卫生研究

目的 了解云南省6～17岁儿童青少年维生素D营养状况及相关因素。方法 2016—2017年，采用多阶段分层随机抽样的方法，抽取云南省7个市(州)13个县(市、区)65所中小学3189名6～17岁儿童青少年，其中男生1580名，女生1609名，城市1367名，农村1822名。通过面对面进行问卷调查，采血并测定血清维生素D。通过多因素Logistic回归分析血清维生素D含量在不同城乡、年龄、体质指数、户外活动时间儿童青少年中的分布情况。结果 云南省6～17岁儿童青少年维生素D均值为(21.98±8.07) ng/mL。城市男生[(23.30±10.13) ng/mL]高于女生[(21.50±8.94)ng/mL](t=3.47,P<0.01)。城市6～8岁组维生素D水平最高[(26.65±9.83)ng/mL],且与除15～17岁组外的其他各年龄组差异有统计学意义(F=41.06,P<0.01)。秋季体检、每天吃鸡蛋和最近1个月吃过动物血和肝脏者维生素D水平分别为(25.34±7.82)ng/mL、(22.78±9.60)ng/mL和(23.66±9.24)ng/mL,且均高于其他组(P<0.05)。农村男生维生素D水平[(22.85±7.31)ng/mL]高于女生[(20.10±6.34)ng/mL](t=8.59,P<0.01)。农村6～8岁组维生素D水平最高[(23.7±7.96)ng/mL],与除15～17岁组外其他各年龄组差异有统计学意义(F=25.05,P<0.01),但低于城市同年龄组(t=4.40,P<0.01)。户外活动时间超过120 min组维生素D水平最高[(22.05±7.84)ng/mL],与其他活动时间组差异有统计学意义(F=5.34,P<0.01)。6～17岁儿童青少年维生素D不足或缺乏率占87.6%。城市和农村女生维生素D不足或缺乏比例均高于男生(χ²值分别为17.48和35.33,P<0.01),且城市和农村不同性别维生素D不足或缺乏比例差异具有统计学意义(χ²=50.14,P<0.01);城市和农村不同年龄组中6～8岁组维生素D充足比例均最高(40.6%和38.5%),且城市和农村维生素D不足或缺乏差别有统计学意义(χ²=71.22,P<0.01)。冬季体检城市和农村儿童青少年维生素D不足或缺乏更严重(χ²=17.11,P<0.01)。多因素Logistic分析显示，女生(OR=2.274,95%CI 1.814～2.852)、农村(OR=1.560,95%CI 1.240～1.961)儿童青少年更容易发生维生素D不足或缺乏，6～8岁(OR=0.395,95%CI 0.287～0.543)、春季体检(OR=0.694,95%CI 0.567～0.849)和秋季体检(OR=0.743,95%CI 0.595～0.926)是维生素D不足或缺乏的保护因素。结论 2016—2017年云南省6～17岁儿童青少年维生素D不足或缺乏率处于较高水平，女生更为突出，春季、秋季体检是维生素D水平的保护因素。

OBJECTIVE To analyze the prevalence status and related factors of Vitamin D in children and adolescent aged 6-17 years in Yunnan Province, and to provide evidence for improving the anemia status of children and teenagers in Yunnan Province.METHODS From 2016 to 2017, a multi-stage stratified random sampling method was used to select 3189 children and adolescents aged 6-17 from 65 primary and secondary schools in 13 counties(cities, districts) of 7 cities(prefectures) in Yunnan Province. 1580 boys and 1609 girls were selected by gender. 1367 urban residents and 1822 rural residents were selected for face-to-face questionnaire survey and serum vitamin D measurement based on urban and rural areas. The distribution of serum vitamin D content in urban and rural areas, age, body mass index and outdoor activity time of school-aged children was analyzed. SPSS20.0 T-test, χ² test and multiple Logistic regression analysis were performed.RESULTS The mean of vitamin D in children and adolescents aged 6-17 in Yunnan Province was(21.98±8.07) ng/mL. The vitamin D level of urban boys was(23.30±10.13) ng/mL, which was higher than that of girls((21.50±8.94) ng/mL)(t=3.47,P<0.01). The vitamin D level of children and adolescents aged 6-8 in urban areas was the highest((26.65±9.83) ng/mL), and the difference was statistically significant compared with other age groups except for the 15-17 age group(F=41.06, P<0.01). The vitamin D levels of children and adolescents who had physical examinations in autumn, ate eggs every day, and had eaten animal blood and liver in the past month were(25.34±7.82),(22.78±9.60) and(23.66±9.24) ng/mL, respectively, which were all higher than those of other groups, and the differences were statistically significant(P<0.05). The vitamin D level of rural boys was(22.85±7.31) ng/mL, which was higher than that of girls((20.10±6.34) ng/mL)(t=5.34, P<0.01). The vitamin D level of children and adolescents aged 6-8 in rural areas was the highest((23.7±7.96) ng/mL), and the difference was statistically significant compared with other age groups except for the 15-17 age group(F=25.05, P<0.01), but it was lower than that of the same age group in urban areas(t=4.40, P<0.01). The vitamin D level was the highest when outdoor activity time exceeded 120 minutes((22.05±7.84) ng/mL), and the difference was statistically significant compared with other activity time groups(F=5.34, P<0.01). The rate of vitamin D insufficiency and deficiency among children and adolescents aged 6-17 was 87.6%. The proportion of vitamin D insufficiency or deficiency among girls in both urban and rural areas was higher than that among boys(χ² values of 17.48 and 35.33, P<0.01), respectively. The proportion of vitamin D insufficiency or deficiency among different genders in urban and rural areas was statistically significant(χ²=50.14, P<0.01). In urban and rural age groups, the proportion of vitamin D sufficiency in 6-8 years old was the highest, accounting for 40.6% and 38.5%, respectively, and the difference between urban and rural vitamin D deficiency or deficiency was statistically significant(χ²=71.22 P<0.01). Vitamin D insufficiency and deficiency were more severe in winter among children and adolescents in both urban and rural areas(χ²=17.11, P<0.01. Multivariate Logistic analysis showed that girls(OR=2.27, 95%CI 1.814-2.852) and rural children and adolescents(OR=1.560, 95%CI 1.240-1.961) were more likely to have vitamin D insufficiency or deficiency. The 6-8 age group(OR=0.395, 95%CI 0.287-0.543), physical examination season in spring(OR=0.694, 95%CI 0.567-0.849), and autumn(OR=0.743, 95%CI 0.595-0.926) were protective factors for vitamin D insufficiency or deficiency.CONCLUSION The deficiency or insufficiency of vitamin D among children and adolescents aged 6 to 17 in Yunnan Province from 2016 to 2017 remains at a relatively high level, with girls being more prominently affected. Undergoing physical examinations in spring and autumn is a protective factor for vitamin D levels.