生后0～6月不同喂养方式对7～12月龄婴儿能量摄入和体格发育的影响

Effects of different feeding patterns during 0-6 months after birth on dietary energy intake and physical growth in infants at 7-12 months old

目的探讨在婴儿早期（o～6月龄）采用纯人工喂养、混合喂养、纯母乳喂养3种不同喂养方式对其7～12月龄膳食能量及宏量营养素摄入和体格发育的影响。方法对全国8个城市中418例7～12月龄婴儿采用问卷获得其基本情况，采用24h膳食回顾获得其膳食情况，并测量其身长、体重。将调查的7～12月龄婴儿按生后0～6月喂养方式分为纯人工喂养组、混合喂养组、纯母乳喂养组，采用秩检验和卡方检验比较3组婴儿的膳食能量及宏量营养素摄人与体格发育的差异。结果男婴的出生体重3组间差异无统计学意义（P〉0．05）；但纯人工喂养组、混合喂养组、纯母乳喂养组女婴出生体重的中位数分别为3．10、3．30、3．40kg，差异有统计学意义（H=12．76，P〈o．05）。除女婴的碳水化合物摄人组间无统计学差异外（P〉0．05），男女婴膳食能量、蛋白质、脂肪、碳水化合物摄入量在3组间的差异均有统计学意义（P〈o．05或0．01），其中人工喂养组最高（男婴的能量、蛋白质、脂肪、碳水化合物摄人量的中位数依次为768．61kJ、24．86g、27．20g、106．59g；女婴依次为884．71kJ、35．95g、35．45g、110．85g），混合喂养组其次（男婴依次为656．68kJ、21．84g、26．03g、84．54g；女婴依次为696．38kJ、20．03g、26．68g、77．28g），母乳喂养组最低（男婴依次为455．88kJ、17．35g、15．69g、71．57g；女婴依次为562．90kJ、18．78g、20．62g、72．00g）。3组男婴间3种宏量营养素的供能比差异无统计学意义（P均〉0．05）。3组婴儿无论男女，其身高别体重z评分、年龄别身高z评分、年龄别体重z评分等级差异均无统计学意义（P均〉0．05）。3组女婴问蛋白质供能比差异无统计学意义（H=4．85，P〉0．05），但脂肪、碳水化合物供能比差异有统计学意义（34．58％、36．48％与28．74％，H=2．38；52．67％、51．10％与57．27％，H=2．90；P均〈0．01），纯母乳喂养组脂肪供能比最低，碳水化合物供能比最高。消瘦率、低体重率、发育迟缓率及超重率在男女婴3组间比较差异均无统计学意义（P均〉0．05），人工喂养组超重率最高（男、女分别为25．8％、20．0％）。结论婴儿前0～6个月的采用人丁喂养或混合喂养，可能导致其在7～12个月能量及宏量营养素摄人偏高，且体重超重率高。

Objective To investigate the effects of different early feeding patterns in the first six months after birth on 7-12-month-old infan（s dietary energy, macronutrients intake and physical growth. Methods Data of 418 infants at 7-12 months old were selected from Maternal, Infants, Nutrition, Growth Study （MING Study）, a study of eight Chinese cities with systematic cluster random sampling method. Children were classified into three groups according to their breast feeding patterns at 0 6 months after birth, i. e. exclusive artificial feeding, mixed feeding and exclusive breastfeeding. The caregivers of those infants were investigated by questionnaires for relativeinformation. And a 24-hour recall was conducted to acquire the children＇s food intake during the day before. Rank test and Chi-square test were used for statistical analysis. Results Birth weight of male infants showed no statistical difference between the three groups （P〉0.05）, but there was statistical difference on the median birth weight of female infants among exclusive artificial feeding, mixed feeding and exclusive breastfeeding group （3.10 kg, 3.30 kg vs 3.40 kg, H= 12.76, P〈 0.05）. There were significant differences among the three groups on intake of energy, protein, fat and carbohydrate （P〈0.01 or 0.05）, regardless of gender, except for carbohydrate intake among female infants （P〉 0.05）. The highest value appeared in artificial feeding group （the median of energy, protein, fat and carbohydrate intake for boys were 768.61 kJ, 24.86 g, 27.20 g and 106.59 g, respectively; for girls were 884.71 kJ, 35.95 g, 35.45 g and 110.85 g）, followed by the mixed feeding group （boys： 656.68 kJ, 21.84 g, 26.03 g and 84.54 g;girls： 696.38 kJ, 20.03 g, 26.68 g and 77.28 g, respectively）. The lowest value appeared in the breast feeding group （boys： 455.88 kJ, 17.35 g, 15.69 g and 71.57 g; girls： 562.90 kJ, 18.78 g, 20.62 g and 72.00 g, respectively）. There was no significant difference in energy intake from protein, fat or carbohydrate of boys among the three groups （all P〉0.05）, neither in physical development （all P〉0.05）（measured by weight for height z score, height for age z score and weight for age z score）. For girls, the energy intake from fat and carbohydrate was different among the three group （34.58, 36.48% vs 28.74%, H=2.38; 52.67%, 51.10%, vs 57.27%, H=2.90; all P%0.01）, but not in energy intake from protein （P〉 0.05）. The lowest proportion of energy intake from fat and the highest proportion of energy intake from carbohydrate were both found in the exclusive breastfeeding group （28.74% and 57.27%）. There was no statistical difference on emaciation rate, underweight rate, stunning rate and overweight rate among the three groups for boys or girls （P〉0.05）, however, the highest rate of overweight infants was found in the artificial feeding groups （ boys ： 25.81% ; girls ： 20.00 % ）. Conclusions The feeding pattern during 0-6 months after birth may affect the future dietary energy intake of infants. Exclusive artificial feeding or mixed feeding in the first six months of life may lead to more energy, protein, fat and carbohydrate intake in infants at 7-12 months old, with higher incidence of overweight.