背景:体重过重与儿童哮喘的发展有关。然而,早产和足月后代的趋势可能不同。
目的:评估年龄纵向体重(WFA)与早期哮喘/反复喘息几率的相关性在早产和足月儿童之间是否存在差异。
方法:本研究使用前瞻性收集的维生素D产前哮喘减少试验(VDAART)的数据。儿童(n=804)进行随访和人体测量,包括WFA,在出生时每年服用,直到6岁。主要结果是3岁和6岁时的哮喘/反复喘息。
结果:在后代中,71(8.8%)过早。在所有的孩子中,WFAz评分每增加一个单位,哮喘/喘息复发的机率在3年时增加15%(aOR=1.15,95CI:1.10~1.20;p<0.001),在6岁时增加9%(aOR=1.09,95CI:1.07~1.11;p<0.001).足月后代和早产后代的几率不同(p交互作用<0.001)。在学期后代中,3岁和6岁患哮喘/反复喘息的几率分别增加了22%和15%,分别(aOR=1.22,95CI:1.16-1.27;p<0.001和aOR=1.15,95CI:1.11-1.18;p<0.001)。在早产后代中,到3岁时,WFAz评分每增加一个单位,哮喘/喘息复发的几率就降低10%(aOR=0.90,95CI:0.81-0.99;p=0.030),到6岁时降低27%(aOR=0.73,95CI:0.61-0.86;p<0.001).
结论:在生命早期,标准WFA的增加与足月儿童哮喘/反复喘息的几率较高相关.相反,在早产儿中,追赶生长期间较高的标准化WFA可能降低与早产相关的哮喘/反复喘息的几率.
Excessive weight is associated with the development of childhood asthma. However, trends among preterm and term offspring may differ.
To assess whether the association of longitudinal weight for age (WFA) and odds of asthma/recurrent wheeze in early life differs between children born preterm and those born at term.
This study used prospectively collected data from the Vitamin D Antenatal Asthma Reduction Trial. Children (n = 804) were followed-up and anthropometric measurements, including WFA, were taken at birth and annually until the age of 6 years. The primary outcome was asthma/recurrent wheeze by age 3 and 6 years.
Among the offspring, 71 (8.8%) were premature. In all the children, the odds of asthma/recurrent wheeze increased by 15% (adjusted odds ratio [aOR], 1.15; 95% CI, 1.10-1.20; P < .001) by age 3 years and 9% (aOR, 1.09; 95% CI, 1.07-1.11; P < .001) by age 6 years for each unit increase in WFA z score. Odds were different between term and preterm offspring (Pinteraction < .001). In term offspring, the odds of having asthma/recurrent wheeze by age 3 and 6 years increased by 22% and 15%, respectively (aOR, 1.22, 95% CI, 1.16-1.27, P < .001, and aOR, 1.15, 95% CI, 1.11-1.18, P < .001). In preterm offspring, by age 3 years, odds of asthma/recurrent wheeze decreased by 10% for each unit increase in WFA z score (aOR, 0.90; 95% CI, 0.81-0.99; P = .030) and decreased by 27% by age 6 years (aOR, .73; 95% CI, 0.61-0.86; P < .001).
During early life, increasing standardized WFA is associated with higher odds of asthma/recurrent wheeze in term children. In contrast, in preterm children, a higher standardized WFA during catch-up growth may decrease the odds of asthma/recurrent wheeze associated with prematurity.