完全母乳喂养婴儿超重危险因素及发育状况研究
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摘要
目的探讨3-4月龄完全母乳喂养婴儿发生超重的危险因素及发育状况,为儿童肥胖的早期干预提供一定的理论依据。
方法于2009年7月-10月在青岛大学医学院附属医院儿童保健科及市北区妇幼保健所选取符合条件的3-4月龄婴儿342名作为研究对象,其中男184例(53.8%),女158例(46.2%),男女之比为1.16：1。对抚养者采用自制的生长发育情况调查问卷进行一般情况及婴儿超重危险因素调查,对婴儿进行体格生长测量和Bayley发育状况测查,按照喂养方式的不同将受试对象分为完全母乳喂养组(162例)和非完全母乳喂养组(178例),采用病例对照研究的方法探讨完全母乳喂养婴儿发生超重的危险因素。
结果①婴儿超重的流行学状况：3-4月龄婴儿超重检出率为17.5%,其中男童超重检出率为16.3%,女童为19.0%,不同性别婴儿超重检出率无差别(χ2=0.423,P=0.515)。完全母乳喂养婴儿超重检出率(22.2%)高于非完全母乳喂养婴儿超重检出率(13.5%),差异有统计学意义(χ2=4.457,P=0.035)。男童完全母乳喂养组超重检出率高于非完全母乳喂养组,差异有统计学意义(χ2=6.108,P=0.013),而女童两种不同喂养方式的超重检出率无差别。②3-4月龄婴儿发育状况：完全母乳喂养组超重婴儿的精神运动发育指数得分(104.29+6.486)低于体格正常婴儿(108.96±8.133)；非完全母乳喂养组超重婴儿的精神运动发育指数得分(106.60±3.373)也低于体格正常婴儿(108.46±6.299),差异均有统计学意义(P<0.01)。两种喂养方式超重婴儿的Bayley发育测试项目具体通过情况存在差异,完全母乳喂养婴儿“手碰手玩”、“接近环“和“尺侧手掌抓方木”通过情况高于非完全母乳喂养婴儿(P<0.01；P<0.05；P<0.05),而“双手张开”项目通过情况低于非完全母乳喂养婴儿(P<0.01)。③完全母乳喂养婴儿超重的危险因素：Logistic回归分析表明父亲文化水平高,经阴道分娩,每次喂养时间长,喂养间隔时间短及夜间喂养次数较多是3-4月龄完全母乳喂养婴儿发生超重的危险因素。
结论3-4月龄婴儿超重检出率较高,超重婴儿与体格正常婴儿的发育情况存在差异。父亲文化水平高,经阴道分娩,每次喂养时间长,喂养间隔时间短及夜间喂养次数较多是完全母乳喂养婴儿发生超重的危险因素。预防儿童肥胖需从儿童早期开始。
Objective To explore the risk factors of overweight and developmental status in fully breastfed infants aged 3-4 months in order to provide theoretical evidence for early intervention of childhood obesity.
Methods The study subjects included 342 infants aged 3-4 months chosen from The affiliated hospital of medical college, Qingdao University and The women and children health institute in the Shibei District of Qingdao City from July to October in 2009, among which males were 184(53.8%)and females were 158(46.2%).The ratio of male to female was 1.16:1. The infants's general conditions and possible relevant risk factors for overweight were investigated by self-made questionnaires filled in by their caregivers. Physical statement was measured and Bayley scales were conducted to measure infants's developmental level. The subjects of study were divided into fully breastfed(162) and non-fully breastfed group(178) according to different feeding methods. Case-control study was conducted to study the risk factors of overweight and developmental level in fully breastfed infants.
Results①The prevalence rate of overweight in infants:The prevalence rate of overweight in infants aged 3-4 months was 17.5%, male 16.3% and female19.0%, respectively. There were no statistical differences between them (χ2= 0.423,P= 0.515).The prevalence rate of overweight in fully breastfed infants was 22.2% and that of non-fully breastfed infants was 13.5%, with statistically differences between them (χ2= 4.457,P=0.035). The prevalence rate of overweight in fully breastfed male infants was higher than that of non-fully breastfed male infants (χ2=6.108,P=0.013) while there were no significant differences in female infants.②The developmental level of infants aged 3-4 months:The scores of psychomotor development index of overweight infants (104.29±6.486)were lower than that of infants with normal BM(108.96±8.133)in fully breastfed group, and the scores of psychomotor development index of overweight infants (106.60±3.373) in non-fully breastfed group were also lower than that of infants with normal BMI (108.46±6.299). There were both significant differences between them (P <0.01).The specific passing situation of overweight infants was different between different feeding methods. The passing rate of“touch hands for play”,“close to the swing loop”and“catch the square timber with ulnar side of hand”was higher in fully breastfed infants (P<0.01,P<0.05,P<0.05) and passing rate of“open hands”was higher in non-fully breastfed infants (P<0.01).③Risk factors of overweight in fully breastfed infants:Logistic regression analysis indicated that fathers with higher education level, vaginal delivery, longer time of feeding each time, shorter feeding intervals and more frequent feeding during night were associated with overweight in fully breastfed infants aged 3-4 months.
Conclusions The prevalence rate of overweight in infants aged 3-4 months is high. The developmental level of overweight infants is different from that of physical normal infants. Fathers with higher education level, vaginal delivery, longer time of feeding each time, shorter feeding intervals and more frequent feeding during night are associated with overweight in fully breastfed infants aged 3-4 months. The prevention of childhood overweight should start from early childhood.
方法于2009年7月-10月在青岛大学医学院附属医院儿童保健科及市北区妇幼保健所选取符合条件的3-4月龄婴儿342名作为研究对象,其中男184例(53.8%),女158例(46.2%),男女之比为1.16：1。对抚养者采用自制的生长发育情况调查问卷进行一般情况及婴儿超重危险因素调查,对婴儿进行体格生长测量和Bayley发育状况测查,按照喂养方式的不同将受试对象分为完全母乳喂养组(162例)和非完全母乳喂养组(178例),采用病例对照研究的方法探讨完全母乳喂养婴儿发生超重的危险因素。
结果①婴儿超重的流行学状况：3-4月龄婴儿超重检出率为17.5%,其中男童超重检出率为16.3%,女童为19.0%,不同性别婴儿超重检出率无差别(χ2=0.423,P=0.515)。完全母乳喂养婴儿超重检出率(22.2%)高于非完全母乳喂养婴儿超重检出率(13.5%),差异有统计学意义(χ2=4.457,P=0.035)。男童完全母乳喂养组超重检出率高于非完全母乳喂养组,差异有统计学意义(χ2=6.108,P=0.013),而女童两种不同喂养方式的超重检出率无差别。②3-4月龄婴儿发育状况：完全母乳喂养组超重婴儿的精神运动发育指数得分(104.29+6.486)低于体格正常婴儿(108.96±8.133)；非完全母乳喂养组超重婴儿的精神运动发育指数得分(106.60±3.373)也低于体格正常婴儿(108.46±6.299),差异均有统计学意义(P<0.01)。两种喂养方式超重婴儿的Bayley发育测试项目具体通过情况存在差异,完全母乳喂养婴儿“手碰手玩”、“接近环“和“尺侧手掌抓方木”通过情况高于非完全母乳喂养婴儿(P<0.01；P<0.05；P<0.05),而“双手张开”项目通过情况低于非完全母乳喂养婴儿(P<0.01)。③完全母乳喂养婴儿超重的危险因素：Logistic回归分析表明父亲文化水平高,经阴道分娩,每次喂养时间长,喂养间隔时间短及夜间喂养次数较多是3-4月龄完全母乳喂养婴儿发生超重的危险因素。
结论3-4月龄婴儿超重检出率较高,超重婴儿与体格正常婴儿的发育情况存在差异。父亲文化水平高,经阴道分娩,每次喂养时间长,喂养间隔时间短及夜间喂养次数较多是完全母乳喂养婴儿发生超重的危险因素。预防儿童肥胖需从儿童早期开始。
Objective To explore the risk factors of overweight and developmental status in fully breastfed infants aged 3-4 months in order to provide theoretical evidence for early intervention of childhood obesity.
Methods The study subjects included 342 infants aged 3-4 months chosen from The affiliated hospital of medical college, Qingdao University and The women and children health institute in the Shibei District of Qingdao City from July to October in 2009, among which males were 184(53.8%)and females were 158(46.2%).The ratio of male to female was 1.16:1. The infants's general conditions and possible relevant risk factors for overweight were investigated by self-made questionnaires filled in by their caregivers. Physical statement was measured and Bayley scales were conducted to measure infants's developmental level. The subjects of study were divided into fully breastfed(162) and non-fully breastfed group(178) according to different feeding methods. Case-control study was conducted to study the risk factors of overweight and developmental level in fully breastfed infants.
Results①The prevalence rate of overweight in infants:The prevalence rate of overweight in infants aged 3-4 months was 17.5%, male 16.3% and female19.0%, respectively. There were no statistical differences between them (χ2= 0.423,P= 0.515).The prevalence rate of overweight in fully breastfed infants was 22.2% and that of non-fully breastfed infants was 13.5%, with statistically differences between them (χ2= 4.457,P=0.035). The prevalence rate of overweight in fully breastfed male infants was higher than that of non-fully breastfed male infants (χ2=6.108,P=0.013) while there were no significant differences in female infants.②The developmental level of infants aged 3-4 months:The scores of psychomotor development index of overweight infants (104.29±6.486)were lower than that of infants with normal BM(108.96±8.133)in fully breastfed group, and the scores of psychomotor development index of overweight infants (106.60±3.373) in non-fully breastfed group were also lower than that of infants with normal BMI (108.46±6.299). There were both significant differences between them (P <0.01).The specific passing situation of overweight infants was different between different feeding methods. The passing rate of“touch hands for play”,“close to the swing loop”and“catch the square timber with ulnar side of hand”was higher in fully breastfed infants (P<0.01,P<0.05,P<0.05) and passing rate of“open hands”was higher in non-fully breastfed infants (P<0.01).③Risk factors of overweight in fully breastfed infants:Logistic regression analysis indicated that fathers with higher education level, vaginal delivery, longer time of feeding each time, shorter feeding intervals and more frequent feeding during night were associated with overweight in fully breastfed infants aged 3-4 months.
Conclusions The prevalence rate of overweight in infants aged 3-4 months is high. The developmental level of overweight infants is different from that of physical normal infants. Fathers with higher education level, vaginal delivery, longer time of feeding each time, shorter feeding intervals and more frequent feeding during night are associated with overweight in fully breastfed infants aged 3-4 months. The prevention of childhood overweight should start from early childhood.
引文
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