Relationship between Levels of Serum 25-hydroxyvitamin D,Calcium,Zinc and Growth and Development of Children
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摘要:
目的 观察儿童血清25-羟基维生素D钙、锌水平,并探析3项指标与儿童生长发育的关系。 方法 将2021年1月至2022年12月于自贡市妇幼保健院接受治疗的98例生长发育迟缓患儿纳入生长发育迟缓组,另取同期于该院体检的80例生长发育正常的儿童为生长发育正常组,对比2组血清25-羟基维生素D钙、锌水平及其他临床资料,分析血清25-羟基维生素D钙、锌水平与生长发育的关系。 结果 生长发育迟缓组身长/身高、体重、钙、锌、25-羟基维生素D水平低于生长发育正常组(P < 0.05);经点二列相关性分析结果显示,钙、锌、25-羟基维生素D水平与儿童生长发育迟缓呈负相关(r < 0,P < 0.05);建立Logistic回归模型,结果显示,身长/身高(95%CI:0.673~0.824)、体重(95%CI:0.477~0.717)、钙(95%CI:0.127~0.467)、锌(95%CI:0.140~0.571)、25-羟基维生素D(95%CI:0.130~0.461)水平是儿童生长发育的保护因素(OR < 1,P < 0.05);绘制ROC曲线,结果显示,钙、锌、25-羟基维生素D水平对儿童生长发育具有一定预测价值(AUC = 0.601、0.627、0.667),3项指标并联预测价值更高(AUC = 0.808)。 结论 儿童生长发育状况与血清25-羟基维生素D钙、锌水平密切相关,临床应动态监测血清25-羟基维生素D钙、锌水平变化,有助于早期预测儿童生长发育状况。 Abstract:Objective To observe the levels of serum 25-hydroxyvitamin D, calcium and zinc in children, and explore the relationship between the three indexes and the growth and development of children. Methods From January 2021 to December 2022, 98 children with growth retardation treated in Zigong Maternal and Child Health Hospital were included in the growth retardation group, and 80 children with normal growth and development were taken as the normal growth and development group. The serum 25-hydroxyvitamin D, calcium , zinc level and other clinical data of the two groups were compared, and the relationship between serum 25-hydroxyvitamin D, calcium , zinc level and growth and development was analyzed. Results The levels of body length/height, weight, calcium, zinc and 25- hydroxyvitamin D in the growth retardation group were lower than those in the normal growth development group (P < 0.05). The results of point-and-column correlation analysis showed that the levels of calcium, zinc and 25- hydroxyvitamin D were negatively correlated with children's growth retardation (r < 0, P < 0.05). Logistic regression model was established. The results showed that the levels of Size / height (95%CI:0.673~0.824), weight (95%CI:0.477~0.717), calcium (95%CI: 0.127~0.467), zinc (95%CI: 0.140~0.571) and 25- hydroxyvitamin D (95%CI: 0.130~0.461) were the protective factors for children's growth and development (or < 1 The ROC curve was drawn. The results showed that the levels of calcium, zinc and 25-hydroxyvitamin D had certain predictive value for children's growth and development (AUC = 0.601, 0.627 and 0.667), and the predictive value of The three indicators are parallel was higher (AUC = 0.808). Conclusion The growth and development of children is closely related to the level of serum 25-hydroxyvitamin D, calcium and zinc. Clinical monitoring of the level of serum 25-hydroxyvitamin D, calcium and zinc is helpful for early prediction of children's growth and development. -
Key words:
- Children /
- 25-hydroxyvitamin D /
- Calcium /
- Zinc /
- Growth and development
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1 生长发育迟缓组与生长发育正常组血清25-羟基维生素D水平及其他临床资料比较[($ \bar x \pm s $)/n](2)
1. Comparison of serum 25-hydroxyvitamin D level and other clinical data between growth retardation group and normal growth group[($ \bar x \pm s$)/n](2)
组别 血清钙(mmol/L) 血清铜(μmol/L) 血清铁(μmol/L) 血清镁(mmol/L) 血清锌(μg/g) 血清25-羟基维生素D(ng/mL) <2.25 ≥2.25 <5.0 ≥5.0 <9.0 ≥9.0 <0.75 ≥0.75 <110 ≥110 <20 ≥20 生长发育迟缓组(n=98) 55 43 29 69 22 76 18 80 42 56 61 37 生长发育正常组(n=80) 19 61 18 62 13 67 11 69 14 66 23 57 χ2 19.003 1.140 1.072 0.689 13.134 19.828 P <0.001* 0.286 0.301 0.407 <0.001* <0.001* *P < 0.05。 表 1 生长发育迟缓组与生长发育正常组血清25-羟基维生素D水平及其他临床资料比较[($ \bar x \pm s $)/n](1)
Table 1. Comparison of serum 25-hydroxyvitamin D level and other clinical data between growth retardation group and normal growth group[($ \bar x \pm s$)/n](1)
组别 性别 年龄(岁) 身长/身高(cm) 体重(kg) 出生情况 骨密度 男 女 自然分娩 剖宫产 正常 异常 生长发育迟缓组(n=98) 47 51 3.46±1.28 94.53±5.29 13.59±2.13 65 33 80 18 生长发育正常组(n=80) 42 38 3.51±1.34 101.39±5.04 16.08±2.24 48 32 71 9 χ2/t 0.363 0.254 8.790 7.580 0.761 1.734 P 0.547 0.800 <0.001* <0.001* 0.383 0.188 *P < 0.05。 表 2 主要自变量赋值
Table 2. Assignment of main independent variables
自变量 变量说明 赋值情况 身长/身高 数值变量 − 体重 数值变量 − 钙 分类变量 0=<2.25 mmol/L,1=≥2.25 mmol/L 锌 分类变量 0=<110 μg/g,1=≥110 μg/g 血清25-羟基维生素D 分类变量 0=<20 ng/mL,1=≥20 ng/mL 表 3 血清钙、锌、25-羟基维生素D水平对儿童生长发育的影响
Table 3. Effects of serum calcium,zinc and 25- hydroxyvitamin D levels on children's growth and development
自变量 β 标准误 Waldχ2 P OR 95%CI 身长/身高 −0.295 0.052 32.678 <0.001* 0.745 0.673~0.824 体重 −0.537 0.104 26.611 <0.001* 0.585 0.477~0.717 钙(≥2.25 mmol/L) −1.413 0.332 18.064 <0.001* 0.244 0.127~0.467 锌(≥110 μg/g) −1.263 0.358 12.437 <0.001* 0.283 0.140~0.571 血清25-羟基维生素D(≥20 ng/mL) −1.408 0.323 18.968 <0.001* 0.245 0.130~0.461 常量 1.840 0.488 14.210 <0.001* 6.294 − *P < 0.05。 表 4 血清钙、锌、25-羟基维生素D水平对儿童生长发育的预测价值
Table 4. Predictive value of serum calcium,zinc and 25-hydroxyvitamin D levels on children’ s growth and development
检验变量 AUC 标准误 P 95%CI 敏感度 特异度 约登指数 钙 0.601 0.042 0.021* 0.517~0.684 0.639 0.638 0.277 锌 0.627 0.042 0.004* 0.545~0.709 0.629 0.675 0.304 血清25-羟基维生素D 0.667 0.041 <0.001* 0.587~0.748 0.722 0.688 0.410 联合 0.808 0.033 <0.001* 0.743~0.873 0.865 0.613 0.478 *P < 0.05。 -
[1] Xie W,Jensen S K G,Wade M,et al. Growth faltering is associated with altered brain functional connectivity and cognitive outcomes in urban Bangladeshi children exposed to early adversity[J]. BMC Med,2019,17(1):199. doi: 10.1186/s12916-019-1431-5 [2] 张颖,王俊峰,丁艳华. 儿童语言发育迟缓的临床特征和影响因素研究[J]. 中国儿童保健杂志,2022,30(8):912-915. doi: 10.11852/zgetbjzz2021-0910 [3] Wolters M,Intemann T,Russo P,et al. 25-Hydroxyvitamin D reference percentiles and the role of their determinants among European children and adolescents[J]. European Journal of Clinical Nutrition,2022,76(4):564-573. doi: 10.1038/s41430-021-00985-4 [4] Sempos C T,Durazo-Arvizu R A,Fischer P R,et al. Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet—a multivariable reanalysis[J]. Am J Clin Nutr,2021,114(1):231-237. doi: 10.1093/ajcn/nqab048 [5] Awasthi S,Kumar D,Singh S,et al. Prevalence of specific micronutrient deficiencies in urban school going children of India aged between 6 and 16 years: Study protocol for a multicentric cross-sectional study[J]. BMJ Open,2021,11(12):e046783. doi: 10.1136/bmjopen-2020-046783 [6] 杨婷,梁希,张功. 个体化营养联合强化钙指导与儿童生长发育情况及骨密度水平的关系研究[J]. 武警后勤学院学报: 医学版,2021,30(8):31-33. [7] Solaiman S G,Min B R. The effect of high levels of dietary zinc on growth performance,carcass characteristics,blood parameters,immune response and tissue minerals in growing boer-cross goat kids[J]. Small Ruminant Res,2019(177):167-174. [8] 中华医学会儿科学分会神经学组,中国医师协会神经内科分会儿童神经疾病专业委员会. 儿童智力障碍或全面发育迟缓病因诊断策略专家共识[J]. 中华儿科杂志,2018,56(11):806-810. doi: 10.3760/cma.j.issn.0578-1310.2018.11.003 [9] 首都儿科研究所,九市儿童体格发育调查协作组. 中国七岁以下儿童身长/身高的体重和体块指数的生长标准值及标准化生长曲线[J]. 中华儿科杂志,2009,59(4):281-285. doi: 10.3760/cma.j.issn.0578-1310.2009.04.011 [10] Susanto T,Yunanto R A,Rasny H,et al. Promoting children growth and development: A community‐based cluster randomized controlled trial in rural areas of Indonesia[J]. Public Health Nurs,2019,36(4):514-524. doi: 10.1111/phn.12620 [11] Alves J G B,Alves G V. Effects of physical activity on children's growth[J]. Jornal De Pediatria,2019,86(95):72-78. [12] Rotenberg A,Assadi M,Agam N,et al. 0128 Mild upper airway obstruction leads to increased energy intake and growth retardation that persists after the obstruction removal[J]. Sleep,2020,43(1):A50-A51. [13] Matonti L,Blasetti A,Chiarelli F. Nutrition and growth in children[J]. Minerva Pediatr,2020,72(6):462-471. [14] Calvo M S,Whiting S J. Perspective: School meal programs require higher vitamin d fortification levels in milk products and plant-based alternatives—evidence from the national health and nutrition examination surveys (NHANES 2001–2018)[J]. Adv Nutr,2022,13(5):1440-1449. doi: 10.1093/advances/nmac068 [15] 王淑慧,高雪婷,周银月,等. 儿童运动发育迟缓与血碱性磷酸酶,血25-羟维生素D3表达水平的相关性[J]. 现代生物医学进展,2021,21(7):1356-1359,1314. [16] Lin Z,Lin W. Study on calcium,zinc and vitamin a supplementation to promote growth and development of children[J]. Clin Res Pract,2019,4(36):106-108. [17] Ambati K,Thyagaraju K. Effect of calcium of lactose free millet milk on growth and development in albino weanling rats[J]. Int J Advanced Sci Technol,2020,29(3):15144-15149. [18] Gera T,Shah D,Sachdev H S. Zinc supplementation for promoting growth in children under 5 years of age in low- and middle-income countries: A systematic review[J]. Indian Pediatr,2019,56(5):391-406. doi: 10.1007/s13312-019-1537-z [19] Abdollahi M,Ajami M,Abdollahi Z,et al. Zinc supplementation is an effective and feasible strategy to prevent growth retardation in 6 to 24 month children: A pragmatic double blind,randomized trial[J]. Heliyon,2019,5(11):e02581. doi: 10.1016/j.heliyon.2019.e02581 [20] 陈毅克,黄敏菁,黎素清,等. 0~6岁儿童血锌、25-羟基维生素D、胰岛素样生长因子结合蛋白-3的水平及临床意义[J]. 南昌大学学报: 医学版,2023,63(1):61-64. [21] Mehta S,Huey S L,Ghugre P S,et al. A randomized trial of iron- and zinc-biofortified pearl millet-based complementary feeding in children aged 12 to 18 months living in urban slums[J]. Clin Nutr,2022,41(4):937-947. doi: 10.1016/j.clnu.2022.02.014 [22] Chao H C,Chang Y J,Huang W L. Cut-off serum zinc concentration affecting the appetite,growth,and nutrition status of undernourished children supplemented with zinc.[J]. Nutrition in Clinical Practice,2018,33(5):701-710. doi: 10.1002/ncp.10079 -