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研究生: 呂忻瑾
論文名稱: 台北都會區不同出生體重嬰兒飲食營養與生長發育之前瞻性研究
指導教授: 盧立卿
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: 2008
畢業學年度: 96
語文別: 中文
論文頁數: 334
中文關鍵詞: 嬰兒期營養嬰兒生長發育副食品添加哺餵方式
英文關鍵詞: infant nutrition, growth and development in infancy, complementary food, feeding pattern
論文種類: 學術論文
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  • 影響嬰兒生長之相關因素有許多,除了先天遺傳基因及其出生體型,出生後良好的營養素攝取也佔極大的影響力。本研究採前瞻性世代追蹤設計,以電訪及郵寄問卷方式追蹤嬰兒出生至一歲間生長情況,探討影響成長之相關因素,如父母體型、餵食方式與營養素攝取、家庭背景環境等。受試者分別是於民國91年及93年間於台北市立婦幼醫院及台大醫院進行招募。研究之初共有280名新生兒參與,自第2個月開始共有261名嬰兒被持續追蹤至滿週歲;依照出生體重25及75百分位將嬰兒分成相對低出生體重嬰兒(relative low birth- weight infants, rLBW)95人、相對適當出生體重嬰兒(relative adequate- birth weight infants, rABW)74人、相對高出生體重嬰兒(relative high birth-weight infants, rHBW)92人。所有統計分析方式皆以SPSS12.0及STATA8.0進行。
    結果發現三組嬰兒出生體重分別為2753.5±144.0公克、3185.1±204. 7公克及3771.2±241.1公克,滿一歲時體重仍維持顯著差異8991.0±975.6公克、9808.6±1050.4公克、10378.3±1030.8公克,但比較體型增加倍數與體重增加百分比(Infant weight gain percentage, IWG%)後發現rLBW嬰兒生長速度較其他兩組快速,體重倍數分別是3.3、3.1、2.8倍,而體重增加百分比為227%、206%及176%。在哺餵方式上,嬰兒2個月時有29.6%嬰兒主要採取母乳哺餵、混合哺餵者為10.4%、配方奶者為60%;所有嬰兒平均開始添加副食品月齡為第5.2個月,最常被使用的副食品為水果/果汁、嬰兒米粉、稀飯及餅乾等,平均開始使用固體食物為正餐時間為第7.8個月,嬰兒滿一歲時僅有24.2%一天使用三次以上固體食物為正餐,有8.0%尚未使用固體食物為正餐,顯示出多數一歲嬰兒(75.8%)仍以奶類為主要熱量來源。營養素攝取部份,第2個月熱量攝取為548大卡,一歲時上升至835大卡,隨月齡增加醣類百分比及蛋白質百分比漸增加,分別由46.0%與9.4%上升至57.0%與13.0%,而脂肪百分比逐漸降低,自45.3%下降至30.1%;不同出生體重嬰兒中以rHBW嬰兒熱量攝取較高,rLBW嬰兒較低,但比較各項營養素攝取後發現整體來說rABW嬰兒營養素攝取情況較佳,皆達DRIs建議標準量;副食品攝取熱量也隨年齡增加,6個月平均107.3大卡,一歲時為370大卡。
    在此一年中嬰兒平均生病次數為4.07次,最常發生的疾病為上呼吸道感染,平均3.21次,一次6.64天,不同出生體重嬰兒在健康狀況方面並無差異。嬰兒在此一年間體重及身長與母親的身高及未懷孕前體重皆呈顯著正相關(p<0.05),與父親體型亦呈正相關,但達顯著值較少,顯示出母親體型對嬰兒影響較大;以淨相關分析發現副食品中攝取營養素較整日飲食攝取對嬰兒一歲體型影響力來得大;不同哺餵方式嬰兒在6個月後體型出現顯著差異(p<0.05),顯示出不同哺餵方式對嬰兒生長速度有所影響。再以多元迴歸方式分析與嬰兒一歲體型相關因素,嬰兒一歲體重及體重增加百分比與出生體重、性別、哺餵方式有顯著相關(p<0.05),一歲身長與出生身長、性別、父母親身高有顯著相關(p<0.05),一歲時體重z分數改變量與出生體重及哺餵方式有顯著相關(p<0.05),由多元迴歸結果顯示出生時體型、性別、哺餵方式等非飲食因子對嬰兒一歲時體型預測力較強,尤其出生體重對一歲體重預測力為15.5%,出生身長對一歲身長預測力為12.6%。

    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 一、研究目的 2 二、研究問題 2 第三節 名詞解釋 4 第二章 文獻探討 7 第一節 嬰兒飲食營養相關文獻 7 一、各國嬰兒營養素建議攝取量 7 二、各國嬰兒飲食建議 11 三、評估嬰兒飲食營養之方法學 14 四、嬰兒飲食營養攝取相關研究 18 4-1國內嬰兒飲食營養攝取相關研究 19 4-2國外嬰兒飲食營養攝取相關研究 21 第二節 嬰兒生長發育相關文獻 31 一、嬰兒生長發育評估方法學 31 二、嬰兒生長發育與影響因素 33 第三節 嬰兒飲食營養與生長發育相關世代追蹤研究 38 一、世代追蹤研究之定義 38 二、各國嬰兒飲食營養與生長發育相關世代研究 38 第四節 嬰兒出生體重與日後體型及健康之相關探討 47 一、影響嬰兒出生體重之相關因素 47 二、嬰兒出生體重對日後體型之影響 49 三、嬰兒出生體重對疾病之影響 50 第三章 研究方法 53 第一節 研究架構 53 第二節 研究設計與實施程序 55 一、研究設計 55 二、實施程序 57 第三節 研究對象 59 第四節 研究工具 60 一、嬰兒家庭背景資料 60 二、24小食飲食回憶紀錄 61 三、非飲食部分 61 第五節 資料蒐集與訪員訓練 63 一、訪員訓練 63 二、資料蒐集 63 第六節 資料處理 66 一、非飲食資料 66 二、飲食資料 67 第七節 統計分析 69 第四章 研究結果 72 第一節 嬰兒基本資料分析 72 一、婦幼民91世代與民93世代嬰兒家庭背景比較 73 二、相對不同出生體重嬰兒家庭背景比較 78 第二節 嬰兒零至一歲生長情形 84 一、嬰兒零至一歲生長情形分析 84 二、相對不同出生體重嬰兒生長速度比較 99 三、家庭背景資料與嬰兒生長情形之相關分析 107 第三節 嬰兒零至一歲營養素攝取情形 117 一、嬰兒2-12個月每月營養素攝取狀況 117 二、嬰兒營養素攝取狀況與一歲生長淨相關分析 152 第四節 嬰兒不同哺餵方式比較 162 一、母乳及配方奶粉資料庫改善 162 二、嬰兒2-12個月哺餵方式 163 三、不同哺餵方式嬰兒2-12個月營養素攝取狀況 164 四、不同哺餵方式嬰兒零至一歲生長情形 180 第五節 嬰兒副食品添加情形 186 一、嬰兒2-12個月副食品添加情形 186 二、副食品中營養素與嬰兒一歲生長淨相關分析 214 第六節 嬰兒零至一歲發展狀況 224 一、嬰兒零至一歲發展狀況 224 二、嬰兒家庭背景資料與發展狀況相關分析 224 三、嬰兒營養素攝取與零至一歲發展相關分析 229 第七節 嬰兒零至一歲健康狀況 238 一、嬰兒零至一歲健康狀況 238 二、嬰兒家庭背景資料、哺餵方式與健康狀況相關分析 240 三、嬰兒營養素攝取與零至一歲健康相關分析 244 四、嬰兒零至一歲健康狀況與生長情形相關分析 251 第八節 影響嬰兒一歲生長狀況之多元迴歸分析 255 一、嬰兒一歲時體重與相關因素之多元迴歸分析 255 二、嬰兒一歲時身長與相關因素之多元迴歸分析 256 三、嬰兒一歲時體重增加百分比與相關因素之多元迴歸分析 257 四、嬰兒一歲時體重z分數改變與相關因素之多元迴歸分析 258 第五章 討論 270 第六章 結論 289 第七章 研究限制與建議 293 參考文獻 296 附錄 附錄一 嬰兒每月健康問卷 311 附錄二 嬰兒每月飲食頻率問卷 314 附錄三 嬰兒健康問卷C 317 附錄四 嬰兒健康問卷A 322 附錄五 嬰兒健康問卷B 324 附錄六 研究調查同意書 325 附錄七 追蹤過程紀錄表 326 附錄八 嬰兒相關變項編碼 328

    一、 中文部分

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    行政院衛生署(民94)。兒童健康手冊。
    李寧遠、蔣見美、許瑞雲(民71)。台灣地區營養及衛生問題之探討。中華民國營養學會雜誌,7,29-45
    沈敬人(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。
    周弘傑(民93)。解讀嬰兒配方奶粉。健康世界,219,11-13
    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。
    林家慧(民95)。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。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。
    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。
    郭曉惠(民95)。國人捐贈乳中一般成份及礦物質含量之建立與研究。輔仁大學食品營養研究所碩士論文,未出版,台北市。
    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,台北縣。
    黃伯超(民68)。食品營養學講座。台北市:健康文化
    黃伯超(民79)。營養學精要。台北市:健康文化
    黃亮瓅(民96)。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。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。
    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。
    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。
    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。
    陳建仁(民88)。流行病學:原理與方法。台北市:聯經出版社
    陳姮霏(民92)。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。
    羅巧珍(民92)。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。
    蘇秋帆(民93)。零至一歲嬰兒飲食營養與生長發展狀況之前瞻性研究。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。
    蘇郁芬(民97)。估計國內母乳攝取量及零到六個月嬰兒營養狀態與生長發育之研究。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、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。
    蘇建文、鍾志從(民73)。出生至一歲嬰兒動作發展的縱貫研究。教育心理學報,17,73-98。
    蘇建文、鍾志從(民73)。我國嬰兒動作發展之研究。教育心理學報,25,81-96。
    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。

    二、 英文部分
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    Arenz, S., Rückerl, R., Koletzko, B., & Kries, R. (2004). Breast-feeding and childhood obesity—a systematic review. Int J Obes, 28, 1247–1256
    Armstrong, J., Reilly, J.J. & Child Health Information Team. (2002). Breastfeeding and lowering the risk of childhood obesity. Lancent. Oct19, 360, 1249-50.
    Barker, D. J., Hales, C. N., Fall, C. H., Osmond, C., Phipps, K., & Clark, P. M. (1993). Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia, 36, 62-67.
    Barker, D. J., & Osmond, C. (1986). Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet, 1, 1077-1081.
    Barker, D. J., Winter, P. D., Osmond, C., Margetts, B., & Simmonds, S. J. (1989). Weight in infancy and death from ischaemic heart disease. Lancet, 2, 577-580.
    Beaty, T. H., Skjaerven, R., Breazeale, D. R. & Liang, K. Y. (1997). Analyzing sibship correlations in birth weight using large sibships from Norway. Genet Epidemiol, 14, 423-33
    Berkke, H.K., Odijk, J.V., & Ludvigsson, J. (2007) . Predictors and dietary consequences of frequent intake of high-sugar, low-nutrient foods in 1-year-old children participating in the ABIS study. Br J Nutr, 97, 176-181
    Betrán, A. P., de Onís, 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 moths of age has a small impact on weight gain. J Nutr, 131, 1879-1880
    Bhandari, N., Mazumder, S., Bahl, R., Martines, J., Black, R. E., & Bhan, M. K., et al. (2004). An Educational Intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. J Nutr, 134, 2342-2348
    Binns, C. E., Graham, K. I., Scott, J. A., & Oddy, W. H. (2007). Ifant who drink cows milk: a cohort study. J Paediatr Child Health, 43, 607-610
    Boersma, B., & Wit, J.M., (1997). Catch-up growth. Endocr Rev. 18, 646-661
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