Department of Politics, Management and Health, School of Public Health, University of São Paulo, São Paulo, Brazil.
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
PLoS One. 2020 Jan 30;15(1):e0228375. doi: 10.1371/journal.pone.0228375. eCollection 2020.
We analyzed the association between birthweight, nutritional status and transverse maxillary growth in 7- to 9-year-old schoolchildren. We undertook a cross-sectional survey nested in a population-based cohort study of 158 schoolchildren. The participants lived in the urban area of a small town within the Western Brazilian Amazon. The outcome was represented by the upper intermolar distance given in millimeters (mm), as an indicator of the degree of maxillary bone growth in its transverse dimension. The exposures were sex, birthweight, the bottle-feeding pattern operationalized by a scale corresponding to the age of introduction of the bottle and Body Mass Index-for-age z-score (BAZ) at 4 to 6 ys. Path analysis was employed to estimate standardized direct, indirect and total effects of exposures on the outcome using structural equations model (SEM) supported by Mplus 7 program. The values of standardized coefficients (SC) showed significant direct positive effects of sex (SC = 0.203; p = 0.006), birth weight (SC = 0.155; p = 0.030) and BAZ (SC = 0.165; p = 0.014) on transverse maxillary growth. The indirect effects (SC = 0.057; p = 0.012) and the total effect (SC = 0.261; p<0.001) of sex on the outcome were statistically significant. The indirect effects of birth weight on the outcome were not significant (SC = 0.018; p = 0.488), however, the total effect was significant (SC = 0.174; p = 0.011). In conclusion, sex, birthweight, bottle beginning age and BAZ showed association with the transverse growth of the maxillary bone. In addition to contributing to an adequate birth weight of the child, policies and programs that favor prenatal care and conditions to guarantee a full-term birth can positively affect transverse growth of the maxilla. From a Public Health Surveillance point of view, children with reduced birthweight, inadequate breastfeeding pattern and nutritional deficit for age may be more likely to develop atrophy of the jaws which, depending on the severity, may result in malocclusion with an important impact on quality of life.
我们分析了 7 至 9 岁学童的出生体重、营养状况与上颌横向生长之间的关系。我们对 158 名学童进行了一项基于人群的队列研究中的嵌套横断面调查。参与者居住在巴西西部亚马孙地区一个小镇的城区。研究结果以上颌中切牙间距离（mm）表示，作为上颌骨横向生长程度的指标。暴露因素包括性别、出生体重、以奶瓶喂养模式为指标（根据引入奶瓶的年龄设定相应的量表）以及 4 至 6 岁时的体重指数年龄别 z 评分（BAZ）。采用路径分析，通过 Mplus 7 程序支持的结构方程模型（SEM）来估计暴露因素对结局的标准化直接、间接和总效应。标准化系数（SC）值显示，性别（SC=0.203；p=0.006）、出生体重（SC=0.155；p=0.030）和 BAZ（SC=0.165；p=0.014）对横向上颌生长有显著的直接正向影响。性别对结局的间接效应（SC=0.057；p=0.012）和总效应（SC=0.261；p<0.001）具有统计学意义。出生体重对结局的间接效应无统计学意义（SC=0.018；p=0.488），但总效应有统计学意义（SC=0.174；p=0.011）。结论：性别、出生体重、奶瓶起始年龄和 BAZ 与上颌骨的横向生长有关。除了促进儿童获得适当的出生体重外，有利于产前保健和保证足月分娩的政策和方案可以对上颌骨的横向生长产生积极影响。从公共卫生监测的角度来看，出生体重较低、母乳喂养模式不足以及年龄相关的营养不足的儿童可能更容易出现颌骨萎缩，如果严重的话，可能会导致错颌畸形，对生活质量产生重要影响。
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