Child wasting and concurrent stunting in low- and middle-income countries.
Child wasting and concurrent stunting in low- and middle-income countries.
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DOI：
10.1038/s41586-023-06480-z
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发表时间：
2023-09
期刊：
影响因子：
64.8
通讯作者：
Arnold, Benjamin F.
中科院分区：
文献类型：
--
作者：
Mertens, Andrew;Benjamin-Chung, Jade;Colford Jr, John M.;Hubbard, Alan E.;van der Laan, Mark J.;Coyle, Jeremy;Sofrygin, Oleg;Cai, Wilson;Jilek, Wendy;Rosete, Sonali;Nguyen, Anna;Pokpongkiat, Nolan N.;Djajadi, Stephanie;Seth, Anmol;Jung, Esther;Chung, Esther O.;Malenica, Ivana;Hejazi, Nima;Li, Haodong;Hafen, Ryan;Subramoney, Vishak;Haggstrom, Jonas;Norman, Thea;Christian, Parul;Brown, Kenneth H.;Arnold, Benjamin F.
可持续发展目标2.2-到2030年消除营养不良-包括消除儿童消瘦，定义为身高体重z分数比世界卫生组织儿童生长标准中位数低两个标准差以上。衡量消瘦的流行方法依赖于横断面调查，无法衡量发病、恢复和持续性--这些关键特征为预防性干预措施和疾病负担估计提供了信息。在这里，我们分析了21个纵向队列，并表明，浪费是一个高度动态的发病和恢复过程，发病率在出生和3个月之间达到峰值。更多的儿童在头24个月的某个时候经历过消瘦，而不是在一个时间点上的流行病例。例如，在24个月大时，5.6%的儿童消瘦，但在同一年龄（24个月）时，29.2%的儿童至少经历过一次消瘦发作，10.0%的儿童经历过两次或更多次消瘦发作。6个月前消瘦的儿童比年龄较大时消瘦的儿童恢复更快，发作时间更短;然而，早期消瘦增加了后期生长停滞的风险，包括并发消瘦和发育迟缓（低年龄z评分），从而增加了死亡风险。在不同的人口与高季节性降雨量，人口的平均体重长度的z分数变化很大（超过0.5 z在一些队列），最低的平均z分数发生在最多雨的月份，这表明，季节性有针对性的干预措施可以考虑。我们的研究结果表明，建立干预措施，以防止从出生到6个月大的浪费，可能是通过改善产妇营养，以补充目前的方案，重点是6-59个月的儿童的重要性。对不同人群的纵向队列数据的分析表明，出生至24个月之间的消瘦发生率高于先前认为的，并强调了影响儿童生长的季节因素的作用。
Sustainable Development Goal 2.2—to end malnutrition by 2030—includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence—key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6–59 months. An analysis of longitudinal cohort data across diverse populations suggests that the incidence of wasting between birth and 24 months is higher than previously thought, and highlights the role of seasonal factors that affect child growth.
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