Volume 199 - Issue 11
Birthweight and fasting glucose and insulin levels: results from the Aboriginal Birth Cohort Study
Author: Katherine A Thurber
Med J Aust 2013; 199 (11): 743-744. || doi: 10.5694/mja13.11022
Published online: 16 December 2013
Published online: 16 December 2013
Managing birthweight potentially reduces the risk of diabetes, but lifestyle factors are also important
To the Editor: The hypothesis that fetal growth restriction is associated with an increased risk of chronic disease is central to the developmental origins of health and disease paradigm. Inconsistent with this general hypothesis, but consistent with the inconclusive findings from other studies of Indigenous populations,1,2 Sayers and colleagues found no significant association between fetal growth restriction (defined as low birthweight for gestational age) and chronic disease biomarkers in the Aboriginal Birth Cohort at 18 years of age.3 However, the authors observed a significant association between increasing birthweight and factors indicating an elevated diabetes risk: fasting glucose levels, fasting insulin levels (adjusted for current height),3 and body mass index.4
Because these analyses were interpreted within the developmental origins of health and disease paradigm, the absence of an association between lower birthweight and these indicators remained the focus. Thus, the authors concluded that interventions to “improve” birthweight would be ineffective in reducing the prevalence of diabetes.3 This focus precluded adequate consideration of the other side of the birthweight spectrum — high birthweight, the other established pathway for chronic disease when followed by childhood overweight.5
Interventions should be based on the appropriate sum of available evidence. With 134 participants, the relatively low power of the study3 means that the negative findings may be unreliable in guiding policy development. Given the significant associations observed between increasing birthweight and chronic disease risk factors, and their consistency with the published evidence,1,2 interventions addressing birthweight outside the normal range, particularly high birthweight, remain potentially important for reducing chronic disease.
Competing interests
No relevant disclosures.
References
- McNamara BJ, Gubhaju L, Chamberlain C, et al. Early life influences on cardio-metabolic disease risk in aboriginal populations — what is the evidence? A systematic review of longitudinal and case–control studies. Int J Epidemiol 2012; 41: 1661-1682. CHDDHEEG
- Thurber KA. Analyses of anthropometric data in the Longitudinal Study of Indigenous Children and methodological implications [master's thesis]. Canberra: Australian National University, 2012. http://hdl.handle.net/1885/9892 (accessed Nov 2013).
- Sayers SM, Mott SA, Mann KD, et al. Birthweight and fasting glucose and insulin levels: results from the Aboriginal Birth Cohort Study. Med J Aust 2013; 199: 112-116. CBBGFEBF
- Sayers S, Mott S, Singh G. Fetal growth restriction and 18-year growth and nutritional status: Aboriginal Birth Cohort 1987-2007. Am J Hum Biol 2011; 23: 417-419. CBBEEDHE
- Eriksson JG, Forsen TJ, Osmond C, et al. Pathways of infant and childhood growth that lead to type 2 diabetes. Diabetes Care 2003; 26: 3006-3010. CBBFIGHA