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      Metabolic syndrome in children born small-for-gestational age Translated title: Síndrome metabólica em crianças nascidas pequenas para a idade gestacional

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          Abstract

          Being born small-for-gestational age and a rapid increase in weight during early childhood and infancy has been strongly linked with chronic diseases, including metabolic syndrome, which has been related to intrauterine life environment and linked to epigenetic fetal programming. Metabolic syndrome includes waist circumference > 90th percentile for age, sex and race, higher levels of blood pressure, triglycerides and fasting glucose, and low levels of HDL-cholesterol. Insulin resistance may be present as early as 1 year of age, and obesity and/or type 2 diabetes are more prevalent in those born SGA than those born AGA. The programming of adaptive responses in children born SGA includes an association with increased blood pressure, changes in endothelial function, arterial properties and coronary disease. Early interventions should be directed to appropriate maternal nutrition, before and during pregnancy, promotion of breast feeding, and prevention of rapid weight gain during infancy, and to promote a healthy lifestyle.

          Translated abstract

          Crianças nascidas pequenas para a idade gestacional (PIG) e um rápido ganho de peso durante a primeira e segunda infâncias estão fortemente ligados à ocorrência de doenças crônicas, incluindo a síndrome metabólica, o que está relacionado ao ambiente intrauterino e a alterações epigenéticas da programação fetal. A síndrome metabólica envolve uma circunferência abdominal > ao percentil 90 para a idade, sexo e raça, níveis mais altos de pressão sanguínea, triglicérides e glicose em jejum, e níveis baixos de HDL-colesterol. A resistência à insulina pode estar presente já no primeiro ano de vida, e a obesidade e/ou o diabetes tipo 2 são mais prevalentes em crianças nascidas PIG do que naquelas nascidas AIG. A programação de respostas adaptativas em crianças nascidas PIG inclui uma associação com uma pressão sanguínea mais alta, alterações na função endotelial e propriedades arteriais, e doença coronariana. Intervenções precoces devem ser direcionadas à nutrição apropriada, antes e durante a gravidez, promoção da amamentação e prevenção de ganho rápido de peso durante a infância e promoção de um estilo de vida saudável.

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          Most cited references62

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          Fetal origins of coronary heart disease.

          The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.
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            Elevated plasma cortisol concentrations: a link between low birth weight and the insulin resistance syndrome?

            Recent studies have shown that reduced fetal growth is associated with the development of the insulin resistance syndrome in adult life. The mechanisms are not known. However increased activity of the hypothalamic-pituitary-adrenal axis (HPAA) may underlie this association; the axis is known to be reset by fetal growth retardation in animals, and there is evidence in humans of an association between raised HPAA activity and the insulin resistance syndrome. We have, therefore, examined the relations among size at birth, plasma cortisol concentrations, and components of the insulin resistance syndrome in a sample of healthy men. We measured 0900 h fasting plasma cortisol and corticosteroid-binding globulin levels in 370 men who were born in Hertfordshire, UK, between 1920-1930 and whose birth weights were recorded. Fasting plasma cortisol concentrations varied from 112-702 nmol/L and were related to systolic blood pressure (P = 0.02), fasting and 2-h plasma glucose concentrations after an oral glucose tolerance test (P = 0.0002 and P = 0.04), plasma triglyceride levels (P = 0.009), and insulin resistance (P = 0.006). Plasma cortisol concentrations fell progressively (P = 0.007) from 408 nmol/L in men whose birth weights were 5.5 lb (2.50 kg) or less to 309 nmol/L among those who weighed 9.5 lb (4.31 kg) or more at birth, a trend independent of age and body mass index. These findings suggest that plasma concentrations of cortisol within the normal range could have an important effect on blood pressure and glucose tolerance. Moreover, this study provides the first evidence that intrauterine programming of the HPAA may be a mechanism underlying the association between low birth weight and the insulin resistance syndrome in adult life.
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              Insulin Resistance in Short Children with Intrauterine Growth Retardation

              P L Hofman (1997)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                abem
                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
                1677-9487
                November 2011
                : 55
                : 8
                : 583-589
                Affiliations
                [1 ] Universidad de Chile Chile
                Article
                S0004-27302011000800012
                10.1590/S0004-27302011000800012
                fc47f98e-755e-4787-9276-8e7d82c1f049

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2730&lng=en
                Categories
                ENDOCRINOLOGY & METABOLISM

                Endocrinology & Diabetes
                Small-for-gestational age,metabolic syndrome,waist circumference,Pequeno para idade gestacional,síndrome metabólica,circunferência abdominal

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