MacDonald Krista, Godziuk Kristine, Yap Jason, LaFrance Rena, Ansarian Mohammad, Haqq Andrea, Mager Diana R
*Department of Agricultural, Food and Nutritional Science †Department of Pediatrics, University of Alberta ‡Pediatric Centre for Weight & Health (PCWH), Misericordia Hospital, Edmonton, Alberta, Canada.
J Pediatr Gastroenterol Nutr. 2017 Oct;65(4):462-466. doi: 10.1097/MPG.0000000000001598.
Vitamin D (VitD) deficiency and obesity are reaching epidemic proportions in North America, particularly in those with comorbid conditions such as diabetes or liver disease. The study objective was to determine the prevalence of suboptimal vitD status and interrelationships with anthropometric, cardiometabolic, liver, mental health, and lifestyle (sleep/screen time) parameters in an ambulatory population of children with obesity.
Children (2-18 years) attending a pediatric weight management clinic (n = 217) were retrospectively reviewed. Variables studied included anthropometric (weight, height, body mass index, waist circumference), vitD (serum 25-hydroxyvitamin D), cardiometabolic (systolic blood pressure, diastolic blood pressure, glucose, insulin, homeostasis model assessment for insulin resistance, triglyceride, high-density lipoprotein, low-density lipoprotein, total cholesterol), liver enzymes (alanine aminotransferase, gamma-glutamyl transferase), and mental health (number, diagnosis) parameters.
Suboptimal vitD status (25-hydroxyvitamin D <75 nmol/L was present in 76% of children with obesity (12.0 ± 2.9 years). Blood pressure categorized as prehypertension, stage I hypertension, and stage II hypertension was present in 14%, 25%, and 7% of children, respectively. Mental health diagnoses including anxiety, attention-deficit hyperactivity disorder, mood disorders, and learning disabilities/developmental delays occurred in 18%, 17%, 10%, and 15%, of children, respectively. Waist circumferences >100 cm were associated with lower vitD levels (58 ± 18 vs 65 ± 17 nmol/L; P = 0.01). VitD status ≥50 nmol/L was associated with lower insulin (15.8 [11.7-23.1] mU/L vs 21.1 [14.3-34.2] mU/L; P < 0.01) and homeostasis model assessment for insulin resistance (3.5 [2.5-4.9] vs 4.8 [3.1-6.9]; P < 0.01) values and systolic blood pressure percentiles (73.0 ± 25.8 vs 80.6 ± 17.0; P = 0.04).
Children with obesity had a high prevalence of vitD deficiency, particularly those at risk for hypertension, reduced insulin sensitivity, and central obesity.
维生素D（VitD）缺乏和肥胖在北美正呈流行趋势，尤其是在患有糖尿病或肝病等合并症的人群中。本研究的目的是确定肥胖儿童门诊人群中VitD状态不佳的患病率，以及其与人体测量学、心脏代谢、肝脏、心理健康和生活方式（睡眠/屏幕时间）参数之间的相互关系。
对一家儿科体重管理诊所的217名2至18岁儿童进行回顾性研究。研究变量包括人体测量学指标（体重、身高、体重指数、腰围）、VitD（血清25-羟基维生素D）、心脏代谢指标（收缩压、舒张压、血糖、胰岛素、胰岛素抵抗稳态模型评估、甘油三酯、高密度脂蛋白、低密度脂蛋白、总胆固醇）、肝酶（丙氨酸转氨酶、γ-谷氨酰转移酶）和心理健康指标（数量、诊断）。
76%的肥胖儿童（12.0±2.9岁）VitD状态不佳（25-羟基维生素D<75 nmol/L）。分别有14%、25%和7%的儿童血压分类为高血压前期、I期高血压和II期高血压。分别有18%、17%、10%和15%的儿童被诊断患有焦虑症、注意力缺陷多动障碍、情绪障碍和学习障碍/发育迟缓等心理健康问题。腰围>100 cm与较低的VitD水平相关（58±18 vs 65±17 nmol/L；P=0.01）。VitD状态≥50 nmol/L与较低的胰岛素水平（15.8[11.7-23.1]mU/L vs 21.1[14.3-34.2]mU/L；P<0.01）、胰岛素抵抗稳态模型评估值（3.5[2.5-4.9]vs 4.8[3.1-6.9]；P<0.01）以及收缩压百分位数（73.0±25.8 vs 80.6±17.0；P=0.04）相关。
肥胖儿童中VitD缺乏的患病率很高，尤其是那些有高血压、胰岛素敏感性降低和中心性肥胖风险的儿童。
