研究生: |
蘇郁芬 Yu-Fen Su |
---|---|
論文名稱: |
估計國內母乳攝取量及零到六個月嬰兒營養狀態與生長發育之研究 Estimation of breast milk intake and nutrient intake and growth development for 0-6 months infants in Taiwan |
指導教授: |
盧立卿
Lyu, Li-Ching |
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: | 2008 |
畢業學年度: | 96 |
語文別: | 中文 |
論文頁數: | 265 |
中文關鍵詞: | 母乳攝取量 、出生體重 、嬰兒期營養 、嬰兒期生長發育 |
英文關鍵詞: | volume of breast milk, birth weight, infant nutrition, growth and development in infancy |
論文種類: | 學術論文 |
相關次數: | 點閱:292 下載:34 |
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世界衛生組織及美國小兒科學會都建議嬰兒出生前6個月以純母乳哺餵,但由於本土少有母乳攝取量之研究資料,以致不易估計國內嬰兒由母乳中所得到的營養素。目前本國嬰兒餵養方式、飲食營養攝取情形以及生長發育狀況調查欠缺長期本土資料,且多數研究對象出生體重多分布正常範圍內,無法看出嬰兒出生體重較高或較低者營養狀態及生長發育情形。本研究分兩部份,第一部分為探討國內6個月嬰兒母乳攝取量之秤重研究,並參考國外母乳量化之文獻,估計不同月齡嬰兒每日母乳攝取量;第二部份則利用母乳量化結果,評估嬰兒由母乳及副食品中獲得的營養素,並探討不同出生體重嬰兒飲食營養及生長發育情形及影響因素。
母乳量化研究是利用秤重試驗 (test weighing),收集15名0-6個月新生兒之母乳攝取量,進一步分析估算不同月齡嬰兒每日母乳攝取量,母乳量化結果將提供基礎研究參考,評估嬰兒由母乳獲得的營養素並與國外量化數據比較;研究第二部份為結合「婦幼民91世代」(蘇秋帆 民93)及「婦幼民93世代」兩世代嬰兒資料,以問卷追蹤的方式收集嬰兒出生至6個月的飲食營養和生長狀況的資料,探討不同出生體重嬰兒飲食營養及生長發育情形及影響因素。結合兩世代分析人數共有264個嬰兒,每個月問卷完成率為93%~96%之間。研究工具包含嬰兒電子秤、哺餵母乳秤重紀錄表、嬰兒每月飲食健康問卷及追蹤過程登記表。資料的統計分析利用統計軟體SPSS12.0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、皮爾森積差相關、斯皮爾曼等級相關及多元回歸。
母乳量化結果顯示,0-6個月嬰兒每日平均哺餵母乳次數介於7.6-9.6次之間,平均每次母乳攝取量為52-112 g。使用線性迴歸(linear regression)方式估算嬰兒1-6個月每日母乳攝取量分別為530 g、580 g、620 g、670 g、720 g及760 g。世代研究結果發現,以母乳哺餵的比例在第2、3、4、5及6個月分別為 33.6%、29.9%、28.4%、25.6%及24.5%;混合哺餵的比例在第2、3、4、5及6個月分別為29.6%、24.7%、22.0%、19.6%及15.7%;哺餵嬰兒奶粉的比例在第2、3、4、5及6個月分別為36.8%、45.4%、49.6%、54.8%及59.8%。營養素攝取分析,出生體重較低的嬰兒營養狀況不佳,每公斤體重熱量、蛋白質攝取量皆低於DRIs(Dietary Reference Intakes)的建議值,尤其是SGA(small for gestational age)嬰兒;出生體重較高的嬰兒營養狀況更不理想,每公斤體重熱量、蛋白質攝取量低於DRIs的建議值許多;而出生體重適當的嬰兒之營養攝取狀況尚可,除了每公斤體重的熱量攝取稍低於DRIs建議值外,每公斤蛋白質的攝取大致符合DRIs建議值。生長分析方面,嬰兒6個月時的體重、身長和頭圍在性別上有顯著差異(p<0.05),男嬰的體型顯著大於女嬰;而不同哺餵方式對嬰兒6個月時生長結果幾乎無差別。
多元迴歸分析的結果顯示,嬰兒性別、出生體重、母親身高、第6個月每公斤體重的熱量攝取,以及第6個月的維生素B12攝取量可以預測嬰兒6個月時體重,解釋量為46.6%,其中以維生素B12的預測力最高;嬰兒性別、出生身長、第6個月每公斤體重的熱量攝取,以及第6個月的生物素攝取量可以預測嬰兒6個月時身長,解釋量為38.8%,其中以出生身長的預測力最高;嬰兒性別、出生頭圍、第6個月每公斤體重的熱量攝取,以及第6個月的脂質的攝取量可以預測嬰兒6個月時頭圍,解釋量為23.9%,其中脂質的攝取量的預測力最高。由多元回歸結果可知,先天條件(性別、出生體型)對嬰兒6個月時生長狀態具相當影響力,而6個月大嬰兒飲食以奶類為主,維生素B12及脂質皆為奶類含量豐富營養素,對嬰兒生長具顯著影響性。
The primary food source of infants from birth to 6 months is milk, the WHO and The American Academy of Pediatrics recommend exclusive breastfeeding until age of 6 month. However, estimating the breast-fed infants nutrients intake is limited by lack of quantitative data in Taiwan. This study has two purposes, one is to assessment the breast milk intakes by test-weighing for birth to 6 months infants and refer published papers to calculate the daily breast milk consumption by difference month age. The other is to estimated nutrient intakes from breast milk, formula milk and supplemental food, and confer dietary intakes and growth status of different birth weight infants and the affected factors.
In the test weighting study, we recruited 15 breas-tfed infants (from birth to 6 months) since Feb 2005 to Aug 2007, then estimate volume of breast milk intake daily. In the cohort study contain two cohorts, we collect feeding data from infants by follow-up questionnaire from birth to 6 months, then we use the data to examine nutrient intakes, growth and development of 264 infants. The study tools contain the baby electronic scales, the Breast-Fed Test Weighting Record and the Monthly Diet and Health Questionnaire. We analyse our data by the software packages of SPSS 12.0 and STATA 8.0.
In the test weighting study, the average number of feedings per day are between 7.6 to 9.6 times and decreased with age. Volume of breast milk intakes per feeding are 52 to 112 g and increase with age. For exclusively breastfed infants from birth to 6 months of age, we estimate 530 g, 580 g, 620 g, 670 g, 720 g and 760 g of breast milk per day.
There were 33.6%, 29.9%, 28.4%, 25.6% and 24.5% of subjects exclusively fed by breast milk, as well as 36.8%, 45.4%, 49.6%, 54.8% and 59.8% of infants exclusively fed by formula at 2 to 6 months, respectively. The calorie and protein intakes per kilogram for low and high birth weight infants are lower than DRIs (Dietary Reference Intakes), but most nutrient intakes of adequate birth weight infants accomplish DRIs. Weight, length and head circumference of the infants in 6th month are differed significantly in gender. The growth of 6 month infants with different feeding patterns have no significant different.
By multiple regression analysis, infants’ gender, birth weight, mothers’ height, and VitB12 intake at 6th month, were positively correlated with infants’ weight at 6th month (p<0.05). The infants’ gender, birth length, and biotin intake at 6th month positively correlated with infants’ length at 6th month (p<0.05). The infants’ gender, birth head circumferences, and fat intake at 6th month positively correlated with infants’ head circumferences at 6th month (p<0.05).
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