Birth weight in relation to health and disease in later life: an umbrella review of systematic reviews and meta-analyses.
Birth weight in relation to health and disease in later life: an umbrella review of systematic reviews and meta-analyses.
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DOI：
10.1186/s12916-016-0692-5
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发表时间：
2016-09-28
期刊：
影响因子：
9.3
通讯作者：
Tzoulaki I
中科院分区：
文献类型：
--
作者：
Belbasis L;Savvidou MD;Kanu C;Evangelou E;Tzoulaki I
出生体重是子宫内环境的一个标志，在流行病学研究中已广泛研究了出生体重与随后健康和疾病的关系。尽管已经发表了许多荟萃分析，研究出生体重和随后的健康相关结果之间的关联，但这些关联的流行病学可信度尚未得到彻底评估。本研究的目的是绘制与出生体重相关的各种健康结果，并评估所报告的相关性的可信度和存在的偏见。进行了一项总括性审查，以确定调查出生体重与随后的健康结局和特征之间关系的观察性研究的系统性审查和荟萃分析。对于每种关联，我们通过随机效应和固定效应模型估计了汇总效应量、95%置信区间和95%预测区间。我们还评估了研究间异质性、小研究效应和过度显著性偏倚的证据。我们进一步应用标准化的方法学标准来评估统计学显著关联的流行病学可信度。39篇文章（包括78篇出生体重与不同结局之间的关联）符合合格标准。研究了广泛的健康结果，包括人体测量和代谢疾病、心血管疾病和心血管风险因素、各种癌症、呼吸道疾病和过敏、肌肉骨骼特征和围产期结果。78个关联中有47个呈现名义上显著的汇总效应，21个关联在P < 1 × 10−6时保持统计学显著性。30个关联呈现出较大或非常大的研究间异质性。小研究效应和过度显著性偏倚的证据分别存在于13和16个关联中。一个与低出生体重相关（全因死亡风险增加），两个与出生体重的剂量反应相关（出生体重每增加1公斤，髋部骨矿物质浓度较高，心血管疾病死亡风险较低），一个与出生体重正常的小于胎龄儿相关（儿童发育迟缓风险增加），这些都提供了令人信服的证据。另外11个协会有高度暗示性的证据。与出生体重相关的结果范围可能比疾病的“胎儿起源假设”最初描述的要窄。有微弱的证据表明，出生体重是一个有效的公共卫生干预指标。本文的在线版本（doi：10.1186/s12916-016-0692-5）包含补充材料，可供授权用户使用。
Birth weight, a marker of the intrauterine environment, has been extensively studied in epidemiological research in relation to subsequent health and disease. Although numerous meta-analyses have been published examining the association between birth weight and subsequent health-related outcomes, the epidemiological credibility of these associations has not been thoroughly assessed. The objective of this study is to map the diverse health outcomes associated with birth weight and evaluate the credibility and presence of biases in the reported associations. An umbrella review was performed to identify systematic reviews and meta-analyses of observational studies investigating the association between birth weight and subsequent health outcomes and traits. For each association, we estimated the summary effect size by random-effects and fixed-effects models, the 95 % confidence interval, and the 95 % prediction interval. We also assessed the between-study heterogeneity, evidence for small-study effects and excess significance bias. We further applied standardized methodological criteria to evaluate the epidemiological credibility of the statistically significant associations. Thirty-nine articles including 78 associations between birth weight and diverse outcomes met the eligibility criteria. A wide range of health outcomes has been studied, ranging from anthropometry and metabolic diseases, cardiovascular diseases and cardiovascular risk factors, various cancers, respiratory diseases and allergies, musculoskeletal traits and perinatal outcomes. Forty-seven of 78 associations presented a nominally significant summary effect and 21 associations remained statistically significant at P < 1 × 10−6. Thirty associations presented large or very large between-study heterogeneity. Evidence for small-study effects and excess significance bias was present in 13 and 16 associations, respectively. One association with low birth weight (increased risk for all-cause mortality), two dose-response associations with birth weight (higher bone mineral concentration in hip and lower risk for mortality from cardiovascular diseases per 1 kg increase in birth weight) and one association with small-for-gestational age infants with normal birth weight (increased risk for childhood stunting) presented convincing evidence. Eleven additional associations had highly suggestive evidence. The range of outcomes convincingly associated with birth weight might be narrower than originally described under the “fetal origin hypothesis” of disease. There is weak evidence that birth weight constitutes an effective public health intervention marker. The online version of this article (doi:10.1186/s12916-016-0692-5) contains supplementary material, which is available to authorized users.
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