Triglycerides and free fatty acids responses

We observed that the postprandial TG responses were significantly greater, particularly, after high-fat meals, for the SGI-group than for the controls. No differences were seen between groups in either fasting TG concentrations or fasting FFA or FFA postprandial responses. Thus, elevated TG responses were not the result of increased adipose tissue lipolysis in the late postprandial state. Elevated TG responses indicate that individuals who grow slowly during early life have altered lipid metabolism. Restricted liver growth during early life may permanently alter

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liver functioning and lipid metabolism, as detected and reported in animal studies (Burns et al. 1997, Lane et al. 2001, Winick and Noble 1966). Excess lipid content in the liver may also cause elevated postprandial lipid responses and insulin resistance. Studies have shown that non-alcoholic fatty liver disease is more common in adults who were born with small body size or were small at infancy (Fraser et al. 2008, Sandboge et al. 2013). Therefore, elevated TG responses could be the result of non-alcoholic fatty liver disease as well.

Our results differ from those of Byrne et al. (1997) and Kensara et al. (2006), who found no effect of birth weight on postprandial TG and FFA responses in elderly men and women. Unlike these two studies in which the effect of birth weight was investigated, we investigated the effect of early growth on postprandial responses and our participants were small at birth as well as at infancy. It was previously reported that prenatal growth has only a moderate effect on fasting TG levels (Huxley et al. 2004), whereas postnatal growth has a much greater effect (Kajantie et al. 2008). Therefore, we suggest that our observed elevated TG responses were mostly due to growth retardation during infancy.

It is well known that elevated postprandial lipid levels are closely related to a number of metabolic diseases, including CVD (Bansal et al. 2007, Nordestegaard et al. 2007). Small body size at birth as well as thinness during infancy are also associated with these diseases (Barker 1995, Barker et al. 2005, Eriksson et al. 2007, Huxley et al. 2007, Mu et al. 2012, Osmond et al. 2007, van Abeelen et al. 2011).

The associations of birth weight with fasting lipid concentrations are quite modest, compared with the associations between birth weight and disease risk in later life.

Since postprandial lipaemia occurs over 4–6 h in healthy individuals, most individuals spend the majority of their waking hours in a postprandial state. In addition, elevated postprandial TG levels are directly atherogenic (Goldberg et al.

2011, Jackson et al. 2012, Kolovou et al. 2011) and cause adverse health effects, such as increase oxidative stress and inflammation (Klop et al. 2012). Therefore, our findings of elevated postprandial TG levels are of significance for the understanding of increased metabolic disease risk among individuals who were born with small body size and who grew slowly during the first year of life.

6.2.3 Appetite regulatory hormones

Epidemiologic evidence is available that subjects who were born with small body size and grew slowly during infancy are less likely to become obese, whereas rapid growth during infancy has been associated with obesity later in life (Baird et al.

2005, Monasta et al. 2010, Monteiro and Victora 2005, Ong and Loos 2006, Schellong et al. 2012, Yu et al. 2011b, Zhao et al. 2012). It has been proposed that the relationship between early growth and obesity is due to alterations in the appetite

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regulatory systems, as observed in several animal models (Breton et al. 2009, Coupe et al. 2009, Desai et al. 2007, Ikenasio-Thorpe et al. 2007, Lopez et al. 2005, Lukaszewski et al. 2013, Plagemann et al. 1999, Plagemann et al. 2000a, Plagemann et al. 2000b, Remmers et al. 2008, Schellong et al. 2013, Yousheng et al. 2008).

We showed that the postprandial responses of the appetite regulatory hormone PYY were significantly higher for the SGI-group than for the age-, sex- and BMI-matched controls. This finding may indicate greater satiety responses after a meal among subjects who grow slowly during early life. Greater satiety responses could potentially be one explanation why subjects who born with small body size and grow slowly during infancy are less likely to become obese.

Our results are in accordance with previous studies in young children that showed that infants who were born with low birth weight (Chen et al. 2012, Siahanidou et al. 2005) or born preterm (Berseth et al. 1992, Chen et al. 2012, Siahanidou et al. 2005, Siahanidou et al. 2007) had elevated levels of fasting PYY, reflecting greater satiety. Although early growth influenced the PYY responses in our study, we did not detect differences in ghrelin levels between the groups.

Previous results from studies, in which the association between birth weight or weight gain during infancy and fasting levels of ghrelin have been investigated, have also been conflicting (Chen et al. 2012, Darendeliler et al. 2009, Iniguez et al. 2002, Kyriakakou et al. 2009, Larnkjaer et al. 2010, Park 2010, Sahin et al. 2012, Siahanidou et al. 2005).

To date, only one study has investigated the effect of birth weight on postprandial appetite regulatory hormone responses in adulthood (Schou et al.

2005). In that study, birth weight did not influence appetite regulation. However, in contrast to our study, they measured only GLP-1 levels, not other hormones that are involved in appetite regulation. We also saw that early growth did not influence the GLP-1 levels, even though it affected the PYY levels.

In addition to these gut-released appetite regulatory hormones, insulin is also an important satiety signal (Flint et al. 2007). Elevated postprandial insulin levels have found to reflect higher satiety feelings (Flint et al. 2007). Therefore, our observed elevated postprandial insulin responses in the SGI-group may thus also reflect greater satiety feelings in the postprandial state. However, it remains to be seen whether these alterations in PYY levels, as well as insulin levels, also reduce meal sizes in normal life and thus decrease the risk for developing obesity.

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