Published online August 1, 2005
PEDIATRICS Vol. 116 No. 2 August 2005, pp. 519 (doi:10.1542/peds.2005-0832)

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Fetal Programming and Risk of Metabolic Syndrome: Prevention Efforts for High-Risk Populations

Felipe Lobelo, MD
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208

To the Editor.—

The Pediatrics article by Boney et al1 explored the role of intrauterine exposure to diabetes, obesity, and large size at birth as risk factors for metabolic syndrome (MS) development in childhood. Their results are biologically plausible and timely, given the current obesity epidemic that affects all age and ethnic groups in the US population. Their study included mostly non-Hispanic white children (94%), a sample that reflected their reference population. However, it is important to focus efforts in the detection and prevention of risk factors among other high-risk groups for MS. Hispanics (including Mexican Americans) have the highest prevalence of gestational diabetes mellitus, MS, and obesity among women of childbearing age.2 Furthermore, Hispanic youth express that same risk pattern, showing a high prevalence of obesity, MS, and type 2 diabetes mellitus.3

Exposure to a hyperglycemic environment in utero (related to maternal insulin resistance, obesity, and gestational diabetes mellitus) is linked to fetal overgrowth among all ethnic groups. Studies have shown that large-for-gestational-age (LGA) and small-for-gestational-age (SGA) neonates already have altered insulin kinetics (high fasting and postglucose insulin levels) and increased adiposity.4 Adverse fetal metabolic programming is linked to both SGA and LGA neonates. If combined with chronic energy imbalance as a result of later environmental exposures, they lead to additional fat accumulation, insulin resistance, and clustering of cardiovascular risk factors at early ages (9–11 years) as reported by Boney et al. Exposure to an adverse environment in utero and/or early in life are significant predictors of MS development in childhood, but their separate contributions are difficult to disentangle. Nevertheless, studies in middle-aged men have shown that the effects of adverse fetal metabolic programming can be alleviated by maintenance of cardiorespiratory fitness through regular vigorous physical activity.5 These findings seem to be applicable in the pediatric setting, in which exercise-training studies have been shown to be capable of improving metabolic profiles and reducing the clustering of risk factors in obese children.

The combined prevalence of being born at either extreme of the birth weight continuum (15%) has sufficient magnitude to become a public health threat among high-risk populations, given its association with MS and related chronic diseases. I applaud the efforts by Boney et al, which offer evidence about preventable risk factors for MS in childhood. Physicians and public health practitioners are being challenged to prevent adverse perinatal and early childhood exposures. By doing so, we will be able to curb the vicious cycle of obesity and MS, which is severely impacting the nation’s health.

REFERENCES

1. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115(3) . Available at: www.pediatrics.org/cgi/content/full/115/3/e290
2. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2003;163 :427 –436[Abstract/Free Full Text]
3. De Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004;110 :2494 –2497[Abstract/Free Full Text]
4. Yada KK, Gupta R, Gupta A, Gupta M. Insulin levels in low birth weight neonates. Indian J Med Res. 2003;118 :197 –203[Medline]
5. Laaksonen DE, Lakka HM, Lynch J, et al. Cardiorespiratory fitness and vigorous leisure-time physical activity modify the association of small size at birth with the metabolic syndrome. Diabetes Care. 2003;26 :2156 –2164[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Lobelo, F. Search for Related Content PubMed PubMed Citation Articles by Lobelo, F. Related Collections Endocrinology Social Bookmarking                         What's this?