{"title":"为肥胖儿童和青少年提供维生素 D 的当代视角:文献综述和临床病例描述","authors":"M. Yatsula, S. Nyankovskyy","doi":"10.25040/lkv2023.03-04.058","DOIUrl":null,"url":null,"abstract":"Introduction. Vitamin D deficiency is currently considered a global epidemic. Recent data highlight its pivotal role in the development of metabolic disorders, including obesity in children and adolescents. The aim of the study. To review current literature on the problem of vitamin D provision in children and adolescents with obesity, and to present a clinical case of a child with obesity, vitamin D deficiency, and accompanying metabolic disorders. Materials and methods: The study included literary review using content analysis, systemic and comparative analysis methods, as well as biblio-semantic methods to explore current data on the problem of vitamin D provision in children and adolescents with obesity. Sources included PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate databases using keywords as follows: children, adolescents, insulin resistance, obesity, vitamin D deficiency, VDR (Vitamin D Receptor) gene polymorphism, leptin, adipocytes. 66 English-language articles were analyzed, highlighting the role of vitamin D in human metabolic processes, its association with obesity, mechanisms of its deficiency impact including the inhibitory effect of leptin and interleukin 6, and the peculiarities of vitamin D biological action through nuclear VDR-mediated control of target genes. The prevalence of vitamin D deficiency in obese children in various countries was determined. Results. Obesity can induce altered protein binding and accelerated metabolic clearance of 25(OH)D, leading to reduced levels of 25(OH)D in the blood serum. It was identified that lower serum vitamin D levels and VDR gene polymorphism are associated with a predisposition to obesity in children and its severe consequences, this link apparently can help to identify VDR features that predict an increased risk of developing obesity, potentially leading to new therapeutic strategies for this metabolic condition. This will also increase public awareness about the psychosocial and clinical consequences of vitamin D deficiency and VDR gene polymorphism in obese children. Children with excessive weight and obesity are often diagnosed with hypovitaminosis, including vitamin D deficiency. Many studies around the world have found that vitamin D deficiency in obese children is at a critical stage and requires a change in diagnostic and treatment strategies. The clinical case described involves a patient who had obesity in association with vitamin D deficiency, and characteristic biochemical changes typical of this pathology. Biochemical indices included vitamin D deficiency, dyslipidemia, insulin resistance, leptin resistance, and hypothyroidism. Bioimpedance analysis revealed the presence of excessive body fat and its abnormal abdominal distribution in the child. Conclusions. Currently vitamin D deficiency is considered a global epidemic, causing concern among physicians and researchers of various specialties. Recent data underscore its leading role in the onset of metabolic disorders, including obesity in children and adolescents. The literature review confirmed the significant impact of vitamin D on the primary biochemical and metabolic processes in the human body, its crucial role in the emergence of obesity and various complications in children and adolescents. The presence of overweight or obesity in these patients requires a number of laboratory indeces, including serum vitamin D, leptin and thyroid hormones levels, protein, carbohydrate and lipid metabolism parameters, to be estimated. The use of bioimpedance analysis and ultrasound examination of the thyroid gland is advisable.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"20 6","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Contemporary perspectives on vitamin D provision in children and adolescents with obesity: a literature review and clinical case description\",\"authors\":\"M. Yatsula, S. Nyankovskyy\",\"doi\":\"10.25040/lkv2023.03-04.058\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction. Vitamin D deficiency is currently considered a global epidemic. Recent data highlight its pivotal role in the development of metabolic disorders, including obesity in children and adolescents. The aim of the study. To review current literature on the problem of vitamin D provision in children and adolescents with obesity, and to present a clinical case of a child with obesity, vitamin D deficiency, and accompanying metabolic disorders. Materials and methods: The study included literary review using content analysis, systemic and comparative analysis methods, as well as biblio-semantic methods to explore current data on the problem of vitamin D provision in children and adolescents with obesity. Sources included PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate databases using keywords as follows: children, adolescents, insulin resistance, obesity, vitamin D deficiency, VDR (Vitamin D Receptor) gene polymorphism, leptin, adipocytes. 66 English-language articles were analyzed, highlighting the role of vitamin D in human metabolic processes, its association with obesity, mechanisms of its deficiency impact including the inhibitory effect of leptin and interleukin 6, and the peculiarities of vitamin D biological action through nuclear VDR-mediated control of target genes. The prevalence of vitamin D deficiency in obese children in various countries was determined. Results. Obesity can induce altered protein binding and accelerated metabolic clearance of 25(OH)D, leading to reduced levels of 25(OH)D in the blood serum. It was identified that lower serum vitamin D levels and VDR gene polymorphism are associated with a predisposition to obesity in children and its severe consequences, this link apparently can help to identify VDR features that predict an increased risk of developing obesity, potentially leading to new therapeutic strategies for this metabolic condition. This will also increase public awareness about the psychosocial and clinical consequences of vitamin D deficiency and VDR gene polymorphism in obese children. Children with excessive weight and obesity are often diagnosed with hypovitaminosis, including vitamin D deficiency. Many studies around the world have found that vitamin D deficiency in obese children is at a critical stage and requires a change in diagnostic and treatment strategies. The clinical case described involves a patient who had obesity in association with vitamin D deficiency, and characteristic biochemical changes typical of this pathology. Biochemical indices included vitamin D deficiency, dyslipidemia, insulin resistance, leptin resistance, and hypothyroidism. Bioimpedance analysis revealed the presence of excessive body fat and its abnormal abdominal distribution in the child. Conclusions. Currently vitamin D deficiency is considered a global epidemic, causing concern among physicians and researchers of various specialties. Recent data underscore its leading role in the onset of metabolic disorders, including obesity in children and adolescents. The literature review confirmed the significant impact of vitamin D on the primary biochemical and metabolic processes in the human body, its crucial role in the emergence of obesity and various complications in children and adolescents. The presence of overweight or obesity in these patients requires a number of laboratory indeces, including serum vitamin D, leptin and thyroid hormones levels, protein, carbohydrate and lipid metabolism parameters, to be estimated. 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引用次数: 0
摘要
引言维生素 D 缺乏症目前被认为是一种全球性流行病。最新数据显示,维生素 D 在代谢紊乱(包括儿童和青少年肥胖症)的发病过程中起着关键作用。本研究的目的回顾有关肥胖儿童和青少年维生素 D 供给问题的现有文献,并介绍一例肥胖、维生素 D 缺乏和伴有代谢紊乱的儿童的临床病例。材料和方法:本研究采用内容分析法、系统分析法、比较分析法以及书目语义法进行文学评论,以探讨有关肥胖儿童和青少年维生素 D 供给问题的现有数据。资料来源包括 PubMed-NCBI、Medline、CochraneLibrary、EMBASE、ResearchGate 等数据库,关键词为:儿童、青少年、胰岛素抵抗、肥胖、维生素 D 缺乏、VDR(维生素 D 受体)基因多态性、瘦素、脂肪细胞。研究分析了 66 篇英文文章,重点研究了维生素 D 在人体代谢过程中的作用、维生素 D 与肥胖的关系、维生素 D 缺乏的影响机制(包括瘦素和白细胞介素 6 的抑制作用)以及维生素 D 通过核 VDR 介导的靶基因控制发挥生物作用的特殊性。研究还确定了不同国家肥胖儿童维生素 D 缺乏症的发病率。研究结果肥胖会引起 25(OH)D 蛋白质结合的改变和代谢清除的加速,从而导致血清中 25(OH)D 水平的降低。研究发现,较低的血清维生素 D 水平和 VDR 基因多态性与儿童易患肥胖症及其严重后果有关,这种联系显然有助于确定预测患肥胖症风险增加的 VDR 特征,从而有可能针对这种代谢疾病制定新的治疗策略。这也将提高公众对肥胖儿童维生素 D 缺乏和 VDR 基因多态性的社会心理和临床后果的认识。体重超标和肥胖的儿童通常被诊断为维生素缺乏症,包括维生素 D 缺乏症。世界各地的许多研究发现,肥胖儿童的维生素 D 缺乏症正处于关键阶段,需要改变诊断和治疗策略。本临床病例涉及一名肥胖伴维生素 D 缺乏症的患者,以及这种病症典型的特征性生化变化。生化指标包括维生素 D 缺乏、血脂异常、胰岛素抵抗、瘦素抵抗和甲状腺功能减退。生物阻抗分析显示该患儿体内脂肪过多,且腹部分布异常。结论。目前,维生素 D 缺乏症被认为是一种全球性流行病,引起了各科医生和研究人员的关注。最近的数据显示,维生素 D 缺乏是导致代谢紊乱(包括儿童和青少年肥胖症)的主要原因。文献综述证实,维生素 D 对人体的主要生化和代谢过程有重大影响,在儿童和青少年肥胖症和各种并发症的出现中起着至关重要的作用。要判断这些患者是否存在超重或肥胖,需要进行一系列实验室检测,包括血清维生素 D、瘦素和甲状腺激素水平,以及蛋白质、碳水化合物和脂质代谢参数的估算。建议使用生物阻抗分析和甲状腺超声波检查。
Contemporary perspectives on vitamin D provision in children and adolescents with obesity: a literature review and clinical case description
Introduction. Vitamin D deficiency is currently considered a global epidemic. Recent data highlight its pivotal role in the development of metabolic disorders, including obesity in children and adolescents. The aim of the study. To review current literature on the problem of vitamin D provision in children and adolescents with obesity, and to present a clinical case of a child with obesity, vitamin D deficiency, and accompanying metabolic disorders. Materials and methods: The study included literary review using content analysis, systemic and comparative analysis methods, as well as biblio-semantic methods to explore current data on the problem of vitamin D provision in children and adolescents with obesity. Sources included PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate databases using keywords as follows: children, adolescents, insulin resistance, obesity, vitamin D deficiency, VDR (Vitamin D Receptor) gene polymorphism, leptin, adipocytes. 66 English-language articles were analyzed, highlighting the role of vitamin D in human metabolic processes, its association with obesity, mechanisms of its deficiency impact including the inhibitory effect of leptin and interleukin 6, and the peculiarities of vitamin D biological action through nuclear VDR-mediated control of target genes. The prevalence of vitamin D deficiency in obese children in various countries was determined. Results. Obesity can induce altered protein binding and accelerated metabolic clearance of 25(OH)D, leading to reduced levels of 25(OH)D in the blood serum. It was identified that lower serum vitamin D levels and VDR gene polymorphism are associated with a predisposition to obesity in children and its severe consequences, this link apparently can help to identify VDR features that predict an increased risk of developing obesity, potentially leading to new therapeutic strategies for this metabolic condition. This will also increase public awareness about the psychosocial and clinical consequences of vitamin D deficiency and VDR gene polymorphism in obese children. Children with excessive weight and obesity are often diagnosed with hypovitaminosis, including vitamin D deficiency. Many studies around the world have found that vitamin D deficiency in obese children is at a critical stage and requires a change in diagnostic and treatment strategies. The clinical case described involves a patient who had obesity in association with vitamin D deficiency, and characteristic biochemical changes typical of this pathology. Biochemical indices included vitamin D deficiency, dyslipidemia, insulin resistance, leptin resistance, and hypothyroidism. Bioimpedance analysis revealed the presence of excessive body fat and its abnormal abdominal distribution in the child. Conclusions. Currently vitamin D deficiency is considered a global epidemic, causing concern among physicians and researchers of various specialties. Recent data underscore its leading role in the onset of metabolic disorders, including obesity in children and adolescents. The literature review confirmed the significant impact of vitamin D on the primary biochemical and metabolic processes in the human body, its crucial role in the emergence of obesity and various complications in children and adolescents. The presence of overweight or obesity in these patients requires a number of laboratory indeces, including serum vitamin D, leptin and thyroid hormones levels, protein, carbohydrate and lipid metabolism parameters, to be estimated. The use of bioimpedance analysis and ultrasound examination of the thyroid gland is advisable.