Cord Blood IGF-I, Proinsulin, Leptin, HMW Adiponectin, and Ghrelin in Short or Skinny Small-for-Gestational-Age Infants

Context: Small-for-gestational-age (SGA) is an indicator of poor fetal growth programming an elevated risk of type 2 diabetes in adulthood. Little is known about early-life endocrine characteristics in SGA subtypes. Stunting (short) and wasting (skinny) are considered distinct SGA phenotypes in neonatal prognosis. Objectives: This work aimed to assess whether SGA infants with stunting or wasting have similar alterations in neonatal endocrine metabolic health biomarkers. Methods: This was a nested case-control study based on the 3D (Design, Develop, and Discover) birth cohort in Canada. The study subjects were 146 SGA (birth weight<10(th) percentile) and 155 optimal-for-gestational age (OGA, 25(th)-75(th) percentiles) infants. Stunting was defined as birth length less than the 10(th) percentile, and wasting as body mass index less than the 10(th) percentile for sex and gestational age, respectively. Main outcome measures included cord plasma concentrations of insulin-like growth factor I (IGF-I), proinsulin, leptin, high-molecular-weight (HMW) adiponectin, and ghrelin. Results: Comparing to OGA infants adjusted for maternal and neonatal characteristics, SGA infants with either stunting only or wasting only had lower cord plasma IGF-I and leptin concentrations. HMW adiponectin concentrations were lower in SGA infants with wasting only (P=.004), but similar in SGA infants with stunting only (P=.816). Only SGA infants with both stunting and wasting had substantially lower proinsulin (P<.001) and higher ghrelin concentrations (P<.001) than OGA infants. Conclusion: This study is the first to demonstrate that SGA infants with wasting only are characterized by low HMW adiponectin concentrations, whereas those with stunting only are not. SGA with both stunting and wasting are characterized by low proinsulin and high ghrelin concentrations.

Automated summary

This study examined the differences in neonatal endocrine metabolic health biomarkers in SGA infants with either stunting or wasting in the 3D birth cohort in Canada. The results showed that SGA infants with either stunting only or wasting only had lower cord plasma IGF-I and leptin concentrations, while those with both stunting and wasting had substantially lower proinsulin and higher ghrelin concentrations. This study highlights the importance of considering different SGA subtypes in understanding endocrine characteristics in early life.