- 學位論文
成人維生素D營養狀況及其相關影響因素
Vitamin D status and its associated factors in Taiwanese adults
摘要
背景：維生素D影響多種重要生理功能，如：維持血鈣平衡、維護骨骼及肌肉系統健康、免疫功能調節等。血鈣下降時會刺激副甲狀腺素分泌作用於腎臟促進25(OH)D羥化為1,25(OH)2D而增加小腸對鈣離子的主動運輸，並促進蝕骨作用及促進腎臟中鈣離子的再吸收作用而維持血鈣濃度。維生素D缺乏會導致次發性副甲狀腺素亢進(secondary hyperarathyroidism)和增加骨質疏鬆症之風險。根據我國2005-2008年之國民營養健康狀況變遷調查(Nutrition and Health Survey in Taiwan, NAHSIT)顯示，有超過66%的國人處於維生素D缺乏(<20 ng/mL)，僅不到2%的民眾是維生素D充足(>33 ng/mL)之狀態。人類獲得維生素D的來源包括飲食攝取(如：魚類、蛋類和蕈菇類)和經日光曝曬由皮下自行合成。本研究目的為了解20至50歲的健康成年人之維生素D營養狀況及可能的影響因素。 材料與方法：本研究為橫斷式研究，於中山醫學大學及鄰近社區招募43位20至50歲的健康成年人，以結構式問卷收集生活型態資料及飲食攝取頻率，並依個案最近一週曝曬時間長短及未採取防曬的曝曬面積計算日光曝曬分數。測量項目包括基本人體測量，及以多功能皮膚檢測系統測量手臂及前額的皮膚黑色素指數，並以雙能量X光吸收儀(dual-energy x-ray absorptiometry, DXA)測量個案全身骨質和體組成，以放射免疫分析法(radioimmunoassay, RIA)定量血清中的維生素D指標(25(OH)D)及副甲狀腺素濃度。 結果：分析結果顯示全體個案維生素D缺乏、不足與充足之盛行率分別為30.23%、 34.88%、 34.88%。男女性之年齡與血清25(OH)D濃度間呈現正相關性。男性的體重、腰圍、腰臀比與血清25(OH)D濃度間呈現正相關性，且BMI和臀圍與血清25(OH)D濃度間呈趨顯著之正相關性。女性的手臂外側平均皮膚黑色素指數與血清25(OH)D濃度間呈正相關性。男性之血磷濃度和女性之血鈣濃度分別與血清25(OH)D濃度間呈顯著負相關。全身骨密度(bone mineral density, BMD)、股骨頸(femoral neck)骨密度Z-score與血清25(OH)D濃度間呈現正相關性。女性攝取鱈魚、蘑菇、金針菇的攝取量與血清25(OH)D濃度呈統計顯著正相關性；男性攝取乳類及其製品之攝取量與血清中25(OH)D濃度呈現統計顯著正相關性。此外，維生素D充足者之年齡與血鈣濃度顯著高於缺乏維生素D者，且維生素D充足組別之鮭魚攝取量高於維生素D不足之組別。 結論：本研究觀察到女性的手臂外側平均皮膚黑色素指數與血清25(OH)D濃度間呈現顯著之正相關性。由於年輕女性經常進行防曬措施，導致維生素D狀態不佳，故鼓勵年輕女性每週至少兩次於早上10點前和下午2點後進行陽光曝曬5-10分鐘。
並列摘要
Background: Vitamin D plays critical roles in maintaining serum calcium and phosphorus balance. The fall in serum level of calcium, usually resulted from inadequate dietary calcium intake, would stimulate the secretion of parathyroid hormone (PTH), which in turn would elevate the serum level of calcium by (1) enhancing the intestinal absorption of dietary calcium by stimulating the renal conversion of the active 1,25-dihydroxyvitamin D; (2) increasing bone resorption to release calcium ions into circulation ; and (3) enhancing calcium reabsorption in the kidneys. Vitamin D deficiency is associated with secondary hyper- parathyroidism and higher risk of osteoporosis. According to the results of the Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008, there is more than 66% of the Taiwanese adults are deficient in vitamin D, and only less than 2% are sufficient in vitamin D. The purposes of the current study were to explore the vitamin D status and its associated factors in Taiwanese adults. Methods: A total of 43 healthy subjects aged 20-50 years were recruited from the neighboring communities near Chung Shan Medical University, Taichung in this cross-sectional study. Structural questionnaires were administered to obtain data of lifestyle information and dietary intake, and a sun exposure score was generated according to the frequency and body parts exposing to sun. Skin melanins at inner and outer forearm as well as forehead were measured by a multiprobe mexameter. Body composition, including bone measurements were measured by a dual-energy x-ray absorptiometry. The venous blood samples were collected and the serum levels of 25(OH)D and PTH were measured by RIA method. Results: The prevalence rates of vitamin D deficiency and insufficiency were 30.33% and 34.88%, respectively. Age was significantly correlated with serum level of 25(OH)D in both genders. In men, weight, waist-circumference, waist-hip ratio were each significantly correlated with serum level of 25(OH)D, whereas BMI and hip-circumference were also positively correlated with serum level of 25(OH)D with borderline significance. The average skin melanin index at outer forearm was significantly correlated with serum level of 25(OH)D in females. Male’s serum level of phosphorus and female’s serum level of calcium were significantly correlated with serum level of 25(OH)D, respectively. Positive correlations were also observed between the intake amounts of codfish, mushroom, and golden mushroom and the level of serum 25(OH)D in females. There was also a positive correlation between the amount of consuming diary products and serum level of 25(OH)D in males. In addition, comparing to the group of vitamin D deficiency [25(OH)D < 20 ng/mL], those who were sufficient in vitamin D had higher serum level of calcium, and higher intake amount of salmon as well. Conclusion: There is positive correlation between women’s average skin melanin index at outer forearm and serum level of 25(OH)D . For young female adults, exposure to sunlight before 10 am and after 2 pm at least twice weekly should be encouraged to improve and/or maintain optimal vitamin D status.
參考文獻
延伸閱讀
- 王馨慧（2011）。維生素D與自體免疫疾病的關係。臺灣兒童過敏氣喘免疫及風濕病醫學會學會通訊，12(2)，11-12。https://doi.org/10.7025/CFSPIHHHHTH.201107.0011
- 林天送（2010）。營養補充品解說 維生素D與鈣。健康世界，(300)，40-43。https://doi.org/10.6454/HW.201012.0040
- 楊志懷、吳美鳳（2020）。正確補充維生素D，掌握原則免出錯。彰基院訊，37(7)，24-25。https://www.airitilibrary.com/Article/Detail?DocID=P20140814001-202007-202007090009-202007090009-24-25
- Su, S., Wang, L., Tang, X., Zhao, N., Guan, C., Li, H., Liu, L., Liu, J., Che, H., Zhang, D., Wang, Q., Fu, S., & Zhen, D. (2013). Vitamin D deficiency in diabetes exacerbates longitudinal risk for atherosclerotic cardiovascular disease in Lanzhou, China. Asia Pacific Journal of Clinical Nutrition, (), 1-20. https://doi.org/10.6133/apjcn.202111/PP.0004
- 董靜馨、龔浩瑄、陳宛秋、潘志寬、周薰修（2007）。Survey on Compliance of Labeling of Vitamin D and Calcium on Dietary Supplements with Regulations in Taiwan。藥物食品檢驗局調查研究年報，()，163-170。https://doi.org/10.6946/ASRNL.200712.0163