Dinh dưỡng, nhiễm trùng và tình trạng thấp còi: vai trò của sự thiếu hụt các dưỡng chất và thực phẩm riêng lẻ, cũng như viêm nhiễm, như những yếu tố quyết định việc giảm tốc độ tăng trưởng chiều cao ở trẻ em
Tóm tắt
Sự điều hòa tăng trưởng chiều cao do ảnh hưởng của dinh dưỡng và viêm nhiễm được xem xét trong bối cảnh quá trình tạo xương vùng sụn tăng trưởng, nhằm hiểu rõ hơn về tình trạng thấp còi ở trẻ em. Tăng trưởng chiều cao được kiểm soát bởi các cơ chế tín hiệu phân tử phức tạp phụ thuộc vào di truyền, sinh lý và dinh dưỡng thông qua các yếu tố nhịn cơ thể/hệ nội tiết/tự tiết, có thể bao gồm cả sự đủ giấc ngủ thông qua ảnh hưởng của nó đến sự tiết hormone tăng trưởng. Viêm nhiễm, đi kèm với hầu hết các bệnh nhiễm trùng và rối loạn tiêu hóa môi trường, cản trở quá trình tạo xương vùng sụn thông qua tác động của các chất trung gian bao gồm cytokine viêm, hệ thống activin A-follistatin, glucocorticoid và yếu tố tăng trưởng nguyên bào sợi 21 (FGF21). Trong các mô hình động vật, tăng trưởng chiều cao đặc biệt nhạy cảm với protein dinh dưỡng cũng như lượng Zn, tác động thông qua insulin, yếu tố tăng trưởng giống insulin-1 (IGF-1) và các protein gắn kết của nó, triiodothyronine, axit amin và Zn2+ để kích thích tổng hợp protein và proteoglycan vùng sụn tăng trưởng cũng như tiến trình chu kỳ tế bào, các hoạt động này bị chặn bởi corticosteroid và cytokine viêm. Các nghiên cứu quan sát trên con người chỉ ra rằng tình trạng thấp còi có liên quan đến chế độ ăn uống thiếu dinh dưỡng, chủ yếu là chế độ ăn dựa trên thực vật. Các nghiên cứu can thiệp cung cấp một số hỗ trợ cho các sự thiếu hụt về năng lượng, protein, Zn và i-ốt cũng như cho sự thiếu hụt nhiều vi chất, ít nhất là trong thai kỳ. Trong các thực phẩm nguồn động vật, chỉ có sữa được chỉ ra đặc biệt và thường xuyên có ảnh hưởng quan trọng đến tăng trưởng chiều cao ở cả trẻ em thiếu dinh dưỡng và đủ dinh dưỡng. Tuy nhiên, viêm nhiễm do nhiễm trùng, rối loạn tiêu hóa môi trường, có thể phổ biến khi không có nước sạch, vệ sinh và vệ sinh đầy đủ (WASH), và viêm nội sinh liên quan đến thừa mỡ, trong mỗi trường hợp này, góp phần vào tình trạng thấp còi và có thể giải thích tại sao các can thiệp dinh dưỡng thường không thành công. Các can thiệp hiện tại nhằm giảm tình trạng thấp còi đang tập trung vào WASH cũng như dinh dưỡng.
Từ khóa
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