探討家庭社經背景對零至兩歲嬰幼兒飲食及生長發育追蹤世代之影響

Abstract

本研究探討不同家庭社經背景之嬰幼兒其哺餵方式、飲食攝取、生長、動作發展及健康之相關資料。此研究合併了三世代資料，受試者分別是於民國91年、93年及98年間於台北市立婦幼醫院及台大醫院進行招募。研究工具以問卷為主，內容包括飲食資料（24小時飲食回憶）、飲食歷史、健康情形等，主要以面對面及電訪方式追蹤，分析399名出生至2歲嬰幼兒其哺餵方式、營養素攝取、體型生長、動作發展及健康情況，依家庭社經背景分成低社經組、中社經組及高社經組三組。資料使用SPSS 19.0及 STATA 8.0版進行統計分析。 結果發現，出生至1歲之間的生長發展相當快速，體重、身長及頭圍的變化很大，而嬰幼兒1歲至2歲之間其體重、身長及頭圍的變化有明顯變小的趨勢。在出生至2歲的嬰幼兒體型（體重、身長及頭圍）於三組間無顯著差異。在營養素攝取方面，2歲時嬰幼兒平均每日熱量攝取為1094大卡，低於DRIs建議量（稍低為1150大卡，適度為1350大卡）；平均蛋白質、脂質及醣類攝取為37、31、167公克，各占總熱量攝取的14%、25%及61%，而蛋白質攝取量高於DRIs所建議的20公克。在嬰幼兒2歲時，三組營養素攝取並無呈現顯著差異。另外也發現，大多數營養素之攝取量多與完全哺餵母乳月數呈顯著負相關，而與完全哺餵配方奶月數呈顯著正相關。 嬰幼兒第6個月時，配方奶哺餵率以高社經組顯著最低(42%, p=0.03)，而母乳哺餵率以高社經組母乳哺餵率為最高(33%, p=0.06)；嬰幼兒2歲時，不同的哺餵方式其三組間皆未達顯著差異。嬰幼兒家庭社經背景因子多與完全哺餵母乳月數是呈顯著正相關，而與完全哺餵配方奶月數呈顯著負相關，並且母乳哺餵時間以高社經組的為最高（約為6個月）。在副食品開始添加之月齡方面，三組間有達顯著差異(p＜0.01)，其中高社經組添加月齡為第5.9個月，最接近6個月大，也發現嬰幼兒家庭社經背景因子皆與副食品開始添加月齡呈顯著正相關。另外，完全哺餵母乳月數與副食品開始添加月齡呈顯著正相關。在健康及發展方面，嬰幼兒哺餵母乳月數多與嬰幼兒動作發展月齡、感冒感染天數、生病頻率呈顯著負相關；而嬰幼兒副食品開始添加時間多與嬰幼兒動作發展月齡、生病頻率呈顯著正相關。 家庭社經背景對於出生至2歲嬰幼兒的哺餵情形造成了強烈影響，而在2歲的營養素攝取方面，並無發現有顯著的差異性存在，表示現今臺灣不同社經背景之家庭，其哺餵狀況雖然不盡相同，但並不會造成嬰幼兒營養攝取量上有顯著的差別，因此，在2歲時體型發展在三組間大多無呈現顯著差異，反應出本研究所探討的生長發育情況。We examined the family socioeconomic status on feeding patterns, nutrient intakes, growth development, motor development and health of infants. The data from three cohort studies were combined. Participants were recruited from Taipei Municipal Women’s and Children’s Hospital and National Taiwan University Hospital between from 2002 to 2009. The methodology adopted the questions asked in the three cohorts were identical. Information including nutrient intakes by 24 hours recalls, dietary history, development and health status was obtained by face-to-face and telephone interviews. We analyzed the dietary intakes from milk and complementary food, nutrient intakes, growth development and health of 399 infants from birth to two years. These participants were divided into three groups according to the family socioeconomic status: low socioeconomic status, adequate socioeconomic status, and high socioeconomic status. The software packages of SPSS 19.0 and STATA 8.0 were used for all statistical analyses. The result indicated that the growth development (weight, length and head circumference) of infants from age 0 to 1 was dramatically fast, but was significantly smaller changes from age 1 to 2. The growth indicators (weight, length and head circumference) of infants between the three groups were not significantly different from age 0 to 2. The mean daily caloric intake of 2-year-old was 1094 Kcal. It’s lower than the DRIs (1150~ 1350Kcal). The average dietary intakes of protein, fat and carbohydrate were 37g, 31g and 167g, respectively, and the total energy was 14% from protein, 25% from fat, and 61% from carbohydrates. The average dietary intakes of protein is higher than the DRIs (20g). The nutrient intakes of infants between the three groups were not significantly different at age 2. We also found that multiple nutrient intakes was negatively associated with the duration of exclusive breastfeeding, but was positively associated with the duration of exclusive formula feeding. At 6 th month, the rate of formula feeding with high socioeconomic group was significantly lowest (42%, p=0.03), and the rate of breastfeeding with high socioeconomic group was highest. The feeding methods of infants between the three groups were not significantly different at age 2. Many factors of family socioeconomic status were positively associated with the duration of exclusive breastfeeding, and were negatively associated with the duration of exclusive formula feeding. The duration of exclusive breastfeeding with high socioeconomic group was significantly highest (about 6 months). The month of infants started consuming complementary food between the three groups were significantly different (p<0.01). The high socioeconomic group started consuming complementary food at 5.9th month, almost 6th month. We also found that many factors of family socioeconomic status were positively associated with the month of infants started consuming complementary food. Besides, the duration of exclusive breastfeeding was positively associated with the month of infants started consuming complementary food. Regarding the health status and motor development, the duration of breastfeeding showed a negativecorrelation with the age of motor development and the frequency of illness. The month of infants started consuming complementary food showed a positive correlation with the age of motor development and the frequency of illness. The family socioeconomic status for infants from birth to two years of feeding patterns caused a strong influence, and in the two-year-old nutrient intakes did not show significant differences. It is showed in Taiwan today that different family socioeconomic status, their feeding situation may be different, but it does not make infant nutrition intake has significant differences. The nutrient intakes of infants between the three groups were not significantly different, and it made the same situation of the growth development.