零至一歲嬰兒飲食營養與生長發展狀況之前瞻性研究

A prospective study of dietary intakes and development for 0-1 year-old infants

蘇秋帆(Su Chiu-Fan)

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(2004年)

摘要

嬰兒能夠健康的成長，除先天遺傳上的差異外，適當的餵養方式及均衡的營養攝取扮演著重要的角色。本研究以前瞻性的研究設計，藉由收集嬰兒出生至一歲間飲食營養和生長發展狀況之相關資料，進一步探討各種相關因素間的關係。資料收集時間為民國92年2月至民國93年7月，以面對面及電話訪談的方式追蹤民國91年於台北市立婦幼醫院招募之孕婦(民91世代)的出生子女每個月的飲食、生長、發展狀況及疾病等資料。研究工具包含嬰兒每月飲食健康問卷、嬰兒每月飲食頻率問卷、嬰兒健康狀況問卷以及追蹤過程登記表。招募之初有151位孕婦參加，產後退出21位，共130個初生嬰兒參加研究，追蹤一年後共有122個嬰兒完成所有問卷(完成率為94%)。資料的統計分析利用統計軟體SPSS11.0及STATA8.0版進行，分析方法包含：次數分配與百分比、平均值與標準差、獨立樣本t考驗、單因子變異數分析、廣義估計公式、淨相關及斯皮爾曼等級相關。
研究結果發現，嬰兒的平均體重由出生時的3172.3±423.1公克增加到9693.1±1054.1公克，平均身長由出生時的49.2±2.0公分增加到75.9±3.3公分，平均頭圍由出生時的34.0±2.4公分增加到45.9±1.7公分，且男嬰的體型皆顯著大於女嬰(p<0.05)。在哺餵方式上，有18%的嬰兒在12個月內完全以母乳哺餵，另有12%的嬰兒在12個月內完全以配方奶粉哺餵，嬰兒的主要照顧者以母親居多，其次為祖母。在副食品的添加上，有45%的嬰兒在第4個月時開始添加副食品，添加種類以米、麥粉和果汁最早，大部分嬰兒(76%)嬰兒在第6個月大時開始以固體食物(solid food)取代奶類為一次正餐，接近四分之一的嬰兒(23%)的嬰兒在一歲時一天吃到3次以上的固體正餐，而有5%的嬰兒到一歲時尚未以固體食物取代奶類為正餐，顯示一歲嬰兒的飲食仍然以奶類為主，嬰兒哺餵方式的衛生教育仍需再加強。在營養素的分析上，由於缺乏母乳定量資料，故嬰兒整日飲食分析以餵食配方奶的嬰兒為主，利用24小時飲食回憶法得到餵食配方奶的嬰兒整年的熱量攝取由第一個月的629大卡增加到891大卡，碳水化合物和蛋白質的攝取百分比隨著月齡的增加而增加(44%至58%，9%至13%)，脂肪的攝取百分比則隨著月齡的增加而下降(48%至29%)，嬰兒每個月每公斤體重的熱量和其他營養素的攝取(除了膽鹼)皆高於DRIs(Dietary Reference Intakes)的建議值。在副食品的營養攝取方面，嬰兒由副食品得到的熱量及三大營養素攝取量皆有逐漸增加的趨勢，熱量由87大卡增加至392大卡，蛋白質由2公克增加至14公克，脂肪由0.4公克增加至5公克，碳水化合物則由19公克增加至72公克。分析與嬰兒生長有關之因素後發現：家庭背景因素與嬰兒生長的相關性不大，嬰兒整年的體重與母親未懷孕前體重有較多顯著正相關(p<0.05)，整年的身長與父母親身高及母親未懷孕前體重有較大的相關性；在雙變項的分析中，以配方奶哺餵之嬰兒在第3個月時有較多的營養素的攝取和一歲時的體重呈正相關(p<0.05)，而第9個月則有較多由副食品得到的營養素和一歲時的頭圍呈顯著正相關(p<0.05)。在健康表現方面，哺餵母乳時間的長短和嬰兒一歲內的總生病頻率呈顯著負相關(r=-0.18，p<0.05)。另外，以多元迴歸分析法分析與嬰兒一歲時生長狀況有關之因素後發現，除了性別的影響外，嬰兒一歲時體重和母親體重呈正相關(p<0.05)；一歲時身長和父親身長呈顯著正相關(p<0.05)；一歲時頭圍則與嬰兒第9個月由副食品獲得的植物性蛋白質呈顯著正相關(p<0.05)，多元迴歸分析的結果顯示除了頭圍以外，預測嬰兒一歲時生長狀況的因素當中，非飲食因素的預測力較佳。

關鍵字

嬰兒期營養 ； 嬰兒期生長發育 ； 副食品添加 ； 24小時飲食回法

並列摘要

In addition to the effects of genetic predisposition, proper feeding and adequate nutrition intakes are important to infant growth and development. This study recruited 130 pregnant women from Taipei Municipal Women’s and Children’s Hospital and collected data of their children from birth to one year between Feb. 2003 and July 2004. Information including feeding practices, nutrient intakes, anthropometric measures, development and health status was obtained by telephone and/or face-to-face interview every month. The tools are included Monthly Diet and Health Questionnaire, Monthly Food Frequency Questionnaire, Infant Health Questionnaire and Follow-up Tracking Record. The software packages of SPSS 11.0 and STATA 8.0 were used for all statistical analyses.
With comparison to data at birth, the participating infants showed the average body weight increased from 3172.3±423.1g to 9693.1±1054.1g at one year old, the average length increased from 49.2±2.0cm to 75.9±3.3cm, and the average head circumference increased from 34.0±2.4cm to 45.9±1.7cm. During the follow-ups of one year, the average weight, height and head circumference were between 50th and 75th percentiles on published growth curve in Taiwan. There were 18% of infants exclusively fed by breast milk and 12% of infants exclusively fed by formula from birth to one year old. The primary care givers of infants were their mothers and grandmothers. The results also showed that 45% of infants having the first complementary food at fourth month. Grain products and juices were the earliest complementary food for infants. Moreover, at sixth month 76% of infants started to eat semi-solid food replacing milk to be a meal. However, at one year old, this study observed that only 23% of infants had semi-solid food to be their three main meals per day. In this study, there were still 5% of infants did not have semi-solid food instead of milk as a meal at one year old.
Because of the lack of quantitative data for estimating breast milk consumption, this study could only calculate nutrient intakes in infants who fed by formula. By 24 hours dietary recalls, infants fed by formula had energy intakes from 629 kcal at first month to 891 kcal at one year old. The percentages of carbohydrate and protein intakes of total energy increased with age (44% to 58%, 9% to 13%) and fat intake was reduced with age (48% to 29%). Except for choline, all other nutrient consumptions were higher compared to the DRIs (Dietary Reference Intakes) in Taiwan. The daily energy intake from complementary food increased from 87 kcal for the first month to 392 kcal at one year old, protein intake increased from 2g to 14g, as well as fat intake increased from 0.4g to 5g and carbohydrate intake increased from 19g to 72g.
During one year of follow-ups, we found that various family factors were not related to infant growth. Infants’ growth indices during one year showed that body weight had more positive correlations with mothers’ pre-pregnancy weight (p<0.05), height had more positive correlations with parents’ height and mothers’ pre-pregnancy weight (p<0.05). The infants fed by formula showed that nutrients intakes in the third month were positively correlated with body weight at one year old (p<0.05) and nutrients intakes from complementary food at the ninth month had positive correlations with head circumferences at one year old (p<0.05). Regarding the health status during one year follow-ups, the duration of breast-feeding showed a negative correlation with the frequency of illness (r=-0.18，p<0.05).
By multiple regression analysis, besides the gender effect, mothers’ pre-pregnancy weight was positively correlated with infants’ weight at one year old (p<0.05). The fathers’ height was positively correlated with infants’ height at one year old (p<0.05). The infants’ plant protein intake from complementary food in the ninth month had positively correlated with head circumferences at one year old (p<0.05).

並列關鍵字

infant nutrition ； growth and development in infancy ； complementary food ； 24 hours dietary recall