急性下呼吸道感染儿童的维生素D摄入

Karen S Leis; J Dayre McNally; Matthew R Montgomery; Koravangattu Sankaran; Chandima Karunanayake; Alan M Rosenberg

PDF(1036 KB)

中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (1) : 1-6.

国外儿科研究

急性下呼吸道感染儿童的维生素D摄入

Karen S Leis, J Dayre McNally, Matthew R Montgomery, Koravangattu Sankaran, Chandima Karunanayake, Alan M Rosenberg

作者信息 +

Vitamin D intake in young children with acute lower respiratory infection

Karen S Leis, J Dayre McNally, Matthew R Montgomery, Koravangattu Sankaran, Chandima Karunanayake, Alan M Rosenberg

Author information +

文章历史 +

摘要

目的：明确维生素D（Vit D）摄入是否与儿童急性下呼吸道感染（ALRI）相关。方法：比较因毛细支气管炎或肺炎入院的5岁以下儿童和非配对、无呼吸道感染的同龄对照组儿童之间Vit D摄入的差别。197例儿童的看护人完成了问卷调查，内容包括人口统计变量、ALRI 危险因素和饮食。评估ALRI与Vit D摄入及其他危险因素的相关性。结果：ALRI组儿童的平均Vit D摄入为每日48 IU/kg，对照组为每日60 IU/kg。当控制年龄、民族、社会经济地位、北部地区居住、母乳喂养、免疫接种和接触吸烟等因素时，Vit D每日摄入<80 IU/kg 的儿童患ALRI 的可能性比每日摄入≥80 IU/kg 的儿童高4倍（OR=4.9; 95%CI: 1.5~16.4）。结论：为了避免罹患ALRI等疾病，5岁以下儿童可能需要摄入比现在推荐量更高的Vit D剂量。因毛细支气管炎和肺炎是年幼儿童住院的最常见原因，增加Vit D的补充可能有重要的公共卫生保健意义。

Abstract

OBJECTIVE: To determine if vitamin D intake is associated with acute lower respiratory infections (ALRI) in children. METHODS: The vitamin D intakes of children younger than 5 years of age admitted to hospital with either bronchiolitis or pneumonia were compared to an unmatched control group of the same age without respiratory infection. Caregivers of 197 children completed a questionnaire collecting information on demographic variables, ALRI risk factors and diet. Associations of ALRI with vitamin D intake and other ALRI risk factors were determined. RESULTS: The mean vitamin D intake of children with ALRI was 48 IU/kg/d compared to 60 IU/kg/d in the control group. When controlling for age, ethnicity, socio-economic status, northern residence, breastfeeding, immunizations and smoking contact, children with a vitamin D intake of less than 80 IU/kg/d were greater than 4 times more likely to have ALRI compared to children with a vitamin D intake exceeding 80 IU/kg/d (OR=4.9; 95%CI: 1.5~16.4). CONCLUSIONS: A higher vitamin D intake than currently recommended might be needed to offer protection against diseases such as ALRI. Increased vitamin D supplementation could have important public health consequences, as bronchiolitis and pneumonia are the most common reasons for hospitalization in young children. (Full English version will be available online at www.amepc.org/tp.)

导出引用

Karen S Leis, J Dayre McNally, Matthew R Montgomery, Koravangattu Sankaran, Chandima Karunanayake, Alan M Rosenberg. 急性下呼吸道感染儿童的维生素D摄入[J]. 中国当代儿科杂志. 2012, 14(1): 1-6

Karen S Leis, J Dayre McNally, Matthew R Montgomery, Koravangattu Sankaran, Chandima Karunanayake, Alan M Rosenberg. Vitamin D intake in young children with acute lower respiratory infection[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(1): 1-6

中图分类号： R725.6

参考文献

［1］Canadian Institute of Child Health. The Health of Canada′s Children［M］. 3rd ed. Ottawa, ON: Canadian Institute of Child Health, 2000.

［2］Mulholland K. Global burden of acute respiratory infections in children: implications for interventions［J］. Pediatr Pulmonol, 2003, 36(6):469-474.

［3］Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia［J］. Bull World Health Organ, 2008, 86(5): 408-416.

［4］Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, et al. Epidemic influenza and vitamin D［J］. Epidemiol Infect, 2006, 134(6): 1129-1140.

［5］Holick MF. High prevalence of vitamin D inadequacy and implications for health［J］. Mayo Clin Proc, 2006, 81(3): 353-373.

［6］Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review［J］. JAMA, 2002, 287(23): 3116-3126.

［7］Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, Rich-Edwards JW, Weiss ST, Gold DR, et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age［J］. Am J Clin Nutr, 2007, 85(3): 788-795.

［8］Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, Martindale S, et al. Maternal vitamin D intake during pregnancy and early childhood wheezing［J］. Am J Clin Nutr, 2007, 85(3): 853-859.

［9］Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al. Serum vitamin D levels and severe asthma exacerbation in the Childhood Asthma Management Program study［J］. J All Clin Immunol, 2010, 126(1):52-58.

［10］Muhe L, Lulseged S, Mason KE, Simoes EA. Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children［J］. Lancet, 1997, 349(9068): 1801-1804.

［11］Najada AS, Habashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases［J］. J Trop Pediatr, 2004, 50(6): 364-368.

［12］Banajeh SM, al-Sunbali NN, al-Sanahani SH. Clinical characteristics and outcome of children aged under 5 years hospitalized with severe pneumonia in Yemen［J］. Ann Trop Paediatr, 1997, 17(4): 321-326.

［13］Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y［J］. Eur J Clin Nutr, 2004, 58(4): 563-567.

［14］Roth DE, Shah R, Black RE, Baqui AH. Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh［J］. Acta Paediatr, 2010, 99(3): 389-393.

［15］McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg AM. Vitamin D deficiency in young children with severe acute lower respiratory infection［J］. Pediatr Pulmonol, 2009, 44(10): 981-988.

［16］Banajeh SM. Nutritional rickets and vitamin D deficiency-association with the outcomes of childhood very severe pneumonia: a prospective cohort study［J］. Pediatr Pulmonol, 2009, 44(12): 1207-1215.

［17］Reid D, Toole BJ, Knox S, Talwar D, Harten J, O′Reilly DS, et al. The relation between acute changes in the systemic inflammatory response and plasma 25hydroxyvitamin D concentrations after elective knee arthroplasty［J］. Am J Clini Nutr, 2011, 93(5): 1006-1011.

［18］Krishnan A, Ochola J, Mundy J, Jones M, Kruger P, Duncan E, et al. Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients［J］. Crit Care, 2010, 14(6): R216.

［19］Roth DE, Jones AB, Prosser C, Robinson JL, Vohra S. Vitamin D status is not associated with the risk of hospitalization for acute bronchiolitis in early childhood［J］. Eur J Clin Nutr 2009, 63(2):297-299.

［20］AlaHouhala M, Koskinen T, Parviainen MT, Visakorpi JK. 25-Hydroxyvitamin D and vitamin D in human milk: effects of supplementation and season［J］. Am J Clin Nutr 1988, 48(4):1057-1060.

［21］Kamao M, Tsugawa N, Suhara Y, Wada A, Mori T, Murata K, et al. Quantification of fat-soluble vitamins in human breast milk by liquid chromatography-tandem mass spectrometry［J］. J Chromatogr, 2007, 859(2):192-200.

［22］Reeve LE, Chesney RW, DeLuca HF. Vitamin D of human milk: identification of biologically active forms［J］. Am J Clin Nutr 1982, 36(1):122-126.

［23］Holden JM, Lemar LE, Exler J. Vitamin D in foods: development of the US Department of Agriculture database［J］. Am J Clin Nutr 2008, 87(4):1092S-1096S.

［24］Canadian Pediatric Society, First Nations and Inuit Health Committee ［Principal author: J Godel］［J］. Vitamin D supplementation: Recommendations for Canadian mothers and infants［J］. Paediatr Child Health 2007, 12(7):583-589.

［25］Moore CE, Murphy MM, Holick MF. Vitamin D intakes by children and adults in the United States differ among ethnic groups［J］. J Nutr, 2005, 135(10): 2478-2485.

［26］Marrie TJ, Carriere KC, Jin Y, Johnson DH. Hospitalization for community-acquired pneumonia in Alberta First Nations Aboriginals compared with non-First Nations Albertans［J］. Can Respir J, 2004, 11(5):336-342.

［27］Stein EM, Laing EM, Hall DB, Hausman DB, Kimlin MG, Johnson MA, et al. Serum 25-hydroxyvitamin D concentrations in girls aged 4-8 y living in the southeastern United States［J］. Am J Clin Nutr, 2006, 83(1):75-81.

［28］Weiler HA, Leslie WD, Krahn J, Steiman PW, Metge CJ. Canadian Aboriginal women have a higher prevalence of vitamin D deficiency than non-Aboriginal women despite similar dietary vitamin D intakes［J］. J Nutr, 2007, 137(2):461-465.

［29］Rasanen M, KronbergKippila C, Ahonen S, Uusitalo L, Kautiainen S, Erkkola M, et al. Intake of vitamin D by Finnish children aged 3 months to 3 years in relation to sociodemographic factors［J］. Eur J Clin Nutr, 2006, 60(11): 1317-1322.

［30］Bhalla AK, Amento EP, Clemens TL, Holick MF, Krane SM. Specific high-affinity receptors for 1,25-dihydroxyvitamin D3 in human peripheral blood mononuclear cells: presence in monocytes and induction in T lymphocytes following activation［J］. J Clin Endocrinol Metab, 1983, 57(6):1308-1310.

［31］Bhalla AK, Amento EP, Krane SM. Differential effects of 1, 25-dihydroxyvitamin D3 on human lymphocytes and monocyte/macrophages: inhibition of interleukin-2 and augmentation of interleukin-1 production［J］. Cell Immunol, 1986, 98(2): 311-322.

［32］Abu-Amer Y, Bar-Shavit Z. Impaired bone marrow-derived macrophage differentiation in vitamin D deficiency［J］. Cell Immunol, 1993, 151(2):356-368.

［33］Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response［J］. Science, 2006, 311(5768):1770-1773.

［34］Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin［J］. J Immunol, 2007, 179(4):2060-2063.

［35］Manaseki-Holland S, Qader G, Isaq Masher M, Bruce J, Zulf Mughal M, Chandramohan D, et al. Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomized controlled trial［J］. Trop Med Int Health, 2010, 15(10):1148-1155.

［36］Belderbos ME, Houben ML, Wilbrink B, Lentjes E, Bloemen EM, Kimpen JL, et al. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis［J］. Pediatrics, 2011, 127(6):e1513-e1520.

［37］Camargo CA Jr, Ingham T, Wickens K, Thadhani R, Silvers KM, Epton MJ, et al. Cord-blood 25-hydroxyvitamin D levels and risk of respiratory infection, wheezing, and asthma［J］. Pediatrics, 2011, 127(1):e180-e187.

［38］Roth DE, Jones AB, Prosser C, Robinson JL, Vohra S. Vitamin D receptor polymorphisms and the risk of acute lower respiratory tract infection in early childhood［J］. J Infect Dis, 2008, 197(5):676-680.

［39］Wagner CL, Greer FR. Prevention of rickets and vitamin d deficiency in infants, children, and adolescents［J］. Pediatrics, 2008, 122(5):1142-1152.

［40］Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D［J］. J Nutr, 2005, 135(2): 317-322.

［41］Roth DE. Bones and beyond: an update on the role of vitamin D in child and adolescent health in Canada［J］. Appl Physiol Nutr Metab, 2007, 32(4):770-777.

［42］Pludowski P, Socha P, Karczmarewicz E, Zagorecka E, Lukaszkiewicz J, Stolarczyk A, et al. Vitamin D supplementation and status in infants: a prospective cohort observational study［J］. J Pediatr Gastroenterol Nutr, 2011, 53(1): 93-99.

［43］Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know［J］. J Clin Endocrinol Metab, 2011, 96(1): 53-58.