5 岁时获得的大小与肠功能障碍和其他因素有关：MAL-ED 出生队列研究结果。

Enteric dysfunction and other factors associated with attained size at 5 years: MAL-ED birth cohort study findings.

机构信息

Fogarty International Center/NIH, Bethesda, MD.

The Pennsylvania State University, University Park, PA.

出版信息

Am J Clin Nutr. 2019 Jul 1;110(1):131-138. doi: 10.1093/ajcn/nqz004.

DOI:10.1093/ajcn/nqz004

PMID:31127812

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6599740/

Abstract

BACKGROUND

Poor growth in early childhood has been associated with increased risk of mortality and morbidity, as well as long-term deficits in cognitive development and economic productivity.

OBJECTIVES

Data from the MAL-ED cohort study were used to identify factors in the first 2 y of life that are associated with height-for-age, weight-for-age, and body mass index z-scores (HAZ, WAZ, BMIZ) at 5 y of age.

METHODS

A total of 1017 children were followed from near birth until 5 y of age at sites in Bangladesh, Brazil, India, Nepal, Peru, South Africa, and Tanzania. Data were collected on their growth, environmental enteric dysfunction (EED), micronutrient status, enteric pathogen burden, illness prevalence, dietary intake, and various other socio-economic and environmental factors.

RESULTS

EED biomarkers were related to size at 5 y. Mean lactulose:mannitol z-scores during the first 2 y of life were negatively associated with all of the growth measures (HAZ: -0.11 [95% CI: -0.19, -0.03]; WAZ: -0.16 [95% CI: -0.26, -0.06]; BMIZ: -0.11 [95% CI: -0.23, 0.0]). Myeloperoxidase was negatively associated with weight (WAZ: -0.52 [95% CI: -0.78, -0.26] and BMIZ: -0.56 [95% CI: -0.86, -0.26]); whereas α-1-antitrypsin had a negative association with HAZ (-0.28 [95% CI: -0.52, -0.04]). Transferrin receptor was positively related to HAZ (0.18 [95% CI: 0.06, 0.30]) and WAZ (0.21 [95% CI: 0.07, 0.35]). Hemoglobin was positively related to HAZ (0.06 [95% CI: 0.00, 0.12]), and ferritin was negatively related to HAZ (-0.08 [95% CI: -0.12, -0.04]). Bacterial density in stool was negatively associated with HAZ (-0.04 [95% CI: -0.08, 0.00]), but illness symptoms did not have any effect on size at 5 y.

CONCLUSIONS

EED markers, bacterial density, and iron markers are associated with growth at 5 y of age. Interventions to reduce bacterial burden and EED may improve long-term growth in low-income settings.

摘要

背景

儿童早期生长不良与死亡率和发病率增加以及认知发育和经济生产力长期缺陷有关。

目的

利用 MAL-ED 队列研究的数据，确定生命最初 2 年中与 5 岁时身高年龄别、体重年龄别和体重指数 z 分数（HAZ、WAZ、BMIZ）相关的因素。

方法

在孟加拉国、巴西、印度、尼泊尔、秘鲁、南非和坦桑尼亚的研究点，共有 1017 名儿童从出生前一直随访到 5 岁。收集了他们的生长情况、肠黏膜通透性障碍（EED）、微量营养素状况、肠道病原体负担、疾病流行率、饮食摄入以及其他各种社会经济和环境因素的数据。

结果

EED 生物标志物与 5 岁时的大小有关。生命最初 2 年中乳果糖：甘露醇 z 分数平均值与所有生长指标均呈负相关（HAZ：-0.11[95%CI：-0.19，-0.03]；WAZ：-0.16[95%CI：-0.26，-0.06]；BMIZ：-0.11[95%CI：-0.23，0.0]）。髓过氧化物酶与体重呈负相关（WAZ：-0.52[95%CI：-0.78，-0.26]和 BMIZ：-0.56[95%CI：-0.86，-0.26]）；而α-1-抗胰蛋白酶则与 HAZ 呈负相关（-0.28[95%CI：-0.52，-0.04]）。转铁蛋白受体与 HAZ（0.18[95%CI：0.06，0.30]）和 WAZ（0.21[95%CI：0.07，0.35]）呈正相关。血红蛋白与 HAZ 呈正相关（0.06[95%CI：0.00，0.12]），铁蛋白与 HAZ 呈负相关（-0.08[95%CI：-0.12，-0.04]）。粪便中细菌密度与 HAZ 呈负相关（-0.04[95%CI：-0.08，0.00]），但疾病症状对 5 岁时的生长没有任何影响。