江苏省多中心横断面研究从出生至5岁儿童维生素D状况与生活方式的关系

The relationship between vitamin D status and lifestyle of children from birth to 5 years old:a multi-center cross-sectional study in Jiangsu Province

目的了解江苏省生命早期从出生至5岁儿童膳食、维生素D和钙补充剂、体力活动与维生素D状况的关系。方法研究进行了多中心大样本的抽样调查,于2014年4月至2015年3月,采用分层整群随机抽样方法从江苏省的10个城市招募0~5岁的儿童。采用食物频率法和体力活动问卷分别调查膳食和体力活动情况,采用酶联免疫法检测血清25-羟基维生素D[25-(OH)D]含量。结果共调查5289名儿童,每天牛奶摄入量<250 ml、每天肉类摄入量>150.0 g、喜荤菜、喜甜食、近3个月没有补充维生素D补充剂、近3个月每天补充维生素D的剂量≤400 IU、近3个月没有补充钙补充剂、每天睡眠时间<10 h、每天户外活动时间<2 h的儿童维生素D缺乏的风险分别显著增加1.24倍、1.46倍、1.34倍、1.27倍、1.47倍、1.39倍、1.19倍、1.38倍、1.20倍,而25-(OH)D水平分别显著降低4.43 nmol/L、9.33 nmol/L、7.10 nmol/L、5.21 nmol/L、8.76 nmol/L、7.18 nmol/L、5.40 nmol/L、5.35 nmol/L、3.24 nmol/L。母乳喂养的儿童25-(OH)D水平显著降低2.46 nmol/L。每天蛋类摄入量<60.0 g和≥60.0 g的儿童25-(OH)D水平分别为63.0 nmol/L、69.0 nmol/L,差异具有统计学意义(P=0.026)。结论较少的牛奶和蛋类摄入、较多的肉类摄入、喜甜食、母乳喂养、没有补充维生素D和钙补充剂、较少的睡眠和户外活动与生命早期从出生至5岁儿童维生素D水平降低相关。

Objective To explore the relationship between vitamin D status and diet,vitamin D and calcium supplements,and physical activity in children during the first five years of life.Methods This was a large population-based cross-sectional multicenter study.Children aged 0-5 years were recruited from Children's Health Care Centers through stratified cluster random sampling in 10 cities in Jiangsu Province from April,2014 to March,2015.The food frequency method and the physical activity questionnaire were used to investigate the diet and physical activity respectively,and serum 25-hydroxyvitamin D(25-[OH]D)was detected via enzyme-linked immunosorbent assay.Results A total of 5,289 children were investigated.Factors significantly associated with increased risk of vitamin D deficiency in children included milk consumption<250 ml/d(odds ratio[OR]=1.24),meat consumption>150.0 g/d(OR=1.46),preferences for meats(OR=1.34),preferences for sweets(OR=1.27),no vitamin D supplementation in the last 3 months(OR=1.47),no calcium supplementation in the last 3 months(OR=1.39),dose of vitamin D supplementation<400 IU/d(OR=1.19),time of sleeping<10 h/d(OR=1.38),and time of outdoor activity<2 h/d(OR=1.20).Children with these factors showed significantly lower 25-(OH)D levels by 4.43 nmol/L,9.33 nmol/L,7.10 nmol/L,5.21 nmol/L,8.76 nmol/L,7.18 nmol/L,5.40 nmol/L,5.35 nmol/L,and 3.24 nmol/L respectively.The 25-(OH)D levels in children with breast feeding and preferences for vegetables were significantly lower by 2.46 nmol/L and 5.29 nmol/L,respectively.The 25-(OH)D levels in children with eggs consumption<60.0 g/d and≥60.0 g were 63.0 nmol/L and 69.0 nmol/L,respectively,showing statistically significant difference(P=0.026).Conclusions Lower intake of milk and eggs,higher intake of meat,sweet foods,breast feeding,no vitamin D and calcium supplements,and less sleep and outdoor activity were associated with lower vitamin D levels in children during the first five years of life.This is an early study focused on the relationship between diet and vitamin D in children during the first five years of life.