目的 分析早产儿食物转换对血清营养素水平的影响,旨在探索出更有效的针对早产儿的食物转换指导方案。方法 2020年3—8月于佛山市妇幼保健院收集210例纠正8~24月龄的早产儿的喂养情况及血清血红蛋白、铁、铁蛋白、钙、磷、维生素D、碱性磷酸酶、血脂、血糖、白蛋白、尿素氮的数据,使用多元线性回归分析两者的关系。结果 1)16.2%的早产儿谷薯类食物摄入过少,29.0%动物性食物摄入过少,9.0%奶量摄入过少,19.5%无规律补充维生素D,66.2%未能达到每日户外活动时间约1 h,19.0%补充铁剂;2)5.2%的早产儿存在贫血,早产儿中42.4%的血清铁<12 μmol/L,11.9%的铁蛋白<12 μg/L,9.0%的碱性磷酸酶>350 U/L,4.3%的钙磷乘积<4,未发现维生素D不足、低白蛋白、低血糖者;3)校正多因素后发现,增加谷薯类食物份量可提升血红蛋白(β=3.434,P=0.001)水平、降低血清维生素D(β=-5.858,P=0.002)水平,增加动物性食物份量可提升血清铁(β=1.471,P=0.002)及铁蛋白(β=13.075,P=0.003)水平、降低甘油三酯(β=-0.267,P=0.029)水平,补充铁剂可提升血清铁蛋白(β=26.042,P=0.019)、磷(β=0.157,P=0.024)、钙磷乘积(β=0.614,P=0.007)水平,增加奶量可提升血清钙磷乘积(β=0.237,P=0.039)水平、降低碱性磷酸酶(β=-55.171,P=0.007)水平。结论 食物转换期早产儿铁缺乏风险高于其他营养素缺乏风险,而谷薯类食物、动物性食物、奶的摄入及铁剂补充可共同影响血清钙、磷、铁、维生素D、脂肪等营养素的代谢平衡,需强调膳食平衡。
Abstract
Objective To investigate the feeding practices and their effects on the nutrient biomarkers of the preterm children after introduction of complementary foods, so as to give effective nutrition advice during introduction of complementary foods. Methods A total of 210 preterm children at the corrected age of 8 to 24 months old were enrolled in this study from Foshan Women and Children Hospital from March to August, 2020. Feeding practice and nutrient biomarkers data were collected. The correlation between nutrient biomarkers and feeding factors was analyzed by multiple linear regression analysis. Results 1) Totally 16.2% and 9.0% of the subjects took less cereal or milk than recommended respectively, while 29.0% took less animal food, 19.5% did not regularly intake vitamin D. Meanwhile, 66.2% could not guarantee at least 1 hour of outdoor activity per day, only 19.0% still took iron supplement as recommended. 2) Totally 5.2% of the subjects suffered from anemia, but 42.4% were with serum iron < 12 μmol/L and 11.9% with ferritin < 12 μg/L, 9.0% were with alkaline phosphatase > 350 U/L, 4.3% were with calcium-phosphorus product < 4, none suffered from vitamin D insufficiency, hypoalbuminemia or hypoglycemia. 3) After adjusting multi-factors, it was found that increase of cereal intake could raise hemoglobin(β=3.434,P=0.001) level, but reduce serum vitamin D(β=-5.858,P=0.002) level. Increase of animal food could raise serum iron(β=1.471,P=0.002) and ferritin(β=13.075,P=0.003) level, but reduce triglyceride(β=-0.267,P=0.029) level. Supplement of iron could raise serum ferritin(β=26.042,P=0.019), phosphorus(β=0.157,P=0.024) and calcium-phosphorus product(β=0.614,P=0.007) level. Increase of milk intake could raise calcium-phosphorus product(β=0.237,P=0.039) level and reduce alkaline phosphatase(β=-55.171,P=0.007) level. Conclusions The risk of iron deficiency might be higher than other nutrition related diseases for the preterm children after introduction of complementary foods. Cereal, animal food and milk intake, as well as iron supplements could mutually affect the homeostasis of calcium, phosphorus, iron, vitamin D and lipid metabolism. Therefore, dietary balance should be emphasized when giving nutrition advice.
关键词
早产儿 /
食物转换 /
营养素
Key words
preterm /
complementary foods /
nutrients
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参考文献
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基金
广东省医学科学技术研究基金项目(A2020472)
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