Uluç YİŞ, Yeşim ÖZTÜRK, Ali Rıza ŞİŞMAN, Sezer UYSAL, Benal BÜYÜKGEBİZ

Erken Süt Çocukluğu Döneminde Anne Sütü Ve Formüla Alan Bebeklerin Antropometrik Verilerinin, Beslenme Özelliklerinin Karşılaştırılması Ve Bu Değişkenlerin Kan Şekeri, İnsülin Ve IGF-1 Hormonları İle İlişkisi

Amaç: Anne sütü ve formüla ile beslenen erken süt çocukluğu dönemindeki bebeklerin antropometrik verilerinin ve beslenme özelliklerinin karşılaştırılması ve bu verilerle beslenme davranışının ve enerji metabolizmasının düzenlenmesinde görev alan insülin ve IGF-1 hormonları arasındaki ilişkinin araştırılması. Gereç ve yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Çocuk Polikliniği’ne kontrol amacı ile getirilen ve yaşları 3-4 ay arasında değişen sağlıklı bebekler çalışmaya alındı. Bebekler yalnızca anne sütü (AS) ile beslenenler ve çeşitli nedenlerden dolayı ilk ay içinde anne sütü kesilip formüla ile beslenenler (F) olarak iki gruba ayrıldı; doğum haftaları, doğum ağırlıkları, bebeklerin beslenme özellikleri sorgulandı; vücut ağırlığı, boyu, baş çevresi ve triseps cilt kıvrım kalınlığı (TCKK) ölçüldü ve vücut kitle indeksi (VKİ) hesaplandı. Bebeklerin beslenme öncesi insülin, IGF-1 ve kan şekeri düzeylerini belirlemek üzere venöz kan örnekleri alındı. Bebeklerin 6. ay kontrollerinde, ek gıdalara geçiş zamanı, beslenme özellikleri ve dışkılama paterni sorgulandı; vücut ağırlığı, boyu, baş çevresi ve TSF’si ölçüldü; VKİ, enerji ve protein alımları hesaplandı. Bulgular: Çalışmada yer alan 47 sağlıklı bebeğin (erkek/kız=25/22) 24’ü AS, 23’ü F grubunda idi. İki grup arasında cinsiyet, doğum ağırlığı ve doğum haftası özellikleri bakımından fark yoktu. Üçüncü ayda yapılan ilk değerlendirmede AS grubundaki bebeklerin vücut ağırlığı, boy, TSF, postnatal kilo artışı, beslenme sıklığı ve süresi daha fazla idi (p < 0,05). Altıncı ayda AS grubundaki bebeklerin 16’sında (%73), F grubundakilerin 19’unda (%95) ek gıdaya geçilmişti. Ek gıdalardan alınan enerji ve protein F grubunda daha fazla idi (p < 0,05). Bu dönemde iki grup arasındaki antropometrik ölçüm farkları ortadan kalkmıştı. Anne sütü ve F grubundaki bebeklerin kan şekeri düzeyleri arasında fark olmamasına ve F grubundakilerin daha zayıf olmalarına karşın, serum insülin düzeyleri F grubunda istatistiksel olarak anlamlı olmamakla birlikte daha yüksek idi. Formüla grubunun ortalama serum IGF-1 düzeyi daha yüksek olarak bulundu (p < 0,05). Tüm bebeklerde serum IGF-1 düzeyi arttıkça, 6. ayda ek gıdalardan alınan enerji ve protein miktarı, vücut ağırlığı, VKİ, TCKK ve 3. aydan 6. aya kadar alınan kilo miktarı da artmakta idi (sırasıyla r=0,350, p < 0,05; r=0,400, p < 0,05; r=0,455, p < 0,05; r=0,524, p < 0,05; r=0,461, p < 0,05). Sonuç: Serumdaki IGF-1 düzeylerinin ikinci üç aylık dönemde enerji, protein ve kilo alımı ile ilişkili olması, bu hormonun ileri yaşlarda vücut ağırlığının düzenlenmesinde önemli rol oynadığını düşündürmektedir. Formüla alan bebeklerde relatif olarak daha yüksek bulunan insülin düzeyleri, bu bebeklerin ek gıdalardan neden daha yüksek enerji ve protein aldıklarının açıklaması olabilir

Anahtar Kelimeler:

Anne sütü, formüla, insülin, IGF-1, antropometri, büyüme, bebek

COMPARISON OF THE ANTHROPOMETRIC DATA AND NUTRITIONAL CHARACTERISTICS AMONG THE BREASTFED AND FORMULA-FED BABIES AND THE RELATION OF THESE PARAMETERS TO INSULIN AND IGF-1 IN EARLY INFANCY

Objective: Comparison of the anthropometric data and nutritional characteristicsamong the breastfed and formula-fed babies in early infancy and evaluation of therelation of these parameters to the hormones insulin and IGF-1that are involved in theregulation of nutritional habits and energy metabolism.Materıal and method: Three to four month-old healthy babies evaluated duringroutine clinical visits in Dokuz Eylül University Medical Faculty Department of Pediatrics were enrolled in the study. The babies were splitted into two groups asbreastfed (BF) and formula-fed (FF). Gestational age, birth weight, and nutritionalcharacteristics of the babies were asked; weight, height, head circumference andtriceps skin fold thickness (TSF) were measured and body mass index (BMI) wascalculated. While fasting venous blood samples of all the babies were obtained forinsulin, IGF-1 and glucose measurement. The babies were re-evaluated at 6th postnatalmonth for weaning time, nutritional characteristics, weight, height, head circumference,TSF, BMI and daily protein intake.Results: There were 47 babies (male/female = 25/22), 24 in BF and 23 in FF groups.Two groups were not different with respect to sex, birth weight and gestational age.Weight, height, TSF, postnatal weight gain, feeding frequency and length were higherin BF group than FF group at first visit in 3-4 months of age (p<0.05). At 6th month, 16(73%) and 19 (95%) of the babies had weaned in the BF and FF groups, respectively.The energy and protein intake by supplemental foods was higher in FF group (p<0.05).At that time, the differences in anthropometric measurements were over among twogroups. Although blood glucose levels were not different among the BF and FF groupand the babies in FF group were leaner, serum insulin levels were higher, although notsignificantly, in FF group. IGF-1 levels were significantly higher in the FF group(p<0.05). As the serum IGF-1 level increased, energy and protein intake bysupplemental foods, weight, BMI, TSF and weight gain from 3 to 6 months of ageincreased in all babies (r=0.350, p<0.05; r=0.400, p<0.05; r=0.455, p<0.05; r=0.524,p<0.05 and r=0.461, p<0.05, respectively).Conclusion: The relation of serum IGF-1 level to energy and protein intake andweight gain in the second 3 month-period of life implies that this hormone play a role inregulation of body weight similar to leptin in later life. Relatively higher levels of seruminsulin in FF group might explain the higher energy and protein intake from thesupplemental foods in these babies.

Keywords:

Breast feeding, formula, insulin, IGF-1, anthropometry, growth, infant,

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