飲食營養對不同出生體重新生兒至二歲生長發育之追蹤研究

Abstract

良好的營養支援是嬰幼兒體格生長及健全發展的關鍵因素，並且嬰幼兒出生體重的不同也會影響生長。本研究利用長期追蹤之前瞻性研究方式收集不同出生體重新生兒至二歲營養攝取狀況與生長發展之相關資料，並探討各相關因素間之關係。研究對像分別是於民國91及93年間於台北市立婦幼醫院及台大醫院進行招募。研究之初招募人數分別為151位及150位。兩世代採取相同的問卷調查方法，內容包括嬰幼兒飲食、健康、發展狀況等資料。此研究結果分析合併兩世代共274位嬰幼兒至二歲之資料，依出生體重第25及第75百分位分成相對低出生體重(relative low birth-weight infants、rLBW)、相對適當出生體重組(relative adequate-birth weight infants、rABW)、相對高出生體重組(relative high birth-weight infants、rHBW)，其中三組人數分別為103、73及98人。資料分析使用SPSS 12.0及 STATA 8.0版進行相關資料分析。 研究結果主要發現嬰幼兒生長至二歲時，rHBW組嬰兒體重仍持續保持最高，且三組間具顯著差異；身高及頭圍部份rHBW組嬰兒二歲時仍顯著高於其他兩組。男女嬰幼兒從出生至二歲體重上皆達到顯著差異性，二歲時男嬰高於女嬰約680公克。在身長及頭圍的部份二歲時男嬰皆顯著高於女嬰，身長部分男嬰分別高於女嬰1.2公分；頭圍部份男嬰分別高於女嬰1.3公分。另外在生長速度包括體重增加倍數及體重增加百分比，不同於零至一歲時發現三組間有明顯差異，一至二歲幼兒已無差異。營養素攝取方面，二歲嬰幼兒平均每日熱量攝取分別為1089大卡，低於DRIs所建議的1200大卡，而蛋白質攝取量為38公克，則高於DRIs所建議的20公克。蛋白質攝取百分比於二歲時約佔總熱量之13-14%，脂肪攝取百分比隨著年齡的增長逐漸下降至約24-27%，醣類攝取百分比則是逐漸提升至約60%。 嬰幼兒二歲時每日飲食模式中，有37%的幼兒一日有3次以一般食物當作正餐並每天喝奶1-2次，也有大部分的幼兒每天喝奶2次，且有2次以一般食物當作正餐。奶類哺餵上有8%的嬰幼兒哺餵母乳，約有70%會使用商業化的幼兒成長奶粉，約15-20%會使用一般成人用的乳品。二歲時約72%的幼兒對食物不會有排斥現象，約有5-8%的幼兒會對肉類、蔬菜、魚類、水果有排斥，另外分別有2.5%及2.0%的幼兒對豆類、蛋類產生排斥。二歲時使用補充劑者約56%，母親大多以嬰幼兒健康及成長髮育為考量而提供，最常使用的補充劑以乳酸菌、鈣片/鈣粉及維生素為主。 三組間二歲時平均每日熱量攝取並無差異，但每公斤體重熱量及蛋白質攝取皆以rLBW組最高，rHBW組最低。二歲時rABW組醣類攝取百分比則顯著高於rHBW組。依性別區分，男女嬰幼兒至二歲時男幼兒熱量、蛋白質、醣類攝取分別高於女幼兒，但三大營養素攝取百分比方面男女嬰幼兒之間並無差異性。 研究中嬰幼兒最常罹患的疾病為上呼道感染(主要為感冒)，三組間生病頻率及各疾病感染天數，經分析比較後並無差異性。另外統計分析發現，哺餵母乳時間越長嬰幼兒二歲時感冒感染的天數越短，並且生病頻率次數也較少。由多變項分析發現於第6,12,18,24個月時出生體重對當時體重之影響，解釋力分別為13.3%、11.4%、12.8%、12.7%。以多元迴歸方式分析與嬰兒二歲體型的相關因素，嬰幼兒二歲體重、出生至二歲體重增加百分比及出生至二歲體重增加倍數與出生體重、性別有顯著相關(p＜0.05)，二歲身長與出生身長有顯著相關(p＜0.01)，出生至一歲半體重z分數改變量與出生體重有顯著相關(p＜0.01)，二歲時飲食中維生素B6及Zn與嬰幼兒二歲時體重、體重增 加百分比、體重增加倍數皆有顯著相關(p＜0.05)。 綜合上述可知，不同出生體重嬰兒生長至二歲體位發展上仍是以rHBW組保持最高。嬰兒生長至二歲因飲食型態的轉變，三大營養素之比例也有所調整，大多數嬰幼兒餵奶次數皆有達2次，但每日以非奶類食物當作正餐達3次的比例仍不高。多元迴歸分析中發現嬰幼兒二歲飲食中的維生素B6及Zn為預測嬰幼兒二歲體位發展之較佳預測因子，故推測可能是嬰幼兒飲食中肉類及奶類等動物性蛋白質攝取量提升所影響。Fine nutritional supply is the important factor of figure building and healthy growing of infants and toddlers. This study is to examine relationships between dietary intakes and growth among different somatotypes of infants from the birth to two years old by a prospective follow-up design. Moreover、various related factors for growth of infants and toddlers are also considered. Participants were recruited from Taipei Municipal Women’s and Children’s Hospital and National Taiwan University Hospital between 2002 and 2004. In the beginning、there were 151 and 150 neonates respectively in two cohorts. The two cohorts used the same questionnaires collecting dietary、health and growth status of infants and toddlers. Our current analyses combined information from two cohorts consisting of 274 infants from the birth to two years old. These participants were divided into three groups according to the 25th and 75th percentile cut points: relative low birth- weight infants group (rLBW、n=103)、relative adequate-birth weight infants group (rABW、n=73)、and relative high birth-weight infants group (rHBW、n=98). The software packages of SPSS 12.0 and STATA 8.0 were employed for the statistical analyses. At two years old、the rHBW group remained highest weight、but there were significant differences among three groups on weight. Moreover、the rHBW group has highest height and head circumstance compared to other two groups at two years old. Boys and girls had significant differences on body weight from birth to two years old、and boys were heavier than girls for an average of 680g at two years old. Boys were significant higher than girls for about 1.2cm、for head circumference、boys were higher than girls for about 1.3cm. Our analyses for the growth rate indices including the multiple of birth weight and infants weight gain percentage (IWG %) showed the significant differences among three groups from the birth to one year old、but there was no significant difference among three groups from one to two years old. The average daily energy intake of infants at two years old was 1089kcal、which is lower than 1250kcal of DRIs. The mean protein intake was 38g、which was higher than 20g for DRIs. The percentage of protein intake accounted for 13-14% total energy intake of the infants at two years old. The percentage of fat intake decreased to 24-27 % gradually as age increased、the percentage of carbohydrate intake increased gradually to 60%. There are 37% of infants and toddlers fed milk one to two times and take table food as a meal three times in a day、most of infants and toddlers fed milk two times and take table food as a meal two times in a day of daily diet pattern at two years old. There are 8% of infants and toddlers still fed by breast milk、about 70% consume commercial childhood formula、about 15-20% consume regular dairy products. There are about 72% of infants and toddlers don’t refuse to eat any food、about 5-8% of infants and toddlers dislike meat、vegetables、fish and fruit. There are 2.5% and 2.0% of infants and toddlers reject to eat bean and egg、respectively. About 56% of infants and toddlers used supplements at two years old、including probiotics、calcium tablet or powder and multivitamins. The average daily energy intake had no significant difference among three groups at two years old、but the rLBW group was the highest for energy intake per kg and protein of body weight per kg、and the rHBW group has the lowest mean value. The percentage of carbohydrate intake of the rABW group was higher than the rHBW group at two years old. Regarding the energy、protein and carbohydrate intakes、boys had higher intakes than girls at two years old、but there was no significant difference for the percentages of three main macronutrients intakes between boys and girls. The most common disease for the infants and toddlers in this research was the upper respiratory tract infection (the main cause was cold). There was no significant difference among three groups for the frequency of illness and the days of infection for each disease. In addition、the duration for breast feeding was negatively correlated with the days for cold and the frequency of illness. We found that the weight at birth had strong influence on the weight at 6 th、12 th、18 th and 24 th month by multivariate analysis、the explanation power is 13.3%、11.4%、12.8%、12.7%、respectively. By multiple regression analysis for the related factors of the infants growth at two years old、the weight at birth and gender were the better predictors for the weight of the infant at two years old、IWG% and multiple of birth weight at birth to two years old (p<0.05). The height at birth was the better predictor for the height of the infant at two years old (p<0.01)、and the weight at birth was the better predictor for z-score changed from the birth to 18 th month. For dietary variables、vitamin B6 and Zn were the better predictors for the weight of the infant at two years old、the multiple of birth weight and IWG% (p<0.05) from the birth to two years old. In conclusion、for growth development at two years old、the rHBW group remains highest compared to the other two groups.The percentages of energy from the three main macronutrients changed significantly from birth to two years old. Most infants and toddlers are fed for two times of milk in a day、but the proportion of taken non-milk food as a meal for three times is low. The results from the multiple regression analyses show that the dietary intake including vitamin B6 and Zn are the better predictors for the weight development at at two years old. Therefore、this study suggests that increased animal protein food sources such as meat and milk、would have significantly positive associations with weight development from birth to two years old.