渭南市4 317例母乳成分检测结果分析

目的 对渭南市成熟母乳成分进行分析,为指导本地区母乳喂养工作提供依据。方法 收集正常乳母分泌的成熟乳汁样本,使用“MIRIS HMA型母乳分析仪”,检测其中宏量营养素含量,分析结果及其相关影响因素。结果 渭南市4 317例乳母的成熟母乳中脂肪、蛋白质、糖类、干物质、能量是动态变化的,婴儿月龄增加时,对应的母乳各营养成分也随之而变化。其中脂肪和干物质有所减少,但不显著(P＞0.05),蛋白质和能量均明显减低,按月龄比较差异有统计学意义(P＜0.05),糖类有所增加,但按月龄比较差异无统计学意义(P＞0.05)。结论 母乳中的各营养成分是动态变化的,乳汁成分高低与乳母年龄、乳儿性别关系不明显,本地区成熟乳所含宏量营养素中,除糖类外,蛋白质、脂肪、能量含量均较国内外高。     

早产儿生后早期母乳营养成分变化分析

目的 分析早产儿生后早期母乳各大营养成分变化的特点,初步探讨提供早产儿个性化营养支持的必要性。 方法 收集2017年1-12月在南京医科大学附属常州妇幼保健院分娩产妇70人的母乳140份,用MIRIS母乳分析仪检测母乳中宏量营养成分及能量,比较不同早产儿性别、乳母年龄和不同分娩方式初乳和过渡乳母乳营养成分的差异及随着出生天数所发生的变化。 结果 1)早产母乳中初乳蛋白质含量大于过渡乳(P<0.01);初乳的脂肪、碳水化合物和能量低于过渡乳(P<0.05)。2)≤ 30周早产初乳蛋白质含量最高,与30⁺¹~33⁺⁶周组和≥34周组比较差异有统计学意义(P<0.05);≤ 30周早产初乳能量显著低于30⁺¹~33⁺⁶周(P<0.05),而脂肪、碳水化合物差异无统计学意义(P>0.05);3)不同胎龄的三组过渡乳中蛋白质、脂肪、能量差异均无统计学意义(P>0.05);碳水化合物分别为(6.28±0.57)、(6.61±0.43)、(6.36±0.81) g/100 ml,随着孕周增加而增加,差异有统计学意义(P＝0.04)。4)母乳营养成分含量在孕母生育年龄、分娩方式、婴儿性别、出生体重方面差异均无统计学意义。5)线性拟合后发现母乳中蛋白质在生后持续下降,其折点天数在第11天,同时,线性拟合发现脂肪、糖类和能量含量呈增长趋势,脂肪变化的折点在出生后第9天,而糖类以及能量在出生14 d内呈近似线性增长关系。结论 早产初乳、过渡乳营养成分差异显著,母乳营养成分含量与孕母生育年龄、分娩方式、婴儿性别、出生体重无相关性。早产儿早期蛋白质累计缺乏以及蛋白质/热卡比例较低,且早产母亲母乳成分的个体差异较大,应该对母乳中蛋白质含量和热卡密度进行“目标性”强化,对母乳添加剂添加需进一步研究。     

297例乳母膳食对乳汁成分的影响

目的 了解膳食成分与乳汁成分的相关性,了解不同的膳食结构对乳汁成分的影响.方法 通过方便取样的方法在城区及农村选取研究对象共297例,分为城区组和农村组.在两组生长过程中从初乳到成熟乳共取乳汁7次(初乳、过渡乳、2月乳、4月乳、6月乳、8月乳、10月乳),应用膳食回顾法调查采集母乳前24h乳母膳食信息.使用数字化超声波精密测量技术检测乳汁中的蛋白质、脂肪、乳糖、能量、水分、密度,采用统计软件对结果进行分析,比较两组的乳汁成分、膳食成分及膳食结构,同时比较各个时期的乳汁与膳食的相关性.结果 通过比较各期乳汁发现:初乳中蛋白质及乳糖含量农村组高于城区组,差异有统计学意义(t=2.77,P<0.05);过渡乳中脂肪含量城区组高于农村组,差异有统计学意义(t=2.64,P<0.05);成熟乳中蛋白质、脂肪及能量含量农村组高于城区组,差异有统计学意义(t值分别为2.16、4.73、4.46,均P<0.05);晚期乳中脂肪及能量含量农村组高于城区组,差异有统计学意义(t值分别为3.65、3.74,均P<0.05);城区组在初乳、过渡乳、2月、4月时乳母蛋白质摄入量高于农村组,差异有统计学意义(t值分别为2.39、3.44、2.10、2.64,均P<0.05);在过渡乳及6月时乳母脂肪摄入量城区组高于农村组,差异有统计学意义(t值分别为2.20、2.93,均P<0.05);在6月、8月及10月时乳母碳水化合物的摄入量农村组高于城区组,差异有统计学意义(t值分别为2.21、2.32、2.43,均P<0.05).通过相关性分析发现乳汁中蛋白质与膳食中脂肪在8月乳有相关性(r=-0.45,P<0.05),乳汁中蛋白质与膳食中蛋白质在过渡乳、4月乳和10月乳时有相关性(r值分别为0.38、0.45、0.47,均P<0.05),乳汁中的乳糖和膳食中的脂肪在4月乳和8月乳时有相关性(r值分别为-0.42、-0.43,均P<0.05),与膳食中的碳水化合物在6月乳时有相关性(r=0.39,P<0.05),乳汁中的能量和膳食中的脂肪在过渡乳和6月乳时有相关性(r值分别为0.89、0.43,均P<0.05),乳汁中的矿物质与膳食中脂肪在2月乳和4月乳时有相关性(r值分别为-0.42、-0.39,均P<0.05),乳汁中的脂肪与膳食中的脂肪在8月乳时有相关性(r=0.40,P<0.05)、与膳食中的碳水化合物在初乳及6月乳有相关性(r值分别为0.39、0.40,均P<0.05)、与膳食中的蛋白质在初乳时有相关性(r=0.39,P<0.05).结论 膳食成分及乳母的膳食与乳汁营养成分密切相关.     

早期足量蛋白质摄入对极低出生体重儿生长影响的临床研究

目的探讨早期足量蛋白质摄入对极低出生体重儿(very low brith weight infant,VLBWI)早期生长速率的影响。方法将出生体重1 000~1 500g并治愈出院的61例VLBWI随机分为研究组[n=31,氨基酸2.0g/(kg·d)开始,1.0g/(kg·d)递增]和对照组[n=30,氨基酸0.5~1.0g/(kg·d)开始,0.5g/(kg·d)递增],比较两组蛋白质、能量摄入情况及蛋白/能量比,血生化指标、体格增长及合并症等,并对两组蛋白质和能量摄入及蛋白/能量比与体格增长速率的关系进行相关分析。结果研究组体重下降幅度比对照组低(6.2%vs 9.5%),恢复至出生体重时间比对照组早(6dvs10d)(P均0.05);平均每周头围增长速率比对照组快[(0.75±0.32)cm vs(0.45±0.25)cm)](P0.05);每日平均体重增长速率比对照组快[(22.3±3.2)g/kg vs(15.1±2.3)g/kg(P0.05);平均每周身长增长速率差异无统计学意义(P0.05)。第3天、第7天总热卡及蛋白质摄入、蛋白/能量比与恢复出生体重后每日平均体重增长速率及平均每周头围增长速率呈正相关(均P0.05)。两组患儿平均血清总胆汁酸及尿素氮水平差异无统计学意义,但平均白蛋白水平研究组明显高于对照组(P0.05)。结论早期足量蛋白质摄入能够降低VLBWI出生早期的体重下降幅度,更早恢复至出生体重,加速住院期间的体重及头围增长速度。     

高学历产妇产后不同阶段母乳成分及喂养方式变化的随访

目的调查高学历产妇产后不同喂养阶段母乳营养成分及喂养方式的动态变化。方法招募大学本科及其以上学历的产妇87名,跟踪随访其在产后0~6个月内选择的喂养方式,分别采集其产后5天、14天、1个月、3个月、6个月母乳样本15 ml进行宏量营养素检测。比较不同时间点母乳中营养成分的差异。结果 1个月成熟乳、3个月成熟乳、6个月成熟乳中的乳糖含量均低于初乳和过渡乳中的乳糖含量,过渡乳和1个月成熟乳中的脂肪含量高于初乳中的脂肪含量,初乳和过渡乳中的蛋白质含量高于1个月成熟乳、3个月成熟乳及6个月成熟乳中蛋白质含量,过渡乳能量高于初乳、3个月成熟乳及6个月成熟乳,初乳及过渡乳中总矿物质含量高于1个月成熟乳、3个月成熟乳及6个月成熟乳中的总矿物质含量,3个月成熟乳、6个月成熟乳中水分含量高于过渡乳中的水分含量,差异均有统计学意义。产后5天内,新生儿纯母乳喂养比例39.7%;产后14天,采集过渡乳的产妇中纯母乳喂养比例72.5%;产后1个月,采集成熟乳的产妇中纯母乳喂养比例85.1%;产后3个月,采集成熟乳的产妇中纯母乳喂养比例为90.0%;产后6个月,采集成熟乳的产妇中纯母乳喂养比例为81.2%。结论母乳中蛋白质、乳糖、矿物质含量随泌乳时间延长而减少;而脂肪、能量含量在初乳中最低,过渡乳中达到高峰,并于成熟乳、晚乳中维持恒定,其变化利于婴儿健康生长。高学历产妇产后14天泌乳量稳定后能较好的保证纯母乳喂养方式,母乳喂养产妇中纯母乳喂养的比例随喂养时间延长逐渐上升。产后6个月,高学历在职产妇重返职场,对坚持母乳喂养产生影响,纯母乳喂养比例相对下降。     

母乳成分调查及影响因素分析

目的:了解分娩后42d～3月龄母乳汁中各种营养成分的含量,并探讨影响母乳营养成分的主要因素.方法:采用MirisHMA母乳成分分析仪,用中红外光谱透射吸收法,精确地直接测定母乳中主要营养成分的含量,包括脂肪、蛋白质、乳糖、干物质、能量等.结果:脂肪(3.89±1.75)g/100mL,蛋白质(1.17±0.17)g/100mL,乳糖(6.63±0.43)g/100mL,干物质(14.9±7.42)g/100mL,能量(70.5±19.15)kcal/100mL.母乳中各种营养成分含量与婴儿性别、母亲睡眠情况比较差异无统计学意义.母乳质量与母亲饮食有直接关系,肉食者、荤素搭配乳母乳汁中的脂肪、蛋白质含量显著高于素食者乳母,但乳糖含量显著低于素食者乳母.结论:孕妇产后母乳中乳糖的含量偏低,临床医师应有针对性地指导乳母饮食.     

不同分娩方式对分娩后3～7天乳汁成分的影响分析

目的分析不同分娩方式对分娩后3~7d乳汁成分的影响。方法选择2016年12月至2017年12月在四川省妇幼保健院进行剖宫产及顺产的产妇各100名,分别设为剖宫产组和阴道分娩组。收集分娩后3~7 d的乳汁,测定、比较母乳中主要营养成分的含量。结果阴道分娩组乳汁中脂肪[(3.22±1.12)g/d L]、蛋白质[(2.95±1.31)g/d L]、干物质含量[(12.13±1.41)g/d L]及总能量[(65.50±6.15)kcal/d L]明显高于剖宫产组[(2.43±1.11)g/d L]、[(2.46±0.58)g/d L]、[(11.70±1.37)g/d L]、[(59.98±9.91)kcal/d L],差异有统计学意义(P0.05);而两组糖类含量[(6.11±0.71)g/d L]vs[(6.20±0.69)g/d L]比较差异无统计学意义(P0.05);应用多重线性回归分析显示分娩方式是3~7d乳汁中脂肪、蛋白质、干物质及总能量的主要影响因素(P0.05);而年龄、身高、分娩方式、新生儿性别和出生体重均对糖类没有影响(P0.05)。结论阴道分娩产妇3~7 d乳汁成分明显优于剖宫产产妇,应积极鼓励阴道分娩。     

降钙素原对早产儿呼吸机相关性肺炎早期诊断的意义

目的评估血清降钙素原(procalcitonin,PCT)检测在早产儿呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)中的诊断意义。方法选择NICU收治的126例早产儿,根据有无机械通分为机械通气组和非机械通气组(对照组)。其中机械通气组的81例按是否发生VAP分为VAP组和非VAP组。回顾性分析机械通气组在机械通气前及48h后血清PCT、WBC、CRP的检测结果,并与同期对照组上述指标进行对照比较。结果机械通气前VAP组、非VAP组及对照组的PCT、WBC、CRP之间差异无统计学意义(P0.05)。机械通气48h后,三组间WBC计数比较差异无统计学差异(P0.05);而PCT、CRP三组间不全相等,VAP组高于非VAP组和对照组,差异有统计学意义(P均0.000),非VAP组与对照组差异无统计学意义(P0.05)。PCT和CRP诊断早产儿呼吸机相关性肺炎的ROC、AUC分别为0.936和0.702,差异有统计学意义(P=0.000)。结论 PCT对新生儿VAP早期诊断的准确性高于CRP、WBC。     

贵阳郊区汉、苗、布依族乳母营养状况及乳中营养素含量的调查

将贵阳郊区１９５名乳母分为孕期营养指导组（５８）、汉族组（４３）、布依族组（４４）、苗族组（５０）四组，进行产后７天、４２～５６天、３月、６月的膳食调查及乳中蛋白质、脂肪和乳糖含量测定，结果表明：四组乳母能量摄入量比较适宜，但随着哺乳期的延长，蛋白质、脂肪、视黄醇当量摄入量逐渐减少，碳水化物、抗坏血酸摄入量逐渐增加。硫胺素、烟酸仅达到ＲＤＡ的７０％左右。铁摄入量均达到或超过ＲＤＡ。钙、核黄素在整个哺乳期仅占ＲＤＡ的２２％～６６％和３８％～５７％。乳汁成分为：随着哺乳期延长，乳汁中蛋白质含量逐渐降低，脂肪、乳糖在整个哺乳期较稳定。四组乳汁中各营养素含量经方差分析无显著性差异（Ｐ＞０．０５）。     

隔代抚养对婴幼儿体格及神经心理发育的影响

目的探讨隔代抚养对婴幼儿体格及神经心理发育的影响,为提高婴幼儿隔代抚养质量提出合理化建议。方法分析比较136例隔代抚养儿及与其1:1配对的父母抚养儿在12月龄和24月龄的体格生长指标及"0~6岁儿童神经心理发育量表"数据。结果两组婴幼儿的体重、身长、头围指标差异均无统计学意义(P0.05);12月龄时,隔代抚养组语言能区评分低于父母抚养组,差异具有统计学意义(P0.05);24月龄时,隔代抚养组在大运动、精细动作、适应能力、语言及社交行为等能区均落后于父母抚养组(P0.05)。结论隔代抚养方式不利于婴幼儿神经心理行为的发育,祖辈和父母要加强沟通交流,优势互补,共同促进儿童健康成长。     

Determination of macronutrients,by chemical analysis,of home-prepared milk feeding bottles and their contribution to the energy and protein requirements of infants from high and low socioeconomic classes

OBJECTIVES: To determine the macronutrients composition of home-prepared milk feeding bottles, by chemical analysis, and assess their contribution to the energy and protein requirements of children under two years of age from high (HSE) and low (LSE) socioeconomic classes. METHODS: 72 samples were analyzed for energy density and protein, fat and carbohydrate content: 41 from the LSE group and 31 from the HSE group. The assessment of the percentages of the energy and protein requirements met by the consumption of the milk bottles was calculated as follows: the energy and protein per 100 mL obtained through chemical analysis were multiplied by the volume consumed at each feeding, then by the number of feedings per day, the results divided by the energy and protein requirements and multiplied by 100. Energy and protein requirements were those recommended by the FAO/WHO/UNU Committee and the Food and Nutrition Board. The children's weight-for-age index was assessed. RESULTS: Unmodified cow's milk was largely consumed by both groups. The addition of sugar and other ingredients to the milk was significantly higher in the LSE group. Moisture, protein and fat content were lower in the LSE group, whereas carbohydrate and energy content were higher. The percentages of energy and protein requirements provided by feeding bottles were higher in the LSE group. Children in the LSE group had lower z-scores for weight-for-age. CONCLUSIONS: Differences in the preparation practices led to differences in the chemical results. The feeding bottles in the LSE group were high in energy, due to the addition of sugar and cereals to the milk in the bottle. The milk feeding bottles were an important weaning food providing more than 50% and 100% of the children's energy and protein requirements, respectively. The children's weight-for-age index was within the normal limits.     

代乳品的研究——Ⅶ 豆制代乳品在婴儿体内的消化和热能代谢

<正> 有些人反映婴儿食用豆制代乳粉容易排稀粪(拉稀)是这种食物不容易被消化而引起的。实际情况是否如此,是需要弄清楚的问题。 在以前,我们用自制的5410代乳糕试喂约一百名婴儿时,家长们按照医师指导的方法喂食,没有反映婴儿在长期食用中发生拉稀的现象。在为期一年的时间内,我们没有亲自观察婴儿的粪便,只是根据家长们的反映作出结论,并相信它是可靠的。在用九名婴儿进行的     

Determination of Macronutrients,by Chemical Analysis,of Home-Prepared Milk Feeding Bottles and their Contribution to the Energy and Protein Requirements of Infants from High and Low Socioeconomic Classes

Objectives: To determine the macronutrients composition of home-prepared milk feeding bottles, by chemical analysis, and assess their contribution to the energy and protein requirements of children under two years of age from high (HSE) and low (LSE) socioeconomic classes.

Methods: 72 samples were analyzed for energy density and protein, fat and carbohydrate content: 41 from the LSE group and 31 from the HSE group. The assessment of the percentages of the energy and protein requirements met by the consumption of the milk bottles was calculated as follows: the energy and protein per 100 mL obtained through chemical analysis were multiplied by the volume consumed at each feeding, then by the number of feedings per day, the results divided by the energy and protein requirements and multiplied by 100. Energy and protein requirements were those recommended by the FAO/WHO/UNU Committee and the Food and Nutrition Board. The children’s weight-for-age index was assessed.

Results: Unmodified cow’s milk was largely consumed by both groups. The addition of sugar and other ingredients to the milk was significantly higher in the LSE group. Moisture, protein and fat content were lower in the LSE group, whereas carbohydrate and energy content were higher. The percentages of energy and protein requirements provided by feeding bottles were higher in the LSE group. Children in the LSE group had lower z-scores for weight-for-age.

Conclusions: Differences in the preparation practices led to differences in the chemical results. The feeding bottles in the LSE group were high in energy, due to the addition of sugar and cereals to the milk in the bottle. The milk feeding bottles were an important weaning food providing more than 50% and 100% of the children’s energy and protein requirements, respectively. The children’s weight-for-age index was within the normal limits.     

Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child

Breastfeeding is a gold standard of feeding of newborns and infants. Tandem breastfeeding (TBF) is feeding two children of different ages at the same time. The knowledge about the composition of human milk in prolonged lactation is still scarce. Milk from tandem breastfeeding women and after weaning was examined. Milk samples were collected from 13 TBF mothers. A 24-h milk collection was done. Analyses of fat, protein, carbohydrate and energy content were performed using MIRIS. Sociodemographic characteristics of TBF mothers was done. Higher fat content, energy value and total protein concentration was found in TBFM milk during tandem breastfeeding, than in milk after weaning the older child. The carbohydrate content remained stable. The composition of breastmilk, in terms of macronutrients, changes after weaning, taking into account the nutritional requirements of the younger child. The milk of nursing mothers in tandem did not show diurnal variability in individual components. These findings suggest an adaptive role of human milk to nutrient requirements of newborn and older children. The results may support the promotion of long breastfeeding, including tandem breastfeeding.     

兰州市城区102例乳母膳食营养状况及其与乳汁成分关系

目的 了解兰州市城区乳母膳食营养状况及其与乳汁成分的关系。方法 招募102位乳母,通过问卷调查其基本情况和膳食状况,计算膳食营养素摄入量,采集血液样本检测血红蛋白和微量元素水平,采集母乳分析体质指数及宏量营养素摄入和乳汁成分的关系。结果 乳母能量摄入量中位数为1 507.5（1 245.5,1 954.5）kcal,能量和宏量营养素及多种微量营养素摄入量均不足,蛋白质、脂肪和碳水化合物供能比分别为13.72%、25.67%、60.90%;乳汁中脂肪、总蛋白质、糖类、干物质、能量的含量分别为（4.33±1.23）g/100 mL、（1.23±0.24）g/100 mL、（7.07±0.32）g/100 mL、（12.82±1.13）g/100 mL、（73.70±10.93）kcal/100 mL。不同BMI分组乳母乳汁中脂肪、干物质以及能量含量不同（均P<0.05）,超重/肥胖组乳母乳汁中能量、脂肪以及干物质含量高。乳汁成分和乳母膳食宏量营养素之间未发现相关性（均P>0.05）。乳母血红蛋白平均含量为（137.23±1.10）g/L,7例（7.53%）贫血,乳母缺乏的微量元素主要为镁（24.73%）和铁（7.53%）。结论 需要加强对乳母的营养宣教,鼓励其合理膳食,定期检测血红蛋白浓度,及时发现健康问题并改善。     

北京市城乡乳母的营养状况、乳成分、乳量及婴儿生长发育关系的研究 Ⅰ.乳母营养状况、乳量及乳中营养素含量的调查

对北京市189名乳母(城区80,近郊58,远郊64名)进行了膳食调查及24小时泌乳量、乳中蛋白质、脂肪和乳糖含量的测定。结果表明,这三个地区的乳母的热能及蛋白质的摄取量是适宜的。城区乳母的脂肪摄取量高于远近郊区。铁、硫胺素和尼克酸的摄取量均高于我国的RDA(推荐膳食供给量)。维生素A的摄取量占RDA的46～88％。钙的摄取量很低,仅占RDA的23～42％。城区、近郊及远郊区乳母产后6个月泌乳量每天分别为689±149,784±156及778±163g。三个地区的母乳中蛋白质含量平均皆为1.2g/100g,但脂肪含量不同,分別为3.8±0.14、3.3±0.20和3.1±0.16g/100g,城区母乳中脂肪含量显著高于远近郊区。三个地区母乳中乳糖含量无明显差別,为7.8±0.6,7.5±0.9及8.1±0.7/g100g。北京市三个地区乳母的热能及蛋白质的摄取量是适宜的。泌乳量,乳中蛋白质及乳糖含量三个地区亦无明显差別。     

Do Maternal Factors and Milk Expression Patterns Affect the Composition of Donor Human Milk?

A primary role of Human Milk Banks (HMBs) is to provide human milk (HM) for preterm infants and to support the mothers of these infants as they establish their own milk supply. A better understanding of the variation in the energy and macronutrients contents of donor human milk (DHM) potentiates targeted nutrition for preterm babies. Therefore, the aim of this study was to assess the variability of energy and macronutrients content in DHM and to investigate the impact of maternal factors and feeding practices on the nutritional value of DHM. The study involved 49 donors registered in the HMB in the Holy Family Hospital in Warsaw, Poland. Samples from each donor were pooled within a maximum of two weeks. The composition of DHM, including energy content, protein, fat, and carbohydrate concentrations, was analyzed using the Miris Human Milk Analyzer. The analyses were performed before the pasteurization process. The mean time of milk donation to HMB was 13.2 ± 6.0 weeks. There were no significant differences in energy and macronutrients contents of DHM in the beginning and at the end of milk donation to HMB, however, HM fat concentration was positively correlated with afternoon feedings (r = 0.289, p = 0.044). The method of feeding (breastfeeding vs. feeding only expressed milk) also did not impact the nutritional value of DHM. Future research for the DHM should include a further cross-sectional observational study with the collection of detailed donor information and characteristics of milk expression and feeding practices to further evaluate the pooling processes and the effect on DHM composition.