童年期寄养与机构照料对青少年心脏代谢与免疫标志物的影响：一项随机对照试验的结果。
The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial.
机构信息
From the Department of Epidemiology and Biostatistics (Slopen), School of Public Health, University of Maryland; Department of Human Development and Quantitative Methodology (Tang, Fox), University of Maryland, College Park; Boston Children's Hospital (Nelson), Harvard Medical School, Boston; Harvard Graduate School of Education (Nelson), Cambridge, Massachusetts; Tulane University School of Medicine (Zeanah), New Orleans, Louisiana; Department of Anthropology and Institute for Policy Research (McDade), Northwestern University, Evanston, Illinois; and Department of Psychology (McLaughlin), Harvard University, Cambridge, Massachusetts.
出版信息
Psychosom Med. 2019 Jun;81(5):449-457. doi: 10.1097/PSY.0000000000000696.
OBJECTIVE
Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.
METHODS
The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.
RESULTS
Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03).
CONCLUSIONS
The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.
CLINICAL TRIAL REGISTRATION
NCT00747396.
目的
暴露于机构抚养环境中的儿童通常在多个发育领域表现出问题。我们比较了长期高质量寄养与标准机构护理的后果，这两种护理都始于儿童早期，在青春期评估时评估了心脏代谢和免疫标志物。
方法
布加勒斯特早期干预项目是对在儿童早期（基线时 6 至 30 个月）被机构收容的儿童进行的纵向研究，这些儿童随后被随机分配到高质量寄养或继续机构护理。在 16 岁时，127 名受访者参与了生物标志物采集方案，其中包括 44 名随机分配接受常规护理的机构化儿童、41 名随机分配在婴儿期离开机构护理并安置在高质量寄养中的机构化儿童和 42 名在生物学家庭中长大的具有匹配人口统计学特征的对照组儿童。结果包括体重指数（BMI）、收缩压和舒张压、C 反应蛋白、白细胞介素（IL）-6、IL-8、IL-10、肿瘤坏死因子-α、糖化血红蛋白 A1c 和 Epstein-Barr 病毒抗体滴度。
结果
早期机构抚养与心脏代谢或免疫标志物无差异相关。寄养的随机分配和安置到寄养的年龄也与这些标志物无关，除了 BMI z 评分，被常规护理分配的儿童的 BMI z 评分相对较低（-0.23 与 0.08，p=0.06），并且安置到寄养的年龄较大与 BMI 较低相关（β=-0.07，p=0.03）。
结论
机构抚养对心脏代谢健康和免疫系统功能的测量的影响要么不存在，要么直到发育后期才明显。这些发现为逆境的生物嵌入提供了新的见解，以及它如何在发展过程中以及在不同的调节系统和逆境类型中变化。
临床试验注册
NCT00747396。
Zotero 插件