PDF(Pubmed)
Abstract：
BACKGROUND: Children with obesity have low 25 hydroxy-vitamin D (25-OH-D3) levels compared to lean children. Recommendations on when to start vitamin D supplementation differ largely between countries. Longitudinal data on 25-OH-D3 levels to guide treatment decisions are scarce since they are largely influenced by solar radiation and are difficult to compare.
METHODS: We carried out a retrospective analysis of multiple 25-OH-D3 and parathyroid hormone (PTH) measurements in a cohort of 543 patients without vitamin D supplementation. All measurements were taken at the local paediatric obesity clinic as documented in the German-Austrian-Swiss APV (Prospective Documentation of Overweight Children and Adolescents) registry from 2009 to 2019. Serial 25-OH-D3 and PTH levels were adjusted for sunshine duration over the last 30 days to account for seasonal variation, as well as for sex and body mass index (BMI). We further performed an exploratory analysis of the association of sunshine duration, sex, BMI SDS (standard deviation score), abnormal lipid levels or dysglycemia with the 25-OH-D3 trend.
RESULTS: 229 obese patients (mean BMI SDS: 2,58 (± 0,56), 53% females, mean age: 12 (± 3) years, range: 2-21 years) with two, 115 with three and 96 with four repeated 25-OH-D3 measurements were identified. Mean adjusted 25-OH-D3 (48.2 nmol/l) and PTH (34.9 ng/l) levels remained stable over 120 weeks. 5% of the patients had an elevated PTH > 65 ng/l. High total cholesterol ≥ 200 mg/dl and high triglycerides ≥ 130 mg/dl were associated with higher 25-OH-D3 levels.
CONCLUSIONS: We propose a simple method to include sunshine duration in the analysis of 25-OH-D3 levels to minimise the bias of seasonal variation. Based on our data we established the pragmatic strategy of limiting vitamin D supplementation to patients with biochemical signs of mineralisation disorders such as elevated PTH and alkaline phosphatase (AP). In children with normal PTH and AP we recommend adjustment of calcium intake and increase of outdoor activity instead.
METHODS: We carried out a retrospective analysis of multiple 25-OH-D3 and parathyroid hormone (PTH) measurements in a cohort of 543 patients without vitamin D supplementation. All measurements were taken at the local paediatric obesity clinic as documented in the German-Austrian-Swiss APV (Prospective Documentation of Overweight Children and Adolescents) registry from 2009 to 2019. Serial 25-OH-D3 and PTH levels were adjusted for sunshine duration over the last 30 days to account for seasonal variation, as well as for sex and body mass index (BMI). We further performed an exploratory analysis of the association of sunshine duration, sex, BMI SDS (standard deviation score), abnormal lipid levels or dysglycemia with the 25-OH-D3 trend.
RESULTS: 229 obese patients (mean BMI SDS: 2,58 (± 0,56), 53% females, mean age: 12 (± 3) years, range: 2-21 years) with two, 115 with three and 96 with four repeated 25-OH-D3 measurements were identified. Mean adjusted 25-OH-D3 (48.2 nmol/l) and PTH (34.9 ng/l) levels remained stable over 120 weeks. 5% of the patients had an elevated PTH > 65 ng/l. High total cholesterol ≥ 200 mg/dl and high triglycerides ≥ 130 mg/dl were associated with higher 25-OH-D3 levels.
CONCLUSIONS: We propose a simple method to include sunshine duration in the analysis of 25-OH-D3 levels to minimise the bias of seasonal variation. Based on our data we established the pragmatic strategy of limiting vitamin D supplementation to patients with biochemical signs of mineralisation disorders such as elevated PTH and alkaline phosphatase (AP). In children with normal PTH and AP we recommend adjustment of calcium intake and increase of outdoor activity instead.
摘要：
背景：与瘦儿童相比，肥胖儿童的25羟维生素D（25-OH-D3）水平较低。关于何时开始补充维生素D的建议在各国之间差异很大。用于指导治疗决策的25-OH-D3水平的纵向数据很少，因为它们在很大程度上受太阳辐射的影响并且难以比较。
方法：我们对543例没有补充维生素D的患者进行了一项25-OH-D3和甲状旁腺激素（PTH）多项测量的回顾性分析。所有测量均在2009年至2019年德国-奥地利-瑞士APV（超重儿童和青少年的前瞻性文件）注册表中记录的当地儿科肥胖诊所进行。连续25-OH-D3和PTH水平根据过去30天的日照时间进行了调整，以考虑季节性变化，以及性别和体重指数（BMI）。我们进一步对日照时间的关系进行了探索性分析，性别,BMISDS（标准差评分），血脂水平异常或血糖异常与25-OH-D3的趋势。
结果：229例肥胖患者（平均BMISDS：2,58（±0,56），53%的女性，平均年龄：12（±3）岁，范围：2-21年）有两个，鉴定了115和96进行三次重复的25-OH-D3测量。平均调整后的25-OH-D3（48.2nmol/l）和PTH（34.9ng/l）水平在120周内保持稳定。5%的患者PTH升高>65ng/l。高总胆固醇≥200mg/dl和高甘油三酯≥130mg/dl与较高的25-OH-D3水平相关。
结论：我们提出了一种简单的方法，将日照时间纳入25-OH-D3水平的分析中，以最大程度地减少季节性变化的偏差。根据我们的数据，我们建立了将维生素D补充限制在患有矿化障碍的生化体征如PTH和碱性磷酸酶（AP）升高的患者的实用策略。对于PTH和AP正常的儿童，我们建议调整钙摄入量并增加户外活动。
方法：我们对543例没有补充维生素D的患者进行了一项25-OH-D3和甲状旁腺激素（PTH）多项测量的回顾性分析。所有测量均在2009年至2019年德国-奥地利-瑞士APV（超重儿童和青少年的前瞻性文件）注册表中记录的当地儿科肥胖诊所进行。连续25-OH-D3和PTH水平根据过去30天的日照时间进行了调整，以考虑季节性变化，以及性别和体重指数（BMI）。我们进一步对日照时间的关系进行了探索性分析，性别,BMISDS（标准差评分），血脂水平异常或血糖异常与25-OH-D3的趋势。
结果：229例肥胖患者（平均BMISDS：2,58（±0,56），53%的女性，平均年龄：12（±3）岁，范围：2-21年）有两个，鉴定了115和96进行三次重复的25-OH-D3测量。平均调整后的25-OH-D3（48.2nmol/l）和PTH（34.9ng/l）水平在120周内保持稳定。5%的患者PTH升高>65ng/l。高总胆固醇≥200mg/dl和高甘油三酯≥130mg/dl与较高的25-OH-D3水平相关。
结论：我们提出了一种简单的方法，将日照时间纳入25-OH-D3水平的分析中，以最大程度地减少季节性变化的偏差。根据我们的数据，我们建立了将维生素D补充限制在患有矿化障碍的生化体征如PTH和碱性磷酸酶（AP）升高的患者的实用策略。对于PTH和AP正常的儿童，我们建议调整钙摄入量并增加户外活动。
