Smith M M, Lifshitz F
Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY 11219.
Pediatrics. 1994 Mar;93(3):438-43.
To determine whether excessive consumption of fruit juice is a contributing factor in nonorganic failure to thrive in early childhood.
Eight patients, aged 14 to 27 months, referred for failure to thrive were evaluated by medical history, physical examination, and biochemical assessment. Growth patterns were reviewed and anthropometric measurements including skinfold thickness and midarm circumference were obtained. Diet history included 3-day food records and 24-hour diet recalls. An open-ended interview explored factors associated with fruit juice consumption. Breath hydrogen testing of fructose, sorbitol, or fruit juice was performed in three children who had a history of diarrhea or gastrointestinal complaints. Nutritional intervention focused on reducing fruit juice consumption and increasing the energy and nutrient density of the children's diets.
In each case, deterioration of weight and linear growth progression coincided with excessive juice consumption. All children exhibited weights < 5th percentile and five also had lengths < -5th percentile. Weight-for-length deficits ranged from 11% to 25%. Two patients demonstrated low arm muscle mass and five children had diminished fat stores. Organic disease was ruled out in all cases. Three children had iron deficiency. The children's diets were hypocaloric, providing 78% to 92% of recommended energy intake for age and weight. Dietary intake included considerable juice consumption (12 to 30 oz/d). Fruit juice, primarily apple juice, contributed 25% to 60% of daily energy intake. As a result, food consumption was reduced; lowering dietary protein, fat, and micronutrient intakes. Excessive juice was consumed for various reasons including children's preferences, parental health beliefs, behavioral feeding difficulties, and financial considerations. Breath hydrogen testing revealed malabsorption of fructose and/or sorbitol. After nutritional intervention, dietary intake increased to 96% to 116% of recommended intakes. Weight gain increased significantly in the first month and persisted for follow-up of 5 to 18 months.
These findings indicate that large intakes of fruit juices may displace more calorie- and nutrient-dense foods. Additionally, fructose and sorbitol malabsorption may occur. Excess fruit juice consumption may present a contributing factor in nonorganic failure to thrive.
确定过量饮用果汁是否是幼儿非器质性生长发育不良的一个促成因素。
对8名年龄在14至27个月、因生长发育不良前来就诊的患儿进行病史、体格检查和生化评估。回顾生长模式并获取人体测量数据，包括皮褶厚度和上臂围。饮食史包括3天的食物记录和24小时饮食回顾。通过开放式访谈探究与果汁饮用相关的因素。对3名有腹泻或胃肠道不适病史的儿童进行果糖、山梨醇或果汁的呼气氢试验。营养干预的重点是减少果汁饮用并提高儿童饮食的能量和营养密度。
在每个病例中，体重和线性生长进程的恶化都与过量饮用果汁同时出现。所有儿童的体重均低于第5百分位数，5名儿童的身高也低于第 -5百分位数。身高别体重不足范围为11%至25%。2名患者显示上臂肌肉量低，5名儿童脂肪储备减少。所有病例均排除了器质性疾病。3名儿童缺铁。儿童的饮食热量不足，提供的能量为年龄和体重推荐摄入量的78%至92%。饮食摄入包括大量的果汁饮用（12至30盎司/天）。果汁，主要是苹果汁，占每日能量摄入的25%至60%。结果，食物摄入量减少；降低了饮食中的蛋白质、脂肪和微量营养素摄入量。过量饮用果汁的原因多种多样，包括儿童的偏好、家长的健康观念、喂养行为困难和经济因素。呼气氢试验显示果糖和/或山梨醇吸收不良。营养干预后，饮食摄入量增加到推荐摄入量的96%至116%。体重在第一个月显著增加，并在5至18个月的随访中持续增加。
这些发现表明，大量饮用果汁可能会取代热量和营养密度更高的食物。此外，可能会出现果糖和山梨醇吸收不良。过量饮用果汁可能是幼儿非器质性生长发育不良的一个促成因素。
