Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA.
J Pediatr. 2023 Dec;263:113653. doi: 10.1016/j.jpeds.2023.113653. Epub 2023 Aug 3.
To evaluate the relative importance of overall and period-specific postnatal growth and their interaction with fetal growth on cognition in a generally well-nourished population.
We included 1052 children from Project Viva, a prospective cohort in Boston, Massachusetts. Using linear spline mixed-effects models, we modeled length/height and body mass index (BMI) trajectories from birth to 7 years and estimated standardized overall (0-7 years) and period-specific growth velocities ie, early infancy (0-4 months), late infancy (4-15 months), toddlerhood (15-37 months), and early childhood (37-84 months). We investigated associations of growth velocities as well as their interactions with birthweight-for-gestational age on mid-childhood (mean age: 7.9 years) IQ, visual memory and learning, and visual motor ability.
Greater overall height velocity was associated with modestly higher design memory score, (adjusted β [95% CI] 0.19 [-0.01,0.38] P = .057])points per SD increase but lower verbal IQ (-0.88 [-1.76,0.00] P = .051). Greater early infancy height velocity was associated with higher visual motor score (1.92 [0.67,3.18]). Greater overall BMI velocity was associated with lower verbal IQ (-0.71 [-1.52,0.11] P = .090). Greater late infancy BMI velocity was associated with lower verbal IQ (-1.21 [-2.07,-0.34]), design memory score (-0.22 [-0.42,-0.03)], but higher picture memory score (0.22 [0.01,0.43]). Greater early infancy height velocity (-1.5 SD vs 1.5 SD) was associated with higher nonverbal IQ (margins [95% CI] 102.6 [98.9106.3] vs 108.2 [104.9111.6]) among small-for-gestational age infants (P-interaction = 0.04).
Among generally well-nourished children, there might not be clear cognitive gains with faster linear growth except for those with lower birthweight-for-gestational age, revealing the potential importance of early infancy compensatory growth.
评估在营养状况良好的人群中，整体和特定时期的产后生长及其与胎儿生长的相互作用对认知的相对重要性。
我们纳入了来自马萨诸塞州波士顿项目活力的 1052 名儿童，这是一个前瞻性队列。我们使用线性样条混合效应模型，对出生至 7 岁的身长/身高和体重指数（BMI）轨迹进行建模，并估计了标准化的整体（0-7 岁）和特定时期的生长速度，即婴儿早期（0-4 个月）、婴儿晚期（4-15 个月）、幼儿期（15-37 个月）和儿童早期（37-84 个月）。我们研究了生长速度及其与出生体重与胎龄的相互作用与儿童中期（平均年龄：7.9 岁）智商、视觉记忆和学习以及视觉运动能力的关系。
整体身高增长速度较快与设计记忆得分略有升高（调整后的β[95%CI]0.19[-0.01,0.38]，P=0.057）有关，但与言语智商降低有关（-0.88[-1.76,0.00]，P=0.051）。婴儿早期身高增长速度较快与视觉运动得分较高（1.92[0.67,3.18]）有关。整体 BMI 增长速度较快与言语智商较低有关（-0.71[-1.52,0.11]，P=0.090）。婴儿晚期 BMI 增长速度较快与言语智商较低（-1.21[-2.07,-0.34]）、设计记忆得分较低（-0.22[-0.42,-0.03]）有关，但与图片记忆得分较高（0.22[0.01,0.43]）有关。与中-小胎龄儿的 1.5SD 相比，婴儿早期身高增长速度较慢（-1.5 SD 与 1.5 SD）与非言语智商较高有关（边缘[95%CI]102.6[98.9106.3]与 108.2[104.9111.6]），差异具有统计学意义（P 交互=0.04）。
在营养状况良好的儿童中，除了那些出生体重与胎龄较低的儿童外，快速的线性生长可能不会带来明显的认知收益，这表明婴儿早期的补偿性生长可能很重要。
