CAJ | 학술논문

背景:维生素A缺乏性疾病是一个世界性的儿童健康问题,中国西部及边远地区尤为严重,需要进行营养干预.目的:比较补充3种不同剂量强化维生素A饼干对3～6岁儿童维生素A营养状况的改善效果,探索预防维生素A缺乏性疾病的强化饼干的理想剂量.设计:随机对照观察.单位:重庆市卫生局卫生监督所、重庆医科大学公共卫生学院营养与食品卫生学教研室和重庆医科大学儿童医院儿童营养研究中心.对象:调查于2002-03/12完成,选择重庆市巴南区8个幼儿园的3～6岁儿童753名,监护人均知情同意.随机分为4组,即30%推荐摄入量组、100%推荐摄入量组、2万国际单位组及20万国际单位组.方法:①30%推荐摄入量组(177名)每日补充维生素A 30%每日推荐摄入量(500IU)强化饼干1次.②100%推荐摄入量组(173名)每日补充维生素A 100%每日推荐摄入量(1 666IU)强化饼干1次.③2万国际单位组(209名)每周补充维生素A 2万国际单位强化饼干1次.④20万国际单位组(194名)补充维生素A 20万国际单位胶丸1次.所有儿童干预前及干预3个月时测定身高、体质量、血清视黄醇、前白蛋白、血红蛋白及视黄醇结合蛋白.30%推荐摄入量组中有87名儿童在补充9个月后再次复查以上指标.主要观察指标:①各组儿童干预前及干预3个月后维生素A缺乏性疾病检出率.②各组儿童干预前及干预3个月后血清视黄醇、血清前白蛋白、血清视黄醇结合蛋白、血红蛋白、身高和体质量.结果:因样本流失和检测技术的问题,复查仅得580名儿童的检测结果.①各组儿童维生素A缺乏性疾病检出率比较:补充3个月后,30%推荐摄入量组、100%推荐摄入量组、2万国际单位组及20万国际单位组儿童维生素A缺乏性疾病检出率均较治疗前显著下降[1.48%,1.42%,1,21%,2.16%;6.78%,6.54%,8.61%,8.25%(χ2=3.86～8.57,P＜0.05～0.01)].②各组儿童血清视黄醇、血清前白蛋白、血清维生素A、血红蛋白、身高和体质量比较:补充3个月后,自身对照除30%推荐摄入量组的前白蛋白和血红蛋白外,各组儿童其余各项指标均明显增加(t=2.52～37.44,P＜0.05～0.01).2万国际单位组血清维生素A的升高幅度明显大于其他组(F=4.62,P＜0.01),30%推荐摄入量组血红蛋白、前白蛋白和身高的增长幅度明显小于其他组(F=5.0～7.78,P＜0.01).30%推荐摄入量组补充9个月后,血红蛋白和前白蛋白的升高明显大于其余组(F=11.62,10.21,P＜0.01),血清视黄醇的升高仍低于2万国际单位组(F=4.21,P＜0.01).结论:补充3种不同剂量的维生素A强化饼干和20万国际单位维生素A胶丸,均可明显改善维生素A的营养状况和血红蛋白水平.其中30%推荐摄入量和100%推荐摄入量风险小、且每日补充能稳定维持体内维生素A水平,可能是更适于儿童的长期补充剂量,而30%推荐摄入最优于100%推荐摄入量. 揹景:維生素A缺乏性疾病是一箇世界性的兒童健康問題,中國西部及邊遠地區尤為嚴重,需要進行營養榦預.目的:比較補充3種不同劑量彊化維生素A餅榦對3～6歲兒童維生素A營養狀況的改善效果,探索預防維生素A缺乏性疾病的彊化餅榦的理想劑量.設計:隨機對照觀察.單位:重慶市衛生跼衛生鑑督所、重慶醫科大學公共衛生學院營養與食品衛生學教研室和重慶醫科大學兒童醫院兒童營養研究中心.對象:調查于2002-03/12完成,選擇重慶市巴南區8箇幼兒園的3～6歲兒童753名,鑑護人均知情同意.隨機分為4組,即30%推薦攝入量組、100%推薦攝入量組、2萬國際單位組及20萬國際單位組.方法:①30%推薦攝入量組(177名)每日補充維生素A 30%每日推薦攝入量(500IU)彊化餅榦1次.②100%推薦攝入量組(173名)每日補充維生素A 100%每日推薦攝入量(1 666IU)彊化餅榦1次.③2萬國際單位組(209名)每週補充維生素A 2萬國際單位彊化餅榦1次.④20萬國際單位組(194名)補充維生素A 20萬國際單位膠汍1次.所有兒童榦預前及榦預3箇月時測定身高、體質量、血清視黃醇、前白蛋白、血紅蛋白及視黃醇結閤蛋白.30%推薦攝入量組中有87名兒童在補充9箇月後再次複查以上指標.主要觀察指標:①各組兒童榦預前及榦預3箇月後維生素A缺乏性疾病檢齣率.②各組兒童榦預前及榦預3箇月後血清視黃醇、血清前白蛋白、血清視黃醇結閤蛋白、血紅蛋白、身高和體質量.結果:因樣本流失和檢測技術的問題,複查僅得580名兒童的檢測結果.①各組兒童維生素A缺乏性疾病檢齣率比較:補充3箇月後,30%推薦攝入量組、100%推薦攝入量組、2萬國際單位組及20萬國際單位組兒童維生素A缺乏性疾病檢齣率均較治療前顯著下降[1.48%,1.42%,1,21%,2.16%;6.78%,6.54%,8.61%,8.25%(χ2=3.86～8.57,P＜0.05～0.01)].②各組兒童血清視黃醇、血清前白蛋白、血清維生素A、血紅蛋白、身高和體質量比較:補充3箇月後,自身對照除30%推薦攝入量組的前白蛋白和血紅蛋白外,各組兒童其餘各項指標均明顯增加(t=2.52～37.44,P＜0.05～0.01).2萬國際單位組血清維生素A的升高幅度明顯大于其他組(F=4.62,P＜0.01),30%推薦攝入量組血紅蛋白、前白蛋白和身高的增長幅度明顯小于其他組(F=5.0～7.78,P＜0.01).30%推薦攝入量組補充9箇月後,血紅蛋白和前白蛋白的升高明顯大于其餘組(F=11.62,10.21,P＜0.01),血清視黃醇的升高仍低于2萬國際單位組(F=4.21,P＜0.01).結論:補充3種不同劑量的維生素A彊化餅榦和20萬國際單位維生素A膠汍,均可明顯改善維生素A的營養狀況和血紅蛋白水平.其中30%推薦攝入量和100%推薦攝入量風險小、且每日補充能穩定維持體內維生素A水平,可能是更適于兒童的長期補充劑量,而30%推薦攝入最優于100%推薦攝入量.
배경:유생소A결핍성질병시일개세계성적인동건강문제,중국서부급변원지구우위엄중,수요진행영양간예.목적:비교보충3충불동제량강화유생소A병간대3～6세인동유생소A영양상황적개선효과,탐색예방유생소A결핍성질병적강화병간적이상제량.설계:수궤대조관찰.단위:중경시위생국위생감독소、중경의과대학공공위생학원영양여식품위생학교연실화중경의과대학인동의원인동영양연구중심.대상:조사우2002-03/12완성,선택중경시파남구8개유인완적3～6세인동753명,감호인균지정동의.수궤분위4조,즉30%추천섭입량조、100%추천섭입량조、2만국제단위조급20만국제단위조.방법:①30%추천섭입량조(177명)매일보충유생소A 30%매일추천섭입량(500IU)강화병간1차.②100%추천섭입량조(173명)매일보충유생소A 100%매일추천섭입량(1 666IU)강화병간1차.③2만국제단위조(209명)매주보충유생소A 2만국제단위강화병간1차.④20만국제단위조(194명)보충유생소A 20만국제단위효환1차.소유인동간예전급간예3개월시측정신고、체질량、혈청시황순、전백단백、혈홍단백급시황순결합단백.30%추천섭입량조중유87명인동재보충9개월후재차복사이상지표.주요관찰지표:①각조인동간예전급간예3개월후유생소A결핍성질병검출솔.②각조인동간예전급간예3개월후혈청시황순、혈청전백단백、혈청시황순결합단백、혈홍단백、신고화체질량.결과:인양본류실화검측기술적문제,복사부득580명인동적검측결과.①각조인동유생소A결핍성질병검출솔비교:보충3개월후,30%추천섭입량조、100%추천섭입량조、2만국제단위조급20만국제단위조인동유생소A결핍성질병검출솔균교치료전현저하강[1.48%,1.42%,1,21%,2.16%;6.78%,6.54%,8.61%,8.25%(χ2=3.86～8.57,P＜0.05～0.01)].②각조인동혈청시황순、혈청전백단백、혈청유생소A、혈홍단백、신고화체질량비교:보충3개월후,자신대조제30%추천섭입량조적전백단백화혈홍단백외,각조인동기여각항지표균명현증가(t=2.52～37.44,P＜0.05～0.01).2만국제단위조혈청유생소A적승고폭도명현대우기타조(F=4.62,P＜0.01),30%추천섭입량조혈홍단백、전백단백화신고적증장폭도명현소우기타조(F=5.0～7.78,P＜0.01).30%추천섭입량조보충9개월후,혈홍단백화전백단백적승고명현대우기여조(F=11.62,10.21,P＜0.01),혈청시황순적승고잉저우2만국제단위조(F=4.21,P＜0.01).결론:보충3충불동제량적유생소A강화병간화20만국제단위유생소A효환,균가명현개선유생소A적영양상황화혈홍단백수평.기중30%추천섭입량화100%추천섭입량풍험소、차매일보충능은정유지체내유생소A수평,가능시경괄우인동적장기보충제량,이30%추천섭입최우우100%추천섭입량.
BACKGROUND: Vitamin A deficiency disorders (VADD) is a healthy problem of children in the world, especially in the west of China and remote areas, and the nutritional intervention is needed.OBJECTIVE: To compare the improved effects of biscuits fortified with three different doses of vitamin A on the vitamin A status in children aged 3-6 years and explore ap ideal dose of vitamin A supplement for preventing VADD.DESIGN: Randomized controlled observation.SETTING: Health Surveillance Institute, Chongqing Municipal Health Bureau; Staff Room of Nutrition and Food Hygiene, College of Public Health, Chongqing University of Medical Sciences; Center for Children Nutrition, Children's Hospital, Chongqing University of Medical Sciences.PARTICIPANTS: The investigation was done between March and December 2002. 753 children aged 3-6 years from 8 kindergartens in Banan district of Chongqing city were enrolled with the agreement of their guardians. They were divided randomly into 4 groups: 30% recommended intake group, 100% recommended intake group, 20 000 international unit (IU) and 200 000 IU groups.METHODS: ① The biscuits fortified with 30% recommended intake of vitamin A (500 IU) were once given to people of the 30% recommended intake group (177 cases) every day. ②The biscuits fortified with 100% recommended intake of vitamin A (1666 IU) were once given to people of the 100% recommended intake group (173 cases) every day. ③The biscuits fortified with 20 000 IU of vitamin A were once given to people of the 20 000 IU group (209 cases) every week. ④The soft gelatin capsule with 200 000 IU of vitamin A were once given to people of the 200 000 IU group (194 cases).Height, body mass, serum retinal, prealbumin, haematoglobin and retinal binding protein of all children were measured before intervention and after intervention for 3 months. Above indexes were rechecked after supplement for 9 months in 87 children of 30% recommended intake groupMAIN OUTCOME MEASURES: ①Prevalence rate of VADD before in-tervention and after intervention for 3 months in children of every group.② Serum retinal, serum prealbumin, serum retinal binding protein,haematoglobin, height and body mass of children before intervention and after interventional for 3 months in every group.RESULTS: Because of lose of samples and detective technology, only 580 children' examination results were got by rechecking. ①Comparison of the prevalence rate of VADD of children in every group: Three months supplementation later, the prevalence of VADD in every group all decreased sig nificantly [1.48%,1.42%,1.21%, 2.16% ;6.78%,6.54%,8.61%,8.25%(χ2=3.86-8.57, P ＜ 0.05-0.01 )]. ②Comparison of serum retinal, serum prealbumin, serum retinal binding protein, haematoglobin, height and body mass of children of every group: After supplement for 3 months, except prealbumin and haematoglobin in the 30% recommended intake group ,other indexes in each group all increased significantly (t=2.52-37.44, P＜ 0.05-0.01 ). The increase of serum vitamin A in the 20 000 IU group was larger than that in the other groups (F=4.62,P＜ 0.01 ). The increases of haematoglobin, prealbumin and height in the 30% recommended intake group were less than those in the other groups (F=5.04-7.78 ,P ＜ 0.01 ).After supplement for 9 months, the increases of haematoglobin and prealbumin in the 30% recommended intake group were larger than those in the other groups (F= 11.62,10.21 ,P ＜ 0.01). The increase of serum retinal was still lower than that in the 20 000 IU group (F=4.21 ,P ＜ 0.01 ).CONCLUSION: Supplement with biscuits fortified with 3 different doses of vitamin A and capsule with 200 000 IU of vitamin A can improve obviously the nourished status of vitamin A and the level of ferrohemoglobin, in which 30% recommended intake and 100% recommended intake have small risk, and everyday supplement can maintain stably the level of vitamin A. That may be suitable for the long-term supplement for children, and the effect of 30% recommended intake was better than that of 100% recommended intake.