FATMA FEYZA DARENDELİLER, FİRDEVS BAŞ, Rüveyde BUNDAK, EMİNE ASUMAN ÇOBAN, Nilay BAŞ, ÖZLEM SANCAKLI, Kabataş Sema ERYILMAZ, Banu KÜÇÜKEMRE, Rian DİŞÇİ, Gülbin GÖKÇAY, Semih AKI, Zeynep İNCE, Nurten ESKİYURT

Preterm doğan çocuklarda prepubertal dönemde insülin direncinin değerlendirilmesi

Amaç: Bu çalışmada preterm doğan ve doğum ağırlığı gestasyon yaşına göre normal (AGA) veya düşük (SGA) olan çocuklarda insülin direncinin değerlendirilmesi hedeflendi. Gereç ve Yöntem: Preterm doğan doksan üç çocuk, prematüre SGA (n=30) ve prematüre AGA (n=63) olarak gruplandı. Kronolojik yaşları sırasıyla 4.6±0.2 ve 4.7±0.1 yıl olan gruplarda glukoz, insülin ve IGFBP-1 düzeyleri değerlendirildi. Bulgular vücut kitle indeksi (VKİ) benzer, 4.5±0.2 yaşındaki term SGA (n=42) ve 3.8±0.1 yaşındaki term AGA (n=44) çocukların değerleri ile karşılaştırıldı. Tüm çocukların boyu hedef boyuna uygundu. İnsülin direnci, bazal insülin değeri ve insülin duyarlılık indeksi (HOMA-IR) ile değerlendirildi. Bulgular: Bazal insülin değeri VKİ’leri benzer olan preterm AGA (4.3±1.4 pmol/l) ve term AGA (7.9±6.4 pmol/l) çocuklarda benzerdi. Preterm SGA çocukların insülin değeri (5.0±3.6 pmol/l) preterm AGA çocuklara benzerdi, ancak term SGA çocuklardan belirgin olarak düşüktü (p=0.001). HOMA-IR sonuçları benzerdi. Term SGA çocukların IGFBP-1 düzeyleri de anlamlı olarak düşüktü. Sonuç: VKİ’leri normal ve büyümede yakalamasını yapmış, prematüre doğan AGA ve SGA çocuklarda, term doğanlar ile karşılaştırıldığında insülin direnci saptanmadı. Preterm SGA va preterm AGA çocuklarda benzer insülin değerleri saptanırken term SGA çocuklarda insülin değerlerinin artmış olarak bulunması, yaşamın ileri dönemlerinde olumsuz metabolik sonuçların ortaya çıkmasında üçüncü trimesterdeki intrauterin olumsuz etkilerin rolüne işaret etmektedir.

Anahtar Kelimeler:

İnsülin direnci, Süt çocuğu, prematür, Süt çocuğu, düşük doğum ağırlıklı, Büyüme

Insulin resistance in preterm born children during prepubertal ages

Objective: Aim of this study was to evaluate insulin resistance in preterm born children born appropriate for gestational age (AGA) or small for gestational age (SGA). Material and Methods: Ninety-three preterm born children grouped as premature SGA (n=30) and premature AGA (n=63) were evaluated at age 4.6±0.2 years and 4.7±0.1 years with respect to their glucose, insulin and IGFBP-1 levels. Their data were compared to that of body mass index (BMI) matched term SGA (n=42) and term AGA (n=44) children of age 4.5±0.2 and 3.8±0.1 years. All children had height appropriate for their target height. Insulin resistance was evaluated by basal insulin and homeostasis model assessment for insulin resistance (HOMA-IR). Results: Basal insulin level was similar in preterm AGA (4.3±1.4 pmol/l) and term AGA (7.9±6.4 pmol/l) children at similar and normal BMI levels. Preterm SGA children had insulin levels (5.0±3.6 pmol/l) similar to preterm AGA children but significantly lower than that in term SGA children (23.7±20.8 pmol/l) (p=0.001). Similar results were obtained for HOMA-IR. Term SGA children also had significantly lower IGFBP-1 levels. Conclusions: Premature born AGA and SGA children do not have insulin resistance when compared to term children if they have made a catch-up growth appropriate for their target height and have normal BMI. The similar insulin levels in preterm SGA and preterm AGA children together with increased insulin levels in term SGA children points to the fact that it is the intrauterine restriction in the third trimester that has an adverse effect on future adverse metabolic outcome.

Keywords:

Insulin Resistance, Infant, Premature, Infant, Low Birth Weight, Growth,

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