Galler Janina R, Koethe John R, Yolken Robert H
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts;
Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Pediatrics. 2017 Apr;139(Suppl 1):S72-S84. doi: 10.1542/peds.2016-2828I.
Approximately 1 out of 5 children worldwide suffers from childhood malnutrition or stunting and associated health conditions, including an increased susceptibility to infections and inflammation. Due to improved early interventions, most children even in low-resource settings now survive early childhood malnutrition, yet exhibit continuing evidence of neurodevelopmental deficits, including poor school achievement and behavioral problems. These conditions are compounded in children who continue to be undernourished throughout the adolescent years. At present, these sequelae of malnutrition and infection are of major concern in the adolescent population, given that young people between the ages of 10 and 24 years represent nearly one-quarter of the world's population. Therefore, there is an urgent need to focus on the well-being of this age group and, in particular, on behavioral, cognitive, and brain disorders of adolescents who experienced malnutrition, infection, and inflammation prenatally, in early childhood, and during adolescence itself. Because one-third of all women globally become pregnant during their adolescent years, brain and behavioral disorders during this period can have an intergenerational impact, affecting the health and well-being of the next generation. This article summarizes the current state of knowledge and evidence gaps regarding childhood and adolescent malnutrition and inflammation and their impact on adolescent neurodevelopment, the limited evidence regarding nutrition and psychosocial interventions, and the role of resilience and protective factors in this age group. This overview should help to inform the development of new strategies to improve the neurodevelopmental outcomes of high risk adolescent populations.
全球约五分之一的儿童患有儿童期营养不良或发育迟缓以及相关健康问题,包括感染和炎症易感性增加。由于早期干预措施的改善,即使在资源匮乏地区,大多数儿童现在也能度过儿童期营养不良阶段存活下来,但仍有持续的神经发育缺陷迹象,包括学业成绩不佳和行为问题。在整个青少年时期持续营养不良的儿童中,这些情况会更加严重。目前,鉴于10至24岁的年轻人占全球人口近四分之一,营养不良和感染的这些后遗症在青少年人群中备受关注。因此,迫切需要关注这个年龄段人群的福祉,特别是关注那些在产前、幼儿期和青少年期经历过营养不良、感染和炎症的青少年的行为、认知和脑部疾病。由于全球三分之一的女性在青少年时期怀孕,这一时期的脑部和行为疾病可能会产生代际影响,影响下一代的健康和福祉。本文总结了关于儿童和青少年营养不良与炎症及其对青少年神经发育影响的现有知识状况和证据空白、关于营养和心理社会干预的有限证据,以及复原力和保护因素在这个年龄段人群中的作用。这一概述应有助于为制定新策略提供信息,以改善高危青少年人群的神经发育结局。