ESPE Abstracts (2015) 84 P-1-55

Intrauterine Growth Restriction is Associated with Greater Severity in Childhood Obesity-Associated Metabolic Impairment and Poorer Adult Height Prediction

Rocío González-Leala, Julián Martínez-Villanuevaa, Jesús Argentea,b & Gabriel Á. Martos-Morenoa,b

aDepartment of Endocrinology, Hospital Infantil Universitario Niño Jesús, IIS La Princesa, UAM, Department of Pediatrics, Madrid, Spain; bCIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain

Background: Intrauterine growth influences the risk of childhood obesity and its associated metabolic derangement.

Objective and hypotheses: To investigate the effect of intrauterine growth (as shown by newborn anthropometry) on physical and metabolic features in obese children and adolescents.

Method: A retrospective study of 1049 obese children and adolescents (46.8% females/53.2% males; age: 10.31±3.23 years; BMI: +4.00±1.95 SDS; 54.9% prepubertal/45.1% pubertal) was performed. Groups were compared according to gestational age adjusted newborn anthropometry: adequate (AGA, n=810), small (SGA, n=73) or large (LGA, n=166). Studied variables: age at obesity onset, age at first visit; bone age (Greulich & Pyle), adult height prediction (Bailey & Pinneau); IGF1, IGFBP-3, BMI-SDS, glucose, insulin, HOMA, cholesterol (total, HDL, LDL, VLDL), triglycerides, area under the curve (AUC) for glucose and for insulin in the OGTT (n=638); LDL/HDL and triglyceride/HDL ratios.

Results: SGA prevalence was 6.3%. No patient received rGH treatment (spontaneous catch-up growth). No inter-group differences were observed in age, BMI-SDS, sex or pubertal distribution. LGA were taller and SGA smaller than AGA (P<0.001) with the later showing more advanced skeletal maturation (P<0.05) that resulted in a poorer adult height prediction (P<0.001), despite similar IGF1 and IGFBP3 levels. No other differences were found between LGA and AGA. In contrast, SGA had lower 25-OH-vitamin D levels (P<0.05) and more severe impairment of carbohydrate metabolism with higher fasting glucose (P<0.01), HOMA and AUCs for glucose and insulin in the OGTT than the two other groups (all P<0.05). When compared exclusively with AGA, SGA patients also had higher triglycerides and triglyceride/HDL ratio (both P<0.05).

Conclusion: i) Restriction of intrauterine growth, as shown by SGA anthropometry, and spontaneous catch-up growth are associated to a higher frequency and severity of obesity-associated metabolic comorbidities. ii) Obese children born SGA with spontaneous catch-up growth exhibit poorer adult height prediction than those born AGA or LGA.

Funding: This work was supported by the CIBER Fisiopatología de la Obesidad y Nutrición (CB06/03) and the Instituto de Salud Carlos III, Fondo de Investigación Sanitaria (FIS: grant number PI10/00747 and PI13/02195).

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