Sudfeld Christopher R, Duggan Christopher, Aboud Said, Kupka Roland, Manji Karim P, Kisenge Rodrick, Fawzi Wafaie W
Departments of Global Health and Population,
Nutrition, and Division of Gastroenterology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA; Departments of.
J Nutr. 2015 Jan;145(1):121-7. doi: 10.3945/jn.114.201566. Epub 2014 Nov 12.
Vitamin D is a potent immunomodulator, but its impact on morbidity and mortality among infants remains unclear.
The objective of the study was to prospectively assess the association of vitamin D status with mortality, morbidity, and growth during the first 2 y of life.
A prospective cohort of 253 HIV-infected and 948 HIV-exposed Tanzanian infants enrolled in a randomized trial of multivitamins (not including vitamin D) was studied. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured at 5-7 wk of age and infants were followed at monthly clinic visits until 24 mo. Physicians performed a clinical exam every 3 mo or when an illness was noted.
Serum 25(OH)D concentrations were (means ± SDs) 18.6 ± 10.3 ng/mL and 18.1 ± 9.2 ng/mL for HIV-infected and HIV-exposed infants, respectively. Unexpectedly, serum 25(OH)D concentrations ≥30 ng/mL were significantly associated with higher mortality as compared to the 20-29.9 ng/mL reference for HIV-infected (HR: 2.47; 95% CI: 1.13, 5.44; P = 0.02) and HIV-exposed (HR: 4.00; 95% CI: 1.67, 9.58; P < 0.01) infants after multivariate adjustment. We found no statistically significant association between 25(OH)D concentrations <10 ng/mL and mortality for HIV-infected (HR: 1.43; 95% CI: 0.74, 2.78; P = 0.29) and HIV-exposed (HR: 1.56; 95% CI: 0.60, 4.03; P = 0.36) infants. Among HIV-exposed infants, 25(OH)D concentrations ≥30 ng/mL were significantly associated with clinical [incidence ratio rate (IRR): 1.34; 95% CI: 1.06,1.70; P = 0.02] and confirmed (IRR: 1.71; 95% CI: 1.71; 1.15, 2.54; P < 0.01) malaria diagnoses, whereas concentrations of <10 ng/mL were associated with oral candidiasis (IRR: 1.47; 95% CI: 1.00-2.15; P = 0.046) and wasting (HR: 1.71; 95% CI: 1.20, 2.43; P < 0.01).
The observational design of this study does not allow for causal interpretation; however, the results indicate a strong need for additional studies of vitamin D among HIV-infected and -exposed children, particularly in malaria-endemic settings. The parent trial was registered at clinicaltrials.gov as NCT00197730.
维生素D是一种强效免疫调节剂，但其对婴儿发病率和死亡率的影响尚不清楚。
本研究的目的是前瞻性评估生命最初2年中维生素D状态与死亡率、发病率及生长发育的关联。
对参加多种维生素（不包括维生素D）随机试验的253名感染HIV的坦桑尼亚婴儿和948名暴露于HIV的坦桑尼亚婴儿进行了前瞻性队列研究。在婴儿5至7周龄时测量血清25-羟基维生素D[25(OH)D]浓度，并在每月的门诊随访直至24个月。医生每3个月或在发现疾病时进行一次临床检查。
感染HIV的婴儿和暴露于HIV的婴儿血清25(OH)D浓度（均值±标准差）分别为18.6±10.3 ng/mL和18.1±9.2 ng/mL。出乎意料的是，与20 - 29.9 ng/mL的参考值相比，血清25(OH)D浓度≥30 ng/mL与感染HIV的婴儿（风险比：2.47；95%置信区间：1.13, 5.44；P = 0.02）和暴露于HIV的婴儿（风险比：4.00；95%置信区间：1.67, 9.58；P < 0.01）的较高死亡率显著相关。在多因素调整后，我们发现血清25(OH)D浓度<10 ng/mL与感染HIV的婴儿（风险比：1.43；95%置信区间：0.74, 2.78；P = 0.29）和暴露于HIV的婴儿（风险比：1.56；95%置信区间：0.60, 4.03；P = 0.36）的死亡率之间无统计学显著关联。在暴露于HIV的婴儿中，血清25(OH)D浓度≥30 ng/mL与临床疟疾诊断（发病率比率：1.34；95%置信区间：1.06, 1.70；P = 0.02）和确诊疟疾诊断（发病率比率：1.71；95%置信区间：1.15, 2.54；P < 0.01）显著相关，而浓度<10 ng/mL与口腔念珠菌病（发病率比率：1.47；95%置信区间：1.00 - 2.15；P = 0.046）和消瘦（风险比：1.71；95%置信区间：1.20, 2.43；P < 0.01）相关。
本研究的观察性设计不允许进行因果解释；然而，结果表明非常有必要对感染HIV和暴露于HIV的儿童中的维生素D进行更多研究，特别是在疟疾流行地区。该母试验在clinicaltrials.gov上注册为NCT00197730。
