云南省4个少数民族贫困地区6~23月龄婴幼儿维生素D水平及影响因素

李艳红; 张娴; 李燕; 赵梦茹; 赵琳; 李琳霞

doi:10.16462/j.cnki.zhjbkz.2019.10.013

云南省4个少数民族贫困地区6~23月龄婴幼儿维生素D水平及影响因素

doi: 10.16462/j.cnki.zhjbkz.2019.10.013

李艳红¹,
张娴¹,
李燕^2, ,,
赵梦茹¹,
赵琳¹,
李琳霞¹

1.
650101 昆明, 昆明医科大学第二附属医院儿科
2.
650101 昆明, 昆明医科大学公共卫生学院

基金项目:

国家自然科学基金 81760593

云南省公共卫生与疾病防控协同创新项目 2014YNPHXT10

详细信息

通讯作者:
李燕, E-mail: 752416854@qq.com

中图分类号: R174
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出版历程
- 收稿日期: 2019-04-23
- 修回日期: 2019-08-01
- 刊出日期: 2019-10-10

Vitamin D status and determinants among children aged 6 to 23 months in 4 poverty-stricken ethnic minority areas of Yunnan Province

1.
Department of Pediatrics, The Second Affiliated Hospital of Kunmng Medical University, Kunming 650101, China
2.
School of Public Health, Kunming Medical University, Kunming 650101, China

Funds:

National Natural Science Foundation of China 81760593

the Public Health and Disease Prevention and Control of Collaborative Innovation Subproject in Yunnan Province 2014YNPHXT10

More Information

Corresponding author: LI Yan, E-mail: 752416854@qq.com

摘要

摘要: 目的了解云南省4个少数民族贫困地区6~23月龄婴幼儿维生素D（vitamin D，VD）水平及影响因素。方法采用多阶段分层整群抽样的方法，在云南省剑川县、彝良县、墨江县和泸水县各选取3~4个乡镇6~23月龄婴幼儿1 255名，完成问卷调查、体格检查和血清25（OH）D测定，描述并分析婴幼儿VD水平及影响因素。结果 VD总体水平为20.6（16.3，25.4）ng/ml，VD缺乏、VD不足、VD充足检出率分别为7.1%、39.2%、53.7%。婴幼儿年龄越大、未补充VD、VD不足的危险性均增加（均有P < 0.05）。哈尼族婴幼儿VD缺乏及不足的危险性降低（均有P < 0.05），而女性"傈僳族、白族、宝宝未补充营养包"婴幼儿患VD缺乏及VD不足的危险性均增加（均有P < 0.05）。结论云南省少数民族贫困地区6~23月龄婴幼儿VD水平偏低，以VD不足为主。女童、傈僳族、白族、18月龄以上幼儿为重点干预人群，提高看护人VD营养认知、积极补充VD及营养包有利于改善VD营养水平。
- 维生素D /
- 儿童 /
- 少数民族 /
- 贫困地区
Abstract: Objective To investigate the vitamin D (VD) level and determinants among young children aged 6 to 23 months in 4 poverty-stricken ethnic minority areas of Yunnan Province. Methods Multistage stratified cluster sampling method was used. 1 255 young children aged 6-23 months from 3 to 4 towns of Jianchuan County, Yiliang County, Mojiang County and Lushui County. Questionnaires on caregivers, physical and serum 25(OH)D measure were achieved. VD level and influencing factors were described and analyzed. Results Overall VD level was 20.6(16.3, 25.4) ng/ml. The proportion of VD deficiency, VD insufficiency and VD sufficiency were 7.1%, 39.2% and 53.7% respectively. The risk of VD insufficiency elevated with children'age increasing or no VD supplement (P < 0.05). Hani minority can decrease the risk of VD deficiency and insufficiency (all P < 0.05). Thus, the risk of VD deficiency and insufficiency in children of female, Lisu or Bai minority, or in children who had no nutritional package supplement would increase (all P < 0.05). Conclusions The VD level of children aged 6-23 months in poverty-stricken ethnic minority areas of Yunnan Province was low. VD insufficiency was dominating. The intervention of VD deficiency and insufficiency may focus on the children of female, Lisu minority, Bai minority or older than 18 months. This study highlight that enhancing caregivers' knowledge of VD nutrition, adding VD and nutritional package supplement actively are beneficial to improve VD nutrition of young children in minority poverty areas of Yunnan.
- Vitamin D /
- Children /
- Ethnic minority /
- Poverty-stricken

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表 1 云南省4个少数民族贫困地区6~23月龄婴幼儿VD水平状况

Table 1. VD status for children aged 6 to 23 months in 4 poverty-stricken ethnic minority areas of Yunnan Province

	人数 (人)	血清VD水平(ng/ml)		VD状态[n(%)]			Z/H值	P值
	人数 (人)	M	P₂₅, P₇₅	VD缺乏	VD不足	VD充足	Z/H值	P值
性别
男	604	21.1	16.8, 25.8	34(5.6)	221(36.6)	349(57.8)	-3.090	0.002
女	575	20.0	15.9, 24.9	50(8.7)	241(41.9)	284(49.4)
年龄(岁)
6~	393	21.9	16.5, 26.3	30(7.6)	123(31.3)	240(61.1)	11.365	0.003
12~	392	20.5	15.9, 25.0	30(7.7)	155(39.5)	207(52.8)
18~23	394	19.7	16.2, 24.5	24(6.1)	184(46.7)	186(47.2)
贫困区
中度	311	19.9	15.8, 23.8	29(9.3)	133(42.8)	149(47.9)	21.438	＜0.001
重度	583	21.6	17.4, 26.9	30(5.1)	202(34.6)	351(60.2)
重灾区	285	19.1	15.3, 24.1	25(8.8)	127(44.6)	133(46.7)
民族
汉族	304	20.2	15.8, 25.1	20(6.6)	126(41.3)	158(52.1)	31.959	＜0.001
傈僳族	198	19.6	15.2, 24.4	18(8.9)	88(44.5)	92(46.6)
白族	280	19.8	15.6, 23.7	27(9.4)	118(42.1)	135(48.6)
哈尼族	270	22.9	19.0, 27.4	9(3.1)	72(26.8)	189(70.1)
其他	127	20.8	16.8, 26.1	9(7.1)	50(39.2)	68(53.7)
注：贫困区婴幼儿VD水平两两比较结果：中度贫困区与重度贫困区，Z=-3.739，P < 0.001；重度贫困区与贫困重灾区，Z=-3.894，P < 0.001；中度贫困区与贫困重灾区，Z=-0.197，P=0.844；校正α=0.017。不同民族婴幼儿VD水平两两比较结果：汉族与傈僳族，Z=-1.020，P=0.308；汉族与白族，Z=-1.341，P=0.180；汉族与哈尼族，Z=-4.212，P < 0.001；傈僳族与白族，Z=-0.224，P=0.823；傈僳族与哈尼族，Z=-4.712，P < 0.001；白族与哈尼族，Z=-5.126，P < 0.001；校正α=0.007。

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表 2 婴幼儿VD水平状况影响因素的单因素分析

Table 2. Univariate analysis of influening factors of VD status of young children

影响因素	血清VD状况[n(%)]			Z/H值	P值
影响因素	VD缺乏	VD不足	VD充足	Z/H值	P值
低出生体重				-2.990	0.003
否	65(6.5)	392(39.2))	542(54.3)
是	6(11.8)	28(54.9)	17(33.3)
早产				-3.176	0.001
否	69(6.9)	381(38.2)	547(54.9)
是	11(9.2)	62(51.7)	47(39.2)
AWZ评分^a(分)				1.344	0.511
≤-2	1(1.7)	23(39.7))	34(58.6)
-2~	73(7.5)	378(38.6)	528(53.9)
≥2	2(6.3)	11(34.4)	19(59.4)
AHZ评分^b(分)				1.997	0.368
≤-2	4(3.7)	40(36.7)	65(59.6)
-2~	68(7.6)	348(38.7))	484(53.8)
≥2	3(5.2)	25(43.1))	30(51.7)
WHZ评分^c(分)				3.381	0.184
≤-2	1(3.8)	15(57.7)	10(38.5)
-2~	72(7.2)	385(38.3)	548(54.5)
≥2	1(3.4)	9(31.0))	19(65.5)
半岁内喂养方式				1.495	0.474
母乳喂养	71(7.1)	390(39.0))	540(53.9)
人工喂养	7(10.4)	27(40.3)	33(49.3)
混合喂养	3(5.2)	28(48.3)	27(46.6)
规律补充维D				-3.134	0.002
是	20(7.4)	82(30.1)	170(62.5)
否	61(7.1)	363(42.5)	430(50.4)
规律补营养包				-4.453	＜0.001
是	7(2.8)	79(31.6)	164(65.6)
否	74(8.2)	371(41.0)	459(50.8)
日晒头面部				-2.732	0.006
是	72(6.9)	407(38.8)	570(54.3)
否	9(11.6)	38(49.4)	30(39.0)
日晒上肢				-1.849	0.065
是	46(6.9)	249(37.1)
376	(56)
否	35(7.5)	198(42.3)	235(50.2)
日晒下肢				-0.397	0.691
是	31(8.3)	138(37.0)	204(54.7)
否	50(6.6)	310(41.0)	397(52.4)
日光暴露部位				3.456	0.178
1个部位	32(7.0)	192(42.3)	230(50.7)
2个部位	30(8.2)	142(38.6)	196(53.3)
3个部位	19(6.4)	106(35.7)	172(57.9)
日光暴露时间(h/d)				0.291	0.864
0~	4(7.7)	20(38.5)	28(53.8)
1~	19(8.8)	84(38.9)	113(52.3)
2~	58(6.8)	339(39.6)	458(53.6)
家庭年收入(元)				0.761	0.683
0~	24(7.5)	127(39.6)	170(53.0)
10 000~	30(7.0)	167(38.7)	234(54.3)
30 000~	16(8.2)	80(41.0)	99(50.8)
看护人学历				-1.507	0.132
高中以下	56(8.8)	272(42.5)	312(48.8)
高中以上	5(6.4)	28(35.9)	45(57.7)
听说过佝偻病				-1.799	0.072
否	66(8.0)	332(40.1)	429(51.9)
是	15(5.2)	109(37.6)	166(57.2)
知道晒太阳可以补VD				-3.559	＜0.001
否	72(7.3)	408(41.6)	501(51.1)
是	9(6.6)	34(24.8)	94(68.6)
知道奶为食物主要钙源				-1.754	0.080
否	60(7.2)	344(41.3)	429(51.5)
是	21(7.3)	99(34.5)	167(58.2)
断母乳后需添乳类				-1.277	0.201
否/不确定	18(5.6)	124(38.6)	179(55.8)
是	63(7.9)	316(39.8)	415(52.3)
注：^a表示年龄体重Z评分；^b表示年龄身高Z评分；^c表示身高体重Z评分。

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表 3 婴幼儿VD缺乏及不足影响因素的多元Logistic回归分析

Table 3. Multivariate Logistic regression analysis on influening factors of VD deficiency and insufficiency of young children

VD营养状况 (参考类别: VD充足)	影响因素	β值	s_x	Wald值	P值	OR值	95%CI值
VD不足	性别(女)	0.419	0.157	7.108	0.008	1.520	1.117~2.069
	年龄(岁)
	6~11月						-
	12~17月	0.473	0.195	5.866	0.015	1.604	1.094~2.352
	18~23月	0.793	0.192	17.131	＜0.001	2.211	1.518~3.219
	民族
	汉族
	哈尼族	-0.621	0.231	7.232	0.007	0.538	0.342~0.845
	傈僳族	0.681	0.253	7.253	0.007	1.975	1.204~3.241
	白族	0.604	0.230	6.881	0.009	1.830	1.165~2.874
	宝宝未补充VD	0.458	0.195	5.534	0.019	1.581	1.079~2.315
	宝宝未补充营养包	0.992	0.221	20.078	＜0.001	2.696	1.747~4.161
	不知道日晒可补VD	0.960	0.258	13.853	＜0.001	2.611	1.575~4.328
VD缺乏	性别(女)	0.770	0.314	6.017	0.014	2.159	1.167~3.994
	宝宝未补充营养包	2.264	0.509	19.780	＜0.001	9.623	3.548~26.101
	民族
	汉族
	哈尼族	-1.700	0.789	4.637	0.031	0.183	0.039~0.858
	傈僳族	1.615	0.454	12.635	＜0.001	5.027	2.064~12.247
	白族	1.476	0.422	12.226	＜0.001	4.377	1.913~10.013

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	人数 (人)	血清VD水平(ng/ml)		VD状态[n(%)]			Z/H值	P值
	人数 (人)	M	P₂₅, P₇₅	VD缺乏	VD不足	VD充足	Z/H值	P值
性别
男	604	21.1	16.8, 25.8	34(5.6)	221(36.6)	349(57.8)	-3.090	0.002
女	575	20.0	15.9, 24.9	50(8.7)	241(41.9)	284(49.4)
年龄(岁)
6~	393	21.9	16.5, 26.3	30(7.6)	123(31.3)	240(61.1)	11.365	0.003
12~	392	20.5	15.9, 25.0	30(7.7)	155(39.5)	207(52.8)
18~23	394	19.7	16.2, 24.5	24(6.1)	184(46.7)	186(47.2)
贫困区
中度	311	19.9	15.8, 23.8	29(9.3)	133(42.8)	149(47.9)	21.438	＜0.001
重度	583	21.6	17.4, 26.9	30(5.1)	202(34.6)	351(60.2)
重灾区	285	19.1	15.3, 24.1	25(8.8)	127(44.6)	133(46.7)
民族
汉族	304	20.2	15.8, 25.1	20(6.6)	126(41.3)	158(52.1)	31.959	＜0.001
傈僳族	198	19.6	15.2, 24.4	18(8.9)	88(44.5)	92(46.6)
白族	280	19.8	15.6, 23.7	27(9.4)	118(42.1)	135(48.6)
哈尼族	270	22.9	19.0, 27.4	9(3.1)	72(26.8)	189(70.1)
其他	127	20.8	16.8, 26.1	9(7.1)	50(39.2)	68(53.7)
注：贫困区婴幼儿VD水平两两比较结果：中度贫困区与重度贫困区，Z=-3.739，P < 0.001；重度贫困区与贫困重灾区，Z=-3.894，P < 0.001；中度贫困区与贫困重灾区，Z=-0.197，P=0.844；校正α=0.017。不同民族婴幼儿VD水平两两比较结果：汉族与傈僳族，Z=-1.020，P=0.308；汉族与白族，Z=-1.341，P=0.180；汉族与哈尼族，Z=-4.212，P < 0.001；傈僳族与白族，Z=-0.224，P=0.823；傈僳族与哈尼族，Z=-4.712，P < 0.001；白族与哈尼族，Z=-5.126，P < 0.001；校正α=0.007。

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云南省4个少数民族贫困地区6~23月龄婴幼儿维生素D水平及影响因素

doi: 10.16462/j.cnki.zhjbkz.2019.10.013

通讯作者:
李燕, E-mail: 752416854@qq.com

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Vitamin D status and determinants among children aged 6 to 23 months in 4 poverty-stricken ethnic minority areas of Yunnan Province

Corresponding author: LI Yan, E-mail: 752416854@qq.com

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云南省4个少数民族贫困地区6~23月龄婴幼儿维生素D水平及影响因素

doi: 10.16462/j.cnki.zhjbkz.2019.10.013

通讯作者: 李燕, E-mail: 752416854@qq.com

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Vitamin D status and determinants among children aged 6 to 23 months in 4 poverty-stricken ethnic minority areas of Yunnan Province

Corresponding author: LI Yan, E-mail: 752416854@qq.com

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出版历程

目录

通讯作者:
李燕, E-mail: 752416854@qq.com