血清 1,25-二羟维生素 D 水平在营养性佝偻病的诊断和发病机制中的作用——一项病例对照研究的多变量重新分析。

Serum 1,25-dihydroxyvitamin D levels in the diagnosis and pathogenesis of nutritional rickets - a multivariable re-analysis of a case-control study.

机构信息

Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States, Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates and Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.

Vitamin D Standardization Program LLC, Havre de Grace, MD, United States.

出版信息

Am J Clin Nutr. 2023 May;117(5):998-1004. doi: 10.1016/j.ajcnut.2023.02.011. Epub 2023 Feb 18.

DOI:10.1016/j.ajcnut.2023.02.011

PMID:36801463

Abstract

BACKGROUND

A multivariable logistic regression model resulting from a case-control study of nutritional rickets in Nigerian children suggested that higher levels of serum 25(OH)D may be required to prevent nutritional rickets in populations with low-calcium intakes.

OBJECTIVES

This current study evaluates if adding serum 1,25-dihydroxyvitamin D [1,25(OH)D] to that model shows that increased levels of serum 1,25(OH)D are independently associated with risk of children on low-calcium diets having nutritional rickets.

METHODS

Multivariable logistic regression analysis was used to model the association between serum 1,25(OH)D and risk of having nutritional rickets in cases (n = 108) and controls (n = 115) after adjusting for age, sex, weight-for age z-score, religion, phosphorus intake and age began walking and the interaction between serum 25(OH)D and dietary calcium intake (Full Model).

RESULTS

Serum 1,25(OH)D levels were significantly higher (320 pmol/L vs. 280 pmol/L) (P = 0.002), and 25(OH)D levels were lower (33 nmol/L vs. 52 nmol/L) (P < 0.0001) in children with rickets than in control children. Serum calcium levels were lower in children with rickets (1.9 mmol/L) than in control children (2.2 mmol/L) (P < 0.001). Dietary calcium intakes were similarly low in both groups (212 mg/d) (P = 0.973). In the multivariable logistic model, 1,25(OH)D was independently associated with risk of having rickets [coefficient = 0.007 (95% confidence limits: 0.002-0.011)] after adjusting for all variables in the Full Model.

CONCLUSIONS

Results confirmed theoretical models that in children with low dietary calcium intake, 1,25(OH)D serum concentrations are higher in children with rickets than in children without rickets. The difference in 1,25(OH)D levels is consistent with the hypothesis that children with rickets have lower serum calcium concentrations which prompt the elevation of PTH levels resulting in an elevation of 1,25(OH)D levels. These results support the need for additional studies to identify dietary and environmental risks for nutritional rickets.

摘要

背景

一项针对尼日利亚儿童营养性佝偻病的病例对照研究得出的多变量逻辑回归模型表明，在钙摄入量低的人群中，可能需要更高水平的血清 25（OH）D 才能预防营养性佝偻病。

目的

本研究旨在评估在该模型中加入血清 1,25-二羟维生素 D[1,25（OH）2D]是否表明血清 1,25（OH）2D 水平升高与低钙饮食儿童患佝偻病的风险独立相关。

方法

采用多变量逻辑回归分析，调整年龄、性别、体重-年龄 z 评分、宗教、磷摄入量、开始行走年龄以及血清 25（OH）D 与膳食钙摄入量之间的相互作用（全模型）后，对病例（n=108）和对照组（n=115）血清 1,25（OH）2D 与患佝偻病风险之间的关系进行建模。

结果

与对照组相比，佝偻病患儿血清 1,25（OH）2D 水平显著升高（320 pmol/L 比 280 pmol/L）（P=0.002），25（OH）D 水平更低（33 nmol/L 比 52 nmol/L）（P<0.0001）。佝偻病患儿血清钙水平较低（1.9 mmol/L），对照组患儿血清钙水平较高（2.2 mmol/L）（P<0.001）。两组患儿的膳食钙摄入量相似（212 mg/d）（P=0.973）。在多变量逻辑回归模型中，在校正全模型中所有变量后，1,25（OH）2D 与佝偻病发病风险独立相关[系数=0.007（95%置信区间：0.002-0.011）]。

结论

研究结果证实了理论模型，即在钙摄入量低的儿童中，佝偻病患儿的血清 1,25（OH）2D 浓度高于无佝偻病患儿。1,25（OH）2D 水平的差异与佝偻病患儿血清钙浓度较低的假设一致，这促使甲状旁腺激素水平升高，导致 1,25（OH）2D 水平升高。这些结果支持需要进一步研究以确定营养性佝偻病的饮食和环境风险。