Miller Laurie C, Joshi Neena, Lohani Mahendra, Singh Rupa, Bhatta Nisha, Rogers Beatrice, Griffiths Jeffrey K, Ghosh Shibani, Mahato Shubh, Singh Padma, Webb Patrick
a Department of Pediatrics , Tufts Medical Center , Boston , MA , USA.
b Friedman School of Nutrition Science and Policy, Tufts University , Boston , MA , USA.
Paediatr Int Child Health. 2016 May;36(2):91-101. doi: 10.1080/20469047.2015.1133517. Epub 2016 Jan 29.
Brain development in early childhood is a key determinant of later cognition, social achievement and educational success. Head circumference (HC) measurements are a simple method to assess brain growth, yet reports of these measurements are uncommon in nutritional surveys of undernourished children.
To evaluate HC measurements in a population of rural Nepali children and relate these measurements to demographics, health and diet.
An observational study of head growth was nested within a longitudinal evaluation of a livestock-based agricultural intervention in rural Nepal. Between 538 and 689 children (aged 6 months to 8 years) were measured (height, weight, HC) at each of six survey visits. A total of 3652 HC measurements were obtained. Results were converted to Z-scores (WHO Anthro).
Mean head circumference Z-scores (HCZ) diminished progressively over the first 4 years of life; a decline of 30% occurred between 3 and 4 years of age (-1.73 to -2.45, P < 0.0001). Overall, 56% of HCZ were <-2. Gender-adjusted HCZ (but not other measurements) were significantly lower for girls than boys [mean (SD) -2.31 (1.0) vs -1.99 (0.094), P < 0.0001]; girls more often had microcephaly (61% vs 50%, P < 0.0001). For children <3 years of age, HCZ were better in those who had eaten two or more animal-source foods (ASFs) within the previous 24 h [-1.69 (.05) vs -2.08 (0.10), P = 0.001] than in those who had eaten none or only one; HCZ correlated with the number of ASFs consumed (P < 0.001). Regression analyses demonstrated that the main determinants of HCZ were age, weight-for-age Z-scores (WAZ) and gender; 43% of the variance in HCZ in younger children was explained by WAZ and ASF consumption.
HCs reflect brain size in young children; brain size is linked to cognitive function. Poor head growth represents another facet of the 'silent emergency' of child undernutrition. Routine HCZ assessments may contribute to better understanding of the links between poverty and cognitive development.
幼儿期的大脑发育是日后认知、社交成就和学业成功的关键决定因素。头围（HC）测量是评估大脑生长的一种简单方法，但在营养不良儿童的营养调查中，这些测量报告并不常见。
评估尼泊尔农村儿童群体的头围测量情况，并将这些测量结果与人口统计学、健康状况和饮食相关联。
在尼泊尔农村对一项以牲畜为基础的农业干预措施进行纵向评估的过程中，嵌套了一项关于头部生长的观察性研究。在六次调查访问中的每次访问时，对538至689名儿童（年龄6个月至8岁）进行测量（身高、体重、头围）。共获得3652次头围测量结果。结果转换为Z评分（世界卫生组织儿童生长标准）。
头围Z评分（HCZ）在生命的头4年中逐渐下降；3至4岁之间下降了30%（从-1.73降至-2.45，P<0.0001）。总体而言，56%的HCZ低于-2。经性别调整后的HCZ（但其他测量指标并非如此）女孩显著低于男孩[均值（标准差）-2.31（1.0）对-1.99（0.094），P<0.0001]；女孩患小头畸形的情况更常见（61%对50%，P<0.0001）。对于3岁以下儿童，在过去24小时内食用过两种或更多动物源性食物（ASF）的儿童的HCZ情况优于未食用或仅食用过一种的儿童[-1.69（0.05）对-2.08（0.10），P=0.001]；HCZ与食用的ASF数量相关（P<0.001）。回归分析表明，HCZ的主要决定因素是年龄、年龄别体重Z评分（WAZ）和性别；幼儿中HCZ变异的43%可由WAZ和ASF摄入量来解释。
头围反映幼儿的脑容量；脑容量与认知功能相关。头部生长不良是儿童营养不良“无声紧急情况”的另一个方面。常规的HCZ评估可能有助于更好地理解贫困与认知发展之间的联系。
