Randomized trial of varying mineral intake on total body bone mineral accretion during the first year of life
Randomized trial of varying mineral intake on total body bone mineral accretion during the first year of life
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DOI：
10.1542/peds.99.6.e12
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发表时间：
1997-06-01
期刊：
影响因子：
8
通讯作者：
Ho, M
中科院分区：
文献类型：
--
作者：
Specker, BL;Beck, A;Ho, M
目标。在健康足月婴儿出生后的第一年，不同矿物质摄入量对全身骨量增加的影响尚不清楚。本研究的目的是确定婴儿出生后第一年的总骨量增加是否受到钙和磷摄入量的影响，以及早期骨量增加的差异是否会持续到1岁。这项前瞻性随机试验分两个阶段进行。在第一阶段，67名婴儿在出生后两周内被随机分为低（每升钙439毫克，每升磷240毫克）或中等（每升钙510毫克，每升磷390毫克）含矿物质配方喂养组。另外一组34名母乳喂养（低矿物质）婴儿也被纳入研究。第二阶段将所有6个月大的婴儿随机分成中等矿物质配方奶粉（见上文）、高矿物质配方奶粉（每升钙1350毫克，磷900毫克）或牛奶（每升钙1230毫克，磷960毫克）喂养组。在1、3、6、9和12个月时，用双能x线骨密度仪测量了人体测量、营养摄入和全身骨矿物质含量（BMC）。在前6个月，与母乳组（2.93 +/- 0.56 kg）相比，中等矿物质组的体重增加幅度更大（3.42 +/- 0.62 kg）；低矿物质组（3.19 +/- 0.62 kg）为中等水平。骨量增加的方向也类似，中等矿物质喂养组比母乳组增加更多，而低矿物质喂养组介于两者之间。包括体重，长度和骨面积作为协变量，低矿物质配方奶和母乳喂养组在3和6月龄时的BMC相似，低于中等矿物质喂养组。3月龄时，中等矿物质配方奶喂养组与低矿物质配方奶和母乳喂养组相比，调整后的平均BMC值分别为127.8 +/- 1.5 (SEM) g和119.2 +/- 1.5和122.1 +/- 1.4 g； 6月龄时，分别为168.7 +/- 2.5 g和157.6 +/- 2.5和158.7 +/- 2.4 g。配方奶喂养婴儿6月龄BMC与前6个月平均膳食磷摄入量（r = 0.592）和平均每日钙摄入量（r = 0.620）相关。即使在控制热量摄入后，BMC和这些矿物质之间的关系仍然显著。由于钙磷两种矿物质之间存在很强的相关性，因此不可能单独确定它们对BMC的影响。尽管在出生后6个月钙和磷的摄入量有显著差异，但在生长参数和骨量增加方面没有差异。9月龄和12月龄各组间BMC平均值（经体重、体长和骨面积调整）无显著差异。接受中等矿物质配方奶粉的婴儿在9月龄和12月龄时的调整平均值分别为199 +/- 2 （SEM）和237 +/- 3 g；接受高矿物质配方奶粉的婴儿在9月龄和12月龄时为198 +/- 2和236 +/- 3克，接受牛奶的婴儿在9月龄和12月龄时为202 +/- 5和233 +/- 5克。后6个月的骨量增加量与前6个月饲喂组不同；在6 - 12个月期间，经过体重、长度和骨骼面积调整后，母乳喂养婴儿的BMC平均变化大于低或中等含矿物质配方奶粉组：母乳喂养婴儿的BMC平均变化为81 +/- 16 g，低和中等含矿物质配方奶粉组的BMC平均变化为73 +/- 15 g和71 +/- 15 g。由于完成研究的婴儿数量较少，在第二个6个月期间喂养全脂牛奶的婴儿被排除在本分析之外。到12月龄时，早饲组和晚饲组的BMC均无差异。这些结果表明，在头6个月，与食用中矿物质配方奶粉的婴儿相比，食用人类配方奶粉或低矿物质配方奶粉的婴儿骨量增加较少。前6个月喂养母乳的婴儿在后6个月的骨量增长比配方奶粉喂养的婴儿要大。到12个月大时，不同喂养组的骨量没有差异。
Objective. The effect of varying mineral intakes on total body bone mass accretion during the first year of life in healthy full-term infants is unknown. The purpose of this study was to determine whether total body bone mass accretion during the first year of life was influenced by the calcium and phosphorus intake of an infant and whether early differences in bone accretion persist through 1 year of age.Design. This prospective, randomized trial was conducted in two phases. In phase I, 67 infants were randomized within the first 2 weeks of life into either a low (439 mg of calcium per liter and 240 mg of phosphorus per liter) or moderate (510 mg of calcium per liter and 390 mg of phosphorus per liter) mineral-containing formula feeding group. An additional group of 34 human milk-fed (low mineral) infants also was enrolled. Phase II involved an additional randomization of all infants at 6 months of age into moderate-mineral formula (see above), high-mineral formula (1350 mg of calcium per liter and 900 mg of phosphorus per liter), or cow milk (1230 mg of calcium per liter and 960 mg of phosphorus per liter) feeding group. Anthropometric measurements, nutrient intake, and total body bone mineral content (BMC) by dual-energy x-ray absorptiometry were measured at 1, 3, 6, 9, and 12 months.Results. During the first 6 months, the moderate-mineral group had a greater increase in weight (3.42 +/- 0.62 kg) compared with the human milk group (2.93 +/- 0.56 kg); the low-mineral group (3.19 +/- 0.62 kg) was intermediate. Bone mass accretion differed in a similar direction, with the moderate-mineral feeding group having a greater increase than the human milk group and the low-mineral group being intermediate of the two. Including weight, length, and bone area as covariates, both the low-mineral formula- and human milk-fed groups had similar BMC, which was lower than that of the moderate-mineral group at 3 and 6 months of age. Adjusted mean BMC values for the moderate-mineral formula-fed group compared with the low-mineral formula- and human milk-fed groups were 127.8 +/- 1.5 (SEM) g vs 119.2 +/- 1.5 and 122.1 +/- 1.4 g, respectively, at 3 months of age and 168.7 +/- 2.5 g vs 157.6 +/- 2.5 and 158.7 +/- 2.4 g, respectively, at 6 months of age. The BMC at 6 months of age among the formula-fed infants was correlated with both average dietary phosphorus intake (r = .592) and average daily calcium intake (r = .620) during the first 6 months. The relationships between BMC and these minerals remained significant even after controlling for caloric intake. It was not possible to determine the independent effects of dietary calcium and phosphorus on BMC because of the strong correlation of these minerals with each other. Despite significant differences in both calcium and phosphorus intakes during the second 6 months of life, there were no differences in growth parameters or bone mass accretion. Means for BMC, adjusted for body weight, length, and bone area, were not significantly different among feeding groups at either 9 or 12 months of age. Adjusted means were 199 +/- 2 (SEM) and 237 +/- 3 g at 9 and 12 months of age for infants receiving moderate-mineral formula; 198 +/- 2 and 236 +/- 3 g at 9 and 12 months of age for infants receiving the high-mineral formulas and 202 +/- 5 and 233 +/- 5 g at 9 and 12 months of age for infants receiving cow milk. The gain in bone mass during the second 6 months differed by the first 6-month feeding group; mean changes in BMC between 6 and 12 months, adjusted for changes in weight, length, and bone area, were greater in human milk-fed infants than in either the low- or moderate-mineral-containing formula groups: 81 +/- 16 g in human milk-fed infants and 73 +/- 15 and 71 +/- 15 g in the low- and moderate-mineral formula groups, respectively. Infants fed whole cow milk during the second 6 months were excluded from this analysis because of the small number of infants completing the study. By 12 months of age there were no differences in BMC in either the early or late feeding groups.Conclusion. These results indicate that during the first 6 months, bone mass accretion is less in infants fed human or low-mineral formula compared with infants fed moderate-mineral formula. Infants fed human milk during the first 6 months had greater bone mass accretion during the second 6 months compared with formula-fed infants. By 12 months of age there were no differences in bone mass among the different feeding groups.