重庆地区4-12月龄体重增加不足婴儿能量摄入状况的研究

Energy intakes in infants with different growth patterns in Chongqing

目的以体重增加为标准,探讨体重增加不足与能量摄入的相关性。方法2004年11月至2005年12月在重庆医科大学儿童医院儿童保健门诊进行健康体格检查的婴儿,年龄4～12个月,由2名儿童保健专业人员负责体格测量。体格评价以美国疾病预防与控制中心的标准为参数。以两次体检体重/年龄Z值之差(⊿WAZ)将研究对象分为体重增加不足组和体重增加正常组,同时两组按月龄分为4～5月龄、～8月龄和～12月龄3个亚组。以食物称重与食物记录法计算每日食物摄入情况。结果研究期间共纳入202名婴儿,体重增加不足组70名(-2<⊿WAZ<-0.67),体重增加正常组132名(-0.67≤⊿WAZ≤0.67)。①体重增加不足组体格发育水平在正常生长范围内,但略低于体重增加正常组。②体重增加不足组除乳类摄入量较体重增加正常组低外(P<0.05),其他食物摄入量接近于体重增加正常组(P>0.05),蛋白质摄入量达WHO和中国营养协会推荐摄入量;体重增加不足组中4～5月龄、～8月龄和～12月龄亚组能量摄入分别为322kJ·kg-1·d-1(77kcal·kg-1·d-1)、322kJ·kg-1·d-1(77kcal·kg-1·d-1)和310kJ·kg-1·d-1(74kcal·kg-1·d-1),显著低于体重增加正常各月龄亚组的351kJ·kg-1·d-1(84kcal·kg-1·d-1),343kJ·kg-1·d-1(82kcal·kg-1·d-1)和360kJ·kg-1·d-1(86kcal·kg-1·d-1)(P<0.05),其中～12月龄亚组摄入食物总能量中谷类食物产能较低(P<0.05);体重增加不足与体重增加正常各月龄亚组摄入食物的能量密度相近(P>0.05)。③Logistic分析显示婴儿体重增加不足的风险因素(OR=3.947)是能量摄入不足,母亲文化程度高是婴儿体重增加正常的保护因素(OR=0.437)。结论①排除相关干扰因素,能量摄入不足造成婴儿体重增加不足的主要原因是乳类摄入量;②一定能量密度范围内,食物摄入量是影响能量摄入的主要因素。

Objective To explore the energy intakes of the infants with different growth velocities. Methods 202 infants aged 4- 12 months were observed, who were brought for the serial measurements in the Department of Primary Child Care, Children＇s Hospital, Chongqing Medical University from November 2004 to December 2005. The weights and the recumbent lengths were measured during the visit by two professional staffs. The physical growth was assessed with CDC2000 reference. All the infants were divided into 3 groups, such as group 4 -5 months, group 6 -8 months, group 9 - 12 months. 70 infants whose Z score change of weight for age （ △ WAZ） was between - 2 to - 0. 67 during two secular visits were defined as deceleration of weight growth, and other 132 infants whose Z scores of weight for age were - 0.67≤ △ WAZ ≤0.67 were defined as normal growth. The food intakes of all the infants were collected by using methods of 24 h dietary recall or dietary weighting and for sequential 3 days. The averages of the three day dietary intakes were daily intake. The food intakes were calculated by Chinese Food Composition 2002 and infant food introduction. Results （1）The growth levels in both groups were similar. There was no significant difference between weight, height, WAZ, LAZ and WLZ in two groups （2）The feeding frequencies of two groups were about 6 times ; the milk intakes of deceleration group were 785 g·d^-1 ,754 g·d^-1 and 676 g ·d^-1in 4-5 months,6- 8 months and 9- 12 months, which were lower than the normal group （ P 〈 0.05 ） ; the other food intakes were same in two groups （ P 〉 0.05 ）. The protein intakes in the deceleration group and normal groups were near to WHO guide and Chinese RNI. The total energy intakes were 2 393 kJ ·d^-1（572 kcal·d^-1） ,2 699 kJ ·d^-1（645 kcal·d^-1） and 3 092 kJ ·d^-1（739 kcal ·d^-1） for4 -5momths, 6 -8month and 9- 12months in deceleration groups, which were lower than the normal groups; The energy intakes per kg in deceleration groups,322kJ·kg^-1·d^-1（77 kcal·kg^-1·d^-1） in4-5 months, 322 kJ·kg^-1·d^-1（77 kcal·kg^-1·d^-1） in6- 8months, 310 kJ·kg^-1·d^-1 （74 kcal ·kg^-1·d^-1） in 9 - 12 months were lower than normal groups （ P 〈 0.05 ）. The energy densities were 2.7 kJ ·d^-1（0.65 kcal·d^-1）, 2.7 kJ ·d^-1 （0.64 kcal·d^-1）, 2.9 kJ ·d^-1（0.69 kcal·d^-1）in deceleration groups, respectively. It was similar between the two groups （ P 〉 0.05 ）. （3）The results by logistic regression analysis showed that low energy intake was the risk factor （ OR = 3. 947 ） , and higher maternal education level was the protective factor （ OR = 0.437 ）. Conclusions （1）The energy intakes in the infants with △ WAZ 〈 - 0.67 were lower than those in infants with - 0.67≤△ WAZ≤0. 67. （2）The sufficient milk intake was the key to maintain energy intakes during infancy. （3）The food intake was the main factor influencing the energy intakes to maintain the energy density.