喂养习惯与婴儿出生后前6个月按身长体质量增加的相关性

摘要

Objective To explore the relationship between infant feeding practices and infants growth,especially the weight gain for length in the first 6 months of life. Methods Two-hundred healthy full-term singlet normal birth weight 5 - 6 months old infants and their main care givers were recruited in Kongjiang community health service center in Shanghai. The questionnaires included infants feeding pattern, feeding environment and care givers feeding behaviors, and were completed on-site by investigators. The birth weight was obtained. The weight and length of infants at 6 months were measured. Results There were 70/200 (35.0%) infants overweight (BMI for age Z score>+1) at 6 months. There were more overweight boys than girls (40.0% vs. 30.9%, x2 = 1.798, P = 0.180). Compared with normal weight infants, the overweight infants had same birth weight (3.30 ± 0.35 kg vs. 3.35 ± 0.32 kg, t =1.010, P = 0.314) and same length at 6 months (67.64 ± 2.10 cm vs. 67.91 ± 1.97 cm, t=- 0.896, P = 0.371). However, the overweight infants gained much more weight for length in the first six months of life. At 6 months, the weight and BMI of overweight infants was significantly higher than that of normal weight infants (9.16 ± 0.67 vs. 7.94 ±0.64, t = 12.324, P < 0.01;19.86 ± 1.24 vs. 17.41 ± 0.80, t = 14.953, P < 0.01). The rates of exclusive breastfeeding for at least four months, continued breastfeeding at six months, complementary food consistency, and complementary feeding frequency, were not significantly differenct between overweight and normal weight infants (x2 =0.723 - 2.701, P > 0.05). The grandparents played an important role in infants feeding in Shanghai. There were 39.0% infants fed only by grandparents, and 23.0% infants fed jointly by grandparents and parents (x2 = 0.175, P > 0.05).The care givers' educational level and knowledge of feeding skill were similar in overweight and normal weight infants (x2 = 0.446, t = 0.949, P > 0.05). However, the overweight infants were fed more quickly than normal weight infants (Z = 2.753, P < 0.01), and there was less language communication between care givers and overweight infants during feeding (Z = 2.932, P < 0.01). In overweight infants, the overfeeding behaviors of care givers were positively correlated with BAZ (r = 0.281, P < 0.05). Conclusions Overweight in early life is associated with some particular infants feeding behaviors of care givers in Shanghai. The long term effect of more rapid weight gain for length in the first 6 months of life on the risk of childhood obesity warranted to be further followed and researched.%目的 探讨导致婴儿出生早期生长过快,尤其是按身长体质量增长过快的相关喂养习惯,包括婴儿的喂养方式、喂养环境以及喂养者的一般情况和喂养行为等,方法以上海市控江社区医疗服务中心常规健康体检的200例足月、单胎、正常出生体质量的健康5～6月龄婴儿及其主要喂养者作为研究对象.有关婴儿喂养习惯的调查问卷,包括婴儿喂养模式、喂养环境、以及喂养者的行为等,由研究小组成员在现场对婴儿的主要喂养者进行一对一调查.记录婴儿的出生体质最,并在婴儿6月龄时测量其体质量和身长.结果 200例婴儿中有70例超重(BAZ>+1),占35%.男婴超重多于女婴(40.0%对30.9%,x2=1.798,P=0.180).超重婴儿和体质量正常婴儿的出生体质量一致(3.30±0.35 kg对3.35±0.32 kg,t=1.010,P=0.314),6月龄时两组婴儿的身长也一致(67.64±2.10 cm对67.91±1.97cm,t=0.896,P=0.371).超重婴儿在出生后前6个月内按身长体质量增加速度明显快于正常体质量婴儿,6月龄时超重婴儿的体质量以及BMI显著高于正常体质量婴儿(9.16±0.67对7.94±0.64,t=12.324,P<0.01;19.86±1.24对17.41±0.80,t=14.953,P<0.01).两组婴儿中纯母乳喂养时间至少4个月,6月龄时持续母乳喂养、辅助食品稠厚度和喂养次数差异无统计学意义(x2=0.723～2.701,P均>0.05).祖父母在上海婴儿的喂养照料中扮演着重要的角色,39.0%的婴儿完全由祖父母承担喂养和照料的责任,而23.0%的婴儿则由父母与祖父母共同承担.两组婴儿的主要喂养者、喂养者学历、婴儿喂养知识掌握差异无统计学意义(x2=0.175、0.446,t=0.949,P均>0.05).超重婴儿喂养者的喂养速度明显快于正常体质量婴儿(Z=2.753,P<0.01),超重婴儿喂养者在喂养过程中与婴儿的语言交流明显较少(Z=2.932,P<0.01).在超重婴儿中,喂养者的过度喂养行为与超重婴儿的BAZ呈显著正相关(r=0.281,P<0.05).结论 上海婴儿出生早期按身长体质量增长过快与某些婴儿喂养习惯相关.婴儿出生后前6个月按身长体质量增加过快是否会增加儿章期肥胖的风险值得进一步观察和研究.