追蹤不同出生體重幼兒至四歲之生長狀況及飲食營養研究

Examination of growth development, diet and nutrition for toddlers with different birth weights until four years old

陳姿媛(Chen Tzu-Yuan)

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(2012年)

摘要

良好的營養支持是嬰幼兒健全生長發展的關鍵因素，且嬰幼兒出生體重的不同對於生長速度亦有所影響。本研究利用長期追蹤前瞻性研究方式，持續收集不同出生體重的新生兒其飲食營養攝取狀況與生長發展資料至四歲，並深入探討各因素間之相關性。本研究招募對象主要來自兩世代，分別各於民國91及93年間於台北市立婦幼醫院及台大醫院進行招募，研究之初招募人數各為151及150位；兩世代採用相同的問卷調查方法，問卷內容包括24小時飲食回憶、健康狀況、體位發展等資料。研究合併兩世代嬰幼兒至四歲的資料(n=165)，依出生體重第25及第75百分位分成相對低出生體重(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。資料使用SPSS 12.0及 STATA 8.0版進行統計分析。
結果發現出生至4歲的幼兒體型（體重、身高及BMI）於三組間均達顯著差異(p<0.05)，且仍以相對高出生體重組(rHBW)保持最高，相對低出生體重組(rLBW)保持最低；但相對適當出生體重組(rABW)與相對低出生體重組(rLBW)兩組間之差異性已漸趨微小。若再以體型增加倍數、體重增加百分比、WHO Anthro運算軟體進行生長速度評估，則發現出生至4歲的幼兒，rLBW組幼兒皆較rHBW組快速，且以出生至1歲為體位值變化最快速的時期。性別差異方面，0~4歲男幼兒的體型（體重、身高及BMI）均高於女幼兒。
營養素攝取方面，本研究幼兒4歲平均攝取熱量為1390大卡，相近於DRIs建議的1300~1450大卡；平均蛋白質、脂質及醣類攝取為48、46、194公克，各占總熱量攝取的14%、29%及56%；但鈣質攝取量（337毫克）僅達DRIs的一半，膳食纖維（8克）更不及美國IOM建議量的一半。飲食型態部分，4歲幼兒因開始就讀幼稚園，多了早點及午點的供給，因此飲食型態傾向以三正餐三點心為主；奶類攝取次數降低，僅有60%幼兒每日有攝取乳製品（全脂鮮乳、沖泡奶粉），份量約為2/3~1份奶類。另外也發現幼兒乳製品攝取量隨年齡增長而下降、零食點心及油炸類食物隨年齡增長而上升、蔬菜水果攝取不足等現象，此於十年前的台灣地區國民營養調查結果一致，顯示幼兒營養問題仍顯然存在。性別差異方面，幼兒1~4歲的熱量及營養素的攝取，均以男幼兒顯著高於女幼兒(p<0.05)；而出生體重差異上，則顯示隨著幼兒年齡增長，三組差異性漸趨微小，飲食型態漸相一致。
以多元迴歸分析橫斷性評估4歲幼兒體位之最佳預測模式，結果顯示先天基因（出生身長、母親身高）對4歲幼兒身高影響力較大，後天飲食攝取（熱量、糖果攝取量）則對4歲幼兒體重影響力較大。進而再縱貫性探討1~4歲幼兒體位之預測模式變化，結果顯示出生體重、雙親體重（尤其母親）對於1~4歲幼兒體重均有影響力，而熱量攝取對幼兒體重之影響力於4歲才顯現；身高部分則顯示先天基因影響力（出生身長、雙親身高）高於後天飲食攝取。此外亦發現早期的蛋白質攝取即已對4歲幼兒體型表現具相關性；而生長速度分析上，顯示蛋白質攝取對於體重增加量具相關性的時間點集中在2~3及3~4歲，對於身高增加量則於1~2歲即有顯著相關性存在。
本研究相較於先前研究，除了新增了生長曲線百分位及z分數來評估幼兒生長速度，亦整合1~4歲影響幼兒生長之因素並予以量化。此外，於不同出生體重幼兒生長發展中，本研究新使用了「演化彈性」(developmental plasticity)概念進行闡述與討論，希冀適度生長追上的「慢慢長」觀念、及「自己跟自己比」的評估方式，能漸推廣至社會大眾，藉由後天均衡且正確的飲食模式建立，使孩童有更佳的生長表現。

關鍵字

相對高出生體重 ； 相對低出生體重 ； 嬰幼兒營養 ； 嬰幼兒生長發育 ； 生長速度

並列摘要

Proper nutrition is the essential factor for growth of healthy children and birth weight may also affect growth rate. This study collected information from birth to 4 years old with different birth weight ranges and focused on analyzing the relationship between the dietary intakes and the growth development of healthy children. These analyses included the first cohort of 130 and the second cohort of 150 children recruited from the Taipei Municipal Women’s and Children's Hospital and the National Taiwan University Hospital from 2002 to 2004. The methodology adopted the questions asked in the two cohorts were identical. Our analyses combined information from the two cohorts consisting of total 165 subjects from birth to 4 years old. 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). The software packages of SPSS 12.0 and STATA 8.0 were employed for the statistical analyses.
The result indicated that the growth indicators (weight, height and BMI) of infants between the three groups are significantly different from age 0 to 4. The rHBW group had higher means for weight, height and BMI and the rLBW group was still the smallest of the three groups. However, the differences between the rABW and rLBW group had become smaller. The assessments of the growth rates by multiplier of figures, weight gain percentages and the WHO Anthropometric calculator indicated that the growth speeds were also significantly different between the three groups. The rLBW group had faster growth speed than the rHBW group, especially from age 0 to 1. The mean weight, height and BMI of boys from birth to 4 years old were significantly higher than the girls.
The mean daily caloric intake of 4-year-old was 1390 Kcal, compared to the DRIs of 1300~1450 Kcal. The average dietary intakes of protein, fat and carbohydrate were 48g, 46g and 194g, respectively. The total energy was 14% from protein, 29% from fat, and 56% from carbohydrates. The mean calcium intake was 337 mg compared to the DRIs of 600 mg, and the mean dietary fiber intake was 8 g compared to the IOM of 25 g. The dietary pattern of 4-year-old toddler tended to three meals with three snacks because most of them already attend the kindergarten. Only 60% of children had daily consumption of dairy products (whole milk and milk powders) and the average intake was less than one serving portion. We also found that the intake of carbonated beverage and fried food increased with age, while the dairy intake decreased with age. In addition, the intakes of vegetable and fruit were insufficient at 4 years old. These conditions were similar to the nutrition survey in Taiwan ten years ago, indicated that the nutritional problems of children still remained. The daily energy and most nutrient intakes of boys from birth to 4 years old were significantly higher than the girls. There was no significant difference for nutrient intakes among the three birth weight groups at any ages.
By multiple regression analysis for the related factors of children growth at 4 years old, the hereditary genetic factors such as birth length and maternal height were the better predictor for the height of the 4-year-old children. The acquired diet intakes such as energy and the candy intake were the better predictor for the weight at 4-year-old. Further by multiple regression analysis for the related factors of children growth from 1 to 4 years old, the maternal weight (especially mother) influenced on the weight of children age 1 to 4, and the effect of the energy intake appeared at 4 years old. The influence of hereditary genes on the height of children was higher than the acquired diet intakes. Moreover, this analysis found that the protein intake during earlier years had influenced on the weight and height at 4-year-old. The protein intake also was associated with the growth rate indicators including weight gain, height gain, and multiplier of figures. The assessment of growth rates indicated that the timing associated with the weight gain were appeared during 2 to 3 and 3 to 4 years old, while the association with the height gain appeared during 1 to 2 years old.
In conclusion, this study not only added percentiles and z-scores calculated by the WHO Anthropometric calculator to assess the growth rates of children, but also quantified the factors affecting the growth of children from 1 to 4 years old compared to previous study. In addition, the study first used a “developmental plasticity” hypothesis to discuss the growth among the children of different birth weights. We hoped that the concepts for “modest growth ” and “compared themselves with their own” can be gradually extended to the general public. By building a balanced dietary pattern, children could have better growth performance to prevent obesity and undernutrition.

並列關鍵字

relative high birth weight infants ； relative low birth weight infants ； nutrition of infants and toddlers ； growth status of infants and toddlers ； growth rate

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