饮水氟超标临界地区儿童氟斑牙与膳食营养因素关系的研究

Relationship between children's dental fluorosis and dietary nutrient in an area with critical levels of fluoride in drinking water

目的调查饮水氟超标临界地区儿童膳食营养状况,分析并探讨儿童氟斑牙患病与膳食营养之间的关系。方法采用1∶1病例-对照研究方法,于2017年5—6月,在河南省清丰县整群随机抽取改水时间超过5年以上的地氟病村的氟斑牙及非氟斑牙(对照)的8~12岁儿童各30名(男女各半),进行连续3 d的"双份饭法"膳食营养调查。结果氟斑牙组与对照组儿童每日饮水氟、食物氟和总摄氟量间比较,差异均无统计学意义(P>0.05)。与氟斑牙组比较,对照组儿童仅食用肉类的比例较高,差异有统计学意义(P<0.05);而食用大豆类、蛋类、蔬菜、水果的比例无明显变化。与对照组比较,氟斑牙组儿童仅膳食磷的摄入量较高,差异有统计学意义(P=0.027);而膳食蛋白质、钙、镁、铁、锌、硒、铜和维生素C的摄入量均无明显变化。与氟斑牙组比较,对照组儿童膳食蛋白质和镁摄入量≥RNI的比例较高,差异均有统计学意义(P<0.05);而膳食钙、磷、铁、锌、硒、铜、维生素C摄入量≥RNI的比例均无明显变化。多因素条件logistic回归分析结果显示,膳食镁摄入量≥RNI(OR=0.231,95%CI=0.064~0.831)是儿童患氟斑牙的保护性因素。结论膳食镁可能是儿童氟斑牙发病保护性因素。为预防儿童氟斑牙,建议氟病区儿童日常膳食营养中应保证充足的镁摄入。

Objective To understand the relationship between dietary nutrients and children＇s dental fluorosis in an area, where the drinking water fluoride is at 0.96-1.11 mg/L,the critical level for the limit ruled by GB5749-2006 Standards for Drinking Water Quality. Methods A 1：1 case-control study was conducted in Qingfeng county, He＇nan province from May 2017 to June 2017. Thirty children with dental fluorosis and thirty children without dental fluorosis in the endemic fluorosis village where drinking water improvement measures had been implemented for more than five years, were investigated for three consecutive days of dietary nutrition survey. Results There was no significant difference between case group and control group in daily intake of water fluoride,food fluoride and total fluoride （P〉0.05）. Compared with the dental fluorosis group, the control group only had a higher proportion of meat consumption （P〈0.05）. No significant changes were observed in the proportion of soybeans, eggs, vegetables and fruits consumption. Compared with the Control group, the dietary phosphorus intake of children in dental fluorosis group was higher （P=0.027）. The intake of dietary protein, calcium, magnesium, iron, zinc, selenium, copper and vitamin C did not changed significantly. Compared with the dental fluorosis group, the proportion of children with dietary protein and magnesium intake 1〉 recommended nutrients intakes （RNI） in control group was higher （P〈0.05）, dietary calcium, phosphorus, iron, zinc, selenium, copper and vitamin C intake ≥RNI in control group were no significant change in the ratio. Multivariate conditional logistic regression analysis showed that dietary intake of magnesium≥RNI （OR=0.231,95%CI=0.064- 0.831） was a protective factor for dental fluorosis of children. Conclusion In order to prevent dental fluorosis in children, it is suggested that enough magnesium intake should be ensured in daily dietary nutrition for the children in the areas where the drinking water fluoride is at the critical level for the limit in GB5749-2006.