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

Yıl 2007, Cilt: 21 Sayı: 3, 165 - 176, 01.12.2007

U. Yiş Y. Öztürk A. R. Şişman S. Uysal B. Büyükgebiz

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

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