孕期维生素D缺乏对孕母及后代影响的研究进展

维生素D(Vit D)缺乏属于全球范围内的一个常见的公共卫生问题。在孕母及后代Vit D缺乏现象尤其多见。Vit D缺乏不仅可导致骨骼方面的疾病,还与过敏性疾病、1型糖尿病、心血管疾病、肿瘤、自身免疫性疾病、神经行为疾病的发生有关。人们越来越担心孕期Vit D缺乏对孕母及后代生命健康会产生不利的影响。本文主要从孕期Vit D缺乏对孕母及后代生命健康的影响进行综述,以期提高孕母补充Vit D的意识,实现优生优育。     

Treatment of Vitamin D Deficiency with Calcifediol: Efficacy and Safety Profile and Predictability of Efficacy

Calcifediol (25-OH-vitamin D3) is the prohormone of the vitamin D endocrine system. It is used to prevent and treat vitamin D deficiency. Calcifediol, as well as cholecalciferol (vitamin D3), is efficient and safe in the general population, although calcifediol has certain advantages over cholecalciferol, such as its rapid onset of action and greater potency. This review analyzed studies comparing the efficacy and safety of both calcifediol and cholecalciferol drugs in the short and long term (>6 months). Calcifediol was found to be more efficacious, with no increase in toxicity. We also assessed the predictability of both molecules. A 25OHD increase depends on the dose and frequency of calcifediol administration. In contrast, after cholecalciferol administration, 25OHD increase depends on more factors than dose and frequency of administration, also phenotypic aspects (such as obesity and malabsorption), and genotypic factors impacts in this increase.     

Prevalence and Predictors of Vitamin D Deficiency and Insufficiency among Pregnant Rural Women in Bangladesh

Although adequate vitamin D status during pregnancy is essential for maternal health and to prevent adverse pregnancy outcomes, limited data exist on vitamin D status and associated risk factors in pregnant rural Bangladeshi women. This study determined the prevalence of vitamin D deficiency and insufficiency, and identified associated risk factors, among these women. A total of 515 pregnant women from rural Bangladesh, gestational age ≤ 20 weeks, participated in this cross-sectional study. A separate logistic regression analysis was applied to determine the risk factors of vitamin D deficiency and insufficiency. Overall, 17.3% of the pregnant women had vitamin D deficiency [serum 25(OH)D concentration <30.0 nmol/L], and 47.2% had vitamin D insufficiency [serum 25(OH)D concentration between 30–<50 nmol/L]. The risk of vitamin D insufficiency was significantly higher among nulliparous pregnant women (OR: 2.72; 95% CI: 1.75–4.23), those in their first trimester (OR: 2.68; 95% CI: 1.39–5.19), anaemic women (OR: 1.53; 95% CI: 0.99–2.35; p = 0.056) and women whose husbands are farmers (OR: 2.06; 95% CI: 1.22–3.50). The risk of vitamin deficiency was significantly higher among younger pregnant women (<25 years; OR: 2.12; 95% CI: 1.06–4.21), nulliparous women (OR: 2.65; 95% CI: 1.34–5.25), women in their first trimester (OR: 2.55; 95% CI: 1.12–5.79) and those with sub-optimal vitamin A status (OR: 2.30; 95% CI: 1.28–4.11). In conclusion, hypovitaminosis D is highly prevalent among pregnant rural Bangladeshi women. Parity and gestational age are the common risk factors of vitamin D deficiency and insufficiency. A husband’s occupation and anaemia status might be important predictors of vitamin D insufficiency, while younger age and sub-optimal vitamin A status are risk factors for vitamin D deficiency in this population.     

孕母维生素D缺乏对后代神经行为发育影响的研究进展

目前世界范围内维生素D缺乏的患病率相当高,其中孕母是维生素D缺乏的高危人群之一。孕母维生素D缺乏可导致后代骨骼疾病、免疫系统疾病、内分泌系统疾病,有研究发现维生素D作为一种具有神经活性的类固醇激素,对后代神经行为发育具有不可或缺的作用,孕母维生素D缺乏对后代神经行为发育的影响日益受到关注。本文就孕母维生素D缺乏对后代神经行为发育的影响及其机制进行综述。     

单剂量肌注维生素D3对维生素 D缺乏孕妇及其新生儿作用的研究

目的：通过对维生素D缺乏孕妇进行单次、单剂量肌注补充维生素D,对其有效性和安全性进行研究。方法检测孕妇维生素D水平,将60例维生素D缺乏的孕妇随机分为干预组和对照组各30例。对干预组孕妇在其36～38孕周时,进行一次性肌注维生素D37．5mg（30万单位）,分析比较干预组与对照组的孕妇及其新生儿血清维生素D水平。结果产时（干预后）干预组孕妇的血清25-（OH）D高于对照组,差异有统计学意义（t＝6．13,P＜0．05）;干预组新生儿的血清25-（OH）D也高于对照组,差异有统计学意义（t＝4．99,P＜0．05）。干预组孕母和新生儿脐血25-（OH）D水平呈正相关（r＝0．53,P＜0．05）;对照组孕母和新生儿脐血25-（OH）D水平也呈正相关（r＝0．63,P＜0．05）。结论孕妇、新生儿体内维生素D水平普遍比较低,单剂量肌注补充维生素D3的干预措施对改善孕妇及其新生儿维生素D的状况有效并且安全。     

双胎脐血维生素D水平与孕母维生素D营养状况的关系

[目的]探讨双胎脐血维生素D水平与孕母维生素D营养状况的关系,进行孕期营养指导.[方法]以2008年3月～2009年3月分娩的37对双胞胎和双胎母亲为研究对象,测定脐血与分娩时母亲血清25羟-维牛素D3[25-(OH)D3]水平,对双胎孕妇于孕4～6月、分娩前进行膳食指导、膳食调查和问卷调查.[结果]双胎儿脐血25-(OH)D3水平为(66.59±32.04)nmol/L;对应母血水平为(67.70±34.39)nmol/L.脐血与母血之间、双胎脐血之间均数比较,差异均无显著性.母血正常组,母血与脐血水平呈正相关(r=0.83.P＜0.01);母血低常组,母血与脐血水平呈负相关(r=0.71,P＜0.01).母孕期平均每日户外活动时间(r=0.85.P=0.00);每天进食含有维生素D食物的种类(r=0.52,P=0.04);孕期补充维生索D史(F=7.55,P=0.01)与母血25-(OH)D3水平有关.母血、脐血25-(OH)D3均正常的孕母孕期平均每日户外活动时间为(1.98±0.82)h;每天进食含有维生素D的食物的种类为(2.01±0.76)种,有服用维生素D制剂的占80%.[结论]双胎脐血维生素D水平与孕母维生素D营养状况密切相关;为维持孕母、胎儿维生素D的正常水平,双胎孕母孕期应采取综合预防措施.     

Nutritional Content and Health Profile of Non-Dairy Plant-Based Yogurt Alternatives

Yogurt is considered a healthy, nutritious food in many cultures. With a significant number of people experiencing dairy intolerance, and support for a more sustainable diet, consumer demand for dairy alternatives has surged. The aim of this study was to conduct a cross-sectional survey of plant-based yogurt alternatives to assess their nutritional content and health profile. A total of 249 non-dairy yogurt alternatives were analyzed from the nutrition label listed on the commercial package. The various yogurt alternatives contained extracts of coconut (n = 79), almonds (n = 62), other nuts or seeds (n = 20), oats (n = 20), legumes (n = 16), and mixed blends (n = 52). At least one-third of the yogurt alternatives had 5 g or more of protein/serving. Only 45% of the yogurt alternatives had calcium levels fortified to at least 10% of daily value (DV), while only about one in five had adequate vitamin D and B12 fortification at the 10% DV level. One-half of the yogurt alternatives had high sugar levels, while 93% were low in sodium. Except for the coconut-based products, the yogurts were not high in fat or saturated fat. The yogurt alternatives were not fortified as frequently or to the same levels as the corresponding non-dairy, plant-based beverages.     

Efficacy of Oral Vitamin Supplementation in Inflammatory Rheumatic Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: We aimed to provide a systematic review and meta-analysis of randomized controlled trials assessing the effect of oral vitamin supplementation on symptoms and disease activity in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA). Methods: A systematic literature review and meta-analysis of randomized controlled trials including patients with inflammatory rheumatic diseases were performed using MEDLINE, EMBASE and abstracts from recent international rheumatology congresses. Studies were reviewed in accordance with PRISMA guidelines. We analysed clinical outcomes according to each type of vitamin supplementation. Results. The initial search yielded 606 articles. Of these, 13 studies were included in the qualitative synthesis: eight studied vitamin D supplementation, two assessed vitamin E supplementation, two folic acid, and one vitamin K, all of them on RA patients. No studies on SpA or PsA were selected. Oral vitamin supplementations were not associated with a reduction in RA activity (DAS-28 or pain) or RA flares. Conclusions: Despite their beneficial effects, the effects of vitamin supplementation on RA activity, if any, seem to be limited. Evidence on their efficacy on SpA or PsA activity is lacking. However, folic acid supplementation should be suggested to prevent methotrexate-related side effects, and vitamin D should be given to patients with vitamin D deficiency to prevent musculo-skeletal complications.     

儿童青少年时期钙和维生素D营养状况对成年后骨骼健康的影响

包括钙和维生素D在内的膳食因素是影响峰值骨量的重要环境因素，增加生长发育期的峰值骨量是延缓成年后发生骨质疏松症的重要措施。本文综述儿童青少年时期的膳食因素对峰值骨量及成年后骨骼健康的影响。     

Nutritional Content and Health Profile of Single-Serve Non-Dairy Plant-Based Beverages

A growing number of people are seeking a non-dairy plant-based beverage both for their personal health, and for the health of the planet. The aim of this study was to conduct a cross-sectional survey of single-serve plant-based beverages to assess their nutritional content and health profile. A total of 51 non-dairy plant-based beverages were analyzed from the nutrition label listed on the commercial package. The various beverages contained extracts of soy (n = 14), almonds (n = 13), oats (n = 12), peas (n = 7), banana (n = 2), coconut (n = 2), and rice (n = 1). Almost one-half (45%) of the single-serve beverages had 5 g or more of protein/serving. A total of 75% and 65% of the single-serve beverages had calcium and vitamin B12 levels, respectively, fortified to at least 20% of the Daily Value (DV), while only 28% had vitamin D fortification at the 20% DV level. Two-thirds of the single-serve beverages had high sugar levels, while 39% were low in sodium, 63% were low in fat, and 96% were low in saturated fat. The single-serve plant-based beverages had more protein, calcium, vitamin B12, and sugar but less fat than the non-dairy, multi-serve plant-based beverages/ serving. A limited number of single-serve beverages met the requirements of school meal programs.     

The Role of Inflammatory Diet and Vitamin D on the Link between Periodontitis and Cognitive Function: A Mediation Analysis in Older Adults

Patients suffering from periodontitis are at a higher risk of developing cognitive dysfunction. However, the mediation effect of an inflammatory diet and serum vitamin D levels in this link is unclear. In total, 2062 participants aged 60 years or older with complete periodontal diagnosis and cognitive tests from the National Health and Nutrition Examination Survey (NHANES) 2011–2012 and 2013–2014 were enrolled. The Consortium to Establish a Registry for Alzheimer’s disease (CERAD) word learning subtest (WLT) and CERAD delayed recall test (DRT), the animal fluency test (AFT) and the digit symbol substitution test (DSST) was used. Dietary inflammatory index (DII) was computed via nutrition datasets. Mediation analysis tested the effects of DII and vitamin D levels in the association of mean probing depth (PD) and attachment loss (AL) in all four cognitive tests. Periodontitis patients obtained worse cognitive test scores than periodontally healthy individuals. DII was negatively associated with CERAD-WLT, CERAD-DRT, AFT and DSST, and was estimated to mediate between 9.2% and 36.4% of the total association between periodontitis with cognitive dysfunction (p < 0.05). Vitamin D showed a weak association between CERAD-DRT, AFT and DSST and was estimated to between 8.1% and 73.2% of the association between periodontitis and cognitive dysfunction (p < 0.05). The association between periodontitis and impaired cognitive function seems to be mediated both by a proinflammatory dietary load and vitamin D deficiency. Future studies should further explore these mediators in the periodontitis-cognitive decline link.     

The Effect of Changing Serum 25-Hydroxyvitamin D Concentrations on Metabolic Syndrome: A Longitudinal Analysis of Participants of a Preventive Health Program

Several studies have shown that a poor vitamin D status may increase the risk of developing metabolic syndrome, which leaves the question whether improving one’s vitamin D status may reduce the risk for the syndrome. Here we investigate the effect of temporal changes in serum 25-hydroxyvitamin D (25(OH)D) concentrations on metabolic syndrome among Canadians enrolled in a preventive health program that promotes vitamin D supplementation. We accessed and analyzed data of 6682 volunteer participants with repeated observations on serum 25(OH)D concentrations and metabolic syndrome. We applied logistic regression to quantify the independent contribution of baseline serum 25(OH)D and temporal increases in serum 25(OH)D to the development of metabolic syndrome. In the first year in the program, participants, on average, increased their serum 25(OH)D concentrations by 37 nmol/L. We observed a statistical significant inverse relationship of increases in serum 25(OH)D with risk for metabolic syndrome. Relative to those without improvements, those who improved their serum 25(OH)D concentrations with less 25 nmol/L, 25 to 50 nmol/L, 50 to 75 nmol/L, and more 75 nmol/L had respectively 0.76, 0.64, 0.59, 0.56 times the risk for metabolic syndrome at follow up. These estimates were independent of the effect of baseline serum 25(OH)D concentrations on metabolic syndrome. Improvement of vitamin D status may help reduce the public health burden of metabolic syndrome, and potential subsequent health conditions including type 2 diabetes and cardiovascular disease.     

孕期维生素D水平与新生儿不良健康结果关系的研究进展

维生素D(Vit D)是一种类固醇衍生物,对人体具有重要作用,Vit D缺乏可导致多种疾病。近年来发现孕期Vit D缺乏现象严重。本文主要从孕期Vit D缺乏对新生儿不良出生结局的影响进行综述,以期提高对孕期Vit D补充的认识,减少新生儿不良出生结局的发生。     

母孕期维生素D水平与婴儿体格生长的相关性研究

目的 探讨母孕期维生素D水平与婴儿体格生长的相关性。方法 检测孕晚期孕妇血清和新生儿脐血的25-(OH)D;并测量出生时、3、6、8月龄婴儿的体格生长指标及3、6、8月龄胫骨超声骨强度。结果 223例孕母血清25-(OH)D水平为(50.7±18.5)nmol/L,与婴儿体格生长指标无相关性;孕母与新生儿25-(OH)D水平呈正相关,并存在季节差异。结论 孕期维生素D水平与婴儿体格生长无相关性。     

Adequacy and Vitamin D in the Preoperative Period of Roux-en-Y Gastric Bypass,Bariatric Surgery,Can Protect Metabolic Health in Metabolically Healthy and Unhealthy Individuals

Evaluating the influence of vitamin D concentrations together with preoperative metabolic phenotypes on remission of chronic noncommunicable diseases (CNCDs) after 6 months of Roux-en-Y gastric bypass (RYGB). Cross-sectional analytical study comprising 30 adult individuals who were assessed preoperatively (T0) and 6 months (T1) after undergoing RYGB. Participants were distributed preoperatively into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) individuals according to HOMA-IR classification and to the adequacy and inadequacy of vitamin D concentrations in the form of 25(OH)D. All participants were assessed for anthropometric characteristics, biochemical variables, and presence of CNCDs. The statistical program used was the SPSS version 21. In face of vitamin D adequacy and regardless of the metabolic phenotype classification in the preoperative period, the means found for HOMA-IR allowed us to define them as metabolically healthy 6 months after RYGB. Only those with vitamin D inadequacy with the MUHO phenotype showed better results regarding the reduction of glucose that accompanied the shift in serum 25(OH)D concentrations from deficient to insufficient. It is possible that preoperative vitamin D adequacy, even in the presence of an unhealthy phenotype, may contribute to the reduction of dyslipidemia and improvement in cholesterol. It is suggested that preoperative vitamin D adequacy in both phenotypes may have a protective effect on metabolic health.     

Vitamin D Status among Women in a Rural District of Nepal: Determinants and Association with Metabolic Profile—A Population-Based Study

Hypovitaminosis D is prevalent worldwide, and especially in South-Asia. According to the Institute of Medicine (IOM), 25(OH)D levels below 30 nmol/L are defined as vitamin D deficiency (VDD) and levels between 30–50 nmol/L as insufficiency (VDI). Besides its role in calcium homeostasis, it has been postulated that vitamin D is involved in metabolic syndrome. Given the scarcity of data on vitamin D status in Nepal, we aimed to examine the prevalence of VDD and VDI, as well as the determinants and association with metabolic parameters (lipids, HbA1c), in a cohort of women in rural Nepal. Altogether, 733 women 48.5 ± 11.7 years of age were included. VDD and VDI were observed in 6.3 and 42.4% of the participants, respectively, and the prevalence increased by age. Women reporting intake of milk and eggs > 2 times weekly had higher 25(OH)D levels than those reporting intake < 2 times weekly. Women with vitamin D levels < 50 nmol/L displayed higher levels of cholesterol, LDL-cholesterol, triglycerides, and HbA1c. Additionally, a regression analysis showed a significant association between hypovitaminosis D, dyslipidemia, and HbA1c elevation. In conclusion, VDI was prevalent and increased with age. Milk and egg intake > 2 times weekly seemed to decrease the risk of VDI. Moreover, hypovitaminosis D was associated with an adverse metabolic profile.     

The Health Effects of Vitamin D and Probiotic Co-Supplementation: A Systematic Review of Randomized Controlled Trials

Evidence of synergic health effects of co-supplementation with vitamin D and probiotics is emerging. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA statement, scientific databases and the grey literature were searched, and a narrative review and risk of bias assessment were conducted. Seven randomized controlled trials were included, which had low risk of bias. Six studies were double-blind, and once single-blind, extended over 6–12 weeks, and included 50–105 participants. Conditions explored included schizophrenia, gestational diabetes, type 2 diabetes and coronary heart disease, polycystic ovarian syndrome, osteopenia, irritable bowel syndrome (IBS), and infantile colic. Supplementation frequency was daily or bi-monthly, with mainly vitamin D3, and Lactobacillus, Bifidobacterium, and Streptococcus. Comparators were placebo, vitamin D, lower vitamin D dose, and probiotics and lower vitamin D dose. The co-supplementation yielded greater health benefits than its comparators did in all studies except in one assessing IBS. Beneficial effects included decreased disease severity, improved mental health, metabolic parameters, mainly insulin sensitivity, dyslipidemia, inflammation, and antioxidative capacity, and lower use of healthcare. Co-supplementation of vitamin D and probiotics generated greater health benefits than its comparators did. More studies in other diseases and various populations are needed to confirm these findings and to elucidate the optimal form, composition, and frequency of this co-supplementation.