FETAL AND INFANT GROWTH AND IMPAIRED GLUCOSE-TOLERANCE AT AGE 64

Objective - To discover whether reduced fetal and infant growth is associated with non-insulin dependent diabetes and impaired glucose tolerance in adult life. Design - Follow up study of men born during 1920-30 whose birth weights and weights at 1 year were known. Setting - Hertfordshire, England. Subjects - 468 men born in east Hertfordshire and still living there. Main outcome measures-Fasting plasma glucose, insulin, proinsulin, and 32-33 split proinsulin concentrations and plasma glucose and insulin concentrations 30 and 120 minutes after a 75 g glucose drink. Results - 93 men had impaired glucose tolerance or hitherto undiagnosed diabetes. They had had a lower mean birth weight and a lower weight at 1 year. The proportion of men with impaired glucose tolerance fell progressively from 26% (6/23) among those who had weighed 18 lb (8-16 kg) or less at 1 year to 13% (3/24) among those who had weighed 27 lb (12.25 kg) or more. Corresponding figures for diabetes were 17% (4/23) and nil (0/24). Plasma glucose concentrations at 30 and 120 minutes fell with increasing birth weight and weight at 1 year. Plasma 32-33 split proinsulin concentration fell with increasing weight at 1 year. All these trends were significant and independent of current body mass. Blood pressure was inversely related to birth weight and strongly related to plasma glucose and 32-33 split proinsulin concentrations. Conclusions - Reduced growth in early life is strongly linked with impaired glucose tolerance and non-insulin dependent diabetes. Reduced early growth is also related to a raised plasma concentration of 32-33 split proinsulin, which is interpreted as a sign of beta-cell dysfunction. Reduced intrauterine growth is linked with high blood pressure, which may explain the association between hypertension and impaired glucose tolerance.