Belykh N A, Blokhova E E
Ryazan State Medical University, 390026, Ryazan, Russian Federation.
Vopr Pitan. 2021;90(2):83-90. doi: 10.33029/0042-8833-2021-90-2-83-90. Epub 2021 Mar 11.
Obesity is a multifactorial disease, the prevalence of which has increased over the past few decades worldwide in all age groups. There is evidence of the pathogenetic role of vitamin D (VD) in the formation of obesity. However, there are few studies concerning the characteristics of calcium-phosphorus metabolism in obese children. Therefore, data on the prevalence of VD deficiency stratified by body mass index categories, characteristics of calcium-phosphorus homeostasis and the relationship between the concentration of parathyroid hormone (PTH) and 25(OH)D in obese children are of scientific and practical interest. of the study was to assess the VD status of children, to analyze the ratio of individual biochemical markers of bone metabolism [concentration of calcium (Ca), phosphorus (P), PTH, alkaline phosphatase (ALP) activity] depending on body mass index (BMI). . The cross-sectional (one-stage) study included 77 children with different weight and height parameters at the age from 8 to 10 years. All children were divided into 3 groups: 1st - 26 children with normal body weight, 2nd - 29 children with overweight, 3rd - 22 people with obesity. All children underwent determination of the level of 25(OH)D, PTH, alkaline phosphatase, Ca, P in blood serum. . Reduced VD supply occurred in all groups. However, children with normal BMI had a higher concentration of 25(OH)D - 32.65 [15.96; 44.4] ng/ml vs 23.6 [11.3; 34.54] ng/ml (p=0.001) in children with overweight and 12.51 [5.7; 19.1] ng/ml (p=0.014) in children with obesity (p<0.05). With an increase in BMI, a decrease in 25(OH)D level was noted (r=-0.480, p<0.05). Vitamin D deficiency in obese children (86.4%) occurred 2.3 fold more often than in overweight children (p=0.002), and 2.8 fold more often than in children with normal body weight (p=0.001). The concentration of PTH in all children was within the physiological norm, while there was a moderate negative correlation between the levels of PTH and 25(OH)D (r=-0.44, p<0.05). A moderate inverse correlation was also found between the concentration of PTH and total Ca (r=-0.38, p<0.05) and P (r=-0.44, p<0.05). With an increase in the BMI/age Z-score, a decrease in serum Ca level was observed (r=-0.497, p<0.05). The P content and ALP activity in blood serum were within the physiological norm in all children, however, in children with overweight and obesity, these indicators were statistically significantly lower than in healthy peers (p<0.05). . In children with overweight and obesity, vitamin D deficit and insufficiency are recorded statistically significantly more often than in healthy children. With an increase in BMI, there is a tendency to a decrease in Ca, P and ALP.
肥胖是一种多因素疾病，在过去几十年中，其在全球所有年龄组中的患病率均有所上升。有证据表明维生素D（VD）在肥胖形成过程中具有致病作用。然而，关于肥胖儿童钙磷代谢特征的研究较少。因此，按体重指数类别分层的VD缺乏患病率数据、钙磷稳态特征以及肥胖儿童甲状旁腺激素（PTH）浓度与25（OH）D之间的关系具有科学和实际意义。本研究旨在评估儿童的VD状况，分析骨代谢的各个生化标志物[钙（Ca）、磷（P）、PTH、碱性磷酸酶（ALP）活性浓度]与体重指数（BMI）的关系。这项横断面（单阶段）研究纳入了77名年龄在8至10岁、体重和身高参数各异的儿童。所有儿童被分为3组：第1组 - 26名体重正常的儿童，第2组 - 29名超重儿童，第3组 - 22名肥胖儿童。所有儿童均接受了血清中25（OH）D、PTH、碱性磷酸酶、Ca、P水平的测定。所有组均存在VD供应减少的情况。然而，BMI正常的儿童25（OH）D浓度较高 - 为32.65 [15.96；44.4] ng/ml，而超重儿童为23.6 [11.3；34.54] ng/ml（p = 0.001），肥胖儿童为12.51 [5.7；19.1] ng/ml（p = 0.014）（p < 0.05）。随着BMI的增加，25（OH）D水平呈下降趋势（r = -0.480，p < 0.05）。肥胖儿童中VD缺乏（86.4%）的发生率比超重儿童高2.3倍（p = 0.002），比体重正常的儿童高2.8倍（p = 0.001）。所有儿童的PTH浓度均在生理正常范围内，而PTH水平与25（OH）D之间存在中度负相关（r = -0.44，p < 0.05）。在PTH浓度与总Ca（r = -0.38，p < 0.05）和P（r = -0.44，p < 0.05）之间也发现了中度负相关。随着BMI/年龄Z评分的增加，血清Ca水平呈下降趋势（r = -0.497，p < 0.05）。所有儿童血清中的P含量和ALP活性均在生理正常范围内，然而，超重和肥胖儿童的这些指标在统计学上显著低于健康同龄人（p < 0.05）。在超重和肥胖儿童中，VD缺乏和不足的统计发生率显著高于健康儿童。随着BMI的增加，Ca、P和ALP有下降趋势。
