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研究生: 陳采蘋
Chen, Cai-Ping
論文名稱: 長期追蹤台灣不同出生體重族群1-16歲飲食攝取與生長發育
A longitudinal study of dietary intakes and growth development from 1 to 16 years old by different birth weight groups in Taiwan
指導教授: 盧立卿
Lyu, Li-Ching
口試委員: 盧立卿
Lyu, Li-Ching
駱菲莉
Yang, Feili-lo
陳信任
Chen, Hsin-Jen
口試日期: 2023/07/06
學位類別: 碩士
Master
系所名稱: 營養科學碩士學位學程
Graduate Program of Nutrition Science
論文出版年: 2023
畢業學年度: 111
語文別: 中文
論文頁數: 211
中文關鍵詞: 出生體重生長發育營養攝取生長速度前瞻性世代研究
英文關鍵詞: birth weight, growth development, nutrition intake, growth rate, prospective cohort study
研究方法: 世代研究縱貫性研究
DOI URL: http://doi.org/10.6345/NTNU202301154
論文種類: 學術論文
相關次數: 點閱:167下載:3
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  • 流行病學研究發現出生體重影響著兒童日後的生長狀況,並與成年後慢性疾病發生的風險有關。此外,飲食與生長和健康發展的關係也密不可分,在成年之前,兒童與青少年期維持良好的營養狀況是也是奠定生長發育和健康的重要基礎。故本研究欲探討本土不同出生體重兒童在兒童與青少年期之飲食營養攝取是否具有差異及對其生長發展之影響。
    本研究為世代研究,研究對象來自民國91及93年所招募之2個長期追蹤世代。將受試者以出生體重之第25及75百分位為切點分為3組:相對低出生體重(relative low birth weight, rLBW)、相對適當出生體重(relative adequate birth weight, rABW)及相對高出生體重(relative high birth weight, rHBW),每年定期以電話訪問收集24小時飲食回憶、體位等資料,持續追蹤兒童至16歲 (n=80)。統計軟體使用SPSS 23.0 進行分析。
    追蹤兒童至16歲,發現到不論身高、體重及BMI,rLBW、rABW及rHBW三組兒童之間歷年體位均達顯著差異。16歲時rHBW兒童之體位為最高,而rLBW為最低。兒童生長速度觀察到,0-2歲時rLBW與rHBW兒童之身高變化量顯著大於rABW兒童;rHBW兒童在出生-1歲及9-10歲之體重變化量顯著高於rLBW兒童。兒童長期營養攝取變遷發現,16年來全體兒童在熱量、三大營養素與多數微量營養素攝取皆隨年齡增加呈顯著增加趨勢;而醣類佔總熱量百分比、鈣及維生素D攝取則是隨年齡增加呈顯著下降趨勢 (p for trend<0.001)。歷年來兒童之膳食纖維及維生素D皆有攝取不足情形,鈣則於4歲後開始攝取不足。比較不同出生體重兒童歷年營養素攝取差異,發現16歲時rABW兒童在熱量、三大營養素顯著高於rLBW與rHBW兒童。
    不同時期營養素攝取與16歲體位之相關性分析中發現,控制性別與出生體重後,13歲之維生素B1、16歲之鉀、鈣、鎂、維生素B1、B2與16歲身高呈顯著正相關;6歲鎂、16歲維生素D、維生素K、維生素B1、維生素C和1歲維生素C與16歲體重呈顯著正相關;6歲鐵、1歲維生素B12以及1歲和16歲之維生素C與16歲BMI呈顯著正相關。綜合以上,出生體重雖影響兒童16歲之體位分佈,但後天適當的微量營養素攝取亦對青少年時期之生長發育相當重要。

    Epidemiological studies have found that birth weight has impact on the growth and is associated with the risk of developing chronic diseases in adulthood. Additionally, the relationship between diet, growth and health development is closely intertwined. Maintaining good nutritional status during childhood and adolescence lays a crucial foundation for growth, development and health before adulthood. Therefore, this study aims to explore whether there are differences in dietary nutrient intakes among children with different birth weights group and its influence on their growth development during childhood in a local population.
    This longitudinal study consists of the two long-term follow-up cohorts recruited in 2002 and 2004. The participants were divided into three groups based on the 25th and 75th percentiles of birth weight cut points: relative low birth weight (rLBW), relative adequate birth weight (rABW), and relative high birth weight (rHBW). Data on 24-hour dietary recalls, anthropometry, and other relevant information were collected through regular telephone interviews every year, and the children were followed until 16 years old (n=80). The data for this study was analyzed using IBM SPSS Statistics software version 23.0.
    Following up the children until 16, significant differences in anthropometry were observed among the three groups (rLBW, rABW, and rHBW), regardless of height, weight, or BMI. At the age of 16, rHBW children had the highest anthropometric measures including height, weight and BMI, while rLBW children had the lowest. On the growth velocity, it was observed that from 0 to 2 years old, rLBW and rHBW children had significantly greater changes in height than rABW children. Additionally, rHBW children showed significantly higher changes in weight than rLBW children during the period from birth to 1 year and at the ages of 9 to 10.
    Regarding the long-term dietary nutrient intake changes in children, it was found that over the 16 years, all children exhibited a significant increase in energy and macronutrient intakes, as well as most micronutrients, with increasing age. However, the percentage of carbohydrates of total energy intake, and the intakes of calcium and vitamin D, showed a significant decreasing trend with age (p for trend <0.001) Throughout the years, inadequate intakes of dietary fiber and vitamin D were observed in children, and calcium intake started to be inadequate after the age of 4. Comparing the differences in nutrient intakes among children with different birth weights, it was found that at the age of 16, rABW children had significantly higher energy and macronutrient intakes compared to rLBW and rHBW children.
    The correlation analysis between nutrients intake at different stages and anthropometry at the age of 16, after adjusting for gender and birth weight, it was found that vitamin B1 at the age of 13, potassium, calcium, magnesium, vitamin B1, B2 at the age of 16 were significantly positively correlated with height at the age of 16. Magnesium at the age of 6, vitamin D, vitamin K, vitamin B1, vitamin C at the age of 16 were significantly positively correlated with weight at the age of 16. Iron at the age of 6, vitamin B12 at the age of 1, and vitamin C at the ages of 1 and 16 were significantly positively correlated with BMI at the age of 16.
    In conclusion, birth weight indeed influences the distribution of anthropometric measures at the age of 16 in children, but proper consumption of micronutrients during adolescence is also crucial for growth development.

    第一章 緒論 1 第一節 研究動機 1 第二節 研究目的與問題 2 第三節 名詞解釋 3 一、 兒童及青少年發展分期 3 二、 出生體重相關名詞 3 三、 生長發育相關名詞 4 第二章 文獻回顧 6 第一節 國內兒童與青少年的飲食營養與生長發育狀況 6 一、 嬰兒期飲食營養與生長發育狀況 6 二、 幼兒期飲食營養與生長發育狀況 8 三、 學齡期飲食營養攝取與生長發育狀況 10 四、 青少年期飲食營養生長發育狀況 11 第二節 兒童與青少年飲食營養與生長發育相關世代研究 12 一、 嬰兒期飲食營養與生長發育相關世代研究 12 二、 幼兒期飲食營養與生長發育相關世代研究 15 三、 學齡期飲食營養與生長發育相關世代研究 17 四、 青少年期飲食營養與生長發育相關世代研究 18 第三節 出生體重、飲食營養與生長發育之關聯 20 一、 出生體重與兒童、青少年的飲食營養關係 20 二、 出生體重與兒童、青少年的生長發展關係 23 第三章 研究方法 26 第一節 研究架構、研究設計與實施程序 26 一、 研究架構 26 二、 研究設計與實施程序 27 第二節 研究對象與研究工具 29 一、 研究對象 29 二、 研究工具 34 第三節 資料處理與統計分析 37 一、資料處理 37 二、統計分析 41 第四章 研究結果 42 第一節 新生兒及家庭基本資料 42 一、 兩世代新生兒基本資料 42 二、 不同出生體重新生兒之家庭基本資料 44 第二節 長期追蹤兒童之生長狀況 49 一、 兒童0-16歲身高、身高z分數 (HAZ)及身高百分位數 49 二、 兒童0-16歲體重及0-10歲體重z分數(WAZ)及體重百分位數 58 三、 兒童0-16歲BMI及BMI z分數(BAZ)及BMI百分位數 66 四、 兒童生長速度 75 五、 不同出生體重兒童16歲體型分佈 78 第三節 長期追蹤兒童之營養素攝取狀況 79 一、 長期追蹤男女兒童1-16歲熱量與營養素攝取變化 79 二、 長期追蹤不同出生體重兒童1-16歲之營養攝取差異 115 三、 不同出生體重男女兒童16歲之營養素攝取差異 150 第四節 兒童不同時期營養素攝取與16歲體位之相關性 153 第五章 討論 162 第一節 兒童生長發育狀況 162 一、 兒童 0~16歲體位狀況 162 二、 兒童生長速度 164 第二節 兒童營養素攝取狀況 166 一、 兒童1-16歲之熱量、營養素攝取量與建議量比較 166 二、 兒童營養素攝取之出生體重差異 169 第三節 研究限制與建議 170 第六章 結論 173 參考文獻 175 附錄 184 附錄一 參與者知情同意書 184 附錄二 研究倫理審查核可證明 190 附錄三 研究問卷 191 附錄四 研究結果附表 200

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