背景:糖尿病在成年期更为明显,但可能在儿童时期处于休眠状态,并起源于胎儿早期发育。在胎儿生物测量中,股骨长度(FL)对于评估胎儿的生长发育至关重要。这项研究旨在评估孟加拉儿童中胎儿股骨生长与糖尿病前期生物标志物之间的潜在关联。
方法:在Matlab中进行了一项基于人群的母体食物和微量营养素补充剂(MINIMat)试验中的队列研究,孟加拉国。对队列中的儿童进行随访,直至15岁。在最初的审判中,在13孕周(GWs)之前通过超声检查确认怀孕。之后,在14,19和30GWs时进行超声评估.从一端到另一端测量FL,捕获完整的股骨图像。FL由GW标准化,并计算z分数。测定血浆和全血中的FBG和HbA1c水平,和甘油三酯-葡萄糖指数,胰岛素抵抗的生物标志物,计算为Ln[空腹甘油三酯(mg/dl)×空腹葡萄糖(mg/dl)/2]。使用广义线性模型进行多变量线性回归分析,以评估14、19和30GWs时FL对9和15岁糖尿病前期生物标志物的影响。母亲微量营养素和食物补充组,奇偶校验,儿童性,将9年或15年时的BMI作为协变量。
结果:共有1.2%(6/515)的参与者在青春期前空腹血糖受损,在青春期增加到3.5%(15/433)。9岁时,6.3%(32/508)的参与者HbA1c%升高,15年增加到28%(120/431)。此外,TyG指数从9.5%(49/515)(青春期前)增加到13%(56/433)(青春期).在14和19GWs时,FL的一个标准偏差降低与FBG增加有关(β=-0.44[-0.88,-0.004],P=0.048;β=-0.59[-1.12,-0.05],P=0.031)和HbA1c(β=-0.01;[-0.03,-0.005],P=0.007;β=-0.01[-0.03,-0.003],P=0.018)15年的水平。9岁时,FL与糖尿病生物标志物无关。
结论:孟加拉青少年中,妊娠中期股骨生长受损可能与糖尿病前期生物标志物升高有关。
BACKGROUND: Diabetes is more apparent in adulthood but may be dormant in childhood and originates during early fetal development. In fetal biometry, femur length (FL) is crucial for assessing fetal growth and development. This study aimed to assess potential associations between fetal femur growth and prediabetic biomarkers in Bangladeshi children.
METHODS: A cohort study embedded in a population-based maternal food and micronutrient supplementation (MINIMat) trial was conducted in Matlab, Bangladesh. The children in the cohort were followed up until 15 years of age. In the original trial, pregnancy was confirmed by ultrasound before 13 gestational weeks (GWs). Afterward, ultrasound assessments were performed at 14, 19, and 30 GWs. FL was measured from one end to the other, capturing a complete femoral image. The FL was standardized by GW, and a z-score was calculated. FBG and HbA1c levels were determined in plasma and whole blood, and the triglyceride-glucose index, a biomarker of insulin resistance, was calculated as Ln [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. Multivariable linear regression analysis using a generalized linear model was performed to estimate the effects of FL at 14, 19 and 30 GWs on prediabetic biomarkers at 9 and 15 years of age. Maternal micronutrient and food supplementation group, parity, child sex, and BMI at 9 years or 15 years were included as covariates.
RESULTS: A total of 1.2% (6/515) of the participants had impaired fasting glucose during
preadolescence, which increased to 3.5% (15/433) during adolescence. At 9 years, 6.3% (32/508) of the participants had elevated HbA1c%, which increased to 28% (120/431) at 15 years. Additionally, the TyG index increased from 9.5% (49/515) (during
preadolescence) to 13% (56/433) (during adolescence). A one standard deviation decrease in FL at 14 and 19 GWs was associated with increased FBG (β = - 0.44 [- 0.88, - 0.004], P = 0.048; β = - 0.59 [- 1.12, - 0.05], P = 0.031) and HbA1c (β = - 0.01; [- 0.03, -0.005], P = 0.007; β = - 0.01 [- 0.03, - 0.003], P = 0.018) levels at 15 years. FL was not associated with diabetic biomarkers at 9 years.
CONCLUSIONS: Mid-trimester impaired femur growth may be associated with elevated prediabetic biomarkers in Bangladeshi adolescents.