从喂养困难到唐氏综合征儿童的营养风险

文献信息

中文摘要

患有唐氏综合征（DS）的儿童可能因肌张力低下、心肺和胃肠道疾病、吞咽功能障碍、口腔运动与感觉差异、喂养技能发育迟缓以及心理社会或环境因素之间的相互作用而出现喂养困难。这些困难可能损害喂养的安全性和效率，限制饮食多样性，并导致液体或营养素摄入不足、生长迟缓、微量营养素缺乏或脂肪过多。本叙述性综述综合了因与DS儿童和青少年喂养发育及营养风险相关而筛选的文献。文献来源通过PubMed/MEDLINE、Scopus和Web of Science核心合集检索确定，并辅以参考文献列表审查和引文追踪；所引文献最后核验日期为2026年8月26日。证据按发育阶段和临床领域进行组织，并关注研究设计、抽样、评估方法及对儿科DS人群的适用性。研究结果表明，母乳喂养是可行的，但可能需要早期评估乳汁转移和营养充足性。口咽性吞咽困难和隐性误吸是重要的临床问题，尽管大部分证据来自经过选择的临床和转诊队列。咀嚼受损、质地进展延迟和食物选择性可能限制肉类、蔬菜、全谷物和其他营养密集食物的摄入，可能减少饮食多样性以及蛋白质、纤维和特定微量营养素的摄入。依赖范围狭窄的可接受软食或能量密集食物仍可能提供充足或过量的能量，使不良饮食质量与超重并存。因此，营养评估应同时考虑食物选择、质地调整和实际营养素摄入，以及生长和体重指数。最强有力的支持在于系统化、个体化和多学科照护，整合吞咽安全、喂养技能、实际饮食和液体摄入、生长、生化状态、相关医学状况及家庭情况。针对特定喂养疗法、补充剂和营养相关干预的证据仍受样本量小、方法异质和随访时间短的限制。需要更多具有代表性、使用标准化且适龄结局指标的纵向和干预研究。

英文摘要

Children with Down syndrome (DS) may experience feeding difficulties arising from interactions among hypotonia, cardiorespiratory and gastrointestinal conditions, swallowing dysfunction, oral-motor and sensory differences, delayed feeding skill development, and psychosocial or environmental factors. These difficulties may compromise feeding safety and efficiency, restrict dietary diversity, and contribute to inadequate fluid or nutrient intake, faltering growth, micronutrient deficiencies, or excess adiposity. This narrative review synthesized the literature selected for its relevance to feeding development and nutritional risk in children and adolescents with DS. Sources were identified through PubMed/MEDLINE, Scopus, and the Web of Science Core Collection, supplemented by reference-list review and citation tracking; cited sources were last verified on 26 August 2026. Evidence was organized according to developmental stage and clinical domain, with attention to study design, sampling, assessment methods, and applicability to the pediatric DS population. The findings indicate that breastfeeding is possible but may require early assessment of milk transfer and nutritional adequacy. Oropharyngeal dysphagia and silent aspiration are important clinical concerns, although much of the evidence comes from selected clinical and referral-based cohorts. Impaired chewing, delayed texture progression, and food selectivity may restrict the consumption of meat, vegetables, whole grains, and other nutrient-dense foods, potentially reducing dietary variety and the intake of protein, fiber, and specific micronutrients. Reliance on a narrow range of accepted soft or energy-dense foods may nevertheless provide adequate or excessive energy, allowing poor dietary quality to coexist with excess body weight. Nutritional assessment should therefore consider food choices, texture adaptations, and actual nutrient intake alongside growth and body mass index. The strongest support is for systematic, individualized, and multidisciplinary care integrating swallowing safety, feeding skills, actual dietary and fluid intake, growth, biochemical status, associated medical conditions, and family circumstances. Evidence for specific feeding therapies, supplements, and nutrition-related interventions remains limited by small samples, heterogeneous methods, and short follow-up. More representative longitudinal and intervention studies using standardized, age-appropriate outcomes are needed.