ITfTllGQUkKtNEIIIEIIClUI
Md'i lien quan giffa tinh trang suy dinh drfcTng va phat tridn tam ly - van dong dr tre em tff
1 dd'n 3 tudi
N g u y i n D S H u y (*)
Nghiin ctfu xdc dfnh lien quan gitfa tinh trgng suy dinh dudng vd chdm phdt triin tdm if • vgn ddng d 492 tre ttf 1-3 ludi tgi Hdi Duong ndm 2009. Cdc thi suy dinh dudng dUOcphdn logi theo tiiu chudn cua Td chtfc Y liThigidi; Stf phdt triin tdm ly - van ddng duac ddnh gid bdng test Denver II dddut^c chudn hda. Phdn tick cd tinh din dnh hudng cua cdc yi'u td nhiiu (kinh ii, xd hdi, dinh dudng thdi ky thai nghen, stfc khde mf khi cd thai, fmh trgng cudc di, bu stfa me) cho thdy suy dinh dudng Id yiu tdnguy coddi vdi chgm phdl triin tdm ly-vgn dgng 6 tre 1- 3 tudi vd stf phdi hgp gitfa suy dinh dudng thdp cdi vd nhe cdn cd liin quan rd rit han so vdi riing le ttfng thi suy dinh dudng d khu vtfc chdm phdt triin ngdn ngtf cd d tri trai vd tre gdi. Cdn tdng cudng stf phdt triin ngdn ngtf d nhtfng tri bi thi suy dinh dudng phdi hgp ndy.
Ttf khda: suy dinh dudng, chdm phdt triin tdm ly vgn dgng. Ire em.
The relationship between malnutrition status and delay of psychomotor development in
children aged 1 to 3 years
Nguyen D o H u y {*)
The purpose of the smdy was to investigate the relationship between malnutrition status and delay of psychomotor development m 492 children aged 1 to 3 years in Hai Duong province, 2009. The malnutrition status was classified according to criteria set by the World Health Organization; and the psychomotor development was assessed using Denver 11 test adapted to Vietnamese children. The analyses adjusted b\ confounding factors (socio-economic status, utero nutrition, maternal health during pregnancy, slants of newborn, and breastfeeding) showed that malnutrition status was a risk factor for suspected delay of psychomotor development in both boys and girls aged Ito 3 years; and the combined malnutrition ben\-een underweight and stunting was more likely to risk suspected delay of language development, in comparison wilh individual of under»'eight or stunting, ll is necessary to promote the language development in children suffering from the combined malnutrition.
i>-
{TtfN&VlltRftNBIIEKCtDI
Key words: Malnutrition, delay of psychomotor development, children.
Tic gii:
(•) TS. BS. NguySn Dfi Huy, Phd Giim &6c Tmng tam dio tao Dinh dUdng va Thi^c ph^m, Vien Dinh diTdng qudc gia. Email: nguyendohnyl 965 @ yahoo com
1. Dat vd'n d&
C i c nghifin cffu tren thfi' gidi cbo tbay Ire bi suy dinh dtfdng trong nhihig nam dau ddi se anb htfdng khong td't dfi'n h i n h vi. nhdn thrfe va p h i t Irien Idm ly-vdn dpng dii sau n i y dtfdc cham sdc v i dinh drfdng lot [5]. Tre suy dinh drfdng co diem IQ thd'p hdn tre binh thrfdng drfdc b i o e i o trong ngbien cfftf tai My. Nghifin ctfu v e hfin quan giffa suy dinh drfdng v i phit tridn hanh vi. nhdn thffc ciia Ire trong 6 nam dau cho thi'y nhrfng khifi'm khuyfi't ve Iri tufi ciia tre suy dinh drfdng xui't hifin ngay trf Iffc tre drfdc 1 va 2 tudi [6].
Tai Vifit Nara, tinb trang dinh dtfdng v i cdc yfi'u Id' nguy cd d tre em da dtfdc nghifin cffu rpng rai lai cfing ddng v i bfinh vifin. Nhieu nghifin cffu danh g i i tinh trang dinh dtfdng vd t i n g trtfdng ve the Itfc cua Ire em tff sd sinh dfi'n 60 thdng ludi [1, 3]. Tuy nhien. nghifin cffu vd stf phdt trien Idm 1;^
v i n dpng ciia tre tai cpng ddng srf diing test Denver II [2] van chrfa drfdc phd bifi'n. Hdn nffa. v l n cdn it nghifin crfu ve srf p h i t trifi'n ve cd the liTc, van dpng va tinh thdn ctia Ire em, dac biet la srf hen quan giffa finh Irang suy dinb dffdng vd srf phdt trien tdm Iy - van dpng ciia Ire trong nhffng n i m dau ddi. Do d o , nghien ctfu ndy cd rauc tifiu xac dinh srf h e n quan giffa finh trang suy dinh dtfdng dd'i vdi stf phdt trifi'n tdm 1# - vdn dpng d tre em trf I de'n 3 tudi lai Hdi Drfdng n i m 2009.
2, Phffcfng p h a p nghifin cffu
Thifi't ke nghifin cffU: Ngbien cffu sff dung phrfdng phdp nghifin cffu cat ngang. Uen bdnh Irf Ihing 10-12 n i m 2009 Iai pbrfdng Tran Phii vd xa T i n Htmg. linb Hdi Drfdng.
Ddi trfdng nghifin etJu: Td't ca Ire trf 1 dfi'n 3 tudi tai 1 xd ndng thon (26S Ire) va 1 phtfdng thdnh thi (227 tre) thda man Ueu chuan de du Ihdng. khdng cd di tat b^m sinh, bfinh m i n tinh v i bat thtfdng ve phdl trien tri lue va ngtfdi me/ngtfdi c h i m sdc c i c Ire n i y dtfpc mdi tham gia nghifin cttu.
Thu t h i p thdng tin ve finh trang kinb te-xa hpi
^ a cdc yeu to' dnh htfdng den finh trang dinh dtfdng v i stf phdt trien tara ly - van dpng bang phtfdng p h i p phdng vi'n trtfc tifi'p ngtfdi me/ngtfdi cham soc tre cd srf dting bd can hdi thifi't ke' s i n .
D a n b gid finh trang dinh dtfdng cua Ire: Tinb trang dinh drfdng cua tre drfdc p h i n loai Iheo Ueu chuan cua Td chrfc Y td the'gidi nam 2004, gdm suy dinh dtfdng the thap coi (chidu cao/tudi). nhe can ( c i n ning/tudi) v i gay cdm (ein n^ng/chieu cao).
Danb gid stf phat trien tdm Iy van ddng cua tre tff 1 -3 ludi: Sff dung test Denver II da dtfdc chuan hda [2] vdi 4 khu vtfc phdt tridn cua tre drfpc ddnh g i i , gdm:
Khu vuc vdn ddng thd sa (Gross motor area):
ddnh gid khd nang phat Irien cac van ddng l o i n than vd kba n i n g giff thing bdng eiia cd the.
Khu vtfc vgn ddng tinh te thich tfng (Finemotor- adaptive area): danh g i i kha n i n g v i n dpng kheo leo ctia ddi tay v i kha n i n g quan s i t tinh tfi'eua ddi mat.
Khu Vtfc cd nhdn - xa hdi (Personal-Social area): ddnh gid kba n i n g nban biet ban than, c h i m sdc bdn thdn vd thie't lap quan he lrfdng tdc vdi ngrfdi khdc.
Khu vtfc ngdn ngtf (Language area): ddnh gid kba n i n g ldng nghe vd d i p ihig vdi am thanh. khd
Tap chi Y t^ Cfing c6ng, 12.2012, Sd 26 (26) 29
- ^
ITli'NGQUAN&MGHllNCtfUl
n i n g phdt dm, v i sau ciing la kha ning pbdi trien Dgdn ngff (nghe hieu v i ndi).
Phdn tich thdng ki: Srf dung kiem dinb Mann - Withney U test de so sinh thdng tudi giffa hai nhdm va sff dung Idem dinh % binb phrfdng (Chi-Square) h o l e Fisher's Exact test de so sdnh cdc ty lfi. Srf lifin quan girfa tinh trang dinh drfdng vd finh trang nghi ngd chira p h i t tridn tdm 1^-vdn dpng drfdc xac dinh bdng phdn lich hdi quy ddn bien va da bifin (logistic regression) Y nghia thdng kfi dat drfde vdi gia tri P value < 0.05 cho 2 phia. Sdlieu drfdc p h i n tich bang phan radra SPSS 16.0.
3 . K d t qua nghifin cffu Bdng 1. Ddc diem cua ddi tUtfng nghien ctfu
QU biCn T u i l rihung 1
G i d i l V i u m l C l n n ) n c M i m i l i > 2 J D 0 E Bu mi: Yiain (oin
< 4 ( h i l i i t 4 . b(hlDC
Crt (tfl CHOJ
D i ItnidnB
M6at 71»rnriuib
> 3
Thinbltii [- = •2X1)
122(5? 71 217195 6)
77 (36 Ol 129(60 3) B(3 7l 215194.7)
169(744)
4 8 C l t)
1 " 153.71 9^141 4 | 1 I I 4 K I
M n R t l l l l n U . = M 5 )
I P 9 - 2 8 S I 142(S3 6 » ) 244 192 I ' l
104 143 71 L27 153 4) 7 ( ' ' 9 ! 241 (90.91
20S l7S 5) 21 17 91 )6113 6)
i a S l 4 0 S l 1 1 2 ( 4 2 ' ! 45(17 01
Chung
<n ° 492) 24 0 (I7 0-2K51 264(53 7) 461 (93 7>
IBI {400) 256 (56 6) 15(3 31 Ait. (92 7)
377176.6) 3 X 6 3 1 84(171)
2301467) 206(4191 5 6 I I I 4 )
P-value 0.12B
OOT-- 0 109 0 241
0,109 0.1134
en.oooi
Sd lifiu trong bang l i n (%), trrf thang tudi la trung vi va khoang 25tb-75th percentile.
P-value nhan drfde trf phan ticb Chi-Square lest boic Fisher's Exact Test cho cdc ty le, trrf kifi'm dinh Mann-Wiihney U test de so sinb tbdng tudi.
D i e diem ctia dd'i trfdng nghifin crfu drfpc Uinh bdy tai Bang 1. Cd srf khdc nhau giffa tre d vung thdnh thi va ndng thdn vd thff ttf sinh va tinh trang cu$c de; TJ le tre d thanh thi drfdc sinh ra bang md dfi Id 21.1% cao hdn 7.5% so vdi tre d nong thdn (P
< 0.05). T J lfi tre Id con thrf 3 trd Ifin d ndng thdn la 17% cao hdn 12% b i n so vdi thdnh thi (P<0.0001).
Khdng cd srf khdc hifii cd y nghia thd'ng kfi ve tudi, gidi. can nang sd sinh, v i cd do cbdi giffa tre d vOng ndng thfin vd thdnh lhi (P > 0.05). Ty Ie bd
rae drfdi 4 thdng dan sau sinb cua nbdm tre ndng Ihdn la 43,7 % cd xu htfdng cao hdn so vdi ty lfi ndy d nhdra tte ihdnh tiii Id 36.0 %, luy nbifin stf khdc bifit khdng cd y nghia thd'ng kfi vdi P > 0,05.
Bdng 2. Liin quan gitfa titng the suy dinh dUdng vd nghi ngtf cham phdt triin tdm ly vgn d$ng theo gidi
Tmh trang dinb duanE
BIDII ItnlBng SDD ihfp cAi SDD nhe cSn SDDgJycbni
Binh tliuitng SDD IhlTp c6i SDD nh? cin SDD giy cbm
Binh ihdiiDg SDD Uifp 1^1 SDD nhf cin SDD ih cbm
Binh Ihirfing SDD ihip sbi SDD nh; cSn SDD giy rim
N a m OR (95* a ) Vflndfin«<h6 1 2 22(092-537) 1,441051-111) 3 29(0 84-12 9) VSn dane unh [^
1 2 101103-4,25) 217(1.14-5.32) 2 42(0.7l-SJ?4) a nh9n-xa hoi 1 121 (0 61-241) 1 44 |0 67-3 08) 1 15(031-4 32) NpSn ngiF 1 1 1IS0 59-2.08J*
1 16(0 57-2 37) 1 13(0 34-3 781
P-ialue
0.076 0,491 0 088
0.040 0.022 0 139
0.SS8 0 353 0S3S
0.756 0.690 0.847
N B OR 195« CI)
1 2 14(0 98-4.67) 2.13(0.90-5.05) 1.16 l0,»-5.58)
1 194(097-3.86) 176(0.81-3.82) 1,1110.28-4 31)
I 3.04(152-6.09) 3,35(1.56-7.21) 3.01(0.88-10.3)
:
1.82 (0.93-3 58) 2 02 (0 95-4.29) 0.96 (0 25-3.74)P-vahie
a056 aos4 0,857
0061 0.156 0 886
o.oca 0002 0.079
0.082 0069 0 952
P-value n h i n dtfdc tff p h i n tich hdi quy logistic ddn bie'n stf lifin quan giffa trfng tbe suy dinh dtfdng va stf phdt tridn t i r a ly-vdn dfing.
Sd'lifiu d Bang 2 cbo bid't stf hfin quan giffa tffng the suy dinh drfdng v i ngbi ngd chdm phdt trifi'n Idm IJ-vdn dpng d 4 khu vrfc van dfing tbd, van dpng tinh tfi', cd n h a n - x i hpi va ngdn ngff. Cd stf khdc nhau ve gidi trong mdi h e n quan trfin: Suy dinb dtfdng Ihap cdi v i nhe can d Ire trai cd lifin quan dfi'n nghi ngd chdm phdt tridn van dpug tmh td(P< 0.05);
trong khi dd d Ire gdi, ca hai the thd'p cdi vd nhe can cd lien quan de'n ngiii ngd chdm phdt trifi'n cd nhin- xa hpi (P < 0.01). Suy dinh dtfdng thd'p cdi ed lifin quan h o | c c6 xu htfdng Ufin quan de'n ta't ca cdc khu vrfc p h i t trien tdm IJ-vdn dfing 6 tre gdi, trong khi dd d Ire trai hien trfdng nay chl quan sdt drfdc d khu vrfc phdt trien vdn ddng tbd vd van dfing unh tfi'. ma khong anh hrfdng den srf kbu vrfc phdt trie'n c i nhdn- xa hfii vd ngdn ngff.
^r-
ITAfiQVflNftNGRlENClUI
Bang 3. Phdn tich hoi quy logistic da biin mdt lien quan giita cdc thi suy dinh duSng va stf phdt triin tdm van dgng d tre trai
Bdng 4. Phdn tich hoi quy logistic da bien mdi Uen quan giita cdc thi suy dinh dudng va sU phdt trien tdm v^n dgng dtre gdi
TlBh DfSf dnh dJOo;
Btahauhkit Q d b i SDD thip 1^1 C U b i S D D i i l t t c i n SDD Atf tAi v i i b e d n B i n b i i k f S D D
BlnliitriBc;
C l i b | S D D l h £ p c 6 i CUb|SDOi<KcIi>
SDDtl<l-pti«'Ai*Krv B i c i h a i h f SDD
Binh d i i M i t ChibiSDDdilpEai Chi b) SDD nhe d o SDD difp c h i l l nhe n n B i c j b a d i f SDD
BUiihKhef C U I i i S D D a i l p c b i O d h SDD ahc c^n SDDlhlr>cAivlnhEciii Bl c i t a Iht'SDD
M a a n i d W i f f i i u c h t o l l 1 | M 6 h i u h i i d , i u c : i * O R ( 9 5 » a ) \p-ni<lt 1 | 0 B ( 9 5 ' 5 C r ) |r>-r3lH ViaXsi iK.
1 j j ; 2 ( i . i » - a 8 i i 17B(0J1-1S41 07H0-09-5 77) 4 ^ < l . ( > i - 1 7 6)
B.023 0600 0751 ILH4
1 385(0 9 2 - i 6 1 l 108 10 l^-S-" 61 a : 3 (002-2 44) 3J2 (0 44-28.01
0065 0620 0.256 0 J 3 i V i n dfin» linh i r
1 1.86(0-76-4,14) l 9 9 ( 0 - » - I O : i 2.7B(0.W-7g91 3 09l0<8-t0 9>
0176 0409 0 0 . 4 007B
1 3 6 ; i i . 0 5 - l 2 J ) 3 J!3 lO.M-26 71 1 3 i « I M - S 6 3 1 J 15 10 75-23 11
0.M2 DJ!79 D,iOI 0 104 CS n h l n - j i hfl,
1 0-89(0^6-2-18) 1 13(0 23-5 651 1-38(0-57-4'51 11S(0_)1-|JS21
O.SOI OBM 0 377 osos
1 1 05 ( O J 3 - 3 , > I 1 1,57 (OJO-12.51 1 vrKCa---* 18!
1J^6(0J2--'M.
093S 0665 0418 0.793 }t^„-l
1 09aiO.,^l-L981 07210 15-3.581 [-36.0->8-3_101 1 12101.3-380)
0793 U6S8 0638 0 M 6
1 0 « 1 0 ^ 7 - J 1 4 1 3S2I069-2L2) 4 M ( n t l - U 9 1 l'8(0JS-B611
0SS7 0 12.'^
0.QCT 0600
"Dah i n n ^ dioh djOng
Blnhihiltaf CU b; S[>D tbfp cAj Chi hi SDD nhe cin SDD di£p cAi VI nhe cin B i c i b > d l ^ S D D
mctomtait C l g - l n S [ » 9 J F ^ Oi^SDDiMac SDD ihfp ((H v i ah« d n B|<^h><bcSDD
Buhdwinif CWb.SDDthrpeoi ( 3 > i b S D D n h c « n SDD>if'i>cAivt u h c d n B i a b a d i J S D D
Blotihugaf Oa h, SDD Ihfp ; m CJiibiSDDnhcdn SDD ihEp ch( ^ i Dhf ctn B i c * h . d . J S D D
MS U a h c b ^ l i d i ^ chloh 1 |x<u Unh d i d i ^ dunh M l ( 9 5 * CTI Ip-i-alue 1 | 0 R ( « ' i C T I | P-iilnt VindBufdKi
1 I I J ( O J M _ ' l )
4,87 (1.74-13.6) l J 5 ( a - » - 6 6 6 )
0 863
o.wa 0 710
1 0-46(008-1.69)
4 18(091-19-2)
• JO (0)7-8,61) 0J91
0066 0853 Vinrtf^ffnohK^
i IJIJ (0J7-3 10]
O H (0-17-4 (Kl i 6 J (0.97-7 141 1-23(0-31-4 881
0688 0 810 0017 0 765
1 0.9010 24-3,46) 143(023-909) l.71(0,49-.S96) 1 13(0 21.6-281
0,879 0 703 0_!9R 0.B86 a nhSn-u h6i
1 3.1J lO S5-5 J2l 1.2H0::4-5 9Rp 4.83(1.76-13 21 1-01(1.15-14 11
0 107 0 819
• M I tax
1 136(0.37-5 03) 0-55(006-5521 5 9 : (143-34 71 4 96(0 82-29-81
0 . ^ 0.611 OHlS OJtSl N i ^ » i f
1 137(0 55-3 381 2.05(0 55-7 6?|
1 }5mj»-iSt., 0499 02K1 d j u e 0839
1 O 9 3 ( 0 : - - 3 ( 4 ) 382(069-2121 4.2011 18-149) 158(0 39-8 61)
0 887 0,125 0JI2T oeoo
Cdc ye'u td'dieu cbinh trong md hinh phan ticb b6i quy multilogistic regression g6m: sd sinh nhe cdn. tinh Irang cudc de. thdi gian cbo bd m e h o i n toan, thdi gian m e chdi vdi tre, m e hi bfinh khi cd thai, tuoi ctia tre. thrf trf sinh. ndi sd'ng vd kinh ke'hfi gia dinh.
So lifiu d Bang 3 cho tha'y chi hi tha'p cdi cd cd lien quan de'n c h | m p h i t trifi'n van dfing tinh Ie' (OR
= 3.62, P = 0.042) vd cd xu hrfdng dnh hrfdng dfi'n stf phdt Ui^n vdn ddng tho (OR = 3.85. P = 0.065) d mo hinh cd dieu chinh. Rifing suy dinb dtfdng thap cdi h o i c ube cdn chrfa thd'y dnb hrfdng ddi vdi srf phdl trien ngon ngtf d c i e md hinh. Tuy nhien, kbi U^ vrfa bi suy dinh drfdng thi'p cdi vd nhe c i n se cd nguy cd chdm phdt tri^n ngdn ngff d tre trai dQ da tinb dfi'n anh hrfdng ctia edc ye'u Id' nguy cd k h i c , e u n g n h r f d i e u e h i n h theo cde yfi'u to nhifiu.
Cdc yfi'u td'dieu cbinh trong rad hinh p h i n tich hoi quy raultilogislic regression gdra: sd sinh nhe cdn. tinh Irang eugc de. thdt gian cho bu m e hoan l o i n , thdi gian me chdi vdi Ire. m e bi bfinh khi cd thai. tu5i ciia ire. thrf trf sinh. ndi song vd kinh ke'ho gia dinh.
Kfi't qua d Bang 4 cho tbay d tre g i i m i c du rieng suy dinh drfdng thap cdi boac nhe c i n khdng cd md'i hen quan dd'i vdi stf phdt trien v^n dong, stf ke't hdp cd suy dinh drfdng thap cdi va nhe c i n d i anh hrfdng cd y nglua tho'ng ke dfi'n srf phdt trien t i m v^n ddng d cdc khu vrfc van dpng thd, vdn ddng tinh tfi', c i n h i n - x i bdi va ngon ngfl vdi OR lan Irfdt la 4.87 (P = 0.003). 2.63 (P = 0.057). 4.82 (P = 0.002), va 3.08 (P = 0.026) Uong md hlnb chrfa d i l u chinh.
Sau ichi dieu ehinh e i c yfi'u tdnbieu. srf kfi't hdp girfa suy dinh drfdng tha'p cdi v i nhe can lam Ue Iang nguy cd chdra phat trien khu vrfc ci nhan-xa bgi vd ngdn ngrf.
4. B a n lu^n
Suy sinh dtfdng, bdn than nd thfi' hien stf chdm p h i l iri^n kich thrfdc cua cd the d c i c dang k h i c nhau, bao gora chim p h i t trifi'n can nang so vdi tudi, cham phdt trien chieu cao so vdi tudi hay khdug cd srf song h i n h eiing phit then cdn nang theo chieu cao. Kfi't qua Uong nghien ctfu n i y cbo thd'y: i) Tre trf 1 dfi'n 3 tudi hi suy dinh drfdng Id yfi'u to' nguy cd ddi vdi nghi ngd ciidm p h i l trien tara ly-vdn dgng v i
Tap chi Y «f Cflng c(^ng, 12.2012, Sd 26 (26) 31
- ^
I TO'NG QUAN ft NGHIEN c l u I
ii) Srf phdi hdp giffa suy dinb drfdng tbap cdi v i nhe cdn c6 hen quan rd ret hdn so vdi rifing le trfng thfi suy dmh drfdng d edc khu vrfc nghi ngd chira p h i l trie'n tdm ly-vdn ddng, dac bifit la ngfin ngff. Anh hrfdng tren cd the Hfiu quan dfi'n srfphdt trie'n vi kich thrfdc ciia he than kinh trung tfdng Uong 6-12 t h i n g dau bi anh hrfdng rd rfit ctia tinh trang suy dinh drfdng d tre [6J vd suy dinh di(3ng d u e sau 1 tudi dnh hrfdng dfi'n kha n i n g hpc, thara gia vd duy tri c i c boat ddng hgc tap [6]. Anh htfdng ro rfit d kbu vrfc ngdn ngrf uong nghifin eihi nay ciing trfdng dong vdi nghifin ci?u tai Brazm 5 trfi trf 6-70 thing tuo'i [9].
Trfin thfi' gidi da cd mdt sdnghifin crfu vi sii lifin quan giffa tinh trang suy dinh drfdng vi phdt tri^n tara ly, van dfing ciia tre trong nhffng nira d i u ddi.
Nghifin crfu cila H. Abigail Raikes n i r a 2005 [8]
cho thd'y anh htfdng ciia mdi trtfdng gia dinh (sdtrfi drfdi 5 tudi trong gia dinb, Iinh hinh drf trrf thrfc pb^m, sd thinh vifin trong hd gia dinh) vd suy dinh drfdng nhe cdn tbeo tuoi dfi'i vdi srfphdt tri^n cua tre Nicaragua trf 2 thdng dfi'n 5 tudi, dnb hrfdng nay manh hdn d khu vrfc phit Uifi'n ngdn ngff va v i n dfing tinh te'. Amanda Sacker v i ddng nghifip [9]
quan sit thd'y bti sffa rae Id yfi'u td' bdo vfi dd'i vdi ch§ra phdt tri^n vdn dpng thfi va tinh te' d tre nhd, Uong dd anh hrfdng cua bii rae vdi phit trien vdn ddng tinh te'cdn cd stf tham gia cua edc yeu id" kinh tfi'-xa hfii va tdm ly. Stf khdc nhau ve chiing tfie bifi'n m^t khi srf hfin quan gifla bti sffa me vd phdt tri^n v | n ddng tinh tfi' drfdc d i l u chinh bdi cdc ye'u td kinh Ifi'-xi hOi.
Vi cd nhieu yfi'u td cd th^ cilng anb hrfdng de'n srf phdt triln t i m l^-vind$ng ciia Ire nhrf dieu kien kinb tfi^-xa bpi, Ihrf trf sinh. linb uang cupc de, sd sinh nhe e i n , bii srfa m e . cbiing loi dd phdn ticb srf lifin quan girfa tinh Uang suy dinh drfdng va phat tridn tSm l^-v|n ddng cd dieu cliinh cdc yfi'u td'trfin, Kfit qua cho t h i y trong md binh dieu chinb, e i c the suy dinh drfdng anb hrfdng dfi'n stf phat trie'n tdm 1;?- vdn dpng d cdc kbu vtfc khdc nhau d u e trai v i tre
gii. Anh htfdng kfi't bdp gifla suy dinh dtfdng Iha'p cdi va nhe cdn kbdng pbu thudc vdo gidi d khu vrfc phdt ttidn ngon ngfl. Do cd It Ire bi phd'i hdp cd ba the suy dinh drfdng. nen c l n cd nghifin crfu ed cd radu ldn hdn de ddnh gid anh hrfdng ke't bdp ndy ddi vdi stf phdt Uidn tdm 1^-vin dgng.
Nghifin ciJu n i y d i srf dung test Denver II drfdc chuan bda tai Viet Nam [5] de ddnh gid srf phdt tridn t i m IJi-vin ddng, ket qud cho phep xdc dinh nhffng Ire nghi ngd ehdm p h i t Uien tdm 1^-vdn ddng. Tuy test Denver II d i n h gid khu vrfc phdt uien c i n h i n - x i bpi vd ngdn ngff, nhtfng ddy khdng phdi l i test kifi'm Ua stf thdng minh cua tre. Test c6 gii tri phdt hifin sdm nhflng tre nghi ngd chdm phdt trien t i m 1^-van dgng so vdi nhffng Ire cung Irfa, iff do gitip cbo nhtJng n h i chuyen mon va gia dinh dp dting nhffng bien p h i p can thifip sdm de tre cd thd phdt trien td't hdn.
Tdra lai, cdc thd suy dinb drfdng Id yeu tdnguy cd do'i vdi nghi ngd ch§m p h i t tridn tdm 1^-vdn dgng d c i c kbu vrfc khdc nhau d tre u a i v i tre g i i trf 1 den 3 tudi. Anh hrfdng kd't hdp girfa suy dinh drfdng Ihap coi v i nhe cdn khdng phti thudc v i o gidi 6 khu vtfc phat tridn ngon ngfl.
Khuyfi'n nghi:
"Tang crfdng phdng chd'ng suy dinh drfdng Ue em gdp p h l u cdi thien phdt trien Iam 1^- v i n dfing cho trfi em.
"Vdi tre e m vrfa hi suy dinh drfdng thi'p cdi vi nhe c i n , can quan lira rfu tifin phit tridn khu vrfc ngdn ngfl va khu vrfc cd nbdn-xa hfii.
Ldi c a m cTn
Xin c h i n t h i n h cam dn Bs. Qudch Thtiy Minh, Cn. N g u y i n Thi Hdng Thrfy-Khoa T i m benh. Bfinh vifin Nhi Trung rfdng - dd ddng gdp quan ugng cho thinh cdng ciSa nghien crfu ndy bdng vific trrfc lidp tham gia tdp hua'n, gidm sat vd phdn Iich sdlifiu ve test Denver II.
ITtfNGQUAN&NBIIIEHGfUl
Tii U$u tham khao TiSngVi^t
1. Lfi Thi Htfp. NguySn Thj Lang (2002), Xu htTiJog tang tnrdng th^ lire vi dnh trang dinh diTdng cia ue em dUdi 24 thing Di^i. Nghifin crfu theo chi^u dpc tai Ha NOi. H^i n ^ Khoa hoc dinh dirdng, tr. lO-U.
2. Qufich Thuy Minh. Hoing dm Td, NguySn Thi Hdng Thuy vi cOng sir (2000), ip dijng Test Denver dinh gii stf phit tti^n tSm v|n d^ng cda tre cm diTdi 6 mdi, Vi^n Nhi Khoa KJ yfi'u c3ng trtnh nghifin crfu khoa hoc nim 2000:354-360.
3. Vi^n khoa hpc giio due- Tnmg tim nghifin cihi giao due mdm non (2000), Nghifin cihi doc die diem phit tri#n ed the vi tim v$n dOng cda tri tif sd sinh dg'n 36 thing lai Hi Npi, DetiiB98-49-58,tr 11-23.
Tie'ng Anb
4, Amanda Sacker, Maria A, Qulgley and Yvonne J Kelly
(2006) Breastfeeding and developmental Delay: findings
&om the millenniom cohort study. Pediatrics. U8;e682- e689.DOI: 10.1542/peds.2005-3141
5. Cfaristo^er N.M. et al. (1989) Growth in utero and cognitive function in adult hfe; follow up smdy of people bora 1920 and 1943. BMJ 312:1393-1396.
6. Giandiam-Mc Gregor (1993) Assessment ofthe effects of nutrition on mental development and behavior in Jamaican smdies. AJCN 57:303S-309S.
7. Harold P. Martin (1973) Nutrition: Its relationship to children's physical, mental and emotional developmenL Am J Clin Nutri 26.766-775.
8. H. Abigail Raikes (2005) Family Environments and Early Development in Low-Income Nicaraguan Children.
Interamerican Joumal of Psychology 39(3):399-412.
9. Terezinha Soares Biscegli, Larissa Bueno Polls. Livia Marcela dos Santos. Mariana Vicentin (2007) Nutritional stams and neurodevelopment of children enroUed in a day care center.Rev Paul Pediatr 25 (4): 3 37-342.
Tap chi Y t ^ C d n g cpng, 12.2012, Sd 26 (26) 33