白河县204例0～3岁婴幼儿25-羟维生素D检测分析

目的:调查0~3岁婴幼儿血清25-羟维生素D(25-(OH)D)水平,为临床诊断和预防维生素D缺乏性佝偻病提供实验室依据。方法:2012年3月~2014年2月儿科门诊就诊的0~3岁婴幼儿204例,用酶联免疫吸附试验(ELISA)进行血清25-(OH)D浓度检测。结果:204例0~3岁婴幼儿中,血清25-(OH)D较为足够99例,占48.6%;相对缺乏79例,占38.7%;缺乏26例,占12.7%,前两者占总人数的87.3%。血清25-(OH)D以2~3岁组最高,0~1岁组最低,不同年龄组比较差异有统计学意义(P0.05),不同性别间25-(OH)D水平差异无统计学意义(P0.05)。结论:婴幼儿25-(OH)D缺乏率较高,其中以2~3岁幼儿25-(OH)D血清水平最低。     

120例0～6岁儿童血清25-羟基维生素D水平的调查

目的:了解中山小榄地区儿童维生素D的营养状况.方法:选择2013年在广东医学院附属陈星海医院儿童保健科和儿科就诊的0～6岁120例儿童为研究对象,采用高效液相质谱法-串联质谱法进行血清25-(OH)D水平检测,并对结果进行统计学分析.结果:120例儿童25-(OH)D水平为(25.7±7.1)ng/ml,婴儿组25-(OH)D水平(31.3±7.2) ng/ml高于幼儿组的(25.7±6.2)ng/ml,幼儿组高于学龄前组的(22.8±7.1)ng/ml;男性儿童25-(OH)D水平(24.2±7.3) ng/ml低于女性儿童的(28.2±6.1)ng/ml,差异均有统计学意义(P＜0.05).儿童25-(OH)D缺乏率为71.7％,幼儿组与学龄前组血清25-(OH)D缺乏率差异无统计学意义(P＞0.05),但高于婴儿组缺乏率(P＜0.05);男性儿童VitD缺乏率73.7％与女性儿童68.2％差异无统计学意义(P＞0.05).结论:中山小榄地区儿童25-(OH)D缺乏率较高,男性和女性缺乏率无差异,25-(OH)D水平随着儿童年龄增大而下降.     

沈阳地区婴幼儿维生素D营养状况的调查研究

目的 了解沈阳地区0～3岁婴幼儿维生素D(VitD)营养状况与其性别、年龄以及季节的关系,为本地区婴幼儿合理进行VitD的补充提供科学依据。方法 对沈阳市妇婴医院儿童保健门诊体检的0～3岁婴幼儿,采用化学发光法进行血清25(OH)D水平检测。结果 2 381例婴幼儿25(OH)D总体平均水平为(36.73±18.75)ng/ml,其中25(OH)D水平严重缺乏组8例(0.34%)、缺乏组174例(7.31%)、不足组149例(6.55%)、正常组2 026例(85.09%)、过量组24例(1.01%);不同性别间血清25(OH)D水平差异无统计学意义(P＞0.05);0～1岁婴儿组血清25(OH)D水平低于1～3岁幼儿组,两组差异有统计学意义(P＜0.05);不同季节婴幼儿血清25(OH)D水平冬季最高,春季最低。结论 沈阳地区0～3岁婴幼儿VitD的总体营养状况较好,但仍存在VitD缺乏及过量现象。应注重科学合理补充VitD,避免出现VitD不足、过量及中毒情况。     

0~14岁儿童25-羟维生素D 水平调查与分析

目的 了解0~14岁儿童体内维生素D的营养状况, 为本地区儿童合理补充维生素D提供科学依据。方法 对广州中山大学附属第三医院儿童保健门诊进行常规体检的1 000例0~14岁的儿童采用酶联免疫法检测血清25-羟维生素D[25-hydroxy vitamin D, 25-(OH)D]水平。结果 25-(OH)D缺乏及不足者634例(63.4%);25-( OH) D水平充足者366例(36.6%)。0~1和1~2岁组儿童血清25-(OH)D水平最高, 2岁后儿童随着年龄增长逐渐下降(P＜0.01)。0~7岁男、女童血清 25-(OH)D水平差异无统计学意义(P＞0.05), 但在7~14岁组儿童男、女比较差异有统计学意义(P＜0.01)。血清25-(OH)D水平夏＞秋＞春＞冬, 冬季维生素D缺乏或不足的检出率为70.29%, 高于其他季节(P＜0.05)。结论 0~14岁儿童 25-(OH)D平均水平低下, 普遍存在维生素D缺乏或不足, 特别是在冬季和年长儿童。     

成都市0～6岁儿童25-羟维生素D水平调查

目的:了解成都市儿童维生素D的营养状况。方法:对来医院儿童保健科门诊进行常规体检的0～6岁701例儿童采用酶联免疫法进行血清25-(OH)D检测。结果:25-(OH)D的平均测定值为(68.60±1.29)nmol/L,25-(OH)D缺乏及严重缺乏的为226例,占32.24%;25-(OH)D水平不足的为237例,占33.811%;水平充足(合适水平)的为238例,占33.95%,前两者占总人数的66.05%。男性和女性血清25-(OH)D水平差异无统计学意义(P>0.05),但25-(OH)D水平随着年龄增高而呈下降(P<0.01)。血清25-(OH)D水平夏秋季显著高于春冬季节(P<0.05)。结论:成都市0～6岁儿童25-(OH)D水平低下,应增加该地区儿童的维生素D摄入量及加强户外活动,尤需重视3～6岁的儿童及冬春季节维生素D的补充。     

湖南地区少年儿童维生素D营养状况分析

目的:了解湖南地区0～18岁少年儿童维生素D营养状况。方法:采用英国IDS公司生产的酶标试剂盒,检测2011年1～5月来院体检合格的285名少年儿童血清25羟维生素D【25(OH)D】水平。结果:血清25(OH)D水平随年龄增长而降低,各年龄组儿童血清25(OH)D水平间比较差异有统计学意义(F=18.922,P<0.05);0～岁组儿童维生素D充足率最高(68.2%),12～岁组最低(9.5%)。结论:湖南地区少年儿童维生素D缺乏问题不仅存在于0～3岁婴幼儿,也存在于儿童和青少年中。     

徐州市区冬季242例儿童25羟基维生素D血清浓度检测结果分析

目的 了解徐州市区冬季0～5岁儿童的维生素D营养状况,指导临床及家长合理使用维生素D。方法 收集2015年12月-2016年2月在徐州市妇幼保健院儿保科门诊进行常规保健的242例0～5岁儿童血清,采用免疫层析法检测血清25-羟基维生素D[25-(OH)VD]。结果 242 例0～5岁儿童血清25-(OH)VD的平均水平为(51.34±19.38)nmol/L,其中充足组108例,占44.63%,有55.37%的儿童25-(OH)VD处于较低水平(26.45%不足、28.93%缺乏)。0～5岁儿童血清25-(OH)VD水平在不同性别间差异无统计学意义(P＞0.05);3～5岁组儿童血清25-(OH)VD水平明显低于＜1岁组,差异有统计学意义(P＜0.05)。结论 徐州市区0～5岁儿童血清25－(OH)VD水平普遍偏低,应重视儿童血清25-(OH)VD的检测及补充。     

0～7岁儿童维生素D营养状况与骨密度的关系

目的探讨0～7岁儿童维生素D营养状况与骨密度的关系。方法选取浙江大学附属第一医院2018年1月-2018年10月体检的390例0～7岁儿童为研究对象,采用电化学发光法测定儿童血清25-羟维生素D [25-(OH) D]水平以评估维生素D营养状况,根据评估结果分为25-(OH) D充足组和25-(OH) D不足/缺乏组,采用定量超声仪测定儿童骨密度,分析维生素D营养状况与骨密度的关系。结果研究中所有儿童的血清25-(OH) D平均浓度为(28. 93±3. 40) ng/ml,25-(OH) D不足/缺乏发生率为43. 3%(169/390),25-(OH) D充足组和25-(OH) D不足/缺乏组不同年龄段儿童的血清25-(OH) D水平差异均有统计学意义(均P<0. 05),并且两组不同年龄段儿童的骨密度Z值差异均有统计学意义(均P<0. 05)、骨密度不足检出率也存在显著性差异(P<0. 05),相关分析显示儿童血清25-(OH) D不足/缺乏时血清25-(OH) D水平与骨密度呈正相关,差异无统计学意义(P<0. 05),而血清25-(OH) D充足时血清25-(OH) D水平与骨密度无明显相关(P>0. 05)。结论 0～7岁儿童维生素D营养状况不佳,25-(OH) D不足/缺乏时儿童的血清25-(OH) D水平与骨密度呈正相关,临床工作中可以通过合理补充维生素D改善儿童骨骼健康状况。     

南京市0～3岁婴幼儿25羟维生素D缺乏与贫血关系的研究

目的 分析南京市0～3岁婴幼儿25羟维生素D[25-(OH)D]水平,并研究其与贫血的相关性,为儿童贫血防治提供理论依据。方法 选取江苏省人民医院妇幼分院儿童保健门诊2017年8月-2019年10月共1 143例常规体检的0～3岁婴幼儿,对其末梢血25-(OH)D、血红蛋白(Hb)结果进行统计分析;并分析各年龄段25-(OH)D水平与Hb的相关性。结果 1 143例0～3岁婴幼儿25-(OH)D平均水平为(79.03±25.71)nmol/L,其中缺乏者113例(9.88%),不足者451例(39.46%),充足者579例(50.66%);不同年龄段25-(OH)D水平差异有统计学意义(F＝25.26,P＜0.01),以2～3岁组水平最低;贫血者122例(10.67%),非贫血者1 021例(89.33%),25-(OH)D缺乏组贫血检出率明显高于充足组,差异有统计学意义(F＝8.261,P=0.004);Pearson相关性分析发现25-(OH)D水平与Hb在0～、0.5～、1～2岁组均存在正相关性(r=0.288,0.274,0.123, P<0.05),2～3岁组未发现相关性(r=0.080,P=0.264)。结论 南京市0～3岁婴幼儿25-(OH)D总体缺乏和不足率较高;0～2岁年龄段婴幼儿25-(OH)D水平与Hb存在正相关性,提示25-(OH)D缺乏可能影响Hb的生成,与婴幼儿贫血的发生相关。     

成都市3～6岁儿童25-羟维生素D营养状况的调查

目的 了解成都市3～6岁儿童25-羟维生素D[25-(OH)D]水平及缺乏率,为儿童维生素D缺乏症的防治提供依据。方法 成都市每个区选择2所在园儿童数在200人以上幼儿园共10所,先发放调查问卷进行基础调查,在家长知情选择的基础上进行维生素D的检测。所有检测在2013年4～6月间完成。结果 共有753例3～6岁儿童进行的维生素D的检测,血清25-(OH)D适宜水平183例,占24.3%,不足360例,占47.8%,缺乏207例,占27.5%。不同年龄维生素D缺乏发生率比较差异有统计学意义(P＜0.05),不同性别组25-(OH)D水平差异无统计学意义(P＞0.05)。753名儿童中 ,每天喝牛奶达到500mL的只占到11.6%, 75.8%的儿童近一个月内未服用任何钙及鱼肝油制剂;有33.5%儿童放学回家后户外活动时间达1 h。结论 成都市3～6岁儿童25-(OH)D缺乏率较高,需要采取措施提高维生素D水平。     

Analysis of the distributional impact of out-of-pocket health payments: evidence from a public health insurance program for the poor in Mexico

Many governments have health programs focused on improving health among the poor and these have an impact on out-of-pocket health payments made by individuals. Therefore, one of the objectives of these programs is to reach the poorest and reduce their out-of-pocket expenditure. In this paper we propose the distributional poverty impact approach to measure the poverty impact of out-of-pocket health payments of different health financing policies. This approach is comparable to the impoverishment methodology proposed by Wagstaff and van Doorslaer (2003) that compares poverty indices before and after out-of-pocket health payments. In order to escape the specification of a particular poverty index, we use the marginal dominance approach that uses non-intersecting curves and can rank poverty reducing health financing policies. We present an empirical application of the out-of-pocket health payments for an innovative social financing policy implemented in Mexico named Seguro Popular. The paper finds evidence that Seguro Popular program has a better distributional poverty impact when families face illness when compared to other poverty reducing policies. The empirical dominance approach uses data from Mexico in 2006 and considers international poverty standards of $2 per person per day.     

Vitamin D: Deficiency,Sufficiency and Toxicity

The plethora of vitamin D studies over the recent years highlight the pleomorphic effects of vitamin D outside its conventional role in calcium and bone homeostasis. Vitamin D deficiency, though common and known, still faces several challenges among the medical community in terms of proper diagnosis and correction. In this review, the different levels of vitamin D and its clinical implications are highlighted. Recommendations and consensuses for the appropriate dose and duration for each vitamin D status are also emphasized.     

Relative concentrations of 25-hydroxyvitamin D2/D3 and 1,25-dihydroxyvitamin D2/D3 in maternal plasma at delivery

Quantitation of circulating 25-OH-D₂, 25-OH-D₃, 1,25-(OH)₂-D₂ and 1,25-(OH)₂-D₃ was performed on the plasma from 10 women collected at delivery following full term pregnancies. These data indicate that approximately 50% of the circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in these women are in the vitamin D₂ form. Further, they demonstrate that vitamin D₂ contributes significantly to the total vitamin D status of these individuals and cannot be considered of trivial importance. It is apparent from this study that assay techniques which specifically quantitate vitamin D₂, as well as D₃ must be employed when measuring the total vitamin D status of individuals who are consuming significant quantities of dietary vitamin D₂.     

An update on UK Vitamin D intakes and status,and issues for food fortification and supplementation

Vitamin D is unique among the essential nutrients in that it can be made in the body via exposure of the skin to sunlight. There are few rich sources of vitamin D in the diet. Vitamin D is essential for maintaining healthy bones and deficiency of vitamin D causes rickets in children and osteomalacia in adults. In the UK, there is evidence that low vitamin D status is prevalent in the population and older adults living in institutions are particularly at risk. There are two forms of vitamin D that can be added to foods and drinks: vitamin D₂ and D₃. They have somewhat different structures, and there are some differences in the way they are metabolised by the body. Overall, the evidence for the relative effectiveness of vitamin D₂ vs. D₃ is mixed, and more studies are needed to provide a clearer picture. However, there does seem to be some indication that D₃ is more effective than D₂ in raising vitamin D status.     

Plasma 25-Hydroxyvitamin D Responses of Younger and Older Men to Three Weeks of Supplementation with 1800 IU/day of Vitamin D

Objective: The objective of this study was to compare changes in plasma 25-hydroxyvitamin D (25(OH)D) levels of younger and older men after three weeks of oral vitamin D supplementation.

Methods: Nine younger men (22 to 28 years) and nine older men (65 to 73 years) with self-reported vitamin D intakes below 200 IU/d were enrolled in February and randomized to 1800 IU/d of ergocalciferol (vitamin D₂, n=11) or to a control group (n=7) and followed for three weeks. Blood was collected at baseline, and after one, two and three weeks for measurement of plasma concentrations of total 25(OH)D, 25(OH)D₂ and 25(OH)D₃.

Results: In both the younger and older supplemented men, 25(OH)D₂ and total 25(OH)D concentrations increased significantly during the study, whereas values of these metabolites did not change in younger or older control subjects. No group showed significant changes in 25-hydroxyvitamin D₃. There was a significant interaction between age group and supplement group, suggesting that the effect of vitamin D₂ supplementation on changes in 25(OH)D₂ changes with age. The mean increase in 25(OH)D₂ was greater in the younger supplemented men than in the older supplemented men (37±9 nmol/L vs. 19.5 nmol/L, p=0.027), and this accounted for their significantly greater increase in total 25(OH)D.

Conclusion: These data are consistent with an age-related decline in the absorption, transport or liver hydroxylation of orally-consumed vitamin D.     

Correlation between 25-hydroxyvitamin D/D3 Deficiency and COVID-19 Disease Severity in Adults from Northern Colorado

Vitamin D deficiency is common in the United States and leads to altered immune function, including T cell and macrophage activity that may impact responses to SARS-CoV-2 infection. This study investigated 131 adults with a history of a positive SARS-CoV-2 nasopharyngeal PCR and 18 adults with no COVID-19 diagnosis that were recruited from the community or hospital into the Northern Colorado Coronavirus Biorepository (NoCo-COBIO). Participants consented to enrollment for a period of 6 months and provided biospecimens at multiple visits for longitudinal analysis. Plasma 25-hydroxyvitamin D levels were quantified by LC-MS/MS at the initial visit (n = 149) and after 4 months (n = 89). Adults were classified as deficient (<30 nM or <12 ng/mL), insufficient (<30–50 nM or 12–20 ng/mL), or optimal (50–75 nM or >20 ng/mL) for 25-hydroxyvitamin D status. Fisher’s exact test demonstrated an association between disease severity, gender, and body mass index (BMI) at baseline. Mixed model analyses with Tukey-Kramer were used for longitudinal analysis according to BMI. Sixty-nine percent (n = 103) of the entire cohort had optimal levels of total 25(OH)D, 22% (n = 32) had insufficient levels, and 9% (n = 14) had deficent levels. Participants with severe disease (n = 37) had significantly lower 25-hydroxyvitamin D (total 25(OH)D) when compared to adults with mild disease (p = 0.006) or no COVID-19 diagnosis (p = 0.007). There was 44% of the cohort with post-acute sequalae of COVID-19 (PASC) as defined by experiencing at least one of the following symptoms after 60 days’ post-infection: fatigue, dyspnea, joint pain, chest pain, forgetfulness or absent-mindedness, confusion, or difficulty breathing. While significant differences were detected in 25-hydroxyvitamin D status by sex and BMI, there were no correlations between 25-hydroxyvitamin D for those without and without PASC. This longitudinal study of COVID-19 survivors demonstrates an important association between sex, BMI, and disease severity for 25-hydroxyvitamin D deficiency during acute stages of infection, yet it is not clear whether supplementation efforts would influence long term outcomes such as developing PASC.     

Vitamin D: An overview of vitamin D status and intake in Europe

In recent years, there have been reports suggesting a high prevalence of low vitamin D intakes and vitamin D deficiency or inadequate vitamin D status in Europe. Coupled with growing concern about the health risks associated with low vitamin D status, this has resulted in increased interest in the topic of vitamin D from healthcare professionals, the media and the public. Adequate vitamin D status has a key role in skeletal health. Prevention of the well‐described vitamin D deficiency disorders of rickets and osteomalacia are clearly important, but there may also be an implication of low vitamin D status in bone loss, muscle weakness and falls and fragility fractures in older people, and these are highly significant public health issues in terms of morbidity, quality of life and costs to health services in Europe. Although there is no agreement on optimal plasma levels of vitamin D, it is apparent that blood 25‐hydroxyvitamin D [25(OH)D] levels are often below recommended ranges for the general population and are particularly low in some subgroups of the population, such as those in institutions or who are housebound and non‐Western immigrants. Reported estimates of vitamin D status within different European countries show large variation. However, comparison of studies across Europe is limited by their use of different methodologies. The prevalence of vitamin D deficiency [often defined as plasma 25(OH)D <25 nmol/l] may be more common in populations with a higher proportion of at‐risk groups, and/or that have low consumption of foods rich in vitamin D (naturally rich or fortified) and low use of vitamin D supplements. The definition of an adequate or optimal vitamin D status is key in determining recommendations for a vitamin D intake that will enable satisfactory status to be maintained all year round, including the winter months. In most European countries, there seems to be a shortfall in achieving current vitamin D recommendations. An exception is Finland, where dietary survey data indicate that recent national policies that include fortification and supplementation, coupled with a high habitual intake of oil‐rich fish, have resulted in an increase in vitamin D intakes, but this may not be a suitable strategy for all European populations. The ongoing standardisation of measurements in vitamin D research will facilitate a stronger evidence base on which policies can be determined. These policies may include promotion of dietary recommendations, food fortification, vitamin D supplementation and judicious sun exposure, but should take into account national, cultural and dietary habits. For European nations with supplementation policies, it is important that relevant parties ensure satisfactory uptake of these particularly in the most vulnerable groups of the population.     

Could the Majority of the Greek and Cypriot Population Be Vitamin D Deficient?

OBJECTIVE: Hypovitaminosis D is prevalent in epidemic proportions in many developed countries. The aim of this study is to investigate the prevalence of adequate 25-hydroxyvitamin D [25(OH)D] levels in two Mediterranean countries, Greece and Cyprus. METHODS: Data such as 25(OH)D, the month of blood sample collection, and demographic information were blindly collected from 8780 Greek and 2594 Cypriot individuals over 5 years. Comorbidities were also recorded for 839 Greek subjects. Univariate and multivariate analyses were used to examine the relationship between these variables and 25(OH)D levels. RESULTS: In the samples studied, 72.7% of the Greek and 69.3% of the Cypriot population sample had inadequate levels of 25(OH)D. The mean level for the Greek subjects was 25.1 ng/mL and for Cypriots 25.8 ng/mL. For both samples, only month and gender were significantly associated with 25(OH)D levels, and the highest mean levels were recorded in September. For the recorded diseases, the lowest levels were recorded in sickle cell anaemia 13.6 ± 10.2 ng/mL, autoimmune diseases 13.0 ± 8.4 ng/mL, and cancer 22.6 ± 9.5 ng/mL. CONCLUSIONS: The prevalence of vitamin D deficiency is paradoxically high in both Mediterranean countries.     

Calcium Absorption Varies within the Reference Range for Serum 25-Hydroxyvitamin D

Background: Calcium absorption is generally considered to be impaired under conditions of vitamin D deficiency, but the vitamin D status that fully normalizes absorption is not known for humans.

Objective: To quantify calcium absorption at two levels of vitamin D repletion, using pharmacokinetic methods and commercially marketed calcium supplements.

Design: Two experiments performed in the spring of the year, one year apart. In the first, in which participants were pretreated with 25-hydroxyvitamin D (25OHD), mean serum 25OHD concentration was 86.5 nmol/L; and in the other, with no pretreatment, mean serum concentration was 50.2 nmol/L. Participants received 500 mg oral calcium loads as a part of a standard low calcium breakfast. A low calcium lunch was provided at mid-day. Blood was obtained fasting and at frequent intervals for 10 to 12 hours thereafter.

Methods: Relative calcium absorption at the two 25OHD concentrations was estimated from the area under the curve (AUC) for the load-induced increment in serum total calcium.

Results: AUC₉ (± SEM), was 3.63 mg hr/dL ± 0.234 in participants pretreated with 25OHD and 2.20 ± 0.240 in those not pretreated (P < 0.001). In brief, absorption was 65% higher at serum 25OHD levels averaging 86.5 nmol/L than at levels averaging 50 nmol/L (both values within the nominal reference range for this analyte).

Conclusions: Despite the fact that the mean serum 25OHD level in the experiment without supplementation was within the current reference ranges, calcium absorptive performance at 50 nmol/L was significantly reduced relative to that at a mean 25OHD level of 86 nmol/L. Thus, individuals with serum 25-hydroxyvitamin D levels at the low end of the current reference ranges may not be getting the full benefit from their calcium intake. We conclude that the lower end of the current reference range is set too low.     

湖州市3 724例0~6岁门诊体检儿童维生素D营养状况

目的 了解0～6岁门诊体检儿童的维生素D营养状况,为科学合理地补充维生素D制剂提供理论依据.方法 选取2013年1月至2014年3月在湖州市妇幼保健院儿童保健门诊进行常规体检的3 724例0～6岁儿童,采用电化学发光法检测血清25-(OH)D的水平,比较不同年龄段儿童及不同季节血清25-(OH)D水平及维生素D不足与缺乏情况.结果 0～6岁门诊体检儿童的血清25-(OH)D平均水平为(37.80±11.67) ng/ml,维生素D不足与缺乏的比例为7.33％,男女童之间差异均无统计学意义(t=-1.57,P=0.117;x2=0.37,P=0.543).＞3且≤6岁儿童血清25-(OH)D水平显著低于≤1岁、＞1且≤2岁和＞2且≤3岁儿童[(27.36±8.90) ng/ml比(38.64±12.10) ng/ml,t=18.60,P=0.000;比(41.63±10.31) ng/ml,t=26.07,P=0.000;比(36.85±10.01) ng/ml,t=16.42,P=0.000],维生素D不足与缺乏比例显著高于其他3个年龄段儿童(104/466比122/1 487,x2=69.06,P=0.000;比18/1 106,x2=196.06,P=0.000;比29/665,x2=85.14,P=0.000).冬季儿童25-(OH)D水平显著低于春、夏、秋季[(35.16±11.30) ng/ml比(40.03±12.57) ng/ml,t=9.15,P=0.000;比(36.86±10.60) ng/ml,t=3.34,P =0.001;比(39.99±11.36) ng/ml,t=9.65,P=0.000],维生素D不足与缺乏的比例显著高于其他3个季节(127/1 189比56/849,x2=10.11,P=0.001;比54/787,x2=8.30,P=0.004;比36/899,x2 =31.71,P=0.000).结论 本院0～6岁门诊体检儿童的总体维生素D营养状况良好,冬季和＞3且≤6岁儿童维生素D水平较低、不足与缺乏的比例较高,因此应重视冬季和3岁以上儿童的维生素D补充,适当增加儿童户外活动,同时加强科学预防维生素D缺乏的宣传教育.