Vu Khanh, Lou Wendy, Tun Hein M, Konya Theodore B, Morales-Lizcano Nadia, Chari Radha S, Field Catherine J, Guttman David S, Mandal Rupasri, Wishart David S, Azad Meghan B, Becker Allan B, Mandhane Piush J, Moraes Theo J, Lefebvre Diana L, Sears Malcolm R, Turvey Stuart E, Subbarao Padmaja, Scott James A, Kozyrskyj Anita L
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Gastroenterology. 2021 Jan;160(1):128-144.e10. doi: 10.1053/j.gastro.2020.08.053. Epub 2020 Sep 16.
BACKGROUND & AIMS: Few studies, even those with cohort designs, test the mediating effects of infant gut microbes and metabolites on the onset of disease. We undertook such a study.
Using structural equation modeling path analysis, we tested directional relationships between first pregnancy, birth mode, prolonged labor and breastfeeding; infant gut microbiota, metabolites, and IgA; and childhood body mass index and atopy in 1667 infants.
After both cesarean birth and prolonged labor with a first pregnancy, a higher Enterobacteriaceae/Bacteroidaceae ratio at 3 months was the dominant path to overweight; higher Enterobacteriaceae/Bacteroidaceae ratios and Clostridioides difficile colonization at 12 months were the main pathway to atopic sensitization. Depletion of Bifidobacterium after prolonged labor was a secondary pathway to overweight. Influenced by C difficile colonization at 3 months, metabolites propionate and formate were secondary pathways to child outcomes, with a key finding that formate was at the intersection of several paths.
Pathways from cesarean section and first pregnancy to child overweight and atopy share many common mediators of the infant gut microbiome, notably C difficile colonization.
很少有研究，即使是那些队列研究设计，会测试婴儿肠道微生物群和代谢产物对疾病发病的中介作用。我们开展了这样一项研究。
我们使用结构方程模型路径分析，测试了1667名婴儿中首次怀孕、分娩方式、产程延长和母乳喂养之间的方向性关联；婴儿肠道微生物群、代谢产物和免疫球蛋白A（IgA）之间的方向性关联；以及儿童期体重指数和特应性之间的方向性关联。
首次怀孕后剖宫产和产程延长后，3个月时较高的肠杆菌科/拟杆菌科比率是超重的主要途径；12个月时较高的肠杆菌科/拟杆菌科比率和艰难梭菌定植是特应性致敏的主要途径。产程延长后双歧杆菌的减少是超重的次要途径。受3个月时艰难梭菌定植的影响，代谢产物丙酸酯和甲酸是影响儿童结局的次要途径，一项关键发现是甲酸处于多条途径的交叉点。
剖宫产和首次怀孕导致儿童超重和特应性的途径有许多共同的婴儿肠道微生物群中介因素，尤其是艰难梭菌定植。
