Uday Suma, Manaseki-Holland Semira, Bowie Jessica, Mughal Mohamed Zulf, Crowe Francesca, Högler Wolfgang
Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Steelhouse lane, Birmingham, UK.
Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK.
Eur J Nutr. 2021 Sep;60(6):3343-3353. doi: 10.1007/s00394-021-02511-5. Epub 2021 Feb 20.
The current study is a post hoc analysis of radiographs obtained as part of a randomised controlled trial. In this double-blind, placebo-controlled trial, deprived Afghan children (n = 3046) aged 1-11 months were randomised to receive six doses of oral placebo or vitamin D3 (100,000 IU) every 3 months for 18 months. Dietary intake was assessed through semi-quantitative food frequency questionnaires at two time points. Anthropometric measurements were undertaken at baseline and 18 months. Serum 25OHD was measured at five time points on a random subset of 632 children. Knee and wrist radiographs were obtained from a random subset (n = 641), of which 565 wrist radiographs were digitised for post-hoc analysis of BA and BHI using BoneXpert version 3.1.
Nearly 93% (522, male = 291) of the images were analysable. The placebo (n = 258) and vitamin D (n = 264) groups were comparable at baseline. The mean (± SD) age of the cohort was 2 (± 0.3) years. At study completion, there was no difference in mean 25-hydroxy vitamin D concentrations [47 (95% CI 41, 56) vs. 55 (95% CI 45, 57) nmol/L, p = 0.2], mean (± SD) BA SDS [- 1.04 (1.36) vs. - 1.14 (1.26) years, p = 0.3] or mean (± SD) BHI SDS [- 0.30 (0.86) vs. - 0.31 (0.80), p = 0.8] between the placebo and vitamin D groups, respectively. Children with advanced skeletal maturity (BA SDS ≥ 0) when compared to children with delayed skeletal maturity (BA SDS < 0), had consumed more calories [mean (± SD) calories 805 (± 346) vs 723 (± 327) kcal/day, respectively, p < 0.05], were significantly less stunted (height SDS - 1.43 vs. - 2.32, p < 0.001) and underweight (weight SDS - 0.82 vs. - 1.45, p < 0.001), with greater growth velocity (11.57 vs 10.47 cm/ year, p < 0.05).
Deprived children have significant delay in skeletal maturation but no substantial impairment in bone health as assessed by BHI. BA delay was influenced by total calorie intake, but not bolus vitamin D supplementation.
本研究是一项对作为随机对照试验一部分所获得的X光片进行的事后分析。在这项双盲、安慰剂对照试验中，1至11个月大的贫困阿富汗儿童（n = 3046）被随机分组，每3个月接受6剂口服安慰剂或维生素D3（100,000国际单位），共18个月。通过半定量食物频率问卷在两个时间点评估饮食摄入量。在基线和18个月时进行人体测量。在632名儿童的随机子集中的五个时间点测量血清25羟维生素D。从一个随机子集（n = 641）获取膝盖和手腕X光片，其中565张手腕X光片被数字化，以便使用BoneXpert 3.1版对骨龄和骨健康指数进行事后分析。
近93%（522张，男性 = 291张）的图像可进行分析。安慰剂组（n = 258）和维生素D组（n = 264）在基线时具有可比性。该队列的平均（±标准差）年龄为2（±0.3）岁。在研究结束时，安慰剂组和维生素D组之间的平均25-羟维生素D浓度[47（95%置信区间41, 56）对55（95%置信区间45, 57）nmol/L，p = 0.2]、平均（±标准差）骨龄标准差分数[-1.04（1.36）对-1.14（1.26）岁，p = 0.3]或平均（±标准差）骨健康指数标准差分数[-0.30（0.86）对-0.31（0.80），p = 0.8]均无差异。与骨骼成熟延迟（骨龄标准差分数<0）的儿童相比，骨骼成熟提前（骨龄标准差分数≥0）的儿童摄入了更多热量[平均（±标准差）热量分别为805（±346）对723（±327）千卡/天，p<0.05]，发育迟缓（身高标准差分数-1.43对-2.32，p<0.001）和体重不足（体重标准差分数-0.82对-1.45，p<0.001）的情况明显更少，生长速度更快（11.57对10.47厘米/年，p<0.05）。
贫困儿童的骨骼成熟明显延迟，但通过骨健康指数评估，其骨骼健康没有实质性损害。骨龄延迟受总热量摄入的影响，但不受大剂量维生素D补充的影响。
