配方奶添加棕榈油对婴儿营养吸收和排便影响的Meta分析

Effects of infant formula containing palm oil on the nutrient absorption and defecation in infants ： a meta-analysis

目的探讨配方奶中添加棕榈油对婴儿营养吸收和排便的影响。方法检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文数据库、维普全文数据库、万方全文数据库和中国生物医学文献数据库（从1990年1月至2009年3月）中的中英文文献，并对纳入文献质量进行评估，分析婴儿肠道营养吸收营养物质，大便中电解质的含量，体内钙的沉积和婴儿排便的情况。结果共纳入文献13篇，配方奶没有添加棕榈酸或添加棕榈酸（Sn-2位置）较配方奶添加棕榈酸（Sn一1，3位置）喂养的婴儿，更有利于肠道吸收脂肪酸和钙离子，减少婴儿大便中钙离子的排泄（P〈0．01）；配方奶没有添加棕榈酸喂养婴儿3、6月龄时骨矿物质含量（bone mineral content，BMC）和骨密度（bone mineral density，BMD）明显高于配方奶添加棕榈酸（Sn-1，3位置）喂养婴儿（P〈0．01），有利于婴儿体内钙的沉积；配方奶添加棕榈酸（Sn-2位置）婴儿大便中皂化物的含量低于没有添加棕榈酸喂养婴儿（P〈0．01），BMC高于没有添加棕榈酸喂养婴儿（P〈0．01）；配方奶没有添加棕榈酸或添加棕榈酸（Sn-2位置）喂养婴儿稀糊状大便的比例明显高于配方奶添加棕榈酸（Sn．1，3位置）喂养的婴儿（P〈0．01）；配方奶没有添加棕榈酸或添加棕榈酸（Sn-2位置）喂养婴儿大便干硬的比例明显低于配方奶添加棕榈酸（Sn-1，3位置）喂养的婴儿（P〈0．01）。结论添加棕榈酸（Sn．1，3位置）较不添加棕榈酸或添加棕榈酸（Sn-2位置）配方奶喂养的婴儿，肠道吸收脂肪酸和钙离子减少，大便中钙离子的排泄增加，BMC含量明显降低，大便干硬的发生率增加。但研究纳入文献的质量有限，对此结论的运用和推广应谨慎。

Objective To evaluate the effects of infant formula containing palm oil on the nutrient absorption and defecation in infants. Methods A search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure, Vip Chinese Periodical Database, Wanfang Chinese Periodical Database and Chinese Bio-medicine Database was performed to identify relevant English and Chinese language articles between January 1990 and March 2009. Two reviewers independently performed data extraction and appraised using Jadad instrument. Double data were input and analyzed by software of Review Manager 4. 2 recommended by Cochrane Collaboration. Intestinal nutrient absorption, electrolyte content of fecal excretion, in vivo calcium deposition, and defecation were included as the target outcomes. These outcomes were evaluated as the combined standardized mean difference （SMD） and relative risk （RR） value and 95% CI of them. Results Thirteen articles were included. Three articles meeting inclusion criteria were analyzed for the effects between infant formula containing palmitie acid at the Sn-2 positions and palmitic acid at the Sn-1, 3 positions; five articles were analyzed for the effects between infant formula containing palmitic acid at the Sn-1, 3 and without palmitic acid; another five articles were analyzed for the effects between infant formula containing palmitic acid at the Sn-2 positions and without palmitie acid. Absorption of fat and calcium was higher, the Ca^2＋ of fecal excretion was lower when the infant formula provided palmitic acid at the Sn-2 positions or without palmitic acid than that determined when formula containing palmitic acid at the Sn-1 and Sn-3 positions was given （ P 〈 0. 01 ）. The bone mineral content （BMC） and bone mineral density （BMD） increased at 3,6 months when the infant formula without palmitic acid as compared with using the formula containing palmitic acid at the Sn-1 and Sn-3 positions （P 〈0. 01 ）. The formation of calcium soaps in stool was reduced, the BMC increased when the infant formula provided palmitic acid at the Sn-2 positions as compared with using the infant formula without palmitic acid （P 〈 0. 01 ）. The incidence of soft stools was higher, and the incidence of hard stools was lower when the infant formula provided palmitic acid at the Sn-2 positions or without palmitic acid than that when formula containing palmitic acid at the Sn-1 and Sn-3 positions was used （ P 〈 0. 01 ）. Conclusion Absorption of fat and calcium was lower, the Ca^2＋ of fecal excretion was higher, the BMC was reduced, the incidence of hard stools increased when the infant formula provided the palmitic acid at the Sn-1 and Sn-3 positions as compared with using formula contained palmitic acid at the Sn-2 positions or without palmitic acid. However, this conclusion should be used cautiously because of the limited quality of studies included into the analysis.