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研究生: 江忻蓉
論文名稱: 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
指導教授: 盧立卿
學位類別: 碩士
Master
系所名稱: 人類發展與家庭學系
Department of Human Development and Family Studies
論文出版年: 2012
畢業學年度: 100
語文別: 中文
論文頁數: 245
中文關鍵詞: 嬰兒期營養哺餵方式副食品添加嬰兒生長世代研究
英文關鍵詞: infant nutrition, feeding pattern, complementary food, growth and development in infancy, cohort study
論文種類: 學術論文
相關次數: 點閱:96下載:44
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  • 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。

    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.

    第一章 緒論 1 第一節 研究動機 1 第二節 研究目的與問題 3 一、研究目的 3 二、研究問題 3 第三節 名詞解釋 5 第二章 文獻探討 6 第一節 嬰兒飲食營養及其營養因素 6 一、國內外嬰兒飲食建議 6 二、影響嬰兒哺餵方式之因素 8 第二節 嬰兒哺餵狀況 14 一、國內外嬰兒哺餵方式情形 14 二、不同哺餵方式營養素攝取情形 21 第三節 嬰兒不同哺餵方式與體型發展 26 一、評估嬰兒生長情形之方法 26 二、嬰兒不同哺餵方式與生長情形之相關 27 第三章 研究方法 33 第一節 研究架構 33 第二節 研究設計與實施程序 35 一、研究設計 35 二、實施程序 36 第三節 研究對象 39 第四節 研究工具 41 一、嬰兒家庭背景資料 42 二、非飲食部分 42 三、飲食部分 43 第五節 資料蒐集與訪員訓練 44 一、訪員訓練 44 二、資料蒐集 44 第六節 資料處理 46 一、非飲食資料 46 二、飲食資料 47 第七節 統計分析 50 第四章 研究結果 52 第一節 嬰兒基本資料分析 53 一、婦幼民91、民93與民98世代嬰兒家庭背景 54 二、橫斷性分析嬰兒1-12個月間每個月之哺餵方式 58 三、縱貫性分析不同哺餵方式與家庭背景之相關性 60 四、家庭背景與及副食品添加月齡之相關性 61 第二節 嬰兒零至一歲生長情形 62 一、嬰兒零至一歲生長情形分析 62 二、家庭背景資料與嬰兒生長情形之相關分析 67 三、添加副食品時機與一歲體型之比較 71 四、以橫斷性資料分析1-12個月間的不同哺餵方式生長情形 71 五、以縱貫性資料分析不同哺餵嬰兒零至一歲生長情形 77 第三節 嬰兒零至一歲營養素攝取情形 80 一、嬰兒零至一歲每月營養素攝取狀況 80 二、嬰兒營養素攝取與一歲生長淨相關分析 89 三、橫斷性分析1-12個月當中的不同哺餵方式嬰兒營養素攝取情形 94 四、縱貫性分析不同哺餵嬰兒間營養素攝取 119 第四節 嬰兒副食品添加情形 136 一、嬰兒開始添加副食品的時機與種類 136 二、嬰兒零至一歲間每個月副食品營養素攝取情形 138 三、橫斷性分析1-12個月當中的不同哺餵方式嬰兒副食品營養素攝取 情形 145 四、縱貫回溯性性分析1-12個月中不同哺餵方式嬰兒副食品營養素攝取 情形 160 五、副食品現況描述 175 第五節 嬰兒零至一歲發展狀況 180 一、嬰兒零至一歲發展狀況 180 二、副食品添加月齡及家庭背景資料與發展之相關分析 182 三、以縱貫性資料分析嬰兒哺餵方式與發展情形相關 184 第六節 嬰兒零至一歲健康狀況 185 一、嬰兒零至一歲健康狀況 185 二、副食品添加月齡與嬰兒健康狀況相關分析 186 三、以縱貫回溯性分析不同哺餵嬰兒與健康相關 187 第五章 討論 189 第六章 結論 208 第七章 研究限制與建議 211 參考文獻 215 附錄 附錄一 受訪者同意書(新生兒) 224 附錄二 追蹤過程登記表 227 附錄三 新生兒基本資料(訪員手冊) 229 附錄四 新生兒24小時飲食回憶及健康狀況問卷 230 附錄五 新生兒預防接種與體位記錄表 234 附錄六 嬰兒每月健康飲食問卷 235 附錄七 嬰兒健康問卷C 238 附錄八 嬰兒相關變項編碼 243 圖目錄 圖3-1.1:研究架構 34 圖3-2.1:研究實施流程圖 38 圖3-6.1:1-6及7-12個月母奶攝取量結果之兩項線性迴歸方程式 49 圖4-2.1:嬰兒0-12個月體重曲線圖 65 圖4-2.2:嬰兒0-12個月身長曲線圖 65 圖4-2.3:嬰兒0-12個月頭圍曲線圖 66 圖4-3.1:嬰兒1-12個月平均每日熱量攝取曲線圖 87 圖4-3.2:嬰兒1-12個月平均每日三大營養素百分比與鐵攝取曲線圖 87 圖4-3.3:嬰兒1-12個月平均每公斤體重攝取熱量曲線圖 88 圖4-3.4:嬰兒1-12月平均每公斤體重蛋白質攝取曲線圖 88 圖4-3.5:不同哺餵方式嬰兒1-12個月熱量攝取直方圖 117 圖4-3.6:不同哺餵方式嬰兒1-12個月平均每公斤體重熱量攝取直方圖 117 圖4-3.7:不同哺餵方式嬰兒1-12個月平均每公斤體重蛋白質攝取直方圖 118 圖4-3.8:不同哺餵嬰兒1-12個月熱量攝取曲線圖 135 圖4-4.1:嬰兒1-12個月副食品平均熱量攝取曲線圖 144 圖4-4.2:嬰兒1-12個月副食品三大營養素百分比與鐵攝取曲線圖 144 表目錄 表 2-1.1:國內外影響嬰兒哺餵方式因素之相關研究 12 表 2-2.1:國內外嬰兒哺餵方式之相關研究 18 表 2-2.2:國內外嬰兒不同哺餵方式營養素攝取之相關研究 24 表2-3.1:國內外嬰兒不同哺餵方式與生長情形之相關研究 31 表3-2.1:三世代之研究資料 37 表3-3.1:三世代研究對象追蹤流失情形 40 表3-4.1:三世代使用之研究問卷 41 表3-5.1:問卷實施流程 45 表3-6.1:1-6及7-12個月母乳量化研究結果 49 表4-1.1:民91、93和98世代嬰兒家庭基本資料分布1 55 表4-1.2:民91、93和98世代嬰兒家庭基本資料分布2 57 表4-1.3:嬰兒1-12個月各哺餵方式之哺餵率與副食品添加率 59 表4-1.4:不同哺餵方式嬰兒之家庭背景比較 60 表4-1.5:不同副食品添加月齡嬰兒之家庭背景比較 61 表4-2.1:嬰兒零至一歲體重分布 63 表4-2.2:嬰兒零至一歲身長分布 64 表4-2.3:嬰兒零至一歲頭圍分布 64 表4-2.4:父母親身高體重與嬰兒零至一歲體重的相關 68 表4-2.5:家庭背景與嬰兒零至一歲體重相關 68 表4-2.6:父母親身高體重與嬰兒零至一歲身長的相關 69 表4-2.7:家庭背景與嬰兒零至一歲身長相關 69 表4-2.8:父母親身高體重與嬰兒零至一歲頭圍的相關 70 表4-2.9:家庭背景與嬰兒零至一歲頭圍相關 70 表4-2.10:不同副食品添加月齡之嬰兒1歲時之體型比較 71 表4-2.11: 1-12個月間每個月不同哺餵方式嬰兒體重結果 75 表4-2.12: 1-12個月間每個月不同哺餵方式嬰兒身長結果 76 表4-2.13: 1-12個月間每個月不同哺餵方式嬰兒頭圍結果 76 表4-2.14:不同哺餵方式嬰兒1-12個月體重分布 78 表4-2.15:不同哺餵嬰兒1-12個月身長分布 79 表4-2.16: 不同哺餵方式嬰兒1-12個月頭圍分布 79 表 4-3.1:嬰兒1-12個月營養素攝取量 83 表4-3.2:嬰兒第3個月營養素攝取量與ㄧ歲生長的淨相關 89 表4-3.3:嬰兒第6個月營養素攝取量與ㄧ歲生長的淨相關 91 表4-3.4:嬰兒第9個月營養素攝取量與ㄧ歲生長的淨相關 92 表4-3.5:嬰兒第12個月營養素攝取量與ㄧ歲生長的淨相關 93 表 4-3.6: 1-12個月每個月的母乳哺餵嬰兒營養素攝取量 96 表 4-3.7: 1-12個月每個月的混合哺餵嬰兒營養素攝取量 102 表 4-3.8: 1-12個月每個月的配方奶哺餵嬰兒營養素攝取量 108 表4-3.9: 1-12個月不同哺餵嬰兒熱量及三大營養素攝取 113 表4-3.10: 1-12個月不同哺餵嬰兒每公斤體重熱量及蛋白質攝取 116 表 4-3.11: 主要母乳哺餵嬰兒1-12個月熱量及三大營養素攝取 121 表4-3.12: 主要混合哺餵嬰兒1-12個月熱量及三大營養素攝取 125 表4-3.13: 主要配方奶哺餵方式嬰兒1-12個月熱量及三大營養素攝取 129 表4-3.14: 不同哺餵嬰兒1-12個月熱量及三大營養素攝取 133 表4-4.1:嬰兒開始添加副食品之時間分布 137 表4-4.2:嬰兒1-12個月副食品攝取占總熱量之百分比 137 表4-4.3:嬰兒1-12個月副食品攝取營養素 140 表4-4.4: 1-12個月母乳哺餵嬰兒副食品攝取營養素 146 表4-4.5: 1-12個月混合哺餵嬰兒副食品攝取營養素 151 表4-4.6: 1-12個月配方奶哺餵嬰兒副食品攝取營養素 156 表4-4.7: 1-12個月間主要母乳哺餵嬰兒副食品營養素攝取量 161 表4-4.8: 1-12個月間主要混合哺餵嬰兒副食品營養素攝取量 166 表4-4.9: 1-12個月間主要配方奶哺餵嬰兒副食品營養素攝取量 171 表4-4.10: 嬰兒1-12個月平均每日奶類攝取次數 178 表4-4.11: 1-12個月中每個月之奶類攝取情形 178 表4-4.12:四項嬰兒副食品添加相關飲食狀況 179 表4-5.1: 嬰兒1-12個月每個月間發展分布 181 表4-5.2: 不同副食品添加時機嬰兒發展比較 182 表4-5.3: 家庭背景與發展相關 183 表4-5.4: 嬰兒第3個月整天攝取營養素與發展的相關 156 表4-5.5: 不同哺餵方法嬰兒發展比較 184 表4-6.1: 嬰兒零至一歲生病情況 185 表4-6.2:比較副食品不同添加時機嬰兒6個月之後之生病次數 186 表4-6.3: 比較不同哺餵方式嬰兒零至一歲生病次數與時間 188 表5-1.1: 本研究室新舊母乳資料庫比較 192

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