OPTIMISE: Optimal preconception nutrition to offset inflammation and non-communicable disease risk in pregnant women and their children

心脏病和糖尿病等非传染性疾病在低收入和中等收入国家迅速增加。与高收入国家相比，这些疾病在中低收入国家发生的年龄更小，并伴随着经济和社会代价。1980年至2014年间，撒哈拉以南非洲、印度和中国的糖尿病患病率翻了一番，现在比许多高收入国家都要高。目前仅在印度和中国就有约1.66亿糖尿病患者（占世界总数的40%）。目前预防糖尿病或心脏病的方法主要集中在减轻体重和增加中年人的身体活动，这些中年人存在肥胖或高血压等风险因素。虽然这些方法为个人带来了一些好处，但对于解决子孙后代的风险却收效甚微。来自世界许多国家的研究表明，出生体重低和胎儿在子宫内生长不良与日后患糖尿病和心脏病的风险增加有关。这些影响会因儿童、青少年或成年期体重增加而加剧。随着社会经济的快速转型，中低收入国家不仅营养不良和出生体重低，而且在儿童后期和青春期体重增加。这种结合的结果导致这些国家的妇女在怀孕时营养不良，怀孕期间糖尿病的发病率增加。研究还表明，慢性炎症（身体对受伤或感染的正常保护性反应）与包括糖尿病和心脏病在内的非传染性疾病有关。营养在调节这种炎症反应中起着关键作用。研究表明，饮食中摄入更多的红肉、高脂肪产品、精制谷物和简单碳水化合物，即使没有受伤或感染，也会导致炎症标志物水平升高。在这方面，健康生活轨迹倡议方案是由加拿大卫生研究所、生物技术部（印度）、医学研究理事会（南非）和国家自然科学基金会（中国）与世界卫生组织合作资助的一项联合倡议。在迈索尔（印度）、约翰内斯堡（南非）、上海（中国）和加拿大的两个省进行了四项独立但协调的干预研究。这些研究将检验这样一种概念，即从怀孕前开始，并在整个怀孕期间和出生后继续采取措施解决产妇营养和福祉问题，将改善产妇和儿童的健康，包括儿童的长期福祉。作为主要研究的一部分，我们将从女性/母亲、父亲和儿童中采集一系列生物样本（血液、口腔和阴道拭子、尿液、粪便、脐带血和胎盘）。在这项研究中，我们将对这些生物样本进行分析。我们的目标是了解影响三个国家（中国，印度和南非）年轻女性炎症的营养因素（如体型和饮食）。我们将探讨炎症是否与妊娠期糖尿病等母体并发症有关，以及它是否影响胎儿生长。我们还将评估干预是否减少炎症和母体并发症的风险，并改善胎儿生长。最后，我们将探索营养、炎症和非传染性疾病之间的相关途径。研究结果将对孕产妇和儿童健康产生重要的全球政策影响，因为这些研究涵盖了处于社会经济转型各个阶段的城市和农村人口。

Non-communicable diseases (NCDs) such as heart disease and diabetes rapidly increasing in low- and middle-income countries (LMICs). These diseases are occurring at younger ages in LMICs compared with high-income countries with accompanying economic and societal costs. Between 1980 and 2014, the prevalence of diabetes doubled in sub-Saharan Africa, India and China and is now higher there than in many high-income countries. There are now ~166 million people with diabetes in India and China alone (40% of the world's total). Current approaches to preventing diabetes or heart disease focus on weight reduction and increased physical activity in middle-aged adults with existing risk factors such as obesity or high blood pressure. While such approaches offer some benefit to the individual, they do little to address the risk in future generations. Research from many countries across the world has shown that low birth weight and poor growth of the fetus in the womb is related to an increased risk of developing diabetes and heart disease in later life. These effects are exacerbated by greater weight gain during childhood, adolescence or adulthood. With rapid socio-economic transition, LMICs are experiencing not only undernutrition and low birth weight, but also increased weight gain during later childhood and adolescence. The consequence of this combination results in women in these countries entering pregnancy with poorer nutrition and increased rates of diabetes during pregnancy. It is therefore possible that measures to improve the nutrition of young women before and during pregnancy may have long-term beneficial effects.Research has also shown that chronic inflammation (a normally protective response of the body to injury or infection) has been associated with NCDs including diabetes and heart disease. Nutrition plays a key role in the regulation of this inflammatory response. It has been shown that diets consisting of a greater intake of red meat, high-fat products, refined grains, and simple carbohydrates can result in higher levels of markers of inflammation, even in the absence of injury or infection. In this context, the Healthy Life Trajectories Initiative (HeLTI) programme was set up as a joint initiative funded by the Canadian Institutes of Health Research, Department of Biotechnology (India), Medical Research Council (South Africa) and the National Natural Science Foundation (China), in collaboration with the World Health Organisation. There are four separate but harmonised intervention studies in Mysore (India), Johannesburg (South Africa), Shanghai (China) and two provinces in Canada. The studies will test the concept that interventions addressing maternal nutrition and well-being from before pregnancy, and continued through pregnancy and after birth will improve maternal and child health including the long-term well-being of the child. As part of the main study, we will collect a range of biological samples (blood, buccal and vaginal swabs, urine, stool, cord blood and placenta) from the women/mothers, fathers and children. In this study, we will undertake analyses of a selection of these biological samples. We aim to understand the nutritional factors (such as body size and diet) that affect inflammation in young women in three countries (China, India and South Africa). We will explore whether inflammation is related to maternal complications such as diabetes during pregnancy, and whether it affects fetal growth. We will also assess whether the intervention reduces inflammation and the risk of maternal complications, and improves fetal growth. Finally, we will explore the pathways by which nutrition, inflammation and NCDs are related. The findings will have important global policy implications for maternal and child health as the studies cover urban and rural populations in various stages of socio-economic transition.