Current feeding practices and maternal nutritional knowledge on complementary feeding in Korea

이유기 보충식 현황과 어머니 인식 조사

  • Yom, Hye Won (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Seoul Metropolitan Dong-bu Hospital) ;
  • Seo, Jeong Wan (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Park, Hyesook (Committee on Nutrition Korean Pediatric Society: Departments of Preventive Medicine, Ewha Womans University School of Medicine) ;
  • Choi, Kwang Hae (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Youngnam University College of Medicine) ;
  • Chang, Ju Young (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Seoul National University College of Medicine, Seoul Metropolitan Boramae Hospital,) ;
  • Ryoo, Eell (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Gachon University, Gil Hospital) ;
  • Yang, Hye Ran (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Jae Young (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Chungnam National University School of Medicine) ;
  • Seo, Ji Hyun (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Kim, Yong Joo (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Hanyang University College of Medicine) ;
  • Moon, Kyung Rye (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Chosun University School of Medicine) ;
  • Kang, Ki Soo (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Jeju National University School of Medicine) ;
  • Park, Kie Young (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital,) ;
  • Lee, Seong Soo (Committee on Nutrition Korean Pediatric Society: Gangneung, Department of Pediatrics,, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital,) ;
  • Shim, Jeong Ok (Committee on Nutrition Korean Pediatric Society: Department of Pediatrics, Kangwon National University School of Medicine)
  • 염혜원 (대한소아과학회 영양위원회: 서울특별시 동부병원 소아청소년과) ;
  • 서정완 (대한소아과학회 영양위원회: 이화여대 의전원 소아과학교실) ;
  • 박혜숙 (대한소아과학회 영양위원회: 이화여대 의전원 예방의학교실) ;
  • 최광해 (대한소아과학회 영양위원회: 영남의대 소아과학교실) ;
  • 장주영 (대한소아과학회 영양위원회: 서울의대 보라매병원 소아과학교실) ;
  • 류일 (대한소아과학회 영양위원회: 가천의대 길병원 소아과학교실) ;
  • 양혜란 (대한소아과학회 영양위원회: 서울의대 분당병원 소아과학교실) ;
  • 김재영 (대한소아과학회 영양위원회: 충남대 의전원 소아과학교실) ;
  • 서지현 (대한소아과학회 영양위원회: 경상대 의전원 소아과학교실) ;
  • 김용주 (대한소아과학회 영양위원회: 한양의대 소아과학교실) ;
  • 문경래 (대한소아과학회 영양위원회: 조선대 의전원 소아과학교실) ;
  • 강기수 (대한소아과학회 영양위원회: 제주대 의전원 소아과학교실) ;
  • 박기영 (대한소아과학회 영양위원회: 울산의대 강릉아산병원 소아과학교실) ;
  • 이성수 (대한소아과학회 영양위원회: 한림의대 소아과학교실) ;
  • 심정옥 (대한소아과학회 영양위원회: 강원대 의전원 소아과학교실)
  • Received : 2009.08.31
  • Accepted : 2009.10.05
  • Published : 2009.10.15

Abstract

Purpose:To evaluate current feeding practices and maternal nutritional knowledge on complementary feeding. Methods:Mothers of babies aged 9-15 months who visited pediatric clinics of 14 general hospitals between September and December 2008 were asked to fill questionnaires. Data from 1,078 questionnaires were analyzed. Results:Complementary food was introduced at 4-7 months in 89% of babies. Home-made rice gruel was the first complementary food in 93% cases. Spoons were used for initial feeding in 97% cases. At 6-7 months, <50% of babies were fed meat (beef, 43%). Less than 12-month-old babies were fed salty foods such as salted laver (35%) or bean-paste soup (51%) and cow's milk (11%). The following were the maternal sources of information on complementary feeding: books/magazines (58%), friends (30%), internet web sites (29%), relatives (14%), and hospitals (4%). Compared to the 1993 survey, the incidence of complementary food introduction before 4 months (0.4% vs. 21%) and initial use of commercial food (7% vs. 39%) had decreased. Moreover, spoons were increasingly used for initial feeding (97% vs. 57%). The average maternal nutritional knowledge score was 7.5/10. Less percentage of mothers agreed with the following suggestions: bottle formula weaning before 15-18 months (68%), no commercial baby drinks as complementary food (67%), considering formula (or cow's milk) better than soy milk (65%), and feeding minced meat from 6-7 months (57%). Conclusion:Complementary feeding practices have considerably improved since the last decade. Pediatricians should advise timely introduction of appropriate complementary foods and monitor diverse information sources on complementary feeding.

목 적:이유기의 영양은 영유아의 성장과 발달 뿐 아니라 성인 건강에도 장기적으로 영향을 미친다. 또한 이 시기의 영양섭취는 전적으로 보호자에게 의존하므로 보호자의 이유기 보충식에 대한 인식이 중요하다. 이에 본 영양위원회에서는 이유기 보충식 현황을 조사하여 과거 영양위원회 보고와 비교하고, 어머니의 이유기 보충식에 대한 인식 수준을 조사분석하여 문제점을 파악하고 영유아 영양 상담의 방향과 개선책을 제시하고자 하였다. 방 법:2008년 9월에서 12월까지 전국 14개 종합병원 소아청소년과를 방문한 9-15개월 영유아의 어머니를 대상으로 본 위원회에서 만든 설문지를 작성하도록 하였다. 총 1,078매 설문지를 SAS 9.1 통계프로그램을 이용하여 분석하였다. 결 과:이유기 보충식을 4-7개월에 89.3%에서 시작하였다. 93.3 %에서 처음 준 음식은 쌀미음이었고, 96.5%에서 숟가락으로 주기 시작하였다. 12-15개월 영유아를 대상으로 식품 도입 시기를 보면 6-7개월에 쇠고기를 준 경우는 43.2%였고 12개월 이전 소금 뿌린 김을 준 경우 35.3%, 된장국을 준 경우는 50.7%, 생우유를 준 경우는 10.7%였다. 이유기 보충식에 대한 정보원은 육아 책이나 잡지(57.9%), 친구나 또래 엄마(29.9%), 인터넷(28.7%), 부모나 친지(14.1%), 의료인(4.4%) 순이었다. 영양위원회에서 시행한 1993년 조사와 비교하면 4개월 이전 이유기 보충식을 시작한 경우(0.4% vs. 20.6%)와 시판 이유기 보충식으로 시작한 경우(6.7% vs. 38.8%)가 현저히 감소하였다. 숟가락으로 시작한 경우(96.5% vs. 57%)는 현저히 증가하였다. 어머니의 이유기 보충식에 대한 인식 수준에 대한 10문항을 점수화 하였을 때 평균 인식 점수는 $7.5{\pm}2.1$였고 다음 4문항에서 동의율이 낮았다: 고기를 이유기 초기에 도입해야 한다(57.4%), 분유(우유)가 두유보다 좋다(65.1%), 아기에게 이온음료를 먹일 필요가 없다(66.6%), 분유병은 15-18개월에 떼야 한다(67.5%). 인식 점수는 출생 순서가 빠른 경우, 어머니의 나이가 30대인 경우, 학력이 대졸 이상인 경우, 거주 지역이 서울과 경기 지역인 경우, 이유기 보충식에 대한 정보원이 의료인과 책이나 잡지인 경우에 가장 높았다. 결 론:이유기 보충식 실행 방법은 과거와 비교하여 현저하게 개선되었다. 소아청소년과 의사는 어떤 음식을 언제 도입하는지에 대한 체계적인 이유기 보충식 스케줄을 제공해야 하며 다양한 이유기 보충식에 대한 정보원을 관리 감독 해야 할 것이다.

Keywords

References

  1. Kleigman RM, Behrman RE, Jenson HB, Stanton BT. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders, 2007: 209
  2. World Health Organization. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization; 2009
  3. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003;362:65-71 https://doi.org/10.1016/S0140-6736(03)13811-1
  4. Monteiro PO, Victora CG. Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obes Rev 2005;6:143-54 https://doi.org/10.1111/j.1467-789X.2005.00183.x
  5. Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46:99-110 https://doi.org/10.1097/01.mpg.0000304464.60788.bd
  6. UNICEF. Complementary feeding. [cited 2008 August 4]. Available from: URL: http://www.unicef.org/nutrition/index _24826.html
  7. Arsenault JE, Brown KH. Zinc intake of US preschool children exceeds new dietary reference intakes. Am J Clin Nutr 2003; 78:1011-7 https://doi.org/10.1093/ajcn/78.5.1011
  8. Lee SJ, Park JO, Sohn CS, Lee HR, Shin JH, Chung HI, et al. A survey on the present status of weaning. J Korean Pediatr Soc 1994;37:1643-56
  9. Lee HG, Choi JY, Kim CG, Han DG, Hyun W, Lee DG. Survey on the present status of weaning in Korean children. J Korean Pediatr Soc 1978;21:664-72
  10. Fiocchi A, Assa'ad A, Bahna S; for the Adverse Reactions to Foods Committee of the American College of Allergy, Asthma and Immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Ann Allergy Asthma Immunol 2006;97:10-20 https://doi.org/10.1016/S1081-1206(10)61364-6
  11. Ziegler EE, Fomon SJ. Fluid intake, renal solute load, and water balance in infancy. J Pediatr 1971;78:561-8 https://doi.org/10.1016/S0022-3476(71)80456-0
  12. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998;316:21-5 https://doi.org/10.1136/bmj.316.7124.21
  13. Morgan JB, Lucas A, Fewtrell MS. Does weaning influence growth and health up to 18 months? Arch Dis Child 2004; 89:728-33 https://doi.org/10.1136/adc.2003.036137
  14. World Health Organization. Complementary feeding: family foods for breastfed children. Geneva: World Health Organization; 2000
  15. Brekke HK, Ludvigsson JF, van Odijk J, Ludvigsson J. Breastfeeding and introduction of solid foods in Swedish infants: the All Babies in Southeast Sweden study. Br J Nutr 2005;94: 377-82 https://doi.org/10.1079/BJN20051499
  16. Kang SA, Shin HJ, Lim YH, Kim GA, Woo YH, Jun YH, et al. A study of mothers' nutritional knowledge on weaning of breast-fed infants, the age of 6 months. Korean J Community Nutrition 2005;10:453-61
  17. Northstone K, Emmett P, Nethersole F, ALSPAC Study Team. The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. J Hum Nutr Diet 2001;14:43-54 https://doi.org/10.1046/j.1365-277X.2001.00264.x
  18. Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: What foods are infants and toddlers eating? J Am Diet Assoc 2004;104:s22-30
  19. Morgan J, Taylor A, Fewtrell M. Meat consumption is positively associated with psychomotor outcome in children up to 24 months of age. J Pediatr Gastroenterol Nutr 2004;39: 493-8 https://doi.org/10.1097/00005176-200411000-00009
  20. Krebs NF, Westcott JE, Butler N, Robinson C, Bell M, Hambidge KM. Meat as a first complementary food for breastfed infants: feasibility and impact on zinc intake and status. J Pediatr Gastroenterol Nutr 2006;42:207-14 https://doi.org/10.1097/01.mpg.0000189346.25172.fd
  21. Hotz C, Gibson RS. Complementary feeding practices and dietary intakes from complementary foods amongst weanlings in rural Malawi. Eur J Clin Nutr 2001;55:841-9 https://doi.org/10.1038/sj.ejcn.1601239
  22. Krebs NF. Meat as an early complementary food for infants: implications for macro- and micronutrient intakes. Nestle Nutr Workshop Ser Pediatr Program 2007;60:221-33 https://doi.org/10.1159/000106371
  23. Norris JM, Barriga K, Hoffenberg EJ, Taki I, Miao D, Haas JE, et al. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA 2005;293:2343-51 https://doi.org/10.1001/jama.293.19.2343
  24. Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth GS, Erlich HA, et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA 2003;290: 1713-20 https://doi.org/10.1001/jama.290.13.1713
  25. Poole JA, Barriga K, Leung DY, Hoffman M, Eisenbarth GS, Rewers M, et al. Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006;117:2175-82 https://doi.org/10.1542/peds.2005-1803
  26. Alan BG. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. Pediatrics 2006;118:S14-5 https://doi.org/10.1542/peds.2006-0900X
  27. Quak SH, Tan SP. Use of soy-protein formulas and soyfood for feeding infants and children in Asia. Am J Clin Nutr 1998;68(suppl):1444S-1446S https://doi.org/10.1093/ajcn/68.6.1444S
  28. Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc 2001;101:670-7 https://doi.org/10.1016/S0002-8223(01)00169-9
  29. Moon JS, Kim JY, Chang SH, Choi KH, Yang HR, Seo JK, et al. Development of a nutrition questionnaire and guidelines for the Korea national health screening program for infant and children. Korean J Pediatr Gastroenterol Nutr 2008;11: 42-55
  30. Pomeranz A, Dolfin T, Korzets Z, Eliakim A, Wolach B. Increased sodium concentrations in drinking water increase blood pressure in neonates. J Hypertens 2002;20:203-7 https://doi.org/10.1097/00004872-200202000-00009
  31. Zinner SH, McGarvey ST, Lipsitt LP, Rosner B. Neonatal blood pressure and salt taste responsiveness. Hypertension 2002;40:280-5 https://doi.org/10.1161/01.HYP.0000029973.76439.AB
  32. Geleijnse JM, Hofman A, Witteman JC, Hazebroek AA, Valkenburg HA, Grobbee DE. Long-term effects of neonatal sodium restriction on blood pressure. Hypertension 1997;29: 913-7 https://doi.org/10.1161/01.HYP.29.4.913
  33. Beauchamp GK, Moran M. Dietary experience and sweet taste preference in human infants. Appetite 1982;3:139-52 https://doi.org/10.1016/S0195-6663(82)80007-X
  34. Skinner JD, Carruth BR, Wendy B, Ziegler PJ. Children's food preferences: a longitudinal analysis. J Am Diet Assoc 2002; 102:1638-47 https://doi.org/10.1016/S0002-8223(02)90349-4
  35. Gunnarsson BS, Thorsdottir I, Palsson G. Iron status in 2- year-old Icelandic children and associations with dietary intake and growth. Eur J Clin Nutr 2004;58:901-6 https://doi.org/10.1038/sj.ejcn.1601910
  36. British Columbia Ministry of Health. HealthLink BC Files: Baby's First Foods. [cited 2007 May]. Available from: URL: http://www.healthlinkbc.ca/healthfiles/hfile69c
  37. We HW, Seo YK, Kim AS, Lee SJ, Cho SM, Lee DS, et al. Survey on the awareness of guardians of young infants on weaning of food in Pohang and Gyeongju area. Korean J Pediatr Gastroenterol Nutr 2006;9:233-41
  38. Park HR, Lim YS. A study of effect of weaning foods-feeding methods in weaning periods on preschool-children's food habitㆍfood preference and iron nutritional status. Korean J Nutrition 1999;32:259-67