Better newborn vitamin D status lowers RSV-associated bronchiolitis in infants

Each year 1.5 million children under the age of 5 years die from pneumonia. In the United States, respiratory syncytial virus (RSV) is the number one cause of bronchiolitis and pneumonia in children under 1 year of age. Low serum 25(OH)D is associated with an increased risk of lower respiratory tract infections (LRTI). Two recent studies have provided important information concerning the association between cord blood 25(OH)D and subsequent risk of developing respiratory infection in very young children. These findings support the need in future studies to determine the extent to which an intervention to change the vitamin D status of mothers during pregnancy can reduce the risk of RSV-associated LRTI in their offspring. An answer to this question would have significant worldwide public health importance given the high prevalence of low vitamin D status worldwide and the high mortality burden accompanying infectious lung diseases in young children.     

Vitamin A status of preterm infants: the influence of feeding and vitamin supplements

Consecutive weekly determinations of plasma retinol, alpha-tocopherol, retinol-binding protein, prealbumin, and zinc were performed on a group of 58 infants weighing less than 2000 g at birth in an intensive-care nursery. Data were classified by the feeding regimen of the preceding week: parenteral, premature formula, or own mother's milk. Mean plasma-retinol values were less than 20 mcg/dl, the lower limit of normal for adults, with the highest values in the formula-fed group. Retinol-binding protein and prealbumin values were lowest in the parenterally-fed group. Alpha-tocopherol concentrations were consistently maintained at levels higher than 500 mcg/dl only in infants fed their own mother's milk. Mean zinc concentrations above 70 mcg/dl, the lower limit of normal for adults, occurred only in parenterally fed infants. Doubling the recommended vitamin supplement in formula-fed infants did not produce a significant increase in plasma retinol or tocopherol.     

北京市2011-2016年早产儿出生状况分析

目的 分析北京市早产儿发生情况及影响因素,为提高早产儿保健管理水平提供决策依据。方法 对北京市16个区所有助产机构2011-2016年74 994例早产儿的分娩情况进行回顾性分析。结果 2011-2016年北京市早产总发生率5.49%,男女性别构成比1.27∶1,胎龄<34周14 146例(18.9％),≥34孕周60 848例(81.1％)。多因素分析发现多胎(OR=2.519, 95%CI:2.433~2.611), 女婴(OR=1.348, 95%CI:1.307~1.387), 温暖季节 (OR=1.055~1.074, 95%CI:1.012~1.119) 和高危儿(OR=47.619, 95%CI:43.478~50.000)是早产儿低出生体重的危险因素。结论 北京市早产儿发生率低于发达国家,但有逐年递增趋势,应重视对出生体重影响较大的因素,为降低早产儿的发生率和改善早产儿预后提供依据。     

Assessment of nutritional folate status and selected vitamin status of women of childbearing age

OBJECTIVE: The aim of the study was to investigate folate and other selected vitamin status (ascorbic acid, tocopherol, retinol, vitamin B12), haematological indices and total homocysteine concentration of serum in women of childbearing age. DESIGN: A cross-sectional study. SETTING: Warsaw. SUBJECTS: Healthy women aged 18-30 y (n=78) not pregnant presently or previously, and not taking drugs. RESULTS: Haemoglobin and haematocrit values according to WHO criteria for 18 to 30-y-old women were normal. The optimal levels of serum tocopherol, >1.29 mg/dl (>29.9 micromol/l) to preventing civilization diseases, were found in 5.5% and serum retinol >71.6 mcg/dl (>2.5 micromol/l) in 6.4% of all studied persons. The analysis of serum folate concentration showed high-risk deficiency,<3 ng/ml (<6.8 nmol/l), in 6.4%, moderate and low risk together (7.0-14.9 nmol/l) in 61.6% and optimal folate levels (>14.9 nmol/l) in 32.0% of the studied group. Folate body stores were insufficient in almost all women. There was no high or moderate deficiency risk of vitamin B12 or ascorbic acid. None of the women under study had serum total homocysteine (tHcy) concentration >15 micromol/l, indicating hyperhomocysteinaemia. Serum total homocysteine concentrations in the range of 5-15 micromol/l were found in 71.8%, and serum tHcy >10 micromol/l in 7.7% of the studied group of women. SPONSORSHIP: The study was sponsored by the Polish Committee for Scientific Research.     

Influence of iron on vitamin A nutritional status

Iron deficiency seems to deteriorate vitamin A metabolism leading to a reduction in serum retinol and an increase in hepatic retinol and retinyl ester. These alterations probably result from an increase in retinol sequestration to the liver and/or impairment in the activity of hepatic retinyl ester hydrolases decreasing vitamin A mobilization.     

Vitamin A status of preterm infants during infancy

Plasma retinol and retinol-binding protein (RBP) were measured in 67 enterally fed preterm infants (750-1398 g) at 33 +/- 2 wk postconceptional age (PCA), and at regular intervals during infancy. Retinol and RBP declined by 35 +/- 2 wk PCA and remained low at 38 wk after discharge, with the infants fed a term-infant formula. At 38 +/- 2 wk PCA, 48% (32 of 67) of these infants had plasma retinol concentrations less than 0.35 mumol/L. Mean retinol and RBP rose over the next 7 mo, but large numbers of infants (26 of 59 at 48 wk, 10 of 61 at 57 wk) had hyporetinolemia (0.35-0.67 mumol/L). Plasma RBP leveled off at 57 +/- 2 wk PCA and remained low (less than 0.95 mumol/L) in many infants throughout the first year of life. Lower plasma retinol and RBP concentrations at 33 and 38 wk correlated with longer periods of intravenous nutrition. At 57 and 69 wk, lower retinol and RBP correlated with higher birth order. Suboptimal vitamin A status may occur for many months after preterm infants are discharged from the hospital.     

Zinc supplementation and plasma concentration of vitamin A in preterm infants

To assess the effect of zinc supplementation on plasma retinol levels, 24 preterm infants were randomly assigned to receive 400 micrograms.kg-1.d-1 of intravenous Zn or no Zn supplementation. Intakes of protein, energy, and vitamin A were similar for both groups as were day 0 plasma concentrations of retinol, retinol-binding protein (RBP), and Zn. Zn concentrations were not significantly different between groups at any time during the 3-wk study; however, retinol values in wk 1 increased more in the supplemented group (delta = 10.0 vs 0.9 micrograms/dL, or 0.35 vs 0.031 mumol/L; p less than 0.005). RBP appeared to increase more in the supplemented group but did not reach statistical significance. We hypothesize that the increase in plasma retinol levels noted in the preterm infants receiving Zn supplementation may be mediated by an increased production of RBP in the liver that in turn enhances the hepatic release of retinol.     

Influence of long-chain polyunsaturated fatty acid formula feeds on vitamin E status in preterm infants

It has been recommended to supplement formulas for preterm infants with n-3 and n-6 long-chain polyunsaturated fatty acids (LCP) to improve growth, visual acuity, and neurodevelopmental performance. However, large amounts of LCP may increase lipid peroxidation and oxidative stress in preterm infants. We investigated if, under high supplementation of natural tocopherols, LCP addition to formula can be performed safely without causing tocopherol depletion in cell membranes. Thirty-one healthy preterm infants with gestational ages from 28 to 32 weeks were evaluated in a prospective, randomized study from birth to day 42. Nine infants received an n-3 and n-6 LCP-enriched formula (A), eleven infants a standard formula (B), and eleven infants breast milk (control group). Alpha- and gamma-tocopherol extracts were added to both formulas, amounting to five times the value in breast milk (2.3 mg/dL in both formulas versus 0.45 mg/dL in breast milk). Erythrocyte arachidonic acid (AA) and docosahexaenoic acid (DHA) in the phosphatidylethanolamine fraction were similar in the three groups over the study period, whereas a significant reduction of erythrocyte AA and DHA could be detected in the phosphatidylcholine fraction in all three groups from day 14 onwards, when compared to respective cord blood values, with lowest values in the standard formula group. Amazingly, levels of alpha- and gamma-tocopherol were higher in plasma, erythrocytes, platelets, monocytes, and polymorphonuclear leukocytes with LCP supplementation as compared to standard formula and breast milk from day 7 onwards, whereas in buccal mucosal cells, this was not the case until day 42. Gammatocopherol uptake in the LCP-supplemented group was also significantly higher in all cell fractions studied from day 7 onwards. We therefore hypothesize that the LCP supplementation used in formula A improves tocopherol solubility and stability in biological membranes. Under high-dose vitamin E addition to n-3 and n-6 LCP-supplemented formula, no evidence for tocopherol depletion and furthermore, high accumulation of tocopherols, can be detected in healthy preterm infants.     

肠外营养联合早期肠内营养对早产儿营养状况影响的研究

目的:探讨肠外营养(PN)联合早期肠内营养(EEN)对早产儿营养状况的影响. 方法:将72例早产儿随机分为试验组和对照组,每组36例.两组病儿出生后均给予PN作为基础营养,其中试验组在出生后12h内给予EN支持;对照组在出生后3d给予EN.监测和记录两组早产儿在出生后第7和第14天体格发育指标(身长、头围、体重)和营养指标(血清清蛋白、前清蛋白)水平的变化,以及两组早产儿达到完全EN的时间. 结果:两组早产儿在出生后第7天,各项指标未见统计学差异(P＞0.05).出生后第14天,试验组病儿的多项指标明显优于对照组,试验组达到完全EN的时间明显短于对照组,两组比较有统计学差异(P＜0.05). 结论:PN联合EEN能改善早产儿的营养状况.     

伴有呼吸道感染症状或健康婴幼儿维生素A营养状况与其贫血的关系

目的探讨伴有呼吸道感染症状或健康婴幼儿维生素A营养状况与其贫血的关系。方法收集435例婴幼儿的临床资料,依据年龄分为0. 5~1岁组、2~3岁组、4~6岁组;依据有无呼吸道感染症状进行分组,其中伴有呼吸道感染症状51例为观察组,无呼吸道感染症状的婴幼儿384例为对照组。检测所有婴幼儿维生素A和血红蛋白(HGB)的水平,通过统计分析婴幼儿维生素A营养状况与其贫血的关系。结果 435例婴幼儿中,男264例,女171例,年龄0. 5~6岁,平均年龄(3. 43±0. 35)岁。观察组维生素A水平较对照组明显降低,差异有统计学意义(P<0. 01);而两组HGB水平的比较,差异无统计学意义(P>0. 05)。不同年龄组间维生素A和HGB水平的比较,差异均有统计学意义(均P<0. 01),随着年龄的增加,婴幼儿维生素A和HGB水平均有所升高。随着维生素A水平的升高,婴幼儿HGB水平亦明显上升,贫血发生率降低,而在维生素A水平低于0. 1 mg/L时,婴幼儿贫血发生率最高(16. 86%)。经Spearman相关性分析结果发现,维生素A和HGB水平均与年龄呈现显著正相关关系(r=0. 46、0. 64,均P<0. 01),并且维生素A与HGB水平存在正相关关系(r=0. 27,P=0. 01)。结论伴有呼吸道感染症状的婴幼儿维生素A水平较健康婴幼儿明显降低,提示其维生素A营养状况较差,并且维生素A水平与贫血发生率存在显著相关性。     

早产儿住院期间及出院后早期营养状况分析

目的 通过对早产儿能量和营养素摄入以及体格发育状况调查,了解早产儿出生早期和出院后能量和营养素摄入的特点以及与体重增长的关系。方法 选取2014年1月－2016年1月在汕头大学医学院第一附属医院新生儿重症监护室住院的141名早产儿为研究对象,计算住院期间恢复至出生体重所需的时间及恢复出生体重后体重增长速率;计算达到早产儿能量推荐摄入标准(RDIs)的时间,比较宫内发育迟缓(IUGR)与宫外发育迟缓(EUGR)的发生率;按照出生胎龄≥34 周或<34 周分为两组,分别比较两组之间体重增长情况、EUGR 的发生率;对所有新生儿出院后3个月内进行门诊随诊,比较不同喂养组发生EUGR的情况。结果 1)该组早产儿恢复至出生体重的中位时间为13.2 d,恢复至出生体重后体重增长速率中位数为16.7 g/(kg·d),达到RDIs的中位时间为10.6 d;2)出院时EUGR 的发生率明显高于出生时IUGR发生率(46.1% vs.17.7%,P<0.01),出院时胎龄<34 周组EUGR 的发生率高于胎龄≥34 周组(P<0.05);3)141名早产儿出院3个月时EUGR 的发生率与出院时相比差异无统计学意义(χ²＝0.05,P>0.05),出院后母乳+母乳强化剂喂养以及母乳+早产儿出院后配方奶PDF喂养的早产儿在出院3个月时EUGR发生率低于纯早产儿出院后配方奶、纯母乳、纯足月儿配方奶、母乳+足月儿配方奶喂养的早产儿(P<0.05),胎龄<34 周与胎龄≥34 周早产儿在出院3个月时EUGR 的发生率差异无统计学意义(χ²＝2.75,P>0.05)。结论 早产儿在生后早期容易出现EUGR,且不能在短期内改善,胎龄越小EUGR发生率越高,出院后以母乳加母乳强化剂或母乳加早产儿出院后配方奶喂养者EUGR发生率低。     

北京市婴儿早期维生素D营养状况与体格生长发育的关系

目的 评估北京地区婴儿早期维生素D营养状况,探讨其与体格生长发育的关系.方法 选取2020年4至10月在北京妇产医院门诊进行42天常规体检、年龄在36～48天的1160例健康婴儿作为研究对象,对其进行身长、体重等体格测量和血清25-羟基维生素D[25(OH)D]水平的测定.根据维生素D营养状况将所有婴儿分为缺乏组、不足组和正常组,分析3组婴儿身长、体重和体质量指数(BMI)等的差异.结果 1160例婴儿血清25(OH)D的平均水平为(25.33±6.82)ng/mL,其中男婴为(25.46±6.70)ng/mL,女婴为(25.21±6.94)ng/mL.维生素D缺乏率、不足率和正常率分别为22.24％、55.09％ 和22.67％,维生素D水平和营养状态性别间差异均无统计学意义(P>0.05).缺乏组、不足组和正常组42天体检时的体重、BM I和BMI增量差异均有统计学意义(F值分别为4.397、8.788、4.042,P<0.05);体重增量、身长和身长增量在3组间的差异均无统计学意义(P>0.05).两两比较显示,缺乏组的婴儿42天体检时体重高于正常组,BMI和BMI增量均高于不足组和正常组(P<0.05).分层分析显示,42天体检时男婴中维生素D缺乏组仅BMI高于正常组(P<0.05);女婴中维生素D缺乏组其体重、BMI和BMI增量均高于不足组和正常组(P<0.05).不同BMI的婴儿其25(OH)D水平差异有统计学意义(F=3.979,P<0.05),肥胖婴儿的25(OH)D水平低于BMI正常者(P<0.05),且肥胖婴儿的维生素D缺乏率高于BMI正常者(χ2=8.287,P<0.05).结论 北京地区婴儿早期维生素D缺乏或不足率较高,婴儿早期维生素D缺乏与肥胖有一定相关性.     

Perinatal vitamin D and calcium status of northern Canadian mothers and their newborn infants

OBJECTIVE: This study was undertaken to examine the vitamin D and calcium status of mothers and their newborns. METHODS: The intakes of vitamin D and calcium were determined prenatally in 121 women including 33 Caucasians, 51 Inuits, and 37 Native Indians, living in the Inuvik zone of the Northwest Territories. Plasma concentrations of 25-(OH)-D and calcium were also measured in mothers as well as in their offspring at delivery. RESULTS: The daily mean vitamin D intake of native mothers, including Inuits and Indians, with (8.1+/-5.5 microg) and without supplements (3.4+/-2.5 microg) was significantly lower than that of non-native mothers (13.2+/-5.9 microg and 5.8+/-4.3 microg, respectively). According to the predicted prevalence of low vitamin D intake, there existed a higher risk of vitamin D deficiency without supplementation in both native (88.6% vs 48.4%) and non-native (63.5% vs. 15.1%) mothers. The trend for calcium intakes with and without supplementation was similar to vitamin D intake. At the point of delivery, the plasma levels of 25-(OH)-D were lower in native mothers (50.1 19.3 nmol/L) and their offspring (34.2+/-13.1 nmol/L) than their counterparts (59.8+/-29.4 nmol/L and 41.4+/-23.5 nmol/L, respectively). Its plasma levels in newborn infants averaged only 67% of their mothers. None of these infants showed clinical evidence of vitamin D deficiency. In fact, their plasma calcium levels were significantly higher than their mothers. CONCLUSIONS: Plasma 25-(OH)-D concentrations of 60 to 70% of maternal levels may represent a "normal" range for newborn infants. However, a supplementation in native northern Canadian mothers during pregnancy and in their neonates during infancy may have a role to play in the prevention of vitamin D deficiency.     

维生素A缺乏对大鼠铁营养状况的影响

目的 研究维生素A(VA)缺乏对大鼠铁营养状况的影响及其可能的机制。方法 雄性Wistar大鼠40只．按体重随机分为IVA和铁缺乏组，ⅡVA完全缺乏组，ⅢVA轻度缺乏组，Ⅳ VA正常对照组。实验动物喂饲8周后处死，测定血清VA、血清铁、铁蛋白、血红蛋白、肝内总铁含量，并用逆转录一聚合酶链反应(RT-PCR)法检测各组大鼠肝脏转铁蛋白mRNA的表达情况。结果 维生素A缺乏显地降低血清铁蛋白、血红蛋白和肝内总铁含量。抑制肝脏转铁蛋白mRNA的表达。结论 维生素A缺乏可能通过降低肝脏转铁蛋白mRNA的表达水平从而抑制了铁的吸收和转运。     

武汉市学龄前儿童VA缺乏及其营养状况调查

对武汉市两所幼儿园２～７岁学龄前儿童进行了营养状况调查。膳食调查结果：蛋白质、脂肪及热能摄入量基本正常；视黄醇摄入量明显不足，占我国推荐量标准４４．５％～６５．１％；钙摄入量不足。实验室检测：贫血率１６．９％；血清ＶＡ缺乏率１０．９０％，亚临床缺乏率２１．９６％；血清ＶＡ水平与血红蛋白呈正相关，相关系数ｒ＝０．１５４。     

学龄儿童维生素A营养状况及其与铁的相关性研究

为观察学龄儿童维生素A(VA)营养状况、亚临床VA缺乏患病率及VA与铁的相关性 ,对北京房山山区 1 0 1 2名 7～ 1 3岁学龄儿童进行膳食调查 ,随机抽取 30 5名儿童 ,静脉采血于避光下分离血清 ,用高效液相色谱法检测血清VA含量 ,同时测定其血清铁蛋白 (SF)、红细胞游离原卟啉 (FEP)和血红蛋白 (Hb) ,并依现行标准将其分为正常、铁缺乏 (ID)、红细胞生成缺铁期 (IDE)与缺铁性贫血 (IDA)四组 ,观察VA与铁的相关性。结果显示受检儿童膳食总能量、蛋白质和铁平均每日摄入量均达到膳食营养素的推荐摄入量 (RNI)及适宜摄入量 (AI) ,但平均每日VA摄入量为 (51 3 7± 2 86 1 ) μgRE ,仅占RNI的 59 7% ;血清VA平均含量为(1 0 1± 0 2 9) μmol L ,血清VA低于 1 0 5μmol L者占受检儿童的 59 0 % ,其中 1 2 8%的儿童血清VA低于0 70 μmol L ,正常及以上者仅占 41 0 %。并观察到血清VA含量与机体铁状况有相互随对方下降而减低的趋势。结果表明 ,该地区儿童存在明显的VA缺乏 ,应加强营养教育、改善不合理的膳食结构并通过适当的VA防治予以纠正     

综合性营养评估法在维持性血液透析患者中的应用

目的 对血液透析患者的几项营养指标进行评估.方法 对142例维持性血液透析(MHD)患者进行主观综合性营养评估(SGA)、膳食调查、生化参数的测定.结果 依据SGA评分,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较:平均每日每公斤体重能量(DEI)和蛋白质摄入(DPI)、血白蛋白(ALb),均有显著性差异(P＜0.001～0.05).但营养良好组的DEI和DPI异常率高达46.0%、49.0%,重度营养不良组中各指标异常率均在80%以上.血前白蛋白(PA)与血ALb有显著相关(P＜0.01),与DPI、DEI均无相关.结论 SGA是评价MHD患者营养状况的简便方法,但还需其它反映营养状况不同侧面指标的补充,如DEI、DPI、血ALb、血PA.