Dinh dng v pht trin tr no: Mt s tin b gn yCraig Jensen, M.DGio s Khoa NhiTrng Y khoa BaylorChuyn khoa Tiu ha, Gan v Dinh dngBnh vin Nhi TexasHouston, Bang Texas

Vai tr ca dinh dng trong pht trin nhn thcC ch nh hng n chc nng nhn thc ca dinh dng:

nh hng gin tip ca dinh dng thng qua ci thin sc khenh hng gin tip ca dinh dng thng qua ci thin sc khenh hng trc tip ca dinh dng ln no

L do cn quan tm n vn DHA (v ARA) trong Giai on u ca trTm quan trng vi no bTm quan trng vi vng mc nh hng n chc nng min dch v khng vim nh hng n chc nng tim mch

S tch t DHA no trcMartinez M. J Pediatr. 1992;120:S129-S138.DHA-200002000400060008000100001200020406080100120140160 tui tr s sinh, tunw-3 LCPUFA, mol/FB DHADPAEPACurve

S pht trin ca no b trong sut thi gian u ca tr040080012001600-60612182430Trng thnhTui, thngKhi lng no b, g~+260% ~+175% ~+18%~+21%S sinhDobbing J, et al. Arch Dis Child. 1973;48:757-767.

Nng DHA v no b0789100-15 wks> 15 wksNhm tuiTr khng c nui b sung thm sa btTr s sinh b sa mNng DHA v no bMakrides M, et al. Am J Clin Nutr. 1994;60:189-184; Farquharson J, et al. Arch Dis Child. 1995;72;198-203.

Mt s yu t lin quan trong nghin cu nh gi DHA v chc nng nhn thcLng DHA (v ARA) c cung cp

Thi gian b sung

tui nghin cu c thc hin nhy cm / "S ph hp" ca th nghim V d: Thang dim Baley o lng s pht trin tr nh c phi l cng c hp l?

Chc nng nhn thc l a chiuCh B nh - Nhn din, ngn hn, di hn Ngn ng - tip thu, ngha L lunbng li ni nh lng S nhn bit nhanhHnh nh / Tru tng K nng Gii quyt vn Tc x l K nng vn ng Cm xc Chc nng "iu hnh"

Tng kt cc kt qu ca cc nghin cu trc y trn tr b m

Vic s dng hm lng DHA cao hn tr b m c cc kt qu sau:

Th gic tt hn sut giai on s sinhCh s IQ cao hn khi o lc 4 tui (DHA c b sung cho m trong sut thai k v thi gian nui con bng sa m) Ci thin pht trin thn kinh vn ng lc 18 thng v kh nng duy tr tp trung cao hn lc 5 tuiInnis S. J Pediatr. 2003;143:S1-8. Helland IB, et al. Pediatrics. 2003;111:e39-e44. Jensen CL, et al. Am J Clin Nutr 2005;82:125-32. Jensen CL, et al. Am J Clin Nutr 2005;82:125-32.

Tng kt cc kt qu ca cc nghin cu trc y trn tr ung sa cng thcVic b sung vo sa cng thc hm lng ~0.32% DHA (+ 0.64% ARA) c cc kt qu sau:Th lc tt hn trong sut thi k s sinhX l tnh hung tt hn lc gn 10 thng Ch s pht trin tr tu Bayley cao hn lc 18 thng Ch s IQ cao hn lc 4 tui

Mt s nghin cu s dng hm lng DHA b sung thp hn khng cho thy cc li ch trnBirch EE, et al. Pediatr Res. 1998;44:201-209. Morale SE, et al. Early Hum Develop. 2005;81:197-203. Birch EE, et al. Dev Med Child Neurol. 2000;42:174-181. Birch et al. Early Hum Dev 2007;83:279-84. Drover JR, et al. Child Dev 2009;80:1376-84.

Nghin cu gn y i vi ch n c DHA cao hnNghin cu DIAMOND (Ch n c DHA v o lng ca s pht trin thn kinh): Tr s sinh ngu nhin c cho n mt trong nhng cng thc sau y trong sut 12 thng u tin:0.32% DHA, 0.64% ARA0.64% DHA, 0.64% ARA0.96% DHA, 0.64% ARAKim sot (nhm chng khng DHA hoc ARA)Birch EE et al. Am J Clin Nutr 2010. Drover JR et al. Early Hum Dev 2011. Colombo et al. Am J Clin Nutr 2013.

Tr nh b sa cng thc ln n 12 thng tuiKt qu sau khi sinhim Th lc (VEP): 1.5, 4, 9, 12 thng tui Thi quen th lc (hnh vi / HR): 4, 6, 9 thng tui Nghin cu s tp trung ch qua vui chi t do: 12, 18 thng tui im Bayley v MacArthur: 18 thng tuiSp xp th theo yu cu v bi kim tra stroop: 36-60 thng tui Kim tra ngn ng, hnh nh Peabody: 60 thng tui WPPSI: 72 thng tui Th nghim b sung DIAMOND

0.00% DHA/0.00% ARA0.32% DHA/0.64% ARA0.64% DHA/0.64% ARA0.96% DHA/0.64% ARATh nghim b sung DIAMOND Colombo et al.

**Th nghim b sung DIAMOND Colombo et al. AJCN, 2013

Cc th nghim chun ha, lc 18 thng tui Colombo et al. AJCN, 2013

DIAMOND: Ch s MDI Bayley, lc 18 thng tui (Khu vc Dallas)Drover JR et al. Early Hum Dev. 2011. MDI= CH s pht trin thn kinh.P=0.02MDI trung bnhNhm dinh dng

Chart1

98.4105.2104.2102.6104.1

Control (0% DHA)

0.32% DHA

0.64% DHA

0.96% DHA

Combined DHA groups

Sheet1

Control (0% DHA)0.32% DHA0.64% DHA0.96% DHACombined DHA groups

MDI score (mean)98.4105.2104.2102.6104.1

Category 22.54.42

Category 33.51.83

Category 44.52.85

To resize chart data range, drag lower right corner of range.

Sp xp th theo yu cuChuyn i:tr chi hnh khi -> tr chi mu sctr chi mu sc-> tr chi hnh khi

S im cui cng ca nhim v sp xp th theo yu cu36, 42, 48, v 60 thngTui (thng)Nhm: F (3, 71,919) = 3,248, p = 0,027 Truy cp: F (3, 67,287) = 34,009, p = 0,000 PrePost: F (1, 72,250) = 227,748, p = 0,000 Nhm X gp F (9, 67,326) = 2,757, p = 0,008 Gp X PrePost: F (3, 69,118) = 3,383, p = 0,023*****Colombo et al. AJCN, 2013

Chart1

3.4123.0653.0593.173

3.3653.2893.8823.254

3.3264.2374.6763.669

4.1754.8815.334.689

0.00% DHA/0.00% ARA

0.32% DHA/0.64% ARA

0.64% DHA/0.64% ARA

0.96% DHA/0.64% ARA

Sheet1

0.00% DHA/0.00% ARA0.32% DHA/0.64% ARA0.64% DHA/0.64% ARA0.96% DHA/0.64% ARA

363.4123.0653.0593.173

423.3653.2893.8823.254

483.3264.2374.6763.669

604.1754.8815.334.689

DIAMOND:Bi kim tra Stroop (36-60 thng)mNgy

DIAMOND:Bi kim tra Stroop (36-60 thng)Colombo et al. AJCN, 2013

Kim tra ngn ng - hnh nh Peabody (48 mos)Colombo et al. AJCN, 2013

t(64)=2.57, P=.006d=0.75t(64)=1.27, P=nsd=0.38t(64) = 1.01, P=nsd=0.27t(64) = 1.92, P=.029d=0.54Colombo et al. AJCN, 2013DIAMOND: Nghin cu v ch s thng minh Wechsler tr mm non v tiu hc (72 thng)

Chart1

87.295.2

90.695.55

100.13104.49

89.9396.37

Unsupplemented (n=15)

Supplemented (n=51)

Sheet1

Unsupplemented (n=15)Supplemented (n=51)

Verbal IQ87.295.2

Performance IQ90.695.55

Processing Speed IQ100.13104.49

Full-Scale IQ89.9396.37

DHA Kt lunTm quan trng trong pht trin no bB sung DHA (+ ARA) gip pht trin h thn kinh trong cc nghin cu v nh gi chc nng nhn thc gn y Tng kh nng th lc v pht trin thn kinh c thy trong mt s nghin cu trc y

Kt qu min dch ci thin khi b sung DHA v ARA

*For Internal Mead Johnson Nutrition Use Only Not for Distribution