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中国循证儿科杂志

中国循证儿科杂志 ›› 2010, Vol. 5 ›› Issue (2): 122-129.DOI:

• 论著 • 上一篇    下一篇

婴儿喂养顺应WHO婴儿喂养指南的横断面调查分析

康宇1,李廷玉2,胡燕3,程茜3,刘友学2,陈洁2   

  1. 1 重庆医科大学公共卫生学院营养与食品卫生教研室,重庆400016；2 重庆医科大学附属儿童医院营养研究中心,重庆400014； 3 重庆医科大学附属儿童医院儿童保健科,重庆400014
  • 收稿日期:2010-01-02 修回日期:2010-02-09 出版日期:2010-03-10 发布日期:2010-03-10
  • 通讯作者: 李廷玉

A cross-section investigation of infant feeding following the latest WHO infant feeding recommendation

KANG Yu1,LI Ting-yu2,HU Yan3,CHENG Qian3,LIU You-xue2,CHEN Jie2   

  1. 1 Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing 400016, China; 2 Department of Children′s Nutrition, Children′s Hospital of Chongqing Medical University, Chongqing 400014, China; 3 Department of Primary Child Care, Children′s Hospital of Chongqing Medical University,Chongqing 400014, China
  • Received:2010-01-02 Revised:2010-02-09 Online:2010-03-10 Published:2010-03-10
  • Contact: LI Ting-yu

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摘要：

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。

关键词: 母乳喂养, 其他食物引入, 体格生长, 婴儿

Abstract:

Objective Adequate nutrition during infancy is fundamental to the development of each child′s full human potential. It is well recognized that the period from birth to one year of age is a ′critical window′ for the promotion of optimal growth, health and behavioral development. Many infant feeding recommendations were issued by WHO in the past decade. The current study aims at investigating feeding practices following the latest infant feeding recommendation issued by WHO in 2002. Methods A cross-section investigation was conducted in the department of primary child care, Children′s Hospital of Chongqing Medical University, which was located in southwest of China, from June 2008 to May 2009.Total 978 healthy infants who were recieving regular physical examination in the hospital were recruited unrandomly, including 529/976（54.2%） boys and 447/976 (45.8%) girls, aged 2 months(n=7), 3 months(n=45), 4 months(n=124), 5 months(n=233), 6 months(n=283), 7 months(n=107), 8 months(n=86), 9 months(n=45), 10 months(n=30), 11months(n=10),12 months(n=8), respectively. A questionnaire was used to collect information of infants′ data and feeding practice which was assessed by 24-hours recall from their major dependents. The anthropometric data of infants including weight and length were measured by qualified nurses using standard instruments and following standard protocol. Weight-for-length Z-score(WLZ), weight-for-age Z-score(WAZ) and length-for-age Z-score(LAZ) were calculated with Anthro software (version 3, April 2009). Means of weight, length, WLZ, WAZ and LAZ at different ages were compared with WHO growth standards using t tests. Results There was a considerable variety of feeding practices compared with the latest infant feeding recommendation issued by WHO. About 89.8% infants were breastfed, of whom 41.5% of whom were exclusively breastfed after delivery, however, 10.2% of the infants had never been breastfed. The proportion of breastfed infants was 25/45(55.6%) at 3 months, 53/124(42.7%) at 4 months, 114/233(48.9%) at 5 months and 100/283（35.3%）at 6 months, respectively. The proportion of exclusively breastfed infants was 15/45(33.3%) at 3 months, 27/124(21.8%) at 4 months, 23/233(11.2%) at 5 months, respectively. By the age of 6 months, the rate of exclusive breastfeeding was dramatically decreased to 15/283(5.3%). It did not meet the standard of exclusive breastfeeding for 6 months(180 days) recommended by WHO. The time of introducing complementary food varied, with 8.8% of infants being introduced complementary foods before 4 months, and the percentage increased to 66.0% during 4-5 months, 12.3% after 6 months, respectively. First food introduced to infancy was infant rice powder(65.5%), yolk(17.2%), vegetable or fruit(9.3%), homemade rice(7.4%) or fish(0.6%), respectively. The median age of introducing infant rice powder, gruels, yolk, vegetable, fruit, meat, fish, rice, noodle and bean was 4.5, 5.7, 5.2, 5.1, 5.1, 6.7, 6.8, 7.9, 6.6 and 7.0 months. Physical growth of the group of infants was above the WHO reference regardless of the time of complementary feeding during 2-12 months of age. Both infants′ weights reached up to the average level of WHO growth curve 2005 (P>0.05), whether or not exclusive breastfeeding was taken during 4-6 months. Mean and standard deviation of WLZ was 0.7±1.1, 0.7± 0.9, 0.6±0.9, 0.6±0.9, 0.7±1.0, 0.6±0.9, 0.6±0.8, 0.4±0.8, 0.6±1.0, 1.0±0.6 that differred significantly from zero (P<0.05) during 3-11 months, respectively. There was no difference found in WLZ, WAZ, and LAZ among the different feeding practice groups at 4th-6th month. Conclusions The current study indicated a unsatisfactory compliancy to WHO recommendation in infant feeding. Compared with WHO recommendation, the study sample showed lower pure breastfeeding rate,but higher proportion of formular feeding in the first 6 months.However, there was few significant difference in growth status associated with early infant feeding practice during the first year in our study.

Key words: Breastfeeding, Complementary feeding, Infants, Physical growth