Published online August 1, 2005
PEDIATRICS
Vol. 116
No. 2
August 2005, pp.
519
(doi:10.1542/peds.2005-0832)
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
- 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
- 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]
- 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]
- Yada KK, Gupta R, Gupta A, Gupta M. Insulin levels in low birth weight neonates.
Indian J Med Res. 2003;118
:197
–203[Medline]
- 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]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
