Krebs Nancy F
Section of Nutrition, Department of Pediatrics University of Colorado School of Medicine Aurora, CO 80045.
Nutr Today. 2014 Nov-Dec;49(6):271-277. doi: 10.1097/NT.0000000000000064.
The period of complementary feeding represents a major portion of the 1000 day critical window and thus impacts a period of substantial and dynamic infant development. This review highlights and synthesizes findings of several recent studies conducted to evaluate food based strategies on outcomes related to micronutrient status, growth and neurocognitive development. Particular emphasis is placed on interventions using meat or fortified products to impact iron and zinc intakes, due to the dependence of breastfed infants on complementary food choices to meet requirements for these two critical micronutrients. Regular consumption of modest amounts of meat or fortified cereals provides adequate absorbed zinc to meet estimated physiologic requirements, whereas homeostatic adaptation to lower zinc intake from unfortified cereal/plant staples is inadequate to meet requirements. Iron fortification of cereals may be somewhat more effective than meat to improve iron status, but neither prevents iron deficiency in breastfed infants, even in westernized settings. Improvements in the quality of complementary foods have had very modest effects on linear growth in settings where stunting is prevalent. Maternal education is strongly associated with both linear growth and with child neurodevelopment. The determinants of early growth faltering are more complex and intractable than 'simple' dietary deficiencies of micronutrients. Solutions to growth faltering in young children most likely need to be multi-factorial, and almost certainly will need to start earlier than the complementary feeding period.
辅食添加期是1000天关键窗口期的主要部分，因此会影响婴儿快速且动态的发育阶段。本综述着重介绍并综合了近期几项研究的结果，这些研究旨在评估基于食物的策略对与微量营养素状况、生长及神经认知发育相关结果的影响。由于母乳喂养的婴儿依赖辅食选择来满足这两种关键微量营养素的需求，因此特别强调了使用肉类或强化产品来影响铁和锌摄入量的干预措施。经常适量食用肉类或强化谷物可提供足够的可吸收锌，以满足估计的生理需求，而对未强化谷物/植物主食中较低锌摄入量的稳态适应不足以满足需求。谷物的铁强化在改善铁状况方面可能比肉类稍有效，但即使在西方化环境中，两者都无法预防母乳喂养婴儿缺铁。在发育迟缓普遍存在的环境中，辅食质量的改善对线性生长的影响甚微。母亲教育与线性生长和儿童神经发育都密切相关。幼儿早期生长发育迟缓的决定因素比微量营养素的“单纯”饮食缺乏更为复杂和棘手。解决幼儿生长发育迟缓问题的方法很可能需要多方面因素，而且几乎肯定需要比辅食添加期更早开始。
