论文部分内容阅读
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A30%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A100%每日推荐摄入量(1666IU)强化饼干1次。③2万国际单位组(209名)每周补充维生素A2万国际单位强化饼干1次。④20万国际单位组(194名)补充维生素A20万国际单位胶丸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。
Background: Vitamin A deficiency disease is a worldwide child health problem. In western China and remote areas, it is particularly serious and requires nutritional intervention. OBJECTIVE: To compare the effects of vitamin A supplementation with 3 different doses of vitamin A biscuits on the nutritional status of vitamin A in children aged 3 ~ 6 years and to explore the ideal dose of fortified biscuit to prevent vitamin A deficiency diseases. Design: Randomized controlled observation. Unit: Health Bureau of Chongqing Health Authority, Chongqing Medical University School of Public Health Nutrition and Food Hygiene Department and Chongqing Medical Children’s Hospital Children’s Research Center. PARTICIPANTS: The survey was completed on March 12, 2002 and 753 children aged 3 ~ 6 years from 8 kindergartens in Banan District of Chongqing were selected. Both guardians informed each other. Randomly divided into 4 groups, namely 30% of the recommended intake group, 100% of the recommended intake group, 20000 IU and 200000 IU. Methods: ① 30% recommended intake group (177) daily vitamin A30% daily recommended intake (500IU) fortified cookies 1 time. ②100% recommended intake group (173) Daily vitamin A100% Daily Recommended Intake (1666IU) Fortified biscuits 1 time. ③ 20,000 international unit group (209) weekly vitamin A2 supplement International unit fortified biscuits 1 time. ④ 200,000 international unit group (194) vitamin A 200 000 international unit of 1 capsule. Height, body mass, serum retinol, prealbumin, hemoglobin, and retinol binding protein were measured in all children before intervention and at 3 months of intervention. 87% of the 30% of the recommended intake group reviewed the above target again after 9 months of supplementation. MAIN OUTCOME MEASURES: ① The detection rate of vitamin A deficiency in children in each group before intervention and 3 months after intervention. ② Serum retinol, serum prealbumin, serum retinol binding protein, hemoglobin, height and body weight before and 3 months after intervention in each group of children. Results: As a result of sample loss and testing techniques, only 580 children were examined. ① Comparison of detection rates of vitamin A deficiency among children in each group: After 3 months of supplementation, 30% recommended intake, 100% recommended intake, 20000 IU and 200000 IU children’s vitamin A The detection rate of deficiency disease was significantly lower than that before treatment [1.48%, 1.42%, 1.21%, 2.16%; 6.78%, 6.54%, 8.61%, 8.25%, respectively] . ② Comparison of serum retinol, serum prealbumin, serum vitamin A, hemoglobin, body height and body weight of children in each group: In addition to pre-albumin and hemoglobin of 30% The remaining indicators of each group were significantly increased (t = 2.52 ~ 37.44, P <0.05 ~ 0.01). The increase of serum vitamin A in 20,000 international units was significantly greater than that in other groups (F = 4.62, P <0.01). The increase of hemoglobin, prealbumin and height in 30% recommended intake group was significantly less than that in other groups (F = 5.0 ~ 7.78, P <0.01). The increase of hemoglobin and prealbumin in 30% of the recommended intake group was significantly greater than that in the remaining 9 months (F = 11.62, 10.21, P <0.01), and the serum retinol level was still lower than 20000 Unit group (F = 4.21, P <0.01). CONCLUSIONS: Supplementation of three different doses of vitamin A fortified biscuits and 200,000 IU vitamin A capsules significantly improved the nutritional status of vitamin A and hemoglobin levels. Of these, 30% recommended intake and 100% recommended intake are less risky, and daily supplementation consistently maintains vitamin A levels in the body, which may be more suitable for children’s long-term supplements, while 30% recommend optimal intake of 100 % Recommended intake.