目的 通过纵向队列研究探索足月小于胎龄儿(SGA)幼儿期增长速率与学龄期肥胖风险,为制定相应防控措施提供理论依据。方法 通过2004-2011年的队列研究,对出生时入组随访至6岁的2 079名SGA儿童进行体格检查,测量身高、体重、头围等基本信息,并根据世界卫生组织标准,采用体重指数(BMI)评价儿童体格状况。结果 根据生后前4个月的体重变化的Z分数(ΔWAZ)分为4组:增长速率缓慢(ΔWAZ<-0.67),增长速率适中(ΔWAZ-0.67～0.67),增长速率快(ΔWAZ 0.67～1.28),增长速率极快(ΔWAZ＞1.28),生长速率增快的同时超重肥胖的风险成倍增加,增长速率极快组以及增长速率快组超重肥胖风险分别是增长速率适中组儿童的11.91、2.34倍(OR=11.91,95%CI:9.04~15.76,P<0.001; OR=2.34,95%CI:1.80~3.03,P<0.001)。增长速率缓慢组的消瘦风险明显增高(OR=2.48,95%CI:1.81~3.39,P<0.001)。增重速率的快速增加不能降低消瘦/生长迟缓的发生(OR=0.68,95%CI:0.48~0.95,P>0.05)。结论 SGA儿童幼儿期增长速率过快将会显著增加学龄期超重肥胖风险,应重视SGA儿童体格发育情况的早期监测,及早确定SGA儿童在幼儿期是否存在增长速率过快的特征,可能会有助于制定相关的预防策略,以减少生长速率过快可能带来的远期不良代谢风险。
Abstract
Objective To explore the correlation between growth rate of small for gestational age(SGA) infants and the risk of obesity in school-age children by longitudinal cohort study,so as to provide theoretical basis for making corresponding prevention and control measures. Methods A cohort study including 2 079 SGA infants was conducted from 2004 to 2011,who were followed up to 6 years old from birth.Height,weight and head circumference of SGA infants were measured,and their physical conditions were assessed by the World Health Organization (WHO) standards. Results According to Z score (ΔWAZ) of body weight change in the first four months after birth,the participants were divided into 4 groups,including slow growth rate (ΔWAZ<-0.67),moderate growth rate (ΔWAZ-0.67-0.67),rapid growth rate (ΔWAZ 0.67-1.28),and extremely rapid growth rate (ΔWAZ＞1.28).The overweight and obesity risks increased with the increasing of growth rate.Compared with children with moderate growth rate,the risk of overweight and obesity in rapid growth rate and extremely rapid growth rate groups were 11.91 times and 2.34 times higher than those in the moderate growth rate group,respectively(OR=11.91,95%CI:9.04-15.76,P<0.001;OR=2.34,95%CI:1.80-3.03,P<0.001).And the risk for emaciation significantly increased in slow growth rate group(OR=2.48,95%CI:1.81-3.39,P<0.001).However,the extremely rapid growth rate could not reduce the risk for emaciation/growth retardation(OR=0.68,95%CI:0.48-0.95,P>0.05). Conclusions Rapid growth rate of SGA infants will increase the risk of overweight and obesity in school-age children significantly.Early monitoring of physical development of SGA infants should be thought highly of,so that whether the growth rate of SGA children is too fast could be determined as early as possible.Thus,related prevention strategies could be made,thereby reducing the long-term risk of adverse metabolism associated with excessive growth.
关键词
足月小于胎龄儿 /
肥胖 /
追赶增长
Key words
full-termsmallforgestationalageinfants /
obesity /
catchingupgrowth
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基金
国家自然科学基金(81670810);上海市科学技术委员会医学引导类项目(14411965200、18411967700);上海申康医院发展中心临床科技创新项目(SHDC12015305); 上海市教育委员会高峰高原学科建设计划(20161432);上海市儿童健康服务能力建设专项规划高端儿科海外研修团队培养计划(GDEK201710);上海申康医院发展中心常见疾病适宜技术研发与推广应用项目(16CR4016A);交大医学院儿科硕士研究生临床科研能力提升计划(EKKY2018006DGD)
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