Department of Agriculture, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
Eur J Clin Nutr. 2012 Apr;66(4):488-95. doi: 10.1038/ejcn.2011.176. Epub 2011 Oct 5.
BACKGROUND/OBJECTIVES: Children with celiac disease (CD) are at risk for decreased bone mineral density (BMD) because of fat-soluble vitamin malabsorption, inflammation and/or under-nutrition. The study objective was to determine the interrelationships between vitamin K/D status and lifestyle variables on BMD in children and adolescents with CD at diagnosis and after 1 year on the gluten-free diet (GFD).
SUBJECTS/METHODS: Children and adolescents aged 3-17 years with biopsy proven CD at diagnosis and after 1 year on the GFD were studied. BMD was measured using dual-energy X-ray absorptiometry. Relevant variables included: anthropometrics, vitamin D/K status, diet, physical activity and sunlight exposure.
Whole-body and lumbar-spine BMD-z scores were low (< or = -1) at diagnosis (10-20%) and after 1 year (30-32%) in the children, independent of symptoms. Whole-body BMD-z scores (-0.55±0.7 versus 0.72±1.5) and serum levels of 25(OH) vitamin D (90.3±24.8 versus 70.5±19.8 nmol/l) were significantly lower in older children (>10 years) when compared with younger children (< or =10 years) (P<0.001). Forty-three percent had suboptimal vitamin D status (25(OH)-vitamin D <75 nmol/l) at diagnosis; resolving in nearly half after 1 year on the GFD. Twenty-five percent had suboptimal vitamin K status at diagnosis; all resolved after 1 year.
Children and adolescents with CD are at risk for suboptimal bone health at time of diagnosis and after 1 year on GFD; likely due in part to suboptimal vitamin D/K status. Therapeutic strategies aimed at optimizing vitamin K/D intake may contribute to improved BMD in children with CD.
背景/目的：由于脂溶性维生素吸收不良、炎症和/或营养不良，乳糜泻（CD）患儿存在骨密度（BMD）降低的风险。本研究旨在确定维生素 K/D 状态与生活方式变量之间的相互关系，以确定初诊和无麸质饮食（GFD）治疗 1 年后 CD 患儿的 BMD 情况。
受试者/方法：本研究纳入了初诊时和 GFD 治疗 1 年后经活检证实为 CD 的 3-17 岁儿童和青少年。采用双能 X 线吸收法测量 BMD。相关变量包括：人体测量学、维生素 D/K 状态、饮食、体力活动和阳光暴露情况。
儿童在初诊时（10-20%）和 GFD 治疗 1 年后（30-32%）的全身体和腰椎 BMD-z 评分均较低（<或= -1），且与症状无关。与年龄较小的儿童（<或= 10 岁）相比，年龄较大的儿童（>10 岁）的全身体 BMD-z 评分（-0.55±0.7 比 0.72±1.5）和血清 25（OH）维生素 D 水平（90.3±24.8 比 70.5±19.8 nmol/L）明显较低（P<0.001）。43%的儿童在初诊时维生素 D 状态不佳（25（OH）-维生素 D <75 nmol/L），而在 GFD 治疗 1 年后近一半的儿童维生素 D 状态得到改善。25%的儿童在初诊时维生素 K 状态不佳，而所有儿童在 GFD 治疗 1 年后均得到改善。
CD 患儿在初诊时和 GFD 治疗 1 年后存在骨健康状况不佳的风险，这可能部分归因于维生素 D/K 状态不佳。旨在优化维生素 K/D 摄入的治疗策略可能有助于改善 CD 患儿的 BMD。
