Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials
Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials
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DOI：
10.1016/s0140-6736(00)04004-6
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发表时间：
2001-02-10
期刊：
影响因子：
168.9
通讯作者：
Lucas, A
中科院分区：
文献类型：
--
作者：
Singhal, A;Cole, TJ;Lucas, A
背景 尽管有数据将生命早期的体型与后来的心血管结果联系起来，但营养影响此类结果的假设尚未成立。母乳喂养与晚年血压降低有关，但之前的研究并未通过使用随机设计和前瞻性随访来控制可能的混杂因素。我们进行了这样一项研究，以检验早期饮食可以影响儿童出生后血压的假设，并在出生时随机分配不同的饮食。方法在英国 5 个新生儿单位的 926 名早产儿童中，在出生时参加了两项平行随机试验，对其中 216 名（23%）儿童在 13-16 岁时测量了血压。饮食干预措施为：捐赠的储存母乳与早产配方奶粉以及标准足月配方奶粉与早产配方奶粉。结果 13-16 岁时随访的儿童在出生时的社会阶层和人体测量方面与未随访的儿童相似。 66 名被指定为储存母乳（单独或除母乳外）的儿童在 13-16 岁时的平均动脉血压低于被指定为早产配方奶的 64 名儿童（平均值 81.9 [SD 7.8] vs 86.1 [6.5] mm Hg；95% Cl 差异 -6.6 至 -1.6；p=0.001）。在非随机分析中，新生儿期肠内摄入母乳的比例与后期平均动脉压呈负相关（每增加 10%，β=-0.3 mm Hg [95% CI -05 至 -0.1]；p=0.006）。足月配方奶粉 (n=44) 与早产配方奶粉 (n=42) 的比较中没有发现差异。 解释 母乳摄入量与早产儿后期血压较低有关。我们的数据提供了通过早期饮食控制心血管危险因素的实验证据，并进一步支持母乳的长期有益作用。
Background Despite data relating body size in early life to later cardiovascular outcomes, the hypothesis that nutrition affects such outcomes has not been established. Breastfeeding has been associated with lower blood pressure in later life, but previous studies have not controlled for possible confounding factors by using a randomised design with prospective follow-up. We undertook such a study to test the hypothesis that early diet programmes blood pressure in later life in children randomly assigned different diets at birth.Methods Blood pressure was measured at age 13-16 years in 216 (23%) of a cohort of 926 children who were born prematurely and had participated at birth in two parallel randomised trials in five neonatal units in the UK. Dietary interventions were: donated banked breastmilk versus preterm formula and standard term formula versus preterm formula.Findings Children followed up at age 13-16 years were similar to those not followed up in terms of social class and anthropometry at birth. Mean arterial blood pressure at age 13-16 years was lower in the 66 children assigned banked breastmilk (alone or in addition to mother's milk) than in the 64 assigned preterm formula (mean 81.9 [SD 7.8] vs 86.1 [6.5] mm Hg; 95% Cl for difference -6.6 to -1.6; p=0.001). In non-randomised analyses, the proportion of enteral intake as human milk in the neonatal period was inversely related to later mean arterial pressure (beta=-0.3 mm Hg per 10% increase [95% CI -05 to -0.1]; p=0.006). No differences were found in the term formula (n=44) versus preterm formula (n=42) comparison.Interpretation Breastmilk consumption was associated with lower later blood pressure in children born prematurely. Our data provide experimental evidence of programming of a cardiovascular risk factor by early diet and further support the long-term beneficial effects of breastmilk.