Rogers I S, Emmett P M
Unit of Paediatric and Perinatal Epidemiology, Division of Child Health, University of Bristol, Bristol, United Kingdom.
Pediatrics. 2001 Sep;108(3):E49. doi: 10.1542/peds.108.3.e49.
In most countries, it is recommended that adults restrict fat intake to 30% to 35% of energy to reduce the risk of coronary heart disease and certain cancers. However, the appropriate level of fat in the diet of children is hotly debated. It has been generally accepted that fat intake by children under 2 years of age should not be limited because of fears that nutrient intakes and thus growth and iron status might be compromised. However, there is very little longitudinal information on the relationship between fat intake and growth in representative populations of free-living children under 2 years old. The objective of this study was to investigate the relationship between fat intake as a percentage of energy, and nutrient adequacy, growth, blood lipids, and iron status in 18- and 43-month-old children.
This study forms part of the Avon Longitudinal Study of Parents and Children (ALSPAC)-a geographically-based cohort study in southwest England. A randomly selected subsample of the ALSPAC cohort attended research clinics approximately every 6 months from birth, at which a variety of anthropometric and other measurements were made. Dietary intakes at 18 and 43 months were assessed using a 3-day unweighed food record. A capillary blood sample was taken at 18 months for measurement of hemoglobin and ferritin levels. Nonfasting venous blood samples were taken at 31 and 43 months and analyzed for total and high-density lipoprotein cholesterol. The children were divided into quartiles of fat intake as a percentage of energy (QFI). QFI groups were compared for the number of children reaching recommended nutrient intakes, and for anthropometry, measures of iron status, and blood lipid levels.
Nine hundred fifty-one children at 18 months and 805 children at 43 months.
The mean (standard deviation) percentages of energy from fat in each quartile at 18 months were 31.2 (2.8), 36.1 (0.9), 39.1 (0.8), and 43.1 (2.2), corresponding to a fat intake in grams of 37.3 (8.1), 44.3 (8.1), 50.4 (10.2), and 55.4 (12.7). The number of children failing to reach recommended intake levels for zinc and vitamin A fell with increasing fat intake, while the number of children consuming less than the recommendations for iron and vitamin C rose at both ages. Despite this, there was no association between fat intake at 18 months and mean height or body mass index (BMI) at either 18 or 31 months. Fat intake at 43 months was also unassociated with concurrent or subsequent height or BMI. There was also no significant increase in the number of children falling below the tenth percentile for height or BMI as QFI fell. Mean ferritin levels at 18 months fell in both sexes as QFI increased. Total cholesterol levels at 31 months were significantly associated with QFI at 18 months, and rose from 3.99 mmol/l in the lowest QFI in boys, to 4.31 mmol/l in the highest QFI. QFI at 43 months was unassociated with cholesterol levels.
These data do not suggest that fat intakes are an important determinant of growth in these children, even before the age of 2 years, or that children at the bottom of the range of fat intakes are experiencing delayed growth. On the other hand, there is also no evidence in this study that children on higher fat intakes are at a greater risk of becoming obese. In contrast to a number of US studies, we have not found children on lower fat intakes to have lower iron intakes-indeed higher fat intakes were associated with a greater chance of consuming less than the recommended intake of iron and with lower ferritin levels. The association of higher fat intakes with higher total cholesterol levels among boys is of concern, as there is evidence that the process of atherosclerosis begins during the preschool years.
在大多数国家，建议成年人将脂肪摄入量限制在能量的30%至35%，以降低患冠心病和某些癌症的风险。然而，儿童饮食中脂肪的适宜水平存在激烈争论。人们普遍认为，2岁以下儿童的脂肪摄入量不应受限，因为担心营养摄入以及生长和铁状态可能会受到影响。然而，关于2岁以下自由生活儿童的代表性人群中脂肪摄入量与生长之间关系的纵向信息非常少。本研究的目的是调查18个月和43个月大儿童的脂肪摄入量占能量的百分比与营养充足性、生长、血脂和铁状态之间的关系。
本研究是埃文亲子纵向研究（ALSPAC）的一部分——这是一项在英格兰西南部基于地理区域的队列研究。从出生起，ALSPAC队列中随机抽取的子样本大约每6个月到研究诊所就诊一次，在此期间进行各种人体测量和其他测量。使用3天非称重食物记录评估18个月和43个月时的饮食摄入量。在18个月时采集毛细血管血样以测量血红蛋白和铁蛋白水平。在31个月和43个月时采集非空腹静脉血样并分析总胆固醇和高密度脂蛋白胆固醇。将儿童按脂肪摄入量占能量的百分比（QFI）分为四分位数。比较QFI组达到推荐营养素摄入量的儿童数量，以及人体测量、铁状态指标和血脂水平。
18个月大的儿童951名，43个月大的儿童805名。
18个月时，每个四分位数中来自脂肪的能量平均（标准差）百分比分别为31.2（2.8）、36.1（0.9）、39.1（0.8）和43.1（2.2），对应的脂肪摄入量（克）分别为37.3（8.1）、44.3（8.1）、50.4（10.2）和55.4（12.7）。未达到锌和维生素A推荐摄入量水平的儿童数量随着脂肪摄入量的增加而减少，而在两个年龄段，摄入铁和维生素C低于推荐量的儿童数量都有所增加。尽管如此，18个月时的脂肪摄入量与18个月或31个月时的平均身高或体重指数（BMI）之间没有关联。43个月时的脂肪摄入量与同时期或随后的身高或BMI也没有关联。随着QFI降低，身高或BMI低于第十百分位数的儿童数量也没有显著增加。18个月时，男女的平均铁蛋白水平均随着QFI的增加而下降。31个月时的总胆固醇水平与18个月时的QFI显著相关，在男孩中，从最低QFI组的3.99 mmol/l上升到最高QFI组的4.31 mmol/l。43个月时的QFI与胆固醇水平无关。
这些数据并不表明脂肪摄入量是这些儿童生长的重要决定因素，即使在2岁之前也是如此，也不表明脂肪摄入量处于较低范围的儿童生长发育迟缓。另一方面，本研究中也没有证据表明脂肪摄入量较高的儿童患肥胖症的风险更大。与美国的一些研究不同，我们没有发现脂肪摄入量较低的儿童铁摄入量也较低——事实上，脂肪摄入量较高与摄入铁低于推荐量的可能性更大以及铁蛋白水平较低有关。男孩中较高的脂肪摄入量与较高的总胆固醇水平之间的关联令人担忧，因为有证据表明动脉粥样硬化过程始于学龄前阶段。
