| ObjectiveTo explore the relationship between catch-up growth and nutrition in small for gestational age infants aged less than 6 months whose rapid growth period and to observe the relationship between catch-up growth and insulin-like growth factor 1(IGF-1)in the early childhood.MethodsA prospective cohort study was conducted and according to inclusion criteria,clinical information about SGA infants and AGA infants(Ages were less than 6 months)visited in the Department of Health Care,the Children's Hospital of Chongqing Medical University ranging from February 2014 to October 2015 and blood samples from children aged 1-3 years were collected ?Z of weight was calculated by the standard deviation of the dispersion method(Z score).In SGA group,?Z? 0.67 was defined as catch-up group,otherwise was no catch-up group.We observed the condition of physical growth in SGA group,compared the feeding patterns,daily energy intake,protein to energy ratios and the differences of daily total energy and energy requirement in the catch-up group,no catch-up group and AGA group.Meanwhile,we explored the the influencing factors of catch-up growth of weight and length and compared the IGF-1 level and methylation rate in SGA group and AGA group.Results(1)We Included 234 SGA cases with less than 6 months,among which 180 cases were full-term SGA(male: 63 cases,female: 117 case),54 cases were preterm SGA(male: 23 cases,female: 31 case),71 cases were full-term AGA(male: 30 cases,female: 41 case),56 cases were preterm AGA(male: 22 cases,female: 34 case).There were 48 SGA cases and 47 AGA cases for children aged 1-3 years.(2)The total catch-up growth rate of SGA aged six months was 62.4%,and no statistic difference(?2=0.010,P=0.921)found between the full-term SGA(62.2%)and preterm SGA(63.0%)in the catch-up growth rate.The ?WAZ0~1m,?WAZ1~3m,?WAZ3~6m and?LAZ0~1m of the catch-up group were significantly higher than those of the no catch-up group or AGA group(F=31.992,23.101,6.049,10.489,all P < 0.01),the?LAZ1 ~ 3m and?HCAZ1 ~ 3mwere significantly higher than that of the no catch-up group(all P<0.01),while there was no difference with AGA group(all P>0.05).There were no differences among catch-up group and no catch-up group and AGA group in the ?LAZ3~6m and ?HCAZ3~6(all P>0.05).The weight of the catch-up group reached P40,length reached P20,and head circumference reached P25 at 6 months of age(WHO standard),which were significantly lower than those in AGA group.The ?WAZ1~3m and ?WAZ3~6m of the preterm SGA group were significantly higher than those of the full-term SGA group and preterm AGA group(F=11.219,7.668,all P<0.01).The ?LAZ1~3m,?LAZ3~6m,?HCAZ1~3m and ?HCAZ3~6m in preterm SGA group were significantly higher than those in the full-term SGA group(all P<0.01),which were no difference with preterm AGA group(all P>0.05).The ?WAZ0~1m and ?LAZ0~1m in full-term SGA group were significantly higher than those in the preterm SGA group and preterm AGA group(F=54.053,34.498,all P<0.01).The weight of the preterm SGA group reached P17,length reached P6,and head circumference reached P15 at 6 months of age.(3)The breast-feeding rate in the catch-up group was significantly higher than that of the no catch-up group at 1,3 months(?2=8.346,4.080,P=0.004,0.043),but not at 6 month(?2=0.817,P=0.366).The breast-feeding rate of the catch-up group(35.7%,40/112)in full-term SGA was significantly higher than that of the no catch-up group(20.6%,14/68)at 6 month(?2=4.610,P=0.032).(4)At 1,3,6 months,the daily total energy(KJ/d)of the catch-up group and the AGAgroup were significantly higher than that of the no catch-up group by repeated measures analysis of variance(F=13.463,P=0.000),while there was no significant difference of the protein to energy ratio among the three groups(F=2.762,P=0.066).The daily total energy in the catch-up group and no catch-up group were higher than the daily energy requirement at 1 month(1845±404,1620±373 VS W×90×4.184,t=6.414,2.578,all P < 0.05),while no statistic differences were found at 3,6 months(2119±323,1866±343 VS W×90×4.184,2411±341,2256±381 VS W×80×4.184,t=-1.966,-1.400,-1.354,0.754,all P>0.05).(5)The ?WAZ in SGA was influenced by the daily total energy during 0 to 3 month(F=4.825,P=0.000),while the?LAZ was not during 0 to 6 month(all P>0.05).The ?WAZ and ?LAZ of SGA were not influenced by the protein to energy ratio(all P>0.05).(6)The serum IGF-1 in the catch-up group was significantly higher than that of the no catch-up group and short AGA group with 1 to 3 years old(114±40 VS 75±40 VS 60±31,F=10.527,P=0.000).The IGF-1 methylation rate of the catch-up group and the normal AGA group were lower than the no catch-up group and the short AGA group in the Cp G point 1 of IGF-1,The IGF-1 methylation rate of the catch-up group were lower than the no catch-up group,the short AGA group and the normal AGA group in the Cp G point 4 of IGF-1,While,there were no significant differences(F=1.061,0.519,P=0.379,0.672).Conclusion(1)The weight,length and head circumference of SGA had significant catch-up growth in the first 6 months.The catch-up velocity of preterm SGA was significantly faster than preterm AGA and full-term SGA,but the point of catch-up growth was slower than full-term SGA,while in accordance with preterm SGA.(2)The breast feeding could promote catch-up growth of SGA at early stage.(3)The weight catch-up growth of SGA was affected by daily total energy within 3 months,and increased daily total energy could promote weight catch-up growth,while the daily total energy was not more than recommended nutrient intake of the 0 to 6 months infants,the length catch-up growth was not affected by daily total energy.The catch-up growth of SGA do not need more protein to energy ratio.(4)The IGF-1 of SGA has effect on the catch-up growth after birth,but not DNA methylation of IGF-1. |
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