目的 探索成年人群血清维生素D（vitamin D,VD）水平与糖尿病/血糖异常患病风险的关系。方法 采用多阶段抽样的方法纳入年龄大于18周岁符合条件的2072名调查对象,收集相关人口统计学、身体测量学指标,检测血清25(OH)D3水平和糖脂代谢指标,将血清25(OH)D3水平分为缺乏组和不缺乏组,统计分析各组相应指标,探索血清25(OH)D3水平与糖尿病/血糖异常的关联性。结果 研究对象中糖尿病患病率为5.69%,血糖异常率为54.68%,而VD缺乏率为19.79%,其中糖尿病患者中VD缺乏率为28.81%,血糖异常人群中VD缺乏率为19.59%;VD缺乏的研究对象糖尿病患病率显著高于VD不缺乏者（8.25% vs 5.06%,P=0.012),而VD缺乏的研究对象血糖异常率与VD不缺乏者血糖异常率差异无统计学意义（20.83% vs 19.59%,P=0.716)。调整年龄、地区、锻炼情况、身体质量指数（BMI）、空腹血脂和血压等因素之后,血清25(OH)D3浓度降低与更高的糖尿病患病率相关（P=0.046）,并且血清25(OH)D3水平每降低10 ng/ml,糖尿病/血糖异常患病风险增加1.391（1.039~1.861）倍（P trend = 0.026）。进一步将糖尿病患者分层后,与VD不缺乏组相比,进行多因素调整后VD缺乏组的糖尿病患病危险度为1.594（1.009~2.250）倍（P=0.046）,血清VD水平每降低10 ng/ml,糖尿病的患病风险分别增加了1.391（1.039~1.861）倍（P trend = 0.026）。结论 血清VD缺乏可能是成年人群糖尿病高发的一个独立危险因素。
Abstract
Objective To explore the associations between serum vitamin D (VD) level and the prevalences of diabetes/abnormal blood glucose in a Chinese population. Methods A total of 2072 eligible subjects over 18 years of age were included by the multi-stage sampling method. Serum 25 hydroxyvitamin D3 (25(OH)D3) level and lipid metabolism indexes were detected, and relevant demographic and physical information were collected. Multiple logistic regression analysis was used to examine the relationship between serum 25(OH)D3 level and the prevalences of diabetes and abnormal blood glucose. Results The prevalence of diabetes was 5.69%, the rate of abnormal blood glucose was 54.68%, and the rate of vitamin D deficiency was 19.79%. The rate of vitamin D deficiency was 28.81% in diabetic subjects and 19.59% in abnormal blood glucose subjects. The prevalence of diabetes in subjects with vitamin D deficiency was significantly higher than that in subjects with vitamin D sufficiency (8.25% vs 5.06%, P=0.012), while there was no statistically significant difference in the rates of abnormal blood glucose between the subjects with vitamin D deficiency and vitamin D sufficiency (20.83% vs 19.59%, P=0.716). After adjusting for multiple factors such as age, region, exercise, BMI, fasting lipids, and blood pressure, the decrease of serum 25 (OH) D3 level was associated with a higher prevalence of diabetes (P=0.046), and the risk of diabetes/abnormal blood glucose was increased by 1.391 (1.039-1.861) times for every 10 ng/ml decrease in serum 25(OH)D3 level (P=0.026). After further stratification of the diabetic subjects, compared with the vitamin D adequate group, the risk of diabetes in the vitamin D deficiency group was 1.594 (1.009-2.520, P=0.046) after multi-factor adjustment. The risk of diabetes was increased by 1.391 (1.039-1.861) times for every 10 ng/ml decrease in serum vitamin D3 level (P=0.026). Conclusion Vitamin D deficiency may be an independent risk factor for high incidence of diabetes in Chinese adult population.
关键词
维生素D /
糖尿病 /
血糖异常
Key words
vitamin D /
diabetes mellitus /
dysglycemia
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th Edition[J]. Diabetes Res Clin Pract, 2019,157: 107843.
[2] Wei W, Jiang W, Han T, et al. The future of prevention and treatment of diabetes with nutrition in China[J]. Cell Metab, 2021, 33: 1908-1910.
[3] Li YX, Zhou L.Vitamin D deficiency, obesity and diabetes[J]. Cell Mol Biol,2015,61: 35-38.
[4] Pittas AG, Dawson-Hughes B, Sheehan P, et al. Vitamin D supplementation and prevention of type 2 diabetes[J]. N Engl J Med, 2019,381: 520-530.
[5] Kim SH, Brodsky IG, Chatterjee R, et al. Effect of vitamin D supplementation on kidney function in adults with prediabetes: a secondary analysis of a randomized trial[J]. Clin J Am Soc Nephrol, 2021, 16:1201-1209.
[6] Aroda VR, Sheehan PR, Vickery EM, et al. Establishing an electronic health record-supported approach for outreach to and recruitment of persons at high risk of type 2 diabetes in clinical trials: the vitamin D and type 2 diabetes (D2d) study experience[J]. Clin Trials, 2019, 16: 306-315.
[7] Wei Z, Yoshihara E, He N, ,et al. Vitamin D switches BAF complexes to protect β cells[J]. Cell. Vitamin D switches BAF complexes to protect β cells[J]. Cell,2018,173:1135-1149.e15.
[8] Wu F,Juonala M,Pitkänen N, et al. Both youth and long-term vitamin D status is associated with risk of type 2 diabetes mellitus in adulthood: a cohort study[J]. Ann Med,2018,50:74-82.
[9] Heath AK,Williamson EJ, Hodge AM, et al. Vitamin D status and the risk of type 2 diabetes: the melbourne collaborative cohort study[J]. Diabetes Res Clin Pract, 2019,149:179-187.
[10] Wang W,Zhang J,Wang H, et al. Vitamin D deficiency enhances insulin resistance by promoting inflammation in type 2 diabetes[J]. Int J Clin Exp Pathol,2019,12: 1859-1867.
[11] Kodama K, Tojjar D, Yamada S, et al. Ethnic differences in the relationship between insulin sensitivity and insulin response: a systematic review and meta- analysis [J]. Diabetes Care, 2013,36:1789-1796.
[12] González-Molero I, Rojo-Martínez G, Morcillo S, et al. Vitamin D and incidence of diabetes: a prospective cohort study[J]. Clin Nutr, 2012, 31:571-573.
[13] Bragg F, Holmes MV, Iona A, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China[J]. JAMA,2017, 317:280-289.
[14] Lu Y, Zheng Y, Wang N, et al. The relationship between vitamin D and type 2 diabetes is intriguing: glimpses from the Spect-China Study[J]. Ann Nutr Metab, 2017,71:195-202.
[15] 杨文英. 中国糖尿病的流行特点及变化趋势[J].中国科学(生命科学),2018,48:812-819.
[16] GBD 2019 Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019BD 2019 Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019[J]. Lancet,2020,396:1135-1159.
[17] Saif-Elnasr M, Ibrahim IM, Alkady MM.Role of vitamin D on glycemic control and oxidative stress in type 2 diabetes mellitus[J]. J Res Med Sci,2017,22:22-27.
[18] Rosen CJ, Adams JS, Bikle DD, et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement[J]. Endocr Rev,2012,33:456-492.
[19] 尉全平,杨建宝,翟洪然等.孕妇糖代谢异常及维生素D缺乏对子代甲状腺功能的影响[J].河北医科大学学报,2023,44:553-556,578.
[20] Pittas AG, Jorde R, Kawahara T, et al. Vitamin D supplementation for prevention of type 2 diabetes mellitus: to D or not to D?[J]. J Clin Endocrinol Metab,2020,105:3721-3733.
[21] 王娜,王海静,时慧,等.维生素D水平与2型糖尿病的相关性研究[J].国际检验医学杂志,2016,37:3504-3506.
[22] 杨洪艳,冯正平.维生素D与糖尿病发生及发展的相关性研究进展[J].现代医药卫生,2020,36:2028-2031.
[23] Serrano MA. Contribution of sun exposure to the vitamin D dose received by various groups of the Spanish population[J]. Sci Total Environ, 2018,619-620: 545-
[24] Kayaniyil S, Harris SB, Retnakaran R, et al. Prospective association of 25(OH)D with metabolic syndrome[J].Clin Endocrinol (Oxf),2014,80:502-507.
[25] Vignali E, Macchia E, Cetani F, et al. Development of an algorithm to predict serum vitamin D levels using a simple questionnaire based on sunlight exposure[J].Endocrine,2017,55:85-92.
[26] 马宝玲,何玉秀,王凌.运动防治向心性肥胖的研究进展[J].中国康复医学杂志,2008,23(8):763-765.
[27] 安红红,宋凯琳,马瑞,等.维生素D对维生素D缺乏的2型糖尿病患者的影响研究[J].中国食物与营养,2023,29:82-85.
[28] Gao Y, Wu X, Fu Q, et al. The relationship between serum 25-hydroxy vitamin D and insulin sensitivity and β-cell function in newly diagnosed type 2 diabetes[J]. J Diabetes Res,2015,2015:636891.
[29] Sheth JJ, Shah A, Sheth FJ, et al. Does vitamin D play a significant role in type 2 diabetes?[J]. BMC Endocr Disord, 2015,15:5.
[30] 凡军芳,时照明.2型糖尿病患者血糖波动与血清25-羟维生素D水平的相关性研究[J].北华大学学报(自然科学版),2021,22:219-222.
[31] Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes[J]. JAMA,2006, 295:1681-1687.
[32] 于连龙,张坚,李素云,等.山东省6~17岁儿童青少年超重肥胖对血清维生素D与空腹血糖的影响[J].卫生研究,2021,50:547-551.
[33] 曾雅琳,王晓华.补充维生素D对空腹血糖受损患者胰岛素抵抗的影响[J].医学理论与实践,2021,34:1870-1872.
[34] Nielsen NO, Bjerregaard P, Rønn PF, et al. Associations between vitamin D status and type 2 diabetes measures among inuit in greenland may be affected by other factors[J]. PLoS One, 2016,11: e0152763.
[35] 邱慧娜. 血清25羟维生素D与2型糖尿病胰岛功能的相关性研究[D].天津:天津医科大学,2021.
[36] 胡咏新,范尧夫,郑仁东,等.维生素D与糖代谢[J].中华骨质疏松和骨矿盐疾病杂志,2019,12:298-302.
基金
国家自然科学基金面上项目 (No.81773414); 教育部产学合作协同育人项目（No.22060702745636）; 山东省教育教学研究课题（No.2023JXY029）; 滨州医学院科研启动基金项目（No.50012304419）
