重庆地区4~12月龄体重增加不足婴儿能量摄入状况的研究

目的 以体重增加为标准，探讨体重增加不足与能量摄入的相关性。方法 2004年11月至2005年12月在重庆医科大学儿童医院儿童保健门诊进行健康体格检查的婴儿，年龄4～12个月，由2名儿童保健专业人员负责体格测量。体格评价以美国疾病预防与控制中心的标准为参数。以两次体检体重/年龄Z值之差（⊿WAZ）将研究对象分为体重增加不足组和体重增加正常组，同时两组按月龄分为4~5月龄、~8月龄和 ~12月龄3个亚组。以食物称重与食物记录法计算每日食物摄入情况。结果 研究期间共纳入202名婴儿，体重增加不足组70名（-2<⊿WAZ<- 0.67），体重增加正常组132名（-0.67≤⊿WAZ≤0.67）。①体重增加不足组体格发育水平在正常生长范围内，但略低于体重增加正常组。②体重增加不足组除乳类摄入量较体重增加正常组低外（P<0.05），其他食物摄入量接近于体重增加正常组（P>0.05），蛋白质摄入量达WHO和中国营养协会推荐摄入量；体重增加不足组中4~5月龄、~8月龄和~12月龄亚组能量摄入分别为322 kJ·kg-1·d-1（77 kcal· kg-1·d-1）、322 kJ·kg-1·d-1（77 kcal· kg-1·d-1）和310 kJ·kg-1·d-1（74 kcal· kg-1·d-1)，显著低于体重增加正常各月龄亚组的351 kJ·kg-1·d-1（84 kcal· kg-1·d-1）, 343 kJ·kg-1·d-1（82 kcal·kg-1·d-1）和360 kJ·kg-1·d-1（86 kcal·kg-1·d-1）（P<0.05），其中~12月龄亚组摄入食物总能量中谷类食物产能较低（P<0.05）；体重增加不足与体重增加正常各月龄亚组摄入食物的能量密度相近（P>0.05）。③Logistic 分析显示婴儿体重增加不足的风险因素（OR=3.947）是能量摄入不足，母亲文化程度高是婴儿体重增加正常的保护因素（OR=0.437）。结论 ①排除相关干扰因素，能量摄入不足造成婴儿体重增加不足的主要原因是乳类摄入量；②一定能量密度范围内，食物摄入量是影响能量摄入的主要因素。     

新生儿肠外营养相关胆汁淤积因素612例分析

目的为提高危重新生儿肠外营养支持的安全性和有效性提供依据。方法对1985．4—2005．3行5d以上静脉营养支持的612例住院新生儿资料进行分析。612例分为甲组（1985．4—1995．3）和乙组（1995．4—2005．3）。其中甲组70例再分为肠外营养相关胆汁淤积组（PNAC组）6例和非PNAC组64例,乙组542例也分为PNAC组12例和非PNAC组530例。比较甲乙两组新生儿PNAC发生率及相关因素。结果接受5d以上静脉营养支持的新生儿PNAC总发生率为2．94％,甲组PNAC发生率为8．57％,乙组发生率为2．21％,后10年PNAC发病率有明显下降（OR值为0．242,95％CI为0．088～0．666）。PNAC组的胎龄、出生体重均小于非PNAC组（其中胎龄33±5周比（36±4）周,P=0．009;OR值为0．827,95％CI为0．698～0．980。出生体重2003g±743g比2393g±764g,P=0．045;OR值为1．001,95％CI为0．999～1．002）,而平均PN持续时间、热卡摄入量均大于非PNAC组（其中PN持续时间32d±30d比13d±10d,P=0．000;OR值为1．072,95％c,为1．032～1．112。PN摄入量（272±46）kJ／（kg·d）[（65．0±10．9kcal／（kg·d）,（1kcal=4．184kJ）]比（232±55）kJ／（kg·d）[（55．5±13．1）kcal／（kg·d）],P=0．002;OR值为1．066,95％CI为1．012～1．122）。非PNAC组体重增加与PNAC组相比有增加趋势[（20±27）g／d比（9±19）g／d,P=0．175]。结论PNAC发生与早产、低出生体重、PN持续时间超过2周、PN提供的热卡量过高有关。     

膳食多样化与婴儿微量营养素摄入及其体格生长的相关性

目的 验证简易的膳食多样化分数(DDS)和食物种类多样化分数(FVS)对评估婴儿膳食质量的有效性.方法 选取足月、单胎、12月龄健康婴儿,针对父母及照料者调查婴儿喂养情况.调查当日测量获得婴儿体格牛长数据.按照婴儿1个月内各类食物摄入频度和种类计算DDS;按照婴儿1周内摄入食物种类计算FVS.详细定量记录婴儿连续3 d的膳食,并运用膳食分析软件计算各种营养素摄入量.结果 共236例12月龄婴儿进入分析.婴儿体格牛长良好,平均按年龄身长、按年龄体质量、按身长体质量的Z评分(LAZ、WAZ、WLZ)分别达到0.44±0.88、0.78±0.81、0.79±0.83.婴儿热能、蛋白质及绝大多数微量营养素的营养素适宜比例(NAR),即膳食摄入量与WHO推荐摄入量的比值,均超过100%.DDS、FVS、DDS+FVS高分组婴儿的LAZ、WAZ、WLZ均高于相应的低分组婴儿,但差异均无统计学意义.DDS和FVS分别与多种微屠营养素的NAR(%)呈显著正相关,DDS+FVS则与更多的微量营养素的NAR(%)呈显著正相关.婴儿体格生长指标与多项微量营养素的NAR(%)呈显著正相关.结论 简易的DDS、FVS评分可用于评价婴儿的膳食质量,DDS+FVS可能更有效.增加食物多样性有利于婴儿获得全面平衡的营养,促进其生长.     

婴儿喂养顺应WHO婴儿喂养指南的横断面调查分析

目的 分析顺应WHO婴儿喂养指南（2002）与婴儿体格生长的关系。方法2008年6月至2009年5月在重庆医科大学附属儿童医院儿保门诊非随机选取体检的2～12月龄健康婴儿及其主要抚养人进行调查,采用横断面问卷调查方式,获得婴儿社会人口学资料、乳类和其他食物喂养状况资料。采用标准人体测量秤和婴儿量床测量婴儿体重和卧位身长,以2005年WHO儿童生长标准计算身长别体重Z评分（WLZ）、年龄别身长Z评分（LAZ）和年龄别体重Z评分（WAZ）等体格生长指标。分别计算各月龄组婴儿纯母乳喂养、部分母乳喂养和配方奶喂养比例,比较婴儿体格生长指标与2005年WHO儿童生长标准平均水平的差异。结果 共调查1 030名婴儿,978名有效数据进入分析。出生时对WHO婴儿喂养指南（2002）顺应性较好,母乳喂养876/975名（89.8%）,其中纯母乳喂养405/975名（41.5%）,部分母乳喂养471/975名（48.3%)。3、4、5和6月龄组母乳喂养分别为25/45名(55.6%)、53/124名(42.7%)、114/233名(48.9%)和100/283名（35.3%）,其中纯母乳喂养分别为15/45名(33.3%)、27/124名(21.8%)、26/233名(11.2%)及15/283名(5.3%),未达到WHO婴儿喂养指南（2002）纯母乳喂养至6月龄的建议。食物转换阶段,仅120/978名（12.3%）婴儿顺应WHO婴儿喂养指南（2002）,在6月龄及以后引入其他食物;645/978名（66.0%）婴儿在4～5月龄引入,86/978名（8.8%）婴儿在4月龄前引入。首次引入的其他食物对WHO婴儿喂养指南（2002）的顺应性较好,537/820名（65.5%）婴儿最早引入强化铁的谷类食物,其次是蛋类（141/820名,17.2%）、蔬菜水果类（76/820名,9.3%）、家制米粉（61/820名,7.4%）和禽肉鱼类（5/820名,0.6%）。不同时间引入其他食物的各月龄组婴儿WLZ、WAZ均达到或超过WHO儿童生长标准的平均水平。4～6月龄不同喂养方式婴儿的WLZ均超过WHO儿童生长标准的平均水平(P<0.05),不同喂养方式间WLZ、LAZ和WAZ差异无统计学意义（P>0.05）。结论 本研究所调查的儿保门诊婴儿对WHO婴儿喂养指南（2002）的顺应性较低,纯母乳喂养比例较低,配方奶喂养比例较高,大部分婴儿引入其他食物的时间早于WHO婴儿喂养指南（2002）的建议。首次引入食物对WHO婴儿喂养指南（2002）顺应性较高,食物转换期不同喂养方式未对本调查人群婴儿的体格生长造成不利影响。     

不发达地区农村6至8月龄婴幼儿喂养指数的横断面调查与其生长发育的相关性研究

目的建立综合婴儿母乳喂养、辅助食品添加次数、辅助食品质地以及膳食多样化评分多个变量的婴幼儿喂养指数（ICFI）,分析不发达地区农村6～8月龄婴儿ICFI与体格生长指标之间的相关性,以证实ICFI应用于定量评估和比较婴幼儿喂养习惯的有效性。方法调查云南省文山州西畴县于2007年2～6月出生的农村户籍足月单胎健康婴儿。以WHO儿童生长标准计算婴儿年龄别身长的Z评分（LAZ）、年龄别体重的Z评分（WAZ）和身长别体重的Z评分（WLZ）等体格生长指标。采用横断面问卷调查方法,获得婴儿母乳喂养和辅助食品添加等喂养资料。选择其中6～8月龄婴儿的数据,以婴儿母乳喂养、辅助食品添加次数、辅助食品质地和膳食多样化评分计算6～8月龄婴儿的ICFI。分析组成ICFI各变量在6～8月龄婴儿间的变化及其与婴儿体格生长指标的相关性。 结果共调查6～8月龄婴儿462名,其中女性204名（44.2%）,男性258名（55.8%）;6月龄153名,7月龄166名,8月龄143名。ICFI与LAZ呈显著正相关（P=0.009）,ICFI≥8分婴儿的LAZ和WAZ均显著高于ICFI≤5分的婴儿（P分别为0.013和0.037）。辅助食品质地与LAZ和WAZ呈显著正相关（P分别为0.001和0.002）;膳食多样化评分与LAZ、WAZ和WLZ无显著相关性。结论ICFI可用于定量评估和比较不发达地区农村婴儿的喂养习惯。     

液体摄入量对早产儿死亡率与并发症发生率的影响

目的系统评价早产儿及低出生体重儿应用不同补液量的疗效及安全性,为临床早产儿合理补液提供依据。方法以生后早期补液量为干预措施,早产儿／低出生体重儿为纳入对象,按Cochrane系统评价方法,评价纳入研究的方法学质量并提取有效数据进行Meta分析。结果共纳入3个随机对照研究,纳入总病例数438例。生后1周时补液量〉150ml／（kg·d）的亚组患儿,动脉导管重新开放率、新生儿坏死性小肠炎发病率显著高于对照组（OR：2．86,95％CI：1．25～6．51;OR：8．32,95％CI：1．56～44．52）,与生后1周时补液量在130～150ml／（kg·d）的亚组分析结果显示差异无统计学意义。高补液量组最大体重下降百分比显著低于对照组（WMD=-2．54,95％CI：-3．95—-1．19）;两组死亡率、支气管肺发育不良发病率、颅内出血发病率差异无统计学意义。结论过高补液总量摄入1〉150ml／（kg·d）]给临床转归带来不利影响,而生后1周时130～150ml／（kg·d）的补液量是安全的。     

早期应用甲基强的松龙治疗儿童川崎病36例临床观察

目的探讨川崎病（KD）患儿初期治疗中应用甲基强的松龙的疗效。方法研究对象为2000年3月-2006年3月收治的74例KD患儿。随机分成两组，对照组（38例）单用静脉丙种球蛋白[1g／（kg·d），连用2天]；治疗组（36例）在对照组的基础上加用甲基强的松龙[20～30mg／（kg·d），连用3天]。结果治疗组和对照组在体温、CRP、ESR、PLT恢复正常时间方面差异有统计学意义（P〈0．05）。病程14～21天时发生CAD例数：治疗组3例（8％），对照组11例（29％），两组比较，差异有统计学意义（P〈0．05）。结论川崎病（KD）患儿初期治疗中应用甲基强的松龙能明显缩短病程，安全有效地降低冠状动脉病变发生。     

双黄连治疗疱疹性咽峡炎疗效观察

目的探讨双黄连粉针剂治疗疱疹性咽峡炎的疗效。方法将80例患儿分为对照组和治疗组，对照组采用利巴韦林10mg／（kg·d）静滴；治疗组采用双黄连60mg／（kg·d）加5％葡萄糖液（稀释成0．6mg/m1）中静滴，各每日1次，均连用5-7天。合并细菌感染均加用青霉素10-15万u／kg静脉滴注。结果对照组与治疗组的退热平均天数及住院天数指标比较均有统计学意义（P〈0．01）。结论双黄连治疗疱疹性咽峡炎疗效显著。     

氧化应激在新生大鼠常压高体积分数氧致脑损伤发生中的作用

目的探讨氧化应激在7日龄新生大鼠高体积分数氧（高氧）性脑损伤发生中的作用。方法体质量12～18g的7日龄SD大鼠42只，随机分为空气组和高氧组。高氧组与其乳母一起置于氧箱中，调节氧流量（3L／min），使箱内氧体积分数维持（800&#177;50）mL／L，用数字式测氧仪进行监测。空气组置于同一室内空气中，氧体积分数为210mL／L，饲养条件与高氧组相同。高氧／空气开始暴露30min后，各取3只大鼠，麻醉后采血，行动脉血气分析。高氧／空气暴露12h后2组大鼠各处死8只，化学比色法检测其脑组织还原型谷胱甘肽（GSH）、氧化型谷胱甘肽（GSSG）、GSSG／GSH、超氧化物歧化酶（SOD）、丙二醛（MDA）水平。高氧／空气暴露12h后2组各处死10只大鼠，取其脑组织常规脱水、包埋、切片（经海马），脱氧核糖核苷酸末端转移酶介导的原位缺口末端标记法观察脑组织细胞凋亡指数。结果空气组平均动脉血氧分压[pa（O2）]为（87．0&#177;2．71）mmHg（1mmHg=0．133kPa），高氧组为（219．0&#177;10．7）mmHg，高氧组明显高于空气组[（87．0&#177;2．71）mmHg]（P〈0．05）。高氧组暴露12h脑细胞凋亡指数[（39．20&#177;7．59）％]较空气组[（4．50&#177;1．87）％]显著增加（P〈0．01）。高氧暴露12h组GSH[（0．994&#177;0．230）μmol／g]较空气组[（1．210&#177;0．210）μmoL／g]明显下降（P〈0．05），高氧组暴露12h SOD[（124．60&#177;4．14）&#215;10^3 U／g]也较空气组[（145．0&#177;6．62）&#215;10^3 U／g]明显下降（P〈0．01）；高氧组GSSG[（0．0283&#177;0．0043）μmol／g]、GSSG／GSH（0．0296&#177;0．0045）、MDA[（5．21&#177;0．41）μmol／g]均较空气组[（0．0212&#177;0．0029）μmol／g，0．0181&#177;0．0031，（4．85&#177;0．25）μmol／g]显著升高（Pa〈0．05）。结论常压高氧可引起新生大鼠脑细胞的凋亡及氧化应激，氧化应激与高氧性脑损伤密切相关。     

早期蛋白质和能量摄入对早产儿生长影响的研究

目的：探讨出生后早期蛋白质和能量摄入对早产儿早期生长速率的影响。方法：采用回顾性研究的方法,收集出生体重小于1800 g并治愈出院的164例早产儿的临床资料,记录早产儿一般情况、肠内外营养支持及体格增长情况。按氨基酸应用起始日的不同分为24 h内应用氨基酸组（EAA组,n=112）和24 h后应用氨基酸组（LAA组,n=52）,比较两组早产儿在住院期间的蛋白质和能量摄入、蛋白/能量比及体格增长速率,并对两组早产儿的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：EAA组的早产儿体重下降幅度比LAA组低（6.3% vs 8.8%）,恢复至出生体重时间比LAA组早（7 d vs 9 d）;每周头围增长速率比 LAA组快（0.79±0.25 cm vs 0.55±0.25 cm）;每日平均体重增长速率比LAA组快（20±3 g/kg vs 17±3 g/kg)。相关分析表明,早产儿第3天及第7天的蛋白质和能量摄入及蛋白/能量比与住院期间平均体重增长速率均呈正相关。恢复出生体重后每周的蛋白质和能量摄入与每周体重增长速率呈多元线性相关（r=0.709,P<0.01）。早产儿第3天及第7天的蛋白质摄入与早产儿头围增长速率及身长增长速率呈正相关。结论：早期应用氨基酸能够降低早产儿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。在适宜能量摄入相对固定的情况下,在一定范围内提高蛋白质摄入量能够增加早产儿的体重、头围及身长的增长速率。     

Growth of very low birth weight infants on varying amounts of human milk protein

In a double-blind, randomized study, 28 healthy, growing very low birth wt, appropriate-for-gestational-age infants were fed human milk, preferably mother's own, fortified daily with human milk protein and/or human milk fat. The infants entered the study when they were stable on complete enteral intakes of 170 mL/kg/d (mean age = 19 d). The study lasted for a mean of 4 wk. Samples from all the milks were collected daily, and intakes of protein, fat, carbohydrates, energy, and electrolytes were calculated weekly during the whole study period. Protein intakes ranged from 1.7 to 3.9 g/kg/d, and energy intakes from 100 to 150 kcal/kg/d. Wt and length gain in the nonprotein-enriched groups were 15.6 +/- 2.7 g/kg/d (mean +/- SD) and 0.88 +/- 0.17 cm/wk; the corresponding figures for the protein-enriched groups were 20.2 +/- 2.1 g/kg/d and 1.24 +/- 0.14 cm/wk. There was a strong correlation between protein intake and growth in wt and length up to an intake of about 3 g/kg/d; more protein did not result in increased growth. The same was true for energy intake, with a maximal growth rate at an intake of about 120 kcal/kg/d. A protein intake of more than 3 g/kg/d resulted in a growth rate equal to or higher than the estimated intrauterine growth rate. Some infants fed mature banked human milk alone had a poor growth. Sodium intake was low, ranging from 1.5 to 2.6 mmol/kg/d. No correlation was found between sodium intake and growth rates.     

Protein and energy intake during weaning: I. Effects on growth

The growth and food consumption of 30 healthy infants from 4 to 6 months of age have been measured. Two groups were assigned randomly to either a formula with 1.9 g of protein and 72 kcal per 100 ml (F1) or 2.7 g of protein and 69 kcal per 100 ml (F2). A third group of infants were fed breast milk (0.96 g of protein and 65 kcal per 100 ml (HM)). All infants received supplementary food according to the same regimen and were fed ad libitum. The mean protein intake was 1.3, 2.6 and 3.6 g/kg/day in the HM-, F1- and F2-groups respectively. The corresponding mean energy intake was 80, 101 and 94 kcal/kg/day. The formula-fed infants had significantly higher protein and energy intakes when compared to the breast-fed group. No significant differences were found in the rate of growth of crown-heel length, head circumference or in weight gain. The differences in protein intake between the breast- and formula-fed infants without differences in growth indicate that the formulas may provide a protein intake in excess to the needs.     

Nutrient intakes of formula-fed infants and infants fed cow's milk

Twenty-four-hour dietary intake data from the second National Health and Nutrition Examination Survey (NHANES II), 1976-1980, were analyzed to compare nutrient intakes among infants 7 to 12 months of age who were fed mixed diets containing solid foods and either infant formula or cow's milk. Solid foods fed to the infants in both groups were low in iron and linoleic acid, and high in sodium, potassium, and protein, relative to Recommended Dietary Allowances. Infants who were fed cow's milk received lower median intakes of iron (7.8 mg v 14.9 mg), linoleic acid (1.8 g v 6.1 g), and vitamin C (39 mg v 64 mg), and higher median intakes of protein (41 g v 25 g), sodium (1,000 mg v 580 mg), and potassium (1,630 mg v 1,020 mg) than formula-fed infants. Seventy-five percent of the infants fed cow's milk had iron intakes below the Recommended Dietary Allowance; 69% had sodium intakes above the range of estimated safe and adequate daily dietary intake. Linoleic acid provided less than 3% of energy intake for 74% of the infants fed cow's milk. Differences in nutrient intakes were due not only to different concentrations of nutrients in each of the milk feedings but also to the different amounts and types of solid foods fed to the two groups of infants.     

Effects of quality of energy intake on growth and metabolic response of enterally fed low-birth-weight infants

Carbohydrate and fat may vary in their ability to support protein accretion and growth. If so, variations in the source of nonprotein energy might be used to therapeutic advantage in enterally fed low-birth-weight infants. To test the hypothesis that high-carbohydrate diets are more effective than isocaloric high-fat diets in promoting growth and protein accretion, low-birth-weight infants weighing 750-1600 g at birth were randomized in a double blind study to receive one of five formulas differing only in the quantity and quality of nonprotein energy. Groups 1, 2, and control received 130 kcal x kg(-1) x d(-1) with 35, 65, and 50% of the nonprotein energy as carbohydrate. Groups 3 and 4 received energy intake of 155 kcal x kg(-1) x d(-1) with 35 and 65% of the nonprotein energy as carbohydrate. Protein intake of all groups was 4 g x kg(-1) x d(-1). Growth and metabolic responses were followed weekly, and macronutrient balances including 6-h indirect calorimetry were performed biweekly. Greater rates of weight gain and nitrogen retention were observed at high-carbohydrate intake compared with high-fat intake at both gross energy intakes. Greater rates of energy storage and an increase in skinfold thickness were observed in group 4 (high-energy high-carbohydrate diet) despite higher rates of energy expenditure. These data support the hypothesis that at isocaloric intakes, carbohydrate is more effective than fat in enhancing growth and protein accretion in enterally fed low-birth-weight infants. However, a diet with high-energy and high-carbohydrate content also results in increased fat deposition.     

Lactational capacity of marginally nourished mothers: infants' milk nutrient consumption and patterns of growth

The consumption of human milk by 58 Bangladeshi infants of marginally nourished mothers was measured during longitudinal studies. Daily milk consumption, as estimated by test weighing, and intakes of energy and protein, as calculated from the measured concentrations of macronutrients in the milk, were related to infant body weight, to internationally recommended intakes of these nutrients, and to the infants' patterns of physical growth. Each of the milk variables, when related to infant body weight, declined significantly with increasing (log) infant age (P less than .001). The average consumption of energy and protein was less than current recommendations at all ages. Nevertheless, the average growth of the Bangladeshi infants approximated the fifth centile of the US National Center for Health Statistics during the first 4 months of life. By the fourth month, however, the weight increments of more than half the infants (79%) were less than the reference data. The intakes of energy and protein by individual infants less than 90 days of age were related to their patterns of growth. There were significant positive relationships between the change in Z score weight-for-age and weight-for-length and the consumption of breast milk energy (kilocalories per kilogram of body weight per day) and protein (grams per kilogram per day). Consumptions of 86.5 kcal/kg/d and protein 1.48 g/kg/d were associated with a nonchanging Z score weight-for-age. Thus, intake of these amounts of nutrients permitted weight gain comparable to the reference population but did not permit recovery from the existing relative weight deficits.     

Energy expenditure, energy balance, and composition of weight gain in low birth weight infants fed diets of different protein and energy content

The effect of energy and protein intakes on energy expenditure, energy balance, and amount and relative rate of both protein and fat deposition in new tissue was investigated in 19 low birth weight infants whose mean protein and energy intakes, respectively, were 2.24 g/kg/d and 113 kcal/kg/d (formula A, n = 8), 3.6 g/kg/d and 115 kcal/kg/d (formula B, n = 5), and 3.5 g/kg/d and 149 kcal/kg/d (formula C, n = 6). The higher energy intake (formula C) but not the higher protein intake (formula B) resulted in greater energy expenditure. Both the higher protein (formula B vs formula A) and higher energy intakes (formula C vs formula B) resulted in greater weight gain secondary, in group B, to a greater absolute rate of protein deposition and, in group C, to a greater absolute rate of fat deposition. The relative composition of the new tissue deposited reflected the proportional intakes of protein and energy. The numerical value of the protein/fat ratio (g/g) of the new tissue deposited by infants fed formulas A and C, the protein contents of which were low relative to energy contents, were similar and significantly lower than the numerical value of the protein/fat ratio of the new tissue deposited by infants fed formula B, which had a higher protein content relative to energy content. These findings suggest that the composition of weight gain is related to both the absolute amounts and the proportions of dietary protein and energy; thus, both must be considered in formulation of nutritional regimens for LBW infants.     

Milk protein quality in low birth weight infants: effects of protein-fortified human milk and formulas with three different whey-to-casein ratios on growth and plasma amino acid profiles.

Growth rates (weight, length, and head circumference) and selected biochemical indexes of protein metabolism (serum urea, acid-base status, and plasma amino acid concentrations) were determined in low birth weight (LBW) infants appropriate for gestational age (birth weight less than 1,650 g) fed three formulas differing only in the whey-to-casein ratios: 60/40, 50/50, and 35/65. A group of infants fed exclusively human milk protein (HMP)-fortified human milk was used as a control. All diets provided similar daily protein and energy intakes, which were 3.5 g/kg and 122 kcal/kg in the human milk-fed infants and 3.3 g/kg and 121 kcal/kg in the formula-fed infants. Neither weight gain nor rate of growth in length and head circumference differed between the feeding groups and reached intrauterine or better rates in all groups. Values for serum urea and acid-base status were normal and also did not differ among the groups. At the end of the study, plasma threonine concentrations were significantly higher in all formula-fed infants than in the infants fed human milk. The highest plasma threonine concentration was found in the infants receiving the whey-predominant formula. Plasma concentrations of valine, methionine, and phenylalanine were also significantly higher in all formula-fed groups when compared with the human milk group. Plasma total essential amino acid concentrations were also significantly higher in the formula-fed infants than in the human milk fed. The results show that protein quality does not affect growth rate or biochemical indexes of metabolic tolerance in LBW infants fed adequate protein and energy intakes.(ABSTRACT TRUNCATED AT 250 WORDS)     

影响极低出生体重儿体重增长的多因素分析

目的探讨影响极低出生体重儿(VLBW)体重增长的相关因素。方法对1998年7月—2004年3月重庆医科大学儿童医院新生儿病房收治的51例VLBW进行回顾性分析。结果单因素分析发现,早开奶、热卡摄入量和蛋白质摄入量对体重增长有显著性影响(P<0·05)。多元逐步回归分析结果示,热卡摄入量和蛋白质摄入量是影响体重增长的显著因素,回归方程为Y(体重增长)=-6·426+0·120X1(热卡摄入量)+3·737X2(蛋白质摄入量)(P<0·01)。达到体重增长目标对象中单纯胃肠内营养组和部分胃肠外营养组热卡摄入量分别为(520·62±21·59)kJ/(kg·d)[(124·43±5·16)kcal/(kg·d)]、(451·49±68·41)kJ/(kg·d)[(107·98±16·35)kcal/(kg·d)],差异有统计学意义(P<0·05)。早开奶组出生体重恢复时间、住院时间和胃肠外营养液体量占总液量比例>75%时间平均秩分别为18·58、20·24、20·11,晚开奶组分别为33·00、32·48、31·83,差异有统计学意义(P<0·05)。结论VLBW在生后应保证足量热卡和蛋白质的供给,对于小于胎龄儿和有严重并发症的患儿更应该加强营养的补充,对VLBW应尽早喂养,同时需要胃肠外营养作为肠内营养的补充。     

Whey predominant,whey modified infant formula with protein/energy ratio of 1.8 g/100 kcal: adequate and safe for term infants from birth to four months

BACKGROUND: Protein quality of breast milk is superior to that of formula proteins. To ensure that the protein intake is sufficient, starter formulas with conventional protein composition provide a protein/energy ratio of 2.2-2.5 g per 100 kcal to infants, which is much higher than that supplied with breast milk. Several studies have shown that formula-fed infants have higher plasma or serum urea concentrations than breast-fed infants do. We tested if feeding formulas with improved protein quality and a protein content corresponding to the minimum level that is consistent with international recommendations (1.8 g/100 kcal) allows patients to achieve normal growth and plasma urea concentrations. METHODS: Healthy term infants were enrolled into the study and were either breast-fed or randomly assigned to three formula-fed groups. Formula-fed infants received either a standard formula with a protein/energy ratio of 2.2 g/100 kcal, whereas the two other groups received formulas with a protein/energy ratio of 1.8g/100 kcal differing mainly by their source of protein. Subjects received breast milk or these formulas ad libitum as the sole source of energy from birth to four months of age in a controlled blind design (except for the breast-fed group). Anthropometric measurements (body weight and length) were obtained at birth, at 30, 60, 90, and 120 days. Energy and protein intakes were calculated from three-day dietary records. Blood was collected for biochemical measurements at 30, 60, and 120 days. RESULTS: No differences were found between the four feeding groups for weight- and length-gains or for body mass indices (BMI). No differences in energy intakes between the formula-fed groups could be found, whereas protein intakes were less in infants fed the 1.8 g/100 kcal formulas. Plasma urea levels of the infants fed the 1.8 g/100 kcal formulas were closer to those found in the breast-fed infants. CONCLUSION: Improvement of the amino acid profile permits a whey predominant starter formula with 1.8 g protein per 100 kcal to meet the needs of normal term infants during the first four months of life.