将慢性病防控关口前移至生命早期

Moving chronic disease prevention and control upstream to early life

摘要

随着社会经济发展和疾病谱的变化,以肥胖、心脑血管疾病、糖尿病、慢性呼吸系统疾病和部分肿瘤为代表的慢性非传染性疾病已成为威胁我国居民健康的重大公共卫生问题。传统慢性病防控策略多聚焦于成年期的行为干预和危险因素控制。越来越多证据表明,慢性病的根源可追溯至生命早期,甚至胎儿期。本文系统阐述了生命早期(包括孕期、婴儿期和儿童早期)营养、环境、心理等因素对个体远期慢性病风险的深远影响,并提出构建覆盖“孕前-孕期-出生后-儿童期”全链条的早期预防策略体系,推进我国儿童保健工作向“以健康促进为中心”转变。

Abstract

With socioeconomic development and changes in disease patterns, chronic noncommunicable diseases, including obesity, cardiovascular and cerebrovascular diseases, diabetes, chronic respiratory diseases, and certain cancers, have become major public health threats to the population in China. Traditional strategies for chronic disease prevention and control have primarily focused on behavioral interventions and risk-factor management during adulthood. However, growing evidence indicates that the origins of chronic diseases can be traced back to early life and even the fetal period. It further proposes establishing a full-chain early prevention strategy system covering the period from pregnancy, infancy, and early childhood, so as to promote the transition of child health care in China toward a health-promotion-centered model.

关键词

慢性病预防 / 生命早期 / 健康与疾病发育起源 / 儿童保健

Key words

chronic disease prevention / early life / Developmental Origins of Health and Disease / child health care

[1] Barker DJP. Developmental origins of chronic disease[J]. Public Health, 2012, 126(3): 185-189.
[2] Gluckman PD, Hanson MA, Buklijas T. A conceptual framework for the developmental origins of health and disease[J]. J Dev Orig Health Dis, 2010, 1(1): 6-18.
[3] Koletzko B, Godfrey KM, Poston L, et al. Nutrition during pregnancy, lactation and early childhood and its implications for maternal and long-term child health: The early nutrition project recommendations[J]. Ann Nutr Metab, 2019, 74(2): 93-106.
[4] Roseboom TJ, van der Meulen JH, Ravelli ACJ, et al. Effects of prenatal exposure to the Dutch famine on adult disease in later life: An overview[J]. Mol Cell Endocrinol, 2001, 185(1-2): 93-98.
[5] Gluckman PD, Hanson MA. Mismatch: Why our world no longer fits our bodies[M]. Oxford University Press, 2006.
[6] Godfrey KM, Reynolds RM, Prescott SL, et al. Influence of maternal obesity on the long-term health of offspring[J]. Lancet Diabetes Endocrinol, 2017, 5(1): 53-64.
[7] Saravanan P; Diabetes in Pregnancy Working Group; Maternal Medicine Clinical Study Group,Royal College of Obstetricians and Gynaecologists, UK. Gestational diabetes: Opportunities for improving maternal and child health[J]. Lancet Diabetes Endocrinol, 2020, 8(9):793-800.
[8] Tarry-Adkins JL, Ozanne SE. Mechanisms of early life programming: Current knowledge and future directions[J]. Am J Clin Nutr, 2011, 94(Suppl):1765-1771.
[9] Lillycrop KA, Burdge GC. Epigenetic mechanisms linking early nutrition to long term health[J]. Best Pract Res Clin Endocrinol Metab, 2012, 26(5): 667-676.
[10] Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect[J]. Lancet, 2016, 387(10017): 475-490.
[11] Rito AI, Buoncristiano M, Spinelli A, et al. Association between characteristics at birth, breastfeeding and obesity in 22 countries: The WHO European childhood obesity surveillance initiative-COSI 2015/2017[J]. Obes Facts, 2019, 12(2): 226-243.
[12] Scheepers LE, Penders J, Mbakwa CA, et al. The intestinal microbiota composition and weight development in children: The KOALA Birth Cohort Study[J]. Int J Obes (Lond), 2015, 39(1): 16-25.
[13] Vandenplas Y, Żółkowska J, Berni Canani R, et al. Probiotics and prebiotics in infant nutrition: A review of current evidence and guidelines[J]. J Pediatr Gastroenterol Nutr, 2022, 75(Suppl 1): 1-50.
[14] 中华医学会儿科学分会内分泌遗传代谢学组, 国家儿童健康与疾病临床医学研究中心, 中华医学会儿科学分会儿童保健学组, 等. 婴幼儿肥胖管理专家共识(2025)[J]. 中华儿科杂志, 2025, 63(11): 1182-1188.
The Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association; National Clinical Research Center for Child Health; the Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Association, et al. Expert consensus on the management of obesity in infant and toddler (2025)[J].Chin J Pediatr, 2025, 63(11):1182-1188. (in Chinese)
[15] Ruan H, Xun P, Cai W, et al. Habitual sleep duration and risk of childhood obesity: Systematic review and dose-response meta-analysis of prospective cohort studies[J]. Sci Rep, 2015, 5: 16160.
[16] Noroña-Zhou AN, Coccia M, Epel E, et al. The effects of a prenatal mindfulness intervention on infant autonomic and behavioral reactivity and regulation[J]. Psychosom Med, 2022, 84(5): 525-535.
[17] Gheisary Z, Thompson JA. The promise and challenges of exposomics in child health research[J]. Pediatr Res, 2025. doi:10.1038/s41390-025-04609-6.
[18] Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice[J]. Curr Opin Psychiatry, 2012,25(2):141-148.
[19] 中华医学会儿科学分会儿童保健学组,中华医学会儿科学分会临床营养学组,中华医学会围产医学分会,等. 母乳喂养促进策略指南(2026版)[J]. 中华儿科杂志,2026,64(5):467-468.
The Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Association;the Subspecialty Group of Clinical Nutrition, the Society of Pediatrics, Chinese Medical Association;the Society of Perinatal Medicine, Chinese Medical Association,Chinese Nutrition Society Maternal and Child Nutrition Branch, et al. Guidelines for breastfeeding promotion strategies (2026)[J]. Chin J Pediatr, 2026,64(5):467-468.(in Chinese)
[20] Cooke R, Goulet O, Huysentruyt K, et al. Catch-up growth in infants and young children with faltering growth: Expert opinion to guide general clinicians[J]. J Pediatr Gastroenterol Nutr, 2023, 77(1): 7-15.
[21] Wang QS, Yin J, Zhang X, et al. Applications of artificial intelligence in early childhood health management: A systematic review from fetal to pediatric periods[J]. Front Pediatr, 2025, 13: 1613150.