Maternal and child undernutrition and overweight in low-income and middle-income countries
Maternal and child undernutrition and overweight in low-income and middle-income countries
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DOI：
10.1016/s0140-6736(13)60937-x
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发表时间：
2013-08-03
期刊：
影响因子：
168.9
通讯作者：
Uauy, Ricardo
中科院分区：
文献类型：
--
作者：
Black, Robert E.;Victora, Cesar G.;Uauy, Ricardo
低收入和中等收入国家的孕产妇和儿童营养不良既包括营养不足，也包括日益严重的超重和肥胖问题。表明产妇营养不良的低体重指数在过去二十年中有所下降，但在亚洲和非洲仍然普遍存在。自1980年以来，产妇体重过重的发生率稳步上升，在所有区域都超过了体重不足的发生率。在过去二十年中，5岁以下儿童线性生长发育迟缓的发生率有所下降，但南亚和撒哈拉以南非洲高于其他地区，2011年全球至少有1.65亿儿童受到影响;至少有5 200万儿童受到消瘦的影响。缺乏维生素A和锌会导致死亡;缺乏碘和铁以及发育迟缓会导致儿童无法发挥其发育潜力。产妇营养不良会导致胎儿生长受限，从而增加新生儿死亡的风险，并增加幸存者在2岁前发育迟缓的风险。次优的母乳喂养会增加生命头2年的死亡风险。我们估计，总体营养不良--包括胎儿生长受限、发育迟缓、消瘦、维生素A和锌缺乏沿着母乳喂养不足--是每年310万儿童死亡的原因，占2011年所有儿童死亡的45%。产妇超重和肥胖导致产妇发病率和婴儿死亡率增加。儿童超重正在成为成人肥胖、糖尿病和非传染性疾病的一个越来越重要的因素。育龄妇女、怀孕妇女和2岁前儿童营养不良造成的目前和未来的高疾病负担应导致针对这些群体的干预措施。
Maternal and child malnutrition in low-income and middle-income countries encompasses both under nutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate-including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding-is a cause of 3.1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by mal nutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.