Breast-feeding vs Formula-feeding for Infants Born Small-for-Gestational-Age: Divergent Effects on Fat Mass and on Circulating IGF-I and High-Molecular-Weight Adiponectin in Late Infancy

Francis de Zegher, Giorgia Sebastiani, Marta Diaz, María Dolores Gómez-Roig, Abel López-Bermejo, Lourdes Ibáñez
2013 Journal of Clinical Endocrinology and Metabolism  
The selection of papers reporting important advancements in the field of growth and growth factors is not an easy task. My choice has focused on the studies apparently more promising for future translations into clinical practice. Clinically important papers relate to the effects of GH therapy on adult height, metabolism, body composition and cognitive function of patients with Prader-Willi syndrome, as well as to long-term drawbacks of the conventional dose of recombinant human IGF-I used in
more » ... ildren with growth hormone insensitivity syndrome. The role of the IGF system in the development of fetal tissues continues to be extensively investigated. I have selected some papers showing the key role played by IGFs and IGFBPs in the development of lung, retina and brain. New evidence supports the role of IGFs in glucose and bone metabolism, which I have included for their potential clinical implications. Finally, in the section 'Food for thought', the reader will find an intriguing experimental study showing the programming effects of infancy duration on the tempo of physiological development and maturation. This selection of papers obviously represents my own bias, but I hope you may find them interesting to read and helpful for your activity in clinical and experimental work. Background: Subjects who are born small for gestational age (SGA) are at high risk of developing insulin resistance, type 2 diabetes and metabolic syndrome in adulthood. A protective role of breastfeeding on metabolic and cardiovascular risk has been demonstrated. The aim of this study was to assess the effects of nutrition in early infancy (breastfeeding vs. formula-feeding; BRF vs. FOF) on body composition and endocrine/metabolic markers in late infancy. Methods: 130 infants were enrolled in a longitudinal controlled study. Body composition, fasting glycaemia, insulin, IGF-I, and high-molecular-weight (HMW) adiponectin were assessed at 4 and 12 months in BRF controls born appropriate-for-GA (n = 31) and in SGA infants receiving either BRF (n = 48) or FOF (n = 51), the latter being randomized to receive a standard formula (FOF1) or a protein-rich formula (FOF2). Results: SGA-BRF infants maintained low adiposity and high insulin sensitivity with normal IGF-I and HMW adiponectin levels. In contrast, SGA-FOF2 infants normalized body composition gaining more fat mass, and showed high IGF-I and low HMW-adiponectin levels. Results of SGA-FOF1 infants were intermediate. Conclusions: Breastfeeding is associated with a better body composition and metabolic status in infants born SGA. Nutritional strategies in SGA infants should aim to achieve high insulin sensitivity and normal IGF-I and HMW adiponectin levels rather than normal body composition. It is well established that breastfeeding is associated with a reduced cardiometabolic risk in adult life [1, 2] . Epidemiological studies conducted in many countries and different ethnicities have shown that subjects with low birth weight have a higher metabolic and cardiovascular risk in adulthood [3] . Background: GH therapy is a worldwide-approved indication for treatment of children with Prader-Willi syndrome (PWS). GH therapy accelerates growth rate and improves body composition by decreasing fat mass (FM) and increasing lean body mass (LBM). However, the persistence of such GH-induced effects on body composition after discontinuation of therapy is still object of debate. The aim of this study was to assess body composition and metabolic status in adults with PWS treated with GH treatment during childhood and adolescence. Methods: 64 adults (mean age 25.4 years) with genetically confirmed PWS were included. Anthropometry, body composition by DXA, resting metabolic rate (RMR) and metabolic biochemical parameters were assessed. Comparison was performed between GH-treated (n = 20) and untreated groups (n = 40). The mean duration of GH treatment in the treated group was 4.4 ± 2.7 years, and the mean time between the end of treatment and the current evaluation was 7.0 ± 4.4 years. Results: GH treatment was associated with lower BMI and FM and higher LBM. Insulin sensitivity was higher in treated patients, whereas no difference in lipid profile was observed. Conclusions: The beneficial effects of GH treatment on body composition and metabolic status of patients with PWS are still present even several years after discontinuation of treatment. Background: GH therapy for short children who were born small for gestational age (SGA) is a worldwide approved indication and is effective in partially reducing the adult height (AH) deficit. An earlier start of GH treatment is associated with a better growth outcome. However, many short children born SGA present to medical attention around the onset of puberty thus reducing the probability of therapeutic success. The aim of this trial was to test the efficacy of the combination of high dose GH with GnRH analog (GnRHa) therapy in improving AH of short SGA children. Methods: The authors performed a randomized, dose-response GH trial in short SGA children (n = 121) of at least 8 years of age, evaluating GH doses 1 vs. 2 mg/m 2 daily from early puberty until adult height. 84 children reached AH. A subgroup (n = 40) of pubertal children with heights <140 cm at start was treated with GH+GnRHa for 2 years. Results: Height improved from -2.9 SDS at start of treatment to -1.7 SDS at AH (p < 0.001). 62% (52 of 84) reached an AH >-2 SDS. AH was 0.6 SDS higher in children randomized to the higher GH dose. The growth outcome of children who started puberty at <140 cm and were treated with GH+GnRHa was similar to that of children who started puberty taller than 140 cm and received GH only. Conclusions: (1) GH therapy increases AH even when started around puberty. (2) The high dose regimen (2 mg/m 2 daily) is more effective in improving AH. (3) The combined GH/GnRHa treatment could represent a strategy to improve AH in SGA children with more severe growth retardation at puberty.
doi:10.1210/jc.2012-3480 pmid:23365126 fatcat:amfw6dfj5vhg7dvlbvbwdlrxcm