Intergenerational Influences on Child Growth and Undernutrition
Intergenerational Influences on Child Growth and Undernutrition
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DOI：
10.1111/j.1365-3016.2012.01298.x
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发表时间：
2012-07-01
影响因子：
2.8
通讯作者：
Zongrone, Amanda
中科院分区：
文献类型：
--
作者：
Martorell, Reynaldo;Zongrone, Amanda
代际对线性增长的影响有充分的文献记载。在动物模型中，需要几代人才能消除营养不良的影响，这与欧洲和北美身高长期趋势的发展一致。婴儿体重在几代人之间是相互关联的，而反映宫内和婴儿发育不良的产妇身材矮小与出生体重低、儿童发育迟缓、分娩并发症和儿童死亡率增加有关，即使在调整社会经济地位之后也是如此。危地马拉的一项营养干预措施减少了儿童发育迟缓;它还改善了下一代的生长，但仅限于女孩的后代。解释代际效应对线性生长的可能机制并不相互排斥，其中包括共同的遗传特征、表观遗传效应、代谢变化的编程以及胎儿生长空间减少的机制。还有一些重要的社会文化因素在起作用，例如贫困的代际传递和对生育大婴儿的恐惧，这导致怀孕期间吃下。目前尚不清楚发展中国家的方案对宫内和婴儿线性生长的影响是否有一个上限，这一上限由母亲的幼儿营养不良决定。在经济和社会迅速发展之后，可以通过收养和移徙，在一些选定的国家实现线性增长的大幅度改善。尽管有明确的文件证明存在代际影响，但如果在怀孕前健康、营养和环境得到极大改善，儿童时期营养不良的母亲所生子女的身高似乎可以达到接近正常的水平。在贫穷国家，仅通过公共卫生方案实现类似程度的影响是极不可能的。贫穷国家的现实限制了可以执行的方案的范围、质量和覆盖面，因此预期效果不大。《柳叶刀》妇幼营养不良系列估计，在高负担国家大规模实施经过验证的干预措施将使发育迟缓减少三分之一;这也许是高质量项目影响的现实上限，除非同时全面改善社会服务并显着减少贫困。最后，由于在一代人的时间内可以取得如此多的成就，代间影响不太可能成为缺乏针对头1000天窗口期的方案影响的重要解释。如果不能防止发展中国家的线性增长失败，就会对短期和长期健康以及人力资本的形成造成严重后果。营养转型造成了双重负担，使肥胖症和相关慢性病成为仍在努力解决孕产妇和儿童营养不良老问题的国家的公共卫生议程上的一个新问题。未来的挑战是加大力度防止线性生长失败，同时防止儿童超重。
Intergenerational effects on linear growth are well documented. Several generations are necessary in animal models to wash out effects of undernutrition, consistent with the unfolding of the secular trend in height in Europe and North America. Birthweight is correlated across generations and short maternal stature, which reflects intrauterine and infant growth failure, is associated with low birthweight, child stunting, delivery complications and increased child mortality, even after adjusting for socio-economic status. A nutrition intervention in Guatemala reduced childhood stunting; it also improved growth of the next generation, but only in the offspring of girls. Possible mechanisms explaining intergenerational effects on linear growth are not mutually exclusive and include, among others, shared genetic characteristics, epigenetic effects, programming of metabolic changes, and the mechanics of a reduced space for the fetus to grow. There are also socio-cultural factors at play that are important such as the intergenerational transmission of poverty and the fear of birthing a large baby, which leads to eating down during pregnancy. It is not clear whether there is an upper limit for impact on intrauterine and infant linear growth that programmes in developing countries could achieve that is set by early childhood malnutrition in the mother. Substantial improvements in linear growth can be achieved through adoption and migration, and in a few selected countries, following rapid economic and social development. It would seem, despite clear documentation of intergenerational effects, that nearly normal lengths can be achieved in children born to mothers who were malnourished in childhood when profound improvements in health, nutrition and the environment take place before conception. To achieve similar levels of impact through public health programmes alone in poor countries is highly unlikely. The reality in poor countries limits the scope, quality and coverage of programmes that can be implemented and modest impact should be expected instead. The Lancet series on Maternal and Child Undernutrition estimated that implementation to scale of proven interventions in high burden countries would reduce stunting by one-third; this is perhaps a realistic upper bound for impact for high quality programmes, unless accompanied by sweeping improvements in social services and marked reductions in poverty. Finally, because so much can be achieved in a single generation, intergenerational influences are unlikely to be an important explanation for lack of programme impact aimed at the window of the first 1000 days. Failure to prevent linear growth failure in developing countries has serious consequences for short- and long-term health as well as for the formation of human capital. The nutrition transition has created a double burden by adding obesity and related chronic diseases to the public health agenda of countries still struggling with the old problems of maternal and child undernutrition. The challenge ahead is to increase efforts to prevent linear growth failure while keeping child overweight at bay.