Santos Iná S, Matijasevich Alicia, Assunção Maria Cecília F, Valle Neiva Cj, Horta Bernardo L, Gonçalves Helen D, Gigante Denise P, Martines José C, Pelto Gretel, Victora Cesar G
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Preventive Medicine, University of São Paulo, São Paulo, Brazil;
J Nutr. 2015 Dec;145(12):2749-55. doi: 10.3945/jn.115.212134. Epub 2015 Oct 21.
A rapid gain in weight for length may put children at a higher risk of noncommunicable diseases later in life.
The objective of this study was to assess the long-term effects of nutrition counseling delivered in the first 2 y of life in Pelotas, a city in Southern Brazil.
The original cluster-randomized controlled trial was conducted in 1998. Nutrition counseling (breastfeeding promotion and increased intake of micronutrient-rich and energy-dense foods) was delivered to mothers of children aged 0-17.9 mo attending primary care. Six months later, weight gain was higher in the intervention group than in the control group for children ≥12 mo of age at enrollment. In 2013 (mean age 15 y), assessments included anthropometric measurements, body composition (air-displacement plethysmography), body shape (3-dimensional photonic scan), and plasma total, LDL, and HDL cholesterol, triglycerides, C-reactive protein, and glucose.
A total of 363 of the 424 original participants were assessed. An a priori decision was made to prioritize analyses of subjects aged 12-17.9 mo at enrollment (51 from the intervention group and 45 from the control group). In this subgroup, boys in the intervention group were [mean (95% CI)] 3.4 (0.8, 6.0) cm taller than those in the control group. Systolic blood pressure tended to be 5.2 (-0.8, 11.1) mm Hg higher in male subjects from the intervention group than in those in the control group. Lipid profiles tended to be healthier in the intervention group. The plasma total cholesterol concentration was -17.8 (-29.8, -5.7) mg/dL lower in boys in the intervention group than in those in the control group. The total-to-HDL cholesterol ratio and triglyceride concentration in the girls in the intervention group were -0.4 (-0.6, -0.1) and -26.3 (-46.3, -6.3) mg/dL, respectively, lower than in the control group. There was no difference between the groups in terms of body composition.
Promotion of weight gain in children between 12.0-17.9 mo of age was not associated with higher metabolic risk 15 y later. On the contrary, there was some evidence of reduced metabolic risk in the intervention group.
体重相对于身高的快速增加可能会使儿童在日后生活中患非传染性疾病的风险更高。
本研究的目的是评估在巴西南部城市佩洛塔对出生后头两年的儿童进行营养咨询的长期效果。
最初的整群随机对照试验于1998年进行。对到初级保健机构就诊的0至17.9个月大儿童的母亲提供营养咨询（促进母乳喂养以及增加富含微量营养素和能量密集型食物的摄入量）。六个月后，对于入组时年龄≥12个月的儿童，干预组的体重增加高于对照组。在2013年（平均年龄15岁），评估包括人体测量、身体成分（空气置换体积描记法）、体型（三维光子扫描）以及血浆总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、C反应蛋白和葡萄糖。
对424名原始参与者中的363人进行了评估。预先决定优先分析入组时年龄在12至17.9个月的受试者（干预组51人，对照组45人）。在这个亚组中，干预组的男孩比对照组的男孩高[平均（95%可信区间）]3.4（0.8，6.0）厘米。干预组男性受试者的收缩压比对照组男性受试者高5.2（-0.8，11.1）毫米汞柱。干预组的血脂谱往往更健康。干预组男孩的血浆总胆固醇浓度比对照组男孩低17.8（-29.8，-5.7）毫克/分升。干预组女孩的总胆固醇与高密度脂蛋白胆固醇比值和甘油三酯浓度分别比对照组低0.4（-0.6，-0.1）和26.3（-46.3，-6.3）毫克/分升。两组在身体成分方面没有差异。
促进12.0至17.9个月大儿童的体重增加与15年后较高的代谢风险无关。相反，有一些证据表明干预组的代谢风险降低。
