维生素 D3 补充对维生素 D 缺乏的超重和肥胖儿童血管和代谢健康的影响：一项随机临床试验。
Effect of vitamin D3 supplementation on vascular and metabolic health of vitamin D-deficient overweight and obese children: a randomized clinical trial.
机构信息
Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Am J Clin Nutr. 2020 Apr 1;111(4):757-768. doi: 10.1093/ajcn/nqz340.
BACKGROUND
Obese children are vulnerable to vitamin D deficiency and impaired cardiovascular health; vitamin D replenishment might improve their cardiovascular health.
OBJECTIVES
The aims were to determine, in vitamin D-deficient overweight and obese children, whether supplementation with vitamin D3 1000 or 2000 IU/d is more effective than 600 IU/d in improving arterial endothelial function, arterial stiffness, central and systemic blood pressure (BP), insulin sensitivity (1/fasting insulin concentration), fasting glucose concentration, and lipid profile and to explore whether downregulation of adipocytokines and markers of systemic inflammation underlies vitamin D effects.
METHODS
We conducted a randomized, double-masked, controlled clinical trial in 225 10- to 18-y-old eligible children. Change in endothelial function at 6 mo was the primary outcome.
RESULTS
Dose-response increases in serum 25-hydroxyvitamin D concentrations were significant and tolerated without developing hypercalcemia. Changes at 3 and 6 mo in endothelial function, arterial stiffness, systemic-systolic BP, lipids, and inflammatory markers did not differ between children receiving 1000 or 2000 IU vitamin D and children receiving 600 IU. Some secondary outcomes differed between groups. Compared with the 600-IU group, central-systolic, central-diastolic, and systemic-diastolic BP was lower at 6 mo in the 1000-IU group [-2.66 (95% CI: -5.27, -0.046), -3.57 (-5.97, -1.17), and -3.28 (-5.55, -1.00) mm Hg, respectively]; insulin sensitivity increased at 3 and 6 mo and fasting glucose concentration declined at 6 mo (-2.67; 95% CI: -4.88, -0.46 mg/dL) in the 2000-IU group.
CONCLUSIONS
Correction of vitamin D deficiency in overweight and obese children by vitamin D3 supplementation with 1000 or 2000 IU/d versus 600 IU/d did not affect measures of arterial endothelial function or stiffness, systemic inflammation, or lipid profile, but resulted in reductions in BP and fasting glucose concentration and in improvements in insulin sensitivity. Optimization of children's vitamin D status may improve their cardiovascular health. This trial was registered at clinicaltrials.gov as NCT01797302.
背景
肥胖儿童易患维生素 D 缺乏症和心血管健康受损；补充维生素 D 可能会改善他们的心血管健康。
目的
在维生素 D 缺乏的超重和肥胖儿童中，确定补充维生素 D3 1000 或 2000 IU/d 是否比 600 IU/d 更有效，以改善动脉内皮功能、动脉僵硬度、中心和全身血压（BP）、胰岛素敏感性（1/空腹胰岛素浓度）、空腹血糖浓度和血脂谱，并探讨脂肪细胞因子和全身炎症标志物的下调是否是维生素 D 作用的基础。
方法
我们在 225 名 10-18 岁符合条件的儿童中进行了一项随机、双盲、对照临床试验。6 个月时内皮功能的变化是主要结局。
结果
血清 25-羟维生素 D 浓度的剂量反应增加是显著的，并且耐受良好，没有发生高钙血症。3 个月和 6 个月时，接受 1000 或 2000 IU 维生素 D 与接受 600 IU 维生素 D 的儿童之间，内皮功能、动脉僵硬度、全身收缩压、血脂和炎症标志物的变化没有差异。一些次要结局在组间有所不同。与 600 IU 组相比，1000 IU 组的中心收缩压、中心舒张压和全身舒张压在 6 个月时更低[-2.66（95%CI：-5.27，-0.046）、-3.57（-5.97，-1.17）和-3.28（-5.55，-1.00）mmHg]；2000 IU 组在 3 个月和 6 个月时胰岛素敏感性增加，6 个月时空腹血糖浓度下降[-2.67；95%CI：-4.88，-0.46 mg/dL]。
结论
在超重和肥胖儿童中，通过补充维生素 D3 1000 或 2000 IU/d 与 600 IU/d 纠正维生素 D 缺乏症并没有影响动脉内皮功能或僵硬度、全身炎症或血脂谱的指标，但可降低血压和空腹血糖浓度，并改善胰岛素敏感性。优化儿童的维生素 D 状态可能会改善他们的心血管健康。本试验在 clinicaltrials.gov 上注册为 NCT01797302。
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