出生体重对6～23月龄婴幼儿体格发育和贫血影响
|
摘要
目的了解湖南省农村地区低出生体重和巨大儿的发生情况,分析出生体重对6～23月龄婴幼儿体格发育和贫血的影响。方法 2017年10—12月在湖南省农村地区采用多阶段抽样和按乡级规模大小成比例的概率抽样相结合的方法随机抽取3 630名6～23月龄婴幼儿作为研究对象,进行问卷调查并测量其身长、体重和末梢血红蛋白,通过Z评分法评估婴幼儿体格发育状况,并运用logistic回归模型分析出生体重对婴幼儿体格发育和贫血的影响。结果湖南省农村地区低出生体重发生率为4.10%(149/3 630),巨大儿发生率为6.72%(244/3 630)。低出生体重组婴幼儿生长迟缓率、低体重率和消瘦率分别为22.82%、14.09%和6.04%,明显高于正常出生体重组(4.97%、2.35%和2.13%)和巨大儿组(0.82%、0.82%和0.41%);低出生体重是婴幼儿生长迟缓、低体重和消瘦的危险因素,其OR值分别为7.91、6.25和3.07。巨大儿组婴幼儿超重肥胖率为25.82%,明显高于低出生体重组(4.70%)和正常出生体重组(13.04%),巨大儿是婴幼儿超重肥胖的危险因素,其OR值为2.27。低出生体重组、正常出生体重组和巨大儿组婴幼儿贫血率分别为25.50%、29.10%和25.41%,差异无统计学意义,出生体重与婴幼儿贫血的发生无关。结论出生体重与婴幼儿体格发育密切相关,低出生体重将增加婴幼儿营养不良的发生风险,巨大儿将增加婴幼儿超重肥胖的发生风险。
Objective To examine the incidence of low birth weight and macrosomia in rural Hunan province, and to analyze effects of birth weight on growth and development and anemia among infants aged 6 – 23 months. Methods A total of 3 630 infants aged 6 – 23 months in rural Hunan province were randomly selected with multistage sampling and probability proportion to size sampling at township-level. Questionnaire survey, body length and weight measurement, and peripheral blood hemoglobin detection were conducted among the participants between October and December 2017.Z-scores were used to evaluate the growth and development, and logistic regression model was used to adjust confounding factors for analyzing the effects of birth weight on growth and development and anemia. Results The incidence of low birth weight was 4.10%(149/3 630) and that of macrosomia was 6.72%(244/3 630) for all the infants. Compared to those with normal birth weight or macrosomia, the infants with low birth weight had obviously higher prevalence rate of stunting(22.82% vs. 4.97% or 0.82%), underweight(14.09% vs. 2.35 % or 0.82%) and wasting(6.04% vs. 2.13% or 0.41%),suggesting that low birth weight was a risk factor for stunting(odds ratio [OR] = 7.91), underweight(OR = 6.25) and wasting(OR = 3.07). The prevalence rate of overweight/obesity was remarkably higher among infants with macrosomia than among those with low birth weight and normal birth weight(25.82% vs. 4.70% and 13.04%), indicating that macrosomia was a risk factor for overweight/obesity(OR = 2.27). The detection rate of anemia rate was 25.50%, 29.10%, and 25.41% among the infants with low birth weight, normal birth weight, and macrosomia, respectively, without significant difference in the rate among the three groups. Conclusion There is a close association between birth weight and infants′ growth and development.Low birth weight could increase the risk of malnutrition among infants compared to normal birth weight, and macrosomia could increase the risk of overweight/obesity. Birth weight is not correlated with anemia in infants.
Objective To examine the incidence of low birth weight and macrosomia in rural Hunan province, and to analyze effects of birth weight on growth and development and anemia among infants aged 6 – 23 months. Methods A total of 3 630 infants aged 6 – 23 months in rural Hunan province were randomly selected with multistage sampling and probability proportion to size sampling at township-level. Questionnaire survey, body length and weight measurement, and peripheral blood hemoglobin detection were conducted among the participants between October and December 2017.Z-scores were used to evaluate the growth and development, and logistic regression model was used to adjust confounding factors for analyzing the effects of birth weight on growth and development and anemia. Results The incidence of low birth weight was 4.10%(149/3 630) and that of macrosomia was 6.72%(244/3 630) for all the infants. Compared to those with normal birth weight or macrosomia, the infants with low birth weight had obviously higher prevalence rate of stunting(22.82% vs. 4.97% or 0.82%), underweight(14.09% vs. 2.35 % or 0.82%) and wasting(6.04% vs. 2.13% or 0.41%),suggesting that low birth weight was a risk factor for stunting(odds ratio [OR] = 7.91), underweight(OR = 6.25) and wasting(OR = 3.07). The prevalence rate of overweight/obesity was remarkably higher among infants with macrosomia than among those with low birth weight and normal birth weight(25.82% vs. 4.70% and 13.04%), indicating that macrosomia was a risk factor for overweight/obesity(OR = 2.27). The detection rate of anemia rate was 25.50%, 29.10%, and 25.41% among the infants with low birth weight, normal birth weight, and macrosomia, respectively, without significant difference in the rate among the three groups. Conclusion There is a close association between birth weight and infants′ growth and development.Low birth weight could increase the risk of malnutrition among infants compared to normal birth weight, and macrosomia could increase the risk of overweight/obesity. Birth weight is not correlated with anemia in infants.
引文
[1]Kirk CM,Uwamungu JC,Wilson K,et al.Health,nutrition,and development of children born preterm and low birth weight in rural Rwanda:a cross-sectional study[J].BMC Pediatr,2017,17(1):191.
[2]王金子,李宏亮,赵艾,等.出生体重对3~6岁儿童生长发育的影响[J].中国妇幼保健,2014,29(36):6039-6042.
[3]戎芬,武俊青,李玉艳,等.出生体重与儿童期超重肥胖的关系[J].中国儿童保健杂志,2011,19(11):989-991.
[4]Jeanne TL,Hooker ER,Nguyen T,et al.High birth weight modifies association between adolescent physical activity and cardiometabolic health in women and not men[J].Prev Med,2017,208:29-35.
[5]Morrison KM,Ramsingh L,Gunn E,et al.Cardiometabolic health in adults born premature with extremely low birth weight[J].Pediatrics,2016,138(4):pii:e20160515.
[6]中华人民共和国卫生部.中国0~6岁儿童营养发展报告(节录)[J].营养学报,2013,35(1):1-4.
[7]张钰,宋艾云,范玉娟,等.出生体重与5至8岁儿童超重和肥胖关联的队列研究[J].中国循证儿科杂志,2015,10(1):46-51.
[8]薛红丽,李芝兰,马国燕,等.甘肃省农村0~7岁儿童超重、肥胖影响因素调查研究[J].卫生研究,2011,40(1):68-70.
[9]Abdeyazdan Z,Ehsanpour S,Hemmati E.Evaluation of growth and development pattern in normal,low and very low birth weight neonates at 18 months of age[J].J Educ Health Promot,2014,3:102.
[10]Zhang J,Himes JH,Guo Y,et al.Birth weight,growth and feeding pattern in early infancy predict overweight/obesity status at two years of age:a birth cohort study of Chinese infants[J].PLoS One,2013,8(6):e64542.
[11]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:113-116.
[12]中华人民共和国卫生部.儿童营养性疾病管理技术规范[EB/OL].[2012-04-20].http://www.moh.gov.cn/cmsresources/mohfybjysqwss/cmsrsdocument/doc14757.doc
[13]沈晓明,桂永浩.临床儿科学[M].2版.北京:人民卫生出版社,2013:562.
[14]World Health Organization.WHO Anthro(version 3.2.2,January2011)and macros[EB/OL].[2017-07-15].http://www.who.int/childgrowth/software/en/.
[15]Pei L,Kang Y,Zhao Y,et al.Changes in socioeconomic inequality of low birth weight and macrosomia in Shaanxi province of northwest China,2010-2013:a cross-sectional study[J].Medicine(Baltimore),2016,95(5):e2471.
[16]房少华,赵钟鸣,刘锦桃,等.云南省低出生体重与体格发育和疾病关系的研究[J].中国妇幼保健,2016,31(9):1871-1875.
[17]刘爽,李骏,龚晨睿,等.湖北农村地区6~23月龄婴幼儿贫血状况分析[J].中国公共卫生,2014,30(7):899-902.
[18]王杰,刘长青,庞学红,等.河北省贫困县婴儿的营养与智力发育状况及影响因素分析[J].卫生研究,2016,45(1):98-102.
[19]刘薇,沈雅利,詹小丽,等.湖北省贫困地区6~24月龄婴幼儿贫血状况及其影响因素分析[J].中国儿童保健杂志,2017,25(4):386-389.
[20]Joo EY,Kim KY,Kim DH,et al.Iron deficiency anemia in infants and toddlers[J].Blood Res,2016,51(4):268-273.
[21]Yang W,Li X,Li Y,et al.Anemia,malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0-18 months in rural areas of Shaanxi province in northwestern China:a cross-sectional study[J].BMCPublic Health,2012,12:1127.
[22]周旭,方俊群,罗家有,等.贫困农村地区6~23月龄婴幼儿贫血现况及影响分析[J].中国公共卫生,2017,33(9):1302-1305.
[2]王金子,李宏亮,赵艾,等.出生体重对3~6岁儿童生长发育的影响[J].中国妇幼保健,2014,29(36):6039-6042.
[3]戎芬,武俊青,李玉艳,等.出生体重与儿童期超重肥胖的关系[J].中国儿童保健杂志,2011,19(11):989-991.
[4]Jeanne TL,Hooker ER,Nguyen T,et al.High birth weight modifies association between adolescent physical activity and cardiometabolic health in women and not men[J].Prev Med,2017,208:29-35.
[5]Morrison KM,Ramsingh L,Gunn E,et al.Cardiometabolic health in adults born premature with extremely low birth weight[J].Pediatrics,2016,138(4):pii:e20160515.
[6]中华人民共和国卫生部.中国0~6岁儿童营养发展报告(节录)[J].营养学报,2013,35(1):1-4.
[7]张钰,宋艾云,范玉娟,等.出生体重与5至8岁儿童超重和肥胖关联的队列研究[J].中国循证儿科杂志,2015,10(1):46-51.
[8]薛红丽,李芝兰,马国燕,等.甘肃省农村0~7岁儿童超重、肥胖影响因素调查研究[J].卫生研究,2011,40(1):68-70.
[9]Abdeyazdan Z,Ehsanpour S,Hemmati E.Evaluation of growth and development pattern in normal,low and very low birth weight neonates at 18 months of age[J].J Educ Health Promot,2014,3:102.
[10]Zhang J,Himes JH,Guo Y,et al.Birth weight,growth and feeding pattern in early infancy predict overweight/obesity status at two years of age:a birth cohort study of Chinese infants[J].PLoS One,2013,8(6):e64542.
[11]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:113-116.
[12]中华人民共和国卫生部.儿童营养性疾病管理技术规范[EB/OL].[2012-04-20].http://www.moh.gov.cn/cmsresources/mohfybjysqwss/cmsrsdocument/doc14757.doc
[13]沈晓明,桂永浩.临床儿科学[M].2版.北京:人民卫生出版社,2013:562.
[14]World Health Organization.WHO Anthro(version 3.2.2,January2011)and macros[EB/OL].[2017-07-15].http://www.who.int/childgrowth/software/en/.
[15]Pei L,Kang Y,Zhao Y,et al.Changes in socioeconomic inequality of low birth weight and macrosomia in Shaanxi province of northwest China,2010-2013:a cross-sectional study[J].Medicine(Baltimore),2016,95(5):e2471.
[16]房少华,赵钟鸣,刘锦桃,等.云南省低出生体重与体格发育和疾病关系的研究[J].中国妇幼保健,2016,31(9):1871-1875.
[17]刘爽,李骏,龚晨睿,等.湖北农村地区6~23月龄婴幼儿贫血状况分析[J].中国公共卫生,2014,30(7):899-902.
[18]王杰,刘长青,庞学红,等.河北省贫困县婴儿的营养与智力发育状况及影响因素分析[J].卫生研究,2016,45(1):98-102.
[19]刘薇,沈雅利,詹小丽,等.湖北省贫困地区6~24月龄婴幼儿贫血状况及其影响因素分析[J].中国儿童保健杂志,2017,25(4):386-389.
[20]Joo EY,Kim KY,Kim DH,et al.Iron deficiency anemia in infants and toddlers[J].Blood Res,2016,51(4):268-273.
[21]Yang W,Li X,Li Y,et al.Anemia,malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0-18 months in rural areas of Shaanxi province in northwestern China:a cross-sectional study[J].BMCPublic Health,2012,12:1127.
[22]周旭,方俊群,罗家有,等.贫困农村地区6~23月龄婴幼儿贫血现况及影响分析[J].中国公共卫生,2017,33(9):1302-1305.