Chapuy M C, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier P J
INSERM U. 403, Hôpital Edouard Herriot, Lyon, France.
Osteoporos Int. 1997;7(5):439-43. doi: 10.1007/s001980050030.
The vitamin D status of a general adult urban population was estimated between November and April in 1569 subjects selected from 20 French cities grouped in nine geographical regions (between latitude 43 degrees and 51 degrees N). Major differences in 25-hydroxyvitamin D (25(OH)D) concentration were found between regions, the lowest values being seen in the North and the greatest in the South, with a significant 'sun' effect (r = 0.72; p = 0.03) and latitude effect (r = -0.79; p = 0.01). In this healthy adult population, 14% of subjects exhibited 25(OH)D values < or = 30 nmol/l (12 ng/ml), which represents the lower limit (< 2 SD) for a normal adult population measured in winter with the same method (RIA Incstar). A significant negative correlation was found between serum intact parathyroid hormone (iPTH) and serum 25(OH)D values (p < 0.01). Serum iPTH held a stable plateau level at 36 pg/ml as long as serum 25(OH)D values were higher than 78 nmol/l (31 ng/ml), but increased when the serum 25(OH)D value fell below this. When the 25(OH)D concentration became equal to or lower than 11.3 nmol/l (4.6 ng/ml), the PTH values reached the upper limit of normal values (55 pg/ml) found in vitamin D replete subjects. These results showed that in French normal adults living in an urban environment with a lack of direct exposure to sunshine, diet failed to provide an adequate amount of vitamin D. It is important to pay attention to this rather high prevalence of vitamin D insufficiency in the general adult population and to discuss the clinical utility of winter supplementation with low doses of vitamin D.
1989年11月至1990年4月间，从法国9个地理区域（北纬43度至51度）的20个城市中选取了1569名成年人，对其维生素D状况进行了评估。各区域间25-羟维生素D（25(OH)D）浓度存在显著差异，北部最低，南部最高，呈现出显著的“阳光”效应（r = 0.72；p = 0.03）和纬度效应（r = -0.79；p = 0.01）。在这一健康成年人群中，14%的受试者25(OH)D值≤30 nmol/l（12 ng/ml），这是采用相同方法（RIA Incstar）在冬季测量正常成年人群时的下限（<2 SD）。血清完整甲状旁腺激素（iPTH）与血清25(OH)D值之间存在显著负相关（p < 0.01）。只要血清25(OH)D值高于78 nmol/l（31 ng/ml），血清iPTH就保持在36 pg/ml的稳定平台水平，但当血清25(OH)D值低于此水平时会升高。当25(OH)D浓度等于或低于11.3 nmol/l（4.6 ng/ml）时，PTH值达到维生素D充足受试者的正常上限值（55 pg/ml）。这些结果表明，对于生活在城市环境中缺乏阳光直接照射的法国正常成年人，饮食未能提供足够的维生素D。关注普通成年人群中维生素D不足的较高患病率，并讨论冬季补充低剂量维生素D的临床实用性非常重要。
