台北地區零至兩歲嬰幼兒飲食營養狀況與生長發育之前瞻性研究

Abstract

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，藉由收集零至兩歲嬰幼兒營養攝取狀況、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，最後完成兩歲問卷有111位幼兒。本研究中嬰幼兒之體重、身高及頭圍介於衛生署公告之生長曲線的50-75百分位，再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，結果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。 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兩歲，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嬰幼兒及家庭問卷；另進行小型母乳哺餵量化方法學研究，採秤重試驗法，共徵求六位受試者，請受試者哺餵母乳前後進行嬰兒秤重並紀錄重量，此結果與美國嬰幼兒餵食研究之母乳量評估結果相似，所以本研究母乳哺餵量之估計量為6個月以下估計780 mL，7個月以上估計600 mL。資料分析使用SPSS11.0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、淨相關、皮爾森積差相關及斯皮爾曼等級相關。 研究結果發現，以母乳哺餵的比例在第1、6、12及18個月分別為40.0%、23.1%、21.3%及12.0%；混合哺餵的比例在第1、6、12及18個月分別為31.5%、11.5%、2.5%及4.2%；哺餵嬰幼兒奶粉的比例在第1、6、12及18個月分別為28.5%、65.4%、76.2%及83.8%。營養素分析上，兩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。第6、12、18及24個月攝取的一般家庭食物占總熱量之百分比分別為19.1%、45.2%、64.0%及75.1%，顯示兩歲幼兒的飲食型態逐漸轉變為一般家庭飲食。生長分析方面：母親體重與18及24個月大幼兒的體重呈顯著正相關(p<0.05)、父母親的身高及體重分別與幼兒18及24個月大幼兒的身長呈顯著正相關(p<0.05)。控制總熱量及相關變項後，嬰幼兒在第6及24個月時有較多的營養素和24個月時的體重呈顯著正相關(p<0.05)，而第6個月時有較多的營養素和24個月時的身長呈顯著負相關(p<0.05)；在一般家庭食物方面，鐵的攝取與18及24個月大的身長呈顯著正相關(p<0.05)。健康方面，以一至兩歲為分析重點，哺餵母乳月數和18至24個月期間的生病頻率、總天數及上呼吸道感染天數呈顯著負相關(p<0.05)；第18個月的鐵攝取量與生病頻率、總天數及上呼吸道感染天數呈顯著正相關(P<0.05)。 多元迴歸分析的結果顯示，幼兒第12個月的體重、母親懷孕前BMI、第24個月每公斤體重的熱量攝取、第12及24個月的維生素B2的攝取量、第24個月植物性蛋白質與動物性蛋白質的攝取量可以預測幼兒兩歲時體重以及一至兩歲的體重，解釋量分別為59.0%及49.0%，其中以動物性蛋白質的預測力最高，顯示動物性蛋白質的主要來源除了嬰幼兒奶粉外，還有奶製品、肉類以及蛋類等食物對於幼兒兩歲及一至兩歲期間體重的發展具重要的影響力；幼兒第12個月的身長、幼兒第一至兩歲之間體重增加量和第24個月鐵的攝取量可以預測幼兒兩歲時的身長，解釋量分別為25.1%及31.6%，其中以鐵質的預測力最高，顯示含鐵質高的食物如蛋黃、肉類以及綠葉蔬菜等和幼兒兩歲及一至兩歲期間身長的發展具有影響力。 綜合上述可知，本研究除詳盡描述零至兩歲嬰幼兒飲食營養變化之現況外，再考慮除母親懷孕前BMI及父親BMI等遺傳因素之後，飲食因子中，以蛋白質對於兩歲幼兒的體重及一至兩歲體重增加量具有顯著性的影響力，而鐵質對於兩歲幼兒的身長及一至兩歲身長增加量具有顯著性的影響力。This study was to examine dietary intakes and growth of infants and toddlers of a prospective follow-up study in Taiwan. We recruited 151 pregnant women from Taipei Municipal Women’s and Children’s Hospital between Feb 2003 and July 2005 and collected related information for growth and nutritional status of their babies (at birth, n=130) until 2 years old (n=111). With comparison to data at birth, the participating infants and toddlers showed the average weight, height and head circumference were between 50th and 75th 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. Information including nutrient intakes by 24 hours recalls, dietary history, development and health status was obtained by telephone interviews. We collected diet and health information monthly before 1 year old. Moreover, additional nutrition, health and family information were collected every six month after 1 year old. In addition, we conducted a pilot methodology study to estimate the breast milk consumption. We recruited 6 breastfed mothers from announcement on Breastfeeding Association of Taiwan website. During test weighting, infants are weighted before and after each feeding and mothers recorded the weight changes. Our results were similar to the published data from the Feeding Infants and Toddlers Study (FITS) in U.S.A. For exclusively breastfed infants under 7 months of age, we estimated an intake of 780mL of breast milk per day, and for infants 7 months of age and older, we used 600mL. 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 11.0 and STATA 8.0. There were 40.0%, 23.1%, 21.3% and 12.0% of subjects exclusively fed by breast milk, as well as 28.5%, 65.4%, 76.2% and 83.8% of infants and toddlers exclusively fed by formula at 1st 、6th 、12th and 18th month, respectively. The percentages of carbohydrate and protein intakes of total energy increased with age and fat intake was reduced with age. The percentages of energy were 19.1%, 45.2%, 64.0% and 75.1% from adult-style foods in 6, 12, 18 and 24 months, showing that toddlers at age 2 had changed into adult-style diet progressively. From growth analyses, the weights at age 18 and 24 months had significantly positive relationships (p<0.05) with mother’s weight; height at age of 18 and 24 months had significantly positive relationships (p<0.05) with both parents’ weight and height. By partial correlation analysis, toddler’s weight at 24 th month had more positive correlations with nutrients intakes at 6 th and 24 th month (p<0.05), toddler’s length at 24 th month had more positive correlations with nutrients intakes at 6 th month (p<0.05). For the adult-style diet, the height at 18th and 24th month had a positive correlation(p<0.05) with Iron intake. Regarding the health status between 1 to 2 years old, the duration of breast-feeding showed a negative correlation with the frequency of illness (p<0.05), and iron intake showed a positive correlation with the frequency of illness (p<0.05). By multiple regression analysis, energy intake per kg of body weight (kcal/kg), riboflavin intake, animal protein intake and plant protein intake at 24th month, riboflavin intake at 12th month, mothers’ pre-pregnancy BMI, were positively correlated with body weight at two years old (p<0.05) and weight development from 1 to 2 years old. Body weight at one year old was positively correlated with weight at two years old (p<0.05), and was negatively correlated with weight development from 1 to 2 years old (p<0.05). Animal protein intake was the best predictor of body weight at two year old and weight development from 1 to 2 years old. Weight development from 1 to 2 years and iron intake at 24th month were positively correlated with height at two years old (p<0.05) and height development from 1 to 2 years old. Height at one year old was positively correlated with height at two years old (p<0.05), and was negatively correlated with height development from 1 to 2 years old (p<0.05). Iron intake was the best predictor of height at two years old and height development from 1 to 2 years old. In conclusion, our study described in detail that dietary intake and growth development from birth to two years old infants and toddlers. In addition to the effects of mothers’ pre-pregnancy BMI and fathers’ BMI, among dietary factors, animal protein intake was the best predictor of body weight attwo years old and weight development from 1 to 2 years old, and iron intake was the best predictor of height at two years old and the height development from 1 to 2 years old.