Chakhtoura Marlene, El Ghandour Sara, Shawwa Khaled, Akl Elie A, Arabi Asma, Mahfoud Ziyad, Habib Robert, Hoballah Hassan, El Hajj Fuleihan Ghada
Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon; Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Metabolism. 2017 May;70:160-176. doi: 10.1016/j.metabol.2017.02.009. Epub 2017 Feb 16.
Hypovitaminosis D affects one-third to two-thirds of children and pregnant women from the Middle East and North Africa (MENA) region.
To evaluate in infants, children, adolescents and pregnant women, from the MENA region, the effect of supplementation with different vitamin D doses on the change in 25-hydroxyvitamin D [25(OH)D] level reached, and other skeletal and non-skeletal outcomes.
This is a systematic review of randomized controlled trials of vitamin D supplementation conducted in the MENA region. We conducted a comprehensive literature search in 7 databases, without language or time restriction, until November 2016. Two reviewers abstracted data from the included studies, independently and in duplicate. We calculated the mean difference (MD) and 95% CI of 25(OH)D level reached when at least 2 studies were eligible in each comparison (low (<800IU), intermediate (800-2000IU) or high (>2000IU) daily dose of vitamin D, or placebo). We pooled data using RevMan version 5.3.
We identified a total of 15 eligible trials: one in infants, 4 in children and adolescents and 10 in pregnant women. In children and adolescents, an intermediate vitamin D dose (1901IU/d), resulted in a mean difference in 25(OH)D level of 13.5 (95% confidence interval (CI) 8.1-18.8) ng/ml, compared to placebo, favoring the intermediate dose (p<0.001). The proportion of children and adolescents reaching a 25(OH)D level≥ 20ng/ml was 74% in the intermediate dose group. In pregnant women, four trials started supplementation at 12-16weeks of gestation and continued until delivery, and six trials started supplementation at 20-28weeks' gestation and stopped it at delivery. The MD in 25(OH)D level reached was 8.6 (95% CI 5.3-11.9) ng/ml (p<0.001) comparing the high dose (3662IU/d) to the intermediate dose (1836IU/d), and 12.3 (95% CI 6.4-18.2) ng/ml (p<0.001), comparing the high dose (3399IU/d) to the low dose (375IU/d). Comparing the intermediate (1832IU/d) to the low dose (301IU/d), the MD in 25(OH)D level achieved was 7.8 (95% CI 4.5-10.8) ng/ml (p<0.001). The proportion of pregnant women reaching a 25(OH)D level≥20ng/ml was 80%-90%, 73% and 27%-43% in the high, intermediate, and low dose groups, respectively. The risk of bias in the included studies, for children, adolescents and pregnant women, ranged from low to high across all doamins.
In children, adolescents and pregnant women from the MENA, an intermediate vitamin D dose of 1000-2000IU daily may be necessary to allow for the majority of the population to reach a desirable 25(OH)D level of 20ng/ml. Further high quality RCTs are required to confirm/refute the beneficial impact of vitamin D supplementation on various clinically important outcomes.
维生素D缺乏症影响中东和北非（MENA）地区三分之一至三分之二的儿童和孕妇。
评估在中东和北非地区的婴儿、儿童、青少年及孕妇中，补充不同剂量维生素D对达到的25-羟维生素D[25(OH)D]水平变化以及其他骨骼和非骨骼结局的影响。
这是一项对在中东和北非地区进行的维生素D补充随机对照试验的系统评价。我们在7个数据库中进行了全面的文献检索，无语言或时间限制，直至2016年11月。两名评价员独立且重复地从纳入研究中提取数据。当每组比较中至少有2项研究符合条件时（维生素D日剂量低（<800IU）、中（800 - 2000IU）或高（>2000IU），或安慰剂），我们计算达到的25(OH)D水平的平均差（MD）和95%置信区间（CI）。我们使用RevMan 5.3版汇总数据。
我们共识别出15项符合条件的试验：1项针对婴儿，4项针对儿童和青少年，10项针对孕妇。在儿童和青少年中，与安慰剂相比，中等剂量的维生素D（1901IU/d）使25(OH)D水平的平均差为13.5（95%置信区间（CI）8.1 - 18.8）ng/ml，支持中等剂量（p<0.001）。中等剂量组中25(OH)D水平≥20ng/ml的儿童和青少年比例为74%。在孕妇中，4项试验在妊娠12 - 16周开始补充并持续至分娩，6项试验在妊娠20 - 28周开始补充并在分娩时停止。将高剂量（3662IU/d）与中等剂量（1836IU/d）比较时，达到的25(OH)D水平的MD为8.6（95%CI 5.3 - 11.9）ng/ml（p<0.001），将高剂量（3399IU/d）与低剂量（375IU/d）比较时，MD为12.3（95%CI 6.4 - 18.2）ng/ml（p<0.001）。将中等剂量（1832IU/d）与低剂量（301IU/d）比较时，达到的25(OH)D水平的MD为7.8（95%CI 4.5 - 10.8）ng/ml（p<0.001）。高、中、低剂量组中25(OH)D水平≥20ng/ml的孕妇比例分别为80% - 90%、73%和27% - 43%。纳入研究中儿童、青少年和孕妇的偏倚风险在所有领域从低到高不等。
在中东和北非地区的儿童、青少年和孕妇中，每日1000 - 2000IU的中等剂量维生素D可能是必要的，以使大多数人群达到理想的25(OH)D水平20ng/ml。需要进一步高质量的随机对照试验来证实/反驳补充维生素D对各种临床重要结局的有益影响。
