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Energy substrate production in infants born small for gestational age
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Tuvemo)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Tuvemo)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Tuvemo)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Tuvemo)
2007 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 1, 29-34 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate energy substrate production and its hormonal regulation in infants born small for gestational age.

Methods: Eleven infants, aged 24.4 ± 5.3 hour, were studied following a fast of 4.0 ± 0.6 hour. Gestational age was 35.4 ± 2.8 weeks and birth weight 1804 ± 472 g (<−2 SD). Rates of glucose production and lipolysis were analyzed using [6,6-2H2]-glucose and [2-13C]-glycerol.

Results: Plasma levels of glucose and glycerol were 4.1 ± 1.1 mmol . L−1 and 224 ± 79 μmol . L−1, respectively. Glucose appearance averaged 30.3 ± 8.2 and glucose production rate 21.1 ± 6.1 μmol . kg−1 . minutes−1. Glycerol production rate was 5.6 ± 1.6 μmol . kg−1 . minutes−1, correlating strongly to birth weight (r = 0.904, p < 0.001). Of the glycerol produced, 55 ± 22% was converted to glucose, corresponding to 8 ± 3% of the glucose production.

Conclusions: Even though the infants could produce energy substrates, lipolysis was reduced and the glucose production was in the low end of the normal range compared with infants born appropriate for gestational age. The correlation between glycerol production and birth weight indicates that lipolysis depends on the amount of stored fat. Data on insulin and insulin-like growth factor binding protein 1 support the view that insulin sensitivity in these infants is reduced in the liver but increased peripherally.

Place, publisher, year, edition, pages
2007. Vol. 96, no 1, 29-34 p.
Keyword [en]
Glucose production, Glycerol, Lipolysis, Newborn infant, SGA
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-92775DOI: 10.1111/j.1651-2227.2007.00040.xISI: 000243812700008PubMedID: 17187599OAI: oai:DiVA.org:uu-92775DiVA: diva2:165969
Available from: 2005-04-01 Created: 2005-04-01 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Perinatal Energy Substrate Metabolism: Glucose Production and Lipolysis in Pregnant Women and Newborn Infants with Particular Reference to Intrauterine Growth Restriction (IUGR)
Open this publication in new window or tab >>Perinatal Energy Substrate Metabolism: Glucose Production and Lipolysis in Pregnant Women and Newborn Infants with Particular Reference to Intrauterine Growth Restriction (IUGR)
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation.

After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea.

We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry.

We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR.

Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 52 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 22
Keyword
Pediatrics, Lipolysis, Glucose, Newborn infant, Pregnant women, IUGR, Insulin, Stable isotopes, Pediatrik
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-4842 (URN)91-554-6186-7 (ISBN)
Public defence
2005-04-22, Rosénsalen, Akademiska Barnsjukhuset, ingång 95/96, NBV, Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-04-01 Created: 2005-04-01Bibliographically approved

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Diderholm, BarbroEwald, UweAhlsson, FredrikGustafsson, Jan

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