MRC Epidemiology Unit, Addenbrookes Hospital, Cambridge, UK.
J Epidemiol Community Health. 2013 Jul;67(7):595-602. doi: 10.1136/jech-2012-202021. Epub 2013 Feb 28.
Childhood growth affects long-term health and could contribute to health inequalities that persist throughout life.
We compared growth data of 4-year-old to 6-year-old children born 1997-2002 in UK (n=15,168), Sweden (n=6749) and rural China (n=10,327). SD scores (SDS) were calculated against the WHO Growth Standard. Obesity and overweight were defined by the International Obesity Taskforce cut-offs, and stunting, underweight and thinness by height, weight or body mass index (BMI)<-2 SDS. Associations with maternal education were standardised by calculating the Slope Index of Inequality (SII).
Mean SDS height, weight and BMI in the UK (-0.01, 0.42, 0.62, respectively) and Sweden (0.45, 0.59, 0.45) were higher than in China (-0.98, -0.82, -0.29). Higher maternal education was consistently associated with taller offspring height SDS (SII: UK 0.25; Sweden 0.17; China 1.06). Underweight and stunting were less common in the UK (prevalence: 0.6% and 2.2%, respectively) and Sweden (0.3% and 0.6%) than in China (9.5% and 16.4%), where these outcomes were inversely associated with maternal education (SII: -25.8% and -12.7%). Obesity prevalence in the UK, Sweden and China was 4.8%, 3.7% and 0.4%, respectively. Maternal education was inversely associated with offspring obesity in the UK (SII: -3.3%) and Sweden (-2.8%), but not in China (+0.3%).
Higher maternal education was associated with more favourable growth in young children: lower obesity and overweight in the UK and Sweden, and lower stunting and underweight in rural China. Public health strategies to optimise growth in early childhood need to acknowledge socioeconomic factors, but possibly with a different emphasis in different settings.
儿童时期的生长发育会影响其长期健康，并可能导致终生持续存在的健康不平等。
我们比较了 1997-2002 年在英国（n=15168）、瑞典（n=6749）和中国农村（n=10327）出生的 4 至 6 岁儿童的生长数据。使用世界卫生组织生长标准计算标准差评分（SDS）。采用国际肥胖工作组的切点定义肥胖和超重，用身高、体重或体重指数（BMI）<-2 SDS 定义发育迟缓、体重不足和消瘦。通过计算不平等斜率指数（SII），使母亲教育的相关性标准化。
英国（-0.01、0.42、0.62）和瑞典（0.45、0.59、0.45）儿童的平均 SDS 身高、体重和 BMI 高于中国（-0.98、-0.82、-0.29）。母亲的教育程度越高，子女的身高 SDS 越高（英国：SII0.25；瑞典：SII0.17；中国：SII1.06）。英国（发生率：分别为 0.6%和 2.2%）和瑞典（发生率：分别为 0.3%和 0.6%）儿童的体重不足和发育迟缓发生率低于中国（发生率：分别为 9.5%和 16.4%），这些结果与母亲的教育程度呈负相关（SII：-25.8%和-12.7%）。英国、瑞典和中国儿童肥胖的患病率分别为 4.8%、3.7%和 0.4%。母亲的教育程度与英国（SII：-3.3%）和瑞典（SII：-2.8%）儿童肥胖呈负相关，但与中国儿童（SII：+0.3%）肥胖无关。
母亲的教育程度越高，其子女在幼儿时期的生长发育越有利：英国和瑞典肥胖和超重的比例较低，中国农村发育迟缓、体重不足的比例较低。在不同的环境下，需要制定不同的公共卫生策略来优化儿童早期的生长发育，但可能需要不同的重点。
