南非育龄妇女维生素D生物标志物、铁状态与血红蛋白之间关联的横断面研究：南非健康生活轨迹倡议
A Cross-Sectional Study of the Associations between Biomarkers of Vitamin D, Iron Status, and Hemoglobin in South African Women of Reproductive Age: the Healthy Life Trajectories Initiative, South Africa.
作者信息
Soepnel Larske M, Mabetha Khuthala, Draper Catherine E, Silubonde Takana Mary, Smuts Cornelius M, Pettifor John M, Norris Shane A
机构信息
SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
出版信息
Curr Dev Nutr. 2023 Mar 30;7(5):100072. doi: 10.1016/j.cdnut.2023.100072. eCollection 2023 May.
BACKGROUND
Vitamin D deficiency and anemia impact the health of women of reproductive age. Evidence suggests an inverse relationship between serum vitamin D (25-hydroxyvitamin D [25(OH)D]) and anemia/iron deficiency, but less is known about these associations in women of reproductive age, in particular in a setting with a combined burden of micronutrient deficiency, food insecurity, and obesity.
OBJECTIVE
We aimed to assess the associations between 25(OH)D and biomarkers of iron and anemia in a cohort of women of reproductive age from Soweto, South Africa. The prevalence of vitamin D deficiency was also assessed.
METHODS
In this cross-sectional substudy of the Healthy Life Trajectories Initiative (HeLTI) South Africa pilot trial, 25(OH)D, iron markers (ferritin and soluble transferrin receptor [sTFR]), and altitude-adjusted hemoglobin (Hb) were measured in 493 women aged 18 to 25 years. Associations between iron deficiency/anemia and vitamin D status were evaluated using multivariable logistic regression, adjusting for confounders including fat mass index (FMI). Structural equation modeling (SEM) was performed to evaluate direct and indirect pathways between 25(OH)D, iron and anemia markers, and covariates.
RESULTS
Of 493 participants, 136 (27.6%) had vitamin D insufficiency (25(OH)D ≥12-20 ng/mL), whereas 28 (5.6%) had vitamin D deficiency (<12 ng/mL). Anemia and iron deficiency were not significantly associated with vitamin D category (25(OH)D<20 ng/mL compared with ≥20 ng/mL) in multivariable logistic regression analyses. In SEM, log-transformed 25(OH)D was not significantly associated with Hb, ferritin, or sTFR, but it was significantly associated with season of data collection, hormonal contraceptive use, and FMI (total effects: B = 0.17, 95% CI: 0.104, 0.236, < 0.001; B: 0.10, 95% CI: 0.041, 0.154, < 0.001; B: -0.01, 95%CI: -0.016, -0.003, = 0.003, respectively).
CONCLUSION
No significant association between vitamin D (25(OH)D), anemia (Hb), and iron markers was found. The inverse relationship between FMI and vitamin D status emphasizes the overlap between adiposity and micronutrient deficiencies in young South African women, exacerbating their risk of disease development.
背景
维生素D缺乏和贫血会影响育龄女性的健康。有证据表明血清维生素D（25-羟基维生素D [25(OH)D]）与贫血/缺铁之间存在负相关，但对于育龄女性中的这些关联了解较少，尤其是在一个存在微量营养素缺乏、粮食不安全和肥胖综合负担的环境中。
目的
我们旨在评估南非索韦托一群育龄女性中25(OH)D与铁和贫血生物标志物之间的关联。还评估了维生素D缺乏的患病率。
方法
在南非健康生活轨迹倡议（HeLTI）试点试验的这项横断面子研究中，对493名年龄在18至25岁的女性测量了25(OH)D、铁标志物（铁蛋白和可溶性转铁蛋白受体[sTFR]）以及海拔校正血红蛋白（Hb）。使用多变量逻辑回归评估缺铁/贫血与维生素D状态之间的关联，并对包括脂肪质量指数（FMI）在内的混杂因素进行校正。进行结构方程模型（SEM）以评估25(OH)D、铁和贫血标志物以及协变量之间的直接和间接途径。
结果
在493名参与者中，136人（27.6%）存在维生素D不足（25(OH)D≥12 - 20 ng/mL），而28人（5.6%）存在维生素D缺乏（<12 ng/mL）。在多变量逻辑回归分析中，贫血和缺铁与维生素D类别（25(OH)D<20 ng/mL与≥20 ng/mL相比）无显著关联。在SEM中，对数转换后的25(OH)D与Hb、铁蛋白或sTFR无显著关联，但与数据收集季节、激素避孕药使用和FMI显著相关（总效应：B = 0.17，95%CI：0.104，0.236，P<0.001；B：0.10，95%CI：0.041，0.154，P<0.001；B：-0.01，95%CI：-0.016，-0.003，P = 0.003，分别）。
结论
未发现维生素D（25(OH)D）、贫血（Hb）和铁标志物之间存在显著关联。FMI与维生素D状态之间的负相关强调了南非年轻女性肥胖与微量营养素缺乏之间的重叠，加剧了她们疾病发展的风险。
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