Erken Süt Çocukluğu Döneminde Anne Sütü Ve Formüla Alan Bebeklerin Antropometrik Verilerinin, Beslenme Özelliklerinin Karşılaştırılması Ve Bu Değişkenlerin Kan Şekeri, İnsülin Ve IGF-1 Hormonları İle İlişkisi

Öz

Amaç: Anne sütü ve formüla ile beslenen erken süt çocukluğu dönemindeki bebeklerin antropometrik verilerinin ve beslenme özelliklerinin karşılaştırılması ve bu verilerle beslenme davranışının ve enerji metabolizmasının düzenlenmesinde görev alan insülin ve IGF-1 hormonları arasındaki ilişkinin araştırılması. Gereç ve yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Çocuk Polikliniği’ne kontrol amacı ile getirilen ve yaşları 3-4 ay arasında değişen sağlıklı bebekler çalışmaya alındı. Bebekler yalnızca anne sütü (AS) ile beslenenler ve çeşitli nedenlerden dolayı ilk ay içinde anne sütü kesilip formüla ile beslenenler (F) olarak iki gruba ayrıldı; doğum haftaları, doğum ağırlıkları, bebeklerin beslenme özellikleri sorgulandı; vücut ağırlığı, boyu, baş çevresi ve triseps cilt kıvrım kalınlığı (TCKK) ölçüldü ve vücut kitle indeksi (VKİ) hesaplandı. Bebeklerin beslenme öncesi insülin, IGF-1 ve kan şekeri düzeylerini belirlemek üzere venöz kan örnekleri alındı. Bebeklerin 6. ay kontrollerinde, ek gıdalara geçiş zamanı, beslenme özellikleri ve dışkılama paterni sorgulandı; vücut ağırlığı, boyu, baş çevresi ve TSF’si ölçüldü; VKİ, enerji ve protein alımları hesaplandı. Bulgular: Çalışmada yer alan 47 sağlıklı bebeğin (erkek/kız=25/22) 24’ü AS, 23’ü F grubunda idi. İki grup arasında cinsiyet, doğum ağırlığı ve doğum haftası özellikleri bakımından fark yoktu. Üçüncü ayda yapılan ilk değerlendirmede AS grubundaki bebeklerin vücut ağırlığı, boy, TSF, postnatal kilo artışı, beslenme sıklığı ve süresi daha fazla idi (p < 0,05). Altıncı ayda AS grubundaki bebeklerin 16’sında (%73), F grubundakilerin 19’unda (%95) ek gıdaya geçilmişti. Ek gıdalardan alınan enerji ve protein F grubunda daha fazla idi (p < 0,05). Bu dönemde iki grup arasındaki antropometrik ölçüm farkları ortadan kalkmıştı. Anne sütü ve F grubundaki bebeklerin kan şekeri düzeyleri arasında fark olmamasına ve F grubundakilerin daha zayıf olmalarına karşın, serum insülin düzeyleri F grubunda istatistiksel olarak anlamlı olmamakla birlikte daha yüksek idi. Formüla grubunun ortalama serum IGF-1 düzeyi daha yüksek olarak bulundu (p < 0,05). Tüm bebeklerde serum IGF-1 düzeyi arttıkça, 6. ayda ek gıdalardan alınan enerji ve protein miktarı, vücut ağırlığı, VKİ, TCKK ve 3. aydan 6. aya kadar alınan kilo miktarı da artmakta idi (sırasıyla r=0,350, p < 0,05; r=0,400, p < 0,05; r=0,455, p < 0,05; r=0,524, p < 0,05; r=0,461, p < 0,05). Sonuç: Serumdaki IGF-1 düzeylerinin ikinci üç aylık dönemde enerji, protein ve kilo alımı ile ilişkili olması, bu hormonun ileri yaşlarda vücut ağırlığının düzenlenmesinde önemli rol oynadığını düşündürmektedir. Formüla alan bebeklerde relatif olarak daha yüksek bulunan insülin düzeyleri, bu bebeklerin ek gıdalardan neden daha yüksek enerji ve protein aldıklarının açıklaması olabilir

Anahtar Kelimeler

• Anne sütü
• formüla
• insülin
• IGF-1
• antropometri
• büyüme
• bebek

COMPARISON OF THE ANTHROPOMETRIC DATA AND NUTRITIONAL CHARACTERISTICS AMONG THE BREASTFED AND FORMULA-FED BABIES AND THE RELATION OF THESE PARAMETERS TO INSULIN AND IGF-1 IN EARLY INFANCY

Öz

Objective: Comparison of the anthropometric data and nutritional characteristics
among the breastfed and formula-fed babies in early infancy and evaluation of the
relation of these parameters to the hormones insulin and IGF-1that are involved in the
regulation of nutritional habits and energy metabolism.
Materıal and method: Three to four month-old healthy babies evaluated during
routine clinical visits in Dokuz Eylül University Medical Faculty Department of Pediatrics were enrolled in the study. The babies were splitted into two groups as
breastfed (BF) and formula-fed (FF). Gestational age, birth weight, and nutritional
characteristics of the babies were asked; weight, height, head circumference and
triceps skin fold thickness (TSF) were measured and body mass index (BMI) was
calculated. While fasting venous blood samples of all the babies were obtained for
insulin, IGF-1 and glucose measurement. The babies were re-evaluated at 6
th postnatal
month for weaning time, nutritional characteristics, weight, height, head circumference,
TSF, BMI and daily protein intake.
Results: There were 47 babies (male/female = 25/22), 24 in BF and 23 in FF groups.
Two groups were not different with respect to sex, birth weight and gestational age.
Weight, height, TSF, postnatal weight gain, feeding frequency and length were higher
in BF group than FF group at first visit in 3-4 months of age (p<0.05). At 6
th month, 16
(73%) and 19 (95%) of the babies had weaned in the BF and FF groups, respectively.
The energy and protein intake by supplemental foods was higher in FF group (p<0.05).
At that time, the differences in anthropometric measurements were over among two
groups. Although blood glucose levels were not different among the BF and FF group
and the babies in FF group were leaner, serum insulin levels were higher, although not
significantly, in FF group. IGF-1 levels were significantly higher in the FF group
(p<0.05). As the serum IGF-1 level increased, energy and protein intake by
supplemental foods, weight, BMI, TSF and weight gain from 3 to 6 months of age
increased in all babies (r=0.350, p<0.05; r=0.400, p<0.05; r=0.455, p<0.05; r=0.524,
p<0.05 and r=0.461, p<0.05, respectively).
Conclusion: The relation of serum IGF-1 level to energy and protein intake and
weight gain in the second 3 month-period of life implies that this hormone play a role in
regulation of body weight similar to leptin in later life. Relatively higher levels of serum
insulin in FF group might explain the higher energy and protein intake from the
supplemental foods in these babies.

Anahtar Kelimeler

• Breast feeding
• formula
• insulin
• IGF-1
• anthropometry
• growth
• infant

Kaynakça

1. Dewey KG, Heinig MJ, Nommsen LA, Peerson J, Lönnerdal B. Growth of breast-fed and formula-fed Infants from 0 to 18 months: The DARLING Study. Pediatrics 1992; 89: 1035-1041.
2. Agostoni C, Grandi F, Gianni ML, et al. Growth patterns of breast fed and formula fed infants in the first 12 months of life: an Italian study. Arch Dis Child 1999; 81: 395-399.
3. Fry T. The new “breast from birth” growth charts. An updated version of the paper given at the Primary Care Conference and Exhibition, May 2003. J Fam Health Care 2003; 13: 124-126.
4. Ong K, Preece MA, Emmett PM, Ahmed ML, Dunger DB. Size at birth and early childhood growth in relation to maternal smoking, parity and infant breast feeding: Longitudinal birth cohort study and analysis. Pediatric Research 2002; 52: 863-867.
5. Thomas B, Clayton DB (eds). Manuel of Dietetic Prac- tice, Second ed, Blackwell Science, Oxford, 1994.
6. Donma MM, Donma O. Infant feeding and growth: A study on Turkish infants from birth to 6 months. Ped Inter 1999; 41: 542-548.
7. Cavell B. Gastric emptying in infants fed human milk or infant formula. Acta Paediatr Scan 1981; 70: 639-641.
8. Lucas A, Boyes S, Bloom Sr, Ansley-Green A. Metabolic and endocrine responses to a milk feed in six-day-old- term infants: differences between breast and cow’s milk formula feeding. Acta Paediatr Scand 1981; 70: 195-200.

9. Mehta KC, Specker BL, Bartholmey S, Giddens J, Ho ML. Trial on timing of introduction to solids and food type on infant growth. Pediatrics 1998; 102: 569-573.
10. Dewey KG, Heinig MJ, Nommsen-Rivers LA, Lönnerdal B. Low energy intake and growth velocities of breast-fed infants: are there functinel consequences? In: Schurch B, Scrimshaw N, eds. Activity, energy expenditure and energy requirements of infants and children. Lausanne, Switzerland: Proceedings of an International Dietary Energy Consultative Group Workshop, IDECG. c/o Nestle Foundation; 1990; 35-43.
11. Dewey KG, Heinig MJ, Nommsen-Rivers LA, Lönnerdal B. Adequacy of energy intake among breastfed infants in the DARLING study: relationship to growth velocity, morbidity and activity levels. J Pediatr 1991;119:538-547.
12. Heinig MJ, Nommsen LA, Peerson JM, Lonnerdal B, Dewey KG. Intake and growth of breast fed and formula fed infants in relation to the timing of introduction of complementary foods: the DARLING study. Acta Pediatr 1993; 82: 999-1006.
13. Fewtrell MS, Lucas A, Morgan JB. Factors associated with weaning in full term and preterm infants. Arch Dis Child Fetal Neonatal Ed 2003; 88: 296-301.
14. Garza C, Butte NF. Energy intakes of human milk-fed infants during the first year. J Pediatr 1990; 117:124-131.
15. Garcia-Mayor RV, Andrade MA, Rios M, Lage M, Dieguez C, Casanueva FF. Serum leptin levels in normal children: relationship to age, gender, body mass index, pituitary-gonadal hormones and pubertal stage. J Clin Endocrinol Metab 1997; 82: 2849-2855.
16. Lucas A, Blackburn A, Aynsley-Green A, Sarson D, Adrian T, Bloom S. Breast vs. bottle: Endocrine respon- ses are different with formula feeding. Lancet 1980: 1: 1267-1269.
17. Ginsburg BE, Lindblad BS, Lundsjö A, Persson B, Zetterström R. Plasma valine and urinary C-peptide in breast fed and artificially fed infants up to 6 monts of age. Acta Paediatr Scand 1984; 73: 213-217.
18. Wallensteen M, Lindblad BS, Zetterström R, Perrson B. Acute C-peptid, insulin and branched chain aminoacid response to feeding in formula and breast fed infants. Acta Paediatr Scand 1991; 80: 143-148.
19. Das UN. The lipids that matter from infant nutrition to insulin resistance. Prostoglandins Leukot Essent Fatty Acids 2002; 67: 1-12.
20. Baur LA, O’Connor J, Pan DA, Kriketos AD, Storlien LH. The fatty acid composition of skeletal muscle membrane phospholipid: its relationship with the type of feeding and glucose levels in young children. Metabolism 1998; 47: 106-112.
21. Fliesen T, Maiter D, Gerard G, Underwood LE, Maes M, Ketelslegers JM. Reduction of serum insulin-like growth factor-1 by dieatry protein restriction is age dependent. Pediatr Res 1989; 26: 415-419.
22. Holl RW, Snehotta R, Siegler B, Scherbaum W, Heinze E. Binding protein for human growth hormone: effects of age and weight. Horm Res 1991; 35: 190-197.
23. Büyükkayhan D, Tanzer F, Erselcan T, Cinar Z, Yonem O. Umblical serum insulin-like growth factor-1 in new- borns: effeects of gestational age, postnatal age and nutrition. Int J Vit Nutr Res 2003; 73: 343-346.
24. Özkan H, Aydın A, Demir D, Erci T, Büyükgebiz A. Associations of IGF-1, IGFBP-1 and IGFBP-3 on intra- utrin and early catch-up growth. Biol Neonate 1999; 76: 274-282.