Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review.
Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review.
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儿童期严重营养不良或饥荒与生命后期心脏代谢非传染性疾病：系统综述
DOI：
10.1136/bmjgh-2020-003161
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发表时间：
2021-03
影响因子：
8.1
通讯作者：
Kerac M
中科院分区：
文献类型：
--
作者：
Grey K;Gonzales GB;Abera M;Lelijveld N;Thompson D;Berhane M;Abdissa A;Girma T;Kerac M
儿童营养不良（营养不足）和成人非传染性疾病（非传染性疾病）是主要的全球公共卫生问题。虽然有令人信服的证据表明产前营养不良与非传染性疾病风险增加有关，但对儿童期营养不良的长期后遗症知之甚少。因此，我们研究了出生后营养不良（包括低/中等收入国家（LMICs）记录的严重儿童营养不良或饥荒暴露）与晚年心脏代谢性NCD之间相关性的证据。我们的同行评审检索策略侧重于“严重儿童营养不良”，“LMIC”，“饥荒”和“心脏代谢性NCD”，以识别Medline，Embase，Global Health和护理和相关健康文献累积索引（CINAHL）数据库中的研究。我们综合结果naradically和评估研究质量与英国国家研究所的健康和护理卓越清单。我们确定了57项关于LMIC（n=14）和历史饥荒（n=43）中记录的严重儿童营养不良幸存者的心脏代谢NCD结局的研究。儿童时期暴露于严重营养不良或饥荒始终与日后患心血管疾病（7/8项研究）、高血压（8/11）、糖代谢受损（15/24）和代谢综合征（6/6）的风险增加相关。对脂质代谢（6/11无效，5/11混合结果）、肥胖（3/13无效，5/13风险增加，5/13风险降低）和其他结局影响的证据不太一致。在一些队列中观察到性别特异性差异，女性始终处于葡萄糖代谢紊乱和代谢综合征的较高风险中。儿童时期严重营养不良或饥荒与心脏代谢性非传染性疾病风险增加有关，这表明发育可塑性超出了产前生活。因此，儿童期严重营养不良不仅对急性发病率和死亡率，而且对幸存者的长期健康都有严重影响。研究间的异质性、产前营养不良的混杂以及饥荒研究中的年龄效应排除了因果关系的确切结论。需要开展研究，以更好地了解产后营养不良与非传染性疾病之间的联系机制，为改善严重营养不良幸存者终身健康的政策和方案拟订提供信息。
Child malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs. Our peer-reviewed search strategy focused on ‘severe childhood malnutrition’, ‘LMICs’, ‘famine’, and ‘cardiometabolic NCDs’ to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist. We identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome. Severe malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors’ long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.
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DOI：
10.1038/nrdp.2017.67
发表时间：
2017-09-21
期刊：
Nature reviews. Disease primers
影响因子：
--
作者：
Bhutta ZA;Berkley JA;Bandsma RHJ;Kerac M;Trehan I;Briend A
通讯作者：
Briend A
影响因子：
4.7
作者：
Fekadu, S.;Yigzaw, M.;Parry, E. H. O.
通讯作者：
Parry, E. H. O.
影响因子：
168.9
作者：
Black, Robert E.;Victora, Cesar G.;Uauy, Ricardo
通讯作者：
Uauy, Ricardo
影响因子：
8.2
作者：
Garofano, A;Czernichow, P;Bréant, B
通讯作者：
Bréant, B
影响因子：
2.9
作者：
Finer S;Iqbal MS;Lowe R;Ogunkolade BW;Pervin S;Mathews C;Smart M;Alam DS;Hitman GA
通讯作者：
Hitman GA