台北地區零至三歲嬰幼兒飲食營養狀況與生長發育之前瞻性研究

Abstract

摘要 本研究為國內唯一嬰幼兒飲食營養與生長之縱貫性長期追蹤研究，藉由收集零至三歲嬰幼兒飲食營養攝取狀況、生長發展之相關資料，探討各相關因素間的關係。自民國91年於台北市立婦幼醫院招募151位孕婦，持續追蹤其出生子女共130位，最後持續完成三歲問卷者有104位幼兒。 研究工具以問卷為主，內容包括飲食資料(主要為24小時飲食回憶記錄)、飲食歷史、健康情形等，以電訪方式追蹤至幼兒三歲，一歲前進行每月飲食健康問卷的追蹤，一歲後則每半年進行一次幼兒飲食及家庭問卷。資料分析使用SPSS12.0及STATA8.0統計分析軟體，分析方法包含：次數分配與百分比、平均值與標準差、獨立樣本t考驗、廣義估計公式、皮爾森積差相關及斯皮爾曼等級相關。 研究結果發現，嬰兒出生至三歲時的體重、身長和頭圍皆位於衛生署公告之生長曲線圖的50百分位左右，並將本研究中嬰幼兒之體重、身高及頭圍以國健局之台灣出生世代研究之初探研究調查結果(n=1620)為參考資料，發現本研究嬰幼兒平均體重和身長的Z-score皆分布於正常值±2之間，顯示本研究世代樣本具代表性。 三歲時幼兒平均熱量的攝取為1156大卡，蛋白質、脂質及醣類的攝取分別為40克、37克及166克，三歲內嬰幼兒熱量及三大營養素攝取情形，除脂質外，蛋白質和醣類的攝取百分比隨著月齡的增加而增加。幼兒第6、12、18、24、30及36個月攝取的一般家庭食物占總熱量之百分比分別為16%、46%、64%、75%、74%及79%，顯示零至三歲幼兒的飲食型態逐漸由奶類轉變為一般家庭飲食。 生長分析方面，幼兒在第12及36個月所攝取的整日營養素有較多的營養素和三歲時的體重和身高呈顯著正相關(p<0.05)，第36個月時在熱量、蛋白質、脂質、維生素B2、葉酸、鉀、鈣、磷、泛酸、生物素、次亞麻油酸及動物性蛋白的攝取量，皆與幼兒三歲的體重和身長呈顯著正相關(p<0.05)。母親體重分別與幼兒第24及36個月的體重呈顯著正相關(p<0.01)，父親體重與36個月大幼兒體重呈顯著正相關(p<0.05)；父親與母親的身高及體重分別與幼兒第24及36個月大時的身長成顯著正相關(p<0.05)，尤其是雙親的身高與幼兒36個月大的身長呈顯著正相關(p<0.01)。另外在幼兒健康和發展狀況與營養素攝取方面的相關則沒有明顯的一致性。 經由多元迴歸分析的結果可以得知，幼兒體重方面，出生體重及父親和母親的BMI值對幼兒三歲時體重的解釋力佔有19%，三歲時熱量與營養的攝取約佔了7%的解釋量。身長方面，出生身長及父親和母親的身高、父親和母親的BMI值對幼兒三歲時身長的解釋力佔有27%，三歲時熱量與營養的攝取約佔了4至6%的解釋力。而幼兒的出生體重和母親與父親的BMI以及第36個月的熱量(kcal)和每公斤體重熱量(kcal)的攝取對於幼兒三歲時的BMI約有44%的解釋力。 綜合上述可知，本研究除詳盡描述零至三歲嬰幼兒飲食營養變化及生長情形之現況均良好之外，顯示來自台北市中高階層家庭的幼兒在熱量及營養均充足富裕的環境中，三歲幼兒的生長發育在微量營養素並不匱乏的情況之下，是由熱量和相關營養素的攝取以及父母親的體型所影響與調控，若是能配合均衡而適量的良好飲食營養模式必定能讓幼兒有更適當的生長與健康。Abstract

This prospective study described in detail about dietary intake and growth development from birth to 3 years old in Taipei. We recruited 151 pregnant women from Taipei Municipal Women’s and Children’s Hospital and collected related information for growth and nutritional status of their babies from birth to 3 years old (at birth n=103, at 3 years old n=104). Information including nutrient intakes by 24 hours recalls, dietary history, development and health status and Food Frequency Questionnaire was obtained by telephone interviews. We analyzed the data at every six month (6, 12, 18, 24, ,30, 36) from birth to 3 years old. The statistical analyses including frequency distribution, the mean and standard deviation, T-test, correlation analysis, multiple regressions and GEE model were performed by SPSS version 12.0 and STATA 8.0. With comparison to data at birth to three years old, the participating infants and toddlers showed the average weight, height and head circumference were between around 50th percentiles on published growth curve in Taiwan. Furthermore, with comparison to the results of Taiwan Birth Cohort Study (n=1620) from Bureau of Health Promotion, Department of Health, showed our subjects were within 2 SD of Z-score for means of weight and height. It confirms our sample population is representative. The average dietary intakes for energy, protein, fat and carbohydrate at 3 years old were about 1156 Kcal, 40 g, 37 g and 166 g, respectively. The total energy intake and the percentages of carbohydrate were increased with age and protein intakes fat intake was reduced with age. The percentages ofenergy intake were 16%, 46%, 64%, 75%, 74%, 79% from adult-style foods at 6th, 12 th, 24 th, 30 th and 36th month, showing that toddlers at age three had changed into adult-style diet progressively. From growth analyses, The energy, protein, fat, vitaminB2, folate, potassium, calcium, phosphorous, pantothenate, biotin, α-linolenic acid, and animal protein intake at 36th month were positively correlated with body weight and height at three years old (p<0.05).The weights at age 24 th and 36 th (p<0.01) month had significantly positive relationships with mother’s weight; the height at age of 36th month had significantly positive relationships (p<0.01) with both parents’ height. There is no consistence association found between toddlers's diet and health or development outcome. Birth weight and parents BMI could explain 19% of weight at age 36th, energy and nutrient intake at 36th could explain 7% of the weight at age 36th. Birth height, parents’s height and their's BMI could explain 27% of height at age 36th, energy and nutrient intake at 36th could explain 4-6% of the height at age 36th. Birth weight, parent’s BMI, energy and pre kilogram body weight energy intake at age 36th could explain 44% of BMI at age 36th. In conclusion, our study described in detail that dietary intake and growth development from birth to three years old infants and toddlers. Our data showed that the influences of parents’s weight and hight, childrens’s energy and macro nutrient intakes are more important than micro nutrient intakes on growth of the three years old toddlers of abundant families in Taipei city. If it can cooperate with good dietary pattern and nutrition supports will be better for their health and development.