Analysis Of Serum Vitamin D Level And Intervention Treatment In Children With Obesity And NAFLD

Objective:To investigate the relationship between serum vitamin D levels and nonalcoholic fatty liver(NAFLD).and its severity in children with simple obesity.To study the changes of metabolic indexes,the level of vitamin D and the improvement of fatty liver in those children with simple obesity combined with NAFLD.Methods:(1)According to the liver ultrasonography,80 obese children aged 4-14 years old from children health department in Fuzhou children's Hospital of Fujian province from August 2015 to September 2016 were divided into obese with NAFLD group(n = 47)and obese without NAFLD group(n = 33),and 20 healthy children with the normal weight in the control group were from same department during the same period,whose age,gender were matched to above obese children.The degree of obesity was assessed by the Body Mass Index(BMI)and the diagnosis and degree of NAFLD were based on abdominal color Doppler ultrasound examination.The levels of serum vitamin D and the correlation between the levels of vitamin D and the related index of glucose and lipid metabolism,homeostasis model assessment-insulin resistance Index(HOMA-IR),alanine aminotransferase(ALT),hyper-sensitivity C-reactive protein(Hs-CRP),the time of the physical examination were assessed respectively.The levels of 25(OH)vitamin D3 were tested by double antibody sandwich enzyme-linked immunosorbent assay.The indexes of glucose and lipid metabolism,ALT and Hs-CRP were detected by automatic biochemical analyzer and immunoturbidimetric assay.The insulin level was evaluated by automatic chemiluminescence instrument detection.(2)Using the prospective randomized controlled method,47 obesity children with NAFLD were divided into vitamin D intervention group(n=25)and non-intervention groups(n=22)by random number method.The children in the intervention group were given vitamin D 800 U per day at 1h after meal while those in non-intervention group without vitamin D intervention.All of children in both groups were given the diet and exercise guidance,and health education for a total of 12 weeks.The changes of metabolic index,vitamin D level and the improvement degree of fatty liverwere studied in both groups before and after intervention.The interaction between the intervention mode and the duration on the changes of serum vitamin D level was analyzed by factorial analysis.Result:(1)The average level of serum vitamin D was 21.63 ± 7.71 ng/ ml in obese children18.02 ± 3.61 ng/ml in obese patients with NAFLD and 22.34 ± 8.41 ng/ml in obese patients without fatty liver,and 29.10 ± 8.68 ng/ml in healthy control group.The obese children with NAFLD group had the lowest level of serum vitamin D.The correlation analysis showed that vitamin D levels were negatively correlated with obesity(BMI).(2)According to the levels of vitamin D,the including children were divided into vitamin D deficiency,insufficient and appropriate groups individually.BMI,TC,TG,HDL,LDL and HOMA-IR and physical examination seasons had significant differences in different groups.The average levesl of serum vitamin D in children whose took physical examination in winter were 20.24 ± 6.43 ng/ml,which was significantly lower than that in summer(24.78 ± 8.56 ng/ml,P<0.01).BMI?TG?HOMA-IR and seasons were the risk factors affecting the levels of serum vitamin D(? =-1.22,6.16,-3.07,1.98).(3)In 47 children were obese with NAFLD,12 mild fatty liver,28 moderate fatty liver and 7 severe fatty liver.The correlation analysis showed that fatty liver severity was positively correlated with ALT,Hs-CRP,and negatively correlated with Vitamin D levels(P <0.01).Serum vitamin D levels,Hs-CRP were risk factors of fatty liver severity(? values were 1.15,0.63 respectively).(4)BMI,HOMA-IR,the levels of serum vitamin D,ALT and Hs-CRP in the obese patients with NAFLD were significantly different(P<0.05).The effective rate of fatty liver treatment was 53.84% in the intervention group,while 47.61% in nonintervention group(c2 = 8.07,P<0.01).The factorial analysis showed that the serum levels of serum vitamin D were significantly higher than those in the control group(P<0.01)after 12 weeks intervention.Oral vitamin D treatment intervention and intervention duration have an interaction on serum vitamin D levels and levels in fatty liver.Conclusion:(1)The simple obesity children with nonalcoholic fatty liver often have lower serum vitamin D levels,dyslipidemia and insulin resistance.(2)The children with serum vitamin D deficiency have more serious abnormal blood lipid metabolism and insulin resistance.The risk factors affecting the level of serum vitamin D included BMI,TG,HOMA-IR and the season of physical examination.The vitamin D levels are negative correlation with the severity of fatty liver.The serum vitamin D levels,Hs-CRP are risk factors for fatty liver severity.(3)The intervention by vitamin D supplementation can improve BMI,HOMA-IR,serum vitamin D level,ALT,Hs-CRP and fatty liver severity in the children with fatty liver.