Mental Health Outcomes Following Childhood Malnutrition

描述（由申请人提供）：营养不良影响全球25%的儿童。在一系列40多篇已发表的论文中，我们记录了333名巴巴多斯儿童早期蛋白质-热量营养不良（PEM）和恶性营养不良的长期影响，以及来自相同社会经济背景的匹配比较病例。现在30至35岁，索引儿童被诊断为中度至重度蛋白质能量或蛋白质营养不良，在他们生命的第一年，之后没有进一步的事件发生。所有以前营养不良的儿童在患病后不久都得到营养恢复，并由国家营养中心定期跟踪，直到他们年满11岁。研究中的所有儿童都有出生和产后数据，并在整个学年（5至18岁）对其进行了全面研究。当与5至11岁的对照组相比时，先前营养不良的儿童表现出与注意力缺陷障碍相关的行为发生率惊人地增加了四倍（15%对60%）。早期注意力问题预示着在11+考试中表现不佳，这是巴巴多斯所有11岁学童参加的高中入学全国统一考试。50%的指数儿童在18岁之前一直存在注意力问题。以前营养不良的儿童的其他缺陷包括智商分数降低，神经系统症状，学习障碍和社交技能受损。相比之下，身体发育延迟，但到16岁时完全“赶上”。为了确定环境因素是否对这些结果有贡献，在儿童的家庭环境中的社会经济条件和因素在发育的各个阶段进行了评估，包括在营养不良发生时。控制这些生态因素的数据分析证实，在所有情况下，儿童营养不良的显着独立的影响。在目前的研究中，我们建议将我们对这一人群的研究扩展到他们的成年年龄。我们计划评估行为，认知和心理健康结果，因为早些年和其他长期产前营养不良研究中记录的缺陷，值得注意的是荷兰饥荒研究，该研究指出了成年期异常心理健康结果的重要性。鉴于巴巴多斯有98%的原始人口，并且存在一套全面的纵向数据，记录了他们从出生到18岁的身心发展，我们相信，对这一人群成年后的随访研究将为我们了解产后营养不良对行为和心理健康结果的长期后果做出重大贡献。据我们所知，没有其他已发表的关于人类出生后营养不良对成人影响的研究。

DESCRIPTION (provided by applicant): Malnutrition affects 25% of the children world-wide. In a series of over 40 published papers, we have documented the long-term effects of early protein-calorie malnutrition (PEM) and kwashiorkor in 333 Barbadian children and matched comparison cases from the same socioeconomic backgrounds. Now 30 to 35 years of age, the index children were diagnosed with moderate to severe protein-energy or protein malnutrition during their first year of life after which no further episodes occurred. All previously malnourished children were nutritionally rehabilitated shortly after their illness and were followed by the National Nutrition Centre on a regular basis, until they reached 11 years of age. Birth and postnatal data were available for all children in the study, and they were studied comprehensively throughout their school years (ages five to 18). When compared with controls at 5 to 11 years of age, previously malnourished children demonstrated a striking fourfold increase (15% versus 60%) in the incidence of behaviors associated with attention deficit disorder. Attentional problems at earlier ages predicted poor performance on the Eleven-Plus Examination, the national common entrance exam for high school placement taken by all Barbadian school children at 11 years of age. Attention problems persisted in 50% of the index children up to 18 years of age. Other deficits in the previously malnourished children included reduced IQ scores, soft neurological signs, learning disabilities and impaired social skills. In contrast, physical growth was delayed but showed complete "catch-up" by 16 years of age. To determine whether environmental factors contributed to these findings, socioeconomic conditions and factors in the child's home environment were evaluated at all stages of development, including at the time that malnutrition occurred. Data analyses controlling for these ecological factors confirmed significant independent effects of childhood malnutrition in all cases. In the current study, we propose to extend our studies of this population to their adult years. We plan to evaluate behavioral, cognitive and mental health outcomes, because of deficits documented in earlier years and other long-term studies of prenatal malnutrition, notable the Dutch Famine study, which pointed to the importance of aberrant mental health outcomes in adulthood. Given the availability in Barbados of 98% of our original population and the existence of the comprehensive set of longitudinal data that document their physical and mental development from birth through 18 years of age, we believe a follow-up study of this population in their adult years will make a significant contribution to our understanding of the long-term consequences of postnatal malnutrition on behavioral and mental health outcomes. To our knowledge, there are no other published studies on the adult consequences of postnatal malnutrition in human populations.