In utero growth retardation has been linked to a reduced rate of cell division in the fetal organs that undergo rapid growth and to permanent changes and adaptations (programming) that may affect the physiology in adult life. In particular, in utero growth retardation as reflected by a low birth weight for gestational age has been shown to be associated with a relative insulin resistance in adults. How programming may influence glucose metabolism is not completely understood, and the possible role of genetic factors has not been explored. The angiotensin I-converting enzyme gene insertion/deletion (ACE I/D) polymorphism may predispose to insulin resistance and modulate the expression of several common cardiovascular and renal disorders, especially in people with diabetes. The possible impact of this polymorphism on plasma glucose and insulin levels was investigated in a group of young adults born at term whose length or weight at birth were in the lowest 3% of the sex and gestational age-adjusted distribution (SGA, n = 172) and a group of control individuals born with an appropriate birth weight for gestational age (AGA, n = 207). In this study, we have previously demonstrated an association between SGA and relative insulin resistance, especially in those with shorter gestational age. In the SGA group, fasting plasma glucose and insulin levels were significantly correlated (R = 0.196, P < 0.015), with this association being significant only in ACE II individuals (R = 0.539, P < 0.0009). In the AGA group, fasting plasma glucose and insulin levels were not significantly correlated. Consistent with this observation, the relationship between the ACE polymorphism and the insulin response to a glucose load was significantly heterogeneous between the AGA and SGA groups (P < 0.05); this was due to a tendency for ACE II individuals in the SGA group to exhibit increased 30-min plasma insulin levels (P < 0.05). In the SGA group, there was a significant interaction between gestational age and genotype on the insulin area (P < 0.0004); this index was inversely associated with gestational age in ACE II (P < 0.0005) and ACE ID (P < 0.005) subjects, but not in DD homozygotes (P > 0.05). The ACE D allele may thus attenuate the additive consequences of SGA and relatively short duration of gestation on insulin resistance in young adults.

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