Background: Children born small-for-gestational age (SGA), especially those who experience spontaneous postnatal catch-up growth, are at increased risk for developing insulin resistance, central adiposity and cardiovascular abnormalities later in life. By age 3-6 years, SGA children have a broader aortic and carotid intima media thickness (aIMT and cIMT) which are markers of preclinical atherosclerosis.
Objective: To assess longitudinally at age 12 and 24 months , cardiac morphology and function, and markers of cardiac dysfunction and cell damage, together with body composition and endocrine-metabolic status, in catch-up healthy children born SGA and in age-matched appropriate-for-gestational age (AGA) children.
Subjects/methods: The study population consisted of 61 AGA (48% girls) and 26 SGA infants (50% girls), born after uncomplicated, term pregnancies; mean birthweight Z-scores: 0.0 and −2.3, respectively. Cardiac morphology, systolic and diastolic function (by M mode, 2D, doppler color echocardiography with a Vivid 7 model and 7MHz phased-array transducer), aIMT, cIMT, pre-peritoneal fat (by US), markers of cardiac dysfunction (homocysteine, Heart-type Fatty Acid-Binding Protein), endocrine-metabolic variables (glucose, insulin, IGF-I, HMW-adiponectin, leptin), and body composition (by DXA) were assessed at 12 and at 24 months.
Results: At age 12 months, SGA infants had a thicker carotida and less lean mass, as compared to AGA infants (both P<0.001). Cardiac morphology assessment disclosed a smaller aortic annulus and left ventricle diameter in systole; those differences disappeared after correcting for cardiac size. At age 24 months, the differences in cIMT and lean mass between subgroups persisted (P<0.0001); in addition, SGA children showed an increase in pre-peritoneal fat a surrogate of visceral fat (P<0.01 vs AGA), a decrease in the left ventricular ejection and shortening fractions, and a thinner interventricular septum in diastole (IVSd) (all P<0.05). The difference in IVSd disappeared after adjusting for cardiac size. Markers of cardiac dysfunction and endocrine-metabolic variables were similar between subgroups. cIMT correlated positively with pre-peritoneal fat at age 12 months (r=0.34, P=0.0016) and 24 months (r=0.35, P=0.0064), and negatively with lean mass (r=−0.40, P=0.0003) at age 12 months.
Conclusion: The present study appears to be the first to have longitudinally explored a series of cardiac and vascular markers in AGA and SGA infants at the ages of 12 and 24 months. Overall, SGA infants displayed reassuring results, but their early increment of cIMT (which was found to be linked to their early deficit of lean mass) and abnormal parameters of left ventricular function may deserve further attention.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology