追蹤孕產期至六歲幼童飲食營養與生長發育之前瞻性研究

A prospective study of dietary intakes and growth development for children from pregnancy to 6 years old

李芳靚(Fang-Jing Lee)

指導教授 ： 盧立卿

國立臺灣師範大學/教育學院/人類發展與家庭學系/碩士(2010年)

摘要

本研究為國內唯一嬰幼兒飲食營養與生長之縱貫性長期追蹤研究，藉由收集零至六歲孩童飲食營養素攝取狀況、生長發展及健康狀況之相關資料，探討各相關因素間的關係。自民國91年於台北市立婦幼醫院招募151位孕婦，持續追蹤其出生子女共130位，最終完成六歲問卷者共有57位孩童。研究工具以問卷為主，採用電訪方式追蹤孩童從出生至六歲期間的飲食營養、生長及健康狀況之相關資料。1歲以前進行嬰幼兒每月飲食健康問卷的追蹤、1歲之後每半年進行一次幼兒飲食與家庭問卷、3歲之後以每年為單位進行問卷調查。本研究主要是進行幼兒5、6歲及家庭問卷的部分，問卷內容包含二天24小時飲食回憶記錄、家庭背景、孩童生活、健康和生長發育狀況。使用SPSS12.0及STATA8.0版進行統計分析。
研究結果發現，孩童從出生到6歲時的體重、身高和頭圍(三歲以前)皆位於衛生署公佈的生長曲線之正常範圍內。比較男女孩之間身高和體重的差異，發現孩童在出生、1歲和2歲時的體重以及出生和1歲時的身高有顯著的性別差異(p<0.05)，但是3歲之後孩童的體重和身高就沒有性別差異。在營養素攝取方面六歲孩童平均整日熱量攝取為1446大卡，蛋白質、脂質和醣類的攝取分別為51克、45克和209克，分別占總熱量的14%、28%和58%。從出生到六歲期間，隨著年齡增長，大多數的整日營養素攝取量都隨之增加，其中維生素A、維生素E、維生素B2、維生素C、鈣及鐵的整日攝取量則隨年齡增長有降低的趨勢。另外，比較男女孩飲食營養素攝取狀況，發現一到六歲期間男女孩在整日熱量和多種營養素的攝取上有顯著性別差異(p<0.05)，其中男孩攝取量皆高於女孩。另外，分析結果發現孩童在5、6歲時，熱量和多種營養素的主要食物來源為攝取量最多的白飯、麵條及奶粉。
生長分析方面，孩童6歲時熱量和多種營養素的攝取與6歲體重、BMI和5~6歲體重增加量呈顯著正相關(p<0.05)，唯有每公斤熱量攝取是呈顯著負相關(p<0.01)；孩童5歲時每公斤熱量攝取也與6歲體重、身高及BMI呈顯著負相關(p<0.05)；一般家庭食物來源方面，6歲時肉魚豆蛋類、蔬菜和水果類的攝取與孩童6歲體重、BMI和5~6歲體重增加量呈顯著正相關(p<0.05)。父親身高與孩童6歲身高呈顯著正相關(p<0.05)；父母親年齡與孩童6歲身高呈顯著正相關(p<0.05)。經多元迴歸分析結果得知，飲食營養素的攝取狀況，尤其是醣類的攝取是預測孩童6歲體重、身高及BMI最強的變項，然而在孩童6歲的身高表現方面，孩童的出生身長和父親的身高亦為最有預測力的變項。
孩童體重反彈現象方面，分析48位(24位為男生，24位為女生)提供完整1 ~ 6歲體位資料的孩童，體重反彈年齡於3 ~ 5歲定義為「前期體重反彈」，若為6歲以後則為「晚期體重反彈」。幼童6歲時「前期組」之BMI (n=28)顯著大於「晚期組」(n=20)(p < 0.05)；熱量供應營養素攝取狀況在此二組間皆無明顯差異，但1歲時的熱量攝取皆以「前期組」為較高。孩童1歲之哺餵狀況發現，停止哺餵母乳或介入配方奶的時間低於4個月之幼童熱量攝取皆為較高，且「前期組」之熱量攝取亦大於「後期組」，因此證實母乳哺餵及配方奶介入時間的長短對幼童體重反彈具有一定的影響力。
綜合上述可知，本研究中孩童在0~6歲期間的飲食營養素攝取及生長狀況均良好之外，顯示這些來自台北市中高階層家庭的孩童，他們6歲時的生長表現除了與父母親的遺傳有關，孩童平時飲食營養素的攝取狀況也扮演極為重要的角色，因此若能藉由後天充足且適當的飲食介入，必定能讓孩童有適當的生長表現。

關鍵字

幼童 ； 長期前瞻性研究 ； 體重反彈 ； 24小時飲食回憶記錄

並列摘要

This prospective study described in detail about dietary intakes, growth development and health status for children from birth to 6 years old. We recruited 151 pregnant women from Taipei Municipal Women’s and Children’s Hospital and collected related information for growth and nutritional status of their babies from birth to 6 years old (at birth n=130, at 6 years old n=84). We collected information for dietary intakes, growth and health status of children by questionnaire, including 2-day 24 hours recalls, family background, child lifestyle, health and growth status by telephone interviews. The statistical analysis was performed by SPSS 12.0 and STATA 8.0.
With comparison to data from birth to 6 years old, the participation children showed the average weight, height and head circumference lie in normal range on published growth curve in Taiwan. The data showed the significant differences by gender for weight at birth, 1 and 2 years old, and height at birth and 1 year old. The average dietary intakes of energy, protein, fat and carbohydrate at 6 years old were 1446 Kcal, 51g, 45g and 209g, respectively. The percentages of total energy from protein, fat and carbohydrate were 14%, 28% and 58%. Most nutrient intakes were increased with age, but vitamin A, vitamin E, vitamin B2, vitamin C, calcium and iron intakes were reduced with age. There were significant differences between boys and girls on daily energy and most nutrient intakes between 1 to 6 years old. Rice, noodles and formula are the major sources of energy and most nutrients at 5 and 6 years old.
The energy and most nutrients at 6 years old were positively correlated with body weight and BMI at 6 years old; also with 5 to 6 years old wight gain(p<0.05). But the per kilo of energy intake had significant negative relationship with body weight and BMI at 6 years old; also with 5 to 6 years old weight gain(p＜0.01). For the adult-style diet, the weight and BMI at 6 years old, and also with 5 to 6 years old weight gain had a positive correlations with meat, fish, soybean, egg, vegetable and fruit intakes(p<0.05). The height at 6 years old had significant positive relationships with father’s height; also with father and mother age (p<0.05). By multiple regression analysis, these children’s dietary nutrient intakes, especially per kilo of energy had si and carbohydrate intakes, were the best predictors of body weight, height and BMI at 6 years old. Birth height and father’s height also were the best predictors of height at 6 years old.
By adiposity rebound analysis(AR), there were 48 subjects in total (24 males and 24 females), offering the information about their body measurement. The children were divided into two groups based on BMI, and characterized as follows: early AR(from 36 but before 60 months), and later AR (after 72 months). These data showed that the comparison of BMI value between early AR (n=28) and later AR (n=20) had a significant statistical difference (P<0.05). At the age of 6 years old, the children in early AR had a higher BMI value than the later AR. The situation of nutrition intake in two groups had no significant difference, but we also observed that the calorie intake of early AR was more than that of later AR at 1 year old. According to the feeding status of one-year-old children, we found that there was an increase of the caloric intake less than 4 months in both groups of children who stopped being breastfed and who started to be fed with formula milk. Within each group, the intake of calorie in early AR was higher than later AR. Here we proved the adiposity rebound was influenced by duration of breastfeeding and formula milk introduced.
In conclusion, our study showed that dietary intake and growth development from birth to 6 years old children were appropriate. Our data showed that besides the influences from parent’s weight and height, children’s dietary intakes are also important factors for the growth from birth to 6 years old.

並列關鍵字

children ； prospective study ； adiposity rebound ； 24 hours dietary recall

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