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한국 소아청소년의 비타민 D 부족과 결핍 유병률: 성별, 연령, 계절 및 지역에 따른 분석

Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors

김영진|이경률|남정모|이안나|김세휘|주수호
대한진단검사의학회 (Korean Society For Laboratory Medicine)|2016.04|Laboratory Medicine Online|제6권 제2호|pp. 70-78

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AdolescentsChildren25-hydroxyvitamin DVitamin D deficiencyVitamin D insufficiencyHypovitaminosis D

초록

배경: 전국에서 의뢰된 0-18세 연령의 25-hydroxyvitamin D (25OHD) 결과를 분석하여 한국 소아청소년의 비타민 D 상태를 평가하고 관련된 요인들을 분석하고자 하였다. 방법: 저자들은 2014년 1-12월 사이에 전국 각 지역의 332개 의료기관으로부터 (재)서울의과학연구소에 화학발광면역분석법(chemiluminescent immunoassay, CLIA)으로 의뢰된 소아청소년(평균 연령: 5.2±4.8세) 13,236명의 25OHD 결과를 후향적으로 분석하였다. 성별, 연령 그룹, 계절 및 지역에 따른 비타민 D 결핍률/부족률을 구하고, 비타민 D 결핍/부족에 대한 요인을 분석하였다. 비타민 D 결핍은 20 ng/mL 미만, 부족은 20.0-29.9 ng/mL, 충분은 30.0 ng/mL 이상으로 정의하였다. 결과: 각 연령군에서 25OHD 농도는 다음과 같았다: <7세, 24.2±9.2 ng/mL; 7-12세, 19.0±5.9 ng/mL; 13-15세, 16.0±6.8 ng/Ml; 16-18세, 15.0±7.3 ng/mL (P<0.001). 25OHD 농도는 연령 증가에 따라 감소하는 경향을 보였고(Spearman 순위상관계수 -0.4033, P<0.001), 비타민 D 결핍률/부족률이 연령 증가에 따라 증가하였다. 전체적으로 남아의 79.8%, 여아의 83.8%가 저비타민증 D에 해당하였다. 비타민 D ‘충분’에 비하여 결핍/부족일 교차비(odds ratio, OR)는 다음과 같았다: 연령 1세 증가 시 1.42/1.25배(all P<0.001); 남아에 비하여 여아일 경우 1.32/1.16배(P<0.001/P=0.004); 여름에 비하여 봄에 1.61/1.80배, 가을에 1.31/1.28배, 겨울에 1.44/2.03배 (all P<0.001); 비 도시에 비하여 도시 지역일 경우 결핍일 교차비가 1.23배(P<0.001)였다. 결론: 한국 소아청소년에서 비타민 D 결핍과 부족률은 매우 높으며, 25OHD 농도는 연령 증가에 따라 감소하는 경향을 보였다. 겨울 및 봄철, 연령 증가, 여아, 도시 지역 거주와 같은 요인이 비타민 D 결핍 및 부족에 대한 위험도 증가와 관련된 것으로 분석되었다. 한국 소아청소년의 비타민 D 상태의 보다 정확한 평가가 필요하며, 비타민 D 상태를 향상시키기 위한 제반 노력이 요구된다.

Abstract

Background: The objective of this study was to assess the serum 25-hydroxyvitamin D (25OHD) status and evaluate the associated factors in a Korean pediatric population aged 0-18 yr. Methods: Serum 25OHD levels were retrospectively analyzed in 13,236 Korean children and adolescents. 25OHD tests by chemiluminescent immunoassay were requested from 332 medical institutions nationwide in Korea between January 2014 and December 2014. Prevalence of vitamin D deficiency (VDD) and insufficiency (VDI) and the associated factors were analyzed. VDD and VDI were defined as serum 25OHD levels of <20.0 ng/mL and 20.0-29.9 ng/mL, respectively. Results: The 25OHD levels negatively correlated with age (r=-0.4033, P<0.001). Overall, 79.8% boys and 83.8% girls had hypovitaminosis D (VDI or VDD). The Odds ratios (ORs) of being in the VDD/VDI category as against the reference category of VDS (vitamin D sufficiency) were as follows: increase in age by 1 yr (OR=1.42/1.25, all P<0.001); girls (OR=1.32/1.16, P<0.001/P=0.004) compared to boys, spring (OR=1.61/1.80), fall (OR=1.31/1.28), and winter (OR=1.44/2.03, all P<0.001) compared to summer season; living in urban areas (OR=1.23, P<0.001) compared to rural areas. Conclusions: VDD and VDI are highly prevalent in children and adolescents in Korea. Serum 25OHD levels decreased significantly according to increasing age. Winter and spring seasons, increasing age, female sex, and living in urban areas are the factors associated with a high risk of VDD or VDI.

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