Maternal and child undernutrition: consequences for adult health and human capital.
Maternal and child undernutrition: consequences for adult health and human capital.
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DOI：
10.1016/s0140-6736(07)61692-4
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发表时间：
2008-01-26
期刊：
影响因子：
168.9
通讯作者：
Sachdev, Harshpal Singh
中科院分区：
文献类型：
--
作者：
Victora, Cesar G.;Adair, Linda;Fall, Caroline;Hallal, Pedro C.;Martorell, Reynaldo;Richter, Linda;Sachdev, Harshpal Singh
在这篇文章中，我们回顾了低收入和中等收入国家母婴营养不良与人力资本和成人疾病风险之间的关系。我们分析了来自巴西、危地马拉、印度、菲律宾和南非的五项长期前瞻性队列研究的数据，并注意到母亲和儿童营养不良的指数(母亲身高、出生体重、胎儿宫内发育受限，以及根据世卫组织新的生长标准在两年时的体重、身高和体重指数)与成人结局(身高、受教育程度、收入或资产、子女出生体重、体重指数、血糖浓度、血压)有关。我们对低收入和中等收入国家的这些结果以及与血脂、心血管疾病、肺和免疫功能、癌症、骨质疏松症和精神疾病相关的指标进行了系统的审查。无论是在对已发表的研究的回顾中，还是在新的分析中，营养不良都与成年身高较低、受教育程度较低、经济生产率下降以及--对于女性--后代出生体重较低密切相关。与成人疾病指标的关联并不是那么明确。出生时和童年时体型的增长与成年体重指数呈正相关，与血压值呈较小程度的正相关，但与血糖浓度无关。在我们新的分析和发表的工作中，出生体重较低和童年时期的营养不良是高血糖、血压和有害血脂的危险因素，一旦成人的体重指数和身高进行了调整，这表明出生后体重的快速增加--特别是在婴儿出生后--与这些情况有关。对已发表的文献的回顾表明，关于免疫功能、血脂或骨质疏松指标的长期变化的信息不足。出生体重与肺功能和一些癌症的发病率呈正相关，营养不良可能与精神疾病有关。我们注意到，2岁的身高是预测人力资本的最佳指标，营养不良与较低的人力资本有关。我们的结论是，在生命早期遭受的损害会导致永久性的损害，并可能影响后代。它的预防可能会带来重要的健康、教育和经济利益。慢性病在营养不良的儿童中尤其常见，他们在婴儿期后体重迅速增加。
In this paper we review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, offspring birthweight, body-mass index, glucose concentrations, blood pressure). We undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and—for women—lower offspring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In our new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain—especially after infancy—is linked to these conditions. The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy.