婴幼儿生长发育与辅食添加的关系

应用1998年6岁以下儿童营养监测现场调查资料分析4至24个月以内婴儿辅助食品添加对婴幼儿生长发育的影响,以便为农村特别是贫困农村合理添加辅助食品提供参考。统计分析采用了描述性,相关回归分析及Logistic回归分析。结果表明贫困农村婴幼儿各类辅助食品添加率低于一般农村和城市。贫困农村婴幼儿在24个月以内平均添加动物性食物只占42％、乳类30．5％、淀粉类57．8％、蔬菜水果类48．6％,相当于城市添加比例的一半。通过相关分析表明,在4至6个月,6至12个月,12至18个月,18至24月几个年龄段的按年龄身高和体重与动物性食物和蔬菜水果类食物的添加率呈显著的正相关关系,但淀粉类食物在各个年龄段相关都不显著。通过回归分析,估算了如果每个营养监测点动物性食物添加率提高10％时,18至24个月的婴幼儿生长迟缓率可下降2．6个百分点,低体重下降1．2个百分点。Logistic回归分析表明,没有添加动物生长迟缓率可下降2．6个百分点,低体重下降1．2个百分点。Logistic回归分析表明,没有添加动物性食物时,发生生长迟缓的危险度（OR＝2．21（4－6个月）、1．73（6－12个月）、2．81（12－18个月）和2．58（12－24个月）。未添加蔬菜水果类食物发生生长迟缓的危险度与动物性食物类似。     

Household food insufficiency is associated with poorer health

The purposes of this study were to estimate the prevalence of household food insufficiency in Canada, to identify sociodemographic characteristics of households most likely to report food insufficiency and to examine the relationship between food insufficiency and physical, mental and social health. These objectives were achieved through an analysis of data from the 1996/1997 National Population Health Survey. An estimated 4% of Canadians, 1.1 million people, were found to be living in food-insufficient households. Single-parent families, households reporting their major source of income as welfare, unemployment insurance or workers' compensation, those who did not own their own homes and households in Western Canada were more likely to report food insufficiency. The likelihood of reporting food insufficiency increased dramatically as income adequacy deteriorated. Individuals from food-insufficient households had significantly higher odds of reporting poor/fair health, of having poor functional health, restricted activity and multiple chronic conditions, of suffering from major depression and distress, and of having poor social support. Individuals in food-insufficient households were also more likely to report heart disease, diabetes, high blood pressure and food allergies. Men in food-insufficient households were less likely to be overweight; after adjusting for potentially confounding variables, no other associations were found between food insufficiency and body mass index. These findings suggest that food insufficiency is one dimension of a more pervasive vulnerability to a range of physical, mental and social health problems among households struggling with economic constraints.     

A longitudinal study of vietnamese children born in Australia: Infant feeding,growth in infancy and after five years

Feeding practices and growth were studied longitudinally from birth to 12 months in a group of Vietnamese infants (25 boys, 23 girls) born in Perth, Western Australia. Weight and height data were recorded for 38 of these children at five years of age. Eighty one per cent of the infants were breast fed on leaving hospital; this rate decreased throughout infancy to 23% at 12 months. The incidence of breast feeding, its duration, and the age at which solids were introduced by immigrant mothers reflected local practices. However, the kinds of solids introduced, and the practice of giving infants extra fluids at a very early age (water, 42% of infants at one week; orange juice, 25% at one month) appear to reflect practices in their country of origin. Median (50th centile) weights of the Vietnamese at birth approximated 10th centile values and median length, between 10th and 25th centile values for Australian (Perth) infants of the same sex. Growth rates in the first three months of life exceeded the rates of Australian infants but subsequently a fall-off in rate of weight gain resulted in the 50th centile weights of the Vietnamese again approximating 10th centile Australian values at 12 months. The data at five years suggest that some small enhancement of growth may have occurred in these children: their 50th centile values for weight at that age fell between the 10th and 25th Australian values, and for height approximated the 25th Australian centiles     

Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home

OBJECTIVES: To compare mothers of undernourished children with mothers of adequately nourished children on maternal depression, parenting self-esteem, social support and exposure to stressors and to determine if these variables are independently related to undernutrition and stimulation provided in the home after controlling for socio-economic status. DESIGN: A case control study. SETTING: Children and their mothers were recruited from 18 government health centres in the Kingston, St Andrew and St Catherine parishes of Jamaica. SUBJECTS: One hundred and thirty-nine mothers of undernourished children (WAZ< or =-1.5z scores) aged 9 - 30 months and 71 mothers of adequately nourished children (WAZ > -1z scores) matched for sex and age group were enrolled into the study. RESULTS: Mothers of undernourished children came from poorer homes but had similar social support to mothers of adequately nourished children. They were more depressed, had lower levels of parenting self-esteem (both P<0.01), reported higher levels of economic stress (P<0.001) and provided a less stimulating home environment (P<0.05). However, after controlling for social background variables there was no independent relationship between either psychosocial function or home stimulation and nutritional status. Undernutrition was found to be mainly explained by economic factors. The mothers' self-esteem was independently associated with the level of stimulation provided to the child. CONCLUSIONS: When caring for undernourished children attention should be paid to the psychosocial status of the mother as well as the physical condition of the child. SPONSORSHIP: Thrasher Research Fund; Campus Research and Publication Fund, UWI, Jamaica.     

Higher glycemic load diet is associated with poorer nutrient intake in women with gestational diabetes mellitus

Changes in the quality and quantity of carbohydrate foods may compromise nutrient intake in women with gestational diabetes mellitus (GDM). We hypothesized that glycemic index, glycemic load (GL), carbohydrate intake, grains, and cereal product consumption would be associated with nutrient adequacy. Eighty-two women with GDM (61% of Asian background, 34% whites) completed a 3-day food record following their routine group nutrition education session. Nutrient intakes were compared to Nutrient Reference Values (NRV) for Australia and New Zealand. Nutrient intake across energy-adjusted tertiles of glycemic index, GL, carbohydrate intake, and intake of grains and cereal products were assessed. The majority of women (66%-99%) did not meet the NRV for fiber, folate, vitamin D, iodine, and iron, and exceeded NRV for saturated fat and sodium. Higher dietary GL was associated with lower intakes of total, monounsaturated, and polyunsaturated fat; vitamin E; and potassium (all P < .001). Higher grain intake was not significantly associated with intake of any micronutrients. In Australian women with GDM, high dietary GL predicts greater risk of poor nutrition.     

Long-term low-level arsenic exposure is associated with poorer neuropsychological functioning: a Project FRONTIER study

Exposure to elements in groundwater (toxic or beneficial) is commonplace yet, outside of lead and mercury, little research has examined the impact of many commonly occurring environmental exposures on mental abilities during the aging process. Inorganic arsenic is a known neurotoxin that has both neurodevelopmental and neurocognitive consequences. The aim of this study was to examine the potential association between current and long-term arsenic exposure and detailed neuropsychological functioning in a sample of rural-dwelling adults and elders. Data were analyzed from 434 participants (133 men and 301 women) of Project FRONTIER, a community-based participatory research study of the epidemiology of health issues of rural-dwelling adults and elders. The results of the study showed that GIS-based groundwater arsenic exposure (current and long-term) was significantly related to poorer scores in language, visuospatial skills, and executive functioning. Additionally, long-term low-level exposure to arsenic was significantly correlated to poorer scores in global cognition, processing speed and immediate memory. The finding of a correlation between arsenic and the domains of executive functioning and memory is of critical importance as these are cognitive domains that reflect the earliest manifestations of Alzheimer's disease. Additional work is warranted given the population health implications associated with long-term low-level arsenic exposure.     

Pregravid body mass index is associated with early introduction of complementary foods

ObjectiveTo determine whether women who entered pregnancy overweight or obese were less likely to follow American Academy of Pediatrics guidelines for introducing complementary foods to infants after 4 months of age. In addition, we explored whether psychological factors accounted for any of the effect of pregravid body mass index on age of complementary food introduction.DesignA prospective cohort study from 2001 to 2005 that recruited pregnant women between 15 to 20 gestational weeks with follow-up through 12 months postpartum from University of North Carolina hospitals (n=550).Statistical analysisMultinomial models were used to estimate relative risk ratios. The outcome was age of complementary food introduction, categorized as younger than 4 months of age, 4 to 6 months, and 6 months or later (referent). Maternal body mass index was categorized as underweight (<18.5), normal weight (18.5 to 24.9), and overweight/obese (≥25). A series of regression analyses tested mediation by psychological factors measured during pregnancy (depressive symptoms, stress, and anxiety).ResultsMore than a third of the study population (35.7% of 550) entered pregnancy overweight/obese. The majority of participants (75.3%) introduced foods to their infants between 4 and 6 months of age. Compared with normal-weight women, those who were overweight/obese before pregnancy were more likely (relative risk ratios=2.22 [95% CI 1.23 to 4.01]) to introduce complementary foods before the infant was 4 months old, adjusting for race, education, and poverty status. Depressive symptoms, stress, and anxiety did not account for any of the effect of pregravid overweight/obesity on early food introduction.ConclusionsThe results suggest that overweight and obese women are more likely to introduce complementary foods early and that psychological factors during pregnancy do not influence this relationship. Future studies need to explore why overweight/obese women are less likely to meet the American Academy of Pediatrics recommendations for the introduction of complementary food.     

A summary index of infant and child feeding practices is associated with child growth in urban Shanghai

ABSTRACT: BACKGROUND: Recently, an infant and child feeding index (ICFI) constructed on brief recalls of breastfeeding, feeding frequency and food diversification was assumed to provide long-term prediction about child feeding practices. The aim of this study was to investigate the association between the cross-sectional ICFI (CS-ICFI) or longitudinal ICFI (L-ICFI) and child anthropometric indices in downtown Shanghai, China. METHODS: The prospective cohort study included 180 infants aged 5-7 mo with their main caregivers who were visited 3 times every 6 months over 12 months. A CS-ICFI was constructed for each visit by using data on feeding practices based on 24-h and 7-d recalls. An L-ICFI was constructed with use of the 3 CS-ICFIs. The associations between ICFI and length-for-age z score (LAZ), weight-for-age z score (WAZ), and weight-for-length z score (WLZ) were examined. The stability of the CS-ICFI was assessed by using repeatability coefficient (RC). RESULTS: The L-ICFI was positively associated with LAZ and WAZ at Visit 3 (beta=0.151, P=0.040 and beta=0.173, P=0.024, respectively). Moreover, the CS-ICFI at Visit 1 was positively associated with LAZ, WAZ and WLZ (beta=0.160, P=0.029; beta=0.191, P=0.009; beta=0.176, P=0.020) at Visit 3, and the CS-ICFI at Visit 3 was also positively associated with LAZ (beta=0.176, P=0.016). Stability of the CS-ICFI was shown by the value of 0.14 (95% CI: 0.07, 0.31) of the RC, which differed significantly from 0 (P<0.05). CONCLUSIONS: The ICFI constructed on brief recalls based on cross-sectional studies can be used to evaluate the effects of child feeding practice on child growth.     

辅食添加对婴幼儿贫血的影响

【目的】 本研究以健康婴幼儿为研究对象,研究不同时间添加辅食、添加不同种类辅食对婴幼儿贫血发生的影响。 【方法】 采用整群抽样的方法,选择北京顺义区3~18月龄婴幼儿143名,向其母亲询问婴儿基本状况、添加辅食时间和辅食种类等;采用氰化高铁血红蛋白方法测量其血红蛋白浓度。 【结果】 本研究发现该组儿童贫血发生率12个月前为30%左右,明显高于12个月后的10%左右 (P< 0.01)。不论男童还是女童, 6个月龄前或6个月龄后儿童,4个月前添加辅食均可以使贫血发生率下降(P< 0.05)。添加铁强化食物(如配方奶和营养素补充剂)可以使血红蛋白浓度升高(P< 0.05)。采用不同贫血诊断标准(97、105、110 g/L),贫血发生率差异仍存在统计学意义 (P< 0.01)。 【结论】 12个月龄前儿童贫血发生率明显高于12个月龄后儿童。虽然4个月前添加铁强化辅食使得铁营养状况得到改善,但适宜的辅食添加时间有待进一步研究。     

A six-month intervention with two different types of micronutrient-fortified complementary foods had distinct short- and long-term effects on linear and ponderal growth of vietnamese infants

Traditional complementary foods (CF) with a low nutrient density have been implicated in growth faltering, stunting, and other adverse outcomes in children. The efficacy of 2 types of locally produced, micronutrient-fortified CF to prevent stunting of infants living in rural Vietnam was evaluated. In a village-randomized controlled study, 426 infants, 5 mo of age, received for 6 mo a fortified CF, either as an instant flour (FF) or a food complement (FC) in village canteens, or traditional CF at home (C). After 6 mo of intervention, weight, length, length-for-age Z-score (LAZ) and weight-for-age Z-score were greater in the 2 intervention groups compared with the C group, with an estimated effect of +0.22 LAZ for the FF group and +0.21 LAZ for the FC group. At the last follow-up, 18 mo after the intervention, there was no significant difference in height-for-age Z-score (HAZ) between the groups, even though the HAZ in the FF group was 0.17 greater than that in the C group (P = 0.18). In contrast, the weight-for-height Z-score and BMI Z-score, indices of ponderal growth, were greater in the FF group (-0.49 and -0.26, respectively) than in the FC group (-0.73 and -0.49, respectively), with Z-scores in the C group intermediate and not significantly different from the others. This study shows that regular provision of locally produced CF fortified with micronutrients partly stopped growth faltering in Vietnamese infants, with differential effects on long-term length and ponderal growth. Providing only micronutrients instead of a complete array of nutrients might result in only short-term length growth benefits.     

Use of tranquilizers and sleeping pills among cancer patients is associated with a poorer quality of life

To evaluate the association between sleeping pill/tranquilizer (SP/T) use and quality of life (QOL) among cancer patients. Patients and methods: Oncology patients (n=909) in three Israeli hospitals were interviewed in clinics, day centers and in-patient departments regarding SP/T use in the previous week. Crude and adjusted QOL scores, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30), were compared in users vs. non-users. Results: Sleeping pill/tranquilizer use was self-reported by 234 (25.7%) participants, but rarely documented in medical charts. Factors associated with SP/T use were female gender (adjusted Odds ratio, OR: 1.79; 95% Confidence interval, CI: 1.22–2.62, age (OR: 4.6; 95% CI: 1.66–12.53 for age 70+), place of birth (OR: 1.97; 95% CI: 1.19–3.26 for Eastern Europe compared with Israel), concomitant use of painkillers (OR: 2.88; 95% CI: 1.97–4.20) and presence of cardiovascular disease (OR: 2.41; 95% CI: 1.48–3.91). Controlling these factors as well as disease status, users had a poorer QOL on all functional scales (P<0.001) as well as global QOL. Furthermore, users reported increased severity of symptoms, especially fatigue, insomnia, pain, dyspnea and constipation (P<0.01), compared to non-users. Conclusions: Use of SP/T, reported by one fourth of cancer patients, was associated with substantially poorer QOL and increased severity of symptoms. Causal inference is not possible given the cross-sectional design. Periodic inquiry regarding use of these medications in the Oncology Clinic is recommended since it may identify patients with poor QOL and unmet needs.     

Increased attrition of leukocyte telomere length in young adults is associated with poorer cognitive function in midlife

Evidence for an association of leukocyte telomere length (LTL) with cognitive function, predominantly in older adults, is inconsistent. No report has examined the association of LTL dynamics (age-specific LTL and its attrition rate) with cognitive function. We aimed to examine the association of LTL dynamics over 13 years in young adulthood with cognitive function in midlife. 497 individuals who had LTL measured at ages 28–32 and 41–46 years were assessed at ages 48–52 for global cognitive function and its five specific component domains with a NeuroTrax computerized test battery. Multivariable regression and logistic models were applied for cognition treated as a continuous and categorical variable, respectively. We found that LTL attrition (adjusted for sex, baseline LTL and potential confounders including socioeconomic variables) was inversely associated with global cognition (standardized β = ?.119, p = .004) and its component domains: information processing speed (β = ?.102, p = .024), visual-spatial function (β = ?.102, p = .017) and memory (β = ?.093, p = .045), but less so for the attention and executive domains. The multivariable-adjusted odds ratio for low global cognition comparing the upper versus lower thirds of LTL attrition was 2.12 (95 % CI 1.11–4.08, p for trend = .023). There was no association of baseline or follow-up LTL with cognition. No effect modification was evident for sex, smoking or inflammatory markers. In conclusion, faster LTL attrition in young adulthood was associated with poorer global and domain-specific cognitive function in midlife, suggesting that more rapid LTL attrition may be predictive of cognitive aging in healthy young adults.     

添加辅食对婴幼儿生长发育的影响

目的:了解添加辅食对2岁以下儿童生长发育的影响。方法:以4～6月龄时婴幼儿是否开始添加辅食分组,由专人负责,统一表格、标准和要求,进行统一规定的～6、～9、～12、～18、～24月5个年龄段儿童的体格检查和母亲的1人1表问卷调查。结果:深圳市4月龄儿童添加辅食率为60.2%,6月龄儿童为83.7%。添加辅食组～24月龄儿童的体重明显大于末加辅食组,P<0.01,～18月龄儿童的血红蛋白浓度添加辅食组明显高于末加辅食组,P<0.02,各年龄组儿童的血红细胞数比较,添加辅食组均明显高于末加辅食组,P<0.05或0.01。添加辅食与否对各年龄组儿童身长的影响,对婴儿独走、独坐、叫爸妈发育的影响,以及对婴儿感冒、支气管炎及肺炎、腹泻、佝偻病等发病率的影响,均无显著性差异,P>0.05。结论:及时合理的添加辅食,对儿童的血红细胞数和血红蛋白浓度以及体格生长发育均有较大的益处。应在大力提倡科学母乳喂养的同时,进一步加强儿童辅食添加知识及喂养行为方面的宣传与指导,促进婴幼儿的生长发育。     

A young child feeding index is not associated with either height-for-age or height velocity in rural Senegalese children

Ruel and Menon recently published a young child feeding index based on characteristics taken from 24-h and 7-d recalls. A strong positive association was found in 7 Latin American Demographic and Health Surveys for 12- to 36-mo-old children (1). The aim of this study was to test for associations of this index with height-for-age and linear growth in African children. Children (n = 500), aged 12-42 mo, living in a rural area of Senegal were visited in their homes in April-May, and 24-h and 7-d food recalls were conducted with their mothers. Height was measured, and measurements taken 7 mo earlier were used to compute linear growth rates. General linear models were used to adjust for potential confounders (child age and sex, maternal height, BMI, and socioeconomic status). The feeding index was not associated with either height-for-age (adjusted means: -1.01, -1.06, and -1.20 Z-scores for the 1st, 2nd, and 3rd tercile, respectively) or with linear growth (6.2, 6.0, and 6.3 cm/7 mo for the 3 terciles, respectively). Continuing breast-feeding was negatively associated with height-for-age (P < 0.05) and positively associated with linear growth (P < 0.01). Frequent consumption of fruit was positively associated with both (P = 0.059 and P = 0.027, respectively, in adjusted models), whereas food consumption from an animal source was not. In conclusion, the composite feeding index was independent of height and linear growth in these rural African children, due in part to reverse causality between breast-feeding duration and stunting.     

Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study

OBJECTIVE: To introduce practices for improving complementary feeding and evaluate their adoption and association with improved dietary intakes. DESIGN: A quasiexperimental pilot study comparing dietary intakes from complementary foods among three intervention communities and one control community before and after the intervention, and adoption of new complementary feeding practices among intervention communities following the intervention. SETTING: Rural subsistence communities in southern Malawi, Central Africa. SUBJECTS: Mothers and their children aged 6 to 23 months receiving complementary foods. INTERVENTIONS: A participatory, nutrition education intervention based on four locally adapted lessons for complementary feeding practices designed to increase: (i) total complementary food intake; (ii) energy and nutrient density of the complementary diet, and; (iii) iron and zinc bioavailability of the complementary diet. RESULTS: Adoption rates for the four practices ranged from 25% for preparation of enriched porridges, to 10% for preparing soaked, pounded maize. The amount of complementary foods (g/day) and intakes of energy, animal protein, niacin, riboflavin, calcium, iron, and zinc, but not vitamin A, were significantly greater (P<0.05) in the intervention compared to control group, as were the energy, iron, and riboflavin density, and the estimated amount of bioavailable iron and zinc. CONCLUSIONS: Several intervention practices were well accepted and adopted and were associated with improved adequacy of energy and nutrient intakes from the complementary diet. Such improvements were attributed mainly to greater total intakes and, to a lesser extent, enhanced dietary quality of the complementary foods.