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目的 探讨4月龄内婴儿喂养方式与0～3岁婴幼儿体格生长和超重肥胖风险的关联。方法 基于母婴营养与健康前瞻性队列研究，于2013—2019年随访太仓队列中1458名0～3岁婴幼儿。采用结构式问卷调查和评价婴儿4月龄内喂养方式，测量婴幼儿出生、1、3、6、8、12、18、24、30和36月龄时的身高/身长和体重，计算年龄别体重Z评分(weight for age Z-score, WAZ)、年龄别身长/高Z评分(length for age Z-score, LAZ)和身长/高别体重Z评分(weight for length Z-score, WLZ)。采用χ2检验、方差分析与SNK比较各喂养方式组之间婴幼儿的营养不良率和体格生长水平的差异，多因素Logistic回归分析喂养方式与婴幼儿超重肥胖发生风险的关联。结果 婴儿4月龄内为纯母乳喂养、基本纯母乳喂养、母乳为主的混合喂养、配方奶粉为主的混合喂养、配方奶粉喂养人数分别为264人(18.11%)、283人(19.41%)、650人(44.58%)、221人(15.16%)和24人(1.65%);除3月龄外的各月龄不同喂养组间LAZ、WLZ和WAZ差异无统计学意义。调整体检季节、出生体重、出生方式、停止母乳喂养月龄、配方奶粉添加月龄和辅食添加月龄后，婴幼儿超重肥胖风险与4月龄内喂养方式无相关。婴幼儿3岁内的超重肥胖风险主要受出生体重、出生方式影响，其中大于胎龄儿12月龄时超重肥胖的风险是适于胎龄儿的4.14倍(95%CI 2.06～8.32),剖宫产婴幼儿12月龄时超重肥胖的风险是顺产儿的2.47倍(95%CI 1.22～4.99)。结论 4月龄内喂养方式与婴幼儿0～3岁体格生长和超重肥胖无显著关联，婴幼儿期超重肥胖主要受婴幼儿出生体重、出生方式的影响。
Abstract：OBJECTIVE To investigate the association between feeding patterns within 4 months of age and both physical growth and the risk of overweight and obesity in young children aged 0-3 years.METHODS Based on the TAWS prospective cohort study in China, children aged 0-3 years were followed up in Taicang cohort from 2013 to 2019. A structured questionnaire was used to collect and evaluate the feeding patterns of children within the first 4 months, weight and height/length were measured at birth and at 1, 3, 6, 8, 12, 18, 24, 30 and 36 months of age, weight for age Z-score(WAZ), length for age Z-score(LAZ) and weight for length Z-score(WLZ) were calculated for each measurement. The χ2 test was used to compare the malnutrition rates, and applied ANOVA to analyze the differences in physical Z-scores among different feeding patterns at each measurement. Multivariate logistic regression was employed to analyze the correlation between feeding patterns and the risk of overweight and obesity.RESULTS Among 1458 children, 18.11%(n=264), 19.41%(n=283), 44.58%(n=650), 15.16%(n=221) and 1.65%(n=24) of them were exclusively breastfed, predominantly breastfed, mixed fed mainly on breast-milk, mixed fed mainly on formula, and formula fed. There were no differences in LAZ、WLZ and WAZ(except 3 months) among the different feeding pattern groups at each time point(P>0.05). After adjusting for the season of physical examination, birth weight, delivery mode, age at weaning, age at introduction of formula and complementary food, feeding patterns within the first 4 months were not associated with the risk of overweight and obesity. The risk of overweight and obesity in children under the age of 3 years was mainly associated with birth weight and delivery mode. Among them, at 12 months of age, the risk of overweight and obesity was higher in children with high birth weight(large-for-gestational-age) than children with normal birth weight(appropriate-for-gestational-age)(OR=4.14, 95% CI 2.06-8.32), and the risk of overweight and obesity was higher in children born by caesarean section than those born naturally(OR=2.47, 95% CI 1.06-8.32).CONCLUSION Children's feeding patterns withinh 4 months are not associated with their physical growth in their first 3 years. Overweight and obesity are mainly influenced by birth weight and delivery mode.
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基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2025.03.005
中图分类号:R174.4
引用信息:
[1]叶梓,孔亚男,闵吉,等.2013—2019年太仓市4月龄内婴儿喂养方式与0～3岁婴幼儿体格生长和超重肥胖的关联[J].卫生研究,2025,54(03):384-389+396.DOI:10.19813/j.cnki.weishengyanjiu.2025.03.005.
基金信息:
国家财政项目(No.102393220020070000016); 国家重点研发计划(No.2023YFC2506705); 联合国儿童基金会项目(No.12241,12217)
2025-05-21
2025-05-21