分析嬰兒哺餵方式及飲食攝取與體型發展之前瞻性研究

A prospective study of infant feeding patterns and dietary intakes for growth development in 0-1 year old infant

江忻蓉

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

嬰兒之飲食攝取包括奶類哺餵方式、副食品添加情形，對營養素攝取、生長及健康等具有一定的影響力。本分析採用三項前瞻性世代資料，探討嬰兒之哺餵方式及飲食攝取與生長之相關並描述嬰兒副食品添加現況。受試者分別是於民國91年、93年及98年間於台北市立婦幼醫院及台大醫院進行招募。研究中分析402名新生兒1-12個月間飲食營養攝取、副食品添加情形、體型生長、發展與健康情形。在哺餵方式分析上，將402位嬰兒依照每個月哺餵方式的不同分組，以橫斷性方式分析嬰兒1-12個月每個月當中的哺餵方式與營養素攝取及體型結果，另外，也回溯嬰兒一歲間主要哺餵方式與探討其1-12個月間飲食營養攝取、體型生長、發展及健康等情形。所有統計分析方式皆以SPSS12.0及STATA8.0進行。
在體型結果部分，以橫斷性分析結果顯示，在第1、2、3、4、5個月當中以母乳哺餵、混合哺餵及配方奶哺餵之嬰兒體型無顯著差異(p>0.05)；但在第6、8、9個月時，以配方奶哺餵嬰兒體重顯著大於母乳哺餵嬰兒(p<0.05)，在12個月時以配方奶哺餵嬰兒體重略大於母乳哺餵嬰兒(p=0.07)；在身長方面，在第7、8、9個月時以配方奶哺餵之嬰兒身長顯著高於母乳哺餵者(p<0.05)；而以縱貫回溯性分析之結果顯示，一歲之間主要以母乳、混合及配方奶哺餵之嬰兒在出生體型上無顯著差異(p>0.05)，但在一歲時，主要以配方奶哺餵嬰兒體重顯著高於母乳哺餵嬰兒(p<0.05)，身長之部分則無顯著差異。
在營養素攝取方面，以橫斷性分析結果顯示1-12個月每個月齡當中不同哺餵嬰兒營養素攝取情形，皆以每個月齡當中之配方奶哺餵者，熱量及三大營養素攝取顯著較高(p<0.05)，而母乳哺餵者顯著較低(p<0.05)。以縱貫回溯性分析後發現，一歲間主要以母乳哺餵嬰兒1-12個月熱量攝取為318-617大卡，混合哺餵為383-887大卡，配方奶哺餵方式嬰兒為396-851大卡，熱量攝取皆以配方奶哺餵為顯著高於母乳哺餵嬰兒(p<0.05)；1-12個月每公斤體重蛋白質攝取，主要以母乳哺餵嬰兒攝取量為1.6-2.3公克/每公斤體重，混合哺餵為1.8-2.9公克/每公斤體重，配方奶哺餵方式嬰兒為2.2-3.0公克/每公斤體重，以配方奶哺餵嬰兒顯著高於母乳哺餵嬰兒(p<0.05)。
研究中所有嬰兒平均開始添加副食品月齡為第5.7個月，其中有2位嬰兒在4個月前即開始添加副食品，71%之嬰兒在4-6個月間開始使用副食品，而28%在6個月之後才添加副食品；副食品熱量攝取部分，橫斷性分析結果顯示，嬰兒在一歲時以母乳哺餵者副食品熱量占總熱量之57%，混合哺餵嬰兒為49%，而配方奶哺餵嬰兒為42%；以縱貫性資料分析結果顯示，母乳哺餵與混合哺餵之嬰兒在4-12個月間副食品熱量占總熱量之9-56%和6-48%，配方奶哺餵嬰兒在3-12個月間副食品熱量占總熱量為2-44%。嬰兒一歲時平均一天吃2餐副食品，尚低於行政院衛生署建議之3餐，且副食品佔總熱量攝取之百分比為44%，顯示出多數一歲嬰兒時仍以奶類為主要熱量來源；嬰兒副食品攝取情形，第6個月時，共有88%嬰兒開始添加含鐵豐富之食物，最常添加的食物為嬰兒專用米麥精（粉），有17%嬰兒在第7個月時開始添加蛋白質之食物，最常添加的為蛋黃和吻仔魚，66%嬰兒在一歲時已以飯（主食）、菜和肉之形式為副食品來源。
本研究分析了嬰兒1-12個月之飲食營養攝取與體型生長情形，研究中利用母乳估量公式估算出研究中嬰兒母乳之攝取量，也利用本研究室資料庫系統計算出嬰兒每個月之奶類攝取量與嬰兒飲食攝取中副食品占總熱量之百分比，並且，除了提供熱量及三大營養素攝取量之外，也提供例如：鈣、鐵、膳食纖維等26種維生素礦物質之攝取情形。在研究結果中發現，以配方奶哺餵之嬰兒體型有較大的趨勢，推論嬰兒不同哺餵方式及副食品攝取情形對此結果皆有影響力，但是其相關性以及嬰兒不同哺餵方式對日後之體型發展影響是值得未來深入探討的。

關鍵字

嬰兒期營養 ； 哺餵方式 ； 副食品添加 ； 嬰兒生長 ； 世代研究

並列摘要

The food consumption during infancy including milk feeding and complementary food intakes affect nutrient intakes, growth and health. The data from three prospective cohort studies were combined to examine the associations of feeding patterns, dietary intakes and growth development, also describe the nutrient contents from complementary food. Participants were recruited from Taipei Municipal Women’s and Children’s Hospital and National Taiwan University Hospital between 2002 to 2009. We analyzed the dietary intakes from milk and complementary food, and indices for growth development and health of 402 infants from 1 to 12 months. By cross-sectional analysis, 402 infants were in the study by three feeding patterns at each month. In addition, we also used the retrospective information for major feeding patterns before 1 year old, and analyzed their dietary nutrient intake, growth, development and health indies.The software packages of SPSS 12.0 and STATA 8.0 were used for all statistical analyses.
The results of the cross-sectional analysis showed that the weight of infants who fed breast milk, mixed milk and formula milk at 1, 2, 3, 4, 5 months was not significantly different (p>0.05). However, the weight of infants who fed formula milk at 6, 8, 9 months was slightly higher than the breast feeding infants (p<0.05), the weight of infants who fed formula milk at 12 month was higher than the breastfeeding infants (p = 0.07). The length of infants who fed formula milk at 7, 8, 9 months was slightly higher than the breast feeding infants (p<0.05). The results of the longitudinal analysis showed that there were not different between birth body size of breast, mixed and formula feeding infants (p>0.05). Between 1-12 months, the weights of formula feeding infants were significantly higher than breast-feeding infants (p<0.05), but the length of 1 year old was not significantly different among three group infants. It suggests that formula-feeding demonstrated more weight gain than breast feeding infants.
The energy, protein, fat and CHO intakes of infants who fed formula milk at every age of month were significantly higher than infant who fed breast milk in the cross-sectional analysis (p<0.05). The results from the longitudinal analysis showed energy intakes from 1 to 12 month of breast, mixed, and formula feeding infants were 318-617 kcal, 383-887 kcal and 396-851 kcal respectively. Protein intakes from 1 to 12 month of breast, mixed, and formula feeding infants was 1.6-2.3 g/kg, 1.8-2.9 g/kg and 2.2-3.0 g/kg respectively. Energy and protein intakes from 1 to 12 month of formula feeding infants was significantly higher than breast-feeding infant (p<0.05).
All infants in our study started consumine complementary food at 5.7th month. There were 2 infants started having complementary food before 4th month, 71% infant started complementary feeding at 4-6th month and 28% infant having complementary feeding after 6th month. Cross sectional analysis showed that energy intake of complementary food at one year old is 57%, 49%, 42% of total energy intake in breast, mixed, formula feeding infants, respectively. Longitudinal data showed that energy intake from complementary foods between 4 and 12 months is 9-56% and 6-48% of total energy intake in breast and mixed feeding infants, respectively. Energy intake from complementary food in 3-12 month is 2-44% of total energy intake in formula-feeding infants. Infants have 2 meals of solid food at one year old that lower than the Department of Health recommended. The energy intake of solid food was 44% of total energy at one year old. Our data suggested that for most infants, milk is still the major energy source at one year old. Total of 88% infants started adding iron rich food at 6th month, cereal is the most commonly used. A total of 17% infants started adding protein food at 7th month, egg yolk and silverfish are the most commonly used. A total of 66% infants start to eat rice, vegetable and meat for the solid food.
Our study provided data for the dietary nutrient intakes and growth information of Taiwanese infants from 1 to 12 month. We estimated the breast milk intakes by linear regression equation. We calculated daily milk intakes and energy intake from complementary food by Normal University Diet Calculation System NUCAL 2. We demonstrated the intakes of energy, protein, carbohydrate and fat, but also 26 kinds of vitamins and minerals such as calcium, iron and dietary fiber. This result showed that formula feeding infants were heavier than the breast feeding infant. Our data suggested the milk feeding patterns and the complementary feeding would affect the growth. The more studies need to exam the relationships between infancy feeding patterns and growth development, and the effect of growth development in the future.

並列關鍵字

infant nutrition ； feeding pattern ； complementary food ； growth and development in infancy ； cohort study

參考文獻

行政院衛生署（民96）。嬰兒期營養。行政院衛生署網站。摘自

何沛穎，2010。國際間對嬰幼兒飲食營養建議之現況分析。台灣衛誌，29(5)，384-400。

蘇郁芬、盧立卿、林家慧、謝武勳、方麗容，2009。評估台灣嬰兒六個月前母乳攝取量及營養狀態之研究。台灣營誌，34(1)，11-21。

陳淑美、蘇建文（民81）。我國嬰兒動作發展之研究。教育心理學報，25，81-96。

GONG Yu-hua, JI Cheng-ye, ZHENG Xiu-xia, SHAN Jin-ping, & HOU