【摘要】：目的:哺乳期婦女處在一個(gè)特殊的生理狀態(tài)并且對(duì)于營(yíng)養(yǎng)的需求較高,母親分泌的乳汁對(duì)于嬰兒的生長(zhǎng)發(fā)育起至關(guān)重要的作用。母乳中的脂肪酸對(duì)嬰兒的身心健康具有重要意義而脂肪酸水平受乳母膳食的影響。因此,本研究旨在分析長(zhǎng)春市201例乳母膳食營(yíng)養(yǎng)素?cái)z入情況并將其攝入的食物種類(lèi)利用因子分析法分成4種膳食模式,研究膳食模式與乳汁脂肪酸構(gòu)成譜的關(guān)系。方法:研究對(duì)象來(lái)自長(zhǎng)春市某產(chǎn)后護(hù)理中心、吉林省婦幼保健院以及本小組通過(guò)網(wǎng)絡(luò)平臺(tái)宣傳招募的志愿者。納入標(biāo)準(zhǔn):健康乳母且為純母乳喂養(yǎng)或混合喂養(yǎng)嬰兒,嬰兒足月分娩,無(wú)出生缺陷或疾病。母親無(wú)吸煙、飲酒等不良嗜好。排除標(biāo)準(zhǔn):孕期37周或42周,嬰兒出生體重2500g或4000g。乳母患有高血壓、糖尿病、冠心病、肥胖癥、肝腎疾病和其他臟器合并疾病病史以及素食的乳母。孕期、哺乳期攝入多不飽和脂肪酸補(bǔ)充劑的乳母。研究對(duì)象均簽署知情同意書(shū),研究設(shè)計(jì)得到吉林大學(xué)公共衛(wèi)生學(xué)院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn)。采用面對(duì)面調(diào)查問(wèn)卷的形式收集研究對(duì)象的基本信息以及膳食信息,采用3d24h膳食回顧問(wèn)卷調(diào)查乳母膳食攝入情況,應(yīng)用金鑰匙營(yíng)養(yǎng)專(zhuān)家系統(tǒng)軟件—孕產(chǎn)婦版(上海營(yíng)康)對(duì)乳母膳食能量及營(yíng)養(yǎng)素?cái)z入情況進(jìn)行分析,同時(shí)利用乳母食物頻率問(wèn)卷以及《2009中國(guó)食物成分表》分析其膳食脂肪酸攝入情況。乳汁收集于乳母產(chǎn)后第22天~3個(gè)月,并置于-80℃冰箱保存。提取乳汁中脂肪酸并進(jìn)行甲酯化,用氣相色譜儀檢測(cè)母乳中脂肪酸甲酯水平,根據(jù)內(nèi)標(biāo)物C17:0的保留時(shí)間找到各脂肪酸色譜峰再利用甲酯轉(zhuǎn)換系數(shù)算出36種脂肪酸水平,根據(jù)脂肪酸水平計(jì)算出各脂肪酸所占比例。采用SPSS16.0統(tǒng)計(jì)軟件分析乳母基本信息,膳食5種脂肪酸、能量、各營(yíng)養(yǎng)素?cái)z入量,利用因子分析法的主成分分析將膳食種類(lèi)分為4種膳食模式,利用4種膳食模式與乳汁脂肪酸進(jìn)行多因素秩和檢驗(yàn)。將有意義的膳食模式與母乳脂肪酸水平進(jìn)一步做兩獨(dú)立樣本非參數(shù)檢驗(yàn),分析不同膳食模式間脂肪酸水平的差異。所有統(tǒng)計(jì)檢驗(yàn)均為雙側(cè)檢驗(yàn),P0.05為差異具有顯著性。結(jié)果:1、201例乳母平均年齡30.00歲,孕周為39.29周,孕期平均增重16.00kg。大部分產(chǎn)婦孕前BMI在正常范圍(58.71%),文化程度以大學(xué)本科為主,占54.73%,研究生及以上學(xué)歷和高中及以下學(xué)歷人數(shù)分別占25.87%和16.42%。月家庭收入分為低收入(2000-5000元/月)、中等收入(5000-10000元/月)以及高收入(10000元/月以上)家庭,分別占16.42%、44.29%和27.86%。有92個(gè)產(chǎn)婦為自然生產(chǎn),占45.77%。2、乳母平均每天能量攝入為1829.42kcal,低于膳食營(yíng)養(yǎng)素參考攝入量(Dietary Reference Intakes,DRIs),由三大產(chǎn)能營(yíng)養(yǎng)素碳水化合物、蛋白質(zhì)和脂類(lèi)提供的能量分別為52.51%、14.42%和33.07%。三類(lèi)產(chǎn)能營(yíng)養(yǎng)素的供能比接近于推薦范圍,碳水化合物供能比在宏量營(yíng)養(yǎng)素可接受范圍(Acceptable Macronutrient Distribution Range,AMDR)內(nèi),而蛋白質(zhì)和脂類(lèi)供能比都稍高于推薦攝入量(Recommended Nutrient Intake,RNI)。3、乳母膳食中攝入的必需脂肪酸亞油酸(Linoleic acid,LA)和α-亞麻酸(Linolenic acid,ALA)的量分別為19.14g/d、2.40g/d,均超過(guò)適宜攝入量(Adequate Intake,AI)。二十碳五烯酸(Eicosapentaenoic acid,EPA)和二十二碳六烯酸(Docosahexenoic acid,DHA)平均攝入量分別為18.24mg/d和11.45mg/d,遠(yuǎn)遠(yuǎn)低于適宜攝入量。4、乳母膳食維生素?cái)z入量偏低,其中維生素A、維生素B1、維生素B2、維生素C和葉酸攝入量均低于RNI,分別占RNI的46.49%、61.33%、66.67%、47.19%、32.89%。維生素E和煙酸超過(guò)RNI,達(dá)到推薦攝入量的178.82%和101.93%。乳母膳食中礦物質(zhì)攝入的鈣、鈉嚴(yán)重不足,僅占RNI的43.86%和43.93%。鐵、鎂、鉀、硒攝入量也低于RNI,分別占RNI的78.50%、75.65%、67.66%和61.44%。只有銅的攝入量超過(guò)RNI,達(dá)到119.29%,鋅的攝入量接近RNI,占RNI的90.25%。5、通過(guò)因子分析的主成分分析將乳母膳食分成4種膳食模式,分別為以菌藻類(lèi)、肉類(lèi)、蛋類(lèi)、水產(chǎn)品為主的模式1;以水果、蔬菜為主的模式2;以豆制品和堅(jiān)果為主的模式3;以谷薯類(lèi)為主的模式4。6、本研究共檢測(cè)母乳中36種脂肪酸,飽和脂肪酸(Saturated fatty acid,SFA)16種,其水平占總脂肪酸的45.41%。其中以棕櫚酸(C16:0)為主,占19.62%;其次是硬脂酸(C18:0),占6.18%;月桂酸(C12:0)占5.27%;肉豆蔻酸(C14:0)占4.88%。單不飽和脂肪酸(Monounsaturated fatty acid,MUFA)9種,其水平占總脂肪酸的29.59%。以油酸(C18:1n9c)為主,占24.25%,其次是十六碳一烯酸(C16:1)占2.83%。多不飽和脂肪酸(Polyunsaturated fatty acids,PUFA)有11種,其水平占總脂肪酸的21.09%。其中n-6PUFA有7種,其水平占總脂肪酸的17.02%,n-3PUFA有4種,其水平占總脂肪酸的3.79%,兩個(gè)通路的脂肪酸含量均以其前體為主,LA和ALA,分別占總脂肪酸的13.70%和2.25%。n-6 PUFA和n-3 PUFA的主要產(chǎn)物花生四烯酸(Arachidonic acid,AA)和DHA分別占總脂肪酸的0.04%和0.94%。SFA:MUFA:PUFA為2.2:1.4:1,其中n-6PUFA:n-3PUFA為4.4:1。7、秩和檢驗(yàn)結(jié)果表明,SFA、PUFA、n-6 PUFA水平在四種膳食模式之間存在差異(P0.05)。兩兩模式間的非參數(shù)檢驗(yàn)結(jié)果顯示,對(duì)于母乳中SFA的水平,模式2乳母乳汁低于模式4乳母乳汁水平(P=0.009),母乳中n-6 PUFA水平,模式1的母乳低于模式2母乳水平(P=0.007),模式2母乳中PUFA、n-6PUFA水平均高于模式4的母乳水平(P=0.003,P=0.004)。結(jié)論:1、本研究對(duì)象中乳母膳食能量攝入低于推薦的能量需要量(Estimated Energy Requirement,EER),碳水化合物供能比在推薦范圍內(nèi),而蛋白質(zhì)、脂類(lèi)供能比高于DRIs。膳食中攝入的LA和ALA水平均高于DRIs推薦的乳母適宜攝入量,而EPA和DHA水平低于適宜攝入量。2、本研究對(duì)象中乳母膳食微量營(yíng)養(yǎng)素,只有維生素E、煙酸、銅高于推薦攝入量,其他維生素、礦物質(zhì)攝入量均低于推薦攝入量。3、本研究對(duì)象乳母乳汁中SFA水平,模式2低于模式4;母乳中PUFA水平,模式2高于模式4。
[Abstract]:Objective: breast-feeding women are in a special physiological state and have a high demand for nutrition. The milk secreted by mothers plays a vital role in the growth and development of infants. The fatty acids in the breast milk are important to the physical and mental health of the baby and the fatty acid level is influenced by the lactating diet. Therefore, this study aims to analyze the length of the milk. The intake of dietary nutrients from 201 cases of milk mother in spring city was divided into 4 dietary patterns by means of factor analysis, and the relationship between the dietary pattern and the composition of milk fatty acid was studied. Methods: the research object was from a postpartum nursing center in Changchun, the maternal and child health care hospital in Jilin province and the group through the network platform. Volunteers. Included in the standard: healthy breast mother and pure breastfeeding or mixed feeding infants, baby full moon delivery, no birth defects or diseases. Mother no smoking, drinking and other bad habits. Exclusion criteria: 37 or 42 weeks of pregnancy, 37 or 42 weeks of pregnancy, baby birth weight 2500g or 4000g. milk mother blood pressure, diabetes, coronary heart disease, obesity, liver and kidney disease and its His organs combined with the history of disease and the mother of vegetarian diet, pregnant, and lactating with polyunsaturated fatty acid supplements. All the subjects signed informed consent and the research and design were approved by the medical ethics committee of the school of public health of Jilin University. The dietary information was investigated by the 3d24h dietary review questionnaire. The dietary energy and nutrient intake of the milk mother were analyzed by using the golden key nutrition expert system software, the maternal version of the maternal Version (Shanghai camp Kang), and the dietary fatty acid intake of the milk mother and the 2009 Chinese food composition table. The milk was collected at ~3 months after twenty-second days after the milk mother and stored in the refrigerator at -80 C. The fatty acids in milk were extracted and methyl ester was extracted. The level of fatty acid methyl esters in breast milk was detected by gas chromatograph. According to the retention time of the internal standard C17:0, the fatty acid chromatographic peaks were found and the 36 fatty acid levels were calculated by the conversion coefficient of methyl ester. The proportion of fatty acids was calculated. The basic information of milk mother, 5 kinds of fatty acids, energy and nutrient intake were analyzed by SPSS16.0 software. The dietary types were divided into 4 dietary patterns by the principal component analysis of factor analysis. The multifactor rank and test of 4 dietary patterns and milk fatty acids were used. The significant dietary pattern and the milk fatty acid level were further tested by two independent samples, and the difference of fatty acid levels between different dietary patterns was analyzed. All the statistical tests were both bilateral tests. The difference in P0.05 was significant. Results: the average age of 1201 cases was 30 years, the pregnancy week was 39.29 weeks, and the average weight increased by 16.00kg. in pregnancy. In some parturients, BMI was in the normal range (58.71%), and the degree of education was mainly university, accounting for 54.73%. The number of graduate students and above and high school and below were 25.87% and 16.42%., respectively, and the family income was divided into low income (2000-5000 yuan / month), middle income (5000-10000 yuan / month) and high income (10000 yuan / month), respectively. 16.42%, 44.29% and 27.86%. have 92 mothers for natural production, accounting for 45.77%.2, and the average daily energy intake of the milk mother is 1829.42kcal, lower than the dietary nutrient reference intake (Dietary Reference Intakes, DRIs), and the energy supplied by three large capacity nutrients, carbohydrates, proteins and lipids is 52.51%, 14.42%, and 33.07%. three capacity battalions, respectively. The energy supply ratio of the nutrient is close to the recommended range, and the carbohydrate energy supply is within the acceptable range of Acceptable Macronutrient Distribution Range (AMDR), while the protein and lipid feed energy ratio is slightly higher than the recommended intake (Recommended Nutrient Intake, RNI).3, and the essential fatty acid linoleic acid (Linole) in the diet of the milk mother (Linole) The amount of ic acid, LA) and alpha linolenic acid (Linolenic acid, ALA) are 19.14g/d, 2.40g/d, which are higher than the appropriate intake (Adequate Intake, AI). The average intake of twenty carbon five enoic acids and twenty-two carbon six enoic acids, respectively, is far below the appropriate intake, milk mother. The intake of vitamin A, vitamin B1, vitamin B2, vitamin C and folic acid were lower than RNI, which accounted for 46.49%, 61.33%, 66.67%, 47.19%, 32.89%. vitamin E and nicotinic acid more than RNI, respectively, to the recommended intake of 178.82% and 101.93%. lactate diet calcium of mineral intake, severe deficiency of sodium, only RNI. 43.86% and 43.93%. iron, magnesium, potassium, selenium intake is also lower than RNI, accounting for 78.50% of RNI, 75.65%, 67.66% and 61.44%., only copper intake exceeds RNI, 119.29%, zinc intake is close to RNI, accounting for 90.25%.5 of RNI. By the principal component analysis of factor analysis, milk mother food is divided into 4 dietary patterns, respectively, bacteria algae, meats, eggs, water, respectively. The main product model 1; the model 2 with fruit and vegetable mainly; the model 3 with bean product and nut mainly; the model 4.6 with grain and potato mainly, this study detected 36 kinds of fatty acids in breast milk, saturated fatty acid (Saturated fatty acid, SFA), which accounted for the 45.41%. of total fatty acid (C16:0) mainly, accounting for 19.62%; secondly, Stearic acid (C18:0) accounted for 6.18%, lauric acid (C12:0) accounted for 5.27%, myristic acid (C14:0) accounted for 9 kinds of 4.88%. monounsaturated fatty acids (Monounsaturated fatty acid, MUFA), and the level of the total fatty acids accounted for oleic acid (C18:1n9c) mainly, accounting for 24.25%, followed by sixteen carbon enoic acid (C16:1) accounted for 2.83%. polyunsaturated fatty acids. S, PUFA) had 11 species, which accounted for 7 of the 21.09%. of total fatty acids, which accounted for 17.02% of the total fatty acids, 4 of n-3PUFA, and 3.79% of the total fatty acids. The two pathways of fatty acids were dominated by their precursors, LA and ALA, accounting for 13.70% of total fatty acids and the main product of 2.25%.n-6 PUFA and n-3 PUFA, peanut four ene. The acid (Arachidonic acid, AA) and DHA accounted for 0.04% of the total fatty acids and 2.2:1.4:1 respectively, and n-6PUFA:n-3PUFA was 4.4:1.7. The rank sum test results showed that SFA, PUFA, n-6 PUFA levels were different between the four dietary patterns. The non parametric test between the 22 patterns showed that the level of the breast milk was the norm. The milk level of type 2 was lower than that of model 4 (P=0.009), the level of n-6 PUFA in breast milk, breast milk in mode 1 was lower than that of mode 2 (P=0.007), and in model 2 breast milk, PUFA, n-6PUFA level was higher than that in mode 4 (P=0.003, P=0.004). Conclusion: 1, dietary energy intake of milk mother was lower than that of recommended energy requirement (Es). Timated Energy Requirement, EER), carbohydrate supply energy ratio is within the recommended range, while protein, lipid feed energy ratio is higher than DRIs. diet LA and ALA levels are higher than the recommended intake of DRIs recommended lactate, and EPA and DHA levels are lower than the appropriate intake.2, the dairy cow dietary micronutrients, only vitamin E, tobacco. Acid, copper was higher than recommended intake, other vitamins and mineral intake were lower than recommended intake.3. SFA level in milk mother milk was lower than model 4 in this study. PUFA level in breast milk was 2, pattern 2 was higher than model 4..
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R153.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郭齊雅;于冬梅;俞丹;王尋;許曉麗;房sリ，

本文編號(hào)：2164298