Impact of cesarean section on metabolic syndrome components in offspring rats

• Published in: Pediatric research Vol. 95; no. 7; pp. 1775 - 1782
• Main Authors: Zhang, Mingxuan, Liu, Mengjiao, Zhang, Long, Chen, Zhangjian, Zhou, Yu-Bo, Li, Hong-Tian, Liu, Jian-Meng
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.06.2024; Nature Publishing Group
• Subjects: Basic Science Article; Cesarean section; Clinical practice guidelines; Epidemiology; Laboratory animals; Medicine; Medicine & Public Health; Metabolic syndrome; Pediatric Surgery; Pediatrics; Triglycerides
• ISSN: 0031-3998; 1530-0447; 1530-0447
• DOI: 10.1038/s41390-024-03079-6

Introduction Epidemiological evidence suggests an association between CS and offspring metabolic syndrome (MetS), but whether a causal relationship exists is unknown. Methods In this study, timed-mated Wistar rat dams were randomly assigned to cesarean section (CS), vaginal delivery (VD), and surrogate groups. The offspring from both CS and VD groups were reared by surrogate dams until weaning, and weaned male offspring from both groups were randomly assigned to receive normal diet (ND) or high-fat/high-fructose diet (HFF) ad libitum for 39 weeks. Results By the end of study, CS-ND offspring gained 17.8% more weight than VD-ND offspring, while CS-HFF offspring gained 36.4% more weight than VD-HFF offspring. Compared with VD-ND offspring, CS-ND offspring tended to have increased triglycerides (0.27 mmol/l, 95% CI, 0.05 to 0.50), total cholesterol (0.30 mmol/l, −0.08 to 0.68), and fasting plasma glucose (FPG) (0.30 mmol/l, −0.01 to 0.60); more pronounced differences were observed between CS-HFF and VD-HFF offspring in these indicators (triglyceride, 0.66 mmol/l, 0.35 to 0.97; total cholesterol, 0.46 mmol/l, 0.13 to 0.79; and FPG, 0.55 mmol/l, 0.13 to 0.98). Conclusions CS offspring were more prone to adverse metabolic profile and HFF might exacerbate this condition, indicating the association between CS and MetS is likely to be causal. Impact Whether the observed associations between CS and MetS in non-randomized human studies are causally relevant remains undetermined. Compared with vaginally born offspring rats, CS born offspring gained more body weight and tended to have compromised lipid profiles and abnormal insulin sensitivity, suggesting a causal relationship between CS and MetS that may be further amplified by a high-fat/high-fructose diet. Due to the high prevalence of CS births globally, greater clinical consideration must be given to the potential adverse effects of CS, and whether these risks should be made known to patients in clinical practice merits evaluation.