亚洲儿童的喂养方式对早期神经认知发育的影响。

Infant feeding effects on early neurocognitive development in Asian children.

机构信息

From the Departments of Obstetrics and Gynecology (SC, WWP, DF, Y-SC, and MSK) and Psychological Medicine (BFPB), Yong Loo Lin School of Medicine; the Departments of Psychology (LS) and Biomedical Engineering and Clinical Imaging Research Centre (AQ); and the Saw Swee Hock School of Public Health (SMS), National University of Singapore, National University Health System, Singapore; the Abbott Nutrition Research and Development Asia-Pacific Center, Singapore (YLL); the Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (ASTAR), Singapore (LWS, SCS, MBB, EQW, AQ, BFPB, PDG, Y-SC, MJM, and AR-G); the School of Psychology, University of New South Wales, Sydney, Australia (JR); the Departments of Neonatology (PA) and Pediatrics (FY), Kandang Kerbau Women's and Children's Hospital, Singapore; the Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK (KMG); Liggins Institute, University of Auckland, Auckland, New Zealand (PDG); and the Departments of Epidemiology, Biostatistics, and Occupational Health (MSK), Pediatrics (MSK), and Psychiatry and Neurology and Neurosurgery (MJM), McGill University, Montreal, Canada.

出版信息

Am J Clin Nutr. 2015 Feb;101(2):326-36. doi: 10.3945/ajcn.114.095414. Epub 2014 Dec 10.

DOI:10.3945/ajcn.114.095414

PMID:25646330

Abstract

BACKGROUND

Breastfeeding has been shown to enhance global measures of intelligence in children. However, few studies have examined associations between breastfeeding and specific cognitive task performance in the first 2 y of life, particularly in an Asian population.

OBJECTIVE

We assessed associations between early infant feeding and detailed measures of cognitive development in the first 2 y of life in healthy Asian children born at term.

DESIGN

In a prospective cohort study, neurocognitive testing was performed in 408 healthy children (aged 6, 18, and 24 mo) from uncomplicated pregnancies (i.e., birth weight >2500 and <4000 g, gestational age ≥37 wk, and 5-min Apgar score ≥9). Tests included memory (deferred imitation, relational binding, habituation) and attention tasks (visual expectation, auditory oddball) as well as the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Children were stratified into 3 groups (low, intermediate, and high) on the basis of breastfeeding duration and exclusivity.

RESULTS

After potential confounding variables were controlled for, significant associations and dose-response relations were observed for 4 of the 15 tests. Higher breastfeeding exposure was associated with better memory at 6 mo, demonstrated by greater preferential looking toward correctly matched items during early portions of a relational memory task (i.e., relational binding task: P-trend = 0.015 and 0.050 for the first two 1000-ms time bins, respectively). No effects of breastfeeding were observed at 18 mo. At 24 mo, breastfed children were more likely to display sequential memory during a deferred imitation memory task (P-trend = 0.048), and toddlers with more exposure to breastfeeding scored higher in receptive language [+0.93 (0.23, 1.63) and +1.08 (0.10, 2.07) for intermediate- and high-breastfeeding groups, respectively, compared with the low-breastfeeding group], as well as expressive language [+0.58 (-0.06, 1.23) and +1.22 (0.32, 2.12) for intermediate- and high-breastfeeding groups, respectively] assessed via the BSID-III.

CONCLUSIONS

Our findings suggest small but significant benefits of breastfeeding for some aspects of memory and language development in the first 2 y of life, with significant improvements in only 4 of 15 indicators. Whether the implicated processes confer developmental advantages is unknown and represents an important area for future research. This trial was registered at www.clinicaltrials.gov as NCT01174875.

摘要

背景

母乳喂养已被证明可提高儿童的全球智力水平。然而，很少有研究在亚洲人群中检测到母乳喂养与婴儿出生后前 2 年特定认知任务表现之间的关联。

目的

我们评估了健康足月亚洲儿童在婴儿期前 2 年中早期婴儿喂养与认知发展详细指标之间的关联。

设计

在一项前瞻性队列研究中，对 408 名来自无并发症妊娠的健康儿童（体重 >2500 且 <4000 g，胎龄 ≥37 周，5 分钟 Apgar 评分≥9）进行神经认知测试。测试包括记忆（延迟模仿、关系绑定、习惯化）和注意力任务（视觉期待、听觉异常）以及贝利婴幼儿发育量表第三版（BSID-III）。根据母乳喂养持续时间和专一性，儿童分为 3 组（低、中、高）。

结果

在控制了潜在的混杂变量后，在 15 项测试中的 4 项测试中观察到了显著的关联和剂量反应关系。较高的母乳喂养暴露与 6 个月时更好的记忆相关，这表现为在关系记忆任务的早期部分（即关系绑定任务）中，儿童更倾向于正确匹配的项目（0.015 和 0.050 分别用于前两个 1000-ms 时间窗）。在 18 个月时未观察到母乳喂养的影响。在 24 个月时，母乳喂养的儿童在延迟模仿记忆任务中更有可能表现出序列记忆（趋势 P = 0.048），且接受母乳喂养较多的幼儿在接受性语言方面得分更高（中等和高母乳喂养组分别为+0.93（0.23，1.63）和+1.08（0.10，2.07），而低母乳喂养组得分较低），以及表达性语言[+0.58（-0.06，1.23）和+1.22（0.32，2.12），分别用于中等和高母乳喂养组]，通过 BSID-III 进行评估。

结论

我们的研究结果表明，母乳喂养对婴儿期前 2 年的某些记忆和语言发育方面具有较小但有意义的益处，仅在 15 项指标中的 4 项指标中显示出显著改善。这些过程是否会带来发育优势尚不清楚，这是未来研究的一个重要领域。该试验在 www.clinicaltrials.gov 上注册为 NCT01174875。