Preventive Gastroenterology Unit, Department of Paediatrics, Università di Firenze, Florence, Italy.
Int J Gen Med. 2012;5:345-53. doi: 10.2147/IJGM.S29889. Epub 2012 Apr 13.
Scheduled meals are considered to be equivalent to those requested by the infant (null hypothesis). In adults, we have found high blood glucose before scheduled meals and low blood glucose after recognition of validated initial hunger. Low preprandial blood glucose is associated with a decrease in energy intake and body weight both in adults who are overtly overweight and in those who are of normal weight with insulin resistance (hidden overweight). In this study, we investigated the validity of the null hypothesis between scheduled and requested meals in 2-year-old infants with chronic nonspecific diarrhea.
We trained a "recognizing request" meal pattern in 70 mother-infant pairs. The trained meal pattern consisted of administering food after a first request that we validated by blood glucose measurement in the hospital laboratory. Using a 7-day food diary, mothers reported preprandial blood glucose measurements for their infants three times a day. We assessed mean preprandial blood glucose, daily energy intake, days with diarrhea, blood parameters, and anthropometry before training and 4 months after training, and compared the results with measurements in 73 randomly selected untrained controls.
In the trained group, there was a decrease in mean blood glucose from 86.9 ± 9.4 mg/dL to 76.4 ± 6.7 mg/dL (P < 0.0001), as well as a decrease in energy intake and days with diarrhea in comparison with control infants who maintained scheduled meals. Only two of 21 infants who had a mean blood glucose lower than 81.2 mg/dL at recruitment showed a statistically significant decrease in mean blood glucose, whereas 36 of 49 infants above this cutoff level showed a statistically significant decrease after training (Chi-square test, P < 0.0001).
Requested meals are associated with low preprandial blood glucose, significantly lower energy intake, and recovery from diarrhea, whereas scheduled meals are associated with high blood glucose, higher energy intake, and persistence of diarrhea. The disparities in blood glucose levels and energy intake disprove the null hypothesis, suggesting the need for a change from scheduled to requested meals early on in food administration, ie, during the neonatal period.
定时进餐被认为与婴儿的需求相同（零假设）。在成年人中，我们发现定时进餐前血糖升高，而在验证初始饥饿时血糖降低。餐前低血糖与能量摄入减少和体重减轻有关，无论是明显超重的成年人还是胰岛素抵抗的正常体重者（隐性超重）。在这项研究中，我们调查了慢性非特异性腹泻的 2 岁婴儿的零假设与请求进餐之间的有效性。
我们对 70 对母婴进行了“识别请求”的饮食模式训练。训练后的饮食模式包括在首次请求后给予食物，我们通过医院实验室的血糖测量来验证该请求。母亲使用 7 天饮食日记，每天三次报告婴儿的餐前血糖测量值。我们评估了训练前和训练后 4 个月婴儿的平均餐前血糖、每日能量摄入、腹泻天数、血液参数和人体测量值，并将结果与 73 名随机选择的未训练对照组进行比较。
在训练组中，平均血糖从 86.9 ± 9.4 mg/dL 降至 76.4 ± 6.7 mg/dL（P < 0.0001），与维持定时进餐的对照组婴儿相比，能量摄入和腹泻天数减少。在招募时平均血糖低于 81.2 mg/dL 的 21 名婴儿中，只有 2 名婴儿的平均血糖有统计学意义的降低，而在该截点以上的 49 名婴儿中，有 36 名婴儿的平均血糖在训练后有统计学意义的降低（卡方检验，P < 0.0001）。
请求进餐与餐前低血糖、显著较低的能量摄入和腹泻恢复有关，而定时进餐与高血糖、较高的能量摄入和腹泻持续有关。血糖水平和能量摄入的差异否定了零假设，表明需要在早期进食时从定时进餐改为请求进餐，即在新生儿期。
