孕期宏量营养素与儿童致死性呼吸道合胞病毒感染。

Macronutrients during pregnancy and life-threatening respiratory syncytial virus infections in children.

机构信息

Fundación INFANT, Ciudad de Buenos Aires, Argentina.

出版信息

Am J Respir Crit Care Med. 2013 May 1;187(9):983-90. doi: 10.1164/rccm.201301-0016OC.

DOI:10.1164/rccm.201301-0016OC

PMID:23449690

Abstract

RATIONALE

Respiratory syncytial virus (RSV) is an important cause of hospitalization and death in infants worldwide. Most RSV deaths occur in developing countries, where burden and risk factors for life-threatening illness are unclear.

OBJECTIVES

We defined the burden of life-threatening (O(2) saturation [O(2) sat] ≤ 87%) and fatal RSV infection, and characterized risk factors for life-threatening disease in hospitalized children. Special emphasis was placed on studying the impact of dietary habits during pregnancy. We hypothesized that dietary preferences, differing from those of our remote ancestors, would negatively impact children's pulmonary health. For instance, a diet rich in carbohydrates is a signature of recent millennia and typical of low-income populations, heavily burdened by life-threatening RSV disease.

METHODS

Prospective study in a catchment population of 56,560 children under 2 years of age during the RSV season in Argentina. All children with respiratory signs and O(2) sat less than 93% on admission were included.

MEASUREMENTS AND MAIN RESULTS

Among 1,293 children with respiratory infections, 797(61.6%) were infected with RSV: 106 of these had life-threatening disease; 1.9 per 1,000 children (95% confidence interval [CI], 1.5-2.2/1,000) under 24 months. A total of 22 hospitalized children died (9 RSV(+)), 26 died at home due to acute respiratory infection (14 attributed to RSV); all were under 12 months old. The annual attributable mortality rate for RSV was 0.7 per 1,000 infants (95% CI, 0.4-1.1/1,000). Life-threatening disease was dose-dependently associated with carbohydrate ingestion during pregnancy (adjusted odds ratio from 3.29 [95% CI, 1.15-9.44] to 7.36 [95% CI, 2.41-22.5] versus the lowest quartile).

CONCLUSIONS

Life-threatening and fatal RSV infections are a heavy burden on infants in the developing world. Diets rich in carbohydrates during pregnancy are associated with these severe outcomes.

摘要

背景

呼吸道合胞病毒（RSV）是导致全球婴儿住院和死亡的重要原因。大多数 RSV 死亡发生在发展中国家，这些国家 RSV 导致危及生命疾病的负担和危险因素尚不清楚。

目的

我们定义了危及生命（氧饱和度[O2 sat]≤87%）和致命 RSV 感染的负担，并描述了住院儿童患危及生命疾病的危险因素。特别强调了研究怀孕期间饮食习惯的影响。我们假设，与我们的远祖不同的饮食偏好会对儿童的肺部健康产生负面影响。例如，富含碳水化合物的饮食是近几千年的特征，也是低收入人群的典型特征，这些人群深受危及生命的 RSV 疾病的影响。

方法

在阿根廷 RSV 季节，对一个 56560 名 2 岁以下儿童的集水区人群进行前瞻性研究。所有有呼吸道症状和入院时 O2 sat 低于 93%的儿童均纳入研究。

测量和主要结果

在 1293 名患有呼吸道感染的儿童中，797 名（61.6%）感染了 RSV：其中 106 名患有危及生命的疾病；每 1000 名儿童中有 1.9 例（95%置信区间[CI]，1.5-2.2/1000），年龄在 24 个月以下。共有 22 名住院儿童死亡（9 例 RSV(+）），26 名在家中因急性呼吸道感染死亡（14 例归因于 RSV）；所有死亡儿童均小于 12 个月。RSV 的年归因死亡率为每 1000 名婴儿 0.7 例（95%CI，0.4-1.1/1000）。危及生命的疾病与怀孕期间碳水化合物的摄入呈剂量依赖性相关（调整后的优势比从 3.29（95%CI，1.15-9.44）增加到 7.36（95%CI，2.41-22.5），与最低四分位数相比）。