Judge Baker Children's Center, Harvard Medical School, Boston, MA, USA.
J Nutr. 2012 Apr;142(4):788-94. doi: 10.3945/jn.111.145441. Epub 2012 Feb 29.
Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.
婴儿营养不良已知与儿童期和青春期的认知和行为障碍有关。关于其对成年后行为结果的长期影响的数据有限。在这项研究中，我们报告了婴儿期营养不良与中年人注意力问题之间的关联。使用康纳斯成人注意缺陷多动障碍评定量表（CAARS）和康纳斯连续性能测试（CPT）评估了 145 名巴巴多斯成年人（年龄 37-43 岁）的注意力问题，这些成年人自童年以来一直进行纵向随访。先前营养不良的参与者（n=80）在生命的第一年经历了中度至重度蛋白质能量营养不良，此后成功康复。他们与健康成年人（n=65）进行了比较，这些健康成年人是指数病例的前同学，并且在童年时期按年龄、性别和惯用手进行了匹配。多元回归分析表明，童年期营养不良对 CAARS 和 CPT 均有持续影响，与童年期家庭生活水平的影响无关。营养不良对 CAARS 评分的影响与智商无关，而在调整智商后，CPT 的这种影响减弱。教师报告的儿童期注意力问题预测了成年期的注意力问题，表明了整个生命周期的连续性。婴儿营养不良可能在经历近 40 年后对注意力过程产生长期影响，即使进行了极好的长期营养康复，并且与童年和青少年时期的社会经济状况无关。这一发现对暴露于儿童早期营养不良的人群具有重大公共卫生意义。
