Context: Children born small-for-gestational age (SGA) tend to develop catch-up growth in infancy and to become overweight by the age of 6 yr. Weight control is advocated as a preventive measure, but it is unknown whether such control suffices to prevent visceral fat excess and hypoadiponectinemia.

Setting: University Hospital

Study Population & Design: 64 children (32 matched pairs) aged 6 yr of whom 32 were born appropriate-for-gestational-age (AGA), and 32 were born SGA and had subsequently developed spontaneous catchup growth; matching was performed for gender, height, weight and thus BMI.

Main Outcomes: fasting insulin, IGF-I, high-molecular-weight (HMW) adiponectin, leptin, visfatin; lean and fat mass, by absorptiometry; abdominally subcutaneous and visceral fat, by magnetic resonance imaging.

Results: After strict matching, SGA children had a total lean mass, total fat mass, leptinemia and visfatinemia comparable to those in AGA children, but they still had higher fasting insulin and IGF-I levels (P < 0.01), much lower HMW adiponectin levels (P < 0.0001), and a striking shift from abdominally subcutaneous to visceral fat (P < 0.0001). Fasting insulin (r = 0.52, P < 0.00001) was a major determinant of visceral fat in boys and girls, explaining 28% of its variance.

Conclusion: SGA children tend to be viscerally adipose and hypo-adiponectinemic, even in the absence of overweight. Hence, measures beyond weight control seem to be needed in order to allow most SGA children to normalize their body composition and endocrine-metabolic homeostasis.