Background: We hypothesized that low birth weight (LBW) subjects with a known increased risk of type 2 diabetes exhibit increased sensitivity towards the deleterious metabolic effects of 4-weeks high carbohydrate overfeeding (HCOF) compared with normal birth weight (NBW) controls.

Methods: Untargeted serum metabolomics and lipidomics were measured before and after 4-weeks HCOF (+25% energy) in 26 non-obese men with LBW (2789±174 g) and 21 normal birth weight (NBW) men/controls (3804±172 g) matched for BMI and age. Data were analyzed using a combination of advanced statistical and bioinformatical tools.

Results: Among 65 identified metabolites, 8 metabolites were affected differentially by HCOF between the two groups (p<0.05) . In response to HCOF, ingenuity pathway analysis (IPA) revealed increased accumulation and peroxidation of lipids in LBW subjects. In contrast, NBW controls increased albumin synthesis after HCOF. Changes in upstream regulators such as nicotinamide nucleotide transhydrogenase (NNT) , uncoupling protein 1 (UCP1) , and carbonic anhydrase 9 (CA9) were observed in both groups in response to HCOF. NBW controls displayed increased NNT and UCP1 activation, whereas LBW subjects responded with paradoxically decreased NNT and UCP1 activation. CA9 expression was decreased in both groups. Network correlation analysis revealed an upregulation of fatty acids in LBW subjects, contrasting a downregulation among NBW controls. Among 279 lipids identified, the LBW subjects exhibited a significantly higher number of lipids to be increased in response to HCOF (n=26) compared to NBW subjects (n=6) (PFisher=0.0004) , and IPA analysis revealed an activation of the PPARG pathway in NBW as opposed to a paradoxical inhibition in LBW subjects.

Conclusion: The results document severe differential perturbations of lipid metabolism in LBW men exposed to HCOF. Public health initiatives promoting low carbohydrate diets in LBW subjects are warranted.


S.O.Villumsen: None. A.A.Vaag: Stock/Shareholder; AstraZeneca. L.Justesen: None. L.Elingaard-larsen: None. A.B.Thuesen: None. M.Kim: None. C.Legido-quigley: None. E.R.Danielsen: None. T.Hansen: None. C.Brøns: Stock/Shareholder; Novo Nordisk.

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