J Korean Med Assoc.  2014 Mar;57(3):234-240. 10.5124/jkma.2014.57.3.234.

A developmental perspective on the origins of obesity and metabolic syndrome

Affiliations
  • 1Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea. ithwang83@hallym.or.kr
  • 2Department of Pediatrics, Hallym University College of Medicine, Seoul, Korea.

Abstract

Metabolic syndrome comprises central obesity, dyslipidemia, hypertension, glucose intolerance, and insulin resistance. Children sometimes develop metabolic syndrome, and it is strongly associated with the same syndrome in adulthood. Recently, there is evidence that obesity and metabolic syndrome originate from fetal life. Possible explanations of fetal and developmental origin of metabolic syndrome are the thrifty genotype and thrifty phenotype hypothesis, which together confer insulin resistance on developing fetus. Poor nutrition in utero as well as extrauterine growth restriction of preterm infants are important triggers of this hypothesis. Like metabolic syndrome in adulthood, the high levels of inflammatory cytokines and adipokines are certainly characteristic in pediatric patients. Increased fat mass was also observed in these patients, although their birth weight was lower than average. The mitochondrial genome is responsible for the inheritance of obesity from the maternal line. This can be a key as to why the phenotypes of obesity and metabolic syndrome start in fetal life with an association with poor maternal nutrition. In such circumstances, catch-up growth with an over-nutrition strategy can aggravate those features, suggesting that rapid catch-up growth in early infancy should not be encouraged.

Keyword

Metabolic syndrome; Pediatric obesity; Small for gestational age infant; Fetal nutrition disorders

MeSH Terms

Adipokines
Birth Weight
Child
Cytokines
Dyslipidemias
Fetal Nutrition Disorders
Fetus
Genome, Mitochondrial
Genotype
Glucose Intolerance
Humans
Hypertension
Infant, Newborn
Infant, Premature
Insulin Resistance
Obesity*
Obesity, Abdominal
Pediatric Obesity
Phenotype
Wills
Adipokines
Cytokines

Figure

  • Figure 1 Hypothesis proposed to explain the development of insulin resistance associated with reduced fetal growth. Thrifty phenotype and genotype are the major underlying mechanisms together with gene-environmental interaction to develop insulin resistance and later metabolic syndrome. SGA, small for gestational age.


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