DeLacey Emily, Tann Cally, Groce Nora, Kett Maria, Quiring Michael, Bergman Ethan, Garcia Caryl, Kerac Marko
Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom.
Holt International, Eugene, OR, United States of America.
PeerJ. 2020 Feb 6;8:e8484. doi: 10.7717/peerj.8484. eCollection 2020.
There are an estimated 2.7 million children living within institutionalized care worldwide. This review aimed to evaluate currently available data on the nutrition status of children living within institutionalized care.
We searched four databases (Pubmed/Medline, CINHAL Plus, Embase and Global Health Database) for relevant articles published from January 1990 to January 2019. Studies that included information on anthropometry or micronutrient status of children living within institutionalized care were eligible for inclusion. The review is registered on PROSPERO: CRD42019117103.
From 3,602 titles screened, we reviewed 98 full texts, of which 25 papers were eligible. Two (8%) studies reported data from multiple countries, nine (36%) were from Asia, four (16%) from Africa, three (12%) from Eastern Europe, four (16%) from the European Union and one (4%) from each of the remaining regions (Middle East, South America and the Caribbean). Twenty-two (88%) were cross sectional. Ten (40%) of the studies focused on children >5 years, seven (28%) on children <5 years, seven (28%) covered a wide age range and one did not include ages. Low birth weight prevalence ranged from 25-39%. Only five (20%) included information on children with disabilities and reported prevalence from 8-75%. Prevalence of undernutrition varied between ages, sites and countries: stunting ranged from 9-72%; wasting from 0-27%; underweight from 7-79%; low BMI from 5-27%. Overweight/obesity ranged from 10-32% and small head circumference from 17-41%. The prevalence of HIV was from 2-23% and anemia from 3-90%. Skin conditions or infections ranged from 10-31% and parasites from 6-76%. Half the studies with dietary information found inadequate intake or diet diversity. Younger children were typically more malnourished than older children, with a few exceptions. Children living within institutions were more malnourished than community peers, although children living in communities were also often below growth standards. High risk of bias was found.
This study highlights the limited amount of evidence-based data available on the nutritional status of children in institutions. Of the studies reviewed, children living within institutionalized care were commonly malnourished, with undernutrition affecting young children particularly. Micronutrient deficiencies and obesity were also prevalent. Data quality was often poor: as well as suboptimal reporting of anthropometry, few looked for or described disabilities, despite disability being common in this population and having a large potential impact on nutrition status. Taken together, these findings suggest a need for greater focus on improving nutrition for younger children in institutions, especially those with disabilities. More information is needed about the nutritional status of the millions of children living within institutionalized care to fully address their right and need for healthy development.
据估计，全球有270万儿童生活在机构照料环境中。本综述旨在评估目前关于机构照料环境中儿童营养状况的可用数据。
我们检索了四个数据库（PubMed/Medline、CINAHL Plus、Embase和全球健康数据库），查找1990年1月至2019年1月发表的相关文章。纳入的研究需包含机构照料环境中儿童的人体测量或微量营养素状况信息。该综述已在国际系统评价注册库（PROSPERO）注册：CRD42019117103。
在筛选的3602篇标题中，我们阅读了98篇全文，其中25篇符合要求。两项（8%）研究报告了多个国家的数据，九项（36%）来自亚洲，四项（16%）来自非洲，三项（12%）来自东欧，四项（16%）来自欧盟，其余地区（中东、南美洲和加勒比地区）各有一项（4%）。22项（88%）为横断面研究。十项（40%）研究关注5岁以上儿童，七项（28%）关注5岁以下儿童，七项（28%）涵盖广泛年龄范围，一项未提及年龄。低出生体重患病率在25%至39%之间。只有五项（20%）纳入了残疾儿童信息，报告的患病率在8%至75%之间。营养不良患病率在年龄、地点和国家之间存在差异：发育迟缓率在9%至72%之间；消瘦率在0%至27%之间；体重不足率在7%至79%之间；低体重指数率在5%至27%之间。超重/肥胖率在10%至32%之间，小头围率在17%至41%之间。艾滋病毒感染率在2%至23%之间，贫血率在3%至90%之间。皮肤疾病或感染率在10%至31%之间，寄生虫感染率在6%至76%之间。一半有饮食信息的研究发现存在摄入不足或饮食多样性问题。除少数例外情况，年幼儿童通常比年长儿童营养不良更严重。机构中的儿童比社区同龄人营养不良更严重，尽管社区儿童也常常低于生长标准。研究发现存在高偏倚风险。
本研究凸显了关于机构中儿童营养状况的循证数据有限。在所审查的研究中，机构照料环境中的儿童普遍营养不良，营养不良对年幼儿童影响尤为明显。微量营养素缺乏和肥胖也很普遍。数据质量往往较差：除了人体测量报告欠佳外，很少有研究查找或描述残疾情况，尽管残疾在这一人群中很常见且对营养状况有很大潜在影响。综上所述，这些发现表明需要更加关注改善机构中年幼儿童的营养状况，尤其是残疾儿童。需要更多关于数百万生活在机构照料环境中儿童营养状况的信息，以充分满足他们健康发展的权利和需求。
