Smotkin-Tangorra Margarita, Purushothaman Radhika, Gupta Ashutosh, Nejati Golali, Anhalt Henry, Ten Svetlana
Division of Pediatric Endocrinology, Infants and Children's Hospital of Brooklyn at Maimonides, NY 11219, USA.
J Pediatr Endocrinol Metab. 2007 Jul;20(7):817-23. doi: 10.1515/jpem.2007.20.7.817.
Recent studies have shown a broad prevalence of vitamin D deficiency in adults. Serum 25-hydroxyvitamin D (25-OHD) levels were reported to be inversely related to body mass index (BMI) and body fat content and correlated directly with hypertension, degree of insulin resistance and progression to diabetes mellitus. We sought to determine the prevalence of vitamin D insufficiency and markers of metabolic syndrome in an obese pediatric population.
Charts of 217 obese (weight >95th percentile for age and sex) children (118 females, 99 males; mean BMI 32.2 +/- 6.4 kg/m2; mean age 12.9 2 5.5; age range 7-18 years) who had received a standard physical examination at the pediatric endocrine clinic of the Infants and Children's Hospital of Brooklyn at Maimonides, Brooklyn, NY, were retrospectively analyzed. Data obtained included age, sex, weight, BMI, height and systolic and diastolic blood pressure. The routine bloodwork panel for obesity at our pediatric endocrine facility includes fasting 25-OHD, total cholesterol, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), triglycerides, ALT, AST, thyroid stimulating hormone (TSH), total T4, and insulin and glucose. Insulin sensitivity as calculated by quantitative insulin-sensitivity check index (QUICKI = 1/[log(I0) + log(G0)], where I0 is fasting insulin and G0 is fasting glucose) was computed following the visit.
Overall, 55.2% of patients were vitamin D insufficient (25-OHD <20 ng/ml). Severely low vitamin D levels (25-OHD < or =10 ng/ml) were seen in 21.6% of 217 patients, which represents almost half of the insufficient group. In the 25-OHD <20 ng/ml group age, BMI, and SBP were significantly higher than in the 25-OHD 220 ng/ml group, while QUICKI (<0.35 is consistent with insulin resistance) was borderline low in the <20 ng/ml group. HDL-C was significantly lower in the 25-OHD < or =10 ng/ml group. The 25-OHD levels correlated negatively with BMI and positively with HDL-C. No other findings were significant.
More than half of the obese children had vitamin D levels <20 ng/ml with equal gender distribution. Vitamin D insufficiency was associated with increased age, BMI, and SBP, and decreased HDL-C.
近期研究表明成人维生素D缺乏普遍存在。据报道，血清25-羟维生素D（25-OHD）水平与体重指数（BMI）和体脂含量呈负相关，与高血压、胰岛素抵抗程度及糖尿病进展呈正相关。我们试图确定肥胖儿童群体中维生素D不足及代谢综合征标志物的患病率。
回顾性分析217名肥胖（体重超过年龄和性别的第95百分位数）儿童（118名女性，99名男性；平均BMI 32.2±6.4kg/m²；平均年龄12.9±5.5岁；年龄范围7 - 18岁）的病历，这些儿童在纽约布鲁克林迈蒙尼德婴儿儿童医院儿科内分泌门诊接受了标准体检。获取的数据包括年龄、性别、体重、BMI、身高以及收缩压和舒张压。我们儿科内分泌机构肥胖症的常规血液检查项目包括空腹25-OHD、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯、谷丙转氨酶（ALT）、谷草转氨酶（AST）、促甲状腺激素（TSH）、总甲状腺素（T4）以及胰岛素和葡萄糖。就诊后计算定量胰岛素敏感性检查指数（QUICKI = 1/[log(I0) + log(G0)]，其中I0为空腹胰岛素，G0为空腹血糖）得出的胰岛素敏感性。
总体而言，55.2%的患者维生素D不足（25-OHD <20 ng/ml）。217名患者中有21.6%的患者维生素D水平极低（25-OHD≤10 ng/ml），这几乎占不足组的一半。在25-OHD <20 ng/ml组中，年龄、BMI和收缩压显著高于25-OHD≥20 ng/ml组，而在<20 ng/ml组中QUICKI（<0.35与胰岛素抵抗一致）处于临界低水平。25-OHD≤10 ng/ml组的HDL-C显著更低。25-OHD水平与BMI呈负相关，与HDL-C呈正相关。无其他显著发现。
超过一半的肥胖儿童维生素D水平<20 ng/ml，且性别分布均衡。维生素D不足与年龄增加、BMI升高、收缩压升高及HDL-C降低有关。
