Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries.
Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries.
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DOI：
10.1093/ije/dyt109
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发表时间：
2013-10
影响因子：
7.7
通讯作者：
Black RE
中科院分区：
文献类型：
--
作者：
Christian P;Lee SE;Donahue Angel M;Adair LS;Arifeen SE;Ashorn P;Barros FC;Fall CH;Fawzi WW;Hao W;Hu G;Humphrey JH;Huybregts L;Joglekar CV;Kariuki SK;Kolsteren P;Krishnaveni GV;Liu E;Martorell R;Osrin D;Persson LA;Ramakrishnan U;Richter L;Roberfroid D;Sania A;Ter Kuile FO;Tielsch J;Victora CG;Yajnik CS;Yan H;Zeng L;Black RE
低收入和中等收入国家继续承受着巨大的发育迟缓负担;据估计，2011年有1.48亿儿童发育迟缓，约占所有儿童的30-40%。在许多这些国家，胎儿生长受限（FGR）是常见的，随后的增长在头2年步履蹒跚。虽然人们一致认为发育迟缓涉及产前和产后生长障碍，但胎儿生长迟缓在多大程度上导致发育迟缓和其他营养状况指标尚不确定。使用现有的纵向出生队列（n = 19），出生体重，胎龄和儿童人体测量（12-60个月）的数据，我们估计了研究特定的和合并的风险估计发育迟缓，浪费和体重不足的小于胎龄（SGA）和早产。我们根据SGA和胎龄的四种组合对儿童进行分组：胎龄足够大小（阿加）和早产; SGA和足月; SGA和早产;以及阿加和足月（参考组）。相对于阿加和足月，阿加和早产、SGA和足月以及SGA和早产相关的发育迟缓的OR（95%置信区间）分别为1.93（1.71，2.18）、2.43（2.22，2.66）和4.51（3.42，5.93）。在消瘦和体重不足方面也观察到类似程度的风险。低出生体重与2.5-3.5倍的消瘦、发育迟缓和体重不足的几率有关。儿童发育迟缓和消瘦结局的总体SGA的人群归因风险分别为20%和30%。这项分析估计，儿童期营养不良可能起源于胎儿期，这表明需要进行早期干预，最好是在怀孕期间进行干预，已知干预措施可以减少FGR和早产。
Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30–40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain. Using extant longitudinal birth cohorts (n = 19) with data on birth-weight, gestational age and child anthropometry (12–60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth. We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5–3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively. This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.