Causes and consequences of child growth faltering in low-resource settings.
Causes and consequences of child growth faltering in low-resource settings.
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DOI：
10.1038/s41586-023-06501-x
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发表时间：
2023-09
期刊：
影响因子：
64.8
通讯作者：
Ki Child Growth Consortium
中科院分区：
文献类型：
--
作者：
Mertens, Andrew;Benjamin-Chung, Jade;Colford, John M., Jr.;Coyle, Jeremy;Van der Laan, Mark J.;Hubbard, Alan E.;Rosete, Sonali;Malenica, Ivana;Hejazi, Nima;Sofrygin, Oleg;Cai, Wilson;Li, Haodong;Nguyen, Anna;Pokpongkiat, Nolan N.;Djajadi, Stephanie;Seth, Anmol;Jung, Esther;Chung, Esther O.;Jilek, Wendy;Subramoney, Vishak;Hafen, Ryan;Haggstrom, Jonas;Norman, Thea;Brown, Kenneth H.;Christian, Parul;Arnold, Benjamin F.;Ki Child Growth Consortium
在生命的前1,000天（从受孕到2岁），儿童的生长迟缓（身高低于年龄或体重低于身高）会影响短期和长期的健康和生存。怀孕和产后期间补充营养等干预措施有助于防止生长停滞，但方案行动不足以消除中低收入国家发育迟缓和消瘦的沉重负担。确定重点关注的年龄窗口和人口亚组将有利于今后的预防工作。在这里，我们使用了33个纵向队列（83，671名儿童，662，763次测量）和30个单独暴露的人群干预效应分析，以表明改善母亲人体测量和出生时的儿童状况可以解释24个月龄时人口增长的身高-年龄z分数高达0.40，体重-身高z分数高达0.15。男孩在各种形式的发育迟缓方面的风险始终高于女孩。出生后早期生长迟缓易使儿童发生随后的和持续的生长迟缓。有多重生长缺陷的儿童从出生到2岁的死亡率高于无生长缺陷的儿童（风险比1.9至8.7）。产前原因的重要性和对经历早期发育迟缓的儿童的严重后果支持把重点放在怀孕前和怀孕期间，作为新的预防性干预措施的一个关键机会。对低收入和中等收入国家33个纵向队列数据的分析表明，孕前、怀孕和出生后头几个月的状况对确定幼儿发育迟缓的风险至关重要。
Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions. Analysis of data from 33 longitudinal cohorts from low- and middle-income countries indicates that conditions during pre-conception, pregnancy and the first few months of life are crucial in determining the risk of growth faltering in young children.
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