Interpretation of Catch-Up Growth in Infants and Young Children with Faltering Growth：Expert Opinion to Guide General Clinicians

doi:10.3877/cma.j.issn.1673-5250.2024.04.001

The international panel of experts on pediatric growth and nutrition，having reviewed and analyzed the existing evidence and guidelines on faltering growth（FG）in infants and young children under 2 years of age and published Catch-Up Growth in Infants and Young Children with Faltering Growth：Expert Opinion to Guide General Clinicians［hereinafter referred to as the FG Consensus（2023 Ed）］.It further clarifies the definition of FG and provides important recommendations for the diagnosis and management of children with FG.The FG Consensus（2023 Ed）emphasizes the differences in the etiology and management of FG infants and young children under 2 years in countries with different income levels，which is a good guide to the clinical practice of FG infants and young children under 2 years.In order to help clinicians better identify and standardize the management of children with FG at an early stage，the authors intend to interpret the definitions of FG，catch-up growth and growth acceleration in the FG Consensus（2023 Ed），and the characteristics of infants and young children with FG，management measures，and diagnostic and nutritional measures in countries with different income levels.

Key words: Faltering growth, Growth and development, Catch-up growth, Practice guideline, Expert consensus, Nutrition governance, Infant and young child

表1 基于《FG 共识（2023版）》的生长减缓和生长迟缓对比

定义及临床意义	生长减缓（faltering growth）	生长迟缓（stunting）
定义	＜2岁婴幼儿，持续超过1个月W/A≤-1s（W/A的Z评分下降值≥1.0），其中不包括出生后前2周生理性体重减轻	婴幼儿H/A低于正常参考值的P₃或2s
临床意义	反映多种原因导致的婴幼儿生长受损	反映婴幼儿长期营养不良

表1 基于《FG 共识（2023版）》的生长减缓和生长迟缓对比

定义及临床意义	生长减缓（faltering growth）	生长迟缓（stunting）
定义	＜2岁婴幼儿，持续超过1个月W/A≤-1s（W/A的Z评分下降值≥1.0），其中不包括出生后前2周生理性体重减轻	婴幼儿H/A低于正常参考值的P₃或2s
临床意义	反映多种原因导致的婴幼儿生长受损	反映婴幼儿长期营养不良

表2 基于《FG 共识（2023版）》的追赶生长和加速生长比较

定义及结局	追赶生长（catch-up growth）	加速生长（growth acceleration）
定义	FG婴幼儿，生长水平恢复到发生FG前的水平	未发生FG的婴幼儿，W/A的Z评分增加≥1.0
结局	改善FG，有益于婴幼儿生长、发育	与婴幼儿成年后发生肥胖和其他代谢疾病相关，不利于其远期健康

表2 基于《FG 共识（2023版）》的追赶生长和加速生长比较

定义及结局	追赶生长（catch-up growth）	加速生长（growth acceleration）
定义	FG婴幼儿，生长水平恢复到发生FG前的水平	未发生FG的婴幼儿，W/A的Z评分增加≥1.0
结局	改善FG，有益于婴幼儿生长、发育	与婴幼儿成年后发生肥胖和其他代谢疾病相关，不利于其远期健康

图1 《FG 共识（2023版）》推荐的对FG 婴幼儿采取的诊疗模式^［2］注：《FG 共识（2023版）》是指《生长减缓婴幼儿的追赶性生长：指导普通临床医师的专家共识（Catch-Up Growth in Infants and Young Children with Faltering Growth：Expert Opinion to Guide General Clinicians）》。FG 为生长迟缓

［1］	National Institute for Health and Care Excellence （NICE）.Faltering growth：recognition and management of faltering growth in children［EB/OL］.（2017-09-27）［2024-03-27］.https：//www.nice.org.uk/guidance/ng75.
［2］	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.DOI：10.1097/mpg.0000000000003784.
［3］	李辉.再论儿童生长发育的科学评估［J］.中国儿童保健杂志，2021，29（6）：581-583.DOI：10.11852/zgetbjzz2021-0771.Li H.Revisiting the scientific assessment of child growth and development［J］.J Child Health Care，2021，29（6）：581-583.DOI：10.11852/zgetbjzz2021-0771.
［4］	宗心南，李辉.中国不同胎龄新生儿生长参照标准的建立：调查方案设计和标准研制方法［J］.中国循证儿科杂志，2020，15（4）：251-260.DOI：10.3969/j.issn.1673-5501.2020.04.003.Zong XN，Li H.Establishment of growth standards for Chinese newborns by gestational ages：study design and stastical methods［J］.Chin J Evidence Based Paediatr，2020，15（4）：251-260.DOI：10.3969/j.issn.1673-5501.2020.04.003.
［5］	de Onis M，Blössner M.The World Health Organization Global Database on Child Growth and Malnutrition：methodology and applications［J］.Int J Epidemiol，2003，32（4）：518-526.DOI：10.1093/ije/dyg099.
［6］	张海洋，刘瀚旻.早产儿生命早期肺发育轨迹研究现状［J/OL］.中华妇幼临床医学杂志（电子版），2021，17（4）：373-379.DOI：10.3877/cma.j.issn.1673-5250.2021.04.001.Zhang HY，Liu HM.Current research status on developmental trajectory of lung in premature infants［J/OL］.Chin J Obstet Gynecol Pediatr （Electron Ed），2021，17（4）：373-379.DOI：10.3877/cma.j.issn.1673-5250.2021.04.001.
［7］	Benjamin-Chung J，Mertens A，Colford JM Jr，et al.Earlychildhood linear growth faltering in low-and middle-income countries［J］.Nature，2023，621（7979）：550-557.DOI：10.1038/s41586-023-06418-5.
［8］	Keats EC，Das JK，Salam RA，et al.Effective interventions to address maternal and child malnutrition：an update of the evidence［J］.Lancet Child Adolesc Health，2021，5（5）：367-384.DOI：10.1016/s2352-4642（20）30274-1.
［9］	Burstein R，Henry NJ，Collison ML，et al.Mapping 123 million neonatal，infant and child deaths between 2000 and 2017［J］.Nature，2019，574（7778）：353-358.DOI：10.1038/s41586-019-1545-0.
［10］	Victora CG，Christian P，Vidaletti LP，et al.Revisiting maternal and child undernutrition in low-income and middleincome countries：variable progress towards an unfinished agenda［J］.Lancet，2021，397（10282）：1388-1399.DOI：10.1016/s0140-6736（21）00394-9.
［11］	唐梅，杨凡.母乳喂养与儿童单纯性肥胖的研究现状［J/OL］.中华妇幼临床医学杂志（电子版），2022，18（3）：269-274.DOI：10.3877/cma.j.issn.1673-5250.2022.03.004.Tang M，Yang F.Current research status between breastfeeding and childhood simple obesity［J/OL］.Chin J Obstet Gynecol Pediatr （Electron Ed），2022，18（3）：269-274.DOI：10.3877/cma.j.issn.1673-5250.2022.03.004.
［12］	Rana R，Mcgrath M，Gupta P，et al.Feeding interventions for infants with growth failure in the first six months of life：a systematic review［J］.Nutrients，2020，12（7）：2044.DOI：10.3390/nu12072044.
［13］	中华预防医学会儿童保健分会.婴幼儿喂养与营养指南［J］.中国妇幼健康研究，2019，30（4）：392-417.DOI：10.3969/j.issn.1673-5293.2019.04.001.China Preventive Medicine Association，Society of Child Health.Guide to infant feeding and nutrition［J］.Chin J Woman Child Health Res，2019，30（04）：392-417.DOI：10.3969/j.issn.1673-5293.2019.04.001.
［14］	中华人民共和国国家卫生健康委员会.儿童青少年生长迟缓食养指南（2023 年版）［EB/OL］.（2023-01-18）［2024-06-01］.http：//www.nhc.gov.cn/sps/s7887k/202301/0e55a01df50c47d9a4a43db026e3afc3.shtml.National Health Commission of the People's Republic of China.Food and nutritional guidelines for children and adolescents with growth retardation（2023 edition）［EB/OL］.（2023-01-18）［2024-06-01］.http：//www.nhc.gov.cn/sps/s7887k/202301/0e55a01df50c47d9a4a43db026e3afc3.shtml.

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