Department of Obstetrics and Gynecology, School of Medicine, National University of Singapore, Singapore.
Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Am J Epidemiol. 2020 Apr 2;189(4):286-293. doi: 10.1093/aje/kwz234.
The evidence that fetal life and early infancy are "critical" or "sensitive" ages for later development of cardiometabolic disease is based on flawed methods for comparing different age periods. Moreover, most previous studies have limited their focus to weight gain, rather than growth in length/height or body mass index (weight (kg)/height (m)2). We undertook a secondary analysis of data from the Promotion of Breastfeeding Intervention Trial (1996-2010), a birth cohort study nested within a large cluster-randomized trial in the Republic of Belarus, that had repeated measurements of weight and length/height taken from birth to 11.5 years of age. We used mixed-effects linear models to analyze associations of changes in standardized weight, length/height, and body mass index during 5 age periods (conception to birth, birth to age 3 months, ages 3-12 months, ages 12 months-6.5 years, and ages 6.5-11.5 years) with fasting glucose, insulin, insulin resistance, β-cell function, and adiponectin at age 11.5 years. We observed strong associations between the metabolic markers and all 3 growth measures, with the largest magnitudes being observed during the latest age period (ages 6.5-11.5 years) and negligible associations during gestation and the first year of life. Later age periods appear more "sensitive" than earlier periods to the adverse metabolic association with rapid growth in childhood.
胎儿期和婴儿早期是心血管代谢疾病后期发展的“关键”或“敏感”时期的证据,这是基于比较不同年龄时期的有缺陷的方法。此外,大多数先前的研究都将其重点局限于体重增加,而不是长度/身高或体重指数(体重(kg)/身高(m)2)的增长。我们对白俄罗斯共和国一项大型群组随机试验中的嵌套出生队列研究——母乳喂养促进干预试验(1996-2010 年)的数据进行了二次分析,该研究从出生到 11.5 岁时重复测量了体重和长度/身高。我们使用混合效应线性模型分析了在 5 个年龄期(受孕至出生、出生至 3 个月、3-12 个月、12 个月至 6.5 岁和 6.5-11.5 岁)期间标准化体重、长度/身高和体重指数的变化与 11.5 岁时的空腹血糖、胰岛素、胰岛素抵抗、β细胞功能和脂联素之间的关系。我们观察到代谢标志物与所有 3 种生长指标之间存在强烈的关联,其中最大的关联发生在最近的年龄期(6.5-11.5 岁),而在妊娠期和婴儿期第一年则几乎没有关联。后期年龄阶段比早期年龄阶段对儿童期快速生长的不良代谢关联更“敏感”。