Mental Health Outcomes Following Childhood Malnutrition

描述(申请人提供)：营养不良影响全球25%的儿童。在一系列发表的40多篇论文中，我们记录了早期蛋白质-卡路里营养不良(PEM)和夸希奥克病对333名巴巴迪亚儿童的长期影响，并记录了来自相同社会经济背景的配对比较病例。现在年龄在30岁到35岁之间，指数儿童在他们生命的第一年被诊断为中到重度蛋白质-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康复，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出生后的数据，并在整个学年(5岁到18岁)进行了全面的研究。与5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显著增加了四倍(15%比60%)。年龄较小的注意力问题预示着11+考试的表现不佳，11+考试是所有11岁的巴巴迪亚学童参加的全国普通高中入学考试。在指数中，50%的18岁以下儿童存在注意力问题。之前营养不良的儿童的其他缺陷包括智商降低、软神经体征、学习障碍和社交技能受损。相比之下，体格发育被推迟，但在16岁时表现出完全的“追赶”。为了确定环境因素是否有助于得出这些结论，对儿童发展的所有阶段，包括营养不良发生时的社会经济状况和家庭环境因素进行了评估。控制这些生态因素的数据分析证实，在所有情况下，儿童营养不良都有显著的独立影响。在目前的研究中，我们建议将我们对这一群体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，因为早些年记录的缺陷，以及其他关于产前营养不良的长期研究，特别是荷兰饥荒研究，指出了成年后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，而且存在一套全面的纵向数据，记录了他们从出生到18岁的身体和心理发育，我们相信，对这一人群成年后的后续研究将对我们理解出生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人口中出生后营养不良的成人后果的研究。

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.