Departments of Epidemiology, University of Washington, Seattle, WA, USA.
J Nutr. 2012 Apr;142(4):757-63. doi: 10.3945/jn.111.148874. Epub 2012 Feb 29.
As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1-infected infants, it remains important to improve growth in HIV-1-exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1-infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49%) were breast-fed and 174 (51%) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29% of children were underweight (WAZ < -2), 18% were wasted (WLZ < -2), and 58% were stunted (LAZ < -2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95% CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95% CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95% CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95% CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95% CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95% CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1-exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1-infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.
随着预防母婴传播 HIV-1 （PMTCT）项目减少了 HIV-1 感染婴儿的数量，改善 HIV-1 暴露但未感染（EU）婴儿的生长仍然很重要。为了确定母乳喂养和配方奶喂养的 EU 婴儿的生长速度和生长迟缓的预测因素，我们利用肯尼亚 HIV-1 感染妇女的随机喂养试验中的数据进行了生长分析[体重年龄（WAZ）、体重长度（WLZ）和长度年龄（LAZ）Z 分数]。根据随机分配到母乳喂养（BF）或配方奶喂养（FF）的情况，使用 Cox 比例风险回归模型比较了 EU 婴儿的生长迟缓情况。线性混合效应模型确定了身长生长的速度和协变量。在 338 名 EU 婴儿中，164 名（49%）接受母乳喂养，174 名（51%）接受配方奶喂养。在两个组中，在随访期间，生长均稳步下降。到 2 岁时，29%的儿童体重不足（WAZ <-2），18%的儿童消瘦（WLZ <-2），58%的儿童发育迟缓（LAZ <-2），两组之间没有差异。较高的母亲教育年限（年）和较高的身高（cm）与体重不足和发育迟缓的风险降低有关[体重不足：调整后的 HR（aHR）= 0.90（95%CI：0.83，0.99），P = 0.03，和 aHR = 0.92（95%CI：0.87，0.97），P = 0.002；发育迟缓：aHR = 0.91（95%CI：0.85，0.97），P = 0.003，和 aHR = 0.96（95%CI：0.92，0.99），P = 0.02]。腹泻与消瘦的风险增加有关[aHR = 2.26（95%CI：1.11，4.62），P = 0.03]。在多变量分析中，FF 与身长生长速度的下降较慢有关[0.24 LAZ/y（95%CI：0.06，0.43），P = 0.009]。尽管未感染，但 HIV-1 暴露的婴儿经常出现生长迟缓，这表明在 PMTCT 计划中需要警惕识别发育迟缓。FF 中身长生长速度下降较慢可能反映了微量营养素的益处。由于 BF 是资源有限环境中 HIV-1 感染母亲的最佳选择，因此应研究营养干预措施对 EU 母乳喂养婴儿生长的影响。
