儿童肥胖与维生素D缺乏研究进展

Research Progress on Childhood Obesity and Vitamin D Deficiency

摘要: 伴随我国儿童青少年肥胖检出率不断升高，维生素D缺乏与肥胖在流行病学上呈现高度共存，本文就近年国内外相关研究进行梳理，围绕共同的上游生活方式因素，脂肪组织存储与容积稀释学说、代谢相关脂肪性肝病所致肝脏羟化代谢障碍等层面探讨肥胖导致维生素D缺乏的可能机制；在此框架下结合儿童生长发育、青春期及脂肪组织功能等生理特点，进一步评估相应孟德尔随机化研究的因果推断，探讨维生素D缺乏对肥胖相关代谢异常的可能影响机制。结合现有维生素D干预补充的最新临床试验与荟萃分析等内容，分析其异质性潜在来源，现有证据支持肥胖是儿童维生素D缺乏的重要上游因素，维生素D则可能参与相关代谢问题的发生发展，而非直接促进肥胖发生，因此维生素D补充目前更宜作为儿童肥胖综合管理的补充措施，其对相关代谢指标的改善尚且缺乏一致证据。未来仍需开展大样本、长期的儿童青少年随机对照研究，以进一步明确维生素D补充对肥胖儿童代谢健康的临床价值及适宜补充策略。

Abstract: With the increasing prevalence of obesity among children and adolescents in China, vitamin D deficiency and obesity show a high degree of epidemiological coexistence. This review summarizes recent relevant studies from China and abroad and explores the potential mechanisms by which obesity leads to vitamin D deficiency from several perspectives, including shared upstream lifestyle factors, adipose tissue sequestration and volumetric dilution, and impaired hepatic vitamin D hydroxylation associated with metabolic dysfunction-associated steatotic liver disease (MASLD). Within this framework, taking into account the physiological characteristics of childhood growth and development, puberty, and adipose tissue function, we further evaluate the causal inferences from relevant Mendelian randomization studies and explore the potential mechanisms through which vitamin D deficiency may contribute to obesity-related metabolic abnormalities. In addition, by reviewing recent clinical trials and meta-analyses of vitamin D supplementation, we analyze potential sources of heterogeneity in the existing evidence. Current evidence supports that obesity is an important upstream factor contributing to vitamin D deficiency in children, whereas vitamin D may be involved in the development and progression of obesity-related metabolic abnormalities rather than directly promoting the development of obesity. Therefore, vitamin D supplementation may currently be better considered an adjunctive measure in the comprehensive management of pediatric obesity, while consistent evidence regarding its beneficial effects on relevant metabolic outcomes remains lacking. Future large-sample, long-term randomized controlled trials in children and adolescents are still needed to further clarify the clinical value of vitamin D supplementation for metabolic health in children with obesity and to determine appropriate supplementation strategies.