Severe Intrauterine Growth Restriction Is Associated With Higher Spontaneous Carbohydrate Intake in Young Women

Abstract

Intrauterine growth restriction (IUGR) is associated with metabolic disorders in adulthood. In rats, an early adverse environment alters food preferences in adult life. We investigated whether IUGR is associated with spontaneous macronutrient preferences in humans. Two thousand sixty-three participants from a Brazilian birth cohort were evaluated at 24 y of age using a food frequency questionnaire, physical examination, anthropometric measurements, and biochemical assays (glucose, insulin, cholesterol, and triglycerides). IUGR was defined by the birth weight ratio (BWR ϭ birth weight/mean weight for gestational age). Individuals were classified as non growth restricted (BWR Ն0.85), moderately growth restricted (0.85 Ͼ BWR Ն 0.75), and severely growth restricted (BWR Ͻ0.75). Severe IUGR women consumed a greater carbohydrate to protein ratio, even after controlling for social variables. There was a continuous association between growth restriction and later carbohydrate to protein ratio consumption in women. Women from both IUGR groups had a larger waist to hip ratio (WHR). The prevalence of metabolic syndrome was comparable between the groups. IUGR women preferred carbohydrates to protein in their regular diet, suggesting that spontaneous food choices may precede the appearance and contribute to the risk for metabolic diseases in this group. (Pediatr Res 65: 215-220, 2009) S tudies have shown that low birth weight, a marker for adverse fetal conditions, is associated with metabolic disorders in adulthood, predicting insulin resistance and type 2 diabetes (1), hypertension (2), obesity (3) and cardiovascular disease (4), especially in cases where there is evidence of postnatal body weight catch-up during childhood. Thus, feeding patterns and accelerated weight gain during the postnatal period are crucial mediators of the risk for subsequent obesity, cardiovascular disease (5), and insulin resistance (6).The developing organism may use the maternal intrauterine environment's hormonal milieu as a signal to indicate conditions that will exist in the postnatal environment (7) to favor the adaptation to the environment in which it will develop. Therefore, for a fetus reared in a stressful environment with possible shortage of nutrients, metabolic and neurochemical patterns would be adjusted very early during development favoring energy storage for the individual's survival.Studies in animals propose that altered eating and exercise behaviors precede the development of obesity and insulin resistance (8 -10). Exposure to a high fat diet further exacerbates the metabolic and cardiovascular abnormalities in these animals (8). In our previous studies in rats (11,12), we demonstrated that early life experience affects sweet food intake later in life. These findings would indicate that adverse perinatal events in humans could affect an individual's voluntary food choices for palatable foods, influencing the risk for metabolic diseases in adult life. We tested this hypothesis in a birth cohort followed to adulthood i...

Preliminary evidence for an impulsivity-based thrifty eating phenotype

“…In support of this hypothesis, we found that young adult women who have experienced IUGR prefer carbohydrates over protein and have larger waist-to-hip ratios, despite having no signs of insulin resistance or diabetes mellitus (14). Other research groups report that there are specific food preferences among individuals exposed to nutritional shortage during gestation, manifesting as intake of high-fat diets (15) and higher energy intake (16) in late middle age.…”

“…Furthermore, in girls alone, eating impulse response scores at the age of 36 mo predicted both quantum of consumption of palatable fat and BMI values at the age of 48 mo, despite there being no such association with BMI at 36 mo. These data take on added significance in conjunction with the finding that young adult women with a history of IUGR show a preference for carbohydrates (14). …”

“…This analysis was split by gender and adjusted for the 48-mo BMI (which could have an independent influence on food intake). We stratified data by gender in this study because our previous work (14) showed that women who had experienced IUGR in utero eat more carbohydrates in adulthood and have a higher waist-to-hip ratio than do women who did not experience IUGR.…”

“…We therefore investigated the possible association between IUGR and impulsive eating, using a snack delay task in 3-year-old Canadian children. Based on our previous findings (14), our first hypothesis was that a history of IUGR would be associated with impulsive response toward a palatable snack at the age of 36 mo, particularly in girls. Our second hypothesis was that impulsive eating at 36 mo would predict the quantum of intake of palatable fat (hypothesis 2a) and/or higher BMIs (hypothesis 2b) at the age of 48 mo.…”

Appetite-Related Eating Behaviours: An Overview of Assessment Methods, Determinants and Effects on Children’s Weight

“…Wardle et al [47] observed that twin children from families with obese/overweight parents had modestly higher preferences for the taste of fatty foods, less liking for low-energy-dense foods, such as vegetables, and displayed stronger positive appetitive reactions to food and drink than children of lean parents. Other studies have reported that individuals with severe intrauterine growth restriction have altered nutritional intake later in life [48, 49]. Lussana et al [50] demonstrated that middle-aged adult participants exposed to famine in early gestation were twice as likely to consume a high-fat diet (> 39% energy from fat) than time controls, supporting long-term effects of intrauterine exposures.…”