Department of Pediatrics, Division of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Pediatrics, Division of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Allergy Clin Immunol. 2016 Apr;137(4):1026-1035. doi: 10.1016/j.jaci.2015.08.050. Epub 2015 Nov 11.
Children born preterm or with a small size for gestational age are at increased risk for childhood asthma.
We sought to assess the hypothesis that these associations are explained by reduced airway patency.
We used individual participant data of 24,938 children from 24 birth cohorts to examine and meta-analyze the associations of gestational age, size for gestational age, and infant weight gain with childhood lung function and asthma (age range, 3.9-19.1 years). Second, we explored whether these lung function outcomes mediated the associations of early growth characteristics with childhood asthma.
Children born with a younger gestational age had a lower FEV1, FEV1/forced vital capacity (FVC) ratio, and forced expiratory volume after exhaling 75% of vital capacity (FEF75), whereas those born with a smaller size for gestational age at birth had a lower FEV1 but higher FEV1/FVC ratio (P < .05). Greater infant weight gain was associated with higher FEV1 but lower FEV1/FVC ratio and FEF75 in childhood (P < .05). All associations were present across the full range and independent of other early-life growth characteristics. Preterm birth, low birth weight, and greater infant weight gain were associated with an increased risk of childhood asthma (pooled odds ratio, 1.34 [95% CI, 1.15-1.57], 1.32 [95% CI, 1.07-1.62], and 1.27 [95% CI, 1.21-1.34], respectively). Mediation analyses suggested that FEV1, FEV1/FVC ratio, and FEF75 might explain 7% (95% CI, 2% to 10%) to 45% (95% CI, 15% to 81%) of the associations between early growth characteristics and asthma.
Younger gestational age, smaller size for gestational age, and greater infant weight gain were across the full ranges associated with childhood lung function. These associations explain the risk of childhood asthma to a substantial extent.
早产儿或出生时体型小于胎龄的儿童患儿童哮喘的风险增加。
我们旨在评估以下假设，即这些关联是由气道通畅性降低引起的。
我们使用了来自 24 个出生队列的 24938 名儿童的个体参与者数据，以检查和荟萃分析胎龄、胎龄大小和婴儿体重增加与儿童肺功能和哮喘（年龄范围 3.9-19.1 岁）之间的关联。其次，我们探讨了这些肺功能结果是否介导了早期生长特征与儿童哮喘之间的关联。
胎龄较小的儿童其 FEV1、FEV1/FVC 比值和呼出 75%肺活量时的用力呼气量（FEF75）较低，而出生时胎龄较小的儿童 FEV1 较低，但 FEV1/FVC 比值较高（P<0.05）。婴儿体重增加较大与儿童期 FEV1 较高但 FEV1/FVC 比值和 FEF75 较低相关（P<0.05）。所有关联在整个范围内均存在，且独立于其他生命早期生长特征。早产、低出生体重和婴儿体重增加较大与儿童哮喘的风险增加相关（汇总优势比分别为 1.34[95%置信区间，1.15-1.57]、1.32[95%置信区间，1.07-1.62]和 1.27[95%置信区间，1.21-1.34]）。中介分析表明，FEV1、FEV1/FVC 比值和 FEF75 可能解释了早期生长特征与哮喘之间关联的 7%（95%置信区间，2%-10%）至 45%（95%置信区间，15%-81%）。
胎龄较小、胎龄较小和婴儿体重增加较大与儿童期肺功能相关。这些关联在很大程度上解释了儿童哮喘的风险。
