Schott Whitney, Aurino Elisabetta, Penny Mary E, Behrman Jere R
Population Studies Center, 3718 Locust Walk, University of Pennsylvania, Philadelphia, PA, 19104, USA; A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA.
Department of Management and Centre for Health Economics and Policy Innovations, Imperial College London and Young Lives, University of Oxford, UK.
Econ Hum Biol. 2019 Aug;34:80-91. doi: 10.1016/j.ehb.2019.05.009. Epub 2019 Jun 15.
As part of the nutritional transition, undernutrition is globally declining while changes brought by economic development have ushered in increases in overweight and its related economic costs and health consequences around the world. We examine trajectories in stunting and overweight from age one year to mid-adolescence and from mid-childhood to early adulthood among two cohorts from Ethiopia, India, Peru and Vietnam using data from the Young Lives study. We examine descriptive data and then model trajectories in stunting and overweight status over age. Group-based trajectory analysis with five ages of overweight and stunting for each country-cohort reveals (1) trajectories of catch-up growth for a subset of study children between the ages of 12 and 19 in the older cohort in Ethiopia (20.1% of the cohort), India (20.5%), Peru (16.9%), and Vietnam (14.0%); (2) trajectories of increasing probabilities of stunting as children age from 12 to 22 in the older cohort in India (22.2%) and Peru (30.7%); (3) trajectories of early (childhood) increases in overweight probabilities (younger cohort: India, 3.4%, Peru, 19.4%, and Vietnam, 8.1%), and of later (adolescence) increases in overweight probabilities (older cohort: Ethiopia, 0.5%, India, 6.3%, Peru, 40.9%, and Vietnam, 9.4%). Multinomial logit prediction of membership in trajectory categories reveals that higher wealth quartiles and maternal schooling are protective against high stunting probability trajectory group membership, but higher wealth and urban residence predict high overweight probability trajectory group membership. This evidence suggests a window of opportunity for interventions to reduce stunting and to avert overweight development in adolescence, in addition to the often-emphasized first 1000 days after conception. A life-course approach to policies and programs to target both undernutrition and overweight should be considered.
作为营养转型的一部分，全球范围内营养不良现象正在减少，而经济发展带来的变化导致全球超重现象及其相关经济成本和健康后果不断增加。我们利用“青年生活”研究的数据，考察了来自埃塞俄比亚、印度、秘鲁和越南的两个队列中，从1岁到青春期中期以及从中童年到成年早期的发育迟缓与超重轨迹。我们先分析描述性数据，然后对发育迟缓和超重状况随年龄变化的轨迹进行建模。对每个国家队列的超重和发育迟缓状况按五个年龄阶段进行基于组的轨迹分析，结果显示：（1）在埃塞俄比亚（占队列的20.1%）、印度（20.5%）、秘鲁（16.9%）和越南（14.0%）的 older cohort 中，一部分12至19岁的研究儿童出现追赶生长轨迹；（2）在印度（22.2%）和秘鲁（30.7%）的 older cohort 中，随着儿童从12岁长到22岁，发育迟缓概率增加的轨迹；（3）超重概率在早期（童年）增加的轨迹（ younger cohort：印度3.4%、秘鲁19.4%、越南8.1%），以及在后期（青春期）超重概率增加的轨迹（ older cohort：埃塞俄比亚0.5%、印度6.3%、秘鲁40.9%、越南9.4%）。对轨迹类别成员身份的多项logit预测表明，较高的财富四分位数和母亲受教育程度可降低发育迟缓高概率轨迹组成员的可能性，但较高的财富和城市居住状况则预示着超重高概率轨迹组成员的可能性。这一证据表明，除了经常强调的受孕后的头1000天之外，还存在一个干预窗口，可用于减少发育迟缓并避免青少年超重的发展。应考虑采用贯穿一生的方法制定针对营养不良和超重问题的政策与计划。
