文章摘要
李海波,赵小元,洪伟,侯冬青,朱忠信,郁兆仓,王宏健,高爱钰,程红,米杰.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[J].中华流行病学杂志,2021,42(3):462-468
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
收稿日期:2020-08-09  出版日期:2021-03-29
DOI:10.3760/cma.j.cn112338-20200809-01048
中文关键词: 儿童;维生素D;骨密度;队列研究
英文关键词: Children;Vitamin D;Bone mineral density;Cohort study
基金项目:国家重点研发计划(2016YFC1300101)
作者单位E-mail
李海波 福建省妇幼保健院出生队列研究室, 福州 350001  
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, 北京 100070  
侯冬青 首都儿科研究所流行病学研究室, 北京 100020  
朱忠信 北京市密云区中小学卫生保健所 101500  
郁兆仓 北京市通州区中小学卫生保健所 101100  
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15 391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10 914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。
英文摘要:
      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 15 391 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 10 914 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.
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