婴儿喂养方式反映了尼泊尔儿童患干眼病的前期风险。

Gittelsohn J, Shankar A V, West K P, Ram R, Dhungel C, Dahal B

Center for Human Nutrition, School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.

Eur J Clin Nutr. 1997 Jul;51(7):484-90. doi: 10.1038/sj.ejcn.1600435.

OBJECTIVE

To determine the relationship between infant feeding history and risk of xerophthalmia due to vitamin A deficiency (VAD) in early childhood.

DESIGN

A case-control study of previously xerophthalmic and non-xerophthalmic children.

SETTING

Rural lowland region of Nepal.

SUBJECTS

One hundred and fifty-six children (aged 1-6 y old), half of whom previously had xerophthalmia due to vitamin A-deficiency, the other half matched by locale, age and the presence and age of a younger sibling (n = 102).

METHODS

Xerophthalmia was determined by trained ophthalmic assistants on the basic of current Bitot's spots, corneal xerosis or report of night blindness. Infant feeding history was collected through a diet history method obtained from the mother of the focus child. Exploratory factor analysis was conducted to determine the presence of underlying patterns in infant feeding practices. Conditional logistic regression was used to estimate odds ratios.

RESULTS

Mothers of control children tended to have a higher level of education (P < 0.10) and to have fewer children who had died (P < 0.10) than mothers of case children. Feeding of meat (OR = 0.09, CI = 0.01-0.70) or fish (OR = 0.41, CI = 0.17-0.99) with liver, eggs (OR = 0.11, CI = 0.01-0.88) and mango (OR = 0.28, CI = 0.13-0.60) were protective in association with xerophthalmia in early childhood. Factor analysis uncovered several distinct patterns in infant feeding, which varied by age of the infant. Only the 'animal flesh' feeding pattern (factor), practiced in the second year of life, proved significantly protective from xerophthalmia (OR = 0.43, CI = 0.20-0.94). Feeding patterns of younger children closely paralleled those of their older siblings with and without VAD.

CONCLUSIONS

The study supports the hypothesis that infant dietary practices can influence subsequent risk for VAD. Our findings emphasize the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.

目的

确定婴儿喂养史与幼儿期维生素A缺乏（VAD）所致干眼症风险之间的关系。

设计

一项针对既往患有干眼症和未患干眼症儿童的病例对照研究。

地点

尼泊尔农村低地地区。

研究对象

156名儿童（年龄1 - 6岁），其中一半曾因维生素A缺乏而患干眼症，另一半按地区、年龄以及同胞弟妹的存在情况和年龄进行匹配（n = 102）。

方法

由经过培训的眼科助理根据当前的毕脱斑、角膜干燥症或夜盲症报告来确定是否患有干眼症。通过从重点儿童的母亲那里获取饮食史的方法来收集婴儿喂养史。进行探索性因素分析以确定婴儿喂养方式中潜在模式的存在情况。使用条件逻辑回归来估计比值比。

结果

与病例组儿童的母亲相比，对照组儿童的母亲往往受教育程度更高（P < 0.10）且子女死亡数更少（P < 0.10）。食用肉类（比值比 = 0.09，可信区间 = 0.01 - 0.70）或鱼类（比值比 = 0.41，可信区间 = 0.17 - 0.99）以及肝脏、鸡蛋（比值比 = 0.11，可信区间 = 0.01 - 0.88）和芒果（比值比 = 0.28，可信区间 = 0.13 - 0.60）对预防幼儿期干眼症具有保护作用。因素分析揭示了婴儿喂养中几种不同的模式，这些模式因婴儿年龄而异。仅在生命的第二年实行的“动物肉类”喂养模式（因素）被证明对干眼症有显著的保护作用（比值比 = 0.43，可信区间 = 0.20 - 0.94）。年龄较小儿童的喂养模式与其有或没有VAD的哥哥姐姐的喂养模式密切相似。