生命最初两年生长与疾病、肠道病原体及饮食摄入之间的关系：MAL-ED出生队列研究的结果
Relationship between growth and illness, enteropathogens and dietary intakes in the first 2 years of life: findings from the MAL-ED birth cohort study.
出版信息
BMJ Glob Health. 2017 Dec 28;2(4):e000370. doi: 10.1136/bmjgh-2017-000370. eCollection 2017.
BACKGROUND
Dietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth.
METHODS
Newborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth.
RESULTS
Diarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. and enteroaggregative detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes.
CONCLUSIONS
Reducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.
背景
饮食和疾病因素会影响生长发育迟缓的风险；肠道病原体的作用尚不清楚。作为肠道感染与营养不良的病因、危险因素及相互作用及其对儿童健康与发育的影响（MAL-ED）研究的一部分，我们对肠道病原体感染、腹泻和饮食对儿童生长的影响进行了量化。
方法
招募新生儿并随访至24个月。每月评估身长和体重。每两周记录疾病情况和母乳喂养情况；从9个月至24个月，每月对非母乳摄入量进行量化。对常规收集的非腹泻粪便进行多种肠道病原体分析。使用线性分段样条模型量化八个MAL-ED研究地点中七个地点各因素与生长速度的关联；估计平均、低（第10百分位数）和高（第90百分位数）暴露水平对24个月时所达到身长的累积影响。此外，评估了六种最常见肠道病原体对生长的影响。
结果
腹泻对生长没有统计学上的显著影响。估计肠道病原体高暴露儿童在24个月时平均比低暴露儿童短1.21±0.33厘米（p<0.001；年龄别身长（LAZ）为0.39），轻0.08±0.15千克（p=0.60；年龄别体重（WAZ）为0.08）。肠聚集性大肠杆菌检测呈阳性分别与身长减少0.83±0.33厘米和0.85±0.31厘米（p=0.011和0.001）以及体重减少0.22±0.15千克和0.09±0.14千克（p=0.14和0.52）相关。估计能量摄入和蛋白质密度低的儿童在24个月时比摄入量高的儿童短1.39±0.33厘米（p<0.001；LAZ为0.42），轻0.81±0.15千克（p<0.001；WAZ为0.65）。
结论
减轻肠道病原体负担以及提高辅食的能量和蛋白质密度可减少发育迟缓。
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