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:179 下載:44 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
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.
行政院衛生署(民98)。新版兒童生長曲線圖。民98年5月18日,取自http://www.bhp.doh.gov.tw/BHPNET/Portal
行政院衛生署(民96)。嬰兒期營養。行政院衛生署網站。摘自
http://www.doh.gov.tw/CHT2006/DM/SEARCH_MAIN.aspx?keyword=%u5b30%u5152%u98f2%u98df
許瑩瑩(民98)。嬰兒餵食方式對嬰兒生長及行為發展之影響:台灣
出生世代之研究。台北醫學大學保健營養學系碩士論文,未出版,
台北市。
黃富源,李宏昌,何啟生。臨床兒科學,2003。
黃伯超。食品營養講座。台北市:健康世界雜誌社,1979,p194。
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。
蘇秋帆(民94)。零至一歲嬰兒飲食營養與生長發展狀況之前瞻性研究。國立台灣師範大學人類發展與家庭研究所碩士論文,未出版,台北市。
蘇遂龍(民80)。台北市立婦幼綜合醫院哺餵母乳衛生教育介入效果之先趨研究。國防醫學院公共衛生研究所碩士論文,未出版,台北市。
蘇建文、鍾志從(民73)。出生至一歲嬰兒動作發展的縱貫研究。教育心理學報,17,73-98。
蘇建文、鍾志從(民73)。我國嬰兒動作發展之研究。教育心理學報,25,81-96。
呂忻瑾(民97)。台北都會區不同出生體重嬰兒飲食營養與生長發育之前瞻性研究。國立台灣師範大學人類發展與家庭研究所碩士論文,未出版,台北市。
葛魯蘋(民73)。台北市古亭區母親哺餵行為之調查與其影響因素之探討。國防醫學院社會學醫學研究所碩士論文,未出版,台北市。
陳姿媛(民100)。台北都會區不同出生體重嬰兒飲食營養與生長發育之前瞻性研究。國立台灣師範大學人類發展與家庭研究所碩士論文,未出版,台北市。
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。
Agampodi, S.B., Agampodi, T.C., & Piyaseeli, U.D. (2007). Breast-
feeding practices in a public health field practice area in Sri Lanka:
a survival analysis. Int Breastfeed J, 2-13.
AOAC Official Method 984.27 (2003). Calcium, Copper, Iron,
Magnesium, Mang- anese, Phosphorus, Potassium, Sodium, and
Zinc in Infant Formula (Inductively C -oupled Plasma Emission
Spectroscopic Method), In Official Methods of Analysis of
AOAC International 17th Ed., Ch 50.1.15.
AOAC Official Method 952.20 (2003) Cobalamin (Vitamin B12 Activity)
in Vita- min Preparations (Microbiological Methods), In Official
Methods of Analysis of AOAC International 17th Ed., Ch 45.2.02.
Briefel, R. R., Reidy, K., Karwe,V., Jankowski, L., & Hendricks, K. (2004).Toddlers' transition to table foods: Impact on nutrient intakes and foodpatterns. J Am Diet Assoc, 104, S38-44.
Bernadette M. Marriott, Larry Campbel, Erica Hirsch, & David Wilson.
(2007). Preliminary Data from Demographic and Health Surveys
on Infant Feeding in 20 Developing Countries. J. Nutr., 137,
518–523.
B Lande, LF Andersen, A Bærug, KU Trygg, K Lund-Larsen, MB
Veierød, & G-E Aa Bjørneboe. (2003). Infant feeding practices
and associated factors in the first six months of life: The
Norwegian Infant Nutrition Survey. Acta Padiatr, 92, 152-161.
Betrán, A. P., de Onís, M., Lauer, J. A., & Villar, J. (2001). Ecological study ofeffect of breast feeding on infant mortality in Latin America. BMJ, 323,1-5.
Chye Fook Yee., & Rebecca Chin. (2007). Parental perception and
attitudes on infant feeding practices and baby milk formula in East
Malaysia. International Journal of Consumer Studies, 31, 363–370.
Cesar G Victora, Saul S Morris, Fernando C Barros, Bernardo L Horta,
Elisabeth Weiderpass, & Elaine Tomasi. (1998). Breast-feeding
and growth in Brazilian infants. Am J Clin Nutr, 67, 452–458.
Department of Health ,UK. (2003, May 1). Infant Feeding Recommen-
dation.from the World Wild Web:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications PolicyAndGuidance/DH_4097197
Dratva J, Merten S, & Ackermann-Liebrich U. (2006). The timing of compl-ementtary feeding of infants in Switzerland: compliance with the Swiss and the WHO guidelines. Acta Paediatr, 95, 818-825.
Dutta, T., Sywulka, S. M., Frongillo, E. A., & Lutter, C. K. (2006).
Characteristics attributed to complementary foods by caregivers in four countries of Latin American and the Caribbean. Food Nurt Bull, 27, 316-326.
Donma, M. M., & Donma, O. (1999). Infant feeding and growth: A study
on Turkish infants from birth to 6 months. Pediatrics International,
41, 542-548.
EYL Leung, KYA Au, SSW Cheng, SY Kok, HK Lui, & WCW Wong.
(2006). Practice of brea- stfeeding and factors that affect breastf-
eeding in Hong Kong. Hong Kong Med J ,12, 432-6.
Food and Agriculture Organization of the United Nations, World Health
Organization, 2003.
Frank R. Geer. (2010). Commentary: concerns for complementary
feeding of infants in Brazil. J Pediatr, 86(3), 169-170.
Florey CD, Leech AM, & Blackhall A.(1995).Infant feeding and mental and motor development at 18 months of age in first born singletons. Int J Epidemio, 24, 21-26.
Guideline for weaning (revised edition). (1999). Ministry of Health and
Welfare, Japan. Pediatr Int, 41,115-7.
Graciete O. Vieira, Luciana R. Silva, Tatiana de O. Vieira, João Aprígio
G. Almeida, & Vilma A. Cabral. (2004). Feeding habits of breastfed and non-breastfed children up to 1 year old. J Pediatr (Rio J), 80(5), 411-416.
GONG Yu-hua, JI Cheng-ye, ZHENG Xiu-xia, SHAN Jin-ping, & HOU
Rui. (2008). Correlation of 4-month infant feeding modes with
their growth and iron status in Beijing. Chin Med J, 121(5), 392,
392-398.
Health Canada (2005, December 08). Food and Nutrition., from the
World Wild Web:
http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_1_e.html#summary
Hawkins, S. S., Griffiths, L. J., Dezateux, C., Law, C., & The Millennium
Cohort Study Child Health Group. (2007). Maternal employment
And breast-feeding initiation: findings from the Millennium Cohort
Study. Paediatr Perinat Epidemiol, 21, 242-247.
Institute of Medicine (2005). DRI Research Synthesis Workshop, from
the World Wild Web:
http://www.iom.edu/CMS/3788/33354/33786.aspx
Ijarotimi, O.S., & Ogunsemore, M. T. (2006). Weaning foods and their
impact on child-feeding practices among low-income Nigerian
mothers. Food Nurt Bull, 27, 327-334.
J Vingraite, R Bartkeviciute, & KF Michaelsen. (2004). A cohort study
of term infants from Vilnius, Lithuania: feeding patterns. Acta
Paediatr, 93, 1349-55.
James K Friel, Rhona M Hanning, Corinne A Isaak, Daniel Prowse, &
Angela C Miller. (2010). Canadian infants' nutrient intakes from
complementary foods during the first year of life. BMC Pediatrics,
10, 43.
J B Morgan, A Lucas, & M S Fewtrell. (2004). Does weaning influence
growth and health up to 18 months? Arch Dis Child, 89, 728–733.
Kathryn G Dewey, M Jane Heinig, Laurie A Nommsen, Janet M Peerson,
& Bo L. (1999). Breast-fed infants are leaner than formula-fed
infants at 1 y of age: the DARLING study13. Am J Clin Nutr, 57,
140-145.
Kathryn G. Dewey, PhD, M. Jane Heinig, MS, Laurie A. Nommsen, MS,
Janet M. Peerson, MS, & Bo Lonnerdal, PhD. (1992). Growth of
breast-fed and formula-fed infant from 0 to 18 months: The
DARLING study. Pediatrics, 89, 1035-1041.
Kramer, M. S., Guo, T., Platt, R. W., Sevkovskaya, Z., Dzikovich, I., Collet, J.P., Shapiro, S., Chalmers, B., Hodnett, E., Vanilovich, I., Ducruet, T.,Shishko, G., & Bogdanovich, N. (2003). Infant growth and healthoutcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am J Clin Nutr, 78, 291-295.
Laurence M. Grummer-Strawn, Kelley S. Scanlon, & Sara B. Fein.
(2008). Infant Feeding and Feeding Transitions During the First
Year of Life. Pediatrics, 122, 36–42.
Lawrence D. Hammer, MD, Susan Bryson, MS, & W. Stewart Agras, MD. (1999). Development of Feeding Practices During the First 5 Years of Life. Arch Pediatr Adolesc Med, 153, 189-194.
Le Thi Hop, Rainer Gross, Tu Giay Soemilah Sastroamidjojo, Werner
Schultink, & Nguyen Thi Lang. (2000). Premature complementary
feeding is associated with poorer growth of Vietnamese children. J
Nutr, 130, 2683-2690.
Lanigan, J., Wells, J. C. K., Lawson, M. S., & Lucas, A. (2001).
Validation of food diary method for assessment of dietary energy
and macronutrient intake in infants and children aged 6-24 months.
Eur J Clin Nutr, 55, 124-129.
Li-Ching Lyu, Barbara M. Posner, Ming-Jer Shieh, Alice H. Lichtenstein,
L. Adrlenne Cupples, Johanna T. Dwyer, Peter W.F. Wilson, &
Emst J. Schaefer. (1994). Cross-cultural comparisons between
Taipei Chinese and Framingham Americans: dietary intakes, blood
lipids and apolipo-proteins. 3,119-125.
Mari Haku. (2007). Breastfeeding: factors associated with the continua-
tion of breastfeeding, the current situation in Japan, and
recommendations for further research. The journal of Medical
Investigation, 54, 224-234.
Mary L Hediger, Mary D Overpeck, W June Ruan, & James F Troendle. (2000). Early infant feeding and growth status of US-born infants and children aged 4–71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr, 72, 159–67.
Michael S Kramer. (2010). Breastfeeding, complementary (solid) foods,
and long-term risk of obesity. Am J Clin Nutr, 91, 500–501.
North, K., Emmett, P., Noble, S., & the ALSPAC Study Team, (2000).
Types of drinks consumed by infants at 4 and 8 months of age:
sociodemographic variations. J Hum Nutr Dietet,13, 71-82.
Nancy F Butte.(1990). Energy requirements of infants. Public Health
Nutrition, 8(7A), 953–967.
N. Butte, K. Cobb, J Dwyer, L. Graney, W. Heird, & K. Rickard.(2004). The start healthy feeding guideline for infants and toddlers. Journal of the American Dietetic Association, 104, 422-454.
Parada, C. M. G. L., Carvalhaes, M. A. B. L., & Jamas, M.T. (2007).
Complementary feeding practices to children during their first
year of life. Rev Latino-am Enfermagem,15, 282-289.
Rolfes, S. R., DeBruyne, L. K., & Whitney, E. N. (1998). Life span
nutrition. London: Wadsworth publishing company.
Rebecca K. Golley, Lisa G. Smithers, Murthy N. Mittinty, Laima
Brazionis, Pauline Emmett, Kate Northstone, Karen Campbell, Sarah A. McNaughton, & John W. Lynch.(2012). An index measuring adherence to complementary feeding guidelines has convergent validity as a measure of infant diet quality. The Journal of Nutrition, 142, 901–908.
S. Noble & P. Emmett. (2006). Differences in weaning practice, food and
nutrient intake between breast- and formula-fed 4-month-old
infants in England. The British Dietetic Association Ltd J Hum
Nutr Diet et, 19, 303–313.
Sara B. Fein, PhD, Judith Labiner-Wolfe, PhD, Kelley S. Scanlon, PhD,
RD, & Laurence M. Grummer-Strawn, PhD. (2008). Selected
Complementary Feeding Practices and Their Association With
Maternal Education. Pediatrics, 122, 91–97.
S Noble1, P Emmett & the ALSPAC Study Team. (2001). Food and
nutrient intake in a cohort of 8-month-old infants in the south-west
of England in 1993. European Journal of Clinical Nutrition, 55,
698-707.
Supapan Tantracheewathorn, MD. (2005). Growth of Breast-fed and
Formula-fed Infants Compared with National Growth References
of Thai Children. J Med Assoc Thai, 88(2), 168-75.
S Scaglioni, C Agostoni, R De Notaris, G Radaelli, N Radice, M Valenti, M Giovannini, & E Riva.(2000). Early macronutrient intake and overweight at five years of age. International Journal of Obesity, 24, 777-781.
USDA-Nutrientdatalaboratory.
http://www.nal.usda.gov/fnic/foodcomp/cgi-bin/list_nut_edit.pl
Vieira, G.O., Silva, L. R., Vieira, T. O., Almeida, J. A. G., & Cabral, V.
A.(2004). Feeding habits of breastfed and npn-breastfed children up to 1 year old. J Pediatr, 80, 411-416.
Wang, X., Wang, Y., & Kang, C. (2005). Feeding practices in 105 counties of rural china. Child Care Health Dev, 31 , 417-423.
Xu, F., Binns, C., Lee, A., Wang, Y., & Xu, B. (2006). Introduction of
complementary foods to infants within the first six months
postpartum in Xinjiang, PR China. Asia Pac J Clin Nutr,16,
462-466.
Xiong, X., Wightkin, J., Magnus, J. H., Pridkian, G., Acuana, JM., &
Buekens, P. (2007). Birth weight and infant growth:optimal infant
weight gain versus optimal infant weight. Matern child health J, 11, 57-63.
Yamawaki N, Yamada M, Kan-no T, Kojima T, Kaneko T, & Yonekubo A. (2005). Macro- nutrient, and trace element composition of breast
milk from Japanese women. J Trace Elem Med Biol, 19, 171-181.
Zvi Zadik, Ela Borondukov, Amnon Zung, & Ram Reifen. (2003).
Adult Height and Weight of Breast-Fed and Bottle-Fed Israeli
Infants. Journal of Pediatric Gastroenter- ology and Nutrition, 37,
462–467.