Nguyen Phuong Thi, Nguyen Phuong Hong, Tran Lan Mai, Khuong Long Quynh, Nguyen Son Van, Young Melissa F, Ramakrishnan Usha
Department of Pediatric, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam.
Department of Nutrition, Diets, and Health, International Food Policy Research Institute, Washington, DC, United States.
Front Nutr. 2024 Feb 26;11:1348225. doi: 10.3389/fnut.2024.1348225. eCollection 2024.
Preterm and small for gestational age (SGA) remain significant public health concerns worldwide. Yet limited evidence exists on their growth patterns during childhood from low-or middle-income countries.
We investigated the postnatal growth patterns of preterm and SGA compared to term appropriate for gestational age (AGA) children from birth to 10-11y, and examined the impact of birth status on child nutritional status during the school age years.
Children born to women who participated in a double-blinded randomized controlled trial of preconception micronutrient supplementation in Vietnam were classified into three groups: preterm AGA ( = 130), full-term SGA ( = 165) and full-term AGA ( = 1,072). Anthropometric data (weight and height) were collected prospectively at birth, 3, 6, 12, 18, 24 months and at 6-7 and 10-11y. We used ANOVA and multiple regression models to examine the differences in growth patterns from birth to 10-11y as well as child undernutrition and overnutrition by birth status.
Children who were born preterm exhibited rapid postnatal growth, but still had lower HAZ at 1y and 2y and showed catch up to the AGA group at 6y. Compared to those born AGA, SGA infants had higher risk of thinness (BMIZ < -2) at 2y and 6y (adjusted Odds Ratio, AOR [95% CI] 2.5 [1.0, 6.1] and 2.6 [1.4, 4.6], respectively); this risk reduced at 10-11y (1.6 [0.9, 2.8]). The risk of stunting (HAZ < -2) was also 2.4 [1.5, 3.8] and 2.3 times [1.2, 4.1] higher in SGA than AGA group at ages 2y and 6-7y, respectively, with no differences at 10y. Although preterm children had higher rates of thinness and stunting at 2y compared to AGA children, these differences were not statistically significant. No associations were found between preterm or SGA and overweight /obesity at age 10-11y.
Children who were born term-SGA continued to demonstrate deficits in weight and height during childhood whereas those born preterm showed catch-up growth by age 6-7y. Additional efforts to reduce the burden of these conditions are needed, particularly during school-age and early adolescents when children are exposed to challenging environments and have higher demands for nutrition.
早产和小于胎龄（SGA）仍是全球重大的公共卫生问题。然而，来自低收入或中等收入国家的关于其儿童期生长模式的证据有限。
我们调查了早产和SGA儿童与足月适于胎龄（AGA）儿童从出生到10 - 11岁的产后生长模式，并研究了出生状况对学龄期儿童营养状况的影响。
越南参与孕前微量营养素补充双盲随机对照试验的妇女所生儿童被分为三组：早产AGA（n = 130）、足月SGA（n = 165）和足月AGA（n = 1072）。前瞻性收集出生时、3、6、12、18、24个月以及6 - 7岁和10 - 11岁时的人体测量数据（体重和身高）。我们使用方差分析和多元回归模型来研究从出生到10 - 11岁的生长模式差异以及按出生状况划分的儿童营养不良和营养过剩情况。
早产儿童出生后生长迅速，但在1岁和2岁时身高别年龄（HAZ）仍较低，6岁时赶上AGA组。与AGA出生的儿童相比，SGA婴儿在2岁和6岁时消瘦（体质指数Z评分[BMIZ] < -2）风险更高（校正比值比，AOR[95%置信区间]分别为2.5[1.0, 6.1]和2.6[1.4, 4.6]）；这种风险在10 - 11岁时降低（1.6[0.9, 2.8]）。在2岁和6 - 7岁时，SGA组发育迟缓（HAZ < -2）的风险也分别比AGA组高2.4[1.5, 3.8]倍和2.3倍[1.2, 4.1]，10岁时无差异。尽管早产儿童在2岁时消瘦和发育迟缓的发生率高于AGA儿童，但这些差异无统计学意义。在10 - 11岁时，未发现早产或SGA与超重/肥胖之间存在关联。
足月SGA出生的儿童在儿童期体重和身高仍持续存在不足，而早产儿童在6 - 7岁时表现出追赶生长。需要做出更多努力来减轻这些情况的负担，特别是在学龄期和青少年早期，此时儿童面临具有挑战性的环境且对营养需求更高。
