Lower insulin sensitivity remains a feature of children born very preterm

Abstract

Background The first report of children born very preterm (<32 weeks of gestation) having insulin resistance was made 16 years ago. However, neonatal care has improved since. Thus, we aimed to assess whether children born very preterm still have lower insulin sensitivity than term controls. Methods Participants were prepubertal children aged 5 to 11 years born very preterm (<32 weeks of gestation; n = 51; 61% boys) or at term (37‐41 weeks; n = 50; 62% boys). Frequently sampled intravenous glucose tolerance tests were performed, and insulin sensitivity was calculated using Bergman's minimal model. Additional clinical assessments included anthropometry, body composition using whole‐body dual‐energy X‐ray absorptiometry scans, clinic blood pressure, and 24‐hour ambulatory blood pressure monitoring. Results Children born very preterm were 0.69 standard deviation score (SDS) lighter (P < .001), 0.53 SDS shorter (P = .003), and had body mass index 0.57 SDS lower (P = .003) than children born at term. Notably, children born very preterm had insulin sensitivity that was 25% lower than term controls (9.4 vs 12.6 × 10−4 minutes−1·[mU/L]; P = .001). Other parameters of glucose metabolism, including fasting insulin levels, were similar in the two groups. The awake systolic blood pressure (from 24‐hour monitoring) tended to be 3.1 mm Hg higher on average in children born very preterm (P = .054), while the clinic systolic blood pressure was 5.4 mm Hg higher (P = .002). Conclusions Lower insulin sensitivity remains a feature of children born very preterm, despite improvements in neonatal intensive care. As reported in our original study, our findings suggest the defect in insulin action in prepubertal children born very pretermis primarily peripheral and not hepatic.

The extremely preterm young adult – State of the art

“…The lipid profile was similar in the two groups. These findings are consistent with the observation of increased insulin resistance [50,51] and population studies among preterm populations which show increased biomarkers for later atherogenic cardiovascular disease [52].…”

Postnatal Expression Profile of MicroRNAs Associated with Cardiovascular Diseases in 3- to 11-Year-Old Preterm-Born Children

“…The highest postnatal microRNA expression levels were observed in children born prematurely at lower gestational ages and in children born with lower birth weight. These findings may also contribute to the explanation of why preterm-born children with lower birth weight have an increased cardiovascular risk and to the explanation of the increase in cardiovascular risk with the decrease in gestational age at delivery [2,5,[9][10][11]15,19,20,22,23,26,27,29,31,35,39,43,44,51,58,59].…”

“…In general, multiple risk factors predisposing to a later development of cardiovascular diseases have been identified in preterm-born individuals. These risk factors involve increased peripheral and central systolic (SBP) and/or diastolic (DBP) blood pressures , higher heart rate (HR) [4,22,23], higher fat mass [21], lower functional skin capillary density [4], lower peripheral skin blood flow [24], abnormal retinal vascularization (both structure and function) [1,3,17], increased sympathoadrenal activity together with higher levels of urine catecholamines [22], kidney hypoplasia, incomplete nephrogenesis (reduced number of nephrons) and impaired renal function (decreased glomerular filtration rate, microalbuminuria) [20,[25][26][27][28], worsened respiratory parameters usually as a consequence of bronchopulmonary dysplasia (BPD) [19,29,30], impaired exercise capacity [19,30], elevated fasting glucose and cholesterol levels [10], higher serum levels of insulin 2 h after the glucose load [31], decreased insulin sensitivity [32][33][34][35][36], or even higher incidence of systolic or diastolic prehypertension/hypertension [13,25,[37][38][39][40], chronic kidney disease [13,25], lipid disorders [39,41], type 1 diabetes mellitus [39,[42]…”