维生素D补充剂和维生素K1摄入量对糖尿病和慢性肾脏病成人患者的维生素D状态及骨密度有影响。

Vitamin D Status and Bone Mineral Density is Influenced by Vitamin D Supplementation and Vitamin K1 Intake in Adults with Diabetes and Chronic Kidney Disease.

作者信息

Hoffmann Michelle R, Senior Peter A, Jackson Stephanie T, Ferland Guylaine, Presse Nancy, Jindal Kailash, Li Ping, Alzaben Abeer S, Mager Diana R

机构信息

a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB.

b Divsion of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB.

出版信息

Can J Diet Pract Res. 2017 Mar;78(1):11-19. doi: 10.3148/cjdpr-2016-023. Epub 2016 Oct 25.

DOI:10.3148/cjdpr-2016-023

PMID:27779902

Abstract

PURPOSE

Patients with diabetes (DM) and chronic kidney disease (CKD) are at increased risk for suboptimal bone health. The study objective was to investigate the relationships between vitamin D (vitD), vitamin K1 (vitK), and calcium intake with bone mineral density (BMD) and vitamin D status in an ambulatory population with DM and CKD.

METHODS

Adults (age 18-80 years; n = 62) with DM and CKD (stages 1-4) were recruited from the Northern Alberta Renal Program. Primary outcome variables included vitD, vitK, and calcium intake; serum 25(OH)D, 1,25(OH)D; and BMD as measured by dual X-ray absorptiometry. Statistical significance was determined at P < 0.05.

RESULTS

Participants met the estimated average requirement or adequate intake for vitD, vitK, and calcium intake in 73% (n = 45), 66% (n = 39), and 52% (n = 31), respectively, with a combined intake of micronutrient supplementation and diet. Participants had serum 25(OH)D concentrations ≥75 nmol/L (n = 41), normal BMDs (n = 48), and 66% (n = 41/62) were taking vitD supplements (>1000 IU/D). BMD was positively influenced by serum 25(OH)D. However, serum 25(OH) ≥100 nmol/L was associated with lower BMD (absolute and T-scores) for whole-body and spine (P ≤ 0.05). VitK intake (≥200 μg/day) was associated with higher whole-body and femoral-neck BMDs (absoluteand T-scores; P ≤ 0.05).

CONCLUSION

VitD status and BMD in adults with DM and CKD was influenced by vitD supplementation and vitK intake.

摘要

目的

糖尿病（DM）和慢性肾脏病（CKD）患者骨骼健康欠佳的风险增加。本研究的目的是调查在患有DM和CKD的非卧床人群中，维生素D（vitD）、维生素K1（vitK）和钙摄入量与骨矿物质密度（BMD）及维生素D状态之间的关系。

方法

从北艾伯塔肾脏项目招募了年龄在18 - 80岁之间、患有DM和CKD（1 - 4期）的成年人（n = 62）。主要结局变量包括vitD、vitK和钙摄入量；血清25(OH)D、1,25(OH)D；以及通过双能X线吸收法测量的BMD。P < 0.05时具有统计学意义。

结果

参与者通过微量营养素补充剂和饮食的联合摄入，分别有73%（n = 45）、66%（n = 39）和52%（n = 31）达到了vitD、vitK和钙摄入量的估计平均需求量或充足摄入量。参与者血清25(OH)D浓度≥75 nmol/L（n = 41），骨密度正常（n = 48），66%（n = 41/62）正在服用vitD补充剂（>1000 IU/天）。血清25(OH)D对BMD有正向影响。然而，血清25(OH)≥100 nmol/L与全身和脊柱较低的BMD（绝对值和T值）相关（P≤0.05）。vitK摄入量（≥200μg/天）与较高的全身和股骨颈BMD（绝对值和T值；P≤0.05）相关。