目的 分析正常和肥胖儿童青少年骨密度与人体成分、骨代谢相关指标血清25-羟维生素D [25-(OH)D]、血清碱性磷酸酶(ALP)、血钙、血磷的相关性,为临床评估儿童骨骼健康提供依据。方法 选择2017年8月-2018年9月在南京医科大学附属儿童医院保健科健康体检门诊和肥胖儿童门诊就诊的6~15岁儿童为研究对象。采用超声骨密度仪检测骨密度。同时测定人体成分及骨代谢相关指标。结果 共纳入儿童1 138 例,其中正常体重组606人,超重肥胖组532人。总体骨密度不足检出率为22.5%(正常组14.7%、肥胖组31.4%);肥胖组儿童平均骨密度明显低于正常组(P<0.001)。相关分析显示,正常组儿童骨密度与体重指数(BMI)呈负相关(P<0.001),与25-(OH)D呈正相关(P=0.001)。而肥胖儿童骨密度与BMI、腰围身高比(W/H)、体脂%(FM%)均呈负相关(P<0.001),与骨骼肌%(P=0.008)、25-(OH)D水平(P=0.001)均呈正相关,无论正常或肥胖儿童,骨密度与血清ALP、钙、磷的相关性不显著(P>0.05)。结论 儿童25-(OH)D水平不足和肥胖尤其是腹型肥胖均可影响骨密度的增加;血清钙、磷、ALP与儿童骨密度无关。
Abstract
Objective To investigate the relationships among bone mineral density,body composition and bone metabolism related factors in normal and obese children and adolescents such as serum 25-hydroxyvitamin D [25-(OH)D],serum alkaline phosphatase(ALP),blood calcium,blood phosphorus,in order to provide reference for clinical assessment. Methods Children aged 6 to 15 years in health examination clinic and obese children′s clinic in Nanjing Children′s Hospital Affiliated to Nanjing Medical University were enrolled in this study from August 2017 to September 2018. Bone density was measured using an ultrasonic bone density meter,meanwhile the body composition and various factors related to bone metabolism were measured. Results Totally 1 138 children were enrolled in this study,of whom 606 were in normal body weight group and 532 were in the overweight and obesity group.The detection rate of insufficient bone density was 22.5%(14.7% in normal group and 31.4% in obesity group).And the average bone mineral density in the obesity group was significantly lower than that in normal group (P<0.001).Correlation analysis showed that bone mineral density was negatively correlated with body mass index (BMI) in the normal group (P<0.001),and was positively correlated with 25-(OH)D level (P=0.001).The bone mineral density of obese children was negatively related to BMI,waist-to-height ratio (W/H),percentage of fat mass (FM%) (P<0.001),and was positively related to skeletal muscle% (P=0.008) and 25-(OH)D level(P=0.001).However,bone mineral density was not associated with serum levels of ALP,calcium or phosphorus in normal or obese children (P>0.05). Conclusions Insufficient 25-(OH)D level and obesity,especially abdominal obesity,have impact on the increase of bone density.Serum calcium,phosphorus and ALP levels are not related to bone mineral density in children.
关键词
肥胖 /
骨密度 /
人体成分 /
25-羟维生素D /
儿童
Key words
obesity /
bone density /
body composition /
25-hydroxyvitamin D /
children
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参考文献
[1] Kocks J,Ward K,Mughal Z,et al.Z-score comparability of bone mineral density reference data bases for children[J].J Clin Endocrinol Metab,2010,95(10):4652-4659.
[2] Zhao Z,Ding M,Hu Z,et al.Trajectories of length,weight,and bone mineral density among preterm infants during the first 12 months of corrected age in China[J].BMC Pediatr,2015,15(1):91.
[3] Golden NH,Abrams SA.Optimizing bone health in children and adolescents[J].Pediatrics,2014,134:29-43.
[4] Videhult FK,Öhlund I,Hernell O,et al.Body mass but not vitamin D status is associated with bone mineral content and density in young school children in northern Sweden[J].Food Nutri Res,2016,60:30045.
[5] 古桂雄,陈艳,花静,等.八市 15 岁以下儿童 2008 年超声骨密度调查[J].中国儿童保健杂志,2011,19(4):313-317.
[6] 熊菲,杨凡,杨速飞,等.0-7 岁儿童 25 羟维生素D和骨密度的关系研究[J].中国当代儿科杂志,2014,6(19):883-886.
[7] 阿斯木古丽·克力木,热依拉·阿不拉,阿孜亚·赛辽汗.1092 例 0～6 岁儿童骨密度与体格发育调查[J].中国妇幼保健,2014,29(6):917-919.
[8] 杨梦利.儿童少年体成分与骨龄及身体素质特点分析[D].郑州:郑州大学,2014.
[9] 毛萌,金星明,赵正言,等.儿童保健与发育行为诊疗规范[M].北京:人民卫生出版社,2015:1-7.
[10] Manousaki D,Rauch F,Chabot G,et al.Pediatric data for dual X-ray absorptiometric measures of normal lumbar bone mineral density in children under 5 years of age using the lunar prodigy densitometer[J].J Musculoskel Neuron,2016,16(3):247-255.
[11] Xu H,Chen JX,Gong J,et al.Normal reference for bone density in healthy Chinese children[J].J Clin Densitom,2007,10(3):266-275.
[12] Pollock NK.Childhood obesity,bone development,and cardio metabolic risk factors[J].Mol Cell Endocrinol,2015,410(1):52-63.
[13] Farr JN,Dimitri P.The impact of fat and obesity on bone microarchitecture and strength in children[J].Calcified Tissue Int,2017,100 (5):500-513.
[14] Soyka LA,Misra M,Frenchman A,et al.Abnormal bone mineral accrual in adolescent girls with Anorexianervosa[J].J Clin Endocr Metab,2002,87(9):4177-4185.
[15] Moro M,van der Meulen MC,Kiratli BJ,et al.Body mass is the primary determinant of midfemoral bone acquisition during adolescent growth[J].Bone,1996,19(5):519-526.
[16] 张峰,马扬.骨碱性磷酸酶与骨密度相关性分析[J].中国妇幼保健,2011,26,4865-4866.
[17] 李国波,连大华,欧萍,等.0-7 岁儿童骨碱性磷酸酶和骨密度检测相关性分析[J].海峡预防医学杂志,2016,18(3):77-78.
[18] 陈银花,毛春婷,李风景,等.25羟维生素 D及骨碱性磷酸酶在评估儿童维生素 D 营养状态中的意义[J].实用儿科临床杂,2010,25(19):1477-1478.
[19] Haimi M,Kremer R.Vitamin D deficiency/ insufficiency from childhood to adulthood:insights from a sunny country[J].World J Clin Pediatr,2017,6:1-9.
[20] Wimalawansa SJ.Associations of vitamin D with insulin resistance,obesity,type 2 diabetes,and metabolic syndrome[J].J Steroid Biochem,2018,175:177-189.
[21] Alemzadeh R,Kichler J,Babar G,et al.Hypovitaminosis D in obese children and adolescents:relationship with adiposity,insulin sensitivity,ethnicity,and season[J].Metabolism,2008,57(2):183-191.
[22] 陈海燕,陈梦莹,彭璐婷,等.肥胖儿童血清25羟维生素D水平及其临床意义[J].中国儿童保健杂志,2013,21(3):247-250.
[23] Fu Y,Hu Y,Qin Z,et al.Association of serum 25-hydr-oxyvitamin D status with bone mineral density in 0~7 year old children[J].Oncotarget,2016,7(49):80811-80819.
[24] Palacios C,Gonzalez L.Is vitamin D deficiency a major global public health problem[J].J Steroid Biochem,2014,144 (PtA):13845.
基金
江苏省重点病种规范化诊疗项目(BE2015607);南京医科大学科技发展基金-一般项目(NMUB2018111)
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