维生素D补充对超重和肥胖儿童的效果观察

Effect of vitamin D supplements on overweight and obese children

目的观察维生素D缺乏的肥胖和正常身体质量指数儿童进行同剂量补充的治疗效果。方法纳入2014年1月至2017年6月在西安市儿童医院营养科就诊的5～14岁25-羟维生素D3[25(OH)D3]缺乏的超重和肥胖儿童198例为肥胖组,选取同期25(OH)D3缺乏的正常身体质量指数(BMI)儿童145例为对照组。对所有受试者补充维生素D3滴剂1 600IU/d,连续8周。干预前后测定其血清25(OH)D3、血钙和全段甲状旁腺素(iPTH)水平,并对结果进行分析。结果干预前后25(OH)D3差值肥胖组为(16.47±6.12)ng/mL,对照组为(20.55±5.29)ng/mL,两组比较差异有统计学意义(t=2.24,P<0.05)。肥胖组复测值25(OH)D3充足(≥30ng/mL)的比例为38.42%(73/190),对照组为66.15%(86/130),两组比较差异有统计学意义(χ2=23.27,P<0.05)。肥胖组的身体质量指数(BMI)值和干预后25(OH)D3升高值散点图显示二者呈负相关关系(相关系数为r=-0.61,P<0.05)。干预前后肥胖组与对照组iPTH差值分别为(0.7±17.4)pg/mL和(-1.6±18.1)pg/mL,两组比较差异无统计学意义(P>0.05)。两组儿童干预前后血钙水平比较差异无统计学意义。结论肥胖儿童对维生素D补充剂的反应性差,因此,为了维持血中足量的25(OH)D3水平,补充剂量也应高于正常儿童,BMI值越高,其补充量也应更高。肥胖儿童iPTH和血钙水平与正常儿童无差异。

Objective To observe the therapeutic effect of same dose of vitamin D supplement on obesity due to vitamin D deficiency and on normal children.Methods A total of 198 overweight and obese children aged 5-14 years with 25(OH)D3 deficiency,who visited the Nutrition Department of Xi’an Children’s Hospital in the period of January 2014 to June 2017,were chosen as obese group.Another 145 children with normal BMI who were short of 25(OH)D3 at the same period were selected as control group.Vitamin D3 drops 1 600 IU/d was supplemented for all subjects for 8 weeks.The serum 25(OH)D3,serum calcium and parathyroid hormone(iPTH)were detected before and after intervention.Results Before and after the intervention,the difference value of25(OH)D3 in the obese group was 16.47±6.12 ng/mL and in the control group was 20.55±5.29 ng/mL.The difference between two groups was statistically significant(t=2.24,P<0.05).The proportion of cases with sufficient 25(OH)D3(≥30 ng/mL)was38.42%(73/190)in the obese group and 66.15%(86/130)in the control group.There was significant difference between two groups(χ2=23.7,P<0.05).The scatter plot of BMI and the increased value of 25(OH)D3 of the obese group showed that that these two had a negative correlation(r=-0.61,P<0.05).The difference value of iPTH before and after intervention in the obese group and the control group was 0.72±17.4 pg/mL and-1.6±18.1 pg/mL,respectively,and no statistical significance was found(P >0.05).There was no significant difference in blood calcium level between two groups of children before and after intervention.Conclusion Obese children have poor reactivity to vitamin D supplements.Therefore,in order to maintain adequate blood level of25(OH)D3,the supplemental dose should also be higher than that of normal children.The higher the BMI value is,the higher the dose should be.The levels of iPTH and blood calcium in obese children are not different from those of normal children.