Torfs C P, Lam P K, Schaffer D M, Brand R J
California Birth Defects Monitoring Program, Emeryville 94608-1811, USA.
Teratology. 1998 Dec;58(6):241-50. doi: 10.1002/(SICI)1096-9926(199812)58:6<241::AID-TERA5>3.0.CO;2-R.
The young age of mothers of infants with gastroschisis, a congenital defect of the abdominal wall, suggested that deficient nutrition, with maternal-fetal competition for nutrients, could be a risk factor for gastroschisis. This population-based hypothesis-generating study consisted of 55 cases of gastroschisis and 182 matched controls. We assessed maternal nutrient intake during the trimester before conception with a self-reported food-frequency questionnaire and screened 38 nutrients to identify those most likely to be associated with gastroschisis. We used statistical classification trees to empirically generate cutpoints that determined the low and high levels of nutrient intakes corresponding to the risk of gastroschisis; cutpoints for most nutrients were similar to the corresponding recommended daily dietary allowances (RDAs). In univariate analysis, low intake of several nutrients emerged as the leading risk factors: carotenoids, e.g., alpha-carotene (odds ratio (OR) = 4.6; 95% confidence interval (CI) = 2.2-9.5), beta-carotene (OR = 3.1; 95% CI = 1.6-6.0); amino-acid compounds, e.g., total glutathione (OR = 3.5; 95% CI = 1.7-7.2); vitamin C (OR = 2.2; 95% CI = 1.5-7.8); vitamin E (OR = 2.3; 95% CI = 1.2-4.4); and minerals, fiber, and the fruit-and-vegetable group (OR = 3.1; 95% CI = 1.5-6.2). High intake of nitrosamines (OR = 2.4; 95% CI = 1.3-4.5) was also a good candidate. Many nutrient values were correlated and, in multivariate analysis, those most associated with gastroschisis were low alpha-carotene (OR = 4.3; 95% CI = 1.9-9.8), low total glutathione (OR = 3.3; 95% CI = 1.4-7.6), and high nitrosamines (OR = 2.6; 95% CI = 1.3-5.4). Adjusting for variables associated with gastroschisis in previous analyses of this population did not substantially alter those risks. These results suggest that maternal dietary inadequacy may be a risk factor for gastroschisis, and the three nutrients that emerged from the nutrient screening appear to be the best candidates to examine in further epidemiological analyses or biological studies.
腹裂是一种先天性腹壁缺陷，患有腹裂婴儿的母亲往往较为年轻，这表明营养不足以及母婴对营养物质的竞争可能是腹裂的一个风险因素。这项基于人群的假设生成研究包括55例腹裂病例和182例匹配的对照。我们通过一份自我报告的食物频率问卷评估了受孕前三个月母亲的营养摄入情况，并筛选了38种营养素，以确定那些最有可能与腹裂相关的营养素。我们使用统计分类树根据经验生成切点，这些切点确定了与腹裂风险相对应的低营养摄入量和高营养摄入量水平；大多数营养素的切点与相应的推荐每日膳食摄入量（RDA）相似。在单变量分析中，几种营养素摄入不足成为主要风险因素：类胡萝卜素，如α-胡萝卜素（比值比（OR）=4.6；95%置信区间（CI）=2.2-9.5）、β-胡萝卜素（OR = 3.1；95% CI = 1.6-6.0）；氨基酸化合物，如总谷胱甘肽（OR = 3.5；95% CI = 1.7-7.2）；维生素C（OR = 2.2；95% CI = 1.5-7.8）；维生素E（OR = 2.3；95% CI = 1.2-4.4）；以及矿物质、纤维和果蔬组（OR = 3.1；95% CI = 1.5-6.2）。亚硝胺摄入量高（OR = 2.4；95% CI = 1.3-4.5）也是一个重要候选因素。许多营养素值相互关联，在多变量分析中，与腹裂最相关的是低α-胡萝卜素（OR = 4.3；95% CI = 1.9-9.8）、低总谷胱甘肽（OR = 3.3；95% CI = 1.4-7.6）和高亚硝胺（OR = 2.6；95% CI = 1.3-5.4）。在对该人群先前分析中与腹裂相关的变量进行调整后，这些风险没有实质性改变。这些结果表明，母亲饮食不足可能是腹裂的一个风险因素，营养筛查中出现的这三种营养素似乎是在进一步的流行病学分析或生物学研究中进行检验的最佳候选因素。
