age (SGA). This study aimed to examine the joint effects of folic acid, iron, and multivitamin supplementation during pregnancy on the risk of obesity in preschoolers born SGA. A total of 8918 children aged 3-6.5 years born SGA were recruited from Longhua District in Shenzhen of China in 2021. Their mothers completed a structured questionnaire about the child's and parents' socio-demographic characteristics, maternal prepregnant obesity, and mothers' prenatal supplementation of folic acid, iron, and multivitamin. In addition, the children's current weight and height were measured by trained nurses. Logistic regression models were used to analyze the associations between prenatal supplementations and the current presence of childhood obesity. After controlling for potential confounders, the results of the logistic regression analysis showed that prenatal supplement of folic acid (OR = 0.72, 95% CI = 0.55~0.93) was associated with a lower likelihood of being an obese preschooler born SGA. In contrast, the ingestion of multivitamin or iron supplements during pregnancy did not seem to be related to the likelihood of childhood obesity in preschoolers born SGA. Moreover, cross-over analysis of prenatal folic acid and multivitamin obtained significant negative associations of prenatal folic acid supplement only (OR = 0.73, 95% CI = 0.55~0.97) and combination supplement of folic acid and multivitamin (OR = 0.67, 95% CI = 0.50~0.90) with obesity of preschoolers born SGA; while the cross-over analysis of prenatal folic acid and iron observed significant negative associations between obesity of preschoolers born SGA and a combination supplement of folic acid and iron (OR = 0.70, 95% CI = 0.52~0.96). Furthermore, the aforementioned significant associations were only found in girls and not in boys when the analyses were stratified by sex. Our findings suggest that the prenatal folic acid supplementation may decrease the risk of obesity in preschool girls born SGA, and that this effect may be modified by prenatal multivitamin or iron supplementation.
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16
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Romano ME, Heggeseth BC, Gallagher LG, Botelho JC, Calafat AM, Gilbert-Diamond D, Karagas MR. Gestational per- and polyfluoroalkyl substances exposure and infant body mass index trajectory in the New Hampshire Birth Cohort Study. ENVIRONMENTAL RESEARCH 2022; 215:114418. [PMID: 36162478 PMCID: PMC9841894 DOI: 10.1016/j.envres.2022.114418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 05/27/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are environmentally persistent, potential metabolic disruptors of concern for infants. Mothers participating in the New Hampshire Birth Cohort Study (NHBCS) provided a plasma sample during pregnancy to measure concentrations of seven PFAS, and infant weight and length were abstracted from well-child visits between birth and 12 months. Sex-specific growth patterns of child body mass index (BMI) were fit using a growth mixture model (GMM) and the relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) for the association of maternal plasma PFAS with BMI growth patterns during infancy were estimated by using multinomial logistic model for the group probabilities in the GMM. Four growth patterns were identified: Group 1) a steep increase in BMI during the first 6 months, then a leveling off; Group 2) a gradual increase in BMI across the year; Group 3) a steep increase in BMI during months 1-3, then stable BMI; and Group 4) a gradual increase in BMI with plateau around 3 months (reference group). For boys, higher maternal pregnancy perfluorooctanoate concentrations were associated with a 60% decreased chance of being in group 3 as compared to group 4, after adjusting for potential confounding variables (RRR = 0.4; 95% CI: 0.1, 0.9). For girls, higher maternal perfluorooctane sulfonate (PFOS) concentrations during pregnancy were associated with a higher likelihood of following the growth pattern of groups 2 (RRR = 2.5; 95% CI: 1.0, 6.1) and 3 (RRR = 2.8; 95% CI: 1.0, 7.6) as compared to group 4, adjusting for potential confounding variables. In this cohort, sex-specific associations of maternal plasma PFAS concentrations during pregnancy with growth patterns during the first year of life were observed, with greater BMI growth observed among infant girls born to mothers with higher pregnancy concentrations of PFOS.
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Affiliation(s)
- Megan E Romano
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA.
| | - Brianna C Heggeseth
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St. Paul, MN, USA
| | - Lisa G Gallagher
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Julianne Cook Botelho
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Margaret R Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
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17
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Goedegebuure WJ, van der Steen M, Smeets CCJ, Hokken-Koelega ACS. Childhood growth hormone treatment and metabolic and cardiovascular risk in adults born small for gestational age after growth hormone cessation in the Netherlands: a 12-year follow-up study. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:777-787. [PMID: 36122581 DOI: 10.1016/s2352-4642(22)00240-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Childhood growth hormone treatment has been associated with increased cardiovascular mortality and morbidity in adults born small for gestational age (SGA) compared with the general population, but these risks have not been compared with untreated control groups. We aimed to investigate longitundinal metabolic and cardiovascular health in adults born SGA after cessation of growth hormone treatment. METHODS We longitudinally investigated the metabolic and cardiovascular health profile of 167 adults born SGA and previously treated with growth hormone during the 12 years after growth hormone cessation. Metabolic and cardiovascular parameters were assessed with the frequently sampled intravenous glucose tolerance test, serum lipids and blood pressure were measured, body composition was determined by dual-energy x-ray absorptiometry, and visceral fat was measured by MRI. At approximately age 30 years, we compared the metabolic and cardiovascular health profile of adults born SGA and previously treated with growth hormone (SGA-GH) with 219 untreated adults: 127 born SGA with either persistent short stature (SGA-S) or spontaneous catch-up to typical adult stature (SGA-CU), and 92 born appropriate for gestational age. FINDINGS During 12 years of follow-up, SGA-GH adults maintained normal β-cell function (p=0·157 for the difference from growth hormone cessation to 12-year follow-up) and showed an increase in insulin sensitivity (p=0·002), fat mass (p<0·001), total cholesterol (p<0·001), and blood pressure (p<0·001). By around age 30 years, these parameters reached similar levels to those in SGA-S adults (insulin sensitivity p=0·242; fat mass p=0·449; total cholesterol p=0·616; systolic blood pressure p=0·523; diastolic blood pressure p=0·538). By around age 30 years, SGA-GH adults also had similar metabolic and cardiovascular health parameters to adults born appropriate for gestational age, with the exception of lower lean body mass (estimated marginal mean 44·67 kg [95% CI 43·54-45·80] in SGA-GH adults vs 47·65 kg [46·39-48·92] in adults born appropriate for gestational age) and higher concentrations of adverse serum lipids, such as cholesterol (4·75 mmol/L [4·55-4·95] vs 4·33 mmol/L [4·13-4·5]), which were present in all groups born SGA. Abdominal adiposity (visceral adipose tissue p=0·107; subcutaneous adipose tissue: p=0·244), liver fat fraction (p=0·104), and blood pressure (systolic blood pressure 0·927; diastolic blood pressure: 0·737) were similar between SGA-GH adults and all control groups. INTERPRETATION At approximately age 30 years, SGA-GH adults had a similar metabolic and cardiovascular health profile to untreated adults born SGA or appropriate for gestational age, indicating long-term metabolic and cardiovascular safety of growth hormone treatment for children born SGA with short stature. FUNDING Novo Nordisk.
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Affiliation(s)
- Wesley J Goedegebuure
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, Netherlands; Dutch Growth Research Foundation, Rotterdam, Netherlands.
| | | | | | - Anita C S Hokken-Koelega
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, Netherlands; Dutch Growth Research Foundation, Rotterdam, Netherlands
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