研究生: |
蘇秋帆 Su Chiu-Fan |
---|---|
論文名稱: |
零至一歲嬰兒飲食營養與生長發展狀況之前瞻性研究 A prospective study of dietary intakes and development for 0-1 year-old infants |
指導教授: |
盧立卿
Lyu, Li-Ching |
學位類別: |
碩士 Master |
系所名稱: |
人類發展與家庭學系 Department of Human Development and Family Studies |
論文出版年: | 2005 |
畢業學年度: | 93 |
語文別: | 中文 |
論文頁數: | 210 |
中文關鍵詞: | 嬰兒期營養 、嬰兒期生長發育 、副食品添加 、24小時飲食回法 |
英文關鍵詞: | infant nutrition, growth and development in infancy, complementary food, 24 hours dietary recall |
論文種類: | 學術論文 |
相關次數: | 點閱:1172 下載:112 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
嬰兒能夠健康的成長,除先天遺傳上的差異外,適當的餵養方式及均衡的營養攝取扮演著重要的角色。本研究以前瞻性的研究設計,藉由收集嬰兒出生至一歲間飲食營養和生長發展狀況之相關資料,進一步探討各種相關因素間的關係。資料收集時間為民國92年2月至民國93年7月,以面對面及電話訪談的方式追蹤民國91年於台北市立婦幼醫院招募之孕婦(民91世代)的出生子女每個月的飲食、生長、發展狀況及疾病等資料。研究工具包含嬰兒每月飲食健康問卷、嬰兒每月飲食頻率問卷、嬰兒健康狀況問卷以及追蹤過程登記表。招募之初有151位孕婦參加,產後退出21位,共130個初生嬰兒參加研究,追蹤一年後共有122個嬰兒完成所有問卷(完成率為94%)。資料的統計分析利用統計軟體SPSS11.0及STATA8.0版進行,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、單因子變異數分析、廣義估計公式、淨相關及斯皮爾曼等級相關。
研究結果發現,嬰兒的平均體重由出生時的3172.3±423.1公克增加到9693.1±1054.1公克,平均身長由出生時的49.2±2.0公分增加到75.9±3.3公分,平均頭圍由出生時的34.0±2.4公分增加到45.9±1.7公分,且男嬰的體型皆顯著大於女嬰(p<0.05)。在哺餵方式上,有18%的嬰兒在12個月內完全以母乳哺餵,另有12%的嬰兒在12個月內完全以配方奶粉哺餵,嬰兒的主要照顧者以母親居多,其次為祖母。在副食品的添加上,有45%的嬰兒在第4個月時開始添加副食品,添加種類以米、麥粉和果汁最早,大部分嬰兒(76%)嬰兒在第6個月大時開始以固體食物(solid food)取代奶類為一次正餐,接近四分之一的嬰兒(23%)的嬰兒在一歲時一天吃到3次以上的固體正餐,而有5%的嬰兒到一歲時尚未以固體食物取代奶類為正餐,顯示一歲嬰兒的飲食仍然以奶類為主,嬰兒哺餵方式的衛生教育仍需再加強。在營養素的分析上,由於缺乏母乳定量資料,故嬰兒整日飲食分析以餵食配方奶的嬰兒為主,利用24小時飲食回憶法得到餵食配方奶的嬰兒整年的熱量攝取由第一個月的629大卡增加到891大卡,碳水化合物和蛋白質的攝取百分比隨著月齡的增加而增加(44%至58%,9%至13%),脂肪的攝取百分比則隨著月齡的增加而下降(48%至29%),嬰兒每個月每公斤體重的熱量和其他營養素的攝取(除了膽鹼)皆高於DRIs(Dietary Reference Intakes)的建議值。在副食品的營養攝取方面,嬰兒由副食品得到的熱量及三大營養素攝取量皆有逐漸增加的趨勢,熱量由87大卡增加至392大卡,蛋白質由2公克增加至14公克,脂肪由0.4公克增加至5公克,碳水化合物則由19公克增加至72公克。分析與嬰兒生長有關之因素後發現:家庭背景因素與嬰兒生長的相關性不大,嬰兒整年的體重與母親未懷孕前體重有較多顯著正相關(p<0.05),整年的身長與父母親身高及母親未懷孕前體重有較大的相關性;在雙變項的分析中,以配方奶哺餵之嬰兒在第3個月時有較多的營養素的攝取和一歲時的體重呈正相關(p<0.05),而第9個月則有較多由副食品得到的營養素和一歲時的頭圍呈顯著正相關(p<0.05)。在健康表現方面,哺餵母乳時間的長短和嬰兒一歲內的總生病頻率呈顯著負相關(r=-0.18,p<0.05)。另外,以多元迴歸分析法分析與嬰兒一歲時生長狀況有關之因素後發現,除了性別的影響外,嬰兒一歲時體重和母親體重呈正相關(p<0.05);一歲時身長和父親身長呈顯著正相關(p<0.05);一歲時頭圍則與嬰兒第9個月由副食品獲得的植物性蛋白質呈顯著正相關(p<0.05),多元迴歸分析的結果顯示除了頭圍以外,預測嬰兒一歲時生長狀況的因素當中,非飲食因素的預測力較佳。
In addition to the effects of genetic predisposition, proper feeding and adequate nutrition intakes are important to infant growth and development. This study recruited 130 pregnant women from Taipei Municipal Women’s and Children’s Hospital and collected data of their children from birth to one year between Feb. 2003 and July 2004. Information including feeding practices, nutrient intakes, anthropometric measures, development and health status was obtained by telephone and/or face-to-face interview every month. The tools are included Monthly Diet and Health Questionnaire, Monthly Food Frequency Questionnaire, Infant Health Questionnaire and Follow-up Tracking Record. The software packages of SPSS 11.0 and STATA 8.0 were used for all statistical analyses.
With comparison to data at birth, the participating infants showed the average body weight increased from 3172.3±423.1g to 9693.1±1054.1g at one year old, the average length increased from 49.2±2.0cm to 75.9±3.3cm, and the average head circumference increased from 34.0±2.4cm to 45.9±1.7cm. During the follow-ups of one year, the average weight, height and head circumference were between 50th and 75th percentiles on published growth curve in Taiwan. There were 18% of infants exclusively fed by breast milk and 12% of infants exclusively fed by formula from birth to one year old. The primary care givers of infants were their mothers and grandmothers. The results also showed that 45% of infants having the first complementary food at fourth month. Grain products and juices were the earliest complementary food for infants. Moreover, at sixth month 76% of infants started to eat semi-solid food replacing milk to be a meal. However, at one year old, this study observed that only 23% of infants had semi-solid food to be their three main meals per day. In this study, there were still 5% of infants did not have semi-solid food instead of milk as a meal at one year old.
Because of the lack of quantitative data for estimating breast milk consumption, this study could only calculate nutrient intakes in infants who fed by formula. By 24 hours dietary recalls, infants fed by formula had energy intakes from 629 kcal at first month to 891 kcal at one year old. The percentages of carbohydrate and protein intakes of total energy increased with age (44% to 58%, 9% to 13%) and fat intake was reduced with age (48% to 29%). Except for choline, all other nutrient consumptions were higher compared to the DRIs (Dietary Reference Intakes) in Taiwan. The daily energy intake from complementary food increased from 87 kcal for the first month to 392 kcal at one year old, protein intake increased from 2g to 14g, as well as fat intake increased from 0.4g to 5g and carbohydrate intake increased from 19g to 72g.
During one year of follow-ups, we found that various family factors were not related to infant growth. Infants’ growth indices during one year showed that body weight had more positive correlations with mothers’ pre-pregnancy weight (p<0.05), height had more positive correlations with parents’ height and mothers’ pre-pregnancy weight (p<0.05). The infants fed by formula showed that nutrients intakes in the third month were positively correlated with body weight at one year old (p<0.05) and nutrients intakes from complementary food at the ninth month had positive correlations with head circumferences at one year old (p<0.05). Regarding the health status during one year follow-ups, the duration of breast-feeding showed a negative correlation with the frequency of illness (r=-0.18,p<0.05).
By multiple regression analysis, besides the gender effect, mothers’ pre-pregnancy weight was positively correlated with infants’ weight at one year old (p<0.05). The fathers’ height was positively correlated with infants’ height at one year old (p<0.05). The infants’ plant protein intake from complementary food in the ninth month had positively correlated with head circumferences at one year old (p<0.05).
ㄧ、中文部份
行政院衛生署(民91)。兒童健康手冊。
行政院衛生署(民92)。國人膳食營養素參考攝取量及其說明。
行政院衛生署(民92)。寶寶日記-嬰兒期營養參考手冊。
行政院衛生署(民93)。母嬰親善醫院認證工作成果。國民健康局母乳哺育網站。摘自http://www.bhp.doh.gov.tw/breastfeeding/
行政院衛生署(民94)。兒童健康手冊。
沉敬人(民90)。台灣地區幼兒營養素攝取狀況。輔仁大學食品營養研究所碩士論文,未出版,台北縣。
林家蓉、曾明淑、詹思萍(民86)。台灣地區一至六歲幼兒營養狀況調查。中華民國營養學會雜誌,22,47-61。
屈蓮(民76)。嬰兒奶粉促銷活動與母親對嬰兒奶粉之選擇的探討。國防醫學院公共衛生研究所碩士論文,未出版,台北市。
范光宇、黃春雄、吳穗華、許子秋、沈鄭秋桔、黃梅(民73)。中華民國台灣地區零至陸歲兒童身高、體重、頭圍、胸圍測量研究報告。中華民國營養學會雜誌,9,1-18。
莊瑞珠、陳麗美、洪哲裕、梁德馨、謝邦昌、劉正夫(民88)。台灣地區零至六歲兒童體位標準調查抽樣設計之研究。民意研究季刊,210,55-68。
郭永芬(民74)。影響孕婦哺乳知識、態度、行為因素之探討。國立台灣師範大學衛生教育研究所碩士論文,未出版,台北市。
陳正宇(民75)。餵奶方式與母親有無工作對6個月大嬰兒健康與照顧之比較研究。國防醫學院公共衛生研究所碩士論文,未出版,台北市。
陳姮霏(民93)。懷孕婦女飲食狀況對新生兒體型影響之前瞻性研究。國立台灣師範大學人類發展與家庭研究所碩士論文,未出版,台北市。
陳偉德(民84)。嬰幼兒生長發育的檢查—台灣嬰幼兒體位現況。台灣醫界,38,25-28。
曾明淑、吳愛芸、李秀紋(民75)。台灣偏遠地區嬰幼兒身高、體重及餵養現況之調查研究。中華民國營養學會雜誌,11,1-16。
曾明淑、林佳蓉、高美丁(民93)。台灣地區幼兒營養狀況與相關議題。曾明淑(主持人),營養監測與政策發展。營養監測與政策發展國際研討會,中研院生物醫學科學研究所。
曾筱晴(民87)。二十四小時飲食回憶法評估幼兒飲食攝取之效度研究。輔仁大學食品營養研究所碩士論文,未出版,台北縣。
黃詩芸(民89)。嬰幼兒的哺育方式與兒童過敏性疾病之相關性研究。國立成功大學環境醫學研究所碩士論文,未出版,台南市。
黃翠華(民77)。不同嬰兒配方乳粉對嬰兒生長與代謝之影響。輔仁大學食品營養研究所碩士論文,未出版,台北縣。
蔡秀玲、郭靜香、蔡佩芬(民80)。生命期營養。台北:藝軒圖書出版社。
葛魯蘋(民73)。台北市古亭區母親哺餵行為之調查與其影響因素之探討。國防醫學院社會學醫學研究所碩士論文,未出版,台北市。
羅巧珍(民93)。懷孕到產後飲食營養與體重變化之前瞻性研究。國立台灣師範大學人類發展與家庭研究所碩士論文,未出版,台北市。
蘇建文、盧欽銘、王鍾和、許美瑞、陳淑美、盧素碧、王安琪、鍾志從(民71)。出生至一歲嬰兒動作能力發展之研究。行政院國家科學委員會補助專題研究計劃(計畫編號:NSC-70-0301-H003-01),未出版。
蘇建文、鍾志從(民74)。母親養育嬰兒方式之調查研究。教育心理學報,18,117-148。
蘇遂龍(民80)。台比市立婦幼綜合醫院哺餵母乳衛生教育介入效果之先趨研究。國防醫學院公共衛生研究所碩士論文,未出版,台北市。
嚴嘉楓(民90)。三歲之前幼兒過敏性疾病與體重成長之關係-以民國85年出生之士林區幼兒為對象。國立陽明大學公共衛生研究所碩士論文,未出版,台北市。
二、英文部份
Betrn, A. P., de Ons, M., Lauer, J. A., & Villar, J. (2001). Ecological study of effect of breast feeding on infant mortality in Latin America. BMJ, 323, 1-5.
Bhandari, N., Bahl, R., Nayyar, B., Khokhar, P., Rohde, J. E., & Bhan, M. K. (2001). Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain. J Nutr, 131, 1946-1951.
Butte, N. F., Wong, W. W., Hopkinson, J. M., O’Brian Smith, E., & Ellis, K. J. (2000). Infant feeding mode affects early growth and body composition. Pediatrics, 106, 1355-1366.
CDC Growth Charts: United States 2000. http://www.cdc.gov/growthcharts/
Csar, J. A., Victora, C. G., Barros, F. C., Santos, I. S., & Flores, J. A. (1999). Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. BMJ, 318, 1316-1320.
Cohen, R. J., Brown, K. H., Canahuati, J., Rivera, L. L., & Dewey, K. G. (1995). Determinants of growth from birth to 12 months among breast-fed Honduran infants in relation to age of introduction of complementary foods. Pediatrics, 96, 504-510.
Eriksson, J. G., Forsn, T., Tuomilehto, J., Winter, P. D., Osmond, C., & Barker, D. J. P. (1999). Catch-up growth in childhood and death from coronary heart disease: longitudinal study. BMJ, 318, 427-431.
Fewtrell, M. S., Lucas, A., & Morgan, J. B. (2003). Factors associated with weaning in full term and preterm infants. Arch Dis Child Fetal Netal Ed, 88, F296-F301.
Foote, K. D. & Marriott, L. D. (2003). Weaning of infants. Arch Dis Child, 88, 488-492.
Fox, M. K., Pac, S., Devaney, B., & Jankowski, L. (2004). Feeding infants and toddlers study: what foods are infants and toddlers eating? J Am Diet Assoc, 104, S22-S30.
Freeman, V., van’t Hof, M., & Haschke, F. (2000). Patterns of milk and food intake in infants from birth to age 36 months: The Euro-Growth Study. J Pediatr Gastroenterol Nutr, 31, 76S-85S.
Gardner, J. M., Walker, S. P., Gavin, K. A., & Ashworth, A. (2002). Complementary foods in Jamaica: viscosity, energy density and feeding practices. Public Health Nutrition, 5, 295-302.
Gibson, R. S., Ferguson, E. L., & Lehrfeld, J. (1998). Complementary foods for infant feeding in developing countries: their nutrient adequacy and improvement. Euro J Clin Nutr, 52, 764-770.
Haschke, F., van’t Hof, M. A., & the Euro-Growth Study Group. (2000). Euro-Growth References for length, weight, and body circumferences. J Pediatr Gastroenterol Nutr, 31, 14S-38S.
Hediger, M.L., Overpeck, M. D., Ruan, W. J., & Troendle, J. F. (2000). Early infant feeding and growth status of US-born infants and children aged 4-71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr, 72, 159-167.
Heinig, M.J., Nommsen, L.A., Peerson, J.M., Lonnerdal, B., & Dewey, K.G. (1993). Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING Study. Am J Clin Nutr, 58, 152-161.
Institute of Medicine. (2001). Dietary reference intakes: Application in dietary assessment. Washington, DC: National Academy Press.
Kramer, M. S., Guo, T., Platt, R. W., Sevkovskaya, Z., Dzikovich, I., Collet, J. P., Shapiro, S., Chalmers, B., Hodnett, E., Vanilovich, I., Ducruet, T., Shishko, G., & Bogdanovich, N. (2003). Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am J Clin Nutr, 78, 291-295.
Lanigan, J. A., Bshop, J. A., Kimber, A. C., & Morgan, J. (2001). Systematic review concerning the age of introduction of complementary foods o the healthy full-term infant. Euro J Clin Nutr, 55, 309-320.
Lartey, A., Manu, A., Brown, K. H., Peerson, J. M., & Dewey, K. G. (1999). A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 of age. Am J Clin Nutr, 70, 391-404.
Li, L., Manor, O., & Power, C. (2004). Early environment and child-to-adult growth trajectories in the 1958 British birth cohort. Am J Clin Nutr, 80, 185-192.
Lucas, A., Fewtrell, M. S., & Cole, T. J. (1999). Fetal origins of adult disease-the hypothesis revisited. BMJ, 39, 245-249.
Lutter, C. K. & Rivera, J. A. (2003). Nutritional status of infants and young children and characteristics. J Nutr, 133, 2941S-2949S.
Morgan, J. B., Lucas, A., & Fewtrell, M. S. (2004). Does weaning influence growth and health up to 18 months? Arch Dis Child, 89, 728-733.
Nguyen, N. D., Allen, J. R., Peat, J. K., Schofield, W. N., Nossar, V., Eisenbruch, M., & Gaskin, K. J. (2004). Growth and feeding practices of Vietnamese infants in Australia. Eur J Clin Nutr, 58, 356-362.
Nicklas, T. A., Farris, R. P., Major, C., Frank, G. C., Webber, L. S., Cresanta, J. L., & Berenson, G. S. (1987). Dietary intakes. Pediatrics, 80, 797-806.
Noble, S., Emmett, P., & the ALSPAC Study Team. (2001). Food and nutrient intake in a cohort of 8-month-old infants in the south-west of England in 1993. Eur J Clin Nutr, 55, 698-707.
Oddy, W. H., Holt, P. G., Sly, P. D., Read, A. W., Landau, L. I., Stanley, F. J., Kendall, G. E., & Burton, P. R. (1999). Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ, 320, 815-819.
Ong, K. K. L., Ahmed, M. L., Emmett, P. M., Preece, M. A., Dunger, D. B., & the Avon Longitudinal Study of Pregnancy and Childhood Study Team. (2000). Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ, 320, 967-971.
Rolfes, S. R., DeBruyne, L. K., & Whitney, E. N. (1998). Life span nutrition. London: Wadsworth publishing company.
Simondon, K. B., Simondon, F., Costes, R., Delaunay, V., & Diallo. (2001). Breast-feeding is associated with improved growth in length, but not weight, in rural Senegalese toddlers. Am J Clin Nutr, 73, 959-967.
Thorsdottir, I., Gunnarsdottir, I., & Palsson, G. I. (2003). Birth weight, growth and feeding in infancy: relation to serum lipid concentration in 12-month-old infants. Eur J Clin Nutr, 57, 1479-1485.
WHO working group on the growth reference protocol and the WHO task force on methods for the natural regulation of fertility. (2002). Growth of healthy infants and the timing, type, and frequency of complementary foods. Am J Clin Nutr, 76, 620-627.
Wilcox, A. J. (2001). On the importance-and the unimportance-of brithweight. Int J Epidemiol, 30, 1233-1241.
Wright, C. M., Parkinson, K. N., & Drewett, R. F. (2004) Why are babies weaned early? Data from a prospective population based cohort study. Arch Dis Child, 89, 813-816.
van’t Hof, M. A., Haschke, F., & the Euro-Growth Study Group. (2000). The Euro-Growth Study: Why, Who, and How. J Pediatr Gastroenterol Nutr, 31, 3S-13S.
van’t Hof, M. A., Haschke, F., & the Euro-Growth Study Group. (2000). Euro-Growth References for body mass index and weight for length. J Pediatr Gastroenterol Nutr, 31, 48S-59S.
Villalpando, S. & Lpez-Alarcn, M. (2000). Growth faltering is prevented by breast-feeding in underprivileged infants from Mexico city. J Nutr, 130, 546-552.
Zembo, C.T. (2002). Breastfeeding. Obstet Gynecol Clin North Am, 29, 51-76.