儿童维生素D营养状况与心血管代谢异常关系的前瞻性队列研究

肖培; 赵小元; 洪伟; 侯冬青; 郁兆仓; 王莲革; 王宏健; 高爱钰; 程红; 米杰

文章摘要

肖培,赵小元,洪伟,侯冬青,郁兆仓,王莲革,王宏健,高爱钰,程红,米杰.儿童维生素D营养状况与心血管代谢异常关系的前瞻性队列研究[J].中华流行病学杂志,2020,41(12):2059-2065

儿童维生素D营养状况与心血管代谢异常关系的前瞻性队列研究

A prospective cohort study on the associations between vitamin D nutritional status and cardiometabolic abnormities in children

收稿日期:2020-08-04 出版日期:2020-12-25

DOI：10.3760/cma.j.cn112338-20200804-01020

中文关键词: 儿童维生素D 心血管代谢异常队列研究

英文关键词: Children Vitamin D Cardiometabolic abnormities Cohort study

基金项目:国家重点研发计划（2016YFC1300101）

作者	单位	E-mail
肖培	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
赵小元	首都儿科研究所流行病学研究室, 北京 100020
洪伟	北京中同蓝博医学检验实验室 100070
侯冬青	首都儿科研究所流行病学研究室, 北京 100020
郁兆仓	北京市通州区中小学卫生保健所 101100
王莲革	北京市密云区中小学卫生保健所 101500
王宏健	北京市房山区中小学卫生保健所 102400
高爱钰	北京市东城区中小学卫生保健所 100009
程红	首都儿科研究所流行病学研究室, 北京 100020
米杰	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	jiemi12@vip.sina.com

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中文摘要:

目的探讨儿童中维生素D营养状况与心血管代谢异常发生的关系。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15 391名6~16岁儿童开展基线调查，2019年对其进行随访调查。采用log-binomial回归分析基线维生素D营养状况与随访期心血管代谢异常（肥胖、高血压、FPG升高和血脂异常）发病风险的关系。结果共纳入10 482名研究对象，维生素D平均水平为（35.6±12.0）nmol/L，缺乏率为35.1%。随访期肥胖、高血压、FPG升高、高TC、高LDL-C、低HDL-C、高TG和高非HDL-C的2年累计发病率分别为4.3%、10.8%、8.5%、3.1%、2.5%、3.4%、2.5%和3.9%。控制相关潜在混杂因素后，与维生素D充足的儿童相比，维生素D缺乏和不足的儿童高TC［RR值（95% CI）：缺乏，2.06（1.19~3.58）；不足，2.80（1.61~4.89）］、高LDL-C［RR值（95% CI）：缺乏，1.67（1.02~2.73）；不足，1.99（1.19~3.33）］和高非HDL-C ［RR值（95% CI）：缺乏，2.00（1.26~3.17）；不足，2.45（1.53~3.92）］的发病风险增高，且随着维生素D水平的降低发病风险呈上升趋势（趋势性P<0.05）。按性别分层分析发现，维生素D缺乏与高TC［RR值（95% CI）：男童，2.64（1.19~5.87）；女童，3.13（1.43~6.83）］和高非HDL-C［RR值（95% CI）：男童，2.58（1.40~4.77）；女童，2.31（1.10~4.84）］的发生风险仍相关。结论儿童期维生素D水平越低，TC、LDL-C和非HDL-C异常的发生风险越高。强调儿童维生素D的充足水平可能有助于心血管疾病的早期预防。

英文摘要:

Objective To investigate the relationships between vitamin D nutritional status and the risks of cardiometabolic abnormities in children. Methods Data were obtained from the School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing were selected by using a stratified cluster sampling method in the baseline survey. A Follow-up investigation was conducted in 2019. Log-binomial regression was used to analyze the relationships between baseline vitamin D nutritional status and the risks of cardiometabolic abnormities (obesity, hypertension, hyperglycemia, and dyslipidemia). Results A total of 10 482 participants were involved in the study. The average vitamin D level was (35.6 ±12.0) nmol/L, and the deficiency rate was 35.1%. The 2-year cumulative incidence rates of obesity, hypertension, hyperglycemia, high TC, high LDL-C, low HDL-C, high TG, and high non-HDL-C were 4.3%, 10.8%, 8.5%, 3.1%, 2.5%, 3.4%, 2.5%, and 3.9% respectively. After the adjustment of potential confounding factors, children with vitamin D inadequacy or deficiency had higher risks of high TC[RR (95% CI):inadequacy, 2.06 (1.19-3.58); deficiency, 2.80 (1.61-4.89)], high LDL-C[RR (95% CI):inadequacy, 1.67 (1.02-2.73); deficiency, 1.99 (1.19-3.33)], and high non-HDL-C[RR (95% CI):inadequacy, 2.00 (1.26-3.17); deficiency, 2.45 (1.53-3.92)] compared with children with adequate vitamin D, and the risks of them increased with the decrease of vitamin D level (trend P<0.05). The gender-stratified analysis showed that vitamin D deficiency was remained associated with high TC[RR (95% CI):boy, 2.64 (1.19-5.87); girl, 3.13 (1.43-6.83)] and high non-HDL-C[RR (95% CI):boy, 2.58(1.40-4.77); girl, 2.31 (1.10-4.84)]. Conclusions The risks of abnormal TC, LDL-C, and non-HDL-C were inversely associated with vitamin D level. Maintenance of adequate vitamin D status in children may contribute to the early prevention of cardiovascular diseases.

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