Research Article: Cardiometabolic risk factors in children born with marginally low birth weight: A longitudinal cohort study up to 7 years-of-age

Date Published: April 19, 2019

Publisher: Public Library of Science

Author(s): Josefine Starnberg, Mikael Norman, Björn Westrup, Magnus Domellöf, Staffan K. Berglund, Antonio Palazón-Bru.


Low birth weight (LBW, <2500 g) may predict an increased risk of an adverse cardiometabolic profile later in life, but long-term effects in different populations and birth weight strata are still unclear. We explored laboratory markers of cardiometabolic risk in children born with marginally LBW (2000–2500 g). This was a prospective longitudinal cohort study including 285 Swedish marginally LBW children and 95 normal birth weight (NBW, 2501–4500 g) controls. At 3.5 and 7 years of age, blood samples for glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), cholesterol, triglycerides, high- and low density lipoprotein (HDL and LDL), apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) were assessed and compared between the groups. No significant differences in levels of insulin, HOMA-IR, hs-CRP or blood lipids were observed between marginally LBW and NBW children. At 7 years there was a higher proportion of marginally LBW children with elevated levels of insulin, defined as above the 90th percentile of the control group (21% vs 8.6%, p = 0.038). This association was, however, confounded by maternal ethnicity. In marginally LBW children born small for gestational age (SGA), mean fasting glucose was significantly higher compared to controls (4.7 vs 4.5 mmol/L, p = 0.020). There were no significant differences in insulin, insulin resistance, hs-CRP or blood lipids between the marginally LBW children and controls. The subgroup of marginally LBW children born SGA may present early signs of glucose imbalance already at school age.

Partial Text

Ischemic heart disease is the leading cause of death worldwide and early prevention among those at risk is therefore of great importance [1, 2]. There is an increasing body of evidence suggesting that exposures during early development, for instance pre- and postnatal growth, contribute to adult cardiovascular disease risk [3]. Studies of different cardiometabolic risk factors in children may help to give us a better understanding of both the underlying mechanisms, as well as effects on different long-term outcomes.

Of the 285 included marginally LBW children, four were diagnosed with congenital diseases (Williams syndrome, DiGeorge syndrome, Ehler-Danlos syndrome and muscular dystrophy) and excluded in all analyses (Fig 1).

In the present study, we explored the largest group of LBW children (2000–2500 g) and used several validated laboratory markers considered important for the future risk of developing metabolic syndrome, diabetes and cardiovascular disease. While we in our previous studies of overweight and body composition in these children, failed to show any increased risk in the marginally LBW cohort [13], the present may indicate that the children born with marginally LBW, and especially those born SGA, have signs of altered insulin and glucose homeostasis, already at 7 years of age.

Reassuringly, we found no evidence of increased cardiometabolic risk in the overall marginally LBW group up to 7 years of age. However, the subgroup of those born SGA did present with a higher fasting glucose, which could be an early indicator for later type 2 diabetes mellitus. Further studies of larger size reaching beyond childhood is warranted to determine the magnitude of this possible cardiometabolic risk, its clinical relevance, and the underlying mechanism.