Mental Health Outcomes Following Childhood Malnutrition

描述（由申请人提供）：营养不良影响着全球25%的儿童。在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-卡路里营养不良（PEM）和营养不良的长期影响，并匹配了来自相同社会经济背景的比较病例。现在30到35岁的儿童，在他们生命的第一年被诊断为中度到严重的蛋白质能量或蛋白质营养不良，之后没有进一步的发作。所有以前营养不良的儿童在患病后不久就得到营养恢复，并由国家营养中心定期跟踪，直到他们年满11岁。研究中所有儿童的出生和产后数据都是可用的，他们在整个学年（5至18岁）进行了全面研究。与5岁至11岁的对照组相比，以前营养不良的儿童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%）。较早年龄的注意力问题预示着在11 +考试中表现不佳，11 +考试是所有巴巴多斯学童在11岁时参加的全国高中入学考试。注意力问题在50%的儿童中一直持续到18岁。之前营养不良儿童的其他缺陷包括智商分数下降、神经系统软症状、学习障碍和社交技能受损。相比之下，身体发育被推迟，但在16岁时表现出完全的“追赶”。为了确定环境因素是否对这些发现有影响，研究人员评估了儿童发育各个阶段的社会经济条件和家庭环境因素，包括发生营养不良的时期。控制这些生态因素的数据分析证实了所有病例中儿童营养不良的显著独立影响。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期。我们计划评估行为、认知和心理健康结果，因为早期记录的缺陷和其他关于产前营养不良的长期研究，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。考虑到巴巴多斯98%的原始人口的可用性，以及记录他们从出生到18岁的身心发展的综合纵向数据集的存在，我们相信，对这些人口成年后的后续研究将对我们了解产后营养不良对行为和心理健康结果的长期影响作出重大贡献。据我们所知，还没有其他发表的关于人类产后营养不良对成人的影响的研究。

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.