Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Adv Nutr. 2021 Mar 31;12(2):461-489. doi: 10.1093/advances/nmaa107.
Early-life nutrition interventions can have lifelong cardiometabolic benefits. Most evidence on this topic is derived from observational studies. We evaluated the association of randomized controlled nutritional trials in early life and long-term cardiometabolic outcomes. Through literature search of PubMed, CABI Global Health, Embase, and Cochrane, with manual reference check and weekly alert from PubMed, we identified 8312 records, and included 53 records from 40 cohorts in 21 countries. The total number of participants was 33,551. Interventions were initiated as early as conception, and the longest until 7 y (except 1 study from infancy to 20 y). The cohorts were followed up for between 3 and 73 y. We identified 7 types of interventions (protein-energy supplements, long-chain PUFAs, single micronutrient, multiple micronutrients, infant and young child feeding, dietary counseling, and other) and 4 categories of cardiometabolic outcomes (biomarkers, cardiovascular, body size and composition, and subclinical/clinical outcomes). Most findings were null. Fasting glucose concentration was 0.04 mmol/L lower (95% CI: -0.05, -0.02 mmol/L; I2 = 0%) in the intervention groups than in the control groups (15 studies). BMI (kg/m2) was 0.20 higher (95% CI: 0.12, 0.28; I2 = 54%) in the intervention groups than control groups (14 studies). No significant effect was observed for total cholesterol (12 studies) or blood pressure (17 studies). Ongoing and personalized dietary counseling was associated with lower glucose and cholesterol, better endothelial function, and reduced risk of metabolic syndrome. The timing of intervention mattered, with earlier initiation conferring greater benefit (improved lipid profile and marginally lower glucose concentration) based on 2 studies. In sum, glucose concentration was lower following early-life nutrition interventions, but there is a risk of unintended consequences, including higher BMI. Maternal and child nutrition interventions must be evidence-based and tailored to each population to promote long-term cardiometabolic health.
早期生活营养干预措施可带来终生的心血管代谢益处。关于这个主题的大多数证据都来自观察性研究。我们评估了早期生活中随机对照营养试验与长期心血管代谢结局的关联。通过对 PubMed、CABI Global Health、Embase 和 Cochrane 的文献检索，并进行手动参考文献检查和每周从 PubMed 获取警报，我们共检索到 8312 条记录，并纳入了来自 21 个国家的 40 个队列中的 53 条记录。研究对象总数为 33551 人。干预措施最早从受孕时开始实施，最长的干预时间持续到 7 岁（除了一项从婴儿期到 20 岁的研究）。这些队列的随访时间为 3 至 73 年。我们确定了 7 种干预措施（蛋白质-能量补充剂、长链多不饱和脂肪酸、单一微量营养素、多种微量营养素、婴幼儿喂养、饮食咨询以及其他）和 4 种心血管代谢结局类型（生物标志物、心血管、身体大小和组成以及亚临床/临床结局）。大多数研究结果为阴性。与对照组相比，干预组的空腹血糖浓度低 0.04mmol/L（95%置信区间：-0.05，-0.02mmol/L；I2=0%）（15 项研究）。干预组的 BMI（kg/m2）比对照组高 0.20（95%置信区间：0.12，0.28；I2=54%）（14 项研究）。12 项研究中总胆固醇和 17 项研究中血压没有显著影响。正在进行的个性化饮食咨询与较低的血糖和胆固醇、更好的内皮功能以及降低代谢综合征风险有关。干预时机很重要，根据 2 项研究结果，早期干预可带来更大的益处（改善血脂谱和血糖浓度略有降低）。总之，早期生活营养干预措施后血糖浓度降低，但存在意外后果的风险，包括 BMI 升高。母婴营养干预措施必须基于证据并针对每个人群进行调整，以促进长期心血管代谢健康。
