臺灣博碩士論文加值系統

兒童期是影響未來體位及飲食習慣的重要時期，國外研究發現出生體重左右了人們一生生長及慢性病發展，而此期間營養攝取是兒童生長發展的關鍵，所以探討本土不同出生體重兒童在兒童時期之飲食營養攝取是否具有差異及對其生長發展有何影響是本研究想進了解的方向。
本研究為世代研究，對象主要來自於民國91及93年所招募之2個長期追蹤世代。將募集到的受試者以出生體重之第25及75百分位分為3組：相對低出生體重(relative low birth weight infants, rLBW)、相對適當出生體重(relative adequate birth weight infants, rABW)及相對高出生體重(relative high birth weight infants, rHBW)，每年定期以電話訪問收集24小時飲食回憶、體位等資料，持續追蹤兒童至10歲(n=94)。統計軟體使用SPSS 22.0及STATA 8.0進行分析。
生長發展分析結果發現，不同出生體重兒童0~10歲體重、身高、BMI均達顯著差異，10年來相對高出生體重組兒童之體位均顯著較高(p<0.05)，而相對低出生體重組則依然保持最低。兒童0~2歲生長追上(z>0.67)之相關分析中發現，不論在體重、身高或是BMI等方面，相對低出生體重組生長追上的比例顯著高於相對高出生體重組；且生長追上組之10歲體重、BMI顯著較高(p<0.05)。
飲食營養攝取中，兒童熱量及能量營養素在10年來呈現顯著增加(p for trend < 0.001)，然而4~10歲鈣質攝取量明顯不足(337~357mg)。兒童每公斤體重熱量及能量營養素攝取隨時間增加而降低(p for trend < 0.001)，但每公斤體重蛋白質攝取均較建議值高（10歲攝取量為1.77g/kg）。而比較不同出生體重兒童歷年營養素攝取時發現，10歲時熱量及營養素攝取多未出現顯著差異(p>0.05)。相關性分析中，兒童歷年之每公斤體重熱量及能量營養素多與10歲體位呈負相關，這也意味著早期每公斤體重熱量及能量營養素攝取量低，10歲體位較高。多元迴歸分析中，單獨放入10歲每公斤體重熱量及能量營養素時發現，每公斤體重熱量及能量營養素與10歲體位呈現負相關，但在個別每公斤體重能量營養素之模式中同時加入熱量時可以觀察到，每公斤體重熱量、脂質與10歲體位仍呈負相關，但每公斤體重蛋白質及醣類攝取呈現正相關。
在體重反彈分析中，早、晚期組體重反彈年齡分別為5及6歲；早期組發生體重反彈（5歲）之後，其平均BMI均高於晚期組。此外，兒童早期每公斤體重蛋白質攝取與體重反彈年齡呈負相關，也就是說早期每公斤體重蛋白質攝取高，體重反彈較早發生，伴隨著未來BMI也就越高。
綜合以上，雖然出生體重、生長追上及體重反彈等因素均影響兒童10歲時體位之分布，但同時兒童早期之每公斤體重熱量及能量營養素亦提供了兒童未來生長之潛在資訊，故了解兒童早期營養攝取並提供適當飲食對其生長發展以及健康狀況格外重要。

Childhood is an important period that affects the body size and eating habits. However, the recent studies have found that birth weight contributes to the development of growth and chronic diseases. Therefore, nutrition status is the key to growth development of children with different birth weights. This study would explore whether dietary nutrition intakes were different in children with different birth weights and how nutrition status benefits the growth development of these children.
The study was a cohort study. The subjects were recruited in 2002 and 2004 from two cohorts. The subjects were divided into three groups according to the 25th and 75th percentile cut points: relative low birth weight (rLBW), relative adequate birth weight (rABW) and relative high birth weight (rHBW). Interviewers gathered the 24-hour dietary recalls, anthropometric measures, and other information of children every year by telephone interviews until children was ten. The software packages of SPSS 22.0 and STATA 8.0 were employed for statistical analysis.
From birth to 10 years old, the results of anthropometric measurements of different birth groups showed that children of different birth weight groups were significantly different in weight, height and BMI (p<0.05). The rHBW group was always with highest and the rLBW group with the lowest mean among the three groups. We analyzed the various indicators of different growth rates. The prevalence of rLBW in the catch-up group (0~2 year, z >0.67) was significantly higher than rHBW and children of catch-up group was significantly heavier and taller (p<0.05).
Energy, protein, fat and carbohydrate intakes of children increased annually but calcium intake was with a mean of 357 mg which was much lower than the recommended value. Although energy per kilogram of body weight and energy nutrients per kilogram of body weight intake decreased year by year, protein per kilogram of body weight intake was higher than the recommended dietary allowance (1.8g/kg at 10). In addition, the energy and nutrient intakes were not significantly different among the three birth weight groups (p>0.05). The results from the correlation analyses showed the energy per kilogram of body weight and energy nutrients per kilogram of body weight intake were negative correlated with the weight, height and BMI at the age of 10 years. By the multiple regression analysis, when the variable of energy per kilogram of body weight and energy nutrients per kilogram of body weight intake singly enter the models, we could find the energy and energy nutrients were negatively associated with the weight, height and BMI at 10. Entering the energy nutrients into the energy model, you found the results that the energy and fat were still negatively correlated with growth indicators at 10 but the protein and carbohydrate were positively with growth indicators.
The mean age at adiposity rebound of children in earlier and later rebound groups was five and six years old, respectively. After adiposity rebound of earlier rebound group appeared, the later BMI values of earlier rebound group were higher than later rebound group. Moreover, the protein per kilogram of body weight intake early in life was negatively associated with the age at adiposity rebound. Therefore our data suggested that the children with higher protein intake early in life might have the earlier the adiposity rebound, and consequently, had the higher subsequent BMI.
In conclusion, our results showed that birth weight, catch-up growth and adiposity rebound had influence on body size at 10. This study found that the energy per kilogram of body weight and energy nutrients per kilogram of body weight intakes were indicators of children growth status at the same time. Therefore, we should pay attention to provide adequate diet early in life for children to support good growth and health status.

第一章 緒論
第一節 研究動機 1
第二節 研究目的與問題 2
第三節 名詞解釋 4

第二章 文獻探討
第一節 兒童期飲食變遷與生長發展之相關研究 7
一、嬰幼兒飲食攝取與生長發展之相關研究 7
二、學齡前兒童飲食攝取與生長發展之相關研究 10
三、學齡期兒童飲食攝取與生長發展之相關研究 12
第二節 兒童出生體重與其生長發展之相關研究 14
一、出生體重對於兒童生長發展之影響 14
二、出生體重對於兒童未來健康發展之影響 15
第三節 兒童生長發展之其他相關研究 17
一、兒童體重反彈 17
二、兒童生長速度 19

第三章 研究方法
第一節 研究架構、研究設計與實施程序 21
第二節 研究對象 26
第三節 研究工具 30
第四節 資料處理與統計分析 33

第四章 研究結果
第一節 家庭基本資料 41
第二節 兒童體型探討 49
第三節 兒童營養攝取探討 98
第四節 兒童體重反彈探討 161

第五章 討論
第一節 兒童體型探討 180
第二節 兒童飲食變遷與營養攝取探討 185
第三節 兒童生長發展與飲食攝取之探討 193
第四節 兒童體重反彈探討 196

第六章 研究限制與建議 199

第七章 結論 203

參考文獻
一、 中文文獻 206
二、 英文文獻 208

附錄
附錄一 學童十歲問卷 217
附錄二 研究參與者同意書 225

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