妊娠期循环钙和 25-羟维生素 D 与糖代谢的关系：欧洲和南亚妇女的横断面研究。

Associations of circulating calcium and 25-hydroxyvitamin D with glucose metabolism in pregnancy: a cross-sectional study in European and South Asian women.

机构信息

Departments of Diabetes and Endocrinology (D.C.W.), Obstetrics and Gynaecology (D.J.T.), and Pathology (T.J.D.) and Bradford Institute for Health Research (J.W.), Bradford Teaching Hospitals National Health Service Trust, Bradford BD9 6RJ, United Kingdom; School of Health Studies (A.J.S.), University of Bradford, Bradford BD7 1DP, United Kingdom; Department of Medicine (W.D.F.), Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom; Edinburgh Ethnicity and Health Research Group (R.S.B.), Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom; and Medical Research Council Centre for Causal Analyses in Translational Epidemiology (D.A.L.), School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom.

出版信息

J Clin Endocrinol Metab. 2014 Mar;99(3):938-46. doi: 10.1210/jc.2013-2896. Epub 2014 Jan 1.

DOI:10.1210/jc.2013-2896

PMID:24423329

Abstract

BACKGROUND

Vitamin D deficiency is thought to impair insulin action and glucose metabolism; however, previous studies have not examined ethnic differences or the influence of calcium and parathyroid hormone. We investigated this in a cohort of predominantly white European and south Asian women during pregnancy.

METHODS

In this cross-sectional study from an urban population in northern England (53.8°N), 1467 women were recruited when undergoing glucose tolerance testing (75 g oral glucose tolerance test) at 26 weeks' gestation.

RESULTS

Gestational diabetes mellitus (GDM) was diagnosed in 137 women (9.3%). Median 25-hydroxyvitamin D concentration for the study population was 9.3 ng/mL (interquartile range 5.2, 16.9) and was higher in European [15.2 ng/mL (10.7, 23.5)] than in south Asian women [5.9 ng/mL (3.9, 9.4), P < .001]. After appropriate adjustment for confounders, 25-hydroxyvitamin D showed a weak inverse association with fasting plasma glucose (FPG; mean difference 1.0% per 1 SD; the ratio of geometric means (RGM) 0.99, 95% confidence interval (CI) 0.98, 1.00), and PTH was weakly associated with FPG (RGM 1.01, 95% CI 1.00, 1.02), but neither was associated with fasting insulin, postchallenge glucose, or GDM. Serum calcium (albumin adjusted) was strongly associated with fasting insulin (RGM 1.06; 95% CI 1.03, 1.08), postchallenge glucose (RGM 1.03, 95% CI 1.01, 1.04), and GDM (odds ratio 1.33, 95% CI 1.06, 1.66) but not with FPG. Associations were similar in European and south Asian women.

CONCLUSIONS

These findings do not indicate any important association between vitamin D status and glucose tolerance in pregnancy. Relationships between circulating calcium and glucose metabolism warrant further investigation.

摘要

背景

维生素 D 缺乏被认为会损害胰岛素作用和葡萄糖代谢；然而，先前的研究并未检查种族差异或钙和甲状旁腺激素的影响。我们在英国北部一个城市人群中的白人欧洲裔和南亚裔女性怀孕期间进行了这项研究。

方法

在这项来自英格兰北部（北纬 53.8°）的城市人群的横断面研究中，在 26 周妊娠时进行葡萄糖耐量试验（75g 口服葡萄糖耐量试验）时，招募了 1467 名女性。

结果

诊断出 137 名女性（9.3%）患有妊娠期糖尿病（GDM）。研究人群的中位 25-羟维生素 D 浓度为 9.3ng/ml（四分位距 5.2，16.9），欧洲裔女性[15.2ng/ml（10.7，23.5）]高于南亚裔女性[5.9ng/ml（3.9，9.4），P<0.001]。在适当调整混杂因素后，25-羟维生素 D 与空腹血糖（FPG）呈弱负相关（每 1SD 差异 1.0%；几何均数比（RGM）0.99，95%置信区间（CI）0.98，1.00），且 PTH 与 FPG 弱相关（RGM 1.01，95%CI 1.00，1.02），但两者均与空腹胰岛素、餐后血糖或 GDM 无关。血清钙（白蛋白校正）与空腹胰岛素（RGM 1.06；95%CI 1.03，1.08）、餐后血糖（RGM 1.03，95%CI 1.01，1.04）和 GDM（比值比 1.33，95%CI 1.06，1.66）呈强相关，但与 FPG 无关。在欧洲裔和南亚裔女性中，相关性相似。