小柯机器人

美国加州大学Benjamin F. Arnold和Andrew Mertens共同合作，近期取得重要工作进展。他们针对低收入和中等收入国家儿童消瘦和发育迟缓的情况进行了相关预防及干预策略的研究。相关研究成果2023年9月13日在线发表于《自然》杂志上。

据介绍，到2030年消除营养不良的可持续发展目标2.2包括消除儿童消瘦，其定义为体重与长度的z分数比世界卫生组织儿童生长标准的中位数低两个标准差以上。衡量消瘦的普遍方法依赖于横断面调查，而横断面调查无法衡量发病、恢复和持续性，而这些特征为预防干预和疾病负担估计提供了关键信息。

研究人员分析了21个纵向群体样本，发现消瘦是一个高度动态的发病和恢复过程，发病率在出生到3岁之间达到峰值月。在出生头24个月的某个时间点出现消瘦的儿童比在某个时间点出现普遍消瘦的儿童要多得多。例如，在24个月大时，5.6%的儿童消瘦，但到同一年龄(24个月)时，29.2%的儿童至少经历过一次消瘦，10.0%经历过两次或两次以上。6个月前消瘦的儿童比年龄较大时消瘦的儿童恢复得更快，发作时间更短；然而，早期消瘦增加了后期生长迟缓的风险，包括同时消瘦和发育迟缓（年龄z评分偏低），从而增加了死亡率。在季节性降雨量大的不同种群中，种群平均体重-长度z评分变化很大（在一些群体中z值超过0.5 ），平均z值最低出现在最多雨的月份，表明可以考虑采取季节性干预措施。

总之，这一研究表明，必须制定干预措施来预防从出生到6个月大的儿童消瘦，可能的办法是改善产妇营养状况，以补充目前针对6到59个月龄儿童的计划。

附：英文原文

Title: Child wasting and concurrent stunting in low- and middle-income countries

Author: Mertens, Andrew, Benjamin-Chung, Jade, Colford, John M., Hubbard, Alan E., van der Laan, Mark J., Coyle, Jeremy, Sofrygin, Oleg, Cai, Wilson, Jilek, Wendy, Rosete, Sonali, Nguyen, Anna, Pokpongkiat, Nolan N., Djajadi, Stephanie, Seth, Anmol, Jung, Esther, Chung, Esther O., Malenica, Ivana, Hejazi, Nima, Li, Haodong, Hafen, Ryan, Subramoney, Vishak, Hggstrm, Jonas, Norman, Thea, Christian, Parul, Brown, Kenneth H., Arnold, Benjamin F.

Issue&Volume: 2023-09-13

Abstract: Sustainable Development Goal 2.2—to end malnutrition by 2030—includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence—key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6–59 months. An analysis of longitudinal cohort data across diverse populations suggests that the incidence of wasting between birth and 24 months is higher than previously thought, and highlights the role of seasonal factors that affect child growth.

DOI: 10.1038/s41586-023-06480-z

Source: https://www.nature.com/articles/s41586-023-06480-z

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