TAP CHI Y HOC VIET NAIifl TAP 454 - THANG S - SOI - 2017
Nhffng nguyen nhan mdi trffdng, nguon nffdc, trinh dp hieu biet, thdi quen sinh hoat ndi tren cd the la nguyen nhan ciia ty le benh mat hot cao dot bien tai day.
T A I L l I U THAIVl KHAO
1. Mabey DC, Solomon AW, Foster A. Trachoma.
Lancet 2003;362(9379): 223-229.
2. World Health Assembly. Global elimination of blinding trachoma. 51st World Health Assembly, Geneva, 16 May 1998, Resolution WHA51.11.
Geneva: World Health Organization; 1998.
3. Solomon AW, Zondervan M, Kuper H, Buchan 3C, Mabey DCW, Foster A. Trachoma controh a guide for program managers. Geneva: World Health Organization; 2006.
4. Solomon AW, Pavluck A, Courtright P, et al.
The Global Traciioma Mapping Project:
methodology of a 34-countTy populataon-based study. Ophthalmic Epidemiol. 2015;22(3):214-225.
5. Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR. A simple system for the assessment of trachoma and its complications. Bulletin of the World Health Organization. 1987;65(4):477-483.
6. Keenan 3D, Lakew T, Aiemayehu W, et al.
Cliniral activity and polymerase chain reaction evidence of chlamydial infection after repeated mass antibiotic treatments for trachoma. The Amencan journal of tropical medidne and hygiene.
2010;82(3):482-487.
7. Lee 3S, Munoz BE, Mkocha H, Gaydos CA, Quinn TC, West SK. The effect of multiple rounds of mass drug administration on the association between ocular Chlamydia trachomatis infection and follicular trachoma in preschool-aged children.
PLoS Negl Trop Dis. 2014;8(4):e2761.
HIEU QUA BO SUNG S A N PHAM DINH DU-ffNG CO BO SUNG DA VI CHAT, TRYPTOPHAN VA CHOLIN DEN GIAC NGO VA PHAT TRIEN TAM VAN D O N G CUA TRE 24-60 T H A N G TUOI
Ngo Thi Thu Huyin', Cao Thi Thu Hu-ong'
T O M TAT
Nghien cilU can thiep ngau nhien cd ddi chffng tren 191 tre 24-60 thang tai 2 xa thuoc huyen Thanh Sdn, Phu Thp. Tre du tieu chuan tham gia dffpc chia ngau nhien ttianh 2 nhom: nhdm can thiep (95 tre):
hang ngay tie dffdc bo sung 2 gdi san pham dinh duOng (38g/g6i); rihdm chutig (96 tre): khong dffdc bd sung san pham dinh dffdng hang ngay. Ket qua: tai dieu tra ban dau: khdng cd sff khac biet giffa 2 nhom ve thdi gian ngu ffung binh moi ngay, thdi gian ru ngu trung bmh, t / le tre ngu khong ngon giac va cac_ ky nang phat tri^h tam van dong dudi nguBng binh ttiudng (DNBT). Kit thuc can thiep, sau 6 ttiang sff dung san pham dinh dudng, tre nhdm can thiep c6 tdng thdi gian ngu nhieu hOn so vdi nhom chffng (10,3
± 0,6 gid so vdi 9,9 ± 0,4 gid, p < 0,05); thdi gian ru ngu cua tre nhom can thiep it hdn nhom chffng (11,2
±15,6 phut so vdl 20,1 ±' 9,1 phut, p < 0,05)^ Ty le tre ngu khong ngon giac 6 nhom can thiep thap hdn nhdm chffng (6,3% so vdi 18,8%, p <.0,05). Nhdm tre sff dung san pham dinh dffdng cd bo sung vi chat dinh duSng va Tryptophan hang ngay cd ty le ky nang van ddng toan than DNBT va ky nang giai quyet van dS DNBT thap hdn so vdi nhdm chffng (2,1% va 14,7% so vdl 10,4% va 29,2%; p < 0,05).
T&khda:Ciac ngu, tam van dong, hieu qua.
'Viin Dinh du&ng
Chm trach nhiem chinh: Cao Thj Thu Hffdng Email: [email protected] Ngay nhan bai: 3.01.2017
Ngay phan bien khoa hoc: 23.3.2017 Ngay duyet bai: 10.4.2017
SUMMARY
EFFICACY OF NUTRITION PRODUCT CONTAINING MULTI-MICRONUTRIENT, TRYPTOPHAN AND CHOLIN ON SLEEP AND
MOTOR-COGNITIVE SKILLS OF CHILDREN AGED 2 4 - 6 0 MONTHS A randomized and controlled trial was conducted in 191 children aged 24-60 months in 2 communes of Thanh Son distnct, Phu Tho province. The subjects with included and excluded criteria were randomlly allocated into two group. Interventton groups (95 children): the children were supplemented 2 sachets of nuttitton product (38 g/sachet). Control group (96 children): the children were not supplemented nutrition product. The resuls showed that: at baseline survey, there was not a significant difference between intervention and control group on average of sleep time and lull bme, prevalence of poor sleep as well as prevalence of abnormal motor-cognitive skills, At end- line survey: after intervention 6 months, the average of sleep times of children in intervention group was higher ttian that of control group (10.3 ±0.6 hours and 9.9 ± 0.4 hours, p < 0.05). The average times of lull of children in intervention gnDup was lower than that in control group (11.2 ± 15.6 vs 20.1 ± 9.1 phut, p < 0.05). The percentage of number children having poor sleep of intervention groups was lower as compared to that of control group (6.3% vs 18.8%, p
< 0.05). The children using daily nutrition product had abnormal skill of gross motor and problem solving was lower as compared to control group (2.1% va 14.7% vs 10.4% va 29.2%; p < 0.05).
Key word: Sleep, motor-cogninitve, efficacy.
VIETNAM MEDICAL JOURNAL H"1 - MAY - 2017
I. DAT VAN oH
Ngu la thdi gian de te bao va md dffdc phuc hoi. Sdng nao dffdc tao ra khi ngu, la cd clie quan trpng trong viec lffu trff thdng tin trong bp nao. Sdng nao cung cd the chuyen thdng tin den vd nao trffdc tran - la ndi lffu trff trong thdi gian dai. Khi khdng ngu dii giac (thieu ngu), nhffng ky ffc khdng the di chuyen ve phia vd nao trffdc tran, tinh trang nay dan den sff lang quen va mat tri nhd ngSn han. De cai thien t r i nhd va ngan chan sff suy giam nhan thffc, tre can ngii dil va giac ngu sau (ngon giac). Ben canh yeu t d mdi trffdng (tieng dn), anh sang (ngay, dem) thi dinh du^ng cung ddng vai trd quan trpng ddi vdi giac ngu cua tre [1][2]. San pham dinh duSng (SPDD) cd du cae thanh phan dinh dffdng, giau nang Iffdng, chat dam va vitamin. SPDD cd bd sung mdt sd acid amin can thiet trong dd cd tiyptophan - tien chat cua serotonin, mpt chat dan truyen than kinh giup ed the dieu hda sff ngon mieng, giac ngu va tam trang [3]. Ngoai ra SPDD cdn cd bo sung them cac vi chat nhff kem, vitamin nhdm B va cae chung ldi khuan lam ffc che sff phat trien cue vi khuan cd hai, tang cffdng vl khuan cd ldl trong he dffdng rudt, giup he tieu hda cua tre khde manh nhd do hap thu eac chat dinh dffdng tdt hdn tre [4].
Tuy nhien, hieu qua cua SPDD cd bd sung vi chat dinh dffdng va Tryptophan ddl vdi giae ngu va phat trien tam - van dpng cua tre em nhff the nao? Oe tra ldi cau hdi nay chung tdi da tien hanh nghien cffu "///^v qua ctia san pham dinh duQng co bo sung, da vi chat, tryptophan va cholin iin giac ngu va phat trien tarn-van dong cua tre 24-60 thang tudi".
II. DOI TUQNG VA PHLTONG PHAP NGHIEN CUXJ 2.1. Ddi t&dng, dja dii'm, thdl gian nghien c&U
Bdi t&^ng: Tre tff 24 - 60 thang tudi, cd nguy cd suy dinh du@ng (SDD) va SDD nhe can:
- 3SD < WAZ < 0 SD, tre khdng bj suy dinh dffdng cap tinh, tre khdng bj suy dinh dffdng thap cdi nang, cha m$ dong y cho tre tham gia nghien cffu.
Ola diem nghiin c&u: Xa Cff Ddng va xa Tat Thang, huyen "Hianh Sdn, tinh Phu Tho,
Thdigian nghiin c&u: 03/2016-12/2016 2.2. Cdmau va chpn mau
C& mau: Cdng thffc tinh cS mau cho nghien cffu mong muon cd sff thay ddl ty le
[z^-,/sj2P(l-P)-HZ,-pVP^(l-P,)-KP,(l-P,j
Zi-a/2 =1,96 khi dd tin cay nghien effu dat 95%, Zi-p =0,84 khi lffe mau dat 80%
Trong dd: Pi: ty le tre cd giac ngu khong ngon cua nhdm chffng tai thdi diem ket thuc can thiep tffdng utig 33%. Pi'- ty le tre cd giac ngu khdng ngon cua nhdm can thiep_tal thdi diem ket thue ean thiep tffdng ffng 13%. P^: (Pi+p2)/2. C3 mau tinh dffdc cho sff thay ddi ve giac ngu khdng ngon cua tre la: 86 tre. Tdng sd tre cho moi nhdm nghien cffu la 100 tre sau khi da cong 15% 6e phdng bd cude. Tdng sd tre thffc te chpn dffdc la 200 tre: trong dd nhdm chffiig co 100 tre va nhdm ean thiep cd 100 tre. K^ thuc nghien effu ed 9 tre d bd cudc d ea 2 nhdm
Chon mau: tre tham gia dffdc phan bd ngau nhien thanh 2 nhdm.
- Nhdm ean thiep; Hang ngay tre dffdc bo sung 2 gdi SPDD cd bo sung vi chat dinh dudng, tryptophan va cholin (moi gdi 38 g).
- Nhdm chuhg: Tre khdng dffdc bd sung SPDD.
Cach s& dung SPDO. Moi tre tham gia dudc phat 1 cdc cd danh dau mffc nffdc 180 ml, moi goi SPDD dffdc dffdc pha vdi 180ml nffdc am (40°C- 50°C) sau dd quay dSu va eho tre udng ngay.
Thdigian can thiip: 6 thang
2.3. Thiet ke nghien ci^u; Nghien cffu tiiij' nghiem ngau nhien cd ddl chffng.
2.4. Thu thap so lieu va danh gia ket qua Thu thap sdlieu va danh gia giac ngu cua ti^.
Sff dung bd cau hdi cau true ( ( ^ dffdc dieu ffa thff) de plidng van ba me nhiitig van de lien quan den giac ngu cua tre.
Danh gia tinh hlnh giac ngu cua tre: Thdi gian ngii trung binh ciia tre (ngay va dem), thdi gian ru ngii (tff khi len giffdng den khi tre ngu). Tinh chat giac ngu: ngu ngon (ngii mpt mach) hay khdng ngii ngon (tinh giac giffa dem, hoang hot, me sang, quay khde) [ 2 ] .
Thu thap va danh gia phat trien tam van dpng ciJa tre: Sff dung bang hdi ve tudi va giai doan phat trien ciia tre (Ages and Stages Questionnaires/ Moi bang hdi gdm 5 Hnh vut, mot Hnh vffc cd 6 cau hdi; moi cau hdi, cha me tra Idi ket hdp vdi quan sat/test tren tre va dffdc tinh dIem nhff sau: neu tre thffc hien dudc thudng xuyen dat 10 diem, tre thffc hien dff^
thinh thoang dat 5 5\em, tre khdng thffe hi^n dffdc: 0 diem. Tong sd diem ciia moi Iinh vffc giao dpng tff 0-60 diem va dffdc so sanh vdi gia hi triing binh (ciia tre binh thffdng theo tffng lffa tuoi) 2.5.XU' ly so li€u: Nhap so lieu bSng chffdng trinh EPI DATA 3.1. Phan tich sd lieu theo chffdng trinh SPSS 16.0. Chi nhuhg tre tham gia
TAP CHI Y HOC VlgT NAM TAP 454 - THANG 5 - SO 1 - 2017 tai dieu tra ban dau va ket thuc mdi dffdc d u ^
vao xff ly sd lieu.
2.S.Van de dao d&c b-ong nghien c&u:
Nghien cuXi tuan thii theo cac nguyen tac trong hd sd dao dffc da dffdc hpi dong dao dffc Vien Dinh dffdng thdng qua.
III.KETQUA NGHIEN CU'U
Tai dieu tra ban dau, moi nhdm nghien effu cd 100 tre. Tai dieu tra ket thue: ty le bd cupc d nhdm chuhg la 4 % va nhdm can thiep la 5%, khdng cd sff khac biet ve ty le bd cudc gluS hai nhdm.
Bang 3 . 1 . Thdl g\z Bien so Tdng thdi gian ngu
(gid) Thdi gian ru ngii
(phut)
n ngu va ru ngu cua tre tai thdi diem tru'dc va sau can thiep Thdi di€m nghien
cuTu/thay doi Dieu tra ban dau (TO) Dieu tra ket thue (T6) Dieu tra ban dau (TO) Dieu tra ket thue (T6)
Nhom ch (Ii'ng ( n = 9 6 ) ( T B ± S D )
9,3 ±0,5 9,9 ±0,4 21,9 ±6,4 20,1 ±9,1
Nhom can thiSp ( n = 9 5 ) fTB±SD)
9,3 ±0,5 10,3 ±0,6' 21,0 ±7,9 11,2 ±15,6' p<0,05, s& khac biit vdi nhdm chuhg CLing thdi diem, TestTdgc ..
Ket qua nghien cffu d bang 3.1 cho thay tai dieu tra ban dau, tong thdi gian ngii va thdi gian ru ngu ciia tre d hai nhdm khdng cd sff khac blet (p>0,05). Ket thuc can thiep (dieu tra ket thuc): tdng thdi gian ngii trung binh ciia tre em nhdm ean thiip (10,3 ±0,6 gid) nhieu hdn so vdl tre nhdm chiTng (9,9 ±0,4 gid), p<0,05. Thdi gian ru ngu eua tre nhdm can thiep (11,2 ±15,6 phiit) thap hdn so vdi nhdm chuhg la 20,1 ±9,1 phut, p<0,05.
Bang 3.2. Ty 1^ t r e ngu khong ngon giac tai thdi diem tru'dc va sau can t h i | p Thdi diem Nhom chu'ng [ n = 9 6 )
o/o
Nhom can thiep ( n = 9 5 ) o/o
Ban dau (TO)
29
30,2Ket thuc (T6)
18 ^ I 18,8 _ . I . 6 _ I 6,3" I
'p<0,05, s&khac biet vdi nhom chuhg cung thdi diim. Test/
Bang 3.2 cho thay: trffdc can thlep, ty le tre ngii khdng ngon giac (tran trpc, giay dap khi ngu...) d nhdm chffng la 30,2%, khdng ed sir khac biet (p > 0,05) so vdi nhdm can thiep (27,3%). Ket thuc can thiep: ty le tre ngu khdng ngon giac eua nhdm ean thiep giam chi cdn 6,3% thap hdn cd y nghTa so vdi rihdm chffng (18,8%) vdi p < 0,05.
Bang 3.3 Ty le t r e c6 ky nang phat trien t a m van dong DNBT (cham va nghi ngd cham that trien) tru'dc v^ sau can thi^p
Ky nang Pieu tra Nhom chuTng n = 9 6 n ( % ) Nhdm can thiep n = 9 5 nC/o]
Giao tiep Ban dau (T0)~
Ket thuc (T6)
12 (12,5) 12 (12,5)
12 (12,6) 9 (9,4)
Van ddng toantlian
Ban dau (TO) Ket thuc (T6)
19 (19,8)
Ban dau (TO)10 (10,4)
25 (26,3)
2(2,1)-^
Van ddng b'nh Ket thuc (T6)
29(30,2) 17(17^7)
39 (41,1) 19 (20,0)'
Giai quyet van de Ban dau (TO)Ket thuc (T6)
29 (30,2)
Ban dau (TO)28 (29,2)
30 (31,6) 15 (14,7)'
Ca nhan xa hdiKet thiic (T6)
22(22,9) 13(13,5)
25(26,3;
8 (8,4)°
' p<0,05 khde biii vdi nhom ch&ng tai cung thdi diem. Test/;
p<0,01 "^ p<0,001 so vdi ti&dc CBn thiep trong cung nhom MC Namer test biet so vdi dieu tra ban dau (p > 0,05). Ket thiic can thlep: tre d nhdm can thiep cd ty le ky nang van ddng toan than DNBT va ky nang glai quySt van de DNBT thap hdn cd y nghTa so vdi nhdm chffng ( 2 , 1 % va 14,7% so vdi 10,4% va 29,2%;
p < 0,05) '' p<0,05;
Ket qua nghien cu\j d bang 3.3 cho thay ty le tre cd k9 nang van ddng tinh DNBT, ky nang giai quyet van de DI^IBT va ky nang ca nhan xa hdi DNBT ciia tre em nhdm can thiep tai thdi diem dieu tra ket thuc giam dang ke so vdi dieu tra ban dau (p<0,001; p<0,05; p<0,01). Q nhdm chffng, mdt sd ky nang cung cd xu hffdng cai thien ( t / le tre cd ky nang phat trien DNBT cd xu hffdng giam), tuy nhien chffa thay cd sff khac
IV. BAN LUAN
Tac dgng vdi giac ngu: Ket qua nghien cifu da chi ra tre udng SPDD cd tdng thdl gian ngii
VIETNAM MhUIOAL JUUKHAL N"1 - MAT - £U1 f nhieu hdn so vdi nhdm ehimg (10,3 ±0,6 gid so
vdi 9,9 ±0,4 gid, p<0,05). Thdi gian ru ngii eua tre nhdm can thiep thap hdn so vdi nhdm chffng (11,2 ±15,6 pliut so vdi 20,1 ±9,1 phut, p<0,05). Ty le tre em nhdm can thiep cd giac ngii khdng ngon thap hdn so vdi nhdm chffng (6,3% so vdi 18,8%,^p<0,05).
Dieu nay cd the mdt phan tac ddng ciia tryptophan trong SPDD. Tryptophan la mdt acid amin cd hai chffc nang quan tnpng, mpt la diidc gan chuyen hda thanh niacin (vitamin B3), hai la eung cap tien chat ciia serotonin, mot chat dan truyen than kinh giup cd the dieu hda sff ngon mieng, giae ngu va tam trang [6], [7]. Ngoai ra mdt sd chat dinh dudng nliff sat cung cd vai trd ddi vdi giac ngu: thieu sat la can nguyen eua hdi chffng ban chan khdng yen.
Tac dpng den phat trien tam van dong: Cac cd quan tham gia vao phat trien tSm van dpng eua tre bao gom: sff phat trien cua nao bd, he thdng than kinh, cd xffdng khdp.
Sff dung SPDD cd bd sung vi chat dinh dffdng, tryptophan hang ngay da glup tre nhdm can thiep giam dang ke ty le ky nang van ddng toan than DNBT, ky nang van dpng tinli DNBT, ky nang gial quyet van de DNBT va ky nang ca nhan xa hdi DNBT so vdi dieu tra ban dau. Sau thdl gian 6 thang can thlep: ty le tre cd ky nang van dpng toan than DNBT va l ^ nang gial quet van de DNBT thap hdn so vdi nhdm chffng. Cd quan tham gia trffc tiep ddi vdi sff phat b-ien tam - van dpng la he thong than kinli va cd - xifdng khdp. Cd rat nliieu chat dinh dffdng tham gia vao cau true va hoat ddng cua he cd- xffdng Widp, tuy nhien vitamin D va calci ddng vai trd chu yeu. Cd, xffdng, khdp ddng vai trd quan trpng trong he van dpng. Tre em cd ky nang van ddng tdt se giup tre ngu ngon - tien de cho sff pliat trien trf nao. Sff dung SPDD cd bd sung vi chat dinh dffdng va tryptophan hang ngay da cai thien tinh trang dinh du'dng ciia tre em nhdm can thiep (ket qua nghien ciTu dffdc trinh bay d bai bao khoa hpc khac). Nhieu nghien cud da ehi ra rang cd sff tffdng quan giffa phat trien tri Iffc vdi tinh trang dinh dffdng ciia tre. Ben eanh cac chat dinh dffdng thiet yeu, SPDD edn ed Cholin (dap uhg 60% nhu cau khuyen nghi hang ngay).
Cholin tham gia vao qua trinh chuyen hda chat beo, khi thieu cholin thi lipid bj tfeh trff nhieu tai gan, Nhieu nghien ciTu cho thay can ttiiet phai bd sung cholin vao khau phan an cho phu nff khi mang thai 6i me cd dii Iffdng choline cung cap cho con qua nhau thai. Ddng thdi de giup tre
tang cffdng phat trien t r i thdng minh cung tan bd sung cholin vao bffa I n eiia tre qua thu'c pham. Nghien cu\i thffc nghiem tren loai gam nham cho thay bd sung Cholin trong gial doan mdi sinh da anh hffdng den tri nhd cua ioai gam nham. Theo Zeisel va cdng sff cd the Cholin tham gia vao qua trinh Methyl hda ADN, qua trinh nhan len va biet hda te bao than kinh.
V. KET LUAN
Sau 6 thang sff dung SPDD cd bd sung vl chat dinh dudng, tryptophan va cholin: Tre em nhdm can thiep cd thdi gian ngii nhieu hdn so vdl nhdm ehffng (10,3 ± 0,6 gid so vdi 9,9 ± 0,4 gid, p < 0,05). Thdl gian ru ngii ciia tre nhom can thiep thap hdn so vdi nhdm chffng (11,2 ± 15,6 phut so vdi 20,1 ± 9,1 phiit, p < 0,05). Ty le tre nhdm can thiep ed giac ngii khdng ngon thap hdn so vdi nhdm chuhg (6,3% so vdi 18,8%, p < 0,05). Nhdm tre sff dung SPDD co bd sung vi chat dinh dffdng va Tryptophan hang ngay cd t / le ky nang van ddng toan than DNBT va liy nang giai quyet van de DNBT thap hdn so vdi nhdm chffng ( 2 , 1 % va 14,7% so vdl 10,4%
va 29,2%; p < 0,05)
KHUYEN NGHj
Can nghien cffu them ve tinh hinh rdi loan giac ngu cua tre tren cdng dong.^
TAI UEU THAIVl KHAO
1. Bjom Rasch and Jan Bom (2013). "About Sleeps role in Memoory". Ffiysbl RevK'pr, 93 (2) 681-766.
2. Srlcharan Moturi and Kristin Avis (2010).
"Assesanent and treatment of common pediatnc sleep disorders". Ps^^iabylQlQ Jun: 7 (6): 24-37.
3. Vernon RY (2001). Protein and Amino acids in Present Knowledge in Nutrition eighth editon, editors: Barbara A Bowman and Robert M Russel.
Pag 43-58.
4. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. (2006 June). "Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo- controlled trials". Lancet Infea Dis 6 (6): 374-82.
5. Squires J and Bricker D (2009). Ages & Stages Questonanaires. Paul H Brookes Publishing Co.
Baltimore, London, Sydney.
6. Vernon RY (2001). Protein and Amino adds In Present Knowledge in Nutrition eighth edi^, editors: Barbara A Bowman and Robert M Russel.
Paq 43-58.
7. Zeisel SH {2012). Cholin in 10 " Pre^nt Knowledge in Nutrition, Eddlded bv Erdman JW, Macdonald LA, Zeisel SH, ILSI and WILEY BLACKWELL, pag 405-418.
