| 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].Chinese journal of Epidemiology,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 |
| Received:August 09, 2020 |
| DOI：10.3760/cma.j.cn112338-20200809-01048 |
| KeyWord: 儿童 维生素D 骨密度 队列研究 |
| English Key Word: Children Vitamin D Bone mineral density Cohort study |
| FundProject:国家重点研发计划（2016YFC1300101） |
| Author Name | Affiliation | E-mail | | Li Haibo | Division of Birth Cohort Study, Fujian Provincial Maternal and Child Health Hospital, Fuzhou 350001, China | | | Zhao Xiaoyuan | Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China | | | Hong Wei | Beijing Zhongtong Lambo Medical Laboratory, Beijing 100070, China | | | Hou Dongqing | Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China | | | Zhu Zhongxin | Beijing Miyun Primary and Secondary School Health Center, Beijing 101500, China | | | Yu Zhaocang | Beijing Tongzhou Primary and Secondary School Health Center, Beijing 101100, China | | | Wang Hongjian | Beijing Fangshan Primary and Secondary School Health Center, Beijing 102400, China | | | Gao Aiyu | Beijing Dongcheng Primary and Secondary School Health Center, Beijing 100009, China | | | Cheng Hong | Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China | | | Mi Jie | Department of Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China | jiemi12@vip.sina.com |
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| Abstract: |
| 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。 |
| English Abstract: |
| 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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