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Composition of Weight Gain during Nutrition Rehabilitation of Severely under Nourished Children in a Hospital Based Study from India

印度某醫院嚴重營養不良孩童在營養恢復期增加體重之組成

摘要


嚴重營養不良的孩童在營養恢復期快速地成長的現象已引起關切,這也許與不成比例地大量的身體脂肪沉積有關。這個研究是調查在印度一個醫院裡那些嚴重營養不良的孩童,當他們經歷營養恢復期,所增加的體重及其組成。藉由測量入院以及餵食補充品一個月後的皮脂厚度來評估80位嚴重營養不良孩童的身體組成(年齡為6-60個月)。在入院時,孩童有嚴重的體重和身高不足以及極度消瘦。平均體重對年齡的z分數、身高對年齡的z分數以及體重對身高的z分數(WHZ)分別為-5.0、-4.2以及-4.1。給予孩童混合飲食,平均攝取熱量為每天每公斤體重177大卡,蛋白質佔總熱量的13%。整體來看,孩童平均體重增加為每天每公斤6.1公克,其中脂肪量約佔40%。當以基礎WHZ分數的三分位來分析體重增加的組成時,分數最低組有明顯較高的體重增加以及非脂肪量增加。但脂肪量的增加則與基礎WHZ分數無關。本研究顯示,對於嚴重營養不良的孩童,給予混合飲食可以快速增加體重及恢復耗損的組織。與相對較高的WHZ分數組相比,WHZ分數最低組的孩童在營養復原期有較高的非脂肪量增加,也許是試著使受損的組織恢復。

並列摘要


Concerns are raised that rapid catch up growth during nutrition rehabilitation of severely malnourished children may be associated with disproportionately higher amounts of body fat deposition. This study examined the composition of weight gain in severely undernourished children who underwent nutrition rehabilitation in a hospital from India. Body composition of 80 severely malnourished children (age 6-60 months) was assessed using skin-fold thickness measurements on admission and after 1 month of supplementary feeding. On admission, children had severe weight and height deficits and were severely wasted. The mean weight for age z score, height for age z score and weight for height z score (WHZ) were -5.0, -4.2 and -4.1 respectively. Children consumed a mixed diet and mean energy intake was 177 kcal/kg/day with a protein energy ratio of 13. Overall, the mean weight gain was 6.1 g/kg/day and fat mass contributed to about 40% of the weight gain. When the composition of weight gain was analysed in tertiles of baseline WHZ score, children in the lowest tertile of WHZ score had significantly higher weight gain and fat free mass (FFM) gain. Gain in fat mass did not differ in relation to the baseline WHZ score. The study demonstrates that it is possible to achieve rapid weight gain with recovery of lost tissue in severely malnourished children with mixed diets. Children with lowest WHZ scores at baseline gained higher FFM during nutrition rehabilitation when compared to the children with relatively higher WHZ score probably in an attempt to recover the lost tissue.

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