出生后 1000 天内的热应激对胎儿和婴儿生长的影响：ENID 随机对照试验的二次分析。

IF 24.1 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health Pub Date : 2024-10-01 DOI:10.1016/S2542-5196(24)00208-0

Ana Bonell PhD , Prof Ana M Vicedo-Cabrera PhD , Giovenale Moirano PhD , Bakary Sonko BSc , David Jeffries PhD , Prof Sophie E Moore PhD , Prof Andy Haines F Med Sci , Prof Andrew M Prentice PhD , Prof Kris A Murray PhD

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引用次数: 0

摘要

背景：气候变化、粮食不安全和营养不良等危机相互交织，对儿童的影响尤为严重。了解热量对受孕至 2 岁儿童生长的影响非常重要，因为热量会在短期内和整个生命过程中对死亡率和发病率产生影响：在这项二次分析中，我们使用了来自冈比亚西基昂早期营养与免疫发展（ENID）随机对照试验的纵向孕期队列数据，该试验发生在 2010 年 1 月 20 日至 2015 年 2 月 10 日之间。ENID试验评估了从妊娠20周开始的生命最初1000天的微量营养素补充情况，在此期间对人体测量数据进行了前瞻性收集。我们采用多变量线性回归评估了热应激（以通用热气候指数[UTCI]定义）对宫内生长受限的影响，该影响基于出生时胎龄身长Z值（LGAZ）、胎龄体重Z值（WGAZ）和胎龄头围Z值（HCGAZ），并评估了补充剂干预对热应激与婴儿人体测量之间关系的影响修正。我们使用多变量、多层次线性回归法评估了热应激对婴儿出生后生长的影响，其依据是婴儿0至2岁期间的体重身高Z值（WHZ）、体重年龄Z值（WAZ）和身高年龄Z值（HAZ）：668 名活产婴儿（329 名[49%]女婴和 339 名[51%]男婴）的完整数据。UTCI日平均最高暴露温度每升高1°C，在妊娠的前三个月，我们观察到WGAZ下降（-0-04 [95% CI -0-09 to 0-00]），而在妊娠的后三个月，我们观察到HCGAZ上升（0-06 [95% CI 0-00 to 0-12]），尽管95% CI包括0.5°C。母体在妊娠三个月内补充蛋白质能量与日平均最高UTCI暴露温度每升高1°C，WGAZ降低（-0-16 [-0-30 to -0-02]）有关，而标准护理（铁和叶酸）或多种微量营养素补充均未发现热应激对WGAZ的影响。在产后分析中，645 名婴儿（316 名[49%]女婴和 329 名[51%]男婴）2 岁时的人体测量数据完整。产后热应激的影响因婴儿年龄而异，6-18 个月的婴儿受影响最大。在 12 个月大的婴儿中，暴露于 30°C 的日平均 UTCI（前 90 天期间）与 25°C 的 UTCI 相比，我们观察到平均 WHZ（-0-43 [95% CI -0-57 to -0-29]）和平均 WAZ（-0-35 [95% CI -0-45 to -0-26]）降低。我们观察到，在 6 个月大时，随着热应激暴露程度的增加，HAZ 略有增加，但在较大年龄时则没有影响：我们的研究结果表明，热应激会影响2岁以内的产前和产后生长，但敏感性可能因年龄而异。在地球迅速变暖的背景下，这些发现可能会对个人健康产生短期和长期影响，并对公共儿童健康产生近期和未来的影响：惠康基金会。

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Effect of heat stress in the first 1000 days of life on fetal and infant growth: a secondary analysis of the ENID randomised controlled trial

Background

The intersecting crises of climate change, food insecurity, and undernutrition disproportionately affect children. Understanding the effect of heat on growth from conception to 2 years of age is important because of mortality and morbidity implications in the near term and over the life course.

Methods

In this secondary analysis, we used longitudinal pregnancy cohort data from the Early Nutrition and Immunity Development (ENID) randomised controlled trial in West Kiang, The Gambia, which occurred between Jan 20, 2010, and Feb 10, 2015. The ENID trial assessed micronutrient supplementation in the first 1000 days of life starting from 20 weeks’ gestation, during which anthropometric measurements were collected prospectively. We used multivariable linear regression to assess the effect of heat stress (defined by Universal Thermal Climate Index [UTCI]) on intrauterine growth restriction based on length-for-gestational age Z score (LGAZ), weight-for-gestational age Z score (WGAZ), and head circumference-for-gestational age Z score (HCGAZ) at birth, and assessed for effect modification of supplement intervention on the relationship between heat stress and infant anthropometry. We used multivariable, multilevel linear regression to evaluate the effect of heat stress on infant growth postnatally based on weight-for-height Z score (WHZ), weight-for-age Z score (WAZ), and height-for-age Z score (HAZ) from 0 to 2 years of age.

Findings

Complete data were available for 668 livebirth outcomes (329 [49%] female infants and 339 [51%] male infants). With each 1°C increase in mean daily maximum UTCI exposure, in the first trimester, we observed a reduction in WGAZ (–0·04 [95% CI –0·09 to 0·00]), whereas in the third trimester, we observed an increase in HCGAZ (0·06 [95% CI 0·00 to 0·12]), although 95% CIs included 0. Maternal protein-energy supplementation in the third trimester was associated with reduced WGAZ (–0·16 [–0·30 to –0·02]) with each 1°C increase in mean daily maximum UTCI exposure, while no effect of heat stress on WGAZ was found with either standard care (iron and folate) or multiple micronutrient supplementation. For the postnatal analysis, complete anthropometric data at 2 years were available for 645 infants (316 [49%] female infants and 329 [51%] male infants). Postnatally, heat stress effect varied by infant age, with infants aged 6–18 months being the most affected. In infants aged 12 months exposed to a mean daily UTCI of 30°C (preceding 90-day period) versus 25°C UTCI, we observed reductions in mean WHZ (–0·43 [95% CI –0·57 to –0·29]) and mean WAZ (–0·35 [95% CI –0·45 to –0·26]). We observed a marginal increase in HAZ with increasing heat stress exposure at age 6 months, but no effect at older ages.

Interpretation

Our results suggest that heat stress impacts prenatal and postnatal growth up to 2 years of age but sensitivity might vary by age. In the context of a rapidly warming planet, these findings could have short-term and long-term health effects for the individual, and immediate and future implications for public child health.

Funding

Wellcome Trust.

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来源期刊

Lancet Planetary Health Multiple-

CiteScore

28.40

自引率

2.30%

发文量

272

审稿时长

8 weeks

期刊介绍： The Lancet Planetary Health is a gold Open Access journal dedicated to investigating and addressing the multifaceted determinants of healthy human civilizations and their impact on natural systems. Positioned as a key player in sustainable development, the journal covers a broad, interdisciplinary scope, encompassing areas such as poverty, nutrition, gender equity, water and sanitation, energy, economic growth, industrialization, inequality, urbanization, human consumption and production, climate change, ocean health, land use, peace, and justice. With a commitment to publishing high-quality research, comment, and correspondence, it aims to be the leading journal for sustainable development in the face of unprecedented dangers and threats.