学龄儿童维生素D营养状况与跟骨骨密度关系的前瞻性队列研究  

Association of vitamin D nutritional status with calcaneal bone mineral density in school-age children:a prospective cohort study

作　　者：李海波 赵小元[2] 洪伟 侯冬青[2] 朱忠信 郁兆仓 王宏健 高爱钰 程红[2] 米杰 Li Haibo;Zhao Xiaoyuan;Hong Wei;Hou Dongqing;Zhu Zhongxin;Yu Zhaocang;Wang Hongjian;Gao Aiyu;Cheng Hong;Mi Jie(Division of Birth Cohort Study,Fujian Provincial Maternal and Child Health Hospital,Fuzhou 350001,China;Department of Epidemiology,Capital Institute of Pediatrics,Beijing 100020,China;Beijing Zhongtong Lambo Medical Laboratory,Beijing 100070,China;Beijing Miyun Primary and Secondary School Health Center,Beijing 101500,China;Beijing Tongzhou Primary and Secondary School Health Center,Beijing 101100,China;Beijing Fangshan Primary and Secondary School Health Center,Beijing 102400,China;Beijing Dongcheng Primary and Secondary School Health Center,Beijing 100009,China;Department of Non-communicable Disease Management,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]福建省妇幼保健院出生队列研究室,福州350001 [2]首都儿科研究所流行病学研究室,北京100020 [3]北京中同蓝博医学检验实验室,北京100070 [4]北京市密云区中小学卫生保健所,101500 [5]北京市通州区中小学卫生保健所,101100 [6]北京市房山区中小学卫生保健所,102400 [7]北京市东城区中小学卫生保健所,100009 [8]国家儿童医学中心儿童慢病管理中心,首都医科大学附属北京儿童医院,北京100045

出　　处：《中华流行病学杂志》2021年第3期462-468,共7页Chinese Journal of Epidemiology

基　　金：国家重点研发计划(2016YFC1300101)。

摘　　要：目的探讨学龄儿童维生素D营养状况与跟骨骨密度的关系。方法研究对象来自“儿童青少年心血管与骨健康促进项目”,于2017年采用分层整群抽样的方法在北京市对15391名6~16岁儿童开展基线调查,2019年对其进行随访调查。进行问卷调查,测量血清25(OH)D和跟骨超声骨密度(BMD)。采用多因素线性回归和logistic回归分析基线维生素D营养状况与随访期跟骨BMD及其变化的关系。结果纳入分析的10914名儿童的年龄为(11.5±3.3)岁,男童占49.6%,基线25(OH)D水平为(35.4±12.0)nmol/L,缺乏率为36.1%。多因素回归分析显示,校正年龄、性别、BMI、吸烟、饮酒、奶制品摄入、维生素D补充、钙剂补充、体力活动、青春期发育状态和基线跟骨BMD Z值后,25(OH)D每增加10 nmol/L,随访时点跟骨BMD Z值增加0.01(P=0.041),2年间发生跟骨BMD Z值下降的OR=0.96(95%CI:0.93~1.00),P=0.030;相对于维生素D充足,维生素D不足和缺乏的儿童随访时点跟骨BMD Z值下降0.03(P=0.307)和0.06(P=0.046),2年间跟骨BMD Z值下降的风险分别增加15%(P=0.037)和21%(P=0.006),趋势P值均<0.05。结论维生素D营养状况与跟骨BMD密切相关,维生素D充足的儿童倾向于获得更高的BMD水平。倡导儿童青少年维持充足的维生素D水平,加强营养与运动,促进骨骼健康。Objective To investigate the relationships between vitamin D nutritional status and the calcaneal bone mineral density(BMD)in children.Methods Data were obtained from School-based Cardiovascular and Bone Health Promotion Program.In 2017,a total of 15391 children aged 6-16 years in Beijing selected through stratified cluster sampling were included in the baseline survey.A follow-up investigation was conducted in 2019.The questionnaire survey,detection of serum 25-hydroxyvitamin D[25(OH)D]level and ultrasound measurement of calcaneal BMD were conducted.Multivariable linear and logistic regression models were used to analyze the relationships between baseline vitamin D nutritional status and the follow-up calcaneal BMD.Results A total of 10914 children aged(11.5±3.3)years(boys accounting for 49.6%)were included in the analysis.The average 25(OH)D level was(35.4±12.0)nmol/L,and the deficiency rate was 36.1%.After the adjustment for age,gender,body mass index,smoking status,alcohol use status,dairy products intake,vitamin D supplement,calcium supplement,physical activity,pubertal development,and baseline calcaneal BMD Z-score,for per 10 nmol/L increase in 25(OH)D,the follow-up calcaneal BMD Z-score increased by 0.01(P=0.041),and the OR(95%CI)of decreased calcaneal BMD Z-score after 2 years was 0.96(0.93-1.00)(P=0.030).Compared with vitamin D adequacy,the follow-up calcaneal BMD Z-score of children with vitamin D insufficiency and deficiency decreased by 0.03(P=0.307)and 0.06(P=0.046),and the risk of decreased calcaneal BMD Z-score after 2 years increased by 15%(P=0.037)and 21%(P=0.006),respectively(P for trend<0.05).Conclusions Vitamin D nutritional status was closely related to calcaneal BMD,and children with adequate vitamin D nutritional status tended to obtain higher BMD.Children and adolescents are encouraged to maintain sufficient vitamin D levels,strengthen nutrition and exercise to promote bone health.

关 键 词：儿童 维生素D 骨密度 队列研究 

分 类 号：R153.2[医药卫生—营养与食品卫生学]