Role of maternal health and infant inflammation in nutritional and neurodevelopmental outcomes of two-year-old Bangladeshi children.
Role of maternal health and infant inflammation in nutritional and neurodevelopmental outcomes of two-year-old Bangladeshi children.
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DOI：
10.1371/journal.pntd.0006363
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发表时间：
2018-05
影响因子：
3.8
通讯作者：
Petri WA Jr
中科院分区：
文献类型：
--
作者：
Donowitz JR;Cook H;Alam M;Tofail F;Kabir M;Colgate ER;Carmolli MP;Kirkpatrick BD;Nelson CA;Ma JZ;Haque R;Petri WA Jr
以前的研究表明，母亲，炎症和社会经济变量与低收入国家儿童的生长和神经发育有关。然而，这些结果是多因素的，缺乏描述哪些预测因子对它们影响最大的工作。我们对孟加拉国儿童从出生到两岁进行了一项纵向研究，以评估口服疫苗的有效性。收集了与孕产妇和围产期健康、社会经济状况、儿童早期肠道和全身炎症以及人体测量有关的变量。在2年时进行Bayley-III神经发育评估。作为二次分析，我们采用分层聚类和随机森林技术来识别和排名哪些变量预测生长和神经发育。聚类分析表明，三个不同的组的预测。母亲的体重和年龄别身高Z评分（LAZ）是两年内LAZ的最强预测因子。Bayley-III的认知评分与入组时的年龄别体重（WAZ）、收入和入组时的LAZ密切相关。语言的主要预测因素包括轮状病毒疫苗接种、血浆IL 5、sCD 14、TNFα、母亲体重和男性。运动功能最好的预测方法是粪便钙卫蛋白、WAZ、粪便新蝶呤和血浆CRP指数。社交情绪评分的最强预测因子包括血浆sCD 14、收入、入组时的WAZ和入组时的LAZ。根据随机森林的预测，两年时LAZ解释的变异百分比估计为35.4%，ΔLAZ为34.3%，认知评分为42.7%，语言为28.1%，运动为40.8%，社交情感评分为37.9%。出生人体测量和母亲体重是生长的强预测因子，而肠道和全身炎症与神经发育有更强的关联。出生人体测量是一个强大的预测所有的结果。这些数据表明，对低收入环境中发育迟缓的进一步研究应包括与孕产妇和产前健康有关的变量，而重点关注神经发育结果的调查应另外针对全身和肠道炎症的原因。来自低收入环境的儿童经历线性生长蹒跚和神经发育延迟，这些与母亲，社会经济和感染/炎症变量相关。鉴于这些关联的相互依赖性，很难理解哪些变量是不良结果的最佳预测因子。我们对孟加拉国儿童从出生到两岁进行了纵向研究，并收集了评估孟加拉国儿童幼儿期母亲，炎症和社会经济方面的预测因素。我们进行了随机森林分析，以排名与生长和神经发育相关的预测因子。线性增长是最好的预测出生人体测量和产妇体重。认知功能预测出生人体测量，社会经济地位，全身炎症。接受轮状病毒疫苗和全身炎症，母亲和社会经济变量的组合预测语言得分。运动评分由全身炎症预测，肠道炎症标志物具有反向关系。社会情绪发展预测全身炎症，出生人体测量学，和经济手段。这项工作表明，特定的途径负责生长和发育的不同方面。我们的数据表明，在低收入环境中调查儿童发育迟缓的研究应侧重于母亲和产前变量，而那些专注于神经发育结果的研究还应针对全身性和肠道炎症的原因。
Previous studies have shown maternal, inflammatory, and socioeconomic variables to be associated with growth and neurodevelopment in children from low-income countries. However, these outcomes are multifactorial and work describing which predictors most strongly influence them is lacking. We conducted a longitudinal study of Bangladeshi children from birth to two years to assess oral vaccine efficacy. Variables pertaining to maternal and perinatal health, socioeconomic status, early childhood enteric and systemic inflammation, and anthropometry were collected. Bayley-III neurodevelopmental assessment was conducted at two years. As a secondary analysis, we employed hierarchical cluster and random forests techniques to identify and rank which variables predicted growth and neurodevelopment. Cluster analysis demonstrated three distinct groups of predictors. Mother’s weight and length-for-age Z score (LAZ) at enrollment were the strongest predictors of LAZ at two years. Cognitive score on Bayley-III was strongly predicted by weight-for-age (WAZ) at enrollment, income, and LAZ at enrollment. Top predictors of language included Rotavirus vaccination, plasma IL 5, sCD14, TNFα, mother’s weight, and male gender. Motor function was best predicted by fecal calprotectin, WAZ at enrollment, fecal neopterin, and plasma CRP index. The strongest predictors for social-emotional score included plasma sCD14, income, WAZ at enrollment, and LAZ at enrollment. Based on the random forests’ predictions, the estimated percentage of variation explained was 35.4% for LAZ at two years, 34.3% for ΔLAZ, 42.7% for cognitive score, 28.1% for language, 40.8% for motor, and 37.9% for social-emotional score. Birth anthropometry and maternal weight were strong predictors of growth while enteric and systemic inflammation had stronger associations with neurodevelopment. Birth anthropometry was a powerful predictor for all outcomes. These data suggest that further study of stunting in low-income settings should include variables relating to maternal and prenatal health, while investigations focusing on neurodevelopmental outcomes should additionally target causes of systemic and enteric inflammation. Children from low-income settings experience linear growth faltering and neurodevelopmental delay that have been associated with maternal, socioeconomic, and infectious/inflammatory variables. Given the interdependent nature of these associations, understanding which variables are the best predictors of poor outcomes has been difficult. We conducted a longitudinal study of Bangladeshi children from birth to two years and collected predictors assessing maternal, inflammatory, and socioeconomic aspects of early childhood in Bangladeshi children. We conducted a random forests analysis to rank predictors associated with growth and neurodevelopment. Linear growth was best predicted by birth anthropometry and maternal weight. Cognitive function was predicted by birth anthropometry, socioeconomic status, and systemic inflammation. The receipt of the rotavirus vaccine and a combination of systemic inflammatory, maternal, and socioeconomic variables predicted language score. Motor score was predicted by systemic inflammation with enteric inflammatory markers having a reverse relationship. Social-emotional development was predicted by systemic inflammation, birth anthropometry, and economic means. This work demonstrates that specific pathways are responsible for different aspects of growth and development. Our data suggest that studies investigating pediatric stunting in low-income settings should focus on maternal and prenatal variables while those focused on neurodevelopmental outcomes should additionally target causes of systemic and enteric inflammation.
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影响因子：
3.7
作者：
Guerrant RL;Leite AM;Pinkerton R;Medeiros PH;Cavalcante PA;DeBoer M;Kosek M;Duggan C;Gewirtz A;Kagan JC;Gauthier AE;Swann J;Mayneris-Perxachs J;Bolick DT;Maier EA;Guedes MM;Moore SR;Petri WA;Havt A;Lima IF;Prata MM;Michaleckyj JC;Scharf RJ;Sturgeon C;Fasano A;Lima AA
通讯作者：
Lima AA
影响因子：
9.3
作者：
Dinel AL;Joffre C;Trifilieff P;Aubert A;Foury A;Le Ruyet P;Layé S
通讯作者：
Layé S
DOI：
10.1111/j.2044-835x.2011.02042.x
发表时间：
2012-06-01
影响因子：
2.3
作者：
Eriksson, Marten;Marschik, Peter B.;Gallego, Carlos
通讯作者：
Gallego, Carlos
DOI：
10.1097/mpg.0b013e3181dcc4a5
发表时间：
2010-10-01
影响因子：
2.9
作者：
de Magistris, Laura;Familiari, Valeria;Bravaccio, Carmela
通讯作者：
Bravaccio, Carmela
影响因子：
1.9
作者：
Dekker, Louise H.;Mora-Plazas, Mercedes;Villamor, Eduardo
通讯作者：
Villamor, Eduardo