InfluenceFactorsonGrowthandDevelopment生長發(fā)育影響因素

1

Therearevariousoffactorsinfluencingchildrengrowthanddevelopment. *hereditaryfactorsItcanbedividedinto: *environmentalfactors2GrowthandDevelopmentTheinteractionofgeneticandenvironmentalfactors.HeriditaryfactorsdecidethepotentialEnvironmentalfactorsdecidethereality3Oneofthemaintasksofchildandadolescenthealthis:

Toinvestigatethefactors promote disturbnormalgrowthanddevelopment4SectionⅠ.GeneticinfluencefactorsHeredity：

thegenetictransmissionofcharacteristicsfromparenttooffspring

It

includesthefollowingsimilaritybetweenparentsandtheiryoung:somatic,functional,structural,physical,etc.

5

Generally,

Parents Theirchildren

high-stature high-stature morelikelyshortershort-stature short-stature morelikelyhigher1.FamilialheredityAsaresult,human’sstatureshowsnormaldistribution,thatis,mostlypersonsbeingofmediumheight

Familial

Regression6YaoMingGrandpa:2.00m

(2.26m)Dad:2.08m

Mum:1.90m

Herwife–YeLi（1.90m）

→YaoXinlei:1.94~2.08m(adulthood)?3yrs—110cmTiezhuMuDaughter:1.73m（22yrs）(2.28m）Son:1.76m（14yrs）HeightData7XisunBaoMum:1.6m

(2.36m)Dad:1.8m

Ukraine2.53mHeightData8Heritability:遺傳度theproportionofphenotypicvarianceattributabletogeneticvariance

Heritability：0.0～1.00.0(genesdonotcontributeatalltophenotypicindividualdifferences)1.0(genesaretheonlyreasonforindividualdifferences)

★9Theheritabilityofheight:0.79－male;0.92－femaleMeansthat:

ThestatureofchildreninwelllivingconditionmainlydependsontheheredityTheheritabilityofheightmeanthegeneticsfactorsplay79%oftotalrolewhiletheotherfactorsplay21%inmale(e.g.nutrition,physicalactivity,etc)10

EarlierorlaterinsexualmaturityandmenarcheagepresentfamilialheredityManyreportsalsoindicatethatthereisafairlygoodcorrelationbetweenthemenarcheagesofmothersandoftheirdaughtersSexualMaturity11Racialcharacteristics--

appearance,bodytype,staturesittingheightratioofsittingheightandbodyheight skeletonage(boneage)menarcheage,……

Thereareverydifferentinvariousethnicgroups.Itmeansthatphysicalstructuremainlyaffectedbythegeneticfactors.2.Ethnicheredity12

Cross-CulturalStudy:AfricanandEuropeanchildren:Undersamelifecondition,theaverageheightshavenosignificantdifference,butlengthoflegislongerintheformerJapanesechildgrowinginLosAngeles:Heighthigherthanthenativechild,buttheproportionofsittingheightandstatureheighthavenotanychange.13同樣是九歲，移居美國的瑪雅人比他們在危地馬拉的老鄉(xiāng)高了一頭143.TwinStudyMZ:monozygotictwins,identicaltwinsDZ:dizygotictwins,fraternaltwins雙生子是研究遺傳對(duì)兒童生長發(fā)育的影響的最好的天然素材15Intwinstudy,theheritabilitywhichexpresstheroleofgeneticfactorscanbecalculated.Heritabilityrangesfrom0.0to1.0Thebiggerofheritability,thegreatereffectofgeneticfactors16Inabroad,manytwinstudieswerereported,suchasintheU.S.,Britain,Australia,SwedenandFinland,NorthernEuropeTheresearchesfoundthatsomecharacteristicsareresembleinMZ：

appearance,fingerprint,serumtype,

antibody,

physiologicalfunction

(likebloodpressure,respiration,heartrate,EEG).17

Sexualdevelopment

isalsounderstronggeneticcontrolThedifferenceinmenarcheage：

2.8mosinagroupof51pairsofMZtwins12.0mosinagroupof47pairsofDZtwins12.9mosinagroupof145pairsofsisters18.6mosin120pairsofunrelatedwomen18InChina,fewtwinstudiesTheyfoundthattheheritabilityofskeletalage(boneage)is0.80

——Theskeletonsystemvariance: 80%bygeneticfactors 20%byenvironmentalfactorsTheincidenceoftwins:Beijing:0.6％US:1/83(1.2%) 1/3MZ19InHarbin，wefoundthattheheritabilityof

Bodyheight：0.86

Sittingheight：0.81

Weight：0.78

Chestcircumference：0.70

Astigmatism：0.77

Myopia：0.43Othersfound: Intelligence:

0.30-0.70 Personality:

0.50.20

SectionII.

TheSocialInfluenceFactors21

1.SocioeconomicstatusDifferencebetweenruralandurbanareas,especiallyinpooreconomicconditionofdevelopingcountry.Inpovertyareastheyhavesignificantretardation.Theprevalenceofbehaviorprobleminruralchildrenissignificanthigherthanthatinurbanchildren.Intellectualdevelopmentofurbanchildrenisbetterthanruralones.22【荷蘭人的增高經(jīng)驗(yàn)】1840年，荷蘭人的平均身高處于低谷，19歲的荷蘭男性只有1.62米多一點(diǎn)十九世紀(jì)中葉之后，荷蘭人開始長高21歲荷蘭男人的平均身高1.838米，21歲女性平均身高1.707米，高居世界之巔十七世紀(jì)大航海時(shí)代，荷蘭是稱霸大洋的強(qiáng)大帝國。但財(cái)富的積累并沒有直接惠及民眾，精英階層和普通民眾之間存在明顯的貧富差異1840年-1848年間，荷蘭逐步確立了議會(huì)制，從那之后，貧富差距逐漸變小。隨著人均收入的提高，荷蘭人也迅速高了起來。【9】JanJacobs,VincentTassenaar.Height,income,andnutritionintheNetherlands:thesecondhalfofthe19thcentury232.Familyfactorssocialstatusparent’soccupationeconomicconditioneducationparent’slifestyleparents’behaviorInhabitationdiethabitparents’personality,hobby,parents’attitudestowardchildrearing24Familystructuresiblings’familyuniquechild

divorcedfamily25各種不同的家庭環(huán)境對(duì)孩子影響的關(guān)系：

挑剔中成長的孩子學(xué)會(huì)苛刻；

敵意中成長的孩子學(xué)會(huì)爭斗；

譏諷中成長的孩子學(xué)會(huì)羞澀；

羞辱中成長的孩子學(xué)會(huì)自疚；

寬容中成長的孩子學(xué)會(huì)忍讓；

鼓勵(lì)中成長的孩子學(xué)會(huì)自信；

贊揚(yáng)中成長的孩子學(xué)會(huì)自賞；

公平中成長的孩子學(xué)會(huì)正直；

支持中成長的孩子學(xué)會(huì)信任；

贊同中成長的孩子學(xué)會(huì)自愛；

關(guān)愛中成長的孩子學(xué)會(huì)關(guān)愛。

263.ModernMediaTVInternetTimeContent27

SectionIII.

TheEnvironmentalFactors28A.Nutritionfactors

Childrenareinrapidlygrowthphase, itisnecessarytointakevariousnutrients, especiallyenergyadequacyandprotein,vitamins,minerals,traceelements,etc.

29FoodPyramid3031Nutrimentdeficiency：

affectlineargrowth,causeacuteandchronicmalnutrition

Catch-upgrowthcanoccurrenceinchildrenofshort-timenutrimentdeficiency.Long-termmalnutritioncanreducethevelocityofskeletalgrowth,sexualdevelopmentandintellectivedevelopment.321.Theeffectofenergyandprotein

Physiqueinfantsareeasytoaffectedby: malnutritionandinfectionsbirthweightofinfants：

enoughATP,Pr,Vitaminfoodwassuppliedtopregnantwomen,theirbaby’smeanbirthweightwasheavier400gramthanthosecontrolgroup.33SkeletondevelopmentskeletalmaturationThelong-termmalnutritioncaninfluenceskeletonmatureandbonelength,andcauseshort-stature.

34SexualdevelopmentDifferentsocialeconomiccondition:pubertalgrowthspurtappearanceofsecondarysexualcharacteristicshormonalchangesmenarcheageingirlsTheageofmenarchewasdelayedindevelopingcountry.Themeanageofmenarcheshowedsignificantretardationof1-2yearsinimpoverishedruraladolescentscomparingtoprivilegedurbanchildren.35IntelligenceNutritionplaysacriticalroleinintellectivedevelopment.From6-9monthsofgestationto6monthsafterborn.Malnutritioncanresultin: impairedsizeofthebrain subsequentintellectualimpairmentIQ(70.9)--(malnutritionchildren)IQ(93.5)–(incontrolgroupchildren)362.MicroelementsandMineralsRecentyears,thefunctionofmicro-elementsandmineralsubstancewasgraduallyemphasizedinvariousnutriment.e.g.Zinc,Calcium,IodineandSeleniumarenecessarytochildrengrowthanddevelopment.37ZincItisnecessarytonormaldevelopmentandsexualmaturationZincdeficiency:impairedtaste

(hypogeusia),Anorexia,Growthretardation,Delayedsexualmaturation,Hypogonadism,Immunedisorders,Dermatitis,

Alopecia,nightblindness,impairedwoundhealing

intelligenceelement38Dermatitis39(Left)Thisboyhasazincdeficiency,andhishairisverythinandsparse(right)aftertreatmenthishairisgrowingmorestrongly40GoodsourcesofZincMeatEggsSeafood(especiallyoysters)BeeryeastLiverSoybeanSpinachMushroomSunflowerseeds41MainmanifestationofiodinedeficiencyMaternaliodinedeficiency→spontaneousabortions,stillbirthandimpairedfoetaldevelopmentIninfancyandchildhood,

→poormentaldevelopmentandgrowthdefects.Adulthood:thyromegalythyroidhypofunction

Iodine4243FigureGlobalprevalenceofgoitre——13percentoftheworld'spopulation,areaffectedbygoitre(WHO,2001b)44Moderateiodinedeficiency:thyroidglandhypertrophiesSevereiodinedeficiency:

Maternal-

retardsfetalgrowthandbraindevelopmentInfants-endemiccretinismAdults-

endemicmyxedema--hypothyroidism45Personslivingincommunitieswithendemiciodinedeficiencymayshowanintelligencequotient13.5pointslowerthanpersonsfromsimilarcommunitieswithadequateiodinesupplies(WHO,2001b)Iodinedeficiencyisthemostpreventablecauseofbraindamageandoneoftheeasiestdisorderstoprevent:itsufficestoaddsmallamountsofiodinetofrequentlyconsumedfoodssuchascommontablesalt46Focuson:

theperiodofoptimalandeffectivelysupply:fetustheoptimalsupplyiodinetoinfants:breast-feedingnaturaliodinerichfood:seafoodsupplyiodine:saltwhichfortifiedwithiodideseafood47About99％calciumintheskeletonandteethThefirstsymptom:tetanyCalciumChildren:bonedeformitiesgrowthretardationRickets48OsteoporosisBonefractureCalciumRequirementofChildreningrowingperiod:50～70mg/kg/dayGoodsourcesofCalcium：Milk,cheese,yoghourt,sirup,almone,bovineliver49FluorideFluoride:acomponentinBonesandTeethpreventionofdentalcariesandpossiblyosteoporosis----WaterFluoridation(artificiallyfluoridatedwater)HighintakeoffluorinecanaffectCNSandcausebrainimpairment Congenitaldementia Dentalfluorosis–mottledappearance skeletalfluorosis50richsources:drinkingwatersaltwaterfishteaFluoridetoothpasteUsebyadequatecontrolinchildren51Tablefluoridecontentinwaterandtoxicityfluoridecontent(ppm)Effectandmanifestation1Preventcaries2Dentalfluorosis5Osteosclerosis810%osteosclerosis20～80Skeletalfluorosis50Thyroidglandpathologicalchanges100Growthretardation125Kidneypathologicalchangesandabnormal2.5～5.0g/LDeath52IronIrondeficiency,whichcancauseanemia,isthemostcommonnutritionaldeficiencyintheworld.Itmayresultfrominadequateironintakeinsomeinfants,adolescentgirls,andpregnantwomen.Allpersonswithirondeficiencyrequireironsupplementation.53IRONiscomponentofhemoglobinandmany

enzymes

inbody.TheeffectofIrondeficiencyanemiaFetus:nervoussystem,intelligencedevelopmentdisorder,retardationphysicaldevelopment,bodyweightundernormallevelInfant:cognitiveabilitybad,responseslow,motilitynotwell,fear,physicalmaldevelopment54Child:learningabilitynotwell,badperformancerecord,don’tlikeactivity,moveslowly,don’tlikecommunicate,physiquethinandsmallandbepronetohaveasickness.Pregnantwomen:weakandeasytofatigue,appetitebad,dizzy,pale,fetusdevelopmentretardation,prematurebirth,deadbirthincreaseinperinatalperiod55susceptiblepopulationinfants,younggirls,pregnantwomanImproveironnutritionWidespreadnutritionknowledge

AdjustdietarypatternIronreplenisherIron-fortifiedfood56SeleniumSeleniumdeficiencyisrareinforeigner,ButinChina,seleniumdeficiencyoccursinassociationwithKeshandisease,anendemicviralcardiomyopathyaffectingchildrenandyoungwomen.57EPIDEMICMapofthedistributionofKeshandiseaseontheChinesemainland,showingabeltcrossingthecountryfromthenortheasttothesouthwest58

lifeliesinmotionB.EffectofPhysicalActivity59EffectonSomaticdevelopment

ChildrenandAdolescents，whoalwaystakeexercisehavehighgrowthvelocity,were1timehigherthanthechildren,whoseldomtakeexercise,inheight,weight,andchestcircumference.60EffectonskeletalandmuscularsystemSuitablesportcanpromotetheskeletondevelopmentandcausebonemineraldensity(BMD)enlargement.Exercisecanacceleratebloodcirculationandsupplymorenutritiontomuscle.Muscletoleranceandweightwasincreasedbyexercise.61

EffectonphysiologicalfunctionOftenphysicalactivitycancause:a.

Reinforcementofmyocardium contractilityb.

Increaseofheartoutputc.

Enlargementofsurfaceofheartd.

Decreasedheartratee.

Reinforcementofbloodvesselspring62EffectonrespiratoryfunctionOftenphysicalactivitycancause:a.enlargementofrespirationweighb.developmentofrespirationmusclec.

enlargementofvitalcapacityd.

addingofchestcircumference63Effectonmuscleforce

Exerciseishelpfultoreinforcementofmuscleforce.64EffectsonNervous,endocrinesystemandimmunologicalfunctioncanraisereactionabilityofchildrenandadolescents.Athlete’reactionabilityis3-5timesaspromptasordinarypersonsreasonablephysicaltrainingcanacceleratephysical,sexualdevelopmentandsecondarysexualcharacteristics65美國衛(wèi)生及公共服務(wù)部等機(jī)構(gòu)建議：每周至少進(jìn)行進(jìn)行150分鐘溫和鍛煉，或75分鐘高強(qiáng)度鍛煉在單位體重消耗的卡路里總量一致的情況下，類似跑步、跳繩等短時(shí)間高強(qiáng)度的鍛煉比散步、悠閑騎行等長時(shí)間溫和的鍛煉方法更有益于健康66Inactivityresearch靜態(tài)對(duì)于健康的危害，即使你堅(jiān)持鍛煉也不會(huì)消除你是活躍的沙發(fā)土豆嗎？運(yùn)動(dòng)強(qiáng)度對(duì)心臟健康的影響呈現(xiàn)出一種U形曲線運(yùn)動(dòng)得少也比不動(dòng)強(qiáng)67C.TheinfluenceofdiseasesDiseaseofdigestivetract:Itisverycommondisease,includingpepticulcer,diarrhea,acuteandchronichepatitis,etc.Thesekindsofdiseasecanimpairnutrientabsorptionandcausemalnutrition.Itcertainlyaffectnormalgrowthanddevelopment.68ParasitosisIntestinalparasites,suchas,ascariasis,hookwormdisease,schistosomiasiscanresultinmalnutrition.Italsocausedelayingrowthanddevelopment.Somechildrenwholivedinschistosomiasisprevalenceareascandevelopdwarf.69EndemicdiseaseEndemiciodinedeficiencyosteoarthrosisdeformansendemicfluorosisinfluencebadlygrowthanddevelopmentofchildren.70

CongenitaldiseaseCongenitalharelipcongenitalcleftpalatecanaffectthefunctionofsuckandswallow,reduceintakeofnutriment.71

EndocrinopathyThepituitarydwarfism,causedbylackofthegrowthhormone,causeseverityretardationofgrowthanddevelopment.Girl:21yrsHeight:79cmWeight:10Kg72HereditarydiseaseDown’ssyndromeCongenitalidiocysyndromeThesechildrenhavelowerIQvalue.73InfectiousdiseaseAcuteinfections,e.g.measles,Acutegutinfections,GuthelminthinfectionsHaveaneffectonlineargrowth.Thismaydecreasefoodintake,causedirectnutrimentlosses.74

OtherdiseaseDiabetesTuberculosisBronchialasthma,Nephrosis,etc.Influencethegrowthanddevelopmentindifferentlevels.Itisverycriticaltopreventivethevariousdiseasesontime.75★

趕上生長（catch-upgrowth）兒童總是沿著一定的軌道生長，患病兒童在克服了阻礙其生長的因素后表現(xiàn)出的加速生長并恢復(fù)到正常軌跡的現(xiàn)象。俗語：

“蔫一蔫，竄一竄”76圖

某甲狀腺功能低下患兒的趕上生長77D.Geographic-climateandSeasonTherearemanyinvestigationsabouttheinfluenceofaspecificregiononthegrowthanddevelopment,butitishardtodrawdefiniteconclusions.Becauseintheareasofdifferentclimate,many