Components of Metabolic Syndrome at 22 years of Age - Findings From Pune Low Birth Weight Study.

Background: To study the early markers of Metabolic syndrome in a cohort of low birth weight (LBW) children followed up since birth, at the age of 22 years.

Design: Prospective cohort study.

Setting: Tertiary-care hospital.

Participants: Neonates weighing less than 2000 g discharged from a neonatal special care unit were followed up prospectively; 153 cases and 77 controls were assessed at 22 years of age.

Methods: Fasting, 30 minute and 120 minute glucose and insulin after a bolus of 75g of glucose was determined. Insulin resistance was calculated. A lipid profile was also done. Anthropometric measurements were taken and abdominal fat was determined by magnetic resonance imaging.

Main Outcome: Prevalence of the five components of Metabolic Syndrome as described by the International Diabetic Federation (IDF).

Results: 65.1% of the cohort was born small for gestational age. All three components of Metabolic syndrome were present in only three cases and none of the controls. However, two components were present in 25 (16.4%) cases and 5 (6%) controls (P=0.039). Cases in the lowest quartile of birthweight who became big at 22 years had significantly higher fasting insulin (P=0.001), Homeostatic Model Assessment - Insulin Resistance (Homa-IR) (P=0.001) and higher systolic blood pressure. Sum of skinfold thickness at 4 sites correlated significantly with fasting insulin and HOMA-IR, and was a stronger correlate compared to BMI, waist circumference and MRI fat. There was no difference in the biochemical parameters between appropriate for gestational age and small for gestational age infants.

Conclusion: Prevelence of three or more components of Metabolic syndrome was low in LBW children at 22 years, but of two components was high. Those 'Small at birth and big at 22 years' had high insulin resistance.