孟加拉国农村一项群组随机对照试验中，水、环境卫生、手卫生和营养干预措施对儿童端粒长度的影响。
Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh.
机构信息
School of Public Health, University of California, Berkeley, Berkeley, United States.
Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, United States.
出版信息
Elife. 2017 Oct 5;6:e29365. doi: 10.7554/eLife.29365.
BACKGROUND
Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life.
METHODS
In a trial in rural Bangladesh, we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat.
RESULTS
Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference −163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (−23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305).
CONCLUSIONS
Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress.
FUNDING
Funded by The Bill and Melinda Gates Foundation.
CLINICAL TRIAL NUMBER
NCT01590095.
背景
较短的儿童端粒长度（TL）和更快的 TL 损耗被广泛认为是压力的表现。然而，健康干预措施对儿童 TL 的潜在影响尚不清楚。我们假设水、卫生、洗手（WSH）和营养干预措施将减缓生命头两年的 TL 损耗。
方法
在孟加拉国农村进行的一项试验中，我们将孕妇的地理集群随机分为单独的水处理、卫生、洗手、营养、WSH 联合、WSH 联合营养加（N + WSH）或对照组。我们进行了一项子研究，招募了来自对照组和 N + WSH 干预组的儿童。参与者和结果评估者没有被蒙蔽；分析被蒙蔽了。在干预后 1 年和 2 年测量相对 TL，并报告相对 TL 的变化。分析是意向治疗。
结果
在 2012 年 5 月至 2013 年 7 月的整个试验中，我们将 720 个地理集群的 5551 名孕妇随机分配到对照组或干预组。在这个子研究中，干预 1 年后，我们共评估了 662 名儿童（341 名干预组和 321 名对照组）和 713 名儿童（383 名干预组和 330 名对照组）。干预组儿童在干预后 1 年的相对 TL 明显短于对照组（差异为-163 个碱基对（bp），p=0.001）。在 1 年至 2 年期间，干预组的 TL 增加（+76 bp），对照组的 TL 减少（-23 bp）（p=0.050）。两年后，两组之间没有差异（p=0.305）。
结论
我们意外地发现，干预组在生命的第一年 TL 损耗增加，这表明在此关键时期快速的 TL 损耗可能反映了干预组的生长改善，而不是累积的压力。
资金来源
由比尔和梅琳达盖茨基金会资助。
临床试验注册号
NCT01590095。
Zotero 插件