儿科学:尽早添加辅食助婴儿睡眠 米果蔬 牛奶花生蛋芝鱼麦

邓文龙

作者：Michael Perkin 来源：《儿科学》

发布时间：2018/7/13 10:16:15

研究称尽早添加辅食有助改善婴儿睡眠

米和/或泥水果或蔬菜，牛奶，花生，鸡蛋，芝麻，白鱼和小麦  米果蔬牛奶蛋鱼花生芝麻麦

发表在最新一期《美国医学会杂志·儿科学》杂志上的一项新研究显示，给半岁以内的婴儿尽早添加辅食而非仅母乳喂养，可让宝宝的睡眠时间更长，夜醒次数更少。

英国伦敦大学国王学院和伦敦大学圣乔治医学院的研究人员在英格兰和威尔士随机选择了１３００多名３个月大的婴儿，将他们分成两组，其中一组半岁前纯母乳喂养，另外一组从３个月大起在母乳喂养的同时添加辅食。

婴儿一周岁前，研究人员要求父母每月完成一次在线调查问卷；１岁至３岁间，父母每３个月完成一次在线调查问卷，最终１２２５名婴幼儿的父母完成了此项调查。调查问卷内容包括辅食添加频率、母乳喂养频率和持续时间以及睡眠持续时间。

研究人员分析发现，尽早添加辅食的婴儿睡眠时间更久，夜里也不容易醒。两组婴儿在６个月时差异最大，尽早添加辅食的婴儿每晚平均多睡１６．６分钟，夜里醒来的次数从平均超过２次降低到１．７４次。

论文共同作者、伦敦大学圣乔治医学院研究人员迈克尔·珀金说，尽管睡眠时间和醒来频率只是略有改善，但婴儿睡眠直接影响父母生活质量，稍许改善可以带来重要好处。

不过，世界卫生组织目前推荐纯母乳喂养直至婴儿６个月，６个月后在继续母乳喂养的同时添加辅食。（来源：新华社 周舟）

https://jamanetwork.com/journals ... fullarticle/2686726

http://paper.sciencenet.cn/htmlpaper/201871310161590846745.shtm



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顾汉现

论文补充说明1中的eMethods :

Google译:

电子方法
向参与者提供有关固体食物介绍的说明
EIG介绍方案
按照正常的血液检测结果（全血细胞计数，骨骼，肝脏，肾脏和脂质谱）
测试），EIG婴儿然后开始介绍婴儿米和/或泥水果或蔬菜
第一周，直到他们建立固体食物。然后，他们继续使用这些固体
在第二周的两天推出了牛奶酸奶。在第三周和第四周的早期
引入方案，花生，煮鸡蛋，芝麻和白鱼（鳕鱼）顺序引入
随机订购每周推出两种新食品。最后，小麦在第五周被引入，
反映了EAT研究开始时关于小麦最佳时间的指导
四个月后的介绍1
到第六周，婴儿理想地消耗所需的量
每周六种致敏食物中的每一种
在这个过程中，非过敏性食物的引入并没有受到限制，而且是过敏性食物
一旦过敏性食物出现，可以与其他食物或其他食物一起给予
成功引入并且耐受良好。
诱导口服耐受所必需的过敏原蛋白的确切体积是未知的，但参与者是
要求每周两次消耗相当于2克的过敏食物蛋白质（4克过敏原
每周食物中的蛋白质）。因此，过敏食品的每周全数量由两个小的组成
40-60克牛奶酸奶，三个圆形茶匙花生酱，一个小鸡蛋（<53克），三个
圆形茶匙芝麻糊，25克白色鱼和两个小麦谷物饼干（例如Weetabix）.2
SIG介绍方案
对于SIG，eTable 7中的标准反映了对当前英国现状的实用解释 - 即a
婴儿喂养建议不完整。因而引起过敏性食物的五种
月（标准C），75％的母亲参加2010年婴儿喂养调查（IFS2010）3
有
向他们的婴儿引入固体，包括面包干（坚硬，干燥的婴儿饼干）和酸奶，每次最多300毫升
入组后牛奶配方食用日（标准D）被认为是可接受的。该
选择体积使得婴儿消耗的大部分乳汁仍然是母乳。数量
在最近的系统评价中回顾了纯母乳喂养婴儿所摄取的母乳.4 3-4
几个月的母乳平均转移量为779（标准差（SD）40）克/天，5
月827（SD 39）克/天，和6个月894（SD 87）克/天。
关于配方奶介绍的参与者的说明
鼓励两组中的母亲加入世界卫生组织（WHO）全球
婴幼儿喂养策略，3
得到英国政府的认可，5建议
母乳喂养直至两岁或以上。同一文件建议排他性
前六个月的母乳喂养。 SIG的母亲被要求坚持英国政府
更加务实的目标是大约六个月的纯母乳喂养
两组的母亲都不鼓励使用配方奶，特别是在早期关键时期
引入期（最多六个月），因为配方奶引入已被证明有害
对母乳喂养表现的影响
如果他们确实引入了自己的意志奶粉，同时仍然
母乳喂养时，鼓励他们保持体积尽可能小，以确保乳房
牛奶仍然是牛奶的主要来源。
在EAT研究中监测食物消耗
每月完成一次在线调查问卷，直至12个月，每隔3个月完成一次
婴儿父母36个月大的时候是沟通健康信息的主要门户
和研究小组的参与者的饮食。在这个在线调查问卷中，两个小组都完成了食物
频率问卷调查部分评估包括六种研究过敏原在内的食物的频率
消耗。
EIG家庭保留了一份预期的每周日记，直到一岁，然后每月一次评估
他们每周达到4克每种过敏性食物蛋白的消费目标的程度。
下载地址：07/13/2018
©2018 Perkin等。 JAMA儿科。
在孩子每个月的生日之前的最后四个完整周中的每一周以及每个孩子的每一周
过敏性食物，父母记录了他们孩子推荐的食物量的百分比
消费（100％，75％，50％，25％或更少，尚未尝试），并提供有关每种食物量的指导
构成这些百分比的食物。然后将该日记数据输入在线问卷中。
最后，在6,12和36个月大的时候，父母完成了为期五天的食物日记记录
孩子的饮食包括份量

英语原文:

eMethods
Instructions given to participants regarding solid food introduction
EIG introduction regimen
Following normal blood test results at enrollment (complete blood count, bone, liver, renal and lipid profile
tests), the EIG infants then proceeded to introduce baby rice and/or pureed fruits or vegetables during the
first week until they were established on solid food. They then continued with these solids and additionally
introduced cow’s milk yogurt on two days of the second week. During weeks three and four of the early
introduction regimen, peanut, hard-boiled egg, sesame and white fish (cod) were introduced sequentially in a
random order with two new foods introduced per week. Finally, wheat was introduced in week five,
reflecting the guidance in place at the time the EAT study commenced on optimal timing of wheat
introduction after four months of age1
and by week six infants were ideally consuming the required amount
of all six allergenic foods each week.2
The introduction of non-allergenic foods was not restricted during this process, and the allergenic foods
could be given in combination with other foods or each other once the allergenic foods had been
successfully introduced and well tolerated.
The exact volume of allergen protein necessary to induce oral tolerance is unknown, but participants were
asked to consume the equivalent of 2g of each allergenic food protein twice each week (4g of allergen
protein per food per week). The full weekly amount for the allergenic foods therefore consisted of two small
40-60g portions of cow’s milk yogurt, three rounded teaspoons of peanut butter, one small egg (<53g), three
rounded teaspoons of sesame paste, 25g of white fish and two wheat-based cereal biscuits (e.g. Weetabix).2
SIG introduction regimen
For the SIG the criteria in eTable 7 reflect a pragmatic interpretation of the current UK status quo – i.e. an
incomplete following of the infant feeding recommendations. Thus allergenic food introduction from five
months (criterion C) by which point 75% of mothers in the Infant Feeding Survey 2010 (IFS2010)3
have
introduced solids to their baby including rusks (hard, dry infant biscuits) and yogurts and up to 300 mls per
day of cow’s milk formula consumption after enrollment (criterion D) were considered acceptable. The
volume was chosen such that the majority of milk consumed by the infant was still breastmilk. The amount
of breastmilk consumed by exclusively breastfed infants was reviewed in a recent systematic review.4 At 3-4
months of age the mean transfer volume of breastmilk was 779 (standard deviation (SD) 40) grams/day, at 5
months 827 (SD 39) grams/day, and at 6 months 894 (SD 87) grams/day.
Instructions given to participants regarding formula milk introduction
Mothers in both groups were encouraged to adhere to the World Health Organization (WHO) Global
Strategy for Infant and Young Child Feeding,3
endorsed by the UK Government,5 which recommends
breastfeeding up to the age of two years or beyond. The same document recommends exclusive
breastfeeding for the first six months. Mothers in the SIG were asked to adhere to the UK Government's
more pragmatic target of around six months exclusive breastfeeding.6
Mothers in both groups were discouraged from introducing formula milk, particularly during the key early
introduction period (up to six months) as formula milk introduction has been shown to have a deleterious
effect on breastfeeding performance.7
If they did introduce formula milk of their own volition, whilst still
breastfeeding, they were encouraged to keep the volume given as small as possible, to ensure that breast
milk remained the principal source of milk.
Monitoring of food consumption in the EAT study
An online questionnaire completed monthly until 12 months of age and every three months between 12 and
36 months of age by the infants’ parents was the main portal of communicating information about the health
and diet of the participants to the study team. Within this online questionnaire, both groups completed a food
frequency questionnaire section assessing how frequently foods including the six study allergens were being
consumed.
EIG families kept a prospective weekly diary up until one year of age and monthly thereafter to assess the
degree to which they were meeting the consumption target of 4g of each allergenic food protein per week.
Downloaded From: on 07/13/2018
© 2018 Perkin et al. JAMA Pediatrics.
For each of the last four complete weeks preceding the child’s monthly birthday and for each of the
allergenic foods, parents recorded the percentage of the recommended amount of food their child was
consuming (100%, 75%, 50%, 25% or less, not tried yet) with guidance provided on the amount of each
food constituting those percentages. This diary data was then entered into the online questionnaires.
Finally, at 6, 12 and 36 months of age parents completed a five day food diary recording in detail their
child’s diet including portion size