背景:健康与疾病的发展起源(DOHaD)范式强调了早期生活因素对预防慢性健康状况的重要性,像2型糖尿病(T2DM)和肥胖,不成比例地影响加拿大的原住民社区。尽管DOHaD在怀孕期间与孕产妇健康相关的研究越来越多,儿童早期的成长模式,以及许多人口的婴儿喂养方法,加拿大原住民社区的数据有限。与桑迪湖原住民合作,该项目的目的是描述第一民族婴儿/儿童在出生后6年的出生体重和生长模式,并研究母婴社会和行为因素对出生体重和生长轨迹的影响。
方法:我们通过社区公告和诊所访问招募了194个家庭。在1周和2周;1、2、6、12和18个月;以及2、3、4、5和6岁时测量婴儿/儿童的身长/身高和体重。孕产妇和婴儿/儿童问卷收集了有关健康的数据,营养,和社会支持。年龄体重z评分(WAZ),身高年龄z得分(HAZ),使用WHO参考标准计算BMI/年龄z评分(BAZ),并使用广义累加模型分析轨迹.使用广义估计方程和逻辑回归来确定暴露与结果之间的关联。
结果:WAZ和BAZ均高于WHO平均值,并随年龄增长而增加,直至6岁。广义估计方程表明WAZ与年龄呈正相关(0.152;95%CI0.014,0.29),HAZ与出生体重呈正相关(0.155;95%CI0.035,0.275),和BAZ与照顾者的BMI呈正相关(0.049;95%CI0.004,0.090)。暴露于妊娠糖尿病后体重快速增加(RWG)的几率增加(OR:7.47,95%CI1.68,46.22)。几乎70%的父母开始母乳喂养,母乳喂养开始与较低的WAZ(-0.18;95%CI-0.64,0.28)和BAZ(-0.23;95%CI-0.79,0.34)适度相关.
结论:这项工作强调了可能导致T2DM病因的早期生活因素,可用于支持社区和土著主导的预防策略。
The Developmental Origins of Health and Disease (DOHaD) paradigm emphasizes the significance of early life factors for the prevention of chronic health conditions, like type 2 diabetes (T2DM) and obesity, which disproportionately affect First Nations communities in Canada. Despite increasing DOHaD research related to maternal health during pregnancy, early childhood growth patterns, and infant feeding practices with many populations, data from First Nations communities in Canada are limited. In partnership with Sandy Lake First Nation, the aims of this project were to characterize birthweights and growth patterns of First Nations infants/children over the first 6 years of life and to
study the impact of maternal and infant social and behavioral factors on birthweight and growth trajectories.
We recruited 194 families through community announcements and clinic visits. Infant/child length/height and weight were measured at 1 and 2 weeks; 1, 2, 6, 12, and 18 months; and 2, 3, 4, 5 and 6 years. Maternal and infant/child questionnaires captured data about health, nutrition, and social support. Weight-for-Age z-score (WAZ), Height-for-Age z-score (HAZ), and BMI-for-Age z-score (BAZ) were calculated using WHO reference standards and trajectories were analyzed using generalized additive models. Generalized estimating equations and logistic regression were used to determine associations between exposures and outcomes.
WAZ and BAZ were above the WHO mean and increased with age until age 6 years. Generalized estimating equations indicated that WAZ was positively associated with age (0.152; 95% CI 0.014, 0.29), HAZ was positively associated with birthweight (0.155; 95% CI 0.035, 0.275), and BAZ was positively associated with caregiver\'s BMI (0.049; 95% CI 0.004, 0.090). There was an increased odds of rapid weight gain (RWG) with exposure to gestational diabetes (OR: 7.47, 95% CI 1.68, 46.22). Almost 70% of parents initiated breastfeeding, and breastfeeding initiation was modestly associated with lower WAZ (-0.18; 95% CI -0.64, 0.28) and BAZ (-0.23; 95% CI -0.79, 0.34).
This work highlights early life factors that may contribute to T2DM etiology and can be used to support community and Indigenous-led prevention strategies.