Early development of visceral fat excess after spontaneous catch-up growth in children with low birth weight

Context: The sequence of prenatal growth restraint and infantile catch-up of weight is by the age of 4 yr associated with hyperinsulinemic adiposity. We studied whether the adiposity of post-catch-up children born small for gestational age (SGA) is further amplified between age 4 and 6 yr and whether visceral fat excess has already emerged by the age of 6 yr. Setting: The study took place at a university hospital. Study Population and Design: A longitudinal cohort (age 2-6 yr) of 22 children born appropriate for gestational age (AGA) and 29 born SGA were studied. Auxological, endocrine, metabolic, and body composition ( by absorptiometry) assessments were made at 2, 4, and 6 yr, and visceral fat was assessed ( by magnetic resonance imaging) at 6 yr. Main Outcomes: Outcome measures included fasting glucose, insulin, IGF-I, neutrophil to lymphocyte ratio, lean mass, and total, abdominal, and visceral fat mass. Results: Between ages 4-6 yr, the relative adiposity of SGA children was further amplified. Between ages 2-6 yr, SGA children gained more total and abdominal fat and raised their insulin, IGF-I, and neutrophil to lymphocyte ratio more than did AGA children (all P < 0.0001). At age 6 yr, the average amount of visceral fat was in SGA children more than 50% higher than in AGA children (P < 0.005). The 0- to 2-yr increment in weight Z-score together with the 2- to 6-yr increment in fasting insulin accounted for 62% of visceral fat variability at age 6 yr. Conclusion: The amount of visceral fat is in post-catch-up SGA children excessive by the age of 6 yr. In populations at risk for type 2 diabetes or metabolic syndrome after fetal growth restraint, the time window for early intervention may have to be advanced into prepubertal childhood.