Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of Head & Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC.
Am J Clin Nutr. 2018 Feb 1;107(2):268-277. doi: 10.1093/ajcn/nqx022.
Prevalence of young adult hearing loss is high in low-resource societies; the reasons for this are likely complex but could involve early childhood undernutrition.
We evaluated preschool childhood stunting, wasting, and underweight as risk factors for hearing loss in young adulthood in Sarlahi District, southern Nepal.
Ear health was assessed in 2006-2008 in a cohort of 2193 subjects aged 16-23 y, who as children <60 mo of age participated in a 16-mo placebo-controlled, randomized vitamin A supplementation trial from 1989 to 1991. At each of five 4-mo assessments, field staff measured children's weight, height, and mid-upper arm circumference (MUAC) and recorded validated parental history of ear discharge in the previous 7 d. Children were classified as stunted [<-2 z score height-for-age (HAZ)], underweight [<-2 z score weight-for-age (WAZ)], or wasted [<-2 z score MUAC-for-age (MUACAZ) or body mass index-for-age (BMIAZ)]. At follow-up, hearing was tested by audiometry and tympanometry, with hearing loss defined as pure-tone average >30dB in the worse ear (0.5, 1, 2, 4 kHz) and middle-ear dysfunction as abnormal tympanometric peak height (<0.3 or >1.4 mmho) or width (<50 or >110 daPa).
Hearing loss, present in 5.9% (95% CI: 5.01%, 7.00%) of subjects, was associated with early childhood stunting (OR: 1.64; 95% CI: 1.10, 1.45), underweight (OR: 1.70; 95% CI: 1.18, 2.44) and wasting by BMIAZ (OR: 1.88; 95% CI: 1.19, 2.97) and MUACAZ (OR: 2.14; 95% CI: 1.47, 3.12). Abnormal tympanometry, affecting 16.6% (95% CI: 15.06%, 18.18%), was associated with underweight (OR: 1.46; 95% CI: 1.16, 1.84) and wasting by BMIAZ (OR: 1.80; 95% CI: 1.32, 2.46) and MUACAZ (OR: 1.42; 95% CI: 1.10, 1.84), but not stunting (OR: 1.18; 95% CI: 0.93, 1.49) in early childhood. Highest ORs were observed for subjects with both hearing loss and abnormal tympanometry, ranging from 1.87 to 2.24 (all lower 95% CI >1.00).
Early childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.
在资源匮乏的社会中，年轻成年人听力损失的患病率很高；其原因可能很复杂，但可能涉及儿童早期营养不良。
我们评估了尼泊尔萨拉希地区学龄前儿童发育迟缓、消瘦和体重不足是否是年轻成年人听力损失的危险因素。
2006-2008 年，我们对 2193 名年龄在 16-23 岁的队列参与者进行了耳部健康评估，这些参与者在 60 个月大之前参加了 1989 年至 1991 年为期 16 个月的安慰剂对照、随机维生素 A 补充试验。在每 4 个月一次的五次评估中，现场工作人员测量了儿童的体重、身高和中上臂围（MUAC），并记录了过去 7 天中父母验证的耳漏病史。儿童被归类为发育迟缓（<-2 z 身高年龄分数（HAZ））、体重不足（<-2 z 体重年龄分数（WAZ））或消瘦（<-2 z MUAC 年龄分数（MUACAZ）或 BMI 年龄分数（BMIAZ））。随访时，通过听力计和鼓室图进行听力测试，将纯音平均听力损失定义为较差耳（0.5、1、2、4 kHz）>30dB，中耳功能障碍定义为异常鼓室图峰值高度（<0.3 或>1.4 毫伏）或宽度（<50 或>110 达帕）。
听力损失（5.9%（95%CI：5.01%，7.00%）的受试者）与儿童早期发育迟缓（OR：1.64；95%CI：1.10，1.45）、消瘦（OR：1.70；95%CI：1.18，2.44）和消瘦（BMI-AZ （OR：1.88；95%CI：1.19，2.97）和 MUACAZ（OR：2.14；95%CI：1.47，3.12）相关。异常鼓室图（16.6%（95%CI：15.06%，18.18%））与消瘦（OR：1.46；95%CI：1.16，1.84）和消瘦（BMI-AZ （OR：1.80；95%CI：1.32，2.46）和 MUACAZ（OR：1.42；95%CI：1.10，1.84）相关，但与儿童早期发育迟缓（OR：1.18；95%CI：0.93，1.49）无关。听力损失和异常鼓室图同时存在的受试者的 OR 值最高，范围为 1.87 至 2.24（所有较低的 95%CI>1.00）。
儿童早期营养不良是年轻成年人听力损失的一个可改变的危险因素。
