美国加州大学伯克利分校Andrew Mertens等研究人员合作揭示低资源环境下儿童发育迟缓的原因和后果。2023年9月13日，《自然》杂志在线发表了这项研究成果。

研究人员对33个纵向队列（83671名儿童，662763次测量）和30个独立暴露进行了人群干预效果分析，结果表明，改善产妇人体测量和儿童出生时的状况，可使24个月大时的人群身长比z值提高0.40，体重比z值提高0.15。男孩出现各种形式生长迟缓的风险始终高于女孩。出生后早期的生长迟缓易导致儿童随后出现持续的生长迟缓。与无生长迟缓的儿童相比，有多种生长迟缓的儿童在出生到两岁期间的死亡率更高（危险比为1.9到8.7）。产前原因的重要性以及早期发育迟缓对儿童造成的严重后果，支持将重点放在孕前和孕期，将其作为采取新的预防干预措施的关键机会。

据介绍，儿童在出生后1000天内（从受孕到2岁）生长迟缓（身长低于年龄或体重低于身长）会影响短期和长期的健康和生存。孕期和产后营养补充等干预措施有助于防止发育迟缓，但在中低收入国家，计划行动不足以消除发育迟缓和消瘦造成的沉重负担。确定重点关注的年龄窗口和人口亚群将有利于未来的预防工作。

附：英文原文

Title: Causes and consequences of child growth faltering in low-resource settings

Author: Mertens, Andrew, Benjamin-Chung, Jade, Colford, John M., Coyle, Jeremy, van der Laan, Mark J., Hubbard, Alan E., Rosete, Sonali, Malenica, Ivana, Hejazi, Nima, Sofrygin, Oleg, Cai, Wilson, Li, Haodong, Nguyen, Anna, Pokpongkiat, Nolan N., Djajadi, Stephanie, Seth, Anmol, Jung, Esther, Chung, Esther O., Jilek, Wendy, Subramoney, Vishak, Hafen, Ryan, Hggstrm, Jonas, Norman, Thea, Brown, Kenneth H., Christian, Parul, Arnold, Benjamin F.

Issue&Volume: 2023-09-13

Abstract: Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions. Analysis of data from 33 longitudinal cohorts from low- and middle-income countries indicates that conditions during pre-conception, pregnancy and the first few months of life are crucial in determining the risk of growth faltering in young children.

DOI: 10.1038/s41586-023-06501-x

Source: https://www.nature.com/articles/s41586-023-06501-x