Moore Sophie E, Doel Andrew M, Ong Ken K, Dunger David B, Affara Nabeel A, Prentice Andrew M, Bernstein Robin M
Department of Women and Children's Health, King's College London SE1 1UL, London, UK.
MRC Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
Gates Open Res. 2020 Feb 24;4:25. doi: 10.12688/gatesopenres.13101.1. eCollection 2020.
Growth retardation (stunting, wasting and poor organ development) among children in low-income countries has major short and long-term health consequences yet very little is known about the nutritional and environmental influences on the key hormonal axes regulating child growth in these settings, nor the tempo and timing of faltering episodes. Here we describe the study protocol and provide a cohort description of the Hormonal and Epigenetic Regulators of Growth (HERO-G) study. This prospective cohort study from rural Gambia, West Africa, followed mothers and children longitudinally from pre-conception, through pregnancy, delivery, and to two years of child age A total of 251 eligible mother-infant pairs were recruited into the HERO-G study, with 206 (82%) followed up until two years of age. Women were seen at scheduled antenatal appointments at 20, 28 and 36 weeks of gestation, and at delivery, where possible. Between one week and 12 months of age, infants were visited every second day for collection of detailed anthropometry and morbidity data. Infants identified as about to enter a growth faltering episode at these visits entered a more detailed 20-day protocol, with the collection of dried blood spots, anthropometry and body composition. All infants were seen for scheduled clinic visits at 3, 6, 9, 12, 18 and 24 months of age for clinical examination and venous blood draw. Data from the HERO-G study is being used to explore three major mechanistic pathways influencing growth: 1) genome-wide investigations for signatures of epigenetic effects on any loci that might affect growth; 2) frequent anthropometric measurement coupled with non-invasive monitoring for rapid identification and interrogation of real-time faltering patterns and aetiology; 3) focused measurement of hormones and cytokines that act together in an integrated manner, both and after birth, to coordinate patterns of growth with immune activation, inflammation, and nutritional status.
低收入国家儿童的生长发育迟缓（发育迟缓、消瘦和器官发育不良）会产生重大的短期和长期健康后果，但对于这些环境中调节儿童生长的关键激素轴的营养和环境影响，以及生长发育迟缓发作的节奏和时间，人们知之甚少。在此，我们描述了研究方案，并提供了生长激素和表观遗传调节因子（HERO-G）研究的队列描述。这项来自西非冈比亚农村的前瞻性队列研究，从孕前开始，对母亲和儿童进行纵向跟踪，历经怀孕、分娩，直至儿童两岁。共有251对符合条件的母婴被纳入HERO-G研究，其中206对（82%）随访至两岁。在可能的情况下，妇女在妊娠20、28和36周以及分娩时按计划进行产前检查。在婴儿1周龄至12月龄期间，每隔一天进行一次访视，收集详细的人体测量数据和发病率数据。在这些访视中被确定即将进入生长发育迟缓阶段的婴儿进入一个更详细的20天方案，收集干血斑、人体测量数据和身体成分数据。所有婴儿在3、6、9、12、18和24月龄时按计划进行门诊检查和静脉采血。HERO-G研究的数据正被用于探索影响生长的三个主要机制途径：1）全基因组研究，寻找可能影响生长的任何基因座上的表观遗传效应特征；2）频繁的人体测量结合非侵入性监测，以快速识别和研究实时生长发育迟缓模式及病因；3）重点测量在出生前后共同发挥作用、以综合方式协调生长模式与免疫激活、炎症和营养状况的激素和细胞因子。
