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研究生: 薛宇慧
Hsueh, Yu-Hui
論文名稱: 不同出生體重兒童至八歲生長發展與飲食營養之研究
Growth development, diet and nutrition for children with different birth weights until eight years old
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: 2015
畢業學年度: 103
語文別: 中文
論文頁數: 167
中文關鍵詞: 出生體重生長發展飲食營養體重反彈
英文關鍵詞: birth weight, growth development, diet and nutrition, adiposity rebound
論文種類: 學術論文
相關次數: 點閱:116下載:25
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  • 兒童時期是建立個人一生良好飲食習慣的關鍵時期,此期間的飲食營養狀況為奠定未來健康生長與發展的重要時機。然而兒童不同的出生體重對於從小到大的生長以及未來慢性疾病的發展有關鍵性的影響,因此飲食營養狀況對於不同出生體重兒童生長發展的影響和助益為何,透過本研究想更深入地探討。
    本研究為前瞻性之世代研究,結合民91及民93兩世代,分別於民國91及民國93年間於台北市立婦幼醫院及台大醫院招募151及150位嬰兒,並依出生體重第25及第75百分位分為相對低出生體重(relative Low Birth Weight infants,rLBW)、相對適當出生體重(relative Adequate Birth Weight infants,rABW)、相對高出生體重(relative High Birth Weight infants,rHBW)三組,而後以相同的問卷透過電話訪問來收集24小時飲食回憶(平日及假日各一天)、體位發展(身高、體重、BMI)、健康狀況等資料,再以SPSS19.0及STATA 8.0進行統計分析。兩世代皆持續追蹤兒童出生至八歲,最後共餘下104位兒童(rHBW ,n=38;rABW,n=28;rLBW,n=38),進而探討此三組體重之兒童從出生至八歲的生長狀況與飲食營養攝取的關係性。
    結果追蹤至八歲後,發現不同出生體重組的兒童,其身高、體重及BMI皆有顯著差異(P<0.01),且rHBW組的體位測量值仍維持最高、rLBW組則仍保持最低,其中還發現rLBW組在出生~2歲有生長追上的情況出現,然而續後追蹤至8歲卻還未發現肥胖機率的增加。而不同出生體重對於兒童從出生到7歲的生長發展皆有所影響,從8歲開始影響力才開始逐漸減弱。
    營養攝取方面,熱量攝取呈逐年上升趨勢,醣類攝取與脂質攝取百分比呈現相反趨勢;蛋白質攝取百分比則多介於13~14%。此外,兒童乳製品攝取量隨年齡增長而降低,蔬菜水果攝取量仍有不足的情況。另外還發現前期體重反彈組之營養素攝取普遍高於後期體重反彈組,而且幼兒於1~2歲的營養素攝取情形會左右體重反彈會較早或較晚發生,其中值得注意的是在2歲時的高蛋白質攝取,會較早產生體重反彈的現象。
    由此結果可知出生體重將會影響兒童一連串的生長發展—從嬰幼兒期、學齡前期,一直到學齡期的前端。此外,在此期間飲食營養的狀況會影響兒童的生長狀態和正常體型發展,因此兒童時期的均衡飲食是非常必要的。

    Childhood is a crucial period to establish good eating habits and healthy growth and development in the future. However, children with different birth weights critically impact growth and future development of chronic diseases. This study explores how different diet nutrition condition impacts and how it is beneficial to the growth and development of children with different birth weights.
    The study was a prospective cohort study, combining subjects from two cohorts. The first cohort of 151 infants recruited in 2002, and the second cohort of 150 infants recuited in 2004, both from the Taipei Municipal Women’s and Children’s Hospital and National Taiwan University Hospital. These participants were divided into three groups according to the 25th and 75th percentile cut points: relative low birth weight infants group (rLBW,) relative adequate birth weight infants group (rABW,) and relative high birth weight infants group (rHBW.) Then same questionnaires were given through telephone interviews to gather 24 hours dietary recall (weekdays and holidays one day each,) anthropometric development (height, weight, BMI,) health status, etc. The software packages of SPSS 19.0 and STATA 8.0 were employed for the statistical analyses. Two cohorts were kept track from the child's birth to the age of eight, the last remaining total of 104 children (rHBW, n = 38; rABW, n = 28; rLBW, n = 38,) and the relationship of growth development and dietary intakes of the children from the three groups of body weight were discussed and analyzed.
    Keeping track until the age of eight, the result shows that children of different birth weights, are significantly different (P <0.01) in height, weight and BMI and the anthropometric measurements of the rHBW group still maintains higher means for weight, height and BMI, while the means of the rLBW group remains lowest among the three groups. The rLBW group also shows the catch-up growth from brith to two years of age; however, continuing the track of collecting data until eight years old, no signs of increased chance of obesity were found. The different birth weights influenced the growth development of children from birth to seven-years-old, but starting from eight-years-old, the influence began to weaken gradually.
    For the dietary intakes, calorie intake increased annually, the percentages of energy from carbohydrate intake and fat intake show the opposite trend; protein intake is 13% to 14% higher. In addition, dairy intake decreases with age, and the intake of fruits and vegetables is still insufficient.
    On the other hand, the nutrient intakes such as mean of early adiposity rebound group is generally higher than the later adiposity rebound group, and for children of one to two years old, the diet determines whether adiposity rebound occurs earlier or later. It is worth noting that high protein intake at the age of two leads to a rebound phenomenon earlier.
    From this study, it could be concluded that birth weight affects a series of children’s growth and development from early childhood, preschool, up to the beginning of school age. In addition, during this period the diet and nutrition status affects children's growth and development of body sizes, so a balanced diet in childhood is essential.

    第一章 緒論 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 第二章 文獻探討 第一節 兒童飲食營養與生長發展之相關世代研究……………………...…5 一、世代研究之來源與定義………………………………………...5 二、各國的兒童飲食營養與生長發展之相關世代研究…………...5 三、體重反彈假說…………………………………………………...8 第二節 出生體重對兒童生長發展及未來的影響…………………………...10 一、影響嬰兒出生體重之相關因素………………………………....10 二、出生體重對嬰幼兒生長速度與發展之影響…………………...11 三、出生體重對兒童未來健康狀況之影響…………………………13 第三節 巨量營養素對兒童生長發展的影響…………………………………16 一、醣類對兒童生長發展的影響……………………………………16 二、蛋白質對兒童生長發展的影響…………………………………17 三、脂質對兒童生長發展的影響……………………………………19 第三章 研究方法 第一節 研究架構………………………………………………………………20 第二節 研究設計與實施程序…………………………………………………22 第三節 研究對象………………………………………………………………25 第四節 研究工具………………………………………………………………29 第五節 資料處理………………………………………………………………34 第六節 統計分析………………………………………………………………37 第四章 研究結果 第一節 兒童基本資料分析……………………………………………………39 第二節 兒童生長情況分析……………………………………………………46 第三節 兒童飲食及營養素攝取狀況分析……………………………………68 第四節 兒童生長情況與飲食營養素之探討…………………………….87 第五節 兒童體重反彈現象………………………………………………..…..107 第五章 討論 第一節 兒童生長情況…………………………………………………………122 第二節 兒童飲食及營養素攝取狀況…………………………………………126 第三節 兒童生長情況與飲食營養素之探討…………………………………131 第四節 兒童體重反彈現象……………………………………………………134 第六章 結論……………………………………………………………………….136 第七章 研究限制與建議………………………………………………………….140 參考文獻 一、 中文部分……………………………………...……………………......142 二、 英文部分……………………………………………………………….144 附錄 附錄一 幼童五歲及家庭問卷(H問卷)…………………………………….149 附錄二 幼童六歲及家庭問卷(I問卷)……………………………………...158 附錄三 研究調查同意書……………………………………………………….167

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