【作者】 周婷婷；

【导师】 彭咏梅； 郭志平； 李慧蓉；

【作者基本信息】 复旦大学 ， 儿科学， 2008， 硕士

【摘要】 【目的】通过比较孕哺期膳食脂肪酸含量差异,了解膳食脂肪酸水平对于母乳以及子代血浆磷脂中脂肪酸组成的影响;并通过对子代生长与发育情况的监测,进而探讨母乳以及血浆磷脂中脂肪酸水平对于婴幼儿生长发育的影响作用。【方法】研究选取两种不同膳食模式地区:江苏省常州市,膳食模式为普通中国南方膳食模式;浙江省温州市,膳食模式为海洋食品消费模式。分别在两地对入组孕母进行孕晚期(孕28周以后)7日前瞻实时膳食调查,根据《2002中国食物成分数据》计算膳食脂肪酸含量;随访过程中,在胎儿娩出时采集脐血,5天、42天及1岁时采集婴儿静脉血,并在5天、42天、4月时留取母乳样本,采用高效毛细气相色谱分析技术检测母乳及婴儿血浆磷脂中脂肪酸浓度。在常州地区,在胎儿娩出后的4个月内对哺乳期母亲再次进行7日膳食调查;并在出生、42天、2月、4月、6月、12月及18月时对这些小儿进行体重、身长、头围等生长指标的测量,6月、12月时根据Gesell发育量表进行认知发育评估。【结果】1.不同膳食模式地区膳食脂肪酸摄入量差异及对母初乳与脐血血浆磷脂中脂肪酸组成的影响①常州与温州两地孕母孕晚期摄入的膳食种类存在差异,温州地区孕母海洋食品摄入远大于常州地区,而植物油摄入则较低(P＜0.001)。②常州地区孕母膳食脂肪酸中亚油酸(LA)和α-亚麻酸(ALA)含量均明显高于温州地区(P＜0.05);而二十二碳六烯酸(DHA)和二十碳五烯酸(EPA)含量则都明显低于温州地区(P＜0.01);而花生四稀酸(AA)含量两地未见显著差异(P＞0.05)。③常州地区5天母初乳LA及ALA含量较温州地区高(P＜0.001),而DHA含量较低(P＜0.05);两地5天母初乳AA及EPA含量差异无统计学意义(P＞0.05)。④常州地区脐血血浆磷脂LA、ALA及AA含量较温州地区高(P＜0.05),但EPA含量较低(P＜0.001);两地脐血血浆磷脂DHA含量无显著差异(P＞0.05)。2.孕晚期和哺乳期膳食脂肪酸摄入量差异及对母乳与小儿血浆磷脂中脂肪酸组成的影响常州地区母亲孕晚期与哺乳期膳食摄入总量无显著差异,哺乳期母亲膳食摄入的海鲜类食品较孕晚期下降而蛋类、禽肉类及河鲜类食品则有增加(P＜0.05)。哺乳期膳食脂肪酸中AA含量较孕晚期显著增高(P＜0.001),而LA、ALA、EPA以及DHA含量无显著差异(P＞0.05)。膳食脂肪酸的这种变化与同一时期的母乳及婴儿血浆磷脂中脂肪酸组成的变化有较大差异。成熟乳与初乳相比,其中的LA、ALA含量明显增高(P＜0.05),AA、DHA含量明显下降(P＜0.001),而EPA含量无显著差异(P＞0.05)。42天血中LA、ALA、DHA含量较5天血增高而AA含量下降(P＜0.001),EPA含量无显著差异(P＞0.05)。3.母乳及脐血血浆磷脂中脂肪酸水平与婴幼儿生长的关系①婴儿出生体重与脐血AA/DHA以及n-6/n-3比例呈负相关(P＜0.05)。②脐血血浆磷脂LA及n-6/n-3比例与2、4、6月龄婴儿身长Z分值呈负相关(P＜0.05):AA/DHA比例则与42天、2及4月龄婴幼儿身长Z分值呈负相关(P＜0.05);而各时点的体重、头围及生长速率未发现与母乳或血浆磷脂中相应脂肪酸水平相关(P＞0.05)。③小儿血浆磷脂脂肪酸水平与BMI Z分值:·脐血血浆磷脂DHA及n-3 PUFAs与6、12、1 8月龄婴儿BMI Z分值呈负相关;n-6/n-3比例则与其呈正相关(P＜0.05)。·5天血血浆磷脂DHA及n-3 PUFAs与12月龄婴儿BMI Z分值呈负相关,n-6/n-3比例则与其呈正相关(P＜0.01)。·42天血浆磷脂DHA及n-3 PUFAs与2、4、6、12、18月龄婴儿BMI Z分值呈负相关;而n-6/n-3比例则与其呈正相关(P＜0.01)。4.母乳及脐血血浆磷脂中脂肪酸水平与婴儿发育的关系母乳以及血浆中的部分脂肪酸与婴儿Gesell DQ值存在相关关系,但这些相关并不具有一致结果。【结论】1.膳食模式不同的两个地区,孕晚期孕母膳食脂肪酸摄入量存在差异,并且这种差异可以影响母初乳以及脐血血浆磷脂脂肪酸组成,从而对胎儿及婴幼儿的生长发育产生影响。2.在同一膳食模式地区,从孕期到哺乳期,母亲膳食中脂肪酸摄入结构仅有较小变化,具有一定稳定性但也有其特殊性。而同期母乳及婴儿血浆磷脂脂肪酸变化与膳食存在较大不一致。这种变化可能更是一种适应性改变。3.脐血血浆磷脂LA、AA/DHA及n-6/n-3比例均与4、6月龄婴儿身长Z分值呈负相关;可以认为脐血血浆磷脂中n-6 PUFAs在婴儿早期的某一段时间内可能会对婴儿身长有一定负面影响,但其长期效应仍不能确定。4.婴儿早期血浆磷脂n-3 PUFAs水平可能对婴儿晚期生长具有显著影响:早期血浆磷脂中n-3 PUFAs(主要是其中的DHA)水平越高,则其在婴儿晚期可以得到更为理想的体重指数(BMI)。5.仅从南方膳食模式地区并未发现母乳及血浆部分脂肪酸与婴儿认知发育的相关关系,尚有待与海洋膳食模式地区数据的比较。更多还原

【Abstract】 ObjectiveTo investigate the influence of maternal fatty acid(FA) intake during pregnancy and lactation on FA composition of breast milk and infants’ plasma phospholipids;and the relationship between FA concentration of breast milk or infants’ blood and infants’ growth and development in their first 1.5 years.MethodsTwo districts with different dietary patterns were selected for study:one was Changzhou of Jiangshu province,which was an inland city with traditional Chinese southern dietary pattern;the other city was Wenzhou of Zhejiang provice,which was a coastal city with seafood dietary pattern.A 7-day dietary record was completed by women in their last trimester of pregnancy from these two places respectively.The FA composition in maternal diet was calculated using the 2002 Chinese food composition database.Umbilical cord blood samples were obtained when the umbilical cord was cut off at delivery.Blood samples from day 5,day 42 and month 12 of the infants were obtained by venipuncture.Breast milk samples were collected on postnatal day 5, day 42 and month 4.The FA composition of blood and breast milk was analyzed by capillary gas-liquid chromatography.In Changzhou,another 7-day dietary record was conducted by lactation mothers within 4 months after delivery.Anthropometric indices like weight,height and head circumference were measured at birth,day 42 and month 2,4,6,12,18.Cognitive assessment was estimated at 6 months and 1 year of age,using Gesell Developmental Diagnosis.Results1.The effect of different dietary patterns on maternal fatty acid intake and the fatty acid profile of colostrum and umbilical cord blood plasma phospholipids ①.There were significant differences in maternal dietary intake of LCPUFAs in these two areas,largely due to the higher intake of sea food and lower vegetable oil intake in Wenzhou(P＜0.001).②.Among mothers in Changzhou,linoleic acid(LA) andα-linolenic acid(ALA) intakes were higher(P＜0.05),while docosahexaenoic acid(DHA) and eicosapentaenoic acid(EPA) intakes were lower than mothers in Wenzhou(P＜0.01).There were no significant differences of arachidonic acid(AA) in maternal diet between these two areas(P＞0.05).③.The LA and ALA contents in colostrum of Changzhou were significantly higher than in that of Wenzhou(P＜0.001),while DHA content was significantly lower (P＜0.05).No significant differences were observed between sites in milk AA and EPA content(P＞0.05).④.The LA,ALA and AA contents in umbilical cord blood plasma phospholipids of Changzhou were significantly higher than in that of Wenzhou(P＜0.05),while EPA content was significantly lower(P＜0.001).There were no significant differences of DHA content between sites in cord blood plasma phospholipids(P＞0.05).2.The effect of maternal FA intake between pregnancy and lactation on FA composition of breast milk and infants’ plasma phospholipidsIn Changzhou,there were no significant differences of total maternal food intake between pregnancy and lactation.Among lactation mothers,the sea food intake decreased,but the intakes of eggs,white meats and freshwater food increased compared with pregnant women(P＜0.05).During lactation,the intake of AA significant increased(P＜0.001),but there were no significant differences of LA,ALA, EPA and DHA intakes between these two periods(P＞0.05).The changes of maternal dietary FA intake were inconsistent with those of FA composition in breast milk and infants’ plasma phospholipids.The LA and ALA contents were higher(P＜0.05) while the AA and DHA contents were lower(P＜0.001) in breast milk on day 42 than colostrums,but no significant differences were observed between milks in EPA content(P＞0.05).The LA,ALA and DHA contents in plasma phospholipids on day 42 were higher(P＜0.001),but the AA content was lower(P＜0.001) than in day 5 plasma. Meanwhile,there were no significant differences between day 5 and day 42 plasma in EPA content(P＞0.05).3.The relationship between FA status of breast milk or infants’ blood and infants’ growth in their first 1.5 years①.The birth weight of infants in Changzhou correlated negatively with the AA/DHA and n-6/n-3 ratio in cord blood plasma phospholipids(P＜0.05).②.The LA content and n-6/n-3 ratio in cord blood plasma phospholipids was inversely associated with the infants’ length Z scores in 2,4 and 6 months of age(P＜0.05).Meanwhile,the AA/DHA ratio in cord blood was inversely associated with the infants’ length Z scores in 42 days,4 and 6 months of age(P＜0.05).There were no significant correlations between FA status of breast milk or blood and the infants’ weight,head circumference or growth rate at any age beyond 1.5 years(P＞0.05).③.The relationship between FA status of infants’ blood plasma phospholipids and their BMI Z scores●The DHA and n-3 PUFAs contents in cord blood plasma phospholipids were inversely associated with the infants’ BMI Z scores in 6,12 and 18 months of age,while the n-6/n-3 ratio was positively associated with them(P＜0.05).●The DHA and n-3 PUFAs contents in plasma phospholipids on day 5 were inversely associated with the infants’ BMI Z scores in 12 months of age,while the n-6/n-3 ratio was positively associated with them(P＜0.01).●The DHA and n-3 PUFAs contents in plasma phospholipids on day 42 were inversely associated with the infants’ BMI Z scores in 2,4,6,12 and 18 months of age,while the n-6/n-3 ratio was positively associated with them(P＜0.01).4.The relationship between FA status of breast milk or infants’ blood and infants’ cognitive development in their first one year of lifeSome FA contents of breast milk and blood plasma phospholipids were associated with infants’ Gesell DQ(P＜0.05).But there were no consistent results of the relationship between FA status and infants’ cognitive development here.Conclusion1.There were significant differences in maternal intakes of FA depending on their dietary habits and these dietary differences appear to influence the FA composition of colostrum and umbilical cord blood,which could finally impact the infants’ growth and development.2.The maternal dietary FA intakes from pregnancy to lactation changed very little in mothers with the same dietary habits.The FA intakes were stable,but also with differences.But the FA composition in breast milk and infants’ plasma phospholipids between these two periods was not consistent with the dietary FA intakes.So,the FA composition in breast milk and infants’ plasma phospholipids may change with adaptive situations.3.The LA content,AA/DHA and n-6/n-3 ratios in cord blood plasma phospholipids were inversely associated with the infants’ length Z scores in 4 and 6 months of age. So we think the n-6 PUFAs content in cord blood would have an inverse effect on infants’ length during early infancy,but its long term effect cannot be ensured now.4.The n-3 PUFAs content in plasma phospholipids during early infancy may have great impact on infants’ growth later.Highlight the blood n-3 PUFAs content(especially DHA) in early infancy may help the infants to achieve optimal body mass index (BMI) later.5.No exact relationships between FA status in breast milk or infants’ blood plasma phospholipids and infants’ cognitive development during the first year have been confirmed in the population with traditional Chinese southern dietary pattern. Further results will be made after being compared to the population with seafood dietary pattern.更多还原