肥胖症儿童脂溶性维生素A、D、E水平及其影响因素

Levels of fat-soluble vitamins A,D,and E and their influencing factors in children with obesity

目的调查肥胖症儿童脂溶性维生素A、D、E水平,并分析其影响因素。方法选取2019年1月至2021年4月就诊于西安市儿童医院营养科的273例肥胖症儿童(肥胖症组)为研究对象,同期健康体检的226例正常体重儿童为对照组。对两组儿童进行体格及体成分的测量,并检测血清维生素A、D、E浓度。结果与对照组比较,肥胖症组血清维生素A[(1.32±0.21)μmol/L vs(1.16±0.21)μmol/L]、维生素E[(9.3±1.4)mg/L vs(8.3±1.2)mg/L]水平较高(P<0.001),25羟维生素D[25-hydroxyvitamin D,25(OH)D]水平[(49±22)nmol/L vs(62±24)nmol/L]较低(P<0.001)。在肥胖症组中,边缘型维生素A缺乏率为5.5%(15/273),维生素D缺乏/不足率为56.8%(155/273),维生素E不足率为4.0%(11/273)。控制体重指数和腰身比后,肥胖症儿童维生素A水平与年龄呈正相关(P<0.001),维生素E和25(OH)D水平与年龄呈负相关(P<0.001)。在控制年龄因素后,未发现肥胖症儿童血清维生素A、维生素E、25(OH)D水平与其肥胖程度、体脂百分比、肥胖时长的相关性,但维生素A和维生素E水平与其腰身比呈正相关(P<0.001)。结论肥胖症儿童的血清维生素A和维生素E水平较高,尤其是腹型肥胖者,而血清维生素D营养状况较差,且随着年龄的增长,状况愈差。因此,应关注肥胖症儿童维生素D营养状况并积极补充。

Objective To investigate the levels of fat-soluble vitamins A,D,and E in children with obesity and their influencing factors.Methods A total of 273 children with obesity who attended the Department of Clinical Nutrition,Xi’an Children’s Hospital,from January 2019 to April 2021 were enrolled as the obesity group.A total of 226children with normal body weight who underwent physical examination during the same period were enrolled as the control group.Anthropometric parameters and body composition were measured for both groups,and the serum concentrations of vitamins A,D,and E were also measured.Results Compared with the control group,the obesity group had significantly higher serum levels of vitamin A[(1.32±0.21)μmol/L vs(1.16±0.21)μmol/L,P<0.001]and vitamin E[(9.3±1.4)mg/L vs(8.3±1.2)mg/L,P<0.001]and a significant reduction in the level of 25-hydroxyvitamin D[(49±22)nmol/L vs(62±24)nmol/L,P<0.001].In the obesity group,the prevalence rates of marginal vitamin A deficiency,vitamin D deficiency/insufficiency,and vitamin E insufficiency were 5.5%(15/273),56.8%(155/273),and4.0%(11/273),respectively.After adjustment for body mass index Z-score and waist-to-height ratio,serum vitamin A level was positively correlated with age(P<0.001),while vitamins E and 25-hydroxyvitamin D levels were negatively correlated with age in children with obesity(P<0.001).After adjustment for age,the serum levels of vitamin A,vitamin E and 25-hydroxyvitamin D were not correlated with degree of obesity,percentage of body fat,and duration of obesity in children with obesity,while the serum levels of vitamins A and E were positively correlated with waist-to-height ratio(P<0.001).Conclusions There are higher serum levels of vitamins A and E in children with obesity,especially in those with abdominal obesity,while serum vitamin D nutritional status is poor and worsens with age.Therefore,vitamin D nutritional status should be taken seriously for children with obesity,and vitamin D supplementation should be performed when necessary.