Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children
Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children
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DOI：
10.1016/j.jaci.2015.08.050
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发表时间：
2016-04-01
影响因子：
14.2
通讯作者：
Duijts, Liesbeth
中科院分区：
文献类型：
--
作者：
den Dekker, Herman T.;Voort, Agnes M. M. Sonnenschein-van der;Duijts, Liesbeth
背景：早产儿或胎龄较小的儿童患儿童哮喘的风险增加。目的：我们试图评估气道通畅性降低可以解释这些关联的假设。方法：我们使用来自 24 个出生队列的 24,938 名儿童的个体参与者数据来检查和荟萃分析胎龄、胎龄大小和婴儿体重增加与儿童肺功能和哮喘的关系（年龄范围、 3.9-19.1岁）。其次，我们探讨了这些肺功能结果是否介导了早期生长特征与儿童哮喘的关联。结果：出生时胎龄较小的儿童的 FEV1、FEV1/用力肺活量 (FVC) 比值以及呼出 75% 肺活量后的用力呼气量 (FEF75) 较低，而出生时胎龄较小的儿童的 FEV1 较低，但 FEV1/FVC 比值较高 (P < .05）。婴儿体重增加较多与儿童期 FEV1 较高但 FEV1/FVC 比值和 FEF75 较低相关 (P < .05)。所有关联都存在于整个范围内，并且独立于其他早期生命生长特征。早产、低出生体重和婴儿体重增加较多与儿童哮喘风险增加相关（合并比值比分别为 1.34 [95% CI, 1.15-1.57]、1.32 [95% CI, 1.07-1.62] 和 1.27 [95% CI, 1.21-1.34]）。中介分析表明，FEV1、FEV1/FVC 比值和 FEF75 可以解释 7%（95% CI，2% 至 10%）至 45%（95% CI，15% 至 81%）的早期生长特征与哮喘之间的关联。结论：较小的胎龄、较小的胎龄体重和较大的婴儿体重增加与儿童肺功能相关。这些关联在很大程度上解释了儿童哮喘的风险。
Background: Children born preterm or with a small size for gestational age are at increased risk for childhood asthma.Objective: We sought to assess the hypothesis that these associations are explained by reduced airway patency.Methods: We used individual participant data of 24,938 children from 24 birth cohorts to examine and meta-analyze the associations of gestational age, size for gestational age, and infant weight gain with childhood lung function and asthma (age range, 3.9-19.1 years). Second, we explored whether these lung function outcomes mediated the associations of early growth characteristics with childhood asthma.Results: Children born with a younger gestational age had a lower FEV1, FEV1/forced vital capacity (FVC) ratio, and forced expiratory volume after exhaling 75% of vital capacity (FEF75), whereas those born with a smaller size for gestational age at birth had a lower FEV1 but higher FEV1/FVC ratio (P < .05). Greater infant weight gain was associated with higher FEV1 but lower FEV1/FVC ratio and FEF75 in childhood (P < .05). All associations were present across the full range and independent of other early-life growth characteristics. Preterm birth, low birth weight, and greater infant weight gain were associated with an increased risk of childhood asthma (pooled odds ratio, 1.34 [95% CI, 1.15-1.57], 1.32 [95% CI, 1.07-1.62], and 1.27 [95% CI, 1.21-1.34], respectively). Mediation analyses suggested that FEV1, FEV1/FVC ratio, and FEF75 might explain 7% (95% CI, 2% to 10%) to 45% (95% CI, 15% to 81%) of the associations between early growth characteristics and asthma.Conclusions: Younger gestational age, smaller size for gestational age, and greater infant weight gain were across the full ranges associated with childhood lung function. These associations explain the risk of childhood asthma to a substantial extent.