Vitamin A deficiency is associated with gastrointestinal and respiratory morbidity in school-age children.
Vitamin A deficiency is associated with gastrointestinal and respiratory morbidity in school-age children.
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DOI：
10.3945/jn.113.185876
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发表时间：
2014-04
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影响因子：
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通讯作者：
K. Thornton;M. Mora-Plazas;C. Marín;E. Villamor
中科院分区：
文献类型：
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作者：
K. Thornton;M. Mora-Plazas;C. Marín;E. Villamor
感染是整个儿童期发病的一个重要原因。微量营养素缺乏是幼儿感染相关疾病的一个危险因素，但尚不清楚这些相关性是否在学龄期间持续存在。我们对哥伦比亚博戈塔公立学校的2774名5-12岁儿童进行了一项前瞻性研究，研究了微量营养素状态生物标志物血液浓度与胃肠道和呼吸道疾病风险之间的关系。在入组队列时测量血液中视黄醇、锌、铁蛋白、平均红细胞体积、血红蛋白、红细胞叶酸和维生素B-12浓度。对儿童的发病率进行为期1学年的随访，包括腹泻伴呕吐、咳嗽伴发热、耳痛或耳分泌物伴发热以及就诊。与充足的维生素A状况相比（≥30.0 μg/dL），维生素A缺乏（<10.0 μg/dL）与腹泻伴呕吐[未校正的发病率比（IRR）：2.17; 95% CI：0.95，4.96; P趋势= 0.03]和咳嗽伴发热的风险增加相关（未校正IRR：2.36; 95% CI：1.30，4.31; P趋势= 0.05）。在调整了一些社会人口学特征和血红蛋白浓度后，血浆视黄醇每10 μg/dL与腹泻伴呕吐天数减少18%（P < 0.001）、咳嗽伴发热天数减少10%（P < 0.001）和医生就诊次数减少6%（P = 0.01）相关。在控制了社会人口因素和视黄醇浓度后，血红蛋白每1 g/dL与耳部感染症状天数减少17%（P < 0.001）和医生就诊次数减少5%（P = 0.009）相关。锌、铁蛋白、平均红细胞体积、红细胞叶酸和维生素B-12状态与发病率或就诊无关。维生素A和血红蛋白浓度与学龄儿童的发病率呈负相关。维生素A补充剂是否能降低5岁以上儿童感染的风险或严重程度还有待确定。
Infection is an important cause of morbidity throughout childhood. Poor micronutrient status is a risk factor for infection-related morbidity in young children, but it is not clear whether these associations persist during school-age years. We examined the relation between blood concentrations of micronutrient status biomarkers and risk of gastrointestinal and respiratory morbidity in a prospective study of 2774 children aged 5-12 y from public schools in Bogotá, Colombia. Retinol, zinc, ferritin, mean corpuscular volume, hemoglobin, erythrocyte folate, and vitamin B-12 concentrations were measured in blood at enrollment into the cohort. Children were followed for 1 academic year for incidence of morbidity, including diarrhea with vomiting, cough with fever, earache or ear discharge with fever, and doctor visits. Compared with adequate vitamin A status (≥30.0 μg/dL), vitamin A deficiency (<10.0 μg/dL) was associated with increased risk of diarrhea with vomiting [unadjusted incidence rate ratio (IRR): 2.17; 95% CI: 0.95, 4.96; P-trend = 0.03] and cough with fever (unadjusted IRR: 2.36; 95% CI: 1.30, 4.31; P-trend = 0.05). After adjustment for several sociodemographic characteristics and hemoglobin concentrations, every 10 μg/dL plasma retinol was associated with 18% fewer days of diarrhea with vomiting (P < 0.001), 10% fewer days of cough with fever (P < 0.001), and 6% fewer doctor visits (P = 0.01). Every 1 g/dL of hemoglobin was related to 17% fewer days with ear infection symptoms (P < 0.001) and 5% fewer doctor visits (P = 0.009) after controlling for sociodemographic factors and retinol concentrations. Zinc, ferritin, mean corpuscular volume, erythrocyte folate, and vitamin B-12 status were not associated with morbidity or doctor visits. Vitamin A and hemoglobin concentrations were inversely related to rates of morbidity in school-age children. Whether vitamin A supplementation reduces the risk or severity of infection in children over 5 y of age needs to be determined.