Prentice Andrew M, Moore Sophie E, Fulford Anthony J
MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
World Rev Nutr Diet. 2013;106:90-9. doi: 10.1159/000342563. Epub 2013 Feb 11.
Meta-analysis of growth data from over 50 low and low-middle income countries shows a consistent pattern of stunting and poor weight gain from about 3 months of age and persisting until at least 5 years. Children tend not to be wasted because their short stature offsets their underweight, leading to a rather adequately proportioned appearance. This frequently conceals the true levels of malnutrition in communities. At the macro-environmental level such growth faltering is due to the combined effects of poverty, food insecurity, low-dietary diversity, a highly infectious environment, poor washing facilities and poor understanding of the principles of nutrition and hygiene. These tend to be ameliorated as communities pass through the demographic transition with improved incomes and education. Because such changes will take generations to achieve, the global health community continues to search for effective interim solutions. Disappointingly, apart from intensive feeding programmes aimed at rehabilitating severely malnourished children, there are few examples of very successful nutrition interventions. This emphasizes the need for a better understanding of the etiology of growth failure. This paper uses anthropometric data collected over 6 decades in subsistence-farming communities from rural Gambia to illustrate the typical key features of growth faltering. Arising from this analysis, and from gaps in the published literature, the following issues are highlighted as still requiring a better resolution: (1) the pre-natal and inter-generational influences on growth failure; (2) the ontogeny of the infant immune system; (3) the exact nature of the precipitating insults that initiate gastroenteropathy; (4) the effects of both enteric and systemic infections on the hormonal regulation of growth; (5) interactions between macro- and micro-nutrient deficiencies and infections in causing growth failure, and (6) the role of the microbiome in modulating dietary influences on health and growth.
对来自50多个低收入和中低收入国家的生长数据进行的荟萃分析表明，从大约3个月大开始就出现了发育迟缓以及体重增加不佳的一致模式，并且这种情况一直持续到至少5岁。儿童往往没有消瘦，因为他们的矮小身材抵消了体重不足，从而呈现出比例较为合适的外观。这常常掩盖了社区中营养不良的真实程度。在宏观环境层面，这种生长发育迟缓是贫困、粮食不安全、饮食多样性低、高感染性环境、卫生设施差以及对营养和卫生原则理解不足等多种因素共同作用的结果。随着社区经历人口转变，收入和教育水平提高，这些情况往往会得到改善。由于实现这些变化需要几代人的时间，全球卫生界仍在继续寻找有效的临时解决方案。令人失望的是，除了针对重度营养不良儿童康复的强化喂养计划外，很少有非常成功的营养干预案例。这凸显了更好地理解生长发育迟缓病因的必要性。本文使用在冈比亚农村自给农业社区收集的60多年人体测量数据，来说明生长发育迟缓的典型关键特征。基于这一分析以及已发表文献中的空白，以下问题被强调仍需要更好地解决：（1）产前和代际对生长发育迟缓的影响；（2）婴儿免疫系统的个体发生；（3）引发胃肠病的促发损伤的确切性质；（4）肠道和全身感染对生长激素调节的影响；（5）大量营养素和微量营养素缺乏与感染在导致生长发育迟缓方面的相互作用，以及（6）微生物群在调节饮食对健康和生长的影响方面的作用。
